Original article
Fifth-year internal medicine residents in Spain: A survey on education, assessment of competencies and job perspectives
Residentes de medicina interna de quinto año en España: encuesta sobre educación, evaluación de competencias y perspectivas de empleo
C. Macía-Rodrígueza,
, M.L. López Reboirob, D. Martín Iglesiasc, A. González-Munerad, J. Moreno Diaze, A. Montaño Martínezf, G. Ortiz Llauradóg, P. Demelo-Rodríguezh, C. Muñoz Muñozi, F. Salgado Ordoñezj
Corresponding author
a Servicio de Medicina Interna, Hospital POVISA, Vigo, Pontevedra, Spain
b Servicio de Medicina Interna, Hospital Comarcal de Monforte de Lemos, Monforte de Lemos, Lugo, Spain
c Servicio de Medicina Interna, Hospital de Cruces, Barakaldo, Vizcaya, Spain
d Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, Spain
e Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain
f Servicio de Medicina Interna, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
g Servicio de Medicina Interna, Hospital de Terrassa-Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
h Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, Spain
i Servicio de Medicina Interna, Hospital General de Cataluña, Sant Cugat del Vallès, Barcelona, Spain
j Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain
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=> "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Medicina Interna, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital de Terrassa-Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital General de Cataluña, Sant Cugat del Vallès, Barcelona, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain" "etiqueta" => "j" "identificador" => "aff0050" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Residentes de medicina interna de quinto año en España: encuesta sobre educación, evaluación de competencias y perspectivas de empleo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 851 "Ancho" => 1583 "Tamanyo" => 56160 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Percentage of residents who had a job offer or had received support from their boss for finding work according to the size of the training hospital.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Specialist training in Spain is based on gradually acquiring expertise, skills and responsibilities to conduct the exercise of these professions in the future.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1,2</span></a> In terms of the internal medicine specialty, the last training program dates from 2007.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a> For years now, there has been a series of legislative moves to promote a substantial change in both the training process and the assessment of our residents.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although the residents’ opinion should be considered when improving the quality of their training,<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">5,6</span></a> the reality in Spain is that specialists are still trained through inertia without there being a self-critique of the system.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The Training Group of the Spanish Society of Internal Medicine (SEMI) has therefore sought to determine residents’ opinion both on the teaching and occupational aspects of their residence period.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This was a cross-sectional, multicenter descriptive study based on an online survey of fifth-year residents during February and March 2017.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The survey was conducted using the Google Drive® application and analyzed the following thematic blocks:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0030" class="elsevierStylePara elsevierViewall">Demographic: age, sex, characteristics of the centers and of the training departments</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Satisfaction with the specialty: satisfaction with the training program and perceived shortcomings</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Mentoring and supervision: presence of educational pathways and perceived degree of supervision</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Curricular merits: acquired curricular background</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Assessment: type of assessment conducted and opinion of the assessment</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Prospects: job expectations and opportunities</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">The survey was disseminated through an email registry of the Partners of SEMI and SEMI social networks (Facebook and Twitter).</p><p id="par0065" class="elsevierStylePara elsevierViewall">The hospitals were classified into 3 groups (primary, secondary and tertiary) according to the specialties with accredited teaching and the departments according to the number of beds (fewer than 50 beds, between 50 and 100 beds and more than 100 beds).</p><p id="par0070" class="elsevierStylePara elsevierViewall">The data were analyzed with SPSS version 22.0 software. We performed a descriptive study and employed the chi-squared test and Fisher's exact test (for frequencies <5) to compare the categorical variables. Values of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 were considered significant.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">A total of 194 residents (62.8% of the total number of residents who completed their training; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>309) responded to the survey, representing hospitals from all levels and from the 17 autonomous communities.</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Demographic data</span><p id="par0080" class="elsevierStylePara elsevierViewall">Some 62.9% of those surveyed were women, and half were younger than 30<span class="elsevierStyleHsp" style=""></span>years. The internal medicine specialty was chosen as the first option by 86.6% of the residents. A little more than half of the residents were trained in tertiary hospitals and in departments of more than 100 beds. The rest of the general data is broken down in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Satisfaction with the specialty and the learning environment</span><p id="par0085" class="elsevierStylePara elsevierViewall">Some 82.0% of the internists would reselect this specialty, and 84.0% believed that the duration was appropriate. The majority of internists thought that their center's healthcare and technical capacity was adequate (56.7%) or highly adequate (26.8%), and 67.0% would recommend the training to a friend. The degree of general satisfaction was similar regardless of the center's size, but residents of secondary hospitals would more often recommend their center than those trained in a tertiary center (82.9% vs. 58.0%), a difference that was significant.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The educational pathway satisfied less than a quarter of those surveyed, given that 76.3% believed that some of the rotations should be eliminated. The surveyed residents recognized a training deficit in rare diseases (74%), management (68%) and addictions (58%). In contrast, 55.7% believed the training to be excessive in the management of polypathological patients. More than two-thirds felt insufficiently prepared to perform the following techniques: skin biopsies (71%), clinical ultrasonography (68%), cannulation of central pathways (67%) and arthrocentesis (61%).</p><p id="par0095" class="elsevierStylePara elsevierViewall">More than half of those interviewed (52%) were opposed to the subspecialization of residents during the training period.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The most positively assessed aspects of the residence were learning in a remunerated manner (83.0%) and working in a team (49%); however, the most negative aspects were job insecurity upon completing the residency (73.7%) and the lack of supervision (37.1%).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Mentoring and supervision</span><p id="par0105" class="elsevierStylePara elsevierViewall">The 1:5 ratio of tutors to residents was respected in 92.8% of the cases. However, a high percentage of residents (56.2%) and assistants responsible for supervising the rotations (63.1%) were unaware of the rotations’ learning objectives.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The assignment of assistants in each rotation was typically conducted by criteria of availability more than by teaching suitability (41.8% vs. 28%). In terms of supervision, 62.9% of the residents felt sufficiently supervised. Nevertheless, this percentage dropped significantly during emergency shifts (48.5%) and specialty shifts (40.2%).</p><p id="par0115" class="elsevierStylePara elsevierViewall">There was also a majority sentiment of having been often (41.8%) or almost always (11.3%) used to cover ward staff functions.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Teaching merits</span><p id="par0120" class="elsevierStylePara elsevierViewall">Two-thirds of the internal medicine residents (67%) had published at least 1 study in a journal, and almost all (93.3%) had given a presentation at a congress. In contrast, the residents’ participation in funded research projects decreased to 37.6%, and fewer than half (48.5%) had the option of writing a doctoral thesis, which was only accomplished in 27.8% of cases. There are differences in all of these aspects depending on the size of the hospital of origin (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). It is worth noting that despite the fact that there is less opportunity for finishing a doctoral thesis in small hospitals, the percentage of residents who are writing a thesis is similar.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Assessment</span><p id="par0125" class="elsevierStylePara elsevierViewall">Some 82.5% of those surveyed would change the assessment system, and 68.0% would favor performing a voluntary, national excellence test.</p><p id="par0130" class="elsevierStylePara elsevierViewall">More than half of hospitals (54.1%) have no system for evaluating the tutors. The use of the SEMI Portfolio as a tool for resident-tutor interaction is low (12.6%).</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Prospects</span><p id="par0135" class="elsevierStylePara elsevierViewall">Undoubtedly, the most negative aspect revealed by the survey was perceived job insecurity at the end of the training cycle (73.7%). Although 74.7% of those surveyed thought that sooner or later they would find work as medical specialists, only 28.4% had a firm job offer. Job opportunities and support from the department heads vary according to hospital size (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The number of residents per year was not statistically related with having job offers or with the feeling of being able to find a job upon completion.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Of those who had a job offer, more than half (57.4%) will work as internists in the public sector, and 35.2% will work as emergency physicians. Some 27.8% were offered an exclusive night shift contract. Of those who had no job offer, 37% would be willing to repeat the medical intern examination, and 28.1% would be willing to travel abroad for work.</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0145" class="elsevierStylePara elsevierViewall">Internal Medicine has been an increasingly attractive specialty in recent decades; the percentage of those surveyed who indicated that it was their first option when choosing a position increased from 69% at the end of the last century to 87% by 2017.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> The overall perceived satisfaction is also very high; 8 of every 10 internists would retake the specialty and consider the learning environment, contents and duration to be appropriate. As with a survey conducted in Catalonia,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a> however, we detected several areas of improvement for shortcomings and specific aspects when implementing the program at the local level. Three-quarters of those surveyed would eliminate some of the rotations, and more than half indicated gaps in the acquisition of certain technical skills and in training in specific areas. This issue could be affected, in most cases, by the fact that the staff responsible for supervising the resident during their rotation is chosen on the basis of availability and not for their teaching aptitude, as well as by the resident's lack of knowledge as to the rotation's objectives. The debate is therefore whether, in addition to certifying teaching units, those responsible for providing the training should also be certified.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Although half of our residents are trained in tertiary hospitals, some of the results of this study seem to indicate that residents of smaller centers are more satisfied. These results agree with results found in Catalonia.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a> Our survey showed that the probability of finding employment after completing the training is greater in primary and secondary centers. Hospital generalists are probably more comfortable in smaller centers. Although large hospitals theoretically have superior techniques and resources, these are not sufficiently taken advantage of due to the relative lack of communication resulting from the dimensions and complexity of the hospitals’ structures. We can therefore infer that medical specialties are hypertrophied in tertiary centers, thereby relegating internal medicine to a secondary role or subspecialization.</p><p id="par0155" class="elsevierStylePara elsevierViewall">If we focus on research, however, residents of secondary and tertiary hospitals published papers more often and had more possibilities for working on funded projects and writing a doctoral thesis. Similarly, although there are fewer opportunities for writing a thesis in small hospitals, the proportional rate of residents writing theses is similar or even greater than that of large hospitals. Previous surveys observed no differences in the dedication to research between academic and nonacademic hospitals.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Therefore, what are the best hospitals for training internists? Each hospital offers some type of benefit over the others: residents should consider their objectives and choose the one that best suits them.</p><p id="par0165" class="elsevierStylePara elsevierViewall">From our survey, as with other previous surveys,<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> we can deduce that the residence model based on “learning while working” is too often diverted towards the second part of the equation, because more than half of the residents felt that they were used as “cheap labor” as a replacement for their staff and to the detriment of their training. Historically, the lack of supervision is accentuated in the night-shift setting.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> Although increased responsibility and burden of care should theoretically be progressive,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a> we all know the paradoxical fact that the emergency department, where the youngest residents are trained and where the most complicated decisions are made, is the area where they feel the least supervised. This is a serious problem for resident training and patient safety and can have severe consequences. This situation deserves deep reflection on the causes of error and on work schedules.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">10,11</span></a> There needs to be an organism responsible for supervising these situations with sufficient power to redress these failings.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">12,13</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">As has been warned for decades, the most deficient aspect of the medical intern system is the assessment method.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">8,14</span></a> Our survey showed that residents agree in changing the current system. It is predicted that the new specialty program includes the assessment by competency. If we want this system to work, we need to institute major reforms: Teachers need to be trained in teaching and assessment techniques such as the mini-CEX and the 360 assessment, and part of their work day needs to be freed up to allow them to devote time to this goal. Another aspect of assessment to consider is that almost two-thirds of residents favor performing a national voluntary excellence test, tests that already exist for other specialties.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a> This could be another method to officialize the final qualification of residents, which would enable them to compare themselves with residents of other hospitals when competing for a job post.</p><p id="par0175" class="elsevierStylePara elsevierViewall">As with previous surveys,<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">7,8</span></a> one of the main negative aspects highlighted by our survey is job insecurity at the completion of the training. Although most residents believed they would find work, a large proportion were not sure of this during the last month of their residence. This insecurity about the future and the short duration of the first contracts often causes significant anxiety in the last months of training, affecting the quality of life and acquisition of knowledge. We need to advocate for better work conditions for all young staff.</p><p id="par0180" class="elsevierStylePara elsevierViewall">As far as we know, this is the first survey conducted on residents of our specialty at the national level<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">7,8,16</span></a> and the second largest in terms of the number of recruited residents after the survey conducted by AREDA in 2015,<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a> thereby providing us with an overall view of internal medicine training in Spain.</p><p id="par0185" class="elsevierStylePara elsevierViewall">The main limitation of this study is that the survey was disseminated mainly among SEMI members and could therefore have a selection bias. However, 62.8% of all residents who completed the specialty (309 internal medicine residents completed their training this year) responded to the survey. We can therefore consider the data to be representative. Furthermore, we only included fifth-year residents because we believed they could provide us with a better overall view of the entire training process.</p><p id="par0190" class="elsevierStylePara elsevierViewall">In conclusion, measures need to be taken to alleviate the deficiency in training. We believe that the measures that could best redress this deficiency are the proper training of tutors and the accreditation of assistants responsible for supervising the rotations. Furthermore, SEMI can help alleviate training deficiencies in certain areas by organizing specific courses. Finally, we need to fight for improved working conditions for our young assistants, eliminating job insecurity during the specialist's first years. It would be interesting to repeat this survey periodically to assess whether our actions have affected the residents’ perception of their training.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusions</span><p id="par0195" class="elsevierStylePara elsevierViewall">Internal medicine residents are generally satisfied with their training, although there is still deficient supervision and general discontent with some of their rotations and with the method for assessing their expertise. Their greatest concern is still job insecurity during the first years as specialists.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1156237" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1083473" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1156236" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1083474" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Demographic data" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Satisfaction with the specialty and the learning environment" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Mentoring and supervision" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Teaching merits" ] 4 => array:2 [ "identificador" => "sec0040" "titulo" => "Assessment" ] 5 => array:2 [ "identificador" => "sec0045" "titulo" => "Prospects" ] ] ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-03-14" "fechaAceptado" => "2018-05-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1083473" "palabras" => array:4 [ 0 => "Specialty" 1 => "Internal medicine" 2 => "Residents" 3 => "Residence" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1083474" "palabras" => array:4 [ 0 => "Especialidad" 1 => "Medicina interna" 2 => "Residentes" 3 => "Residencia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Specialist training is based on the gradual acquisition of expertise, skills and responsibilities. The aim of this study is to determine the opinion of residents regarding their training.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a cross-sectional descriptive study based on an online survey of 5th-year residents during February and March 2017.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 194 residents (62.8% of the total) responded to the survey, 62.9% of whom were women and 50% of whom were younger than 30<span class="elsevierStyleHsp" style=""></span>years, representing hospitals from all levels and from the 17 autonomous communities. More than 80% of the residents choose the specialty once again and believed that the duration of the residence was appropriate; however, 76.3% would eliminate some of their rotations. Most of the residents did not know the objectives of each rotation, and 37.1% felt they were not adequately supervised. Some 82.5% would change the evaluation system, and 68.0% would favour performing an excellence test. Most of the residents had published at least one article or performed one presentation at a congress; however, only 27.8% had completed a doctoral thesis. Although 74.7% of the internists believed they would find employment, only 28.4% had an offer 1<span class="elsevierStyleHsp" style=""></span>month after completing their residence.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The residents are satisfied with their training, although there is still a deficit in supervision and dissatisfaction with the method of assessing their knowledge and the precarious job market during the first year for specialists.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La formación de especialistas está basada en la adquisición gradual de conocimientos, habilidades y responsabilidades. El objetivo del estudio es conocer la opinión de los residentes sobre su formación.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo transversal basado en una encuesta online realizada a los residentes de quinto año durante los meses de febrero y marzo de 2017.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Respondieron la encuesta 194 residentes (62,8% del total); el 62,9% fueron mujeres y el 50% eran menores de 30<span class="elsevierStyleHsp" style=""></span>años, con representación de hospitales de todos los niveles y de las 17 comunidades autónomas. Más del 80% volverían a elegir la especialidad y creen que la duración de la residencia es adecuada; sin embargo, el 76,3% eliminarían alguna de las rotaciones. La mayoría de los residentes desconocen los objetivos de cada rotación y un 37,1% no se han sentido adecuadamente supervisados. Un 82,5% cambiarían el sistema de evaluación y un 68,0% estarían a favor de realizar una prueba de excelencia. La mayoría de residentes han publicado al menos un artículo o realizado una comunicación en un congreso; sin embargo, solo el 27,8% están realizando una tesis doctoral. A pesar de que un 74,7% consideran que van a encontrar empleo, solo un 28,4% tienen una oferta a un mes de finalizar la residencia.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los residentes están satisfechos con la formación recibida, aunque sigue existiendo un déficit en la supervisión y un descontento tanto con la forma de evaluar sus conocimientos como con la precariedad laboral durante los primeros años de especialistas.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Macía-Rodríguez C, López Reboiro ML, Martín Iglesias D, González-Munera A, Moreno Diaz J, Montaño Martínez A, et al. Residentes de medicina interna de quinto año en España: encuesta sobre educación, evaluación de competencias y perspectivas de empleo. Rev Clín Esp. 2019;219:61–66.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 851 "Ancho" => 1583 "Tamanyo" => 56160 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Percentage of residents who had a job offer or had received support from their boss for finding work according to the size of the training hospital.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristic \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Age</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Under 30 years of age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97 (50.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>30–40 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89 (45.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Older than 40 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (4.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72 (37.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">122 (62.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Hospital size</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Regional hospital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (12.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Secondary hospital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 (36.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tertiary hospital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 (51.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Number of beds in the department</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fewer than 50 beds \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (7.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Between 50 and 100 beds \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78 (40.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>More than 100 beds \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">102 (52.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">No. of residents per year</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (20.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 (33.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (15.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>4 or more \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (25.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No response \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (5.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Autonomous communities</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Andalusia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (19.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Aragon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Asturias \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Balearic Islands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Canary Islands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cantabria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Castilla-La Mancha \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Castilla y León \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (6.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Catalonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (12.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Community of Valencia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (9.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Extremadura \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Galicia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>La Rioja \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Madrid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (20.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Murcia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Navarra \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (3.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Basque country \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1974093.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">General data of surveyed residents.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Primary \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Secondary \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tertiary \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Opportunity to complete a doctoral thesis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (37.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (57.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 (55.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Completing doctoral thesis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (37.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (27.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (31.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Participation in funded research projects \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (33.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (28.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 (46.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Publication of more than one article \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (58.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 (65.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 (70.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Giving more than one speech at a congress \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (91.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 (97.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91 (91.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1974094.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Research activity according to the size of the originating hospital.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0090" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Boletín Oficial del Estado. 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