Intervalo de confianza para el porcentaje poblacional de profesores con categoría docente Asistente / Confidence interval for the percent of teaching population with category of Teaching Assistant

RESUMEN En el proceso de autoevaluación de las carreras de Estomatología y Medicina para su acreditación en la Universidad de Ciencias Médicas de Matanzas en Cuba, dentro de la variable profesores se señala como una debilidad de los claustros docentes, el no predominio de las categorías principales titular y auxiliar, con un grupo de profesores mayoritariamente en la categoría de asistente, lo que motivó que se realizara la estimación de un intervalo de confianza para el verdadero valor del porcentaje de profesores con categoría asistente en el claustro de la Universidad con el objetivo de opinar basado en un método sólido y sencillo el rango de valores donde posiblemente se encuentre el valor real, utilizando las fórmulas del intervalo estándar y el de Wilson (AU).

SUMMARY The non-predominance of the main categories of Main Professor and Lecturer, with a group of professors mostly in the category of Assistant was pointed out in the variable Teachers, as weakness of the faculties in the auto evaluation process of Stomatology and Medicine undergraduate studies for their accreditation in the University of Medical Sciences of Matanzas in Cuba; it motivated the estimation of a confidence interval for the true value of the percent of teachers with category of Assistant in the University staff with the aim of holding a position based on a solid and simple method, on the rank of values where possibly is the real value, using the standard and Wilson´s interval formula (AU).

Embedding a longitudinal diagnostic reasoning curriculum in a residency program using a bolus/booster approach.

Background Diagnostic reasoning skills are essential to the practice of medicine, yet longitudinal curricula to teach residents and evaluate performance in this area is lacking. We describe a longitudinal diagnostic reasoning curriculum implemented in a university-based internal medicine residency program and self-evaluation assessment of the curriculum's effectiveness. Methods A longitudinal diagnostic reasoning curriculum (bolus/booster) was developed and implemented in the fall of 2015 at the University of Iowa. R1, R2, and R3 cohorts were taught the "bolus" curriculum at the beginning of each academic year followed by a "booster" component to maintain and build upon diagnostic reasoning skills taught during the "bolus" phase. Self-administered diagnostic thinking inventory (DTI) scores were collected in the spring of pre-curriculum (baseline, 2014-2015) and post-curriculum (2016-2017). Results The overall DTI scores improved in the R1 cohort, although statistically significant differences were not seen with R2s and R3s. In the original DTI categories, R1s improved in both flexibility of thinking and structure of thinking, the R2s improved in structure of thinking and the R3s did not improve in either category. R1s showed improvement in three of the four subcategories - data acquisition, problem representation, and hypothesis generation. The R2s improved in the subcategory of problem representation. R3s showed no improvement in any of the subcategories. The R3 cohort had higher mean scores in all categories but this did not reach statistical significance. Conclusions Our program created and successfully implemented a longitudinal diagnostic reasoning curriculum. DTI scores improved after implementation of a new diagnostic reasoning curriculum, particularly in R1 cohort.

Effect of a small-group, active learning, tutorial-based, in-course enrichment program on student performance in medical physiology.

Physiology is one of the major foundational sciences for the medical curriculum. This discipline has proven challenging for students to master due to ineffective content acquisition and retention. Preliminary data obtained from a survey completed by "low-performance" students (those maintaining a grade average below the passing mark of 70%) at Morehouse School of Medicine reported that students lacked the ability to adequately recognize and extract important physiological concepts to successfully navigate multiple-choice assessments. It was hypothesized that a specially designed, small-group, active learning, physiology in-course enrichment program would minimize course assessment failure rates by enhancing the ability of low-performance students to effectively identify important course content, successfully perform on multiple-choice assessments, and, thereby, improve overall course performance. Using self-report surveys, study skills and test-taking deficiencies limiting successful comprehension of course material and examination performance were identified. Mini-quiz assessments and assignments in formulating multiple-choice examination questions were given to help students recognize and solidify core concepts and improve test-taking ability. Lastly, self-report surveys evaluated the effectiveness of the enrichment program on overall course performance. Results showed a marked improvement in student confidence levels with regards to approaching multiple-choice assessments, and a significant improvement in grades achieved in the physiology component of the first-year curriculum, as 100% of participants achieved a final passing grade average of ≥70%. It was concluded that students became more proficient in identifying, understanding, and applying core physiological concepts and more successful in mastering multiple-choice questions.

A flipped classroom method based on a small private online course in physiology.

A small private online course (SPOC) supports blended learning on a small scale, enabling students to have a more comprehensive and deeper learning experience. It also provides instructors with a flexible and feasible model to better understand the students' learning needs and to supervise students' learning behaviors. In this study, we adopted SPOC flipped classroom blended teaching in the physiology course for clinical undergraduate students of Kunming Medical University. Compared with the control group [lecture-based learning (LBL)], the SPOC flipped classroom method significantly increased the scores of students in the preclass test (65.13 ± 12.45 vs. 53.46 ± 8.09, SPOC vs. LBL) and postclass test (80.43 ± 14.29 vs. 69.01 ± 12.81, SPOC vs. LBL), which is induced by students' increased interest in self-learning. More importantly, the significant difference between the preclass scores of the two groups suggested that the video lecture-based preview is more effective than the textbook-based preview. The study indicated that the SPOC flipped classroom was effective in enhancing the examination scores of students, reflecting an improved learning efficiency and a deeper understanding of the knowledge. In summary, the flipped classroom based on SPOC improves learning outcomes compared with LBL and has a wide application in the learning of basic medical courses.

Guía metodológica para la autoevaluación de la calidad institucional en una Facultad de Enfermería / Methodological Guidelines for Institutional Quality Self-Assessment in a Nursing School

Introducción: Las instituciones de educación superior que forman recursos humanos para la salud, se esfuerzan por perfeccionar los perfiles de egreso en armonía con las necesidades de la población. Mientras, se incrementan los cuestionamientos a la calidad académica, como producto de las relaciones de poder entre el mercado y el estado. La Facultad de Enfermería es el único centro estatal responsable de la formación de grado y posgrado. Disponer de una tecnología para la autoevaluación de la calidad institucional, podría impactar en la mejora de las funciones universitarias y en la misión social. Objetivos: Diseñar una guía metodológica para implementar el proceso de autoevaluación de la calidad institucional y validar la misma, para desarrollar un proceso sistemático y confiable. Métodos: Consistió en un proyecto de desarrollo tecnológico. El diseño preliminar fue ajustado en función de la consulta a expertos y las mediciones de los coeficientes de Alfa de Cronbach y correlación de Pearson. Se implementó una prueba de autoevaluación mediante la técnica de informantes clave. Resultados: La opinión de los expertos fue favorable para la totalidad de los contenidos. Las pruebas estadísticas demostraron un alto índice de consistencia interna y confiabilidad. El diseño obtenido, integró las pautas universitarias establecidas y las particularidades del servicio. Las recomendaciones se orientaron a mejorar la información disponible y formalizar una metodología participativa. Conclusiones: El diseño de la guía fue validado y permitió un autoconocimiento de la calidad institucional con mayor rigurosidad científica. Se identificaron limitaciones en la fase de intercambio entre los evaluadores(AU)

Introduction: Higher education institutions that train human resources in health strive to improve graduation profiles in harmony with the population needs. Meanwhile, the questioning increases for academic quality, as a product of power relations between the market and the state. The School of Nursing is the only state-run center responsible for undergraduate and postgraduate training. Having a technology for the self-evaluation of institutional quality could have an impact on the improvement of the functions and social mission of the university. Objectives: To design methodological guidelines for implementing the process of self-assessment of institutional quality and to validate it, in order to develop a systematic and reliable process. Methods: This consisted in a technological development project. The preliminary design was adjusted based on expert consultation and measurements of the Cronbach's Alpha coefficients and Pearson's correlation. A self-assessment test was implemented using the key informant technique. Results: The opinion of the experts was favorable for all the contents. The statistical tests showed a high index of internal consistency and reliability. The design obtained integrated the established university guidelines and the service particularities. The recommendations were aimed at improving the available information and at formalizing a participatory methodology. Conclusions: The design of the guidelines was validated and allowed a self-knowledge about institutional quality with greater scientific rigor. Limitations were identified in the exchange phase between the evaluators(AU)

Evaluating a nursing erasmus exchange experience: Reflections on the use and value of the Nominal Group Technique for evaluation.

This paper discusses the use of Nominal Group Technique (NGT) for European nursing exchange evaluation at one university. The NGT is a semi-quantitative evaluation method derived from the Delphi method popular in the 1970s and 1980s. The NGT was modified from the traditional version retaining the structured cycles and but adding a broader group discussion. The NGT had been used for 2 successive years but required analysis and evaluation itself for credibility and 'fit' for purpose which is presented here. It aimed to explore nursing students' exchange experiences and aid programme development futures exchanges and closure from exchange. Results varied for the cohorts and students as participants enthusiastically engaged generating ample data which they ranked and categorised collectively. Evaluation of the NGT itself was two fold: by the programme team who considered purpose, audience, inclusivity, context and expertise. Secondly, students were asked for their thoughts using a graffiti board. Students avidly engaged with NGT but importantly also reported an effect from the process itself as an opportunity to reflect and share their experiences. The programme team concluded the NGT offered a credible evaluation tool which made use of authentic student voice and offered interactive group processes. Pedagogially, it enabled active reflection thus aiding reorientation back to the United Kingdom and awareness of 'transformative' consequences of their exchange experiences.

Guía de ejercicios interactivos para autoevaluación de estudiantes de Enfermería en práctica preprofesional / Set of interactive exercises for the self-assessment of Nursing students in the pre-professional practice

Introducción: la práctica preprofesional ocupa el último curso de la Licenciatura en Enfermería. Contribuye a la educación y entrenamiento final del futuro egresado, lo que permite el desarrollo de habilidades relacionadas con la práctica de enfermería. Objetivo: elaborar una guía de ejercicios interactivos que propicie la autoevaluación de los estudiantes de enfermería que se encuentran en la práctica preprofesional. Métodos: se realizó un estudio de innovación tecnológica en la Facultad Tecnológica, de la Universidad de Ciencias Médicas de Camagüey, entre marzo y mayo de 2015. Para el diagnóstico se emplearon la entrevista estructurada y el análisis documental. Fueron utilizados además, la lluvia de ideas y el criterio de especialistas. El producto se elaboró a partir del programa Mediator. Resultados: el diagnóstico mostró un conjunto de deficiencias en la formación profesional de los estudiantes universitarios. Para contribuir a su erradicación se diseñó una guía de ejercicios sustentada en los objetivos del programa. La guía se elaboró a partir del programa Mediator, lo que permitió confeccionar un medio de enseñanza que propicia la autoevaluación. El criterio valorativo de los especialistas fue positivo. Estos reconocen el enfoque metodológico y didáctico del producto y emitieron sugerencias que serán tomadas en cuenta perfeccionar la propuesta. Conclusiones: la multimedia elaborada proporciona a los estudiantes un aprendizaje y autoevaluación continuos, con un enfoque metodológico y didáctico útiles para reforzar el aprendizaje teórico y práctico de la disciplina Enfermería(AU)

Introduction: The pre-profesional practice is the last course of the Nursing major. It contributes to the forthcoming graduates' education and final training, which allows the development of skills related to the nursing practice. Objective: To elaborate a set of interactive exercises that facilitates the self-assessment of the Nursing students who are in their pre-professional practice. Methods: A study of technological innovation was carried out at the University of Medical Sciences of Camagüey Technological School from March to May 2015. The structured interview and documentary analysis were used for the diagnosis. Brainstorming and the specialists' criteria were also used. The product was elaborated using the Mediator program. Results: The diagnosis showed a group of deficiencies in the professional training of university students. In order to contribute to its eradication, a set of exercises was designed based on the program's objectives. The set was developed using the program Mediator, which made it possible to create a teaching environment that encourages self-assessment. The specialists' criterion on value was positive. They recognized the product's methodological and didactic approach, and delivered suggestions that will be taken into account to perfect the proposal. Conclusions: The multimedia developed provides students with continuous learning and self-assessment, with a methodological and didactic approach useful to reinforce the theoretical and practical learning of the Nursing discipline(AU)

El proceso de autoevaluación en las instituciones universitarias pedagógicas: Una estrategia para su mejora / The self- evaluation process in the pedagogical university institutionsA strategy for its improvement

Fundamento: La calidad de los servicios educacionales constituye uno de los retos que enfrenta hoy la Educación Superior en Cuba, razón por la que la autoevaluación institucional es un instrumento esencial para la mejora de los procesos universitarios. Objetivo: Diseñar e implementar una estrategia de mejora para certificar la calidad en la Universidad de Ciencias Pedagógicas de Sancti Spíritus. Metodología: Se utilizó la investigación acción, que se corresponde con un enfoque metodológico predominantemente cualitativo. Resultados: Se aplicó una estrategia de mejora centrada en una visión integradora de los procesos sustantivos y contextualizados a las características de esta institución universitaria; las acciones se dirigieron a elevar la cultura de la calidad de los agentes participantes y aproximar los procesos universitarios a los estándares establecidos. Se minimizaron las debilidades y se aprovecharon las fortalezas en función del perfeccionamiento de los procesos sustantivos de la universidad. Conclusiones: La implementación de la propuesta en la Universidad Pedagógica contribuyó a alcanzar la categoría de acreditación de Institución Calificad.

Background: The quality of the educational services constitutes one of the challenges that face today the high education level in Cuba, a reason for which the institutional self-evaluation is an essential instrument to improve the university process. Objective: To design and implement a strategy of improving the registered quality in the science pedagogical university from Sancti Spiritus. Methodology: The action research was used in correspondence with a methodological approach mainly in quality. Results: An improving strategy was applied in an integrated vision of the contextualized and substantive processes to the characteristic of this university institution, the actions were gather to increase the agents and to approximate the university processes to the established standards. Were minimized the weakness in function of the improvement of the substantives processes of the university. Conclusions: The implementation of the proposal in the university contributed to enrich the accreditation category in the registered institution.

A formative midterm test increases accuracy of identifying students at risk of failing a third year surgery clerkship.

BACKGROUND: Providing midclerkship feedback to identify students at risk for failing is a Liaison Committee on Medical Education standard. Objective criteria for that feedback are critical. The investigators studied the value of a formative midterm (MT) test in identifying students at risk for failing a surgery clerkship. METHODS: A written midclerkship test, which did not contribute to the final grade, was administered (n = 155). The Bayesian specificity, sensitivity, and predictive values for clerkship failure of low MT score, low global clinical performance rating GCPR, and the combination of low MT and low GCPR were computed. RESULTS: Low MT as a predictor of clerkship failure was sensitive (1.0) but not specific (.35). Likewise, low GCPR was sensitive (1.0) but not specific (.31). The combination of low MT and GCPR, however, was both specific (1.0) and sensitive (.87). CONCLUSIONS: The addition of an MT test to clinical performance ratings can stratify students' risk for clerkship failure.

Development of an instrument to evaluate residents' confidence in quality improvement.

BACKGROUND: Practice-based learning and improvement is a core competency that all medical residents must demonstrate. Because confidence is important in translating competence into action, effective quality improvement (QI) curricula should evaluate trainees' knowledge and confidence to perform QI. Past efforts to assess educational outcomes in QI have not adequately evaluated trainees' confidence from a multidimensional perspective. METHODS: Participants--732 internal medicine and family medicine residents from 42 training programs in the United States--completed the 31-item Quality Improvement Confidence Instrument (QICI), which was developed to measure confidence in six QI skill domains based on the Institute for Healthcare Improvement model ofQI. Confirmatory factor analysis was performed to support construct validity. Multivariate analysis of covariance was used to examine associations between residents' QI experience and other characteristics with confidence scores. RESULTS: Confirmatory factor analysis supported the QICI's multidimensional structure. Individual items yielded adequate variability, and reliability estimates for all six domains were high (> 0.86). On average, residents rated their confidence lowest for skills pertaining to choosing a target for improvement (specifically, using methods to evaluate interventions and to identify sources of process errors) and for testing a change in practice using specific tools for data collection and analysis. After controlling for program year and other characteristics, residents with previous QI experience reported significantly greater QI confidence. CONCLUSION: The QICI offers a psychometrically rigorous approach to evaluating residents' confidence levels. It can be used to gauge the appropriateness of a trainee's confidence against actual QI performance.

Delivering endocrinology and reproduction in an integrated modular curriculum.

OBJECTIVE: To ascertain the perceptions of students and faculty of Shifa College of Medicine, Islamabad regarding the delivery of Endocrinology and Reproduction module as a component of the newly introduced Integrated Modular Curriculum. METHODS: A descriptive study, using mixed qualitative and quantitative method, starting from June 6 to August 15 2008. A period of 10 weeks was spent on the study including 8 weeks of planning, 2 weeks of delivery and assessment and a 2 weeks period of post hoc analysis and data collection. A multidisciplinary team of faculty developed themes, clinical cases, objectives and table of specification of the Endocrinology and Reproduction Module for Fourth Year MBBS Class. Continuous assessment was done by theme-based assignments and student presentations. Summative assessment was done by Multiple Choice and Short Answer Questions. Likert scale-based student feedback questionnaire was administered while the students were also encouraged to comment on the module for improvement. Feedback was obtained from the faculty in a similar manner. RESULTS: Out of a class of 86 students, 47 (55%) agreed to a balance between basic and clinical concepts addressed in the module, 21 (24%) agreed that emphasis on clinical concepts was appropriate, 37 (43%) agreed that learning strategies were well integrated, 50 (58%) were of the opinion that the assigned learning material was consistent with the session objectives, while 39 (45%) agreed that case-based instruction was useful, and 40 (47%) students were of the opinion that large group discussion was useful. Faculty feedback was positive towards integrated learning. CONCLUSIONS: Integrated Endocrinology and Reproduction module received mixed response from students. This led us to modify and tailor the curriculum to better cater for the needs of students. Feedback from students and faculty is essential for improvement in the quality of educational interventions.

The parametric, psychological, neuropsychological, and neuroanatomical properties of self and world evaluation.

BACKGROUND: As an individual moves from adolescence to adulthood, they need to form a new sense of self as their environment changes from a limited to a more expansive structure. During this critical stage in development the last dramatic steps of neural development occur and numerous psychiatric conditions begin to manifest. Currently, there is no measure that aids in the quantification of how the individual is adapting to, and conceptualizing their role in, these new structures. To fill this gap we created the Self and World Evaluation Expressions Test(SWEET). METHOD: Sixty-five young adults (20.6 years-old), 36 with a history of drug use, completed the SWEET. A factor analysis was performed on the SWEET and the resultant factors were correlated with psychological, neuropsychological, and neuroanatomical battery that included both T1-wieghted and diffusion tensor magnetic resonance imaging scans. RESULTS: WE DERIVED FOUR FACTORS: Self, Social-Emotional, Financial-Intellectual, and Spirituality. While showing limited relationships to psychological and neuropsychological measures, both white matter integrity and gray matter density showed significant relationships with SWEET factors. CONCLUSIONS: These findings suggest that while individual responses may not be indicative of psychological or cognitive processes they may relate to changes in brain structure. Several of these structures, such as the negative correlation of the affective impact of world with the dorsal anterior corpus callosum white matter integrity have been observed in psychiatric conditions (e.g., obsessive-compulsive disorder). Further longitudinal research using the SWEET may help understand the impact of dramatic shifts in self/world conceptualization and potentially link these shifts to underlying changes in brain structure.

Educating nurses about research ethics and practices with a self-directed practice-based learning program.

Learner-driven and practice-based education programs are recommended for integration of learning. A continuing education program on research ethics was introduced to five nurses in an ambulatory care setting at a Magnet® hospital, using a commercially available web-based course followed by a research practicum. The seasoned nurses reported little previous education in this area. Working with a nurse researcher, three nurses participated in a research project for improving clinic care delivery. The success of the continuing education program was determined by knowledge acquisition, satisfaction with learning activities, and perceived confidence in research participation. This continuing education program was effective in providing for knowledge and skill development in research ethics. The integrative learning format was well received.