Actividades realizadas, experiencias exitosas y resultados

El texto aborda la elaboración e implementación de modelos como la Guía de Servicios de Salud y el modelo de Fortalecimiento de la Salud, la capacitación en Qi Gong realizada en diferentes estados, y el desarrollo del Modelo de la Dieta de la Milpa en colaboración con diversas comunidades y especialistas. Destaca la capacitación para formar replicadores en varios estados y la promoción de una metodología educativa intercultural basada en teorías pedagógicas reconocidas. Durante la pandemia, se realizaron talleres online para continuar con la formación, y se promovió activamente la Dieta de la Milpa a través de diversos materiales educativos. Además, se implementaron estos modelos en unidades de salud con la colaboración de autoridades tradicionales y se reconocieron experiencias exitosas en centros de salud que incluyeron actividades físicas y promoción de alimentos saludables.

[The impact of public organizations on development of professional qualification of medical workers].

The professional development of personnel is one of highest priority task of development of both medicine as science and health system as mechanism protecting health of citizens. The public organizations are professional communities of medical specialists specializing in particular sectors of medicine that actively participate in implementation of educational measures and other initiatives targeted to support opportunities for professional growth and improving competence level of participants of these communities. The article considers examples of such initiatives as exemplified by foreign and Russian public organizations of pulmonologists and dentists.

The evaluation and enhancement strategies of core competencies for older adult caregivers in integrated medical and older adult care institutions.

The study aimed to understand the main skills of older adult caregivers and find ways to improve these skills. We selected participants using a method called random cluster sampling, where caregivers from 17 different medical and nursing care facilities across seven districts in Hangzhou were chosen. We collected 492 valid questionnaires and conducted interviews with 150 people. To analyze the data, we used T-tests and Analysis of Variance (ANOVA) to identify what factors affect caregivers' skills. We also performed multiple regression analysis to explore these factors in more depth. The analysis showed that age (p = 0.041), annual income (p < 0.001), and having a training certificate (p < 0.001) significantly influence the skills of older adult caregivers. Specifically, caregivers' age and whether they had a training certificate were linked to how competent they were, with income being a very strong factor. The study highlighted a gap between the caregivers' current skills and the skills needed for high-quality care. This gap shows the need for training programs that are specifically tailored to the caregivers' diverse needs and cultural backgrounds. Medical and eldercare facilities should adjust their work and educational programs accordingly. It's also important to look at how caregivers are paid to make sure their salary reflects their skills and the quality of care they provide. Finally, it's crucial to integrate a comprehensive training program that leads to certification within eldercare organizations.

Virtual Education in Urogynecology: Enhancing Understanding and Management of Pelvic Fistulas.

Introduction: Pelvic fistulas affect a significant number of patients globally, with a relatively low prevalence in the United States. Virtual education offers an effective, scalable solution to bridge this educational gap and lead to a deeper understanding of more common conditions, such as urinary and fecal incontinence. Methods: We developed two virtual cases on rectovaginal and vesicovaginal/ureterovaginal fistulas to enhance medical students' exposure, knowledge, and confidence regarding assessment of pelvic fistulas. The cases could be completed in approximately 30 minutes, asynchronously, and at students' own pace. The cases were integrated into an OB/GYN clerkship. We conducted a survey among students receiving the cases to gather feedback on usability, acceptability, and educational value, which guided subsequent improvements. Results: Forty medical students, ranging from first to third year, participated in the urogynecology elective; 21 (53%) completed the survey. Ninety-one percent agreed or strongly agreed they were satisfied with the cases. All respondents found the format easy to use and appropriate for their level of learning. Most reported the cases improved their confidence in nonsurgical and surgical management options for pelvic fistulas. Discussion: Offering virtual and interactive patient cases on e-learning platforms represents an innovative approach to increasing clinical exposure to urogynecologic disorders. By providing medical students with the opportunity to interact with pelvic fistulas virtually, these cases can help bridge a gap in clinical education. Future exploration is valuable for examining knowledge deficiencies and developing cost-effective, self-paced, easily accessible educational resources to advance medical training and optimize patient care.

Vascular Anastomoses and Dissection: A Six-Part Simulation Curriculum for Surgical Residents.

Introduction: As surgical technologies grow, so too do demands on surgical trainees to master increasing numbers of skill sets. With the rise of endovascular surgery, trainees have fewer opportunities to practice open vascular techniques in the operating room. Simulation can bridge this gap. However, existing published open vascular simulation curricula are basic or based on expensive models. Methods: We iteratively developed an open vascular skills curriculum for second-year surgery residents comprising six 2-hour sessions. We refined the curriculum based on feedback from learners and faculty. The curriculum required skilled facilitators, vascular instruments, and tissue models. We evaluated the latest iteration with a survey and by assessing participants' technical skills using the Objective Structured Assessment of Technical Skills (OSATS) form. Results: Over the past 10 years, 101 residents have participated in the curriculum. Nine of 13 residents who participated in the latest curricular iteration completed the survey. All respondents rated the sessions as excellent and strongly agreed that they had improved their abilities to perform anastomoses with tissue and prosthetic. Facilitators completed 18 OSATS forms for residents in the fifth and sixth sessions of the latest iteration. Residents scored well overall, with a median 26.5 (interquartile range: 24-29) out of a possible score of 35, with highest scores on knowledge of instruments. Discussion: This simulation-based curriculum facilitates open vascular surgical skill acquisition among surgery residents. The curriculum allows residents to acquire critical vascular skills that are challenging to learn in an increasingly demanding operative setting.

An At-Home Laparoscopic Curriculum for Junior Residents in Surgery, Obstetrics/Gynecology, and Urology.

Introduction: Laparoscopic surgery requires significant training, and prior studies have shown that surgical residents lack key laparoscopic skills. Many educators have implemented simulation curricula to improve laparoscopic training. Given limited time for dedicated, in-person simulation center practice, at-home training has emerged as a possible mechanism by which to expand training and promote practice. There remains a gap in published at-home laparoscopic curricula employing embedded feedback mechanisms. Methods: We developed a nine-task at-home laparoscopic curriculum and an end-of-curriculum assessment following Kern's six-step approach. We implemented the curriculum over 4 months with first- to third-year residents. Results: Of 47 invited residents from general surgery, obstetrics/gynecology, and urology, 37 (79%) participated in the at-home curriculum, and 25 (53%) participated in the end-of-curriculum assessment. Residents who participated in the at-home curriculum completed a median of six of nine tasks (interquartile range: 3-8). Twenty-two residents (47%) responded to a postcurriculum survey. Of these, 19 (86%) reported that their laparoscopic skills improved through completion of the curriculum, and the same 19 (86%) felt that the curriculum should be continued for future residents. Residents who completed more at-home curriculum tasks scored higher on the end-of-curriculum assessment (p = .009 with adjusted R 2 of .28) and performed assessment tasks in less time (p = .004 with adjusted R 2 of .28). Discussion: This learner-centered laparoscopic curriculum provides guiding examples, spaced practice, feedback, and graduated skill development to enable junior residents to improve their laparoscopic skills in a low-stakes, at-home environment.

Normal Pregnancy Care and Physiology and Select Pregnancy Complications: A Flipped Classroom Case for the OB/GYN Clerkship.

Introduction: This module teaches core knowledge and skills for undergraduate medical education in reproductive health, providing instruction in the management of normal and abnormal pregnancy and labor utilizing interactive small-group flipped classroom methods and case-based instruction. Methods: Advance preparation materials were provided before the education session. The 2-hour session was facilitated by clinical educators using a faculty guide. Using voluntary surveys, we collected data to measure satisfaction among obstetrics and gynecology clerkship students and facilitators following each education session. Results: Capturing six clerkships spanning 9 months, 116 students participated, and 64 students completed the satisfaction survey, with 97% agreeing that the session was helpful in applying knowledge and principles to common clinical scenarios. Most students (96%) self-reported that they achieved the session's learning objectives utilizing prework and interactive small-group teaching. Nine clinical instructors completed the survey; all agreed the provided materials allowed them to facilitate active learning, and the majority (89%) agreed they spent less time preparing to teach this curriculum compared to traditional didactics. Discussion: This interactive flipped classroom session meets clerkship learning objectives related to the management of pregnancy and labor using standardized materials. The curriculum reduced preparation time for clinical educators as well.

The Interprofessional Standardized Patient Experience: An Effective Interprofessional Education Activity for Prelicensure Health Professional Students.

Introduction: For future success in the modern health care environment, health professions students require effective interprofessional education experiences to develop their perceptions of other professionals on the health care team. The Interprofessional Standardized Patient Experience (ISPE) is an interprofessional education activity for prelicensure health professional students in nursing, pharmacy, physical therapy, medicine, social work, and occupational therapy. Methods: The ISPE involved collaboration among students to conduct a subjective interview. Students from six health care professions individually interviewed a simulated patient while being observed by students from other professions. A structured faculty-guided debriefing session followed the comprehensive interview process. Students completed a voluntary pre- and post-ISPE survey with interprofessional questions and feedback on the activity. Descriptive statistics were used to analyze individual responses. Differences in student opinions by student profession and by the number of professions present were examined using chi-square tests. Results: Over 4 consecutive academic years, 1,265 students completed the ISPE, and 1,028 completed the pre- and post-ISPE surveys. Analysis of the survey responses indicated that the ISPE enhanced student awareness of the functions of an interprofessional team and increased student knowledge of the roles of different health care professions. Students rated the ISPE as a valuable experience. Differences were noted in some of the measures by profession and group size. Discussion: A single ISPE had a significant impact on prelicensure students' perceptions. The ISPE is a novel and effective approach to interprofessional education that students appreciate.

Building Interprofessional Competencies Through a Collaborative Prescribing Activity With Osteopathic, Pharmacy, and Physician Assistant Students.

Introduction: Medication errors can lead to significant adverse events. Nearly 50% of medication errors occur during the prescription-writing stage of the medication use process, and effective interprofessional collaboration and communication are key to reducing error in this process. Methods: We developed a three-part, 60-minute, interprofessional education activity providing medical, physician assistant, and pharmacy students the opportunity to practice collegial interprofessional communication surrounding prescribing practices. Learners met virtually initially as a large group and divided into small groups facilitated by a health professional. Part 1 involved reviewing two prescriptions prepared by learners; part 2 was a discussion about the education, roles, and responsibilities of each profession; and part 3 focused on identifying prescription errors in examples provided by faculty. Students completed a post-pre survey measuring their perception of learning the Interprofessional Collaborative Competency Attainment Survey (ICCAS) areas. Results: Of 317 participants (151 doctor of osteopathy, 68 master of physician assistant studies, and 98 doctor of pharmacy students), 286 completed the post-pre survey, for a 90% response rate. Students reported statistically significant (p < .001) increases in all 20 questions spanning the six ICCAS areas. Discussion: The virtual format allowed multiple institutions to participate from various locations. It broadened the learners' experience by fostering interaction among those with varied perspectives and allowed collaboration between locations and programs that otherwise could not have participated. The activity introduced students to virtual collaboration and key telehealth skills, enhancing their confidence and familiarity with virtual interactions in a professional setting.

Flipped and Peer-Assisted teaching: a new model in virtual anatomy education.

INTRODUCTION: In response to the COVID-19 crisis, this study aimed to introduce a new virtual teaching model for anatomy education that combines Peer-Assisted Learning (PAL) and flipped classrooms, aligning with constructivist principles. METHOD: The Flipped Peer Assisted (FPA) method was implemented in a virtual neuroanatomy course for second-year medical students at Birjand University of Medical Sciences via a descriptive study. The method involved small groups of PAL, with peer learning serving as educational assistants and the teacher acting as a facilitator. Educational content was uploaded to the university's learning management system (LMS). The opinion of medical students regarding the teaching method were evaluated using a 15-item questionnaire on a five-point Likert scale. RESULTS: A total of 210 students participated in the instruction using the FPA method. The analysis of students' scores revealed an average score of 26.75 ± 3.67 on the 30-point test. According to student feedback, this teaching method effectively motivated students to study, enhanced teamwork and communication skills, transformed their perspective on the anatomy course, provided opportunities for formative assessment and feedback, and demonstrated the teacher's dedication to education. CONCLUSION: The FPA model demonstrates its effectiveness in transforming traditional classroom teaching and fostering teaching and learning in virtual environments, particularly during pandemics like COVID-19. This model holds promise for enhancing anatomy education in challenging circumstances.

An observer tool to enhance learning of medical students during simulation training of cardiopulmonary resuscitation: a randomised controlled trial.

BACKGROUND: Simulation training in cardiopulmonary resuscitation (CPR) is effective but active practice time is limited given the large number of students and the learning effect size remains small. To improve learning during observation, the use of an observer tool (OT) has been advocated. The aim was to assess the value of OT to improve medical students' learning outcomes during CPR simulation training. METHODS: This prospective, randomized study took place during CPR training of medical students. The workshop targeted recognition of unconsciousness, absence of breathing, call for help, cardiac massage and defibrillation. Students practicing in dyads were randomized to use an OT (i.e., a checklist summarizing CPR skills and step-by-step actions) (OT +) or not (OT-) when observing others. At the end of the training, the global performance of the dyad was assessed by an evaluator using the OT checklist (primary outcome). The non-technical skills (NTS), chest compression quality, perceived improvement in knowledge and skills and knowledge score (MCQ) were also recorded. RESULTS: The student dyads were included (OT + : n = 40 and OT-: n = 41). Immediately after training, the global performance was similar between the two groups: OT + : 24 [23-25] and OT-: 23 [21-24] (out of 25), p = 0.052. However, better learning of breathing assessment and cardiac massage performance, as well as a better knowledge score, were found in the OT + group. No significant difference was observed for NTS or perceived improvement in knowledge and skills. Satisfaction was higher in the OT- group. CONCLUSIONS: The use of an OT during CPR simulation did not show any pedagogical benefit on the global performance of medical students. However, a potential benefit was found for several important secondary outcomes. Further studies are needed to confirm these positive results.

Test-reduced teaching for stimulation of intrinsic motivation (TRUST): a randomized controlled intervention study.

BACKGROUND: The anatomy dissection course is a major part of the first two years of the traditional medical curriculum in Germany. The vast amount of content to be learned and the repeated examination is unanimously perceived by students and teachers as a major stress factor that contributes to the increase of psychosocial stress during the first two years of the course of study. Published interventions for specific stress reduction are scarce. METHODS: In a randomized, controlled design two intervention groups were compared with a control group (CG) over the whole dissection course (nine measuring points before, during and after first and second semester). The 'Stress Management intervention (IVSM)' targeted at the setting of personal standards, the 'Friendly Feedback intervention (IVFF)' at the context of frequent testing. Quantitative surveys were distributed at nine measuring points. The questionnaire comprised validated instruments and self-developed items regarding stress, positive and negative affect, anxiety, intrinsic and extrinsic motivation, self-efficacy, and perceived performance. RESULTS: Out of 195 students inscribed in the dissection course, 166 (85%) agreed to participate in the study. The experience of stress during the dissection course was significantly higher in the CG than in the IVFF. Anxiety and negative affect were lower in students of the IVFF while positive affect, intrinsic motivation, and self-efficacy were higher than in the CG. For anxiety and negative affect in the IVSM this was especially seen at the end of the second semester. The self-perceived increase in both knowledge and preparedness for the first big oral and written examination did not differ between the study groups. About three quarters of the participants would choose the intervention 'Friendly Feedback' if given the choice. CONCLUSIONS: Replacing formal tests with friendly feedback has proven to be an effective measure to reduce stress and negative affect and foster positive affect, self-efficacy, and intrinsic motivation, while it did not impair self-perceived academic performance.

An Interprofessional Graduate Student and Family Coaching Program in Naturalistic Communication Techniques.

Researchers implemented a short-term cascading coaching model focusing on naturalistic developmental behavioral intervention with three participant triads. Triads consisted of a graduate student clinician, a minimally verbal child with autism spectrum disorder, and the child's parent. Coaching and intervention occurred during an interprofessional summer clinic that included graduate student clinicians from special education and speech and hearing sciences departments. The efficacy of short-term instruction, researcher coaching for student clinicians, and student clinician coaching of parents was evaluated using a multiple baseline across participants' design. The dependent variables were student clinician's and parent's use of elicitation techniques (creating communication temptations, waiting, and prompting) and response techniques (naturally reinforcing children's communication and providing spoken language models). Following coaching, parents and student clinicians from all triads increased their use of elicitation and response techniques, with very large effect sizes across all variables. Visual analysis findings suggest individualized differences and variability across triads. Implications for graduate education and parent coaching programs are discussed.

Laparoscopic Pancreatoduodenectomy: Twenty years later, where are we?

In its 20th anniversary, laparoscopic pancreatoduodenectomy, while feasible and safe in the hands of experienced surgeons, has not seen the anticipated popularity observed in other digestive surgery procedures. The primary hurdle remains the absence of a clear advantage over traditional open surgery, paired with the procedures complexity and a consequent steep learning curve. In regions with limited pancreatic surgery services, conducting this procedure without adequate training can have serious repercussions. Given the advent of robotic platforms and the anticipation of prospective and randomized studies on this new technology, it is imperative to engage in comprehensive discussions, endorsed by surgical societies, on the value, application, and implementation strategies for various minimally invasive pancreatoduodenectomy techniques. Such dialogue is crucial for advancing the field and ensuring optimal patient outcomes.

Revolutionizing thoracic surgery education: a bibliometric analysis of the past decade's literature.

OBJECTIVES: Thoracic surgery is a complex field requiring advanced technical skills and critical decision-making. Surgical education must evolve to equip trainees with proficiency in new techniques and technologies. METHODS: This bibliometric analysis systematically reviewed 113 articles on thoracic surgery skills training published over the past decade, retrieved from databases including Web of Science. Publication trends, citation analysis, author and journal productivity, and keyword frequencies were evaluated. RESULTS: The United States contributed the most publications, led by pioneering institutions. Simulation training progressed from basic to sophisticated modalities and virtual reality emerged with transformative potential. Minimally invasive techniques posed unique learning challenges requiring integrated curricula. CONCLUSION: Ongoing investments in educational research and curriculum innovations are imperative to advance thoracic surgery training through multidisciplinary strategies. This study provides an evidentiary foundation to optimize training and address the complexities of modern thoracic surgery.

Improving the diagnostic performance of inexperienced readers for thyroid nodules through digital self-learning and artificial intelligence assistance.

Background: Data-driven digital learning could improve the diagnostic performance of novice students for thyroid nodules. Objective: To evaluate the efficacy of digital self-learning and artificial intelligence-based computer-assisted diagnosis (AI-CAD) for inexperienced readers to diagnose thyroid nodules. Methods: Between February and August 2023, a total of 26 readers (less than 1 year of experience in thyroid US from various departments) from 6 hospitals participated in this study. Readers completed an online learning session comprising 3,000 thyroid nodules annotated as benign or malignant independently. They were asked to assess a test set consisting of 120 thyroid nodules with known surgical pathology before and after a learning session. Then, they referred to AI-CAD and made their final decisions on the thyroid nodules. Diagnostic performances before and after self-training and with AI-CAD assistance were evaluated and compared between radiology residents and readers from different specialties. Results: AUC (area under the receiver operating characteristic curve) improved after the self-learning session, and it improved further after radiologists referred to AI-CAD (0.679 vs 0.713 vs 0.758, p<0.05). Although the 18 radiology residents showed improved AUC (0.7 to 0.743, p=0.016) and accuracy (69.9% to 74.2%, p=0.013) after self-learning, the readers from other departments did not. With AI-CAD assistance, sensitivity (radiology 70.3% to 74.9%, others 67.9% to 82.3%, all p<0.05) and accuracy (radiology 74.2% to 77.1%, others 64.4% to 72.8%, all p <0.05) improved in all readers. Conclusion: While AI-CAD assistance helps improve the diagnostic performance of all inexperienced readers for thyroid nodules, self-learning was only effective for radiology residents with more background knowledge of ultrasonography. Clinical Impact: Online self-learning, along with AI-CAD assistance, can effectively enhance the diagnostic performance of radiology residents in thyroid cancer.