Understanding the relevance of surgical specialties in undergraduate medical education: Insights of graduates.

BACKGROUND: The relevance of training medical students in surgical specialty services has been a matter of debate in contexts where the health care system focuses on primary health care. Some educators argue that medical students should be trained in primary care settings. Other educators assert that rotating in highly complex hospitals strengthens the competencies of future general practitioners. Nonetheless, little attention has been paid to the added value that rotations in surgical specialties have brought to newly graduated doctors' lives. In this study, we explored the perceptions of a group of graduates by focusing on the relevant experiences they had during their surgical specialty rotations in undergraduate medical training and how this training influenced their personal and professional life. METHODS: We conducted a qualitative study using a convenience sampling strategy to recruit a total of seven junior doctors. Data were collected through semi-structured interviews in 2022. Thematic analysis was used to analyse the data until code saturation was reached. RESULTS: The recurring themes were (1) perception of rotations, (2) valuable learning for medical practice and (3) defining their professional future. Participants felt that their experiences in surgical specialty rotations were beneficial, as they gained confidence to perform professionally and decide on future employment and strengthened their research and primary healthcare competencies. CONCLUSION: Although training in primary healthcare centres is crucial in undergraduate medical education, these results suggest that including rotations in surgical specialties may be valuable in enhancing the future careers of junior doctors.

De la formación basada en competencias a las actividades profesionales encomendables / From competency-based training to entrustable professional activities

Introducción: En los últimos años, la formación por competencias transita hacia las actividades profesionales encomendables, enfoque que facilita su operativización y evaluación. Objetivo: Actualizar los conceptos y metodologías del enfoque de actividades profesionales encomendables. Material y Métodos: Se realizó una revisión de alcance en la que se consultaron las bases de datos: SciELO, LILACS y PubMed. Se usó el término de búsqueda: "entrustable profesional activities", tanto en español, como en inglés, desde el año 2005 al 2021. Se encontraron 1 011 artículos en total, se revisaron 290, de los cuales se seleccionaron finalmente 43, todos relacionados con aspectos conceptuales y metodológicos de las actividades profesionales encomendables. Desarrollo: Se explica el concepto de actividades profesionales encomendables, sus características, usos, descripción y diferencias con el término "competencia". Se mencionan los pasos para desarrollarlas según Taylor, y se mencionan algunos desafíos de su aplicación. Conclusiones: Las actividades profesionales encomendables constituyen un novedoso enfoque en la educación médica contemporánea, que no siempre es bien comprendido. Aplicable no solo a pregrado, sino también a posgrado, especialidades médicas-quirúrgicas, tecnologías de la salud, enfermería y otras. Se ofrece información actualizada sobre su descripción y se reflexiona sobre su aplicación e implementación en el contexto nacional y regional(AU)

ABSTRACT Introduction: In recent years, competency training has moved towards training with entrustable professional activities, an approach that facilitates its operationalization and evaluation. Objective: To update the conceptual and methodological aspects of the entrustable professional activities approach. Material and Methods: Databases such as Scielo, LILACS and PubMed were used to collect information. The search term: "entrustable professional activities" was used in both Spanish and English. The review was undertaken during the period from 2005 to 2021. A total of 1 011 articles were found; 290 were read, and 37 were selected. All selected articles were related to conceptual and methodological aspects of entrustable professional activities. Development: The concept of entrustable professional activities is defined, as well as its characteristics, uses, and differences with the term "competence". The steps to develop entrustable professional activities according to Taylor are mentioned. Some challenges for its application in the national context are also mentioned. Conclusions: The entrustable professional activities constitute a novel approach to contemporary medical education, which is not always well understood. The e ntrustable professional activities are applicable not only to undergraduate but also to postgraduate education, medical-surgical specialties, health technologies, nursing, and others. Updated information on entrustable professional activities, their description, and reflections on their application and implementation in national and regional contexts are provided(AU)

En casa de herrero, azadón de palo. ¿Por qué estudiar medicina puede llegar a ser perjudicial para la salud y un riesgo para el fracaso académico? / Why studying medicine can be detrimental to health and a risk for academic failure?

No es un secreto que estudiar medicina se caracteriza por tener altas cargas académicas, estar expuesto al sufrimiento de los pacientes y, en algunos casos, a sus muertes, lo que puede generar estrés y ansiedad. No obstante, existen algunos vacíos de conocimiento en relación con esta problemática. Por ejemplo, aún no está del todo claro, por la poca evidencia disponible, cómo se relacionan el estrés académico y los hábitos de estudio inadecuados o la ansiedad y la somnolencia diurna en un ambiente educativo con estas características. Si estas asociaciones se demuestran, o se llegan a entender mejor, se podría concluir entonces que estudiar medicina (en particular) o una carrera universitaria con demandas académicas y emocionales similares (en general), tendría un nexo causal con los problemas de salud vinculados con la ansiedad, las alteraciones del sueño y los altos índices de estrés. Estos problemas incluyen, por ejemplo, las enfermedades mentales, como la depresión, o las alteraciones cardiovasculares, como la hipertensión arterial. Adicionalmente, vivir una experiencia de aprendizaje con este tipo de tensiones puede desencadenar dificultades para la concentración y la memoria, procesos que son fundamentales para el éxito académico

It is no secret that studying medicine is characterized by high academic loads, exposure to patients' suffering and, in some cases, their deaths, which can generate stress and anxiety. However, there are some gaps in knowledge regarding this issue. For example, it is still not entirely clear, due to the limited evidence available, how academic stress and inadequate study habits or anxiety and daytime sleepiness are related in an educational environment with these characteristics. If these associations are demonstrated, or become better understood, it could then be concluded that studying medicine (in particular) or a university career with similar academic and emotional demands (in general), would have a causal link to health problems linked to anxiety, sleep disturbances and high rates of stress. These problems include, for example, mental illnesses, such as depression, or cardiovascular disorders, such as high blood pressure. In addition, living a learning experience with this type of stress can trigger difficulties in concentration and memory, processes that are fundamental for academic success

Educational Strategies to Develop and Implement a Comprehensive Health Care Model Focused on Primary Care in Colombia.

The traditional, subject-based medical curriculum in Colombia has been mainly focused on the biomedical model proposed by Flexner in 1910. This means learning outcomes or competences are framed on curative care and the specialization of physicians. Students are mainly trained to work in highly complex hospitals in urban centers and encouraged to enroll (as soon as possible) in residencies. This curriculum lacks pertinence to implement the new Colombian Primary Health Care Model as the focus is a shift toward the promotion of health and prevention of illness. Recommendations to provide light on how to implement a change for ensuring pertinence of medical education in this context are discussed.

The influence of different curriculum designs on students' dropout rate: a case study.

The relationship between students' withdrawal and educational variables has generated a considerable number of publications. As the explosion of information in sciences and integration theories led to creating different curriculum designs, it has been assumed that differences among designs explain academic success and, therefore, students' retention. However, little attention has been given to examine explicitly how diverse designs influence dropout rates in practice, which questions if decisions to reform curricula are sufficiently informed. This article describes our curriculum reform, which exposes our former and current curriculum designs as having had dissimilar dropout percentages. Furthermore, we aimed to explore the influence of different curriculum designs on students' dropout rates. The conclusion is that dropout variations may be explained not only because of the curriculum design itself, but also because of the power relationship changes between teachers and students that brought out the design change. Consequently, more research is needed to fully understand the political implications of different curriculum designs and their influence on dropout rates.

El nuevo trívium en la formación médica más allá de la comunicación médico-paciente / The new trivium in medical training beyond the doctor-patient communication

Uno de los elementos innovadores de los currículos de medicina en las últimas décadas es el énfasis en la comunicación médico-paciente. Sin embargo, las competencias comunicativas van más allá; implican habilidades cognitivo-lingüísticas que soporten la escucha activa, la lectura, la escritura y la oralidad en el contexto del aprendizaje y práctica de la medicina. Creemos que limitar la enseñanza de la comunicación al encuentro médico-paciente deja de lado los procesos cognitivos y las manifestaciones lingüísticas fundamentales para asegurar el éxito comunicativo del médico dentro de la sociedad. En otras palabras, además de las técnicas para una mejor comunicación, las habilidades cognitivo-lingüísticas resultan esenciales en el momento de elegir, organizar, clasificar y categorizar la información que se ha de brindar tanto al paciente y su familia como a la comunidad médica para el mejoramiento de la salud de individuos y poblaciones. En este artículo pretendemos argumentar por qué es importante el aprendizaje integral de las habilidades comunicativas, ejemplificando el caso del nuevo trívium del currículo de medicina de la Universidad del Rosario, la cual constituye un espacio propicio para que el estudiante desarrolle habilidades cognitivo-lingüísticas para la comunicación clínica en su comunidad científica.

One of the innovative elements of medical curricula in recent decades is the emphasis on the doctor-patient communication. However, communicative competences go further; they involve cognitive-linguistic skills that support active listening, reading, writing and orality in the context of learning and practicing medicine. We believe that limiting the teaching of communication to the doctor-patient encounter leaves the cognitive processes and the fundamental linguistic manifestations aside to ensure the communicative success of the doctor within the society. In other words, in addition to the techniques for better communication, cognitive-linguistic skills are essential at the time of choosing, organizing, classifying and categorizing the information that must be provided both to the patient and his family and to the medical community for the improvement of the health of individuals and populations. In this article, we intend to argue why it is important to comprehensively learn the communication skills, exemplifying the case of the new trivium of the medicine curriculum of Universidad del Rosario, which constitutes a favorable space for the students to develop cognitive-linguistic skills for the clinical communication in their scientific community.

The magnitude of the injury pattern in femicides by stabbing in Colombian women / La magnitud del patrón de lesión en los feminicidios con arma cortopunzante en mujeres colombianas

Abstract Introduction: Assessing the severity of the injuries suffered by victims may contribute to prevent femicide more effectively. Objective: To establish whether the amount of wounds recorded in femicides by stabbing vary according to the age of the victim and the victim-offender relationship. Materials and methods: Cases of Colombian women who were stabbed to death between 2011 and 2013 (n=331; age: 14-91 years) were included in the study. They were classified according to age ranges and the type of relationship with the offender. Descriptive analyses were conducted. Two one-way ANOVAs and a factorial ANOVA were performed to assess the differences in the mean number of the stab wounds received by the victim, and to determine the effects of interaction among the established categories. Results: The pattern of injury severity was higher in women aged 22 to 40 years than in those aged 41 to 55 years, and in women attacked by their intimate partners than in those attacked by strangers and acquaintances. Age ranges and types of relationship had an interaction effect on the dimension of the sustained wound. Conclusion: The age of the victims and the types of relationship they had with the offender are variables that should be considered to propose preventive policies on femicide since both are correlated to violent acts with greater injury patterns.

Resumen Introducción. Estudiar la gravedad del trauma físico en las víctimas de feminicidio podría contribuir a prevenirlo de forma más efectiva. Objetivo. Determinar si el número de heridas en los feminicidios con arma cortopunzante varía respecto a la edad de la víctima y su relación con el atacante. Materiales y métodos. La población correspondió a mujeres colombianas lesionadas hasta la muerte con arma cortopunzante entre 2011 y 2013 (n=331; edad promedio 14-91 años), quienes fueron categorizadas por rangos de edad y tipos de relación con los agresores. Dos análisis ANOVA de una vía y uno factorial permitieron identificar diferencias entre los promedios de las lesiones de las víctimas y los efectos de interacción entre las categorías establecidas. Resultados. El patrón de gravedad del trauma físico fue mayor en mujeres entre los 22 y 40 años y con vínculos románticos con los agresores. Los rangos de edad y tipos de relación tuvieron efectos de interacción sobre la cantidad de heridas sufridas. Conclusión. La edad de las víctimas y el tipo de relación que tenían con el agresor son variables a considerar al diseñar políticas de prevención del feminicidio dado que su conexión con actos violentos resulta en un patrón peor de lesiones.

Extending the theoretical framework for curriculum integration in pre-clinical medical education.

INTRODUCTION: Curriculum integration is widely discussed in medical education but remains ill defined. Although there is plenty of information on logistical aspects of curriculum integration, little attention has been paid to the contextual issues that emerge from its practice and may complicate students' knowledge integration. Therefore, we aimed to uncover how curriculum integration is manifested through context. METHODS: We collected data from the official curriculum and interviewed ten participants (including curriculum designers, facilitators, and students) in the bachelor's medical program at Aalborg University. We observed various learning activities focused on pre-clinical education. Inspired by grounded theory, we analyzed the information we gathered. RESULTS: The following theoretical constructs emerged after the inductive analysis: 1) curriculum integration complexity is embedded in the institutional learning perspectives; 2) curriculum integration is used to harmonize conflicting learning perspectives in curriculum practice; 3) curriculum integration creates tensions that self-organize its structure; and 4) curriculum integration becomes visible in collaborative learning spaces. DISCUSSION: These constructs provide a framework for analyzing curriculum integration in the context in which it is meant to appear, which may assist educationalists to gain a more specific understanding of the term. This may enable effective curriculum integration since contextual issues are addressed in addition to the goals specified in the official curriculum.

Integración curricular mecanicista versus sistémica / Curricular integration in medical education

Introducción: la integración curricular ha sido un factor fundamental para el desarrollo de los currículos médicos modernos; sin embargo, en sus modelos más conocidos, que incluyen la integración horizontal y vertical, se continúan entendiéndose el aprendizaje de la medicina en torno a temas, tal como se hace en los currículos tradicionales. Esta manera de concebir el aprendizaje no permite analizar de manera metodológica el diseño de currículos integrados/integradores que involucran otras formas de aprender. Objetivo: suscitar una reflexión teórica y metodológica sobre la integración curricular en la educación médica con la finalidad de orientar el diseño y la evaluación de los currículos integrados/integradores y polemizar sobre qué tan innovadoras son las integraciones verticales y horizontales. Desarrollo: los currículos integrados horizontal y verticalmente son similares a los currículos tradicionales fragmentados en su concepción lineal del diseño, mientras que en la integración curricular sistémica, cuyos ejemplos pueden visualizarse en los currículos diseñados mediante el aprendizaje basado en problemas, se aborda el diseño curricular de manera circular mediante la conexión de cuestiones que se retroalimentan las unas a las otras, por tanto, las actividades de aprendizaje podrían diseñarse y evaluarse de forma simultánea. Conclusiones: al pensar en la integración curricular como una estrategia de innovación educativa implica debatir qué se entiende por currículos integrados/integradores, cómo se analizando la práctica de nuestros currículos médicos, con qué marcos teóricos estamos realizando ese análisis y qué implicaciones tiene esto en el diseño y la evaluación de los currículos(AU)

Introduction: Curricular integration has been a fundamental factor in the development of modern medical curricula; however, in its more well-known models, including horizontal and vertical integrations, the learning of medicine around subjects, as it is done in traditional curricula, continues to be understood. This way of conceiving learning does not allow methodological analysis of the design of integrated/integrative curricula that involve other ways of learning. Objective: To stimulate a theoretical and methodological reflection on curriculum integration in medical education, with the aim of orienting the design and assessment of integrated/integrative curricula and to discuss how innovative vertical and horizontal integrations are. Development: Horizontally and vertically integrated curricula are similar to traditional curricula fragmented in their design linear conception, while in systemic curricular integration, examples of which can be visualized in curricula designed through problem-based learning, curricular design is addressed in a circular way by connecting issues that feed back to one another; therefore, learning activities could be designed and assessed simultaneously. Conclusions: Thinking about curricular integration as a strategy of educational innovation implies discussing what we are understanding as integrated/ integrative curricula, how we are analyzing the practice of our medical curricula, with which theoretical frameworks we are doing that analysis, and what implications this has in curricula design and assessment(AU)

Integrated Medical Curriculum: Advantages and Disadvantages.

Most curricula for medical education have been integrated horizontally and vertically--vertically between basic and clinical sciences. The Flexnerian curriculum has disappeared to permit integration between basic sciences and clinical sciences, which are taught throughout the curriculum. We have proposed a different form of integration where the horizontal axis represents the defined learning outcomes and the vertical axis represents the teaching of the sciences throughout the courses. We believe that a mere integration of basic and clinical sciences is not enough because it is necessary to emphasize the importance of humanism as well as health population sciences in medicine. It is necessary to integrate basic and clinical sciences, humanism, and health population in the vertical axis, not only in the early years but also throughout the curriculum, presupposing the use of active teaching methods based on problems or cases in small groups.