Anesthesia training: Are we doing enough in three years? Cross-sectional study

Introduction: The mínimum number of procedures required to be performed during anesthesia training has not been officially defined in Colombia. Although a number is no guarantee of acquired competencies, it does indicate the level of opportunity offered by the different programs. This study describes the practical training afforded to residents in a graduate anesthesia program in Colombia, and compares its results with international standards. Objective: Describe exposure to procedures performed by residents enrolled in a three-year anesthesia specialization program in Colombia between 2015 and 2020, and compare with the standards proposed by ASCOFAME and ACGME. Methods: Descriptive, cross-sectional study which included residents who did their specialization in a Colombian anesthesia program between 2015 and 2020. Complexity, anesthesia techniques, invasive monitoring and airway approach were described. Finally a descriptive comparison was made with the published references of the Colombian Association of Medical Schools (ASCOFAME) and the Accreditation Council for Graduate Medical Education (ACGME). Results: The results for 10 residents were included. Each resident had a median of 978 cases (IQR 942-1120), corresponding to 25 surgical specialties, the most frequent being general surgery (18%), orthopedics (16%), pediatric surgery (19%), and obstetrics (10.8%). According to the American Society of Anesthesiology (ASA) classification, the majority of patients were ASA II (39.63%) and ASA III (28.4%). Adequate exposure was achieved in 11 of the 15 categories proposed by ACGME and in 6 of the 15 proposed by ASCOFAME. Conclusions: A detailed description of the practice component acquired by the residents during their three years of training was obtained. This baseline provides insight into the national landscape and allows to describe the relationship with international standards.

Introducción: En Colombia no se encuentra oficialmente definido el número mínimo de procedimientos que se deben realizar durante el entrenamiento en anestesiología. Aunque el número no garantiza la adquisición de competencias de la especialidad, sí es un indicador de la oportunidad ofertada por parte de los programas. Este estudio describe el entrenamiento práctico que tienen los médicos residentes en un programa de posgrado de anestesiología en Colombia y compara sus resultados con estándares internacionales. Objetivo: Describir la exposición a procedimientos realizados por los médicos residentes de un programa de especialización en anestesiología de tres años en Colombia, entre 2015 y 2020, y compararlo con los estándares propuestos por ASCOFAME y el ACGME. Métodos: Estudio descriptivo de corte transversal; se incluyeron los residentes que cursaron su programa de especialidad en un programa colombiano de anestesiología entre 2015 y 2020. Se describieron la complejidad, técnicas anestésicas, monitoría invasiva y abordaje de la vía aérea. Finalmente, se compararon los resultados de manera descriptiva con lo referenciado por la Asociación Colombiana de Facultades de Medicina y el Accreditation Council for Graduate Medical Education (ACGME). Resultados: Se incluyeron los resultados de 10 médicos residentes. El número de casos por residente tuvo una mediana de 978 casos (RIQ942-1120), correspondientes a 25 especialidades quirúrgicas; cirugía general (18 %), ortopedia (16 %), cirugía pediátrica (19 %) y obstetricia (10,8 %) fueron las más frecuentes. Según la clasificación de la Sociedad Americana de Anestesiología (ASA), la mayoría de los pacientes tenían ASA 2 (39,63 %), ASA 3 (28,4 %). Se alcanzó una exposición adecuada en 11 de las 15 categorías propuestas por el ACGME y en 6 de las 15 propuestas por la Asociación Colombiana de Facultades de Medicina. Conclusiones: Se obtuvo una descripción detallada del aspecto práctico de los residentes de anestesiología durante sus tres años de formación. Esta línea de base permite ampliar el panorama a escala nacional y describir la relación con estándares internacionales.

Perspectives of residents, students and faculty about residents as teachers at a University Hospital in Karachi.

This was a cross sectional study, conducted at the Aga Khan University, Karachi, from December 2018 to December 2019, to determine the residents' performance as teachers and understand the difficulties they faced. Anonymous feedback was obtained from students (n=200) to rate the teaching skills of residents in the paediatric department. The residents (n=60) also filled out an anonymous survey to assess their teaching performance and barriers to teaching. Furthermore, the faculty rated the residents' teaching abilities on a 5-point scale. A total of 145 (98.7%) students considered teaching as an important role of the residents. Ten (40%) residents identified themselves as beginners in teaching. The main barriers were time limitation (n=19, 76%), critical patients (n=3, 12%) and lack of appropriate skills (n=3, 12%).

A filosofia da Medicina de Família e Comunidade segundo Ian McWhinney e Roger Neighbour / The philosophy of Family and Community Medicine according to Ian McWhinney and Roger Neighbour / La filosofía de la Medicina Familiar y Comunitaria según Ian McWhinney y Roger Neighbour

Introdução: O presente artigo revisita os pressupostos filosóficos da Medicina de Família e Comunidade (MFC) a partir dos escritos de Ian McWhinney e Roger Neighbour. Objetivo: Fortalecer a discussão sobre as bases teóricas da MFC na academia e nos programas de residência em MFC. Métodos:Trata-se de um ensaio reflexivo que compara e analisa dois dos principais livros da MFC: o clássico "Manual de Medicina de Família" de Ian McWhinney e "The inner physician: why and how to practise 'Big Picture Medicine'" de Roger Neighbour. Resultados e Discussão: Ian McWhinney e Roger Neighbour utilizam a epistemologia de Thomas Kuhn para propor um paradigma diferente à medicina. Nesse processo, os autores desenvolveram propostas distintas, porém complementares, que optamos por categorizar em: (a) paradigma organísmico de McWhinney e quântico de Neighbour; (b) distinção entre a prática generalista e a do especialista focal; e (c) relação médico-paciente e consigo mesmo. Conclusão: Para navegar nas incertezas da prática generalista é necessário fomentar e refletir a respeito da essência do MFC, tanto nos cursos de graduação quanto nos programas de residência, para formar profissionais sensíveis à condição humana.

This article revisits the philosophical assumptions of Family and Community Medicine (FCM) from Ian McWhinney's and Roger Neighbour's writings. Objective: To strengthen the discussion on the theoretical foundations of FCM both in the academy and in residency programmes in FCM. Methods:This is a reflexive essay that compares and analyses two of the main books on FCM: the classic "Textbook of Family Medicine" by Ian McWhinney and "The inner physician: why and how to practise 'Big Picture Medicine'" by Roger Neighbour. Results and Discussion: Ian McWhinney and Roger Neighbour apply the epistemology of Thomas Kuhn to propose a different paradigm to medicine. In this process, the authors developed distinct but complementary proposals that we decided to categorise into: (a) McWhinney's organismic paradigm and Neighbour's quantum paradigm; (b) a distinction between general practitioner and focal specialist; and (c) doctor-patient relationship and with itself. Conclusion: To navigate the uncertainties of general practice, it is necessary to nurture and reflect on the essence of FCM, both in undergraduate courses and in residency programmes, to train professionals sensitive to the human condition.

El presente artículo revisita las premisas filosóficas de la Medicina de Familia y Comunidad (MFC) a partir de los escritos de Ian McWhinney y Roger Neighbour. Objetivo: Fortalecer la discusión sobre las bases teóricas de la MFC en la academia y en los programas de residencia en MFC. Métodos: Se trata de un ensayo reflexivo que compara y analiza dos de los principales libros de la MFC: el clásico "Manual de Medicina de Familia" por Ian McWhinney y "The inner physician: why and how to practise 'Big Picture Medicine'" por Roger Neighbour. Resultados y Discusión: Ian McWhinney y Roger Neighbour utilizan la epistemología de Thomas Kuhn para proponer un paradigma diferente a la medicina. En ese proceso, los autores desarrollaran propuestas distintas, pero complementarias que optamos por categorizar en: (a) paradigma organísmico de McWhinney y cuántico de Neighbour; (b) distinción entre la práctica generalista y la del especialista focal; y (c) relación médico-paciente y consigo mismo. Conclusión: Para navegar en las incertidumbres de la práctica generalista es necesario fomentar y reflexionar sobre la esencia del MFC, tanto en los cursos de graduación como en los programas de residencia, para formar profesionales sensibles a la condición humana.

Qualidade de vida de médicos residentes de um hospital escola / Quality of life of medical residents from a teaching hospital

OBJETIVOS: Avaliar a qualidade de vida de médicos residentes de um hospital escola situado na cidade de Goiânia, Goiás. MÉTODOS: Trata-se de um estudo transversal descritivo com abordagem quantitativa. A pesquisa foi realizada por meio de um censo entrevistando todos os médicos residentes do hospital. Foram aplicados dois questionários, sendo um com dados sociodemográficos e ocupacionais e o outro o instrumento World Health Organization Quality of Life - Bref (WHOQOL-Bref), que avalia a qualidade de vida. A análise estatística utilizada foi a paramétrica, com o uso da escala intervalar, análise de variância Scheffé e teste do qui-quadrado, considerando o nível de p<0,05. RESULTADOS: Foram entrevistados 84 médicos residentes, com média de idade de 29,8±3,6 anos, sendo 54 (64,3%) do sexo feminino e 53 (63,1%) solteiros. Trinta e oito entrevistados estavam cumprindo o primeiro ano de residência médica, 39 o segundo ano e sete o terceiro ano. A média da carga horária semanal era de 63,19±11,30 horas, e 56 (66,7%) referiram possuir outro emprego além da residência. A qualidade de vida total apresentou o escore 3,44±0,54, o domínio físico 3,51±0,61, o psicológico 3,43±0,63, o de relações sociais 3,42±0,80 e o de meio ambiente 3,39±0,54. A percepção da qualidade de vida apresentou um escore de 2,99±1,00 e a satisfação pessoal com a saúde de 3,04±1,17. Os homens apresentaram escore mais alto para a qualidade de vida total (média 3,64) do que as mulheres (média 3,32) (p=0,005). A diferença significativa entre os sexos apareceu também no domínio físico (p=0,005) e psicológico (p=0,004), nos quais as mulheres apresentaram escores mais baixos (médias respectivamente de 3,8 e 3,7) do que os homens (médias respectivamente de 4,3 e 4,2). CONCLUSÕES: A análise geral da qualidade de vida apresentou uma média boa, sendo todos os domínios enquadrados nesta classificação. A autoavaliação evidenciou uma percepção regular da própria qualidade de vida. O sexo feminino foi preditor de pior qualidade de vida geral e nos domínios físico e psicológico.

AIMS: To assess the quality of life of medical residents from a teaching hospital located in Goiânia, State of Goiás, Brazil. METHODS: This is a descriptive cross-sectional study with a quantitative approach. The survey was conducted using a census, during which all medical residents were interviewed. Two questionnaires were applied: one containing sociodemographic and occupational data and the World Health Organization Quality of Life - Bref (WHOQOL-Bref), which assesses quality of life. A parametric statistical analysis was used, including interval scale, Scheffé analysis of variance, and chi-square test. A p<0.05 was considered to be statistically significant. RESULTS: A total of 84 medical residents with a mean age of 29.8±3.6 years were interviewed. Fifty-four (64.3%) were female and 53 (63.1%) were single. Thirty-eight were attending the first year, 39 were in the second year, and seven were in the third year of residency. The weekly workload showed an average of 63.19±11.30 hours and 56 (66.7%) reported having a job besides the residency program. A score of 3.44±0.54 was obtained for the overall quality of life, 3.51±0.61 for the physical domain, 3.43±0.63 for the psychological domain, 3.42±0.80 for social relations, and 3.39±0.54 for environment. The perception about quality of life showed a score of 2.99±1.00 whereas that of personal satisfaction with health was equal to 3.04±1.17. Men had a higher score for overall quality of life (mean of 3.64) than women (mean of 3.32) (p=0.005). A significant difference between male and female residents was also observed in the physical domain (p=0.005) and in the psychological one (p=0.004), in which women had lower scores (means of 3.8 and 3.7, respectively) than men (means of 4.3 and 4.2, respectively). CONCLUSIONS: The overall quality of life assessment yielded a good mean, and all domains were included under this classification. Selfassessment demonstrated regular perception about the residents' own quality of life. Being a female was a predictor of worse overall quality of life and worse scores in the physical and psychological domains.

[Depression, anxiety and suicide risk symptoms among medical residents over an academic year]. / Síntomas de depresión, ansiedad y riesgo de suicidio en médicos residentes durante un año académico.

BACKGROUND: One of the causes of dissatisfaction among residents is related to burnout syndrome, stress and depression. The aim of this study is to describe the prevalence of depression, anxiety and suicide risk symptoms and its correlation with mental disorders among medical residents over an academic year. METHODS: 108 medical residents registered to second year of medical residence answered the Beck Depression Inventory, the State-Trait Anxiety Inventory and the Suicide Risk Scale of Plutchik: at the entry, six months later and at the end of the academic year. RESULTS: Residents reported low depressive symptoms (3.7 %), low anxiety symptoms (38 %) and 1.9 % of suicide risk at the beginning of the academic year, which increased in second measurement to 22.2 % for depression, 56.5 % for anxiety and 7.4 % for suicide risk. The statistical analysis showed significant differences between the three measurements (p < 0.001). The prevalence of depressive disorder was 4.6 % and no anxiety disorder was diagnosed. Almost all of the residents with depressive disorder had personal history of depression. None reported the work or academic environment as a trigger of the disorder. There was no association by specialty, sex or civil status. CONCLUSIONS: The residents that are susceptible to depression must be detected in order to receive timely attention if they develop depressive disorder.

Introducción: uno de los orígenes de la insatisfacción de los médicos residentes está relacionado con el síndrome de burnout, el estrés y la depresión. El objetivo es describir la prevalencia y las características clínicas de los síntomas de depresión, ansiedad y riesgo de suicidio y su correlación con trastorno mental en residentes de medicina a lo largo de un año académico. Métodos: se incluyeron 108 residentes de segundo año que respondieron el inventario de depresión de Beck, el inventario de ansiedad rasgo-estado y la escala de riesgo suicida de Plutchik al inicio del ciclo académico, así como seis y doce meses después. Resultados: en la primera medición se reportó una prevalencia de 3.7 % para síntomas de depresión, 38 % para síntomas de ansiedad y 1.9 % para riesgo de suicidio; a los seis meses la prevalencia aumentó a 22.2 % para depresión, 56.5 % para ansiedad y 7.4 % para riesgo de suicidio. El análisis estadístico mostró diferencias significativas entre las tres mediciones (p < 0.001). La prevalencia de trastorno depresivo fue de 4.6 %. Casi todos los residentes que desarrollaron trastorno depresivo tenían antecedente personal de depresión. El ambiente académico y laboral tuvo poca asociación con los trastornos. Conclusiones: es recomendable la detección de residentes con vulnerabilidad a la depresión con el objeto de que reciban atención oportuna en caso de que desarrollen trastorno depresivo.

An analysis of the questionnaire survey about the first year residency training in internal medicine in Peking Union Medical College Hospital / 中华内科杂志

Objective To evaluate the effects of medical residency training program in postgraduate-year-one (PGY-1) residents at Peking Union Medical College (PUMC) Hospital.Methods PGY-I medical residents at PUMC Hospital were surveyed by a self-administered questionnaire after they completed their first year residency.Results Forty-nine residents who completed their first year residency training participated in the survey with a 100％ response rate.Before training,only a few had bedside (n =18) and on-call experiences (n =10).At the end of the one-year-training,all the residents (100％) considered themselves being improved to certain degrees,especially in clinical practice capability,and passed all the examinations.However,53.1％ and 8.2％ of all the residents agreed that they need to improve their abilities in teaching (n =26) and doctor-patient communication (n =4),respectively.All residents hoped to get further improved by taking part in various forms of teaching activities,including experience summary/sharing and basic skills training.During the first year,95.9％ of them participated in all teaching activities in medicine actively.Conclusions The tradition and current models of medical residency training program at PUMC Hospital had a significant impact on professional development of the 1st year resident physicians.It is critical to focus on basic skill training and multi-level teaching to improve residents' clinical competency.