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.

Contribución de las Mutuas de Previsión Social al Sistema Hospitalario español: el caso de La Alianza / Contribution of the Mutual Insurance Societies to the Spanish Hospital System: the case of La Alianza

Las sociedades de ayuda o apoyo mutuos fueron un conjunto variado de insti-tuciones de carácter social, de naturaleza privada y sin ánimo de lucro, que proporcionaron prestaciones socio-asistenciales también en caso de enfermedad, a buena parte de la población, entre la segunda mitad del siglo XIX y primera del XX. En España, fueron escasos los hospitales promovidos por estas instituciones, quizá porque la mayoría no llegaron a tener suficiente número de socios para hacerlo. Los hospitales de este tipo se encontraban, mayoritariamente, en Cataluña, donde las sociedades obreras de ayuda mutua tuvieron un mayor desarrollo. A través del caso paradigmático de los hospitales de La Alianza, el estudio muestra que estos hospitales estuvieron abiertos a diversos tipos de pacientes (privados o derivados por otras instituciones) y tuvieron una dependencia económica múltiple. También se analizan los cam-bios que más influyeron en los hospitales de las mutuas, en la segunda mitad del siglo XX: el proceso de federación de las mutuas de previsión social y el itinerario de concertación pública. Estos hospitales participaron en el desarrollo de nuevas especialidades médico-quirúrgicas hospitalarias. Se advierte que fueron precisamente los hospitales de La Alianza los que llevaron a un mayor desarrollo de esta entidad. (AU)

Simposio: la formación de los médicos especialistas. Historia y futuro del sistema MIR: Tarragona, 16 de enero de 2020 / No disponible

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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.

Formación especializada en España: y después de la troncalidad, ¿qué? / Specialised training in Spain: and after the core curriculum, what's next?

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Tesis doctorales de Medicina defendidas por mujeres pioneras en España (1882-1954) / Doctoral theses in Medicine by pioneer women in Spain (1882-1954)

FUNDAMENTO Y OBJETIVO: La presencia de mujeres pioneras en estudios superiores de Medicina en España cuenta con notables realizaciones. Este estudio indaga tesis doctorales en Medicina defendidas por mujeres en España desde 1882 a 1954 (el 1% de la producción total para ese periodo) e indexadas en las bases Cisne de la Universidad Complutense de Madrid. MATERIAL Y MÉTODO: Se recuperan y revisan 50 tesis doctorales. Se realiza un estudio longitudinal retrospectivo de análisis documental de tesis doctorales identificadas por año de defensa, título de cada tesis, nombre de la doctora, especialidad médica adscribible y palabras clave. RESULTADOS: El número de tesis de mujeres autoras se incrementa linealmente a lo largo del tiempo. Las especialidades médicas más comunes de tales tesis son: Ginecología y Obstetricia, Farmacología, Hematología, Pediatría y Endocrinología. También se realiza un conteo de frecuencias de los descriptores, en el cual destacan los términos: farmacología/terapia, educación, patogenia, enfermedad y niños. DISCUSIÓN Y CONCLUSIONES: La Medicina española dispone de 50 tesis doctorales pioneras defendidas por mujeres entre 1882 y 1954, aunque estas representan solo el 1% de la producción total de tesis doctorales en Medicina para ese periodo. Tan exiguo porcentaje alerta de un sesgo por techo de cristal que podría estar gravitando aún sobre las mujeres médicas. Una recomendación final se emite alentando a mejorar la situación de la mujer investigadora en Medicina

BACKGROUND AND OBJECTIVE: The presence of pioneer women in Spanish Medical Education has a notable impact. The objective of this study is to investigate doctoral theses in Medicine written by women in Spain between 1882 and 1954 and indexed in the Cisne library catalogue of Madrid Complutense University. These theses account for 1% of the total output for the period. MATERIAL AND METHOD: This retrospective longitudinal document analysis study examines doctoral theses identified by year of submission, title, author's name, ascribable medical speciality, and keywords. A total of 50 doctoral theses were identified and reviewed. RESULTS: The number of theses by female authors increased linearly over time. The most common medical specialities studied by female candidates were gynaecology and obstetrics, pharmacology, haematology, paediatrics, and endocrinology. The frequency of study descriptors was also calculated, and the following key terms detected: pharmacology/therapy, education, pathogenesis, disease, and children. DISCUSSION AND CONCLUSIONS: A total of 50 doctoral theses in medicine were written by pioneer female candidates in Spain between 1882 and 1954, accounting for just 1% of total output during this period. This tiny percentage indicates potential bias due to a glass ceiling that may continue to be a barrier to female doctors today. More still needs to be done to improve conditions for female medical researchers

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.

Escuelas urológicas españolas (1880-1970) / Spanish urological schools (1880-1970)

Introducción y objetivos: Investigamos el comienzo de la especialización urológica en España, desde finales del siglo xix hasta la institución del sistema de formación (MIR), con el objetivo de dar a conocer los centros y las personas que crearon unidades docentes o escuelas de adiestramiento urológico en las que se especializaron los primeros urólogos españoles. Material y métodos: Extraemos las referencias de los libros de historia de urología, de las publicaciones periódicas urológicas y de los pósteres sobre historia presentados en los congresos de la Asociación Española de Urología, completamos los datos y las fechas con el diccionario histórico de urólogos españoles. Resultado: Son 30 los focos de especialización urológica, 8 contaron con acreditación oficial reconocida por el ministerio correspondiente; de los que no nos consta su oficialidad, son en los servicios de urología de los grandes hospitales del país, los hospitales clínicos universitarios y en escuelas privadas dirigidas por destacados urólogos. Catorce son los núcleos principales, que corresponden cronológicamente a las ciudades de: Madrid, Barcelona, Santiago de Compostela, Sevilla, Las Palmas de Gran Canaria, Cádiz, Santander, Valencia, Granada, Bilbao, San Sebastián, Oviedo, Zaragoza y Salamanca. Conclusión: La formación urológica en España desde finales del siglo xix y la primera mitad del xx estuvo bien establecida, tanto en centros acreditados oficialmente como en los servicios de urología de los principales hospitales, en los clínicos universitarios y en escuelas y clínicas privadas, dirigidas por urólogos bien preparados, que garantizaba una adecuada docencia y adiestramiento, método que persistió hasta la institución del sistema MIR en 1970

Introduction and objectives: We researched the start of urological specialisation in Spain, from the end of the 19th century to the institution of the education system (resident medical intern) to learn about the centres and individuals who created the urological teaching units and training schools in which the first Spanish urologists specialised their training. Material and methods: We extracted the references from books on the history of urology, from periodic urological publications and from the posters on history submitted to the congresses of the Spanish Urological Association and filled in the data and dates with the Historical Dictionary of Spanish Urologists. Result: There are 30 urological specialization centres, 8 with official accreditation recognised by the corresponding ministry but whose official status is unknown. These centres are in the urology departments of large Spanish hospitals, university clinic hospitals and in private schools directed by notable urologists. There are 14 main centres, corresponding chronologically to the following cities: Madrid, Barcelona, Santiago de Compostela, Seville, Las Palmas of Gran Canaria, Cadiz, Santander, Valencia, Granada, Bilbao, San Sebastian, Oviedo, Zaragoza and Salamanca. Conclusion: Urological training in Spain from the end of the 19th century to the first half of the 20th century was well-established, both in officially accredited centres and in the urology departments of the main hospitals, in university clinic hospitals and in private schools and clinics. The training was directed by experienced urologists who ensured proper teaching and training, a method that persisted until the institution of the resident medical intern system in 1970