Coping trajectories of intensive care nurses as second victims: A grounded theory.

A qualitative study that provides evidence of the institutional support required by intensive care unit (ICU) nurses as second victims of adverse events (AEs). BACKGROUND: The phenomenon of second victims of AE in healthcare professionals can seriously impact professional confidence and contribute to the ongoing occurrence of AEs in hospitals. OBJECTIVES: The objective of this study was to describe the coping trajectories of second victims among nurses working in ICUs in public hospitals in Chile. METHODS: Conducting qualitative research through the grounded theory method, this study focused on high-complexity hospitals in Chile, using theoretical sampling. The participants consisted of 11 nurses working in ICUs. Techniques used included in-depth interviews conducted between March and May 2023, as well as a focus group interview. Analysis, following the grounded theory approach proposed by Strauss and Corbin, involved constant comparison of data. Open, axial, and selective coding were applied until theoretical data saturation was achieved. The study adhered to reliability and authenticity criteria, incorporating a reflexive process throughout the research. Ethical approval was obtained from the ethics committee, and the study adhered to the consolidated criteria for reporting qualitative research. RESULTS: From the interviews, 29 codes were identified, forming six categories: perception of support when facing an AE, perception of helplessness when facing an AE, initiators of AE, responses when facing an AE, professional responsibility, and perception of AE. The perception of support when facing an AE emerged as the main category, determining whether the outcome was stagnation or overcoming of the phenomenon after the AE. CONCLUSIONS: For the coping process of ICU nurses following an AE, the most crucial factor is the support from colleagues and supervisors.

[Scores obtained by physicians in the national health services admission contest between 2016 and 2020]. / Resultados del sistema de puntuación del Concurso Nacional de Ingreso a los Servicios de Salud entre 2016 y 2020.

BACKGROUND: Medical specialists are an essential resource for the functioning of the health system and in Chile there is a growing deficit of these specialists. To address this shortage, the government has strategies for training health professionals, such as a national public contest for medical scholarships, named CONISS, which stands out for its high capacity to produce medical specialists. The scoring system of this contest is used for the allocation of training resources to the best candidates. AIM: To describe the results of the CONISS scoring system between 2016 and 2020. MATERIAL AND METHODS: Analysis of public registries of physicians participating in the CONISS contest between 2016 and 2020. RESULTS: During the study period 7,373 physicians participated in this contest (49% females). Annual participation increased progressively. The participants graduated from 21 Chilean universities and a variable number from foreign universities. The scores obtained by participants improved by 1.47 points between the first and last year of the study period. CONCLUSIONS: Interpretation of these results is complicated by the characteristics and limitations of the measurements of the CONISS scoring system. This precludes establishing whether this system effectively filters out the best candidates for medical specialization programs.

[Negative effects of the patients' rights law and neuro-rights bill in Chile]. / Efectos negativos en la investigación y el quehacer médico en Chile de la Ley 20.584 y la Ley de Neuroderechos en discusión: la urgente necesidad de aprender de nuestros errores.

Recently, the Chilean Senate approved the main ideas of a constitutional reform and a Neuro-rights bill. This bill aims to protect people from the potential abusive use of "neuro-technologies". Unfortunately, a literal interpretation of this law can produce severe negative effects both in the development of neuroscience research and medical practice in Chile, interfering with current treatments in countless patients suffering from neuropsychiatric diseases. This fear stems from the observation of the negative effects that recent Chilean legislations have produced, which share with the Neuro-Rights Law the attempt to protect vulnerable populations from potential abuse from certain medical interventions. In fact, Law 20,584 promulgated in 2012, instead of protecting the most vulnerable patients "incapacitated to consent", produced enormous, and even possibly irreversible, damage to research in Chile in pathologies that require urgent attention, such as many neuropsychiatric diseases. This article details the effects that Law 20.584 had on research in Chile, how it relates to the Neuro-Rights Law, and the potential negative effects that the latter could have on research and medical practice, if it is not formulated correcting its errors.

[Analysis of the cases admitted to a regional ethics court of the Chilean medical association]. / Reclamos contra la conducta ética en el ejercicio de la medicina. Análisis de las causas ingresadas a un Tribunal de Ética del Colegio Médico de Chile.

BACKGROUND: The Ethics Committees of medical associations define standards of conduct to avoid improper professional behavior. AIM: To identify the areas of professional behavior with most allegations of misconduct. MATERIAL AND METHODS: Analysis of all ethical claims received at the Regional Ethics Court of the Chilean Medical Association between 2016 and 2021. RESULTS: Of 323 cases analyzed, 17% of complaints argued a failure in achieving a satisfactory standard of medical care, 15% unprofessional behavior, 14% disruptive interaction among physicians, 12% failure to fulfill therapeutic expectations, 6% poor quality of care, 6% fraud, 6% complains against institutions, 6% sexual misconduct, 6% inappropriate billing, 3% diagnostic errors, 3% inappropriate social behaviors, 1% refusal to provide a sick leave and 1% illegal practice. Only 41.5% of complaints were filed against registered physicians, thus limiting the capabilities of the medical ethical board. CONCLUSIONS: The most common complaints observed were professional misconduct and relationship problems between physicians.

[Competence profiles for technicians in higher-level nursing, declared by different teaching institutions]. / Técnicos en enfermería en Chile: mirada a su formación desde las competencias declaradas en los perfiles de egreso.

BACKGROUND: The career of Technician in Higher-Level Nursing (TENS in Spanish) is the technical career that has the higher number of students in Chile. There are important disparities among the higher education institutions that teach it. AIM: To analyze differences in competencies declared in TENS career graduate profiles by type of higher education institution. MATERIAL AND METHODS: Using Atlas.ti 7, we carried out a content analysis of 31 graduate profiles of TENS, published in websites of Universities, Professional Institutes and Technical Training Centers that teach the career, during 2019. RESULTS: Procedural competencies are predominant in graduate profiles, followed by interpersonal ones, with cognitive and ethics competencies being the least declared. Accredited higher education institutions consistently declare more cognitive and ethics competencies than those that are not accredited. CONCLUSIONS: There is a procedural bias in graduate profiles, which tends to under declare cognitive and ethics competencies, fundamental for decision-making processes.

[National health services system entrance contest for specialties in Chile. Quotas and scores obtained by applicants]. / Puntaje total, calificación médica nacional y cupos según programa de especialidad en el Concurso de Ingreso al Sistema Nacional de Servicios de Salud. Período 2017-2019.

Among the several programs that allow access to medical specialization in Chile, the National Health Services System Entrance Contest (CONISS) is held annually for newly graduated physicians, which has a high number of applicants. The academic qualifications expressed as National Medical Qualification (CMN) are the main item of the scoring system. We reviewed the total scores and the CMN of the different medical specialization programs that exist in the country, which constitutes novel and relevant information for future medical graduates interested in applying to the program. In addition, the quotas of the different programs are reported, expressed as total, free, and used quotas.

[The presence of women in Chilean medicine: from the times of Eloísa Díaz to this day]. / Las mujeres en la medicina chilena: Desde los tiempos de Eloísa Díaz a la actualidad.

Though the presence of many women in medicine goes unnoticed today, their incorporation to the field was slow and difficult. It took until the end of the nineteenth century for women to be finally allowed to study at the University in Chile, being Eloísa Díaz the first woman to become a medical doctor in 1887. In that century, only six women became medical doctors. However, throughout the twentieth century, this small proportion of women in medicine increased at a similar rate as tuition did in the schools of medicine, especially from the 1960's when limited quotas for women were abolished. At present, women doctors constitute 40% of the total pool of medical doctors in Chile, being present in all specialties, though preferably found as general practitioners, family doctors and pediatricians. While many women have stood out in academia and in politics, they have also successfully reached high positions in scientific societies (and other offices such in the Health Ministry, and even the country's presidency) their participation is still limited in these areas. It is only fair to conclude that the outstanding participation that women in Chilean medicine enjoy today is not solely due to their long-lasting efforts, but more importantly, to their tireless struggle to overcome prejudice, discrimination and misunderstanding; the latter being especially represented by pioneer women of medicine.

[The first chilean female doctors: Eloísa Díaz Insunza and Ernestina Pérez Barahona]. / Las primeras médicas de Chile y Latinoamérica: Eloísa Díaz Insunza y Ernestina Pérez Barahona.

Dr. Eloísa Díaz Insunza (1866-1950) was the first woman to become a doctor-surgeon in Chile and Latin America in 1887. Less known is her distinguished colleague, Dr. Ernestina Pérez Barahona (1865-1951), the second woman graduated in Chile as a physician, only seven days after Dr. Diaz. Dr. Diaz entered the School of Medicine of the University of Chile in 1881 and Dr. Pérez in 1883. However, both graduated from Bachelor of Medicine and Pharmacy in 1885 and received their degree in 1887. This paper highlights the extraordinary parallelism in their medical studies.

Interprofessional team member's satisfaction: a mixed methods study of a Chilean hospital.

INTRODUCTION: The health organizations of today are highly complex and specialized. Given this scenario, there is a need for health professionals to work collaboratively within interprofessional work teams to ensure quality and safe care. To strengthen interprofessional teamwork, it is imperative that health organizations enhance strategic human resources management by promoting team member satisfaction. OBJECTIVE: To analyze the satisfaction of members in interprofessional teams and to explore interpersonal relationships, leadership, and team climate in a hospital context. METHODOLOGY: This study is an explanatory sequential mixed methods (quantitative/qualitative) study of 53 teams (409 professionals) at a university hospital in Santiago, Chile. The first phase involved quantitative surveys with team members examining team satisfaction, transformational leadership, and team climate. Social network analysis was used to identify interactions among team members (cohesion and centrality). The second phase involved interviews with 15 professionals belonging to teams with the highest and lowest team satisfaction scores. Findings of both phases were integrated. RESULTS: Significant associations were found among variables, and the linear regression model showed that team climate (ß = 0.26) was a better predictor of team satisfaction than team leadership (ß = 0.17). Registered nurse was perceived as the profession with the highest score on the transformational leadership measure (mean = 64), followed by the physician (mean = 33). Team networks with the highest and lowest score of team satisfaction showed differences in cohesion and centrality measures. Analysis of interviews identified five themes: attributes of interprofessional work; collaboration, communication, and social interaction; interprofessional team innovation; shared leadership; and interpersonal relationship interface work/social. Integration of findings revealed that team member satisfaction requires participation and communication, common goals and commitment for patient-centered care, clear roles and objectives to support collaborative work, and the presence of a transformational leader to strengthen well-being, dialog, and innovation. CONCLUSIONS: Results have the potential to contribute to the planning and decision-making in the field of human resources, providing elements to promote the management of health teams and support team member satisfaction. In turn, this could lead to job permanence especially where the local health needs are more urgent.

Review and analysis of Chilean dental undergraduate education: curriculum composition and profiles of first year dental students.

BACKGROUND: In Chile, dentistry has become a very popular career choice for students, which has resulted in a substantial increase in both, the number of dental graduates and dental schools. Nonetheless, there is a need for change in the way dental schools select and educate their students to keep pace with the rapidly changing nature of societal needs and to tackle the marked health inequalities that exist in the country. The aim of this study was to review and critique dental undergraduate education in Chile, with a particular focus on the curriculum composition and profiles of students admitted to dental schools from 2010 to 2014. METHODS: A descriptive and retrospective design was utilised. Two different methods were undertaken: primary data collection regarding curriculum and secondary data analysis in relation to students' profiles. Descriptive statistics were used to assess the relative proportions of subject modules within the undergraduate dental curriculum and in particular the public health components. The analysis of the student profiles described specific background factors, namely, gender, age, secondary school type, location, rural-urban status and student's year of admission. Also, trends of dental students' intake between 2010 and 2014 were investigated. Logistic regression analysis was undertaken to assess potential associations between the aforementioned background factors and students' choice of dental school. RESULTS: Regarding the curriculum review, a 67% response rate was obtained. The most dominant component of Chilean dental curriculum was the clinical subjects (33%), followed by the basic and biological sciences (16%) and then medical and dental sciences (13%). In relation to the admission of students, the majority attended private schools (72%); most were females (62%); aged 19 years or less (74%); had an urban origin (99%); and came from subsidised private secondary schools (48%). Significant differences were found between students admitted to traditional and private dental schools. CONCLUSIONS: Clinical sciences are the most dominant subjects in the Chilean dental curriculum. Overall, traditional and private institutions had a broadly similar composition in their curriculum with the exception of the public health component. Students from disadvantaged backgrounds were the minority in dental schools across Chile.

[Foundations for the classification of medical specialist programs in a national qualifications framework]. / Fundamentos para la clasificación de los programas de médico especialista en un marco de cualificaciones nacional.

Qualification of learning outcomes in terms of knowledge, skills, responsibility and autonomy provided by medical specialist programs is of interest to State authorities, educational service providers, employers, and specialists. Countries that are signatories to the Bologna Process and others outside Europe, established that the guaranteed primary degree for medical studies is the Master in Medicine (second cycle). There is agreement that medical specialist programs are more advanced than a Master of Medicine but are different from the Doctor of Medicine (third cycle) in their clinical orientation. These programs usually do not have research components and occasionally they are not carried out in the higher education system. However, the level of qualification of medical specialist programs has not been established due to lack of consensus. In Chile, this decision becomes even more complicated due to the certification of "licenciatura" (first cycle) that medical schools provide. There are also gaps in the educational classification procedure employed by the country. However, the review of national qualification frameworks and government acts shows that some countries have validated these certifications as third cycle. Medical specialties certainly do not correspond to PhD programs and the eligibility of the qualification level must be guaranteed to all stakeholders, who require an agreement on the specific national framework of learning outcomes and competencies.

[Medical specialization in Chile. A centralized vision]. / Especialización médica en Chile: tipos, mecanismos y requisitos de postulación. Una actualización de los procesos para los médicos generales.

Medical graduates face different postgraduate training options, but their priority is to obtain a primary medical specialty, defined as a specialty that does not derive from other. There are different specialty training programs in Chile, which can be dependent or independent of the Ministry of Health. The information about these programs is available in different Internet sites. However a centralized information service that groups and synthetize these programs is lacking, hampering graduate choice decisions. This article aims to review all specialization program modalities, providing a general vision of the institutional structure and implications that govern the specialization process in Chile.

[Facilitators and barriers to implementation of intercultural health policy in Chile]. / Facilitadores y obstaculizadores de la implementación de la política de salud intercultural en Chile.

Objective To identify elements that either facilitate or hinder implementation of Chile's intercultural health policy. Methods A descriptive study was conducted with the participation of health services users from the Mapuche ethnic group, biomedical health professionals, intercultural facilitators, and key informants in two health facilities serving towns with a high density of Mapuche population. The information was obtained through semi-structured interviews that were analyzed thematically. Results Factors identified as facilitating the implementation of this policy include laws and regulations pertaining to the rights of indigenous peoples, the empowerment of users around their rights, the formation of implementation teams, the presence of professionals of Mapuche origin in health facilities, and the existence of processes for systematization of the work carried out. The asymmetric relationship between the Mapuche people and the state, and between the Mapuche health system and the biomedical model, constitutes a fundamental barrier. Other obstacles include the lack of theoretical and practical clarity around the concept of intercultural health and a lack of resources. Conclusions Despite the facilitators identified and the achievements to date, meaningful progress in implementation of an intercultural health policy is limited by barriers that are hard to change. These include the usual forms of government planning and the hegemony of the biomedical model.

[Professor Hernán Alessandri, M.D.: his legacy for the new generations of physicians]. / El Profesor Doctor Hernán Alessandri: su legado para las nuevas generaciones de.

Professor Alessandri died in 1980. We started our residency in Internal Medicine about 30 years later. Considering the profound changes our society has witnessed, including medical practice, I would like to approach the meaning of his work for our generation. It is not the Father's figure nor his Aura what inspires us today. Neither is his personality nor his shape. His universality comes from his transcendent image as a teacher. Today's teachers live rough times, their social status has changed, their professional requirements have grown exponentially, they have to adapt to social phenomena like the Internet and multiculturalism. Being a teacher nowadays demands to be a multifaceted expert. Things have changed since Professor Alessandri made rounds with his patients. But a deeper look allows us to understand that everything returns to where it started: professional deontology of the teacher, never fading but transcendent. We know that Doctor Alessandri had the natural gift to keep faithful to that code with consistency and perseverance. He excelled with integrity in every aspect including professional betterment, constructive work for his institution, collegiality, a warm relationship with students and a model of social values. Beyond virtues and personal defects he will keep on being the mould in which present teachers should be formed, engraved in their souls and in the subconscious of students that seek to learn.

[Inequality and inequity in the use of medical services in Chile, by age group, 2000-2011]. / Desigualdad e inequidad en la utilización de servicios médicos según grupos etarios en Chile, 2000-2011.

OBJECTIVE: To calculate indices of inequality and inequity in the use of medical services for children, adults, and older adults in Chile from 2000 to 2011. METHODS: Based on the CASEN survey (2000-2011), the concentration index (CI) was calculated to measure inequality and the horizontal inequity index (HI) was calculated to measure inequity in the use of medical services. Four groups were studied: children under 5, children aged 6-18 years, adults, and older adults. RESULTS: The results indicate higher levels of inequality in the use of specialized physician services in the child groups, and higher levels of inequity in the adult group. In the use of dental services, the greatest inequality and inequity is found among older adults. For visits to emergency services in the last two years for which data are available (2009 and 2011), the adult group shows a higher level of inequality. CONCUSIONS: In terms of levels of inequity and inequality, there are differences among children, adults, and older adults over the years in at least three of the six variables studied.

[Accreditation process of pediatric healthcare professionals in Chile]. / El proceso de acreditación de Especialistas en Pediatría en Chile.

In Chile since 1984, the Autonomous Corporation for Certification of Medical Specialties (CONACEM) has certified 12,294 medical specialists. The Pediatrics discipline began its certification processes in 1984; it had certified 1,329 specialists by December, 2012. There are three possible ways to get certified: a) to have passed the Training Graduate Degree Program, taken by 57% of the applicants; b) to meet the requirements for Training in Practice for 5 years, achieved by 39% of applicants; c) to have been trained oversees according to validated programs. There are 11 accredited 3-year long university programs, which take place in Santiago and Provinces with a total annual capacity of 96 students. With the exception of doctors approved by accredited medical university programs, the rest of the applicants must pass a practical examination. A written examination has been added since 2002, whose approval is required to take the practical examination, which has proven to have good discrimination (22% average rejection in 11 years). The certifications granted today are good for 10 years and recertification is good for 7 years. The expiration of the certification process is related to recertification. This review discusses the reasons behind it and discusses the requirements and a table of credits to complete. Current legislation requires the action of at least one certification body, a condition that has been legally and uniquely granted by the Ministry of Health to CONACEM since 2/11/2014.

Workload and psychosocial risks among nurses in mental health and psychiatry in Chile.

The present study aims to explore and compare psychosocial risks and work overload among nursing professionals in the field mental health and psychiatry in Chile. Quantitative, observational and cross-sectional research was designed for this purpose. Nurses from community, ambulatory, hospital and emergency units in mental health and psychiatry in Chile were recruited between January and May 2022. Instruments of psychosocial variables and an occupational psychosocial risk scale based on the Copenhagen Psychosocial Questionnaire were used. Descriptive and correlational statistics were used, as well as independent samples t-tests, Factorial Anova and post-hoc analysis with Bonferroni correction. As a result, 174 nursing professionals were recruited, 79.3% female, average age 33.9 years. One-third belonged to the Metropolitan Region of Chile. The highest psychosocial risk was obtained by nurses over 30 years of age, from the Metropolitan Region, with more than 16 patients under their care, at the hospital or psychiatric emergency level. Significant differences were observed in work overload and psychosocial risks according to personal and work characteristics of the professionals, as well as of the users and health services. The levels of psychosocial risk and work overload of mental health and psychiatric nurses were reported, as well as the comparison of these according to personal, sociodemographic, and work characteristics. In order to improve the quality of work life of these professionals and the quality of these services, it is essential to develop interventions focused on the dimensions addressed, as well as to define norms and policies that ensure a workload in accordance with international standards.

Maternity protection vs. maternity rights for working women in Chile: a historical review.

Maternity leave in Chile has been a social right since 1919, when the International Labour Organization set the first global standards. From its inception, Chile's labour legislation focused on protecting motherhood and the family. The length of maternity leave has been extended several times since then but its main aim remains the protection of infant health. In 1931, Chile's first Labour Code required anyone employing 20 or more women to provide day care services and facilitate childcare and paid breastfeeding time for all mothers of children under one. Labour laws began to play an important role in accommodating the care of infants within working conditions, though not always effectively. In spite of job protection during pregnancy and breastfeeding, women can be dismissed on grounds other than pregnancy. It was only under Salvador Allende and again in the past two decades that Chile has enfranchised women as holders of health rights. However, many unresolved tensions remain. Chile promotes motherhood, but often considers that working women who demand employment protection abuse the system. Motherhood is a magic wand that represents the selflessness of women, but society throws a blanket of mistrust over women who wish to exercise their maternity rights and to determine the number and spacing of their children.