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Resumo Introdução: O acidente vascular cerebral isquêmico tem como tratamento a terapia trombolítica, aplicada ainda na fase aguda, promovendo melhora importante nas sequelas acarretadas por este agravo. Considerando a complexidade da terapia trombolítica, torna-se necessário que os enfermeiros compreendam suas competências para auxiliar no cuidado. Objetivo: Identificar evidências científicas acerca das competências do enfermeiro no cuidado a pacientes com acidente vascular cerebral elegíveis à terapia trombolítica. Metodologia: Revisão integrativa composta por seis etapas em seis etapas (elaboração da questão, busca na literatura, coleta de dados, análise, discussão e apresentação da revisão), realizada nas bases de dados MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase e CINAHL. A busca foi realizada entre agosto e setembro de 2022 adotando como critérios de inclusão estudos primários; gratuitos, disponíveis eletronicamente na íntegra; nos idiomas inglês, português e espanhol. Foram obtidos inicialmente 2.830 estudos, os quais passaram por uma seleção, onde foram incluídos aqueles que atendiam os critérios previamente estabelecidos. Resultados: Com base nos doze estudos incluídos nesta revisão identificaram-se competências voltadas à três atividades do cuidado: gestão do cuidado como trabalho em equipe, códigos, fluxos e protocolos, assistência ao paciente antes, durante e após a utilização da terapia trombolítica e educação em saúde para equipe, pacientes e familiares. Conclusão: Os achados desta revisão puderam evidenciar as competências do enfermeiro no cuidado aos pacientes elegíveis a terapia trombolítica, as quais perpassam diferentes áreas de atuação do enfermeiro. Para este estudo prevaleceram as competências assistências, seguida por competências gerenciais.
Resumen Introducción: El accidente cerebrovascular isquémico se trata con terapia trombolítica, aplicada incluso en la fase aguda, que promueve una mejoría significativa de las secuelas provocadas por este padecimiento. Considerando la complejidad de la terapia trombolítica, es necesario que las personas profesionales de enfermería comprendan sus competencias para ayudar en el cuidado. Objetivo: Identificar evidencias científicas sobre las competencias del personal de enfermería en el cuidado de pacientes con accidente cerebrovascular elegibles para terapia trombolítica. Metodología: Revisión integradora que consta de seis etapas (elaboración de la pregunta, búsqueda bibliográfica, recolección de datos, análisis, discusión y presentación de la revisión), realizada en las bases de dados MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase y CINAHL. La búsqueda se realizó entre agosto y septiembre de 2022. Los criterio de inclusión fueron: estudios primarios, gratuito, disponible electrónicamente en su totalidad, en inglés, portugués y español. Inicialmente se obtuvieron 2830 estudios, los cuales fueron sometidos a un proceso de selección, que incluyó aquellos que cumplían con los criterios previamente establecidos. Resultados: A partir de los doce estudios incluidos en esta revisión, se identificaron competencias centradas en tres actividades asistenciales: gestión del cuidado como trabajo en equipo, códigos, flujos y protocolos, atención a pacientes antes, durante y después del uso de la terapia trombolítica y educación en salud para personal, pacientes y familias. Conclusión: Los hallazgos de esta revisión pudieron resaltar las competencias de las personas profesionales en enfermería en el cuidado de personas elegibles para terapia trombolítica, que abarcan diferentes áreas de actuación del personal de enfermería. Para este estudio, prevalecieron las habilidades asistenciales, seguidas de las competencias gerenciales.
ABSTRACT Introduction: Ischemic stroke is treated with thrombolytic therapy, applied even in the acute phase, promoting a significant improvement in the after-effects caused by this condition. Considering the complexity of thrombolytic therapy, it is necessary for nurses to understand the skills required to assist in care. Objective: To identify scientific evidence about the competencies of nurses in the care of patients with stroke who are eligible for thrombolytic therapy. Methodology: An integrative review consisting of six stages (elaboration of the question, literature review, data collection, analysis, discussion, and presentation), conducted in MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase, and CINAHL databases. The search was carried out between August and September 2022 using primary studies as the inclusion criteria: free of charge, fully available electronically, published in English, Portuguese, or Spanish. Initially, 2.830 studies were obtained, which underwent a selection process that included only those studies that met the previously established criteria. Results: Based on the twelve studies included in this review, competencies focused on three care activities were identified: care management such as teamwork; codes; flows and protocols; patient care before, during, and after the use of thrombolytic therapy; and education health education for staff, patients, and families. Conclusion: The findings of this review highlighted the nurses' competencies in the care of patients eligible for thrombolytic therapy, which encompass different areas of the nurse's work. For this study, assistance competencies prevailed, followed by management competencies.
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Humanos , Terapia Trombolítica/enfermería , Accidente Cerebrovascular/enfermería , Atención de EnfermeríaRESUMEN
Estudo exploratório descritivo, quantitativo, realizado em um hospital pediátrico filantrópico, com objetivo de compreender as competências profissionais da enfermagem no atendimento da parada cardiorrespiratória em pediatria, além de investigar suas percepções. Participaram 30 profissionais da equipe de enfermagem e a coleta de dados foi realizada por meio de um questionário fechado. Os resultados, analisados por meio de estatística descritiva, mostraram que os profissionais de enfermagem, em sua maioria, apresentaram conhecimento sobre o atendimento da emergência investigada. Em relação às suas percepções sobre as habilidades técnicas necessárias, notou-se que a maioria dos participantes se perceberam seguros para as manobras de ressuscitação e para a administração de medicações durante o atendimento; contudo, ao abordar o manuseio do desfibrilador e a realização de punção venosa, a maior parte da amostra afirmou não se sentir totalmente segura para estas atividades. Concluiu-se que a maioria dos participantes apresentam conhecimento teórico-prático para a execução do atendimento.
Descriptive, quantitative exploratory study, carried out in a philanthropic pediatric hospital, with the objective of understanding the nursing professional competencies in the care of cardiorespiratory arrests in pediatrics, besides investigating. 30 professionals from the nursing team participated and data was collected using a closed questionnaire. The results, analyzed using descriptive statistics, showed that the majority of nursing professionals had knowledge about the care of the investigated emergency. In relation to their perceptions about the necessary technical skills, the majority of participants perceived themselves to be confident in resuscitation maneuvers and the administration of medications during care. However, when approaching the handling of the defibrillator and performing a venipuncture, most of the sample stated that they did not feel complete confidence for these activities. Study concluded that the majority of participants had theoretical-practical knowledge to perform the service.
Estudio exploratorio descriptivo, cuantitativo, realizado en un hospital pediátrico filantrópico, con el objetivo de comprender las competencias profesionales de enfermería en el cuidado de la parada cardiorrespiratoria en pediatría, además de investigar sus percepciones. Participaron 30 profesionales del equipo de enfermería y la recolección de datos se realizó mediante cuestionario cerrado. Los resultados, analizados mediante estadística descriptiva, mostraron que la mayoría de los profesionales de enfermeira tenían conocimiento sobre la atención de la emergencia investigada. En relación a sus percepciones sobre las habilidades técnicas necesarias, se observa que la mayoría de los participantes se observó que la mayoría de los participantes se percibió confiada en las maniobras de reanimación y la administración de medicamentos durante la atención. Sin embargo, al abordar el manejo del desfibrilador y realizar una punción venosa, la mayoría de la muestra manifestó no sentirse completamente segura para estas actividades. Estudio concluyó que la mayoría de los participantes presentó conocimientos teórico-prácticos para realizar el servicio.
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Competencia ClínicaRESUMEN
Introduction: The mínimum number of procedures required to be performed during anesthesia training has not been officially defined in Colombia. Although a number is no guarantee of acquired competencies, it does indicate the level of opportunity offered by the different programs. This study describes the practical training afforded to residents in a graduate anesthesia program in Colombia, and compares its results with international standards. Objective: Describe exposure to procedures performed by residents enrolled in a three-year anesthesia specialization program in Colombia between 2015 and 2020, and compare with the standards proposed by ASCOFAME and ACGME. Methods: Descriptive, cross-sectional study which included residents who did their specialization in a Colombian anesthesia program between 2015 and 2020. Complexity, anesthesia techniques, invasive monitoring and airway approach were described. Finally a descriptive comparison was made with the published references of the Colombian Association of Medical Schools (ASCOFAME) and the Accreditation Council for Graduate Medical Education (ACGME). Results: The results for 10 residents were included. Each resident had a median of 978 cases (IQR 942-1120), corresponding to 25 surgical specialties, the most frequent being general surgery (18%), orthopedics (16%), pediatric surgery (19%), and obstetrics (10.8%). According to the American Society of Anesthesiology (ASA) classification, the majority of patients were ASA II (39.63%) and ASA III (28.4%). Adequate exposure was achieved in 11 of the 15 categories proposed by ACGME and in 6 of the 15 proposed by ASCOFAME. Conclusions: A detailed description of the practice component acquired by the residents during their three years of training was obtained. This baseline provides insight into the national landscape and allows to describe the relationship with international standards.
Introducción: En Colombia no se encuentra oficialmente definido el número mínimo de procedimientos que se deben realizar durante el entrenamiento en anestesiología. Aunque el número no garantiza la adquisición de competencias de la especialidad, sí es un indicador de la oportunidad ofertada por parte de los programas. Este estudio describe el entrenamiento práctico que tienen los médicos residentes en un programa de posgrado de anestesiología en Colombia y compara sus resultados con estándares internacionales. Objetivo: Describir la exposición a procedimientos realizados por los médicos residentes de un programa de especialización en anestesiología de tres años en Colombia, entre 2015 y 2020, y compararlo con los estándares propuestos por ASCOFAME y el ACGME. Métodos: Estudio descriptivo de corte transversal; se incluyeron los residentes que cursaron su programa de especialidad en un programa colombiano de anestesiología entre 2015 y 2020. Se describieron la complejidad, técnicas anestésicas, monitoría invasiva y abordaje de la vía aérea. Finalmente, se compararon los resultados de manera descriptiva con lo referenciado por la Asociación Colombiana de Facultades de Medicina y el Accreditation Council for Graduate Medical Education (ACGME). Resultados: Se incluyeron los resultados de 10 médicos residentes. El número de casos por residente tuvo una mediana de 978 casos (RIQ942-1120), correspondientes a 25 especialidades quirúrgicas; cirugía general (18 %), ortopedia (16 %), cirugía pediátrica (19 %) y obstetricia (10,8 %) fueron las más frecuentes. Según la clasificación de la Sociedad Americana de Anestesiología (ASA), la mayoría de los pacientes tenían ASA 2 (39,63 %), ASA 3 (28,4 %). Se alcanzó una exposición adecuada en 11 de las 15 categorías propuestas por el ACGME y en 6 de las 15 propuestas por la Asociación Colombiana de Facultades de Medicina. Conclusiones: Se obtuvo una descripción detallada del aspecto práctico de los residentes de anestesiología durante sus tres años de formación. Esta línea de base permite ampliar el panorama a escala nacional y describir la relación con estándares internacionales.
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RESUMEN Introducción: Con el panorama cambiante de la educación médica, es crucial examinar críticamente los enfoques y marcos existentes. La educación médica basada en competencias (EMBC) surge como un prometedor cambio de paradigma, que prioriza el desarrollo de habilidades, conocimientos y actitudes explícitas centrado en el alumno y orientado a los resultados. Objetivo: Identificar los ajustes estructurales y procedimentales esenciales necesarios para una implementación eficaz de la EMBC. Se subraya la importancia de reorganizar las instituciones educativas, adaptar las técnicas de instrucción y evaluación y fomentar la adopción de la EMBC en el aula. Resultados: Para impartir con eficacia la EMBC, es imperativo reestructurar las instituciones educativas para que se centren en planes de estudios basados en competencias y en la enseñanza personalizada. Asimismo, es necesario modificar las estrategias de enseñanza y evaluación para facilitar la evaluación continua y el aprendizaje activo. Conclusiones: Adoptar los principios de EMBC puede permitir que la educación médica produzca profesionales equipados con las habilidades necesarias para satisfacer las demandas dinámicas de la medicina moderna.
ABSTRACT Introduction: With the changing landscape of medical education, it is crucial to critically examine existing approaches and frameworks. competency-based medical education (CBME) emerges as a promising paradigm shift, which prioritizes learner-centered, outcome-oriented development of skills, knowledge, and attitudes. Objective: To identify the essential structural and procedural adjustments needed for effective implementation of CBME. It underscores the importance of reorganizing educational institutions, adapting instructional and assessment techniques, and fostering acceptance of CBME in the classroom. Results: To effectively deliver CBME, it is imperative to restructure educational institutions to focus on competency-based curricula and personalized instruction. Also, there is a need to modify teaching and assessment strategies to facilitate continuous assessment and active learning. Conclusions: Adopting CBME principles can enable medical education to produce professionals equipped with the skills necessary to meet the dynamic demands of modern medicine.
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In order to analyze the clinical characteristics of death cases in the oral emergency depart-ment of the stomatological hospital,and to improve the first aid technique before and in hospitals,we col-lected the clinical data of death cases in the Department of Oral Emergency in Peking University School and Hospital of Stomatology from January 2010 to January 2023 for retrospective analysis.General cha-racteristics,such as the patients'gender,age,chief complaint,maxillofacial diseases,systemic under-lying diseases,rescue situation,cause of death and seasonal distribution of death were summarized.The results showed that a total of 8 death cases(5 males and 3 females)occurred during the 13-year period,ranging in age from 40 to 86 years,with a median age of 66 years.Among the 8 patients,5 reported bleeding from oral cancer,1 reported chest tightness and dyspnea after oral cancer surgery,1 reported loss of consciousness after maxillofacial trauma,and 1 reported oral erosion and aphagia.All the 8 pa-tients had one or more underlying diseases,such as hypertension,coronary heart disease,diabetes,renal failure,and cerebral infarction,etc.and 2 of them showed dyscrasia.Among them,the cause of death in 5 cases was respiratory and circulatory failure caused by oral cancer rupture and hemorrhage or poor sur-gical wound healing and hemorrhage;1 case was uremia and hyperkalemia leading to circulatory failure;1 case was asphyxia caused by swelling of oral floor tissue after maxillofacial trauma;and the other case was acute myocardial infarction caused circulatory failure after oral cancer surgery.According to the vital state at the time of treatment,6 patients had loss of consciousness,respiratory and cardiac arrest before hospital,and 2 patients suffered from loss of consciousness,respiratory and cardiac arrest during treat-ment.All the patients received cardiopulmonary resuscitation and some advanced life support measures,and the average rescue time was 46 min.Due to the low incidence of death in the oral emergency depart-ment,medical personel have little experience in first aid.First aid training and drills and assessment should be organized regularly.First aid facilities should be always available and regularly maintained by special personnel,such as electrocardiogram(ECG)monitor,defibrillator,simple breathing apparatus,oxygen supply system,negative pressure suction system,endotracheal intubation and tracheotomy equip-ment.The death cases mainly occurred in the elderly patients with oral cancer bleeding and systemic un-derlying diseases.Education of emergency awareness for the elderly patients with oral cancer after surgery should be enhanced.Medical staff should strengthen first aid awareness and skills.
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Objective: Blunt cardiac rupture is a life-threatening injury that requires surgical repair by cardiovascular or trauma surgeons. We report a case of blunt cardiac rupture in a rural area in which emergency physicians performed emergency department thoracotomy and surgical repair to save the patient’s life.Patient and Methods: This case involved an 18-year-old female who was injured in a traffic accident and underwent emergency thoracotomy and surgical repair.Results: The patient’s left thorax was deformed, and sonographic assessment revealed pericardial effusion. She experienced cardiopulmonary arrest 13 min after hospital arrival. An emergency physician performed an emergency department thoracotomy. The clots were removed from the surface of the left ventricle, followed by wound compression to control bleeding from the ruptured left ventricular wall. After the recovery of spontaneous circulation, the emergency physician sutured the ruptured heart. The patient survived with good neurological function.Conclusion: In rural areas, blunt cardiac rupture may require emergency department thoracotomy and cardiac repair by emergency physicians. The establishment of educational systems that include continuous education on trauma surgical procedures and consensus guidelines is needed to assist rural emergency physicians in performing surgical procedures.
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Abstract Objective: To identify the factors affecting clinical performance among dental students and to help addressing these problems. Material and Methods: A cross-sectional study in which students of third and final year of dentistry participated. Data was collected from June 2022 till September 2022. Data was collected from the third and final year dental students of both public and private dental colleges within the Pakistan using a purposive sampling technique. Results: A total of 372 dental students participated in this study. Thirty eight (31.9%) students belonged to third year while 81 (68.1%) were final year students from government college. For the private dental college, 121 (47.8%) were third year students while 132 (52.2%) were final year students. Majority of the participants were males from both the colleges. 42.9% of government dental students and 26.5% of private dental students agreed on well-preparedness of clinical instructors. 5.5% from private and 21.0% from government dental colleges agreed that adequate personal protective equipment were present in clinical departments. Conclusion: From this study, it is concluded that there should be focus more focus on the factors to enhance clinical skills, supervision of students in clinical practice to help addressing the problems faced during learning and performance in a clinical environment, to produce self-confident, motivated, knowledgeable, skillful and a professional dental graduates.
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Humanos , Masculino , Femenino , Adulto , Estudiantes de Odontología , Salud Laboral , Evaluación del Rendimiento de Empleados , Pakistán/epidemiología , Estudios Transversales/métodos , Encuestas y Cuestionarios , Interpretación Estadística de Datos , Aprendizaje Basado en ProblemasRESUMEN
ABSTRACT Purpose: To assess the effect of the coronavirus disease 2019 (COVID-19) pandemic on cataract surgery by residents who had mandatory surgical simulator training during residency. Methods: In this retrospective, observational analytical study, the total number of cataract surgeries and surgical complications by all senior residents of 2019 (2019 class; prepandemic) and 2020 (2020 class; affected by the reduced number of elective surgeries due to the COVID-19 pandemic) were collected and compared. All residents had routine mandatory cataract surgery training on a virtual surgical simulator during residency. The total score obtained by these residents on cataract challenges of the surgical simulator was also evaluated. Results: The 2020 and 2019 classes performed 1275 and 2561 cataract surgeries, respectively. This revealed a reduction of 50.2% in the total number of procedures performed by the 2020 class because of the pandemic. The incidence of surgical complications was not statistically different between the two groups (4.2% in the 2019 class and 4.9% in the 2020 class; p=0.314). Both groups also did not differ in their mean scores on the simulator's cataract challenges (p<0.696). Conclusion: Despite the reduction of 50.2% in the total number of cataract surgeries performed by senior residents of 2020 during the COVID-19 pandemic, the incidence of surgical complications did not increase. This suggests that surgical simulator training during residency mitigated the negative effects of the reduced surgical volume during the pandemic.
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ABSTRACT Medical specialties have recognized that breaking bad news assists clinical practice by mitigating the impact of difficult conversations. This scenario also encourages various studies on breaking bad news in ophthalmology since certain ocular diagnoses can be considered bad news. Thus, the objective is to review the scientific literature on breaking bad news in ophthalmology. The literature databases like MEDLINE/PUBMED, EMBASE, LILACS, SCOPUS, COCHRANE, and SCIELO, were screened for related research publications. Two independent reviewers read all the articles and short-listed the most relevant ones. Seven articles, in the formats of original article, review, editorial, oral communication, and correspondence, were reviewed. Conclusively it reveals that ophthalmologists are concerned with communicating bad news effectively but lack related studies. Nevertheless, there is a growing realization that training in breaking bad news can increase physicians' confidence during communication, thus, benefiting the therapeutic relationship with the patient and his family. Therefore, it would be valuable to include breaking bad news training in the curriculum of residencies.
RESUMO O reconhecimento sobre a comunicação de más notícias como mitigadora de conversas difíceis por outras especialidades médicas, incentiva o estudo desta temática na oftalmologia. Sendo assim, o objetivo deste estudo é revisar a produção de pesquisas científicas sobre a comunicação de más notícias em oftalmologia. Para isso, foi realizada uma revisão de literatura. As bases de dados utilizadas foram MEDLINE/PUBMED, EMBASE, LILACS, SCOPUS, COCHRANE e SCIELO. Dois revisores independentes leram todos os artigos e selecionaram a amostra final. Sete artigos foram escolhidos nos formatos de artigo original, revisão, editorial, comunicação oral e correspondência. Os oftalmologistas estão preocupados em comunicar as más notícias de forma eficaz, mas faltam estudos sobre o tema. No entanto, há uma crescente percepção de que o treinamento de comunicação de más notícias aumenta a confiança dos médicos na comunicação, beneficiando a relação terapêutica. Portanto, seria valioso incluir este treinamento no currículo das residências.
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O objetivo deste estudo foi analisar a priorização e valorização de competências para a produção do cuidado integral no internato obrigatório (IO) da faculdade de Medicina da Universidade Federal Fluminense. O percurso metodológico contou com análise documental das competências para o IO e suas formas de avaliação, seguido de entrevistas remotas com docentes. A análise de conteúdo categorizou unidades temáticas de acordo com o momento da produção do cuidado integral no encontro com o paciente e nos demais encontros ocorridos para além deste. Foram evidenciadas priorização e valorização da integração de habilidades de comunicação e de técnicas semióticas; e raciocínio clínico com atitudes éticas e humanísticas e de competências relacionadas ao trabalho em equipe; participação em espaços coletivos de discussão; gestão do cuidado; abordagem comunitária; e processo de produção do conhecimento baseado nos signos do "ser médico(a)".
El objetivo de este estudio es analizar la priorización y valorización de las competencias para la producción de cuidados integrales en el Internado Obligatorio de la Facultad de Medicina de la Universidad Federal Fluminense. La metodologia incluye análisis documental y entrevistas con profesores. El análisis de contenido fue categorizado en unidades temáticas según el momento de producción de la atención integral: en el encuentro y en los encuentros necessários a partir de este encuentro com el paciente. Em el encuentro, se priorizó la integración de habilidades comunicativas y técnicas semióticas y de razonamiento clínico con actitudes éticas y humanísticas, y en los demás encuentros, las habilidades relacionadas con el trabajo en equipo, participación en espacios colectivos de discusión, gestión del cuidado, enfoque comunitario, además del propio proceso de producción de conocimiento, todos basado en la idea de lo que significa ser médico.
The objective of this study is to analyze the prioritization and valorization of competences within the production of comprehensive care at Mandatory Internship at the Faculty of Medicine at Fluminense Federal University. The methologic included analysis of the documents that contained the competencies and its forms of assessment at the Mandatory Internship, and remote interviews with professors. The analysis of the content was categorized into thematic units according to the moment of the production of comprehensive care: in the encounter with patient and beyond others encounters needed after this first one. By the encounter, there was a prioritization of the integration of communication skills and semiotic techniques and clinical reasoning with ethical and humanistic attitudes, and in the second one the competencies related to teamwork, participation in collective spaces for discussion, care management, community approach, in addition of the knowledge production process itself, based on the idea of being a doctor.
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ABSTRACT Objective: To evaluate the knowledge of pedodontists and residents in the face of pediatric medical emergencies. Material and Methods: This descriptive-analytical study was conducted on pedodontists and residents participating in the Congress. The knowledge evaluation tool was a researcher-made questionnaire with acceptable validity and reliability. The questionnaire consisted of seven sections on information and education, prevention, office staff readiness, practical abilities, cardiopulmonary resuscitation skills and intravenous access, medicines, and emergency treatment equipment. After completing the questionnaires, the data were analyzed using SPSS 21. Chi-squared test, t-test, ANOVA, correlation test, and linear regression were used for data analysis (P<0.05). Results: The study examined 150 specialists, 88 residents, and 62 pedodontists. The level of knowledge of specialists and pedodontic residents in the face of pediatric medical emergencies was 35.3% (moderate) and 31.7 (weak), respectively. The specialists' scores on the entire questionnaire and areas of information, medicine, and equipment were significantly higher than those of residents. Moreover, participation in lectures and reading papers significantly increased general awareness. Conclusion: The results indicated that specialists' awareness and pedodontic residents about pediatric medical emergencies during dentistry were at a different level, necessitating more practical and theoretical training.
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Resumen La evaluación es un proceso sistemático que resulta en un juicio de valor para tomar decisiones. Los instrumentos empleados para obtener datos sobre el desempeño de los estudiantes requieren de un proceso sistemático y objetivo para su implementación. El mini-CEX es un instrumento de observación directa que ha sido empleado para la evaluación de la competencia clínica en los estudiantes de pre y posgrado desde su invención en 1955. Cuenta con diferentes evidencias de validez para su uso en distintos contextos educativos y clínicos. Permite realizar evaluaciones rápidas, acompañadas de realimentación y que proporcionan información relevante del desarrollo de la competencia clínica. El objetivo de este escrito es exponer la experiencia de la implementación del mini-CEX en el pregrado médico para la evaluación formativa de los estudiantes utilizando la simulación con pacientes estandarizados. Para lograr este objetivo se empleó la siguiente secuencia: búsqueda, planeación, integración y aplicación. Posterior a estos pasos se dan una serie de recomendaciones para la implementación del mini-CEX. Se concluye que la evaluación de la competencia clínica es importante para la mejora continua y permanente de los estudiantes de pre y posgrado. Es necesario sistematizar la evaluación ajustada siempre a objetivos y necesidades específicas de la evaluación.
Abstract Evaluation is a systematic process that results in a judgment to make decisions. The instruments used to obtain data on student performance require a systematic and objective process for their implementation. The mini-CEX is a direct observation tool that has been used for the evaluation of clinical competence in undergraduate and postgraduate students since its invention in 1955. It has different validity evidence for use in different educational and clinical contexts. It allows rapid evaluations, accompanied by feedback and providing relevant information on the development of clinical competence. The objective of this paper is to expose the experience of the implementation of the mini-CEX in the medical undergraduate for the formative evaluation of students using simulation with standardized patients. To achieve this goal, the following sequence was used: search, planning, integration, and application. After these steps we make some recommendations for the implementation of the mini-CEX. Its is concluded that the evaluation of clinical competence is important for the continuous and permanent improvement of undergraduate and graduate students. It is necessary to systematize the evaluation always adjusted to objectives and specific needs of the evaluation.
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Introducción: el correcto manejo de la hipotensión arterial durante la hemodiálisis es fundamental en la formación y trabajo del personal de enfermería nefrológica del Centro Médico Naval. El personal debe tener conocimientos suficientes sobre la hipotensión y sus factores asociados que le ayuden a predecirla y actuar de manera preventiva, así como con habilidades instrumentales para llevar a cabo medidas en la práctica. Objetivo: analizar la competencia clínica del personal de enfermería en el servicio de hemodiálisis del Centro Médico Naval con respecto a su formación académica y experiencia profesional en el manejo de la hipotensión arterial intradialítica. Metodología: estudio prospectivo, descriptivo y observacional. Se emplearon dos instrumentos: una adaptación del Cuestionario de conocimientos para el manejo de hemodiálisis de Miller y la Guía de observación de habilidades instrumentales en el personal de enfermería de Murillo. Resultados: se contó con una muestra de doce enfermeros pertenecientes al servicio de hemodiálisis. El 33.3% mostró un nivel regular de competencia clínica y 66.7% un nivel bueno. En promedio, la competencia clínica se ubicó en 78%. Discusión: los resultados obtenidos difieren de los reportados en otras investigaciones, tanto por el año de aplicación como de los sujetos evaluados. Limitaciones: se contó con una muestra baja debido a que el personal del servicio no es numeroso. Conclusiones: es necesario reforzar los conocimientos del personal sobre el tema. Sin embargo, se observó que las habilidades instrumentales fueron excelentes en todos los casos. No se observa relación con el nivel de estudios o la experiencia profesional.
Introduction: the correct management of arterial hypotension during hemodialysis is fundamental in the training and work of the nephrological nursing staff at the Naval Medical Center. The staff must have sufficient knowledge about hypotension and its associated factors to help them predict it and act preventively, as well as instrumental skills to carry out measures in practice. Objective: to analyze the clinical competence of the nursing staff in the hemodialysis service of the Naval Medical Center concerning their academic training and profesional experience in the management of intradialytic arterial hypotension. Methodology: a prospective, descriptive, and observational study. Two instruments were used: an adaptation of Miller's Hemodialysis Management Knowledge Questionnaire and Murillo's Guide to Observation of Instrumental Skills in Nursing Personnel. Results: There was a sample of twelve nurses belonging to the hemodialysis service. 33.3% percent showed a fair level of clinical competence and 66.7% a good level. On average, clinical competence was 78%. Discussion: the results obtained differ from those reported in other studies, in terms of both the year of application and the subjects evaluated. Limitations: there was a low sample size due to the small number of service personnel. Conclusions: it is necessary to reinforce the knowledge of the personnel on the subject. However, it was observed that instrumental skills were excellent in all cases. No relationship was observed with the level of studies or professional experience.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Personal de Enfermería , Diálisis Renal , Competencia Clínica , HipotensiónRESUMEN
El examen clínico objetivo estructurado (ECOE) es una herramienta válida para medir competencias clínicas. En el contexto de la pandemia por COVID-19 se debieron adaptar las evaluaciones, habitualmente presenciales, a un formato virtual. El objetivo de este artículo es comunicar la experiencia de utilizar una modalidad virtual del ECOE para residentes de primer año de pediatría durante la pandemia por COVID-19. El ECOE comprendió 12 estaciones utilizando casos simulados en línea y consultas virtuales a distancia. Participaron del ECOE 115 residentes, aprobaron 110 (95,7%) y solo 17 participantes aprobaron el 100% de las estaciones. Las estaciones con mejor rendimiento fueron las referidas a alimentación complementaria, abordaje del traumatismo encéfalo craneano, interpretación de resultados de laboratorio y de imágenes radiológicas. El menor rendimiento se observó en uso de equipo de protección personal y vacunas. La encuesta de satisfacción fue respondida por 80/115 participantes (69,5%). El 91% de los participantes encontró fácil de utilizar la plataforma virtual. La mayoría (73/80) consideró que los temas fueron acordes al nivel de formación. La estación de pautas madurativas fue identificada como la más difícil. El 57% refirió que el ECOE les resultó útil para identificar puntos débiles en su formación. La implementación de una modalidad virtual del ECOE fue posible y presentó buena aceptación de los participantes.
The objective structured clinical examination (OSCE) is a helpful tool for assessing clinical competencies. During the COVID-19 pandemic, assessments usually carried out in person had to be adapted to a virtual format. We aim to report our experience using a virtual OSCE administered to first-year pediatric residents during the COVID-19 pandemic. The OSCE included 12 stations, including online simulated cases and virtual remote consultations. In total 115 residents participated in the OSCE; 110 (95.7%) passed the test, but only 17 participants passed all stations. The stations with the highest performance were related to complementary feeding, management of traumatic head injury, interpretation of lab test results and imaging. The lowest performance was observed using personal protective equipment and checking vaccine schedules. The user satisfaction survey was completed by 80 out of 115 participants (69.5%); 91 % of the participants found the virtual platform easy to use. Most of the residents (73/80) considered the topics to be appropriate for their training level. The station related to child development guidelines was identified as the most challenging. 57% reported that the OSCE was helpful for identifying weaknesses in their training. Conclusion: the implementation of a virtual OSCE was feasible and it was well accepted by the participants.
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Introducción: Las competencias profesionales son cualidades humanas que permiten una visión personalizada en un individuo, el cual se desempeña en un contexto único y, a la vez, cambiante, buscando desarrollar los recursos personológicos que debe utilizar en su vida laboral. Objetivo: Valorar la implementación de un modelo para el desarrollo de competencias profesionales específicas en la atención a pacientes con enfermedades estomatognáticas. Métodos: Se realizó un estudio en educación médica en la Facultad de Estomatología de la Universidad de Ciencias Médicas en Santiago de Cuba, durante el curso 2018-2019. La población estuvo constituida por los 59 residentes que cursaban el primer año de la especialidad de Estomatología General Integral, en quienes se aplicó un modelo para el desarrollo de competencias profesionales específicas. Durante la investigación se usaron métodos teóricos y empíricos, así como estadísticos, particularmente la distribución de frecuencias absoluta y relativa y la prueba de McNemar para determinar el nivel de desarrollo después de implementado el modelo. Resultados: Se obtuvieron opiniones positivas en el taller de socialización luego de la implementación práctica del modelo. De los residentes en estomatología, 96,4 % aprobó su pertinencia, mientras que 83,1 % estuvo muy satisfecho con él. Conclusiones: Luego de aplicado el modelo propuesto, se evidenció el desarrollo de las competencias profesionales específicas en la atención a pacientes con afecciones odontológicas.
Introduction: Professional competencies are human qualities that allow a personalized vision in an individual, who performs his functions in an unique, and at the same time, changing context, and seeks to develop the personological features that he must use in his working life. Objective: To assess the implementation of a model for the development of specific professional competence in the care of patients with stomatognathic diseases. Methods: A study in medical education was conducted at the Faculty of Dentistry in the University of Medical Sciences from Santiago de Cuba, during the 2018-2019 academic year. The population consisted of the 59 residents who were in the first year of the specialty of Comprehensive General Dentistry, in whom a model for the development of specific professional competence in dental care was applied. During the investigation theoretical and empirical methods were used, as well as statistics, particularly the distribution of absolute and relative frequencies, and McNemar test to evaluate the level of development after the model has been implemented. Results: In the socialization workshop, after the practical implementation of the model, positive opinions were obtained. Among the residents in dentistry, 96.4% approved the relevance of the model, while 83.1% were very satisfied. Conclusions: After applying the proposed model, the development of specific professional competence in the care of patients with dental conditions was evidenced.
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Introducción: La creciente aparición del cáncer bucal en etapas avanzadas revela la necesidad de egresar profesionales preparados que contribuyan a su prevención y diagnóstico precoz. Objetivo: Evaluar un sistema de tareas docentes para el desarrollo de la habilidad en el diagnóstico precoz del cáncer bucal. Métodos: Se realizó un preexperimento en 32 estudiantes y 10 profesores vinculados al proceso de enseñanza-aprendizaje de la asignatura Atención Integral a la Población de la carrera de Estomatología en la Universidad de Ciencias Médicas de Guantánamo, en el curso escolar 2022-2023. A tal efecto, se determinó la variable el desarrollo de la habilidad para el diagnóstico precoz del cáncer bucal, con sus dimensiones e indicadores, y se comprobó la significación de un sistema de tareas docentes para este fin a través de la prueba de Wilcoxon. Resultados: De acuerdo con los rangos de Wilcoxon, el sistema de tareas docentes resultó confiable para contribuir al desarrollo de la habilidad objeto de estudio (p<0,05). Los estudiantes consideraron que dicho sistema constituye la vía idónea para su preparación en el tema; de igual forma, todos los profesores coincidieron en cuanto a su pertinencia, factibilidad, efectividad, utilidad práctica y relevancia. Conclusiones: El sistema de tareas docentes aplicado durante la práctica preprofesional de los estudiantes de estomatología demostró ser factible para el desarrollo de la habilidad en el diagnóstico precoz del cáncer bucal.
Introduction: The increasing appearance of advanced oral cancer reveals the need of graduating professionals, prepared to contribute to its prevention and early diagnosis. Objective: To evaluate a system of teaching tasks for the development of competence in oral cancer early diagnosis. Methods: A pre-experiment was carried out with 32 students and 10 professors, who were involved in the teaching-learning process of the subject Comprehensive Dental Care for the Population of Dentistry degree in the University of Medical Sciences from Guantánamo, in the 2022-2023 academic year. For this purpose, the development of competence in oral cancer early diagnosis was determined as the variable, with its dimensions and indicators, and the significance of a system of teaching tasks for this objective was verified through the Wilcoxon test. Results: According to the Wilcoxon ranks, the teaching task system was reliable in contributing to the development of the competence under study (p<0.05). The students considered that this system is the ideal way for their training on the subject; in the same way, all teachers agreed regarding the relevance, feasibility, effectiveness, and practical utility of the teaching task system. Conclusions: The teaching task system applied during pre-professional practice of dentistry students proved to be feasible for the development of competence in oral cancer early diagnosis.
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Neoplasias de la Boca , Detección Precoz del CáncerRESUMEN
Fundamento: El estudio teórico, el diagnóstico realizado y la experiencia de los investigadores, posibilitan formular como problema de la presente investigación: limitaciones en el desarrollo de la habilidad diagnosticar enfermedades dermatológicas en los residentes de la especialidad de Dermatología del Hospital General Provincial Docente "Dr. Antonio Luaces Iraola" de Ciego de Ávila. Objetivo: Elaborar una concepción didáctica del proceso de formación interdisciplinar de la habilidad diagnosticar enfermedades dermatológicas en los residentes de la especialidad de Dermatología, a partir de la caracterización del estado actual de esta habilidad. Metodología: Se realizó una investigación educativa con un componente descriptivo en el Hospital General Provincial Docente "Dr. Antonio Luaces Iraola" de Ciego de Ávila, en los cursos escolares desde 2016 al 2020. La población de estudio fueron los 16 residentes de 1.er año que matricularon la especialidad de Dermatología en el período de estudio. Se emplearon métodos del nivel teórico y empírico. Resultados: La caracterización realizada reveló limitaciones en el desarrollo de la habilidad diagnosticar enfermedades dermatológicas en los laboratorios de Anatomía Patológica, Microbiología y Parasitología Médica, por los residentes (100 %). La concepción didáctica del proceso de formación interdisciplinar de la habilidad diagnosticar orienta el proceso desde las actividades docentes-atencionales y prácticas de laboratorio en una consecutividad lógica y sistematización desde las diferentes formas de enseñanza y tipologías de clase. Integra la interdisciplinariedad y la utilización del método investigativo establecido en las ideas rectoras. Conclusiones: La concepción didáctica como aporte de la investigación resuelve la contradicción dialéctica entre la aplicación del método clínico y los procedimientos en la práctica de laboratorio que se da en ese proceso formativo y constituye un soporte didáctico que respalda las actividades prácticas en los laboratorios para cumplir con los objetivos del Plan de estudio de la especialidad.
Background: The theoretical study, the diagnosis conducted and the experience of the researchers make possible to formulate the problem of the present research: limitations in the development of the ability to diagnose dermatological diseases in residents of the Specialty of Dermatology of the General Provincial Teaching Hospital "Dr. Antonio Luaces Iraola" of Ciego de Avila. Objective: To elaborate a didactic conception of the interdisciplinary training process of the ability to diagnose dermatological diseases in residents of the specialty of Dermatology, based on the characterization of the current state of that ability. Methodology: An educational research with a descriptive component was conducted at the Provincial General Teaching Hospital "Dr. Antonio Luaces Iraola" of Ciego de Avila, in the 2016-2020 school years. The study population consisted of the 16 first-year dermatology residents who enrolled in the specialty during the study period. Results: The characterization conducted showed limitations in the development of the ability to diagnose dermatological diseases in anatomic pathology laboratories, Microbiology and Medical Parasitology, by residents (100%). The didactic conception of the interdisciplinary training process of diagnostic ability focuses on teaching and learning activities and laboratory practices in a logical consecutiveness and systematization from the different forms of teaching and class typologies. It integrates the interdisciplinary and the use of the research method that is established in the guiding ideas. Conclusions: The didactic conception, as a research contribution, resolves the dialectic contradiction between the application of the clinical method and the procedures in laboratory practice that occurs in this formative process which is a didactic support that backs up the practical activities in the laboratories in order to achieve the objectives of the study plan of the specialty.
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Competencia Clínica , Dermatología/educación , Educación Médica/métodos , Prácticas Interdisciplinarias/métodos , Cuerpo MédicoRESUMEN
By replacing bedside clinical training with online lectures and simulation-based case scenarios, the Covid-19 pandemic has transformed the healthcare and medical education system of India. The compromise in clinical competency, patient interaction, coping strategies, and lack of resources and preparedness were the major constraints in delivering quality healthcare services during the pandemic. The pandemic taught us key lessons on empathy, preparedness and patience. Here is my experience as a student from the batch of MBBS students who had received their final year training through online lectures and then, as an intern having my first hospital posting amidst the second wave of Covid-19.
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Historically, death has been socially accepted, but for the last decades it has been hidden in hospitals, transforming physicians into "death specialists". Thus, medical graduates should feel prepared to assume this responsibility accompanying the patient and their family through the process. With this in consideration, the present work explores students' and graduates' perceptions of preparation to face a patient's death (SPEM) in a Chilean Medical school and identifies SPEM-associated characteristics. An observational study was performed using a digital form sent by email to interns and 2018 and 2019 graduates of the Facultad de Medicina CAS-UDD, in which they were asked about their SPEM and possible SPEM-related variables. The results showed that 63% and 31% of interns and graduates reported feeling inadequately prepared or unprepared to address a patient's death, respectively. During the first two years of their profession, 71% of graduates faced a patient's death. There was a significant correlation between the SPEM and death-facing training. Considering these results and the previous evidence of the positive impact that classes and courses have on SPEM, it is suggested that an obligatory course should be added to improve SPEM in medical students.
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Introducción: el electrocardiograma constituye un examen de gran utilidad clínica. Por tal motivo, se necesita lograr en los estudiantes habilidades que permitan su interpretación correcta. Objetivo: caracterizar la preparación de los estudiantes de Medicina para la identificación de las alteraciones electrocardiográficas durante la educación en el trabajo. Materiales y métodos: se realizó un estudio observacional descriptivo transversal en el Hospital General Docente Dr. Antonio Luaces Iraola, Ciego de Ávila, en el curso escolar 2020-2021. La población de estudio fue de 21 estudiantes de tercer año de Medicina del Grupo Básico de Trabajo asignado a la Sala de Cardiología, a quienes se aplicó una encuesta de autoevaluación. Resultados: el 52 % se autoevaluaron de Mal, y el 43 % de Regular, en la identificación del electrocardiograma normal y patológico. En cuanto a la relación entre método clínico e interpretación del electrocardiograma para el diagnóstico de diferentes enfermedades cardiovasculares, un 48 % se evaluaron de Regular y un 43 % de Mal. En la precisión al reconocer el origen de cada onda, segmentos e intervalos, y cada una de sus desviaciones patológicas, el 71 % se evaluó de Mal y el 29 % de Regular. En la precisión para el diagnóstico de síndromes electrocardiográficos potencialmente vitales, el 91 % se evaluó de Mal; de igual manera lo hizo el 95 % en el reconocimiento de los criterios electrocardiográficos para el diagnóstico de las hipertrofias de las cavidades. Conclusiones: el diagnóstico reveló dificultades, demostradas en las autoevaluaciones de los estudiantes, de Regular y Mal en todos los indicadores.
Introduction: electrocardiogram is a very useful clinical examination. For that reason, it is necessary to achieve in the students skills allowing its correct interpretation. Objective: to characterize the training of Medicine students for identifying electrocardiographic alterations during their education at work. Materials and methods: a cross-sectional descriptive observational study was carried out at the General Teaching Hospital Dr. Antonio Luaces Iraola, of Ciego de Avila, during the 2020-2021 school year. The study population was 21 third-year Medicine students from the Basic Work Team assigned to the Cardiology Ward, to whom a self-assessment survey was applied. Results: 52% of students self-evaluated Unsatisfactory, and 43% Acceptable in the identification of normal and pathological electrocardiogram. Regarding the relationship between the clinical method and the interpretation of the electrocardiogram for the diagnosis of different cardiovascular diseases, 48% was evaluated Acceptable and 43% Unsatisfactory. In the accuracy when recognizing the origin of each wave, segments or intervals, and each of their pathological deviations, 71% was evaluated Unsatisfactory and 29% Acceptable. In the precision for the diagnosis of potentially life-threatening electrocardiographic syndromes, 91% was evaluated Unsatisfactory; 95% was also evaluated Unsatisfactory in recognizing the electrocardiographic criteria for the diagnosis of cavity hypertrophies. Conclusions: the diagnosis revealed difficulties assessed as acceptable and unsatisfactory in all indicators, exposed in the students' self-evaluations.