Submitted by Erika Demachki (erikademachki@gmail.com) on 2015-05-11T17:24:31Z No. of bitstreams: 4 Dissertação - Heloísa Helena Rodrigues Dias - 2014.pdf: 1577847 bytes, checksum: 18d6b6de9c8de894b1155e0800760591 (MD5) Produto Técnico - Heloísa Helena Rodrigues Dias - 2014.pdf: 293785 bytes, checksum: 20e72a928cb369f284ddbcc0000bfff2 (MD5) Produto Técnico - Mapa Conceitual - Heloísa Helena Rodrigues Dias - 2014.jpg: 274367 bytes, checksum: c9566061688179eedaaa8675ddbed173 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Erika Demachki (erikademachki@gmail.com) on 2015-05-11T17:26:05Z (GMT) No. of bitstreams: 4 Dissertação - Heloísa Helena Rodrigues Dias - 2014.pdf: 1577847 bytes, checksum: 18d6b6de9c8de894b1155e0800760591 (MD5) Produto Técnico - Heloísa Helena Rodrigues Dias - 2014.pdf: 293785 bytes, checksum: 20e72a928cb369f284ddbcc0000bfff2 (MD5) Produto Técnico - Mapa Conceitual - Heloísa Helena Rodrigues Dias - 2014.jpg: 274367 bytes, checksum: c9566061688179eedaaa8675ddbed173 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-05-11T17:26:05Z (GMT). No. of bitstreams: 4 Dissertação - Heloísa Helena Rodrigues Dias - 2014.pdf: 1577847 bytes, checksum: 18d6b6de9c8de894b1155e0800760591 (MD5) Produto Técnico - Heloísa Helena Rodrigues Dias - 2014.pdf: 293785 bytes, checksum: 20e72a928cb369f284ddbcc0000bfff2 (MD5) Produto Técnico - Mapa Conceitual - Heloísa Helena Rodrigues Dias - 2014.jpg: 274367 bytes, checksum: c9566061688179eedaaa8675ddbed173 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-12-09 / INTRODUCTION: This study is about knowing the perception of former students and preceptors relative to the Multidisciplinary Residency in Health at the Federal University of Goiás Public Hospital during the period of 2010 to 2012. OBJECTIVES: To analyze the perception of social workers (preceptors and former students) with respect to their performance, as well as understand the deployment and implementation process of the Multidisciplinary Residency in Health Program (PRMS as the portuguese acronym); identify the necessary skills to labor in the SUS and describe the difficulties encountered in the field of action. METHODS: A descriptive and exploratory study with qualitative approach. The instrument was a semi-structured interview with open questions recorded from five preceptors and twelve former social workers students. The transcribed interviews were submitted to content analysis proposed by Bardin and using the software ATLAS TI. The analyzes were performed taking into account the formation and the professional performance in residence and presented the factors that affect the field of action. RESULTS: It’s necessary to: acquire new knowledges to work in multidisciplinary teams; to develop specific competencies for preceptorship and for work in the SUS; to enhance inter-branch, multi-professional and interpersonal relationships. CONCLUSION: The analysis of the content of the interviews showed that the goals of the health multi-professional residence, specifically in Social Work, have been achieved, though, it is necessary to consider specific actions to improve skills that contribute to the exercise of the preceptor role and to work in the SUS focused on interdisciplinarity and integrality of health care. / INTRODUÇÃO: Este estudo busca conhecer a percepção de preceptores e residentes egressos acerca da Residência Multiprofissional em Saúde ocorrida no Hospital das Clínicas da Universidade Federal de Goiás no período de 2010 a 2012. OBJETIVOS: Conhecer a percepção de assistentes sociais (preceptoras e egressas) em relação à sua atuação, bem como compreender o processo de implantação e implementação do Programa de Residência Multiprofissional em Saúde (PRMS); identificar as competências necessárias quanto ao preparo para o trabalho no SUS e descrever as dificuldades encontradas no campo de atuação. MÉTODOS: Estudo descritivo, exploratório, com abordagem qualitativa. O instrumental utilizado foi entrevista semiestruturada com perguntas abertas, a cinco preceptoras e a doze assistentes sociais egressas. As entrevistas transcritas foram submetidas à análise de conteúdo proposta por Bardin utilizando o software ATLAS TI. As análises foram feitas levando em consideração a formação e a atuação profissional na residência e apresentados os fatores que interferem no campo de atuação. RESULTADOS: Há necessidade de aquisição de novos conhecimentos para o trabalho em equipe multiprofissional; desenvolver competências específicas de preceptoria e para o trabalho no SUS e aprimorar as relações interprofissionais, multiprofissionais e interpessoais. CONCLUSÃO: A análise das entrevistas demonstrou que os objetivos da residência multiprofissional em saúde no Serviço Social foram alcançados, embora, seja necessário pensar em ações específicas para o aprimoramento de competências que contribuam para o exercício da função de preceptor e para o trabalho no SUS focado na interdisciplinaridade e integralidade da atenção em saúde.

Submitted by Adriely Bruce (adriely_bruce@hotmail.com) on 2016-12-16T14:37:15Z No. of bitstreams: 1 Dissertação - Danielle Bezerra Maia.pdf: 1128352 bytes, checksum: d5934a05aa3d62e00465213212384621 (MD5) / Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2016-12-22T14:15:49Z (GMT) No. of bitstreams: 1 Dissertação - Danielle Bezerra Maia.pdf: 1128352 bytes, checksum: d5934a05aa3d62e00465213212384621 (MD5) / Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2016-12-22T14:18:26Z (GMT) No. of bitstreams: 1 Dissertação - Danielle Bezerra Maia.pdf: 1128352 bytes, checksum: d5934a05aa3d62e00465213212384621 (MD5) / Made available in DSpace on 2016-12-22T14:18:26Z (GMT). No. of bitstreams: 1 Dissertação - Danielle Bezerra Maia.pdf: 1128352 bytes, checksum: d5934a05aa3d62e00465213212384621 (MD5) Previous issue date: 2015-09-10 / CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico / The Politics of Permanent Education in Health proposes the practice of transformative actions taking education as a coping strategy in the health / disease. In 2009, it was created by the Ministry of Health and Education Multidisciplinary Residency in Health - RMS as a training modality sharing possibilities and contributions to the consolidation of the principles governing the SUS. In 2010, in Manaus started the first RMS class at the University Hospital of the capital. Motivated by better understand this new reality the research had the general objective: To analyze the Multidisciplinary Residency Program in Health University Hospital Getulio Vargas Manaus, training workers for SUS from the perspective of comprehensiveness. The specific objectives were to examine the theoretical basis leading to oriented training for the NHS and the principles of comprehensiveness and interdisciplinarity; Identify how the principle of comprehensiveness and interdisciplinarity are experienced in teaching and service of RMS; Check the RMS's contribution to the training of workers for SUS from the perspective of those principles. In seeking to achieve these objectives, methodologically the research was a critical approach, qualitative and quantitative techniques. The method procedure was Case Study. The site at the University Getulio Vargas Hospital - HUGV. The sample was intentional and consists of a population of forty-one (41) trained graduates between the years 2012-2015 and twelve (12) multi-professional residents (R2 in 2015) with a total population of fifty-three (53) respondents, these trinte-three (33) agreed to participate. As the technique used the same was due in indirect documentation, through literature and right documentation with the use of evaluative questionnaire techniques using a Likert scale of five points with the graduates and residents and audio recorded interviews with semi-structured only residents. Data were analyzed from the qualitative perspective. The results show that the search for train skilled professionals to work in the SUS RMS is configured as an important strategy. Throughout the assessment in the research it was found that the theoretical and practical basis of the SUS has good concept since 94% of respondents assessed positively. In contrast to the low quality assigned subjects (40%) who treated the principles of multidisciplinary and interdisciplinary. Also were identified in the interviews, some shortcomings such as the organization of practical and theoretical-practical activities in and out of HUGV. Regarding the experiences of the principles of comprehensiveness and interdisciplinarity by the team it was identified that despite the shallow understanding of these principles was possible to notice the change initiative in acting professional front health issues / disease mostly know each other professions (91% ) and manage to identify other needs of users beyond their area of training (70%). Appointed as higher contribution provided by the residence (55%) that they have known and worked in the three health care levels and act in a multidisciplinary team. So the Multidisciplinary Residency is posited as a reality of great potential for change, requiring its expansion within the capital and in the interior of Amazonas state. / A Política de Educação Permanente em Saúde propõe a prática de ações transformadoras tendo a educação como estratégia de enfrentamento no processo saúde/doença. Em 2009, foi criada pelo Ministério da Saúde e da Educação a Residência Multiprofissional em Saúde – RMS como uma modalidade de formação que compartilha possibilidades e contribuições para a consolidação dos princípios que regem o SUS. Em 2010, em Manaus se iniciou a primeira turma de RMS no Hospital Universitário da capital. Motivada por entender melhor essa nova realidade a pesquisa teve por objetivo geral: Analisar o programa de Residência Multiprofissional em Saúde do Hospital Universitário Getúlio Vargas de Manaus, na capacitação de trabalhadores para o SUS sob a ótica da integralidade. Os objetivos específicos foram: conhecer as bases teóricas que conduzem para uma formação voltada para o SUS e para os princípios de integralidade e interdisciplinaridade; Identificar como o princípio de integralidade e a interdisciplinaridade são vivenciados no ensino e no serviço da RMS; Verificar a contribuição da RMS para a formação de trabalhadores para SUS sob a ótica desses princípios. Na busca por alcançar tais objetivos, metodologicamente a pesquisa teve uma abordagem crítica, de natureza qualitativa com técnicas quantitativa. O método de procedimento foi o de Estudo de Caso. O local no Hospital Universitário Getúlio Vargas - HUGV. A Amostra foi intencional sendo constituída por uma população de quarenta e um (41) egressos formados entre os anos de 2012 a 2015 e doze (12) residentes multiprofissionais (R2 em 2015) totalizando um universo de cinquenta e três (53) respondentes, desses trinte e três (33) aceitaram participar da pesquisa. Quanto a técnica utilizada a mesma foi dívida em documentação indireta, por meio da pesquisa bibliográfica e documentação direita com o uso das técnicas de questionário avaliativo usando uma escala Likert de cinco pontos com os egressos e residentes e de entrevistas áudio gravadas com roteiro semiestruturado apenas com os residentes. Os dados foram analisados sob a perspectiva qualitativa. Os resultados apontam que na busca por formar profissionais qualificados para atuarem no SUS a RMS se configura como uma importante estratégia. Ao longo das avaliações realizadas na pesquisa constatou-se que a base teórica e prática sobre o SUS possui bom conceito posto que 94% dos respondentes avaliaram de forma positiva. Em contraste com a baixa qualidade atribuída as disciplinas (40%) que trataram dos princípios de multidisciplinaridade e interdisciplinaridade. Além disso foram apontadas, nas entrevistas, algumas deficiências como a organização das atividades práticas e teórico-práticas dentro e fora do HUGV. Em relação a vivencia dos princípios de integralidade e interdisciplinaridade pela a equipe foi identificado que apesar da rasa compreensão de tais princípios foi possível notar a iniciativa de mudança no agir profissional frente as questões de saúde/doença principalmente por conhecerem melhor as outras profissões (91%) e conseguirem identificar outras necessidades dos usuários para além de sua área de formação (70%). Apontado como maior contribuição proporcionada pela Residência (55%) o fato de terem conhecido e atuado nos três níveis de atenção da saúde e de atuarem em uma equipe multiprofissional. Portanto a Residência Multiprofissional está posta como uma realidade de grande potencial de mudanças, sendo necessário sua ampliação dentro da capital e no interior do Estado do Amazonas

Introdução: A curva de aprendizado em cirurgia é um período de sedimentação de habilidades onde procedimentos são realizados com maior dificuldade e lentidão, maior risco de complicações intra-operatórias e menor eficácia clínico-funcional devido à inexperiência do cirurgião. Nós analisamos a curva de aprendizado inicial da prostatectomia radical retropúbica realizada por médicos residentes do Setor de Uro-Oncologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Método: estudo prospectivo, envolvendo 184 prostatectomias radicais retropúbicas, realizadas por cinco residentes consecutivamente, entre 02/06/2006 e 31/01/2008. Foram considerados: o tempo operatório, sangramento transoperatório, necessidade de transfusão sanguínea, taxa de margens cirúrgicas comprometidas, complicações intra-operatórias e avaliação funcional precoce. Resultados: cada residente realizou em média 37 cirurgias. O PSA mediano foi de 9,3 ng/mL e o estágio clínico T1c em 71% dos pacientes. O estágio patológico foi pT2 (73%), pT3 (23%), pT4 (4%); o escore de Gleason na peça cirúrgica foi de 54% (Gleason <7), 33% (Gleason 7) e 13% (Gleason >7). O tempo cirúrgico mediano foi de 140 minutos, o sangramento mediano de 488 mL e a necessidade de transfusão sanguínea de 7,2%. A taxa de margens cirúrgicas positivas de 23% foi constante nos 30 primeiros casos. A avaliação funcional precoce (até 6 meses de pós-operatório) mostrou 89% de continência, 57% de disfunção erétil e 7% de recidiva bioquímica. Conclusão: Durante a curva de aprendizado da prostatectomia radical, ocorre redução significativa do tempo operatório após 20 cirurgias e tendência de redução do sangramento e da necessidade de transfusão sanguínea após 29 cirurgias. As margens cirúrgicas permanecem estáveis em 23%. / Introduction: The learning curve is a period of skills improvement. Procedures are carried through with longer operating time, high risk of surgical complications and sub optimal functional outcomes. We have analyzed the residents\' initial learning curve in open radical prostatectomy in our institution. Method: Between June of 2006 and January of 2008, 184 open radical prostatectomies have been performed in our service by five senior residents in Urology. We prospectively evaluated: operating time, blood loss, blood transfusion rate, positive surgical margins, intra-operative complications and early functional outcomes. Results: an average of 37 open radical prostatectomies was performed by each resident. Medium PSA was 9,3ng/mL; clinical stage T1c in 71% of the patients. The pathological stage was pT2 (73%), pT3 (23%), pT4 (4%) and Gleason score was 54% (Gleason <7), 33% (Gleason 7) and 13% (Gleason >7). The medium operating time was 140 minutes, medium blood loss of 488 mL and positive margins were found in 23% during the first 30 cases. Early functional outcomes (less than 6 months after surgery) revealed 89% of urinary continence, 43% of normal erectile function and 7% of biochemical recurrence. Conclusion: During the initial learning curve significant reduction in operating time occurs after first 20 procedures, blood loss and transfusion improves after 29 prostatectomies and positive margins remain stable during the first 30 patients (23%).

Anualmente, a Secretaria de Estado da Saúde de São Paulo (SES/SP) realiza o Concurso SUS-SES/SP para o preenchimento de vagas de RM oferecidas pelas instituições participantes, nas diferentes especialidades médicas. Partindo da compreensão que a decisão pela especialidade é um momento singular na trajetória da profissão médica, e que, a RM desempenha um importante papel para o sistema de saúde; este trabalho objetivou conhecer a tendência da demanda por especialidades médicas tomando como referência, o universo dos candidatos que se inscreveram no Concurso SUS, no período entre 1999 e 2004. Dentre as especialidades que contaram com aumento na procura estão a Anestesiologia, Cirurgia Cardiovascular, Cirurgia Oncológica, Cirurgia Plástica, Clínica Médica, Dermatologia, Endocrinologia e Psiquiatria. As especialidades que apresentaram queda na procura foram Cirurgia de Cabeça e Pescoço, Gastroenterologia, Oftalmologia, Pediatria e Pneumologia / Annually, the Secretaria de Estado da Saúde de São Paulo (SES/SP) opens Single Health System SES/SP Medical Residency Contest offered by participant institutions in different medical specialties. The public selection process has been held in partnership with Fundação Carlos Chagas for more than fifteen years. Currently, this process counts with almost six thousand candidates enrolled from several regions of Brazil. Assuming that making decision for specialty is a very singular moment for medical career, and that, Medical Residency conducts an important function for Health System; this research aims to point out tendencies for medical specialties, using the amount of enrolled candidates for SUS Contest, between 1999 and 2004, as reference. Therefore, the number of inscriptions raised 18% in this period, distinguishing male predominance. Considering candidates hometown, 52% lived outside Sao Paulo State in the moment of contest inscription, making evident the attractive potential for doctors from different regions of Brazil. In terms of numbers, basic specialties took part in half inscriptions in this period. In terms of numbers, basic specialties took part in half inscriptions in this period. The specialties with raised number of searching were Anesthesiology, Surgery Cardiovascular, Oncology Surgery, Plastic Surgery, General Internal Medicine, Dermatology, Endocrinology and Psychiatry. The specialties with decreased number of searching were Head and Neck Surgery, Gastroenterology, Ophthalmology, Pediatrics and Pneumology

A Residência Multiprofissional em Saúde pretende ser uma nova estratégia para políticas de educação permanente que enfoca diversas categorias profissionais da área de saúde e favorece a produção das condições necessárias para mudanças no perfil profissional para prepará-los para uma atuação na perspectiva da atenção integral à saúde. Este trabalho objetiva analisar o processo de formação do cirurgião-dentista do curso de Residência Multiprofissional em Saúde da Família (RMSF) da Casa de Saúde Santa Marcelina (CSSM), a partir da visão do egresso. Foram entrevistados os egressos da primeira turma desta residência. Os discursos foram analisados segundo a metodologia qualitativa pelo método da análise de conteúdo temática proposta por Bardin. A análise gerou quatro categorias. Na primeira A vivência no serviço preparando o residente observou-se que a articulação entre ensino e serviço na residência multiprofissional possibilitou uma imersão do egresso no campo de prática. A partir da vivência no serviço o aluno/profissional pode enfrentar as dificuldades existentes nos processos de trabalho e na organização do serviço refletindo e construindo conhecimentos importantes para sua formação profissional. Na segunda - Trabalhando em equipe multiprofissional: desafios e aprendizados observou-se as modificações que o trabalho em equipe proporcionou aos residentes que puderam refletir sobre o processo de trabalho no Programa de Saúde da Família e a interação entre essas categorias possibilitou uma nova abordagem no cuidado à saúde. Foi possível observar também que os residentes experimentaram as dificuldades que existem no trabalho em equipe. A lógica do trabalho multiprofissional impõe uma prática diferente daquela que os profissionais estão acostumados. Na terceira - Importância de dois atores no processo de formação: tutores e preceptores verificou-se que os tutores e preceptores desempenham papéis importantes na RMSF. Os tutores orientam o residente na sua formação e os preceptores exercem uma função indispensável na mediação das relações entre coordenação-residente-tutor. Foi possível observar que estes papéis não estavam bem definidos pelos atores envolvidos no processo de formação o que dificultou o enfretamento de alguns problemas vivenciados pelos residentes na prática. Torna-se evidente um melhor preparo destes profissionais para que as práticas pedagógicas aplicadas na residência sejam operadas a contento. Por fim a quarta categoria - Apresentando os nós críticos: do aluno, do serviço e do curso apontou alguns entraves encontrados no processo de formação: a imaturidade do recém formado: visão restrita da graduação em relação ao serviço público; despreparo do serviço em receber o residente e problemas estruturais e organizacionais da residência. Por fim, foi possível observar que a formação na RMSF da CSSM proporcionou aos egressos a percepção, o aprendizado, e o exercício de novos saberes, competências, habilidades e atitudes, tais como: atuação multiprofissional e interdisciplinar, promoção e educação em saúde, humanização e personalização do atendimento, concepção ampliada de saúde, novas relações entre profissionais de saúde e entre estes e a população. Pelos relatos dos egressos, esses e outros elementos, ainda que percebidos muitas vezes de forma fragmentada, foram identificados como componentes importantes de um novo modelo de atenção à saúde. / The Multidisciplinary Residency in Health aims to be a new strategy for permanent learning policies that focus on various categories of health professionals and promotes the production of the necessary conditions for changes in professional profile to prepare them for a performance from the perspective of comprehensive health care. The objective of this paper is to analyze the process of training of dentists in al Multidisciplinary Residency in Family Health (MRFH) at the Casa de Saúde Santa Marcelina (CSSM), from the perspective of the graduate. The first group of graduates of the residence was interviewed. The reports were analyzed according to qualitative methodology by the method of thematic content analysis proposed by Bardin. The analysis produced four categories. The first - The experience in service preparing the student - it was observed that the linkage between education and service to the student provided a multi-immersion of the graduates in terms of professional practice. From the experience in the service the student / professional can face the existing difficulties in work processes and organization of service reflecting and constructing knowledge relevant to their professional training. The second - Working in multi-professional teams: challenges and learning - the changes observed that teamwork provided to residents who might reflect on the process of working in the Family Health Program and the interaction between these categories provided a new approach to health care. It was also observed that students have experienced the difficulties that exist in teamwork. The logic of multi-professional work requires a different practice from what the professionals are accustomed. In the third - The importance of two actors in the process of education: mentors and tutors - it was observed that tutors and mentors play important roles in the MRFH. Tutors guide the student in his training and have a crucial role in mediating the relationships between coordination-student-tutor. It was observed that these roles were not well defined by the actors involved in the training process making it difficult to confront with some problems experienced by residents in practice. It is clearly evident the better preparation of these professionals for the pedagogical practices applied to the residence to be operated satisfactorily. Finally the fourth category - Introducing the critical questions: the student, service and the course - pointing out some obstacles encountered in the training process: the immaturity of the newly formed: restricted view of the undergraduation related to public service, lack of preparation of the care service to receive the students and organizational and structural problems of the course. It was also observed that the formation of MRFH in CSSM gave the students perception, learning, and the pursuit of new knowledge, skills, abilities and attitudes, such as multidisciplinary and interdisciplinary promotion and health education, humanization and personalization of care, expanded concept of health, new relationships between professionals and between them and the population. According to the reports of graduates, these and other factors, though often perceived as fragmented, were identified as important components of a new model of health care.

Orientador: Keila Miriam Monteiro de Carvalho / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T22:28:51Z (GMT). No. of bitstreams: 1 Millan_Tatiana_D.pdf: 832401 bytes, checksum: a7fe03bf52a6548852d38fb545a91e2e (MD5) Previous issue date: 2012 / Resumo: Introdução: Os programas de residência médica em oftalmologia credenciados pelo Ministério de Educação são avaliados baseados em critérios objetivos e podem não refletir as percepções que os egressos desses programas têm sobre sua formação. Há poucos estudos no Brasil que avaliaram se as habilidades necessárias para a prática estão sendo adequadamente adquiridas ou como os egressos dos programas de residência percebem a aquisição dessas habilidades. Objetivos: Verificar as percepções de médicos oftalmologistas egressos de programas de residência médica em oftalmologia do estado de São Paulo nos últimos 5 (cinco) anos sobre como sua residência médica os preparou para a prática, verificando o nível de satisfação dos egressos quanto à aquisição de conhecimentos clínicos, à aquisição de habilidades cirúrgicas e ao desenvolvimento da relação médico-paciente e identificando possíveis deficiências no ensino da oftalmologia nas diversas áreas clínicas e cirúrgicas. Material e Métodos: O instrumento de pesquisa utilizado foi um questionário, elaborado com base nos critérios exigidos para credenciar os programas de residência em oftalmologia pelo Conselho Brasileiro de Oftalmologia, com perguntas estruturadas e uma escala do tipo Likert para avaliar o nível de satisfação dos egressos quanto ao seu curso de residência. A amostra calculada foi de 206 sujeitos para um nível de significância de 5%. O questionário foi aplicado através de correio eletrônico de janeiro a dezembro de 2010. Resultados: Duzentos e onze egressos de programas de residência em oftalmologia do estado de São Paulo responderam ao questionário, sendo 95 do sexo feminino e 116 do sexo masculino. Os níveis de satisfação encontrados foram: 89,1% estavam extremamente ou muito satisfeitos com a aquisição de conhecimento clínico, 93,4% estavam extremamente ou muito satisfeitos com a aquisição de habilidades cirúrgicas e 74,9% estavam extremamente ou muito satisfeitos com o desenvolvimento da relação médico-paciente. Em cada uma das áreas clínicas e cirúrgicas foi avaliada a percepção ou não de deficiência no ensino. As áreas clínicas em que eles perceberam mais deficiência foram órbita (48,3%) e patologia ocular (47,9%) e as áreas cirúrgicas foram cirurgia refrativa (65,9%) e cirurgia orbitária (59,2%). Análise estatística mostrou que quanto maior o tempo que haviam terminado a residência, maior era a satisfação dos egressos com a aquisição de conhecimento clínico (Coeficiente de Correlação de Pearson r=0,292, p<0,001) e menor era a percepção de deficiência nas áreas de uveíte (p=0,017), emergência (p=0,012) e órbita clínica (p=0,048) e cirúrgica (p=0,044). Na cirurgia refrativa, porém, quanto mais tempo de prática de oftalmologia, mais frequente foi à percepção de deficiência (p<0,001). A Razão de Chances (Odds Ratio) de perceber deficiência na área cirúrgica quando havia deficiência na área clínica correlacionada era estatisticamente significativa para todas as áreas exceto para as áreas correlacionadas refração e cirurgia refrativa. Conclusões: As percepções de egressos de programas de residência médica em oftalmologia do estado de São Paulo mostraram um bom nível de satisfação dos mesmos com sua residência na aquisição de conhecimento clínico, aquisição de habilidades cirúrgicas e desenvolvimento da relação médico-paciente, tendo sido identificadas deficiências no ensino de áreas específicas / Abstract: Introduction: The ophthalmology residency training programs accredited by the Ministry of Education are evaluated based on objective criteria and may not reflect the perceptions of graduates about their training. There are few studies in Brazil that evaluated whether the skills needed to practice are being properly acquired or how the graduates of residency programs perceive the acquisition of these skills. Objectives: To verify the perceptions of ophthalmologists graduates of residency programs in ophthalmology in the state of São Paulo in the last five (5) years regarding on how their residency prepared them for practice, checking the level of satisfaction of graduates with the acquisition of knowledge clinical, acquisition of surgical skills and development of doctor-patient relationship and identifying possible deficiencies in the teaching of ophthalmology in several clinical and surgical areas. Material and Methods: The survey instrument used was a questionnaire developed based on the criteria for accrediting of ophthalmology residency training programs by the Brazilian Council of Ophthalmology, with structured questions and a Likert scale to assess the level of satisfaction of the graduates with their residency training program. The calculated sample was of 206 subjects for a significance level of 5%. The questionnaire was administered by electronic mail from January to December 2010. Results: Two hundred and eleven graduates of residency programs in ophthalmology in the state of São Paulo answered the questionnaire, 95 females and 116 males. Satisfaction levels were: 89.1% were extremely or very satisfied with the acquisition of clinical knowledge, 93.4% were extremely or very satisfied with the acquisition of surgical skills and 74.9% were extremely or very satisfied with the development of the doctor-patient relationship. The perceptions of deficiency in the teaching of each of the clinical and surgical areas were assessed. The clinical areas that they had perceived more deficiency were orbit (48.3%) and ocular pathology (47.9%) and the surgical areas were refractive surgery (65.9%) and orbital surgery (59.2%). Statistical analysis showed that the longer the time they had finished the residence, the greater the satisfaction of graduates with the acquisition of clinical knowledge (Pearson Correlation r = 0292, p <0.001) and the smaller the perception of deficiency in uveitis (p = 0.017), emergency (p = 0.012) and clinical orbit (p = 0.048) and surgical orbit (p = 0.044). In refractive surgery, however, the longer the practice of ophthalmology, the more common the perception of deficiency (p <0.001). The odds ratio (odds ratio) for perceiving a surgical area deficiency when there was deficiency in the correlated clinical area was statistically significant for all areas except for the areas of refraction and refractive surgery. Conclusions: Perceptions of graduates from ophthalmology residency training programs in the state of São Paulo showed a good level of satisfaction with their residency training program in the acquisition of clinical knowledge, acquisition of surgical skills and development of surgical doctor-patient relationship and identified deficiency in the teaching of specific areas / Doutorado / Oftalmologia / Doutora em Ciências Médicas

Cette Thèse a pour objet d’identifier les règles qui s’appliquent aux travailleurs mobiles qui s’impatrient en France et ceux qui s’expatrient hors de France et d’en déterminer les conséquences fiscales. Une des problématiques majeures sera celle de la détermination de la résidence fiscale de ces individus mobiles afin d’en déduire les règles qui s’appliquent à eux, tout en tenant compte de la spécificité de chaque situation. Il conviendra de s’intéresser aux mesures et régimes issus de notre droit interne mais aussi à ceux issus du droit conventionnel. En effet, les Conventions fiscales prévoient des règles spécifiques afin que les contribuables ne soit pas imposés plus d’une fois sur les mêmes revenus. Il conviendra de mesurer le champ d’application des règles fiscales particulières prévues pour ces travailleurs dans le contexte de mobilité internationale que nous connaissons / The purpose of this Thesis is to identify the applicable rules for mobile workers, defined as individuals who chose to either move to France for work or become expatriates working abroad, and the tax consequences related to such mobility. One of the main points will be to determine the tax residency of such individuals in order to identify the applicable treatments, by taking into account the specificity of each situation. We will examine the rules and special treatments raised by not only our internal law but by tax treaties as well. Indeed, tax treaties set forth special rules in order to avoid tax payers from being taxed several times on the same income. We will identify the particular tax rules’ field of application that applies for these workers in the context of international mobility

Background: Studies have demonstrated that new graduate nurses' (NGNs) transition experience is complex and often negative leading to dissatisfaction with nursing and increased attrition. Many existing studies of NGNs' transition experience are small, qualitative, concerned with NGNs experiences in the West. No study has been conducted to date examining NGNs' transition experience in any of the developing countries where the cultural context and nursing education and practice are different to those in the West. Aim: To explore the experience of NGNs during their transition period in one of the developing countries, the Sultanate of Oman. Method: Qualitative case study utilising an embedded-single case design was conducted to investigate the transition experience of baccalaureate NGNs graduating from Sultan Qaboos University (SQU) and working at Sultan Qaboos University Hospital (SQUH). Data were collected from the perspective of NGNs and also from the perspective of other key informants using triangulated methods. This includes individual and focus group interviews, observation and documentary analysis. Results: Four over-arching themes are identified from NGNs' transition experience in the Sultanate of Oman. These are 'Studying Experience'; 'Role Transition'; 'Working Conditions' and 'Status of the Nursing Profession'. This study showed that nursing is not an attractive choice for Omani students to study and pursue as a future career because of its low status. During the transition period, NGNs experienced reality shock which mainly resulted from a theory-practice gap. NGNs had limited practical experience but a high level of theoretical knowledge, which they were unable to utilise in practice. They found the working environment to involve many competing priorities resulting in task-orientation and compromised patient care. This study showed that many NGNs resented their involvement in basic nursing care, which they believed should not be part of their role as degree nurses. Despite the challenges of the transition period, many NGNs remarked that nurses play the most important role at the hospital and they are proud being nurses. Conclusion: Omani NGNs' transition experience is complex and similar in many respects to NGNs experience in the West. However, there are distinctive challenges Omani NGNs faced due to the Omani culture, working environment and the status of nursing in Oman.

Access to health care in rural communities is challenged by workforce shortages. Nurse practitioners (NPs) have been filling the gap created by physician migration into specialty areas. Flex hospital legislation allows critical access hospitals (CAHs) to staff the emergency department with NPs or physician assistants without on-site physicians. NP education often lacks emergency and trauma curriculum, resulting in gaps in education and practice expectations and leading to significant role transition stress and turnover. The purpose of this project was to construct an evidence-based transition-to-practice residency program to support NPs providing emergency department care in the CAH. Theoretical frameworks used to guide the project include rural health theory, novice to expert, and from limbo to legitimacy frameworks. Global outcomes include increased quality of care, patient safety, NP job satisfaction, and decreased turnover. The quality improvement initiative engaged an interprofessional team of institutional and community stakeholders (n = 10) to develop primary products including the residency program, curriculum modules, and the secondary products necessary to implement and evaluate the project. Implementation will consist of a pilot followed by expansion throughout the rural health network. Evaluation will involve the CAH dashboard to monitor patient outcomes, Misener NP job satisfaction scale, and employee turnover rates. The project expands understanding of the on-boarding needs of rural NPs. The results of this project will serve as a guide to publish outcome data and collaborate with higher education to develop programs to award academic credit for paid clinical experiences leading to academic degrees.

Healthcare agencies and stakeholders expect registered nurses to be competent at all times. When nurses are not confident in competencies, negative patient outcomes can occur. The purpose of this quantitative quasiexperimental with posttest only study was to investigate Quality and Safety Education for Nurses (QSEN) competency confidence levels of 2 groups of new nurses who had 5-6 months of clinical experience. Framed by the Duchscher theory and the QSEN framework, the research question was developed to examine the differences between QSEN competency confidence levels of new nurses who participated in a prelicensure program plus a residency program and nurses who only attended the residency program. Sixty-eight new nurses from 1 health facility answered the Nursing Quality and Safety Self-Inventory (NQSSI). An independent t test was used to compare each knowledge, skills, and attitudes (KSA) QSEN competency confidence levels for two groups. The results of this study demonstrated a difference between QSEN competency confidence levels between the 2 groups, but not all 18 NQSSI items reached a statistically significant difference. The 7 items that reached a statistically significant difference included the QSEN competency confidence level in knowledge and skills in evidence-based practice, quality improvement, and informatics. A statistically significant difference was also noted in the QSEN competency confidence level for patient-centered care skills. A 3-day professional development (PD) workshop was developed based on the results. Participating in the PD workshop could further increase the new nurses' QSEN competency confidence levels which can enhance patient outcomes resulting in positive social change.