Tendencias históricas en la formación de los cirujanos generales a nivel mundial / Historical trends about the training of general surgery specialists worldwide

Introducción: Los avances tecnológicos y educativos en ciencias médicas durante los últimos cincuenta años han sido mayores que en toda la historia de la humanidad. Objetivo: Caracterizar la formación del especialista de cirugía general en el mundo en su devenir histórico y actual. Métodos: Se hizo una revisión bibliográfica en las bases de datos CUMED, SciELO, LILACS, Web of Science y PubMed, mediante el motor de búsqueda de información Google Académico. Fueron seleccionados 23 artículos: 19 (82,6 por ciento) del quinquenio 2016-2020, publicados en español e inglés, concernientes al objetivo propuesto, para lo cual se aplicó el método teórico de investigación científica histórico-lógico. Desarrollo: A partir del siglo xix, la evolución de la cirugía en el mundo discurre desde sus limitaciones ocasionadas por el dolor, las infecciones, las hemorragias y el shock hasta el vertiginoso desarrollo de la anestesiología y la reanimación, la asepsia y antisepsia, los novedosos métodos de diagnóstico y tratamiento, la cirugía de trasplante de órganos y tejidos, la cirugía de mínimo acceso, la simulación y la robótica durante el siglo xx y en el presente. Conclusiones: Los avances educativos en la formación profesional durante el período de especialización en cirugía general no marchan al ritmo del desarrollo tecnológico a escala mundial. De ahí surge la necesidad de potenciar al máximo el proceso de enseñanza y aprendizaje de posgrado mediante el desarrollo de estos avances educativos, de manera que no queden a la zaga de los progresos tecnológicos(AU)

Introduction: Technological and educational advances in medical sciences during the last fifty years have been greater than in the entire history of humanity. Objective: To characterize the training of general surgery specialists worldwide considering its historical and current evolution. Methods: A bibliographic review was carried out in the databases CUMED, SciELO, LILACS, Web of Science and PubMed, using the search engine Google Scholar. Twenty-three articles were selected: 19 (82.6 percent) from the five-year period 2016-2020, published in Spanish and English, concerning the set objective, for which the theoretical method of historical-logical scientific research was applied. Development: From the 19th century on, the evolution of surgery worldwide goes from its limitations caused by pain, infections, bleeding and shock to the dizzying development, during the twentieth century and nowadays, of anesthesiology and resuscitation, asepsis and antisepsis, novel methods for diagnosis and treatment, organ and tissue transplant surgery, minimal access surgery, simulation and robotics. Conclusions: Educational advances in professional training during the period of specialization in general surgery do not go in step with technological development on a global scale, hence the need to maximize the postgraduate teaching and learning process through the development of these educational advances, in order for them not to be left behind technological progress(AU)

Boundary work: the Mensendieck system and physiotherapy education in Norway.

The history of physiotherapy can be seen as a history of boundary conflict, as the profession sought to first establish, then maintain, its distinctive professional identity. Traditional approaches to the sociology of the professions support this, seeing professionalization as an ongoing process of enclosure, encroachment, and conflict. Recent work, however, has emphasized the fluidity and collaborative nature of professionalization projects, and placed more emphasis on inter-professional negotiations and disciplinary coexistence. In this paper, we draw on this work to analyze the harmonization of the independent Mensendieck System of medical gymnastics in Norway, and the emerging state-sponsored physiotherapy system. Our contention is that over the course of the middle decades of the 20th century, advocates of the Mensendieck System and providers of orthodox, biomedically informed physiotherapy, came together and found a way to work collaboratively in a shared space without compromising their distinctive professional identities. We argue that this approach both points to ways we might revisit traditional conflict-based analyses of the history of physiotherapy, while also suggesting new ways of imagining how the profession might change in the years to come.

From Alma-Ata to Astana: the path of Primary Health Care in Portugal, 1978-2018 and the genesis of Family Medicine. / De Alma-Ata a Astana: o percurso dos Cuidados de Saúde Primários em Portugal,1978-2018 e a génese da Medicina Familiar.

Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.

Ao longo século XX, as profundas alterações que ocorreram na Medicina apenas podem ser completamente esclarecidas se forem observadas numa perspectiva histórica, pois elas sempre ocorreram em resposta a influências externas, umas científicas e tecnológicas, outras de ordem social. A moderna Medicina Familiar é uma das muitas disciplinas novas que se desenvolveram durante o curso da história da Medicina e aqui debatemos de forma crítica, os últimos 40 anos dos cuidados primários em saúde em Portugal, começando em 1971, mesmo antes da Declaração de Alma-Ata (1978). Ao longo do percurso, em 2005, surge a Reforma dos Cuidados Primários em Saúde em Portugal e as novas unidades de saúde familiar, que até setembro de 2019 atendiam cerca de 94% dos cidadãos portugueses, ou seja, mais de nove milhões e meio de pessoas. No final dessa trajetória, de forma solidária e voluntária, esta Reforma serviu de inspiração para outra, no Brasil, na cidade do Rio de Janeiro, em 2009. Por fim, apresentamos os desafios apontados na Declaração de Astana de 2018, dentre elas, a questão da força de trabalho nos cuidados de saúde primários, como fator essencial para o desempenho e a sustentabilidade dos sistemas de saúde.

De Alma-Ata a Astana: o percurso dos Cuidados de Saúde Primários em Portugal, 1978-2018 e a génese da Medicina Familiar / From Alma-Ata to Astana: the path of Primary Health Care in Portugal, 1978-2018 and the genesis of Family Medicine

Resumo Ao longo século XX, as profundas alterações que ocorreram na Medicina apenas podem ser completamente esclarecidas se forem observadas numa perspectiva histórica, pois elas sempre ocorreram em resposta a influências externas, umas científicas e tecnológicas, outras de ordem social. A moderna Medicina Familiar é uma das muitas disciplinas novas que se desenvolveram durante o curso da história da Medicina e aqui debatemos de forma crítica, os últimos 40 anos dos cuidados primários em saúde em Portugal, começando em 1971, mesmo antes da Declaração de Alma-Ata (1978). Ao longo do percurso, em 2005, surge a Reforma dos Cuidados Primários em Saúde em Portugal e as novas unidades de saúde familiar, que até setembro de 2019 atendiam cerca de 94% dos cidadãos portugueses, ou seja, mais de nove milhões e meio de pessoas. No final dessa trajetória, de forma solidária e voluntária, esta Reforma serviu de inspiração para outra, no Brasil, na cidade do Rio de Janeiro, em 2009. Por fim, apresentamos os desafios apontados na Declaração de Astana de 2018, dentre elas, a questão da força de trabalho nos cuidados de saúde primários, como fator essencial para o desempenho e a sustentabilidade dos sistemas de saúde.

Abstract Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.

Medicine in Milan between the Nineteenth and Twentieth centuries.

The author deals with the medical-surgical panorama in Milan at the turn of the 19th century and at the beginning of the 20th century. The advances in knowledge acquired from the mid-nineteenth century on led to the emergence of medical and surgical specializations, as well as of new tools for the prevention and treatment of diseases, and the creation of a health and care network, on which it was possible to graft highly developed training opportunities. The example of an institution set up in Milan at the beginning of the twentieth century to treat the results of traumatic events is emblematic, not only because it is related to occupational accidents, but also because it explains the need to have specialists from various medical and surgical disciplines at the service of the entire population.

Construcción de la infancia y de un saber médico especializado: los comienzos de la pediatría en Buenos Aires, 1890-1920 / The construction of childhood and its specialized medical care: the beginnings of pediatrics in Buenos Aires, 1890-1920

Resumen Se analiza la constitución de la pediatría como un saber médico especializado en Buenos Aires, entre 1890 y 1920. Se busca mostrar que este proceso resulta de un doble movimiento: la delimitación y caracterización del niño como un particular objeto de conocimiento e intervención y la institucionalización de ciertos médicos como un grupo profesional que procura legitimar su especificidad tanto hacia el interior de la medicina como en el campo social más amplio. Luego de contextualizar socio históricamente las preocupaciones del saber médico acerca de la infancia, se profundiza en el modo en que ésta es construida, así como en el movimiento asociativo y académico que permite a los pediatras constituirse como un grupo de especialistas portadores de un saber experto.

Abstract It analyzes the set-up of pediatrics as a specialized medical field in Buenos Aires, between 1890-1920. The article seeks to demonstrate this process as a result of two movements: the delimitation and characterization of children as a particular object of knowledge and intervention, and the institutionalization of some physicians as a professional group that sought to legitimate their specificity within the medicine field and beyond. After contextualizing socially and historically the concerns of medical knowledge on childhood, it explores with detail how the field was constructed, and the associative and academic movement that allowed pediatricians to constitute themselves as a group of specialists that bear a specific expertise.

[50 years specialty for child and adolescent psychiatry in Germany. History, current situation, and future perspectives]. / 50 Jahre Facharzt für Kinder- und Jugendpsychiatrie in DeutschlandGeschichte, Gegenwart und Zukunftsperspektiven 1.

50 years specialty for child and adolescent psychiatry in Germany. History, current situation, and future perspectives Abstract. Abstracts: Method: Review of the historical background and implementation of an independent medical specialty "child and adolescent psychiatry" (CAP) in Germany. Results: The implementation of an independent specialty for CAP in 1968 was crucial for the progressive further development of the discipline. The Enquête Commission "Psychiatry" of the Federal Government, followed by the Model Program "Psychiatry", the Staff Regulations for Psychiatry, the Agreement on the Social Psychiatry and the Psychotherapy Act have had significant impact on the care for psychiatrically ill children and adolescents and their families. This led to an institutional anchoring of new structures, covering three of the four leading principles of the Model Program, namely integration into medicine, community-based and appropriate care. Equality of psychiatric patients with other patient groups has, nevertheless, not yet been achieved and is still to be claimed. Current and future challenges are: (1) The realistic evaluation of new research methods and epochal trends and elimination of opposites, (2) the establishment of future-oriented research initiatives, (3) the intensive promotion of clinical and scientific staff members, and (4) a renewed attention for the subjective perspective of the illness. Conclusions: The implementation of an independent specialty "child and adolescent psychiatry" was an important stimulus for the further development of the discipline. Essential demands for the future will be: the integration of CAP into the curriculum for medical students and the promotion of young researchers within the scope of regional and supra-regional projects.

[The construction of childhood and its specialized medical care: the beginnings of pediatrics in Buenos Aires, 1890-1920]. / Construcción de la infancia y de un saber médico especializado: los comienzos de la pediatría en Buenos Aires, 1890-1920.

It analyzes the set-up of pediatrics as a specialized medical field in Buenos Aires, between 1890-1920. The article seeks to demonstrate this process as a result of two movements: the delimitation and characterization of children as a particular object of knowledge and intervention, and the institutionalization of some physicians as a professional group that sought to legitimate their specificity within the medicine field and beyond. After contextualizing socially and historically the concerns of medical knowledge on childhood, it explores with detail how the field was constructed, and the associative and academic movement that allowed pediatricians to constitute themselves as a group of specialists that bear a specific expertise.

Se analiza la constitución de la pediatría como un saber médico especializado en Buenos Aires, entre 1890 y 1920. Se busca mostrar que este proceso resulta de un doble movimiento: la delimitación y caracterización del niño como un particular objeto de conocimiento e intervención y la institucionalización de ciertos médicos como un grupo profesional que procura legitimar su especificidad tanto hacia el interior de la medicina como en el campo social más amplio. Luego de contextualizar socio históricamente las preocupaciones del saber médico acerca de la infancia, se profundiza en el modo en que ésta es construida, así como en el movimiento asociativo y académico que permite a los pediatras constituirse como un grupo de especialistas portadores de un saber experto.

[Why a degree of speciality instead of a Master's?] / ¿Por qué especialidad y no maestría?

It was at the beginning of the last century, in the hospitals where most of the attention was given, when it was established the habit of admitting apprentices as members of the medical team. However, it was not clearly established how aspirants were admitted, how their learning was to be developed, or what their functions were.

Fue a principios del siglo pasado, en los hospitales donde se brindaba la mayor parte de la atención, cuando se fue estableciendo la costumbre de admitir aprendices como miembros del equipo médico. Sin embargo, no estaba claramente establecido cómo se admitía a los aspirantes, de qué manera se iba a desarrollar su aprendizaje, o en qué consistían sus funciones.