ABSTRACT
BACKGROUND: In the formative period of the courses taken in medical specializations, new and greater responsibilities are accepted by physicians in personal and academic spheres. The interaction of several factors that encompass the practice of these physicians could surpass their capacity to cope, causing on these professionals a high level of stress and professional exhaustion, which will affect their academic development. The objective of this research was to establish if the occupational stress of these medical residents affects their academic progress. METHODS: We administered the Spanish version of the Maslach Burnout Inventory (MBI) to 52 residents of three specializations in Oncology (Medical Oncology, Surgical Oncology, and Radio-Oncology). These residents accepted voluntarily at the same time of their third cognitive exam. RESULTS: The prevalence of burnout syndrome was 13.5 %, with a high frequency among medical residents of first degree. Medical Oncology residents showed a higher emotional exhaustion and lower personal fulfillment. Considering the three specializations, the academic progress was higher in the third year, with a significant difference to Surgical Oncology and Medical Oncology (p = 0.026 and 0.015, respectively). No significant difference was found between burnout syndrome, academic progress and sociodemographic characteristics. CONCLUSION: The presence of burnout syndrome does not affect the academic progress of Oncology medical residents.
Introducción: en el periodo formativo de los cursos de especializaciones médicas se asumen nuevas y grandes responsabilidades en el ámbito profesional y personal. La interacción de diferentes factores que envuelven el ejercicio de estos médicos puede llegar a sobrepasar su capacidad de afrontamiento y ocasionarles niveles elevados de estrés y desgaste profesional, lo cual afectará su desarrollo académico. El objetivo es determinar si el estrés laboral presente en los médicos residentes afecta su aprovechamiento académico. Métodos: se aplicó el cuestionario de Maslach a 52 médicos residentes de tres especialidades oncológicas que aceptaron participar voluntariamente el día que acudieron a su tercer examen ordinario del área cognoscitiva. Resultados: la prevalencia de burnout fue del 13.5 % con una frecuencia mayor en el primer año de la especialidad. En sus dimensiones, se encontró un mayor agotamiento emocional y baja realización personal en Oncología Médica. El aprovechamiento académico fue mayor para el tercer año de la residencia, con una diferencia significativa para Cirugía Oncológica y Oncología Médica (p = 0.026 y 0.015, respectivamente). No obstante, no se observó relación alguna con la presencia de burnout, ni tampoco con sexo (p = 0.437), estado civil (p = 0.329), número de hijos (p = 0.467) o escolaridad de la pareja (p = 0.784). Conclusión: la presencia de burnout no afecta el aprovechamiento académico de los médicos residentes en oncología.
Subject(s)
Achievement , Burnout, Professional/psychology , Internship and Residency , Medical Oncology/education , Burnout, Professional/diagnosis , Burnout, Professional/epidemiology , Cross-Sectional Studies , Female , Humans , Male , Mexico/epidemiology , PrevalenceABSTRACT
OBJECTIVE: To estimate the development degree to critical reading aptitude of clinical investigation papers among oncology residents. METHODS: A transversal study with 40 oncology residents (surgical oncology, 17; medical oncology, 15; and radio-oncology, 8) was done. An instrument containing six abstracts of clinical articles selected according to a clinical purpose, methodological design and approach to the three most frequent malignancies in Mexico with 150 items to explore three critical reading aptitude indicators was constructed; experts validated it. A pilot test was done in 20 internal medicine residents; a Kuder-Richardson coefficient of 0.90 was obtained to estimate the internal reliability. The instrument was applied simultaneously. RESULTS: The overall scores were low without difference among specialties (37.5, 35.5 and 38.0, respectively; maximum score: 150). According to indicators, the best score was observed to interpret and to treat, while the score to propose decreased in accordance with the higher specialty degree. CONCLUSIONS: The aptitude development degree to critical reading among oncology residents was deficient. A better environment to develop a more critical and reflexive education should be considerated.
Subject(s)
Internship and Residency , Judgment , Medical Oncology , Periodicals as Topic , Professional Competence , Reading , Cross-Sectional Studies , Prospective StudiesABSTRACT
BACKGROUND: The effect of uncontrolled chronic glycemia (UCG) in the diabetic patient with a neoplasm (DPN) has not been evaluated during the early postoperative period. Our objective was to determine the frequency of early surgical complications in the DPN with UCG. METHODS: A cohort of 184 consecutive diabetic patients who had a histological malignant diagnosis were studied; they were matched with 184 non-diabetic controls by age, gender, neoplasm type and surgery, those who received chemotherapy or irradiation 30 days before surgery were excluded. Fasting blood glucose, HbA1c, presence of diabetic complications and co-morbidity before surgery; type of surgery and postoperative early morbidity and mortality were measured. RESULTS: The DPN with UCG had a higher frequency of surgical postoperative complications than their controls. The presence of comorbidity (p < 0.011) and HbA1c > 6.5 % (p < 0.011) were independent and ominous significant predictors. CONCLUSIONS: Preoperative UCG increases the risk of early surgical complications in DPN.
Subject(s)
Diabetes Complications/complications , Hyperglycemia/complications , Neoplasms/complications , Neoplasms/surgery , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Chronic Disease , Female , Humans , Male , Middle Aged , Risk Factors , Time FactorsABSTRACT
BACKGROUND: Despite of advances obtained today, the enterocutaneous fistula has a mortality rate from 25 to 50%. The presence of cancer increases death frequency and makes difficult its treatment. OBJECTIVE: Evaluate the results of management of enterocutaneous fistula in cancer patients. METHODS: Seventy six cancer patients with average age of 56.8 +/- 13.5 years old and received curative primary treatment for malignancy at the Oncology Hospital, National Medical Center in Mexico who developed an enterocutaneous fistula between 1992 and 2002 were studied. RESULTS: Resolution of fistula was obtained in 52 patients (68.4%). Among these 52, 41 fistulae (53.9%) resolved spontaneously, and 11 required surgical treatment. All patients were treated with parenteral nutrition and octreotide. The meantime to fistula resolution, in those patients whose fistula was spontaneously resolved, was 20 days. Among the 24 patients who died, 21 had sepsis. Fistula-related mortality was highest in those patients with postoperative origin (82%; p = 0.024), of high output (57%; p = 0.001) and ileum site (45%; p = 0.04). CONCLUSIONS: The spontaneous closure is high and the surgical treatment is the best option. The mortality rate is moderate and sepsis the most frequent cause of death.
