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Realising the benefits of systematic secondary fracture prevention requires supporting local sites to get started and becoming effective. We here describe the development, implementation and impact of a regional fracture liaison service (FLS) mentorship programme in Latin America that led to 64 FLS getting started and coverage of 17,205 patients. INTRODUCTION: Despite treatments and service models to deliver effective secondary fracture prevention, most patients are left untreated after a fragility fracture. To improve the capability to get FLS started and more effective, we describe the development, implementation and evaluation of an international programme to develop national communities of FLS mentors as part of the Capture the Fracture Partnership in Latin America. METHODS: The IOF regional team and the University of Oxford developed the curriculum and associated resources for training mentors in setting up FLS, service improvement and mentorship. Mentors were selected during a preparatory meeting, trained using live online sessions followed by regular mentor-led post-training meetings. The programme was evaluated using a pre-training needs assessment and post-training evaluation based on Moore's outcomes. RESULTS: The mentorship programme was initiated in Mexico, Brazil, Colombia and Argentina. The mentors were multidisciplinary, including orthopaedic surgery, rehabilitation, rheumatology, endocrinology, geriatrics, gynaecology and internal medicine. There was 100% participation in training sessions and reported satisfaction with the training. Since the initiation of the training programme, 22 FLS have been set up in Mexico, 30 in Brazil, 3 in Colombia and 9 in Argentina, in comparison with two in Chile and none in any other LATAM countries that were not involved in the mentorship programme. This equates to approximately 17,025 additional patients identified from 2019 to 2021 after initiation of mentorship. The mentors have engaged with 58 FLS for service development. Post-training activities include two published national best practice guidelines and other country-specific resources for FLS in the local language. CONCLUSION: Despite the COVID pandemic, the mentorship pillar of the Capture the Fracture Partnership has developed a community of FLS mentors with measurable improvement in national FLS provision. The programme is a potentially scalable platform to develop communities of mentors in other countries.

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OBJECTIVE: Founded in 2020, the Thoracic Surgery Medical Student Association is the first national organization dedicated to supporting medical students interested in pursuing cardiothoracic surgery. Our inaugural survey aimed to describe their basic characteristics and needs. METHODS: An Institutional Review Board-approved, nonincentivized, anonymous electronic survey was distributed to any medical students enrolled in Liaison Committee on Medical Education-accredited medical schools through social media such as Twitter, national organizations (Association of Women Surgeons, Thoracic Surgery Resident Association), and medical school cardiothoracic surgery interest groups. Their basic characteristics, attitudes, and preferences regarding cardiothoracic surgery were recorded. RESULTS: Of the 167 students from 117 unique schools who completed the survey, 53% identified as White and 57% identified as female. Stages of training were well distributed: 16% first-year medical students, 33% second-year medical students, 16% third-year medical students, 21% fourth-year medical students, and 14% dual degree/research students. Most participants (57%) did not have (32%) or were not aware of having (25%) a thoracic surgery training program at their home institution. The majority (72%) of students reported not having a cardiothoracic surgery interest group at their home institution. The most desired areas of cardiothoracic were networking (31%) and mentorship (28%). CONCLUSIONS: There is a significant need to directly engage medical students who are interested in cardiothoracic surgery considering limited exposure at home institutions through a lack of cardiothoracic surgery interest groups and cardiothoracic residency programs. The Thoracic Surgery Medical Student Association is poised to address these areas with directed networking by connecting cardiothoracic surgery faculty and residents from other institutions with medical students interested in pursuing cardiothoracic surgery.

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En el artículo se analiza la importancia de la tutoría universitaria en la definición del proyecto formativo-profesional del alumnado. Empleando cuestionarios y entrevistas se registran y analizan las opiniones que 410 estudiantes de 4 promociones hicieron de los Planes de Orientación y Acción Tutorial. Los resultados confirman que los/as tutores/as son un referente importante para el alumnado y la tutoría una estrategia relevante de acompañamiento desde el momento en que inicia sus estudios y a lo largo de su trayectoria formativa. Se concluye que es necesario reforzar la institucionalización de la tutoría, promoviendo modelos activos, integrales e inclusivos de aprendizaje. Estos datos son relevantes para la práctica educativa y para la puesta en práctica de programas de orientación al alumnado.

O artigo analisa a importância da tutoria universitária na definição do projeto formativo-profissional do aluno. Por meio de questionários e entrevistas, foram registradas e analisadas as opiniões de 410 alunos de 4 promoções realizadas nos Planos de Orientação e Ação Tutorial. Os resultados confirmam que os tutores são uma importante referência para os alunos e a tutoria uma estratégia de apoio relevante desde o início dos estudos e ao longo da sua carreira escolar. Conclui-se que é necessário reforçar a institucionalização da tutoria, promovendo modelos de aprendizagem ativos, integrais e inclusivos. Esses dados são relevantes para a prática educacional e para a implementação de programas de orientação estudantil.

The article analyzes the importance of university tutoring in the definition of the student's training-professional project. Using questionnaires and interviews, the opinions that 410 students from 4 promotions made of the Orientation Plans and Tutorial Action were recorded and analyzed. The results confirm that tutors are an important reference for students and tutoring is a relevant support strategy from the moment they start their studies and throughout their educational career. It is concluded that it is necessary to reinforce the institutionalization of tutoring, promoting active, comprehensive and inclusive learning models. These data are relevant for educational practice and for the implementation of student orientation programs.

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Resumen: Objetivo: Conocer los factores de estrés más prevalentes en el alumnado novel de las Facultades de Enfermería de las Universidades de Cádiz, Córdoba, Huelva y Sevilla, así como su relación con sus características sociodemográficas, académicas, socioeconómicas, de orientación y de salud. Diseño: Estudio observacional, descriptivo, transversal. Metodología: Se encuestó a un total de 617 estudiantes (tasa de respuesta del 95,66 %) del primer curso del grado en Enfermería. Los participantes completaron dos cuestionarios: uno sociodemográfico y de salud; y un cuestionario de estrés percibido por alumnos noveles. Se realizó un análisis descriptivo de los factores de estrés con frecuencia, media y desviación típica. Las relaciones se examinaron con análisis diferencial a través de estudios no paramétricos U Mann-Whitney y Kruskal-Wallis. Resultados: Las situaciones que más estrés causan a los nuevos universitarios son: "hacer frente a los exámenes" y "la cantidad de trabajo que tengo que afrontar". En consecuencia, el factor más estresante es el "estrés académico" y el menos estresante el "sentimiento de soledad". Los estudiantes que perciben mayor estrés en varios factores son: mayores de 25 años, mujeres, el alumnado que procede de otras provincias y los que viven de alquiler durante el curso académico. Conclusiones: La entrada a la universidad produce factores de estrés en el alumnado de enfermería, que pueden afectar a su salud, su calidad de vida y su rendimiento académico. Hacer frentes a los exámenes y la alta carga académica son las principales determinantes de estrés. Sin embargo, sería conveniente indagar más en esta línea con el fin de conocer las posibles causas de este problema y poder desarrollar estrategias de prevención que mejoren la calidad de vida de estos estudiantes.

Resumo: Objetivo: Conhecer os fatores de estresse mais prevalentes em novos alunos das Faculdades de Enfermagem das Universidades de Cádis, Córdoba, Huelva e Sevilha, bem como sua relação com suas características sociodemográficas, acadêmicas, socioeconômicas, de orientação, educacionais e saúde. Delineamento: Estudo observacional, descritivo, transversal. Metodologia: Foram pesquisados ​​617 alunos (taxa de resposta de 95,66 %) do primeiro ano do curso de Enfermagem. Os participantes responderam a dois questionários: sociodemográfico e de saúde; e questionário de estresse percebido por alunos iniciantes. Foi realizada análise descritiva dos fatores de estresse com frequência, média e desvio padrão. Os relacionamentos foram examinados com análise diferencial por meio de estudos não paramétricos de U Mann-Whitney e Kruskal-Wallis. Resultados: As situações que mais estressam os novos estudantes universitários são "fazer exames" e "a quantidade de trabalho que tenho que enfrentar". Conseqüentemente, o fator mais estressante é o "estresse acadêmico" e o menos estressante são os "sentimentos de solidão". Os alunos que percebem o maior estresse em vários fatores são: maiores de 25 anos, mulheres, alunos que vêm de outras províncias e aqueles que vivem de aluguel durante o ano letivo. Conclusões: O ingresso na universidade produz fatores estressantes nos estudantes de enfermagem, que podem afetar sua saúde, sua qualidade de vida e seu desempenho acadêmico. A realização de exames e a alta carga acadêmica são apontados como os principais determinantes do estresse. No entanto, seria conveniente aprofundar as investigações nesse sentido para conhecer as possíveis causas desse problema e poder desenvolver estratégias de prevenção que melhorem a qualidade de vida desses alunos.

Abstract: Objective: To determine the prevalent stress factors among new students to the Faculties of Nursing at the Faculties of Nursing at the Universities of Cadiz, Cordoba, Huelva and Seville, and the influence of socio-demographic, academic, socio-economic, orientation and health factors. Design: A descriptive, observational and cross-sectional study. Methodology: 617 first year nursing students were surveyed (with a 95.66 % response rate) by means of two questionnaires, one for socio-demographics and health, the other for the stress perceived by new students. A descriptive analysis of the stress factors was then carried out for the frequency, mean and standard deviation. The relation between factors was examined through differential analysis by means of the Mann-Whitney U and Kruskal-Wallis non-parametric tests. Results: The situations of greatest anxiety among new undergraduates are "taking examinations" and "the amount of work I have to do". Consequently, the most stressful factor is "academic stress" whilst the least stressful is "feelings of loneliness". The students who feel most stress across various factors can be identified as: over 25, women, studying outside their home province, and living in rented accommodation during the academic year. Conclusions: Starting a degree in nursing is a stressful time, and students can find their health, quality of life and academic performance negatively affected. The main determinants of stress among new undergraduates are the joint demands of examinations and workload. It would undoubtedly be enlightening to examine this issue further in order to find the possible causes of the problem and to develop strategies that can help in its prevention and so improve the students' experience of university.

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BACKGROUND: This study assessed the impact of distance cataract surgical wet laboratory training on surgical competency of ophthalmology residents at a tertiary-level ophthalmic training center in Trujillo, Peru. METHODS: Three five-week distance wet lab courses were administered through Cybersight, Orbis International's telemedicine platform. Weekly lectures and demonstrations addressed specific steps in phacoemulsification surgery. Each lecture had two accompanying wet lab assignments, which residents completed and recorded in their institution's wet lab and uploaded to Cybersight for grading. Competency was assessed through anonymous grading of pre- and post-training surgical simulation videos, masked as to which occurred before and after training, using a standardized competency rubric adapted from the Ophthalmology Surgical Competency Assessment Rubric (OSCAR, scale of 0-32). Day one best-corrected post-operative visual acuity (BVCA) was assessed in the operative eye on the initial consecutive 4-6 surgeries conducted by the residents as per the norms of their residency training. An anonymous post-training satisfaction survey was administered to trainees'. RESULTS: In total, 21 ophthalmic residents participated in the courses, submitting a total of 210 surgical videos. Trainees' average competency score increased 6.95 points (95%CI [4.28, 9.62], SD = 5.01, p < 0.0001, two sample t-test) from 19.3 (95%CI [17.2, 21.5], SD = 4.04) to 26.3 (95%CI [24.2, 28.3], SD = 3.93). Visual acuity for 92% of post-training resident surgeries (n = 100) was ≥20/60, meeting the World Health Organization's criterion for good quality. CONCLUSIONS: Structured distance wet lab courses in phacoemulsification resulted in significantly improved cataract surgical skills. This model could be applicable to locations where there are obstacles to traditional in-person training, such as the current COVID-19 pandemic.

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Resumo: Introdução: A mentoria é uma importante estratégia de ensino em cursos de graduação e no treinamento profissional, especialmente no momento em que o mundo vivencia a pandemia da Covid-19. Essa estratégia possibilita aprendizado dinâmico e coletivo, ao mesmo tempo que minimiza os impactos sociais e emocionais gerados pela pandemia, sem comprometer o isolamento físico. Relato de experiência: A experiência dos alunos da UFMG com a mentoria nos formatos presencial (realizada em 2019) e virtual (durante a pandemia de 2020) demonstrou que, apesar de a modalidade virtual ter aspectos negativos, as vantagens são superiores. O aspecto mais vantajoso elencado por todos os mentorandos foi a possibilidade de discutir temas que iam além do aprendizado da medicina, como uma forma de preparação prática para a vida profissional. Discussão: A mentoria é uma estratégia singular de grande importância na educação médica. O formato misto, composto por reuniões virtuais e presenciais, foi considerado o melhor modelo para sua aplicação. Conclusão: Acreditamos que o presente relato estimulará outras instituições a adotar disciplinas no formato de mentoria, além da utilização do recurso remoto como estratégia de ensino.

Abstract: Introduction: Mentoring is an important teaching tool in undergraduate courses and in professional training, especially at a time when the world is experiencing the Covid-19 pandemic. This strategy enables dynamic and collective learning, while minimizing the social and emotional impacts generated by the pandemic, without compromising physical isolation. Experience report: The experience of UFMG students with mentoring in the face-to-face (held in 2019) and virtual (during the 2020 pandemic) format demonstrated that, although the virtual modality has negative aspects, these are outweighed by the advantages. The most advantageous aspect listed by all the mentors was the possibility of discussing topics that went beyond the learning of medicine, as a way of practical preparation for professional life. Discussion: Mentoring is a unique strategy of great importance in medical education. The mixed format, composed of virtual and face-to-face meetings, was considered the best model for its application. Conclusion: We believe that the present report will encourage other institutions to adopt disciplines in the form of mentoring, in addition to using the remote resource as a teaching strategy.

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Maternal mortality is unacceptably high in our region. In 2015, the Latin American Center for Perinatology and Women´s Reproductive Health (CLAP) created a regional network of institutions including 16 countries, committed to improving epidemiological surveillance and healthcare of women in a situation of abortion or near miss event, using a common platform, the Perinatal Information System (SIP). The objective of the current pilot project was to test a new method of study called EviSIP (Evidence from SIP), a method of generating information on maternal near miss and abortion for the region. We describe the implementation of this initiative in reproductive healthcare facilities using SIP. Junior researchers/clinicians from these countries were included, along with expert researchers in reproductive health from across the world. Articles were produced with data on maternal near miss and abortion gathered from the SIP of each participating sentinel center; and recommendations from experts. EviSIP was the first joint workspace to discuss patient outcomes after treatment of abortion or near miss cases, with data analysis of each Sentinel Center; discuss and analyze data among centers, at a country and regional level; discuss the main outcomes and their impact on changing procedures and policies; strengthen the operational research capacity of the centers; develop and encourage the publication of scientific articles. The EviSIP initiative also promoted training of healthcare professionals in research. EviSIP provided a unique opportunity to train for research and mentorship and was pivotal to the production of scientific knowledge of reproductive health in the region.

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AIM: To explore perspectives of nurse managers about their preparation for transitioning into positions of leadership. BACKGROUND: There have been serious concerns about the level of preparation as well as availability of support systems for transitioning of nurses into positions of authority. METHODS: This was a quantitative study conducted in four Caribbean countries targeting nurses promoted to leadership positions within the last 5 years. Data were collected using a 30-item questionnaire. Ethical approvals were received from the University of the West Indies and the participating countries. RESULTS: Most participants were female, had 15 or more years' experience and an associate degree/diploma in nursing. They felt prepared through training and acting opportunities although many were not preceptored/mentored into the position. Preparation by training was positively correlated to acting opportunities, preceptorship programme and having a preceptor. CONCLUSION: Transitioning into positions of leadership requires readiness from a personal as well as an organisational perspective. There must be investment in the development opportunities to support nurses' transition into leadership positions. IMPLICATIONS FOR NURSING MANAGEMENT: Organisational continuity and effectiveness will be dependent on a balance between investing in experienced nursing personnel while encouraging personal development of less-experienced nurses. Peer mentorship must be utilized to facilitate nurse transition.

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Aim: To explore perspectives of nurse managers about their preparation for transitioning into positions of leadership. Background: There have been serious concerns about the level of preparation as well as availability of support systems for transitioning of nurses into positions of authority. Methods: This was a quantitative study conducted in four Caribbean countries targeting nurses promoted to leadership positions within the last 5 years. Data were collected using a 30-item questionnaire. Ethical approvals were received from the University of the West Indies and the participating countries. Results: Most participants were female, had 15 or more years' experience and an associate degree/diploma in nursing. They felt prepared through training and acting opportunities although many were not preceptored/mentored into the position. Preparation by training was positively correlated to acting opportunities, preceptorship programme and having a preceptor. Conclusion: Transitioning into positions of leadership requires readiness from a personal as well as an organisational perspective. There must be investment in the development opportunities to support nurses' transition into leadership positions. Implications for Nursing Management: Organisational continuity and effectiveness will be dependent on a balance between investing in experienced nursing personnel while encouraging personal development of less-experienced nurses. Peer mentorship must be utilized to facilitate nurse transition.

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