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Morales-García D, Docobo Durantez F, Capitán Vallvey J, Suarez Grau JM, Serra Aracil X, Campo Cimarras ME, González Vinagre S, Hidalgo Grau LA, Puigcercos Fusté J, Valera Sánchez Z, Vega Ruiz V, Zaragoza Fernández C. Training in ambulatory surgery. A pending subject in our country. Cir Esp 2023; 101:790-796. [PMID: 37879403 DOI: 10.1016/j.cireng.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/21/2023] [Indexed: 10/27/2023]
Abstract
The implementation and generalized use of Ambulatory Surgery worldwide is currently a clear reality. Its progressive growth is expected in the short term, but this globalization can also negatively affect the education and training of future doctors, as well as those who are being trained now, if it is not standardized and regulated, since a significant part of the management of the most common pathology that could be performed in Ambulatory Surgery is completed outside the training circuits of hospitals where resident doctors are trained.
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Affiliation(s)
- Dieter Morales-García
- Hospital Clínico Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, IBIMA, Málaga, Spain.
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Serra Aracil X, Pino Pérez O. How to start and develop a multicenter, prospective, randomized, controlled trial. Cir Esp 2023; 101:377-380. [PMID: 35914720 DOI: 10.1016/j.cireng.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/18/2021] [Indexed: 05/16/2023]
Affiliation(s)
- Xavier Serra Aracil
- Coordinador Sección de Formación AEC, Profesor Agregado del Departamento de Cirugía UAB, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain.
| | - Oriol Pino Pérez
- Unidad de Cirugía Colorrectal, Servicio Cirugía General y Ap Digestivo, Hospital Universitario Parc Taulí, Universidad Autónoma de Barcelona, Sabadell, Barcelona Spain
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Mora López L, Pallisera Lloveras A, Serracant Barrera A, Garcia-Nalda A, Caraballo Angeli M, Pino Pérez O, Navarro Soto S, Serra Aracil X. Robotic left hemicolectomy with intracorporeal anastomosis: Description of the technique and initial results. Colorectal Dis 2022; 24:1080-1083. [PMID: 35437870 DOI: 10.1111/codi.16146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/27/2022] [Accepted: 04/03/2022] [Indexed: 02/08/2023]
Abstract
AIM The aim was to describe the robot-assisted intracorporeal anastomosis technique in left colon surgery (rLCS) and report the initial results. METHOD The rLCS was performed in 25 consecutive patients, starting with a Pfannenstiel incision and introducing a prepared anvil. The robot was docked and the affected segment resected. Colotomy was performed and the anvil was introduced in the proximal segment. End-to-end anastomosis was performed and reinforced. An air-leak test was performed. RESULTS The results varied in terms of patient's age, American Society of Anesthesiologists grade, weight and the technique performed. Most patients had cancer. There was no suture failure or mortality, and the mean hospital stay was 3 days. CONCLUSIONS The rLCS is a safe, reproducible technique with good initial results. Prospective studies should be performed to demonstrate its advantages.
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Affiliation(s)
- Laura Mora López
- Coloproctology Unit, General Surgery Department, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
| | - Anna Pallisera Lloveras
- Coloproctology Unit, General Surgery Department, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
| | - Anna Serracant Barrera
- Coloproctology Unit, General Surgery Department, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
| | - A Garcia-Nalda
- Coloproctology Unit, General Surgery Department, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
| | - M Caraballo Angeli
- Coloproctology Unit, General Surgery Department, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
| | - Oriol Pino Pérez
- Coloproctology Unit, General Surgery Department, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
| | - Salvador Navarro Soto
- Coloproctology Unit, General Surgery Department, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
| | - Xavier Serra Aracil
- Coloproctology Unit, General Surgery Department, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
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Miguelena Bobadilla JM, Serra Aracil X, Targarona Soler EM, Ramos Rodríguez JL, Jover Navalón JM, Millán Scheiding M, Morales-García D. Reaccreditation or recertification of general surgeons in Spain: That's the question. Results of a national survey. Cir Esp 2022; 100:149-153. [PMID: 35216909 DOI: 10.1016/j.cireng.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The Law for the Regulation of Health Professions (LOPS) indicates that health professionals will carry out continuous training throughout their professional life, and will regularly prove their professional competence. The objective of the study was to carry out a national survey to find out the opinion of Spanish surgeons and thus be able to prepare a recertification project by the Spanish Association of Surgeons. METHODS Cross-sectional observational study carried out in June-July 2020, through a survey sent to the members of the Spanish Association of Surgeons. RESULTS The survey had a total of 1230 visits and an overall completion rate of 784 responses (67.3%). 69.6% were unaware of the LOPS forecasts and 83.4% were unaware of similar initiatives in other specialties and 95.5% agreed to demand adequate information. 71.4% believed it necessary but only 57% believed that it should be mandatory. 82.9% would agree that it should be regulated through an objective and predictable official procedure. CONCLUSIONS The concept of re-accreditation is not well known in our specialty and in view of the results obtained, adequate and reliable information seems necessary. Therefore, it would be pertinent to propose by the A.E.C. a specific project to assess activities and skills.
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Affiliation(s)
| | | | | | | | | | | | - Dieter Morales-García
- Servicio de Cirugía, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
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Serra Aracil X, Pino Pérez O. Cómo poner en marcha y desarrollar un estudio multicéntrico, prospectivo, controlado y aleatorizado. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ma Miguelena Bobadilla J, Serra Aracil X, Ma Targarona Soler E, Luis Ramos Rodríguez J, Ma Jover Navalón J, Millán Scheiding M, Morales-García D. Reaccreditation or recertification of general surgeons in Spain: That's the question. Results of a national survey. Cir Esp 2021; 100:S0009-739X(20)30397-3. [PMID: 33487436 DOI: 10.1016/j.ciresp.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Law for the Regulation of Health Professions (LOPS) indicates that health professionals will carry out continuous training throughout their professional life, and will regularly prove their professional competence. The objective of the study was to carry out a national survey to find out the opinion of Spanish surgeons and thus be able to prepare a recertification project by the Spanish Association of Surgeons (AEC). METHODS Cross-sectional observational study carried out in June-July 2020, through a survey sent to the members of the AEC. RESULTS The survey had a total of 1230 visits and an overall completion rate of 784 responses (67.3%). 69.6% were unaware of the LOPS forecasts and 83.4% were unaware of similar initiatives in other specialties and 95.5% agreed to demand adequate information. 71.4% believed it necessary but only 57% believed that it should be mandatory. 82.9% would agree that it should be regulated through an objective and predictable official procedure. CONCLUSIONS The concept of re-accreditation is not well known in our specialty and in view of the results obtained, adequate and reliable information seems necessary. Therefore, it would be pertinent to propose by the AEC a specific project to assess activities and skills.
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Affiliation(s)
| | | | | | | | | | | | - Dieter Morales-García
- Servicio de Cirugía, Hospital Universitario Marqués de Valdecilla, Santander, España.
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Morales-García D, Alcazar-Montero JA, Miguelena-Bobadilla JM, Serra Aracil X. Response to the article: Concentration of treatments can improve clinical results in complex cancer surgery. Cir Esp 2018; 97:183-184. [PMID: 30316454 DOI: 10.1016/j.ciresp.2018.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/13/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Dieter Morales-García
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Sección de Formación Postgraduada, Asociación Española de Cirujanos (AEC).
| | - Jose Antonio Alcazar-Montero
- Sección de Formación Postgraduada, Asociación Española de Cirujanos (AEC); Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Salamanca, Salamanca, España
| | - Jose María Miguelena-Bobadilla
- Sección de Formación Postgraduada, Asociación Española de Cirujanos (AEC); Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Xavier Serra Aracil
- Sección de Formación Postgraduada, Asociación Española de Cirujanos (AEC); Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Parc Taulí, Sabadell, Barcelona, España
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Mora López L, Flores Clotet R, Serra Aracil X, Montes Ortega N, Navarro Soto S. The use of the modified Neff classification in the management of acute diverticulitis. Rev Esp Enferm Dig 2018; 109:328-334. [PMID: 28376628 DOI: 10.17235/reed.2017.4738/2016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Acute diverticulitis (AD) is increasingly seen in Emergency services. The application of a reliable classification is vital for its safe and effective management. OBJECTIVE To determine whether the combined use of the modified Neff radiological classification (mNeff) and clinical criteria (systemic inflammatory response syndrome [SIRS] and comorbidity) can ensure safe management of AD. MATERIAL AND METHODS Prospective descriptive study in a population of patients diagnosed with AD by computerized tomography (CT). The protocol applied consisted in the application of the mNeff classification and clinical criteria of SIRS and comorbidity to guide the choice of outpatient treatment, admission, drainage or surgery. RESULTS The study was carried out from February 2010 to February 2016. A total of 590 episodes of AD were considered: 271 women and 319 men, with a median age of 60 years (range: 25-92 years). mNeff grades were as follows: grade 0 (408 patients 70.6%); 376/408 (92%) were considered for home treatment; of these 376 patients, 254 (67.5%) were discharged and controlled by the Home Hospitalization Unit; 33 returned to the Emergency Room for consultation and 22 were re-admitted; the success rate was 91%. Grade Ia (52, 8.9%): 31/52 (59.6%) were considered for outpatient treatment; of these 31 patients, 11 (35.5%) were discharged; eight patients returned to the Emergency Room for consultation and five were re-admitted. Grade Ib (49, 8.5%): five surgery and two drainage. Grade II (30, 5.2%): ten surgery and four drainage. Grade III (5, 0.9%): one surgery and one drainage. Grade IV (34, 5.9%): ten patients showed good evolution with conservative treatment. Of the 34 grade IV patients, 24 (70.6%) underwent surgery, and three (8.8%) received percutaneous drainage. CONCLUSIONS The mNeff classification is a safe, easy-to-apply classification based on CT findings. Together with clinical data and comorbidity data, it allows better management of AD.
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Affiliation(s)
- Laura Mora López
- Servicio de Cirugía General, Hospital Universitari Parc Taulí, ESPAÑA
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Serra Aracil X, Navarro Soto S, Aparicio Rodríguez O, Hermoso Bosch J, Montmany Vioque S, Carmona Navarro D, Corredera Cantarin C, Gómez Diaz C. Cuatro años de experiencia con el libro informático del residente de la AEC. Cir Esp 2009; 86:147-53. [DOI: 10.1016/j.ciresp.2009.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 02/04/2009] [Indexed: 10/20/2022]
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Alcantara Moral M, Serra Aracil X, Bombardó Juncá J, Mora López L, Hernando Tavira R, Ayguavives Garnica I, Aparicio Rodriguez O, Navarro Soto S. [A prospective, randomised, controlled study on the need to mechanically prepare the colon in scheduled colorectal surgery]. Cir Esp 2009; 85:20-5. [PMID: 19239933 DOI: 10.1016/s0009-739x(09)70082-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 07/23/2008] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Mechanical preparation of the colon (MPC) in colorectal surgery has been a dogma that has been questioned over the last few years. The objective of this study is to demonstrate that morbidity in scheduled colorectal surgery is the same or lower without MPC. MATERIAL AND METHOD Patients subjected to scheduled left colon and rectal surgery with primary anastomosis randomised into two groups. The "Preparation" group (MPC) received MPC and the "non-preparation" group (No-MPC) had only cleaning enemas. The variables collected were: demographic, oncological, nutritional, risk prediction models and morbidity-mortality. RESULTS Of the 193 patients included: 69 received MPC and 71 did not; 89 patients with colocolic anastomosis (MPC, 38; no MPC, 51) and 50 colorectal (MPC, 31; no MPC, 19). Statistically significant differences were seen in the overall analysis in favour of "no preparation" as regards morbidity (43.55 % with MPC and 27% with No MPC) and nosocomial infection (27.5% and 11.4%). There was 11.6% wound infections in the MPC compared to 5.7% in the no MPC, which was not statistically significant. The only mortalities were in the MPC group 2/69 (2.9% of patients). As regards the location of the anastomosis, in the colocolics the differences were more pronounced, with statistically significant differences in the morbidity, anastomosis dehiscence, and nosocomial infection variables. The effect of no MPC was not so evident in colorectal anastomosis. CONCLUSIONS Our results suggest that there is no benefit in MPC before surgery in colocolic anastomosis. No-MPC is not associated with a higher morbidity in wound infection or anastomotic dehiscence. In colorectal anastomosis the differences are not so evident, therefore a much bigger series needs to be studied.
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Affiliation(s)
- Manuel Alcantara Moral
- Servicio de Cirugía General y Aparato Digestivo, Corporación Sanitaria Parc Taulí, Sabadell, Barcelona, España.
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Serra Aracil X, Bombardó Juncá J, Mora López L, Alcantara Moral M, Ayguavives Garnica I, Darnell Marti A, Casalots Casado A, Pericay Pijaume C, Campo Fernández de Los Ríos R, Navarro Soto S. [Site of local surgery in adenocarcinoma of the rectum T2N0M0]. Cir Esp 2009; 85:103-9. [PMID: 19231466 DOI: 10.1016/j.ciresp.2008.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 09/05/2008] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The local exeresis adenocarcinoma of the rectum T(2)N(0)M(0) (ADC-T2), using transanal endoscopic microsurgery (TEM), has the benefit of achieving lower morbidity with a better quality of life. However, local occurrence of the local exeresis is greater than 20%, which is unacceptable these days. PATIENTS AND METHODS Prospective, observational follow up study. The tumours committee agreed that those ADC-T2 patients could have the following treatments: total mesorectal excision (TME), simple TEM, TEM with postoperative chemo- and radiotherapy (Ct-Rt), preoperative Ct-Rt with subsequent TEM and radical surgical rescue (TME) within at least 4 weeks. RESULTS Of the 146 patients operated on using TEM, 75 had adenocarcinomas, 59 adenomas, 6 scarring wounds, 5 carcinoids and 1 GIST. Of the adenocarcinomas 22 were ADC-T2. Follow up: median of 16 months (range, 3-32 months). The overall local recurrence was 18% (4/22). According to the treatment strategy the local occurrence was: TEM as the only procedure, 20% (2/10). Radical surgical rescue was performed on 3 patients after TEM, with no local or systemic recurrences. TEM with Qt-Rt after surgery was performed on 6 patients, with a local recurrence of 33% (2/6). Ct-Rt and subsequent TEM in 3 patients, with no local or systemic recurrences. CONCLUSIONS Treatment of ADC-T2 using simple TEM is not effective. The combination of Ct-Rt after TEM, does not improve the results of TME. It is possible to rescue those patients without changing the overall survival. Preoperative Ct-Rt and TEM appears to be the approach that obtains a clinical and histological response, although a response is needed by clinical trials.
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Affiliation(s)
- Xavier Serra Aracil
- Servicio de Cirugía General y del Aparato Digestivo, Corporación Sanitaria Parc Taulí, Sabadell, Barcelona, España.
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Miguelena Bobadilla JM, Landa García JI, Jover Navalón JM, Docobo Durantez F, Morales García D, Serra Aracil X, Lobo Martínez E. Formación en cirugía general y del aparato digestivo: nuevo programa, mismos retos. Cir Esp 2008; 84:67-70. [DOI: 10.1016/s0009-739x(08)72136-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Serra Aracil X, Bombardó Junca J, Mora López L, Alcántara Moral M, Ayguavives Garnica I, Navarro Soto S. [Transanal endoscopic microsurgery (TEM). Current situation and future expectations]. Cir Esp 2006; 80:123-32. [PMID: 16956547 DOI: 10.1016/s0009-739x(06)70940-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Transanal endoscopic microsurgery (TEM) uses specific equipment that allows resection of large rectal adenomas and incipient malignancies in the rectal ampulla. TEM aims to provide an alternative to conventional abdominal surgery (low anterior resection or abdominoperineal amputations), which carries not inconsiderable morbidity and mortality. Application of the technique of endoanal excision is limited by the height and extension of the lesions. In this review, the authors present their own experience with this technique and that described in the literature. The protocol for selecting candidates for TEM, their preoperative preparation, equipment, characteristics of the surgical technique, postoperative complications, and follow-up are described. The collaboration of a multidisciplinary team is essential when developing this technique. TEM-associated morbidity is low and mortality is practically nil. TEM is the technique of choice in large rectal adenomas and malignant rectal tumors in stages pT1 localized in the rectal ampulla. The frequency of recurrence is similar to that in abdominal surgery. The technique does not cause complications of urinary or sexual dysfunction and fecal incontinence is minimal. In more advances stages of rectal cancer, the results of better patient selection and future studies on the possible application of neoadjuvant therapy associated with TEM are required.
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Affiliation(s)
- Xavier Serra Aracil
- Unidad de Coloproctología, Servicio de Cirugía General y Aparato Digestivo, Corporación Sanitaria Parc Taulí, Sabadell, Barcelona, España.
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Serra Aracil X, Navarro Soto S, Artigau Nieto E, Rebasa Cladera P, Hernando Tavira R, Moreno Matías J, Aparicio Rodríguez O, Hermoso Bosch J, Montmany Vioque S. ¿Cómo evaluamos la actividad de los médicos internos residentes? El libro informático del residente. Cir Esp 2006; 80:145-50. [PMID: 16956549 DOI: 10.1016/s0009-739x(06)70942-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Because of the developments that have occurred in surgery in the last few years, updates are required not only in the content of resident physicians' training but also in evaluation of the knowledge acquired. The present article aims to present our experience of an integral evaluation model. This model is based on evaluation of theoretical knowledge and surgical skills. MATERIAL AND METHOD The training program for resident physicians (medico interno residente [MIR]) has four main branches: clinical work, continuing training, research (doctorate) and evaluation of the activity performed (computerized activity record). This record allows the theoretical knowledge and skills acquired to be evaluated at the end of each rotation. Through 6-monthly evaluations, each resident's activity can be quantified over time and compared with that of other residents. RESULTS The system was introduced in July 2004. Each resident was given his or her own database. All the activities performed were then introduced into the database. The results of overall activity and that of each resident are presented. CONCLUSIONS The method used allows residents' integral progress to be followed-up and a completely objective evaluation to be made at the end of each year and at the end of the residency period. Widespread use of this system, or a similar system, would enable comparisons with other centers to be made under similar premises. This system could also help to unify criteria and identify deviations in training.
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Affiliation(s)
- Xavier Serra Aracil
- Servicio de Cirugía General y Aparato Digestivo, Corporación Sanitaria Parc Taulí, Sabadell, Barcelona, España.
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