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BACKGROUND: Eating disorders and food ingestion (EDs) are serious mental illnesses with a higher prevalence in young adults, with difficult diagnoses that cause serious morbidity and mortality problems. There is not much information about the risk of positive screening for EDs, specifically, anorexia nervosa (AN) and bulimia nervosa (BN) and night eating syndrome (NES) in undergraduate medical interns (UMI) and medical residents (MR) in Mexico. AIM: To determine the risk of AN, BN and NES and to determine the risk factors of such conditions such as age, body mass index (BMI) and gender of MR and UMI with AN/BN and NES at four private hospitals in northeastern Mexico. METHODS: A cross-sectional, descriptive, non-randomized survey in MR and UMI in four hospitals in Northeastern Mexico was conducted using an electronic questionnaire that included: informed consent signature, SCOFF questionnaire for AN and BN screening, NES questionnaire. Also, a survey on general sociodemographic data of each participant was included. Chi-square test and a logistic regression model were computed for analyses. RESULTS: The population included a total of 129 MR and UMI. It was observed that 48.8% were positive for AN or BN and 32.6% were positive for the NES. There was no difference between age, sex, BMI, or medical specialty (if they were MR); however, MR from the first year had a higher risk of AN or BN (OR 23.7, 95% CI 1.181-475.266). CONCLUSIONS: There was a higher risk of positive screening for AN or BN and NES in UMI and MR in our population. In the case of MR, those in first year have a higher risk of AN and BN. Timely diagnosis and treatment are mandatory in this population.
Eating disorders and food ingestion such as anorexia (AN) or bulimia (BN) nervosa and night eating syndrome (NES) are a group of mental illnesses that are frequently under diagnosed. Medical residents (MR) and undergraduate medical interns (UMI) are a high-risk population for such disorders due to their young age, stress environments, erratic eating patterns and long working hours. The aim of this study was to determine the risk of AN, BN and NES and to determine the risk factors of such conditions. One hundred twenty-nine UMI and MR were studied and showed that 48.8% were positive for AN or BN and 32.6% were positive for NES. MR in the first year of medical residency had a higher risk. Timely diagnosis and treatment are mandatory in this population.
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Introduction: Depression is a mental health disorder characterized by the presence of sadness or loss of the ability to feel pleasure, with a high incidence in patients with COVID 19. The investigations have focused on patient care and little on the care of health personnel, these being the ones with the highest mortality rate, so the objective of the study was to investigate the prevalence of depression symptoms and suicide risk and understand the association of depressive disorder and suicide risk with levels of serum cholesterol and low levels of serum cortisol among internal medicine fellows in a specialist medical hospital in Leon, Guanajuato, Mexico, before and after COVID-19. Methods: In this longitudinal study, internal medicine residents were initially monitored for 2months before starting to care for patients with COVID-19. Participants were asked to fill out depression symptoms and suicide risk surveys. We measured the serum cholesterol and cortisol of each participant, and again after 11months of treating COVID-19 patients. Results: Depression symptoms and suicide risk were assessed; significant differences were found between the two time periods for depression (p < 0.01), and no difference was found for suicide risk (p = 0.182). We found a significant correlation between serum cholesterol levels and suicide risk (r = 0.366, p < 0.01); we also found differences in serum cortisol levels (p < 0.01) and cholesterol (p < 0.0001) before and after the pandemic. Conclusion: Caring for patients with COVID-19 in the hospital contributed to an increase in levels of depression symptoms and suicidal ideation, as well as differences in levels of cortisol and cholesterol in resident physicians of internal medicine; among the possible reasons for this change could be the conditions of personal protection while treating patients, the uncertainty in the first months of not knowing how the virus was transmitted and not having or knowing when vaccinations would be available, as well as the lack of a strategy of adequate mental health support from the institutions dedicated to their academic training.
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BACKGROUND: Different stages of a physician's career may be associated with different types of mental health impairment. AIMS: This study aimed to compare symptoms of anxiety, depression, and stress and their associated factors among medical students, medical residents, and physicians. METHODS: A cross-sectional study was conducted. Data collection included sociodemographic data, religiosity (Duke University Religion Index), and mental health (21-item Depression, Anxiety and Stress Scale - DASS-21) data. The comparison between the groups was performed using ANOVA, and the associated factors were evaluated via linear regression models. RESULTS: The sample consisted of 1,417 participants: 778 medical students, 190 medical residents, and 468 established physicians. Medical students had significantly higher depression, anxiety, and stress scores as compared to medical residents and established physicians. However, regarding DASS 21 scores, no significant differences were found between established physicians and medical residents. The factors associated with mental health in the different groups showed that being married and male were associated with better mental health among physicians and medical residents, while the factors of male gender, being in later years of the course, and lower religious attendance were associated with better mental health in students. CONCLUSION: Medical students had worse mental health outcomes when compared to residents and established physicians. Interventions are needed to minimize suffering during medical education and career.
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Salud Mental , Estudiantes de Medicina , Humanos , Masculino , Estudiantes de Medicina/psicología , Depresión/psicología , Estudios Transversales , Ansiedad/psicología , Estrés Psicológico/epidemiología , Estrés Psicológico/psicologíaRESUMEN
Shift work disorder (SWD) may affect medical residents because their workload, academic demands and extended work hours. This condition set residents at risk of more sleep disorders. The study compared parasomnias among residents with and without shift work disorder (SWD) and weighed their relative risk (RR) for each parasomnia. One hundred twenty-six residents participated in the study. The Munich Parasomnia Screening questionnaire and the Barger Questionnaire for SWD were used for the screening of parasomnias and SWD, respectively. Means and percentages of studied variables were compared between groups. Relative risk (RR) was calculated for each type of parasomnia. The more frequent parasomnias in residents with SWD the RR (and 95% confidence intervals) were: sleep terrors, 5.60 (1.84-17.01); confusional arousals, 3.73 (1.84-7.56); sleep paralysis, 3.27 (1.53-6.93); hypnagogic/hypnopompic hallucinations, 2.55 (1.03-6.28); somniloquies, 2.45 (1.21-4.92); and nightmares, 2.01 (1.54-2.62). Our data suggest that residents who experience SWD may be at risk of having lower threshold for the occurrence of rapid eye movement (REM) and non-REM (NREM) sleep parasomnias. Additional research is needed to confirm these results, and to further identify the contribution to this association.
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ABSTRACT BACKGROUND: New medical schools and new medical residencies in Brazil, mainly in its interior, were opened under the justification of collaborating towards distribution of these healthcare professionals and specialist doctors across the national territory. However, this proposal did not guarantee that medical practitioners would become established in the place where they graduated and specialized. OBJECTIVE: To calculate, through interviews, how many specialists who graduated in the state of Tocantins stayed there after finishing their medical residency; and to analyze the factors that made them stay or leave the place. DESIGN AND SETTING: Cross-sectional exploratory study conducted at a Brazilian federal public higher education institution. METHODS: All graduates from medical residencies in Tocantins, who graduated between 2013 and 2019, were contacted by telephone and, after obtaining consent, an interview was conducted. The interviews took place between June 2020 and January 2021. RESULTS: The permanence of medical residency graduates in the state increased from 50% in an earlier study to 55.8% in the current study, thus showing a situation of stability. In addition, we detected some reasons for staying or not. In a multivariate analysis, only working in the state capital was related to staying in the state of Tocantins, showing a 5.6 times greater chance. CONCLUSIONS: The percentage of those who remained was just over 50%, even some years after implementation of the first programs. Most specialists remained working for the state health department, with a smaller proportion in municipal health departments, and were concentrated in the state capital.
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OBJECTIVE: We evaluated clinical performance when the TCu380A intrauterine device (IUD) and the levonorgestrel (LNG) 52-mg intrauterine system (IUS) were inserted by different categories of healthcare professionals. METHODS: A retrospective study was conducted at the University of Campinas, Brazil. The medical records were reviewed of all women in whom an IUD was inserted between January 1980 and December 2018, with data for at least 1 year, and for whom information on the healthcare provider who inserted the device was available. RESULTS: Overall, 19 132 (76.9%) IUD and 5733 (23.1%) LNG-IUS insertions were included, with residents/interns performing 13 853 (55.8%), nurses 7024 (28.2%), and physicians 3988 (16.0%). Removals for pregnancy and infection were significantly higher when physicians inserted the device, while removals for bleeding/pain and other medical reasons were more common when nurses performed the insertion. Expulsion and removals for personal reasons were similar for all three categories. CONCLUSION: Clinical outcomes were similar regardless of whether trained nurses, residents/interns, or physicians inserted the device, and were irrespective of users' age and parity. These results could stimulate other healthcare services, particularly in regions where there is a shortage of physicians, to invest in training nurses to perform insertions of IUDs.
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Personal de Salud/estadística & datos numéricos , Dispositivos Intrauterinos de Cobre/estadística & datos numéricos , Dispositivos Intrauterinos Medicados/estadística & datos numéricos , Levonorgestrel/administración & dosificación , Adolescente , Adulto , Brasil , Niño , Anticonceptivos Femeninos/administración & dosificación , Atención a la Salud , Femenino , Hemorragia/epidemiología , Humanos , Embarazo , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVES: To assess the attitudes, knowledge, and experiences of Brazilian resident physicians regarding religiosity/spirituality (R/S), factors associated with addressing this issue, and its influence on clinical practice. METHODS: We report results of the multicenter "Spirituality in Brazilian Medical Residents" (SBRAMER) study involving 7 Brazilian university centers. The Network for Research Spirituality and Health (NERSH) scale (collecting sociodemographic data, opinions about the R/S-health interface, and respondents' R/S characteristics) and the Duke Religion Index were self-administered. Logistic regression models were constructed to determine those factors associated with residents' opinions on spirituality in clinical practice. RESULTS: The sample comprised 879 resident physicians (53.5% of total) from all years of residency with 71.6% from clinical specialties. In general, the residents considered themselves spiritual and religious, despite not regularly attending religious services. Most participants believed R/S had an important influence on patient health (75.2%) and that it was appropriate to discuss these beliefs in clinical encounters with patients (77.1%), although this was not done in routine clinical practice (14.4%). The main barriers to discussing R/S were maintaining professional neutrality (31.4%), concern about offending patients (29.1%), and insufficient time (26.2%). Factors including female gender, clinical specialty (e.g., internal medicine, family medicine, psychiatry) as opposed to surgical specialty (e.g., surgery, obstetrics/gynecology, orthopedics), having had formal training on R/S, and higher levels of R/S were associated with greater discussion of and more positive opinions about R/S. CONCLUSION: Brazilian resident physicians held that religious and spiritual beliefs can influence health, and deemed it appropriate for physicians to discuss this issue. However, lack of training was one of the main obstacles to addressing R/S issues in clinical practice. Educators should draw on these data to conduct interventions and produce content on the subject in residency programs.
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Médicos , Espiritualidad , Brasil , Estudios Transversales , Femenino , Humanos , Religión , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To evaluate residents' knowledge about the evolution of abortion rates in countries where abortion has been legalized, and to assess whether such knowledge correlates with residents' sociodemographic characteristics and experience in abortion care. METHODS: A multicenter, cross-sectional study was conducted in 21 Brazilian hospitals with 404 medical residents in obstetrics and gynecology. Data collection occurred during February 2015 through January 2016. Data were collected through a self-administered, anonymous questionnaire. The χ2 test, Fisher exact test, and multiple logistic regression analysis were performed. RESULTS: Of residents, 60% believed that the abortion rate would increase after legalization; 82% had been involved in the care of women with incomplete abortion and 71% in the care of women admitted for legal abortion. Associations were found between knowledge of the evolution of the abortion rate after legalization and region of birth, region of medical school, and importance attached to religion. Multiple regression confirmed that studying medicine in the south/southeast of Brazil and attaching little importance to religion were associated with knowing that legalization does not lead to an increase in abortion rate. CONCLUSION: Information relating to abortion in medical schools and during residency is very limited and should be improved.
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Aborto Inducido/psicología , Aborto Legal/legislación & jurisprudencia , Actitud del Personal de Salud , Aborto Inducido/estadística & datos numéricos , Adulto , Brasil , Estudios Transversales , Femenino , Ginecología/educación , Humanos , Internado y Residencia/estadística & datos numéricos , Obstetricia/educación , Embarazo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
In teaching medicine, resident physicians play a very important role, as on many occasions they are the ones who have to teach the medical students, undergraduate rotary interns and residents of other years. Sometimes his preparation as teachers is not adequate, so it is very important to include this topic in his academic curriculum, in order to professionalize the teacher. The Graduate Division of the School of Medicine of the National Autonomous University of Mexico (UNAM in spanish) included in the Single Program of Medical Specializations (PUEM in spanish) since 1994, the Seminar of Medical Education and for two years this seminar is carried online, has mandatory character for both resident doctors and teachers. However, it is necessary to give greater importance to the training of resident physicians as teachers, this action will lead to better preparation of undergraduate students, rotary interns, residents themselves and will encourage teachers to improve and professionalize their teaching character.
En la enseñanza de la medicina, los médicos residentes desempeñan un papel muy importante, ya que en muchas ocasiones son quienes tienen que dar las clases a los estudiantes de medicina, internos rotatorios de pregrado y a los residentes de menor jerarquía. En ocasiones, su preparación como docentes no es la adecuada, por lo que es muy importante la inclusión de este tema en su currículum académico, con el fin de profesionalizar al docente. La División de Postgrado de la Facultad de Medicina de la Universidad Nacional de México incluyó en el Programa Único de Especializaciones Médicas (PUEM) desde 1994, el Seminario de Educación Médica y desde hace dos años este Seminario se lleva en línea, tiene carácter obligatorio tanto para los médicos residentes como los profesores. Sin embargo, es necesario dar mayor importancia a la formación de los médicos residentes como docentes, esta acción llevará a una mejor preparación de los estudiantes de pregrado, internos rotatorios, los residentes mismos y estimulará a los profesores a mejorar y profesionalizar su carácter de docentes.
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Internado y Residencia , Curriculum , HumanosRESUMEN
Purpose: To investigate the opinions of Brazilian medical residents in Obstetrics and Gynaecology on abortion legislation according to their personal beliefs.Material and methods: A multicentre cross-sectional study. Residents at 21 university teaching hospitals completed a self-report questionnaire on their opinions in abstract terms, and about punishing women who abort in general and women they know.Results: In abstract terms, 8% favoured allowing abortion under any circumstances (fully liberal); 36% under socioeconomic or psychological constraints (broadly liberal); 75.3% opposed punishing a woman who has aborted (liberal in general practice); and 90.2% opposed punishing women they knew personally (liberal in personal practice). Not having a stable partner and not being influenced by religion were factors associated with liberal opinions. In personal practice, however, 80% of those who are influenced by religion were liberal. The percentage of respondents whose opinions were liberal was significantly greater among those who believed that abortion rates would remain the same or decrease following liberalisation.Conclusions: Judgements regarding the penalisation of women who abort are strongly influenced by how close the respondent is to the problem. Accurate information on abortion needs to be provided. Although about one third of the respondents were broadly liberal, the majority oppose punishment.
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Aborto Inducido/psicología , Ginecología/educación , Internado y Residencia , Obstetricia/educación , Estudiantes de Medicina/psicología , Adulto , Brasil , Estudios Transversales , Femenino , Hospitales de Enseñanza , Humanos , Juicio , Masculino , Castigo/psicología , Religión , Factores SocioeconómicosRESUMEN
Abstract Introduction Medical residents (MR) are an important pillar for a future effective health system. As such, it is important to study all the factors throughout their training that may influence their professional development, like gender-based violence (GV). Objetive To design and evaluate the psychometric proprieties of subtle GV among medical residents' assessment scale (SGEVRA). Method The design was carried out in two phases: (1) in the qualitative phase, three focus groups were interviewed to obtain information about GV during medical training; and (2) in the quantitative phase, the information was incorporated into the instrument and the psychometric properties were tested. Results A total of 1,645 medical residents (MRs) completed the instrument. Exploratory factor analysis led to a final two factor model comprised of 31 items that explained 74.9% of the variance. The factors were labelled as gender discrimination (factor 1) and sexual violence (factor 2); both demonstrated high internal consistency using Cronbach's alpha (factor 1: .987; factor 2: .935). Discussion and conclusion The SGEVRA is a brief, valid, and reliable instrument for assessing subtle GV among MR.
Resumen Introducción Los residentes médicos (MR) son un pilar importante para un futuro sistema de salud efectivo. Por ello, es importante estudiar todos los factores a lo largo de su capacitación que puedan influir en su desarrollo profesional, como la violencia de género (GV). Objetivo Diseñar y evaluar las propiedades psicométricas de la Escala de Violencia Sutil de Género en médicos residentes (SGEVRA, por sus siglas en inglés). Método El diseño se realizó en dos fases: (1) cualitativa: se entrevistó a tres grupos focales para obtener información sobre la VG durante la capacitación médica; y (2) cuantitativa, donde la información se incorporó al instrumento y se evaluaron las propiedades psicométricas. Resultados 1,645 residentes médicos (MR) completaron el instrumento. El análisis factorial exploratorio condujo a un modelo final de dos factores compuesto por 31 reactivos que explicaron el 74.9% de la varianza. Los factores fueron etiquetados como discriminación de género (factor 1) y violencia sexual (factor 2); ambos demostraron una alta consistencia interna con el alfa de Cronbach (factor 1: .987; factor 2: .935). Discusión y conclusión SGEVRA es un instrumento breve, válido y confiable para evaluar GV en MR.
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BACKGROUND: Several studies correlate medical residency with the occurrence of mental health disorders, Burnout Syndrome and quality of life impairment. It has been demonstrated that mental health disorders increase medical errors and lead to less effective patient care. Considering such context, this study aimed to evaluate the prevalence of anxiety, depression, stress and to identify its correlates with Burnout Syndrome and quality of life in a sample of medical residents and fellow physicians of the largest Brazilian academic health system. METHODS: In 2017, 1648 participants were voluntarily and anonymously surveyed online about demographic characteristics, Burnout Syndrome, mental symptoms, and quality of life measured by validated questionnaires. Responses were captured through REDCap platform and multivariate statistical analyses were performed with STATA 15. RESULTS: A total of 606 (36.8%) residents/fellows physicians completed the survey. Depression symptoms were present in 19%, anxiety symptoms in 16% and stress symptoms in 17.7% of the sample. Burnout Syndrome was present in 63% of the sample. Multivariate analysis showed a statistical significant positive correlation between Burnout Syndrome and depression, anxiety and stress symptoms and a negative correlation between mental symptoms and quality of life scores. CONCLUSIONS: Mental health symptoms prevalence in this study is similar to other studies and their occurrence is positively correlated with Burnout Syndrome among medical residents/fellow physicians of the largest Brazilian academic health system. These results are relevant and must be confirmed by multicentric longitudinal studies. This study reinforces the importance of debating interventions to improve mental health among doctors in training.
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Ansiedad/epidemiología , Depresión/epidemiología , Internado y Residencia/estadística & datos numéricos , Estrés Psicológico/epidemiología , Centros Médicos Académicos/estadística & datos numéricos , Adulto , Ansiedad/etiología , Brasil/epidemiología , Agotamiento Profesional/epidemiología , Agotamiento Profesional/etiología , Depresión/etiología , Humanos , Prevalencia , Escalas de Valoración Psiquiátrica , Calidad de Vida/psicología , Estrés Psicológico/etiologíaRESUMEN
Introdução: A residência médica é caracterizada por um período de desenvolvimento pessoal e profissional marcado por diversas mudanças de estilo de vida, que podem levar a um prejuízo na saúde física e mental, interferindo na qualidade de vida. Objetivo: Avaliar a qualidade de vida dos residentes de Ortopedia brasileiros, e os fatores que a influenciam. Método: Trata-se de estudo descritivo, transversal e quantitativo que foi conduzido por meio de questionário autorrespondido para avaliação da qualidade de vida dos residentes de Ortopedia do Brasil. Foram utilizados o questionário WHOQOL-Abreviado de Qualidade de Vida e um questionário sociodemográfico elaborado pela pesquisadora. Resultados: Participaram deste estudo 250 residentes de Ortopedia, do terceiro ano. Observou-se que o residente do terceiro ano (R3) de Ortopedia brasileiro caracteriza-se por ser, em sua maioria, do sexo masculino, com idade média de 30 anos, solteiro, sem filhos, de cor branca, morar sozinho, possuir automóvel próprio, ter pais com nível de escolaridade superior completo ou pós-graduação, ter até 6 anos de formado, não apresentar outra especialidade médica e já ter escolhido a subespecialidade em Ortopedia. Em relação aos hábitos de vida, em sua maioria não são fumantes, bebem, encontram-se acima do peso, apesar de praticarem atividades físicas regularmente. Apresentam qualidade de sono regular a ruim e não utilizam medicamento de uso contínuo. Em relação aos hábitos de estudo, relatam estudar em média 1 a 4 horas/dia, estudam em LAPTOPS/TABLETS, utilizam conteúdos on-line como fonte para estudo, têm acesso a banco de dados médico-científicos e dominam a língua inglesa. Em relação aos hábitos de trabalho, a maioria encontra-se nas capitais, dá plantões além do exigido pela residência, trabalhando em torno de 41 a 80 horas semanais, recebe bolsa ou compensação financeira e avalia seu desempenho na residência em 7,4 (escala de 1 a 10) e o seu serviço de residência em 7,4 (escala de 1 a 10). O serviço de residência situa-se na capital e possui biblioteca básica, bem como, reuniões clínicas semanais. Observou-se neste estudo, que os residentes distribuíram-se em três grupos com graus de Qualidade de Vida distintos (com diferença significativa entre eles): grau III > grau II > grau I. Os indivíduos do grupo grau três, que apresentaram maiores pontuações em todos os domínios (71,7 a 81,1), na sua maioria caracterizam-se por já terem escolhido a subespecialidade na Ortopedia, apresentar uma excelente/boa qualidade de sono, autoavaliar-se bem em seu desempenho na residência médica. Conclusão: Esse estudo possibilitou a caracterização do residente de Ortopedia e dos serviços de residência de Ortopedia brasileiros, sob a ótica do residente, e a identificação dos fatores que influenciam na Qualidade de Vida dos mesmos
Main Objective: To evaluate the quality of life of Brazilian orthopedic residents and the factors that influence it. Method: This was a descriptive, cross-sectional and quantitative study that was conducted through the self-administered questionnaire to evaluate the quality of life of Brazilian orthopedic residents. The WHOQOL-Bref Quality of Life questionnaire and a sociodemographic questionnaire prepared by the researcher were used. Results: 250 third-year orthopedic residents participated in this study. It was observed that the resident of the third year (R3) of Brazilian orthopedics is characterized by the majority of males, average 30 years old, single, without children, white, living alone, owning a car, having parents with a college or university degree, up to 6 years of training, there is no other medical specialty and has already chosen the subspecialty in orthopedics. Regarding lifestyle habits, most are not smokers, they drink, are overweight, although they practice regular physical activities. They have poor and regular sleep quality and do not use continuous use medication. In relation to study habits, they study on average 1 to 4 hours / day, study in LAPTOPS / TABLETS, use online content as a source for study, access medical-scientific database and dominate the English language. Related to work habits, most of them live in the capitals, work on medical shifts beyond the required by the medical residence, working 41 to 80 hours a week, earn financial compensation or scholarship, and evaluate its performance in the residence in 7.4 (scale of 1 to 10) and your residence service at 7.4 (scale from 1 to 10). The residence service is located in the capital and has basic library as well as weekly clinical meetings. It is observed in the study that it is distributed in three groups with different degrees of quality of life (grade different among them): grade III> grade II> grade I. The residents of the grade three group, which presented higher scores in all domains (71.7% to 81.1%), that is, presented better quality of life, most of them characterized by having already chosen the subspecialty in orthopedics, presenting excellent / good sleep quality, self-evaluating well in their performance in the medical residency and evaluate your medical residency service well. Conclusion: This study allowed the characterization of the Brazilian orthopedic resident and the Brazilian orthopedic residency services, from the perspective of the resident, and an identification of the factors that influence their quality of life
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Humanos , Masculino , Femenino , Adulto , Adulto Joven , Ortopedia , Educación Médica , Calidad de Vida , Estudiantes de Medicina , Internado y ResidenciaRESUMEN
El insomnio es un trastorno que puede presentarse en cualquier edad y hasta un 30% de la población mundial lo padece en algún momento; puede ser síntoma de un sinnúmero de patologías médicas que incluye muchos trastornos psiquiátricos. El objetivo de este estudio observacional analítico de corte transversal fue determinar el grado de conocimiento sobre insomnio en médicos residentes de Asunción-Paraguay; se incluyeron 54 médicos residentes entre 26-39 años de edad de las Cátedras de Medicina Interna (26), Medicina Familiar (11) y Psiquiatría (17). Significativamente mayor proporción de residentes de Psiquiatría (47,1%) y de Medicina Familiar (45,5%) tuvieron buen conocimiento comparado a los de Medicina Interna (7,7%). El 59,3% de los residentes (Psiquiatría: 58,8%, Medicina Familiar: 75,0% y Medicina Interna: 53,8%) había diagnosticado alguna vez insomnio primario y la mayoría de ellos registra ≤20% de los pacientes con insomnio en las historias clínicas. Sobre el tratamiento instaurado, el 57,4% utiliza medidas farmacológicas, el 55,5% medidas de higiene del sueño, mientras que 18,5% recomienda actividad física. Entre los grupos farmacológicos que conocen para el tratamiento del insomnio, el 72,2% de los residentes citó a las benzodiacepinas; hipnóticos no benzodiacepínicos (16,7%); antipsicóticos (35,2%); antihistamínicos (9,3%) y otras medicaciones (27,8%). Los conocimientos de los residentes respecto a la terapéutica del insomnio son suficientes, pero no del nivel deseable. Esto resalta la necesidad de establecer oportunidades educativas sobre el manejo y tratamiento del insomnio y mayor profundización de la teoría y la práctica de la medicina del sueño en estudiantes de grado y posgrado
Insomnia is a global distribution disorder that may occur at any age and up to 30% of the world's population suffers from insomnia at some point in their lives. Insomnia presents the peculiarity of being a symptom of a number of medical pathologies among which are many psychiatric disorders. The objective of this cross-sectional, observational study was to determine the knowledge on insomnia in medical residents in Asunción, Paraguay. The study includes 54 medical residents between 26 and 39 years of age, from the Departments of Internal Medicine (26), Family Medicine (11) and Psychiatry (17). A higher proportion of residents of Psychiatry (47.1%) and Family Medicine (45.5%) had a good knowledge of insomnia compared to Internal Medicine residents (7.7%); 59.3% of residents (Psychiatry: 58.8%, Family Medicine: 75.0% and Internal Medicine: 53,8%) had ever diagnosed primary insomnia and the majority of them recorded ≤20% of the patients with an insomnia diagnosis in the medical records. About the treatment established, 57.4% used pharmacological measures, 55.5% sleep hygiene measures, while 18.5% recommended physical activity. Among the pharmacological groups known for the treatment of insomnia, 72.2% of residents cited benzodiazepines; non-benzodiazepine hypnotics (16.7%); antipsychotics (35.2%); antihistamines (9.3%) and, other medications (27.8%). Residents' knowledge of insomnia therapy is sufficient, but not at the desirable level. This highlights the need to establish educational opportunities on the management and treatment of insomnia and further deepening the theory and practice of sleep medicine in undergraduate and postgraduate students
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Humanos , Masculino , Femenino , Adulto , Conocimientos, Actitudes y Práctica en Salud , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Cuerpo Médico de Hospitales/educación , Paraguay , Estudios Transversales , Encuestas y CuestionariosRESUMEN
El objetivo de este trabajo consistió en determinar el nivel de conocimiento que tienen los médicos residentes del Hospital Nacional de Itauguá sobre reanimación cardiopulmonar básica y avanzada en adultos. Estudio observacional, descriptivo, de corte transverso, con muestreo no probabilístico de casos consecutivos que incluyó a médicos residentes del Hospital Nacional de Itauguá, de distintas especialidades. Los participantes completaron un cuestionario de 20 preguntas seleccionadas del banco de preguntas de las guías de Soporte Vital Básico para profesionales de la salud (BLS) y Soporte Vital Avanzado en Adultos (ACLS) de la American Heart Association, actualización del 2010. Participaron del estudio 135 médicos, de los cuales 76 (56,3%) fueron del sexo masculino y 59 (43,7%) del sexo femenino. La edad media de los participantes fue de 27,57 ± 4 años, estando 92 (68,1%) médicos con edades comprendidas entre los 26 y 31 años. En cuanto al conocimiento de los participantes sobre la reanimación cardiopulmonar de adultos, 113 (83,7%) presentaron un nivel no satisfactorio, al responder menos de 17 preguntas del cuestionario de manera correcta. La evidente deficiencia que mostraron los médicos residentes participantes de este estudio en sus conocimientos sobre reanimación cardiopulmonar, nos hace plantear la necesidad de insistir que todas las Facultades de Medicina del país incorporen un mejor y mayor enfoque teórico y práctico de los contenidos sobre reanimación cardiopulmonar dentro de sus planes de estudio e implementen estrategias de capacitación continua en esta área
The objective of this study was to determine the level of knowledge of adult basic and advanced cardiopulmonary resuscitation of medical residents at the National Hospital of Itauguá. Observational, descriptive and cross-sectional study with a nonprobabilistic sampling of consecutive cases. The study participants were medical residents of the National Hospital of Itauguá, from different specialties, who completed a questionnaire of 20 questions selected from the Basic Life Support for Health Professionals (BLS) and Advanced Cardiovascular Life Support in Adults (ACLS) of the American Heart Association guides, 2010 update. The study included 135 physicians, of which 76 (56.3%) were men and 59 (43.7%) were women. The mean age of participants was 27.57 ± 4 years and 92 (68.1%) were physicians between 26 and 31 years of age. Regarding the participants' knowledge about cardiopulmonary resuscitation, 113 (83.7%) presented an unsatisfactory level, by answering less than 17 questions of the questionnaire correctly. The evident deficiency shown by the medical residents in their knowledge of cardiopulmonary resuscitation makes it necessary to insist on incorporating a better and greater theoretical and practical approach of the contents on cardiopulmonary resuscitation within the curricula of all the Medical Schools of the country, and they should implement continuous training strategies in this area.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Conocimientos, Actitudes y Práctica en Salud , Reanimación Cardiopulmonar/educación , Cuerpo Médico de Hospitales/educación , Paraguay , Estudios Transversales , Encuestas y CuestionariosRESUMEN
La elevada demanda asistencial aunada a la carga académica de los cursos de especialización en medicina afecta la salud mental de los médicos residentes produciendo manifestaciones que van desde el simple malestar emocional hasta el desarrollo de trastornos afectivos en personas predispuestas. El suicidio de médicos ha generado programas para su atención en algunos países. Presentamos la primera clínica de salud mental para médicos residentes de un hospital de alta especialidad en México, centrada en la prevención del suicidio y depresión, tratamiento de trastornos mentales y promoción de la salud mental. A diferencia de los reportes de baja tasa de respuesta en otros países, hemos conseguido una participación mayor al 95%, proporcionamos tratamiento oportuno y seguimiento a los residentes identificados con trastorno mental, y no se han presentado suicidios consumados. Suponemos que la utilización de diferentes estrategias (escrutinio, adaptación de modelos de prevención del suicidio como entrenamiento por pares y entrenamiento gatekeeper, sesiones informativas de desestigmatización y promoción de la salud mental, intervenciones dirigidas a individuos y grupos con conflictos) ha sido de utilidad contra las barreras que impiden que los médicos identifiquen los signos de alarma de riesgo de suicidio, busquen ayuda por la presencia de trastorno mental y procuren mejorar su salud mental
High demand of care and the academic burden of courses of specialization in medicine affect the mental health of medical residents with events ranging from simple emotional discomfort to development of affective disorders in susceptible individuals. The suicide of physicians has produced programs for their attention in some countries. We present the fi rst mental health clinic for residents of a high specialty hospital in Mexico, focused on the prevention of suicide and depression, treatment of mental disorders and mental health promotion. Unlike the reports of other countries, we get participation of more than 95%, we provide appropriate treatment and follow-up to residents with mental disorder, and there has not been a consummate suicide. We assume that the use of different strategies (scrutiny, adapting models of prevention of suicide as a peer and gatekeeper training, informative sessions of mental health promotion and stigma, interventions targeted at individuals and groups with confl icts) has been useful against barriers that do not allow doctors to identify the risk of suicide warning signs, seek help for mental disorder, and seek to improve their mental health.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Suicidio , Médicos/psicología , Suicidio/prevención & control , Atención a la Salud Mental , Cuerpo Médico de Hospitales/psicologíaRESUMEN
OBJECTIVES: The adequacy of laboratory test orders by medical residents is a longstanding issue. The aim of this study is to analyze the number, types, and pattern of repetition of tests ordered by medical residents. METHODS: We studied all tests ordered over a 1-year period for inpatients of an internal medicine ward in a university hospital. Types, results, and repetition pattern of tests were analyzed in relation to patients' diagnoses. RESULTS: We evaluated 117,666 tests, requested for 1,024 inpatients. The mean number of tests was 9.5 per day. The test repetition pattern was similar, regardless of patients' diagnoses, previous test results, or duration of stay. The probability of an abnormal result after a sequence of three normal tests was lower than 25%, regardless of the diagnosis. CONCLUSIONS: Number of tests and repetition were both high, imposing costs, discomfort, and risks to patients, thus warranting further investigation.
Asunto(s)
Pruebas Diagnósticas de Rutina/economía , Hospitales Universitarios/economía , Laboratorios de Hospital/economía , Pautas de la Práctica en Medicina/economía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Femenino , Humanos , Internado y Residencia , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Las competencias en investigación han sido reconocidas como parte esencial de la educación médica en el postgrado. El objetivo de este estudio piloto fue evaluar las actitudes y desafíos percibidos de médicos residentes de Medicina Familiar hacia la investigación. Estudio piloto, observacional, descriptivo, de corte transverso y muestreo no probabilístico, en el que se incluyeron 20 médicos residentes. Se utilizó un cuestionario sobre actitudes y desafíos percibidos sobre la investigación. Se realizó estadística descriptiva para todas las variables. Los resultados se expresaron en frecuencias, porcentajes, medias y desvíos estándar. Del total de participantes, sólo 7 (35%) participaron en algún proyecto de investigación durante la residencia, principalmente, en estudios descriptivos (30%) y reportes de casos (15%). El 60% respondió que en la residencia no desarrollaban un programa específico de formación en investigación, aunque la mayoría estuvo de acuerdo con que la investigación es esencial para el desarrollo de una carrera académica (95%), que mejora la atención sanitaria del paciente (75%) y que su estudio debe ser obligatorio en el currículo académico (70%). Los médicos residentes paraguayos presentan actitudes positivas y reconocen la importancia de la investigación, no obstante, sólo el 35% ha realizado investigaciones durante su programa de residencia, siendo el principal desafío al que se enfrentan, la falta detiempo protegido. Se considera necesario el rediseño del currículo del programa de residencia en Medicina Familiar de la Universidad Nacional de Asunción a fin de incluir de manera trasversal la formación en investigación de médicos residentes.
Research skills have been recognized as an essential part of medical education at thepostgraduate level. The objective of this pilot study was to evaluate the attitudes andperceived challenges of family medicine residents toward research. This was anobservational, descriptive and cross-sectional pilot study, of non-probabilistic sampling, which included 20 medical residents. A questionnaire on attitudes and perceived challengeson research was used. Descriptive statistics were performed for all variables. The resultswere expressed as frequencies, percentages, means and standard deviations. Of the totalparticipants, only 7 (35%) participated in a research project during residency, mainly indescriptive studies (30%) and case reports (15%). Sixty percent of participants respondedthat their residency did not develop a specific program of research training, although mostagreed that research was essential for the development of an academic career (95%),improved patient healthcare (75%) and that the study of research techniques should bemandatory in the academic curriculum (70%). Paraguayan medical residents have positiveattitudes and recognize the importance of research. However, only 35% have conductedresearch during their residency program; being the main challenge they face, the need for aprotected time for research. It is considered necessary to redesign the curriculum of theFamily Medicine residency program of the National University of Asuncion, in order toinclude research training in a transversal way.
Asunto(s)
Humanos , Masculino , Femenino , Conocimientos, Actitudes y Práctica en Salud , Cuerpo Médico de Hospitales/educación , Evaluación de la Investigación en Salud , Investigación , Medicina Familiar y Comunitaria , Población ResidenteRESUMEN
BACKGROUND: The evaluation of clinical competence in medical residents is a complex procedure. Teachers need reliable and valid instruments to evaluate objectively the, clinical competence. The aim of this study was to determine the reliability and validity of an instrument designed to evaluate the clinical competence of medical residents. METHODS: We designed an instrument taking into consideration every part of the clinical method, and three different levels of competence were determined for each one. The instrument was examined with regards to the clarity, pertinence and sufficiency of each clinical indicator by five expert pediatricians. The instrument was finally constituted by 11 indicators. Each resident was evaluated independently by three pediatricians. RESULTS: A total of 651 measurements were done in 234 residents. The instrument distinguished between extreme groups, had a value of Cronbach's alpha of 0.778 and the factorial analysis set apart two factors: clinical competence and complementary competences. No statistical differences were found between evaluators neither in global evaluation or in each indicator. CONCLUSIONS: The instrument here proposed is valid and reliable. It may be used in formative evaluation of medical residents in clinical specialization programs.
Introducción: la evaluación de la competencia clínica de un residente es un proceso complejo. Los profesores requieren de instrumentos confiables y válidos para evaluar objetivamente la competencia clínica. El objetivo fue evaluar la confiabilidad y validez de un instrumento (IECC) diseñado para evaluar la competencia clínica integral de los médicos residentes. Métodos: se diseñó un instrumento a partir de los diferentes pasos del método clínico, y se determinaron tres niveles de competencia para cada uno. El instrumento fue revisado respecto a su claridad, pertinencia y la suficiencia de sus indicadores planteados por cinco médicos pediatras expertos. Cada residente fue evaluado independientemente por tres médicos. Resultados: se obtuvieron en total 651 mediciones en 234 residentes. El instrumento discriminó entre grupos extremos. Se obtuvo un valor de alfa de Cronbach de 0.778 y el análisis factorial distinguió dos factores: competencia clínica y competencias complementarias. No se encontraron diferencias entre evaluadores en las calificaciones globales ni en cada uno de los indicadores. Conclusión: el instrumento propuesto es válido y confiable. Se propone como una herramienta más en la evaluación formativa de los médicos residentes de especialidades clínicas.
Asunto(s)
Competencia Clínica/normas , Internado y Residencia/normas , Pediatría/educación , Humanos , México , Variaciones Dependientes del Observador , Pediatría/normas , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: In countries such as United States and European Nations changes have been proposed regarding to duty and academic structure of specialists in training, this implies adjustments in the norms concerning the number of hours a week that residents work. The main argument which has underpinned such transformations is based on the assumption that excessive working hours (more than 16 hours uninterrupted) cause cognitive and psychomotor disorders in residents. OBJECTIVE: To evaluate the association between sleep deprivation and cognitive and psychomotor skills of a sample of residents of different specialties of Medicine. METHODS: Longitudinal study with measurements pre and post shifts, in 31 residents of Medicine. The measured variables were: cognitive and psychomotor skills, demographic data and conditions of the shift, quality of sleep and psychopathology. RESULTS: 81% residents showed detriment in at least one of the tests, however, in psychomotor skills significant different results were found in CPR maneuvers between pre and post shift with an improvement in scores. CONCLUSIONS: Sleep deprivation causes detriment of cognitive and psychomotor skills. While our results can't be generalized, they may constitute a precedent for possible changes in the working hours of medical residencies.
Antecedentes: en países como Estados Unidos y las naciones europeas se han propuesto cambios a la estructura asistencial y académica de los médicos especialistas en formación que proponen transformaciones a las normas relativas al número de horas que trabajan a la semana los residentes. El argumento principal que sustenta esas transformaciones se basa en el supuesto de que las horas de trabajo excesivas (más de 16 horas ininterrumpidas) provocan alteraciones cognitivas y psicomotrices en los residentes. Objetivo: evaluar la asociación entre la privación de sueño y las habilidades cognitivas y psicomotoras de una muestra de residentes de diferentes especialidades médicas. Material y métodos: estudio longitudinal, con mediciones pre y post guardia, en 31 residentes de Medicina. Se midieron las variables de: habilidades cognitivas y psicomotoras, datos sociodemográficos y de condiciones de guardia, calidad de sueño y psicopatología. resultados: 81% de los residentes tuvo detrimento en, al menos, una de las pruebas realizadas; sin embargo, en los resultados de las habilidades psicomotoras y en la maniobra de reanimación cardiopulmonar básica se encontró una diferencia significativa en los momentos pre y post guardia con mejoría en las puntuaciones. Conclusiones: la privación de sueño disminuye las habilidades cognitivas y psicomotoras. Si bien nuestros resultados no son generalizables, pueden constituir un precedente para fundamentar posibles cambios referentes a las guardias en las residencias médicas.