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O objetivo deste estudo é construir e validar uma cartilha educativa para estudantes do ensino médio sobre Suporte Básico de Vida nas escolas. Trata-se de uma pesquisa metodológica, realizada em três etapas. Na primeira etapa foi realizada revisão bibliográfica, na segunda etapa procedeu-se a elaboração da cartilha educativa e por fim, a validação do material por especialistas. Entre os resultados destaca-se que a cartilha aborda as principais recomendações acerca da segurança do socorrista e suporte básico de vida no adulto e possui 14 páginas. Conclui-se que todos os itens da cartilha educativa obtiveram índice de validade de conteúdo maior que 0,82 conseguindo a validação.

The objective of this study is to build and validate an educational booklet for high school students about Basic Life Support in schools. This is a methodological research, carried out in three stages. In the first stage, a bibliographic review was carried out, in the second stage, the educational booklet was elaborated and, finally, the material was validated by specialists in the subject. Among the results, it is highlighted that the booklet addresses the main recommendations regarding rescuer safety and basic adult life support and has 14 pages. It was concluded that all items in the educational booklet had a content validity index greater than 0.82, achieving validation.

El objetivo de este estudio es construir y validar una cartilla educativa para estudiantes de secundaria sobre Soporte Vital Básico en las escuelas. Se trata de una investigación metodológica, realizada en tres etapas. En la primera etapa se realizó una revisión bibliográfica, en la segunda etapa se elaboró la cartilla educativa y, finalmente, el material fue validado por especialistas en el tema. Entre los resultados, se destaca que la cartilla aborda las principales recomendaciones sobre seguridad del reanimador y soporte vital básico del adulto y tiene 14 páginas. Se concluyó que todos los ítems de la cartilla educativa tuvieron un índice de validez de contenido superior a 0,82, lográndose la validación.

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OBJECTIVES: Attending physicians in pediatric emergency medicine (PEM) must be able to perform lifesaving procedures, yet guidelines for maintaining procedural competency do not exist. We implemented a biannual 2-hour "bootcamp" designed to help PEM faculty maintain procedural competency. METHODS: A survey-based needs assessment was used to create a set of goals and objectives for the session and determine which procedural skills to include. Sessions of 4 simulated skills were held twice a year and limited to 12 faculty. Post-bootcamp evaluations were administered at the 1-year and 6-year marks to evaluate the usefulness of the training. RESULTS: Twenty-eight of our 55 current faculty members (50%) responded to the 6-year follow-up evaluation. Overall, the bootcamp was felt to be beneficial, with 64% of faculty rating it "great" (5) or "highly useful" (6) on a 6-point Likert scale. The majority of participants also rated the airway, vascular access, and cardiopulmonary resuscitation/defibrillator training favorably. Faculty who later had the opportunity to perform specific resuscitation procedures clinically felt that the circulation (cardiopulmonary resuscitation/defibrillator) and airway stations contributed to the success of their procedure performance. CONCLUSIONS: The clinical setting alone may be insufficient in maintaining procedural competency in lifesaving skills in PEM. Giving faculty the opportunity to practice these skills is feasible and can be effective in increasing confidence. Future training sessions should aim toward practicing to a defined mastery level.

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BACKGROUND: The electrocardiogram (ECG) is the most relied upon tool for cardiovascular diagnosis, especially in low-resource settings because of its low cost and straightforward usability. It is imperative that internal medicine (IM) and emergency medicine (EM) specialists are competent in ECG interpretation. Our study was designed to improve proficiency in ECG interpretation through a competition among IM and EM residents at a teaching hospital in rural central Haiti in which over 40% of all admissions are due to CVD. METHODOLOGY: The 33 participants included 17 EM residents and 16 IM residents from each residency year at the Hôpital Universitaire de Mirebalais (HUM). Residents were divided into 11 groups of 3 participants with a representative from each residency year and were given team-based online ECG quizzes to complete weekly. The format included 56 ECG cases distributed over 11 weeks, and each case had a pre-specified number of points based on abnormal findings and complexity. All ECG cases represented cardiovascular pathology in Haiti adapted from the Association of Program Directors in Internal Medicine evaluation list. The main intervention was sharing group performance and ECG solutions to all participants each week to promote competition and self-study without specific feedback or discussion by experts. To assess impact, pre- and post-intervention assessments measuring content knowledge and comfort for each participant were performed. RESULTS: Overall group participation was heterogeneous with groups participating a median of 54.5% of the weeks (range 0-100%). 22 residents completed the pre- and post-test assessments. The mean pre- and post-intervention assessment knowledge scores improved from 27.3% to 41.7% (p = 0.004). 70% of participants improved their test scores. The proportion of participants who reported comfort with ECG interpretation increased from 57.6% to 66.7% (p = 0.015). CONCLUSION: This study demonstrates improvement in ECG interpretation through a team-based, asynchronous ECG competition approach. This method is easily scalable and could help to fill gaps in ECG learning. This approach can be delivered to other hospitals both in and outside Haiti. Further adaptations are needed to improve weekly group participation.

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OBJECTIVES: The Hospital for Sick Children in Toronto has offered a 1-year subspecialty residency training program in pediatric emergency medicine (PEM) to Canadian and internationally trained pediatricians and emergency physicians since 1993. The program is intended to support clinical service delivery while simultaneously offering a unique educational opportunity to Canadian and international physicians who desire 1 year of clinically focused training. We describe the experiences and career outcomes of participants who completed this program. METHODS: Two surveys were sent to the 68 individuals who completed the clinical fellowship program from its inception in 1993 until 2014. A blinded survey focused on the fellowship experience and subsequent career activities. A nonblinded survey subsequently determined whether participants had served as a medical director or training program director. RESULTS: Sixty of the 68 participants (88%) completed the blinded survey. Ninety-one percent were in practice in emergency medicine. Twenty-five percent of the participants were living in Canada, compared with 17% before completing the program. This net migration of 8% was not significant (P = 0.26). Thirty-six of the 50 participants (72%) who applied from outside Canada responded to the nonanonymous survey; 18 (50%) had served as an emergency department medical director, and 18 (50%) reported serving as a PEM training program director. CONCLUSIONS: Many participants attained leadership positions in PEM in countries outside of North America and/or participated in training program development. There was no significant change in the proportion of participants living in North America at the time of application compared with the time of survey completion.

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Pediatric emergency medicine (PEM) is a relatively new and rapidly evolving subspecialty in many countries. The purposes of this study were to describe the characteristics and to find common/shared practices in current available PEM fellowship programs across Latin America. METHODS: An electronic, multicenter survey was created and stored on Google forms. The survey was in Spanish language and included 30 questions about the characteristics of the pediatric emergency program, history of the program, and support expected from the Latin American Pediatric Emergency Society. RESULTS: A total of 11 PEM programs in 6 countries were acknowledged in Latin America. All programs are placed in pediatric tertiary care hospitals. All PEM programs were approved by the local universities and the Ministries of Health in each country. Difficulties to start a PEM program included a lack of physicians properly trained in PEM who could direct the program, physician instructors in specific topics, places to complete rotations of the future fellows, and getting the local health authorities to acknowledge the importance of the program. With regard to the duration of the program, 72.7% (8) have a 2-year curriculum and 27.3% (3) have a 1-year curriculum. Four (36.4%) program directors mentioned an admission examination as a requirement, 4 (36.4%) needed an examination plus an interview, 3 (27.3%) mentioned that it is necessary just like an interview, and 2 (18.2%) mentioned that the physicians are admitted with a scholarship. With regard to the structure of the programs and rotations included, most of the programs have rotations that are compulsory in different pediatric subspecialties. In 80% of the programs, fellows are evaluated based on different technical skill procedures that they need to learn and perform during PEM fellowship training. The PEM fellowship is recognized by different societies in emergency medicine and pediatrics, except in Dominican Republic where it is only recognized by the Ministry of Health and the university. After completion of the program in 90% (10) of the programs, graduates are not guaranteed a job, and in half, there is no mechanism implemented for recertification of the pediatric emergency physicians by the local medical council. CONCLUSIONS: In Latin America, postgraduate programs in pediatric emergencies are a response to a need for health systems. Being an innovative specialty, it surpassed each country's own challenges, until it was able to reach an internationally standardized level, with a great diversity of pedagogical methodology, which the product has been to offer a high quality of emergency care to children.

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INTRODUCTION: Globally, medical students have demonstrated knowledge gaps in emergency care and acute stabilization. In Colombia, new graduates provide care for vulnerable populations. The World Health Organization (WHO) Basic Emergency Care (BEC) course trains frontline providers with limited resources in the management of acute illness and injury. While this course may serve medical students as adjunct to current curriculum, its utility in this learner group has not been investigated. This study performs a baseline assessment of knowledge and confidence in emergency management taught in the BEC amongst medical students in Colombia. METHODS: A validated, cross-sectional survey assessing knowledge and confidence of emergency care congruent with BEC content was electronically administered to graduating medical students across Colombia. Knowledge was evaluated via 15 multiple choice questions and confidence via 13 questions using 100 mm visual analog scales. Mean knowledge and confidence scores were compared across demographics, geography and prior training using Chi-Squared or one-way ANOVA analyses. RESULTS: Data were gathered from 468 graduating medical students at 36 institutions. The mean knowledge score was 59.9% ± 23% (95% CI 57.8-62.0%); the mean confidence score was 59.6 mm ±16.7 mm (95% CI 58.1-61.2). Increasing knowledge and confidence scores were associated with prior completion of emergency management training courses (p<0.0001). CONCLUSION: Knowledge and confidence levels of emergency care management for graduating medical students across Colombia demonstrated room for additional, specialized training. Higher scores were seen in groups that had completed emergency care courses. Implementation of the BEC as an adjunct to current curriculum may serve a valuable addition.

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Introducción: la evaluación y acreditación de la calidad en la formación de las especialidades médicas en Cuba, conceptualiza el monitoreo del impacto como el proceso dirigido a evaluar la correspondencia entre los objetivos del programa y los resultados alcanzados por sus participantes en el entorno social donde se desarrollan profesionalmente. Objetivo: aplicar la metodología diseñada para el monitoreo del impacto en la formación de las especialidades médicas en el Programa de Medicina Intensiva y Emergencias. Materiales y métodos: se realizó un estudio de corte pedagógico donde se aplicó la metodología diseñada en la Universidad de Ciencias Médicas de Matanzas, para monitorear el impacto en la formación de la especialidad de Medicina Intensiva y Emergencias, desarrollado en el Hospital Universitario Comandante Faustino Pérez Hernández. Participaron 6 egresados, 11 profesores, 8 tutores y 4 directivos de la última edición concluida (octubre de 2016 a noviembre de 2019). Resultados: se observó un alto impacto en la institución y mediano en el individuo, con contraste entre el diagnóstico inicial y durante la formación: de excelencia en el 100 % de los residentes, pero un diagnóstico final con 33,3 % excelente y 66,6 % bien. No se evaluó la etapa de transferencia o impacto en la sociedad, por el corto de tiempo de experiencia laboral de los egresados. Conclusiones:la metodología aplicada permitió conocer un mediano impacto en la formación de los egresados de Medicina Intensiva y Emergencias, por contrastación entre el diagnóstico inicial y durante la formación, de excelente con un diagnóstico final de bien (AU).

Introduction: the evaluation of the quality in the formation of the medical specialties in Cuba, conceptualize the monitored of the impact like the process directed to evaluate the correspondence among the objectives of the program and the results reached by their participants in the social environment where they are developed professionally, guaranteeing the relevancy of the program. Objective: to apply the methodology designed for the monitored of the impact in the formation of the medical specialties in the program of intensive Medicine and emergencies. Materials and methods: carried out a study of pedagogic court where the methodology was applied designed in the Medical University of Matanzas, for the monitored of the impact in the formation of the specialty of intensive Medicine and emergencies, developed in the university hospital "Faustino Pérez Hernández." They participated six graduate, four directives, 11 professors and tutors of the last concluded edition, from October of the 2016 to November of the one 2019. Results: a high impact was observed in the institution and medium in the individual, with a contrast among the initial diagnosis and during for formation of excellence in 100% of the residents, with a final diagnosis of 33,3% excellent and 66,6% well. It was not evaluated the transfer stage or impact in the society, for the short of time of labor experience of the graduate. Conclusions: the applied methodology allowed to know the medium impact in the formation of graduate in Intensive Medicine and Emergencies in Matanzas, for a contrast among the initial diagnosis and during the formation of excellent with the final diagnosis of well (AU).

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BACKGROUND: Prehospital care is a key component of an emergency care system. Prehospital providers initiate patient care in the field and transition it to the emergency department. Emergency Medicine (EM) specialist training programs are growing rapidly in low- and middle-income countries (LMICs), and future emergency physicians will oversee emergency care systems. Despite this, no standardized prehospital care curriculum exists for physicians in these settings. This report describes the development of a prehospital rotation for an EM residency program in Central Haiti. METHODS: Using a conceptual framework, existing prehospital curricula from high-income countries (HICs) were reviewed and adapted to the Haitian context. Didactics covering prehospital care from LMICs were also reviewed and adapted. Regional stakeholders were identified and engaged in the curriculum development. RESULTS: A one-week long, 40-hour curriculum was developed which included didactic, clinical, evaluation, and assessment components. All senior residents completed the rotation in the first year. Feedback was positive from residents, field sites, and students. CONCLUSIONS: A standardized prehospital rotation for EM residents in Haiti was successfully implemented and well-received. This model of adaptation and local engagement can be applied to other residency programs in low-income countries to increase physician engagement in prehospital care.

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Objetivo: Determinar o perfil socioprofissional dos médicos que atuam em serviços hospitalares de urgência e emergência. Métodos: Realizou-se uma pesquisa descritiva com delineamento transversal. Foram avaliadas as informações de 60 médicos que atuavam em três hospitais com serviços de urgência e emergência do município de Imperatriz (MA), no período de janeiro a março de 2018. Para coleta de dados, utilizou-se um questionário autoaplicável contendo 18 questões. Resultados: Dos 60 participantes, 70% eram do sexo masculino, e 53,3% não ingressaram em programas de Residência Médica. A média de idade dos profissionais foi de 37 anos, enquanto a média do tempo de atuação no setor de urgência e emergência foi de 11 anos. Dos participantes, 85% referiram ter realizado cursos complementares voltados para a área da emergência. Os cursos mais citados foram o Advanced Cardiac Life Support (39,3%) e o Advanced Trauma Life Support (38,1%). Conclusão: Os perfis dos médicos foram de jovens, com predominância do sexo masculino e com pouco tempo de experiência profissional em atuação no setor de urgência e emergência. Identificou-se grande adesão aos cursos complementares na área de emergência e de educação continuada. Entretanto, apenas uma minoria dos participantes possuía especialidade e pós-graduação stricto e lato sensu.

Objective: To establish the social and professional profile of physicians working in emergency hospital services. Methods: A descriptive study with cross-sectional design was carried out. The information of 60 physicians working in hospitals with emergency services in the municipality of Imperatriz, MA, from January to March 2018 was assessed. A self-administered questionnaire with 18 questions was applied for data collection. Results: Of the 60 participants, 70% were men and 53.3% did not enroll in Medical Residency Programs. The physicians' mean age was 37 years, while the mean time of work in the emergency department was 11 years. Of the participants, 85% declared taking complementary courses on the emergency area. The most cited courses were Advanced Cardiac Life Support (39.3%) and Advanced Trauma Life Support (38.1%). Conclusion: The physicians' profiles were being young, a predominance of men, and little experience in on the emergency area. There was high adhesion to complementary courses in the area of emergency and of Continuing Education. However only a minority of participants had a graduate certificate or a graduate degree.

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ABSTRACT The impact of traditional public health emergencies on the comprehensive education of medical students in colleges and universities is mainly reflected in the test of comprehensive literacy. Based on this, this paper studies the construction of a public health emergency impact analysis platform from a medical perspective and cloud computing. From the platform's database construction, event collection methods, impact evaluation rules and other aspects to achieve accurate analysis of the impact of emergencies, using the cloud computing method for comprehensive analysis and evaluation, the algorithm can analyze and intelligently classify information data on the Internet in the process of multiple input, and respond to potential public health emergencies according to cloud computing technology, in order to analyze the impact on the comprehensive quality of medical students. The experimental results show that the public health emergency analysis platform has the advantages of high feasibility and high data utilization, and can effectively improve the impact of public health emergencies on the comprehensive literacy of medical students.

RESUMO O impacto das tradicionais emergências de saúde pública sobre a formação integral de estudantes de medicina em faculdades e universidades reflete-se principalmente no teste de formação integral. Com base nisso, este documento estuda a construção da plataforma de análise de impacto de emergência de saúde pública sob a perspectiva médica e computação em nuvem. A partir da construção da base de dados da plataforma, foram desenvolvidos métodos de coleta de eventos, regras de avaliação de impacto e outros aspectos para obter uma análise precisa do impacto das emergências, usando o método de computação em nuvem para análise e avaliação. O algoritmo pode realizar a análise e classificação inteligente de dados de informação na Internet no processo de introdução múltipla, e responder a possíveis emergências de saúde pública de acordo com a tecnologia de computação em nuvem a fim de analisar o impacto sobre a qualificação dos estudantes de medicina. Os resultados experimentais mostram que a plataforma de análise de emergências de saúde pública tem as vantagens de alta viabilidade e alta utilização de dados, pode melhorar efetivamente o impacto das emergências de saúde pública na formação integral dos estudantes de medicina.

RESUMEN El impacto de las emergencias de salud pública tradicionales en la educación integral de los estudiantes de medicina en los colegios y universidades se refleja principalmente en la prueba de comprensión de textos. Con base en esto, este trabajo estudia la construcción de una plataforma de análisis de impacto de emergencias en salud pública desde una perspectiva médica y de computación en la nube. A partir de la construcción de la base de datos de la plataforma, los métodos de recolección de eventos, las reglas de evaluación de impacto y otros aspectos para lograr un análisis preciso del impacto de las emergencias, utilizando el método de computación en la nube para un análisis y evaluación integral, el algoritmo puede analizar y clasificar de manera inteligente los datos de información en Internet en el proceso de entrada múltiple. También puede responder a potenciales emergencias de salud pública de acuerdo con la tecnología de computación en la nube, con el fin de analizar el impacto en la calidad integral de los estudiantes de medicina. Los resultados experimentales muestran que la plataforma de análisis de emergencias de salud pública tiene las ventajas de alta viabilidad y alta utilización de datos, y puede mejorar de manera efectiva el impacto de las emergencias de salud pública en la comprensión de textos de los estudiantes de medicina.

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INTRODUCTION: In 2016, the Ministry of Health in Jamaica selected the Emergency Severity Index as the triage tool to be used nationally. This study evaluated the effectiveness of this approach by assessing the interrater reliability among new users trained with minimal resources by 2 experienced trainers, 1 local and 1 international. METHODS: A retrospective case series review was conducted within an online learning collaborative framework. After completion of the training, the participants from each of the 19 clinical sites were asked to submit 2 triage cases per month for blinded review by the expert trainers. The triage categories assigned by each reviewer were compared with those assigned by the newly trained Emergency Severity Index providers. A weighted kappa value was calculated to assess the degree of agreement between the sites and the expert trainers. RESULTS: A total of 166 cases were received over the study period. Participation in the learning collaborative was consistently below 50%. The interrater reliability between the expert trainers (κ = 0.48) as well as between each scorer and each accident and emergency department site (κSF = 0.33, κPT = 0.26) was low, although there was improvement over the study period. Incomplete triage documentation limited raters' ability to assign triage categories and assess interrater reliability. DISCUSSION: Despite a rigorous implementation process, the interrater reliability of the Emergency Severity Index skills of Jamaican emergency nurses and doctors when compared with that of the 2 experts was poor. Several areas were identified for strengthening. Considerations for the implementation of the Emergency Severity Index in countries outside of the US were also discussed.

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Resumo: Introdução: As situações de emergência requerem ações e decisões rápidas por parte do médico, que deve articular competências técnicas, como o conhecimento e as habilidades clínicas, para o diagnóstico, e não técnicas, como a liderança e o trabalho em equipe, para proporcionar a assistência segura. Objetivo: Este estudo teve como objetivo conhecer as percepções dos professores médicos sobre o ensino das competências não técnicas para o atendimento de situações de emergência, no contexto de um curso de graduação em Medicina. Método: Trata-se de pesquisa de abordagem qualitativa, exploratória e descritiva, desenvolvida com 24 professores médicos de um curso de Medicina em fase de implantação. A coleta de dados foi realizada por meio de entrevistas, com uso de roteiro semiestruturado, gravadas em áudio, com o consentimento dos participantes. Para análise dos dados, utilizou-se análise temática. Resultados: A análise das entrevistas possibilitou a construção de dois temas: "Ensinar urgência e emergência: uma reprodução de procedimentos" e "A transição de racionalidades no ensino das competências não técnicas para atendimentos de emergência", com os subtemas, "Competência não técnica: por mais que eu ensine você não vai aprender" e "É possível desenvolver as competências não técnicas". Conclusões: No grupo estudado, sobressai a visão tecnicista, em que se enfatiza o ensino técnico-procedimental para assistência às situações de emergência. Entretanto, coexistem diferentes concepções de ensinar e aprender, indicando uma transição de racionalidades que perpassa o entendimento dos professores. Ressalta-se a necessidade de propostas de desenvolvimento permanente do corpo docente que possibilitem repensar criticamente as concepções de aprendizagem no campo das emergências, sobretudo no âmbito dos novos cursos de graduação em Medicina.

Abstract: Introduction: Emergency situations require rapid response and decisions by the physician, who must articulate technical skills, such as knowledge and clinical skills for the diagnosis, and non-technical skills, such as leadership and teamwork, to provide safe care. Objective: To know the medical faculty's perceptions on the teaching of non-technical skills for emergency care in the context of an undergraduate medical course. Method: Qualitative, exploratory and descriptive study developed with 24 medical teachers of a medical course in the implementation phase. Data collection was performed through interviews, using a semi-structured script, recorded in audio, with the participants' consent. Thematic analysis was used for the data analysis. Results: the analysis of the interviews allowed the construction of two themes: "Teaching urgency and emergency: a reproduction of procedures" and "The transition of rationalities in teaching non-technical skills for emergency care", with the subthemes, "Non-technical skills: however much I teach you, you will not learn" and "It is possible to develop non-technical skills". Conclusions: In the studied group, a technicist vision stands out, emphasizing technical and procedural teaching to assist emergency situations. However, different conceptions of teaching and learning coexist, indicating a transition of rationalities that permeates the teachers' understanding. The need for proposals for the continuing development of the faculty is emphasized, allowing critically rethinking the conceptions of learning in the field of emergencies, especially in the context of new undergraduate medical courses.

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INTRODUCTION: Emergency medicine (EM) was recognized as a specialty in Ecuador in 1993. Currently, there are two four-year EM residency programs and an estimated 300 residency-trained emergency physicians countrywide. This study describes the current challenges in EM in Ecuador. METHODS: We conducted 25 semi-structured, in-person interviews with residency-trained emergency physicians, general practitioners, public health specialists, prehospital personnel, and physicians from other specialties. The interviewer asked about challenges in the areas of emergency care, working conditions of emergency physicians, EM residency education, EM leadership, and prehospital care. We analyzed data for challenges and registered the number of interviewees who mentioned each challenge. RESULTS: Interviewees worked in the three largest cities in the country: Quito (60%); Guayaquil (20%); and Cuenca (20%). Interviewees included 16 (64%) residency-trained emergency physicians; six (24%) residency-trained physicians from other specialties working in or closely associated with the emergency department (ED); one (4%) general practitioner working in the ED; one (4%) specialist in disasters; and one (4%) paramedic. Shortage of medical supplies, need for better medico-legal protection, lack of EM residencies outside of Quito, and desire for more bedside teaching were the challenges mentioned with the highest frequency (each 44%). The next most frequently mentioned challenges (each 38%) were the need for better access to ultrasound equipment and the low presence of EM outside the capital city. Other challenges mentioned included the low demand for emergency physicians in private institutions, the lack of differential pay for night and weekends, need for more training in administration and leadership, need for a more effective EM national society, and lack of resources and experience in EM research. CONCLUSION: Emergency medicine has a three-decade history in Ecuador, reaching important milestones such as the establishment of two EM residencies and a national EM society. Challenges remain in medical care, working conditions, residency education, leadership, and prehospital care. Stronger collaboration and advocacy among emergency physicians can help strengthen the specialty and improve emergency care.

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OBJECTIVE: To describe the academic-assistance activities of the graduates of the specialty of emergencies in the Regional General Hospital 25 of the Mexican Institute of Social Security. METHOD: Observational descriptive type study in which the 25 generations graduated from the specialty will be analyzed. The scientific, teaching and care productivity of its graduates was analyzed, as well as the subsequent training and the managerial positions held. RESULTS: From 1991 to 2018 238 residents entered, of which 88.65% concluded the specialty. 57.34% are male. 78.67% of the graduates work exclusively in the IMSS and 68.72% do it in more than one institution. 72% of them have certification. They published 112 scientific articles and 4 books. 12.32% of the graduates attended a second specialty, being the predecessor of patient care in the critical state (84.61%). Among the main achievements of the headquarters are in the first emergency room of the country in the Quality Postgraduate Program of Consejo Nacional de Ciencia y Tecnología. 53% of these specialists work or perform in management positions. CONCLUSIONS: This office is considered a reference in the specialty of emergencies in Latin America.

OBJETIVO: Describir las actividades académico-asistenciales de los egresados de la especialidad de urgencias en el Hospital General Regional 25 del Instituto Mexicano del Seguro Social (IMSS). MÉTODO: Estudio observacional de tipo descriptivo en el que se analizaron las 25 generaciones egresadas de la especialidad. Se analizó la productividad científica, docente y asistencial de sus egresados, así como la formación posterior y los puestos directivos desempeñados. RESULTADOS: De 1991 a 2018 ingresaron 238 residentes, de los cuales el 88.65% concluyó la especialidad. El 57.34% son de sexo masculino. El 78.67% de los egresados laboran exclusivamente en el IMSS y el 68.72% lo hacen en más de una institución. El 72% cuentan con certificación. Publicaron 112 artículos científicos y 4 libros. El 12.32% de los egresados cursaron una segunda especialidad, siendo la predominante la de Atención del Paciente en Estado Crítico (84.61%). Entre los logros principales de la sede están el de ser la primera sede de urgencias del país en ser incluida en el Programa de Posgrados de Calidad del Consejo Nacional de Ciencia y Tecnología. El 53% de estos especialistas se desempeñan o han desempeñado en puestos directivos. CONCLUSIONES: Esta sede se constituye como un referente dentro de la especialidad de urgencias en Latinoamérica.

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OBJECTIVE: To develop and validate a questionnaire to assess the knowledge of mechanical ventilation among final-year medical students in Brazil. METHODS: A cross-sectional study conducted between October 2015 and October 2017 involving 554 medical students was carried out to develop a questionnaire for assessing knowledge on mechanical ventilation. Reproducibility was evaluated with the intraclass correlation coefficient, internal consistency was evaluated with Cronbach's alpha, and construct validation was evaluated with a tetrachoric exploratory factor analysis. To compare the means of the competences among the same type of assessment tool, the nonparametric Friedman test was used, and the identification of the differences was obtained with Dunn-Bonferroni tests. RESULTS: The final version of the questionnaire contained 19 questions. The instrument presented a clarity index of 8.94±0.83. The value of the intraclass correlation coefficient was 0.929, and Cronbach's alpha was 0.831. The factor analysis revealed five factors associated with knowledge areas regarding mechanical ventilation. The final score among participants was 24.05%. CONCLUSION: The instrument has a satisfactory clarity index and adequate psychometric properties and can be used to assess the knowledge of mechanical ventilation among final-year medical students in Brazil.

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INTRODUCTION: When hydrological disasters occur in local rural communities, the demand for health services increases, especially in primary healthcare.1 Health services are essential in the response to a disaster where nurses all over the world play a significant role. AIM: To identify nurses' competencies when responding to disasters caused by floods in the rural area. METHODS: A descriptive, exploratory, and qualitative study was developed. The Critical Incidents Technique was adopted. Twenty public health nurses who worked during the flood season in the years of 2014 and 2015 in a rural area in Southern Brazil were interviewed. Critical incidents and requirements identified in the empirical data gave rise to the development of the competencies. RESULTS: Thirty competencies were identified and classified in the following domains: leadership and management, teamwork, health care, community-oriented, communication, psychological support, health surveillance, and education. DISCUSSION: Although the competencies could be related to the established international competencies for the nurse in disasters, some were described only in this study. They can contribute to the education and practice of nurses in primary health care, strengthening its capacity to face disaster situations by flood in the rural area.

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STUDY OBJECTIVE: Although intubation is a commonly discussed procedure in emergency medicine, the number of opportunities for emergency physicians to perform it is unknown. We determine the frequency of intubation performed by emergency physicians in a national emergency medicine group. METHODS: Using data from a national emergency medicine group (135 emergency departments [EDs] in 19 states, 2010 to 2016), we determined intubation incidence per physician, including intubations per year, intubations per 100 clinical hours, and intubations per 1,000 ED patient visits. We report medians and interquartile ranges (IQRs) for estimated intubation rates among emergency physicians working in general EDs (those treating mixed adult and pediatric populations). RESULTS: We analyzed 53,904 intubations performed by 2,108 emergency physicians in general EDs (53,265 intubations) and pediatric EDs (639 intubations). Intubation incidence varied among general ED emergency physicians (median 10 intubations per year; IQR 5 to 17; minimum 0, maximum 109). Approximately 5% of emergency physicians did not perform any intubations in a given year. During the study, 24.1% of general ED emergency physicians performed fewer than 5 intubations per year (range 21.2% in 2010 to 25.7% in 2016). Emergency physicians working in general EDs performed a median of 0.7 intubations per 100 clinical hours (IQR 0.3 to 1.1) and 2.7 intubations per 1,000 ED patient visits (IQR 1.2 to 4.6). CONCLUSION: These findings provide insights into the frequency with which emergency physicians perform intubations.

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Quality improvement (QI) is a science of systematic analysis and improvement of health care delivery systems. Working knowledge of QI models is imperative to professional development of future pediatric emergency medicine practitioners. The Accreditation Council for Graduate Medical Education has established a list of QI and patient safety expectations for trainees. In order to address educational needs in this area, we have created a novel QI curriculum for pediatric emergency medicine fellows that include didactic sessions, active participation in QI projects, and mentorship by QI faculty. As a part of the curriculum, fellows are required to participate in variety of QI and patient safety activities, such as Morbidity and Mortality conferences, QI and Patient Case Review committees, and Clinical Care Guideline work groups. As a measure of success, fellows who have participated in this curriculum have shared their successful QI work at the local and national levels. This goal of this report is to share our experience in order to provide other institutions a framework for their own curriculum development.

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Introducción: La Radiología de Urgencias es una unidad de aprendizaje longitudinal a toda la residencia. En ella los residentes se enfrentan a patología de urgencia en distintas modalidades de imagen. Además del dominio cognitivo, los residentes deben desarrollar habilidades de comunicación y colaboración que les permitan enfrentar adecuadamente los turnos de residencia. Previo a incorporarse a los turnos nocturnos, los residentes deben aprobar un Examen Clínico Objetivo Estructurado (ECOE). Propósito: Evaluar competencias de comunicación y colaboración a través de estaciones de ECOE de Radiología de Urgencias aplicado a residentes de 2º año de residencia. Metodología: Se seleccionaron objetivos específicos a evaluar para las competencias de comunicación y colaboración y contenidos de Radiología Abdominal, Osteoarticular y Pediátrica para diseñar tres estaciones de ECOE, las cuales fueron incorporadas en el instrumento de evaluación aplicado el año 2017. Se calcularon porcentajes de logro por estación y tipo de pauta de evaluación. Para evaluar la implementación de las estaciones, se diseñó y aplicó una encuesta de percepción a los residentes. Resultados: Se diseñaron tres estaciones, dos para el rol Comunicador y una para el rol Colaborador. La validez de contenido se aseguró a través de un panel de expertos. Los porcentajes de logro global en las estaciones fluctuaron entre 74,7% y 95,6%. Las estaciones fueron bien evaluadas por parte de los residentes, quienes valoraron la incorporación de competencias diferentes al dominio cognitivo en el instrumento de evaluación. Conclusión: El ECOE permite certificar habilidades transversales como comunicación y colaboración de manera apropiada

Introduction: Emergency radiology (ER) is taught and learned throughout the entire residency. Trainees are exposed to different subspecialties ER cases and through varied imaging techniques. In addition to the "medical expert" domain, residents must develop communication and collaboration skills that will help them during their call schedule. Before they can take night-call, radiology residents must pass an Objective Structured Clinical Examination (OSCE). Purpose: To evaluate communication and collaboration competencies on an ER-OSCE applied to second-year radiology residents. Methods: Specific learning objectives were defined to evaluate communication and collaboration skills in abdominal, musculoskeletal and pediatric ER. Three OSCE stations were designed for this purpose and added to the evaluation instrument in 2017. On each station, resident performance was assessed with a specific template and percentage of goal achievement was calculated. Trainee´s opinion of this new modality was obtained through a perception survey. Results: Three stations were designed, two for the communicator role and one for the collaborator competency. Validity of content confirmed through an expert panel. Percentages of goal achievement on each station varied between 74,7% and 96,6. The new stations were positively evaluated by residents, which valued that competencies other than "medical expert" were being assessed. Conclusion: ER-OSCE allows the appropriate assessment of generic competencies such as communication and collaboration in radiology.

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