2020, Number 4
Mexican Board of General Surgery, A.C. Origins and development. Present and future
Full text
10.35366/101406
Language: English/Spanish [Versi?n en espa?ol]
References: 10
Page: 339-344
PDF size: 192.94 Kb.
ABSTRACT
On the forty-second anniversary of the creation of the Mexican Board of General Surgery, A.C. (Consejo Mexicano de Cirugía General, A.C. [CMCG]) the following historical synthesis is presented with the intention of recalling the origins of the institution, its evolution and current condition, and to highlight its transcendence for the national general surgery.INTRODUCTION
Although the origins of general surgery in our country date back to pre-Columbian times, it was in Mexico at the end of the 19th century and the first half of the 20th century when the first surgical specialties such as gynecology, urology, digestive system surgery, abdominal wall surgery, orthopedic surgery, ophthalmology, among others, were established, and it was not until 1969 when general surgery as such was recognized as a core specialty by the Division of Postgraduate Studies of the Faculty of Medicine of the National Autonomous University of Mexico (UNAM).1 The training of surgeons prior to this date was tutorial and surgeons learned the surgical fundamentals with each of their rotations through the medical and surgical services of the different specialties.2
In our country, during most of the first half of the 20th century, "specialist" physicians were largely self-taught since neither internships nor medical residencies as we know them today existed. For young physicians interested in perfecting their learning and orienting it towards a particular "specialty" to achieve their goal, it was necessary to approach one of their outstanding teachers in the intended discipline. Teachers were generally chosen by the students for their charisma and professional prestige, and students were selected or admitted by the preceptor based on their background as undergraduates, and on the sympathy the teacher felt for them. We must remember that in the 1930s there were only nine medical schools in the whole country, which explained the closeness that often prevailed in teacher-student relationships in the national medical field, since they knew each other in depth since their undergraduate stage, so that both knew perfectly well what to expect from each other, that is, it was a selection loaded with subjectivity, but no less efficient than the current one.3
In 1970 the General Surgery Program was formally integrated to the postgraduate courses of the Faculty of Medicine of the UNAM. This program was revised and updated in 1976 and the courses had a duration of three years until 1994, when the program was substantially modified, increasing one year to the initial program, resulting in a current duration of four years for training courses in general surgery throughout the country;4 even in some universities the current duration of the residency is up to five years.
BACKGROUND AND CREATION OF THE CMCG
In response to the concerns of creating the Mexican Board of General Surgery (CMCG), on September 22, 1976, the following doctors met in the meeting room of the Blood Bank of the Mexican Red Cross Hospital: Drs: César Athié Gutiérrez, Guillermo Alamilla Gutiérrez, Carlos Albarrán Treviño, José Luis Bravo Llamosa, Antonio Capetillo Robles Gil, Fernando Díaz Ballesteros, Óscar Díaz Giménez, Enrique Fernández Hidalgo, Enrique Flores Espinosa, Manuel Manzanilla, Carlos Moreno Fernández, Manuel Quijano Narezo, Fernando Romero Castillo, Mario Trápaga Altamirano, José Valencia del Riego, Alfredo Vicencio Tovar, and Alberto Villazón Sahagún with the purpose of ratifying the statutes that would govern the CMCG and/or initiating the procedures for its legal constitution before a notary public and requesting its registration before the Mexican Ministry of Health and the approval of the National Academy of Medicine. These were the founding members of the Mexican Board of General Surgery, A.C. All of them were full professors of the specialization courses in general surgery registered at the Division of Higher Studies of the Faculty of Medicine of UNAM.5
DEFINITIVE CONSTITUTION OF THE CMCG
As part of the agreements of that meeting, it was proposed and accepted that invitations to be certified soon be sent to all surgeons in the country. This communication was sent through the health institutions as well as the institutions that used to train surgeons. The distinctive logo of the CMCG was also proposed and accepted and it was agreed to invite an equal number of surgeons representing the entire Mexican Republic, that is, 15 surgeons, to confer it the national character and it was agreed to initiate the corresponding notary procedures to legalize the constitution of the CMCG.
A little more than a year later, on November 19, 1977, in the same meeting room of the Blood Bank of the Mexican Red Cross Hospital, the 30 surgeons listed below met:
Dr. Guillermo Alamilla Gutiérrez CDMX*
Dr. Carlos Albarrán Treviño CDMX*
Dr. César Athié Gutiérrez CDMX*
Dr. Leonel Barrera Cantú Chihuahua
Dr. José Luis Bravo Llamosa CDMX*
Dr. Antonio Capetillo Robles-Gil CDMX*
Dr. Fernando Díaz Ballesteros CDMX*
Dr. Óscar Díaz Giménez CDMX*
Dr. Enrique Fernández Hidalgo CDMX*
Dr. Enrique Flores Espinoza CDMX*
Dr. Pedro Gama Carpio Guanajuato
Dr. Gilberto López Betancourt Nuevo Leon
Dr. Manuel Manzanilla Sevilla CDMX*
Dr. Armando Martínez Santaella Oaxaca
Dr. Ricardo Mondragón Mexico
Ballesteros State of
Dr. Raúl Montalvo Escamilla Yucatan
Dr. Carlos Moreno Fernández CDMX*
Dr. Jaime Paredes Ugarte Puebla
Dr. Javier Preciado Zepeda Jalisco
Dr. Manuel Quijano Narezo CDMX*
Dr. Ricardo Quilantán Antiga San Luis
Potosi
Dr. Gregorio Ramírez Valdez Coahuila
Dr. Fernando Reyes Méndez Guerrero
Dr. Francisco Rivadeneyra Michoacan
Hinojosa
Dr. Rafael Sedas Rendón Veracruz
Dr. José Valencia del Riego CDMX*
Dr. Juan Vela Trujillo Tamaulipas
Dr. Alfredo Vicencio Tovar CDMX*
Dr. Alberto Villazón Sahagún CDMX*
Dr. Héctor Zazueta Duarte Sinaloa
* Former Federal District (D.F.)On this occasion, with the purpose of declaring the definitive constitution of the Mexican Board of General Surgery, A.C., in this session, Dr. Manuel Quijano Narezo informed the details of the registration of the CMCG before the Mexican Ministry of Foreign Relations and the Ministry of Health. Afterwards, the governing body was elected unanimously naming first secretary Dr. Manuel Quijano Narezo, second secretary Dr. Enrique Flores Espinoza and treasurer Dr. Carlos Moreno Fernández.6
BECOMING
During 1978, the first year in which the CMCG came into operation and based on a transitory article, 1,769 surgeons from all over the country were certified who, in response to the call issued by the CMCG, took advantage of the mentioned transitory article and were all certified-on November 11, 1978.7
The first certification exam was held on December 7 and 8, 1979 at the traditional General Hospital of Mexico and from that year onwards the exam has been held annually at different venues.
Currently, the evaluation process is carried out in three phases: curricular (carried out altruistically and efficiently by the counselors), followed by a written and oral evaluation. To allow recent graduates of university courses to take the written exam days before officially concluding their residency, in the month of February of each year, the month in which the residents graduate from their academic programs, the written phase is carried out simultaneously in four venues, in the cities of Monterrey, Nuevo Leon, Guadalajara, Jalisco, Puebla, and Mexico City (at the Tlatelolco Evaluation Center of the Torre de Vinculación y Gestión Universitaria of the UNAM) and those who pass the written phase take the oral phase of the exam in the month of April for the interior of the Republic in Monterrey, Guadalajara, and Puebla and in the month of May, the oral exam is held in Mexico City at the facilities of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.
It is worth mentioning that in 1980 the Mexican Ministry of Health granted the recognition of certification in general surgery and in 1981 both the Mexican Academy of Surgery and the American College of Surgeons granted this recognition. Likewise, it is important to highlight that in 1994 the CMCG signed the constitutive act of the National Normative Committee of Medical Specialties Councils (CONACEM).
It is equally important to point out that on September 1, 2011, articles 81 and 272-Bis II of the General Health Law were modified, which establish the obligation for all general surgeons in the country to have the current certification by the CMCG in order to perform surgical procedures of the specialty.8 Likewise, in 2012 the CMCG was the first council to sign an agreement with the Federal Institute of Access to Information (IFAI) within the framework of respect and observance of the Personal Data Protection Law.
It should be noted that, in agreement with CONACEM, chapters have been opened within the CMCG itself, establishing the certification processes for bariatric surgeons as of 2013 and for renal transplant surgeons as of 2014, with the process of creating the endoscopy certification chapter for the surgeon in the pipeline.
The certification and recertification evaluations as well as the recertification processes by curricular points currently carried out at the CMCG are:
General Surgery Chapter:
- 1. First time certification (written and oral exams).
- 2. Recertification by examination.
- 3. Recertification by curricular points.
- 4. Surgery for rural health services.
- 5. Surgeons with more than 15 years of experience.
- 6. Training. Emphasizing that this exam is directed to the third-year residents of the specialty so that they become familiar with the type of exams and registration processes through the CMCG web page, with the purpose that their performance in the actual certification exam is optimal. This examination modality was implemented in the first decade of the present century.
Chapter of Bariatric Surgery:
- 1. First time certification (written and oral exams).
- 2. Recertification by examination.
- 3. Recertification by curriculum points.
Chapter of Renal Transplant Surgery:
- 1. First time certification (written and oral exams).
- 2. Recertification by examination.
- 3. Recertification by curriculum points.
As part of the principles that reflect the philosophy of the Consejo Mexicano de Cirugía General, A.C., we will mention its mission, vision, and values:
CMCG mission: To be and remain the only academic certifying body in Mexico that leads the regulation, standards, and certification in general surgery, with national and international recognition for the quality of the certification processes developed as well as for the quality and performance of its staff and members of the CMCG.
CMCG vision: Is the establishment, transparent management, and continuous improvement of processes, parameters, and standards to carry out the certification and recertification of general surgeons practicing their specialty in the Mexican Republic, which guarantee the high and homogeneous quality of knowledge, skills, and academic training of excellence of all graduates in the various academic training programs in the country.
CMCG values: Responsibility, quality and continuous improvement, honesty, honorability, professional reliability and probity.9
With our certification processes we seek that the approved surgeons are worthy of the endorsement conferred by the Mexican Council of General Surgery, A.C. and the National Regulatory Committee of Medical Specialties Councils as well as the recognition of suitability granted by both the National Academy of Medicine and the Mexican Academy of Surgery. Since the certification is valid for five years, with the five-year recertification mandate we also seek the constant and optimal updating of the general surgeon to permanently maintain their level of medical preparation.
LIST OF FORMER PRESIDENTS OF THE MEXICAN BOARD OF GENERAL SURGERY
1978-1980 Dr. Manuel Quijano Narezo
1980-1982 Dr. Alberto Villazón Sahagún
1982-1984 Dr. Alfredo Vicencio Tovar
1984-1986 Dr. Jorge Bautista O'Farril
1986-1988 Dr. Óscar Díaz Giménez
1988-1990 Dr. César Gutiérrez
Samperio
1990-1992 Dr. Víctor Manuel
Arrubarrena Aragón
1992-1994 Dr. Jorge Pérez-Castro
Vázquez
1994-1996 Dr. José Fenig Rodríguez
1996-1998 Dr. Rubén Cortés González
1998-2000 Dr. Ángel Zárate Aguilar
2000-2002 Dr. Alfonso G. Pérez
Morales
2002-2004 Dr. Gilberto López
Betancourt
2004-2006 Dr. Lorenzo De la Garza
Villaseñor
2006-2008 Dr. Patricio Rogelio Sánchez
Fernández
2008-2011 Dr. Luis Humberto Ortega
León
2011-2014 Dra. Adriana Hernández
López
2014-2016 Dr. Ricardo Blas Azotla
2016-2018 Dr. Héctor F. Noyola
Villalobos
2018-2020 Dr. Jordán Zamora Godínez
CURRENT BOARD OF DIRECTORS (2018-2020)
President: Dr. Jordán Zamora Godínez
Vice-president: Dr. Juan Pablo Pantoja
Millán
Secretary: Dr. Enrique Jiménez
Chavarría
Treasurer: Dr. Vicente González Ruiz
SUITABILITY
Although the CMCG oversees the evaluation of the surgeons in the country, the CMCG in turn is evaluated by the CONACEM and the National Academy of Medicine and the Mexican Academy of Surgery to be able to confer the recognition of suitability endorsed by them.
The certificates that are physically delivered to the surgeons who pass the exams or the recertification processes, are made exclusively by CONACEM, have several security measures and, very important, they have with the recognition of suitability granted by both CONACEM and the National Academy of Medicine and the Mexican Academy of Surgery. This condition of suitability and its corresponding seal must be renewed every five years and its attainment depends on the evaluation that CONACEM and the academies make of the CMCG. The latest recognition of suitability was granted to the CMCG on February 16, 2018, and is valid until 2023.
In its 42 years of existence of the CMCG, both the exam format and the registration and evaluation processes have evolved according to the modernity of each historical moment, starting from printed sheets, through slides, the use of optical sheets for scoring and analysis of the results, etc., to the moment in which there is a very efficient electronic platform that allows both the registration and the application of exams and their evaluation.
All the information is integrated in a reliable database linked to the CMCG web page (www.cmcgac.org.mx) through which the applicants carry out the registration process and in which, among other things, the calls for the different types of exams offered by the CMCG and the directory of doctors with current certification are published, which can be consulted by any person, at anytime and anywhere in the world.
In this same period, the CMCG has certified, at least once, 10,232 general surgeons, of which 4,242 are currently certified.
CMCG HEADQUARTERS
The first address of the CMCG was located at Av. Veracruz No. 93-202, Colonia Condesa, Delegación Cuauhtémoc, Mexico City, first rented and since 1990 owned.
Current and own address since August 2011: World Trade Center of Mexico City, Montecito Street No. 38, 18th Floor, Office 21, Colonia Nápoles, Alcaldía Benito Juárez, Mexico City, C.P. 03810. Telephone numbers 55-5286-3012 and 55-5211-0074.
CONCLUSION
In summary, the training of medical specialists in the country is made up of a large number of institutions, initially public and, since the last third of the last century, also private institutions, with varying degrees of development and, therefore, with different educational offerings, so that the specialists who graduate have great heterogeneity and differences in their training.10 Despite this, this system is so far the best option for the training of human resources for health.
However, it is precisely because of this heterogeneity in the training of general surgeons in Mexico that it is essential to have an academic, professional and completely neutral body in charge of establishing the minimum academic and deontological criteria that a general surgeon must have, regardless of the university that endorses him or her or the hospital or hospitals where he or she has been trained, and to evaluate, by means of its examinations, all surgeons in the country with the purpose of accrediting that the current certified surgeon has the adequate preparation for his patients to receive quality care in any part of the national territory in both public and private health institutions, and that organism is precisely the Mexican Council of General Surgery, A.C.
REFERENCES
Carrasco Rojas JA. Cirugía general. En: Fajardo Dolci G, Graue Wiechers E, Kershenobich Stalnikowitz D, Vilar Puig P. Desarrollo de las especialidades médicas en México. Secretaría de Salud, Universidad Nacional Autónoma de México, Academia Nacional de Medicina. México: Ed. Alfil S.A. de C.V.; 2012. p. 83.
Vargas Saldo E. La formación de médicos especialistas. En: Vázquez Martínez D, Cuevas Álvarez R, Crocker Sagástume R. La formación de personal de salud en México. Programa Colaborativo de Recursos Humanos en Salud, Instituto de Investigación de Recursos Humanos en Salud. México: Centro Universitario de Ciencias de la Salud de la Universidad de Guadalajara, AMFEM y UAM-Xochimilco; 2005. p. 118.
AFFILIATIONS
1 Mexican Council of General Surgery, A.C. Mexico.
CORRESPONDENCE
Jordán Zamora-Godínez, MD. E-mail: cmcgac@live.com y jordanzamoragodinez@gmail.comReceived: 02/26/2020. Accepted: 06/22/2020