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8.
Rev. méd. Urug ; 35(4): 298-301, dic. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1026158

RESUMO

La formación de cirujanos generales es responsabilidad de las clínicas quirúrgicas de la Facultad de Medicina. Su programa de formación de tres años presentaba carencias en cuanto al volumen y complejidad de la cirugía que cada residente realizaba. Objetivo: presentar los resultados de la producción quirúrgica de los residentes de Cirugía General luego de la implementación del cuarto año curricular del posgrado en la Clínica Quirúrgica 3 del Hospital Maciel y compararlos con los del período previo cuya duración era de tres años. Material y método: estudio observacional, descriptivo y retrospectivo de la producción quirúrgica de los residentes de la Clínica Quirúrgica 3 que cursaron en el período 2011-2015. Las variables consideradas fueron: número total de cirugías realizadas por todos los residentes, promedio de cirugías totales y por año por residente, número máximo y mínimo de cirugías realizadas por un residente, porcentaje total de cirugías de coordinación y urgencia, y promedio de cirugías por residente de acuerdo a la categorización en altas, mayores, corrientes y menores. Los datos se extrajeron del sistema de descripciones operatorias de la Administración de los Servicios de Salud del Estado, Hospital Maciel. Conclusiones: el incremento de un año en la duración de la residencia de Cirugía General determinó un aumento en el número y complejidad de la cirugía realizada por los residentes en la Clínica Quirúrgica 3 del Hospital Maciel, así como un incremento de las cirugías de coordinación en relación con las de urgencia y emergencia.


The general surgeons training program is under the responsibility of the Surgical Clinics of the School of Medicine. The 3-year training program evidenced deficiencies in terms of the volume and complexity of the surgeries carried out by the different residents. Objective: to present the surgical outcome of the General Surgery residents after the implementation of the fourth year in the curriculum of graduate studies of the Surgical Clinic 3 at Maciel Hospital and to compare it to that of the residents trained in the previous 3-year studies plan. Method: observational, descriptive and retrospective study of the surgical outcome of residents of the Surgical Clinic 3 who studied in the 2011-2015 period. Below follow the variables considered: total number of surgeries carried out by all residents, average number of surgeries per year and per resident, maximum and minimum number of surgeries by a resident, total percentage of coordination and urgent surgeries and average number of surgeries by resident according to the classification into high complexity, complex, regular and minor. Data were taken from the ASSE surgery description system - Maciel Hospital. Conclusions: increasing one year the duration of the general surgery residence resulted in a higher number and complexity of surgeries carried out by the residents of Surgical Clinic 3 at Maciel Hospital, as well as an increase in the coordination surgeries when compared to urgency and emergency surgeries.


A formação de cirurgiões gerais é responsabilidade das Clínicas Quirúrgicas da Facultad de Medicina. O programa de formação de 3 anos apresentava carências tanto em relação ao volume como também à complexidade da cirurgia que cada residente realizava. Objetivo: apresentar os resultados da produção cirúrgica dos Residentes de Cirurgia Geral depois da implementação do quarto ano curricular da pós-graduação na Clínica Quirúrgica 3 do Hospital Maciel e compará-los com os do período prévio cuja duração era de 3 anos. Material e método: estudo observacional, descritivo e retrospectivo da produção cirúrgica dos Residentes da Clínica Quirúrgica 3 que cursaram no período 2011 ­ 2015. As variáveis estudadas foram: número total de cirurgias realizadas por todos os residentes, média de cirurgias totais e por ano por residente, número máximo e mínimo de cirurgias realizadas por residente, porcentagem total de cirurgias eletivas e de urgência e média de cirurgias por residente segundo a classificação como de grande, meio e pequeno porte e corrente. Os dados foram obtidos do sistema de descrições operatórias de ASSE - Hospital Maciel. Conclusões: o incremento de um ano na duração da residência de cirurgia geral levou a um aumento no número e na complexidade das cirurgias realizadas pelos residentes na Clínica Quirúrgica 3 del Hospital Maciel, bem como uma aumento das cirurgias eletivas em relação às de urgência e emergência.


Assuntos
Cirurgia Geral/educação , Educação de Pós-Graduação em Medicina , Educação Médica , Internato e Residência
9.
Handchir Mikrochir Plast Chir ; 51(6): 418-423, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31698485

RESUMO

The profitability of medical treatment has gained increasing importance in health politics and likewise has become a considerable part of a microsurgeon's daily practice. The resulting cost pressure leads to microsurgeons having to justify their often complex and expensive treatments against hospital providers and health insurances. In this position paper of the German Speaking Group for Microsurgery of Peripheral Nerves and Vessels, we analyze the current status of profitability of microsurgical extremity and breast reconstruction, and its impact on choice of therapy and residency training. We specifically highlight the available literature, that shows often reduced long-term treatment costs after microsurgical reconstruction in comparison to cheaper initial treatments. The statements are based on a consensus workshop on the 40th meeting of the DAM in Lugano, Switzerland.


Assuntos
Microcirurgia , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Internato e Residência , Mamoplastia/economia , Microcirurgia/economia , Microcirurgia/métodos , Nervos Periféricos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/economia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Suíça
10.
N Engl J Med ; 381(21): 1992-1993, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31747727
11.
J Surg Orthop Adv ; 28(3): 175-179, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31675293

RESUMO

The objective of this analysis was to compare the efficiency of scholarly activity withinmilitary orthopaedic training programs. The authors obtained the lists of abstracts accepted for presentation at the 2009 through 2014 Society of Military Orthopaedic Surgeons (SOMOS) annual meetings. Data were extracted for each individual presentation. Three primary groups were compared: a traditional program, a research program, and a hybrid program. The hybrid program produced the highest percentage of the presentations (28.6%). The traditional program contributed the most presentations (3.32) and publications (2.16) per resident and had the highest publication rate (87.7%) and the shortest time to publication (14.4 months). The research program published in the highest average impact journals (3.2). The addition of a research year does not improve the number of academic presentations or published papers but may improve the impact factor of the journals in which the projects are published. (Journal of Surgical Orthopaedic Advances 28(3):175-179, 2019).


Assuntos
Internato e Residência , Ortopedia , Publicações , Bolsas de Estudo , Humanos , Militares , Ortopedia/educação
14.
Br J Anaesth ; 123(6): 887-897, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31591019

RESUMO

BACKGROUND: An unintended consequence of medical technologies is loss of personal interactions and humanism between patients and their healthcare providers, leading to depersonalisation of medicine. As humanism is not integrated as part of formal postgraduate anaesthesiology education curricula, our goal was to design, introduce, and evaluate a comprehensive humanism curriculum into anaesthesiology training. METHODS: Subject-matter experts developed and delivered the humanism curriculum, which included interactive workshops, simulation sessions, formal feedback, and patient immersion experience. The effectiveness of the programme was evaluated using pre- and post-curriculum assessments in first-year postgraduate trainee doctors (residents). RESULTS: The anaesthesiology residents reported high satisfaction scores. Pre-/post-Jefferson Scale of Patient Perceptions of Physician Empathy showed an increase in empathy ratings with a median improvement of 12 points (range; P=0.013). After training, patients rated the residents as more empathetic (31 [4] vs 22 [5]; P<0.001; 95% confidence interval [CI]: 7-12) and professional (47 [3] vs 35 [8]; P<0.001; 95% CI: 9-16). Patient overall satisfaction with their anaesthesia provider improved after training (51 [6] vs 37 [10]; P<0.001; 95% CI: 10-18). Patients rated their anxiety lower in the post-training period compared with pretraining (1.8 [2.3] vs 3.6 [1.6]; P=0.001; 95% CI: 0.8-2.9). Patient-reported pain scores decreased after training (2.3 [2.5] vs 3.8 [2.1]; P=0.010; 95% CI: 0.4-2.8). CONCLUSIONS: Implementation of a humanism curriculum during postgraduate anaesthesiology training was well accepted, and can result in increased physician empathy and professionalism. This may improve patient pain, anxiety, and overall satisfaction with perioperative care.


Assuntos
Anestesiologia/educação , Competência Clínica/estatística & dados numéricos , Currículo , Humanismo , Internato e Residência , Satisfação do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesiologia/métodos , Atitude do Pessoal de Saúde , Empatia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudantes de Medicina/psicologia , Adulto Jovem
15.
Isr J Health Policy Res ; 8(1): 74, 2019 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-31610814

RESUMO

One of the major health disparities between Israel's center and periphery relates to the physician to population ratio. To overcome it, the Israeli government launched a financial incentive program in 2011, in an attempt to encourage physicians to work in the periphery and in specialties experiencing major shortages. A recent IJHPR study found that residents who choose to work in a peripheral institution gave more weight to the grant in their decision-making process than did residents from central institutions. This finding lends support to the rationale behind the government program and suggests that it is an effective means of achieving the desired goal.This commentary details how the program was repeatedly adjusted during the 2011-2018 period, in light of changing needs. As financial and human resources are expected to remain scarce in the future, the program must continue to be constantly evaluated and adjusted in order to maintain its effectiveness.


Assuntos
Internato e Residência , Governo , Humanos , Israel , Motivação , Autorrelato , Recursos Humanos
16.
Am J Orthod Dentofacial Orthop ; 156(4): 522-530, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31582124

RESUMO

INTRODUCTION: Although unquantifiable features, such as faculty passion and dedication to teaching, play a vital role in defining the quality of residency education, determinable features that are fundamental to the definition of a "top tier" orthodontic residency program also exist. The objective of this study was to identify those features. METHODS: A survey with 32 items was developed and validated to assess the features of an excellent orthodontic program based on the following 3 major domains: faculty, education, and resident/graduate student/alumni. The survey was sent to 62 orthodontic residency programs in the United States. RESULTS: Thirty-nine programs (63%) completed the survey. Recurring attributes that were identified in what constitutes an excellent program included the following: an adequate number of full-time clinical orthodontic faculty, with each member providing 1 day per week clinic coverage. The average of all respondents was 4, and the range was 1-6; a healthy mix of part-time faculty members with ≥1 full-time faculty member who monitors every clinical session; 80% full-time faculty members who are American Board of Orthodontics (ABO) certified; a craniofacial faculty member; 4 residents/graduate students per each faculty member who covers a clinical session; resident/graduate student exposure to a wide range of treatment modalities and appliances; approximately 70 new case starts per resident/graduate student (50%-60% of patients who are started are debonded by the starting resident/graduate student); patients with craniofacial anomalies and orthognathic surgery patients should be started by each resident/graduate student; 1.5 operatory chairs per resident or graduate student; 1 dental assistant per 4 residents/graduate students; 1 laboratory person; 1 receptionist/secretary per 4 residents; 100% of residents/graduate students successfully completing ABO written examination upon graduation; 60% of residents/graduate students obtaining ABO certification within 5 years of graduation; 50% of residents/graduate students presenting at national meetings would be ideal; and 50% of living alumni contributing financially to the department during the past 5 years. CONCLUSIONS: Based on the responses from the majority of the US orthodontic residency programs, this study has identified certain features that educators feel are ideal for an excellent orthodontic program.


Assuntos
Educação de Pós-Graduação em Odontologia/normas , Internato e Residência/normas , Ortodontia/educação , Ortodontia/normas , Docentes de Odontologia/educação , Docentes de Odontologia/normas , Humanos , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Estados Unidos
17.
Harefuah ; 158(10): 630-634, 2019 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-31576706

RESUMO

AIMS: To describe three interventions that have improved the quality of the internship. BACKGROUND: All medical school graduates are required to take a one year internship, rotating through various hospital departments. By various objective and subjective measures, the quality, benefit and efficacy of the internship varies significantly between departments and hospitals and also depends on where the interns studied. METHODS: The interventions were: First, all graduates of foreign medical schools (FMG) were required to interview and present a patient, demonstrating practical knowledge of spoken and written Hebrew and basic medical terminology prior to the start of the internship. Second, on the first day of their internship in internal medicine the new interns participate in an orientation day, addressing multiple clinical, administrative and other components. Third, upon the completion of their rotation in internal medicine, the interns participate in an interactive session to help them prepare for their future career. RESULTS: First, during the first 3 years after introducing the Hebrew test, 101 FMGs took the test, 89 (88%) passed the first time, the remainder passed the 2nd or 3rd test after another 1-3 months of studying Hebrew. Of 31 women, 30 (97%) passed the first time, compared to 59/70 (84%) of the men (p=0.065); 27/28 (96%) of Jewish interns passed the first time compared to 62/73 (85%) non-Jewish interns (p=0.99). Physicians report on the significantly increased ability of FMGs to participate in all activities from the onset of their internship. Second, upon completion of the orientation, 137 interns provided feedback of its 12 components; satisfaction was marked on a Likert scale (ranging from 1 [low] to 5 [high]) and ranged from 4.2±0.1 to 4.7±0.6; high/very high satisfaction with the various components ranged from 79% to 96%. Third, feedback was provided by 96 interns after participating in the interactive session helping to prepare for the future; satisfaction with the 5 components of the session ranged from 3.8±0.8 (on the acquired insight into the possibilities, scope and limitations regarding their future career) to 4.5±0.7 (regarding the relevance of such sessions). Sub-analysis revealed several statistically significant differences between male and female interns (male interns indicated these sessions to be more important to them than females, p<0.01), and FMG (as compared to graduates from Israeli medical schools) indicated that they had acquired relevant information more often (p<0.001). CONCLUSIONS: Various interventions positively impact the quality, benefit and efficacy of the internship as observed by physicians working with the residents, as well as perceived by the interns themselves.


Assuntos
Internato e Residência , Faculdades de Medicina , Competência Clínica , Feminino , Humanos , Medicina Interna , Masculino , Satisfação Pessoal
18.
Harefuah ; 158(10): 639-642, 2019 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-31576708

RESUMO

INTRODUCTION: Examinations are an integral part of the process of medical specialization in the State of Israel and a resident cannot receive an expert degree without passing the exams. The Scientific Council is the body responsible for the physician's training process, and the Higher Examinations Committee for the exams. Professional examinations committees are subject to the professional guidance by the Higher Examinations Committee. The residency exams are performed in two phases: Stage A (written examination) and Stage B (oral examination). Changes in Stage A exams, Stage B exams, and in the process of appeals to the exam results, are conducted after thorough thinking and testing procedures and under the guidance of professionals. During the course of the current Higher Examinations Committee, a number of significant changes were made in Stage A exams, including: 1. Reducing the number of questions in the surgical fields exams; 2. Consolidating the two parts of the exam in General Surgery, Urology, Vascular Surgery, Plastic Surgery, and Pediatric Surgery. 3. Exposing the questions and answers after the examination and altering the appeals process. There have also been changes in some specialties in Stage B exams according to the following rules: 1. Aspiration for multi-test stations; 2. Two examiners in each station; 3. Structured and unified content on all exam stations; 4. Structured evaluation forms; 5. Filling out the evaluation form by the examiners without consulting between them; 6. Automatic calculation of scores based on the percentage of accumulated points that the examinees accumulated from the maximum possible points; 7. An upfront decision on the passing score. The Higher Examinations Committee of the Scientific Council works, and will act constantly, for the construction of professional, fair, reliable and valid residency examinations.


Assuntos
Internato e Residência , Médicos , Faculdades de Medicina , Criança , Competência Clínica , Avaliação Educacional , Humanos , Israel , Especialização , Cirurgia Plástica
19.
Harefuah ; 158(10): 654-655, 2019 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-31576711

RESUMO

INTRODUCTION: Post-Graduate Medical Education in the surgical professions, as in other medical professions as well, has gone through an organizational revolution during the past 10-15 years. Catalyzers of this change were the information revolution, technological changes, life-work balance needs of residents, legalization of the medical system and different duty hours' restrictions that followed. These changes require rethinking traditional Post-Graduate Medical Education and adaptation of teaching methods, quality measurement methods, new definition of program director's role and more. In this article we review these changes as they appear in updated literature and the significance of the changes in the Israeli health system since the last physicians' bargaining agreement of 2011.


Assuntos
Internato e Residência , Cirurgiões , Humanos , Admissão e Escalonamento de Pessoal , Médicos , Carga de Trabalho
20.
Harefuah ; 158(10): 656-658, 2019 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-31576712

RESUMO

INTRODUCTION: Competence based surgical education is gaining acceptance in many residency programs around the world. Changing and fluctuating working hours for residents, the need for vast knowledge acquisition during residency, as well as the application of new emerging technologies in surgical practices, call for the modification of educational platforms and domains in surgical teaching. Milestones of cognitive knowledge, as well as surgical and other essential skills needed for the "formation" of a competent resident are judiciously laid during the residency process. These educational requirements are then measured for their proper acquisition by the trainee. Assessing surgical skills and other performance competences of the novice in the operating theatre need to be longitudinally evaluated and measured as well.


Assuntos
Competência Clínica , Educação Médica , Internato e Residência , Cirurgiões , Humanos
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