Bioethics in teaching gynaecology and obstetrics

El currículo del pregrado de Medicina incluye la práctica clínica dentro de las herramientas para la enseñanza, aunque cada vez se cuenta con docentes más preparados académicamente se requiere de una mayor cualificación de los docentes. El aprendizaje basado en problemas se ha convertido en el método pedagógico más importante para la enseñanza de la medicina pero requiere incluir al paciente como un ser biopsicosocial para una formación integral del futuro profesional de la medicina. En el campo de la ginecología y obstetricia aunque existen recomendaciones éticas sobre la formación médica como directrices de la Federación Internacional de la especialidad se requiere mayores lineamientos sobre el número máximo de estudiantes por docente y la inclusión de un cuerpo docente que incluya la bioética dentro del currículo oculto.The undergraduate medical curriculum includes clinical practice within teaching tools, but increasingly there are more academically prepared teachers are required higher qualifications of teachers. Problem-based learning has become the most important teaching method for teaching medicine but requires including the patient as a biopsychosocial being for a comprehensive professional training future of medicine. In the field of gynecology and obstetrics although there are ethical guidelines on medical training and guidelines of the International Federation of the specialty further guidance on the maximum number of students per teacher and the inclusion of a faculty that includes bioethics it is required within the hidden curriculum

Colombian surgical outcomes study insights on perioperative mortality rate, a main indicator of the lancet commission on global surgery – a prospective cohort studyResearch in context

Summary: Background: Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia. Methods: A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions. Findings: 3807 patients were included with a median age of 48 (IQR 32–64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien–Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68–12.76) and any complication (31.6%, 30.09–33.07). POMR stood at 1.9% (1.48–2.37), with elective and emergency surgery mortalities at 0.7% (0.40–1.23) and 3% (2.3–3.89) respectively. Interpretation: The POMR was higher than the ratio reported in previous national studies, even when patients had a low–risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care. Funding: This work was supported by Universidad del Rosario and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017