Prognosis of acute heart failure in patients followed up in nursing homes in Spain: Results from the RICA registry / Impacto pronóstico en la supervivencia de los pacientes en residencias de ancianos con insuficiencia cardiaca en España: Resultados del Registro RICA

Background: Patients with chronic diseases such as heart failure (HF) are at risk of hospital admission. We evaluated the impact of living in nursing homes (NH) on readmissions and all-cause mortality of HF patients during a one-year follow up. Methods: An observational and multicenter study from the Spanish National Registry of Heart Failure (RICA) was performed. We compared clinical and prognostic characteristics between both groups. Bivariate analyses were performed using Student's t-test and Tukey's method and a Kaplan–Meier survival at one-year follow up. A multivariate proportional hazards analysis of [Cox] regression by the conditional backward method was conducted for the variables being statistically significant related to the probability of death in the univariate. Results: There were 5644 patients included, 462 (8.2%) of whom were nursing home residents. There were 52.7% women and mean age was 79.7±8.8 years. NH residents had lower Barthel (74.07), Charlson (3.27), and Pfeiffer index (2.2), p<0.001). Mean pro-BNP was 6686pg/ml without statistical significance differences between groups. After 1-year follow-up, crude analysis showed no differences in readmissions 74.7% vs. 72.3%, p=0.292, or mortality 63.9% vs. 61.1%, p=0.239 between groups. However, after controlling for confounding variables, NH residents had a higher 1-year all-cause mortality (HR 1.153; 95% CI 1.011–1.317; p=0.034). Kaplan–Meier analysis showed worse survival in nursing home residents (log-rank of 7.12, p=0.008). Conclusions: Nursing home residents with heart failure showed higher one-year mortality which could be due to worse functional status, higher comorbidity, and cognitive deterioration.(AU)

Introducción: Los pacientes con enfermedades crónicas como la insuficiencia cardiaca (IC) presentan mayor riesgo de ingreso. Se evaluó el impacto sobre los reingresos y la mortalidad por todas las causas de los pacientes con IC respecto a vivir o no en residencias de ancianos durante un año de seguimiento. Métodos: Estudio observacional y multicéntrico a partir del Registro Nacional de Insuficiencia Cardiaca (RICA). Se compararon las características clínicas y pronósticas entre ambos grupos. Se realizó un análisis bivariante mediante el método de t de Student y Tukey y un análisis de supervivencia mediante Kaplan-Meier al año de seguimiento, así como un análisis multivariante de riesgos proporcionales de regresión (Cox) por el método de retroceso condicional para las variables que se relacionaban de forma estadísticamente significativa con la probabilidad de muerte en el univariante. Resultados: Fueron incluidos 5.644 pacientes; 462 (8,2%) de ellos estaban en residencias, el 52,7% eran mujeres y la edad media era de 79,7±8,8 años. Los pacientes en residencias tenían menor Barthel (74,07), Charlson (3,27) y Pfeiffer (2,2) (p<0,001). El pro-BNP medio era de 6.686 pg/ml sin diferencias significativas. Tras un año de seguimiento, el análisis bruto no mostró diferencias en los reingresos (74,7 vs. 72,3%; p=0,292) ni en mortalidad (63,9 vs. 61,1%; p=0,239) entre ambos grupos. Tras controlar las variables de confusión, los pacientes en residencias presentaron una mayor mortalidad por todas las causas a un año (hazard ratio 1,153; IC 95%: 1,011-1,317; p=0,034) así como peor supervivencia en el análisis de Kaplan-Meier (log-rank 7,12; p=0,008). Conclusiones: Los pacientes con IC en residencias de ancianos mostraron una mayor mortalidad a un año, que podría deberse a un peor estado funcional, a mayor deterioro cognitivo y a más comorbilidad.(AU)

Prognosis of acute heart failure in patients followed up in nursing homes in Spain: Results from the RICA registry.

BACKGROUND: Patients with chronic diseases such as heart failure (HF) are at risk of hospital admission. We evaluated the impact of living in nursing homes (NH) on readmissions and all-cause mortality of HF patients during a one-year follow up. METHODS: An observational and multicenter study from the Spanish National Registry of Heart Failure (RICA) was performed. We compared clinical and prognostic characteristics between both groups. Bivariate analyses were performed using Student's t-test and Tukey's method and a Kaplan-Meier survival at one-year follow up. A multivariate proportional hazards analysis of [Cox] regression by the conditional backward method was conducted for the variables being statistically significant related to the probability of death in the univariate. RESULTS: There were 5644 patients included, 462 (8.2%) of whom were nursing home residents. There were 52.7% women and mean age was 79.7±8.8 years. NH residents had lower Barthel (74.07), Charlson (3.27), and Pfeiffer index (2.2), p<0.001). Mean pro-BNP was 6686pg/ml without statistical significance differences between groups. After 1-year follow-up, crude analysis showed no differences in readmissions 74.7% vs. 72.3%, p=0.292, or mortality 63.9% vs. 61.1%, p=0.239 between groups. However, after controlling for confounding variables, NH residents had a higher 1-year all-cause mortality (HR 1.153; 95% CI 1.011-1.317; p=0.034). Kaplan-Meier analysis showed worse survival in nursing home residents (log-rank of 7.12, p=0.008). CONCLUSIONS: Nursing home residents with heart failure showed higher one-year mortality which could be due to worse functional status, higher comorbidity, and cognitive deterioration.

Síndrome de Burnout en residentes y posgrados de Neonatología en un centro hospitalario de tercer nivel. Análisis situacional y seguimiento, período 2021 - 2023

Introducción: los residentes y posgrados son un eslabón central en los servicios hospitalarios. El síndrome de Burnout se define como el agotamiento físico y emocional resultado de la exposición crónica al estrés en el ámbito laboral. El Maslach Burnout Inventory (MBI-HSS) es un instrumento diseñado y validado para evaluarlo. El objetivo de este estudio es determinar la prevalencia del síndrome de Burnout en nuestro servicio y compararla entre los estudiantes de distintas generaciones para luego poner en marcha mecanismos que permitan realizar seguimiento, detección temprana e identificación de factores modificables. Material y método: estudio transversal, descriptivo, observacional, desarrollado en abril de 2021 a través de la realización del test MBI-HSS para el diagnóstico de situación. Este estudio continuará con una segunda etapa que consta de la aplicación del test cada cuatro meses, la cual no desarrollaremos en el presente trabajo. La población objetivo la constituyen todos los residentes y posgrados de la especialidad de Neonatología en un centro hospitalario de tercer nivel. Se aplicó el cuestionario MBI-HSS y un cuestionario general para caracterizar a la población. Resultados: se incluyeron un total de 22 participantes, de los cuales 13 presentaron puntajes altos de agotamiento emocional, 9 obtuvieron un valor alterado de despersonalización y 9 presentaron puntajes bajos de realización personal. Seis participantes (27%) presentaron puntajes alterados para las tres variables. Conclusiones: se evidenció una alta prevalencia de Burnout, el 27% en la población total. Se encontraron diferencias estadísticamente significativas para los ítems despersonalización y realización personal entre los distintos años de la especialidad, con mayor puntaje de despersonalización y menor puntaje de realización personal en los de segundo y tercer año. Esto constituye un elemento de alarma que exige la modificación inmediata del funcionamiento y de las actividades.

Introduction: Residents and postgraduates are a fundamental part of hospital services. Burnout Syndrome is defined as physical and emotional exhaustion resulting from chronic exposure to stress in the workplace. The Maslach Burnout Inventory (MBI-HSS) is an instrument designed and validated to evaluate it. The objective of this study is to determine the prevalence of Burnout Syndrome in our service and to compare it among students of different generations to then implement mechanisms that allow monitoring, early detection and identification of modifiable factors. Materials and methods: Cross-sectional, descriptive, observational study carried out in April 2021 through the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) test to carry out a diagnosis of the situation. This study will continue with a 2nd stage consisting of the application of the test every 4 months, which we will not develop in this work. The target population is all residents and postgraduates in the neonatology specialty at a tertiary level hospital. The MBI-HSS questionnaire and a general questionnaire were applied to characterize the population. Results: A total of 22 participants were included, of which 13 presented high scores of emotional exhaustion, 9 obtained an altered value of depersonalization and 9 presented low scores of personal fulfillment. Six participants, 27%, presented altered scores for the three variables. Conclusions: A high prevalence of Burnout was evidenced, being 27% in the total population. Statistically significant differences were found for the items "depersonalization" and "personal fulfillment" between the different years of the specialty, with higher depersonalization scores and lower personal fulfillment scores in the second and third years. This constitutes an alarm element, which requires immediate modification of the operation and activities.

Introdução: Residentes e pós-graduandos constituem um elo central nos serviços hospitalares. A Síndrome de Burnout é definida como exaustão física e emocional resultante da exposição crônica ao estresse no ambiente de trabalho. O Maslach Burnout Inventory (MBI-HSS) é um instrumento elaborado e validado para avaliá-lo. Objetivo: O objetivo deste estudo é determinar a prevalência da Síndrome de Burnout no Serviço de Neonatologia do Centro Hospitalario Pereira Rossel e compará-la entre estudantes de diferentes gerações para então implementar mecanismos que permitam monitoramento, detecção precoce e identificação de fatores modificáveis. Materiais e métodos: Estudo transversal, descritivo, observacional realizado em abril de 2021 por meio do teste Maslach Burnout Inventory - Human Services Survey (MBI-HSS) para diagnóstico da situação. Este estudo continuará com uma 2ª etapa que consiste na aplicação do teste a cada 4 meses, que não desenvolveremos neste trabalho. A população-alvo são todos os residentes e pós-graduandos da especialidade de neonatologia de um hospital de nível terciário. O questionário MBI-HSS e um questionário geral foram aplicados para caracterizar a população. Resultados: Foram incluídos 22 participantes, dos quais 13 apresentaram escores elevados de exaustão emocional, 9 obtiveram valor alterado de despersonalização e 9 apresentaram escores baixos de realização pessoal. Seis participantes, 27%, apresentaram escores alterados nas três variáveis. Conclusões: Evidenciou-se uma alta prevalência de Burnout de 27% na população total. Foram encontradas diferenças estatisticamente significativas nos itens "despersonalização" e "realização pessoal" entre os diferentes anos da especialidade, com maiores pontuações de despersonalização e menores pontuações de realização pessoal no segundo e terceiro anos. Isto constitui um elemento de alarme, que requer modificação imediata do funcionamento e das atividades.

Concept of opportunistic bilateral salpingectomy in a sample of Mexican gynecologists. What should residents be trained on? / Concepto de salpingectomía bilateral oportunista en una muestra de ginecólogos mexicanos. ¿En qué se debe capacitar a los residentes?

Background: Ovarian cancer is the fifth deadliest cancer among women. There is no effective screening method. It has been suggested that ovarian cancer originates from precursor lesions in the fimbriae of the fallopian tubes. Objective: The aim of this study was to determine the level of knowledge of opportunistic bilateral salpingectomy by gynecologists. Methods: A cross-sectional study was carried out and a survey was sent electronically to gynecologists and gynecology residents. Demographic characteristics as well as questions of interest related to clinical practice and indication for surgery were included. Results: 52 subjects were included, 21 women and 31 men, with a mean age of 40.7 years. Thirty-five board certified gynecologists, as well as 17 gynecology residents, were included as part of the total survey group. Thirty-six individuals (69.2%) reported performing elective salpingectomy. The motivation they had to perform salpingectomy as a method of sterilization was: “reduction in the risk of ovarian cancer in the future” (55.6%). The indication for elective salpingectomy while performing other procedures was: “to prevent ovarian cancer” (61.1%). Certified gynecologists (42.9%) as well as residents (41.1%) considered “transvaginal ultrasound screening” as the best primary prevention method for ovarian cancer in low-risk women. Conclusions: Opportunistic bilateral salpingectomy is safe and cost-effective. However, when gynecologists are interviewed to find out their level of knowledge, there is poor acceptance of opportunistic bilateral salpingectomy in Mexico. A training strategy should be designed in the gynecology residency in order to motivate ovarian cancer prevention.(AU)

Antecedentes: El cáncer de ovario es el quinto cáncer más mortal entre las mujeres. No existe un método de detección eficaz. Se ha sugerido que el cáncer de ovario se origina a partir de lesiones precursoras en las fimbrias de las trompas de Falopio. Objetivo: Determinar el nivel de conocimiento de los ginecólogos sobre la salpingectomía bilateral oportunista. Métodos: Se envió una encuesta por vía electrónica a médicos ginecólogos y residentes de Ginecología. Se incluyeron características demográficas, así como preguntas de interés relacionadas con la práctica clínica y la indicación de cirugía. Resultados: Se incluyeron 52 sujetos, 21 mujeres y 31 hombres, con una edad media de 40,7 años. Treinta y cinco ginecólogos certificados, así como 17 residentes de ginecología, se incluyeron como parte del grupo total. Treinta y seis individuos (69,2%) informaron haber realizado salpingectomía electiva. La motivación que tuvieron para realizar la salpingectomía como método de esterilización fue: «reducción del riesgo de cáncer de ovario en el futuro» (55,6%). La indicación de salpingectomía electiva mientras se realizaban otros procedimientos fue: «para prevenir el cáncer de ovario» (61,1%). Los ginecólogos certificados (42,9%) y los residentes (41,1%) consideraron la «detección con ultrasonido transvaginal» como el mejor método de prevención primaria para el cáncer de ovario en mujeres de bajo riesgo. Conclusiones: Cuando entrevistamos a los ginecólogos detectamos poca aceptación de la salpingectomía bilateral oportunista en México. Se debe diseñar una estrategia de formación en la residencia de Ginecología para motivar la prevención del cáncer de ovario.(AU)

Factores que influyen en la elección de la plaza de formación sanitaria especializada de MIR / Factors influencing the choice of MIR specialized health formation

Introducción: El examen de médico interno residente (MIR) se debe superar para acceder a una plaza de formación de médico especialista en España. Este estudio pretende: a) determinar los factores que influyen en la elección de la plaza de MIR; b) valorar el grado de información sobre el hospital/centro seleccionado; c) analizar las prioridades profesionales durante y posteriormente a la formación de MIR; y d) comparar los resultados entre estudiantes de sexto de Medicina y residentes MIR de primer año. Material y métodos: Se envió una encuesta anónima a 370 estudiantes de sexto de Medicina y 494 residentes de primer año de Cataluña y Aragón. Resultados: Contestaron 105 estudiantes y 104 residentes (24%). El 71% de los estudiantes y el 56% de los residentes preferían formarse en un centro distinto al que habían estudiado. Lo prioritario para escoger la plaza fue la especialidad, por encima de otros factores, como el hospital/centro o la ciudad. Globalmente, el 90% se informó acerca de las plazas, preferiblemente a través de otros residentes. Un 45% de los estudiantes y un 12% de los residentes se mostraban dispuestos a repetir el examen de MIR en caso de no disponer de la especialidad y el centro deseados en primera opción. Los encuestados valoraron positivamente aspectos como un ambiente de trabajo adecuado, un buen nivel asistencial y condiciones laborales óptimas. Conclusión: El factor más importante en la elección de la plaza de MIR es la especialidad deseada. En el centro de trabajo se valoran positivamente el nivel asistencial, el buen ambiente y las condiciones laborales.(AU)

Introduction: The MIR (médico interno residente, medical internal resident) examination must be passed to gain access to a specialist medical training place in Spain. This study aims to: a) determine the factors that influence the choice of the MIR position; b) assess the degree of information about the selected hospital/center; c) analyze the professional priorities during and after the MIR training; and d) compare the results between sixth year medical students and first year MIR residents: Material and methods: An anonymous survey was sent to 370 sixth year medical students and 494 first year residents from Catalonia and Aragon. Results: One hundred anf five students and 104 residents (24%) answered the survey. Seventy-one percent of students and 56% of residents preferred to train in a center other than the one in which they had studied. Priority was given to the specialty, above other factors such as the hospital/center or the city. Overall, 90% were informed about the positions, preferably through other residents. Forty-five percent of students and 12% of residents were willing to repeat the MIR exam if they did not have the desired specialty and center as their first choice. Respondents positively valued aspects such as an adequate working environment, a good level of care and optimal working conditions. Conclusion: The most important factor in the choice of the MIR position is the desired specialty. In the work center, the level of care, good environment and working conditions are positively valued.(AU)

Prevalencia del Síndrome burnout en época covid-19 / Prevalence of burnout syndrome in time covid-19

El estudio se llevó a cabo entre los meses de mayo a julio de 2021. Se recogieron datos de 56 profesionales todos ellos trabajadores del Hospital Universitario Río Hortega de Valladolid (Castilla y León), con el objetivo de describir si los profesionales que eran muestra de estudio presentaban o no riesgo de padecer Síndrome de Burnout (también denominado síndrome del quemado). Se realizó una recolección sistemática de variables utilizando para ello un doble cuestionario que consta de una primera parte en la que se recogen datos sociodemográficos, profesionales e individuales y una segunda parte la cual, es el propio cuestionario Maslach Burnout Inventory (MBI) adaptado al español. Se realizó un estudio transversal y analítico en el que, tras el análisis de los datos recogidos, se obtuvo que la prevalencia de profesionales de la muestra que pueden desarrollar el Síndrome de Burnout en el momento del estudio es del 64,29% (correspondiente a 36 profesionales que presentan al menos en 1 ítem del cuestionario Burnout un resultado “Alto”), lo cual quiere decir que el riesgo de nuestros sanitarios de padecer el Síndrome es alto. Además, se analizaron factores que pueden aumentar o incidir en el riesgo de aparición del Síndrome como son: sexo, edad, número de hijos, estado civil, categoría profesional, tipo de contrato, antigüedad profesional, horario laboral, lugar de trabajo, baja laboral en el último año, horas semanales dedicadas al ocio, existencia de enfermedad crónica, toma de psicofármacos, además de unas preguntas de autopercepción relacionadas con el periodo de pandemia por Covid-19. (AU)

The study was carried out between the months of May to November 2021. Data were collected from 56 professionals, all of them workers at the Río Hortega University Hospital in Valladolid (Castilla y León), with the aim of describing whether the professionals who were a sample of study had or did not have a risk of suffering from Burnout Syndrome (also called burnout syndrome) A systematic collection of variables was carried out using a double questionnaire that consists of a first part in which sociodemographic, professional and individual data are collected and a second part which is the Maslach Burnout Inventory (MBI) questionnaire adapted to Spanish We carried out a cross-sectional and analytical study in which, after analyzing the data collected, we obtained that the prevalence of professionals in the sample who may develop Burnout Syndrome at the time of the study is 64.29% (corresponding to 36 professionals that present at least 1 item of the Burnout questionnaire a “High” result), which means that the risk of our health workers of suffering from the Syndrome is high. In addition, factors that can increase or influence the risk of the appearance of Syndrome were analyzed, such as: sex, age, number of children, marital status, professional category, type of contract, professional seniority, working hours, place of work, sick leave In the last year, weekly hours dedicated to leisure, existence of chronic disease, taking psychotropic drugs, as well as some self-perception questions related to the Covid-19 pandemic period. (AU)

Perception of training and job perspectives among final-year residents in the specialty of Endocrinology and Nutrition.

INTRODUCTION: The medical specialisation model in Spain is carried out in the context of specialised health training, through the residency programme. The aim of the study is to analyse, by an anonymous survey, the opinion on three aspects among final-year residents in Endocrinology and Nutrition (E&N): self-assessment of the knowledge acquired, working prospects, care and training consequences arising from the pandemic COVID-19. MATERIALS AND METHODS: Cross-sectional observational study using a voluntary and anonymous online survey, shared among final-year national interns in the last year of the E&N programme, carried out between June-July 2021. RESULTS: 51 responses were obtained, 66% of the fourth-year residents. Overall perception of their knowledge was 7.8 out of 10. Most external rotations were in thyroid and nutrition areas. A total of 96.1% residents, carried out some activity associated with COVID-19, with a training deterioration of 6.9 out of 10. 88.2% cancelled their rotations and 74.5% extended their working schedule. The average negative emotional impact was 7.3 out of 10. 80.4% would like to continue in their training hospital, remaining 45.1%. 56.7% have an employment contract of less than 6 months, most of them practising Endocrinology. CONCLUSION: The perception of the knowledge acquired during the training period is a "B". Residents consider that the pandemic has led to a worsening of their training, generating a negative emotional impact. Employment outlook after completing the residency can be summarised as: temporality, practice of Endocrinology and interhospital mobility.

Guardias médicas durante la formación del residente de neurología en España: cambios en la última década / 24-hour on-duty shifts during the training of neurology residents in Spain: changes in the last decade

Introducción: El programa formativo de neurología en España, aprobado en 2006, incide en la realización de guardias específicas supervisadas por un neurólogo. En una evaluación de la Comisión Nacional de Neurología en 2008, se constató un cumplimiento desigual de este objetivo docente: el 60,3% de las unidades ofrecía a sus residentes una guardia de 24 horas con supervisión física, y sólo el 43% era en su propio centro. Tras más de una década, y con un nuevo plan formativo en redacción, queremos conocer la situación actual y posibles factores implicados. Material y métodos. Estudio mediante encuestas autoadministradas a las unidades docentes de neurología que hubiesen formado recientemente una promoción completa de residentes (n = 77). Se recogieron respuestas entre octubre de 2021 y febrero de 2022. Resultados: Respondió el 100% de las unidades. En 2021, el 88,3% cumplía los objetivos docentes, con un 83% con guardias de 24 horas con supervisión física en su propio centro. Entre los factores relacionados, se observó una asociación directa y estadísticamente significativa con el tamaño del centro y la existencia de unidad de ictus. Discusión. La supervisión de residentes durante la guardia de neurología está siguiendo la línea marcada por el plan formativo y la comisión nacional de la especialidad, aunque siguen existiendo diferencias que van más allá de aspectos puramente asistenciales. El futuro plan estatal podría marcar nuevas pautas que nos ayuden a conseguir una menor heterogeneidad, a fin de ofrecer una misma capacitación en el abordaje urgente del paciente neurológico.(AU)

Introduction: The neurology training program in Spain, approved in 2006, emphasizes the importance of residents’ on-duty shifts supervised by a neurologist. An evaluation of the Specialty National Commission in 2008 showed an unequal fulfillment of this goal: 60.30% of the training units offered their residents 24-hour shifts with on-duty supervision, and only 43% in their own center. After more than a decade, and a new national training program on design, we would like to know the current situation and possible factors that might be involved. Material and methods. Cross-sectional study through self-administered surveys to neurology training units that had recently graduated residents (n = 77). Responses were collected between October 2021 and February 2022. Results: All units answered the survey. In 2021, 88.30% met the supervision objectives, and 83% offered their trainees 24-hour on-duty shifts with a neurologist in their center. Among related factors, there is a significant direct relationship between this kind of shift, the hospital’s size, and the existence of a stroke unit. Discussion. Residents’ guidance during the 24-hour neurology on-duty shifts follows the path set by the training program and the national commission. However, there are still some differences that go beyond purely healthcare aspects. The future national program could establish new guidelines that help us achieve less heterogeneity, in order to offer the same training in the assessment of acute neurological patients.(AU)

Formación del residente en cirugía laparoscópica en coloproctología: análisis retrospectivo de morbimortalidad y pronóstico oncológico sobre 408 pacientes en nuestro centro / Resident training in colorectal laparoscopic surgery: A retrospective morbidity, mortality and survival analysis of 408 cases in our environment

Introducción El cáncer de colon y recto presenta una incidencia creciente en nuestra sociedad. Sin embargo, la realización de intervenciones por laparoscopia en este subcampo sigue sin incluirse de forma protocolizada en el Programa Nacional de Formación. Ante la falta de referencias, nuestro objetivo fue analizar la participación del residente en cirugía colorrectal laparoscópica y su posible efecto sobre la morbimortalidad y el pronóstico oncológico. Métodos Estudio retrospectivo longitudinal unicéntrico que incluyó todas las intervenciones de cirugía colorrectal realizadas por residentes (grupo R) y adjuntos (grupo A) por laparoscopia entre el 01 de enero de 2009 y el 31 de diciembre de 2017, manteniendo el seguimiento hasta el 31 de diciembre de 2018. Se analizó la morbimortalidad postoperatoria, la supervivencia global (SVG) y libre de enfermedad (SLE), y su relación con la participación del residente como primer cirujano. Resultados Se analizaron 408 pacientes, de los cuáles 138 (33,8%) fueron intervenidos por parte de residentes bajo supervisión y 270 (66,2%) por parte de adjuntos. No se detectaron diferencias en la tasa de complicaciones postoperatorias entre ambos grupos (OR: 1,536; IC 95%: 0,947-2,409; p = 0,081). Asimismo, la participación del residente no tuvo influencia sobre la recidiva tumoral (grupo R:14,2% vs. grupo A: 16,9%; p = 0,588) ni sobre la SVG (p = 0,562) ni SLE (p = 0,305). Conclusiones La realización de cirugía laparoscópica colorrectal por parte del residente no tuvo influencia sobre la morbimortalidad ni el pronóstico oncológico en nuestro centro. La realización de estudios prospectivos y de mayor evidencia proporcionará un mayor conocimiento, posibilitando una mejora progresiva de la metodología docente (AU)

Introduction Colorectal cancer has a growing incidence in our society. However, the performance of laparoscopic interventions in this field is still not included in the National Training Program. Given the lack of references, our objective was to analyze the resident's participation in laparoscopic colorectal surgery and its possible effect on morbidity and mortality and oncological prognosis. Methods A retrospective longitudinal single-center study that included all laparoscopic colorectal surgical procedures performed by residents (R group) and by attending surgeons (A group) between 01/01/2009 and 12/31/2017, maintaining follow-up until 12/31/2018. Postoperative morbidity and mortality, overall survival (OS) and disease-free survival (DFS), as well as their relationship with the resident involvement as first surgeon were analyzed. Results 408 patients were analyzed, of which 138 (33.8%) were operated by a supervised resident and 270 (66.2%) by the attending surgeon. No differences were detected in the rate of postoperative complications between both groups (OR: 1.536; 95% CI: 0.947-2.409; p=0.081). Furthermore, resident participation had no influence on tumor recurrence rate (R Group: 14.2% vs. A Group: 16.9%; p=0.588) or on overall (p = 0.562) or disease-free survival (p = 0.305). Conclusion Resident involvement in laparoscopic colorectal surgery had no influence on morbidity and mortality or oncological prognosis in our center. Conducting prospective studies in this regard will provide greater knowledge, enabling a progressive improvement of the training program (AU)

La resiliencia como mediador entre el síndrome del quemado (burnout) y el bienestar subjetivo en residentes de hospitales españoles / Resilience as a mediator between burnout syndrome and subjective well-being in Spanish hospital residents

Numerosos estudios han demostrado el impacto del síndrome del quemado(burnout) en el bienestar de los residentes, sin embargo, los mecanismos queexplican esta influencia siguen sin estar claros. Este estudio analizó el grado delsíndrome del quemado, así como su evolución en los años formativos y el papelmediador de la resiliencia entre el síndrome y el bienestar subjetivo en una muestrade 237 residentes de diferentes especialidades de hospitales españoles. A losparticipantes se les administró el “Inventario del síndrome del quemado deMaslach”, la “Escala de resiliencia de Connor-Davidson” y la “Escala reducida debienestar subjetivo”. Del total de residentes, el 48,9% puntuaron alto en elsíndrome del quemado, el 53,6% en agotamiento emocional y el 74,7% endespersonalización. Los niveles del síndrome aumentaron según avanza laresidencia y la resiliencia medió en la relación entre los niveles de síndrome delquemado y de bienestar subjetivo. Estos resultados sugieren que la resiliencia es unfactor protector a implementar en programas preventivos. (AU)

Ample research has supported the detrimental impact of burnout on the wellbeing of resident doctors. However, the mechanisms accounting for this influenceremain unclear. Consequently, this study analysed for the first time the degree ofburnout as well as its evolution throughout the residency period and tested themediational role of resiliency in the relationship between burnout and its subscalesand well-being in a sample of 237 Spanish residents of different specialties fromSpanish hospitals. Participants were administered the Maslach Burnout Inventory, the Connor Davidson Resilience Scale and the short-version scale of SubjectiveWell-being. From the total sample of residents, 48.9% reported high levels of totalburnout, 53.6% in the subscale of emotional burnout and 74.7% indepersonalization. Additionally, burnout levels increased as the residency periodprogressed, and resilience mediated the relationship between burnout andsubjective well-being level. Such findings suggest resilience as a protector factoragainst burnout that should be included in prevention programs. (AU)

Desempeño asistencial en la formación del residente de gastroenterología / Heath care performance in the training of the gastroenterology resident

Introducción: El desempeño asistencial del residente de gastroenterología en cuanto al diagnóstico y tratamiento de pacientes con enfermedades digestivas condiciona su pertinencia profesional en la salud pública. Objetivo: Profundizar en el proceso de formación del residente de gastroenterología. Métodos: Se realizaron un análisis epistemológico y un diagnóstico fáctico del proceso de formación del residente de gastroenterología en cuanto a la atención a pacientes con neoplasias digestivas, en el Hospital General Docente Dr. Juan Bruno Zayas de Santiago de Cuba, durante el bienio 2017-2018, a partir de la observación del desempeño asistencial, la aplicación de una encuesta a residentes y de entrevistas a especialistas de esa rama en la provincia. Resultados: Existieron inconsistencias en esta formación como resultado de una visible polarización médico-instrumental de la práctica en la asistencia, orientada hacia la endoscopia digestiva diagnóstica y terapéutica en detrimento de lo preventivo. Conclusiones: Pudo confirmarse que no se había sistematizado lo suficiente la dimensión de asistencia a pacientes con neoplasias digestivas a partir de la integración formativa de la prevención, el diagnóstico y la terapéutica en la praxis endoscópica de ese profesional.

Introduction: The heath care performance of the gastroenterology resident conditions his professional pertinence in the public health as for the diagnosis and treatment of patients with digestive diseases. Objective: To deepen in the training process of the gastroenterology resident. Method: An epistemologic analysis and factic diagnosis of the training process of the gastroenterology resident regarding the care to patients with digestive neoplasm in Juan Bruno Zayas Teaching General Hospital from Santiago de Cuba during the biennium from the observation of the health care performance, the survey to residents and interviews to specialists of this branch in the province. Results: There were inconsistencies in this training as a result of a visible polarization doctor-tools of practice in the care, orientated to the endoscopic and therapeutic digestive endoscopy contrary to the preventive procedure. Conclusion: It could be confirmed that the care dimension had not been sufficiently systematized while giving care to patients with digestive neoplasm taking into account the training integration of prevention, diagnosis and therapeutics in the endoscopic praxis of this professional.

Resident training in colorectal laparoscopic surgery: A retrospective morbidity, mortality and survival analysis of 408 cases in our environment.

INTRODUCTION: Colorectal cancer has a growing incidence in our society. However, the performance of laparoscopic interventions in this field is still not included in the National Training Program. Given the lack of references, our objective was to analyze the resident's participation in laparoscopic colorectal surgery and its possible effect on morbidity and mortality and oncological prognosis. METHODS: A retrospective longitudinal single-center study that included all laparoscopic colorectal surgical procedures performed by residents (R group) and by attending surgeons (A group) between 01/01/2009 and 12/31/2017, maintaining follow-up until 12/31/2018. Postoperative morbidity and mortality, overall survival (OS) and disease- free survival (DFS), as well as their relationship with the resident involvement as first surgeon were analyzed. RESULTS: 408 patients were analyzed, of which 138 (33.8%) were operated by a supervised resident and 270 (66.2%) by the attending surgeon. No differences were detected in the rate of postoperative complications between both groups (OR: 1.536; 95% CI: 0.947-2.409; p = 0.081). Furthermore, resident participation had no influence on tumor recurrence rate (R Group: 14.2% vs. A Group: 16.9%; p = 0.588) or on overall (p = 0.562) or disease-free survival (p = 0.305). CONCLUSION: Resident involvement in laparoscopic colorectal surgery had no influence on morbidity and mortality or oncological prognosis in our center. Conducting prospective studies in this regard will provide greater knowledge, enabling a progressive improvement of the training program.

Perception of knowledge about Clinical Hospital Nutrition among resident doctors in a tertiary hospital.

INTRODUCTION: Resident physicians' proper use of nutritional support and knowledge about Clinical Nutrition is essential to ensuring that their patients receive suitable nutritional care. MATERIALS AND METHOD: An online survey was sent to resident physicians at our hospital in specialisations with hospital beds. The survey featured 20 multiple-choice questions scored from 1 to 10 (1 being "completely disagree" and 10 being "completely agree") across the following themes: nutritional assessment, diets, oral nutritional supplements, enteral nutrition and perception of the Nutrition Unit. RESULTS: The survey was completed by 69% of resident physicians in medical specialisations and 70% of those in surgical specialisations. Overall, the average survey score was 6.28, with higher scores among medical residents than surgical residents (6.86 versus 5.38; p < 0.001), especially in the sections on nutritional assessment, diets and oral nutritional supplements. The respondents had a positive perception of the Nutrition Unit (mean score 7.6). DISCUSSION: Residents in medical specialisations afford greater importance to their patients' nutrition than residents in surgical specialisations, although in both groups the average score was rather low. There is much room for improvement in the training in Clinical Nutrition of this group, and it is important to include topics in Clinical Nutrition in training programmes for all residents in hospital specialisations.

Programa MIR. ¿De dónde venimos? / MIR program. Where do we come from?

En 1976 se implantó el sistema formativo MIR (médicos internos residentes) en España. Su aceptación y sus resultados han sido un éxito. Sin embargo, hemos vivido momentos de incertidumbre (por ejemplo, la fallida implantación del proyecto de troncalidad) y conflicto (por ejemplo, la prueba de acceso, el método de elección de plazas, etc.).En tiempos en los que se reflexiona sobre cambiar la estructura o los contenidos de la formación médica especializada parece útil recordar de dónde venimos. Conocer el prototipo de residencia quirúrgica tradicional permite reflexionar y tomar decisiones.El sistema MIR español es una extrapolación del modelo norteamericano de “aprender trabajando”. En 1889 nació el primer programa moderno de residencia quirúrgica, desarrollado bajo la influencia de William Stewart Halsted (1852-1922) en el hospital Johns Hopkins (Baltimore, Maryland, Estados Unidos).El concepto de residencia de Halsted, muy influido por sus experiencias y su personalidad, era muy rígido (sistema piramidal) y severo (muchos años y a tiempo completo). No obstante, logró excelentes resultados académicos entre sus discípulos, muchos de los cuales superaron al maestro. Ellos difundieron el modelo hastediano de residencia por toda Norteamérica.La adaptación del modelo residencial “tipo Halsted” ha sido la base de los programas formativos de excelencia que actualmente existen.(AU)

In 1976 the MIR training system (resident intern medical) was introduced in Spain. Its acceptance and results have been a success. However, we have experienced moments of uncertainty (e.g. failed implementation of the trunk project) and conflict (e.g. entrance exam, method of choice of places, etc.).In times when it is considered to change the structure and/or contents of specialized medical training, it seems useful to remember where we come from. Knowing the prototype of the classic surgical residency allows you to reflect and make decisions.The Spanish MIR system is an extrapolation of the North American model of “learn by working”. In 1889 the first modern surgical residency program was born, developed under the influence of William Stewart Halsted (1852-1922) at Johns Hopkins Hospital (Baltimore, Maryland, USA).Halsted's concept of residence, greatly influenced by his experiences and personality, was very rigid (pyramidal system) and severe (many years and full time). However, he achieved excellent academic results among his disciples, many of whom surpassed the teacher; they spread the Hastedian model of residence throughout North America.The adaptation of the residential model “Halsted type” has been the basis of the training programs of excellence that currently exist.(AU)

Sleep deprivation among surgical residents: Does it affect performance while practising a laparoscopic intestinal anastomosis?

INTRODUCTION: To assess the impact of fatigue due to incorrect night rest in the performance of a laparoscopic manual anastomosis. METHODS: A prospective study evaluating the results from the realization of a manual endotrainer entero-enteral anastomosis performed by residents in terms of fatigue caused by inadequate nightly rest. Two groups were established; the FATIGUE group (F): anastomosis performed by residents coming off shift who slept less than seven hours and the REST group(R), being those who slept at home for more than 7 h. The time taken, length of the anastomosis and quality of such were compared based on 4 parameters: Air leak test, correct tension on the suture line, accurate opposition of the edges and optimal distance between stitches. RESULTS: 402 anastomoses were studied (211 rest group, 191 fatigue group). In the fatigue group leaks were detected in 33.5% anastomoses, as opposed to 19.4% in the rest group (P < .01). El rest group performed the anastomosis in 56.75 min and the fatigue group in 61,49 min (P = .006). There were no significant differences in the others parameters. CONCLUSIONS: Fatigue increases the risk of leakage and the time to do the exercise.

Fatiga por deprivación de sueño en residentes de cirugía: ¿Afecta a los resultados al realizar una anastomosis laparoscópica intestinal? / Sleep deprivation among surgical residents: does it affect performance while practising a laparoscopic intestinal anastomosis?

IntroducciónEvaluar el impacto de la fatiga por incorrecto descanso nocturno en la realización de una anastomosis manual laparoscópica.MétodosSe lleva a cabo un estudio prospectivo observacional evaluando la realización de una anastomosis manual enteroenteral en endotrainer por residentes. Se dividen en dos grupos; el grupo descanso incluye a residentes que han dormido en casa siete o más horas vs. al grupo fatiga formado por residentes de guardia o que han dormido menos de siete horas. Se evalúa el tiempo empleado, la longitud de la anastomosis, la correcta tensión de la línea de sutura, la correcta aposición de los bordes, la distancia entre puntos y la fuga de aire, en prueba neumática de estanqueidad.ResultadosSe evalúan 402 anastomosis, siendo 211 pertenecientes al grupo descanso y 191 al grupo fatiga. Se detecta fuga en el 33,5% de las anastomosis del grupo fatiga frente al 19,4% en el grupo descanso (p < 0,01). El tiempo empleado en el grupo descanso es de 56,75 vs. 61,49 min en el grupo fatiga (p = 0,006). No hay diferencias en el resto de los parámetros.DiscusiónLa fatiga aumenta el riesgo de fuga y el tiempo que se tarda en completar el ejercicio (AU)

IntroductionTo assess the impact of fatigue due to incorrect night rest in the performance of a laparoscopic manual anastomosis.MethodsA prospective study evaluating the results from the realization of a manual endotrainer entero-enteral anastomosis performed by residents in terms of fatigue caused by inadequate nightly rest. Two groups were established; the fatigue group (F): anastomosis performed by residents coming off shift who slept less than seven hours and the rest group (R), being those who slept at home for more than 7 hours. The time taken, length of the anastomosis and quality of such were compared based on 4 parameters: Air leak test, correct tension on the suture line, accurate opposition of the edges and optimal distance between stitches.Results402 anastomoses were studied (211 rest group, 191 fatigue group). In the fatigue group leaks were detected in 33,5% anastomoses, as opposed to 19,4% in the rest group (p < 0.01). El rest group performed the anastomosis in 56,75 min and the fatigue group in 61,49 min (p = 0.006). There were no significant differences in the others parameters (AU)

How the COVID-19 pandemic has affected the training of Endocrinology and Nutrition Residents. Results of a survey by the Spanish Society of Endocrinology and Nutrition.

INTRODUCTION: COVID-19 disease has become a priority for our healthcare system. The resident physicians training in endocrinology and nutrition (E&N residents) have been integrated into the COVID-19 teams. This study has been designed with the aim of analysing the educational, occupational and health impact on E&N residents. MATERIAL AND METHODS: Cross-sectional observational study via a web survey, aimed at E&N residents who are members of the SEEN, carried out in November 2020. The following data were analysed: demographic variables, number of beds in the training hospital, alteration of rotations, integration in COVID-19 teams, participation in telemedicine, scientific activity and impact on physical and emotional health. RESULTS: 87 responses were obtained (27% of all E&N residents), 67.8% women, 28.1 ±â€¯1.8 years, 60% 4th year E&N residents. 84% participated in COVID-19 teams and 93% in the telemedicine consultations of their service. Most have had their rotations interrupted. 97.7% have participated in scientific meetings or virtual congresses and a third of them have collaborated in scientific work on COVID-19 in relation to endocrinology and nutrition. Overall, 75.8% think the pandemic has affected their mood a lot or quite a lot, and 73.8% think that the pandemic has negatively impacted their training. CONCLUSIONS: The SARS-CoV-2 pandemic has compromised the training, work activity and health of E&N residents. They have been integrated both in COVID-19 teams and in the restructured activity of their departments. However, they have managed to continue their training in virtual format and have participated in scientific work.

Práctica, praxis y desempeño asistencial: su redimensionamiento epistemológico en la formación del residente de Gastroenterología / Practice and assistance performance: its epistemologic resizing in the training of the Gastroenterology resident

Introducción: En la formación del residente de Gastroenterología, la función asistencial emerge como una de las más esenciales porque prepara al futuro especialista para aplicar los principios básicos fundamentales en la práctica de la endoscopia diagnóstico-terapéutica, con vistas a garantizar la calidad de su desempeño médico en la atención a pacientes con neoplasias digestivas. Sin embargo, la relación entre la práctica y la praxis asistencial aún necesita un redimensionamiento epistemológico para favorecer la transformación del quehacer profesional de estos especialistas. Desarrollo: Se realizó un análisis epistemológico de la relación entre práctica, praxis y desempeño asistencial en la formación del residente de Gastroenterología, lo que permite connotarla a partir de un nivel de interpretación más esencial, de manera que trascienda la visión fragmentada e instrumental de su enfoque teórico hacia uno nuevo totalizador que sistematiza su esencia formativa desde una intervención endoscópica holística, que integra la prevención, el diagnóstico y la terapéutica en la atención a pacientes con neoplasias digestivas. Conclusiones: La reinterpretación epistemológica de esta investigación consolidó la dialéctica entre la práctica y la praxis asistencial en un estadio epistemológico superior, lo que permite sustentar un nuevo tratamiento teórico de esta relación a partir del vínculo entre la práctica integral de procedimientos preventivos endoscópicos del aparato digestivo y la praxis interventiva endoscópica preventivo-curativa a fin de perfeccionar la formación de este especialista.

Introduction: In the training of the Gastroenterology resident, the assistance function emerges as one of the most essential because it prepares the future specialist to apply the fundamental basic principles in the practice of the diagnostic-therapeutic endoscopy, aimed at guaranteeing the quality of its medical performance in care of patients with digestive neoplasms. However, the relationship between the practice and the assistance practice still needs an epistemologic resizing to favor the transformation of the professional performance of these specialists. Development: An epistemologic analysis of the relationship between practice, and assistance performance in the training of the Gastroenterology resident was carried out, what allows to connote it starting from a more essential interpretation level, so that transcends the fragmented and instrumental vision of its theoretical approach toward a new totalizer approach that systematizes its training essence from an holistic endoscopic intervention that integrates prevention, diagnosis and therapeutic in the care of patients with digestive neoplasms. Conclusions: The epistemologic reinterpretation of this investigation consolidated the dialectics between the practice and the assistance practice in a superior epistemologic stage, what allows to sustain a new theoretical treatment of this relationship starting from the link between the integral practice of endoscopic-digestive preventive procedures and the preventive-curative endoscopic interventive practice in order to perfect this specialist training.

[Impact of the Covid-19 pandemic on specialized healthcare training in a teaching center]. / Impacto de la pandemia COVID-19 en la formación sanitaria especializada en un centro docente.

OBJECTIVE: Evaluation of the impact of the health crisis caused by the Covid-19 pandemic on specialized healthcare training in a teaching center. METHODS: Cross-sectional descriptive study, by means of an electronic questionnaire sent to 167 residents in June 2020, to evaluate the burden of care, suspension of rotations and Covid-19 symptoms. The impact on the acquisition of professional competencies was measured using a four-level Likert scale (none, a little, quiet, a lot). The profile of acquired competencies was constructed and its association with the professional profile was studied using Generalized Linear Models. The qualitative approach was carried out through an open question on how it influenced their learning and the different categories were extracted through triangulation. RESULTS: The impact on learning was important for 94.8% of the residents. A total of 81.4% left the rotations they were doing and reported high workload, loss of training opportunities, uncertainty and ethical conflicts. They appreciated significant learning in the competencies of teamwork (93.2%), professionalism (86.2%), ethics (79.9%) and communication (78%). Technical competencies were deficient. The final balance of learning was perceived as positive by 54.4%, especially residents in central services and medical specialties. A total of 67.8% felt overwhelmed at times due to fatigue-emotional impact, care overload, ethical conflicts and lack of resources. CONCLUSIONS: The Covid-19 pandemic had an exceptional impact on specialized health care training. It is necessary to re-evaluate training programs to ensure the acquisition of the technical competencies that are lacking.

The use of deliberate reflection to reduce confirmation bias among orthopedic surgery residents / O uso da reflexão deliberada para reduzir o viés de confirmação em residentes de ortopedia

Introduction: cognitive biases might affect decision-making processes such as clinical reasoning and confirmation bias is among the most important ones. The use of strategies that stimulate deliberate reflection during the diagnostic process seems to reduce availability bias, but its effect in reducing confirmation bias needs to be evaluated. Aims: to examine whether deliberate reflection reduces confirmation bias and increases the diagnostic accuracy of orthopedic residents solving written clinical cases. Methods: experimental study comparing the diagnostic accuracy of orthopedic residents in the resolution of eight written clinical cases containing a referral diagnosis. Half of the written cases had a wrong referral diagnosis. One group of residents used deliberate reflection (RG), which stimulates comparison and contrast of clinical hypotheses in a systematic manner, and a control group (CG), was asked to provide differential diagnoses with no further instruction. The study included 55 third-year orthopedic residents, 27 allocated to the RG and 28 to the CG. Results: residents on the RG had higher diagnostic scores than the CG for clinical cases with a correct referral diagnosis (62.0±20.1 vs. 49.1±21.0 respectively; p = 0.021). For clinical cases with incorrect referral diagnosis, diagnostic accuracy was similar between residents on the RG and those on the CG (39.8±24.3 vs. 44.6±26.7 respectively; p = 0.662). We observed an overall confirmation bias in 26.3% of initial diagnoses (non-analytic phase) and 19.5% of final diagnoses (analytic phase) when solving clinical cases with incorrect referral diagnosis. Residents from RG showed a reduction in confirmation of incorrect referral diagnosis when comparing the initial diagnosis given in the non-analytic phase with the one provided as the final diagnosis (25.9±17.7 vs. 17.6±18.1, respectively; Cohen d: 0.46; p = 0.003). In the CG, the reduction in the confirmation of incorrect diagnosis was not statistically significant. Conclusions:confirmation bias was present when residents solved written clinical cases with incorrect referral diagnoses, and deliberate reflection reduced such bias. Despite the reduction in confirmation bias, diagnostic accuracy of residents from the RG was similar to those from the CG when solving the set of clinical cases with a wrong referral diagnosis.

Introdução: os vieses cognitivos podem afetar tanto os processos de tomada de decisão como o raciocínio clínico e o viés de confirmação está entre os mais importantes. O uso de estratégias que estimulem a reflexão deliberada durante o processo diagnóstico parece reduzir o viés de disponibilidade, mas seu efeito na redução do viés de confirmação precisa ser avaliado. Objetivos: examinar se a reflexão deliberada reduz o viés de confirmação e aumenta a acurácia do diagnóstico de residentes de ortopedia ao resolverem casos clínicos escritos. Métodos: estudo experimental comparando a acurácia diagnóstica de residentes de ortopedia na resolução de oito casos clínicos escritos contendo um diagnóstico de encaminhamento. Metade dos casos escritos tinha um diagnóstico de encaminhamento errado. Um grupo de residentes utilizou a reflexão deliberada (GR), que estimula a comparação e o contraste de hipóteses clínicas de maneira sistemática, e um grupo controle (GC) foi solicitado a fornecer diagnósticos diferenciais sem maiores instruções. O estudo incluiu 55 residentes de ortopedia do terceiro ano, 27 alocados no GR e 28 no GC. Resultados: residentes no GR tiveram escores diagnósticos mais altos do que o GC para casos clínicos com um diagnóstico de encaminhamento correto (62,0±20,1 vs. 49,1±21,0 respectivamente; p = 0,021). Para os casos clínicos com diagnóstico de encaminhamento incorreto, a acurácia diagnóstica foi semelhante entre os residentes do GR e os do GC (39,8±24,3 vs. 44,6±26,7 respectivamente; p = 0,662). Observamos viés geral de confirmação em 26,3% dos diagnósticos iniciais (fase não analítica) e 19,5% dos diagnósticos finais (fase analítica) na resolução de casos clínicos com diagnóstico de encaminhamento incorreto. Os residentes do GR mostraram uma redução na confirmação do diagnóstico de encaminhamento incorreto ao comparar o diagnóstico inicial dado na fase não analítica com aquele fornecido como diagnóstico final (25,9±17,7 vs. 17,6±18,1, respectivamente; Cohen d: 0,46; p = 0,003). No GC, a redução na confirmação do diagnóstico incorreto não foi estatisticamente significativa. Conclusões: o viés de confirmação esteve presente quando os residentes resolveram casos clínicos escritos com diagnósticos de encaminhamento incorretos e a reflexão deliberada reduziu esse viés. Apesar da redução do viés de confirmação, a acurácia diagnóstica dos residentes do GR foi semelhante à do GC na solução do conjunto de casos clínicos com diagnóstico de encaminhamento incorreto.