Profesionalismo en tiempos de crisis: análisis de las principales controversias éticas durante la pandemia del COVID-19 / Professionalism in times of crisis: the analysis of the main ethical controversies during the COVID-19 pandemic

El cuidado del equipo interprofesional de salud es un factor indispensable para que el sistema sanitario funcione de manera estable y resi-liente, especialmente cuando la presión se vuelve extrema. La pandemia, además de poner a prueba los sistemas de salud y sus actores, ha dejado algunas dudas respecto a los alcances del profesionalismo, frente a las demandas y expectativas que la sociedad tiene. Para efectos de la presente revisión, el concepto de profesionalismo en tiempos de crisis incluye controversias y dilemas que surgen en la relación con la sociedad, ética profesional y responsabilidad sobre el autocuidado. El compromiso y la resiliencia para garantizar el cuidado del paciente son evidentes en el actuar de los profesionales de la salud; sin embargo, en ocasiones esto ha ido en detrimento de su propia integridad física y moral. La agenda de salud en México está en deuda con médicos, residentes y profesionales de enfermería, una vía para saldarla es a través del fortalecimiento de las instituciones, la definición de políticas y normativas institucionales que promuevan el autocuidado y, entre otras medidas, el establecimiento de sistemas que no obliguen a aquéllos a convertirse en héroes enfrentados a los riesgos de una crisis.

The care of the interprofessional health team is an indispensable factor for the health system to function in a stable and resilient manner, especially when the pressure becomes extreme. In addition to putting health systems and their actors to the test, the pandemic has left some doubts about the scope of professionalism in the face of society's demands and expectations. For this review, the concept of professionalism in times of crisis includes controversies and dilemmas that arise in the relationship with the community, professional ethics, and responsibility for self-care. Commitment and resilience to ensure patient care are evident in the actions of health professio-nals; however, at times, this has been to the detriment of their own physical and moral integrity. The health system in Mexico is indebted to physicians, residents, and nursing professionals, and a way to settle it is through the strengthening of institutions, the definition of institutional policies and regulations that promote self-care, and, among other measures, the establishment of systems that do not force them to become heroes facing the risks of a crisis.

Integración de la educación interprofesional: autodiagnóstico para programas de salud / Integration of Interprofessional Education: Self-Assessment for health care programs

Introducción: la educación interprofesional se produce cuando dos o más profesionales se conocen y se relacionan entre sí para permitir una colaboración eficaz con la intención de mejorar los resultados de salud. Diferentes marcos de referencia de identidad profesional y competencias han establecido la importancia de este tipo de formación. Sin embargo, cada programa puede contar con diferentes niveles de implementación para integrarlo en el mismo. Método: el objetivo del presente trabajo fue desarrollar un instrumento de autodiagnóstico sobre Integración de la Educación Interprofesional en los programas de salud, considerando su formalización y des-pliegue. Se utilizó una validación de expertos para el diseño del instrumento y una prueba piloto con directivos de cinco programas de salud. Resultados: el instrumento consta de 12 ítems para valorar si los alumnos cuentan con condiciones formativas interprofesio-nales: 1) Identifican, 2) Colaboran, 3) Toman decisiones y 4) Construyen soluciones. Para ello la institución educativa puede A. Definir, B. Comunicar, C. Formar, D. Evaluar o E. Mejorar las intervenciones formativas para garantizar una implementación adecuada de dichos propósitos. El modelo resultante es una guía taxonómica que permite identificar la formalización de la implementación cada una de las competencias en un programa de salud. Conclusiones: el instrumento propuesto cuenta con contenidos comprensibles y adecuados para cumplir con sus propósitos de autodiagnóstico en la formalización en la implementación de competencias interprofesionales. Sin embargo, más que un carácter estrictamente incremental, confiere una visión dinámica en la cual pueden implementarse escalas superiores sin haber cerrado un ciclo de mejora completo en las competencias previas.

Introduction: Interprofessional education occurs when two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. Different frameworks of professional identity and competencies have established the importance of interprofessional education. However, each program may have different levels of formalisation or implementation. Methods: The objective of this work was to develop a self-assessment instrument regarding the interprofessional education integration for health care programs. An expert validation was applied for the instrument design, and the heads of five health programs conducted a pilot test. Results: The instrument consists of 12 items to assess interprofessional education: 1) Identify, 2) Collaborate, 3) Make deci-sions, and 4) Build solutions. The educational institution can A. Define, B. Communicate, C. Train, D. Evaluate, or E. Improve educational interventions to ensure adequate implementation. The resulting model is a taxonomic guide that allows identifying the formalisation of the implementation of each of the competencies in a health care undergraduate program. Conclusions: The proposed self-assessment has understandable and adequate content to address its purposes. However, more than a strictly incremental approach, it confers a dynamic vision in which higher scales can be implemented without closinga complete improvement cycle in the previous competencies.

Current Activities Centered on Healthy Living and Recommendations for the Future: A Position Statement from the HL-PIVOT Network.

We continue to increase our cognizance and recognition of the importance of healthy living (HL) behaviors and HL medicine (HLM) to prevent and treat chronic disease. The continually unfolding events precipitated by the coronavirus disease 2019 (COVID-19) pandemic have further highlighted the importance of HL behaviors, as indicated by the characteristics of those who have been hospitalized and died from this viral infection. There has already been recognition that leading a healthy lifestyle, prior to the COVID-19 pandemic, may have a substantial protective effect in those who become infected with the virus. Now more than ever, HL behaviors and HLM are essential and must be promoted with a renewed vigor across the globe. In response to the rapidly evolving world since the beginning of the COVID-19 pandemic, and the clear need to change lifestyle behaviors to promote human resilience and quality of life, the HL for Pandemic Event Protection (HL-PIVOT) network was established. The 4 major areas of focus for the network are: (1) knowledge discovery and dissemination; (2) education; (3) policy; (4) implementation. This HL-PIVOT network position statement provides a current synopsis of the major focus areas of the network, including leading research in the field of HL behaviors and HLM, examples of best practices in education, policy, and implementation, and recommendations for the future.

MOOC Learning Assessment in Clinical Settings: Analysis from Quality Dimensions.

Online learning is becoming a fundamental modality of learning in medical education, and can be of great help during global crisis like the current COVID-19 pandemic. The MOOC (massive open online course) mode of e-learning is increasing its penetration worldwide, as a valid teaching approach to reach large populations. A major challenge in clinical education is the assessment of medical students and residents in clinical settings, and there is substantial evidence that the current situation requires improvement. The goal of this study was to evaluate the quality dimensions of a MOOC titled "Learning assessment in clinical settings," developed by three Mexican universities in the Coursera platform. A mixed-method study design was used to assess the quality dimensions of the MOOC in two phases: pilot and implementation. The best-rated aspects were learning resources and pedagogical perspective, and those with opportunity for improvement were collaboration and time management. Assessment might be learned through a MOOC format, especially for participants willing to engage with educational technology and self-direction.

Professional Culture in Medical Schools: A Medical Educator Interpretation.

Besides sharing knowledge, values, and attitudes, the members of a profession share a way of understanding how to perceive life, also known as professional identity. The formation of this identity is related to the acquisition of multiple roles, responsibilities, and collaboration, defining their professional culture. The medical educator is a professional who is committed to student development, who is a leader in his field, and who is active in academic or clinical activities, demonstrating the commitment to the community. The objective of this study was to explore the professional culture through the perception of the medical educator identity. A qualitative method was implemented by applying a content analysis strategy. A sample of 39 medical educators participated in structured interviews. Answers transcription was analyzed unitizing assumptions, effects, enablers, and barriers through the professional culture model: individualism, balkanized, collegiality per project, and extended collaboration. The definition of the medical educator was associated with 44% to individualism, 31% balkanized, 13% collegiality per project, and 13% extended collaboration. Generally, contributions from Basic Science educators are more individual, and the projects in the university are part of the operation planned for the short and medium term. Clinical Science educators are used to working in medical specialty groups, and some of them are involved in strategical social projects that provide care for the community. A cultural change transitioning from a highly autonomous strategy toward meaningful collaborative projects can help physicians and health professionals to develop a shared vision of what it means to be a medical educator. The medical school should provide a sense of collegial community environment to set common goals and expectations with adequate resources, and leadership is the standard.