Llegar a ser matrona en España. Parte II

The midwife's field of competence is related to women's sexual and reproductive health care from a holistic perspective, in which respect for women's autonomy is consubstantial to care and implies a deep involvement in the ethical and value-based training of future professionals. Likewise, achieving professional excellence implies the continuous evaluation of the training project, so that midwives acquire the necessary competencies to respond to the needs of a constantly changing society. In this sense, in recent years there have been voices critical of the current training model, initiating the necessary steps to implement the training of midwives as an independent University Degree.     

Historia de la formación sanitaria especializada en España y sus claves docentes

The modernisation of the National Health System (NHS) in Spain occurred in parallel with the creation and development of the Postgraduate Medical Education system (medical specialty training system, the so-called “residency system”) throughout the 60's to 80's of the 20th century. The system was a translation of the “to learn by working” US model. The Hospital General de Asturias (Oviedo) in 1963 (an initiative by Fernando Alonso Lej de las Casas and Carles Soler Durall), and the Clínica Puerta de Hierro (Madrid) in 1964 (initiative of José María Segovia de Arana), were the first two hospitals to start the Spanish Specialty Training system, which was extended to the whole NHS in 1972, and was legally consolidated in 1984 as the only official specialisation route. Since them, the system continues to be developed by the NHS according to the Ministry of Health and the Departments of Health (Regional Governments) instructions and criteria. The Spanish university has no responsibility in this process. The training is guaranteed through an employment contract, whereby the resident has the obligation to be provided a job and the right to receive training according to the national residency programs of each specialty.     

¿Existe igualdad de condiciones para el acceso al Grado de Medicina en España?

IntroductionThe aim of this article is to investigate whether the binomial equality of competences-opportunities to enter medical schools in Spain is fulfilled.Material and methodsFor this purpose, 38 public universities were considered, together with the criteria of the University Entrance Exams, the weighting criteria of the university districts, the places offered, and the cut-off marks from 2017/2018 to 2021/2022, identifying four groups of university districts: A1, A2, B1, B2.ResultsThe result shows that students with the same level of competence have a different evaluation depending on where they have taken the PAU and in which district they apply. Thus, the nominal evaluation of a student can vary by 2.80 points out of 14, which largely determines access to the Bachelor's Degree in Medicine. Applying homogeneous criteria, the cut-off marks of all the faculties in Spain are recalculated.ConclusionThrough the discussion it is concluded that the university districts where the greatest effort is required to enter medical school are those in group B2 (Catalonia, Galicia and the Balearic Islands), followed by A2 (most of the Autonomous Regions), B1 (Basque Country), B1 (Valencia) and A1 (Madrid, Aragon and Navarre). This study helps to reach a consensus on homogeneous criteria for access to the Bachelor's Degree in Medicine.     

El tutor de formación sanitaria especializada en España (parte I): Regulación y reconocimiento de su labor

The serious health, economic and social crisis caused by the outbreak of the COVID-19 pandemic has also had a dramatic impact on the organization of health services, on the provision of health care and, therefore, on the development of Specialized Health Training programmes. In this context, considering the new requirements for the tutoring of residents, it is necessary to review the figure of the tutor, the measures adopted to facilitate their work, as well as their recognition and incentives. To this end, the legal and conceptual framework has been reviewed; the competences of the autonomous communities in this regard have been identified and a comparative analysis of their regulatory developments has been made, in this first part of the article, in relation to the concept of tutor, appointment, accreditation and the recognition and incentive system.     

Las unidades de educación médica en las facultades de Medicina y de Ciencias de la Salud en España. ¿Son necesarias?

In a majority of countries, medical education is one more medical specialty and presides over academic life in undergraduate, graduate and continuing education. But, the situation in Spain is very improvable. Although there is a growing interest in medical education as a discipline or specialty, most of the Spanish faculties of Medicine do not have a unit or department of medical education, which is in charge of advancing the discipline. Some faculties have arranged a unit, chair, department or study center, attached or independent to the management of the center, sometimes without any organic relationship to the training process. In this article we will describe why we believe these structures are necessary, their usefulness, as well as their functions and the scope of their activities. We will analyze the current situation in Spain with the aim of promoting the creation of these structures in all the faculties of Medicine. We will also review the mechanisms that specialized postgraduate training has been equipped to provide answers to their training needs.     

La modernización del hospital y la educación médica. El caso de España en perspectiva histórica

IntroductionIn Spain, hospital underwent a long and tortuous transformation from a charitable establishment aimed at the poor where the therapeutic inefficiency and death reigned, into a scientific institution with the following functions: healthcare, teaching and research. This new conception of hospital, linked to the birth of the clinic (to follow the analyses by Foucault and Ackerknecht) and to the development of hospitals as spaces of medicalization, led to the consolidation of the idea that hospital was the right place to enact the ideal of a physician based on the new way of training of medical professionals.MethodsThe article identifies historical factors that, in the period ranging from the late eighteenth to the mid-twentieth century, led to the emergence of modern, rationalized hospital in Spain and to the consolidation of the new conception of hospital as a scientific institution, in which medical training was one of the main aims.ResultsThe Spanish case shows a number of specific patterns. First and foremost, the hospital reform emerged and consolidated later than in many countries in Europe and North America.ConclusionsIn Spain, the process of reform and modernization of hospitals and of medical training did not occur systematically until the 1960s. This article focuses on the precedents and on the first stages of the process in the period from the end of the eighteenth- to the early twentieth century.     

La figura docente del profesor contratado doctor vinculado: situación actual en España y la experiencia de Andalucía

A discussion is presented on the national legal foundations, and more specifically, those of Andalusia, that support the figure of the tenure-eligible lecturer and the possibility of filling the corresponding positions in the faculties of medicine in Spanish public universities are discussed. The clinical and academic characteristics that they must have in order to fill those public positions are also presented. The current situation as regards such a figure as a lecturer in Spanish faculties of medicine is then summarised. An analysis is made of the advantages and the possible limitations arising from having a tenure-eligible lecturer, and how this affects both the medical specialists possibly interested in opting for one of these positions, as well as for the corresponding health centres and faculties of medicine. Finally, mention is made of the possible use of the document prepared by the National Conference of Medical Faculty Deans (CNDFME) in the General Assembly held in the Oviedo Faculty of Medicine from 17 to 19 May 2018, and updated in March 2020.     

El tutor de formación sanitaria especializada en España (parte ii): funciones y medidas para facilitar el desempeño de la tutoría

Many changes are taking place in the transmission and generation of knowledge. The emerging models imply different ways of understanding teaching, which are not alien to specialized health training. The requirements regarding the competence profile of tutors, their functions and their responsability for the training of residents have increased considerably. These demands have generated the need to professionalise the figure of the tutor, although they have not been accompanied by resources, the support measures to facilitate the process of tutoring residents or by the recognition of their work, despite all this has been repeatedly voiced over the years. The prevailing lack of motivation among resident tutors, which are the main guarantors of their training, jeopardizes the teaching capacity of the centres, the quality of teaching and then the quality of health care. This second part of the article focuses on the analysis of the regulations in relation to the functions of tutors and the measures adopted by the Autonomous Regions to facilitate their work, namely: continuous training, time for tutoring and the tutor work plan.     

Medicina interna en el Uruguay. Enseñanza de la especialidad

Internal medicine in Uruguay has undergone a change in recent years related to labor and economic aspects at our society level. This is rethought to the formation of the speciality trying to achieve a doctor more competent and updates with a profile in line with the progress of medicine worldwide. This is a review of the teaching of the speciality in internal medicine in Uruguay with the most innovative aspects in term of training.     

Títeres: sus usos en salud y enseñanza en Enfermería

Health promotion uses education as a tool to help individuals and the community achieve full physical, mental, and social well-being. In this educational task, different strategies, methodologies and educational resources have been used, one of which is education using puppets, with satisfactory results. However, there is limited experience as regards the training of health professionals in techniques and strategies for carrying out an educational activity using puppets. The limited results presented in the literature show isolated innovations in the training of nurses. Although these have resulted in satisfactory experiences for students and teachers, they are not included in the curricula as a resource that should be learned by future professionals that will carry out educational activities in the community.     

Continuum: el poder del aprendizaje virtual y la Web 2.0 en la formación médica en Pediatría. Tres años de experiencia

Doctors are committed to maintain competence and be critical in their professional practice. The internet revolution has led to a new age of disseminating information and knowledge. The Scientific Societies are entrusted with the training needs of those that they represent, with the development of strategies to link training and medical practice. They also have a responsibility to provide optimal healthcare to the population. The experience of Continuum is presented in this article. It is a training platform based on the Global Curriculum for Paediatric Education (GPEC), designed ad hoc by the Spanish Paediatric Association. Continuum promotes a competency-based training, in which students (undergraduate, graduate, and practicing physicians) are the centre of the teaching-learning process. The Continuum approach establishes a direct relationship between the competences that are needed for a competent paediatric practice (knowledge, skills, and attitudes), as well as training material.Training activities in Continuum include: training courses and individual learning activities, distributed into different sections (“Weekly image”, “interactive clinical cases”, “News in bibliography”, “Highlighted Article”, “Pills” and “tools for daily practice”). In this article we present the hallmarks and strengths of Continuum, the training platform of the Spanish Paediatric Association, and the experience achieve during these first three years of its existence.     

¿Es adecuado lo que estamos aprendiendo y enseñando en Cardiología?

The evolution of technology and it's application in medicine, tend to improve the disease's diagnostic and management methods; during the learning and teaching processes in Cardiology and other specialities, post grade students replace medical knowledge for technology tools instead of using them as help. We, as the ones with ability of discriminating the scientific validity of the medical literature, are direct or indirectly responsible of the resident's training, and we have the obligation to improve this guideline now imposed, in most of the cases, for globalized information non always exempt of disguised economic interests. The world needs better specialists.     

Una estrategia para la formación en seguridad del paciente durante la residencia: desde el incidente crítico a la simulación. Parte 2

Patient safety training during residency contributes to the culture of safety and quality of care. Patient safety curriculum incorporates different activities throughout the specialty and appropriate to each moment: courses, workshops, critical incident sessions, safety rounds, which have been described above, and simulation. The simulation allows the safe training of complex clinical situations in multiprofessional teams. Structure the learning of human factor through the management of resources in crises, and provide feedback in debriefing improves competition. The simulation can be part of the objective formative evaluation of the residents. It has been shown to have results in the performance of health professionals, improves the quality of care and has effects on patients.     

Zur Physiologie des Blasinstrumentenspiels. Die Blechbläser

Zusammenfassung Mißt man den Luftüberdruck in der Mundhöhle beim Blasen, so erhält man Werte, die von der Tonhöhe, der Lautstärke, der Art des Instrumentes und dem Bläser abhängig sind. Der Druck steigt mit wachsender Tonhöhe und Lautstärke und erreicht Werte bis zu 124 mm Hg. Die Lippenspaltweite und damit der Anteil der Lippen an der Tonbildung wird nach der angegebenen Methode berechnet.Die Untersuchungen geben ein Bild von der Leistungsfähigkeit der Bläser und vermögen Hinweise für die Gründe etwaiger Mißerfolge zu vermitteln. Die Regulationsvorgänge beim laut- und leise-Blasen, beim Überwinden großer Tonintervalle werden ebenso wie die Eigentümlichkeiten der einzelnen Blasinstrumente auf Grund der ermittelten Werte erörtert. Der mittlere Luftverbrauch erweist sich für jede Instrumentengattung als charakteristisch.Die Untersuchungen sollen die bisherige, rein handwerksmäßige Überlieferung ergänzen und ein Beitrag zu einer Physiologie der Musikausübung sein, von der sich die Klärung praktisch wichtiger Fragen erhoffen läßt.