[The role of ideas in knowledge and life sciences]. / El papel d elas ideas en el conocimiento y las ciencias de la vida.

In this paper about the role of ideas within knowledge, the importance of identifying theoretical problems beyond empirical ones (scientific facts) are emphasized. Theoretical problems arise when we reflect upon what underlies scientific discourse: a) Paradigms that rule logical thought and way of understanding. b) Inveterate beliefs and convictions. c) Universally accepted theories considered the objective reality. The paradigm proposed by E. Morin of disjunction, reduction, simplification and exclusion (DRSE) is discussed, as well as its effects in the splitting of humanistic culture from science and the predominance of analytical tradition in exclusion of the synthetic one in scientific research. The premises of neopositivism that rule scientific work are criticized and alternatives that recognize the importance of explicative ideas are proposed. By arguing that intellectual possibilities depend on ideas, it is highlighted the approaching quality of every theory and its potential contributions: comprehension, explication, understanding and description. The DRSE paradigm underlines mechanism which is the prevailing approach to understand living beings in both health and illness (the optimized machine and the broken down one), and the mechanist causality (MC) used to identify causes of disease and its natural history. The attributes of MC are described, demonstrating its limitations to understand human life and its vicissitudes. Alternative theories to understand both health and disease such as: cultural history of disease, the environment interiorization and anticipation theory and the contextual causality, are introduced and discussed briefly. The text concludes with the importance of recognizing theoretical problems along the way of knowledge about life, health and disease.

Progress in medicine and artificial intelligence.

This essay questions, with regard to medicine, the idea of progress as technological development by focusing on people rather than things. It analyzes how the predominance of such an idea of progress converts today's societies to techno-fetishism that degrades community life and medical practice, contributing to the medicalization of social life. It is argued that the realization of technological potentialities depends on their forms of use; that the main motive of technological development is unlimited profit and that priority developments are those that enhance the social control that maintains the status quo. The intelligence as an intelligence quotient is criticized by proposing it as an attribute of the human being as a whole, manifested in the ways of thinking and proceeding of people in their circumstances, where affectivity and critical thinking are essential for their development; it is emphasized that its antecedent is the harmonic concert of planetary life that contrasts with the prevailing human disharmony. It is proposed that artificial intelligence is the most recent creation of techno-fetishism that deposits vital attributes in technology and that its forms of use will accentuate the degradation of human and planetary life. Another idea of medical progress is proposed, based on forms of organization conducive to the development of inquisitive, critical and collaborative skills that promote permanent improvement, whose distant horizon is dignifying progress: spiritual, intellectual, moral and convivial sublimation of collectivities in harmony with the planetary ecosystem.

Este ensayo cuestiona, a propósito de la medicina, la idea de progreso como desarrollo tecnológico al centrarlo en las personas y no en las cosas. Se analiza cómo el predominio de tal idea de progreso convierte a las sociedades actuales al tecno-fetichismo que degrada la vida comunitaria y la práctica médica contribuyendo a la medicalización de la vida social. Se argumenta que la realización de las potencialidades tecnológicas depende de sus formas de uso, que el móvil principal del desarrollo tecnológico es el lucro sin límites, y que los desarrollos prioritarios son los que potencian el control social que mantiene el statu quo. Se critica la idea de inteligencia como cociente intelectual al proponerla como atributo del ser humano como un todo, manifiesto en las formas pensar y proceder de las personas en sus circunstancias, donde la afectividad y el pensamiento crítico son imprescindibles para su desarrollo. Se destaca que su antecedente es el concierto armónico de la vida planetaria contrastante con la disarmonía humana imperante. Se plantea que la inteligencia artificial es la más reciente hechura del tecno-fetichismo que deposita en la tecnología atributos vitales, y que sus formas de uso acentuarán la degradación de la vida humana y planetaria. Se propone otra idea de progreso médico basado en formas de organización propicias para el desarrollo de aptitudes inquisitivas, críticas y colaborativas que impulsen la superación permanente, cuyo horizonte lejano es el progreso dignificante: sublimación espiritual, intelectual, moral y convivencial de las colectividades en armonía con el ecosistema planetario.

Progress in medicine and artificial intelligence.

This essay challenges the idea of progress as technological development in relation to medicine by focusing on people rather than things. It analyzes how the prevalence of such an idea of progress leads contemporary societies to a technofetishism that degrades community life and medical practice, contributing to the medicalization of social life. It is argued that the realization of technological potentialities depends on their forms of use, that the main motive of technological development is unlimited profit, and the priority developments are those that enhance social control which maintains the status quo. Intelligence as an intelligence quotient is criticized by proposing it as an attribute of the human being as a whole, manifested in the ways of thinking and acting of human beings in their circumstances, where affectivity and critical thinking are essential for their development; it is emphasized that its antecedent is the harmonic concert of planetary life, which contrasts with the prevailing human disharmony. It is proposed that artificial intelligence is the latest creation of technofetishism, which deposits vital attributes in technology, and that its use will accentuate the degradation of human and planetary life. Another idea of medical progress is proposed, based on forms of organization that is conducive to the development of inquisitive, critical, and collaborative skills that promote permanent improvement, whose distant horizon is dignified progress: the spiritual, intellectual, moral, and convivial sublimation of collectivities in harmony with the planetary ecosystem.

Este ensayo cuestiona, a propósito de la medicina, la idea de progreso como desarrollo tecnológico al centrarlo en las personas no en las cosas. Se analiza cómo el predominio de tal idea de progreso convierte a las sociedades actuales al tecno-fetichismo que degrada la vida comunitaria y la práctica médica contribuyendo a la medicalización de la vida social. Se argumenta: que la realización de las potencialidades tecnológicas depende de sus formas de uso; que el móvil principal del desarrollo tecnológico es el lucro sin límites y que los desarrollos prioritarios son los que potencian el control social que mantiene el statu quo. Se critica la idea de inteligencia como cociente intelectual al proponerla como atributo del ser humano como un todo, manifiesto en las formas pensar y proceder de las personas en sus circunstancias, donde la afectividad y el pensamiento crítico son imprescindibles para su desarrollo. Se destaca que su antecedente es el concierto armónico de la vida planetaria contrastante con la disarmonía humana imperante. Se plantea que la inteligencia artificial es la más reciente hechura del tecno-fetichismo que deposita en la tecnología atributos vitales y que sus formas de uso acentuarán la degradación de la vida humana y planetaria. Se propone otra idea de progreso médico basado en formas de organización propicias para el desarrollo de aptitudes inquisitivas, críticas y colaborativas que impulsen la superación permanente, cuyo horizonte lejano es el progreso dignificante: sublimación espiritual, intelectual, moral y convivencial de las colectividades en armonía con el ecosistema planetario.

Educación y conocimiento liberador.

This essay begins with an aphorism on education: "forger of the liberating forces towards the progress of the human condition", in its spiritual, intellectual, moral and convivial connotation in harmony with the planetary ecosystem (dignifying progress). It highlights the coincidence of the highest historical levels of professional education with the extreme degradation of Western culture, which reveals the role of education that favors passivity in the face of knowledge and the prevailing order. The characteristics of passive education are contrasted with those of participatory education based on the development of critical thinking. Critical thinking is defined and the type of educational environment that stimulates and channels it is argued, in particular the complex and integrative thinking alluding to the self projected to who we are and where we are, absent in reductionist science. Liberating knowledge is specified and its purpose defined as "to understand ourselves as fraternal humanity and to find our place in harmony with the infinitely diverse concert of the living world". The theoretical revolutions -now dismissed- being seeds of liberating knowledge that revealed anthropocentrism and ethnocentrisms as "prisons of the spirit" are synthesized. It is concluded that liberating knowledge fulfills the utopian role of signaling the endless walking towards dignifying human progress.

Este ensayo inicia con un aforismo sobre la educación: «forjadora de las fuerzas liberadoras hacia el progreso de la condición humana¼, en su connotación espiritual, intelectual, moral y convivencial en armonía con el ecosistema planetario (progreso dignificante). Se realza la coincidencia de las mayores cotas históricas de educación profesional con la extrema degradación de la cultura occidental, reveladora del papel de la educación que favorece la pasividad ante el conocimiento y el orden imperante. Se contrastan los caracteres de la educación pasiva con los de la participativa basada en el desarrollo del pensamiento crítico. Se define el pensamiento crítico y se argumenta el tipo de ambiente educativo que lo estimula y encauza, en particular, el pensamiento complejo e integrador alusivo al sí mismo proyectado al quiénes somos y dónde estamos, ignorado por la ciencia reduccionista. Se especifican el conocimiento liberador y su finalidad: «entendernos como humanidad fraterna y encontrar nuestro lugar en armonía con el concierto infinitamente diverso del mundo viviente¼. Se sintetizan las revoluciones teóricas ­hoy desestimadas­, simientes del conocimiento liberador que develaron al antropocentrismo y a los etnocentrismos como «prisiones del espíritu¼. Se concluye que el conocimiento liberador cumple el papel utópico de orientar y señalizar el caminar interminable hacia el progreso dignificante.

Evolution and disease.

This essay questions evolutionary or Darwinian medicine for its uncritical adherence to evolutionary theory to explain diseases, which leaves aside the very vital process that transformed an "inert planet" into a "living one" where the nascent biological order subordinated the physicochemical one to prevail. The biological order is comparable to an "infinitely diverse harmonic concert", which has created and recreated, for eons, the environments conducive to its own permanence and evolution. The arrival of homo sapiens meant the cultural order emergence, which progressively supplanted, in its effects, the biological order by causing drastic and vertiginous changes in the planetary ecosystem that silenced the evolutionary process "without time to manifest". Adaptation as an ability to overcome adverse situations is a non-sense in the "harmonic concert"; instead, it is characteristic of the cultural order that imposes inhospitable and stressful environments on humans as inescapable adaptive demands. The vital quality of the biological order is the sequential anticipation of situations of interaction with significant objects in the environment, which enables the consummation of basic vital activities, emblematic of the state of maturity of living beings. To think that evolution explains chronic diseases is not only illusory but counterproductive because it covers up the root of our problems: a humanity in constant disharmony between bellicose ethnocentrisms, perpetrator of planetary devastation, whose supreme value is profit without limits.

Este ensayo cuestiona a la medicina evolutiva o darwiniana por su adhesión acrítica a la teoría evolucionista para explicar las enfermedades, que deja de lado el propio proceso vital que transformó un planeta "inerte" en uno "viviente", donde el orden biológico naciente subordinó al fisicoquímico imperante para prevalecer. El orden biológico es equiparable a un "concierto armónico infinitamente diverso", que ha creado y recreado, por eones, los ambientes propicios para su propia permanencia y evolución. El arribo del homo sapiens significó el surgimiento del orden cultural que suplantó progresivamente en sus efectos, al orden biológico, al provocar cambios drásticos y vertiginosos en el ecosistema planetario que silenciaron el proceso evolutivo "sin tiempo para manifestarse". La adaptación como aptitud para sobreponerse a situaciones adversas, es un contrasentido en el "concierto armónico"; en cambio, es característica del orden cultural que impone a los humanos ambientes inhóspitos y estresantes como exigencias adaptativas ineludibles. La cualidad vital propia del orden biológico es la anticipación secuencial de las situaciones de interacción con los objetos significativos del ambiente, que posibilita la consumación de las actividades vitales básicas, emblema del estado de madurez de los seres vivos. Pensar que la evolución explica las enfermedades crónicas no solo es ilusorio, sino contraproducente, porque encubre la raíz de nuestros problemas: una humanidad en constante disarmonía entre etnocentrismos belicosos, perpetradora de la devastación planetaria, cuyo valor supremo es el lucro sin límites.

The causality-chance binomial: explanatory principle of scientific knowledge in medicine?

This essay questions mathematical truths as an explanatory principle of the medical scientific knowledge. It analyzes, in the first place, the current concept of normality based on a distribution of probabilistic values and its limitations and mistakes to capture the complexity of the human condition are highlighted. The closed systems (gambling) origin of the theory of probabilities and the binomial causality-chance are compared with open systems typical of the complexity of the vital process, and their extreme differences are argued. The nonsense of depositing in the causality-chance binomial the meaning of associations between events typical of the complexity of human life in health and disease is highlighted. The characteristics of mechanistic causality (punctual, homogeneous, linear, unidirectional and fixed), which equates the organism with a machine and is the only accepted scientific explanation of events of human life, are confronted with those of contextual causality (diffuse, heterogeneous, hierarchical, multidirectional and changing), which specifies various interacting causal orders that shape of human condition: the historical, the social, the political, the economical, the cultural or the biological that represents a scrutinizing and penetrating look at the complexity of human beings. It concludes the superiority of contextual causality over mechanistic causality that opens up explanatory possibilities of the vital events that are usually put away as "effects of chance". This integrative approach to the human complexity can enrich and strengthen the clinical method that is now degraded and at risk of extinction.

Este ensayo cuestiona las verdades matemáticas como principio explicativo del conocimiento científico médico. Se analiza, en primer término, el concepto de normalidad actual basado en una distribución de valores probabilísticos, y se destacan sus limitaciones y equívocos para captar la complejidad de la condición humana. Los sistemas cerrados (juegos de azar), origen de la teoría de las probabilidades y del binomio causalidad-azar, se comparan con los sistemas abiertos propios del proceso vital y se argumentan sus diferencias extremas. Se destaca el despropósito de depositar en el binomio causalidad-azar el significado de asociaciones entre sucesos propios de la complejidad de la vida humana en salud y enfermedad. Se confrontan las características de la causalidad mecanicista (puntual, lineal, unidireccional, homogénea y fija), que equipara al organismo con una máquina y es la única explicación científica aceptada del acontecer de la vida humana, con las de la causalidad contextual (difusa, heterogénea, jerárquica, multidireccional y cambiante), que especifica diversos órdenes causales interactuantes que dan forma a la condición humana: el histórico, el social, el político, el económico, el cultural o el biológico, que representa una mirada escrutadora y penetrante de la complejidad de los seres humanos. Se concluye la superioridad de la causalidad contextual sobre la mecanicista, que abre posibilidades explicativas de sucesos vitales que suelen arrumbarse como «efectos del azar¼. Esta aproximación integradora a la complejidad humana puede enriquecer y fortalecer el método clínico, hoy degradado y en riesgo de extinción.

[Role of creative discussion in the learning of critical reading of scientific articles]. / Papel de la discusión creadora en el aprendizaje de la lectura crítica de artículos científicos.

OBJECTIVE: To compare two active educational strategies on critical reading (two and three stages) for research learning in medical students. MATERIAL AND METHODS: Four groups were conformed in a quasi-experimental design. The medical student group, related to three stages (critical reading guide resolution, creative discussion, group discussion) g1, n = 9 with school marks > 90 and g2, n = 19 with a < 90, respectively. The two-stage groups (guide resolution and group discussion) were conformed by pre-graduate interns, g3, n = 17 and g4, n = 12, who attended social security general hospitals. A validated and consistent survey with 144 items was applied to the four groups before and after educational strategies. Critical reading with its subcomponents: interpretation, judgment and proposal were evaluated with 47, 49 and 48 items, respectively. The case control studies, cohort studies, diagnostic test and clinical trial designs were evaluated. Nonparametric significance tests were performed to compare the groups and their results. A bias calculation was performed for each group. RESULTS: The highest median was obtained by the three-stage groups (g1 and g2) and so were the medians in interpretation, judgment and proposal. The several research design results were higher in the same groups. CONCLUSIONS: An active educational strategy with three stages is superior to another with two stages in medical students. It is advisable to perform these activities in goal of better learning in our students.

[Colonialism and medical education: educare or educere?] / Colonialismo y educación médica: ¿educare o educere?

En este trabajo se recuperan las raíces latinas de la educación, educare y educere, y se muestran sus respectivas equivalencias con la educación pasiva y la educación participativa. Se da cuenta del predomino histórico de la educación pasiva (educare) y su implantación en los países colonizados. Se plantea que el papel de la educación pasiva en la reproducción de los rasgos degradantes de las sociedades actuales (ethos), como el individualismo, la pasividad política y la competitividad, es la razón de su predominio, así como su contribución al control de conciencias que encubre el colapso civilizatorio en curso. Con respecto a la educación médica, los influjos colonizadores revestidos de modernidad han perpetuado la educación pasiva; desde el Informe Flexner hasta las competencias profesionales. Se afirma que las mentes colonizadas son el mayor obstáculo al progreso de la educación médica. La educación participativa (heredera de educere) se sustenta en la crítica profunda y creativa, potencia cognoscitiva capaz de elaborar un conocimiento penetrante y liberador. Se argumenta que la cima de este tipo conocimiento son formas superiores de ser en lo espiritual, intelectual, moral y convivencial, que cristaliza al emprender proyectos vitales orientados a una descolonización efectiva, que permita aproximarse a sociedades inclusivas, pluralistas, justas y solidarias basadas en la progresión de los derechos humanos y comunitarios, así como en la revaloración y la preservación de la diversidad biológica del planeta.

Revelaciones de la pandemia de COVID-19.

"Societies unveil their entrails during a crisis and hide or conceal them in normal situations" is the premise of this essay that offers a propositional critique of the foundations of civilization by characterizing some revelations from the COVID-19 pandemic that seriously compromises the globalized world. Especially the neoliberal myth as the only way of human progress, and technological development as the essence of social progress and main reason for scientific research. Among the significant revelations is the dismantling of the Welfare state and public health services, which render the population's vulnerability in the face of pandemics. Planetary devastation favors its emergence, and the correlation between the despondency of human activities and the (fleeting) improvement of planetary life, which denotes the radical incompatibility between the permanence of neoliberal capitalism that degrades everything and preservation and care of life in its infinite diversity, including human life! Another notion of human progress is proposed: the rise of values involved in the coexistence, and the spiritual, intellectual, and moral growth of the human condition in harmony with the planetary ecosystem. Regarding the deep reasons for the catastrophe, it is argued that it is humanity itself by its way of being, thinking, acting, living together and relating to the planet. Therefore, the conclusion reached is the urgent need to undertake an alternative path in the search for another possible world, hospitable and dignifying for all forms of life.

Bajo la premisa de que «las sociedades revelan sus entrañas en momentos críticos y las ocultan o encubren en situaciones de normalidad¼, este ensayo emprende, a partir de caracterizar algunas revelaciones de la pandemia de COVID-19 ­que ha puesto en jaque al mundo globalizado­, una crítica propositiva de los basamentos de la civilización. En particular, el mito neoliberal como camino único de progreso humano y el del desarrollo tecnológico como esencia del progreso social y razón principal del quehacer científico. Dentro de las revelaciones significativas destaca el desmantelamiento del Estado de bienestar y de los servicios públicos de salud, que hacen vulnerable a la población ante las pandemias; la devastación planetaria, que favorece su emergencia; y la correlación entre el desplome de las actividades humanas y la mejoría (fugaz) de la vida planetaria, que denota la incompatibilidad radical entre la permanencia del capitalismo neoliberal, que todo lo degrada, y la preservación y el cuidado de la vida en su infinita diversidad… ¡la humana incluida! Se propone otra idea de progreso humano: el auge de los valores implicados en la superación espiritual, intelectual, moral y de convivencia en armonía con el ecosistema planetario. Respecto a las razones profundas de la catástrofe, se argumenta que es la propia humanidad por su forma de ser, de pensar, de actuar, de convivir y de relacionarse con el planeta. Por tanto, la conclusión a la que se llega es la urgente necesidad de emprender un camino alternativo en la búsqueda de otro mundo posible, hospitalario y dignificante para todas las formas de vida.

[Participatory education and the development of critical reading in teachers theoretical texts. Multicenter study]. / Educación participativa y el desarrollo de la lectura crítica de textos teóricos en profesores. Estudio multicéntrico.

AIM: Determine what the relationship between participation in classroom of students attending courses at the Educational Research and Teacher Education (CIEFD's) and the development of proficiency in critical reading of theoretical texts in education. MATERIAL AND METHODS: Intervention study, multicenter students (medical specialist) level Diploma in teaching methodology (DMDN) 1 and 2 (n=46 n=29) of the six CIEFD's (DF Siglo XXI, Mexico City La Raza, Nuevo Leon, Sonora, Puebla and Veracruz), period: March to August 2007 and a Masters in education (n=9, generation 2007-2008). Two instruments were constructed that evaluated the participation variables and critical reading of theoretical texts in education, conceptual validity; content and reliability were assessed by experts in education research. The educational intervention was in the form of seminars (three times a week in DMDN 1 and twice weekly in DMDN 2 and Masters). Participation was assessed halfway through the course and on completion, critical reading at the beginning as well as the end. RESULTS: Statistically significant associations were observed in DMDN 1 (four Centers) and the Masters, but not DMDN 2. DISCUSSION: In this investigation some of the theoretical proposals of the participatory education were recreated, starting from the analysis of our results. CONCLUSION: In some centers and in the masters, strengthening participation in this educational intervention is related to the development of critical reading of theoretical texts in education.

[A comparative study between two academic working environments in residents of family medicine]. / Satisfacción de los residentes de medicina familiar con el ambiente académico laboral.

OBJECTIVE: To compare the satisfaction level in the academic working environments (AWE) between the residents of two training primary care units. METHODS: Observational, transversal and comparative study. A previously constructed and validated instrument was applied, it included 30 items that evaluated the AWE with the following indicators: support, satisfaction, participation and respect; the reliability index's instrument was high (Cronbach's alpha is 0.88). The statistical analysis was made with the Mann-Whitney U test, and χ2 test for proportions. RESULTS: Regarding the AWE, 4.28% of the residents obtained a really inappropriate environment; 8.57% very appropriate and 14% inappropriate environment. However the 72% was between intermediate environments. No statistical significant difference was found between the three measurements. CONCLUSIONS: Our results are consistent with other national studies results where the "respect" indicator was the one with higher rank. The environment along with "participation," and "support," creates a favorable relationship among residents, teachers and the staff. However, the "imposition" and "rigidity" produces a decrease in the collective participation.

Colonialism, science, and health.

In addition to genocide, slavery, and the dispossession of indigenous people, colonialism, as a form of control, meant the suppression of traditional knowledge. The imposition of Christianity, the modern Western paradigm, and modern science that followed perpetrated this suppression. The universal role held by modern science is supported neither by epistemic nor social aspects. It is ineffective and complicit in the collapse of civilization, and it is worsened by comprehensive and unifying ideas to be reduced to an input-process of technological innovation for the benefit of social control industries such as the military, information technology, communication, or health. Furthermore, it suppresses ancestral knowledge related to health and medicine that may be beneficial and must be researched (stimulant medicines). Coupled with the health industry, it promotes the medicalization of life, spreading uncertainty, anxiety, and unease. Therefore, it is an instrument of neocolonialism that imposes its priorities, supplanting problems in subordinated countries, and extracts substantial resources, which is detrimental to social policies and programs. The biggest objection to the universality of modern science is derived from its empiricist and reductionist nature. Through the practically impossible idea of a unifying and explanatory knowledge, it impedes researchers the understanding of the complexity of the world and their historical moment and to act accordingly. It transforms great creative and liberating potential to submissiveness for the interests of capital and its representatives.

El colonialismo, como forma de dominación, significó, además de genocidio, esclavitud o despojo de pueblos originarios, la supresión de saberes tradicionales perpetrada por la imposición del cristianismo, del paradigma moderno occidental y de la ciencia moderna que le siguió. El carácter universal detentado por la ciencia moderna no se sostiene en lo epistémico ni en lo social; es inoperante con y cómplice del colapso civilizatorio; se empobrece de ideas comprensivas e integradoras para reducirse al insumo-proceso de la innovación tecnológica en provecho de las industrias del control social (militar, informática, de comunicación o de la salud); y suprime saberes ancestrales de la esfera de la salud que encierran beneficios y posibilidades que es preciso investigar (medicina estimulante). Aunada a la industria de la salud, impulsa la medicalización de la vida, preñándola de incertidumbre, angustia y desasosiego. Es instrumento del neocolonialismo al imponer sus prioridades, que suplantan las propias de los países subordinados y sustraen cuantiosos recursos en detrimento de políticas y programas sociales. La mayor objeción a la universalidad de la ciencia moderna deriva de su carácter empirista y reduccionista que, al condicionar la imposibilidad práctica de un conocimiento integrador y explicativo, aleja a los investigadores del entendimiento de la complejidad del mundo, de su momento histórico y de actuar en consecuencia, y transforma la gran potencialidad creativa y liberadora de este enorme contingente en docilidad a los designios de los intereses del capital y sus agentes.

[Clinical competence of anesthesiology residents in patients requiring hospital care in the specialty hospital "Siglo XXI"]. / Competencia clínica de los residentes de anestesiología en pacientes que requieren atención médica en un hospital de especialidades.

INTRODUCTION: The study of clinical competence is essential because it summarizes the attributes that characterize a specialist capable of providing quality health care OBJECTIVE: Investigate the development of clinical competence among anesthesiology residents that care for patients in a tertiary level facility. MATERIAL AND METHODS: In February 2007 we conducted a cross-sectional study among 42 anesthesiology residents, 21 were in second and 21 in third year. In order to measure the degree of development of clinical competence we created an instrument with four case studies that summarized patients undergoing surgical anesthetic procedure. The instrument included 200 items that explored eight indicators and covered a range of time periods: pre-trans and post anesthesia. The instrument was validated by a group of experts with clinical, teaching and publication experience. We carried out a pilot test and estimated the instrument's internal reliability using the Kuder-Richardson test (KR-21). We obtained a coefficient of 0.95. We collected the study data and instrument rating technique using a blinded design. Statistical analysis was performed using nonparametric tests. RESULTS: In the overall ranking, third-year medical residents versus sophomores, achieved the highest scores, which resulted in statistically significant differences (p = 0.045). Regarding the degree of expertise we found that most participants had scores of "very low" and "low". In the study of ratings by indicator, we noted that when comparing second vs third year residents we only found statistically significant differences in default decisions that were also potentially iatropathogenic (p = 0.026). CONCLUSION: The clinical competence of anesthesiology residents who care for patients attending a tertiary level facility is low when compared with the maximum theoretical scores they should obtain.

[Development of a position on sexuality in health care providers]. / Desarrollo de una postura ante la sexualidad en personal de salud.

BACKGROUND: two attitudes were considered about sexual practice; one is centered in the reproduction, attaching to as a natural thing and intolerance to different expressions of sexuality. The other view according to prevent damage and sexual practices without guilt, bashful attitudes and intolerance. Our objective was to evaluate the effect of an educational intervention, upon the development of the position on sexuality in health care providers. METHODS: study of comparative intervention. Two experimental groups and one control group with initial and final measurements were used. To compare two groups we used the U tests of Mann-Whitney and Kruskal-Wallis. RESULTS: the initial median of the experimental group 1 (GE1) and the witness (GT) were equal and significantly different from the experimental group 2 (GE2); in this one, only 31% of its members initiated without position, as opposed to the 100% of the GE1, and of 93 % of the GT. CONCLUSIONS: a high proportion of health care providers had no posture on sexuality. A position was not reached with the accumulating information; it develops through the questioning of their experience, the educational perspective being an essential factor to achieving it.

[Validate an instrument constructed to assess mentorship assessment in master programs]. / Construcción y validación de un instrumento para evaluar la labor docente de asesoría en programas de maestría en el área de la salud.

BACKGROUND: The mentorship assessment is important to the students. There is not an instrument that evaluates the professors' skills to assess students. Our objective was to build and validate an instrument to evaluate the teaching labor on assessment of Master's degree (MD) students in Education and to compare with other programs of MD. METHODS: Construct and validate an instrument to evaluate mentorship assessment (EMA) was carried out. It was answered by the students to evaluate their own teachers in four programs of MD. The instrument measure four indicators: opening, disposition, respect and expertise with a total of 50 items. RESULTS: The global scoring obtained in EMA didn't point out the statistical significant differences among the different programs of MD with the Kruskal-Wallis test, however statistical significant differences were found with chi(2) p < 0.05 when compared each program in favor of the MD in education. CONCLUSIONS: The instrument EMA showed validity and consistency.

Criticism of mechanistic causality in life sciences.

The reductionist empiricism (RE) underlying the current scientific habitus by imposing mechanistic causality (MC) as an explanatory principle of life sciences has obscured the understanding of the life process by equating it with that of a machine. The shapes ideas can take within knowledge are analyzed: as paradigms (anthropocentric and of disjunction, reduction and simplification), implicit logics of human ways of thinking and acting, and as comprehensive-explanatory theories. It is proposed that, by dismissing the ideas, the RE supplants the biological significance of what is observed by the statistical significance of the MC and the linear and probabilistic mathematics. It is argued that objectivity does not derive from experimental control, but from an interpretative framework pertinent to the type of events being studied and that the conviction that objectivity lies in the method of observation constitutes a myth of the RE that circumvents paradigms and its influence. Contextual causality is proposed and contrasted with the MC to highlight its limitations to explain the ungraspable biological complexity. The coincidence of the ongoing collapse of civilization and the apotheosis of reductionist science justifies dismissing it as mostly indifferent, ominous, impotent, accommodating or complicit with the dominance of profit interests without limits that degrade everything. It is concluded that it is time for resolutions: integrate with forces that aim, in various ways, to counteract this dominance and preserve our common habitat or to continue with the suicidal individualist complicity of "each their due and every man for himself."

El empirismo reduccionista (ER) subyacente al habitus científico actual, al imponer la causalidad mecanicista (CM) como principio explicativo de las ciencias de la vida, ha oscurecido la comprensión del proceso vital al equipararlo al de una máquina. Se analizan las formas diversas que toman las ideas en el conocimiento como paradigmas (antropocéntrico y de disyunción, reducción y simplificación): lógicas implícitas de las formas de pensar y actuar humanos y como teorías comprensivo-explicativas. Se plantea que el ER, al desestimar las ideas, suplanta la significación biológica de lo observado por la significación estadística de la CM y las matemáticas lineales y probabilísticas. Se argumenta que la objetividad no deriva del control experimental, sino de un marco interpretativo pertinente al tipo de sucesos bajo estudio, y que la convicción de que la objetividad radica en el cómo se observa constituye el gran mito del ER que soslaya los paradigmas y su influencia. Se propone la causalidad contextual y se contrasta con la CM para realzar sus limitaciones y explicar la complejidad biológica. La coincidencia del colapso civilizatorio y la apoteosis de la ciencia reduccionista justifica tacharla de mayormente indiferente, omisa, impotente, acomodaticia o cómplice de la dominancia de los intereses de lucro sin límites, que todo lo degradan. Se concluye que son tiempos de definiciones: integrarse a fuerzas que apuntan, de modos diversos, a contrarrestar esa dominancia y preservar nuestro hábitat común o persistir en la complicidad individualista y suicida de «cada quién lo suyo y sálvese quien pueda¼..

La crítica y la educación médica: hacia un conocimiento liberador. Parte II.

The critique of medicine begins at unveiling and specifying its network of predominant logics, ideas and practices: logics of disjunction and reductionism; the health-disease binomial; the natural history of the disease; the medicalization of social life; the dehumanizing technologization of medical practice and reductionist suppressive medicine. It goes on to argue about its role as agents of domination of limitless profit interests and as an expression of the power of the health industry, justifying itself with the proposal of alternatives tending to overcome that network: transdisciplinarity and the concept of organism as hierarchical totality and interacting with its environment, with respect to disjunction and reductionism; the cultural history of the disease in relation to the health-disease binomial and the dehumanizing technologization; good living, the search for spiritual, intellectual, moral and coexistence growth as meaning of human life, as an alternative to the medicalization and antidote of degrading traits and stimulating medicine of the endogenous healing forces of the organism whose foundation of possibility and credibility is the placebo effect as an alternative to suppressive therapy for non-communicable chronic conditions, based on the pharmacological effect with unfailing side effects. It concludes that without an education based on critique, liberating knowledge would hardly accompany and guide the various social groups in the search for an inclusive, pluralistic, egalitarian, fair, solidary and caring of the planetary ecosystem world.

La crítica del quehacer médico como espacio educativo implicó caracterizar el entramado de lógicas, ideas y prácticas prevalentes: la disyunción y el reduccionismo; el binomio salud-enfermedad; la historia natural de la enfermedad; la medicalización de la vida social; la tecnologización deshumanizante de la práctica médica, y la medicina supresora reduccionista. La crítica continúa discutiendo la contribución de ese entramado al control social como agente de la dominación de los intereses de lucro sin límites y como expresión del poder de la industria de la salud, justificándose con la argumentación de alternativas tendientes a superar ese entramado: la lógica transdisciplinaria y el concepto de organismo como totalidad jerarquizada e interactuante con su entorno respecto de la disyunción y el reduccionismo; la historia cultural de la enfermedad como alternativa a la historia natural de la enfermedad y al binomio salud-enfermedad; el bien vivir, la búsqueda de la superación espiritual, intelectual, moral y convivencial que confiere sentido profundo a la vida humana, como alternativa a la medicalización y antídoto de la tecnologización deshumanizante y los rasgos degradantes; la medicina estimulante de fuerzas curativas endógenas para afecciones crónicas no trasmisibles, cuyo fundamento de factibilidad y credibilidad radica en la omnipresencia del efecto placebo con respecto a la medicina supresora, basada en fármacos con efectos secundarios indefectibles. Sin una educación basada en la crítica, difícilmente el conocimiento liberador podrá acompañar y orientar a médicos y otros profesionales a organizarse en la búsqueda, desde su ámbito, de un mundo inclusivo, igualitario, justo, solidario y cuidadoso del ecosistema planetario.

[The cultural history of disease]. / La historia cultural de la enfermedad.

In this essay the concept of Cultural History of Disease (CHD) is proposed as an alternative to Natural History of Disease (NHD). A brief historic recapitulation of the concept of disease is made, and the present idea is given a detailed account which is the basis of the nosological theory of the health/disease paradigm. The main aspects of the NHD are specified, its limitations and restrictive consequences in health care are highlighted. It is proposed the idea of disease as particular and differential ways of being from human beings. It is showed how culture (everything that make us human) "takes the reins of evolution" in our species and determines, in every period, our ways of being, of living, and getting sick. Some distinctive qualities of life are showed to take a distance from the idea of machine and the dominant mechanism of health care in our time. The concept of CHD is developed as a proposal that "lightens" aspects ignored by NHD. An account is made of how, by cultural effect, a number of diseases no longer exist; others have appeared or increased their presence, have changed their features or varied their distribution. The every time more and more unsupported congenital/acquired dichotomy is discussed. It is showed how the epigenetic inheritance is a strong evidence against the separation between genetic and environmental. The mechanist causality, in its different characteristics, proper of the health/disease paradigm and of NHD, is contrasted to contextual causality proper of CHD. The implications of CHD in the way of approaching to diseases, in restating the patients', physicians' and health care institutions' role are discussed. As well as in recognizing that health care has no sense without life care in its different manifestations, from which derives the need to fight for more proper conditions and circumstances for a dignified, satisfactory, serene, fraternal life in including societies.

[Toward a new paradigm of education]. / Hacia un nuevo paradigma de la educación.

This work has as starting point the concept of paradigm proposed by E. Morin: principal categories that guide the intelligibility and logical thinking. The great paradigm of the western hemisphere (prevailing paradigm) is characterized by its effects of disjunction, reduction, simplification, and exclusion. The effects of the paradigm in the medical practice, in the scientific work, and in education are analyzed. The epistemological premises of neopositivism, heir of the prevailing paradigm, and of critical of experience are confronted. It emphasizes the opposite roles that each epistemological tendency gives to the ideas and facts in knowledge. The disjunction between the creation and use of knowledge, typical of the school institution, originates the passive perspective of education. The idea of knowledge as elaboration of the learner in knowledge situation, originates the participative perspective of education. The characteristics of both perspectives of education in relation to the role of theory and practice, the role of the professor and student, and the main purposes are contrasted. It is briefly analyzed how the different educational schools appeared in the XX century do not represent true alternatives to the paradigm, except P. Freire's proposals. The more relevant aspects of the participative perspective of education are emphasized: habit of reflective thinking about the vital experience, exercise of criticism and self-criticism, development of points of view about problem situations of experience and of methodological and practical abilities. Different considerations are made about what the participative perspective of education implies in the pretension to overcome the effects of disjunction, reduction and simplification of the ruling paradigm.

[The reflective experience and education]. / La experiencia reflexiva y la educación.

The reflective experience is proposed in this article as the way to approach the elaboration of knowledge. The concept of vital experience is proposed to make reference to the links with a great affective significance that characterizes each person in his/her relation with the world. Some considerations are made about perception with its affective, cognitive and evaluative components and its implications in the knowledge process. The idea of knowledge as the use and consumption of information is discussed. This idea that prevails at school corresponds with the passive perspective of education. We propose the idea of knowledge as an elaboration of the person in knowledge situation which originates the participative perspective of education. The characteristics of both perspectives of education are contrasted with respect to the role of theory and practice, the role of the professor and the student, the main purposes and the type of society that they aspire. The more relevant aspects of participative education are shown: the practice of criticism and self-criticism; the development of solid points of view about problem situations of experience, the development of methodological and practical aptitudes, with emphasis on medical education. Considerations are made about in what way the participative perspective concerns pre-graduate and post-graduate medical education and its possible incorporation to the programs.