Survey on graduate education in the Confederación Americana de Urología: Opinions and reality | Actas Urológicas Españolas (English Edition)

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Angulo, H. Davila, R. Vela" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J.C." "apellidos" => "Angulo" "email" => array:1 [ 0 => "jangulo@futurnet.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "H." "apellidos" => "Davila" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Vela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 3 => array:2 [ "colaborador" => "Members of the CAU Educational Forum" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "◊" "identificador" => "fn0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Vocal de Actividades Científicas, Publicaciones y Congresos, Confederación Americana de Urología, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Secretario General, Confederación Americana de Urología, Caracas, Venezuela" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Catedrático Emérito de Urología, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Encuesta sobre la formación de postgrado en la Confederación Americana de Urología: opiniones y realidades" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1163 "Ancho" => 2804 "Tamanyo" => 181236 ] ] "descripcion" => array:1 [ "en" => "Graph that reflects the density of specialists (population ratio by specialists, in thousands of inhabitants) according to CAU Environment states." ] ] ] "textoCompleto" => "IntroductionThe American Confederation of Urology (CAU) understands that one of its fundamental commitments is that its members, current and future urologists of the CAU territory, can receive excellent training in their respective countries, completing any type of local deficiencies with the appropriate demands to the respective ministries of education and health of each of the sovereign states that make up the confederation. The CAU believes that it is necessary to facilitate mobility among training residents with the appropriate strategies and to plan continuing medical education activities that reach them wherever they reside.In order to satisfy the first objective, it is necessary to define precisely the academic and professional content of the medical-surgical specialty of Urology, as well as the period of training residency, the educational itinerary, and the accreditations of the responsible teaching units. Continuing training, which is qualified in a recertification format, is also an opportunity for continuous improvement of the quality of professionals to which all the states that make up the confederation should aspire.This study has been carried out as a result of the analysis presented by the constituents of the 2nd Educational Forum held in Cancún on October 10, 2015,<a class="elsevierStyleCrossRef" href="#bib0075">1</a> regarding the feasibility of a common training and a joint degree for the different confederate states in the CAU, and in the presentations and discussion of the III Educational Forum held in the City of Panama on October 4, 2016.<a class="elsevierStyleCrossRef" href="#bib0075">1</a>Material and methodsDesign and administration of the surveyThe discussion generated at the 2nd CAU Educational Forum showed a heterogeneous reality in the Postgraduate of Urology in the different countries of the CAU environment. For this reason, a survey has been designed based on 20 direct questions, 2 of them (10%) with guided responses in qualitative range, to describe the reality of postgraduate training in each state (<a class="elsevierStyleCrossRef" href="#sec0060">Appendix B</a>, supplementary material available in the electronic version of this article). The survey was sent on August 2, 2016 to the presidents and former presidents of each national urological scientific society (24 societies), a society per state except for Mexico, which has 2 confederate scientific societies. The survey analyzes realities and need on the degree of specialists in Urology in each country, the existence of an organized training program, and an evaluation test for the accreditation of specialists in Urology, and the impact of a possible joint degree in Latin America for the realities of each country. Two months after sending the data, they were collected in an Excel table and analyzed using the Statistical Analysis System. The conclusions of the survey were presented at the 3rd CAU Educational Forum.ResultsA total of 28 presidents and former presidents responded representing 21 countries that make up the Confederation today, with the exception of the newly incorporated commonwealth of Puerto Rico, US territory. Those states with more than one response were evaluated individually to homogenize discordant responses. In this scenario, the survey describes that a total of 664 residents start their training program each year, in a territory that serves 645.4×106 inhabitants, with an active professional force of 16,752 specialists. These data reflect an annual replacement rate of 3.96%, so if it is stable, every 25 years the full generation replacement of professionals in the Confederation will take place.Training realityThe number of new residents/year is variable, from 3 to 165 (median 12, interquartile range [IQR] 28). In absolute terms, the countries with the highest number of residents/year are: Brazil (n=165), Mexico (n=110), Spain (n=98), and Argentina (n=80); which represents 68.2% of the new residents/year of the entire CAU territory. On the other hand, the countries with the lowest density of new residents/year are: Costa Rica (n=4), El Salvador, Guatemala, and Panama (n=3 each) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Honduras does not have its own resident training program.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>There is organized legislative evidence on the training of residents in 76.2% of the Confederate States in the CAU. The median length of the training is 4 years (IQR 0.5, range 3–6): 3 years in Peru, Guatemala and Venezuela; 4 in Argentina, Bolivia, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Panama, Paraguay and Uruguay; 5 in Brazil, Chile, Spain and Mexico; 6 in Portugal. The median duration of rotation in surgery is one year (IQR 1; range 0–2). It is less than one year in 35% of the states offering residence programs (Colombia, Ecuador, Spain, Nicaragua, Panama, Paraguay and Peru), one year in 40% (Argentina, Bolivia, Costa Rica, Cuba, Dominican Republic, Mexico, Portugal and Uruguay) and 2 years in the remaining 25% (Brazil, Chile, El Salvador, Guatemala and Venezuela). The core is organized (although this does not mean that it is still fulfilled) in 50% of the states, so it is applied or will be applied to 73.9% of new residents/year.The organizations that guarantee the degree at the end of the residence also vary depending on the country. In 50% of the states, a single accredited entity issues the degree, while in the remaining 50% there are several entities that jointly certify the specialty. Globally, the main accreditation body in the CAU countries is universities (65%), but the ministries of health and medical colleges are also important (30%). However, the role of national societies is scarce (20%), and even more so that of the ministries of education (10%).Work realityWith respect to labor access, respondents say that the difficulty in finding a job when the resident completes their training is (on a scale of 1–4): none 57.1%, some 42.9%, quite 0%, a lot 0%; although this response also depends on whether the work environment is rural or urban. Paradoxically, it is the little inhabited environments that offer more opportunities to access work. On the other hand, taking into account realities and needs, the respondents perceive the labor market situation as: deficit (52.4% of the states, which adjusted to the number of residents/year accounts for 40.5%), balance (by states 42.9%, by number of residents 57.7%) or surplus (by states 4.8%, by number of residents 1.8%).The density of specialists (population ratio by specialists) and the density of residents (population ratio by new residents/year) are very variable in each country and depend on the wealth of the same, the investment in health, and the trajectory of the health coverage that each state has decided. The population treated by each specialist varies from Spain to Guatemala, although the figures are not exactly the same when referring to specialists or residents (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). The rate of (new) residents per 100 specialists ranges from 2.5 in Brazil to 14.3 in Paraguay. These variations reveal tendencies to slow down or speed up the professional replacement rate.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Accreditation and recertification of specialistsRespondents reveal that currently 42.9% of states use specialty accreditation tests, which means that globally 64.5% of Confederation residents are objectively accredited at the end of their residency. Residents in Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Spain, Guatemala, Nicaragua, Panama, Peru or Venezuela do not carry out these tests; but those from Argentina, Bolivia, Brazil, Chile, Cuba, Mexico, Paraguay, Portugal and Uruguay do so.Focused on practicing specialists, 28.6% of states have specialty recertification programs and perform it every 2–5 years (median 5, IQR 3). Taking into account the number of residents of these same countries, 39.3% of these will undergo a future periodic recertification. Mexico, Panama, Paraguay and Peru recertify their specialists obligatorily; and on a voluntary basis, Argentina and Cuba. Continuous training is carried out throughout the CAU environment, although in a variable manner too. In 81% of the states, these activities depend on the scientific urological societies of each country, in 19% they are activities promoted from universities, and in 14.3% they are activities of medical schools.The presidents of societies believe that 90.5% of the states would accept to carry out a CAU joint accreditation. The 9.5% in which this does not seem possible are the states of Spain and Portugal, which in a geographical and political form are framed in the European Union; that is to say, from a structural point of view, the members of their scientific societies are usually also members of the European Urological Association and their professionals often also hold the European Board of Urology (EBU). Of the remaining 19 states, all geographically located in the American continent, only Brazil (5.3%; 29.8% of total residents/year) considers that their residents would not be willing to take a certification test of a common CAU degree. This same country is not subject to a periodic recertification test today either.A possible CAU joint degree may have important implications in territorial mobility and the flow of specialists. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> shows the variation of ‘new resident density/density of specialists’ ratios with respect to the mean, which is 20.37 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). This chart shows deficient conditions of urologists in training related to baseline condition in Brazil, Portugal, Colombia, Chile and Spain, as well as relative surplus conditions of urologists in training in Paraguay, Bolivia, Nicaragua and Ecuador. Deficit or surplus conditions may have consequences both under current conditions and in the event of a joint CAU joint degree program (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>DiscussionEach state that forms the CAU has sustained the continuing training of its specialists in the role played by the different urological scientific societies, which have spanned between 25 and more than 100 years of history throughout the American continent, Spain and Portugal.<a class="elsevierStyleCrossRef" href="#bib0080">2</a>The postgraduate or residency in Urology, due to its medical-surgical specialty, entails a structure of learning in knowledge and skills that needs a correct definition of the training itinerary: duration, contents, and teaching methods.<a class="elsevierStyleCrossRef" href="#bib0085">3</a> The resident physician is an important professional for the maintenance and improvement of national health systems and must be a respected and highly regarded figure from a labor and legal point of view, with the right to mobility and subspecialty options that allow him to establish his own career.<a class="elsevierStyleCrossRef" href="#bib0090">4</a>At the beginning of the last century, the training program of general surgeons was recognized as ‘boarding school’ and later as ‘residence’. As natural evolutionary logic, the emergent specialties of the common core of the Surgery were organized in several years of general surgical training with a reduced time specific for the new specialty. Surprisingly, these programs are still valid in some countries, although, in the majority of the specific training period in urology, it has been extended, reaching a time that ranges from 3 to 6 years, while the core period tends to be shortened. Within the European Union and through its institutions Union Européenne des Médecins Spécialistes and EBU, a minimum consensus of 5 years of residence was achieved with a variable period of core between 1 and 3 years.<a class="elsevierStyleCrossRefs" href="#bib0095">5–7</a>There is no doubt that the training of surgical skills and education in the medical-surgical specialties is undergoing a tremendous transformation. The concept and principles of mentoring continue to be the focus of all surgical training, fundamental to awaken the developing operative skill. However, modern technology and external pressures are forcing the surgeon-educators to make changes in the teaching environment of the doctrine: ‘see, do, teach’. Concern for patient safety, cost escalation in operating room time, and minimizing the risk of surgical complications are new challenges and problems in medical education. But not all are difficulties. The emerging field of surgical simulation offers an opportunity to teach and practice surgical skills outside the operating room environment. On the other hand, the incorporation of modular training in surgical teaching programs facilitates the transmission of the knowledge necessary to carry out complex surgical procedures.<a class="elsevierStyleCrossRefs" href="#bib0110">8,9</a>The current breadth of care of urology requires a specific long period of training that cannot be reduced in any way in favor of the increase in the core period.<a class="elsevierStyleCrossRefs" href="#bib0120">10,11</a> One of the fundamental arguments in favor of this proposal was searched in the comparison of the professional development of the countries with the maximum and minimum core period in the European Union: United Kingdom and Spain, which also shows wide differences in the population treated by every professional. With the survey that we have analyzed, there are also large differences in the population density of urologists in CAU environment, and even in the population density of residents in these same states. These differences support the need to establish minimums and maximums not only in each country, but also in supranational environments.<a class="elsevierStyleCrossRef" href="#bib0130">12</a> Only in this way will we be able to provide homogeneous quality care, thus fulfilling the fundamental principle of equity in the health offer of our people. In the same way, with open and long-term planning, it will be possible to establish an orderly health replacement and that our professionals enjoy widely fair and desirable working conditions.This study presents the realities of the countries of the CAU environment, as well as the opinions of the presidents of the urological societies of these countries. The situation is widely variable, with states fully satisfied with their postgraduate education forms compared to others that are deficient in number and quality, forced to the mobility of the resident to achieve complementary acceptable training levels in other centers. The CAU, as a unitary scientific society representing 24 companies in a territory of 22 countries, can and should have the authority to establish compulsory recommendations. However, it is important to reach a consensus position before convincing the respective political, academic, and labor authorities of each country in such specific and important points as the ideal number of urologists, service portfolios, health care of the population, accreditation and recertification of professionals, the suitability of labor structures or even the mode and rate of labor replacement. The challenges to be achieved will depend on the degree of commitment on the part of each society to satisfy the health needs and, at the same time, to watch over the professionals that make them up.If it is aspired to achieve quality and equity, it seems necessary to carry out a planning that corrects, at least in part, the variability existing in the different training itineraries, in the duration of the postgraduate and in the fulfillment of the necessary and desirable core of the surgical specialties.<a class="elsevierStyleCrossRef" href="#bib0135">13</a> Quite possibly, if structural reforms are undertaken without causing profound changes in health systems, there will be migratory repercussions of specialists. A situation of relative labor surplus will make it possible to improve the population rate treated by number of specialists, which will lead to an improvement of health care in the most disadvantaged areas. In a forced recertification environment, this same scenario will also allow employers and contracting entities to choose more qualified specialists. Likewise, given the hypothetical achievement of a degree and the joint overall recognition in the territorial environment of the Confederation, migratory flows of specialists will be initiated from states with surplus compared to other states with deficit.<a class="elsevierStyleCrossRef" href="#bib0140">14</a>In summary, hand in hand with the national health authorities, the scientific societies that are part of the CAU should try to achieve the best possible training and recertification programs. This starting point is presented as a key to reduce the variability inherent to such a large and multinational geographic environment. At present, the role of national urological societies is key in continuing training strategies, but they play a minor role in the definition of training paths, more in the hands of universities. Urological societies should make an effort to better control training programs and the objectives to achieve in certification. It seems unacceptable that a third of CAU residents do not undergo objective accreditation tests at the end of their residency. Equally worrying, or even more so, is the fact that two-thirds of them will never undergo periodic recertification tests. Mexico, Argentina, Panama, Paraguay and Peru are following recertification models based on the American Board of Urology, which necessarily have to expand throughout the Confederation, although there is still a long way to go.As a main roadmap for establishing a joint degree for specialists in CAU Urology, a double administrative appeal must be established in the CAU: (a) an accreditation mechanism similar to that established by the European Urological Association in its European Urology-Accredited Continuing Medical Education office, which offers a continuous and personalized medical education for the members of the European Urological Association, and (b) a board similar to the European Board of Urology, which, in turn, is an office of the Union Européenne des Médecins Spécialistes, a supranational body that regulates and homogenizes medical training in the European Union. The EBU, with a career of more than 2 decades, regulates the accreditation of basic training units and subspecialized units, as well as the approval of continuing training activities and the certification tests known to obtain the title of Fellow of the European Board of Urology. The European Urology-Accredited Continuing Medical Education and the EBU do not pursue legislative or executive power. Its purpose is to promote and harmonize training and urological training in Europe. Similarly, the CAU should establish appropriate offices, which could be called Office of Accreditation and Training Office, desirably in line, which are not currently available. Regrettably, there is no organism like Union Européenne des Médecins Spécialistes for the Iberian peninsula and Latin America, which further complicates relationships between the various CAU environment governments and the bodies involved (national scientific societies, medical colleges and universities) in training in Health Sciences.ConclusionThe main conclusion of the survey is that we must plan strategies and undertake appropriate changes in order to achieve the desired development of a CAU joint urological degree. In parallel and simultaneously, each society must argue before their governments a desire for professional development that allows equitable, homogenous, and quality health coverage for the treatment of urological diseases. This way, it will be avoided that a possible joint degree not only does not improve the health conditions of the most depressed countries, but also feeds migratory flows that lead to the loss of qualified specialists. The urological societies that make up the Confederation must make their concerns known to their respective health authorities.Conflict of interestThe authors declare that they have no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres843918" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec839028" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres843917" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec839029" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design and administration of the survey" ] ] ] 6 => array:3 [ "identificador" => "sec0020" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Training reality" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Work reality" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Accreditation and recertification of specialists" ] ] ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-10-08" "fechaAceptado" => "2016-11-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec839028" "palabras" => array:5 [ 0 => "Urology" 1 => "Postgraduate training" 2 => "Accreditation" 3 => "Re-certification" 4 => "Confederación Americana de Urología" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec839029" "palabras" => array:5 [ 0 => "Urología" 1 => "Formación de postgrado" 2 => "Acreditación" 3 => "Recertificación" 4 => "Confederación Americana de Urología" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveQuality graduate medical training is a concern of Confederación Americana de Urología (CAU), the third largest urological society worldwide. It is important to analyze the diversity in the state training programs and the feasibility and implications of conducting a common CAU program. Material and methodsA 20-item questionnaire was distributed to the directors of national societies who are members of the CAU concerning the graduate urological training in their institutions. ResultsA total of 28 presidents and expresidents representing 21 countries responded, the total number of independent states that constitute the confederation. In this setting, 664 residents start their training program every year, in an area that treats 645.4 million inhabitants, with an active professional force of 16,752 specialists. We present data on the realities of the training (length of the program, core curriculum) and occupation (job access, possible flow between countries) and on how accreditation and re-certification of specialists in these countries are conducted. We also present the opinions on the feasibility of a joint CAU degree, as well as a number of its implications. ConclusionsThe actual graduate training in the CAU setting is heterogeneous in its programs and in its accreditation and re-certification methods. There is a strong desire to achieve joint degrees, except in Spain and Portugal. To enable joint certification, there will need to be intervention on numerous aspects and levels, redefining the desire for healthcare coverage in each country and considering the possible flow of specialists." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoLa formación médica en el postgrado de calidad es una preocupación en la Confederación Americana de Urología (CAU), tercera sociedad urológica mundial. Es importante analizar la diversidad en los programas estatales de formación y la viabilidad e implicaciones de llevar a cabo un programa CAU común. Materiales y métodosSe ha distribuido a directivos de sociedades nacionales que componen la CAU un cuestionario de 20 preguntas directas sobre la formación de postgrado urológica en su entorno. ResultadosUn total de 28 presidentes y expresidentes respondieron representando a 21 países, el total de los estados independientes que componen la confederación. En este escenario 664 residentes inician su programa de formación cada año, en un territorio que atiende 645,4 millones de habitantes, con una fuerza profesional activa de 16.752 especialistas. Se presentan datos acerca de la realidad formativa (duración de programas, troncalidad) y laboral (acceso laboral, posible flujo entre países), y sobre cómo se lleva a cabo la acreditación y recertificación de especialistas en estos países. Se presentan también las opiniones acerca de la viabilidad de una titulación conjunta CAU, así como algunas de sus implicaciones. ConclusionesLa formación de postgrado actual en el entorno de la CAU es heterogénea en sus programas, así como en los modos de acreditación y de recertificación. Existe un importante deseo de alcanzar una titulación conjunta, salvo en España y Portugal. Para habilitar una certificación conjunta será necesario intervenir en múltiples aspectos y niveles, redefinir los deseos de cobertura sanitaria en cada país y considerar el posible flujo de especialistas." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:2 [ 0 => array:3 [ "etiqueta" => "◊" "nota" => "The names of the members of the CAU Educational Forum are listed in <a class="elsevierStyleCrossRef" href="#sec0055">Annex 1</a>." "identificador" => "fn0005" ] 1 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Angulo JC, Dávila H, Vela R, miembros del Foro Educativo CAU. Encuesta sobre la formación de postgrado en la Confederación Americana de Urología: opiniones y realidades. Actas Urol Esp. 2017;41:316–323." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:2 [ 0 => array:4 [ "apendice" => "Jaime Abad (Ecuador), Andrés Arley (Costa Rica), Hugo R. Arriaga (Guatemala), Cleveland Beckford (Panamá), Jose L. Borgen (Nicaragua), Gustavo Bueso (Honduras), Luis F. Cano (Paraguay), Octavio Castillo (Chile), Pedro Castillo (República Dominicana), Francisco Cornejo (Ecuador), Juan G. Corrales (Perú), Miguel Costa (Argentina), Jose M. Cózar (España), Octavio M. de la Concepción (Cuba), Arnaldo Figueirido (Portugal), Norberto Lafos (Argentina), Luis A. Lobo (Colombia), Gerardo López-Secchi (Uruguay), Odir G. Martínez (El Salvador), Archimedes Nardozza (Brasil), Alberto Páez (Venezuela), Alberto J. Pazos (Perú), Mauricio Plata (Colombia), Carlos R. Portillo (El Salvador), Denis Salvador (Nicaragua), Eduardo A. Serrano (México), Federico Suero (República Dominicana), Jesús Torres (México), Marcelo Torrico (Bolivia)." "etiqueta" => "Annex 1" "titulo" => "Co-authors of the CAU Educational Forum" "identificador" => "sec0055" ] 1 => array:4 [ "apendice" => "The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix B" "titulo" => "Supplementary data" "identificador" => "sec0065" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1163 "Ancho" => 2804 "Tamanyo" => 181236 ] ] "descripcion" => array:1 [ "en" => "Graph that reflects the density of specialists (population ratio by specialists, in thousands of inhabitants) according to CAU Environment states." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1291 "Ancho" => 2819 "Tamanyo" => 205333 ] ] "descripcion" => array:1 [ "en" => "Graph that reflects the density of new residents (population ratio by new residents/year, in thousands of inhabitants) according to CAU Environment states." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1943 "Ancho" => 2934 "Tamanyo" => 265304 ] ] "descripcion" => array:1 [ "en" => "(A) Ratio of new residents per 100 specialists. (B) Variation of ratios (density of new residents/density of specialists) with respect to the mean." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Country \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of new residents per year \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of active specialists \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Population of the country \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ratio of residents per million population \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ratio of population (thousand inhabitants) per resident \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ratio of specialists per million population \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ratio of population (thousand inhabitants) per specialist \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variation of ratios (mean 20.37) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variation of ratios compared to the mean \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ratio of residents per 100 specialists (mean 5.6) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Argentina \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1,500 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">500 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bolivia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">107 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">112 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Brazil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">165 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6,500 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1212 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−19.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chile \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">400 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−5.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Colombia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">700 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1800 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−7.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Costa Rica \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1125 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cuba \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">350 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">600 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dominican Republic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">270 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">875 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ecuador \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1071 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">El Salvador \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3333 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">154 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2,500 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">469 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−5.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Guatemala \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5167 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">221 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−3.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mexico \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">110 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">120 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1091 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nicaragua \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1033 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Panama \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1333 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Paraguay \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">700 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peru \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">700 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">737 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Portugal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">350 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">833 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−8.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Uruguay \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">583 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Venezuela \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">600 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1023 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1425413.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "With the exception of Honduras because it does not train residents in the country (population 9×106, 42 active specialists)." ] ] ] "descripcion" => array:1 [ "en" => "Data on the number of professionals and demographic considerations in the countries of the CAU environment.<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>" ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Possible consequences of the relative surplus of training specialists \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Improving the rate of population treated/number of specialists \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Improving health care in the most disadvantaged areas \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Generating poor working conditions in the country \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Choosing more qualified specialists in a context of obligatory recertification \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Donating specialists to other CAU states if a common CAU degree was articulated \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Possible consequences of the relative deficit of training specialists \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Worsening the population rate treated/number of specialists \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abandonment of health care in the most disadvantaged areas \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Improving working conditions in the country \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Decreased specialist training if recertification is not required \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Receiving specialists from other CAU states if a joint CAU degree was articulated \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1425412.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Future implications." ] ] 5 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 192638 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0075" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Confederación Americana de Urología. 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Survey on graduate education in the Confederación Americana de Urología: Opinions and reality

Encuesta sobre la formación de postgrado en la Confederación Americana de Urología: opiniones y realidades

J.C. Anguloa,b,

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jangulo@futurnet.es

Corresponding author.

, H. Davilac, R. Velad, Members of the CAU Educational Forum ◊

a Vocal de Actividades Científicas, Publicaciones y Congresos, Confederación Americana de Urología, Madrid, Spain

b Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, Spain

c Secretario General, Confederación Americana de Urología, Caracas, Venezuela

d Catedrático Emérito de Urología, Madrid, Spain

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  "doi" => "10.1016/j.acuroe.2017.04.004"
  "estado" => "S300"
  "fechaPublicacion" => "2017-06-01"
  "aid" => "950"
  "copyright" => "AEU"
  "copyrightAnyo" => "2016"
  "documento" => "article"
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  "cita" => "Actas Urol Esp. 2017;41:316-23"
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The survey was sent on August 2&#44; 2016 to the presidents and former presidents of each national urological scientific society &#40;24 societies&#41;&#44; a society per state except for Mexico&#44; which has 2 confederate scientific societies&#46; The survey analyzes realities and need on the degree of specialists in Urology in each country&#44; the existence of an organized training program&#44; and an evaluation test for the accreditation of specialists in Urology&#44; and the impact of a possible joint degree in Latin America for the realities of each country&#46; Two months after sending the data&#44; they were collected in an Excel table and analyzed using the Statistical Analysis System&#46; The conclusions of the survey were presented at the 3rd CAU Educational Forum&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">A total of 28 presidents and former presidents responded representing 21 countries that make up the Confederation today&#44; with the exception of the newly incorporated commonwealth of Puerto Rico&#44; US territory&#46; Those states with more than one response were evaluated individually to homogenize discordant responses&#46; In this scenario&#44; the survey describes that a total of 664 residents start their training program each year&#44; in a territory that serves 645&#46;4<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span> inhabitants&#44; with an active professional force of 16&#44;752 specialists&#46; These data reflect an annual replacement rate of 3&#46;96&#37;&#44; so if it is stable&#44; every 25 years the full generation replacement of professionals in the Confederation will take place&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Training reality</span><p id="par0030" class="elsevierStylePara elsevierViewall">The number of new residents&#47;year is variable&#44; from 3 to 165 &#40;median 12&#44; interquartile range &#91;IQR&#93; 28&#41;&#46; In absolute terms&#44; the countries with the highest number of residents&#47;year are&#58; Brazil &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>165&#41;&#44; Mexico &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>110&#41;&#44; Spain &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>98&#41;&#44; and Argentina &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>80&#41;&#59; which represents 68&#46;2&#37; of the new residents&#47;year of the entire CAU territory&#46; On the other hand&#44; the countries with the lowest density of new residents&#47;year are&#58; Costa Rica &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; El Salvador&#44; Guatemala&#44; and Panama &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3 each&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Honduras does not have its own resident training program&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">There is organized legislative evidence on the training of residents in 76&#46;2&#37; of the Confederate States in the CAU&#46; The median length of the training is 4 years &#40;IQR 0&#46;5&#44; range 3&#8211;6&#41;&#58; 3 years in Peru&#44; Guatemala and Venezuela&#59; 4 in Argentina&#44; Bolivia&#44; Colombia&#44; Costa Rica&#44; Cuba&#44; Dominican Republic&#44; Ecuador&#44; El Salvador&#44; Panama&#44; Paraguay and Uruguay&#59; 5 in Brazil&#44; Chile&#44; Spain and Mexico&#59; 6 in Portugal&#46; The median duration of rotation in surgery is one year &#40;IQR 1&#59; range 0&#8211;2&#41;&#46; It is less than one year in 35&#37; of the states offering residence programs &#40;Colombia&#44; Ecuador&#44; Spain&#44; Nicaragua&#44; Panama&#44; Paraguay and Peru&#41;&#44; one year in 40&#37; &#40;Argentina&#44; Bolivia&#44; Costa Rica&#44; Cuba&#44; Dominican Republic&#44; Mexico&#44; Portugal and Uruguay&#41; and 2 years in the remaining 25&#37; &#40;Brazil&#44; Chile&#44; El Salvador&#44; Guatemala and Venezuela&#41;&#46; The core is organized &#40;although this does not mean that it is still fulfilled&#41; in 50&#37; of the states&#44; so it is applied or will be applied to 73&#46;9&#37; of new residents&#47;year&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The organizations that guarantee the degree at the end of the residence also vary depending on the country&#46; In 50&#37; of the states&#44; a single accredited entity issues the degree&#44; while in the remaining 50&#37; there are several entities that jointly certify the specialty&#46; Globally&#44; the main accreditation body in the <span class="elsevierStyleUnderline">CAU</span> countries is universities &#40;65&#37;&#41;&#44; but the ministries of health and medical colleges are also important &#40;30&#37;&#41;&#46; However&#44; the role of national societies is scarce &#40;20&#37;&#41;&#44; and even more so that of the ministries of education &#40;10&#37;&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Work reality</span><p id="par0045" class="elsevierStylePara elsevierViewall">With respect to labor access&#44; respondents say that the difficulty in finding a job when the resident completes their training is &#40;on a scale of 1&#8211;4&#41;&#58; none 57&#46;1&#37;&#44; some 42&#46;9&#37;&#44; quite 0&#37;&#44; a lot 0&#37;&#59; although this response also depends on whether the work environment is rural or urban&#46; Paradoxically&#44; it is the little inhabited environments that offer more opportunities to access work&#46; On the other hand&#44; taking into account realities and needs&#44; the respondents perceive the labor market situation as&#58; deficit &#40;52&#46;4&#37; of the states&#44; which adjusted to the number of residents&#47;year accounts for 40&#46;5&#37;&#41;&#44; balance &#40;by states 42&#46;9&#37;&#44; by number of residents 57&#46;7&#37;&#41; or surplus &#40;by states 4&#46;8&#37;&#44; by number of residents 1&#46;8&#37;&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The density of specialists &#40;population ratio by specialists&#41; and the density of residents &#40;population ratio by new residents&#47;year&#41; are very variable in each country and depend on the wealth of the same&#44; the investment in health&#44; and the trajectory of the health coverage that each state has decided&#46; The population treated by each specialist varies from Spain to Guatemala&#44; although the figures are not exactly the same when referring to specialists or residents &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; The rate of &#40;new&#41; residents per 100 specialists ranges from 2&#46;5 in Brazil to 14&#46;3 in Paraguay&#46; These variations reveal tendencies to slow down or speed up the professional replacement rate&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Accreditation and recertification of specialists</span><p id="par0055" class="elsevierStylePara elsevierViewall">Respondents reveal that currently 42&#46;9&#37; of states use specialty accreditation tests&#44; which means that globally 64&#46;5&#37; of Confederation residents are objectively accredited at the end of their residency&#46; Residents in Colombia&#44; Costa Rica&#44; Dominican Republic&#44; Ecuador&#44; El Salvador&#44; Spain&#44; Guatemala&#44; Nicaragua&#44; Panama&#44; Peru or Venezuela do not carry out these tests&#59; but those from Argentina&#44; Bolivia&#44; Brazil&#44; Chile&#44; Cuba&#44; Mexico&#44; Paraguay&#44; Portugal and Uruguay do so&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Focused on practicing specialists&#44; 28&#46;6&#37; of states have specialty recertification programs and perform it every 2&#8211;5 years &#40;median 5&#44; IQR 3&#41;&#46; Taking into account the number of residents of these same countries&#44; 39&#46;3&#37; of these will undergo a future periodic recertification&#46; Mexico&#44; Panama&#44; Paraguay and Peru recertify their specialists obligatorily&#59; and on a voluntary basis&#44; Argentina and Cuba&#46; Continuous training is carried out throughout the CAU environment&#44; although in a variable manner too&#46; In 81&#37; of the states&#44; these activities depend on the scientific urological societies of each country&#44; in 19&#37; they are activities promoted from universities&#44; and in 14&#46;3&#37; they are activities of medical schools&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The presidents of societies believe that 90&#46;5&#37; of the states would accept to carry out a CAU joint accreditation&#46; The 9&#46;5&#37; in which this does not seem possible are the states of Spain and Portugal&#44; which in a geographical and political form are framed in the European Union&#59; that is to say&#44; from a structural point of view&#44; the members of their scientific societies are usually also members of the European Urological Association and their professionals often also hold the European Board of Urology &#40;EBU&#41;&#46; Of the remaining 19 states&#44; all geographically located in the American continent&#44; only Brazil &#40;5&#46;3&#37;&#59; 29&#46;8&#37; of total residents&#47;year&#41; considers that their residents would not be willing to take a certification test of a common CAU degree&#46; This same country is not subject to a periodic recertification test today either&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">A possible CAU joint degree may have important implications in territorial mobility and the flow of specialists&#46; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> shows the variation of &#8216;new resident density&#47;density of specialists&#8217; ratios with respect to the mean&#44; which is 20&#46;37 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; This chart shows deficient conditions of urologists in training related to baseline condition in Brazil&#44; Portugal&#44; Colombia&#44; Chile and Spain&#44; as well as relative surplus conditions of urologists in training in Paraguay&#44; Bolivia&#44; Nicaragua and Ecuador&#46; Deficit or surplus conditions may have consequences both under current conditions and in the event of a joint CAU joint degree program &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Each state that forms the CAU has sustained the continuing training of its specialists in the role played by the different urological scientific societies&#44; which have spanned between 25 and more than 100 years of history throughout the American continent&#44; Spain and Portugal&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The postgraduate or residency in Urology&#44; due to its medical-surgical specialty&#44; entails a structure of learning in knowledge and skills that needs a correct definition of the training itinerary&#58; duration&#44; contents&#44; and teaching methods&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a> The resident physician is an important professional for the maintenance and improvement of national health systems and must be a respected and highly regarded figure from a labor and legal point of view&#44; with the right to mobility and subspecialty options that allow him to establish his own career&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">At the beginning of the last century&#44; the training program of general surgeons was recognized as &#8216;boarding school&#8217; and later as &#8216;residence&#8217;&#46; As natural evolutionary logic&#44; the emergent specialties of the common core of the Surgery were organized in several years of general surgical training with a reduced time specific for the new specialty&#46; Surprisingly&#44; these programs are still valid in some countries&#44; although&#44; in the majority of the specific training period in urology&#44; it has been extended&#44; reaching a time that ranges from 3 to 6 years&#44; while the core period tends to be shortened&#46; Within the European Union and through its institutions <span class="elsevierStyleItalic">Union Europ&#233;enne des M&#233;decins Sp&#233;cialistes</span> and EBU&#44; a minimum consensus of 5 years of residence was achieved with a variable period of core between 1 and 3 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">There is no doubt that the training of surgical skills and education in the medical-surgical specialties is undergoing a tremendous transformation&#46; The concept and principles of mentoring continue to be the focus of all surgical training&#44; fundamental to awaken the developing operative skill&#46; However&#44; modern technology and external pressures are forcing the surgeon-educators to make changes in the teaching environment of the doctrine&#58; &#8216;see&#44; do&#44; teach&#8217;&#46; Concern for patient safety&#44; cost escalation in operating room time&#44; and minimizing the risk of surgical complications are new challenges and problems in medical education&#46; But not all are difficulties&#46; The emerging field of surgical simulation offers an opportunity to teach and practice surgical skills outside the operating room environment&#46; On the other hand&#44; the incorporation of modular training in surgical teaching programs facilitates the transmission of the knowledge necessary to carry out complex surgical procedures&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The current breadth of care of urology requires a specific long period of training that cannot be reduced in any way in favor of the increase in the core period&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">10&#44;11</span></a> One of the fundamental arguments in favor of this proposal was searched in the comparison of the professional development of the countries with the maximum and minimum core period in the European Union&#58; United Kingdom and Spain&#44; which also shows wide differences in the population treated by every professional&#46; With the survey that we have analyzed&#44; there are also large differences in the population density of urologists in CAU environment&#44; and even in the population density of residents in these same states&#46; These differences support the need to establish minimums and maximums not only in each country&#44; but also in supranational environments&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a> Only in this way will we be able to provide homogeneous quality care&#44; thus fulfilling the fundamental principle of equity in the health offer of our people&#46; In the same way&#44; with open and long-term planning&#44; it will be possible to establish an orderly health replacement and that our professionals enjoy widely fair and desirable working conditions&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">This study presents the realities of the countries of the CAU environment&#44; as well as the opinions of the presidents of the urological societies of these countries&#46; The situation is widely variable&#44; with states fully satisfied with their postgraduate education forms compared to others that are deficient in number and quality&#44; forced to the mobility of the resident to achieve complementary acceptable training levels in other centers&#46; The CAU&#44; as a unitary scientific society representing 24 companies in a territory of 22 countries&#44; can and should have the authority to establish compulsory recommendations&#46; However&#44; it is important to reach a consensus position before convincing the respective political&#44; academic&#44; and labor authorities of each country in such specific and important points as the ideal number of urologists&#44; service portfolios&#44; health care of the population&#44; accreditation and recertification of professionals&#44; the suitability of labor structures or even the mode and rate of labor replacement&#46; The challenges to be achieved will depend on the degree of commitment on the part of each society to satisfy the health needs and&#44; at the same time&#44; to watch over the professionals that make them up&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">If it is aspired to achieve quality and equity&#44; it seems necessary to carry out a planning that corrects&#44; at least in part&#44; the variability existing in the different training itineraries&#44; in the duration of the postgraduate and in the fulfillment of the necessary and desirable core of the surgical specialties&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> Quite possibly&#44; if structural reforms are undertaken without causing profound changes in health systems&#44; there will be migratory repercussions of specialists&#46; A situation of relative labor surplus will make it possible to improve the population rate treated by number of specialists&#44; which will lead to an improvement of health care in the most disadvantaged areas&#46; In a forced recertification environment&#44; this same scenario will also allow employers and contracting entities to choose more qualified specialists&#46; Likewise&#44; given the hypothetical achievement of a degree and the joint overall recognition in the territorial environment of the Confederation&#44; migratory flows of specialists will be initiated from states with surplus compared to other states with deficit&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">In summary&#44; hand in hand with the national health authorities&#44; the scientific societies that are part of the CAU should try to achieve the best possible training and recertification programs&#46; This starting point is presented as a key to reduce the variability inherent to such a large and multinational geographic environment&#46; At present&#44; the role of national urological societies is key in continuing training strategies&#44; but they play a minor role in the definition of training paths&#44; more in the hands of universities&#46; Urological societies should make an effort to better control training programs and the objectives to achieve in certification&#46; It seems unacceptable that a third of <span class="elsevierStyleUnderline">CAU</span> residents do not undergo objective accreditation tests at the end of their residency&#46; Equally worrying&#44; or even more so&#44; is the fact that two-thirds of them will never undergo periodic recertification tests&#46; Mexico&#44; Argentina&#44; Panama&#44; Paraguay and Peru are following recertification models based on the American Board of Urology&#44; which necessarily have to expand throughout the Confederation&#44; although there is still a long way to go&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">As a main roadmap for establishing a joint degree for specialists in <span class="elsevierStyleUnderline">CAU</span> Urology&#44; a double administrative appeal must be established in the CAU&#58; &#40;a&#41; an accreditation mechanism similar to that established by the European Urological Association in its European Urology-Accredited Continuing Medical Education office&#44; which offers a continuous and personalized medical education for the members of the European Urological Association&#44; and &#40;b&#41; a board similar to the European Board of Urology&#44; which&#44; in turn&#44; is an office of the <span class="elsevierStyleItalic">Union Europ&#233;enne des M&#233;decins Sp&#233;cialistes</span>&#44; a supranational body that regulates and homogenizes medical training in the European Union&#46; The EBU&#44; with a career of more than 2 decades&#44; regulates the accreditation of basic training units and subspecialized units&#44; as well as the approval of continuing training activities and the certification tests known to obtain the title of Fellow of the European Board of Urology&#46; The European Urology-Accredited Continuing Medical Education and the EBU do not pursue legislative or executive power&#46; Its purpose is to promote and harmonize training and urological training in Europe&#46; Similarly&#44; the CAU should establish appropriate offices&#44; which could be called Office of Accreditation and Training Office&#44; desirably in line&#44; which are not currently available&#46; Regrettably&#44; there is no organism like <span class="elsevierStyleItalic">Union Europ&#233;enne des M&#233;decins Sp&#233;cialistes</span> for the Iberian peninsula and Latin America&#44; which further complicates relationships between the various CAU environment governments and the bodies involved &#40;national scientific societies&#44; medical colleges and universities&#41; in training in Health Sciences&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusion</span><p id="par0120" class="elsevierStylePara elsevierViewall">The main conclusion of the survey is that we must plan strategies and undertake appropriate changes in order to achieve the desired development of a CAU joint urological degree&#46; In parallel and simultaneously&#44; each society must argue before their governments a desire for professional development that allows equitable&#44; homogenous&#44; and quality health coverage for the treatment of urological diseases&#46; This way&#44; it will be avoided that a possible joint degree not only does not improve the health conditions of the most depressed countries&#44; but also feeds migratory flows that lead to the loss of qualified specialists&#46; The urological societies that make up the Confederation must make their concerns known to their respective health authorities&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Quality graduate medical training is a concern of Confederaci&#243;n Americana de Urolog&#237;a &#40;CAU&#41;&#44; the third largest urological society worldwide&#46; It is important to analyze the diversity in the state training programs and the feasibility and implications of conducting a common CAU program&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A 20-item questionnaire was distributed to the directors of national societies who are members of the CAU concerning the graduate urological training in their institutions&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 28 presidents and expresidents representing 21 countries responded&#44; the total number of independent states that constitute the confederation&#46; In this setting&#44; 664 residents start their training program every year&#44; in an area that treats 645&#46;4 million inhabitants&#44; with an active professional force of 16&#44;752 specialists&#46; We present data on the realities of the training &#40;length of the program&#44; core curriculum&#41; and occupation &#40;job access&#44; possible flow between countries&#41; and on how accreditation and re-certification of specialists in these countries are conducted&#46; We also present the opinions on the feasibility of a joint CAU degree&#44; as well as a number of its implications&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The actual graduate training in the CAU setting is heterogeneous in its programs and in its accreditation and re-certification methods&#46; There is a strong desire to achieve joint degrees&#44; except in Spain and Portugal&#46; To enable joint certification&#44; there will need to be intervention on numerous aspects and levels&#44; redefining the desire for healthcare coverage in each country and considering the possible flow of specialists&#46;</p></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La formaci&#243;n m&#233;dica en el postgrado de calidad es una preocupaci&#243;n en la Confederaci&#243;n Americana de Urolog&#237;a &#40;CAU&#41;&#44; tercera sociedad urol&#243;gica mundial&#46; Es importante analizar la diversidad en los programas estatales de formaci&#243;n y la viabilidad e implicaciones de llevar a cabo un programa CAU com&#250;n&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se ha distribuido a directivos de sociedades nacionales que componen la CAU un cuestionario de 20 preguntas directas sobre la formaci&#243;n de postgrado urol&#243;gica en su entorno&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Un total de 28 presidentes y expresidentes respondieron representando a 21 pa&#237;ses&#44; el total de los estados independientes que componen la confederaci&#243;n&#46; En este escenario 664 residentes inician su programa de formaci&#243;n cada a&#241;o&#44; en un territorio que atiende 645&#44;4 millones de habitantes&#44; con una fuerza profesional activa de 16&#46;752 especialistas&#46; Se presentan datos acerca de la realidad formativa &#40;duraci&#243;n de programas&#44; troncalidad&#41; y laboral &#40;acceso laboral&#44; posible flujo entre pa&#237;ses&#41;&#44; y sobre c&#243;mo se lleva a cabo la acreditaci&#243;n y recertificaci&#243;n de especialistas en estos pa&#237;ses&#46; Se presentan tambi&#233;n las opiniones acerca de la viabilidad de una titulaci&#243;n conjunta CAU&#44; as&#237; como algunas de sus implicaciones&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La formaci&#243;n de postgrado actual en el entorno de la CAU es heterog&#233;nea en sus programas&#44; as&#237; como en los modos de acreditaci&#243;n y de recertificaci&#243;n&#46; Existe un importante deseo de alcanzar una titulaci&#243;n conjunta&#44; salvo en Espa&#241;a y Portugal&#46; Para habilitar una certificaci&#243;n conjunta ser&#225; necesario intervenir en m&#250;ltiples aspectos y niveles&#44; redefinir los deseos de cobertura sanitaria en cada pa&#237;s y considerar el posible flujo de especialistas&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Materiales y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:3 [
        "etiqueta" => "&#9674;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">The names of the members of the CAU Educational Forum are listed in <a class="elsevierStyleCrossRef" href="#sec0055">Annex 1</a>&#46;</p>"
        "identificador" => "fn0005"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Angulo JC&#44; D&#225;vila H&#44; Vela R&#44; miembros del Foro Educativo CAU&#46; Encuesta sobre la formaci&#243;n de postgrado en la Confederaci&#243;n Americana de Urolog&#237;a&#58; opiniones y realidades&#46; Actas Urol Esp&#46; 2017&#59;41&#58;316&#8211;323&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:2 [
          0 => array:4 [
            "apendice" => "<p id="par0130" class="elsevierStylePara elsevierViewall">Jaime Abad &#40;Ecuador&#41;&#44; Andr&#233;s Arley &#40;Costa Rica&#41;&#44; Hugo R&#46; Arriaga &#40;Guatemala&#41;&#44; Cleveland Beckford &#40;Panam&#225;&#41;&#44; Jose L&#46; Borgen &#40;Nicaragua&#41;&#44; Gustavo Bueso &#40;Honduras&#41;&#44; Luis F&#46; Cano &#40;Paraguay&#41;&#44; Octavio Castillo &#40;Chile&#41;&#44; Pedro Castillo &#40;Rep&#250;blica Dominicana&#41;&#44; Francisco Cornejo &#40;Ecuador&#41;&#44; Juan G&#46; Corrales &#40;Per&#250;&#41;&#44; Miguel Costa &#40;Argentina&#41;&#44; Jose M&#46; C&#243;zar &#40;Espa&#241;a&#41;&#44; Octavio M&#46; de la Concepci&#243;n &#40;Cuba&#41;&#44; Arnaldo Figueirido &#40;Portugal&#41;&#44; Norberto Lafos &#40;Argentina&#41;&#44; Luis A&#46; Lobo &#40;Colombia&#41;&#44; Gerardo L&#243;pez-Secchi &#40;Uruguay&#41;&#44; Odir G&#46; Mart&#237;nez &#40;El Salvador&#41;&#44; Archimedes Nardozza &#40;Brasil&#41;&#44; Alberto P&#225;ez &#40;Venezuela&#41;&#44; Alberto J&#46; Pazos &#40;Per&#250;&#41;&#44; Mauricio Plata &#40;Colombia&#41;&#44; Carlos R&#46; Portillo &#40;El Salvador&#41;&#44; Denis Salvador &#40;Nicaragua&#41;&#44; Eduardo A&#46; Serrano &#40;M&#233;xico&#41;&#44; Federico Suero &#40;Rep&#250;blica Dominicana&#41;&#44; Jes&#250;s Torres &#40;M&#233;xico&#41;&#44; Marcelo Torrico &#40;Bolivia&#41;&#46;</p>"
            "etiqueta" => "Annex 1"
            "titulo" => "Co-authors of the CAU Educational Forum"
            "identificador" => "sec0055"
          ]
          1 => array:4 [
            "apendice" => "<p id="par0140" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix B"
            "titulo" => "Supplementary data"
            "identificador" => "sec0065"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1163
            "Ancho" => 2804
            "Tamanyo" => 181236
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Graph that reflects the density of specialists &#40;population ratio by specialists&#44; in thousands of inhabitants&#41; according to CAU Environment states&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1291
            "Ancho" => 2819
            "Tamanyo" => 205333
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Graph that reflects the density of new residents &#40;population ratio by new residents&#47;year&#44; in thousands of inhabitants&#41; according to CAU Environment states&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1943
            "Ancho" => 2934
            "Tamanyo" => 265304
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Ratio of new residents per 100 specialists&#46; &#40;B&#41; Variation of ratios &#40;density of new residents&#47;density of specialists&#41; with respect to the mean&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of new residents per year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of active specialists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Population of the country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ratio of residents per million population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ratio of population &#40;thousand inhabitants&#41; per resident&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ratio of specialists per million population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ratio of population &#40;thousand inhabitants&#41; per specialist&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variation of ratios &#40;mean 20&#46;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variation of ratios compared to the mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ratio of residents per 100 specialists &#40;mean 5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Argentina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bolivia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Brazil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">165&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1212&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;19&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;5&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Colombia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">700&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1800&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;7&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Costa Rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cuba&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">350&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">600&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dominican Republic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">270&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">875&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ecuador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1071&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">El Salvador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3333&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">469&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;5&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Guatemala&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5167&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">221&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;3&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mexico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1091&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nicaragua&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1033&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Panama&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1333&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Paraguay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">700&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peru&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">700&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">737&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Portugal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">350&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">833&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;8&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Uruguay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">583&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Venezuela&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">600&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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