Effective analysis of job satisfaction among medical staff in Chinese public hospitals: a random forest model.

Objective: This study explored the factors and influence degree of job satisfaction among medical staff in Chinese public hospitals by constructing the optimal discriminant model. Methods: The participant sample is based on the service volume of 12,405 officially appointed medical staff from different departments of 16 public hospitals for three consecutive years from 2017 to 2019. All medical staff (doctors, nurses, administrative personnel) invited to participate in the survey for the current year will no longer repeat their participation. The importance of all associated factors and the optimal evaluation model has been calculated. Results: The overall job satisfaction of medical staff is 25.62%. The most important factors affecting medical staff satisfaction are: Value staff opinions (Q10), Get recognition for your work (Q11), Democracy (Q9), and Performance Evaluation Satisfaction (Q5). The random forest model is the best evaluation model for medical staff satisfaction, and its prediction accuracy is higher than other similar models. Conclusion: The improvement of medical staff job satisfaction is significantly related to the improvement of democracy, recognition of work, and increased employee performance. It has shown that improving these five key variables can maximize the job satisfaction and motivation of medical staff. The random forest model can maximize the accuracy and effectiveness of similar research.

Caminhos profissionais dos egressos em um grande hospital de São Paulo / Professional paths of graduates in a large hospital in São Paulo

Este trabalho tem como objetivo avaliar o perfil dos caminhos profissionais após o programa de residência de uma instituição em São Paulo (Hospital do Servidor Público Municipal de São Paulo). Além disso, de forma mais específica, busca-se traçar o perfil de satisfação do egresso com a residência, bem como levantar a produção científica dos egressos durante o programa e correlacionar o perfil do ex aluno e produção científica durante o programa. O trabalho foi realizado com os egressos do Curso de Residência de Clínica Médica no Hospital do Servidor Público Municipal (HSPM), a partir das turmas com ingresso no ano de 2012. Para o levantamento de dados foi disponibilizado um questionário on-line, identificado, através do site Google no modelo Google Forms, este questionário foi composto de sessões que objetivam compreender dados gerais sobre os alunos, informações a respeito dos caminhos traçados após a residência (residência nova ou pós graduação) e compreender o que levou o médico a escolher estes caminhos. O aluno foi convidado a responder o questionário através de links no seu e-mail institucional ou via aplicativo WhatsApp nos números disponibilizados pelo banco de dados da instituição. Os dados foram analisados descritivamente utilizando frequências absolutas e percentuais para as variáveis categóricas e das medidas: média, desvio padrão e mediana. O projeto foi submetido ao Comité de Ética em Pesquisa do HSPM, seguindo a Resolução 466/2012 do Conselho Nacional de Saúde do Ministério de Saúde (CONEP/MS). Os autores do trabalho se comprometem a manter o sigilo das informações coletadas através dos questionários. Palavras-chave: Residência médica. Egresso de residência. Residência em Saúde. Internato e Residência. Hospitais de Ensino.

El covid-19 y sus consecuencias en la vida y el trabajo de médicos residentes de La Paz, Bolivia / Covid-19 and its consequences in the life and the work of medical residents of La Paz, Bolivia

Este artículo es un apretado resumen de los principales resultados de una investigación mayor realizada por MEDICON, cuantitativa y cualitativa, en línea, a médicos residentes de 2º año del Sistema Departamental de Salud La Paz, en Bolivia. Los datos y relatos recogidos tienen que ver con la pandemia, el cumplimiento de las medidas de bioseguridad, la afectación experimentada por la cuarentena, la donación de plasma, el desempeño del personal de salud, entre otros. En el 55% la enfermedad fue confirmada por laboratorio. No hubo hospitalizados y la mayoría se automedicó. No recibieron soporte psicológico, por lo que es factible que algunos hubieran desarrollado el síndrome de burnout. Los que se enfermaron o tuvieron allegados con covid-19 dieron a conocer sus vivencias sobre la manera en que ellos y sus familiares enfrentaron el problema. (AU)

This article is a tight summary of the main results of a major investigation conducted by MEDICON, quantitative and qualitative, online, to second-year resident physicians of the La Paz Departmental Health System, in Bolivia. The data and reports collected have to do with the pandemic, compliance with biosecurity measures, the impact experienced by quarantine, plasma donation, the performance of health personnel, among others. In 55% the disease was confirmed by laboratory. There were no hospitalized and most self-medicated. They did not receive psychological support, so it is possible that some had developed ­ burnout syndrome. Those who became ill or had relatives with covid-19 shared their experiences about the way that they and their relatives faced the problem. (AU)

Situación actual de la mujer en Urología en Colombia / Current situation of women in Urology in Colombia

INTRODUCCIÓN Y OBJETIVOS: Existe la creencia de que la urología es una especialidad de hombres. Según la American-Urology-Association, en 2013 las mujeres representaban el 7,7% de los urólogos en EE.UU. Actualmente, de 678 urólogos adscritos a la Sociedad Colombiana de Urología, 61 son mujeres (9%), y de 102 residentes, 41 (40%), son mujeres. El objetivo de este estudio es demostrar las tendencias de trabajo de las urólogas, las tendencias a futuro de las residentes, e identificar si los pacientes tienen preferencias en cuanto a la atención según el género de(la) urólogo(a). MATERIAL Y MÉTODOS: Estudio de corte observacional descriptivo con encuestas anónimas realizadas a urólogas, residentes y pacientes. Las preguntas evaluaban las características demográficas de los encuestados; las preguntas a urólogas evaluaban sus tendencias de trabajo, las de las residentes sus planes a futuro como urólogas, y las de los pacientes su deseo de ser valorados en consulta y operados por un urólogo o una uróloga. RESULTADOS: Cincuenta y tres urólogas respondieron la encuesta. El promedio de edad fue 37 años, la mayoría (54%) trabajan en Bogotá. Dieciocho (34%) se han subespecializado, la mayoría en andrología (16%), endourología (16%) y urología pediátrica (16%). La mayoría (73,6%) operan entre 5-20 horas semanales, y las principales cirugías que realizan son colocación de cinta libre de tensión, resección transuretral de próstata, y varicocelectomía. Dieciocho (34%) refieren acoso laboral por el hecho de ser mujer. Treinta y seis de 41 residentes respondieron la encuesta. El promedio de edad era 28 años. El promedio de publicaciones académicas era de 3 (0-12). Ochenta por ciento desean realizar una subespecialización en el futuro, de las cuales 24% lo harían en endourología,17,2% en pediatría o uroginecología, y 10,3% en oncología. Cuarenta y un por ciento refieren acoso laboral por el hecho de ser mujer. Ciento ochenta y ocho pacientes respondieron la encuesta, siendo 96 hombres y 87 mujeres, de los cuales, 44,1% prefieren ser atendidos en consulta por una uróloga, y 49,2% prefieren ser operados por un urólogo. CONCLUSIONES: El número de mujeres urólogas ha aumentado exponcialmente en los últimos años, al igual que el porcentaje de mujeres en la residencia. Las residentes desean subespecializarse en diversos campos de la urología. Los pacientes prefieren ser atendidos en consulta por una uróloga, pero ser operados por un urólogo aunque las mujeres siguen prefiriendo ser operadas por una mujer

INTRODUCTION AND OBJECTIVES: There are 61 (9%) female urologist enrolled at Sociedad Colombiana de Urología. 41 (40%) of urology residentes in Colombia are women. The aim of this study is to demonstrate the work tendencies of female urologist, female residents and patient’s preferences regarding the gender of their urologist. MATERIALS AND METHODS: Descriptive observational sectional study with anonymous surveys carried out to practicing female urologists, female residents, and patients. The questions evaluated the demographic characteristics of the surveyed individuals; the questions for female urologists evaluated their work tendencies; for the residents we evaluated their plans as urologists; and the patients were asked about their preferences to be evaluated in medical consultation and to have a surgery performed by either a male or female urologist. RESULTS: The survey was answered by 53 female urologists. The average age was 37 years, the majority (54%) worked in Bogotá. 34% have subspecialized, the majority in andrology (16%) endourology (16%) and pediatric urology (16%). Most of them (73.6%) perform surgery between 5-20 hours weekly, and the most performed surgery was varicocelectomy. 34% referred to have been harassed in their work environment based on their gender. Thirty-six female residents answered the survey. The average age was 28 years. The average number of academic publications was 3. 80% wish to achieve a sub-specialization, of which 24% would do it in endourology. 41% referred to have been harassed. 188 patients answered the survey, 96 men and 87 women; 44.1% preferred to be attended in medical consultation by a female urologist, and 49.2% preferred to be operated by a male urologist. CONCLUSIONS: The number of female urologists has exponentially increased, just as the percentage of female residents. Female residents wish to subspecialize in diverse areas. Patients prefer to be attended by a female urologist in medical consultation but prefer to have surgery performed by a male urologist

Consumo de alcohol de los estudiantes de Medicina, Enfermería y residentes de Medicina Familiar y Comunitaria / Alcohol use among Medical and Nursing students and Family and Community Medicine residents

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Participación de residentes de cirugía plástica de Chile en la publicación científica: revisión de los últimos 20 años / Participation of chilean plastic surgery residents in scientific publications: review of the last 20 years

Resumen Objetivo: Analizar la participación de los residentes de cirugía plástica de Chile en la publicación científica de los últimos 20 años y evaluar su experiencia durante la residencia. Materiales y Método: Revisión de la literatura desde 1998-2018 bajo los términos: Cirugía Plástica, Plastic Surgery y Chile. Se incluyeron aquellos con al menos un autor cirujano plástico con filiación en Chile. Se registró la participación reportada de residentes y analizaron sus autores según su período de residencia y fecha de publicación, agregándolos como residentes no reportados. Se analizó tema, año de publicación y revista. Se aplicó una encuesta a residentes de cirugía plástica y postbecados recientes para conocer la percepción sobre su participación en actividades científicas. Se comparó la participación entre residentes con y sin año de investigación mediante el test exacto de Fisher. Resultados: Predominó la temática reconstructiva (48,2%), en adultos (68,6%) y en centros universitarios (48,7%). La participación reportada de residentes fue de 8,4%, subiendo a 38,2% al ampliarla a los no explicitados como residentes. Los encuestados expusieron la falta de tiempo como principal impedimento a la publicación y participación en congresos. Discusión: La participación en actividades científicas resulta beneficiosa para residentes, sus tutores y la reputación académica de sus centros. La mayoría de los residentes cree que su participación podría haber sido mayor en caso de que se hubiesen dado más facilidades. Conclusiones: La participación de residentes de cirugía plástica se encuentra subreportada. Programas de investigación, tiempos protegidos y mayor tutorización podrían aumentar esta cifra.

Aim: Evalúate the participation of Chilean plastic surgery residents in scientific publication in the last 20 years and assess their experience during residency. Materials and Method: Literature review from 1998-2018 under the terms: Cirugia Plastica AND Plastic Surgery AND Chile. Publications with at least one plastic surgeon author with filiation reported in Chile were considered. Those with reported participation of residents were registered and their authors were also analyzed according to their period of residence and date of publication, adding them as unreported residents. Subjects, year of publication and journals were analyzed. A survey was applied to plastic surgery residents and recent plastic surgery graduates to evaluate the perception of their participation in scientific activities. Residents participation with and without a previous research fellow was compared using Fisher's exact test. Results: Reconstructive themed studies (48.2%), in adults (68.6%) and in university centers (48.7%) prevailed among the included articles. The reported participation of residents was 8.4%, which rised to 38.2% when it was extended to those not explicitly reported as residents among the authors. Residents exposed the lack of time as the main barrier to publication and congress participations. Discussion: Participation in scientific activities is beneficial for residents, their mentors and the academic reputation of their centers. The majority of residents believe that their participation could have been greater if more facilities had been given. Conclusions: Participation of plastic surgery residents in scientific publications is under reported. The implementation of research programs, protected times and active mentoring could increase this number.

Encuesta nacional on-line sobre el consentimiento informado para la realización de paracentesis. ¿Lo tenemos? ¿Lo utilizamos? / No disponible

INTRODUCCIÓN: el uso del consentimiento informado es necesario en los procedimientos invasivos como documento garantizador de la relación sanitaria ética y de la seguridad del paciente. OBJETIVO: analizar si se poseen y utilizan los documentos de consentimiento informado para paracentesis en los centros sanitarios, así como obtener algunos datos de interés sobre la técnica. MATERIAL Y MÉTODO: realizamos un estudio observacional descriptivo mediante una encuesta transversal on-line difundida por redes sociales, destinada a los especialistas y residentes de aparato digestivo durante diciembre de 2019. RESULTADOS: incluimos 203 encuestas anónimas (55,2 % adjuntos y 44,8 % residentes) de 74 centros sanitarios de 34 provincias españolas. Noventa encuestados (44,3 %) tenían dicho documento en sus centros; de estos, 29 (32,2 %) lo entregaban siempre; 31 (34,4 %), algunas veces; y 21 (23,3 %), nunca. Setenta y dos profesionales (35,5 %) contestaron no tenerlo y 41 (20,5 %), ser desconocedores; de entre ellos, 77 (68,1 %) consideraban necesaria su creación, 31 (27,4 %) no lo creían así y cinco (4,4 %) no contestaron. En cuanto a la técnica, 173 facultativos (85,2 %) realizan la punción bajo visión directa y 30 (14,8 %), ecoguiada en la mayoría de las ocasiones. Ciento nueve (53,7 %) aplican siempre anestésico local, 80 (39,4 %) lo aplican en algunas ocasiones y 14 (6,9 %) no lo utilizan. Ciento sesenta y siete encuestados (82,3 %) consideraron que es una técnica sencilla, frente a 36 (17,7 %) que la consideran de complejidad intermedia. En cuanto al riesgo, 150 (73,5 %) lo consideran bajo y 52 (25,6 %), medio. Noventa y nueve de ellos (48,8 %) refieren haber tenido complicaciones menores y 37 (18,2 %), mayores. CONCLUSIONES: la paracentesis es una técnica habitual en los servicios de digestivo y, a pesar de ser considerada sencilla y segura, entraña complicaciones. Por ello consideramos necesaria la formación reglada en esta técnica, así como la creación, difusión y utilización de los consentimientos informados dada la importante variabilidad intra e interhospitalaria que presenta

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Burnout y malestar psicológico en los residentes de Medicina Familiar y Comunitaria / Burnout and psychological distress among trainee General Practitioners

OBJETIVO: Estimar la prevalencia de burnout y malestar psicológico de los médicos residentes de Medicina Familiar y Comunitaria (MFyC) de dos unidades docentes y determinar su relación con el año de residencia, los estilos de vida y las condiciones laborales. DISEÑO: Estudio transversal. Emplazamiento: Atención Primaria. Participantes: Se realizaron encuestas presenciales a los residentes de dos unidades docentes (n = 278), incluyendo a todos los residentes de la muestra. El porcentaje de respuesta fue del 76,9%. MEDICIONES PRINCIPALES: Prevalencia de burnout mediante la escala Maslach Burnout Inventory (MBI) y prevalencia de malestar psicológico mediante la escala General Health Questionnaire-12 (GHQ-12). También variables sobre estilos de vida, organización laboral y consumo de drogas. RESULTADOS: El 72% de los participantes son mujeres. La prevalencia de burnout es del 33,8% (IC 95% 27,0-40,6), siendo del 25,6% (IC 95% 19,5-31,7) el agotamiento emocional, 37,9% (IC 95% 31,0-44,7) la despersonalización y 52,9% (IC 95% 45,9-59,9) la baja realización personal. La prevalencia aumenta de forma significativa en todas las dimensiones a partir del segundo año de residencia, excepto en la realización personal. La prevalencia de malestar emocional es del 40,4% (IC 95% 33,5-47,3), sin diferencias significativas según año de residencia. De los residentes con malestar psicológico, el 50,0% presenta también burnout, mientras que este porcentaje es del 22,1% entre los que no presentan malestar psicológico. CONCLUSIONES: La prevalencia de malestar emocional y de burnout (especialmente en baja realización personal) es elevada en los residentes de Medicina Familiar y Comunitaria. Esta es superior a la descrita en estudios previos para otros colectivos de profesionales de la salud y se debe tener en cuenta para desarrollar medidas preventivas

OBJECTIVE: To estimate the prevalence of burnout and psychological distress among trainee General Practitioners of two training placements and its relationship with the year of residence, lifestyle and working conditions. DESIGN: Cross-sectional study. LOCATION: Primary Care. PARTICIPANTS: On-site surveys for all trainees of two training placements (n = 278), including all trainees of the sample. The response percentage is 76.9%. MAIN MEASUREMENTS: Prevalence of burnout using the Maslach Burnout Inventory (MBI) scale and prevalence of psychological distress using the General Health Questionnaire-12 scale (GHQ-12). Also variables on lifestyles, labor organization and drug use. Outcomes: 72% of participants are women. The prevalence of burnout is 33.8% (CI 95% 27.0-40.6), being 25.6% (CI 95% 19.5-31.7) emotional exhaustion, 37.9% (CI 95% 31.0-44.7) depersonalization and 52.9% (CI 95% 45.9-59.9) the low personal accomplishment. Prevalence increases significantly in all dimensions after the second year of training, except in personal accomplishment. The prevalence of emotional distress is 40.4% (CI 95% 33.5-47.3), without significant differences according to year of training. In the group of trainees with psychological distress, 50.0% also have burnout, while this percentage is 22.1% among those who do not present psychological distress. CONCLUSIONS: The prevalence of emotional distress and burnout (especially in low personal accomplishment) is high in trainee General Practitioners. The prevalence in higher than the described in previous studies for other groups of health professionals and should be taken into account to develop preventive measures

Enfoque de género en las residencias médicas de un hospital universitario / Gender approach in medical residences of a university hospital

Se observa un proceso de feminización de la profesión médica, sin embargo, el acceso masivo de las mujeres se asocia a nuevas desigualdades de género, denominadas segregación horizontal y vertical. La segregación horizontal se manifiesta en la desigual distribución de hombres y mujeres en ciertas especialidades médicas y la segregación vertical, en la escasa representación de las mujeres en la mayoría de los altos cargos profesionales. El objetivo de este estudio fue determinar cómo se distribuyen hombres y mujeres en las distintas instancias del proceso que implica el ingreso al sistema de residencias médicas de un hospital universitario de Buenos Aires, Argentina y analizar la segregación horizontal y vertical de género en el proceso de ingreso a las residencias médicas. A partir de datos de postulantes a un hospital universitario, en el período 2015-2017, se realizó un análisis de regresión logística múltiple para ajustar el odds ratio de ser hombre o mujer con potenciales confundidores. No se observó asociación entre ser hombre o mujer y la realización del examen, su aprobación y el ingreso a entrevista. El odds ratio ajustado para el ingreso a la residencia de los hombres con respecto a las mujeres fue 2.03 (1.44-2.85). Para las residencias quirúrgicas fue 2.75 (1.54-4.92) y para las clínicas fue 1.89 (1.17-3.00). En la inscripción, las mujeres optaron mayormente por residencias clínicas, y los hombres por quirúrgicas. Se observó segregación horizontal y vertical en el proceso de ingreso a la residencia. Visibilizar la segregación de género permitirá generar una sociedad equitativa.

A process of feminization of the medical profession is observed, however, the massive access of women is associated with new gender inequalities named horizontal and vertical segregation. Horizontal segregation manifests itself in the unequal distribution of men and women in certain medical specialties and vertical segregation, in the limited representation of women in most high professional positions. The objective of this study was to determine how men and women are distributed in the different stages of the process that involves entering the medical residency system of an universitary hospital from Buenos Aires, Argentina, and to analyze the horizontal and vertical segregation of gender in the process of admission to medical residencies. Based on data from applicants to an universitary hospital, in the 2015-2017 period, a multiple logistic regression analysis was conducted to adjust the odds ratio of being male or female with potential confounders. There was no association between being man or woman and the performance of the exam, its approval and the admission to the interview. The adjusted odds ratio for the admission to the residency of men with respect to women was 2.03 (1.44-2.85). For the surgical residencies it was 2.75 (1.54-4.92) and for clinical it was 1.89 (1.17-3.00). In the inscription, women opted mainly for clinical residencies, and men for surgical purposes. Horizontal and vertical segregation was observed in the process of the residency. Making gender segregation visible will allow generating an equitable society.

Diagnóstico dual en médicos residentes: una revisión sistemática / Dual diagnosis among medical residents: a systematic review

El período de preparación como médico residente (en español, MIR) suele asociarse a una elevada sobrecarga emocional tanto por las nuevas exigencias profesionales como por otros factores psicosociales. El objetivo de este estudio es conocer las características del diagnóstico dual en los MIRs. Se llevó a cabo una revisión sistemática de las bases de datos MEDLINE (PubMed), Web of Science y Google Scholar, seleccionando artículos publicados en inglés y español entre 1984 y 2017. Se obtuvieron 2.415 artículos: se excluyeron 2.276 por título, 105 por el contenido del resumen y 17 por el contenido del artículo. En la revisión final se incluyeron 17 artículos. La prevalencia de clínica depresiva varía del 10,2% al 70%, de ansiedad entre 13,2% y 33,9%, de ideación suicida entre 6,7% y 25% mientras que el consumo de riesgo de alcohol se encuentra aproximadamente en torno al 20%, entre 2% y 13,4% se auto-prescriben medicamentos psicótropos y del 2,7% al 14% consumen otras sustancias. La mayoría de los estudios analizados adolecen de limitaciones metodológicas importantes lo que dificulta una adecuada comprensión del fenómeno. Las variaciones en las cifras de prevalencia tienen que ver con la disparidad de escalas y de criterios diagnósticos empleados, entre otros factores. Aún así, los estudios muestran que el consumo de alcohol y/u otras sustancias se correlacionan positivamente con el malestar emocional en los MIRs. Se hace necesario mejorar el conocimiento del diagnóstico dual en este grupo profesional para que se puedan prevenir y tratar sus consecuencias de manera más eficaz

The post-graduate period as a resident doctor (MIR, in Spanish) is usually associated with high emotional distress due to new professional demands and to other psychosocial factors. The objective of this study is to determine the characteristics of dual diagnosis among MIRs. A systematic review was carried out in MEDLINE (PubMed), Web of Science and Google Scholar databases, selecting articles published in English and Spanish between 1984 and 2017. A total of 2,415 articles were obtained: 2,276 were excluded by their title, 105 by the abstract and 17 after a complete review of the article; 17 papers were finally included. The prevalence of depressive symptoms among MIRs ranges from 10.2% to 70%, while the prevalence of anxious symptoms varies from 13.2% to 33.9%, from 6.7% to 25% reported suicidal ideation, 20% hazardous drinking, 2%-13.4% self-prescribed psychotropics, and 2.7%-14% used other drugs. Most studies present important methodological limitations, thus complicating adequate understanding of the phenomenon. High variations in prevalence data are related to differences in the psychometric scales and to disparity in diagnosis criteria, among other limitations. However, most studies report that alcohol and drug use is correlated with severe distress among MIRs. More research is needed to ascertain the nature of dual diagnosis in this professional group in order to effectively prevent and treat its serious consequences

Autoavaliação do conhecimento em cuidados paliativos por médicos residentes de um hospital universitário / Self-assessment of knowledge in paliative care by physicians resident of a university hospital / Autoevaluación de conocimientos en atención paliativa por médicos residentes de un hospital universitario

Objective: The study's purpose has been to verify the knowledge self-assessment of resident physicians at Hospital Universitário Lauro Wanderley (HULW) [University Hospital] regarding Palliative Care (PC). Methods: It is a quantitative, observational, and cross-sectional study that was carried out involving resident physicians at HULW who answered a questionnaire with sociodemographic and Palliative Care-related questions. Results: From a total of 172 physicians, 99 (57.6%) took part in this research, 47.5% were between 28 and 32 years old and 54.5% were female. Most of the participants claimed to have learned about the control of common symptoms in palliative assistance, although 97% needed improving their PC knowledge. Only 16.2% knew about the current PC Basic Law; However, over 80% understood the bioethical aspects of the research. Yet, over 75% of the answers which were compatible with PC knowledge occurred in only 5 out of the 16 questions (31.2%). Conclusion: There is a relative lack of knowledge regarding PC among the interviewed physicians, making further studies on curricular interventions imperative to contribute to the improvement of these professionals

Objetivo: Verificar a autoavaliação do conhecimento de médicos residentes do Hospital Universitário Lauro Wanderley (HULW) acerca de Cuidados Paliativos (CP). Métodos: Realizou-se um estudo observacional, transversal, quantitativo, envolvendo médicos residentes do HULW, que responderam ao questionário com perguntas sociodemográficas e conhecimentos em CP. Resultados: Dos 172 médicos, 99 (57,6%) participaram da pesquisa, 47,5% entre 28 e 32 anos e 54,5% do sexo feminino. A maioria respondeu que aprendeu sobre o controle dos sintomas comuns na assistência paliativista, embora 97% necessitassem aperfeiçoar seus conhecimentos sobre CP. Apenas 16,2% conheciam a atual Lei de Bases dos CP, porém mais de 80% compreendiam os aspectos bioéticos pesquisados. Contudo, mais de 75% de respostas compatíveis com conhecimento sobre CP ocorreram em apenas 5 das 16 questões (31,2%). Conclusão: Existe relativa escassez de conhecimento acerca dos CP entre os médicos entrevistados, tornando indispensáveis estudos adicionais de intervenções curriculares que possam contribuir para o aperfeiçoamento desses profissionais

Objetivo: verificar la autoevaluación del conocimiento de los médicos residentes en el Hospital Universitario Lauro Wanderley (HULW) sobre Cuidados Paliativos (CP). Métodos: se realizó un estudio observacional, transversal y cuantitativo con médicos residentes de HULW, que respondieron un cuestionario con preguntas sociodemográficas y conocimiento de los CP. Resultados: De los 172 médicos, 99 (57,6%) participaron en la investigación, 47,5% entre 28 y 32 años y 54,5% mujeres. La mayoría de los residentes respondieron que aprendió a respecto del control de los síntomas comunes en los CP, aunque el 97% respondieron que necesitaban mejorar su conocimiento de CP. Solo el 16,2% respondieron conocer la Ley Básica de CP actual, pero más del 80% conocían los aspectos bioéticos investigados. Sin embargo, los porcentajes superiores al 75% de las respuestas compatibles con el conocimiento de los CP ocurrieron en solo 5 de las 16 preguntas (31,2%). Conclusión: existe una relativa falta de conocimiento en el enfoque de los cuidados paliativos entre los médicos residentes entrevistados y a respecto de la ley actual de CP, haciendo necesidad de estudios adicionales de intervenciones curriculares que pueden contribuir para la mejora de habilidades y competencias de estos profesionales

Consideraciones sobre la necesidad de supervisión a los ingresantes a las residencias médicas / On the need for supervision of the entrants to medical residences

Según la Asociación Americana de Facultades de Medicina existen 13 actividades profesionales confiables que los graduados de medicina deberían poder realizar en su primer día de residencia sin supervisión directa. Esas actividades no están claramente definidas en nuestro país. Además, no existen datos locales sobre la necesidad de su supervisión. Nuestro objetivo fue evaluar la opinión de residentes y docentes acerca del nivel de supervisión que requieren los médicos ingresantes al sistema de residencias para realizar esas actividades. Se efectuó un estudio de corte transversal. Se incluyeron residentes de primer año de especialidades clínicas y quirúrgicas y sus docentes. Se enviaron encuestas electrónicas o en papel, con participación voluntaria y anónima. Se investigó la estimación sobre el nivel de supervisión que requerían los médicos ingresantes durante el primer mes de formación para 13 actividades. Se observaron diferencias significativas entre la evaluación hecha por residentes (n = 71) y los docentes (n = 39) en 11 de 13 de esas actividades. Más de la mitad de los docentes consideró que los residentes requerían supervisión directa para realizarlas, con las excepciones de formular interrogatorios clínicos y buscar evidencia. La mayoría de los residentes consideró que se requería supervisión directa solo en seis de ellas. En conclusión, los residentes estimaron requerir menor supervisión que sus docentes, quienes pensaban que los ingresantes al sistema de residencia no eran capaces de realizar la mayoría de las competencias clínicas de manera autónoma. Sería importante mejorar esta evaluación en los recién graduados, para definir con mayor precisión los niveles de supervisión.

According to the Association of American Medical Colleges, there are thirteen core Entrustable Professional Activities (EPAs) that medical graduates should be able to perform in their first day of residency, without direct supervision. In Argentina EPAs are not clearly defined. Moreover, there is no local data about the need of supervision regarding these activities. The aim of this study was to assess residents' and teaching physicians' estimations about the level of supervision that physicians in their first month of residency needed in order to perform EPAs. A cross-section study was conducted. First-year medical residents and teaching physicians were included. Electronic or paper surveys were sent, asking the level of supervision the participants estimated that residents needed to perform the 13 core EPAs, during their first month of residency. Participation was voluntary and anonymous. There were significant differences between the opinion of residents (n = 71) and teaching physicians (n = 39), for 11 out of 13 EPAs. More than half of the teaching physicians considered that residents needed direct supervision when performing EPAs, except for asking clinical questions and looking for evidence. Most residents thought that they required direct supervision in 6 EPAs. In conclusion, medical residents perceived the need of lower levels of supervision when compared to teaching physicians, who considered that medical graduates were not capable of performing most EPAs without direct supervision upon entering residency. Thus, it would be important to improve the procedures to evaluate the competences of medical graduates in order to establish more accurate supervision levels.

Seroprevalencia de Bordetella pertussis en el personal de enfermería y médicos residentes del Hospital Infantil de México Federico Gómez / Seroprevalence of Bordetella pertussis in pediatric healthcare workers at the Hospital Infantil de México Federico Gómez

Resumen Introducción Bordetella pertussis es el agente causal de la tosferina, una enfermedad de alta letalidad, especialmente en menores de 6 meses, pero prevenible mediante la vacunación. Los reportes en hospitales de brotes de tosferina muestran que el caso índice suelen ser personas adultas. En adultos, la enfermedad se manifiesta principalmente con tos persistente. El propósito de este estudio fue conocer la seroprevalencia de B. pertussis en el personal de salud de un hospital pediátrico en un país donde aún no se considera la vacunación obligatoria para los empleados. Métodos Participaron personal de enfermería y médicos residentes en trato directo con pacientes hospitalizados. A cada participante se le realizó detección de anticuerpos inmunoglobulina G, antitoxina de pertussis (anti-TP) y se le aplicó un cuestionario para datos clínicos y demográficos. Resultados Se incluyeron 93 individuos, el 85% de personal de enfermería con mediana de edad de 35 años (rango intercuartil: 29-42.5). El 21.5% de los participantes laboraban en el Servicio de Urgencias, el 8.6%, en la Unidad de Terapia Intensiva Pediátrica, el 6.5%, en la Unidad de Cuidados Intensivos Neonatales. Se encontraron títulos detectables de anticuerpos anti-TP en el 18.3%, de los cuales, el 53% presentaron títulos de infección reciente y solamente el 23.5%, historia de tos de más de dos semanas de evolución. Conclusiones El personal de salud está en riesgo de sufrir la enfermedad y de transmitirla a los lactantes, quienes pueden fallecer por esta causa. Este estudio sugiere que las políticas actuales de vacunación en personal de salud se deben de modificar para determinar obligatoriedad de la vacuna, especialmente en quienes atienden a la población pediátrica.

Abstract Background Bordetella pertussis is the causative agent of pertussis, a disease that is preventable by vaccination but has a high mortality, particularly in children < 6 months. Reports of pertussis outbreaks in hospitals show that the index case is usually an adult. In adults, the disease manifests mainly with persistent cough. The purpose of this study was to determine the seroprevalence of B. pertussis in the health personnel of a pediatric hospital in a country where vaccination of this staff is not considered mandatory. Methods Nursing staff and resident doctors who were involved in direct treatment with hospitalized patients participated in the study. Each participant was screened for immunoglobulin G anti-pertussis toxin antibodies (anti-PT), and a questionnaire was applied for clinical and demographic data. Results Ninety-three individuals were included, of which 85% were nurses, median age 35 years (interquartile range: 29-42.5). The participants worked in the emergency department (21.5%), in the Pediatric Intensive Care Unit (8.6%), and in the Neonatal Intensive Care Unit (6.5%). Detectable titers of anti-TP antibodies were found in 18.3%, of which 53% presented titles suggestive of recent infection and only 23.5% cough > 2 weeks of duration. Conclusions Health personnel are at risk of suffering from the disease and be potential transmitters to infants, who may die from this cause. This study suggests that the current vaccination policies in health personnel should be modified to determine the compulsory nature of the vaccination, especially in those individuals in charge of the care of the pediatric population.

Attitudes and experiences during training and professional expectations in generation-y surgical residents

SUMMARY BACKGROUND: Residency programs, especially in surgery, have been undergoing constant changes. The profile of residents in surgical fields is changing too since residents are now part of the Generation Y (Millenials). This change in profile mandates a re-evaluation to adapt surgical residency programs. Six years ago, we carried out a study evaluating attitudes and experiences during training, and the professional expectations of residents. This study aims to survey surgical residents to evaluate current attitudes, experiences, and expectations. METHODS: We surveyed 50 residents to determine professional satisfaction, residency-program satisfaction, future expectations, financial expectations, and correct attitude towards patients. RESULTS: Our results show that half of the residents are satisfied with the residency program. However, dissatisfaction reaches 40% on surgical volume and 80% on mentorship; 62% of the residents are not confident to perform operations after the residency, the majority believes a specialization is necessary; most residents believe financial compensation will decrease with time, but concerns with reimbursement are low; and most residents are worried about injuring patients, but only two thirds are satisfied working with patients. CONCLUSIONS: Current residents present lower job satisfaction and more criticism of teaching techniques. These changes compared to previous results match the profile of Generation Y, who is more iconoclastic when compared to previous generations.

RESUMO INTRODUÇÃO: Os programas de residência, especialmente em cirurgia, estão em constante mudança. O perfil dos residentes nos campos cirúrgicos também vem mudando, dado que atuais residentes fazem parte da Geração Y (Millennials). Essa mudança de perfil demanda uma reavaliação para adaptar os programas de residência. Este estudo tem como objetivo entrevistar os residentes de áreas cirúrgicas para avaliar suas atuais atitudes, experiência e expectativas. MÉTODOS: Entrevistamos 50 residentes para determinar satisfação profissional, expectativas em relação ao futuro, expectativas financeiras e atitude correta em relação aos pacientes. RESULTADOS: A insatisfação com o volume cirúrgico chega a 40% e a 80% com a preceptoria; 62% dos residentes não se sentem confiantes para realizar procedimentos sozinhos após o fim do programa e a maioria acredita que uma especialização cirúrgica é necessária; a maioria dos residentes acredita que os ganhos monetários diminuirão com o tempo. CONCLUSÃO: Os atuais residentes apresentam menor satisfação com o trabalho quando comparados com os antigos, e são mais críticos quanto ao ambiente de ensino. Essas mudanças seguem as premissas da Geração Y, cujos participantes são mais iconoclastas quando comparados a gerações passadas.

Leadership potential of physicians in a public teaching hospital in the city of São Paulo / Potencial de liderança em médicos de um hospital público de ensino na cidade de São Paulo

ABSTRACT Objective To analyze the leadership potential of physicians in a public hospital in the city of São Paulo. Methods A descriptive pilot study, in which 40 assistant physicians and medical residents were randomly selected to receive an electronic invitation of the company Caliper Estratégias Humanas do Brasil . To those who accepted it, a link was sent to fill out a personality evaluation focused on the work, comprising 112 alternatives related to 21 domains of 4 performance areas. According to the Caliper Profile Questionnaire, the ipsative measures expressed as a percentage are distributed on a Likert scale, and three categories are established based on behavioral tendencies at work: need for improvement, moderate and high potential. Results A total of 47.5% of physicians invited accepeted taking part in the study. Regarding to leadership, the need for improvement was over 30% among the evaluated physicians. In the interpersonal relationship analysis, only 18.4% of assistant physicians and 37% of medical residents required improvement. The percentage of physicians who needed improvement in problem-solving and decision-making was similar among the assistant and resident physicians (12.6% versus 14%). In the evaluation of personal organization and time management, we obtained similar percentages in assistant physicians and residents who needed improvement (14% in both groups). High potential leadership was observed in these domains (18.4% and 20% for assistant physicians and residents, respectively). Conclusion The physicians assessed presented high leadership potential in 25% of the cases, requiring improvement in the performance domains, such as interpersonal relationship, problem solving, decision-making, personal organization and time management.

RESUMO Objetivo Avaliar o potencial de liderança de médicos ativos de um hospital público na cidade de São Paulo. Métodos Estudo-piloto descritivo, no qual foram selecionados aleatoriamente 40 médicos assistentes e residentes para receberem o link com convite eletrônico da empresa Caliper Estratégias Humanas do Brasil. Aos que o aceitaram, foi encaminhado o link para preenchimento de avaliação de personalidade focada no trabalho, composta por 112 alternativas relativas a 21 domínios de 4 áreas de desempenho. De acordo com Questionário Perfil Caliper, as medidas ipsativas expressas em percentual são distribuídas em uma escala do tipo Likert, e são determinadas três categorias em relação às tendências comportamentais no trabalho: necessidade de aprimoramento, potencial moderado e alto potencial. Resultados A taxa de adesão dos médicos convidados ao estudo foi de 47,5% (19 médicos). No domínio liderança, a necessidade de aprimoramento ultrapassou 30% dos médicos avaliados. No relacionamento interpessoal, apenas 18,4% dos médicos assistentes necessitavam de aprimoramento e, no grupo dos médicos residentes, 37% necessitavam aprimoramento. Para resolução de problemas e tomada de decisões, as percentagens de necessidade de aprimoramento foram semelhantes (12,6% versus 14%). Na avaliação da organização pessoal e da administração do tempo, obtivemos percentagens semelhantes entre médicos assistentes e residentes, com necessidade de aprimoramento (14% nos dois grupos) e alto potencial nestas áreas (18,4% e 20% para médicos assistentes e residentes, respectivamente). Conclusão Os médicos avaliados apresentaram alto potencial de liderança em um quarto dos casos, necessitando aprimoramento nas áreas de desempenhos, como relacionamento interpessoal, resolução de problemas, tomada de decisão, organização pessoal e administração do tempo.

Satisfaction of Emergency Physicians with the Care Provided to Patients with Cardiovascular Diseases in the Northern Region of Minas Gerais / Satisfação de Médicos dos Serviços de Urgência com o Cuidado às Doenças Cardiovasculares na Região Ampliada Norte de Minas Gerais

Abstract Background: The dissatisfaction of health professionals in emergency services has a negative influence on both the quality of care provided for acute myocardial infarction (AMI) patients and the retention of those professionals. Objective: To assess physicians' satisfaction with the structure of care and diagnosis at the emergency services in the Northern Region of Minas Gerais before the implementation of the AMI system of care. Methods: This cross-sectional study included physicians from the emergency units of the ambulance service (SAMU) and level II, III and IV regional hospitals. Satisfaction was assessed by using the CARDIOSATIS-Team scale. The median score for each item, the overall scale and the domains were calculated and then compared by groups using the non-parametric Mann-Whitney test. Correlation between time since graduation and satisfaction level was assessed using Spearman correlation. A p value < 0.05 was considered significant. Results: Of the 137 physicians included in the study, 46% worked at SAMU. Most of the interviewees showed overall dissatisfaction with the structure of care, and the median score for the overall scale was 2.0 [interquartile range (IQR) 2.0-4.0]. Most SAMU physicians expressed their dissatisfaction with the care provided (54%), the structure for managing cardiovascular diseases (52%), and the technology available for diagnosis (54%). The evaluation of the overall satisfaction evidenced that the dissatisfaction of SAMU physicians was lower when compared to that of hospital emergency physicians. Level III/IV hospital physicians expressed greater overall satisfaction when compared to level II hospital physicians. Conclusion: This study showed the overall dissatisfaction of the emergency physicians in the region assessed with the structure of care for cardiovascular emergencies.

Resumo Fundamentos: A insatisfação dos profissionais de saúde dos serviços de urgência tem influência negativa na qualidade do cuidado ao infarto agudo do miocárdio (IAM) e na fixação desses profissionais. Objetivo: Avaliar a satisfação de médicos com a estrutura de atendimento e diagnóstico de serviços públicos de urgência na Região Ampliada Norte de Minas Gerais, previamente à implantação da linha de cuidado ao IAM. Métodos: Estudo transversal, que incluiu médicos das unidades de emergência do SAMU e de hospitais regionais nível II, III e IV. Foi avaliada a satisfação usando a escala CARDIOSATIS-Team. O escore mediano para cada item, a escala global e os domínios foram calculados e então comparados por grupos, utilizando o teste não paramétrico de Mann-Whitney. Foi avaliada a correlação entre tempo de formação e nível de satisfação com o método de Spearman. Um valor-p < 0,05 foi considerado significativo. Resultados: De 137 médicos incluídos, 46% trabalhavam no SAMU. A maior parte dos entrevistados demonstrou insatisfação geral com a estrutura de atendimento, cuja mediana da escala global foi 2,0 (intervalo interquartil [IQ] 2,0-4,0). A maioria dos médicos do SAMU demonstrou-se insatisfeita quanto a atendimento prestado (54%), estrutura para condução das doenças cardiovasculares (52%) e tecnologia disponível para diagnóstico (54%). Na avaliação da satisfação global, evidenciou-se que a insatisfação dos médicos do SAMU foi menor quando comparada à dos médicos de urgência hospitalar. Os médicos de hospitais nível III/IV demonstraram maior satisfação global quando comparados aos de hospitais nível II. Conclusão: Este estudo demonstrou insatisfação geral dos médicos dos serviços de urgência na região em relação à estrutura de atendimento às emergências cardiovasculares.

Prevalencia de Síndrome de Burn-Out en médicos de áreas críticas de la Clínica Universitaria Reina Fabiola / Prevalence of Burn-Out Syndrome in physicians in critical areas of the Clínica Universitaria Reina Fabiola

El Síndrome de Burn-Out fue descripto en 1974 y se caracteriza por una progresiva pérdida de energía, hasta llegar al agotamiento, con aumento de los síntomas de ansiedad y depresión. Este Síndrome se presenta con agotamiento emocional, despersonalización y disminución del sentimiento de realización personal, acompañado de un sentimiento de pérdida de prestigio o reconocimiento personal. (AU)

Burn-Out Syndrome was described in 1974 and is characterized by a progressive loss of energy, to exhaustion, with increased symptoms of anxiety and depression. This syndrome occurs with emotional exhaustion, depersonalization and diminished feeling of personal fulfillment, accompanied by a feeling of loss of prestige or personal recognition. (AU)

Patient safety: knowledge between multiprofessional residents / Segurança do paciente: conhecimento entre residentes multiprofissionais

ABSTRACT Objective To assess the knowledge of multiprofesional residents in health about the security of the patient theme. Methods Cross-sectional study, quantitative, developed with graduate courses/residence specialties of health in a public university of Paraná, Brazil. Participants (n=78) answered a questionnaire containing nine objective questions related to patient safety. Data were analyzed using descriptive statistics, in proportion measures. The minimum 75% of correct answers was considered the cutoff for positive evaluation. Results The sample was predominantly composed of young people from medical programs. Almost half of the items evaluated (n=5) achieved the established positive pattern, especially those who dealt with the hand hygiene moments (98.8%) and goal of the Patient Safety National Program (92.3%). The identification of the patient was the worst rated item (37.7%). In the analysis by professional areas, only the Nursing reached the standard of hits established. Conclusion Knowledge of the residents was threshold.

RESUMO Objetivo Verificar o conhecimento de residentes multiprofissionais na área da saúde sobre o tema segurança do paciente. Métodos Estudo transversal, quantitativo, desenvolvido com pós-graduandos dos cursos/especialidades de residência da área da saúde de uma universidade pública do Paraná. Os participantes (n=78) responderam um questionário contendo nove questões objetivas relacionadas com a segurança do paciente. Os dados foram analisados por estatística descritiva, em medidas de proporção. O mínimo de 75% de acertos foi considerado ponto de corte para avaliação positiva. Resultados A amostra foi composta por profissionais predominantemente jovens, oriundos de programas médicos. Quase metade dos itens avaliados (n=5) alcançou o padrão de positividade estabelecido, com destaque para os que trataram dos momentos de higienização das mãos (98,8%) e o objetivo do Programa Nacional de Segurança do Paciente (92,3%). A identificação do paciente foi o pior item avaliado (37,7%). Na análise por áreas profissionais, somente a Enfermagem alcançou o padrão de acertos estabelecido. Conclusão O conhecimento dos residentes foi limiar.