A Historical Cross-Professional Perspective on the Fellowship in Occupational Therapy.

Health professions education is increasingly creating learning experiences after one's entry-level practice degree. Such experiences include residency and fellowship experiences for health professions practitioners. This review of residency and fellowship programs across several health professions includes the development of residency programs and the implications these developments have on occupational therapy. The analysis across health professions includes medicine, pharmacy, physical therapy, speech-language pathology, and occupational therapy. This thorough analysis can help guide the development of occupational therapy fellowships. This background provides a foundation to focus on the implications for emerging fellowships within occupational therapy. The findings can be utilized to assist in the development of new successful fellowship programs.

Family and Community Medicine in Uruguay from 1997 to 2019: how many kilometers will it take to reach that town? / La Medicina Familiar y Comunitaria en Uruguay de 1997 a 2019: ¿cuántos kilómetros faltarán para llegar al pueblo aquel?

The Family and Community Medicine Residency started in Uruguay in 1997. Through a self-managed process, the first generations were molded into training that integrated hospital knowledge and experience with territorial praxis in a community-based health service with a population of reference. The academic recognition of the specialty and the installation of the institutional areas for its management were achievements parallel to that process in the first decade. The second decade was marked by the territorial teaching-assistance expansion in the country, university decentralization and the active participation of Family and Community Medicine in the Health Reform, and the country's rights agenda. The third decade of the specialty begins with a crisis triggered by the sustained decline in the aspiration for residency. An initial approach to explanations reflects on the possibility of facing a more profound crisis and the need to find the keys to a 21st century Medicine that allows us to achieve the principles of Alma-Ata that are still current.

La residencia de medicina familiar y comunitaria comenzó en Uruguay en el año 1997. A través de un proceso autogestionado, las primeras generaciones se moldearon en una formación que integraba en ellos el conocimiento y la experiencia hospitalarios junto con la praxis territorial en un servicio de salud de base comunitaria con población de referencia. El reconocimiento académico de la especialidad y la instalación de los ámbitos institucionales para su gestión fueron conquistas paralelas a ese proceso en la primera década. La segunda década estuvo marcada por la expansión territorial de la estructura docente-asistencial, la descentralización de la universidad y la participación activa de la medicina familiar y comunitaria en la reforma de la salud y la agenda de derechos. La tercera década de la especialidad se presenta en su inicio como crisis dada por la caída sostenida en la aspiración a la residencia. Desde una aproximación inicial a las explicaciones, se reflexiona sobre la posibilidad de estar frente a una crisis más profunda y la necesidad de encontrar las claves de una medicina del siglo XXI que permita alcanzar los principios de Alma Ata, siempre vigentes.

La Medicina Familiar y Comunitaria en Uruguay de 1997 a 2019: ¿cuántos kilómetros faltarán para llegar al pueblo aquel? / Family and Community Medicine in Uruguay from 1997 to 2019: how many kilometers will it take to reach that town?

Resumen La residencia de medicina familiar y comunitaria comenzó en Uruguay en el año 1997. A través de un proceso autogestionado, las primeras generaciones se moldearon en una formación que integraba en ellos el conocimiento y la experiencia hospitalarios junto con la praxis territorial en un servicio de salud de base comunitaria con población de referencia. El reconocimiento académico de la especialidad y la instalación de los ámbitos institucionales para su gestión fueron conquistas paralelas a ese proceso en la primera década. La segunda década estuvo marcada por la expansión territorial de la estructura docente-asistencial, la descentralización de la universidad y la participación activa de la medicina familiar y comunitaria en la reforma de la salud y la agenda de derechos. La tercera década de la especialidad se presenta en su inicio como crisis dada por la caída sostenida en la aspiración a la residencia. Desde una aproximación inicial a las explicaciones, se reflexiona sobre la posibilidad de estar frente a una crisis más profunda y la necesidad de encontrar las claves de una medicina del siglo XXI que permita alcanzar los principios de Alma Ata, siempre vigentes.

Abstract The Family and Community Medicine Residency started in Uruguay in 1997. Through a self-managed process, the first generations were molded into training that integrated hospital knowledge and experience with territorial praxis in a community-based health service with a population of reference. The academic recognition of the specialty and the installation of the institutional areas for its management were achievements parallel to that process in the first decade. The second decade was marked by the territorial teaching-assistance expansion in the country, university decentralization and the active participation of Family and Community Medicine in the Health Reform, and the country's rights agenda. The third decade of the specialty begins with a crisis triggered by the sustained decline in the aspiration for residency. An initial approach to explanations reflects on the possibility of facing a more profound crisis and the need to find the keys to a 21st century Medicine that allows us to achieve the principles of Alma-Ata that are still current.

The Evolving Presence of Women in Academic Plastic Surgery: A Study of the Past 40 Years.

BACKGROUND: Among surgical subspecialties, plastic surgery holds the highest percentage of women, and, the female contingent of board-certified plastic surgeons and trainees has grown steadily. However, their academic impact has been underestimated. We present the academic footprint of female plastic surgeons over the past 40 years. METHODS: A list of female plastic surgeons currently active at, and retired from, Accreditation Council for Graduate Medical Education-accredited plastic surgery residency programs was compiled. Each surgeon was searched on PubMed to gather their total number of publications, journals, and topics of research after completion of training. Date of publication and 5-year impact factor for each journal were recorded. Publications were organized into 10-year periods (1976 to 1985, 1986 to 1995, 1996 to 2005, and 2006 to 2016). RESULTS: One hundred fifty-five currently active and 80 retired academic female plastic surgeons were identified, who published 2982 articles in 479 peer-reviewed journals. The average 5-year impact factor was 4.093. The number of publications increased with each decade: 37 (1976 to 1985), 218 (1986 to 1995), 472 (1996 to 2005), and 2255 (2006 to 2016). The most commonly published areas were hand/nerve (22 percent), craniofacial (21 percent), and breast (20 percent). Over time, publications in hand/nerve research decreased (76, 60, 38, and 14 percent, respectively); craniofacial-related publications increased (8, 11, 18, and 23 percent, respectively); and publications in breast research increased (0, 8, 9, and 24 percent, respectively). The 2006 to 2016 period yielded the most even distribution of research topics. CONCLUSION: The academic contribution of female plastic surgeons has substantially increased in number and has become more evenly distributed across subspecialty topics.

[Historical and social perspective from the 64-65 Mexican medical movement]. / Perspectiva histórica y social del Movimiento Médico de 1964-1965 en México.

The Mexican Medical Movement from 1964-1965 constitutes an important event from the rising urban middle-class, besides it was the first time medical doctors claimed for fair working conditions. The background of this movement is the so-called Crisis of 1958, which included the Movements from the educators union, oil workers union, telegraph workers union and the railroad workers union. The conflict began because interns and residents from the "Hospital 20 de Noviembre" would not get a payment at the end of the year, so on November 26th, 1964, the movement started. The Asociación Mexicana de Médicos Residentes e Internos (AMMRI) was created and their demands were the following: 1) Full working site restitution without retaliations, 2) Legal examination of the scholarship-contract terms, in order to get annual, renewable and progressive contracts, and a fixed salary with the usual working-hours and characteristics of each institution, 3) To have preference to get an adscription at the hospital where the resident studied, 4) Active participation from the resident in the elaboration of the academic plans, and 5) Resolution of each hospital's problems. This movement had social impact for Mexico's contemporary life, nevertheless some of the demands are still unchanged among medical residents.

El movimiento médico mexicano de 1964-1965 constituyó parte del primer despertar de la clase media urbana, además de haber sido la primera vez que los médicos reclamaron condiciones de trabajo justas. Como antecedente se tiene la llamada crisis de 1958, la cual incluyó los movimientos: revolucionario del Magisterio, del Sindicato de Trabajadores Petroleros, de la Alianza de Telegrafistas, y del Sindicato de Trabajadores Ferrocarrileros de la República Mexicana. El comienzo del conflicto médico se debió a que los residentes e internos del Hospital 20 de Noviembre del hoy Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) no recibieron su aguinaldo, por lo que el 26 de noviembre de 1964 inició el paro, a partir del cual se formó la Asociación Mexicana de Médicos Residentes e Internos (AMMRI), cuyas demandas fueron: 1) Restitución total en sus puestos, sin represalias, 2) Revisión legal y cambio de los términos del contrato-beca, en el sentido de lograr contratos de trabajo anuales, renovables y progresivos, con el horario y características acostumbrados en cada institución además de determinación de sueldos base, 3) Preferencia para ocupar plaza de médico adscrito a los residentes egresados de las propias instituciones, 4) Participación activa del residente en la elaboración de los planes de enseñanza, y 5) Resolución de los problemas de cada hospital. Este movimiento, aunque tuvo repercusiones sociales para la vida contemporánea en México, a 50 años de su inicio, algunas de las demandas siguen sin ser resueltas para los médicos residentes.

The founding of the Mayo School of Graduate Medical Education.

The Mayo Foundation for Medical Education and Research (hereafter the Mayo Foundation), the precursor to the Mayo School of Graduate Medical Education, was incorporated in 1915. The Mayo Foundation, which was affiliated with the University of Minnesota Graduate School, aimed to establish a higher standard for training medical specialists. Together, the University of Minnesota and the Mayo Foundation pioneered a graduate medical education program that allowed residents to earn master's and PhD degrees in clinical medicine and surgery. Unlike elsewhere in the United States, the residency training program was not pyramidal. (In a pyramidal residency program, each training year, some residents are systematically eliminated to reduce the number of more senior trainees.) All those who started the Mayo Foundation residency program had an opportunity to finish depending on their own merits. Louis B. Wilson, the first director of the Mayo Foundation, became a major figure in graduate medical education in the 1920s and 1930s. Although the granting of graduate degrees in medicine and surgery stopped over time, Mayo Clinic ultimately became the largest site of graduate medical education in the world.

The subspecialization of surgery: a paradigm shift.

General surgery has become increasingly fragmented into subspecialties and diseases previously treated by general surgeons are now managed by "specialists". The Resident Education Committee of the Society for Surgery of the Alimentary Tract (SSAT) has reviewed the history of surgical training and factors that have contributed to this evolution to subsepcialization. As it is unlikely that this paradigm shift is reversible, a clear understanding of the contributing factors is essential. Herein, we present a timeline and taxonomy of forces in this evolution to subspecialization.

The path to modernity: a personal testimony to the restructuring of the Department of Dermatology, Vargas Hospital, Caracas, Venezuela.

In the late 1950s and early1960s, there was a concerted effort to modernize teaching, training, and patient care in the Vargas Hospital of Caracas, Venezuela. The above included the development of research in the frame of postgraduate training. This effort was to be helped by USA funds and institutions but could only be achieved by the work of Venezuelans, sharing a vision of progress. Dermatology spearheaded this initiative, and the fruit of this was the exponential development of Venezuelan Dermatology and the creation of the National Institute of Dermatology on the grounds of the Vargas Hospital. The purpose of this contribution is to review these events that happened more than half a century ago from my own perspective. I sincerely hope that these lines could serve as an inspiration to the younger generations that toil today under less-than-favorable conditions.

Neurosurgery simulation in residency training: feasibility, cost, and educational benefit.

BACKGROUND: The effort required to introduce simulation in neurosurgery academic programs and the benefits perceived by residents have not been systematically assessed. OBJECTIVE: To create a neurosurgery simulation curriculum encompassing basic and advanced skills, cadaveric dissection, cranial and spine surgery simulation, and endovascular and computerized haptic training. METHODS: A curriculum with 68 core exercises per academic year was distributed in individualized sets of 30 simulations to 6 neurosurgery residents. The total number of procedures completed during the academic year was set to 180. The curriculum includes 79 simulations with physical models, 57 cadaver dissections, and 44 haptic/computerized sessions. Likert-type evaluations regarding self-perceived performance were completed after each exercise. Subject identification was blinded to junior (postgraduate years 1-3) or senior resident (postgraduate years 4-6). Wilcoxon rank testing was used to detect differences within and between groups. RESULTS: One hundred eighty procedures and surveys were analyzed. Junior residents reported proficiency improvements in 82% of simulations performed (P < .001). Senior residents reported improvement in 42.5% of simulations (P < .001). Cadaver simulations accrued the highest reported benefit (71.5%; P < .001), followed by physical simulators (63.8%; P < .001) and haptic/computerized (59.1; P < .001). Initial cost is $341,978.00, with $27,876.36 for annual operational expenses. CONCLUSION: The systematic implementation of a simulation curriculum in a neurosurgery training program is feasible, is favorably regarded, and has a positive impact on trainees of all levels, particularly in junior years. All simulation forms, cadaver, physical, and haptic/computerized, have a role in different stages of learning and should be considered in the development of an educational simulation program.

Análise do perfil e da evolução dos programas de residência em medicina de família e comunidade no Brasil / Profile and evolution of family and community health residency programs in Brazil

As mudanças recentes do perfil do Programa de Residência em Medicina de Família e Comunidade (MFC) e o seu papelno atual contexto da Atenção Primária à Saúde (APS) e doSistema Único de Saúde (SUS) são os focos deste trabalho.Pretende-se, ainda, descrever a evolução da oferta de vagasem programas de Residência Médica (RM) no país, especialmenteno que se refere à proporcionalidade do crescimentode novas vagas na especialidade MFC em relação às demais especialidades. Verificar-se-á também a evolução do númerode vagas da RM em MFC segundo as regiões do paíse os vínculos institucionais das entidades mantenedoras.Foram pesquisadas as informações existentes no banco dedados do Ministério da Educação - Secretaria de EducaçãoSuperior (MEC-SESu), entre julho e setembro de 2007,em que puderam ser consultados os dados referentes aos Programas de Residência Médica. Foi levantado o período compreendido entre 2002 e 2007, incluindo as seguintesvariáveis: instituição, número de vagas, especialidade,tempo de duração da especialização, região do país em quese encontra e categoria administrativa. Cada variável foianalisada separadamente e, depois, em conjunto, possibilitandoas comparações, por ano, por especialidades e porcategoria administrativa. A despeito da prioridade dada pordiversos segmentos da gestão do SUS à Estratégia Saúdeda Família e o decorrente aumento da demanda por este profissional, conclui-se que o Programa de Residência emMFC sofreu transformações importantes no sentido de seadequar às exigências da Política de APS no país e que os Programas de Residência Médica no Brasil e, em particular a de MFC, têm tido um crescimento importante, ainda que estes estejam aquém das necessidades.

Recent changes to the Family Medicine Residency Programand the role of this program in the context of the Primary Health Care (PHC) and the Brazilian Unified Health System (Sistema Único de Saúde - SUS) arethe focus of this paper. It also intends to describe theevolution of the slots offered by medical residency programsin the country, especially concerning the growing proportion of new slots in Family Medicine comparedto other specialties. It also verifies the evolution in the number of slots offered by Family Medicine Medical Residency Programs, according to the geographic are a and the institutional relation ships with the sponsor ingnstitutions.The Ministry of Education-Higher Education Secretaria tdatabase was searched between July and September2007. Data concerning Medical Residency Programswere obtained for the 2002-2007 period, including thefollowing variables: institution, number of slots offered,specialties, specialization time, geographic location in the country and administrative category. Each variable wasanalyzed individually and later as a whole, for comparisonsby year, specialty and administrative category. In spiteof the priority assigned by the SUS to the family health strategy, and the consequent increasing demand for thiskind of service, and in spite of the important transformations suffered by the Family and Community Medicine Residency Programs to meet PHC guidelines in Brazil,there are still unmet needs.