Evaluation of trainning and professional expectations of surgery residents

Abstracts

Os programas de residência médica, em especial na cirurgia, vêm passando por modificações constantes, não só em nosso meio, como internacionalmente. Em virtude da deterioração da valorização e remuneração médica, as expectativas e perfil do médico residente na área cirúrgica vêm mudando. A avaliação das atitudes, experiência durante o treinamento e expectativas profissionais nos residentes é tópico importante. Recentes trabalhos internacionais publicados na área demonstram tal fato. É digno de nota a ausência de trabalhos semelhantes em nosso meio e a raridade em outros países. O presente estudo tem por objetivo avaliar em médicos residentes da área de cirurgia, através de questionário, atitudes, experiências durante o treinamento e expectativas profissionais. Foram aplicados e analisados questionários adaptados e traduzidos para o Português em 50 residentes de ambos os sexos e diferentes anos de residência. Os resultados deste trabalho mostram alta satisfação com a especialidade, porém grande preocupação financeira e opiniões conflitantes quanto ao futuro da especiliadade;

Avaliação; Cirurgia; Residência médica

TEACHING

Evaluation of trainning and professional expectations of surgery residents

Fernando Augusto Mardiros Herbella, TCBC-SP^I; Rogerio A. Fuziy^II; Guilherme F. Takassi^III; Atilla Dubecz^IV; Jose C. Del Grande, TCBC-SP^V

^IAssociate Professor, Department of Surgical Gastroenterology, Escola Paulista de Medicina - SP-BR

^IIResident, Department of Surgical Gastroenterology, Escola Paulista de Medicina - SP-BR

^IIIMedical School Graduate, Escola Paulista de Medicina - SP-BR

^IVAssistant Professor, Klinikum Nürnberg Nord, Germany

^VAssociate Professor, Department of Surgical Gastroenterology, Escola Paulista de Medicina - SP-BR

Correspondence

ABSTRACT

Residency programs, especially in surgery, have been undergoing constant changes, not only in our country, but also internationally. Due to the depreciation of medical specialties and their lowering compensation, expectations and profile of residents in surgical fields are changing. The assessment of attitudes, experience in training and professional expectations among residents is an important topic. Recent international studies published in the area demonstrate this fact. It is worth noting the absence of similar studies in our country, as well as others. This study aims to assess the residents of the area of surgery, through a questionnaire, their attitudes, experiences during training and professional expectations. We applied and analyzed questionnaires adapted and translated into Portuguese to 50 professionals of both sexes and different years of residence. The results of this study showed high satisfaction with the specialty, but large financial concern and conflicting opinions about the future of the specialty.

Key words: Evaluation. Surgery. Internship and residency.

INTRODUCTION

Residency programs, especially in surgery, have been undergoing constant changes, not only in our country, but also internationally.

Due to the depreciation of medical specialties and their lowering compensation, as well as the search for quality of life, expectations and profile of residents in surgical fields are changing. Also, adverse conditions often alter the attitudes of not only residents but also tutors, making the assessment of attitudes, experience in training and professional expectations of residents an important topic for the correct planning of education and training in surgery.

This article evaluates medical residents in the area of surgery by questionnaires accessing their attitudes, experience in training and professional expectations.

METHODS

There were 50 residents of both sexes from the area of the surgical residency program at the São Paulo Hospital, Paulista Medical School, from several levels of experience (years of attendance), who voluntarily participated in the study. The interviews were conducted by a resident, co-author of this work, in order to avoid constraints and biases of authority.

We used the questionnaire from Yeo et al.¹, translated and adapted to Portuguese, whose response options are: agree, Indifferent and disagree, taking into account randomly oriented human, technical and professional dimensions (Tables 1, 2 and 3). The questionnaire was not identified in sheets and responses were kept anonymous.

The study was approved by the Ethics Committee in Research of São Paulo Federal University (1650/09).

RESULTS

We evaluated 41 male and 9 female residents, median age 27 years (range 24-32). They were residents of the 1st, 2nd, 3rd, 4th and 5th years, respectively 16, 17, 11, 5 and 1 individuals.

The answers to the questionnaire are shown in table 4.

DISCUSSION

As already mentioned, the profile and attitudes of residents in the surgical area is clearly changing. Multiple studies^1-5, all North American, demonstrate this fact. Motivated in the evaluation of local residents, a group of academic surgeons strove to reproduce the work published by Yeo et al.¹. It is multicenter and international, with participants from Germany, Austria, Japan, Bolivia, Russia, Colombia, Hungary, Puerto Rico, Brazil and Italy. Hospital São Paulo is the single Brazilian participant. The study is in the process of data collection and writing, the results of the evaluation in Brazil being exposed here. A subanalysis of results based on gender or years of residence was not calculated due to the small number of individuals studied in this branch.

The Brazilian branch was conducted at the Universidade Federal de São Paulo, which is a federal agency under the Ministry of Education. Its teaching hospital is the Hospital São Paulo, which belongs to the Paulista Society for the Development of Medicine, a nonprofit entity constituted by teachers of the University. The Escola Paulista de Medicina was one of the pioneers to implement Medical Residency Programs in Brazil. The Residency was set up following the same design of the programs developed at the beginning of the century in the United States under the inspiration of Halsted and Osler. Since 1957, the Escola Paulista de Medicina maintains and constantly seeks to improve and modernize its medical residency programs, according to medical advances and needs of the society. In the 1960s, the Residency was composed of two basic cycles: clinical and surgical, where there were distributed twenty doctors, 10 clinics and 10 surgeons. The specialties were initiated only in the third year. In the following years, the Residency has become diversified, until the present day, when 64 different programs are offered to 555 residents⁶.

The surgery department has 16 vacancies for general surgery, with two-year program and a prerequisite for the specialties, and 17 of specialties such as surgery of the digestive tract, cardiovascular, pediatric, plastic, thoracic, vascular and urology, with programs of two or three years.

To compare the results obtained from other countries or with the available literature was not the purpose of this study, since such comparisons may be artificial because of the different realities and they will be published in the multicenter study.

Our results show great satisfaction with the surgical career through the questions that assess this matter (numbers 4, 18, and 35 to 42), but high financial concerns and conflicting opinions about the future of the specialty. It should be noted that the questions "like to operate" and "caring for patients", with 49 answers "agree" each, were the most frequent. The questions that assess satisfaction with the residency program showed great response heterogeneity. Interestingly, almost 20% of the respondents have already thought about leaving the program. Other remarkable results are: (1) 76% of young surgeons believe the education with a specialty is essential and only 4% accept the idea that training limited to general surgery is appropriate; (2) a significant number of respondents were concerned with the medical insurance, despite currently limited use in our country; (3) a very high number of dissatisfaction with the ethics of tutors; (4) only 38% of residents are satisfied with the training content of their programs; (5) only 20% think the volume of procedures they participate in is enough; (6) only 60% of residents would use their mentors to solve problems in the residency affairs; (7) 38% of residents deny the presence of a structure for personal support in their programs; and (8) almost half (48%) of residents feel that their opinions have no value in their work environments.

In conclusion, our results show high satisfaction with the specialty, but large financial concern and conflicting opinions about the future of the especialty.

REFERENCES

• 1. Yeo H, Viola K, Berg D, Lin Z, Nunez-Smith M, Cammann C, et al. Attitudes, training experiences, and professional expectations of US general surgery residents: a national survey. JAMA 2009; 302(12):1301-8.
• 2. Saalwachter AR, Freischlag JA, Sawyer RG, Sanfey HA. The training needs and priorities of male and female surgeons and their trainees. J Am Coll Surg 2005; 201(2):199-205.
• 3. Bell RH. Surgical council on resident education: a new organization devoted to graduate surgical education. J Am Coll Surg 2007; 204(3):341-6.
• 4. Sachdeva AK, Bell RH Jr, Britt LD, Tarpley JL, Blair PG, Tarpley MJ. National efforts to reform residency education in surgery. Acad Med 2007; 82(12):1200-10.
• 5. Bell RH Jr. Graduate education in general surgery and its related specialties and subspecialties in the United States. World J Surg 2008; 32(10):2178-84.
• ⁶
  Escola Paulista de Medicina. Coreme Comissão de Residência Médica [online]. São Paulo, Brasil; 2010. [acessado em 29 jul. 2010] Disponível em: http://www.proex.unifesp.br/residencia/coreme/index.htm,

Publication Dates

• Publication in this collection
  26 Sept 2011
• Date of issue
  Aug 2011

History

• Accepted
  30 Nov 2010
• Received
  20 Oct 2010