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Introducción. El acoso laboral y sexual son problemas latentes durante la formación de los cirujanos, que conllevan repercusiones negativas a nivel individual, organizacional y del sistema sanitario. El objetivo del presente estudio fue explorar la prevalencia de estos tipos de acoso en residentes de cirugía colombianos. Métodos. Estudio nacional, de corte transversal, realizado en los veinte programas de residencia del país en septiembre de 2023. Los residentes autoevaluaron su exposición a ambas formas de acoso mediante cuestionarios validados. Se realizaron comparaciones entre víctimas y no víctimas de acoso, en función de las características demográficas de la población. Se evaluó la frecuencia de conductas de acoso laboral cometidas por diferentes perpetradores. Resultados. Se incluyeron 238 residentes (64,7 % del total de la población). Las tasas de acoso laboral y sexual fueron de 35,3 % y 18,1 %, respectivamente. Ambos tipos de acoso fueron significativamente mayores en los programas ubicados en el centro del país. El acoso sexual fue significativamente mayor entre las mujeres. Los profesores de cirugía y los residentes de niveles superiores fueron los principales perpetradores de conductas de acoso laboral. Conclusiones. El acoso laboral y sexual es altamente prevalente en la formación de los cirujanos colombianos. Estos hallazgos deben alertar a profesores, médicos residentes y otros grupos de interés, para fomentar ambientes y cultura educativa saludables, que permitan disminuir la prevalencia de estos comportamientos.

Introduction. Workplace and sexual harassment are latent problems during surgical training, which have negative repercussions at the individual, organizational and health system levels. The objective of the present study was to explore the prevalence of these types of harassment in all Colombian surgical residents. Methods. National cross-sectional study conducted in twenty residency programs in September 2023. Residents self-assessed their exposure to both forms of harassment using validated questionnaires. Comparisons were made between victims and non-victims of bullying, based on the demographic characteristics of the population. The frequency of workplace harassment behaviors committed by different perpetrators was evaluated. Results. A total of 238 residents were included (64.7% of population). Rates of workplace and sexual harassment were 35.3% and 18.1%, respectively. Both types of harassment were significantly higher in programs located in the central region of the country. Sexual harassment was significantly higher among women. Surgery professors and senior residents were the main perpetrators of workplace bullying behaviors. Conclusions. Workplace and sexual harassment is highly prevalent during surgical training of Colombian surgeons. These findings should alert professors, residents, and other interest groups to promote healthy educational environments and culture, which will reduce the prevalence of these behaviors.

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OBJECTIVE: This study assessed 2 modalities for teaching responsible conduct of research and human subjects protection (RCR/HSP) to surgical residents in Guatemala-an "off the shelf" online curriculum and a new in-person curriculum specific to the local context. METHODS: In 2018, 160 surgical residents in 3 large urban hospitals in Guatemala City completed 2 online programs in RCR/HSP. Residents in the intervention arm also completed 7 weeks of in-person training. Pre- and post-assessments tested awareness of key concepts with particular attention to international and Guatemalan research regulations. Group differences in matched (pre- and post-) mean scores were analyzed using t-tests. RESULTS: One hundred forty residents completed pre- and post-training assessments and were included in the analytic sample. Overall mean scores improved modestly from 52.7 to 58.7 points out of 100. Intervention-arm trainees reported greater confidence in recognizing ethical issues, understanding legal and ethical requirements for research, and identifying, reporting and avoiding scientific misconduct than control-arm trainees. CONCLUSION: Given the limited availability of RCR/HSP faculty, financial resources, and time in the surgical training schedule, the investigators recommend that academic authorities in Guatemala consider online training programs in RCR/HSP in all surgical residency programs as an affordable and scalable strategy to build ethical research skills in its surgical workforce. Investment in human resources to support in-person ethics education as a way to build self-efficacy in ethical decision-making should be considered.

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Introducción: En Cuba existen numerosos cirujanos que han dedicado una gran parte de su vida profesional a la cirugía del tórax no cardiovascular, pero solo ostentan el título de especialista de primer o segundo grado en cirugía general. Objetivo: Exponer los argumentos que demuestren la necesidad de crear e implementar la especialización de primer grado en cirugía torácica general o la maestría en cirugía del tórax. Métodos: Se realizó una búsqueda documental a partir de los motores de búsqueda de información científica Google Académico y Highwire Press. De la Web of Science, PubMed, Lilacs y Scopus se seleccionaron 23 artículos relacionados directamente con el objetivo propuesto. Desarrollo: En 2008 el profesor Benito Saínz Menéndez publicó un artículo en el cual expuso la necesidad de crear un programa de posgrado sobre cirugía torácica general; sin embargo, después de 14 años, aún se mantiene el debate sobre este tema. En tal sentido, los reclamos de la comunidad quirúrgica cubana en la propuesta de un programa de maestría y en una tesis doctoral se han hecho sentir en varias reuniones académicas y en diversas publicaciones. La nueva solicitud se justifica desde distintas aristas. Conclusión: El desarrollo de la educación de posgrado y la necesidad de formar recursos humanos capacitados en cirugía general ha acumulado los suficientes preceptos para solicitar la cirugía torácica como una subespecialidad o la inserción de una maestría sobre este tema. Se recomienda que se evalúe la posibilidad de la creación e implementación de la especialización o maestría en cirugía de tórax no cardiovascular(AU)

Introduction: In Cuba, there are numerous surgeons who have dedicated a large part of their professional life to noncardiovascular thoracic surgery, but they only hold the title of first- or second-degree specialist in General Surgery. Objective: To present the fundamentals demonstrating the need to create and implement the first-degree residence for general thoracic surgery or a master's degree in thoracic surgery. Methods: A document search was carried out using the scientific information search engines Google Scholar and Highwire Press. From the Web of Science, PubMed, Lilacs and Scopus, 23 articles directly related to the proposed objective were selected. Development: In 2008, Professor Benito Saínz Menéndez published an article in which he presented the need to create a postgraduate curriculum for general thoracic surgery; however, after 14 years, the debate on this subject is still ongoing. In this respect, the claims of the Cuban surgical community concerning the proposal of a master's program and a doctoral dissertation have been felt in several academic meetings, as well as in several publications. The new request is justified from different points of view. Conclusion: Through the development of postgraduate education and the need to train skilled human resources in general surgery, enough principles have been accumulated for requesting that thoracic surgery be taught as a subspecialty, or the insertion of a master's degree on this subject. The assessment is recommended for the possibility of creating and implementing a specialization or a master's degree in noncardiovascular thoracic surgery(AU)

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BACKGROUND: Formal recognition of palliative medicine as a specialty has been one of the main drivers in the development of palliative care. AIM: To provide a comparative, comprehensive overview on the status of palliative medicine as medical specialty across Latin America. METHODS: We conducted a comparative study of 19 Latin American countries. Key informants and persons in charge of the specialization training programs were identified and interviewed. We collected data on general recognition as specialty (title, process of certification) and on training program characteristics (title, start year, requirements, training length, and type full time or part time). RESULTS: Eight of 19 countries (42%) Argentina, Brazil, Colombia, Costa Rica, Ecuador, Mexico, Paraguay and Venezuela reported palliative medicine as medical specialty. Thirty-five (sub)specialization training programs in palliative medicine were identified in the region (eight as a specialty and 27 as a subspecialty), the majority in Colombia (43.5%) and Brazil (33.7%). A total of 20% of the programs have yet to graduate their first cohort. Length of clinical training as specialty varied from two to four years, and from 520 hours to three years for a subspecialty. CONCLUSION: Despite long-standing efforts to improve quality of care, and significant achievements to date, most Latin American countries have yet to develop palliative medicine as medical specialty. Specialty and sub-specialty training programs remain scarce in relation to regional needs, and the programs that do exist vary widely in duration, structure, and content.

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ABSTRACT Objective: To determine the specialty preferences and the reasons for those choices among medical interns and junior medical doctors at the Georgetown Public Hospital Corporation (GPHC), Guyana. Methods: A cross-sectional study of recent medical graduates at GPHC using anonymous self-administered questionnaires was used. Results: Of the study population of 66, 60 of the questionnaires that were filled were returned (response rate of 91.5%). The females comprised 60% of the respondents and 98% of the respondents were interested in Postgraduate Medical Education (PGME). Paediatrics was the most popular programme (25% of the respondents) followed by internal medicine (21%), and the main reason among the respondents for their choice of training programme was personal interest (69%). Gender differences occurred in paediatrics and ophthalmology where the females were predominant, and in orthopaedics and anaesthesia, where the males were predominant. Conclusion: To ensure an adequate and balanced medical specialists workforce for the future, information on medical graduates' perceptions and preferences of PGME and the factors influencing their choices is important to policy planners and medical educators and efforts must be made to correct any of the maldistributions noted.

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Introducción: Se presenta el diseño de un curso para el desarrollo de la competencia comunicativa intercultural (CCI) a través del inglés en la Educación Médica Posgraduada. Objetivo: Valorar el diseño del curso, teniendo en cuenta principios de los enfoques histórico-cultural y comunicativo, en que se sustenta. Material y Métodos: La población y muestra varía según objetivos y métodos empleados, se consultaron informantes claves (especialista y director de postgrado, docentes de posgrado y profesionales de la salud que han cumplido misión en países de habla inglesa). Las indagaciones empíricas se realizaron a través de entrevistas a profundidad, encuestas, observación del desempeño y revisiones documentales. Para la interpretación de los resultados se emplearon el análisis y la síntesis, la inducción y la deducción. Resultados: Se muestra la pertinencia de los sustentos seleccionados como fundamentación teórica del curso, los objetivos, contenidos y metodología, en particular las tareas docentes que estimulan el aprendizaje significativo de los participantes. Se brindan indicadores de desarrollo de la CCI que fueron esenciales para la determinación de los contenidos. Conclusiones: El diseño del Curso: Competencia Comunicativa Intercultural a través del inglés en la Educación Médica Posgraduada, revela una relación lógica entre su fundamentación teórica y todos sus componentes didácticos, resaltando la importancia de las exigencias de las tareas docentes y sus potencialidades para desarrollar la Competencia Comunicativa Intercultural y responder a las necesidades de aprendizaje identificadas(AU)

Introduction: The design of a course for the development of intercultural communicative competence (ICC) through English in Postgraduate Medical Education is presented. Objective: To assess the design of the course taking into account the principles of the historical, cultural and communicative approaches on which it is based. Material and Methods: The population and sample varies according to the objectives and methods used. Key informants were consulted (one specialist and one postgraduate director, postgraduate teachers and health professionals who have fulfilled missions in English-speaking countries). Empirical inquiries were made through in-depth interviews, surveys, performance observation and documentary reviews. For the interpretation of results, analysis and synthesis, induction and deduction were used. Results: The relevance of the selected aspects as the theoretical foundation of the course, objectives, contents and methodology, particularly the teaching tasks that stimulate the significant learning of the participants are shown. ICC development indicators that were essential for content determination are provided. Conclusions: The course design related to Intercultural Communicative Competence through English in Postgraduate Medical Education reveals a logical relationship between its theoretical foundation and all its didactic components, highlighting the importance of the demands of teaching tasks and their potential to develop Intercultural Communicative Competence and respond to identified learning needs(AU)

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OBJECTIVES: To translate the 35-item version of the Dutch Residency Educational Climate Test (D-RECT), and assess its reliability, construct validity and concurrent validity in the Spanish language. METHODS: For this validation study, the D-RECT was translated using international recommendations. A total of 220 paper-based resident evaluations covering two Colombian universities were cross-sectionally collected in 2015. A Confirmatory Factor Analysis (CFA) was used to assess the internal validity of the instrument using the Comparative fit index (CFI), Tucker-Lewis index (TLI), Standardized root mean square residual (SRMSR), and Root mean square error of approximation (RMSA). Cronbach's α was used to assess reliability. The concurrent validity was investigated through Pearson correlations with the Spanish version of the Postgraduate Hospital Educational Environment Measure (PHEEM). RESULTS: The original 9-factor structure showed an appropriate fit for the Spanish version of the instrument (CFI = 0.84, TLI = 0.82, SRMSR = 0.06, and RMSA = 0.06). The reliability coefficients were satisfactory (>0.70). The mean total scores of the D-RECT and the PHEEM showed a significant correlation (r = 0.7, p<0.01). CONCLUSIONS: This study confirms the validity and reliability of the Spanish version of the Dutch Residency Educational Climate Test, indicating that the instrument is suitable for the evaluation of departments' learning climate in the Spanish context. Future research is needed to confirm these findings in other Spanish speaking countries.

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Maximising the potential of the workplace as a learning environment entails understanding the complexity of its members' interactions. Although some articles have explored how residents engage with supervisors, nurses and pharmacists individually, there is little research on how residents enter into and engage with the broader community of clinical practice (CoCP). To this end, we designed a constructivist grounded theory study that took place at Universidad Javeriana in Bogotá, Colombia. We conducted semi-structured interviews with 13 residents from different training levels and disciplines during the first weeks of their new rotations. During the interviews, we used the Pictor technique as a visual aid to collect data. Using iterative data collection and analysis, constant comparison methods and theoretical sampling, we constructed the final results. When entering a CoCP, residents experienced recurring and intertwined processes including: exploring how their goals and interest are aligned with those of the CoCP; identifying the relevant CoCP members in the workplace environment; and understanding how these members could assist their successful engagement with the community's practices. Residents entered a CoCP with the intention of either having a central or a peripheral trajectory in it. The final resident participation and role resulted from negotiations between the resident and the CoCP members. Optimising workplace learning includes being mindful as to how each member of the healthcare team influence residents' engagement on practice, and on understanding the nuances of residents' participatory trajectories while interacting with them. Understanding such nuances could be key to align CoCPs' learning affordances and residents' goals and intentions.

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OBJECTIVE: To understand the extent to which barriers and misperceptions about intrauterine contraception (IUC) remain among Brazilian gynaecologists, particularly for nulliparous women. METHODS: An online survey was developed to assess Brazilian gynaecologists' knowledge and attitudes towards IUC. Data collected included demographic and professional data, main barriers when considering IUC for women in general and/or nulliparous women, attitudes towards inclusion of IUC in contraceptive counselling, and opinions on what could increase IUC prescription for nulliparous women. A question regarding knowledge about WHO medical eligibility criteria (WHO MEC) was also included in the survey. RESULTS: 101 gynaecologists completed the survey. The insertion rate in nulliparous women was 79.2%. Brazilian gynaecologists were more likely to consider IUC in counselling or provide it on request for parous than for nulliparous women (p<0.05) and perceived more complications in nulliparous women. 74.2% of gynaecologists recognised a higher risk of pelvic inflammatory disease (PID)/infertility associated with IUC use in nulliparous women than in parous women. Difficult and painful insertion were also relevant for 83.2% and 77.3% of the gynaecologists, respectively. Respondents showed a high level of awareness of the WHO MEC classification. CONCLUSIONS: The three most commonly reported barriers to considering IUC as a contraceptive option for nulliparous woman were concerns about PID and difficult or painful insertion. The challenge is to ensure that gynaecologists understand the evidence and do not disregard IUC as a potential option for nulliparous women.

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El Programa de formación de especialistas para la atención primaria de salud y el sistema público, fue iniciado por el Ministerio de Salud de Chile en el año 2007 y se implementa en ocho facultades de Medicina. El Programa dura seis años; la mitad del período transcurre en centros de salud familiar. La primera cohorte de médicos se graduará a comienzos del año 2014. Participan 498 médicos jóvenes, estudiando en hospitales de nivel universitario y trabajando en 73 centros de salud que atienden una población de cerca de dos millones de usuarios potenciales. Actualmente hay suficiente evidencia de que las autoridades, los profesores de clínica, los residentes, las municipalidades y los evaluadores externos consideran que el Programa es necesario y efectivo. El Ministerio proporciona el financiamiento adecuado; pero todavía preocupa su estatus legal y organizacional. Las actividades se orientan a la consolidación de la gestión clínica, al fortalecimiento de las funciones de promoción y prevención en los centros de salud, al progreso en la equidad y efectividad del sistema y a la educación de los usuarios y de las comunidades. Durante la formación también se desarrolla un curso (diploma) de Salud Pública. Los objetivos de mayor alcance incluyen: la planificación de la cobertura a alcanzar durante el próximo ciclo de seis años, la definición de las condiciones deseables para ejecutar la atención primaria, y la evaluación del costo efectividad de las acciones, incluyendo el destino ulterior de los egresados.

The Training Program of specialists incorporated in the primary health care teams and in the public medical care system was started by the Ministry of Health of Chile in 2007 and is carried out in cooperation with eight Medical Faculties. The program lasts six years; half of the time is spent in primary care clinics. The fist cohort will graduate as specialists beginning of 2014. In all, 498 young physicians are now participating in the Program in 73 clinics that cover nearly 2 million potential users. It is generally agreed by all concerned – authorities, faculty, residents, municipalities, external evaluators - that the Program is necessary and effective. However, at this stage and in spite of the financial and administrative support so far provided, there is a concern regarding the legal and organizational status of the Program. Current efforts are being directed towards consolidating the clinical management of patients, strengthening promotion and prevention in the clinics, improving the equity and effectiveness of the system and educating the users and the communities. This is supported by a public health course delivered during the entire duration of the Program. Broader objectives include: planning the coverage to be attained during the next six-year cycle; defining the required type of PHC facilities, and evaluating the cost-effectiveness of the Program, including the subsequent destination of its graduates.

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