Evaluation of a Medical Residency Program in Gynecology and Obstetrics

Sanchez, Natalia Romano; Rodrigues, Cibele Isaac Saad

doi:10.1590/1981-5271v44.2-20190311.ING

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ORIGINAL ARTICLE • Rev. bras. educ. med. 44 (2) • 2020 • https://doi.org/10.1590/1981-5271v44.2-20190311.ING copy

Evaluation of a Medical Residency Program in Gynecology and Obstetrics

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Introduction:

Medical residency in gynecology and obstetrics is unquestionably important in the training of physicians who choose this specialty of the Brazilian Ministries of Health and Education. However, studies evaluating these residency programs are scarce, especially regarding the reflexive qualitative aspects of the research. Therefore, this exploratory and descriptive study aimed to evaluate the current medical residency program in gynecology and obstetrics of the School of Medical and Health Sciences at Pontifícia Universidade Católica de São Paulo (PUC-SP) using a quantitative and qualitative approach.

Method:

The methodology included a comparative curriculum analysis between the program recommended by the National Committee of Medical Residency until 2018 and the program offered by PUC-SP School of Medical and Health Sciences, as well as a self-administered questionnaire completed by individuals who graduated between 2007 and 2018.

Results:

The most significant findings of the comparative curriculum analysis include discrepancies in the percentage arrangement of annual workload, indicating an overload of on-call duty hours, and unequal distribution of internships. The questionnaire response rate was 66% (41 of 62 participants). Most respondents were women (n=32, 78%), who worked mainly in the cities of Sorocaba (n=21, 43.7%) and São Paulo (n=10, 21%). Most medical graduates were partially satisfied with the program (n=34, 82.9%). Some responses also matched the findings of the comparative curriculum analysis, such as dissatisfaction with the number of gynecological surgical procedures performed (n=39, 95.1%). Regarding the content analysis of open-ended answers, categorized according to Bardin, the graduates appreciated activities in obstetrics, and the most relevant criticisms were related to fewer hours assigned to certain activities, especially those devoted to gynecological surgical practices and theoretical activities.

Conclusions:

Based on the findings, suggestions were proposed and accepted by the managers for changes that should have a positive impact on the medical residency program. This research contributes to the diagnostic evaluation of a traditional medical residency program in Brazil, proposes improvements, and uses reproducible methods, thus serving as a comparison basis for other studies so that advances can be made in the training of these specialists.

Keywords:
Medical Education; Internship and Residency; Educational Assessment; Gynecology; Obstetrics

Characteristic	N	%
Gender
Female	32	78
Male	9	22
Age
28-34	27	65,8
35-41	14	34,2
Marital Status
Married	23	56
Single	14	34,2
Common-law marriage	4	9,8
Ethnicity
Caucasian	37	90,2
Mixed-race	2	4,9
Asian	2	4,9
Nationality
Brazilian	40	97,6
Foreigner	1	2,4
Number of children
0	24	58,5
1	8	19,5
2	9	22
Year of Medical School Graduation
2002 - 2010	21	51,2
2011 - 2014	20	48,8
Medical School graduated from
PUC-SP	18	43,9
Other Universities in the state of São Paulo	11	26,8
Other Universities in Brazil	12	29,3
City of work
Sorocaba	21	51,2
São Paulo	10	24,4
Other cities in Brazil	10	24,4
Academic Degree
Specialist physician	36	87,8
Latu Sensu Postgraduate Degree	4	9,8
Master´s Degree	1	2,4
Personal Income
R$ 5 mil -R$ 15 mil	20	48,8
R$ 15 mil -R$ 25 mil	14	34,2
R$ 25 mil ou mais	7	17
Work Activity
Private Hospital	36	87,8
Private Clinic	27	65,9
Health Insurance Outpatient Clinic	26	63,4
Public Hospital	21	51,2
SUS Outpatient Clinic	17	41,5
Teaching Hospital	11	26,8

Topic	N	%
Satisfaction with the attended Program
Partially satisfied	34	83
Fully satisfied	6	14,6
Unsatisfied	1	2,4
The program was previously presented
Yes, partially	19	46,3
No	12	29,3
Yes, fully	10	24,4
The evaluation methods were previously presented
There was not any type of evaluation	19	46,3
No	12	29,3
Yes, partially	8	19,5
Yes, fully	2	4,9
Thought about giving up the during the course
No	24	58,5
Yes	17	41,5
There was Preceptor / Teacher with the resident during a patient treatment
Majority of times	23	56,1
Sometimes	14	34,1
Always	4	9,8
There was educational guidance during case discussion
Majority of times	23	56,1
Sometimes	15	36,6
Always	2	4,9
Never	1	2,4
There was a post-duty resting period
Sometimes	17	41,5
Majority of times	11	26,7
Never	9	22
Always	4	9,8
There was a weekly theoretical activity during the course
Sometimes	17	41,5
Always	14	34,1
Majority of times	8	19,5
Never	2	4,9
The residents were participating in theoretical activities
Sometimes	19	46,3
Majority of times	18	43,9
Always	2	4,9
Never	2	4,9
Avarege hours of weekly theoretical activity
2h	17	41,5
4h	10	24,4
1h	7	17,1
3h	5	12,1
0h	2	4,9
Were you offered learning opportunities with technologies that help diagnose/treat obstetrics & gynecology pathologies
Sometimes	33	80,5
Never	6	14,6
Majority of times	2	4,9
Always	0	0
Considered the number of obstetric procedures appropriate for learning
Yes	37	90,2
No	4	9,8
Considered the number of gynecological procedures appropriate for learning
No	39	95,1
Yes	2	4,9
Had any incentive for Scientific researches during the program
Never	22	53,6
Sometimes	17	41,5
Majority of times	2	4,9
Always	0	0
Had any article published in a journal during the Program
No	38	92,7
Yes	3	7,3
Had any article published in a journal after finishing the Program
No	34	82,9
Yes	7	17,1
Had any article/research presented in a scientific event during the Program
No	28	68,3
Yes	13	31,7
Had any article/research presented in a scientific event after finishing the program
No	32	78
Yes	9	22

Categories to each topic	Number of affirmations	%
Satisfaction with the attended Program
Dissatisfaction with the program’s practical performance	32	51,61
Dissatisfaction with the program’s organization and coordination	27	43,55
Fully satisfied with the residency training	3	4,84
Reasons for thinking about leaving the program
Physical stress	16	57,14
Emotional stress	7	25
Incompatibility between expectations and the reality found	5	17,86
Presence of a Preceptor / Teacher with the resident during a patient treatment
No monitoring during medical treatment, giving autonomy to the resident	9	42,86
Medical treatment monitored only by the oldest resident	6	28,57
Present in most activities, except at the on-call shifts	3	14,29
Present in most activities, except at the outpatient clinics	3	14,29
Educational guidance during case discussion with the Teacher / Preceptor
Focus of the discussion was only for resolution of the shift	5	62,5
Opportunity made available only by a few teachers/preceptors	3	37,5
Participation or not of residents in theoretical activities
Forbidden by the preceptors / On-call chiefs	16	80
Lack of interest in the class topic by the resident	3	15
Hierarchical position	1	5
Were you offered learning opportunities with technologies that help diagnose/treat obstetrics & gynecology pathologies
Poor structure of the program / hospital for the activities	12	63,16
Limited material availability for these activities	5	26,32
Poor faculty availability for these activities	2	10,53
Reasons for considering surgical procedures as appropriate or inappropriate for learning during the Program
Few training opportunities in the Program schedule	25	62,5
Surgical cancellations	11	27,5
Small number of Teachers / Preceptors available for these activities	4	10
Reasons for the frequency of scientific research stimulation during the Program found
Lack of encouragement from Preceptors / Teachers	5	83,33
The interest always came from the resident	1	16,67
R1 Strengths
Delivery care	35	70
Large volume of patient care	12	24
Good learning in urgency and emergency	3	6
R2 Strengths
Learning in Obstetric subspecialties	25	48,08
Personal and professional development	9	17,31
Learning in Gynecology subspecialties	6	11,54
Workload reduction in comparison to the previous year	5	9,62
Surgical Learning	4	7,69
There were no strengths to be mentioned	3	5,77
R3 Strengths
Middle and High-complexity surgical procedures	20	35,71
Obstetric practice	13	23,21
Subspecialty practice in Obstetrics and Gynecology	12	21,43
Personal and professional development	6	10,71
There were no strengths to be mentioned	3	5,36
Workload reduction in comparison to the previous year	2	3,57
R1 weaknesses
Lack of monitoring, supervision and guidance by preceptorship / faculty	17	26,15
Little dedication to theoretical support during the year	14	21,54
Physical and emotional stress due to amount of workload	13	20
Lack of practice in ambulatory gynecology	12	18,46
Lack of active participation in surgical procedures	6	9,23
Lack of obstetric practice in primary care	2	3,08
There were no strengths to be mentioned	1	1,54
R2 weaknesses
Little surgical practice	26	43,33
Little gynecolgy practice	12	20
Little dedication to theoretical support during the year	11	18,33
Lack of organization, supervision and guidance by the preceptorship / faculty	6	10
Little practice in low-risk activities	4	6,67
There were no strengths to be mentioned	1	1,67
R3 weaknesses
Little surgical practice	19	32,76
Little gynecolgy practice	15	25,86
Lack of organization of the program’s schedule	9	15,52
Little dedication to theoretical support during the year	8	13,79
Lack of supervision and guidance by the preceptorship / faculty	7	12,07
Improvement suggestions given by the participants
Improve the program structure and organization	59	45,38
Add educational planning with emphasis on learning for each year	26	20
Increase stimulation and scientific production with the participation of teachers, preceptors, residents and students	21	16,15
Pedagogical training and updating of the preceptorship / faculty working in the services of the program	15	11,54
Incorporating constructive feedback and assessment techniques	7	5,38
No suggestions for change	2	1,54

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[1] ADDRESS FOR CORRESPONDENCE
Natalia Romano Sanchez. Rua Capitão Grandino, 380/1104, Sorocaba, São Paulo, SP, Brasil. CEP: 18040-560. E-mail: nataliasanchez.med@gmail.com