An integrative multi-omics approach to characterize interactions between tuberculosis and diabetes mellitus.

Tuberculosis-diabetes mellitus (TB-DM) is linked to a distinct inflammatory profile, which can be assessed using multi-omics analyses. Here, a machine learning algorithm was applied to multi-platform data, including cytokines and gene expression in peripheral blood and eicosanoids in urine, in a Brazilian multi-center TB cohort. There were four clinical groups: TB-DM(n = 24), TB only(n = 28), DM(HbA1c ≥ 6.5%) only(n = 11), and a control group of close TB contacts who did not have TB or DM(n = 13). After cross-validation, baseline expression or abundance of MMP-28, LTE-4, 11-dTxB2, PGDM, FBXO6, SECTM1, and LINCO2009 differentiated the four patient groups. A distinct multi-omic-derived, dimensionally reduced, signature was associated with TB, regardless of glycemic status. SECTM1 and FBXO6 mRNA levels were positively correlated with sputum acid-fast bacilli grade in TB-DM. Values of the biomarkers decreased during the course of anti-TB therapy. Our study identified several markers associated with the pathophysiology of TB-DM that could be evaluated in future mechanistic investigations.

As escolhas das especialidades médicas e a afetividade: revisão de literatura / Specialty choices and affectivity: literature review

RESUMO Introdução: A escolha da especialidade é fator determinante da prática profissional do médico. A especialização médica é o meio não somente de atingir a excelência técnica e científica na atenção à saúde, mas também é a estratégia em que se estabelecem o poder e o status entre os pares e a sociedade em geral. Neste estudo, os aspectos psicossociais dessas escolhas foram analisados a partir dos artigos de educação médica selecionados. Objetivo: Este estudo teve como objetivo apresentar os fatores psicossociais mediadores nas escolhas por especialidades médicas a partir do olhar da psicologia sócio-histórica. Método: Trata-se de uma revisão de literatura em que foi realizada uma busca com os descritores residência médica, especialidade e escolha nas plataformas PubMed e SciELO, para estudos publicados nos últimos cinco anos. Resultado: A busca nas bases de dados resultou em 509 estudos, dos quais foram selecionados 53 artigos para análise crítica. Desses 53 artigos, selecionaram-se 18 para análise de conteúdo, resultando em indícios de que a categoria psicossocial "afetividade", identificada neste estudo - nas emoções vivenciais, no sentimento do cuidado de si, no sentimento de pertencimento e nas emoções da interação social nos processos formativos é a mediadora da escolha da especialidade médica e, por isso, deve ser considerada nos processos educacionais das ciências médicas. Conclusão: A afetividade é o principal fator psicossocial mediador nos processos das escolhas de especialidades médicas. E isso indica a necessidade de estudos mais aprofundados sobre os sentimentos e as emoções dos alunos de Medicina que visem colaborar para uma educação mais crítica e significativa para os educandos e profissionais, refletindo na qualidade da saúde coletiva.

ABSTRACT Introduction: The choice of specialty is a determining factor in the doctor's professional practice. Medical specialization is the means not only of achieving technical and scientific excellence in health care, but it is also the strategy by which power and status are established among peers and society in general. In this study, the psychosocial aspects of these choices were analyzed based on selected medical education articles. Objective: To present the psychosocial factors that mediate the choices of medical specialties from the perspective of socio-historical psychology. Method: This is a literature review where a search was carried out using the descriptors 'medical residency', 'specialty' and 'choice' on the PubMed and SciELO platforms, for studies published in the last five years. Result: The search in the databases found 509 studies that matched the descriptors, from which 53 articles were selected for critical analysis. Of these 53 articles, 18 were selected for content analysis, resulting in indications of the important mediator role played in specialty choice and therefore significance in medical science educational processes of the psychosocial category: affectivity, identified in this study in terms of experiential emotions, the feeling of self-care, the feeling of belonging and in the emotions of interaction social in training processes. Conclusion: Affectivity is the main psychosocial mediating factor in the processes of choosing medical specialties. Indicating the need for more in-depth studies into the feelings and emotions of medical students to collaborate with a more critical and meaningful education for students and professionals, reflecting on the quality of collective health.

Intención de estudiar una especialidad médica: El caso de la Universidad Católica del Norte, Chile / Factors Influencing Medical Students' Intentions to Pursue Specialization in Chile

ANTECEDENTES: La decisión de estudiar una especialidad médica implica considerar una serie de factores personales, familiares y profesionales, y actualmente en Chile se dispone de muy poca información acerca de esto. OBJETIVO: Determinar los factores que explican la intención por estudiar una especialidad médica en estudiantes de medicina. MATERIALES Y MÉTODOS: Se realizó una encuesta a estudiantes de medicina con un total de 266 respuestas válidas (58,7% de tasa de respuesta). El instrumento midió la intención, la actitud, las normas subjetivas y la autopercepción de capacidades hacia el estudio de una especialidad médica. Dicho instrumento fue verificado en cuanto a su confiabilidad y validez. Para la estimación del modelo se usó la técnica de ecuaciones estructurales (SEM) a través de mínimos cuadrados parciales (SEM-PLS). RESULTADOS: El coeficiente Alpha de Cronbach, la fiabilidad compuesta, el indicador Dijkstra-Hernseler's y las cargas de cada ítem mostraron valores adecuados. Respecto del modelo estructural, el test de efecto tamaño indicó que dos de los tres constructos son relevantes para explicar la intención. Las pruebas por bootstrapping mostraron la relevancia predictiva del modelo. Globalmente, el ajuste global del modelo fue adecuado. CONCLUSIONES: El factor que más influye en la intención de los estudiantes por continuar hacia una especialidad médica es la actitud personal, seguido por el control percibido de la conducta, y por último por los ingresos futuros esperados.

BACKGROUND: The decision to study a medical specialty involves considering several personal, family, and professional factors, and currently, in Chile, there needs to be more information about this. OBJECTIVE: To determine the factors that explain the intention to study a medical specialty in medical students. MATERIALS AND METHODS: A survey of medical students was conducted with 266 valid responses (58.7% response rate). The instrument measured the intention, attitude, subjective norms, and self-perception of abilities toward studying a medical specialty. This instrument was verified for its reliability and validity. We used the Structural Equations Model (SEM) through partial least squares (SEM-PLS) to estimate the whole model. RESULTS: Cronbach's Alpha coefficient, composite reliability, and Dijkstra-Hernseler's indicator of each item showed adequate values. Regarding the structural model, the size effect test indicated that two of the three constructs are relevant to explaining the intention. Bootstrapping tests showed the predictive relevance of the model. The overall fit of the model was adequate. CONCLUSIONS: The factor that most influence students' intention to continue towards a medical specialty is personal attitude, followed by perceived control of behavior, and finally by expected future income.

Is U=U consistently known and implemented? A survey among different medical specialists in Brazil.

Despite solid scientific evidence, the concepts of treatment as prevention (TASP) and Undetectable = Untransmittable (U = U) remain unfamiliar and underutilized for some healthcare providers. We conducted a self-completion survey to evaluate the knowledge of TASP/U = U in different medical specialties. Wilcoxon Rank-Sum, Chi-square and Fisher's exact tests were used for group comparisons and a logistic regression model was used to assess factors independently associated with U = U-non-supportive attitudes. 197 physicians were included; 74% agreed/strongly agreed that people living with HIV (PLHIV) under regular treatment with undetectable viral do not transmit HIV sexually. However, only 66% agree/strongly agree that PLHIV should be informed about that. The knowledge about these concepts was poorer among gynecologists, urologists and internal medicine specialists when compared to infectious diseases specialists after adjustment for age, race/skin color, gender, and sexual orientation. Our study found that knowledge of crucial concepts of HIV prevention may be lacking for some medical specialties. This highlights the need of improvement in medical education.

Una mirada crítica a los Trabajos de Terminación de la Especialidad en Medicina General Integral

RESUMEN Introducción: El trabajo de terminación de la especialidad representa un poderoso instrumento en el proceso de formación docente- investigativo de los futuros especialistas. Objetivo: Realizar una revisión crítica de los trabajos de terminación de la especialidad de Medicina General Integral. Métodos: Se realizó un estudio observacional descriptivo, de corte transversal, en el Policlínico Docente Ernesto Guevara del municipio de Niquero, provincia Granma. Fueron sometidas a revisión 37 tesis pertenecientes a estudiantes de la especialidad médica durante los años 2019 y 2020. Se emplearon métodos teóricos (histórico-lógico, análisis-síntesis, inductivo-deductivo) y empíricos (revisión documental). Los datos fueron expresados en frecuencias absolutas y porcentajes. Resultados: Constituyeron mayoría los temas relacionados con el Programa Materno-Infantil, el 35,14 %. Existió franco predominio de las investigaciones de intervención educativa en salud, el 62,16 %. Entre las deficiencias en los aspectos metodológicos se señalaron la poca profundidad en la discusión, la comparación con estudios desactualizados y la carencia de posición autoral en el 75,67 % de los informes. Entre los aspectos formales se evidenció un predominio de la vaguedad en la redacción/uso repetitivo de palabras en el 64,86 %. Discusión: Se revisaron los trabajos de terminación de la especialidad de Medicina General Integral del Policlínico Docente "Ernesto Guevara". En ellos se identificaron los temas investigados y los tipos de estudios más frecuentes, así como las principales dificultades en el orden metodológico y formal.

ABSTRACT Introduction: The completion works of the specialty represents a powerful instrument in the teaching-research training process of future specialists. Objective: To carry out a critical review of the completion works in the specialty of Comprehensive General Medicine specialty. Methods: A descriptive, cross-sectional, observational study was conducted at the Ernesto Guevara Teaching Polyclinic in the municipality of Niquero, Granma province. 37 theses belonging to students of the medical specialty were submitted for review during the years 2019 and 2020.Theoretical and empirical methods were used. Data were expressed in absolute frequencies and percentages. Results: Topics related to the Maternal-Child Program constituted the majority, 35.14 %. There was a clear predominance of educational intervention research in health, 62.16 %. Among the deficiencies in the methodological aspects, the little depth in the discussion, the comparison with outdated studies and the lack of authorial position in 75.67 % of the reports were pointed out. Among the formal aspects, there is evidence of a predominance of vagueness in the writing/repetitive use of words in 64.86 %. Discussion: The topics investigated and the most frequent types of studies were identified, as well as the main methodological and formal insufficiencies, among which are difficulties in formulating the scientific problem and the scarcity of the epidemiological context; little depth in the discussion, the comparison with outdated studies and the lack of authorial position, in a total of 28 reports, which represents 75.67%.

Factores psicosociales en residentes de especialidades médicas en Barranquilla. Dimensiones demandas de trabajo / Psychosocial factors in residents of medical specialties in Barranquilla. Work demands dimensions

RESUMEN Objetivo Describir los factores psicosociales en las dimensiones demandas de trabajo en los residentes de especialidades médicas en Barranquilla. Métodos Estudio cualitativo con metodología fenomenológica en residentes de especialidades médicas adscritos a una institución de educación superior en Barranquilla. Mediante entrevistas en profundidad se recogieron las experiencias, vivencias y consideraciones manifestadas en su vida cotidiana y en su salud mental, frente a las situaciones que afrontan a diario en su formación en el contexto laboral en medio de la ejecución de sus responsabilidades operativas. Resultados En el dominio de demandas de trabajo se concentraron las cinco dimensiones más sobresalientes, con 266 testimonios-demandas de autocontrol emocional; seguidos de 237 en la dimensión demandas cuantitativa; 165, en demandas de carga mental; 152, en demandas ambientales y de esfuerzo físico; y 142, en exigencias de responsabilidad del cargo. Conclusiones Es importante revisar las cargas de las demandas de trabajo a lo largo del curso de la residencia de las especialidades medico quirúrgicas para disminuir los riesgos psicosociales en el desempeño de sus funciones.

ABSTRACT Objective To describe the psychosocial factors in the dimensions of work demands in the residents of medical specialties in Barranquilla. Methods A qualitative study with phenomenological methodology in residents of medical specialties assigned to an Institution of Higher Education in Barranquilla. Through the in-depth interviews, the experiences, experiences, and considerations manifested in their daily lives and mental health were collected, in the face of the situations, they face daily in their training in the work context amid the execution of their operational responsibilities. Results The five most outstanding dimensions were concentrated in the domain demands of work, with 266 testimonies demands of emotional self-control, followed by 237 in the dimension quantitative demands, 165 in demands of mental load, 152 in environmental demands and of physical effort, and 142 in demands of responsibility of the position. Conclusions It is important to review the burdens of work demands throughout the course of the residency of the medical-surgical specialties to reduce psychosocial risks in the performance of their functions.

Palliative Medicine Specialization in Latin America: A Comparative Analysis.

BACKGROUND: Formal recognition of palliative medicine as a specialty has been one of the main drivers in the development of palliative care. AIM: To provide a comparative, comprehensive overview on the status of palliative medicine as medical specialty across Latin America. METHODS: We conducted a comparative study of 19 Latin American countries. Key informants and persons in charge of the specialization training programs were identified and interviewed. We collected data on general recognition as specialty (title, process of certification) and on training program characteristics (title, start year, requirements, training length, and type full time or part time). RESULTS: Eight of 19 countries (42%) Argentina, Brazil, Colombia, Costa Rica, Ecuador, Mexico, Paraguay and Venezuela reported palliative medicine as medical specialty. Thirty-five (sub)specialization training programs in palliative medicine were identified in the region (eight as a specialty and 27 as a subspecialty), the majority in Colombia (43.5%) and Brazil (33.7%). A total of 20% of the programs have yet to graduate their first cohort. Length of clinical training as specialty varied from two to four years, and from 520 hours to three years for a subspecialty. CONCLUSION: Despite long-standing efforts to improve quality of care, and significant achievements to date, most Latin American countries have yet to develop palliative medicine as medical specialty. Specialty and sub-specialty training programs remain scarce in relation to regional needs, and the programs that do exist vary widely in duration, structure, and content.

O PERFIL DO MÉDICO APROVADO NA RESIDÊNCIA MÉDICA DE MINAS GERAIS EM 2019 / Minas Gerais 2019's medical residency: The approved physician's profile

Introdução: Os processos seletivos de residência médica (PSRM) estão progressivamente mais concorridos e carecem de análises do seu perfil de candidatos aprovados. Objetivos: Analisar o desempenho e perfil do aprovado no Processo Seletivo de Residência Médica do Estado de Minas Gerais (PSU-MG) nas quatro especialidades médicas mais comuns no Brasil. Métodos: Analisamos candidatos aprovados ou selecionados nos três hospitais de Belo Horizonte com maior oferta de vagas em Cirurgia Geral (CIR), Clínica Médica (CLM), Ginecologia e Obstetrícia (GOB) e Pediatria (PED). Utilizamos a publicação da primeira chamada do PSU-MG 2019 e a Plataforma Lattes para análise do currículo quanto à especialidade e hospital pretendidos, notas de prova e de currículo, sexo e instituições cursadas. Resultados: Foram analisados 1087 candidatos. Candidatos de escolas médicas públicas apresentaram maiores medianas de notas de prova e de currículo (63,9 e 8,42 versus 60,3 e 7,00 respectivamente; p<0,05), foram mais aprovados no PSU-MG (p < 0,05) e tiveram mais inscrições em CIR e CLM e menos em PED (p<0,05) do que alunos de escolas médicas pagas. Não houve associação significativa entre o sexo e aprovação no concurso, porém, encontrouse associação positiva entre sexo feminino e as especialidades de GOB e PED, e sexo masculino e CIR e CLM. Conclusões: A relação Candidato/vaga e a escola de graduação parecem influenciar o desempenho dos candidatos em PSRM. Estudos adicionais e mais amplos são necessários para elucidação dos fatores que interferem no desempenho nos PSRM.

Introduction: Medical Residency Selection Processes (MRSP) are increasingly competitive and lack of objective analysis concerning approved candidates. Objective: Analyze the profile of physicians approved in the largest MRSP in the state of Minas Gerais - Brazil in 2019 (PSU-MG) in each of the four most common Brazilian specialties. Methods: Our sample consisted of approved or selected candidates for the hospitals in Belo Horizonte which offered more vacancies in the Internal Medicine (INTMED), Gynecology and Obstetrics (OB/ GYN), Pediatrics (PEDS) and General Surgery (GS) specialties in the PSU-MG. We used the PSU-MG approved candidates list and the Lattes curriculum for data regarding specialty, selected hospital, test and curriculum grades, gender, and attended institutions. Results: A total of 1087 candidates were analyzed. Physicians who graduated at public medical colleges had higher test and curriculum scores medians (63.9 and 8.42 versus 60.3 and 7.00 respectively; p<0.05), were more approved at the MRSP (p<0.05) and were more enrolled in GS and INTMED (p<0.05) and less enrolled in PEDS than candidates from private schools. There was no significant association between gender and approval. Female candidates were more enrolled in OB/GYN and PEDS, and male candidates in GS and INTMED. Conclusion: Both the ratio between candidate and vacancy for medical residency and the medical school graduation funding type seem to influence the approved candidate's performance on MRSP. Further studies are needed to better elucidate factors that interfere on the performance in MRSP.

Puntajes del Concurso Nacional de Ingreso al Sistema Nacional de Servicio de Salud por universidad. Periodo 2017 ­ 2020 / Scores of the National Entrance Contest to the National Health Service System by university. Period 2017 - 2020

INTRODUCCIÓN: El Concurso Nacional de Ingreso al Sistema Nacional de Servicio de Salud (CONISS) es una de las modalidades más conocidas para acceder a una especialización médica en Chile. Se basa en la evaluación de 5 rubros diferentes y en los últimos años no ha sido capaz de cubrir la demanda de los postulantes haciendo necesario un mejor conocimiento de este. El objetivo del estudio es describir los resultados del concurso CONISS de los últimos 4 años según las universidades de los participantes. Material y método: Estudio observacional, corte transversal, descriptivo. Asociación de puntajes obtenidos por los estudiantes con su respectiva universidad, obteniéndose datos de la página de superintendencia de Salud y utilizándose software Microsoft Excel® para su procesamiento. Resultados: El total de egresados fue de 6.092, provenientes de 22 universidades chilenas. Destaca la Pontificia Universidad Católica de Chile por liderar en el rubro 1 y el puntaje total durante los 4 años y la Universidad Pedro de Valdivia por encontrarse en el último puesto. Los rubros 4 y 5 fueron los que más se completaron. Las universidades con mejor desempeño en el rubro 1 fueron también las que obtuvieron mejor desempeño en el puntaje final. Discusión: El rubro 1 es el que posee mayor importancia en el resultado final del concurso y no se encuentra estandarizado entre universidades quedando sujeto al criterio de cada institución. No completar el resto de los rubros representa una desventaja comparativa pues la mayoría tiene buenos puntajes, pero estos resultados se ven limitados en gran medida por las calificaciones.

INTRODUCTION: The National Entrance Contest to the National Health Service System (CONISS) is one of the best known modalities to access a medical specialization in Chile. It is based on the evaluation of 5 different areas (items) and in recent years it has not been able to meet the demand of the applicants, making it necessary to know more about the subject. The objective of the study is to describe the results of the CONISS by university for the last 4 years. Material and method: Observational, cross-sectional, descriptive study. Association of scores obtained by students with their respective university, obtaining data from the Superintendency of Health page and using Microsoft Excel® software for processing. Results: The total number of graduates was 6,092, from 22 Chilean universities. The Pontificia Universidad Católica de Chile stands out for leading in item 1 and the total score during the 4 years and "Pedro de Valdivia" University for being in the last position. Items 4 and 5 were the most completed. The universities with the best performance in item 1 were also the ones that obtained the best performance in the final score. Discussion: Item 1 is the one that has the greatest importance in the final result of the contest and is not standardized among universities, being subject to the criteria of each institution. Not achieving the other items implies a comparative disadvantage as most participants have good scores, but these results are largely limited by grades.

Fatores Associados à Escolha da Especialidade de Medicina de Família e Comunidade / Factors Associated with the Choice of Specializing in Family Medicine

Resumo: Introdução: A Medicina de Família e Comunidade (MFC) é considerada a especialidade mais relacionada com os princípios de longitudinalidade, integralidade e coordenação do cuidado da atenção primária à saúde (APS). A escolha da especialidade de MFC pode ser considerada por aspectos pessoais, profissionais e do currículo médico. O objetivo deste estudo foi analisar o perfil dos médicos residentes e egressos dos programas de residência de MFC de Pernambuco e os fatores associados à escolha da especialidade. Método: Realizou-se um estudo de corte transversal envolvendo 129 médicos ingressantes nas residências de MFC de Pernambuco, de 2012 a 2017. A coleta de dados foi feita com a aplicação de questionário eletrônico do LimeSurvey em escala tipo Likert de cinco pontos, com perguntas sobre fatores que contribuíram para a escolha da especialidade. Fizeram-se análises descritivas das variáveis do estudo no Epi Info 7.0, apresentadas em distribuição de frequência e medidas de tendência central e dispersão. Avaliou-se a consistência interna dos dados pelo alfa de Cronbach. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade Pernambucana de Saúde. Resultados: Responderam ao questionário 104 médicos, com média de idade de 31 + 6,1 anos. Do total de participantes, 58,6% eram mulheres, 70% eram egressos de faculdades públicas e 66,3% escolheram a MFC após a conclusão da faculdade. Os aspectos pessoais analisados como influenciadores na escolha da especialidade de MFC foram: compromisso social, aptidão e afinidade com a especialidade, e circunstâncias da vida pessoal. Em relação às características da residência, a duração e a disponibilidade de vagas favoreceram a escolha. A maior parte dos aspectos relacionados com as caraterísticas próprias da especialidade exerceu influência positiva na escolha dos participantes. Os fatores do currículo da graduação que favoreceram a escolha da especialidade foram: influência de preceptores modelos e atividades práticas no contexto da MFC. O coeficiente alfa de Cronbach foi de 0,847. Conclusões: Entre os fatores referidos pelos residentes como influenciadores na escolha da especialidade de MFC, incluem-se os aspectos pessoais e as características do programa de residência e da especialidade. Por sua vez, os aspectos do currículo da graduação, de forma geral, não contribuíram para a essa escolha, entretanto houve concordância de que a vivência em cenário de prática de MFC e o exemplo de preceptores modelos influenciaram na decisão.

Abstract: Introduction: Family Medicine (FM) is considered the specialty which is most closely related to the primary health care (PHC) principles of longitudinality, comprehensiveness and coordination. The choice to specialize in FM can be related to personal, professional and curricular aspects. Objective: To analyze the profile of family medicine residents in Pernambuco and the factors associated with the choice of this specialty. Method: Cross-sectional study, involving 129 physicians entering FM residency in Pernambuco from 2012 to 2017. Data collection was performed by applying an electronic LimeSurvey questionnaire using a five-point Likert scale with questions about factors that may have contributed to their choice of the specialty. Descriptive analyses of the study variables were performed in EpiInfo® 7.0, presented in frequency distribution and measures of central tendency and dispersion. The internal consistency of the data was assessed using Alpha Cronbach. The study was approved by the Research Ethics Committee of the Faculdade Pernambucana de Saúde. Results: 104 physicians answered the questionnaire, with a mean age of 31 + 6.1 years, 58.6% women, 70% were graduates from public universities and 66.3% of the medics decided to specialize in FM after graduating. Personal aspects analysed in relation to influence on the physician's choice to specialize in FM are social commitment, aptitude, affinity with the specialty and personal life circumstances. In terms of the characteristics of medical residency, both the duration and the availability of places in the state's FM programs played a part in the choice. Most aspects related to the choice of following a career in FM were classed as a positive influence on that choice. Factors related to the undergraduate curriculum included model preceptors and practical activities in the family medicine setting. Cronbach's alpha coefficient was 0.847. Conclusion: The factors cited by residents as influencing their choice to specialize in FM include personal aspects, characteristics of the residency program as well as characteristics of the specialty itself. On the other hand, aspects related to the undergraduate curriculum in general did not contribute to this choice. There was, however, agreement that practical experience in a FM setting and the example of model tutors influenced the decision.

Factores asociados a la elección de psiquiatría como especialidad en internos de medicina de dos universidades privadas del Perú / Factors associated with choosing psychiatry among medical interns in two private universities in Peru

Objetivo: Determinar los factores asociados a la elección de psiquiatría como especialidad médica en internos de medicina de dos universidades privadas del Perú. Material y métodos: Estudio transversal realizado en internos de medicina de las universidades Ricardo Palma y San Juan Bautista. Se les administró tres instrumentos: El Inventario de Personalidad - Eysenck para adultos (EPI), la Escala de Valoración del Proceso Enseñanza - Aprendizaje, y el Cuestionario General de Salud Mental de Goldberg (QHG-12), para el estudio de las variables personalidad, percepción del proceso enseñanza - aprendizaje del curso de psiquiatría y psicopatología respectivamente. Se utilizó la prueba estadística X2 cuadrado para determinar la existencia de asociación entre las variables. Resultados: De los 223 internos de medicina estudiados, 35 (15,7%) manifestaron que elegirán psiquiatría como especialidad. La elección de psiquiatría como especialidad se asoció con: personalidad sanguínea (p=0,001); extroversión (p=0,02) y ser emocionalmente estable (p=0,03). Por otro lado, el estudio no evidenció asociación significativa entre las variables sexo, parientes con carreras afines al área de la salud mental y psicopatología con la elección de psiquiatría. Conclusiones: Existe asociación estadísticamente significativa entre el tipo de personalidad y la elección de psiquiatría. Los internos de medicina que les interesa especializarse en psiquiatría, por lo general tienen una personalidad tipo sanguínea, además son extrovertidos y emocionalmente estables.

Objective: To determine the factors associated with choosing psychiatry as a specialty among medical interns in two private universities in Peru. Methods: A cross-sectional study was carried-out among medical interns of Ricardo Palma and San Juan Bautista Universities. Three instruments were applied: personality inventory-Eysenck for adults, scale to evaluate the teaching-learning process and the Goldberg´s general survey of mental health to evaluate personality, perception of the teaching-learning process of the psychiatry and psychology courses. The X2 test was used to determine associations. Results: out of 233 medical interns evaluated, 35 (15.7%) said that would elect psychiatry as a specialty. The election of psychiatry was associated with a blood personality (p=0.001); extroversion (p=0.02) and being emotionally stable (p=0.039). On the other hand, the study did not reveal and association with sex, relatives with specialties closed to mental health and psychopathology. Conclusions: there is an association between type of personality and choosing psychiatry as a) specialty. Medical interns interested in becoming psychiatrist have a blood type of personality, are extroverted and emotionally stable.

Fatores que Influenciam a Escolha da Especialização Médica pelos Estudantes de Medicina em uma Instituição de Ensino de Curitiba (PR) / Factors that Influence the Choice of Medical Specialty by Medical Students of an Educational Institution in Curitiba (PR)

RESUMO A escolha da especialidade médica é de suma importância para o estudante de Medicina, uma vez que representa a escolha da sua prática diária. Embora a realização acadêmica, considerações financeiras e preferências de estilo de vida influenciem a escolha, os aspectos intrapessoais têm impacto na decisão do médico. Objetivos Avaliar os principais fatores que influenciam o acadêmico de Medicina na escolha da especialidade médica e identificar as áreas de atuação preferidas pelos estudantes dos quatro primeiros anos de uma instituição de ensino superior de Curitiba (PR). Resultados Dos 397 estudantes, 307 responderam a um questionário previamente elaborado para este estudo, sendo que 291 foram considerados válidos. Duzentos e quatro estudantes são do sexo feminino e 87 do sexo masculino. Os fatores de influência foram comparados entre os estudantes dos diferentes anos e com resultados publicados na literatura. Os principais fatores considerados pelos estudantes nesta decisão foram: conhecimento mais amplo ou específico, contato com o paciente, local de atuação profissional e estilo de vida após a residência médica. Para as mulheres, a pressão do dia a dia durante o exercício da especialidade, a relação a longo prazo com o paciente e a facilidade de emprego foram significativamente mais relevantes na escolha da especialidade do que para os homens. Pai ou mãe médicos influenciam os estudantes na decisão da escolha da especialidade. O perfil financeiro do estudante influenciou a escolha quando relacionado a retorno financeiro a longo prazo, sendo mais relevante para os estudantes com renda familiar mensal entre 6 mil e 15 mil reais ou maior que 20 mil reais. A especialidade de Cirurgia Geral foi a preferida pelos estudantes, com predominância no sexo masculino, seguida de Pediatria, Clínica Médica e Psiquiatria. Conclusões Estilo de vida, local de atuação e retorno financeiro precoce foram considerados igualmente importantes por estudantes de todos os anos avaliados. Devido à grande quantidade de variáveis avaliadas e de fatores que influenciam esta decisão, estudos adicionais são necessários para comparações mais significativas com a literatura disponível.

ABSTRACT Choosing a medical specialty is extremely important for medical students as it represents the choice of their day-to-day practice. While this choice is influenced by academic achievement, financial considerations and lifestyle preferences, intrapersonal aspects also have an impact on the decision. Objectives To evaluate the main factors that influence medical students in their choice of medical specialty, and to identify the areas of practice preferred by students in the first four years of a Higher Education Institution. Results Out of a total of 397 students, 307 answered a questionnaire previously prepared for this study, and of these, 291 were considered valid. 204 female, and 87 male. Influencing factors were compared among students from different years, and with results published in the literature. The main factors considered by the students in this decision were: broader or specific knowledge, contact with the patient, place of professional activity, and lifestyle after medical residency. For the women, the factors day-to-day stress of the specialty, the long-term relationship with the patient, and the ease of finding a job were significantly more relevant in the choice of specialty than for the men. Parents who were doctors also influenced the choice of specialty. The student's financial profile influenced the choice when related to long-term financial returns, being more relevant for students with monthly family incomes at the higher or lower ends of spectrum, i.e., - between 6 and 15 thousand Brazilian reals, or more than 20 thousand Brazilian reals. The specialty General Surgery was the first choice , predominantly among the male students, followed by Pediatrics, Clinical Medicine and Psychiatry. Conclusions Lifestyle, place of professional activity and early financial returns were considered equally important by students across all the years evaluated. Due to the large number of variables evaluated, and the many factors that influence this decision, additional studies are needed, in order to make more significant comparisons with the literature.

Fatores que influenciam o sucesso na prova de obtenção de título de especialista em infectologia: estudo retrospectivo - 2011 a 2017 / Factors associated with the approval in the Infectious Diseases specialist test: a retrospective study - 2011 to 2017

Introdução: a especialização é fase importante da formação médica. O médico pode obter o título de especialista por meio de Residência Médica ou de prova de título realizada pela sociedade de especialidade, que tem autonomia para realização da prova dentro de parâmetros previamente estabelecidos pela Associação Médica Brasileira. Além da Residência Médica, muitas sociedades permitem que egressos de cursos de especialização lato sensu reconhecidos por ela ou médicos que comprovem tempo mínimo de exercício da especialidade, realizem a prova. Poucos estudos avaliaram os fatores associados à aprovação na prova de título no Brasil, justificando, assim, esse estudo. Objetivo: identificar fatores associados à aprovação na prova de título de especialista em Infectologia. Materiais e métodos: estudo retrospectivo que incluiu médicos que realizaram a prova de obtenção de título de especialista em infectologia entre 2011 e 2017. Os dados sociodemográficos e relacionados à formação profissional foram coletados por meio de questionário on-line. As informações sobre aprovação foram retiradas do banco de dados da Sociedade Brasileira de Infectologia. O desfecho foi a aprovação na prova de título de especialista, sendo a variável principal possuir Residência Médica em Infectologia. Avaliou-se, também, a percepção do candidato em relação à prova. O projeto foi aprovado pelo Comitê de Ética e Pesquisa da instituição. Resultados: dos 185 médicos que realizaram prova de título entre 2011 e 2017, 62 concordaram em participar do estudo. Devido à baixa representatividade dos voluntários de 2011 a 2016, optou-se por considerar, dos fatores associados, a aprovação apenas dos 35 candidatos que realizaram a prova em 2017. Não houve diferença estatisticamente significativa entre a aprovação na prova de título e nenhuma das variáveis analisadas, inclusive Residência Médica em Infectologia. Destaca-se que quase 50% dos candidatos com Residência foram reprovados. Conclusão: nenhum dos fatores analisados associou-se à aprovação na prova para obtenção da prova de Título de Especialista em Infectologia. A taxa de reprovação entre candidatos com Residência Médica foi maior que a esperada

Background: Specialization is an important stage in medical training. In Brazil, a physician could obtain the specialist title by Medical Residency or specialist title test (STT) carried out by the specialty society. The specialty societies have autonomy to carry out the STT according to Brazilian Medical Association parameters. In addition to the Medical Residency, many societies allow graduates students from lato sensu courses recognized by them or physicians who prove a minimum time of specialty practice to take the test. Few studies have evaluated the factors associated with the approval on specialization tests in Brazil, thus justifying this study. Objective: To identify factors associated with the approval on Infectious diseases STT. Materials and methods: this was a retrospective study that included physicians who took the STT on infectious disease from 2011 to 2017. The sociodemographic and professional training data were collected through online questionnaire. Information on STT approval was taken directly from the Brazilian Society of Infectious Diseases database. The outcome was the STT approval and the main variable was participating on Infectious diseases Medical Residency program. The candidate's perception of the test was also evaluated. The institutional Ethics and Research Committee approved this project. Results: 185 physicians who had taken a STT between 2011 and 2017 and 62 agreed to participate. Due to the low representativeness of the volunteers from 2011 to 2016, only the 35 candidates who took the test in 2017 were considered for the analysis of factors associated with the STT approval. There was no statistically significant difference between STT approval and any analyzed variables, including Infectious Diseases Medical Residency. About 50% of candidates with Residence were not approved. Conclusion: none of the factors analyzed was associated with the STT approval. The failure index among candidates who had participated on the Infectious Diseases Residency program was higher than expected.

Junior doctors' medical specialty and practice location choice: simulating policies to overcome regional inequalities.

There are nowadays over 1 million Portuguese who lack a primary care physician. By applying a discrete choice experiment to a large representative sample of Portuguese junior doctors (N = 503) in 2014, we provide an indication that this shortage may be addressed with a careful policy design that mixes pecuniary and non-pecuniary incentives for these junior physicians. According to our simulations, a policy that includes such incentives may increase uptake of general practitioners (GPs) in rural areas from 18% to 30%. Marginal wages estimated from our model are realistic and close to market prices: an extra hour of work would require an hourly wage of 16.5€; moving to an inland rural setting would involve an increase in monthly income of 1.150€ (almost doubling residents' current income); a shift to a GP career would imply an 849€ increase in monthly income. Additional opportunities to work outside the National Health Service overcome an income reduction of 433€. Our simulation predicts that an income increase of 350€ would lead to a 3 percentage point increase in choice probability, which implies an income elasticity of 3.37, a higher estimation compared to previous studies.

[The importance of master's degree and doctorate degree in general surgery]. / Importancia de la maestría y el doctorado en cirugía general.

BACKGROUND: The Doctor of Philosophy is the highest academic degree that can be obtained in universities. Graduate Education Program in Medicine in Mexico is divided into 2 major categories: Medical Specialty and Master studies/Doctor of Philosophy. The objective of this study was to demonstrate the importance of master's degrees and Doctor of Philosophy in general surgery. MATERIAL AND METHODS: A literature search in PubMed and Medline among others, from 1970 to 2015 with subsequent analysis of the literature reviews found. DISCUSSION: The physicians who conducted doctoral studies stand out as leaders in research, teaching and academic activities. Dual training with a doctorate medical specialty is a significant predictor for active participation in research projects within the best educational institutions. RESULTS: It is important to study a PhD in the education of doctors specialising in surgery, who show more training in teaching, research and development of academic activities. Currently, although there is a little proportion of students who do not finish the doctoral program, the ones who do are expected to play an important role in the future of medical scientific staff. It has been shown that most doctors with Doctor of Philosophy have wide range of career options. CONCLUSION: The importance of doctoral studies in the formation of general surgery is due to various reasons; the main one being comprehensively training physician scientists who can develop in clinical, teaching and research.

Médicos residentes en México: tradición o humillación / Resident physicians in Mexico: tradition or humiliation

México tiene una gran historia y tradición en la formación de médicos residentes. Pero ¿qué encontramos detrás de este proceso? Relaciones de poder implícitas y explícitas, inadvertidas o ignoradas por conveniencia por parte de las instituciones universitarias y de salud, con el agravante de olvidar su compromiso en la formación de mujeres y hombres profesionales. Los residentes son reducidos a un indicador más de recursos humanos para la salud. El médico residente en formación académico-científica está sumergido en esta vorágine deshumanizada y termina por convertirse en un individuo para el cual el dominio del conocimiento es un instrumento de poder. En este proceso olvida que su actuar y su razón de ser radican en el principio de primun non nocere y de servir. El artículo describe la realidad actual de los residentes en México y propone algunas medidas para mejorar las condiciones en las cuales se desempeñan.

Mexico has a great history and tradition in relation to the training of resident physicians, but what we find behind this process?, Power relations implied and not implied, unnoticed or ignored for convenience by the academic and health institutions, with the aggravation of forgetting its commitment to the training of men and women "professionals" and limited to meet another indicator of "human resources for health." The resident physician in academic and scientific training is immersed in this dehumanized maelstrom and ends up becoming a character for the domain of knowledge as power, forgetting that his act and its rationale lies in the principle of "primum non nocere" to that we would add: nor your person, nor your fellowman, much less whom you have the moral, ethical and civic responsibility to convey some of your knowledge and your experience, that is, part of your essence”.