[Determinants of the choice of the first level of care in medicine as a field of training and work: A qualitative study]. / Determinantes de la elección del primer nivel de atención en medicina como ámbito de formación y laboral: un estudio cualitativo.

OBJECTIVE: To explore the determinants of eligibility and the choice of the first level of care as a workplace and training environment for health professionals. DESIGN: Qualitative study. SETTING: Four universities in the Metropolitan Area of Buenos Aires, Argentina. PARTICIPANTS: Recently graduated doctors and medical students. METHOD: Based on the grounded constructivist theory, semi-structured interviews and focus groups were conducted for data collection and subsequent analysis. RESULTS: 31 interviews and three focus groups were conducted during 2019-2020. Emerging concepts were organized in main axes for analysis. Positive and negative experiences were identified in relation to primary health care (PHC) in curricular spaces and practical rotations, and a significant lack of knowledge of its scope. For the choice of medical specialties, personal interests, future projections, social prestige, economic income and knowledge of a specific area of medicine are important. There is a devaluation in terms of the role and resolution capacity of PHC, and it is also associated with the assistance of populations with low socioeconomic resources. CONCLUSIONS: Little knowledge of PHC, its lack of prestige, and insufficient remuneration for first-level care professionals were identified as the main barriers to choosing PHC as a place of work and training. In contrast, social commitment, the possibility of having a better lifestyle, and the type of doctor-patient relationship appear as the main facilitators.

[Analysis of the Argentine residency system from the paradigm of Complexity Sciences] / Análisis del sistema de residencias argentino desde el paradigma de las Ciencias de la Complejidad.

Aim: The objective is to carry out an analysis of the system of residences in Health in Argentina from the Theory of Complexity, in order to improve the understanding of the reality of this system, allowing an analysis to be carried out from another perspective different from the traditional. Source and synthesis of data: In this review, the properties and characteristics of the residence system are analyzed according to the new paradigm of the Science of Complexity. For those who make decisions about the residential training of young professionals, full knowledge of the system in a holistic way and reflection on the characteristics of an open system applied to the residential system is of great importance and, it gives (or can give off) great benefits and possible improvements for those who live the day to day of these training programs. Conclusions: It is important to mention the ultimate benefit that knowledge of the study system analyzed here has or can have: the possibility of multidisciplinarity, as one more step in the evolution of this type of system.

Objetivos: El objetivo es realizar un análisis sobre el sistema de residencias en Salud de la Nación Argentina desde la Teoría de la Complejidad, a fin de lograr mejorar la comprensión de la realidad de este sistema, permitiendo realizar un análisis desde otra perspectiva distinta a la tradicional. Fuente y síntesis de datos: En esta revisión se analizan las propiedades y las características del sistema de residencias según el nuevo paradigma de la Ciencia de la Complejidad. Para quienes toman decisiones de la formación residencial de profesionales jóvenes, el conocimiento pleno del sistema de manera holística y la reflexión de las características de un sistema abierto aplicado al sistema residencial tiene gran importancia y, desprende (o puede desprender) grandes beneficios y posibles mejoras para quienes viven el día a día de estos programas de formación. Conclusiones: Es importante mencionar el beneficio último que tiene o puede tener el conocimiento del sistema de estudio aquí analizado: la posibilidad de la multidisciplinariedad, como un paso más en la evolución de este tipo de sistemas.

Reliability and acceptability of the multiple mini-interview for selection of residents in cardiology.

INTRODUCTION: The multiple mini-interview (MMI) model can be useful to evaluate non-cognitive domains and guide the selection process in medical residency programs. The aim of this study was to evaluate the reliability and acceptability of the MMI model for the selection of residents in a cardiology residency program. METHODS: We conducted an observational and prospective study. It was performed in a tertiary-care center specialized in cardiology and included candidates for the cardiology residency program in March 2018. Ten stations were developed to evaluate different non-cognitive domains. Reliability was evaluated by the generalizability G coefficient. Candidates and interviewers were surveyed to evaluate the acceptability of the MMI model. RESULTS: Nine faculty members were trained and 22 candidates were evaluated. The G study showed a relative G coefficient between 0.56 and 0.73, according to the design. 91% of the candidates stated that they preferred MMI over other types of interviews as a selection method for admission to the residency program, and all the interviewers considered they had enough time to evaluate the candidates and their strengths as future residents. CONCLUSION: The MMI is a reliable model to evaluate candidates for a residency program in cardiology with high acceptability among residents and observers.