Cuidemos nuestro futuro / Let's Take Care Of Our Future

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Protocolo de actuación quirúrgica en casos confirmados o sospechosos de enfermedad por Ébola y otras enfermedades víricas altamente transmisibles / Surgical protocol for confirmed or suspected cases of Ebola and other highly transmissible diseases

Las epidemias por virus altamente transmisibles como la enfermedad por virus del Ébola (EVE) pueden generar casos importados a Europa y América. Aunque la probabilidad de actuación quirúrgica en ellas es baja, la Asociación Española de Cirujanos ha elaborado un protocolo de actuación quirúrgica. INDICACIÓN: No está indicada la cirugía electiva. Puede necesitarse cirugía urgente en: personas en observación, casos probables y casos confirmados en fase precoz. En algunas condiciones de habitual tratamiento quirúrgico puede instaurarse una terapia médica conservadora con intención de evitar la intervención. HOSPITALES Y EQUIPOS: Los casos deben concentrarse en hospitales de alta especialización, únicos centros en los que se practique una eventual intervención quirúrgica. Estos deben garantizar la seguridad de los profesionales. Los equipos quirúrgicos han de recibir extensa formación mediante simulación. PROTOCOLO QUIRÚRGICO: Las recomendaciones se basan en protocolos de uso del equipo de protección individual, guías clínicas de otras sociedades y recomendaciones específicas para el área quirúrgica

Outbreaks of viral haemorrhagic fevers such as Ebola can lead to imported cases in Europe and America. The eventuality of surgery in the setting of Ebola Virus Disease (EVD) is low, but the Spanish Association of Surgeons elaborated a surgical protocol for EVD. INDICATION: Elective surgical procedures are not indicated. Emergency cases can be considered in: persons under investigation, possible cases and early confirmed cases. In some conditions usually treated by surgery a medical treatment can be tested. HOSPITALS AND TEAMS: All cases must be treated in high technology hospitals. These hospitals must be equipped with adequate means for healthcare provider's protection. All members of the healthcare team should practice thorough simulation prior to caring for a possible Ebola patient. SURGICAL PROTOCOL: This protocol is based on international guidelines on use of Personal Protective Equipment, protocols of other scientific societies, and specific recommendations for the operating room environment

Surgical protocol for confirmed or suspected cases of Ebola and other highly transmissible diseases.

Outbreaks of viral haemorrhagic fevers such as Ebola can lead to imported cases in Europe and America. The eventuality of surgery in the setting of Ebola Virus Disease (EVD) is low, but the Spanish Association of Surgeons elaborated a surgical protocol for EVD. INDICATION: Elective surgical procedures are not indicated. Emergency cases can be considered in: persons under investigation, possible cases and early confirmed cases. In some conditions usually treated by surgery a medical treatment can be tested. HOSPITALS AND TEAMS: All cases must be treated in high technology hospitals. These hospitals must be equipped with adequate means for healthcare provider's protection. All members of the healthcare team should practice thorough simulation prior to caring for a possible Ebola patient. SURGICAL PROTOCOL: This protocol is based on international guidelines on use of Personal Protective Equipment, protocols of other scientific societies, and specific recommendations for the operating room environment.

¿Qué operan los residentes españoles durante la residencia?: análisis de la aplicabilidad del programa de la especialidad de Cirugía General y Digestiva al finalizar el periodo de residencia / The surgical experience of general surgery residents: An analysis of the applicability of the specialty program in General and Digestive Surgery

El entrenamiento quirúrgico siguiendo un periodo de residencia ha conseguido que los residentes en nuestro país posean una formación homogénea y satisfactoria para el desarrollo de su actividad profesional. Ello se debe a la existencia de planes de formación específicos para cada especialidad. El plan vigente promulgado en 2007 detallaba el número mínimo de intervenciones quirúrgicas y procedimientos que un cirujano debía haber efectuado para completar su periodo de formación. El objetivo de este estudio es conocer la aplicación del programa de la especialidad en cuanto al número de intervenciones practicadas durante el periodo de residencia. MATERIAL Y MÉTODOS: Se diseñó una hoja de recogida de datos que incluía la relación de intervenciones enunciada en el programa de la especialidad, que fue remitida en abril de 2014 a todos los hospitales que disponen de unidades acreditadas para la formación de residentes. En septiembre de 2014 se tabularon las respuestas remitidas y se efectuó un estudio estadístico descriptivo general, y un subanálisis en función del sexo del residente y de la comunidad autónoma. A la vez se analizó la actividad efectuada en función del número de residentes que existiera en cada unidad docente acreditada. RESULTADOS: La encuesta se remitió a los 117 hospitales con unidades acreditadas, que incluyen un total de 190 plazas ofertadas. De ellas se obtuvieron 91 respuestas (53%). La formación ofrecida se adapta en líneas generales a la propuesta por el plan de la especialidad. El número global de intervenciones practicadas de acuerdo a las diferentes subáreas, en cirugía laparoscópica y de urgencias, cumple o supera las cifras previstas, excepto en cirugía esofagástrica y HPB. El subanálisis de la actividad quirúrgica según la comunidad autónoma no evidencia diferencias significativas en el número total de intervenciones, sin embargo, sí se objetivan diferencias en cirugía endocrina (p = 0,001) y de la mama (p = 0,042). Un 55% de los residentes eran mujeres, sin diferencias significativas en cuanto a su distribución en las comunidades autónomas. Sin embargo, las cirujanas operan más que los cirujanos durante la residencia (625 ± 244 vs 527 ± 209; p < 0,01). También se observa que el número de residentes adscrito a cada unidad docente se correlaciona con el número de intervenciones realizadas: han efectuado más intervenciones los cirujanos que están solos en su unidad que aquellos que tienen compañeros de su mismo año (669 ± 237 vs. 527 ± 209; p = 0,004). CONCLUSIÓN: La actividad quirúrgica efectuada por los cirujanos españoles se adecua a la propuesta por el plan actual de la especialidad, excepto en cirugía HPB y esofagogástrica. La distribución es homogénea de acuerdo a las comunidades autónomas, aunque existen diferencias en función del número de residentes por hospital y el sexo del residente. Esta información es esencial para evaluar la idoneidad del plan de formación y el diseño de nuevos planes formativos

Residents in our country have achieved a homogenous surgical training by following a structured residency program. This is due to the existence of specific training programs for each specialty. The current program, approved in 2007, has a detailed list of procedures that a surgeon should have performed in order to complete training. The aim of this study is to analyze the applicability of the program with regard to the number of procedures performed during the residency period. MATERIAL AND METHODS: A data collection form was designed that included the list of procedures from the program of the specialty; it was sent in April 2014 to all hospitals with accredited residency programs. In September 2014 the forms were analysed, and a general descriptive study was performed; a subanalysis according to the resident's sex and Autonomous region was also performed. The number of procedures performed according to the number of residents in the different centers was also analyzed. RESULTS: The survey was sent to 117 hospitals with accredited programs, which included 190 resident places. A total of 91 hospitals responded (53%). The training offered adapts in general to the specialty program. The total number of procedures performed in the different sub-areas, in laparoscopic and emergency surgery is correct or above the number recommended by the program, with the exception of esophageal-gastric and hepatobiliary surgery. The sub-analysis according to Autonomous region did not show any significant differences in the total number of procedures, however, there were significant differences in endocrine surgery (P = .001) and breast surgery (P = .042). A total of 55% of residents are female, with no significant differences in distribution in Autonomous regions. However, female surgeons operate more than their male counterparts during the residency period (512 ± 226 vs. 625 ± 244; P < .01). The number of residents in the hospital correlates with the number of procedures performed; the residents with more procedures trained in hospitals where there were less residents (669 ± 237 vs. 527 ±2 09; P = .004). CONCLUSION: The surgical activity performed by spanish surgeons is adequate to the specialty program, except in hepatobiliary and esophageal-gastric surgery. The distribution is homogeneous in the different autonomous regions, although there are differences that depend on the number and sex the of residents in each hospital. This information is essential to evaluate the quality of the specialty program and to design new training programs

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)

Advanced trauma life support, 8th edition, the evidence for change.

The American College of Surgeons Committee on Trauma's Advanced Trauma Life Support Course is currently taught in 50 countries. The 8th edition has been revised following broad input by the International ATLS subcommittee. Graded levels of evidence were used to evaluate and approve changes to the course content. New materials related to principles of disaster management have been added. ATLS is a common language teaching one safe way of initial trauma assessment and management.