Contribution of ethical reasoning learning sessions on medical training.

INTRODUCTION: Ethical reasoning is an important skill for all physicians who often face complex ethical dilemmas in their daily practice. Therefore, medical training should include methods for learning ethical theories and concepts, as well as how to apply them in practical situations. AIM: Assess the contribution of an Ethical Reasoning Learning session to fifth medical students' training through a comparison of results of the same objective and structured clinical examination (OSCE) in the form of simulated interview before and after sessions. METHODS: Four 45- minutes' sessions of Ethical Reasoning Learning (ERL) were implemented during a psychiatry internship for four groups of 5th-year students of the faculty of medicine of Monastir (Tunisia). Each session was divided into 7 parts: introduction, reading of a clinical vignette, brainstorming concerning the problems posed by this clinical situation, classification of the problems, identification of the principles of medical ethics, construction of the ethical matrix, and a conclusion. RESULTS: Fifty-seven students participated in the study divided into 4 groups. We found a significant difference in the means of the OSCE scores before and after the ERL session and a significant difference between the probability of respecting medical secrecy during pre and post-ethical reasoning learning sessions (p <0.001). We have found an effect of ERL sessions on the acquisition of this ethical competence by medical students. CONCLUSION: We learned that an ERL session has improved medical training in ethics applied to psychiatry. Other sessions dealing with other ethical skills are necessary to confirm these results.

Should Obtaining Informed Consent Be Considered an Entrustable Professional Activity? Insights From Whether and How Attendings Entrust Surgical Trainees.

PURPOSE: Because residents are frequently delegated the task of obtaining consent early in their training, the American Association of Medical Colleges describes "obtaining informed consent" as a core entrustable professional activity (EPA) for medical school graduates. However, prior studies demonstrated that residents frequently perform this task without receiving formal instruction or assessment of competency. This study sought to understand how attending physicians decide to delegate obtaining informed consent for surgical procedures to trainees. METHOD: The authors conducted a survey of attending surgeons at a university-based health care system of 6 affiliated teaching hospitals (October-December 2020) to collect data about current entrustment practices and attendings' knowledge, experience, and attitudes surrounding the informed consent process. Summary statistics and bivariate analyses were applied. RESULTS: Eighty-five attending surgeons participated (response rate, 49.4%) from diverse specialties, practice types, and years in practice. Fifty-eight of 85 (68.2%) stated they "never" granted responsibility for the consent conversation to a trainee, and 74/81 (91.4%) reported they typically repeated their own consent conversation whenever a trainee already obtained consent. The most common reasons they retained responsibility for consent were ethical duty (69/82, 84.1%) and the patient relationship (65/82, 79.3%), while less than half (40/82, 48.8%) described concerns about trainee competency. Reflecting on hypothetical clinical scenarios, increased resident competency did not correspond with increased entrustment ( P = .27-.62). Nearly all respondents (83/85, 97.7%) believed residents should receive formal training; however, only 41/85 (48.2%) felt additional training and assessment of residents might change their current entrustment practices. CONCLUSIONS: Attendings view informed consent as an ethical and professional obligation that typically cannot be entrusted to trainees. This practice is discordant with previous literature studying residents' perspectives. Furthermore, resident competency does not play a predominant role in this decision, calling into question whether informed consent can be considered an EPA.

Assessing Moral Skills in General and Post-Graduate Dental Students in the Southeast of Iran: A Cross-Sectional Study

Abstract Objective: To assess the level of moral skills in dental students and residents. Material and Methods: This cross-sectional and descriptive-analytical study was conducted on dental students and residents of Kerman University of Medical Sciences, selected by census sampling. Data collection tools included a demographic information checklist (age, gender, marital status, educational level (before basic sciences, after basic sciences, residency), and moral skills inventory questionnaire. The data were analyzed using a T-test and multiple regression analysis at a confidence level of 95%. Results: The total score of the moral skills questionnaire was about 44 out of 80, and there was no difference between males and females in moral skills (p=0.79). However, there was a significant difference in moral sensitivity between married and single students (p=0.036). Residents gained significantly higher moral integrity scores than students (p=0.046). Conclusion: The study highlights that the level of professional moral skills in Kerman dental students and residents was acceptable. Single students got higher scores in the moral sensitivity domain, although residents got the highest scores in the moral integrity domain. There was no significant correlation between gender and the level of moral skills (AU).

Conocimiento y comprensión del consentimiento informado durante la formación médico legal y bioética de los residentes de Cirugía General / Knowledge and understanding of informed consent during the legal and bioethical medical training of residents of general surgery

Introducción: el consentimiento informado es una herramienta de información que debe ser clara, precisa y adecuada para una correcta relación médico paciente y debe ser inculcada durante la formación de los médicos residentes de cirugía general. El desconocimiento de los contenidos del consentimiento informado por parte de los médicos residentes, impide la correcta comunicación, por lo que se convierte en un documento incompleto y poco comprendido, disminuyendo la calidad asistencial y la confianza del paciente en el médico tratante, desmejorando así la calidad prestacional en los procedimientos quirúrgicos (11). El consentimiento informado es más que un acto puntual de información, es un proceso gradual que no termina con la firma del mismo, sino involucrando médico, paciente e institución. Dado los antecedentes mencionados, resulta importante inculcar a jóvenes profesionales los aspectos éticos de su formación e implicancias médico legales en su proceder. Objetivos: Analizar el conocimiento y capacidad de comprensión de los contenidos del consentimiento informado por parte de los médicos residentes de Cirugía General del Hospital Aeronáutico Central. Material y Método: Estudio prospectivo, descriptivo, observacional. Se consideró un primer periodo comprendido entre los meses de Diciembre 2015/febero2016, de capacitación en aplicación del consentimiento informado y comprensión de los contenidos del mismo a residentes de cirugía general con evolución de conocimientos, al inicio y finalización del mismo, y un segundo periodo, marzo 2016-mayo 2016, se realizó análisis del instrumento para la evaluación mediante observación directa y supervisión de residentes de cirugía general, evaluando el conocimiento durante la aplicación del mismo, donde se consideró el tipo de cirugía, procedimiento alternativo, consecuencia de no realizar el procedimiento, eventos adversos y complicaciones. Se consideró además la terminología y lenguaje utilizado para la transmisión de la información. Resultados: Del análisis obtenido de las evaluaciones realizadas durante el primer período, se obtuvieron los siguientes resultados: al inicio del periodo: n=10 médicos residentes de los cuales: conoce el consentimiento informado: 10 (100%).Conoce la ley que lo ampara: 3 (30%).Conoce la composición de la ley: 2 (20%). Función del consentimiento: 4 (40%). En el segundo periodo se realizó evaluación mediante observación directa y supervisión con su posterior análisis (tabla1) de los cuales se obtuvo: n= 120 procedimientos quirúrgicos en los cuales se cumplimiento con el consentimiento informado en la totalidad de los mismos (100%).Se realizó observación directa n= 104, de los cuales: en el 104 (100%) respuesta afirmativa respecto al conocimiento de la cirugía a realizar. La explicación del tratamiento propuesto 92 (88.4%) pudieron ser explicados. Consecuencias de no realizar el procedimiento: 102 (98%) arrojo respuesta afirmativa. Eventos adversos: 73 (70,1%) estaban completos y explicados de manera precisa. Utiliza terminología médica 101(97.1%) de los consentimientos. La explicación verbal con lectura se realizó en el 100% de los procedimientos quirúrgicos. Utiliza terminología adecuada al paciente 73 (70.1%). El 100% de los pacientes comprendió correctamente lo informado por el profesional. Conclusiones: El conocimiento del contenido del consentimiento informado, saber transmitirlo y la práctica constante, con lectura crítica del mismo, es fundamental para la formación del médico residente en el desarrollo de su relación quirúrgica con el paciente. Es de práctica habitual entre médicos cirujanos dar por sobre entendido que los médicos en formación puedan aplicar de manera correcta este documento. En muchas oportunidades suele ser incumplido sin la asistencia y supervisión constante de los mismos, perjudicando de esta manera la relación médico paciente. La educación médica respecto del consentimiento informado a través de talleres y clases resulta muy importante considerándose trascendental para la formación integral del residente. Enfatizar en promover la investigación de campo para evaluar en las prácticas quirúrgicas el cumplimiento del consentimiento informado.

Introduction: the informed consent is an information tool that should be clear, accurate and adequate for a correct patient medical relationship and shoul be inculcated during the training of resident physicians of general surgery. Ignorance of the contents of informed consent by the residents, prohibit the correct communication, so it becomes an incomplete and poorly understood document, reducingthe quality of care and patient trust in the treating physician, thus degrading the quality of surgical procedures(11). Informed consent is more than a punctual act of information, it is a gradual process that doesn ́t end with the signature of the same, but involving physician, patient and institution. Given the aforementioned antecedents, it is important to inculcate in young professionals the ethical aspects of their training and legal medical implications in their proceeding. Objectives: to analyze the knowledge and comprehension of the contents in the informed consent by the resident of General Surgery, of the Central Aeronautical Hospital. Material and method: prospective, descriptive, observational study. A first period from December 2015/February 2016, was considered to provide training in the application of informed consent and understanding of the contents of the same to residents of general surgery with the evolution of knowledge, at the beginning and end of the same, and a second period, March 2016- May 2016, analysis of the instrument for the evaluation by direct observation and supervision of residents of general surgery was carried out, evaluating the knowledge during the application of the instrument, where the type of surgery, alternative procedure, the procedure, adverse events and complications. The terminology and language used for the transmission of information were also considered Results: from the analysis obtained from the evaluations performed during the first period, the following results were obtained at the beginning of the period: n=10 resident physicians of whom, knows informed consent 10 (100%). It covers: 3 (30%). Knows The composition of the law: 2 (20%). In the second period, direct observation and supervision were carried out with the following analysis (table 1), of which: n=120 surgical procedures in which carrying out with the informed consent was obtained in all of them (100%). Direct observation n= 104, of which: in the 104 (100%) affirmative answer regarding the knowledge of the surgery to be performed. The explanation of the proposed treatment 92 (88.4%) could be explained. Consequences of not performing the procedure: 102 (98%) bold affirmative response. Adverse events 73 (70.1%) were complete and accurately explained. Uses medical terminology 101 (97.1%) of consents. The verbal explanation with reading was performed in 100% of the surgical procedures. Uses appropriate terminology to the patient 73 (70.1%). 100% of the patients correctly understood the information provided by the proffesional. Conclusions: Knowledge of the content of informed consent, knowing how to transmit it, and constant practice, with a critic al reading of it, is essential for the training of the resident physician in the development of his surgical relationship with the patient. It is common practice among surgeons to take it for granted that physicians in training can apply this document correctly. In many cases, it is then not followed up without the assistance and constant supervision of the patients, thus prejudicing the patient physician relationship. The medical education regarding the informed consent through workshops and classesis very important, considering it transcendental for the integral formation of the resident. Emphasize in promoting field research to evaluate fulfillment of the informed consent in surgical practices.

A residência médica: articulações entre a prática e o ensino / Medical residence: articulations between practice and teaching

O objetivo desta tese de doutorado é o estudo da residência médica e de suas articulações com o campo educacional e o da saúde. Propõe-se uma análise histórico - dialética, tomando como ponto de partida a articulação da medicina e da educação na estrutura social. Parte-se da concepção segundo a qual a prática e o saber no campo educacional e na saúde estão ligados à transformação histórica do processo de produção econômica. Essa compreensão remete à chamada determinação em última instância: a estrutura econômica determina o lugar e a forma de articulação da medicina e da educação na estrutura social. Para compreender as peculiaridades do ensino e da residência médica no Brasil faz-se uma caracterização da assistência médica, sobretudo do papel assumido pelo Estado na configuração do campo: primeiro, a adoção de um sistema em que compete ao Estado a responsabilidade pela universalização da atenção básica, através de serviços próprios ou em parceria com organizações não governamentais; segundo, a atenção especializada, com maior incorporação tecnológica, seria prestada pelo setor privado, mediante incentivos concedidos pelo Estado. Dessa divisão, resulta, no desenho atual, ao invés de um único sistema, a conformação de dois ou mais sistemas de saúde, em que a segmentação da assistência implica em práticas diferenciadas. O efeito desta divisão no mercado de trabalho repercute na escola e na residência médicas. A residência, em particular, por suas características de treinamento em serviço, responde diretamente aos condicionantes do mundo do trabalho, reproduzindo o modelo de prática hegemônica.

Exceso de horas de trabajo en la residencia de cirugía general: resultados de una encuesta nacional / Excessive hours of work in general surgery residency: results from a national survey

Introducción: Crece el interés en el mundo sobre las causas y consecuencias del ôerror médicoõ. En EEUU se han sancionado leyes que limitan la cantidad de horas laborales de los residentes. El objetivo de este trabajo es averiguar el número de horas por semana que permanece un residente de cirugía dentro del hospital.Material y método: se realizó una encuesta desde julio de 2004 a mayo de 2005, a médicos residentes de cirugía general de todo el país. Se completaron 320 cuestionarios, de 19 programas de residencia distribuidos en 10 provincias.Resultados: Un grupo de residentes de años inferiores superan las 80 horas semanales, un segundo grupo de residentes de años superiores tiene una carga horaria notoriamente menor.Conclusiones: Existe un exceso en el número total de horas de trabajo de los residentes de cirugía. Esta carga horaria esta irregularmente distribuida, sobrecargando al grupo de residentes de años inferiores.