What happens with teaching in Ophthalmology

Jiménez Benito, J.; Piñón Mosquera, R.; Ortega Alonso, E.; Gordón Bolaños, C.

doi:10.1016/j.oftale.2019.10.001

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Jiménez Benito, R. Piñón Mosquera, E. Ortega Alonso, C. Gordón Bolaños" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Jiménez Benito" "email" => array:1 [ 0 => "jjimenez@saludcastillayleon.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Piñón Mosquera" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Ortega Alonso" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Gordón Bolaños" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario de Burgos, Burgos, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "?¿Qué sucede con la docencia en Oftalmología?" ] ] "textoCompleto" => "The main characteristic that differentiates humans from other living beings is that we are all born in a cultural environment which provides a language and a knowledge of reality inherited from our forbearers that facilitates an easier adaptation to life.In our profession we carry the essential scientific knowledge of the ophthalmologists that came before us. For this reason we need education in order to carry out our profession adequately<a class="elsevierStyleCrossRef" href="#bib0050">1</a>. Our work requires a practical as well as theoretical knowledge that is provided by the intern resident system known as MIR in Spain.In our country, the MIR system was consolidated in 1984<a class="elsevierStyleCrossRef" href="#bib0055">2</a> and since then it is the only legal way to obtain the medical specialist degree. Possibly the main achievement of the MIR system consisted in devising an impartial examination enabling access to specialized training for all medical graduates.MIR facilitates a practical knowledge of our specialty on the basis of learn while you work, an excellent initiative originated in the Johns Hopkins Hospital in Baltimore (USA) in the late 19th century<a class="elsevierStyleCrossRef" href="#bib0060">3</a> which became widespread in the past century due to its efficiency.In the public health system, teaching is not an option. Act 44/20033 dated November 21 on the regulation of health professions, establishes in Section 1 of Article 11 on Research and Teaching that the entire structure of the health system shall be available for health research and for teaching health professionals.The body of law on MIR is quite broad and somewhat overblown. The Ophthalmology training program is summarized in the Official Gazette (BOE) Order SAS/3072/2009<a class="elsevierStyleCrossRef" href="#bib0065">4</a>. It is beyond the scope of this note to discuss the full contents of said Act although some details are relevant and possibly ignored during the training of Ophthalmology residents. Said program emphasizes the importance of training in refraction, bioethics, clinic management, research and promotion of critical judgement, among others. Said Act also describes the levels of competency and responsibility that must evolve during the training of residents. In practical terms, when a resident completes training he or she must have carried out 50 operations as main surgeon, including cataract, glaucoma (including laser) and refractive surgery, 3 retina surgeries, 5 operations on extrinsic ocular musculature and 2 dacryocystorhinostomies, among others.Residents are entitled to receive training and are also obliged to contribute their work. Specialists must consider residents as peers and respect them as such. MIR trainees have specific labour legislation<a class="elsevierStyleCrossRef" href="#bib0070">5</a> including rights which must be respected, specifically being exempted from shift work is a labour right and not a privilege. We should never regard resident physicians as low cost specialists, although unfortunately some doctors and more frequently health administrations tend to treat them as such.Adequate training of ophthalmologists involves a huge impact that is not easy to assume because it requires a lot of time and effort. In departments that comprise teaching duties, all professionals participate in training residents<a class="elsevierStyleCrossRef" href="#bib0075">6</a> with the teaching physician being qualified as a tutor. Regulations in this field are up to the Autonomous Communities of Spain<a class="elsevierStyleCrossRef" href="#bib0080">7</a>.In resident education, surgical and diagnostic skill development is very important but training in moral values is also essential<a class="elsevierStyleCrossRef" href="#bib0085">8</a>. It is surprising to see how resident doctors treat patients in the same way as their teachers do. In this regard, it is important to make reference to two articles, the first one included in the Medical Deontology Code<a class="elsevierStyleCrossRef" href="#bib0090">9</a>:Article 63.2.- Teaching physicians must take advantage of any circumstances in the course of medical practice to instil ethical values in their students as well as the knowledge of this Code. They must be aware of the training value of the example they give and that all medical actions include an ethical component.The second reference is found in BOE Order SAS/3072/2009 on the training program of ophthalmology residents:6.3.6. Teacher physicians must imbue in future ophthalmologists the certainty about practising science with human contents, avoiding dehumanization in their work.In the above teaching activity our future is at stake, not only as health professionals but also as patients (which we will be at some point). It should be taken into account that never before did we have the high quality of present-day technical training, largely due to the generalization of the MIR system. However, we are seeing disturbing changes in said training such as requiring payments for rotations in some internationally renowned hospitals. To date, training physicians was seen as a value without a price, which brings to mind a quote by Francisco Quevedo, the 17th century Spanish writer and later emphasized by Antonio Machado, the 19th century poet: Only fools confuse value with price." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Jiménez Benito J, Piñón Mosquera R, Ortega Alonso E, Gordón Bolaños C. ?¿Qué sucede con la docencia en Oftalmología?. archsocespoftalmol. 2019;94:573–574." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El valor de educar" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F. Savater" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "fecha" => "1997" "paginaInicial" => "14" "editorial" => "Ariel S.A" "editorialLocalizacion" => "Barcelona" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0055" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Real Decreto, 127/1984, de 11 de enero, por el que se regula la formación médica especializada y la obtención de título de Médico Especialista [accessed 1 Jul 2019]. Available from <a target="_blank" href="https://www.boe.es/boe/dias/1984/01/31/pdfs/A02524-02528.pdf">https://www.boe.es/boe/dias/1984/01/31/pdfs/A02524-02528.pdf</a>." ] ] ] 2 => array:3 [ "identificador" => "bib0060" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.D. Tutosaus Gómez" 1 => "J. Morán-Barrios" 2 => "F. 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Available from: <a target="_blank" href="https://www.boe.es/buscar/pdf/2006/BOE-A-2006-17498-consolidado.pdf">https://www.boe.es/buscar/pdf/2006/BOE-A-2006-17498-consolidado.pdf</a>." ] ] ] 5 => array:3 [ "identificador" => "bib0075" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Real Decreto 183/2008, de 8 de febrero, por el que se determinan y clasifican las especialidades en Ciencias de la Salud y se desarrollan determinados aspectos del sistema de formación sanitaria especializada. BOE-A-2008-3176 [accessed 15 Jul 2019]. 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ISSN: 2173-5794
e-ISSN: 1989-7286

Archivos de la Sociedad Española de Oftalmología is the official journal of the Ophthalmology Society of Spain, that has over 4,000 members. It gives priority to the publication of basic, translational and clinic research including reviews, original articles, short communications, editorials, letters to the editor and clinic practice guides related to Ophthalmology and its subspecialties. A small section of the journal is reserved for the most relevant papers presented at the annual Congress of the Society. All manuscripts considered for publication are reviewed by expert examiner peers (double blind). The journal is published monthly and even though its official language is Spanish all articles are translated into English to increase the dissemination of scientific information. At present, Archivos is the only Spanish language Ophthalmology journal indexed in PubMed/MEDLINE in addition to other prestigious international databases such as Scopus.

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