National examination for medical residency admission: academic performance in a high-stakes test and the need for continuing education.

INTRODUCTION: Performance and selection rate of non-newly graduated physicians in a medical residency admission test as an indicator for the need of continuing education. METHODS: A database comprising 153 654 physicians who took a residency admission test in the period 2014-2018 was analysed. Performance and selection rates were assessed in relation to year of graduation and performance in medical school. RESULTS: The whole sample scored at a mean of 62.3 (SD ±8.9; range 1.11-91.11). Examinees who took the test in their year of graduation performed better (66.10) than those who took the test after their year of graduation (61.84); p<0.001.Selection rates differed accordingly; 33.9% for newly graduated physicians compared with 24.8% in those who took the test at least 1 year after graduation; p<0.001. An association between selection test performance and medical school grades was established using Pearson's correlation: r=0.40 for newly graduated physicians and r=0.30 for non-newly graduated physicians. There were statistically significant differences in selection rates for every ranking group of grades in medical school based on the χ2 test (p<0.001). The selection rates are decreased years after graduation even for candidates with high grades in medical school. DISCUSSION: There is an association between performance in a medical residency admission test and academic variables of the candidates: medical school grades and time elapsed from graduation to test taking. The evidence of decrease in retention of medical knowledge since graduation highlights the pertinence of continuing education interventions.

Descontrol glucémico: desafío de salud pública en prepandemia y pandemia.

OBJETIVO: Comparar el control glucémico entre pacientes con diabetes mellitus tipo 2 prepandemia vs pandemia de Covid-19 que acudieron a unidades de salud de primer nivel de atención de la Ciudad de México. Material y métodos. Se analizaron los registros de 23 912 pacientes con diabetes; 78.7% fueron del grupo prepandemia (2016 a 2020) y 21.3% del grupo pandemia (marzo 2020 a julio 2021). Se calcularon medidas de tendencia central y de dispersión, pruebas t de Student y se ajustó un modelo de regresión logística múltiple. RESULTADOS: La mayoría de los pacientes con diabetes fueron mujeres (66.6 y 62.6%) con edad promedio de 59 y 58 años, respectivamente, y con hemoglobina glucosilada (HbA1) final de 7.7 vs el grupo pandemia (8.0). Las variables asociadas con el descontrol glucémico incluyeron periodo, nivel de HbA1, sobrepeso, obesidad, antecedente de padres con diabetes, número de medicamentos y tipo de insulina. CONCLUSIONES: La mayoría de los pacientes con diabetes en ambos grupos tuvieron descontrol glucémico. Los pacientes del grupo pandemia tuvieron mayor descontrol glucémico de HbA1 comparados con los del grupo prepandemia. Después de recibir atención médica en ambos grupos, los pacientes mejoraron su control glucémico.

Health sciences undergraduate students academic track records.

BACKGROUND: Academic track record analysis is essential for evaluating the training of students and the structure of higher education study programs, which allows diagnosing and preventing educational lag and school dropout. OBJECTIVE: To analyze the differences in academic track records of UNAM health sciences undergraduate students from generations 2001 to 2016. MATERIAL AND METHODS: Study of real cohorts; graduation and lag rates were calculated. ANOVA was used to contrast the graduation rates between campuses by undergraduate program and time. To identify critical periods, survival functions were used with Kaplan-Meier's method. RESULTS: The lowest percentages of lag were observed in nursing and medicine students; nursing students had the highest graduation rates, especially at Zaragoza campus; dentistry students had the lowest graduation rates and the highest dropout and lag rates. Women showed higher graduation rates and lower risk of dropout and lag. CONCLUSIONS: Nursing, medicine and psychology undergraduate students at Zaragoza and Iztacala campuses, with modular programs, achieved the highest graduation percentages and the lowest dropout and lag rates.

ANTECEDENTES: El análisis de las trayectorias académicas es fundamental para evaluar la formación de los estudiantes y la estructura de los programas de estudio de educación superior, lo que permite diagnosticar y prevenir el rezago y abandono escolar. OBJETIVO: Analizar las diferencias en las trayectorias académicas de los estudiantes de las licenciaturas en ciencias de la salud de la UNAM de las generaciones 2001 a 2016. MATERIAL Y MÉTODOS: Estudio de cohortes reales; se calcularon tasas de egreso y rezago. Se realizó ANOVA para contrastar el egreso entre planteles por carrera y tiempo. Para identificar los períodos críticos se utilizaron funciones de supervivencia con el método de Kaplan-Meier. RESULTADOS: En las licenciaturas en enfermería y medicina se observaron los menores porcentajes de rezago; enfermería presentó los mayores porcentajes de egreso, sobre todo en la Facultad de Estudios Superiores Zaragoza; odontología mostró los menores índices de egreso y mayores índices de abandono y rezago. Las mujeres mostraron mayor egreso y menor riesgo de abandono y rezago. CONCLUSIONES: Los estudiantes de las licenciaturas en enfermería, medicina y psicología de las facultades de estudios superiores Zaragoza e Iztacala, con programas modulares, alcanzaron los mayores porcentajes de egreso y menores índices de abandono y rezago.

Medicine and the metaverse: current applications and future.

Innovative technologies such as the metaverse and chat GPT-4 (based on artificial intelligence) are present in the daily discourse of society; recently, they have been introduced into medical practice and are bringing about important changes. In the case of the metaverse ("beyond the universe"), various medical schools and departments around the world are beginning to use it as an innovative strategy for teaching subjects such as anatomy, histology, ophthalmology, and simulation in parallel (virtual) worlds for learning and supervision of surgeries, as well as for other applications in medical education and in the doctor-patient relationship. Although it should be regarded as an area of opportunity for the transformation of medicine, it is important to consider the various limitations and risks of the metaverse in medical practice, student training, and physicians' relationship with the health problems they have to deal with in their practice.

Las innovadoras tecnologías del metaverso y el chat GPT4 (basado en inteligencia artificial) están presentes en el discurso cotidiano de la sociedad; recientemente se han introducido en la práctica médica y están provocando importantes cambios. En cuanto al metaverso ("después del universo"), diversas escuelas y facultades de medicina del mundo comienzan a utilizarlo como una estrategia innovadora dirigida a la enseñanza de materias como anatomía, histología, oftalmología y simulación en mundos paralelos (virtuales) para el aprendizaje y supervisión de cirugías, así como para otras aplicaciones en educación médica y en la relación médico-paciente. Si bien debe tomarse en cuenta como un área de oportunidad para la transformación de la medicina, es importante considerar las diversas limitaciones y riesgos del metaverso en la práctica médica, la formación de estudiantes y la relación del médico con los problemas de salud a los que se enfrenta en su práctica.

Antibiotic prescription errors: the relationship with clinical competence in junior medical residents.

BACKGROUND: A large portion of prescribing errors can be attributed to deficiencies in medication knowledge. These errors are preventable and most often occur at the time of prescription. Antimicrobials are the drug class most common incorrectly prescribed. OBJECTIVE: To characterize the relationship between clinical competence and antibiotic prescription errors. We also investigated the frequency and severity of antibiotic prescription errors to identify items and attributes of clinical competence which are correlated with the antibiotic prescription error ratio. METHOD: A cross-sectional study was applied to assess clinical competence of junior medical residents in two reference academic hospitals and a regional hospital in Mexico City. It was conducted during February 2019. We used an infectious disease Objective Structured Clinical Examination (OSCE) to assess clinical competence and a measure of frequency, and severity of antibiotic prescription errors. RESULTS: The number of eligible participants was ~ 255 (hospital meeting attendance), and the number of residents in this study were 51 (~ 20%), 31 were female (60.8%). The mean OSCE score was 0.692 ± 0.073. The inter-item (Cronbach's alpha = 0.927) and inter-station internal consistency was adequate (Cronbach's alpha = 0.774). The G coefficient in generalizability theory analysis was 0.84. The antibiotic prescription error ratio was 45.1% ± 7%. The most frequent category of severity of antibiotic prescription errors was category E (errors that may contribute to or result in temporary harm to the patient and require intervention), 235 (65.2%). We observed a negative and significant correlation between clinical competence and antibiotic prescription errors (r = -0.33, p < 0.05, CI95% -0.57 to -0.07), which remained significant after controlling for the effect of gender and time since graduation from medical school (r = -0.39, p < 0.01, CI95% -0.625 to -0.118). Using exploratory factor analysis we identified two factors, which explained 69% of the variance in clinical competence, factor 1 evaluated socio-clinical skills and factor 2 evaluated diagnostic-therapeutic skills. Factor 2 was correlated with antibiotic prescription error ratio (r = -0.536, p < 0.001). CONCLUSIONS: We observed a negative correlation between clinical competence and antibiotic prescription error ratio in graduated physicians who have been accepted in a medical specialty. The therapeutic plan, which is a component of the clinical competence score, and the prescription skills had a negative correlation with antibiotic prescription errors. The most frequent errors in antibiotic prescriptions would require a second intervention.

Simultaneous Schlieren-Shadowgraph Visualization and Temperature Measurement Fields of Fluid Flow Using One Color CCD Camera.

Visualizing two variables in the fluid flow requires a complex optical system to fulfill such a purpose. Furthermore, in these applications, measuring the temperature fields of the fluid is sometimes necessary. In this work, we use a color digital camera to record in one snapshot shadowgraph and two direction sensitivity Schlieren images. Furthermore, the Schlieren images obtained are used to measure temperature fields. The optical system, as main components, employs an rgb Light Emitting Diode (LED), two knife edges represented by shortpass and longpass ultra-thin filters, and a color digital camera. The results of this study show that shadowgraph images are contaminated with the crosstalk effect, and correction against it was applied. On the other hand, the reached resolution of the optical system to measure temperature values is approximately one degree.

Panoramic reconstruction of quasi-cylindrical objects with digital holography and a conical mirror.

In this work, we present a panoramic digital holographic system for the first time capable of obtaining 3D information of a quasi-cylindrical object by using a conical mirror. The proposed panoramic digital holographic system is able to scan the entire surface of the object to determine the amplitude and phase simultaneously. This paper demonstrates the feasibility of analyzing quasi-cylindrical objects in a short time (0.5 s) with a single camera and a minimum number of optical components. In addition, it can be applied to determine not only topographic measurement of the cylindrical surface but also measurements of radial deformations. Experimental results are presented at different magnifications, thus illustrating its capabilities and versatility.

National examination for medical residency admission: academic variables and performance among different schools.

OBJECTIVE: To identify medical school characteristics associated with performance in a medical residency admission test. MATERIALS AND METHODS: Performance and selection rates according to type of medical school (Student´s t-test, Chi-squared test), accreditation status (Student´s t-test) and geographic regions (Anova) were analyzed from a database comprising 153 654 physicians who took the residency admission test Examen Nacional de Aspirantes a Residencias Médicas (ENARM) in the period 2014-2018. RESULTS: Performance was 62.5% for accredited programs and 61.4% for non-accredited programs (p<0.001); public schools reached 62.3% and private schools 62.2% (p<0.001). Northern regions performed above 63% while South-Southeast at 58.9% (p<0.001). Selection rate was 26.2% for accredited programs and 22.9% for non-accredited (p<0.001); 26.6% for public schools and 23.6% for private schools (p<0.001). North-East and North-West reached 31% while South-Southeast 20.7%. CONCLUSIONS: Type of school, accreditation status and geographic region may influence performance and selection rate.

Specialty choice determinants among Mexican medical students: a cross-sectional study.

BACKGROUND: The choice of medical specialty is related to multiple factors, students' values, and specialty perceptions. Research in this area is needed in low- and middle-income countries, where the alignment of specialty training with national healthcare needs has a complex local interdependency. The study aimed to identify factors that influence specialty choice among medical students. METHODS: Senior students at the National Autonomous University of Mexico (UNAM) Faculty of Medicine answered a questionnaire covering demographics, personal experiences, vocational features, and other factors related to specialty choice. Chi-square tests and factor analyses were performed. RESULTS: The questionnaire was applied to 714 fifth-year students, and 697 provided complete responses (response rate 81%). The instrument Cronbach's alpha was 0.8. The mean age was 24 ± 1 years; 65% were women. Eighty percent of the students wanted to specialize, and 60% had participated in congresses related to the specialty of interest. Only 5% wanted to remain as general practitioners. The majority (80%) wanted to enter a core specialty: internal medicine (29%), general surgery (24%), pediatrics (11%), gynecology and obstetrics (11%) and family medicine (4%). The relevant variables for specialty choice were grouped in three dimensions: personal values that develop and change during undergraduate training, career needs to be satisfied, and perception of specialty characteristics. CONCLUSIONS: Specialty choice of medical students in a middle-income country public university is influenced by the undergraduate experience, the desire to study a subspecialty and other factors (including having skills related to the specialty and type of patients).

Educational experiences in a master of health professions education program at the National Autonomous University of Mexico: A qualitative study.

Background: Medical schools and healthcare institutions need leaders with formal training in education, in order to provide quality medical teaching. An answer to this need lies in the graduate programs of health professions education. Many programs exist, but there is a dearth of publications about their educational processes and experiences. The purpose of this study was to explore the teaching and learning experiences of students, teachers, and graduates of the Master in Health Professions Education (MHPE) program at the National Autonomous University of Mexico (UNAM). Methods: A qualitative approach was used with focus group discussions with students, graduates, and teachers, to explore their opinions, feelings, and experiences about the program. Purposeful sampling of participants was done. Focus group guides were developed for the different study groups; testimonies were codified and categorized with axial coding and a constant comparison method. Results: Testimonies from 19 participants in three focus groups were obtained (five graduates, seven current students, and seven teachers). The data were grouped in seven thematic categories: expectations, feedback of research projects, the tutorial process, teaching strategies, usefulness of what was learned, professional development, and assessment. Positive elements of the program were identified as well as areas in need of improvement. Discussion: The MHPE program at UNAM has been a positive experience for students and mostly fulfilled their expectations, they learned the basic theories and practical aspects of teaching, learning, and assessment in the health professions. Some areas need improvement, such as tutor performance and timely feedback to the students. Graduates think the competencies acquired in the program are useful for their professional practice. This information will be used to improve the program. There is a need to meet international standards in MHPE programs.

[La analítica del aprendizaje en educación médica: ¿punto de inflexión?]

La analítica del aprendizaje es una disciplina novedosa que tiene un enorme potencial para mejorar la calidad de la educación médica y la evaluación del aprendizaje. Se define como: "la medición, recopilación, análisis y reporte de datos sobre los alumnos y sus contextos, con el propósito de entender y optimizar el aprendizaje y los entornos en que ocurre". En las últimas décadas, la aparición de grandes volúmenes de datos (big data), acompañada de una rápida evolución en la minería de datos educativos, la aparición de tecnologías sofisticadas para analizar y visualizar datos de cualquier tipo, así como la disponibilidad de dispositivos móviles con conectividad permanente, mayor velocidad de procesamiento y capacidad de recuperación de información, han generado un contexto que favorece el uso de la analítica del aprendizaje en la medicina clínica y la educación médica. En este artículo se describe la historia reciente del concepto de analítica del aprendizaje, sus ventajas y desventajas en educación superior, así como sus aplicaciones en la enseñanza de las ciencias de la salud y la evaluación educativa. Es necesario que la comunidad de educadores médicos conozca la analítica del aprendizaje, para ser capaces de integrarla en su contexto eficaz y oportunamente.

Learning analytics is an innovative discipline that has an enormous potential to improve the quality of medical education and learning assessment. It is defined as: "the measurement, collection, analysis and reporting of data about learners and their contexts, for purposes of understanding and optimizing learning and the environments in which it occurs". In recent decades, the appearance of large volumes of data (big data), accompanied by a quick evolution of educational data mining techniques, the emergence of sophisticated technologies to analyze and visualize any type of data, as well as the availability of permanently-connected mobile electronic devices, higher processing speed and capacity of information retrieval, have generated a context that favors the use of learning analytics in clinical medicine and medical education. In this paper, the recent history of the concept of learning analytics is described, as well as its advantages and disadvantages in higher education, and its applications in the teaching of health sciences and educational assessment. It is necessary for the community of medical educators to be acquainted with learning analytics, in order to be able to integrate it to our context in an efficacious and timely manner.

Dual-plane slightly off-axis digital holography based on a single cube beam splitter.

In order to recover the holographic object information, a method based on the recording of two digital holograms, not only at different planes but also in a slightly off-axis scheme, is presented. By introducing a π-phase shift in the reference wave, the zero-order diffracted term and the twin image are removed in the frequency domain during the processing of the recorded holograms. We show that the zero-order elimination by the phase-shifted holograms is better than working with weak-order beam and average intensity removal methods. For recording experimentally two π-shifted holograms at different planes slightly off-axis, a single cube beam splitter is used. Computer simulations and experimental results, carried out to validate our proposal, show a high accuracy of π/14 that can be comparable with phase-shifting digital holography. For high fringe spacing, our proposal could be applied in electron holography, avoiding high voltage in a biprism.

[Diagnostic and formative assessment of competencies at the beginning of undergraduate medical internship]. / valuación diagnóstica y formativa de competencias en estudiantes de medicina a su ingreso al internado médico de pregrado.

INTRODUCTION: Research on diagnostic and formative assessment competencies during undergraduate medical training is scarce in Latin America. OBJECTIVE: To assess the level of clinical competence of students at the beginning of their medical internship in a new curriculum. METHODS: This was an observational cross-sectional study in UNAM Faculty of Medicine students in Mexico City: a formative assessment of the second class of Curriculum 2010 students as part of the integral evaluation of the program. The assessment had two components: theoretical and practical. RESULTS: We assessed 577 students (65.5%) of the 880 total population that finished the 9th semester of Curriculum 2010. The written exam consisted of 232 items, with a mean of 61.0 ± 19.6, a difficulty index of 0.61, and Cronbach's alpha of 0.89. The mean of the objective structured clinical examination (OSCE) was 62.2 ± 16.8, with a mean Cronbach's alpha of 0.51. Results were analyzed by knowledge area and exam stations. CONCLUSIONS: The overall results provide evidence that students achieve sufficiently the competencies established in the curriculum at the beginning of the internship, that they have the necessary foundation for learning new and more complex information, and integrate it with existing knowledge to achieve significant learning and continue their training.

[Level of clinical competence in seven cohorts of medical students at the end of the internship]. / Grado de competencia clínica de siete generaciones de estudiantes al término del internado médico de pregrado.

INTRODUCTION: Objective structured clinical examination is the instrument with more validated evidence to assess the degree of clinical competence of medical students. OBJECTIVES: To assess the degree of clinical competence of medical students at the end of their internship; to assess the reliability of the instruments with G theory. METHODS: This was an observational, longitudinal, and comparative study. The target population was composed of 5,399 interns of seven generations that finished their internship at the Faculty of Medicine of UNAM, between 2009 and 2015. The instrument used was 18 OSCE stations, three in each subject of the internship. RESULTS: The undergraduate medical interns show a sufficient degree of clinical competence to be general practitioners. The laboratory interpretation and physical examination had the highest scores. The interpretation of imaging studies was the component with the lowest score. The Family Medicine disciplinal area had the highest average score in the OSCE; in contrast, Pediatrics obtained the lowest score on average. The reliability was measured with Generalizability Theory and ranged between 0.81 and 0.93. CONCLUSIONS: The clinical competence of undergraduate medical interns is considered sufficient. The results also show the subjects that require educational interventions to improve clinical competence of students.

[Construction and validation of an instrument to assess primary care level patient satisfaction]. / Construcción y validación de un instrumento para medir la satisfacción de los pacientes del primer nivel de atención médica en la Ciudad de México.

OBJECTIVE: To develop an instrument to assess the satisfaction of patients using health services at the first care level of the city of Mexico (SSA), adapted to the socio-cultural characteristics of the population, and to examine its reliability and validity. METHODS: The instrument reagents were designed using the natural semantic networks technique. The dimensions used have been determined from the literature. Participants included 230 adults with type 2 diabetes attending eight SSA health centers. Subsequently, intelligibility was determined by conducting a pilot, then the construct validity of the instrument by means of exploratory factor analysis was evaluated and its internal consistency was determined by calculating Cronbach's alpha. RESULTS: The questionnaire is composed of six factors with a Likert-type scale. Its consistency showed a Crombach´s alpha of 0.94. The factor structure included 29 reagents that correlated with the six dimensions with factorial loads>0.581 that explained 66.8% of the total variance. CONCLUSIONS: The patient satisfaction questionnaire incorporates the sociocultural characteristics of the target population and has an adequate level of validity and reliability and is quick and easy in application.

Evaluation of a Biomedical Informatics course for medical students: a pre-posttest study at UNAM Faculty of Medicine in Mexico.

BACKGROUND: Biomedical Informatics (BMI) education in medical schools is developing a sound curricular base, but there are few published reports of their educational usefulness. The goal of this paper is to assess knowledge change and satisfaction in medical students after a BMI curriculum. METHODS: The National Autonomous University of México Faculty of Medicine (UNAM) recently implemented a curricular reform that includes two BMI sequential courses (BMI-1 and BMI-2). The research design was one-group pretest-posttest. An objective test with evidence of validity was used for knowledge measurement. A satisfaction questionnaire was applied at the end of the courses. Two-tailed paired Student's t-tests were applied, comparing knowledge scores in the pre and post-test for each course. RESULTS: The study included student cohorts during two consecutive academic years. The 2013 BMI-1 course (n = 986 students) knowledge pretest score was 43.0 ± 8.6 (mean percent correct ± SD), and the post-test score was 57.7 ± 10.3 (p < 0.001); the 2014 BMI-1 (n = 907) pretest score was 43.7 ± 8.5, and the post-test was 58.1 ± 10.5 (p < 0.001). The 2012 BMI-2 course (n = 683) pretest score was 26.3 ± 7.9, the post-test score was 44.3 ± 13.3 (p < 0.001); the 2013 BMI-2 (n = 926) pretest score was 27.5 ± 7.5, and the post-test was 42.0 ± 11.0 (p < 0.001). The overall opinion of the students regarding the course was from good to excellent, with a response rate higher than 90%. The satisfaction questionnaires had high reliability (Cronbach's alpha of 0.93). CONCLUSIONS: The study shows a significant increase in BMI knowledge after an educational intervention in four medical student cohorts, and an overall positive evaluation by the students. Long-term follow-up is needed, as well as controlled studies of BMI educational interventions using performance endpoints.

[Diagnostic assessment of knowledge and competencies in medical students at the end of the second year of medical school: the challenge of building an airplane while it's flying]. / Evaluación diagnóstica de conocimientos y competencias en estudiantes de medicina al término del segundo año de la carrera: el reto de construir el avión mientras vuela.

INTRODUCTION: In Latin America there is almost no published information about knowledge retention and formative assessment of competencies in medical students, during medical school training and curricular changes. OBJECTIVE: To assess knowledge level and clinical competencies in medical students at the end of the second year in a new curriculum. METHODS: Observational, cross-sectional study in UNAM Faculty of Medicine students. A diagnostic evaluation was performed in the first class of the "Plan of Studies 2010" curriculum, as part of an integral program evaluation strategy. The assessment had two components: theoretical and practical. RESULTS: 456 (87%) of the 524 students that successfully completed the second year of Plan 2010 were assessed. The written test had 211 items, a mean score of 60 ± 14.5, mean difficulty index of 0.60, reliability with Cronbach's alpha of 0.85. The OSCE mean global score was 58 ± 9, Cronbach's alpha of 0.36, and G-coefficient of 0.48, and results were provided for each station. Results by area of knowledge, course, and station were reported. CONCLUSIONS: The results in general are acceptable, compared with previous written evaluations at the end of the second year, suggesting that the new program is achieving its educational goals. Competencies were formally assessed for the first time in our Institution, establishing a starting point for follow-up. The study provided useful information to the institution, teachers and students.

[Clinical competence evaluation using the Objective Structured Clinical Examination (OSCE) in medical internship at UNAM]. / Evaluación de la competencia clínica con el examen clínico objetivo estructurado en el internado médico de la Universidad Nacional Autónoma de México.

INTRODUCTION: The Objective Structured Clinical Examination (OSCE) is a widely used measurement tool to assess clinical competence in the health sciences. There is little published evidence of its use in Mexican medical schools. OBJECTIVE: To assess clinical competence in medical students with an OSCE, before and after the Medical Internship. METHODS: Prospective cohort study, pre- post-test research design. The assessed population was medical students at UNAM Faculty of Medicine in Mexico in their Internship year. The instrument was an 18-stations OSCE, three stations per academic area of the Internship curriculum. RESULTS: We assessed the clinical competence of 278 students in a pretest OSCE when starting the Internship year, and tested them 10 months later with an equivalent post-test OSCE. The sample of students was 30.4% of the total Internship population. Test reliability with Cronbach's alpha was 0.62 in the pre-test and 0.64 in the post-test. The global mean score in the pretest OSCE was 55.6 ± 6.6 and in the post-test 63.2 ± 5.7 (p < 0.001), with a Cohen's d of 1.2. CONCLUSIONS: The clinical competence of medical students measured with an OSCE is higher after the medical internship year. This difference suggests that the internship can influence the development of clinical competence in medical students.

Combining Spirometry and the ARISCAT Respiratory Risk Assessment Can Improve Postoperative Outcomes and Reduce Mortality Risk in Mexico.

Introduction: Although a major goal of preoperative evaluation is to identify risk factors and improve postoperative outcomes, current clinical guidelines in Mexico indicate that preoperative spirometry should only be performed on patients with pulmonary disease. The aim of this study was to compare the incidence of postoperative complications (POC), mortality, and risk factors among adults who did or did not undergo preoperative spirometry, based on their Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) risk level. Material and methods: An observational, retrospective and comparative study design was used to identify 2059 patients from the General Hospital of Mexico who had an ARISCAT assessment during 2013-2017. Patients were classified in two groups: ARISCAT with spirometry (n = 1306) and ARISCAT without spirometry (n = 753). Chi-square, Fisher's exact test and the Student's t-tests were used to compare groups. Logistic regression was used to identify factors associated with an increased risk of POC and mortality. Results: In the ARISCAT with spirometry group, 11% of patients had POC, compared with 48% of patients in the ARISCAT without spirometry group. High-risk ARISCAT patients who did not receive spirometry had higher mortality (18%), than those who underwent spirometry (0.4%). Logistic regression results indicate that not performing preoperative spirometry increases the probability of POC and mortality. Conclusions: Our findings suggest that the combined use of preoperative spirometry and ARISCAT is associated with reduced POC and mortality. Future clinical guidelines should recommend the use of preoperative spirometry for patients with a moderate or high ARISCAT level in Mexico.

Introducción: La evaluación preoperatoria se centra en identificar los factores de riesgo y mejorar los resultados posoperatorios; las guías clínicas actuales en México indican la espirometría preoperatoria solo en pacientes con enfermedad pulmonar. El objetivo fue comparar la incidencia de complicaciones posoperatorias (CPO), la mortalidad y los factores de riesgo en pacientes clasificados por su nivel de riesgo de la escala de riesgo respiratorio en pacientes quirúrgicos de Cataluña (ARISCAT) sometidos o no a una espirometría preoperatoria. Material y métodos: Estudio observacional, retrospectivo y comparativo. Se clasificaron 2.059 pacientes del Hospital General de México durante 2013 a 2017; en dos grupos: ARISCAT con espirometría (n = 1.306) y ARISCAT sin espirometría (n = 753). Se aplicaron pruebas de X2, f de Fisher y t de Student para comparar los grupos y análisis de regresión logística para identificar los factores asociados a mayor riesgo de CPO y mortalidad. Resultados: Las CPO en el grupo ARISCAT con espirometría se presentaron en 11% de los pacientes, en comparación con el grupo ARISCAT sin espirometría (48%). Los pacientes ARISCAT sin espirometría de alto riesgo tuvieron una mortalidad más elevada (18%), en comparación con los pacientes que sí la realizaron (0.4%). Los resultados de la regresión logística indican que no realizar la espirometría preoperatoria incrementa la probabilidad de CPO y mortalidad. Conclusiones: Nuestros hallazgos sugieren que el uso combinado de espirometría preoperatoria y ARISCAT se asocia con menores CPO y mortalidad. Las guías clínicas futuras deberán recomendar el uso de la espirometría preoperatoria para pacientes con un nivel moderado o alto de ARISCAT en México.

Temperature and velocity measurement fields of fluids using a schlieren system.

This paper proposes a combined method for two-dimensional temperature and velocity measurements in liquid and gas flow using a schlieren system. Temperature measurements are made by relating the intensity level of each pixel in a schlieren image to the corresponding knife-edge position measured at the exit focal plane of the schlieren system. The same schlieren images were also used to measure the velocity of the fluid flow. The measurement is made by using particle image velocimetry (PIV). The PIV software used in this work analyzes motion between consecutive schlieren frames to obtain velocity fields. The proposed technique was applied to measure the temperature and velocity fields in the natural convection of water provoked by a heated rectangular plate.