Validation of entrustable professional activities for use in neonatal care residency programs.

OBJECTIVE: Define and develop a set of entrustable professional activities (EPAs) to link clinical training and assessment of the hospital components of neonatal care in neonatology medical residency programs. METHODS: An exploratory study was conducted in two phases using a modified Delphi approach. In the first phase, a committee of five neonatology residency program coordinators drafted an initial set of EPAs based on the national matrix of competencies and on EPAs defined by international organizations. In the second phase, a group of neonatal care physicians and medical residents rated the indispensability and clarity of the EPAs and provided comments and suggestions. RESULTS: Seven EPAs were drafted by the coordinators´ committee (n = 5) and used in the content validation process with a group (n = 37) of neonatal care physicians and medical residents. In the first Delphi round, all EPAs reached a content validity index (CVI) above 0.8. The coordinators´ committee analyzed comments and suggestions and revised the EPAs. A second Delphi round with the revised EPAs was conducted to validate and all items maintained a CVI above 0.8 for indispensability and clarity. CONCLUSION: Seven entrustable professional activities were developed to assess residents in the hospital components of neonatal care medicine. These EPAs might contribute to implementing competency-based neonatology medical residency programs grounded in core professional activities.

Red de formación y de cuidados para la transición de adolescentes con inmunodeficiencias primarias / Care and training network for the transition of adolescents with primary immunodeficiencies

En este escrito nos proponemos relatar y sistematizar los aspectos centrales de la estrategia de gestión, formación y atención diseñada por el Servicio de Inmunología y Psicología Institucional del Hospital Garrahan junto a los Hospitales Durand y Posadas para la transición de adolescentes con inmunodeficiencias primarias a la atención de adultos. La formalización de las primeras transiciones comenzó en 2007 con el Hospital Durand y progresivamente se fueron complejizando y expandiendo los procesos y actores participantes, sumándose el Hospital Posadas y otros centros de atención que reciben un porcentaje menor de pacientes. El eje central de la estrategia fue la implementación de un sistema de rotaciones para los residentes del último año de la especialidad de adultos por el servicio de pediatría. La formalización de la estrategia también readecuó de manera gradual aspectos internos de la atención de los adolescentes en el hospital pediátrico. En una etapa posterior se implementaron encuentros por videoconferencia con centros de adultos para redefinir acuerdos entre los servicios. Además, la asociación civil de pacientes (Asociación de Ayuda al Paciente con Inmunodeficiencias Primarias - AAPIDP) cumplió un rol relevante desde los primeros años de la estrategia. Estas acciones propiciaron la creación de una red de formación y cuidados en inmunodeficiencias primarias para la transición (AU)

In this article, we aim to describe and systematize the central aspects of the management, training, and care strategy designed by the Departments of Immunology and Institutional Psychology of the Garrahan Hospital, in collaboration with the Durand and Posadas Hospitals, for the transition of adolescents with primary immunodeficiencies to adult care. The first transitions were formalized in 2007 with the Durand Hospital. Over time, the processes and actors involved have become more complex and expanded, incorporating the Posadas Hospital and other care centers that receive a smaller percentage of patients. The central axis of the strategy was the implementation of a rotation system for residents in their final year of the adult specialty in the Department of Pediatrics. The formalization of the strategy also led to gradual readjustments in the internal aspects of adolescent care within the pediatric hospital. In a later stage, videoconference meetings with adult centers were implemented to redefine agreements between departments. Additionally, the patient association (Asociación de Ayuda al Paciente con Inmunodeficiencias Primarias - AAPIDP) has played a significant role since the early years of the strategy. These actions have led to the creation of a network for training and care in primary immunodeficiencies for the transition (AU)

Prevalence and factors associated with anxiety, depression and burnout in gynecology and obstetrics residents during the COVID-19 pandemic.

Objective: To determine the prevalence of anxiety, depression and burnout in residents of Gynecology and Obstetrics during COVID-19 pandemic in Brazil and its associated factors. Methods: Cross-sectional study involving all regions of Brazil, through the application of a sociodemographic questionnaire, the Hospital Anxiety and Depression Scale (HAD) and the Maslach Burnout Inventory (MBI-HSS) instrument. Multivariate analysis was performed after adjusting the Poisson model. Results: Among the 719 participating medical residents, screening was positive for anxiety in 75.7% and for depression in 49.8% of cases. Burnout syndrome was evidenced in 41.3% of the physicians studied. Those with depression are more likely to have anxiety (OR 0.797; 95%CI 0.687 - 0.925) and burnout syndrome (OR 0.847 95%CI 0.74 - 0.97). Residents with anxiety (OR 0.805; 95%CI 0.699 - 0.928) and burnout (OR 0.841; 95%CI 0.734 - 0.963) are more likely to have depression. Conclusion: High prevalence of anxiety, depression and burnout were found in residents of Gynecology and Obstetrics in Brazil, in addition to important correlations between anxiety-depression and depression-burnout.

Puntaje final del examen de admisión según el promedio de grado de los postulantes a la convocatoria de la Comisión Nacional de Residencias Médicas Paraguay 2019-2023

Introducción: La Comisión Nacional de Residencias Médicas (CONAREM) es el principal sistema de admisión para la tutoría clínica de residencias médicas en Paraguay, avalado por Ministerio de Salud Pública y Bienestar Social. Objetivos. Determinar la relación entre el puntaje final obtenido y el promedio de grado en postulantes a convocatorias CONAREM 2019-2023. Metodología: Estudio transversal con variables sociodemográficas, académicas, puntajes del examen y puntaje final. Se aplicaron métodos descriptivos y pruebas de Kolmogórov-Smirnov, t de Student, U de Mann-Whitney, Kruskal-Wallis y correlación de Spearman; utilizando software Stata© 17.0 de StataCorp LLC. Se consideraron significativos cuando p<0.05. Resultados: De 2019 a 2023, 4.768 médicos postularon examen CONAREM. 62,12 % eran mujeres, 34,51 % tenían entre 22 y 25 años y 95,30 % estaban solteros. El promedio de grado fue 3,56  0, 49. La mayoría (69,09 %) provenían de universidades privadas. En las especialidades preferidas, clínica médica fue más común (20,31 %), luego cirugía general y pediatría (ambas 14,30 %), 39,14 % pudo acceder a especialidad preferida. El puntaje final promedio fue 67,92 (RIC 60,78 - 76,76) con diferencias significativas según edad, universidad de procedencia y año de examen. Con modelo de regresión logística se demostró que promedio de grado, edad, universidad pública y primera participación en examen estaban asociados con mayor probabilidad de obtener mejores puntajes. El modelo tenía coeficiente de ajuste de 0, 318, indicando que solo predice el 32 % de resultados. La correlación fue moderada y significativa entre puntaje final y promedio general de grado. Según universidad, la correlación fue baja y no significativa para universidades extranjeras, mientras que universidades públicas y privadas mostraron correlación moderada pero significativa. Discusión. Los mejores promedios de grado se correlacionan moderadamente con mayor probabilidad de puntajes altos y acceder a especialidades de preferencia de los médicos recientemente graduados, provenientes de universidades públicas que hayan rendido por primera vez el examen de la CONAREM.

Introduction: The National Commission of Medical Residencies (CONAREM) is the main admission system for clinical tutoring of medical residencies in Paraguay, endorsed by the Ministry of Public Health and Social Welfare. Objectives: Determine the relationship between the final score obtained and the average degree in applicants to CONAREM calls 2019-2023. Methods: Cross-sectional study with sociodemographic and academic variables, exam scores and final score. Descriptive methods and tests of Kolmogorov-Smirnov, Student's t, Mann-Whitney U, Kruskal-Wallis and Spearman's correlation were applied; using Stata© 17.0 software from StataCorp LLC. They were considered significant when p<0.05. Results: From 2019 to 2023, 4,768 doctors applied for the CONAREM exam. 62.12% had a female female, 34.51% from 22 to 25, and 95.30% were single. The grade point average was 3.56(0.49. The majority (69.09%) came from private universities. As for preferred specialties, medical clinic was more common (20.31%), then general surgery and pediatrics (both 14.30%). 39.14% could access preferred specialty. The average final score was 67.92 and significant differences were found according to age, university of origin and year of examination. With logistic regression model, it was shown that average grade, age, public university and first participation in the exam were associated with a higher probability of obtaining better scores. The model had an adjustment coefficient of 0.318, indicating that it only predicts 32% of outcomes. The correlation was moderate and significant between final score and overall grade point average. By type of university, the correlation was low and not significant for foreign universities, while public and private universities showed moderate but significant correlation. Discussion: The best grade point averages correlate moderately with higher probability of high scores and access to specialties of preference and are associated with recently graduated doctors from public universities and took the exam for the first time.

Percepción de los médicos residentes de Pediatría sobre el impacto de la pandemia por COVID-19 en su proceso formativo / Pediatric residents' perceptions about the impact of the COVID-19 pandemic on their training

Introducción. Las residencias médicas experimentaron modificaciones que pudieron afectar la formación académica durante la pandemia por COVID-19. Objetivos. Describir la percepción de residentes de Pediatría en relación con el impacto de la pandemia en su formación. Efectuar la adaptación transcultural y validación al idioma español del instrumento "COVID-19 Resident Education and Experience Survey". Materiales y métodos. Estudio observacional, transversal. Participaron residentes de Pediatría de distintos hospitales del país. Se utilizó la encuesta de Ostapenko y col. modificada. Se realizó el análisis descriptivo utilizando SPSS vs. 21. El proyecto fue aprobado por el Comité de Ética institucional. Resultados. Completaron la encuesta 127 residentes. La mayoría dedicaba más de 50 horas a actividades asistenciales antes y durante la pandemia. El 43,3 % (IC95% 35-52) dedicaba hasta 1 hora diaria al estudio individual previo a la pandemia, y un 63 % (IC95% 54,3-70,9) dedicaba ese tiempo durante la pandemia. El 75,6 % (IC95% 67,4-82,2) reportó que el tiempo previo dedicado a actividades académicas era al menos de 4 horas semanales, descendiendo al 41,7 % (IC95% 33,5-50,4) en la pandemia. Más del 60 % (IC95% 54,3-70,1) percibió que la pandemia perjudicó su formación para convertirse en especialista y el 93,7 % (IC95% 88,1-96,8), que su nivel de estrés se incrementó. Conclusiones. La cantidad de horas destinadas a actividades académicas fue percibida como menor durante la pandemia. La mayoría de los encuestados refirió que su nivel de estrés aumentó y que la pandemia perjudicó su formación para convertirse en especialista.

Introduction. Medical residency programs suffered changes that may have affected academic training during the COVID-19 pandemic. Objectives. To describe the perceptions of pediatric residents about the pandemic's impact on their education. To transculturally adapt and validate the COVID-19 Resident Education and Experience Survey into Spanish. Materials and methods. Observational, cross-sectional study. Participants were pediatric residents from hospitals across the country. The survey by Ostapenko et al. was used. A descriptive analysis was done using the SPSS software, version 21. The project was approved by the Institutional Ethics Committee. Results. The survey was completed by 127 residents. Most did more than 50 hours of health care activities before and during the pandemic. Also, 43.3% (95% CI: 35­52) spent at least 1 hour a day studying individually before the pandemic, while 63% (95% CI: 54.3­70.9) did so during the pandemic. In relation to the time spent doing academic work, 75.6% (95% CI: 67.4­82.2) reported that, before the pandemic, they spent at least 4 hours a week doing academic activities, dropping to 41.7% (95% CI: 33.5­50.4) during the pandemic. More than 60% (95% CI: 54.3­70.1) perceived that the pandemic impaired their training to become a specialist and 93.7% (95% CI: 88.1­96.8), that their stress levels increased. Conclusions. The perception was that participants spent less hours doing academic activities during the pandemic. Most surveyed participants mentioned that their stress levels increased and that the pandemic impaired their training to become a specialist.

Pediatric residents' perceptions about the impact of the COVID-19 pandemic on their training. / Percepción de los médicos residentes de Pediatría sobre el impacto de la pandemia por COVID-19 en su proceso formativo.

Introduction. Medical residency programs suffered changes that may have affected academic training during the COVID-19 pandemic. Objectives. To describe the perceptions of pediatric residents about the pandemic's impact on their education. To transculturally adapt and validate the COVID-19 Resident Education and Experience Survey into Spanish. Materials and methods. Observational, cross-sectional study. Participants were pediatric residents from hospitals across the country. The survey by Ostapenko et al. was used. A descriptive analysis was done using the SPSS software, version 21. The project was approved by the Institutional Ethics Committee. Results. The survey was completed by 127 residents. Most did more than 50 hours of health care activities before and during the pandemic. Also, 43.3% (95% CI: 35-52) spent at least 1 hour a day studying individually before the pandemic, while 63% (95% CI: 54.3-70.9) did so during the pandemic. In relation to the time spent doing academic work, 75.6% (95% CI: 67.4-82.2) reported that, before the pandemic, they spent at least 4 hours a week doing academic activities, dropping to 41.7% (95% CI: 33.5-50.4) during the pandemic. More than 60% (95% CI: 54.3-70.1) perceived that the pandemic impaired their training to become a specialist and 93.7% (95% CI: 88.1-96.8), that their stress levels increased. Conclusions. The perception was that participants spent less hours doing academic activities during the pandemic. Most surveyed participants mentioned that their stress levels increased and that the pandemic impaired their training to become a specialist.

Introducción. Las residencias médicas experimentaron modificaciones que pudieron afectar la formación académica durante la pandemia por COVID-19. Objetivos. Describir la percepción de residentes de Pediatría en relación con el impacto de la pandemia en su formación. Efectuar la adaptación transcultural y validación al idioma español del instrumento "COVID-19 Resident Education and Experience Survey". Materiales y métodos. Estudio observacional, transversal. Participaron residentes de Pediatría de distintos hospitales del país. Se utilizó la encuesta de Ostapenko y col. modificada. Se realizó el análisis descriptivo utilizando SPSS vs. 21. El proyecto fue aprobado por el Comité de Ética institucional. Resultados. Completaron la encuesta 127 residentes. La mayoría dedicaba más de 50 horas a actividades asistenciales antes y durante la pandemia. El 43,3 % (IC95% 35-52) dedicaba hasta 1 hora diaria al estudio individual previo a la pandemia, y un 63 % (IC95% 54,3-70,9) dedicaba ese tiempo durante la pandemia. El 75,6 % (IC95% 67,4-82,2) reportó que el tiempo previo dedicado a actividades académicas era al menos de 4 horas semanales, descendiendo al 41,7 % (IC95% 33,5-50,4) en la pandemia. Más del 60 % (IC95% 54,3-70,1) percibió que la pandemia perjudicó su formación para convertirse en especialista y el 93,7 % (IC95% 88,1-96,8), que su nivel de estrés se incrementó. Conclusiones. La cantidad de horas destinadas a actividades académicas fue percibida como menor durante la pandemia. La mayoría de los encuestados refirió que su nivel de estrés aumentó y que la pandemia perjudicó su formación para convertirse en especialista.

Modelos de preceptoria de residência em medicina de família e comunidade: um estudo Delphi / Models of preceptorship in family and community medicine residence: a Delphi study

Resumo Introdução: A preceptoria na atenção primária à saúde desempenha papel central na formação do residente, já que 70%-80% da carga horária dos programas de residência de medicina de família e comunidade (PRMFC) acontece na unidade de saúde da família. Como preceptor entende-se o professor que ensina na prática clínica. O cenário atual de expansão dos PRMFC, associado a poucos profissionais especializados em preceptoria, fez com que vários modelos fossem praticados. Uma revisão de literatura feita em estágio anterior a este trabalho, além das contribuições da Sociedade Brasileira de Medicina de Família e Comunidade, identificou quatro modelos de preceptoria em MFC: ombro a ombro, preceptor da equipe ao lado, preceptor de unidade e preceptor de campo. Objetivo: Este estudo teve como objetivos validar esses quatro modelos e identificar outros, determinar, sob a ótica da qualidade de formação dos residentes, a aceitabilidade e o grau de recomendação dos modelos, e reconhecer os pontos positivos e negativos. Método: Utilizou-se a técnica Delphi modificada por questionários on-line. O estudo começou com 24 participantes de todo o Brasil na primeira rodada e terminou com 18. Aplicaram-se a técnica de estatística descritiva e a análise de conteúdo. O estudo foi realizado entre fevereiro e abril de 2022. Resultado: Validaram-se os quatro modelos apresentados, e nenhum outro foi identificado. Os modelos ombro a ombro, preceptor da equipe ao lado e preceptor de unidade foram considerados aceitáveis; e o modelo preceptor de campo, inaceitável. Os modelos ombro a ombro e preceptor de unidade foram recomendados. Reconheceram-se 92 aspectos como pontos positivos e negativos, dos quais 81 atingiram consenso. Conclusão: Obteve-se a validação dos quatro tipos de modelos de preceptoria para PRMFC. Como os modelos ombro a ombro e preceptor de unidade foram elencados como aceitáveis e recomendáveis, é importante que sejam priorizados na implantação e manutenção dos PRMFC. Os modelos preceptor da equipe ao lado e preceptor de campo foram julgados como não recomendados e, portanto, devem ser evitados. O conhecimento das fortalezas e fraquezas de cada modelo prepara os PRMFC para as possíveis dificuldades e os auxilia na escolha do modelo adequado às diversas realidades existentes no país.

Abstract Introduction: Medical residency preceptorship in primary healthcare plays a major role in the professional qualification of medical residents, since 70-80% of the workload of the Family and Community Medical Residency Program (PRMFC) takes place in primary care clinics. A preceptor is understood as an experienced practitioner who teaches during clinical practice. The current scenario of expansion of PRMFCs in Brazil, associated with the limited number of professionals specialized in preceptorship, has resulted in the practice of different preceptorship models. A literature review performed in the previous stage of this study, added to the contributions of the Brazilian Society of Family and Community Medicine, pointed out four models of preceptorship in family practice: shoulder-to-shoulder, next-door team, clinic preceptor and field preceptor. Objective: To validate these four models of preceptorship and identify if there are others models; to determine, from the perspective of the quality of training residents, the acceptability and degree of recommendation of the models and recognize the positive and negative points. Method: The Delphi technique modified by online questionnaires was used. It was initiated with 24 participants from all over Brazil in the first round and ended with 18. Descriptive statistics and content analysis method was applied. The study was conducted between February and April 2022. Result: The four models presented were validated and no others were identified. The shoulder-to-shoulder, nextdoor team preceptor and clinic preceptor models were considered acceptable and the field preceptor model, unacceptable. The shoulder-to-shoulder and clinic preceptor models were recommended. Ninety-two aspects were recognized as positive and negative points. Of these, 81 achieved consensus. Conclusion: The shoulder-to-shoulder preceptor and clinic preceptor models were validated as acceptable and recommended, so it is important to prioritize these models in the implementation and maintenance of PRMFCs. The next-door team preceptor and field preceptor models were deemed as not recommended and, therefore, should be avoided. Information about the strengths and weaknesses of each model prepares the PRMFCs for possible implementation difficulties and helps them to select the appropriate model for the different realities existing in the country.

Uso do Mini-Clinical Evaluation Exercise (Mini-CEX) na residência médica: uma revisão de escopo / Use of Mini-Clinical Evaluation Exercise (Mini-CEX) in medical residency: a scoping review

Resumo Introdução: Com a evolução do ensino médico para currículos baseados em competências, fez-se necessária uma readequação dos currículos e dos métodos de avaliação, com maior enfoque sobre o cenário de prática profissional e, portanto, na utilização de ferramentas como o Mini-Clinical Evaluation Exercise (Mini-CEX). Objetivo: Este estudo teve como objetivo avaliar o uso da estratégia Mini-CEX como método de avaliação nos programas de residência médica. Método: Trata-se de uma revisão de escopo, cuja estratégia de busca realizada no PubMed resultou em 578 artigos. Após aplicar a metodologia do Instituto Joanna Briggs para inclusão e exclusão, foram selecionados 24 estudos transversais. Resultado: Selecionaram-se artigos referentes a estudos realizados entre 1995 e 2021, em diversos continentes, diferentes programas de residência, e cenários ambulatorial, internação e de emergência. O Mini-CEX mostrou-se aplicável no contexto da residência médica, pois trata-se de uma avaliação observacional direta do atendimento realizado pelo médico residente nos diversos cenários de atuação, como ambulatórios, internações e emergências. Trata-se de uma avaliação com tempo de observação variando de dez a 40 minutos e que permite a abordagem de vários aspectos do atendimento médico, como anamnese, exame físico, raciocínio clínico e aconselhamento, além de possibilitar a realização de um feedback sobre o desempenho dos residentes. Conclusão: O Mini-CEX constitui uma ferramenta de fácil aplicabilidade e promove alto grau de satisfação dos envolvidos, podendo ser utilizada de forma rotineira nos programas de residência médica.

Abstract Introduction: With the evolution of medical education towards competency-based curriculum, the need has emerged to reconfigure curriculum and assessment methods, with increased focus on the professional practice setting, thus leading to the utilization of tools such as the mini-CEX (mini-Clinical Evaluation Exam). Objective: To evaluate the use of the mini-CEX strategy as an assessment method in medical residency programs. Method: This is a scoping review, and the search performed on PubMed resulted in 578 articles. After applying the Joanna Briggs Institute methodology for inclusion and exclusion, 24 cross-sectional studies were selected. Results: The selected articles were based on studies conducted between 1995 and 2021, in various continents and in both clinical and surgical residency programs, including outpatient, inpatient, and emergency settings. The Mini-CEX was shown to be applicable in the context of medical residency, as it is an observational assessment of the care provided by the resident physician in various practice settings such as outpatient clinics, inpatient wards, and emergency departments. It involves a variable observation time ranging from 10 to 40 minutes and allows for the evaluation of various aspects of medical care, including history taking, physical examination, clinical reasoning, counseling, and provides an opportunity for providing feedback on the residents' performance. Conclusion: The mini-CEX is a tool that is easy to implement and promotes a high degree of satisfaction among stakeholders. It could be used more routinely in medical residency programs.

Avaliação do perfil do egresso e da residência médica em ortopedia e traumatologia do HCFMRP-USP / Evaluation of the graduate profile and of the medical residency in orthopedics and traumatology at HCFMRP-USP

Resumo Introdução: Bons programas de residência médica (PRM) devem investir na estruturação e no desenvolvimento contínuo dos serviços de assistência no contexto da rede de saúde, na organização da estrutura de apoio às atividades didáticas e assistenciais, e na remuneração e capacitação contínua de preceptores e coordenadores. Objetivo: Este estudo observacional, transversal e descritivo buscou caracterizar o perfil dos egressos do Programa de Residência Médica em Ortopedia e Traumatologia (PRMOT) do HCFMRP-USP e coletar dados sobre as características do programa que orientem ações de aperfeiçoamento na metodologia de ensino. Método: Participaram do estudo egressos do PRMOT ou que concluíram os programas de complementação especializada e residência médica em cirurgia da mão entre 1964 e 2020. Resultado: Foi encaminhado um questionário a 302 indivíduos (73,6% do total de egressos), obtendo 214 respostas (70,8% dos indivíduos contatados ou 52,2% do total de egressos). Indivíduos do sexo masculino correspondem a 92,5% dos egressos, e 71,9% residem no estado de São Paulo. As duas subespecialidades mais cursadas foram cirurgia do joelho e da mão. A pós-graduação stricto sensu fez parte da formação acadêmica de 40,6% dos egressos, dos quais 60,7% trabalharam com ensino médico. Dos egressos, 71% atuam na subespecialidade escolhida. Na avaliação do ensino do PRMOT e do grau de satisfação profissional, os aspectos que se destacaram positivamente foram: capacitação para atendimento em níveis terciário e secundário, número de atendimentos, variabilidade dos casos e preparo para o mercado de trabalho. Os aspectos que se destacaram negativamente foram: remuneração mensal, carga horária de aulas teóricas e realização de procedimentos cirúrgicos. Conclusão: O estudo conseguiu traçar o perfil do egresso e determinar os pontos fortes e as oportunidades de melhoria do PRMOT do HCFMRP-USP.

Abstract Introduction: Good Medical Residency Programs (PRM) must invest in the structuring and continuous development of care services in the health network setting; in the organization of the support structure for teaching and care activities and in the remuneration and continuous training of preceptors and coordinators. Objective: This study is an observational, cross-sectional, and descriptive investigation aimed at providing an in-depth understanding of the characteristics of individuals who have successfully completed the medical residency program in Orthopedics and Traumatology (MRPOT) at the Clinic Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo. Additionally, the study seeks to gather comprehensive data regarding the features of the educational program in order to offer insights for potential enhancements. The study encompassed a total of 418 participants who completed their training between 1964 and 2020. Methods: This group includes physicians who not only graduated from the MRPOT but also those who completed supplementary specialized programs and medical residencies in hand surgery, all within the same department. Data were systematically collected through an electronic questionnaire. Results: Among the participants, 302 graduates (73.6% of the total cohort) were identified, and responses were obtained from 214 individuals, which corresponds to 70.8% of the reached contacts or 52.2% of the entire graduate pool. The predominant demographic of the sample is male, with 198 respondents (92.5%), most of whom reside in the state of São Paulo (154 individuals, 71.9%). A significant portion of the participants, 184 (86%), pursued further specialized training or embarked on additional medical residencies within the field. The most prevalent subspecialties within this group are Knee Surgery, accounting for 63 individuals (34.2%), and Hand Surgery, comprising 49 individuals (26.6%). Postgraduate education played a role in the academic training of 87 respondents (40.6%). Research activities primarily took place within public universities (81%) and were carried out by 79 graduates (36.9%). A substantial proportion, 130 individuals (60.7%), had prior experience in medical education, either as preceptors or professors for both undergraduate and medical residency levels. The majority of participants, 152 individuals (71%), currently practice within their respective subspecialties. However, a considerable number of graduates also engage in traumatology (34.1%) and general orthopedics (31.8%). The evaluation of the educational framework of the program and the level of professional satisfaction revealed notable aspects that received positive assessments from the respondents. These included the diversity and volume of cases, training tailored for tertiary and secondary care, and preparation for the professional sphere. On the other hand, concerns were raised regarding the adequacy of monthly remuneration, the scarcity of theoretical instruction, and the limited exposure to surgical training. These specific areas garnered lower scores both in the objective metrics and subjective feedback. Conclusion: This study effectively delineated the characteristics of MRPOT graduates and identified the program's key strengths. Simultaneously, it highlights areas that have drawn criticism and warrant attention.

Síndrome de burnout em residentes de ginecologia e obstetrícia de uma maternidade-escola / Burnout syndrome in gynecology and obstetrics residents of a teaching maternity unit

RESUMO Introdução: Os médicos residentes constituem um grupo de risco para distúrbios emocionais e comportamentais, e isso pode levar à síndrome de burnout e interferir negativamente no atendimento prestado. Objetivo: Este estudo teve como objetivos identificar os estressores vivenciados por residentes de ginecologia e obstetrícia (GO) de uma maternidade-escola do Sul do Brasil e estimar a prevalência da síndrome de burnout entre eles. Método: Realizou-se a coleta de dados de agosto a dezembro de 2020 com 21 residentes. A coleta compreendeu duas etapas: na primeira, fez-se uma entrevista semiestruturada, por meio de um roteiro-guia, visando identificar os estressores vivenciados pelos residentes em GO. Na sequência, os participantes receberam um questionário autoaplicável que teve por objetivo medir o nível de burnout pautado no Maslach Burnout Inventory. Para análise dos dados qualitativos, adotou-se a metodologia discurso do sujeito coletivo. Para análise dos dados quantitativos, foi utilizada a descrição analítica dos dados. Resultado: Entre os estressores vivenciados pelos residentes, destacam-se: falta de acolhimento pela equipe multiprofissional ao ingressarem na residência; excessiva carga horária de trabalho; poucas horas de sono; o desafio de se tornarem responsáveis pelo próprio aprendizado; as várias abordagens terapêuticas por preceptores diferentes para um mesmo problema; sensação de insuficiência de conteúdo teórico durante a residência; culpa por não estudarem o quanto acreditam que deveriam; diminuição do tempo destinado ao lazer e à atividade física; alto nível de estresse; abalo emocional que a grande responsabilidade assumida acarreta; e falta de apoio psicológico. Dos 21 médicos residentes, a síndrome de burnout esteve presente em 57,1% dos participantes. Exaustão emocional foi a mais frequente dimensão (52,7%), seguida por despersonalização (33,3%) e baixa realização profissional (9,5%). Conclusão: Os estressores relatados apontam para necessidade de revisão da residência a fim de que consequências nefastas à saúde mental de residentes, como a síndrome de burnout e suas consequências, sejam prevenidas, diminuídas ou sanadas, de modo a evitar danos tanto para os residentes como para os pacientes por eles atendidos e para instituição de saúde. São propostas medidas profiláticas na busca de melhorias na qualidade de vida, na qualidade do atendimento e, talvez no aspecto mais importante: a mudança de foco, da residência centrada no serviço para a residência centrada no aprendiz.

ABSTRACT Introduction: Medical residents constitute a risk group for emotional and behavioral disorders, which can lead to Burnout Syndrome, negatively interfering with the care provided. Objective: To identify the stressors experienced by Gynecology and Obstetrics residents of a teaching maternity hospital in southern Brazil and estimate the prevalence of Burnout Syndrome among them. Method: Data was collected from August to December 2020 with 21 residents and comprised two stages: the first consisted of a semi-structured interview, using a guide script, aiming to identify the stressors experienced by the GO residents. Subsequently, the participants received a self-administered questionnaire that aimed to measure the level of Burnout based on the Maslach Burnout Inventory. Qualitative data analysis was performed using the Collective Subject Discourse methodology. Quantitative data analysis was performed using the analytical description of the data. Results: Among the stressors experienced by residents, the following stand out: lack of acceptance by the multidisciplinary team when entering the residency; excessive workload; lack of sleep; the challenge of becoming responsible for one's own learning; the various therapeutic approaches by different preceptors for the same problem; feeling of insufficient theoretical content during the residency; guilt for not studying as much as you believe you should; decreased time devoted to leisure and physical activity, high level of stress; emotional upheaval that the great responsibility assumed entails and lack of psychological support. Of the 21 resident physicians, Burnout Syndrome was present in 57.1% of the participants. Emotional exhaustion was the most frequent dimension (52.7%), followed by Depersonalization (33.3%) and Low professional achievement (9.5%). Conclusion: The reported stressors point to the need to review the residency so that harmful consequences to the mental health of students, such as Burnout syndrome and its consequences, are prevented, reduced or remedied, avoiding damage to the residents, their patients and the health care institution. Prophylactic measures are proposed in the search for improvements in the quality of life, the quality of care and, perhaps most importantly, the shift in focus from a service-centered residency to a learner-centered residency.

O que é Residência Médica em Rede? / What is Network- Based Medical Residency?

RESUMO Introdução: A Residência Médica em Rede é um novo modelo de formação de médicos especialistas que visa expandir o treinamento médico tradicional, particularmente nas redes de atenção à saúde do Sistema Único de Saúde (SUS). Embora legalmente respaldada, carece de regulamentação específica e definição precisa. Desenvolvimento: Um programa em rede, a nosso ver, opera nas redes temáticas do SUS, é coordenado por uma instituição pública, desenvolvido em cidades com mais de 50 mil habitantes, aprovado pela Comissão Nacional de Residência Médica e tem um programa de educação permanente para preceptores. Os desafios incluem padronização de conteúdo, treinamento contínuo de preceptores e um projeto andragógico sólido. O perfil de competências requer não só habilidades médicas, mas também de gestão, trabalho em equipe, conhecimento profundo do SUS e de atenção primária. Barreiras incluem a coordenação de cenários distintos e avaliações apropriadas. Conclusão: O sucesso do modelo exige regulamentação precisa, padronização e integração efetiva para formar especialistas alinhados com o SUS.

ABSTRACT Introduction: Network-Based Medical Residency is a new model for training specialist doctors that expands traditional education, particularly in the Health Care network of the Unified Health System (SUS). Although with legal foundation, it requires specific regulations and a precise definition. Development: In our view, a Network-Based program has the following characteristics: it is coordenated by a public institution, operates in SUS thematic networks in cities >50,000 inhabitants, it is approved by the National Medical Residency Commission and involves a Continuing Education Program for preceptors. The challenges include content standardization, ongoing preceptor training, and a solid andragogical design. The skills profile not only requires medical skills, but also management knowledge, teamwork, in-depth knowledge of the SUS and Primary Care. The barriers include coordinating diverse practice scenarios and assessments. Conclusion: The success of the model requires precise regulation, standardization and effective integration to train specialists aligned with the SUS.

Perfil do estudante e fatores que influenciam o interesse pela medicina de família e comunidade / Profile of medical students and factors that influence theirinterest in the family and community medicine residency

RESUMO Introdução: A medicina de família e comunidade (MFC) apresenta-se como uma carreira médica de importância social, porém seu crescimento nas regiões do Brasil ainda é pouco representativo, sendo necessário identificar os fatores que influenciam o estudante do curso de Medicina na escolha dessa carreira profissional. Objetivo: Este estudo teve como objetivo analisar fatores que influenciam o interesse pela residência em MFC pelos alunos do internato do curso de Medicina. Método: Trata-se de um estudo transversal, descritivo, de análise quantitativa, realizado com os alunos matriculados nos estágios do penúltimo e último anos dos cursos de Medicina de uma capital brasileira. Resultado: Participaram da pesquisa 229 estudantes matriculados no internato de Medicina. Aqueles que demonstraram interesse pela MFC eram, em sua maioria, jovens, de ambos os gêneros, na faixa etária entre 26 e 35 anos, casados, com filhos e renda familiar menor que cinco salários mínimos. Duas variáveis estiveram associadas à opção pela MFC: a faixa etária e a avaliação positiva acerca da especialidade. Conclusão: Compreender os fatores que influenciam na escolha da MFC pode contribuir para aprimorar a formação médica, alinhando as preferências dos estudantes com as necessidades da sociedade e do Sistema Único de Saúde.

ABSTRACT Introduction: Family and community medicine (FCM) is presented as a socially important medical career; however, its growth in regions of Brazil remains relatively low. It is necessary to identify the factors that influence medical students in their choice of this professional path. Objective: To analyse factors that influence interest in FCM residency among medical interns. Methods: A cross-sectional, descriptive, quantitative analysis study was conducted with students enrolled in the penultimate and final years of medical courses in a Brazilian capital city. Results: 229 medical interns participated in the research. Those interested in FCM are mostly young, of both genders, aged between 26 and 35, married, with children, and have a family income of less than five minimum wages. Two variables were associated with choosing FCM: age and positive evaluation of the specialty. Conclusion: Understanding the factors that influence the choice of FCM can contribute to improving medical education, aligning student preferences with the needs of society and the Public Healthcare System.

System for Evaluation of Teaching Qualities (SETQ) Smart para o uso no Brasil: versão para residente / System for Evaluation of Teaching Qualities (SETQ) Smart for use in Brazil: resident's version

RESUMO Introdução: Já se reconhece que o incremento do potencial de aprendizagem dos alunos está diretamente relacionado às qualidades do preceptor. Nesse sentido, a avaliação da prática dos docentes impõe-se como um elemento essencial da garantia de qualidade na formação de novos especialistas. Todavia, no contexto da educação médica no Brasil, existem atualmente poucas pesquisas sobre avaliação de preceptores e escassez de instrumentos para essa finalidade. Um dos instrumentos atualmente disponíveis é o System for Evaluation of Teaching Qualities (SETQ). Objetivo: Este estudo teve como objetivo executar a adaptação transcultural e a validade de conteúdo do SETQ para uso no Brasil. Método: Esse instrumento é composto por duas versões, e neste estudo foi adaptada a versão dos residentes para avaliação do preceptor. A adaptação cultural seguiu cinco etapas: duas traduções iniciais do inglês para o português brasileiro; duas traduções de síntese; duas retrotraduções; uma avaliação do comitê de especialistas em termos de análise conceitual, equivalência semântica, idiomática e cultural; e um pré-teste. Além disso, um painel de juízes especialistas conduziu a validação de conteúdo. Resultado: Quarenta médicos residentes, com idade mediana de 30 anos (IQR = 6,25), participaram do pré-teste. Oitenta por cento dos participantes classificaram os componentes que compõem o SETQ Smart como claros e culturalmente apropriados, exceto pelo enunciado do questionário. O painel de juízes especialistas incluiu dez residentes, 70% do sexo feminino. As taxas de concordância variaram de 80% a 100% em relação à clareza, adequação cultural, representatividade dos itens dentro de seus respectivos domínios e permanência de cada item nas avaliações do instrumento. Conclusão: Este estudo adaptou culturalmente uma das duas versões do SETQ Smart para uso no Brasil e forneceu evidências preliminares de validade dessa versão por meio da validação de conteúdo.

ABSTRACT Introduction: It is commonly recognized that the enhancement of students' learning potential is directly related to preceptors' qualities. In this sense, the assessment of teachers' practice becomes an essential element in ensuring the quality in the training of new specialists. However, in the context of medical education in Brazil, there are currently few studies on the evaluation of preceptors and a shortage of instruments for this purpose. One of the currently available instruments is the System for Evaluation of Teaching Qualities (SETQ) Smart. Objective: To conduct a cross-cultural adaptation and content validity of SETQ for use in Brazil. Methods: This instrument comprises two versions and, in this study, the version for residents was adapted for preceptor assessment. The cultural adaptation followed five steps: two initial English to Brazilian Portuguese translations; two synthesis translations; two back-translations; an expert committee assessment of conceptual analysis, semantic, idiomatic and cultural equivalences; and a pre-test. In addition, a panel of expert judges conducted the content validation. Results: Forty resident physicians, with a median age of 30 (IQR = 6.25), participated in the pre-test. Eighty percent of the participants rated the components that make up the SETQ Smart as clear and culturally appropriate, except for the title statement. The expert panel of judges comprised ten residents, 70% female. The agreement rates ranged from 80 to 100% regarding clarity, cultural adequacy, item representativeness within their respective domains and each item permanence in the instrument assessments. Conclusion: This study culturally adapted one of the two versions of the SETQ Smart for use in Brazil and provided preliminary evidence sources of validity of the versions through content validation.

Qualidade da residência médica na perspectiva das partes interessadas: revisão de escopo e painel Delphi / Quality of medical residency from the stakeholders' perspective: a scoping review and Delphi panel

RESUMO Introdução: Embora na literatura médica existam diversas métricas para avaliar a qualidade dos programas de residência, os instrumentos avaliativos tendem a focar as dimensões dos residentes e preceptores. Isso negligencia uma ampla gama de partes interessadas (stakeholders), cujas perspectivas são fundamentais para uma compreensão holística da qualidade dos programas. Objetivo: Diante desse contexto, esta revisão teve como objetivos mapear os principais stakeholders envolvidos na residência médica, identificar e categorizar as métricas de avaliação da qualidade dos programas mais prevalentes na literatura, e analisar a sua relevância em relação às perspectivas das partes interessadas. Método: Inicialmente, foi realizada uma revisão de escopo da literatura para identificar e categorizar os stakeholders, além de mapear as métricas de qualidade. Posteriormente, um painel Delphi foi conduzido para analisar a relevância dessas métricas em relação às perspectivas das partes interessadas identificadas. Resultado: Foram mapeados 14 stakeholders e identificadas 17 métricas, posteriormente divididas em quatro categorias principais. As métricas "adaptabilidade" e "bem-estar" se destacaram, sendo unanimemente reconhecidas por todos os stakeholders como "favorável" ou "altamente favorável". Por sua vez, "autoavaliação" e "satisfação do paciente" receberam avaliações mais cautelosas ou negativas. Os painelistas enfatizaram que "nenhuma métrica é capaz de fornecer individualmente uma avaliação precisa da qualidade de um programa de residência médica". Conclusão: Ao mapear os stakeholders da residência médica, bem como identificar, categorizar e analisar as métricas de avaliação da qualidade mais prevalentes, este estudo ampliou o debate sobre a complexidade das perspectivas em torno da formação médica. A diversidade de atores envolvidos justifica valorizações distintas das várias dimensões da qualidade, reforçando a conclusão de que métricas isoladas não capturam integralmente a qualidade dos programas. Na prática, os resultados sublinham a importância da implementação de sistemas de avaliação da qualidade que sejam equilibrados e alinhados com as expectativas e necessidades dos principais stakeholders.

ABSTRACT Introduction: Medical literature abounds with metrics to assess the quality of residency programs, yet evaluative tools predominantly focus on the dimensions relevant to residents and preceptors. This overlooks a wide range of stakeholders, whose perspectives are essential for a holistic understanding of program quality. Given this context, this review aimed to map key stakeholders in medical residency, identify and categorize the most prevalent quality assessment metrics found in the literature, and analyze their relevance in relation to the stakeholders' perspectives. Method: Initially, a scoping review of the literature was conducted to identify and categorize stakeholders, as well as to map quality metrics. This was followed by a Delphi panel to assess the relevance of these metrics in relation to the perspectives of the identified stakeholders. Results: Fourteen stakeholders were mapped, and seventeen metrics were identified, subsequently divided into four main categories. The metrics "Adaptability" and "Well-being" stood out, being unanimously recognized by all stakeholders as "Favorable" or "Highly Favorable". Conversely, "Self-assessment" and "Patient Satisfaction" elicited more cautious or negative evaluations. Panelists emphasized that "no single metric can provide an accurate assessment of the quality of a medical residency program on its own". Conclusion: By mapping the stakeholders of medical residency, as well as identifying, categorizing, and analyzing the most prevalent quality assessment metrics, this study broadened the debate on the complexity of perspectives surrounding medical education. The diversity of actors observed justifies distinct evaluations across the various dimensions of quality, reinforcing the conclusion that isolated metrics cannot fully capture the program quality. In practice, the findings underscore the importance of implementing quality assessment frameworks that are balanced and aligned with the expectations and needs of the main stakeholders.

Depressão, estresse e ansiedade em médicos residentes durante o período de pandemia da Covid-19 / Depression, stress and anxiety in resident physicians during the Covid-19 pandemic

RESUMO Introdução: A pandemia do novo coronavírus trouxe um agravamento de transtornos psíquicos, especialmente em populações específicas, como profissionais de saúde. Nesse contexto, vem à tona a residência médica (RM), período de treinamento intenso e com importantes modificações na rotina durante a pandemia. Objetivo: Este estudo teve como objetivo avaliar os sintomas de depressão, estresse e ansiedade, por meio da Depression, Anxiety and Stress Scale - Short Form (DASS-21), nos médicos residentes de um hospital universitário no Nordeste do Brasil, buscando possíveis associações com parâmetros sociais, de carga horária de trabalho e de hábitos de vida. Método: Trata-se de um estudo observacional, transversal e analítico, realizado no período de outubro de 2021 a fevereiro de 2022, envolvendo médicos residentes ativos, pertencentes aos programas de RM entre março de 2021 e fevereiro de 2022. Resultado: Avaliaram-se 41 residentes, 68,3% do sexo feminino, com média de idade de 30,5 ± 3,7 anos. Algum sintoma de depressão, estresse e ansiedade estava presente em 68,3%, 41,5% e 85,4% da amostra, respectivamente. Nove usaram psicotrópicos no último ano, 13 realizaram psicoterapia e cinco passaram por acompanhamento psiquiátrico. Houve associação estatisticamente significativa entre o uso de psicotrópicos nos últimos 12 meses e maior pontuação na subescala de estresse da DASS-21 (18,00 ± 12,61 versus 9,81 ± 9,34; p = 0,038). Houve associação entre uma menor média de tempo de sono por dia e a presença de algum sintoma de depressão apontada pela DASS-21 (6,03 ± 0,79 versus 6,77 ± 1,01; p = 0,016). Conclusão: Observou-se frequência elevada de sintomas de ansiedade, estresse e depressão nos médicos residentes, havendo baixos índices de acompanhamento psiquiátrico e de intervenção psicoterapêutica ou farmacológica.

ABSTRACT Introduction: The new coronavirus pandemic has led to an exacerbation of psychological disorders, especially among specific populations such as healthcare professionals. In this context, medical residency comes to the forefront, as it represents a period of intense training that, during the pandemic, was subjected to significant modifications to the routine. Objective: To assess the symptoms of depression, stress, and anxiety among medical residents from a university hospital in northeastern Brazil using the Depression, Anxiety and Stress Scale - Short Form (DASS-21), and explore possible associations with social parameters, working hours, and lifestyle habits. Method: This was an observational, cross-sectional, and analytical study conducted from October 2021 to February 2022, involving active medical residents enrolled in medical residency programs between March 2021 and February 2022. Results: A total of 41 residents were evaluated, with 68.3% being female and a mean age of 30.5 ± 3.7 years. At least one symptom of depression, stress, and anxiety were reported in 68.3%, 41.5%, and 85.4% of the sample, respectively. Nine participants had used psychotropic medications in the year leading up to the survey, 13 had undergone psychotherapy, and five had received psychiatric care. There was a statistically significant association between the use of psychotropic medications in the preceding 12-month period and higher scores on the stress subscale of the DASS-21 (18.00 ± 12.61 vs. 9.81 ± 9.34; p = 0.038). There was also an association between a shorter average daily sleep duration and the presence of any symptom of depression as indicated by the DASS-21 (6.03 ± 0.79 vs. 6.77 ± 1.01; p = 0.016). Conclusion: A high frequency of symptoms of anxiety, stress, and depression were observed among medical residents with low rates of psychiatric monitoring and psychotherapeutic or pharmacological intervention.

Como estamos avaliando competências? Projeto de intervenção nos instrumentos avaliativos de um programa de residência medicina intensiva / How are we assessing competencies? Experience report of an intervention project in the evaluation instruments of an intensive care medicine residency program

RESUMO Introdução: O ensino baseado em competências no âmbito das residências médicas tornou evidente o descompasso dos processos de avaliação tradicionais com os objetivos educacionais dos projetos pedagógicos alinhados às matrizes de competências de cada especialidade. A matriz de competência para o Programa de Residência em Medicina Intensiva (acesso direto em três anos) foi aprovada em 2021. O objetivo deste artigo é descrever o relato de experiência de um projeto de intervenção nos instrumentos de avaliação de desempenho dos residentes no Programa em Residência em Medicina Intensiva de um hospital público universitário em São Luís, no Maranhão. Relato de experiência: Após a organização do grupo de estudo e de trabalho para a intervenção, houve a escolha do objeto "ferramentas de avaliação de competências" e a seleção do Programa de Residência de Medicina Intensiva. Inicialmente, foi aplicado um questionário a todos os médicos preceptores e residentes, com atuação no cenário da unidade de terapia intensiva (UTI), com o objetivo de aferir as percepções deles acerca do instrumento avaliativo vigente, seguindo a pergunta norteadora: "A avaliação atual atende à concepção do programa traduzido pela matriz de competência da Comissão Nacional de Residência Médica?". Discussão: Embora a maioria dos preceptores e residentes tenha considerado que os métodos de avaliação atendiam à concepção do programa, havia pontos frágeis em relação ao feedback e à avaliação de desempenho dos residentes. Como intervenção, propusemos adaptação da ferramenta existente, adequando-a aos desempenhos previstos na matriz de competências da especialidade com formalização do feedback e introdução de avaliação de desempenho em cenário real utilizando o Miniexercício Clínico Avaliativo (Mini-Cex). Conclusão: Os limites entre a avaliação e a aprendizagem são tênues. Com base em indicadores sobre a percepção de preceptores e residentes de fragilidades na avaliação utilizada de longa data, foi proposta uma intervenção de modificação dos instrumentos avaliativos com o intuito de adequar/melhorar a avaliação de competências.

ABSTRACT Introduction: Competency-based teaching in medical residencies has evidenced the mismatch between traditional assessment processes and the educational objectives of pedagogical projects aligned with the competency matrices of each specialty. The competency matrix for the Intensive Care Medicine Residency Program (3-year direct admission) was approved in 2021. The objective of this article is to describe an experience report of an intervention project in the performance assessment instruments of residents attending the Intensive Care Medicine Residency Program at a university hospital in São Luís-Maranhão. Experience Report: After organizing the study and working group for the intervention, the object "skills assessment tools" was chosen and the Intensive Care Medicine Residency Program was selected. Initially, a questionnaire was applied to all preceptors and residents working in the intensive care unit (ICU) setting with the aim of evaluating their perceptions regarding the current assessment tool, following the guiding question: does the current assessment meet the conception of the program translated by the competency matrix of the National Medical Residency Commission? Discussion: Although the majority of the preceptors and residents considered that the evaluation methods met the Program design, there were weaknesses in relation to feedback and evaluation of the residents' performance. As an intervention, we proposed adapting the existing tool, making it adequate to the performance predicted in the specialty competency matrix with formalization of feedback and introduction of performance assessment in a real scenario using the Mini Clinical Assessment Exercise (Mini-CEX). Conclusion: The boundaries between assessment and learning are blurred. Based on indicators on the perception of preceptors and residents of weaknesses in the assessment used for a long time, an intervention was proposed to modify the assessment instruments with the aim of adapting/improving the assessment of skills.

Entre "centrado na pessoa" e "freestyle": a abordagem do sofrimento mental comum em residências de medicina de família e comunidade / The "patient-centered" or "freestyle" method: the approach to common mental suffering in family and community medicine residency programs / Entre "centrado en la persona" y "freestyle": el abordaje del sufrimiento mental común en residencias de medicina de familia y comunidad

Este trabalho apresenta um estudo qualitativo sobre a abordagem do sofrimento mental comum (SMC) em programas de residência de Medicina de Família e Comunidade de Minas Gerais. Foram realizadas entrevistas semiestruturadas com 16 participantes de três programas de residência, entre março e maio de 2022. A interpretação dos dados seguiu os princípios da Análise Temática de Braun e Clarke. Para os participantes, o SMC é uma demanda frequente na Atenção Primária que deve ser abordada, principalmente com intervenções psicossociais. Contudo, os participantes reconhecem que não têm aplicado essas intervenções nos moldes recomendados pela literatura. Os entrevistados relatam conhecer diversas técnicas de intervenção, mas só sabem aplicar algumas, com destaque para os componentes do "método clínico centrado na pessoa". Esse fato contribui para despertar emoções negativas, como angústia e frustração, e aumentar o número de referenciamentos desnecessários para outros profissionais.(AU)

This work presents a qualitative study of the approach to common mental suffering (CMS) in family and community medicine residency programs in the state of Minas Gerais, Brazil. Semi-structured interviews were conducted with 16 participants from three residency programs between March and May 2022. The data were interpreted drawing on the principles of Braun and Clarke's thematic analysis method. According to the participants, CMS is a frequent demand in primary care and should be approached using mainly psychosocial interventions. However, the participants recognize that they have not applied these interventions in the manner recommended by the literature. The interviewees reported that despite being aware of a diverse range of intervention techniques, they only know how to apply some, with emphasis on the components of the "patient-centered clinical method". This fact has contributed to the awakening of negative emotions, such as anguish and frustration, and increased the number of unnecessary referrals to other professionals.(AU)

Este trabajo presenta un estudio cualitativo sobre el abordaje del sufrimiento mental común (SMC) en programas de residencia de Medicina de Familia y Comunidad del estado de Minas Gerais. Se realizaron entrevistas semiestructuradas con 16 participantes de tres programas de residencia, entre marzo y mayo de 2022. La interpretación de los datos siguió los principios del Análisis Temático de Braun y Clarke. Para los participantes, el SMC es una demanda frecuente en la atención primaria que hay que abordar, principalmente, con intervenciones psicosociales. No obstante, los participantes reconocen que no han aplicado esas intervenciones en los estándares recomendados por la literatura. Los entrevistados relatan que conocen diversas técnicas de intervención, pero que solo saben aplicar algunas, con destaque para los componentes del método clínico centrado en la persona?. Este hecho contribuye para despertar emociones negativas, tales como angustia y frustración, y para aumentar el número de derivaciones innecesarias para otros profesionales.(AU)

Prevalence and factors associated with anxiety, depression and burnout in gynecology and obstetrics residents during the COVID-19 pandemic

Abstract Objective: To determine the prevalence of anxiety, depression and burnout in residents of Gynecology and Obstetrics during COVID-19 pandemic in Brazil and its associated factors. Methods: Cross-sectional study involving all regions of Brazil, through the application of a sociodemographic questionnaire, the Hospital Anxiety and Depression Scale (HAD) and the Maslach Burnout Inventory (MBI-HSS) instrument. Multivariate analysis was performed after adjusting the Poisson model. Results: Among the 719 participating medical residents, screening was positive for anxiety in 75.7% and for depression in 49.8% of cases. Burnout syndrome was evidenced in 41.3% of the physicians studied. Those with depression are more likely to have anxiety (OR 0.797; 95%CI 0.687 - 0.925) and burnout syndrome (OR 0.847 95%CI 0.74 - 0.97). Residents with anxiety (OR 0.805; 95%CI 0.699 - 0.928) and burnout (OR 0.841; 95%CI 0.734 - 0.963) are more likely to have depression. Conclusion: High prevalence of anxiety, depression and burnout were found in residents of Gynecology and Obstetrics in Brazil, in addition to important correlations between anxiety-depression and depression-burnout.

Core Competencies Self-Assessment and Patient-Practitioner Orientation during the First Year of a Brazilian Orthopedic Residency.

Objective Training a competent physician requires to direct the resident profile of graduate students for practice activities. We sought to identify the doctor-patient relationship orientation and the self-assessment of the core competencies, which they pointed out needed to be developed. Methods All 56 orthopedic residents admitted between 2016 and 2019 participated in the present prospective observational study. The Patient Practitioner Orientation Scale (PPOS) and a self-assessment questionnaire were answered at the beginning and end of the first year of residency (R1) in Orthopedics and Traumatology. We calculated mean and standard deviation for PPOS items and scores and analyzed them through the paired t-test. Self-Assessment Questionnaire answer options were "yes" or "I need to improve it" and skills were classified in decreasing order of the frequency of "I need to improve it" responses with description of absolute number and percentage. We compared frequencies using Fisher Test. P-values < 0.05 were considered statistically significant. GraphPad Prism 8.4.3 (GraphPad Software, San Diego, CA, USA) and Microsoft Excel (Microsoft Corporation, Redmond, WA, USA) were used for statistical analysis. Results In the period between the beginning and the end of R1, the total PPOS mean score significantly decreased from 4.63 to 4.50 ( p = 0.024), more biomedical-focused. Around one-third of the residents identified competencies of patient care, practice-based learning and improvement, and interpersonal and communication skills as needed to improve. Conclusions The PPOS and self-assessment activities could promote reflection practices and are possible tools for learner-centered competency assessment. Biomedical guidance tends to prevail as the training of physicians progresses, and periodic self-assessments can be worked on to build a growth mindset.

Desarrollo e implementación de un programa de investigación durante la residencia de ortopedia y traumatología / Development and implementation of a research program during the orthopedics residency

Introducción: Dentro de las recomendaciones internacionales para la formación de médicos expertos, se encuentra el integrar la mejor evidencia disponible a la práctica clínica y contribuir a la creación del conocimiento científico. El objetivo de este trabajo es describir la implementación de un programa formal de investigación en residentes de ortopedia y traumatología. Metodología: Se desarrolló un programa de investigación para residentes de ortopedia y traumatología, coordinado por un equipo con formación en metodología y bioestadística. El objetivo principal fue que los residentes lograran adquirir herramientas en el desarrollo del método científico e integrar la medicina basada en la evidencia en la práctica profesional. Para ello, se enfocó en tres ejes: 1. formación general 2. análisis crítico de la literatura y 3. desarrollo de investigación científica. Resultados: El año 2015 se implementó el programa. Comenzó con el módulo de formación general a través de seminarios de investigación y una rotación mensual obligatoria. De forma semanal se implementaron reuniones de revisiones críticas de la literatura a partir de casos clínicos y cada dos o tres meses sesiones de journal club. Se han formulado 30 proyectos de investigación, 22 de ellos se han presentado en congresos y ha habido un total de 27 publicaciones con coautoría de residentes (6 de primer autor). Conclusión: A través del programa de investigación, los residentes han adquirido herramientas para poder integrar la medicina basada en la evidencia a su práctica profesional y desarrollar proyectos científicos.

Introduction: In the international recommendations for resident education, there is integrating the best available evidence into clinical practice and contributing to the creation of scientific knowledge. This research aims to describe implementing a formal research program for orthopedic residents. Methodology: We developed a research program for orthopedic residents coordinated by a team trained in methodology and biostatistics. The main objective for residents was to acquire tools to develop the scientific method and to integrate evidence-based medicine into professional practice. To do this, it focused on: 1. theoretical courses, 2. critical analysis of literature, and 3. creation of scientific research. Results: 2015, the program started with a theoretical course through research seminars and a mandatory monthly rotation. Critical analysis of articles meetings were weekly, and journal club sessions every 2 or 3 months. Residents formulated 30 research projects and presented 22 at national and international congresses. There were 27 scientific publications with resident participation (6 were lead authors). Conclusion: Through the research program, residents have acquired tools to integrate evidence-based medicine into their professional practice and develop scientific projects.