Experiencias de estudiantes de medicina que interrumpen sus estudios universitarios: un estudio cualitativo / Experiences of medical students dropping out studies. A qualitative approach

Background: Medical students have a higher prevalence of mental health problems and are more likely to drop out their studies as a result. Aim: To comprehend the academic experiences of medical students who dropped out medical studies in a university that experienced an increase in drop out by medical students and consultations to mental health services. Material and Methods: A qualitative study with a phenomenological design, in which in-depth interviews were conducted with eight medical students who dropped out studies. The analysis was carried out by means of the constant comparison method up to the level of open coding. Results: Two categories were identified, namely experiences prior to interrupting studies, which comprised the subcategories of academic and social experiences, and motives that lead to drop-out, which considered the subcategories related to vocation, mental health and pursuing other projects. Conclusions: These results identified the challenges faced by students prior to stopping-out, that are related to academic aspects, peer relations and student-teacher relationship. The main motives for drop-out reported by students were mental health problems.

¿Enseña diferente un docente comprometido? Relación entre compromiso docente y prácticas pedagógicas en académicos de carreras de la salud / Relationship between occupational commitment and teaching practices among healthcare teachers

Background: A central aspect of professional identity is occupational commitment, which has a significant relationship with motivation and positive mental states in healthcare environments. However, it is not clear how occupational commitment is related to teaching practices in universities. Aim: To apply the Occupational Commitment Questionnaire (OCQ) to university teachers and relate its results with the Teaching Practices Questionnaire. Material and Methods: OCQ and Teaching Practices Questionnaire were answered by 319 university teachers from 13 Chilean regions, who were selected through a non-probabilistic volunteer sampling. Data collection was done after informed consent. An exploratory factor analysis was performed for OCQ. The internal consistency of each factor was calculated with Cronbach's Alpha. Spearman correlations were used to explore the relationship between the two questionnaires. Results: Two factors were identified in OCQ, namely Teacher Commitment and Ethical-Professional Commitment. Cronbach's Alpha was 0.85 for both factors. A moderate direct relationship between teacher commitment, ethical-professional commitment, and the Teaching Practices Questionnaire was found. Conclusions: OCQ showed an adequate internal consistency, and it was directly related with teaching practices. Committed teachers had better teaching practices. This confirms the importance of teachers' values and perceptions on their professional performance.

Formación clínica en carreras de la salud: ¿dónde se incluye la diversidad? / The inclusion of diversity in clinical training

Background Educational inclusion, a concept that has changed over time, is becoming relevant. It initially considered only disability and now contemplates education for all people. Educational inclusion has special relevance in health care workers' training, who will have direct contact with heterogeneous populations, where diversity-oriented treatments are required. Aim To describe how diversity is integrated into health care training in a clinical context. Material and Methods qualitative study, based on Grounded Theory. Two group interviews and thirteen semi-structured interviews were conducted among 11 teachers and 25 students of health careers. Data was analyzed using Atlas-ti 7.5.2. A constant comparison method, reaching an axial coding level, was used. Results The category of training in health careers in the context of diversity emerged. It is a process that operates in cognitive, affective and behavioral dimensions. It accounts for the diversity of system actors and the model of a health professional and teacher facing diversity. Conclusions These dimensions should be understood during clinical training. Socio-cultural diversity encompassing gender, sex, ethnicity, religion and disability should be considered. Therefore, educational inclusion is an important issue to be considered by universities.

Tensión educativa entre la tradición y las nuevas alternativas / Educational tension between tradition and the new alternativesx

La educación enfrenta la tensión entre un pensamiento moderno y otro posmoderno. Dicha problemática nos llevará a preguntar lo siguiente: ¿qué ha gobernado a la cuestión educativa para estar en tensión en la actualidad? Abordaremos el modo en que la racionalidad técnico-instrumental, propia del pensamiento moderno, reverbera fuertemente en la actualidad. En contraposición, examinaremos cómo el pensamiento posmoderno emerge cuestionando la legitimidad del método científico tradicional y comienza a ser una respuesta para aquel descontento social que tensiona a la educación. En otras palabras, el objetivo del presente trabajo será analizar cómo dichas posiciones teóricas se han ido permeando sigilosamente en la discusión educativa, lo que finalmente nos ayudará a abrir una discusión sobre qué entenderemos por educar y qué camino reflexivo pudiese seguir la disciplina de la Educación Médica en Latinoamérica(AU)

Education faces the tension between modern and postmodern thinking. This problem will lead us to ask the following: What has governed the educational question as being in tension today? We will address the way in which technical-instrumental rationality, inherent in modern thought, reverberates strongly today. In contrast, we will examine how postmodern thinking emerges by questioning the legitimacy of the traditional scientific method and begins to be a response to that social discontent that stresses education. In other words, the objective of the present work will be to analyze how these theoretical positions have been stealthily permeating in the educational discussion, which will finally help us open a discussion about what we will understand by educating and what reflective path should be followed by the discipline of Medical Education in Latin America(AU)

Roles y habilidades docentes según escenarios educativos en carreras de la Salud / Teaching Roles and Skills According to Educational Scenarios in Health-Related Majors

Introducción: Las carreras de la salud se caracterizan por contemplar dos contextos educativos, el aula que abarca casi la totalidad del plan curricular en el ciclo básico y parte importante del pre-clínico; y el contexto de enseñanza clínica que caracteriza el último ciclo de formación profesional en Ciencias de la Salud. Objetivos: Describir los roles docentes que se practican en la actualidad en diversos escenarios educativos de carreras Salud en una Universidad de alta complejidad en Chile. Métodos: Investigación cualitativa, teoría fundamentada de Strauss y Corbin. Se utilizaron dos instrumentos para la recolección de datos, previo consentimiento informado: entrevistas individuales semi-estructuradas y focus group, por muestreo teórico. Los participantes fueron 31 docentes de seis carreras de las Ciencias de la Salud. Se utilizó el método de comparación constante para el análisis de datos y fueron procesados en Atlas ti. Resultados: Se observaron diferencias en el rol que ejerce el docente que realiza enseñanza en aula quien despliega habilidades que le permite tener un mayor control sobre el proceso de enseñanza-aprendizaje y el rol que ejerce en campos clínicos, donde debe desplegar diversas estrategias espontáneas. Conclusiones: Los habilidades docentes le permiten ir adaptándose a los escenarios educativo en lo que enseña, sin embargo, también provoca que éstos ejerzan otro tipo de roles docentes que los que se propone en la teoría(AU)

Introduction: Health-related majors are characterized by contemplating two educational contexts: the classroom, which covers almost the entire curricular plan in the basic cycle and an important part of the pre-clinical cycle; and the clinical teaching context, which characterizes the last cycle of professional training in Health Sciences. Objectives: To describe the teaching roles currently practiced in different educational contexts of health majors in a high-complexity university in Chile. Methods: Qualitative research, grounded theory by Strauss and Corbin. Two instruments were used for data collection, with prior informed consent: semi-structured individual interviews and focus group, by theoretical sampling. The participants were 31 teachers from six Health Sciences majors. The constant comparison method was used for the data analysis. The data were processed in Atlas ti. Results: Differences were observed in the role played by the professor working in the classroom, where skills are displayed permitting greater control over the teaching-learning process, and the role played in clinical fields, where various spontaneous strategies must be deployed. Conclusions: The teaching skills allow the professor to adapt to the educational teaching scenarios; however, it also causes professors to exercise other types of teaching roles than those proposed in the theory(AU)

Identidad ocupacional en docentes de carreras de la salud y su relación con las prácticas pedagógicas / Psychometric properties of a newly developed occupational identity questionnaire for university teachers

Background: Occupational identity is defined as the perception of occupational interests, abilities, goals, and values, and the structure of the meanings that link these self-perceptions to career role. We developed an occupational identity questionnaire suitable to be used with university teachers. Aim: To evaluate the psychometric properties of the Occupational Identity Questionnaire (OIQ) and relate its results with those of the Teaching Practices questionnaire. Material and Methods. The OIQ and Teaching Practices Questionnaire were answered by 311 university teachers along Chile, who were selected through a non-probabilistic volunteer sampling. An exploratory factor analysis was performed and the internal consistency of each factor was calculated with Cronbach's Alpha. Spearman correlations were used to explore the relationship between the two questionnaires. Results: Two factors were identified in OIQ: Teaching Vocation and Sense of Competence. Cronbach's Alpha was 0.75 for teaching vocation and 0.82 for the sense of competence. There was a moderate direct relationship between teaching vocation, sense of competence and the results of the Teaching Practices Questionnaire. Conclusions: OIS has an adequate internal consistency, its factorial structure showed two different types of identities and it is directly related to the results of the Teaching Practices Questionnaire.

Intervención para el aprendizaje en clases didácticas prolongadas de asignaturas clínicas / Intervention for learning in lengthened didactic lessons of clinical subjects

Introducción: las clases didácticas o magistrales son utilizadas frecuentemente en educación médica, aunque se sabe que la atención de los estudiantes disminuye progresivamente y la retención de la información es limitada. Las clases interactivas reducen estos inconvenientes, pero su efecto sólo se ha evaluado en clases de una hora o menos de duración y predominantemente en el ciclo básico de medicina. Objetivo: evaluar la intervención implementada para el alcance de un mayor aprendizaje en clases didácticas prolongadas de asignaturas clínicas. Método: la intervención se realizó en un módulo educativo del ciclo clínico de la carrera de medicina de una universidad privada chilena. Participaron 60 estudiantes de 5to año. Las clases de la unidad intervenida se impartieron en 4 h académicas sucesivas de 45 min cada una. Al inicio de cada clase, los estudiantes respondieron un cuestionario con sentencias en formato verdadero o falso referidas a los objetivos centrales de cada temática. Las clases se estructuraron con el método clásico y el estilo docente predominante fue proveedor visual de información. La evaluación se realizó después de 3 meses mediante un test de conocimientos con 40 preguntas de opción múltiple (11 de cardiología). Se incluyó una selección de sentencias de verdadero y falso de aquellas utilizadas durante las clases y una encuesta de satisfacción en formato Likert. Además, se aplicó una escala diferencial semántica para recolectar información sobre las clases de las demás unidades con el propósito de controlar el efecto halo atribuido a preferencias de docentes participantes. Resultados: el promedio de las calificaciones en las preguntas de cardiología del test de conocimientos fue significativamente superior al promedio de las otras unidades de geriatría [t(59)=-28,3; p< 0,001]. El porcentaje promedio de aciertos del post-test fue 45,2 por ciento superior al pretest [t(59)= -24,9; p< 0,001]. La metodología fue bien evaluada: 100 por ciento de estudiantes estimó que mantuvo su atención durante las clases. La apreciación de las clases impartidas por los diferentes docentes del módulo de geriatría fue positiva, sin diferencias entre ellos. Conclusiones: el uso de cuestionarios con sentencias de verdadero y falso, referidas a los objetivos educacionales, antes de cada sesión de clases prolongadas es una estrategia que permite mantener la atención de los estudiantes y favorece el rendimiento cognitivo en asignaturas clínicas del pregrado de Medicina(AU)

Introduction: didactic or master classes are frequently used in medical education, although the students' attention is known to decrease progressively and information retention is limited. Interactive classes reduce these disadvantages, but their effect has only been evaluated in one-hour or less lessons and predominantly during the basic medical cycle. Objective: to evaluate the intervention implemented for attaining greater knowledge in extended didactic classes on clinical subjects. Method: the intervention was carried out in an educational module of the clinical cycle of the medical major of a Chilean private university. Sixty fifth-year students participated. The lessons of the intervened unit were taught in four consecutive academic hours of 45 minutes each. At the beginning of each lesson, the students answered a questionnaire with statements for the true/false format and referring the central objectives of each subject. The lessons were structured with the classical method and the predominant teaching style was visual information provider. The evaluation was carried out after 3 months through a knowledge test with 40 multiple-choice questions (11 about cardiology). It included a selection of true/false statements from those used during the lessons and a satisfaction survey in the Likert format. In addition, a differential semantic scale was applied to collect information about the lessons of the other units with aim at controlling the halo effect attributed to the preferences of participating teachers. Results: the average of the scores in the cardiology questions of the knowledge test was significantly higher than the average of the other geriatric units (t (59)= -28.3, p< 0.001). The average percentage of correct answers in the post-test was 45.2 percent, higher than the pretest (t (59)= -24.9, p< 0.001). The methodology was evaluated well: 100 percent of students considered that they kept their attention during the lessons. The appreciation of the lessons given by the different teachers of the geriatric module was positive, without differences between them. Conclusions: the use of questionnaires with true/false statements and referring the educational objectives, before each session of extended lessons, is a strategy that allows to keep the students' attention and favors the cognitive performance in undergraduate medical-clinical subjects(AU)

Razonamiento clínico inductivo o deductivo: una propuesta cualitativa en kinesiología / nductive or deductive clinical reasoning: a proposal qualitative in kinesiology

Introducción: a través del proceso de razonamiento clínico, los profesionales de la salud evalúan críticamente sus intervenciones, siendo esta habilidad necesaria para reconocer qué factores son relevantes para el usuario, a fin de realizar juicios clínicos apropiados que contribuyan a la condición de salud óptima del paciente. La literatura indica que el proceso en un estudiante puede no ser lineal, siendo necesario retroceder y buscar nuevas soluciones y patrones para determinar una elección terapéutica. Objetivo: describir el proceso de razonamiento clínico realizado en estudiantes de ciclo intermedio de Kinesiología en la Universidad de Concepción. Método: investigación cualitativa y descriptiva. 7 estudiantes de tercer y cuarto año de la Universidad de Concepción participaron en la recolección de datos, siguiendo un proceso de consentimiento informado. Se aplicó un cuestionario sociodemográfico y se analizaron los problemas kinesiológicos de un caso clínico mediante asociación libre. Los registros se obtuvieron con una grabadora y luego se realizó un análisis de contenido utilizando CAQDAS Atlas-ti 7.5.2. Resultados: a partir de la lectura de los documentos grabados, surgieron 335 unidades asociadas al razonamiento clínico de los estudiantes de Kinesiología. Estas unidades se agruparon en 58 códigos y estos a su vez, en 2 categorías: razonamiento deductivo y razonamiento inductivo. Discusión: el análisis del proceso es esencial para identificar qué estrategias buscan los estudiantes para resolver en un caso clínico, qué diferencias y particularidades existen entre los estudiantes, y qué metodologías de enseñanza son las más adecuadas para guiar apropiadamente las decisiones terapéuticas que enfrentarán los profesionales de la salud en forma diaria.(AU)

Introduction: Through the clinical reasoning process, health professionals critically evaluate their interventions, being these skills required to recognize which factors are relevant to the user, in order to make appropriate clinical judgments that contribute to the optimal health condition of the user. The literature shows that the student´s process may not be linear, needing to go back and look for new solutions and patterns to determine a therapeutic choice. Objective: Describe the process of clinical reasoning carried out in Physiotherapy students who study in the intermediate cycle at the University of Concepción. Method: Qualitative and descriptive research. 7 students from third and fourth year at the Universidad de Concepción started the sample collection, following an informed consent process. A socio-demographic questionnaire was applied, and kinesthetic problems of a clinical case were analyzed by free association. Records were obtained with a tape recorder and then a content analysis was performed using CAQDAS Atlas-ti 7.5.2. Results: From the listening of the recorded documents, 335 units emerged associated with the clinical reasoning of the Physiotherapy students. These units were grouped into 58 codes and these in turn, in 2 categories: deductive reasoning and inductive reasoning. Discussion: Analysis of the process is essential to identify which strategies students seek to resolve a case, what differences and particularities exist among students, and which teaching strategies are best suited to adequately guide the therapeutic decisions they will face as health professionals on a daily basis.(AU)

¿Cómo han cambiado los estudiantes que ingresan a medicina? Aprendizaje autodirigido y antecedentes académicos de las cohortes 2010 a 2014 de una universidad tradicional / Self-directed learning and academic background of 2010 to 2014 cohorts of medical students

Background: The widespread growth of higher education is increasing the heterogeneity of university students in terms of socioeconomic characteristics, academic story and cultural background. Medical schools are not an exception of this phenomenon. Aim: To compare the academic background and self-directed learning behavior of students who entered to a public medial school between 2010 and 2014. Material and Methods: A non-probabilistic sample of 527 medical students aged between 17 and 29 years (60% men), was studied. Their academic information was collected from the University data base; they answered the Self-directed learning readiness scale of Fisher. Results: Students from the 2014 cohort had higher high school grades than their counterparts. The scores in mathematics of the Scholarship Aptitude Test (SAT) were higher in the cohorts of 2010 and 2011. Those of the sciences test were superior in the 2013 cohort. The 2014 cohort had the lower general score of self-directed learning behaviors. Conclusions: The lower SAT and self-directed learning scores of the students entering medical school in 2014, indicate the progressive increase in the heterogeneity of Medical students.

Prácticas reflexivas del proceso de enseñanza en docentes universitarios de las ciencias de la salud / Reflective practices of the teaching process in university health science professors

Introducción: para transformar los procesos de formación de los docentes universitarios es relevante generar espacios reflexivos, ya que estos influyen en el cambio y la innovación docente. Objetivo: comprender cómo se desarrollan las prácticas reflexivas en el proceso de enseñanza-aprendizaje de docentes universitarios del área de la salud de la Universidad de Concepción. Métodos: cualitativo, enfoque de estudio de casos. Participaron 8 docentes universitarios del área de la salud, previo consentimiento informado, se realizó un análisis de contenido. Resultados: los escenarios educativos y las concepciones de enseñanza influyen en los procesos reflexivos de los docentes. Conclusión: las prácticas reflexivas deben ser estimuladas, ya que favorecen una mayor conciencia de la formación y mejoramiento educativo(AU)

Introduction: for the purpose of transforming the process of university professor formation, it is relevant to generate spaces for reflection since these may influence the educational change and innovation. Objective: to understand the development of reflective practices of the teaching-learning process of university health science professors in Universidad de Concepción. Method: qualitative method, case study approach. Eight university professors of health careers participated in this study after giving their informed consent. A contents analysis was made. Results: educational scenarios and teaching conceptions influence reflective practice of professors. Conclusions: reflective practices must be encouraged since they facilitate greater awareness about formation and educational improvement (AU)