I dedicate this post to the PR who are thinking about choosing a specialty, that as you will read is not very encouraging, but I think it's better to know the reality before making of the most important decisions of your life.
MIR Teaching of surgery is governed by a decree which provides in detail the training program, courses, rotations, surgery and assessments. The program is perfect, but nobody is fully compliant, especially in regard to laparoscopic surgery, research and publications.
This lowering of the law is very typical our society in that he requires and he must meet that no will know fully. fraud is a law book! , especially when the resident at the end of the residence automatically becomes a specialist in general surgery and digestive system without a filter examination and practically nonexistent.
In fact I've never seen a suspension to a resident unless he decides to leave. The obvious result is that the training of residents is not guaranteed, the title itself. This alarming situation clearly does not worry health authorities more focused on solving the waiting lists and demands of citizens.
Most newly graduated specialists are able to solve common problems in surgery, but unquantified, percentage approaching 20% \u200b\u200b- is unable to solve them without help. Depending on the hospital, the service and the rest of the companions may be that patients treated by that surgeon did not receive proper care. There is a problem of degree but of discharging its functions: no guarantee your competition.
Many residents do not meet number of times that makes the training program or have been able to operate many patients with a type of surgery and none of another. Anyway, the minimum number of interventions, described in the decree does not guarantee competition at the end of the residence. The truth is that there are too many surgical residents and young deputy in training, this prevents residents operate the required number of patients to obtain the necessary skills.
Ambitions for laparoscopic surgery and research seem a joke in some hospitals. The teaching license has not been reviewed properly and residents services and even lying to auditors for fear of not being hired at the end of the residence. A specialist degree is given by the ministry of education but the means to ensure compliance with the training program in the hands of public health systems of autonomy. The public health care systems by recruiting every year 190 surgical residents so that the cheap labor and replacement of retirements is guaranteed. Quality does not matter if they have their title officer to exercise, no matter if they have more capabilities than others, or better training, cover a hole in the system, they can not choose and that is not for the many who are better trained.
The inclusion of core subjects in 2012 can further complicate compliance with the minimum number of interventions.
The English Association of Surgeons (ACS) has created courses for residents who can acquire the knowledge and skills in different areas of training or in other words the Super Specialty: abdominal wall, breast, esophageal, gastric, colorectal, hepato-biliop-ancreática, endocrine, multiple trauma, infections and even health management. Neck probably been easier to keep up, the problem is when you arrive at your service: the practice is different, do not let you apply your new knowledge, and practice the skills learned in the operating room.
This negative view and apocalyptic tone is not feigned but real sad end specialty residents are increasingly green -often with excellent knowledge theoretical. You need to take urgent measures to ensure the competence of the new surgeons. As in other areas this depends on many actors: public health, Ministry of Education, National Commission of the specialty, regional ministries of health, surgical services and residents.
What can a resident, or rather a group of residents is required to fulfill its training plan, if not it should be to inform the department head and the teaching committee of the center. If results can not request an audit committee of experts. If takes a passive stance, very common on the other hand, will need at least two more years of practice to acquire a real competition, expecting that you can work continuously and not only do guards. It's much better to have less well-educated residents than the usual coffee for everyone in healthcare.
For those who want more information : Training in general surgery and the digestive system: new program, same challenges. Joseph M. Bobadilla Migueleña
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