¿Qué operan los residentes españoles durante la residencia?: análisis de la aplicabilidad del programa de la especialidad de Cirugía General y Digestiva al finalizar el periodo de residencia

Experiencia operatoria de los residentes de cirugía general: Resultados de un estudio transversal multinstitucional en Colombia

Introducción. Una parte fundamental del entrenamiento de un residente de cirugía es lograr un volumen operatorio suficiente para alcanzar una competencia adecuada en su vida laboral independiente. Tanto el volumen como la autonomía, son desafíos para los programas de residencia en cirugía general de Colombia. Métodos. Se realizó un estudio multinstitucional, con la participación de 5 programas de especialización en cirugía general, de diferentes regiones del país. Se utilizó la bitácora electrónica Logbook para el registro de procedimientos durante un periodo de 12 meses. Se hizo un análisis de la base de datos recolectada. Resultados. Un total de 111 médicos residentes participaron en el estudio. Se registraron 29.622 procedimientos quirúrgicos, que correspondieron a 23.206 pacientes. El 51,7 % de los procedimientos fueron cirugías electivas, el 46,9 % cirugías de urgencia y el 1 % de emergencia. El 22,6 % de los procedimientos se realizó a través de un abordaje mínimamente invasivo. Los cinco procedimientos quirúrgicos más frecuentemente registrados fueron: colecistectomía (n=4341), apendicectomía (n=2558), herniorrafia inguinal (n=2059), herniorrafia umbilical (n=1225) y lavado peritoneal (n=1198). En promedio, cada residente realizó 27 cirugías por mes y en estos procedimientos el rol predominante del residente fue el de cirujano principal, desde momentos tempranos en su formación (a partir del segundo año). Discusión. Es posible lograr a nivel nacional el registro de las actividades a través de una bitácora. Los médicos residentes colombianos realizan un número de cirugías similares o mayores a lo descrito en otros países. Debemos actualizar nuestras expectativas según la formación que reciben actualmente los médicos residentes.

Meta-analysis of operative experiences of general surgery trainees during training

BACKGROUND

General surgical training curricula around the world set defined operative numbers to be achieved before completion of training. However, there are few studies reporting total operative experience in training. This systematic review aimed to quantify the published global operative experience at completion of training in general surgery.

METHODS

Electronic databases were searched systematically for articles in any language relating to operative experience in trainees completing postgraduate general surgical training. Two reviewers independently assessed citations for inclusion using agreed criteria. Studies were assessed for quantitative data in addition to study design and purpose. A meta-analysis was performed using a random-effects model of studies with appropriate data.

RESULTS

The search resulted in 1979 titles for review. Of these, 24 studies were eligible for inclusion in the review and data from five studies were used in the meta-analysis. Studies with published data of operative experience at completion of surgical training originated from the USA (19), UK (2), the Netherlands (1), Spain (1) and Thailand (1). Mean total operative experience in training varied from 783 procedures in Thailand to 1915 in the UK. Meta-analysis produced a mean pooled estimate of 1366 (95 per cent c.i. 1026 to 1707) procedures per trainee at completion of training. There was marked heterogeneity between studies (I²  = 99·6 per cent).

CONCLUSION

There is a lack of robust data describing the operative experiences of general surgical trainees outside the USA. The number of surgical procedures performed by general surgeons in training varies considerably across the world.

Training in breast surgery in Spain

Breast surgery is a key part of training and competency in general surgery in Spain and is a "frontier area" that can be efficiently managed by general surgeons and gynecologists. The main objective of the training process consists of the surgical treatment of breast cancer, including conservative surgery, oncoplastic and reconstructive techniques. This article analyses the current status of breast surgery training in Spain and schematically proposes potential targets of the different training programs, to improve access and training for surgeons and residents in this area, taking into account the RD 639/2014 and European regulation. The priority is to specify the level of training that should be achieved, in relation to the group of professionals involved, considering their area of competency: surgery resident, educational programs, and surgeons with special dedication to this area.