DIA-Person Integration Model to increase the quality of teaching, research and medical care. A person-oriented strategy.

Current model of medicine has made for medical care, teaching and research to be driven apart, with an impact on the patient: during the process of care, the doctor fails to apply the scientific method, he only treats the ailment without accompanying the patient. The medical researcher looks for answers to questions far removed from patient ailments and, in the best-case scenario, conducts research on patient specimens. In addition, the student-teacher dyad is characterized by the transmission of knowledge and leaves aside understanding of the patient. Patients, doctors, researchers and students are oblivious to decision-making and, without questioning, they merely follow processes. One way to address the problem is to return to the DIA-person Integration Model: "concern and doing for the person, accompanied by the integration of teaching, research and medical care", which would allow the transfer of knowledge, skills and benefits from one activity to others. The model consists of contrasting the patient condition with knowledge, carrying out research during and parallel to the medical care-teaching process, as well as applying the architecture of research model "clinical judgment structured description", as a reference and reflection process that integrates the activities of teaching-research and person-oriented medical care.

El modelo actual de la medicina ha distanciado la atención médica, la docencia y la investigación, con impacto en el paciente: durante la atención, el médico omite aplicar el método científico, solo atiende la dolencia sin acompañar al paciente; el investigador médico busca respuestas a preguntas alejadas de las dolencias del paciente y, en el mejor de los casos, realiza investigación en especímenes provenientes de este; la díada estudiante-profesor se caracteriza por la transmisión de conocimiento y deja de lado la comprensión del paciente. Pacientes, médicos, investigadores y estudiantes son ajenos a la toma de decisiones y sin cuestionamientos solo siguen procesos. Una manera de abordar el problema es regresar al Modelo de Integración DIA-persona: "la preocupación y el hacer por la persona, acompañados por la integración de docencia, investigación y atención médica", lo que permitiría el traslado del conocimiento, destrezas y beneficios de una actividad a otra. El modelo consiste en contrastar la condición del paciente con el conocimiento, realizar investigación durante y en paralelo al proceso de atención-docencia médica, así como aplicar el modelo arquitectónico de la investigación "descripción estructurada del juicio clínico", como proceso de referencia y reflexión que integra las actividades de docencia-investigación y atención médica orientadas a la persona.

[Patient safety training and a safe teaching in primary care]. / La formación en seguridad del paciente y una docencia segura en atención primaria.

This narrative review manuscript aims to raise the difficulties and opportunities for patient safety in specialised healthcare training considering undergraduate, postgraduate, specialist and continuing education, even during the COVID-19 pandemic. It also suggests some proposals for carrying it out. It very briefly discusses this specific training and its current situation in primary care. Highlighting that patient safety is a need, an area of competence and a training opportunity for residents. It establishes the general framework of patient safety in primary care in the document "7 steps for Patient Safety in Primary Care", stating the need for a systemic approach. It highlights the elaboration and presentation of cases on clinical errors as the most frequent training strategy. The real-life clinical scenarios relate to difficult patients, critical incidents and bioethics issues in professional practice. These scenarios have as common characteristics, the fact to produce difficulties and suffering for all the actors involved. Several instruments for training in patient safety are also included. The medium-term goal is to consolidate clinical safety in specialised healthcare training. Finally, an analysis is made of the impact of the pandemic on patient safety training, particularly on specialised healthcare training and some proposals are recommended on how to carry out safe teaching in the times of the COVID-19 pandemic.

Mentor-mentee relationship in medicine. / La relación mentor-aprendiz en medicina.

This study will review various aspects of the mentoring process, mainly in the medical field (both educational and research), in order to describe the mentor's role, the characteristics of the ideal mentor and mentee, how to find a good mentor, mentoring types, the benefits of a mentor-mentee relationship, and potential obstacles and possible solutions. Our ultimate goal is to encourage potential mentors to become actual mentors, and potential mentees to actively seek a mentor and not lose the opportunity to receive this precious gift that many of us have been fortunate to enjoy.

[Teaching infectious diseases in the Medical Degree within the European higher education area]. / La enseñanza de las enfermedades infecciosas en el grado de Medicina en el marco del espacio europeo de educación superior.

During their medical studies, students must acquire basic competencies in different areas of knowledge, one of which is infectious diseases. Training in infectious diseases is essential for general medical practice and for academic or professional expertise in many areas of medicine, both medical and surgical. The vast amount of knowledge that is continuously generated about infectious diseases requires a well-structured undergraduate medical education program and framed in a setting dominated by globalization. The incorporation of Spain to the European higher education area has forced medical schools to adapt their curriculum and to establish the content and learning objectives of all courses of study. In this paper, we discuss the implications of the integration of the Spanish university system in the European higher education area («Bologna Process¼) in the teaching of infectious diseases in the Degree of Medicine, and describe the learning program in infectious diseases of the University Miguel Hernández of Elche (Alicante, Spain) based on learning outcomes and competencies.

Hospital variability in postoperative mortality after rectal cancer surgery in the Spanish Association of Surgeons project: The impact of hospital volume.

OBJECTIVE: This multicentre observational study examines variation between hospitals in postoperative mortality after elective surgery in the Rectal Cancer Project of the Spanish Society of Surgeons and explores whether hospital volume and patient characteristics contribute to any variation between hospitals. METHODS: Hospital variation was quantified using a multilevel approach on prospective data derived from the multicentre database of all rectal adenocarcinomas operated by an anterior resection or an abdominoperineal excision at 84 surgical departments from 2006 to 2013. The following variables were included in the analysis; demographics, American Society of Anaesthesiologists classification, tumour location and stage, administration of neoadjuvant treatment, and annual volume of surgical procedures. RESULTS: A total of 9809 consecutive patients were included. The rate of 30-day postoperative mortality was 1.8% Stratified by annual surgical volume hospitals varied from 1.4 to 2.0 in 30-day mortality. In the multilevel regression analysis, male gender (OR 1.623 [1.143; 2.348]; P<.008), increased age (OR: 5.811 [3.479; 10.087]; P<.001), and ASA score (OR 10.046 [3.390; 43.185]; P<.001) were associated with 30-day mortality. However, annual surgical volume was not associated with mortality (OR 1.309 [0.483; 4.238]; P=.619). Besides, there was a statistically significant variation in mortality between all departments (MOR 1.588 [1.293; 2.015]; P<.001). CONCLUSION: Postoperative mortality varies significantly among hospitals included in the project and this difference cannot be attributed to the annual surgical volume.

[Communication skills in the curriculum of Medical students from Spain (1990-2014): From the Primary Health Care to the Bologna Plan. A descriptive study]. / Competencia en comunicación en el currículo del estudiante de Medicina de España (1990-2014): de la Atención Primaria al Plan Bolonia. Un estudio descriptivo.

OBJECTIVES: Analyse the currently situation of teaching in communication skills in the Spanish Medical Schools (MS) and the grade of implementation from the recommended by the National Agency of Evaluation of the Quality and Accreditation. DESIGN: Descriptive-comparative, transversal and quantitative-qualitative study. SITUATION: University teaching field. SAMPLE: The whole population of MS in Spain. INCLUSION CRITERIA: teaching during the academic year 2013-2014 the Degree in Medicine homologated by the National Agency of Evaluation of the Quality and Accreditation and offering information of their educational plans and teaching guides (online, telephonic or e-mail). VARIABLES: 1) Existence of courses about communication skills; 2) type of teaching; 3) format of the course; 4) credits; 5) length, and 6) grade. They were analysed with descriptive parameters and the Cohen's coefficient (d). RESULTS: Forty-two MS: 10 privates and 32 publics. Thirty MS (71.43%) presented at least one course of communication skills. The 78.12% of the public MS contained this kind of teaching as an entire course versus the 50.00% of the private MS. The national average by MS was 2.77 (σ=2.41), lower than the 5.0 credits recommended by the the National Agency of Evaluation of the Quality and Accreditation (relevant difference: d=1.63>>0,8). The 63.63% contained this teaching over the second cycle (mode: second degree). CONCLUSIONS: The course loads in terms of credits destined to this skills has increased considerably from 1990 to 2014 (d= 1,43>>0,8). However, it has not been completely established yet the recommendations about this aspect in most of the Spanish MS. The public universities seem to be more aware of this teaching. Furthermore, it would be interesting strengthen this skills in the sixth grade.

The elements of dermatology: the legacy of Covisa and Bejarano.

In 1936, Covisa and Bejarano published a treatise entitled Elementos de Dermatología (The Elements of Dermatology). In this surprisingly modern book they abandoned the nosological debates characteristic of the 19th century and instead classified diseases according to their etiology and pathogenesis based on the scientific and technical advances of the time. Moreover, unlike other books available at the time, which were essentially adaptations of foreign texts, this was the first medical work to reflect the reality of Spanish medicine. However, the future of both the book and its authors was to be determined by the start of the Spanish Civil War in the same year. Covisa and Bejarano, who were both extremely active in the public health system and medical education during the Second Republic, were obliged to seek exile in America. Due to the difficulties of the time, very few copies of the book reached the public and no new editions were ever printed. We will never know what would have happened if the war had not started, but we believe that this important work should be remembered.

Undergraduate radiodiagnostic professors.

The international literature on university teaching, has insisted on the need to combine a double component in the professional profile of teachers: content knowledge and pedagogical content knowledge. Regarding the content, the area of knowledge of radiology and physical medicine is made up of different medical specialties, among which are radiodiagnosis, nuclear medicine, radiation oncology, physical medicine and rehabilitation. On the other hand, the pedagogical content knowledge is framed by framework that the Bologna Declaration (1999). Focusing on radiodiagnosis, the ideal candidates must be professionals in this medical specialty, vocational teachers and people who find in the undergraduate teaching process an opportunity to transmit their knowledge, experiences and values in an entertaining and understandable way for students who are incorporated into medical knowledge.

Student survey after ten years of continuous blended teaching of echocardiography.

OBJECTIVE: To analyse the impact of 10 years of blended echocardiography teaching. METHODS AND RESULTS: A questionnaire was emailed to all medical doctors who graduated from the blended learning diploma in echocardiography developed by the University of Chile and taught by a team from Chile and Spain. One hundred and forty of the 210 students who graduated from the program between 2011 and 2020 completed the questionnaire: 53.57% were anaesthesiologists, and 26.42% were intensivists. More than 85% of respondents indicated that the online teaching met their expectations, and 70.2% indicated that the hands-on practice fulfilled the stated objectives. In a retrospective analysis using self-reported data, graduates reported that their use of transthoracic and transoesophageal echocardiography has increased from 24.29% to 40.71% and from 13.57% to 27.86%, repectively, after the programme compared to before the programme. They used echocardiography mainly in the perioperative period (56.7%) and during intensive care (32.3%), while only 11% of respondents used it in emergency care units. Nearly all (92.4%) respondents reported that the skills learned was very useful in their professional practice. CONCLUSIONS: Ten years after its launch, the blended learning diploma in echocardiography was well rated by graduate specialists, and is associated with a significant increase in the use of echocardiography in the perioperative period and during intensive care. The main challenges are to establish a longer period of practice and achieve greater implantation in emergency medicine.

[ChatGPT is an above-average student at the Faculty of Medicine of the University of Zaragoza and an excellent collaborator in the development of teaching materials]. / ChatGPT es un estudiante por encima de la media en la Facultad de Medicina de la Universidad de Zaragoza y un colaborador excelente en la elaboración de material docente.

INTRODUCTION AND OBJECTIVE: Artificial intelligence is fully present in our lives. In education, the possibilities of its use are endless, both for students and teachers. MATERIAL AND METHODS: The capacity of ChatGPT has been explored when solving multiple choice questions based on the exam of the subject «Anatomopathological Diagnostic and Therapeutic Procedures¼ of the first call of the 2022-23 academic year. In addition, to comparing their results with those of the rest of the students presented the probable causes of incorrect answers have been evaluated. Finally, its ability to formulate new test questions based on specific instructions has been evaluated. RESULTS: ChatGPT correctly answered 47 out of 68 questions, achieving a grade higher than the course average and median. Most failed questions present negative statements, using the words «no¼, «false¼ or «incorrect¼ in their statement. After interacting with it, the program can realize its mistake and change its initial response to the correct answer. Finally, ChatGPT can develop new questions based on a theoretical assumption or a specific clinical simulation. CONCLUSIONS: As teachers we are obliged to explore the uses of artificial intelligence and try to use it to our benefit. Carrying out tasks that involve significant consumption, such as preparing multiple-choice questions for content evaluation, is a good example.

Teaching radiology in integrated educational programs.

Radiology is a medical discipline, an area of transversal knowledge integrated into any clinical situation. The optimal training of learning knowledge, skills and aptitudes in Radiology in the Degree in Medicine requires the integration of any imaging modality in the different areas of knowledge; from the basic subjects to any clinical subject of the Degree. This article describes the integration of Radiology teaching into the curriculum throughout the Medicine Degree at the University of Girona (UdG), describing the different radiology teaching activities that are taught. The specific activities of the subject "Radiology" are detailed; through workshops, seminars, practices, interactive computer game; and describing the characteristics of the main teaching methodological activity of the UdG, Problem-Based Learning.

Executive Summary of the Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR) Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management.

The Airway section of the Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) present the Guidelines for the integral management of difficult airway in adult patients. This document provides recommendations based on current scientific evidence, theoretical-educational tools and implementation tools, mainly cognitive aids, applicable to the treatment of the airway in the field of anesthesiology, critical care, emergencies and prehospital medicine. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations and optimization in the progression of the application of strategies to preserve adequate alveolar oxygenation in order to improve safety and quality of care.

Physiotherapy students' perceptions of ageing - Playing narratives as a pedagogical innovation.

INTRODUCTION AND OBJECTIVES: There is a considerable lack of structure in training health professionals in geriatrics. The narratives can promote a collaborative reflection on different topics and might be used as a pedagogic strategy for undergraduate health students. This study aimed to explore the adoption of new perspectives on ageing after the implementation of dynamic narratives in the first graduate year for physiotherapy students. MATERIALS AND METHODS: An exploratory qualitative study was performed. Participants were included if they were: ≥18 years old, physiotherapy students and agreed to participate. Physiotherapy students (n=44) were recruited from the School of Health Sciences, Polytechnic Institute of Leiria. Two gaming sessions were performed to help students, as narrators, express their visions and ways to deal with the geriatrics field. Students' perspectives about ageing at baseline (T1) and after the narratives experience (T2) were collected by answering the following question: What is your perception regarding ageing? Two evaluators were involved in qualitative data analysis by performing: (i) an individual analysis of themes/subthemes and a discussion meeting to evaluate discrepancies and to reach a consensus. RESULTS: Negative perceptions about ageing were referred 39 times at T1 (most of them related to restriction; deterioration subthemes). There were no negative perceptions registered at T2. Positive perceptions increased at T2, from n=39 to n=52, and three new subthemes emerged (beginning of something, fighting ageism, challenge). CONCLUSION: This study demonstrated the potential of narrative-based experiences as a desirable pedagogic methodology (board games-oriented) for geriatric education in undergraduate health students.

In-hospital cardiac arrest: Incidence, prognostic factors and results.

BACKGROUND AND AIMS: In-hospital cardiac arrest (CA) is a clinical entity with high morbidity and mortality that occurs in up to 2% of hospitalized patients. It is a public health problem with important economic, social, and medical repercussions, and as such its incidence needs to be reviewed and improved. The aim of this study was to determine the incidence of in-hospital CA, return of spontaneous circulation (ROSC), and survival rates at Hospital de la Princesa, and to define the clinical and demographic characteristics of patients with in-hospital CA. PATIENTS AND METHODS: Retrospective observational chart review of patients presenting in-hospital CA and treated by anaesthesiologists from the hospital's rapid intervention team. Data were collected over 1 year. RESULTS: Forty four patients were included in the study, of which 22 (50%) were women. Mean age was 75.7 years (±15.78 years), and incidence of in-hospital CA was 2.88 per 100,000 hospital admissions. Twenty two patients (50%) achieved ROSC and 11 patients (25%) survived until discharge home. The most prevalent comorbidity was arterial hypertension (63.64%); 66.7% of cases were not witnessed, and only 15.9% presented a shockable rhythm. CONCLUSIONS: These results are similar to those reported in other larger studies. We recommend introducing immediate intervention teams and devoting time to training hospital staff in in-hospital CA.

[Undergraduate Pathology: Video tutorials including digital pathology make teaching more practical and the subject more attractive]. / Anatomía Patológica para el estudiante de Medicina: videotutoriales con integración de Patología digital como una valiosa herramienta para hacer la asignatura más práctica y atractiva.

INTRODUCTION AND OBJECTIVES: Although pathology is one of the cornerstone subjects of the medical curriculum, for many students it can prove too theoretical and remote from clinical relevance. We present the results of a new distance learning project designed to make the teaching of pathology more practical and render the subject more attractive to the medical student. MATERIALS AND METHODS: We developed a teaching programme which included digital pathology images and video tutorials of clinical cases; the students were required to arrive at a final diagnosis. An explanatory video of how biopsies are processed was also included. Twitter was used for rapid interaction with the students. A questionnaire was then completed by the participants evaluating the various aspects of the project. RESULTS: All the students reached a correct diagnosis for the clinical cases. 89% of the participants were extremely satisfied with the project. The majority agreed that the different activities were interesting and useful for improving their understanding of pathology and thus recommended that they should be continued. CONCLUSIONS: Our results support the inclusion of digital pathology into the curriculum together with video tutorials to enhance undergraduate pathology teaching. In the future, such distance learning could prove a useful resource in combination with conventional face-to-face lectures and tutorials.

[Analysis of the university teaching organization of Pathological Anatomy in Spain]. / Análisis de la organización docente universitaria de la Anatomía Patológica en España.

INTRODUCTION: To describe and analyze the current situation of Pathology teaching and its characteristics in the degree of Medicine in public medical schools in Spain. METHODS: Descriptive analysis of the teaching guides of the undergraduate studies of 32 Spanish public medical schools, identifying the number of credits, hours of theoretical practical teaching, teaching elements, rotation through hospital services and teachers in the subject of Pathology. RESULTS: In the 32 medical schools analyzed, 31 (96.7%) present in their study plans at least 1 AP subject. Data could not be obtained from one faculty. 67% of the subjects offered imply rotation by AP services. The most frequent year for AP teaching is the third one, and the median number of ECTS credits is 6. 49.5% of the subjects involve contents related to the clinical autopsy. 12.5% of the subjects have either theoretical or practical content on digital Pathology or telepathology. Regarding the teaching staff, 112 people are civil servants (University Professor or Professor, of which 91 are linked -92,9%), 244 people are non-civil servants, where 76.2% have the teaching figure of Associate Professor. CONCLUSIONS: The teaching of Pathology is widely distributed, the rotation of Pathology health services is scarce and the most frequent teaching figure is that of an Associate Professor.

Medical training programs: comparisons between family and community medicine, internal medicine, intensive care medicine, anesthesiology and critical care, and emergency medicine. / Análisis comparativo de los Programas de Formación Sanitaria Especializada de Medicina Familiar y Comunitaria, Medicina Interna, Medicina Intensiva, Anestesiología y Reanimación y Medicina de Urgencias y Emergencias.

OBJECTIVES: To analyze whether current medical residency training programs in Spain foster the acquisition of knowledge and skills that enable specialists to provide emergency and urgent medical care. MATERIAL AND METHODS: We studied documents related to the content of residency programs for the following 4 specialties in effect in June 2021: internal medicine, intensive care medicine, anesthesiology and critical care, and family and community medicine. Program descriptions were obtained from the website of the Spanish Ministry of Health and the professional associations for each specialty. The associations' unofficial drafts and proposed updates were also studied. For emergency and urgent medicine, we studied drafts and updates of proposals presented to the Ministry of Health by the Spanish Society of Emergency Medicine (SEMES) in 2010 and an updated version presented in 2021. The proposals were drafted by the SEMES committee to promote specialization in emergency medicine. RESULTS: Existing residency programs treat the management of urgent events from diverse points of view related to hospital settings (internal medicine focusing on admitted patients, anesthesiology on patients in perioperative settings, and intensive care on those in their specialized units) or to primary care centers (family medicine), where they are an extension of routine care. The residents' rotations in emergency medicine vary. In anesthesiology, intensive care medicine, and family medicine, training occurs while residents are on call - in the first year for trainees in anesthesiology and intensive care medicine but throughout the 4-year residency (with time decreasing each year) for trainees in family medicine. Internal medicine offers an initial 3-month rotation in emergency medicine in the early phase and then assigns on-call shifts, without specifying a number. The proposed program submitted by SEMES includes wide-ranging contact with emergencies in various hospital settings (observation ward, trauma care, and pediatric care). Training in out-of-hospital emergencies and emergency and urgent care resource coordination centers are also included. CONCLUSION: Currently available residency training in Spain does not provide appropriate preparation for practicing emergency medicine. Emergency medicine has its own body of theory and settings for practice that differ from those of other specialties. Therefore, at present there is a training gap in Spain that should be filled by creating a specialization in emergency medicine.

OBJETIVO: Analizar si con las especialidades actuales se adquieren los conocimientos y habilidades necesarios para desempeñar las funciones propias de la Medicina de Urgencias y Emergencias (MUE). METODO: Mediante análisis de contenido documental, se comparan los programas formativos de Medicina Interna (MI), Medicina Intensiva (MIV), Anestesiología y Reanimación (AyR) y Medicina Familiar y Comunitaria (MFyC) vigentes a fecha de junio de 2021, accesibles tanto en el portal web de Ministerio de Sanidad (MS), como a través de las sociedades científicas de las especialidades, incluidos los borradores no oficiales y propuestas de actualización de los programas y del programa de formación elaborado por la Comisión Promotora de la Especialidad de MUE, presentado por SEMES (Sociedad Española de Medicina de Urgencias y Emergencias) al MS en 2010 y actualizado en 2021. RESULTADOS: Los programas formativos de las especialidades existentes en la actualidad contemplan el manejo de las enfermedades urgentes de forma heterogénea en sus distintas áreas asistenciales (MI en las áreas de hospitalización, AyR en el perioperatorio y MIV en unidades de críticos) o como extensión de la actividad asistencial en el centro de salud (MFyC). Los periodos formativos en el área de la MUE son variables y se realizan en el caso de AyR, MIV y MFyC en un formato exclusivo de guardias (AyR y MIV únicamente durante el primer año y MFyC a lo largo de los 4 años de residencia, con porcentaje decreciente conforme avanza el tiempo de formación), y en el de MI a través de un rotatorio inicial de 3 meses durante su primera etapa formativa, y el resto del tiempo a través de guardias, sin especificar su número. La propuesta del programa de formación en MUE detalla un contacto amplio y específico tanto en los SUH, incluyendo todas sus áreas asistenciales propias (observación, urgencias traumatológicas y pediátricas) como en los dispositivos de emergencias extrahospitalarias y centros coordinadores de urgencias y emergencias. CONCLUSIONES: No es posible la adecuada preparación para desarrollar la MUE con la oferta formativa actual. La MUE presenta un cuerpo doctrinal y ámbito de actuación propios que son diferentes de los de otras especialidades. Esto provoca que en España exista un vacío formativo que se solventaría mediante la creación de una especialidad primaria en MUE.

[Pillars for excellence in nutrition support units. Training]. / Pilares para la excelencia en las unidades de nutrición. Formación.

INTRODUCTION: Few areas of current medicine have undergone change and evolution in recent years such as those of clinical nutrition. Currently, 98 % of endocrinology and nutrition departments in hospitals with 500 or more beds incorporate a clinical nutrition and dietetics Unit. The training of the professionals that integrate these units has been and will be a key point in their ongoing development towards excellence. In medicine degree studies, despite its relevance, nutrition training is currently scarce and heterogeneous, and needs improvement, which may come hand in hand with the recently published ESPEN proposals. In the case of doctors specializing in endocrinology and nutrition, the adaptations in the teaching program established by the National Commission for this specialty, and the training efforts led by the SEEN have allowed significant improvement. In hospital pharmacy studies there is a nutrition training curriculum that could be updated. University training in nutrition within the nursing degree is also heterogeneous. The most related studies such as the Degree of Human Nutrition and Dietetics, Technician in Dietetics, Food Science and Technology or Bromatology fundamentally address issues related to dietetics. There is a lack of coordinated effort to define the role of the members of these multidisciplinary UNCyDs, also in regard to their training.

INTRODUCCIÓN: Pocas áreas dentro de la medicina actual han experimentado en los últimos años un cambio y una evolución como los de la nutrición clínica. Actualmente, el 98 % de los servicios de endocrinología y nutrición en los hospitales de 500 o más camas incorporan una unidad de nutrición clínica y dietética (UNCyD). La formación de los profesionales que integran estas unidades ha sido y será un punto clave para continuar su desarrollo hacia la excelencia. En los estudios del Grado de Medicina, a pesar de su relevancia, la formación en nutrición es actualmente escasa y heterogénea, y necesita una mejora que puede venir de la mano de las propuestas de la ESPEN recientemente publicadas. En el caso de los médicos especialistas en endocrinología y nutrición, las sucesivas adaptaciones del programa docente establecido por la Comisión Nacional de la especialidad y los esfuerzos en formación liderados por la SEEN han permitido una importante mejoría. En la farmacia hospitalaria existe un curriculum de formación en nutrición que podría actualizarse. La formación universitaria en nutrición dentro del Grado de Enfermería también es heterogénea. Los estudios más relacionados, como el Grado de Nutrición Humana y Dietética, Técnico Superior en Dietética, Ciencia y Tecnología de los Alimentos o Bromatología, abordan fundamentalmente temas relacionados con la dietética. Se echa de menos un esfuerzo de coordinación para definir el papel de los integrantes de estas UNCyD multidisciplinares también en lo referente a su formación.

Consensus Document on Medical Faculty Education on the Treatment of Smoking. / Documento de consenso sobre la docencia del tabaquismo en las facultades de Medicina.

We report the results of a consensus reached by an expert group of representatives from different medical societies in Latin America on the objectives, competencies (knowledge, and skills), content, and duration of smoking cessation education in Latin American medical schools. The document discusses the following aspects: epidemiology, nicotine dependence, factors for initiation and maintenance of tobacco use, smoking-related disorders, diagnosis, minimal intervention, non-pharmacological and pharmacological interventions for smoking cessation, and prevention of smoking.

[Pathology training in Spain: What is the status quo and how should we improve?] / Residencia de Anatomía Patológica en España: ¿cómo estamos y en qué debemos mejorar?

The unpopularity of Pathology among medical students is of concern worldwide, as is the high drop-out rate during the speciality training programme. Spain is no exception, with an estimated annual drop-out rate greater than 20%. In the present study, we aimed to analyse factors related to motivation, teaching and satisfaction with post-graduate training. Postgraduates in their 3rd and 4th year of speciality training programmes and pathologists during their first three years as specialists were asked to fill in a questionnaire; 155 participants from different parts of Spain took part in the study. Our results revealed a high level of satisfaction among those who had chosen pathology as their specialty and that their satisfaction correlated significantly with two factors: a previous knowledge of the speciality when choosing it and the quality of the training received. We detected certain differences amongst different training centres. The weakest points and thus those that need to be improved were training in molecular techniques, research methods and fine needle aspiration. Improving speciality training is certainly possible and should be the concern of all those who are responsible for postgraduate education in teaching hospitals.