A Call for Action for an Association of Program Directors in Surgery in Mexico.

General surgery (GS) residency remains among medical students' most pursued post-graduate training programs. However, the vast heterogeneity of GS programs in Mexico remains a cause of concern. For instance, as of 2018, among 169 official programs registered in Mexico, certified by 33 universities, all varied in size, location, academic activities, and surgeries performed. Establishing continuous, uniform, and modern education is of utmost importance. The development of a society solely dedicated to the training and formation of GS residents in Mexico may prove to be a valuable and efficient tool to tackle these issues. On this perspective, we call for action for the creation of a Program Directors Association in Surgery in Mexico to establish an action plan and implement changes that ensure high standards of surgical residencies around the nation. These ideas are relevant for all countries and should be promoted to develop strategies that enhance the quality of surgical education all-around.

Perspectives on the Fellowship Training in Cardiac, Thoracic, and Vascular Anesthesia and Critical Care in Europe From Program Directors and Educational Leads Around Europe.

This article reviews fellowship training in adult cardiac, thoracic, and vascular anesthesia and critical care from the perspective of European program initiators and educational leaders in these subspecialties together with current training fellows. Currently, the European Association of Cardiothoracic Anaesthesiology (EACTA) network has 20 certified fellowship positions each year in 10 hosting centers within 7 European countries, with 2 positions outside Europe (São Paulo, Brazil). Since 2009, 42 fellows have completed the fellowship training. The aim of this article is to provide an overview of the rationale, requirements, and contributions of the fellows, in the context of the developmental progression of the EACTA fellowship in adult cardiac, thoracic, and vascular anesthesia and critical care from inception to present. A summary of the program structure, accreditation of host centers, requirements to join the program, teaching and assessment tools, certification, and training requirements in transesophageal electrocardiography is outlined. In addition, a description of the current state of EACTA fellowships across Europe, and a perspective for future steps and challenges to the educational program, is provided.

Board social capital and structure, ownership and financial variables of Brazilian companies: A three levels dataset integrating directors, board networks and firm characteristics.

This data article incorporates, in an unbalanced panel data, five variables types: financial and market; board structure; board network and social capital; ownership and governance level; the cost of capital. The dataset is formed of 6024 firm-level annual observations based on 622 Brazilian public companies investigated between the years of 2002 and 2015, totaling 56 variables. A three-level data structure was created to allow aggregate directors and network board data into the panel data. Directors' data and adjacency matrix are included to allow for multilevel hierarchical analyzes as well as the use of analytical methods of social networks.

The Clinical Competency Committee in Adult Cardiothoracic Anesthesiology-Perspectives From Program Directors Around the United States.

The clinical competency committee offers a fellowship program a structured approach to assess the clinical performance of each trainee in a comprehensive fashion This special article examines the structure and function of this important committee in detail. Furthermore, the strategies for the optimal functioning of this committee are also discussed as a way to enhance the overall quality of the fellowship program.

Aquecimento do diretor de psicodrama para o trabalho com grandes grupos / The psychodrama director's warm-up in preparation for sessions with large groups / Preparación del director de psicodrama para el trabajo con grandes grupos

Este artigo discute a importância do aquecimento do diretor de Psicodrama para o trabalho com grandes grupos e analisa a utilização de um plano de direção como instrumento facilitador desse processo, a partir do relato de uma experiência. Considerando aspectos da teoria e da prática psicodramáticas, conclui-se que o aquecimento do diretor pode facilitar o desenvolvimento de um trabalho organizado, estético, espontâneo-criativo.

This article discusses the importance of the Psychodrama directors' warm-up in order to work with large groups and analyses the use of a direction plan as a facilitating instrument of this process, based on the narrative of an experience. As a conclusion, considering the aspects of psychodrama theory and practice, director's warm-up may facilitate the development of a organised, aesthetic and spontaneous-creative work.

Este artículo discute la importancia de la preparación del director de Psicodrama para el trabajo con grandes grupos y analiza la utilización de un plan de dirección como instrumento facilitador de ese proceso, a partir del relato de una experiencia. Considerando los aspectos de la teoría y de la práctica psicodramáticas, se concluye que la preparación del director puede facilitar el desarrollo de un trabajo organizado, estético, espontáneo-creativo.

Relación entre gestión del director y satisfacción del usuario externo en centros de salud de un distrito del Ecuador / Relationship between director management and the external user satisfaction in health centers in a district of Ecuador

La gestión sanitaria, su competencia y conducción directiva, se ha ejercitado con protagonismo médico. Cambios en su enfoque evolucionaron a centrar las acciones en el usuario externo al logro de su satisfacción. Estudios independientes de gestión y satisfacción visualizaron diferentes efectos de resultados ante organizaciones, gestores y usuarios. Es relevante priorizar nodos críticos entre sus dimensiones para elaborar proyectos de mejora continua. Objetivo. Establecer la relación entre la gestión del director y la satisfacción del usuario externo. Diseño. Estudio transversal, de correlación. Lugar. Distrito 17D09 del Ecuador. Participantes. Nueve directores de centros de salud y 652 usuarios externos. Intervención. Muestreo aleatorio simple, juicio de expertos, formularios válidos: SERVQUAL modificado de satisfacción y EVAL O1-MRL de gestión, consentimiento informado, análisis en sistemas SPSS V20, Excel. Principal medida de resultado. Índice de gestión del director. Resultados. La gestión del director fue 56% de nivel regular y 44% satisfactoria. La insatisfacción del usuario externo fue 89% de nivel moderada y 11% leve. La mala calidad de atención institucional fue 100%. El nivel de correlación dimensional fue variado entre gestión e insatisfacción tipo: negativa débil (-0,28 y -016); positiva débil (0,31) y negativa fuerte (-0,52 y -070). Conclusiones. Existió correlación directa significativa entre una gestión inadecuada y la insatisfacción del usuario.

Introduction: Health management, competence and policy conduction, has exercised with medical prominence. The change in approach evolved to focus their actions on the external user to achieve their satisfaction. Independent studies on management and satisfaction visualized different effects of organizations, managers and users results. It is relevant to prioritize critical nodes between its dimensions in order to develop projects of continuous improvement. Objective: To establish the relationship between the director management and the external user satisfaction. Design: Cross-sectional, correlation study. Setting: District 17D09, Ecuador. Participants: Nine directors of health centers and 652 external users. Interventions: Simple random sampling, expert judgment, validated forms: satisfaction modified SERVQUAL, and management EVAL O1-MRL, informed consent, SPSS V20 analysis, Excel software. Main outcome measure: Director´s Management Index. Results: Director's management was of regular level in 56% and satisfactory in 44%. External user dissatisfaction was moderate in 89% and mild in 11%. The institutional care was of poor quality in 100%. The level of dimensional correlation was varied between management and dissatisfaction: weak negative (-0.28and -016), weak positive (0.31) and strong negative (-0.52 and -070). Conclusions: There was a direct and significant correlation between poor management and patient dissatisfaction.

The link between quality and accreditation of residency programs: the surveyors' perceptions.

Accreditation of medical residency programs has become globally important. Currently it is moving from the goal of attaining minimal standards to a model of continuous improvement. In some countries, the accreditation system engages peers (physicians) to survey residency programs. The surveyors are sometimes volunteers, usually engaged in multiple clinical and education activities. Few studies have investigated the benefits of residency program evaluation and accreditation from the perspective of the surveyors. As peers they both conduct and receive accreditation surveys, which puts them in a privileged position in that it provides the surveyor with an opportunity to share experiences and knowledge and apply what is learned in their own context. The objective of this study is to obtain the perceptions of these surveyors about the impact of an accreditation system on residency programs. Surveyors participated in semi-structured interviews. A thematic analysis was performed on the interview data, and resulting topics were grouped into five themes: Burden (of documentation and of time needed); Efficiency and efficacy of the accreditation process; Training and experience of surveyors; Being a peer; Professional skills and recognition of surveyors. These categories were organized into two major themes: 'Structure and Process' and 'Human Resources'. The study participants proposed ways to improve efficiency including diminish the burden of documentation to the physicians involved in the process and to increase efforts on training programs and payment for surveyors and program directors. Based on the results we propose a conceptual framework to improve accreditation systems. ABBREVIATIONS: PD: Program director.

Grupo autodirigido: uma estratégia para o desenvolvimento do papel de diretor e ego-auxiliar / The Self-directed Group: a strategy for developing the roles of director and auxiliary ego / Grupo Autodirigido: una estrategia para el desarrollo del rol de director y ego auxiliar

Este artigo apresenta uma experiência de grupo autodirigido visando ao desenvolvimento do papel de diretor e ego-auxiliar em Psicodrama, em um curso de formação de Pós-Graduação lato sensu. A formação das duplas de direção deu-se por livre escolha, de acordo com seus interesses, suas afinidades, com base em suas áreas de atuação profissional. As direções foram tematizadas atendendo às demandas profissionais das duplas, ou segundo as necessidades do grupo. Os resultados evidenciaram ganhos significativos no desenvolvimento do papel de diretor e ego-auxiliar dos alunos em processo formativo na área de Psicodrama.

This article presents the experience of a self-directed group aiming to develop the roles of director and auxiliary ego in Psychodrama, as applied in a post-graduate training programme. Pairs of directors were formed through free choice, according to their interests, affinities, and areas of professional practice. The action was focused around themes, in response to the professional needs of the pairs or in accordance with the needs of the group. The results showed significant gains in the development of the director and auxiliary ego roles for Psychodrama trainees.

Este artigo presenta una experiencia de grupo autodirigido que tiene como meta el desarrollo del rol de director y de ego auxiliar en Psicodrama, en un curso de formación de Posgrado sin título. Las parejas de dirección se formaron por libre elección, de acuerdo a sus interés, sus afinidades y a partir de sus áreas de actuación profesional. Las direcciones se tematizaron para satisfacer las demandas profesionales de las parejas, o según las necesidades del grupo. Los resultados mostraron avances significativos en el desarrollo del rol de director y ego auxiliar de los estudiantes en proceso de formación en el campo del Psicodrama.

Psicodrama com crianças: das intervenções clínicas às psicossociais / Psychodrama with children: from clinical to psycho-social interventions / Psicodrama con niños: de las intervenciones clínicas hacia las psicosociales

O texto apresenta intervenções clínicas e socioeducacionais com crianças, a partir dos trabalhos de psicoterapia individual, grupal e de trabalhos institucionais. Conceitua e mostra como a Realidade Suplementar pode ser de grande valia no trabalho familiar com crianças pequenas, ao permitir a ressignificação das relações em status nascendi e a diminuição do sintoma. Pontua a importância da subjetividade do diretor no manejo de um grupo psicoterápico. Mostra intervenções socioeducacionais na Casa do Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC) que visam ir aonde a demanda se encontra, atualizando um movimento instituinte. Por fim, pontua as especificidades das intervenções no trabalho com crianças nos focos psicoterápico e socioeducacional e sinaliza a importância da formação de psicodramatistas que trabalham com crianças.

This text presents clinical and psychosocial interventions with children, based on individual and group psychotherapy, as well as organizational practices. We describe how Surplus Reality can be of great value when working with young children and their families, enabling to bring new meanings to relationships in their status nascendi and to reduce symptoms. We emphasize the importance of the director's subjectivity when conducting a psychotherapy group. We describe the socio-educational interventions that were used at the Support House for Children and Adolescents with Cancer (GRAACC), which aim to go where the demand is, bringing a fresh approach to the work of institutions. Finally, we discuss the specificities of working with children psychotherapeutically and socio-educationally and the importance of training for psychodramatists working with children.

El texto presenta las intervenciones clínicas y socioeducativas con niños, partiendo de los trabajos de psicoterapia individual, grupal e institucionales. Dessarrolla el concepto y muestra cómo la Realidad Suplementar puede ser de gran valor para el trabajo familiar con niños pequenos, permitiendo así, el replanteamiento de las relaciones en status nascendi y la disminución del síntoma. Señala la importancia de la subjetividad del director en la condución de un grupo psicoterapéutico. Muestra intervenciones socioeducativas en la Casa de Atención a Niños y Adolescentes con Cáncer (GRAACC) destinada a caminar en la dirección de la demanda, actualizando un movimiento instituyente. Por fin, señala las especificidadesde de las intervenciones en el trabajo con los niños en los enfoques psicoterapéutico y socioeducativo y enfatiza la importancia de la formación de psicodramatistas que trabajan con niños.

O mal-estar docente em gestores escolares / The malaise in teaching school director / El malestar docente endirectores de enseñanza escolar

Esta pesquisa objetivou identificar e analisar o impacto de eventos estressores em gestores escolares associados ao mal-estar docente. Participaram 29 gestoras, na função de diretoras ou vice-diretoras de rede municipal, do interior do Estado de São Paulo, com respostas ao Inventário IMPIL (Evaluación Psicológica Del Estrés por Inestabilidad Laboral). Os resultados indicam a presença de estressores em todas as áreas avaliadas, em índices diferenciados. Os estressores de maior pontuação foram Preocupações com a saúde, Moléstias emocionais e Preocupações econômicas. O grau de mal-estar tende a aumentar com a idade, porém está presente desde o ingresso na função. As atribuições extensas da gestão indicam a ocorrência em graus diferenciados de impactos entre os grupos, demonstrando que a subjetividade deve ser considerada para a proposição de melhorias das condições e organização de trabalho. As transformações sociais aceleradas, as exigências das reformas educacionais e a falta de reconhecimento da profissão foram associadas ao mal-estar docente.

This research aimed to identify and analyze the impact of stressful events associated with the school administrators in teacher malaise. 29 managers participated in his capacity as directors or deputy directors of the municipal system, the interior of São Paulo, with responses to the Inventory IMPIL (Evaluación Psicológica Del Estrés por InestabilidadLaboral - FIGUEROA; SCHUFER, 2006). The results indicate the presence of stressors in all areas assessed at different rates. The highest ranking stressors were concerns with health, emotional Diseases and economic concerns. The degree of discomfort tends to increase with age, but since the entry into this function. The extensive powers of management, indicate the occurrence of different degrees of impact between the groups, demonstrating that subjectivity needs to be considered for proposing improvements in working conditions and health organizations. Social changes, the demands of educational reforms and lack of recognition of the profession were associated with teacher malaise.

Esta investigación tuvo como objetivo identificar y analizar el impacto de eventos estresantes en los administradores de escuelas asociado al malestar docente. Participaron 29 administradoras en su calidad de directoras o subdirectoras de la red municipal del interior del Estado de São Paulo, con las respuestas a la IMPIL (Evaluación Psicológica Del Estrés por Inestabilidad Laboral - FIGUEROA; SCHUFER, 2006). Los resultados indican la presencia de factores estresantes en todas las áreas evaluadas en diferentes índices. Los mayores factores de estrés fueron las preocupaciones con la salud, enfermedades emocionales y las preocupaciones económicas. El grado de molestia tiende a aumentar con la edad, pero están presentes en esta función desde su iniciación. Los amplios poderes de gestión, indican la ocurrencia de diferentes grados de impacto entre los grupos, demostrando que la subjetividad debe ser considerada para las propuestas de mejoras de las condiciones de trabajo y organizaciones de salud. Las aceleradas transformaciones sociales, las exigencias de reformas educativas y la falta de reconocimiento de la profesión se asociaron al malestar docente.

Papel de Diretor de Sociodrama: competências e limitações / The role of the sociodrama director: potentials and limitations of the role

Neste trabalho buscou-se conceituar e caracterizar, teórica e vivencialmente, o papel de diretor de sociodrama, sua formação, suas competências e suas limitações. Ressaltou-se a importância: da ética no desempenho desse papel; da atitude de cuidador das relações entre humanos e dos fenômenos característicos de grupos sociais. A parte prática do trabalho, desenvolvida por meio do método sociodramático, ocorreu na Clínica Socializada da Associação Bahiana de Psicodrama e Psicoterapia de Grupo (Asbap), em Salvador (BA)...

Through reflection on theory and practice, this paper aims to conceptualize and explore the development, potentials and limitations of the role of the sociodrama director. The importance of the following aspects is emphasized: performing this role in an ethical manner; a caring attitude toward human relationships and toward the phenomena characteristic of social groups. Using the sociodramatic method, this work was carried out at the Social Clinic of the Psychodrama and Group Psychotherapy Association of Bahia (Asbap), in Salvador (BA)...

Papel de Diretor de Sociodrama: competências e limitações / The role of the sociodrama director: potentials and limitations of the role

Neste trabalho buscou-se conceituar e caracterizar, teórica e vivencialmente, o papel de diretor de sociodrama, sua formação, suas competências e suas limitações. Ressaltou-se a importância: da ética no desempenho desse papel; da atitude de cuidador das relações entre humanos e dos fenômenos característicos de grupos sociais. A parte prática do trabalho, desenvolvida por meio do método sociodramático, ocorreu na Clínica Socializada da Associação Bahiana de Psicodrama e Psicoterapia de Grupo (Asbap), em Salvador (BA).(AU)

Through reflection on theory and practice, this paper aims to conceptualize and explore the development, potentials and limitations of the role of the sociodrama director. The importance of the following aspects is emphasized: performing this role in an ethical manner; a caring attitude toward human relationships and toward the phenomena characteristic of social groups. Using the sociodramatic method, this work was carried out at the Social Clinic of the Psychodrama and Group Psychotherapy Association of Bahia (Asbap), in Salvador (BA).(AU)

Aproximación al perfil de los directores de centros de salud de atención primaria en Chile / Description directors of health centers of primary care in Chile

Objetivo. Describir el perfil de los Directores de los Centros de Salud Rural, Centros de Salud Urbanos y Centros de Salud Familiar pertenecientes a la Atención Primaria de Salud en Chile. Metodología. Este es un estudio de tipo descriptivo, transversal, no experimental. La muestra es aleatoria, estratificada por región y se obtuvo desde un universo comprendido por 506 directores de CESFAM y CES de Chile. Los Datos se analizaron a través de medidas de frecuencia, tendencia central y asociación entre calidad laboral y post-formación a través de χ2 (p<0.05). Resultados . El promedio de edad de los directores a nivel nacional es de 45 años, siendo un 66,2 por ciento mujeres. Las profesiones con mayor frecuencia son: Medicina (21,2 por ciento), Enfermería (17,6 por ciento) y Obstetricia (16,2 por ciento); la mayoría se encuentra en su cargo como titular (76,6 por ciento). Sobre el tiempo de permanencia en el cargo, obtenemos una mediana de 29,5 meses y experiencia previa de 10 años; un 88,7 por ciento posee algún tipo de post-formación en gestión y/o salud pública. Conclusiones. En Chile contamos con directivos en los centros de salud primaria: consolidados, con experiencia previa y postformados lo cual constituye una masa técnica altamente positiva en este subsistema y un capital de importancia para los próximos desafíos sanitarios.

Objective: To describe the profile of Directors of the Rural Health Centers, Health Centers and Urban Family Health Centers belonging to Primary Health Care in Chile. Materials and methods: Descriptive, cross-sectional, non experimental study. The stratified, random sample was extracted from region, with a universe of 506 directors. The data was analyzed by measures of frequency, central tendency and association between job quality and post-training through χ2 (p <0.05).Results: The average age of directors nationwide is 45 years old, and the 66.2 percent are women. The most frequent professions are: Medicine (21.2 percent), nursing (17.6 percent) and obstetrics (16.2 percent), most are in their positions as titular directors (76.6 percent). About how long they’ve been in their position, we get a median of 29.5 months, and 10 years of previous experience, 88.7 percent have some type of post-training in management and /or public health. Conclusions: In Chile we have managers in Primary Health Centers consolidated with previous experience and post-trained, so we have a highly technical specialized mass in this subsystem and it’s also a great capital for the next health challenges of our country.

The chaotic world of the nursing program director / El mundo caótico del director(a) de un programa de enfermería

Aim: The environment of the nursing program dean or director within a community college or state university can be politically, fiscally, and emotionally challenging. There are few studies that investigate that environment. The purpose of this study was to describe the major barriers and incentives facing these nursing deans or directors as they implemented their proposed interventions related to the Central Valley Nursing Diversity Project. Additionally, we sought to identify successful strategies used to keep the programs competitive for resources and status within their institutions and within their local communities. Methodology: The study is descriptive; the data collection method was structured interviews and data were analyzed using content analysis. Findings: Findings indicate that among the most difficult barriers faced by the directors and the faculty was the over subscribed status (more applicants than positions) of the programs. The deans or directors described three significant points that acted as barriers. These were 1) limited space in science laboratory pre-requisite courses, 2) limited classroom space in nursing courses, and 3) limited space in clinical (hospital) sites. The largest single external pressure reported was the reduction in funding and all deans or directors indicated they had difficulty hiring qualified or credentialed faculty. Conclusion: Colleges must manage more effectively student demand by modifying admissions criteria to be more selective and admit students with greater likelihood of graduating; encourage innovative partnerships between employers and schools of nursing; and increasing funding for nursing faculty salaries, classrooms, and laboratories.

Objetivo: El ambiente de un(a) decano(a) o director(a) o de un Programa de Enfermería en un colegio comunitario o una universidad estatal puede ser un reto político, físico y emocional. Hay pocos estudios que investiguen ese ambiente. El propósito de este estudio fue describir las principales barreras e incentivos que enfrentan las(os) decanas(os) o directoras(es) al implementar las intervenciones del Proyecto de Diversidad en Enfermería en el Valle Central. Adicionalmente, se identificaron estrategias exitosas para mantener competitivos a los programas en cuanto a recursos y estatus en las comunidades locales. Metodología: El estudio es descriptivo; la información se recolectó mediante entrevistas estructuradas y fue analizada mediante análisis de contenido. Hallazgos: La barrera más difícil fue la demanda exagerada de los programas. Las(os) decanas(os) o directoras(es) describieron tres barreras significativas: 1) espacio limitado en laboratorios de ciencias para los cursos pre-requisito, 2) espacio limitado en los salones de clase para los cursos de enfermería, 3) espacio limitado en los sitios de práctica clínica. La principal presión externa fue la reducción de financiación, lo que produce dificultades para conseguir docentes calificados. Conclusión: Las instituciones deben manejar más efectivamente la demanda estudiantil, modificar los criterios de admisión para hacerlos más selectivos y admitir estudiantes con mayor posibilidad de graduarse; promover alianzas innovadoras entre empleadores y escuelas de enfermería e incrementar la financiación para salarios de docentes, aulas de clase y laboratorios.