IntroductionEmergency medicine (EM) is in different stages of development around the world. Colombia has made significant strides in EM development in the last two decades and recognized it as a medical specialty in 2005. The country now has seven EM residency programs: three in the capital city of Bogotá, two in Medellin, one in Manizales, and one in Cali. The seven residency programs are in different stages of maturity, with the oldest founded 20 years ago and two founded in the last two years. The objective of this study was to characterize these seven residency programs.MethodsWe conducted semi-structured interviews with faculty and residents from all the existing programs in 2013–2016. Topics included program characteristics and curricula.ResultsColombian EM residencies are three-year programs, with the exception of one four-year program. Programs accept 3–10 applicants yearly. Only one program has free tuition and the rest charge tuition. The number of EM faculty ranges from 2–15. EM rotation requirements range from 11–33% of total clinical time. One program does not have a pediatric rotation. The other programs require 1–2 months of pediatrics or pediatric EM. Critical care requirements range from 4–7 months. Other common rotations include anesthesia, general surgery, internal medicine, obstetrics, gynecology, orthopedics, ophthalmology, radiology, toxicology, psychiatry, neurology, cardiology, pulmonology, and trauma. All programs offer 4–6 hours of protected didactic time each week. Some programs require Advanced Cardiac Life Support, Pediatric Advanced Life Support and Advanced Trauma Life Support, with some programs providing these trainings in-house or subsidizing the cost. Most programs require one research project for graduation. Resident evaluations consist of written tests and oral exams several times per year. Point-of-care ultrasound training is provided in four of the seven programs.ConclusionAs emergency medicine continues to develop in Colombia, more residency programs are expected to emerge. Faculty development and sustainability of academic pursuits will be critically important. In the long term, the specialty will need to move toward certifying board exams and professional development through a national EM organization to promote standardization across programs.
Objectives In the 2016 Peace Accord with the Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised to reincorporate 14,000 ex‐combatants into the healthcare system. However, FARC ex‐combatants have faced significant challenges in receiving healthcare, and little is known about physicians’ abilities to address this population's healthcare needs. Methods An electronic questionnaire sent to the Colombian Emergency Medicine professional society and teaching hospitals assessed physicians’ knowledge, attitudes, and experiences with the FARC ex‐combatant reincorporation process. Results Among 53 participants, most were male (60.4%), and ∼25% were affected by the FARC conflict (22.6%). Overall knowledge of FARC reincorporation was low, with nearly two‐thirds of participants (61.6%) scoring in the lowest category. Attitudes around ex‐combatants showed low bias. Few physicians received training about reincorporation (7.5%), but 83% indicated they would like such training. Twenty‐two participants (41.5%) had identified a patient as an ex‐combatant in the healthcare setting. Higher knowledge scores were significantly correlated with training about reincorporation (r = 0.354, n = 53, P = 0.015), and experience identifying patients as ex‐combatants (r = 0.356, n = 47, P = 0.014). Conclusion Findings suggested high interest in training and low knowledge of the reincorporation process. Most physicians had low bias, frequent experiences with ex‐combatants, and cared for these patients when they self‐identify. The emergency department (ED) serves as an entrance into healthcare for this population and a potential setting for interventions to improve care delivery, especially those related to mental healthcare. Future studies could evaluate effects of care delivery following training on ex‐combatant healthcare reintegration.
Introduction Globally, medical students have demonstrated knowledge gaps in emergency care and acute stabilization. In Colombia, new graduates provide care for vulnerable populations. The World Health Organization (WHO) Basic Emergency Care (BEC) course trains frontline providers with limited resources in the management of acute illness and injury. While this course may serve medical students as adjunct to current curriculum, its utility in this learner group has not been investigated. This study performs a baseline assessment of knowledge and confidence in emergency management taught in the BEC amongst medical students in Colombia. Methods A validated, cross-sectional survey assessing knowledge and confidence of emergency care congruent with BEC content was electronically administered to graduating medical students across Colombia. Knowledge was evaluated via 15 multiple choice questions and confidence via 13 questions using 100 mm visual analog scales. Mean knowledge and confidence scores were compared across demographics, geography and prior training using Chi-Squared or one-way ANOVA analyses. Results Data were gathered from 468 graduating medical students at 36 institutions. The mean knowledge score was 59.9% ± 23% (95% CI 57.8–62.0%); the mean confidence score was 59.6 mm ±16.7 mm (95% CI 58.1–61.2). Increasing knowledge and confidence scores were associated with prior completion of emergency management training courses (p<0.0001). Conclusion Knowledge and confidence levels of emergency care management for graduating medical students across Colombia demonstrated room for additional, specialized training. Higher scores were seen in groups that had completed emergency care courses. Implementation of the BEC as an adjunct to current curriculum may serve a valuable addition.
Background Following the 2016 Peace Agreement with the Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised to reincorporate more than 13,000 guerrilla fighters into its healthcare system. Despite a subsidized healthcare insurance program and the establishment of 24 Espacios Territoriales de Capacitación y Reincorporación (ETCRs—Territorial Spaces for Training and Reintegration) to facilitate this transition, data has shown that FARC ex-combatants access care at disproportionately lower rates, and face barriers to healthcare services. Methods Semi-structured interviews were conducted with FARC health promoters and healthcare providers working in ETCRs to determine healthcare access barriers for FARC ex-combatants. Analysis was completed with a qualitative team-based coding method and barriers were categorized according to Julio Frenk’s Domains of Healthcare Access framework. Results Among 32 participants, 25 were healthcare providers and 7 self-identified as FARC health promoters. The sample was majority female (71.9%) and worked with the FARC for an average of 12 months in hospital, health center, medical brigade, and ETCR settings. Our sample had experiences with FARC across 16 ETCRs in 13 Departments of Colombia. Participants identified a total of 141 healthcare access barriers affecting FARC ex-combatants, which affected healthcare needs, desires, seeking, initiation and continuation. Significant barriers were related to a lack of resources in rural areas, limited knowledge of the Colombian health system, the health insurance program, perceived stigma, and transition process from the FARC health system. Conclusions FARC ex-combatants face significant healthcare access barriers, some of which are unique from other low-resource populations in Colombia. Potential solutions to these barriers included health insurance provider partnerships with health centers close to ETCRs, and training and contracting FARC health promoters to be primary healthcare providers in ETCRs. Future studies are needed to quantify the healthcare barriers affecting FARC ex-combatants, in order to implement targeted interventions to improve healthcare access.
We present a hybrid algorithm based on Genetic Algorithms and Discrete Event Simulation that computes the algorithmic-optimal location of emergency resources. Parameters for the algorithm were obtained from computed historical statistics of the Bogotá Emergency Medical Services. Considerations taken into account are: (1) no more than a single resource is sent to an incident, (2) resources are selected according to incidentpriorities (3) distance from resource base to incident location is also considered for resource assignment and (4) all resources must be used equally. For every simulation, a different set of random incidents is generated so it’s possible to use the algorithm with an updated set of historical incidents. We found that the genetic algorithm converges so we can consider its solution as an optimal. With the algorithmic-optimal solution we found that arrival times are shorter than the historical ones. It’s also possible to compute the amount of required resources to reduce even more the arrival times. Since every Discrete Event Simulation takes a considerable amount of time the whole algorithm takes a heavy amount of time for large simulation time-periods and for many individuals for generation in the genetic algorithm, so an optimization approach is the next step in our research. Also, less restricted considerations must be taken into account for future developments in this topic.
In this paper, we propose a hybrid optimization method to compute a reallocation of ambulances to obtain improved response times. As we want to minimize response times by changing ambulances allocations, we develop a hybrid algorithm based on a genetic algorithm, with randomized ambulances configurations as population individuals. Also, we embed into the genetic algorithm discrete event simulations to model the reporting, assignment, travel, and attendance processes. We later find that the algorithm optimizes the response times for simulated events, even though these times don’t yet compare to response times found in real data. So, we need to evaluate any improvement in real response times. As a study case, we use data from 2014 to 2017 provided by the health authority of Bogotá, Colombia, that contains real values of emergency medical incidents, and the quantity and type of ambulances that attended such incidents.
El triaje permite la priorización de pacientes según su urgencia médica. Se propone realizar un modelo estadístico correlacionado con mortalidad para generación de alertas desde el triaje. Una cohorte prospectiva de 6438 adultos que ingresaron a urgencias del Hospital Universitario San Ignacio, del 01/03/2018 al 28/02/2019. Se dividieron aleatoriamente los datos en entrenamiento y prueba. Sobre los datos de entrenamiento se realizó una regresión logística bivariada entre triaje y mortalidad y luego una regresión logística multivariada, se redujo el modelo mediante pruebas de razón de verosimilitud. En los datos de prueba se realizaron áreas bajo la curva (AUC) para cálculo de punto de corte. Fue evaluado mediante medidas de asociación. Se realizaron áreas bajo la curva para los modelos realizados, encontrando el modelo “triage” con de AUC 0.82, “reducido” una AUC 0.90 y “Edad+sistólica” una AUC 0.87, sin diferencia significativa. Se seleccionó “reducido” con una Sensibilidad 0.869, Especificidad 0.842, VPP: 0.062, VPN: 0.998 Para seleccionar punto de corte, se realizó un árbol de decisiones teniendo en cuenta las variables significativas encontrando mayor mortalidad en pacientes triage 1-2, con TAS menor de 117mmHg y mayores de 58 años. El modelo final podría funcionar como tamización para generación de alarmas de mortalidad en triaje iguales. Palabras Clave: Medicina de Urgencias, Servicios Médicos de Urgencia, Triaje, Mortalidad, Indicadores de Salud
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