Considerations on the implementation of the Clinical Microbiology and Parasitology training program in Spanish hospitals: A national survey

INTRODUCTION

The specialty of Microbiology and Parasitology is a four-year multidisciplinary training with a central role in the diagnosis and epidemiological surveillance of infectious diseases. The aim of this study is to analyze the degree of implementation of the official program and the degree of satisfaction of residents with their training.

METHODS

We conducted an online survey distributed in eight sections to which active residents of the Specialty of Clinical Microbiology and Parasitology had access.

RESULTS

A total of 69 responses were received, with a predominance of residents from the regions of Madrid (43.5%) and of FIR admission route (55%). The areas in which the residents feel best prepared correspond to systematic bacteriology, antimicrobials and clinical aspects of microbiology. The areas with the worst preparation, on the other hand, are mycology, parasitology and microbiological emergencies. There are significant differences between the clinical rotation time for residents with MIR access pathway with respect to residents with other degrees. Respondents perceive a high degree of responsibility and a medium agreement with the quality of teaching. Attendance at clinical sessions and external rotations is frequent. Research activity is perceived as complicated, both at the level of doctoral studies and with respect to entering research lines and the publication of scientific results.

CONCLUSION

Some points of improvement of the training itinerary have been identified that need to be reinforced. Likewise, it would be interesting to seek a better balance between care, teaching and research activities.

Gamification: Basic concepts and applications in radiology

Gamification is the use of elements from games in non-game environments, such as education. It is an alternative educational focus that promotes students' motivation and participation in the learning process. Gamification had proven effective in training health professionals and can play an important role in diagnostic radiology training, both at the undergraduate and postgraduate levels. Gamification activities can be carried out in real environments, such as classrooms or session rooms, but there are also interesting online modalities that favor remote access and user management. The possibilities of gamification in virtual worlds to teach undergraduate students radiology are very promising and deserve to be explored in training residents. This article aims to review general concepts in gamification and to present the main types of gamification used in medical training, pointing out its applications and advantages and disadvantages and emphasizing experiences in radiology education.

Exposición a radiación ionizante en médicos residentes de ortopedia en un hospital de referencia

OBJECTIVE

To describe and analyze the exposure to ionizing radiation of orthopedic residents.

METHOD

A prospective study was carried out to evaluate the degree of exposure to ionizing radiation with a bandage dosimeter placed under the lead apron for medical residents for 10 months. An online survey measured the degree of knowledge about radiation safety.

RESULTS

54 resident physicians participated. 55.6% report having knowledge of the existence of radiological protection equipment and 40.7% report that they had previous training in its use. 77.8% use the leaded apron and 31.5% use thyroid protection. 81.5% were positioned less than 1 meter from the source of the X-ray production of the arc in C. The total mean radiation exposure was 2.9 ± 2.17 mSv (95% confidence interval: 1.25-14.28; p = 0.424).

CONCLUSIONS

Orthopedic residents present radiation doses below the International Commission on Radiological Protection recommended limit. However, there is a lack of knowledge of radiation protection and as well as a lack of interest and ignorance of the adverse effects of radiation.

Impact of the COVID-19 pandemic on the training of otorhinolaryngology residents

Background and objectives

Training in surgical specialties has declined during the COVID-19 pandemic. A study was carried out to further analyze the impact of the COVID-19 pandemic on specific aspects of clinical, training, and research activities performed by the otolaryngology residents in Spain.

Methods

A cross-sectional qualitative study was conducted during the last two weeks of February 2021. The study consisted of an online survey taken by otolaryngology residents who had undertaken one-year continuing training from February 15, 2020, to February 15, 2021, and consisted of 26 questions exploring the impact of the COVID-19 on the health of the ENT residents and training activities. Categorical variables were reported as frequency and percentage. When indicated, Pearson’s Chi-square test (χ2) with Yates’s correction and Pearson's correlation coefficient (r) were used.

Results

143 completed surveys were received from 264 Residents (54.17%). 36 residents (25.2%) have suffered from the disease due to SARS-CoV-2. Most of them only developed mild symptoms (86.1%), with 3 requiring hospitalisation (8.3%). The origin of infection was unknown in all reported cases and the need for confinement was principally due to either attending an asymptomatic patient in 9 cases (6.3%) or to being supposedly in close contact with an asymptomatic person in 22 (15.4%). 60.1% of the residents surveyed reported having lost more than 6 months of their training period, and in 18.8% of cases, it was as high as 10 and 12 months. There has been a reduction of more than 75% of what was planned in surgical training (p < 0.05) of tympanoplasty, mastoidectomy, stapedectomy, cochlear implants, endoscopic sinonasal and anterior skull base surgery, septoplasty and turbinoplasty.

Conclusions

The decline in ENT activity and residents having to assist in other COVID-19 units during the most critical moments of the pandemic, has caused the main reduction in their training capacity. Contagion mainly occurred through contact with asymptomatic carriers during patient care and through supposedly close contact with asymptomatic carriers. Virtual activities have been widely accepted, but they have not completely replaced all residents’ training needs. Measures should be implemented to recover lost training, especially surgical practical learning in otology and rhinology.

Has 2020 been a lost year in orthopedic surgery and trauma training? Residents' perceptions

OBJECTIVE

The COVID-19 pandemic has affected specialized healthcare training at all levels. Surgical learning has been severely affected, and the impact on orthopedic surgery residency training has so far not been assessed.

MATERIAL AND METHODS

An online survey of 17 questions was sent via web link to orthopedic surgery residents throughout Spain between February 10, 2021 and February 28, 2021. The effects of the COVID-19 pandemic on the care and training activities of residents were analyzed.

RESULTS

A total of 307 orthopedic surgery residents from all over Spain responded to the online survey. A total of 77.2% of the respondents had to suspend their rotations. Of these, 67.5% would like to resume the rotations they missed during the pandemic. A total of 69.7% of scheduled surgeries were suspended. Surgical activity was completely stopped for an average of 8 weeks. 66.8% of the residents consider that their surgical training has been affected and this will have repercussions on their future work. 49.5% considered the online training offered to be insufficient. Of the total number of respondents, 52.1% considered that the impact of the pandemic situation on their training situation was bad or very bad.

CONCLUSIONS

The data collection shows a negative impact on both theoretical and clinical training. This study highlights the need to continue offering quality training by maximizing learning opportunities.

[Implementation of Recommendations and Clinical Practice Guidelines by residents: the role of the Multiprofessional Family and Community Care Teaching Units in Spain]

OBJECTIVE

To analyze the role of Family and Community Care Trainig Units as facilitators of the implementation of Clinical Practice Guidelines (CPG) and the factors associated with a greater effort in this task.

MATERIAL AND METHODS

Design: Cross-sectional descriptive study with analytical approach.

PARTICIPANTS

Training Units in Spain (N=94).

MAIN MEASUREMENTS

Variables were collected through a self-completed survey into five domains: characteristics of Training Units, training activity directed at evidence-based clinical practice (EBPP), importance attributed to this activity, responsibility for EBPP implementation, perception of barriers and facilitators to its use. Descriptive and multivariate analysis with the dependent variable being the perceived effort of the training unit to implement CPG.

RESULTS

45 Training Units responded (47.9%). 42.2%(CI 95%: 27.8-56.6) of their coordinators have directed research projects and 31.1% (CI 95%:17.6-44.6) have participated in elaborating CPG. They organized an average of 51hours (SD 47.2) of training in PCBP. 97.7% (CI95%:93.3-100) considered it fundamental that the residents ow and apply PCBP and 93.3% (CI95%:86.0-100) considered that tutors are responsible for the implementation. The participation of the coordinator in CPG (coef: 0.58; IC 95%: 0.00-1.16), awareness of how important is that residents know about CPG (coef: 0.89; IC 95%: 0.24-1.54) and that CPG appear to be widely applicable. applicable (coef: 0.35; IC 95%: -0.01-0.70) were related to a greater effort by the training units.

CONCLUSIONS

The training units recognize the importance of CPGs and consider that tutors are responsible for their implementation. Training Units effort to implement CPG was related to unit coordinators previous experience, the perception of applicability and residents needs.

Exploring the Residents' Perspective on Smart learning Modalities and Contents for Virtual Urology Education: Lesson Learned During the COVID-19 Pandemic

PURPOSE

The COVID-19 outbreak has substantially altered residents' training activities. While several new virtual learning programs have been recently implemented, the perspective of urology trainees regarding their usefulness still needs to be investigated.

METHODS

A cross-sectional, 30-item, web-based Survey was conducted through Twitter from April 4th, 2020 to April 18th, 2020, aiming to evaluate the urology residents' perspective on smart learning (SL) modalities (pre-recorded videos, webinars, podcasts, and social media [SoMe]), and contents (frontal lessons, clinical case discussions, updates on Guidelines and on clinical trials, surgical videos, Journal Clubs, and seminars on leadership and non-technical skills).

RESULTS

Overall, 501 urology residents from 58 countries completed the survey. Of these, 78.4, 78.2, 56.9 and 51.9% of them considered pre-recorded videos, interactive webinars, podcasts and SoMe highly useful modalities of smart learning, respectively. The contents considered as highly useful by the greatest proportion of residents were updates on guidelines (84.8%) and surgical videos (81.0%). In addition, 58.9 and 56.5% of responders deemed seminars on leadership and on non-technical skills highly useful smart learning contents. The three preferred combinations of smart learning modality and content were: pre-recorded surgical videos, interactive webinars on clinical cases, and pre-recorded videos on guidelines.

CONCLUSION

Our study provides the first global «big picture» of the smart learning modalities and contents that should be prioritized to optimize virtual Urology education. While this survey was conducted during the COVID-19 outbreak, our findings might have even more impact in the future.

Surgical resident training program to perform laparoscopic bariatric procedures: Are safety and postoperative outcomes compromised?

INTRODUCTION

Laparoscopic bariatric procedures such as laparoscopic Roux-en-Y gastric bypass (LRYGB) are technically demanding and require a long learning curve. Little is known about whether surgical resident (SR) training programs to perform these procedures are safe and feasible. This study aims to evaluate the results of our SR training program to perform LRYGB.

METHODS

We designed a retrospective study including patients with LRYGB between January 2014 and December 2018, comparing SR results to experienced bariatric surgeons (EBS). In our country, SR have a five-year surgical formative period, and in the fourth year they are trained for 6 months in our bariatric surgery unit, from January to June. In the beginning, they perform different steps of this procedure, to finally complete an LRYGB. We collected demographic data, comorbidities, intraoperative outcomes, and postoperative complications and outcomes after a one-year follow-up.

RESULTS

Two hundred and eight patients were eligible for inclusion: 67 in group I (SR), and 141 in group II (EBS). Both groups were comparable. There was no statistically significant difference in operating time (166.45min in group I vs. 156.69min in group II; P=0.156). Conversion to open surgery, hospital stay, postoperative complications, and short-term outcomes had no significant differences between the two groups. There was no mortality registered during this period.

CONCLUSION

Implementation of LRYGB stepwise learning as part of an SR training program is safe, and results are comparable to EBS, without loss of efficiency. Therefore, it is feasible to train SR in bariatric surgery under EBS supervision.

[Burnout and psychological distress among trainee General Practitioners]

OBJECTIVE

To estimate the prevalence of burnout and psychological distress among trainee General Practitioners of two training placements and its relationship with the year of residence, lifestyle and working conditions.

DESIGN

Cross-sectional study.

LOCATION

Primary Care.

PARTICIPANTS

On-site surveys for all trainees of two training placements (n = 278), including all trainees of the sample. The response percentage is 76.9%.

MAIN MEASUREMENTS

Prevalence of burnout using the Maslach Burnout Inventory (MBI) scale and prevalence of psychological distress using the General Health Questionnaire-12 scale (GHQ-12). Also variables on lifestyles, labor organization and drug use.

OUTCOMES

72% of participants are women. The prevalence of burnout is 33.8% (CI 95% 27.0-40.6), being 25.6% (CI 95% 19.5-31.7) emotional exhaustion, 37.9% (CI 95% 31.0-44.7)depersonalization and 52.9% (CI 95% 45.9-59.9) the low personal accomplishment. Prevalence increases significantly in all dimensions after the second year of training, except in personal accomplishment. The prevalence of emotional distress is 40.4% (CI 95% 33.5-47.3), without significant differences according to year of training. In the group of trainees with psychological distress, 50.0% also have burnout, while this percentage is 22.1% among those who do not present psychological distress.

CONCLUSIONS

The prevalence of emotional distress and burnout (especially in low personal accomplishment) is high in trainee General Practitioners. The prevalence in higher than the described in previous studies for other groups of health professionals and should be taken into account to develop preventive measures.

Ten years of experience of the Mexican Academy of Surgery in the promotion of the next generations of researchers

Objective

To describe the productivity of the research works presented in the Interuniversity and resident doctors Competition of the Mexican Academy of Surgery since its origin in 2010.

Method

Observational cross-sectional descriptive study in which the variables are considered: category of participation (university/resident) type of work (research, clinical case, etc.), university and institution of origin, type of presentation [poster/oral]) Descriptive statistics was used.

Results

Since 2010, 9 interuniversity competitions and 8 resident doctors have been developed. A total of 974 papers were presented, predominantly residents (65.29%), oral presentations (54.51%) and original works (58.11%). 8.9% of the published works.

Conclusions

The Contest is a good forum to disseminate research in the new generations of doctors.

Do success rate, complications of transobturator tape procedure differ based on experienced surgeon or residents?

OBJECTIVES

To investigate the postoperative surgical complications and patient satisfaction with the outside-in transobturator tape (TOT) procedure performed by an experienced surgeon compared to those performed by residents in training.

METHODS

Patients who received TOT surgery performed by a resident under supervision of a faculty were included in group 1 (n = 31) whereas, patients operated by the same faculty were included in group 2 (n = 26). Both groups were compared for demographic data, procedure results, satisfaction rates as well as intraoperative and early postoperative (urinary retention, vaginal erosion, dyspareunia, infection, abnormal discharge) complications. Statistical Package for Social Sciences for Windows was used for statistical analyses. For continuous variables Mann-Whitney U test and for categorical variables Chi-square, Fishers exact tests were used. RESULTS: Stress incontinence in groups 1 and 2 were either completely cured or improved in 87.1% and 84.6%, respectively. The question" Would you like to have an operation like this again?" was answered positively by 26 (83.9%) of patients in group 1 and by 22 (84.6%) in group 2. There was no significant difference between two groups for the complication rates occurred within 90-days period. However, there was a significantly higher groin pain persisting more than three weeks in group 1 (38.7%) compared to group 2 patients (7.7%). CONCLUSIONS: There was statistically significant increased groin pain in the early period in TOT procedures performed by the residents. However, the complications observed in both groups did not affect the success rate or patient satisfaction.

Influence of previous experience on the benefits of laparoscopic surgical training based on simulation

INTRODUCTION

Surgical training based on simulation seeks the acquisition of skills in novice participants and ongoing sill development in experts. The aim of this study is to assess the evolution of students in an intensive laparoscopic anastomosis course and to analyse their results depending on their level and previous experience.

METHODS

The students of all the anastomosis courses conducted during 30 months in the Valdecilla virtual hospital (Santander) were analysed. Manual side-to-side intestinal anastomoses with porcine 'ex vivo' viscera were performed in a laparoscopic endotrainer. The technical and quality differences between the first and the last anastomoses were analyzed and the progression between residents and specialists was compared.

RESULTS

We analyzed 45 participants, 22 of them residents and 23 specialists. A statistically significant improvement of 80.5% was observed in all procedural parameters (94.8% residents vs. 67.3% specialists). The time was reduced by 48.1% in the residents and 43.2% in the specialists (p<.001). In terms of quality, significant improvements were obtained in the group of residents: an increase of 90% in adequate tension, and a reduction of 75% of everted edges and 60% of leaks. In addition, they obtained results comparable to the specialists (27.3% leak in the last anastomosis vs. 34.8% by the specialists, p=.59), which presented improvement without statistical significance.

CONCLUSIONS

The group of residents presented a major and significant improvement in procedural skills and in the quality of the technique, reaching the level of the specialists after completion of the course.

Medical-surgical activity and the current state of training of urology residents in Spain: Results of a national survey

OBJECTIVES

To determine the actual state of medical-surgical activity and training for urology residents in Spain.

MATERIAL AND METHOD

We designed 2 anonymous surveys, which were uploaded with the Google Docs^© tool so that the respondents could answer the surveys online. The online collection period was September 2015 to January 2016. The collected data were processing using the statistical programme IBM SPSS for Windows, Version 21.0 and the programme R version 3.2.3.

RESULTS

The total number of responders was 163. In reference to the number of physically present on-call residents, the majority conducted between 4 and 6 shifts a month. Eighty-four of those surveyed indicated that they were in the operating room less than 20hours a week, and 43 of these even less than 10hours. Thirty percent of those surveyed had not performed any transurethral resection. The majority had performed at least one prostatic adenomectomy, but had not performed any major oncologic procedure, either laparoscopically or openly. In the questions concerning training and training courses, we found that most of the residents trained in laparoscopy at the hospital or at home. The overall satisfaction for the residence was assessed at 2.6. Based on this score, the overall satisfaction could be considered moderate.

CONCLUSIONS

Efforts should be directed towards standardising the acquisition of surgical and nonsurgical skills, ensuring access to training courses, establishing a minimum of required operations per year and achieving an objective assessment of the specialty.

Are neurology residents interested in headache?

INTRODUCTION

The years of residency are the pillars of the subsequent practice in every medical specialty. The aim of our study is to evaluate the current situation, degree of involvement, main interests, and perceived quality of the training received by Spanish residents of neurology, specifically in the area of headache.

METHODS

A self-administered survey was designed by the Headache Study Group of the Spanish Society of Neurology (GECSEN) and was sent via e-mail to all residents who were members of the Society as of May 2015.

RESULTS

Fifty-three residents completed the survey (N = 426, 12.4%): 6% were first year residents, 25.5% second year, 23.5% third year, and 45% fourth year residents, all from 13 different Spanish autonomous communities. The areas of greatest interest are, in this order: Vascular neurology, headache, and epilepsy. Of them, 85% believe that the area of headache is undervalued. More than half of residents (52.8%) do not rotate in specific Headache Units and only 35.8% complete their training dominating anaesthetic block and toxin infiltration techniques. Of them, 81.1% believe that research is scarce or absent; 69.8% have never made a poster/presentation, 79.3% have not published and only 15% collaborate on research projects in this area. Lastly, 40% believe that they have not received adequate training.

CONCLUSIONS

Headache is among the areas that interest our residents the most; however, we believe that we must improve their training both at a patient healthcare level and as researchers. Thus, increasing the number of available courses, creating educational web pages, involving residents in research, and making a rotation in a specialised unit mandatory are among the fundamental objectives of the GECSEN.

Dermatologic emergencies in a tertiary hospital: A descriptive study

BACKGROUND AND OBJECTIVE

Dermatology in-house call is uncommon in the Spanish national health system. The objective of the present study was to define the groups of dermatologic diseases and conditions most frequently seen in the emergency department and to evaluate the need for dermatology in-house call in the training of medical residents.

MATERIAL AND METHODS

We performed a descriptive study of all patients who attended the emergency department with a skin complaint during a 1-year period (June 2013 to May 2014) and were assessed by 9 dermatology residents. The study variables were date/day, sex, age, diagnosis, special surgical procedures, additional laboratory tests, and need for hospitalization and/or follow-up. We also evaluated patients attending their first scheduled visit to the dermatologist between January and June 2014 in order to compare the most frequent conditions in both groups.

RESULTS

A total of 3084 patients attended the emergency room with a skin complaint (5.6% of all visits to the emergency department), and 152 different diagnoses were made. The most frequent groups of diseases were infectious diseases (23%) and eczema (15.1%). The specific conditions seen were acute urticaria (7.6%), contact dermatitis (6.1%), and drug-induced reactions (4.6%). By contrast, the most frequent conditions seen in the 1288 patients who attended a scheduled dermatology appointment were seborrheic keratosis (11.9%), melanocytic nevus (11.5%), and actinic keratosis (8%). A follow-up visit was required in 42% of patients seen in the emergency department. Fourth-year residents generated the lowest number of follow-up visits.

CONCLUSIONS

We found that infectious diseases and eczema accounted for almost 40% of all emergency dermatology visits. Our results seem to indicate that the system of in-house call for dermatology residents is very useful for the hospital system and an essential component of the dermatology resident's training program.

[Geriatric post-graduate training: Current recommendations and opinion of the trainees]

OBJECTIVE

To evaluate the level of compliance with the official curriculum residence programme by geriatrics trainees, and to analyse their level of satisfaction.

MATERIAL AND METHODS

A questionnaire was developed including these sections: trainee filiation, and questions related to their clinical training, academic formation, research training, satisfaction, and other comments. The survey was performed in Survey Monkey and sent to a geriatric trainee per hospital in March 2014. The results were collected between March and April of 2014.

RESULTS

Responses were received from 41% of the trainees of 23 Geriatric Teaching Units. Rates of over 95% were observed as regards clinical rotations in the basic period, while in the specific period these percentages varied between 34% and 69%, probably because some of the trainees had not yet arrived at the period in which these rotations are programmed. An external rotation could be performed by 83% of the trainees, and 90% do the recommended number of shifts. The mean number of instruction sessions per week was 2.3, and the number of meetings with the tutor was 2.5 times per year. The median number of presentations in congresses was 3.7 per trainee, with 0.2 publications during training. Each trainee attended 1.2 national meetings, 0.3 European meetings, and 0.1 American. Most of the trainees (85%) were satisfied or very satisfied with their training.

CONCLUSIONS

Geriatrics curricula for trainees are followed in the basic aspects, but not so much in the specific ones. The average level satisfaction of the trainees is very high. The recommended training activities within the specific department (sessions, etc.) are not always fulfilled. The research activity, evaluated by publications and presentations at meetings, is low. Following these data, reflection and the establishment of improvements are required in Geriatrics training at post-graduate level.

[Catalan hospital emergency department heads' opinions on the creation of a residency program for specializing in emergency medicine]

OBJECTIVES

To understand the opinions of emergency department (ED) heads in Catalonia on their support for a residency program for specializing in emergency medicine (EM) and on their beliefs about the impact such a program would have.

MATERIAL AND METHODS

Heads of ED were asked if there would be support (from them, their staff, and their hospital) for a residency program to train specialists in EM. They were also asked their opinion on the impact that specialization would have on quality of care and costs in their department. Responses were compared by type of hospital and ED and by affiliation or not with the Spanish Society of Emergency Medicine (SEMES).

RESULTS

Responses were received from 79 of the 82 heads of hospital EDs in Catalonia (96%). They reported that favorable opinions toward creation of an EM specialization were held by them personally (93.7%; 95% CI, 85.8%-97.9%), by their in their departments (88.6%; 95% CI, 79.4%-94.7%), and by staff in their hospitals (48.7%; 95% CI, 36.7%-59.6%). A majority thought that the impact of specialization would be good in the short term (82.0%; 95% CI, 71.7%-89.8%) and in the medium and long term (94.8%; 95% CI, 87.2%-98.6%). The respondents were neutral about whether there would be an impact on costs (60.3%; 95% CI, 48.6%-71.2%). More heads in mid-sized hospitals, private hospitals, and nonmembers of SEMES thought that creating a specialty would raise ED costs (p<0,05).

CONCLUSION

The heads of Catalan ED, their staff, and their hospitals' staffs hold favorable opinions of the proposal to create a residency program allowing specialization in EM. They foresee short-, medium-, and long-term benefits for the EDs and scarce impact on costs.

[Assessment of resident physicians' performance in a university hospital's emergency department]

OBJECTIVES

To describe an experience with the evaluation of resident physicians doing rotations in a tertiary-care hospital emergency department and to analyze the correlation between results on the various assessment tools and the resident's rank on Spain's standardized selection examination for admission to residency programs.

MATERIAL AND METHODS

The residents took 2 written examinations in 2013 and 2014, and rotation supervisors wrote subjective evaluations of the residents' clinical performance in the workplace. The residents also provided self-assessments of theoretical and practical knowledge and their aptitude for emergency department work. The results on these assessment tools were tabulated independently, and it was investigated if there were correlations between them.

RESULTS

We observed an inverse correlation between the residents' rank on the standardized selection examination and their scores on the written examinations of knowledge and the supervisors' workplace assessments. The written examination scores after the rotation correlated positively with workplace assessments. Self-assessments were distributed normally, suggesting they were of scarce value, and they did not correlate with the results of the other assessment tools.

CONCLUSION

Written examinations are acceptably correlated with subjective workplace assessments of practical competencies, whereas ranking on the residency program admissions examination is not acceptably correlated with emergency department workplace performance. We believe that efforts to prepare ways to evaluate residents' emergency department performance will be of interest in the future, once a specialization in emergency medicine is approved.

The Computer Book of the Internal Medicine Resident: competence acquisition and achievement of learning objectives

BACKGROUND

The Computer Book of the Internal Medicine resident (CBIMR) is a computer program that was validated to analyze the acquisition of competences in teams of Internal Medicine residents.

OBJECTIVES

To analyze the characteristics of the rotations during the Internal Medicine residency and to identify the variables associated with the acquisition of clinical and communication skills, the achievement of learning objectives and resident satisfaction.

METHODS

All residents of our service (n=20) participated in the study during a period of 40 months. The CBIMR consisted of 22 self-assessment questionnaires specific for each rotation, with items on services (clinical workload, disease protocolization, resident responsibilities, learning environment, service organization and teamwork) and items on educational outcomes (acquisition of clinical and communication skills, achievement of learning objectives, overall satisfaction). Associations between services features and learning outcomes were analyzed using bivariate and multivariate analysis.

RESULTS

An intense clinical workload, high resident responsibilities and disease protocolization were associated with the acquisition of clinical skills. High clinical competence and teamwork were both associated with better communication skills. Finally, an adequate learning environment was associated with increased clinical competence, the achievement of educational goals and resident satisfaction.

CONCLUSIONS

Potentially modifiable variables related with the operation of clinical services had a significant impact on the acquisition of clinical and communication skills, the achievement of educational goals, and resident satisfaction during the specialized training in Internal Medicine.