Original article
Getting to know internal medicine mentors: New training requirements
Conociendo a los tutores de Medicina Interna: nuevas necesidades para la formación
J. Moreno Díaza,
, M. Aranda Sánchezb, A. González Munerac, P. Demelo Rodríguezc, D. Martín Iglesiasd, C. Macía Rodígueze, C. Muñoz Muñozf, G. Ortiz Llauradób, M. Lorenzo López Reboirog, F. Salgado Ordóñezh,i
Corresponding author
a Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain
b Medicina Interna, Consorcio Sanitario de Terrassa, Barcelona, Spain
c Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, Spain
d Medicina Interna, Hospital de Cruces, Baracaldo, Vizcaya, Spain
e Medicina Interna, Hospital POVISA, Vigo, Spain
f Medicina Interna, Hospital General de Cataluña, Barcelona, Spain
g Medicina Interna, Hospital de Monforte de Lemos, Lugo, Spain
h Medicina Interna, Hospital Regional Universitario, Málaga, Spain
i Grupo de Formación de SEMI, Spain
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"apellidos" => "Salgado Ordóñez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">h</span>" "identificador" => "aff0040" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">i</span>" "identificador" => "aff0045" ] ] ] ] "afiliaciones" => array:9 [ 0 => array:3 [ "entidad" => "Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Medicina Interna, Consorcio Sanitario de Terrassa, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Medicina Interna, Hospital de Cruces, Baracaldo, Vizcaya, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Medicina Interna, Hospital POVISA, Vigo, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Medicina Interna, Hospital General de Cataluña, Barcelona, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Medicina Interna, Hospital de Monforte de Lemos, Lugo, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Medicina Interna, Hospital Regional Universitario, Málaga, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Grupo de Formación de SEMI, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Conociendo a los tutores de Medicina Interna: nuevas necesidades para la formación" ] ] "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" => 946 "Ancho" => 1584 "Tamanyo" => 87178 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Topics covered in the residents’ interviews.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">The mentor's mission for residents is to plan and actively collaborate in the residents’ learning of knowledge, skills and attitudes to ensure that the goals of each specialty's training program are met.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">To this end, the resident's educational pathway and individual training plan should be prepared for subsequent approval by each center's teaching commission. Specific knowledge of teaching strategies is therefore needed.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The implementation of training programs by competency involves unprecedented changes in the specialized healthcare training system.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The current medical oncology program already uses this system of competencies,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> covering the knowledge and techniques that need to be learned during the residency.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The assessment instruments also change, evolving far beyond notepads at the end of rotations. It is clear that mentors should be trained in the understanding and use of these methods.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The current trend in medical education manifests the need for residents to know the learning objectives of their rotations and how they should learn them. To this end, focused and structured feedback tools are employed. The mentor-resident interview is the most typical method, and it is essential to be knowledgeable about training to be able to apply and adapt the knowledge.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The lack of a defined time to conduct their functions, the lack of knowledge of assessment methods and the excessive number of residents under their charge can lead to mentor burnout.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The Teaching Guide for Cardiology Mentors<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> demonstrates these problems: a lack of time for mentoring, a lack of preparation as instructors and the need for the teaching and healthcare structures to recognize the mentors’ work and functions.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The Training Group of the Spanish Society of Internal Medicine (SEMI) has attempted to determine the mentors’ situation, in an effort to detect shortcomings and areas of improvement, with surveys whose results are shown below.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0050" class="elsevierStylePara elsevierViewall">We designed a descriptive study based on an online survey aimed at internal medicine mentors in Spain. We created the survey on the <a id="intr0010" class="elsevierStyleInterRef" href="http://www.e-encuestas.com/">www.e-encuestas.com</a> platform, with subsequent dissemination by email to the 251 surveyed mentors of SEMI and through the social networks of SEMI (Twitter, Facebook), with up to 4 reminders (Appendix available in the online version).</p><p id="par0055" class="elsevierStylePara elsevierViewall">The collected variables were as follows:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">demographic data (sex, age, autonomous community where the mentors work and the number of beds in the center where they work),</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">basic mentor information (years instructing and number of residents mentored), method of choosing mentors.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Opinion on the number of residents in the autonomous community, hospital center and residents directly mentored.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Use of interviews as a method for detecting problems.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel"><span class="elsevierStyleBold">-</span></span><p id="par0080" class="elsevierStylePara elsevierViewall">Aspects of the planning of rotations: <span class="elsevierStyleItalic">who chooses them, how are they planned and where are they conducted</span>.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Supervision of sessions, research and presentations at congresses.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Methods for assessing residents.</p></li></ul></p><p id="par0095" class="elsevierStylePara elsevierViewall">The responses were closed, with one or multiple choices, with the possibility of adding clarifying comments on most of the variables. The data collection lasted from May to June 2017.</p><p id="par0100" class="elsevierStylePara elsevierViewall">We excluded 4 surveys that were not completely finished. The data were processed using the SPSS<span class="elsevierStyleSup">®</span> program, version 20.0.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">General data</span><p id="par0105" class="elsevierStylePara elsevierViewall">We obtained 110 complete responses, with the SEMI census of 251 mentors (43.8%), from 13 autonomous communities distributed as follows: 23 (20.9%) from the Community of Valencia, 18 (16.4%) from the Community of Madrid, 18 (16.4%) from Andalusia, 13 (11.8%) from Castilla y León, 10 (9.1%) from Catalonia, 8 (7.3%) from Galicia, 6 (5.5%) from Castilla la Mancha, 5 (4.5%) from Aragon, 3 (2.7%) from Extremadura, 2 (1.8%) from the Region of Murcia, 2 (1.8%) from Asturias, 1 (0.9%) from La Rioja and 1 (0.9%) from the Canary Islands.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Sixty-three (57.3%) of those surveyed were men. The mentors’ ages ranged from 32 to 65 years, with a mean age of 48.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.2 years, with no differences between sexes (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.316).</p><p id="par0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">The range of experience as mentor was 1–30 years, with a mean of 8.5</span><span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">6.5 years.</span> There was a significant difference between men and women in terms of experience (9.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.4 vs. 6.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.7 years, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.033).</p><p id="par0120" class="elsevierStylePara elsevierViewall">In terms of the number of beds in the internal medicine department of the hospital center where those surveyed work, 57 (51.8%) worked in departments with 50 to 100 beds, 40 (36.4%) worked in departments with more than 100, and 13 (11.8%) worked in departments with fewer than 50 beds.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Selection and training of mentors</span><p id="par0125" class="elsevierStylePara elsevierViewall">Most of the mentors were chosen by their department head <span class="elsevierStyleItalic">(37 cases, 33.6%). One of the mentors indicated that they accepted the position by imposition</span>. The others volunteered after taking courses on training (33 cases, 30%) or were interested in training without having taken courses (31 cases, 28.2%). In 9 cases (8.2%), the mentors were chosen by the residents. Seventy-eight (70.9%) mentors had taken a course on training.</p><p id="par0130" class="elsevierStylePara elsevierViewall">In terms of the number of residents per mentor, 13 (11.8%) of those surveyed reported supervising more than 5 residents. Fifty-four percent of those surveyed believed that the number of residents they had to supervise was acceptable. Thirty percent of those surveyed believed that they could supervise their residents but would not know the residents’ peculiarities, and 16% of those surveyed believed that they had too many residents to mentor them properly.</p><p id="par0135" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the opinion of the surveyed mentors on the current number of residents in their center and autonomous community.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Although the number of responses was not the same for all autonomous communities, the mentors in Aragon (60%), Castilla la Mancha (50%) and the Community of Madrid (17%) were most in favor of reducing the number of residents in training.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Communication with the residents</span><p id="par0145" class="elsevierStylePara elsevierViewall">Of those surveyed, 102 (92.7%) conducted interviews with residents: 68% conducted them quarterly, 14% on a monthly basis, 14% every six months and 4% annually.</p><p id="par0150" class="elsevierStylePara elsevierViewall">The majority (52, 47.3%) of mentors conducted structured interviews but with open fields to detect problems. In 34 cases (31%), a script was not followed, and in 16 cases (14.5%) the interview was closed.</p><p id="par0155" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the most common issues discussed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">In terms of the usefulness of the interviews, only 2 (2%) of the mentors who conducted interviews did not consider them useful. When asking the same question of those who did not conduct interviews, 4 (50%) mentors did consider them useful.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Planning of rotations</span><p id="par0165" class="elsevierStylePara elsevierViewall">In terms of the planning of rotations, most of the mentors adapted the rotations to each resident: 61 of those surveyed (55.5%) planned the rotations, and 24 (21.8%) adapted them from other mentors. In 7 (6.4%) cases, the plans were not modified; in 15 (13.6%) cases, the plans were imposed by the teaching unit; and in 3 (2.7%) cases, the plans were imposed by the department head.</p><p id="par0170" class="elsevierStylePara elsevierViewall">External rotations were not performed in only 3 cases (2.7%). Of the rest of those surveyed, 54% had the residents select the rotations, and the mentors contacted the destination center. In 40% of cases, the residents chose and contacted the centers, and 6% of the mentors chose and contacted the centers.</p><p id="par0175" class="elsevierStylePara elsevierViewall">The most requested external rotations were in infectious diseases, with 87 responses (79%), followed by autoimmune diseases, with 77 responses (70%).</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Rotations in internal medicine departments</span><p id="par0180" class="elsevierStylePara elsevierViewall">We asked the mentors as to the time (in months) the residents spent in conventional hospitalization in internal medicine, in specific areas and in consultations (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> shows the specific areas most commonly rotated through by residents.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall">Only 3 (2.7%) of those surveyed reported that their residents did not rotate through outpatient clinics. In most cases (64.5%), the residents were always supervised; in 47 cases (42.7%), the residents were supervised for more than 2 months; and in 24 cases (21.8%), the residents were supervised for less than 2 months. In the rest of the cases, the residents were not supervised in the outpatient clinics. In 33 of these cases (30%), the residents spent more than 2 months in this situation, and in 3 cases (2.7%), the residents spent less than 2 months in this situation.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Supervision of sessions and publications</span><p id="par0195" class="elsevierStylePara elsevierViewall">Some 41.8% of those surveyed reported that the subjects of the sessions were chosen by the residents and supervised by the mentors; in 35.5% of the cases, the subjects were chosen and supervised by the mentors; and in 22.7% of the cases, they were not supervised.</p><p id="par0200" class="elsevierStylePara elsevierViewall">We also studied the supervision of presentations at congresses. In 57.3% of the cases, the subjects were chosen by the residents and supervised by the mentors; in 36.4% of the cases, the subjects were chosen and supervised by the mentors; and in 6.4% of the cases, the presentations were prepared without supervision.</p><p id="par0205" class="elsevierStylePara elsevierViewall">Lastly, we asked about the publications during the residency. Some 77.3% of the mentors advised and supervised the residents, 17.3% of the mentors published their own manuscripts taking into account the residents, and only 5.5% of the residents published without supervision.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Assessment</span><p id="par0210" class="elsevierStylePara elsevierViewall">In 67 cases (60.9%), the opinion was that the assessment of residents was not performed correctly.</p><p id="par0215" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> shows the most widely used assessment methods.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0220" class="elsevierStylePara elsevierViewall">The residents’ clinical competencies were assessed in only 19 (17.3%) cases, and in 8 (7.3%) cases, the scientific foundations were assessed. Communication with patients was assessed by 16 (14.5%) of those surveyed, and self-training, research and critical analysis was assessed by 37 (33.6%) mentors.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Career counseling</span><p id="par0225" class="elsevierStylePara elsevierViewall">Some 17.3% of the residents managed their own job opportunities. Most of those surveyed (58 responses, 52.7%) counseled their residents on how and where to find jobs. Some 26.4% of the mentors helped the residents write their curriculum vitae.</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0230" class="elsevierStylePara elsevierViewall">In our study, the profile of the internal medicine mentor is a man over 45 years of age, with more than 8 years of experience, instructing 5 or fewer residents. According to Royal Decree 183/2008,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> the maximum number of residents assigned to a mentor is 5.</p><p id="par0235" class="elsevierStylePara elsevierViewall">Although the outlook seems acceptable, 11.8% of mentors supervise more than 5 residents. This figure is similar to that of other surveys, such as the one conducted by the Spanish Society of Medical Oncology.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">Half of the surveyed mentors reported being unable to fully dedicate time to mentoring the residents or not getting to know the peculiarities of each resident, which can affect the mentor-resident relationship.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">Additionally, up to 30% of the mentors had never taken a course on training residents.</p><p id="par0250" class="elsevierStylePara elsevierViewall">Considering that most of the mentors recognized that they would not reduce the number of residents in their hospitals, the outlook could improve by increasing the number of mentors, the time dedicated to mentoring and by adding necessary training in the techniques of mentoring.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">The interview with the resident is one of the most widely used and effective forms of detecting problems.</span> On this issue, it is important to note that 16 of those surveyed (14.5%) conducted closed interviews with no option for discussing other types of problems, a nonnegligible number. This practice can sideline much of the freedom offered by this type of mentor-resident relationship, as has been indicated in an article by García del Barrio.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">During the interviews, the planning of rotations is the more often discussed topic, which assumes that the residents participate in the objectives of the rotations.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> Of the 8 mentors who did not use interviews as communication tools, 4 did consider them a useful option. We therefore hope that this article, with more positive than negative opinions regarding the use of interviews, encourages mentors to use them in their centers.</p><p id="par0265" class="elsevierStylePara elsevierViewall">There was an important and worrying finding: 1 of every 4 mentors did not adapt the rotations to their residents according to the teaching needs. This situation, which fails to meet the premise of continuous and individual mentoring as laid out in Royal Decree 183/2008,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> could be related to the peculiarities of each internal medicine department but should make mentors consider a more individualized training program.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a></p><p id="par0270" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">The external rotations are a key point in the training of residents.</span> Most of the residents chose the autoimmune and infectious diseases career path. When choosing and requesting the rotations, there was a notably high rate of self-management among the residents (40% of cases), a finding that in our opinion is excessive and goes against Royal Decree 183/20081 establishing that mentors should contact the various centers.</p><p id="par0275" class="elsevierStylePara elsevierViewall">In terms of the rotations in the internal medicine sections, we see a repeated tendency of the more classical areas of the specialty, although there is increased interest in palliative care units, alternatives to conventional hospitalization, support for surgery departments and polypathological patients, as well as clinical ultrasonography.</p><p id="par0280" class="elsevierStylePara elsevierViewall">This finding is clearly related to the changes occurring in the current healthcare situation.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0285" class="elsevierStylePara elsevierViewall">Although unifying the amount of time that residents spend working in outpatient clinics would be ideal, in a third of the cases there is no supervision.</p><p id="par0290" class="elsevierStylePara elsevierViewall">Supervision was nonexistent in the clinical meetings in 22.7% of the cases, in 6.4% of the presentations to congresses and in 5.5% of the scientific publications.</p><p id="par0295" class="elsevierStylePara elsevierViewall">There is a high percentage of mentors who choose the subjects of the clinical sessions and of the presentations to congresses, which indicates involvement; however, we also found situations in which the residents are the ones who choose what to talk about. The election of the subjects by the mentors could be more indicated for first-year residents, giving last-year residents more freedom.</p><p id="par0300" class="elsevierStylePara elsevierViewall">In terms of how to assess residents, 60% of those surveyed believe that the assessment is not performed correctly. We see that classical forms are the most widely used; the more complex and complete assessments (based on objective data such as observation of clinical practice and procedures and the analysis of clinical reports) are still in the minority.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a></p><p id="par0305" class="elsevierStylePara elsevierViewall">Lastly, the end of the residency deserves special attention in our study, given that 17.3% of the residents self-manage their job opportunities. Of course, the mentors’ role is not to obtain jobs for their residents but to supervise the curriculum and indications of where and how to job hunt, which, although only based on each mentor's own experience, can be of considerable help.</p><p id="par0310" class="elsevierStylePara elsevierViewall">The response rate, lower than 50% of the mentors surveyed by SEMI, represents the study's major limitation. However, the communities where most residents are trained are the most represented; we have therefore created an adequate situation map of internal medicine mentors in Spain.</p><p id="par0315" class="elsevierStylePara elsevierViewall">Another limitation is the subjectivity of some of the questions in the survey; knowing the residents’ opinion is therefore essential for obtaining a more global view.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusions</span><p id="par0320" class="elsevierStylePara elsevierViewall">The profile of the internal medicine mentor is represented by a 45-year-old man with more than 8 years practicing as such; however, 30% have not taken any instructor course. The mentors declared that they mentored 5 or fewer residents, although they considered it an excessive number, which hinders the proper planning of the training.</p><p id="par0325" class="elsevierStylePara elsevierViewall">Mentoring in internal medicine is of good quality but can be improved in 2 key aspects: supervision and scheduling the rotations calendar adapted for each resident. <span class="elsevierStyleItalic">The use of interviews as a method for detecting problems is widely used, and those centers that do not conduct them should consider implementing them.</span></p><p id="par0330" class="elsevierStylePara elsevierViewall">These problems could be solved by increasing the number of mentors in each center, providing them with sufficient time and improving their training in mentoring techniques.</p><p id="par0335" class="elsevierStylePara elsevierViewall">Additionally, implementing more complex and innovative assessment systems in the teaching units would be of considerable help in understanding, in a more objective fashion, the virtues and deficiencies of each resident so as to personalize and improve their learning during this important training period.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of interest</span><p id="par0340" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.Supplementary data</p><p id="par0345" class="elsevierStylePara elsevierViewall">Supplementary data associated with this article can be found, in the online version, at <a id="intr0015" class="elsevierStyleInterRef" href="http://dx.doi.org/10.1016/j.rceng.2018.06.007">doi:10.1016/j.rceng.2018.06.007</a>.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1156240" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 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" => "xpalclavsec1083477" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1156239" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 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" => "xpalclavsec1083478" "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:8 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "General data" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Selection and training of mentors" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Communication with the residents" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Planning of rotations" ] 4 => array:2 [ "identificador" => "sec0040" "titulo" => "Rotations in internal medicine departments" ] 5 => array:2 [ "identificador" => "sec0045" "titulo" => "Supervision of sessions and publications" ] 6 => array:2 [ "identificador" => "sec0050" "titulo" => "Assessment" ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Career counseling" ] ] ] 7 => array:2 [ "identificador" => "sec0060" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0065" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-03-12" "fechaAceptado" => "2018-06-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1083477" "palabras" => array:4 [ 0 => "Mentor" 1 => "Resident" 2 => "Planning of training" 3 => "Teaching" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1083478" "palabras" => array:4 [ 0 => "Tutor" 1 => "Residente" 2 => "Planificación de formación" 3 => "Docencia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mentors are responsible for planning the residents’ learning. The aim of this study was to determine the situation of internal medicine mentors in Spain and detect areas of improvement that can facilitate their work.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Online surveys were sent to internal medicine mentors from May to July 2017, the results of which were subsequently analyzed.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 110 mentors from 13 autonomous communities and from hospitals of all levels with courses in internal medicine responded to the survey. Of these mentors, 63 were men (57.3%), and the mean age was 48 years. The mean experience as mentors was 8.5 years. Some 88.2% of the cases had a ratio of 5 residents to 1 mentor; 46% of the mentors believed this ratio should be decreased to optimize their work.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A third of the mentors were chosen by the heads of the department, and 30% had not previously taken courses on training.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The mentor-resident interview was used by most mentors (96.4%) as a communication tool.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A quarter of the rotations were not planned by the mentors, and only half had contact with the centers where the residents performed the external rotations.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Sixty-one percent of the mentors were of the opinion that resident assessments were not conducted properly, with very little use of the new assessment tools.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Reducing the mentor-resident ratio and adding training in assessment techniques and learning development could improve the quality of the mentoring.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 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 y objetivos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Los tutores son los responsables de planificar el aprendizaje de los residentes. El objetivo de este trabajo es conocer la situación de los tutores de <span class="elsevierStyleItalic">Medicina Interna</span> en España y detectar áreas de mejora que puedan facilitar su trabajo.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Encuestas <span class="elsevierStyleItalic">online</span> a tutores de Medicina Interna de mayo a julio de 2017 con análisis posterior de los datos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Respondieron 110 tutores, de 13 comunidades autónomas y hospitales de todos los niveles con docencia en Medicina Interna. Sesenta y tres fueron hombres (57,3%), la media de edad fue de 48 años y tenían una experiencia como tutores de 8,5 años. En el 88,2% de los casos se respeta la ratio de cinco residentes por tutor; un 46% piensa que debería disminuirse esta ratio para optimizar su labor.</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Un tercio había sido elegido por el responsable del servicio y el 30% nunca ha realizado cursos sobre formación.</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La entrevista tutor-residentes es utilizada por la mayoría de los tutores (96,4%) como herramienta de comunicación.</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">En relación a las rotaciones, la cuarta parte no son planificadas por los tutores y, solo la mitad, contacta con los centros donde los residentes realizan las rotaciones externas.</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">El 61% cree que no se realiza bien la evaluación de residentes, con muy escasa utilización de las nuevas herramientas de evaluación.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Disminuir la ratio tutor/residente y la formación en técnicas de evaluación y desarrollo del aprendizaje podría mejorar la calidad de la tutorización.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 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: Moreno Díaz J, Aranda Sánchez M, González Munera A, Demelo Rodríguez P, Martín Iglesias D, Macía Rodíguez C, et al. Conociendo a los tutores de Medicina Interna: nuevas necesidades para la formación. Rev Clin Esp. 2019;219:67–72.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0350" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0080" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 946 "Ancho" => 1584 "Tamanyo" => 87178 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Topics covered in the residents’ interviews.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 896 "Ancho" => 2152 "Tamanyo" => 128212 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Specific areas of internal medicine most in demand.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1050 "Ancho" => 2077 "Tamanyo" => 118829 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Assessment methods.</p>" ] ] 3 => 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">Number of residents \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">It is an acceptable number \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">Needs more residents \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">Too many \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">In their autonomous community \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82 (74.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (11.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (13.6%) \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">In their hospital center \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 (64.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (21.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (13.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1974096.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Opinion on the number of residents in each hospital center and autonomous community.</p>" ] ] 4 => 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">Range (months) \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">Mean (±SD) \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">In conventional hospitalization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8–36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.8 \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">In specific areas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0–36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.8 \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">In outpatient clinics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0–34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1974097.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Duration of each rotation type in internal medicine.</p>" ] ] 5 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 488888 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "España. 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