Share
array:23 [ "pii" => "S2173579419301902" "issn" => "21735794" "doi" => "10.1016/j.oftale.2019.10.001" "estado" => "S300" "fechaPublicacion" => "2019-12-01" "aid" => "1586" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2019" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Soc Esp Oftalmol. 2019;94:573-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "HTML" => 2 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0365669119303065" "issn" => "03656691" "doi" => "10.1016/j.oftal.2019.10.006" "estado" => "S300" "fechaPublicacion" => "2019-12-01" "aid" => "1586" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Soc Esp Oftalmol. 2019;94:573-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 96 "formatos" => array:2 [ "HTML" => 68 "PDF" => 28 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "¿Qué sucede con la docencia en Oftalmología?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "573" "paginaFinal" => "574" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "What happens with teaching in Ophthalmology?" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Jiménez Benito, R. Piñón Mosquera, E. Ortega Alonso, C. Gordón Bolaños" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Jiménez Benito" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Piñón Mosquera" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Ortega Alonso" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Gordón Bolaños" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579419301902" "doi" => "10.1016/j.oftale.2019.10.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579419301902?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669119303065?idApp=UINPBA00004N" "url" => "/03656691/0000009400000012/v2_202108180557/S0365669119303065/v2_202108180557/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579419301719" "issn" => "21735794" "doi" => "10.1016/j.oftale.2019.08.001" "estado" => "S300" "fechaPublicacion" => "2019-12-01" "aid" => "1567" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:575-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "HTML" => 2 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Unexplained ocular and visual symptoms: The need for a psychosomatic approach in Ophthalmology" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "575" "paginaFinal" => "578" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síntomas visuales y oculares sin causa: la necesidad de un enfoque psicosomático en oftalmología" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Arntz, C. Ibañez, T. Covarrubias" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Arntz" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Ibañez" ] 2 => array:2 [ "nombre" => "T." "apellidos" => "Covarrubias" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669119302643" "doi" => "10.1016/j.oftal.2019.08.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669119302643?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579419301719?idApp=UINPBA00004N" "url" => "/21735794/0000009400000012/v1_201912161902/S2173579419301719/v1_201912161902/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "What happens with teaching in Ophthalmology" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "573" "paginaFinal" => "574" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. 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" => "<span class="elsevierStyleSup">*</span>" "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" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "?¿Qué sucede con la docencia en Oftalmología?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">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.</p><p id="par0010" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">1</span></a>. Our work requires a practical as well as theoretical knowledge that is provided by the intern resident system known as MIR in Spain.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In our country, the MIR system was consolidated in 1984<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></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.</p><p id="par0020" class="elsevierStylePara elsevierViewall">MIR facilitates a practical knowledge of our specialty on the basis of <span class="elsevierStyleItalic">learn while you work</span>, an excellent initiative originated in the Johns Hopkins Hospital in Baltimore (USA) in the late 19<span class="elsevierStyleSup">th</span> century<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> which became widespread in the past century due to its efficiency.</p><p id="par0025" class="elsevierStylePara elsevierViewall">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.</p><p id="par0030" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">4</span></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.</p><p id="par0035" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">5</span></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 <span class="elsevierStyleItalic">low cost</span> specialists, although unfortunately some doctors and more frequently health administrations tend to treat them as such.</p><p id="par0040" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">6</span></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"><span class="elsevierStyleSup">7</span></a>.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In resident education, surgical and diagnostic skill development is very important but training in moral values is also essential<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></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"><span class="elsevierStyleSup">9</span></a>:</p><p id="par0055" class="elsevierStylePara elsevierViewall">Article 63.</p><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">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.</span></p><p id="par0070" class="elsevierStylePara elsevierViewall">The second reference is found in BOE Order SAS/3072/2009 on the training program of ophthalmology residents:</p><p id="par0075" class="elsevierStylePara elsevierViewall">6.3.6. Teacher physicians must imbue in future ophthalmologists the certainty about practising science with human contents, avoiding dehumanization in their work.</p><p id="par0080" class="elsevierStylePara elsevierViewall">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 17<span class="elsevierStyleSup">th</span> century Spanish writer and later emphasized by Antonio Machado, the 19<span class="elsevierStyleSup">th</span> century poet: <span class="elsevierStyleItalic">Only fools confuse value with price.</span></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">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.</p>" ] ] "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. Pérez Iglesias" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Historia de la Formación Sanitaria especializada en España y sus claves docentes; Educ Med" "fecha" => "2018" "volumen" => "19" "paginaInicial" => "229" "paginaFinal" => "234" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0065" "etiqueta" => "4" "referencia" => array:2 [ 0 => null 1 => null ] ] 4 => array:3 [ "identificador" => "bib0070" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Real Decreto 1146/2006, de 6 de octubre,;1; por el que se regula la relación laboral especial de residencia para la formación de especialistas en Ciencias de la Salud. BOE-A-2006-17498 [accessed 15 Jul 2019]. 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]. Available from: <a target="_blank" href="https://www.boe.es/buscar/pdf/2008/BOE-A-2008-3176-consolidado.pdf">https://www.boe.es/buscar/pdf/2008/BOE-A-2008-3176-consolidado.pdf</a>." ] ] ] 6 => array:3 [ "identificador" => "bib0080" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Decreto 75/2009, de 15 de octubre, por el que se regula la ordenación del sistema de formación sanitaria especializada en el ámbito de la Comunidad de Castilla y León [accessed 15 Jul 2019]. Available from: <a target="_blank" href="http://bocyl.jcyl.es/boletines/2009/10/21/pdf/BOCYL-D-21102009-1.pdf">http://bocyl.jcyl.es/boletines/2009/10/21/pdf/BOCYL-D-21102009-1.pdf</a>." ] ] ] 7 => array:3 [ "identificador" => "bib0085" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Spranzi M. Integrity: Professional Encyclopedia of Global Bioethics DOI 10.1007/978-3-319-05544-2_252-1 [accessed 15 Jul 2019]. Available from: <a target="_blank" href="https://link.springer.com/referenceworkentry/10.1007%2F978-3-319-05544-2_252-1">https://link.springer.com/referenceworkentry/10.1007/978-3-319-05544-2_252-1</a>" ] ] ] 8 => array:3 [ "identificador" => "bib0090" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Consejo General de Colegios Oficiales de Médicos. Código de deontología médica. Guía de Ética Médica. Julio, 2011 [accessed 30 Julio 2019]. Available from: <a target="_blank" href="https://www.cgcom.es/sites/default/files/codigo_deontologia_medica.pdf">https://www.cgcom.es/sites/default/files/codigo_deontologia_medica.pdf</a>." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009400000012/v1_201912161902/S2173579419301902/v1_201912161902/en/main.assets" "Apartado" => array:4 [ "identificador" => "5814" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009400000012/v1_201912161902/S2173579419301902/v1_201912161902/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579419301902?idApp=UINPBA00004N" ]
