BackgroundThe choice of medical specialty is related to multiple factors, students’ values, and specialty perceptions. Research in this area is needed in low- and middle-income countries, where the alignment of specialty training with national healthcare needs has a complex local interdependency. The study aimed to identify factors that influence specialty choice among medical students.MethodsSenior students at the National Autonomous University of Mexico (UNAM) Faculty of Medicine answered a questionnaire covering demographics, personal experiences, vocational features, and other factors related to specialty choice. Chi-square tests and factor analyses were performed.ResultsThe questionnaire was applied to 714 fifth-year students, and 697 provided complete responses (response rate 81%). The instrument Cronbach’s alpha was 0.8. The mean age was 24 ± 1 years; 65% were women. Eighty percent of the students wanted to specialize, and 60% had participated in congresses related to the specialty of interest. Only 5% wanted to remain as general practitioners. The majority (80%) wanted to enter a core specialty: internal medicine (29%), general surgery (24%), pediatrics (11%), gynecology and obstetrics (11%) and family medicine (4%). The relevant variables for specialty choice were grouped in three dimensions: personal values that develop and change during undergraduate training, career needs to be satisfied, and perception of specialty characteristics.ConclusionsSpecialty choice of medical students in a middle-income country public university is influenced by the undergraduate experience, the desire to study a subspecialty and other factors (including having skills related to the specialty and type of patients).
La elección de una especialidad médica es un proceso que está determinado por múltiples factores, tales como las características demográficas, necesidades y valores del estudiante o su percepción de las distintas especialidades. La elección de la especialidad es importante tanto para los estudiantes como para los sistemas de salud, pues desde los años 90 se ha observado un incremento en la cantidad de subespecialistas y una tendencia a elegir de forma menos frecuente especialidades relacionadas con la atención primaria (medicina general, medicina familiar, medicina interna o pediatría). Otras opciones de formación al terminar la carrera de medicina (investigación, docencia, otro posgrado), dependen fuertemente de la exposición del estudiante a estas opciones durante los años clínicos, al igual que optar por opciones menos conocidas (médicas o quirúrgicas) depende de haber rotado por las mismas durante la formación clínica. En algunos casos el estudiante ya ha tomado la decisión desde el principio (o antes) de la formación médica, como en el caso de aquellos que seleccionan especialidades quirúrgicas, pero en el resto la elección parece tomarse posteriormente. En esta revisión evaluamos los factores relacionados con la elección de una especialidad (con un énfasis particular en México y América Latina), de acuerdo con el modelo de elección de Bland-Meurer.
Morbidly obese patients are at increased risk for structural and functional abnormalities of the heart. This paper summarizes the effects of obesity on the heart, the effect of weight reduction on cardiac function, the impact of coronary artery disease on cardiac cardiomyopathy, and our experience in obesity heart disease at the Instituto Nacional de la Nutrición in Mexico.
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