Estudio prospectivo, multicéntrico sobre la actividad de los residentes de cirugía general y del aparato digestivo en España a través del libro informático del residente / A prospective, multicentre study on the activity of general and digestive surgery residents based on the use of the computerised logbook

Introducción: No hay datos cuantificados de la actividad real conseguida durante los 5 años de formación en España de la especialidad de Cirugía General y del Aparato Digestivo (CGAD). Igualmente, hay escasos datos en los programas de otros países y especialidades quirúrgicas. El objetivo es estimar la actividad media quirúrgica global, por áreas de capacitación específica y grado de complejidad, del programa español de la especialidad. Participantes y método Estudio multicéntrico prospectivo observacional sobre la actividad de los residentes de CGAD en España a través del libro informático del residente de la Asociación Española de Cirujanos (LIR-AEC). Cada residente registra su propia actividad supervisado por su tutor. El periodo de muestra fue de 6 meses. A partir de los resultados se estimaron las medianas de actividad anual y del periodo de la residencia. Resultados Actividad quirúrgica: se ha estimado que durante la residencia asisten a 1.325 intervenciones, realizan como cirujano principal 654 (49%). Actividad asistencial: la media de guardias es de 5,2±1,8 al mes. La actividad en consultas externas es de 548 primeras visitas y casi el doble de segundas visitas. Actividad científica: el número total de cursos y congresos es de 34. La media estimada de comunicaciones a congresos es de 14 y de publicaciones de 3.ConclusionesEl LIR-AEC es una herramienta adecuada para verificar la actividad del programa español de CGAD. Estos resultados permitirán una evaluación comparativa con la formación de los programas de otros países y especialidades quirúrgicas (AU)

Introduction: There are no quantified data on the real activity carried out by residents during the 5 years of training in the specialty of general and digestive surgery (GGS) in Spain. There are also limited data on programs in other surgical specialities, and in other countries. The aim of the study is to estimate the mean overall surgical activity by (..) (AU)

[A prospective, multicentre study on the activity of general and digestive surgery residents based on the use of the computerised logbook]. / Estudio prospectivo, multicéntrico sobre la actividad de los residentes de cirugía general y del aparato digestivo en España a través del libro informático del residente.

INTRODUCTION: There are no quantified data on the real activity carried out by residents during the 5 years of training in the specialty of general and digestive surgery (GGS) in Spain. There are also limited data on programs in other surgical specialities, and in other countries. The aim of the study is to estimate the mean overall surgical activity by specific skill areas and by the level of complexity of the Spanish program in the specialty of GGS. PATIENTS AND METHOD: A prospective, observational, multicentre study was performed on the activity of GGS residents in Spain using the Resident Computerised Logbook of the Spanish Surgeons Association (LIR-AEC). Each of the residents registered their own activity supervised by their tutor. The sample period was 6 months. The medians of the annual activity and the period of residency were calculated from the results. RESULTS: Surgical activity: during the residency, it was estimated that that they attended 1,325 operations, 654 (49%) as lead surgeon. Health care activity: the mean number of times on-call was 5.2±1.8 per month. Activity in outpatient clinics was 548 first visits, and almost double for second visits. Scientific activity: the total number of courses and conferences attended was 34. The estimated mean number of presentations at conferences was 14, with 3 publications. CONCLUSIONS: LIR-AEC is a suitable tool to verify activity in the Spanish GGS Program. These results may be useful for comparing with training programs in other countries and in other surgical specialties.

Análisis de la calidad asistencial del tratamiento quirúrgico del cáncer colorrectal en 2008. Estudio de ámbito nacional / Analysis of the quality of surgical treatment of colorectal cancer, in 2008. A national study

Objectivos: Estudio de ámbito nacional realizado por la Asociación Española de Cirujanos con el objetivo de analizar el tratamiento quirúrgico del cáncer colorrectal (CCR) en España y compararlo con la bibliografía. Material y métodos: Estudio multicéntrico descriptivo, prospectivo y longitudinal de pacientes intervenidos quirúrgicamente de forma programada por CCR. Han participado 50 hospitales de 15 comunidades autónomas aportando 496 casos intervenidos en 2008. Se han recogido 88 variables. Resultados: Mediana de edad 72 años, aumento de pacientes ASA III, preoperatorio correcto, en el recto un 4% sin estatificar. Tendencia a no realizar preparación del colon o a hacerlo únicamente un día. Los porcentajes de complicaciones están en rangos de la bibliografía excepto infección de herida quirúrgica (19%). Media de ganglios resecados: 13,2; 4,3% no resección mesorrectal. Anastomosis mecánicas: 80,8%, 65,9% de las intervenciones realizadas por cirujano colorrectal, Radioterapia preoperatoria en cáncer de recto 43,5%. Quimioterapia 32,9%. Laparoscopia: 35,1% de los casos, índice de conversión 13,8%. Uso de antibióticos: 37,1%, transfusión sanguínea: 20,6% y nutrición parenteral: 26,5%. Conclusiones: El tratamiento quirúrgico del CCR en España tiene un nivel de calidad y unos resultados perioperatorios similares al resto de Europa. Respecto a estudios previos, se observan avances en la preparación del paciente, estudio preoperatorio, técnicas de imagen y mejoras en técnica quirúrgica con adopción de escisión del mesorrecto, linfadenectomías adecuadas y preservación de esfínteres. Existen áreas de mejora como disminución de la infección de la herida quirúrgica, mayor uso de estomas de protección, uso adecuado de antibióticos, nutrición parenteral o neoadyuvancia y colonoscopias completas (AU)

Objective: A national study conducted for the Spanish Association of Surgeons with the aim of analysing the surgical treatment of colorectal cancer (CRC) in Spain and to compare it with scientific literature. Material and methods: A multicentre, descriptive, prospective and longitudinal study of patients with CRC who were treated by elective surgery. A total of 50 hospitals in 15 Autonomous Regions took part, with 496 treated cases in 2008. A total of 88 variables were collected. Results: The median age was 72 years, increase in ASA III patients; correct preoperative studies, 4% with no staging in the rectum. There was a tendency not to use the colon cleansing or to do it only one day. The percentage of complications is within the ranges in the literature, with the exception of surgical wound infections (19%). Mean of resected lymph nodes: 13.2; 4.3% no mesorectal resection. Mechanical anastomosis: 80.8%, 65.9% of the operations performed by a colorectal surgeon. Preoperative radiotherapy in 43.5% of rectal cancers. Chemotherapy: 32.9%. Laparoscopy: 35.1% of cases, conversion rate 13.8%. Use of antibiotics: 37.1%, blood transfusion: 20.6% and parenteral nutrition: 26.5%. Conclusions: Surgical treatment of CRC in Spain has a level of quality and peri-operative results similar to the rest of Europe. Compared to previous studies, it was observed that there were advances in preparation of the patient, preoperative studies, imaging techniques, and improvements in surgical techniques with adoption of mesorectal excision, appropriate lymphadenectomies and preservation of sphincters There are areas for improvement, such as a reduction in surgical wound infections, increase use of protective stoma, appropriate use of antibiotics, parenteral nutrition or neoadjuvants and complete colonoscopies (AU)

[Analysis of the quality of surgical treatment of colorectal cancer, in 2008. A national study]. / Análisis de la calidad asistencial del tratamiento quirúrgico del cáncer colorrectal en 2008. Estudio de ámbito nacional.

OBJECTIVE: A national study conducted for the Spanish Association of Surgeons with the aim of analysing the surgical treatment of colorectal cancer (CRC) in Spain and to compare it with scientific literature. MATERIAL AND METHODS: A multicentre, descriptive, prospective and longitudinal study of patients with CRC who were treated by elective surgery. A total of 50 hospitals in 15 Autonomous Regions took part, with 496 treated cases in 2008. A total of 88 variables were collected. RESULTS: The median age was 72 years, increase in ASA III patients; correct preoperative studies, 4% with no staging in the rectum. There was a tendency not to use the colon cleansing or to do it only one day. The percentage of complications is within the ranges in the literature, with the exception of surgical wound infections (19%). Mean of resected lymph nodes: 13.2; 4.3% no mesorectal resection. Mechanical anastomosis: 80.8%, 65.9% of the operations performed by a colorectal surgeon. Preoperative radiotherapy in 43.5% of rectal cancers. Chemotherapy: 32.9%. Laparoscopy: 35.1% of cases, conversion rate 13.8%. Use of antibiotics: 37.1%, blood transfusion: 20.6% and parenteral nutrition: 26.5%. CONCLUSIONS: Surgical treatment of CRC in Spain has a level of quality and peri-operative results similar to the rest of Europe. Compared to previous studies, it was observed that there were advances in preparation of the patient, preoperative studies, imaging techniques, and improvements in surgical techniques with adoption of mesorectal excision, appropriate lymphadenectomies and preservation of sphincters. There are areas for improvement, such as a reduction in surgical wound infections, increase use of protective stoma, appropriate use of antibiotics, parenteral nutrition or neoadjuvants and complete colonoscopies.

Formación quirúrgica en España: resultados de una encuesta nacional / Surgical training in Spain: Results of a national survey

Introducción: El objetivo del estudio intenta realizar una aproximación al estado de la formación quirúrgica en España y analizar su adecuación a los objetivos del programa. Material y métodos: Se presentan y se analizan los resultados de dos encuestas realizadas por la Asociación Española de Cirujanos a los residentes y a los tutores de Cirugía General basadas en las conclusiones del XXVII Congreso Nacional de Cirugía. Las cuestiones formuladas hacían referencia a aspectos generales del servicio y particulares en relación con el acceso, la actividad docente, la actividad quirúrgica, la actividad investigadora y las perspectivas personales. Las respuestas fueron definidas, adaptadas y categorizadas como variables cuantitativas y cualitativas. Se utilizó un programa estadístico G Stat 2.0 para el procesamiento y la presentación descriptiva de los resultados. Resultados: El número de residentes y tutores a quienes se enviaron las encuestas fue de 626 y 142. Fueron respondidas el 19% de las encuestas de residentes y el 29% de las encuestas de tutores. Según el año de residencia, predominaron las de residentes de primer año (32%) frente a los de años ulteriores, siendo el índice de respuesta de los R5 del 7,2%. El 91% conocía bien el programa de la especialidad y el 76% estaba satisfecho con la formación recibida. Conclusiones: Los resultados obtenidos en cuanto a actividad quirúrgica concuerdan con los previstos en el programa tanto en el número de procedimientos como en su progresión a lo largo de la residencia, aunque no es posible asegurar su uniformidad. Las funciones y la acreditación de los tutores que constituyen uno de los pilares fundamentales del proceso formativo están pendientes de regulación específica (AU)

Introduction: The aim of the study is to try and find out the state of surgical training in Spain and to determine whether it meets the objectives of the Program. Material and methods: The results of two surveys carried out on Residents and General Surgery Tutors by the Spanish Surgeons Association, based on the conclusions of the XXVII Congreso Nacional de Cirugía. The questions formulated referred to general aspects of the Service and specific ones related to access, teaching activity, surgery, research and personal perspectives. The responses were defined, adjusted and categorised as quantitative and qualitative variables. The statistics program G Stat 2.0 was used for processing and the descriptive presentation of the results. Results: The surveys were sent to 626 Residents and 142 Tutors, with a response rate of 19% and 29%, respectively. First year residents predominated (32%) compared to later years, with an R-5 response index of 7.2%. A total of 91% knew the speciality Program well, and 76% were satisfied with the training received. Conclusions: The results obtained as regards surgical activity agree with those established in the Program, both in the number of procedures and in their progression throughout the Residency, although it is not possible to ensure its uniformity. The functions and accreditation of the Tutors which are one of the main foundations of the training process are pending specific regulations (AU)

[Surgical training in Spain: results of a national survey]. / Formación quirúrgica en España: resultados de una encuesta nacional.

INTRODUCTION: The aim of the study is to try and find out the state of surgical training in Spain and to determine whether it meets the objectives of the Program. MATERIAL AND METHODS: The results of two surveys carried out on Residents and General Surgery Tutors by the Spanish Surgeons Association, based on the conclusions of the XXVII Congreso Nacional de Cirugía. The questions formulated referred to general aspects of the Service and specific ones related to access, teaching activity, surgery, research and personal perspectives. The responses were defined, adjusted and categorised as quantitative and qualitative variables. The statistics program G Stat 2.0 was used for processing and the descriptive presentation of the results. RESULTS: The surveys were sent to 626 Residents and 142 Tutors, with a response rate of 19% and 29%, respectively. First year residents predominated (32%) compared to later years, with an R-5 response index of 7.2%. A total of 91% knew the speciality Program well, and 76% were satisfied with the training received. CONCLUSIONS: The results obtained as regards surgical activity agree with those established in the Program, both in the number of procedures and in their progression throughout the Residency, although it is not possible to ensure its uniformity. The functions and accreditation of the Tutors which are one of the main foundations of the training process are pending specific regulations.

[General surgery and the digestive system: new program, same challenges]. / Formación en cirugía general y del aparato digestivo: nuevo programa, mismos retos.

On 8 may 2007, the Official Bulletin (BOE) published the new Specialist Training Program. The Post-Graduate Training Section of the Spanish Surgeons Association (AEC), conscious of the importance of this situation, has carried out a reflective analysis of this Program and proposes a series of objectives. The new plan coordinates a training program that sets out three general objectives as regards, knowledge, skills and attitudes that the resident must assimilate and develop, it strictly defines the final product, without substantially changing the previous program and emphasises two fundamental aspects: training in minimally invasive surgery and research training, although the inclusion of previously unpublished new rotations and the continuation of the current assessment model. The logic in the definition of general surgery as "a major discipline paradigm" should lead to important structural changes. Aspects such as regulating work and training times, European Directives, lack of professional motivation and changes in the vocational spectrum of new residents, will make the optimisation of the results difficult a priori. The year 2017 will be the time to judge the results after five groups of surgeon graduates have been trained by this program.

Formación en cirugía general y del aparato digestivo: nuevo programa, mismos retos / General surgery and the digestive system: new program, same challenges

El 8 de mayo de 2007 se publicó en el BOE el nuevo Programa Formativo de la Especialidad. La Sección de Formación Posgraduada de la AEC, consciente de la trascendencia de esta situación, ha realizado un análisis preliminar reflexivo de él y propone una serie de objetivos. El nuevo plan articula un programa formativo que establece 3 objetivos generales en relación con los conocimientos, habilidades y actitudes que el residente debe asimilar y desarrollar, define puntualmente el producto final, sin modificaciones sustanciales con el anterior programa y potencia 2 aspectos fundamentales: la formación en cirugía mínimamente invasiva y la formación investigadora, aunque sorprende la incorporación de nuevas rotaciones, anteriormente inéditas, y la continuidad del modelo actual de evaluación. La coherencia en la definición de la cirugía general como “paradigma de disciplina troncal” debería suponer modificaciones estructurales importantes. Aspectos como regulación del tiempo de trabajo y formativo, directrices europeas, desmotivación profesional y modificación del espectro vocacional de los nuevos residentes dificultarán a priori la optimización del resultado. En 2017 y tras 5 promociones de cirujanos así formados será momento de juzgar los resultados de este programa (AU)

On 8 may 2007, the Official Bulletin (BOE) publi-shed the new Specialist Training Program. The Post-Graduate Training Section of the Spanish Surgeons Association (AEC), conscious of the importance of this situation, has carried out a reflective analysis of this Program and proposes a series of objectives. The new plan coordinates a training program that sets out three general objectives as regards, knowledge, skills and attitudes that the resident must assimilate and develop, it strictly defines the final product, without substantially changing the previous program and emphasises two fundamental aspects: training in minimally invasive surgery and research training, although the inclusion of previously unpublished new rotations and the continuation of the current assessment model. The logic in the definition of general surgery as “a major discipline paradigm” should lead to important structural changes. Aspects such as regulating work and training times, European Directives, lack of professional motivation and changes in the vocational spectrum of new residents, will make the optimisation of the results difficult a priori. The year 2017 will be the time to judge the results after five groups of surgeon graduates have been trained by this program (AU)

La cirugía que se avecina. La cirugía mujer. Respuesta del autor / The surgery to come. The feminization of surgery. Author’s response

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Proyecto de programa de la especialidad de cirugía general y del aparato digestivo / Update on the residency training program in the Specialty of General and Digestive Surgery

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La cirugía que se avecina: disminución de vocaciones y cambios en la forma de enseñarla y de ejercerla / The surgery to come: less vocation and changes in the form of teaching and practicing surgery

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Informe sobre los criterios para establecer prioridades al incluir pacientes en lista de espera de cirugía / Report on criteria for establishing priorities when including patients on the surgical waiting list

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