Violence and Clinical Learning Environments in Medical Residencies.

INTRODUCTION: The objective of this study was to describe and analyze residents' perceptions of characteristics on the expansive/restrictive continuum of their clinical learning environment. METHODS: We conducted a quantitative, descriptive and cross-sectional study. A self-administered questionnaire was designed, programmed and applied to residents at the Faculty of Medicine of the National Autonomous University of Mexico. The instrument was structured in eight sections, and for this article, Section 3, which referred to clinical environments and violence was considered. The questionnaire had an 85% response rate, with 12,612 residents from 113 medical units and 78 specialties participating. The reliability and internal consistency measured with alpha omega obtained a value of ω 0.835 (CI; 0.828-0.843). RESULTS: Unpleasant, competitive, tense and conflictive contexts were related to restrictive environments. Sexual orientation influenced the perception of intolerance in the clinical setting with respect to discriminatory comments, such that for gender minorities, the environment was experienced as exclusionary. First-year residents perceived environments as more aggressive, a perception that tended to decrease in later years of residency. DISCUSSION: Abuses in power relations, rigid hierarchical positions and offensive clinical interactions may foster restrictive environments. In such settings, the reproduction of socio-culturally learned violence is feasible; however, asymmetrical relationships may be deconstructed and transformed.

Usefulness of Mobile Devices in Learning Process for Residents of Pediatric Surgical Specialties.

INTRODUCTION: In the hospital setting, the use of mobile devices among surgical residents is increasing. To assess the usefulness of mobile devices for residents of pediatric surgical specialties. MATERIALS AND METHODS: The study used a mixed-method design. First, a self-developed online questionnaire with 23 items was used to obtain quantitative data, which was analyzed via simple discriminant analysis. Qualitative data were obtained using the focus group technique with the subsequent triangulation of quantitative and qualitative data. RESULTS: The residents used mobile devices for learning and communication. Using quantitative data, the study found that the major functions of mobile devices were communicating with other residents and taking clinical photos, and that for learning, were speaking with attendings, residents, collecting patient information, and searching for unfamiliar terms. Triangulation analysis confirmed that mobile devices aid in agile communication, the search for data on drugs or diseases, and consultation of medical applications. Qualitative data informed the limitations of devices and the inconsistencies between official regulations and their advantages in clinical practice. CONCLUSIONS: We demonstrate the usefulness of mobile devices among surgical residents in clinical care and recommend that hospitals should regulate policies to maximize the use of mobile devices.

Experiencias de docentes y estudiantes en la educación remota de emergencia: oportunidades para mejorar la educación del pregrado en medicina / Faculty and student experience during remote emergency education: opportunities for improving undergraduate medical education

Introducción: Los ciclos clínicos de pregrado representan los escenarios principales en los que los estudiantes de medicina consolidan los conocimientos. Sin embargo, a principios de 2020, la mayoría de los estudiantes fue confinada en sus domicilios debido a la pandemia por el SARS-CoV-2. Los procesos formativos continuaron desde los hogares por medio de la educación remota de emergencia, una modalidad de enseñanza basada en el uso intensivo de la tecnología que, a pesar de hacerse de manera improvisada, respondió a la situación educativa de urgencia. El propósito de este estudio fue indagar la experiencia educativa de estudiantes y docentes que se encontraban en los años clínicos de pregrado de la carrera de medicina con el fin de identificar las oportunidades de mejora en la enseñanza a partir de la crisis sanitaria vivida. Sujetos y métodos: Se realizó un estudio cualitativo de carácter descriptivo con la técnica de grupos focales. El análisis se basó en la reducción de datos, en la triangulación entre estamentos y en la bibliografía del tema. Resultados: Se realizaron 16 grupos focales con un total de 148 participantes. Se identificaron cuatro categorías generales: a) enseñanza y aprendizaje; b) evaluación de la práctica clínica; c) identidad profesional, y d) sugerencias en busca de mejoras en la formación de los médicos Conclusiones: Las reflexiones reconocen la necesidad de incorporar las tecnologías digitales de una manera planeada y diseñada en conjunto por expertos y docentes para adaptarlas a las necesidades de los contextos educativos, y continuar con modelos híbridos o combinados para mejorar la educación médica.(AU)

Introduction: During medical education, undergraduate clinical cycles represent the main scenarios where students consolidate knowledge. However, in the early 2020s, most students were confined to their homes due to the SARS-Cov-2 pandemic. In this situation, the digital network allowed the educational processes to continue from their homes through remote emergency education (REE), a teaching modality based on the intensive use of technology that, despite having been improvised, responded to the emergency educational situation. Therefore, this study aimed to investigate the educational experience of students and teachers in the undergraduate clinical years of the medical degree in order to identify opportunities for improvement in teaching after the health crisis. Subjects and methods: A descriptive qualitative study was carried out with a phenomenological approach through the focus group technique. The qualitative analysis was based on data reduction and triangulation between strata and subject literature. Results: Sixteen focus groups were integrated with a total of 148 participants. Four categories were identified: a) teaching and learning; b) evaluation of clinical practice; c) professional identity, and d) suggestions for improvement in the training of physicians. Conclusions: The reflections lead to recognizing the need to incorporate digital technology designed by experts and teachers to adapt them to the real needs of the educational contexts and to continue with a hybrid or combined model that supports the improvement of medical education.(AU)

La tutoría como un factor influyente en la identidad profesional del alumno de pregrado de medicina / Tutoring as an influential factor in the professional identity of undergraduate medicine students

Resumen Introducción: la formación de la identidad profesional médica se logra en etapas durante las cuales se internalizan las características, los valores y las normas de la profesión médica, lo que da como resultado que el individuo piense, actúe y se sienta como un médico. Los tutores en medicina deben aclarar y animar los principios dentro de los programas de estudio y los entornos de aprendizaje con el fin de apoyar la formación de la identidad profesional de sus alumnos. Objetivo: el propósito de este escrito es develar la participación de la tutoría médica como uno de los factores más influyentes que contribuyen al desarrollo de la identidad profesional de los estudiantes de la licenciatura de medicina, así como dar algunas pautas para que la formación de tutores contemple herramientas que les permitan contribuir en la construcción positiva y valorada de la identidad profesional de los estudiantes.

Abstract Introduction: the formation of the medical professional iden tity is achieved in stages during which the characteristics, values and norms of the medical profession are internalized, which results in the individual thinking, acting and feeling like a doctor. Tutors in medicine should clarify and encourage the principles within study programs and learning environments in order to support the formation of the professional identity of their students. Objective: the purpose of this paper is to reveal the participation of medical tutoring as one of the most influential factors that contribute to the development of the professional identity of medical students, as well as to give some guidelines so that the training of tutors. It contemplates tools that allow them to contribute to the positive and valued construction of the professional identity of the students.

Adaptation of the Psychological Wellbeing Scale in Mexican medical students / Adaptación de la Escala de Bienestar Psicológico en estudiantes Mexicanos de medicina

Abstract Introduction The Ryff Scale of Psychological Well-Being is the most widely used instrument for assessing the eudemonic perspective of well-being. Although it has been adapted for the Spanish population, it has not been modified for health science students in the Mexican population. Objective Adapt and obtain the psychometric properties of this scale for medical students in the Mexican population. Method The study was conducted with 1,974 undergraduate students, 1,551 from the UNAM Medicine Faculty and 423 from the La Salle University Mexican School of Medicine. The analysis was undertaken using the IBM SPSS Statistics 21 and AMOS 21 SPSS programs. Results An instrument with a robust structure derived from the exploratory and confirmatory factor analyses carried out was obtained, with satisfactory explained variance, adequate internal consistency obtained through the Cronbach's alpha coefficient, and appropriate discrimination. Discussion and conclusion Our adaptation is a suitable version for Mexican medical students with four final dimensions; purpose in life, personal rejection and self-acceptance, personal control, and personal growth.

Resumen Introducción La Escala de Bienestar Psicológico de Carol Ryff es la más utilizada para evaluar la perspectiva eudaimónica de bienestar. Si bien se ha adaptado para población española no se ha adaptado para estudiantes de ciencias de la salud de población mexicana. Objetivo Realizar adaptación y obtener propiedades psicométricas de esta escala para estudiantes de medicina de población mexicana. Método El estudio se desarrolló con 1974 estudiantes de pregrado, 1551 de la Facultad de Medicina de la UNAM y 423 de la Escuela Mexicana de Medicina de la Universidad La Salle. El análisis desarrollado se realizó mediante el programa IBM SPSS Statistics 21 y AMOS 21 de SPSS. Resultados Se obtuvo un instrumento con una estructura sólida derivada de los análisis factoriales exploratorios y confirmatorios desarrollados, con una varianza explicada satisfactoria, una consistencia interna obtenida mediante el coeficiente alfa de Cronbach adaptada y una discriminación favorable. Discusión y conclusión El artículo es una adaptación del instrumento adecuada para estudiantes de medicina mexicanos con cuatro dimensiones finales; proyecto de vida, rechazo personal y auto aceptación, control personal y crecimiento personal.

[Impact of the COVID-19 pandemic on the performance and academic experience of undergraduate interns]. / Impacto del COVID-19 en el desempeño y experiencia académica de médicos internos.

Background: The COVID-19 pandemic has had a great impact and high cost on the education of physicians that has not been determined in the long term. Objective: To determine the impact of COVID-19 on undergraduate interns and how it affected their academic training. Material and methods: Mixed study. Qualifications of the bimonthly departmental exam from 2018 to 2020 of the FACMED-UNAM internal doctors were reviewed, the focus group technique was used to investigate their experience and repercussions during the pandemic. Results: The grade point average for 18-19 was 70.76+/- 10.12. In 2020 76.19+/-10.66 (p = 0.000). In the CDMX 2018-2019 an average 70,405+/-10,156 against 71.97+/- 10.28 of foreign headquarters (p > 0.05). In 2020, the capital's headquarters an average of 77.02+/-10.31 against 73.86+/-11.296 in the interior (p = 0.000). When comparing the bimonthly ratings, there were no significant differences in 2018 and 2019; However, in 2020 there is an increase from 69.40 +/-9.538 to 79.39 +/-10.709. Conclusions: The ratings for 2020 had better results in relation to 2018 and 2019, they were higher in capital cities in relation to foreign ones. The retrospective perception of the inmates was that they had more time to study thematic contents and less pressure in the care work; They stated that they would have preferred to stay in their rotations, with the necessary protective equipment to avoid getting infected.

Introducción: la pandemia por COVID-19 ha tenido un gran impacto y alto costo en la educación de los médicos en formación que no ha sido determinado a largo plazo. Objetivo: determinar el impacto del COVID-19 en médicos internos de pregrado y cómo repercutió en su formación académica. Material y métodos: estudio mixto en el que se revisaron las calificaciones del examen departamental bimestral del 2018 al 2020 de los médicos internos Facultad de Medicina de la Universidad Nacional Autónoma de México; se utilizó la técnica de grupos focales para indagar su experiencia y repercusiones durante la pandemia. Resultados: el promedio de calificaciones de los años 2018-2019 fue de 70.76 +/- 10.12. En el 2020 de 76.19 +/- 10.66 (p = 0.000). En la CDMX durante 2018-2019 se registró una media de 70.40 +/- 10.15 frente a 71.97 +/- 10.28 de las sedes foráneas (p > 0.05). En el 2020, las sedes de la capital tuvieron una media de 77.02 +/- 10.31 frente a 73.86 +/- 11.296 de las del interior (p = 0.000). Al comparar las calificaciones bimestrales, no hubo diferencias significativas en 2018 y 2019; sin embargo, en el 2020 hubo una elevación de 69.40 +/- 9.538 a 79.39 +/- 10.70. Conclusiones: se registraron mejores resultados en las calificaciones del 2020 en relación con las del 2018 y 2019, estas fueron más altas en las sedes capitalinas en relación con las foráneas. La percepción retrospectiva de los internos fue que dispusieron de más tiempo para el estudio de contenidos temáticos y menor presión en el trabajo asistencial; declararon que hubieran preferido quedarse en sus rotaciones, con el equipo de protección necesario para evitar contagiarse.

Impacto del COVID-19 en el desempeño y experiencia académica de médicos internos / Impact of the COVID-19 pandemic on the performance and academic experience of undergraduate interns

Introducción: la pandemia por COVID-19 ha tenido un gran impacto y alto costo en la educación de los médicos en formación que no ha sido determinado a largo plazo. Objetivo: determinar el impacto del COVID-19 en médicos internos de pregrado y cómo repercutió en su formación académica. Material y métodos: estudio mixto en el que se revisaron las calificaciones del examen departamental bimestral del 2018 al 2020 de los médicos internos Facultad de Medicina de la Universidad Nacional Autónoma de México; se utilizó la técnica de grupos focales para indagar su experiencia y repercusiones durante la pandemia. Resultados: el promedio de calificaciones de los años 2018-2019 fue de 70.76 +/- 10.12. En el 2020 de 76.19 +/- 10.66 (p = 0.000). En la CDMX durante 2018-2019 se registró una media de 70.40 +/- 10.15 frente a 71.97 +/- 10.28 de las sedes foráneas (p > 0.05). En el 2020, las sedes de la capital tuvieron una media de 77.02 +/- 10.31 frente a 73.86 +/- 11.296 de las del interior (p = 0.000). Al comparar las calificaciones bimestrales, no hubo diferencias significativas en 2018 y 2019; sin embargo, en el 2020 hubo una elevación de 69.40 +/- 9.538 a 79.39 +/- 10.70. Conclusiones: se registraron mejores resultados en las calificaciones del 2020 en relación con las del 2018 y 2019, estas fueron más altas en las sedes capitalinas en relación con las foráneas. La percepción retrospectiva de los internos fue que dispusieron de más tiempo para el estudio de contenidos temáticos y menor presión en el trabajo asistencial; declararon que hubieran preferido quedarse en sus rotaciones, con el equipo de protección necesario para evitar contagiarse.

Background: The COVID-19 pandemic has had a great impact and hig+h cost on the education of physicians that has not been determined in the long term. Objective: To determine the impact of COVID-19 on undergraduate interns and how it affected their academic training. Material and methods: Mixed study. Qualifications of the bimonthly departmental exam from 2018 to 2020 of the FACMED-UNAM internal doctors were reviewed, the focus group technique was used to investigate their experience and repercussions during the pandemic. Results: The grade point average for 18-19 was 70.76+/10.12. In 2020 76.19+/-10.66 (p = 0.000). In the CDMX 2018-2019 an average 70,405+/-10,156 against 71.97+/10.28 of foreign headquarters (p > 0.05). In 2020, the capital's headquarters an average of 77.02+/-10.31 against 73.86+/-11.296 in the interior (p = 0.000). When comparing the bimonthly ratings, there were no significant differences in 2018 and 2019; However, in 2020 there is an increase from 69.40 +/-9.538 to 79.39 +/-10.709. Conclusions: The ratings for 2020 had better results in relation to 2018 and 2019, they were higher in capital cities in relation to foreign ones. The retrospective perception of the inmates was that they had more time to study thematic contents and less pressure in the care work; They stated that they would have preferred to stay in their rotations, with the necessary protective equipment to avoid getting infected.

Modelo de rol, experiencias y capacidades comunicativas en estudiantes de medicina / Role model, experiences and communicative skills in medical students

Introducción: La comunicación se ha definido como un elemento central y eje transversal de los currículos médicos a nivel mundial. Además, en el proceso formativo del estudiante de medicina, el efecto de los modelos de rol docente se reconoce como factor clave. Objetivo: Revisar conceptualmente el modelo de rol en relación con el currículo en comunicación, y su influencia en el proceso de enseñanza y aprendizaje de los estudiantes de medicina. Métodos: Se llevó a cabo una revisión bibliográfica sistemática de artículos científicos disponibles en las bases de datos EbscoHost y PubMed, así como de textos de educación médica, teniendo en cuenta las palabras clave validadas en el tesauro DeCs. Resultados: Se presentó la definición y la importancia del modelo de rol, la identidad, las características y las capacidades pedagógicas del profesor; además se expusieron conceptos como "modelo de rol positivo" y "antimodelo". También se mostró el contexto en el que se desarrollaba el rol docente en función de la experiencia de comunicación, y los escenarios, los momentos y las formas con los que se lograron las capacidades, competencias y habilidades comunicativas en los estudiantes, lo que demostró que el aprendizaje por medio del ejemplo de los profesores resultaba fundamental. Conclusiones: Se necesita propiciar procesos de formación docente como medio para resignificar el sentido de los modelos de rol en la práctica comunicativa del estudiante. El modelo de rol y su influencia en el desarrollo de capacidades en la comunicación y el profesionalismo se constituyen como perspectiva para la investigación en educación médica(AU)

Introduction: Communication has been defined as a key element and cross-sectional pivot of medical curricula worldwide. Also, in the training process of the medical student, the effect of professorial role models is recognized as a key factor. Objective: To review, conceptually, the role model in association with to the communicative curriculum, as well as its influence on the teaching and learning process of medical students. Methods: A systematic bibliographic review was carried out of scientific articles available in the databases EbscoHost and PubMed, as well as medical education texts, taking into account the keywords validated on the Health Sciences Descriptors (DeCS). Results: We presented the definition and importance of the role model, as well as the professor's identity, characteristics and pedagogical capacities. Concepts such as positive role model and antimodel were also exposed. We also showed the context in which the teaching role was developed based on the communication experience, as well as the settings, moments and ways by which the students' communication capacities, competences and abilities were achieved, which showed that learning through the professorial model was essential. Conclusions: It is necessary to promote professorial training processes as means to redefine the significance of role models in the student's communicative practice. The role model and its influence on the development of communication skills and professionalism constitute a perspective for research in medical education(AU)

Training of general practitioners, a Mexican medical school curriculum evaluation / Formación de médicos generales, evaluación curricular en una escuela mexicana de medicina

Background: Educational curricula require constant improvement to respond to the needs of students, institutions and society. Objective: To evaluate the Plan de Estudios 2010 of the Facultad de Medicina de la Universidad Nacional Autónoma de México. Methods: Documentary and qualitative study of three phases. First, revision of trends of general medicine in special databases and comparison of curricula between universities. Second, focus groups with clinical teachers and basic sciences to investigate experiences and opinions in relation to trends in general medicine. Third, a "Generalists Committee" was convened to whom the results were presented (phase one and two) and the recommendations were adapted to adapt the results to the general practitioner's context. The participants were informed about the research objective and their participation was voluntary, the anonymity of theirs comments was protected. Results: The trend towards specialization in clinical practice defines the future of general medicine, and the administrative uses have an impact on the practices of the general practitioner and on the patient's medical relationship. Conclusion: Various aspects mainly educational and assistance hindered the quality of the practice of general medicine.

Introducción: los currículos educativos requieren estar en constante perfeccionamiento para responder a las necesidades de estudiantes, instituciones y de la sociedad. Objetivo: evaluar el Plan de Estudios 2010 de la carrera de medicina de la Facultad de Medicina de la Universidad Nacional Autónoma de México. Métodos: estudio documental y cualitativo, de tres fases. En la primera se revisaron las tendencias de la medicina general en bases de datos especializadas y se compararon los planes de estudios entre universidades. En la segunda, se realizaron grupos focales con docentes clínicos y de ciencias básicas para indagar experiencias y opiniones en relación con las tendencias de la medicina general. En la tercera, se convocó a un "Comité de Generalistas" a quienes se les presentaron los resultados de las fases anteriores, y se realizaron las recomendaciones pertinentes para adecuar los resultados al contexto del médico general. La participación de los entrevistados fue voluntaria, fueron informados sobre el objetivo de investigación y se resguardó el anonimato de sus testimonios. Resultados: la tendencia hacia la especialidad en la práctica clínica define el futuro de la medicina general; asimismo, los intereses administrativos repercuten en las prácticas del médico general y en la relación médico-paciente. Conclusión: diversos aspectos, principalmente educativos y asistenciales, obstaculizan la calidad de la práctica de la medicina general.

Educational experiences in a master of health professions education program at the National Autonomous University of Mexico: A qualitative study.

Background: Medical schools and healthcare institutions need leaders with formal training in education, in order to provide quality medical teaching. An answer to this need lies in the graduate programs of health professions education. Many programs exist, but there is a dearth of publications about their educational processes and experiences. The purpose of this study was to explore the teaching and learning experiences of students, teachers, and graduates of the Master in Health Professions Education (MHPE) program at the National Autonomous University of Mexico (UNAM). Methods: A qualitative approach was used with focus group discussions with students, graduates, and teachers, to explore their opinions, feelings, and experiences about the program. Purposeful sampling of participants was done. Focus group guides were developed for the different study groups; testimonies were codified and categorized with axial coding and a constant comparison method. Results: Testimonies from 19 participants in three focus groups were obtained (five graduates, seven current students, and seven teachers). The data were grouped in seven thematic categories: expectations, feedback of research projects, the tutorial process, teaching strategies, usefulness of what was learned, professional development, and assessment. Positive elements of the program were identified as well as areas in need of improvement. Discussion: The MHPE program at UNAM has been a positive experience for students and mostly fulfilled their expectations, they learned the basic theories and practical aspects of teaching, learning, and assessment in the health professions. Some areas need improvement, such as tutor performance and timely feedback to the students. Graduates think the competencies acquired in the program are useful for their professional practice. This information will be used to improve the program. There is a need to meet international standards in MHPE programs.

Mapping an EPA-based comprehensive curricular proposal for UME.

This article was migrated. The article was marked as recommended. In medical education, there have been three important reforms: science-based curriculum, problem-based learning, and competency-based education. Currently, the concept of Entrustable Professional Activities (EPA) goes a step beyond competencies. The aim of this paper is twofold: first, to present a proposal for an EPA-based curriculum for undergraduate medical education, and second, to describe its curricular framework, educational model and organization. This curricular proposal integrates EPA-based education with the foundations of the interpretive epistemology, the constructivist paradigm and the health care transformations. Using Actividades Profesionales Confiables (APROC) as a curricular guideline helps the educators define knowledge, skills, and attitudes; teachers can plan activities that link theory to practice; evaluators can assess the student's performance and provide him with feedback, and Faculty leaders and collaborators can implement projects to improve educational quality. The curriculum proposal includes a flexible modular system, the integration of biomedical, socio-medical and clinical sciences, and a close link between theory and practice. This curriculum puts medical education at the forefront, it favors the comprehensive education of future physicians, and it constitutes a true educational revolution.

Burnout en estudiantes del Plan de Estudios Combinados en Medicina, Facultad de Medicina, Universidad Nacional Autónoma de México / Burnout in students of the Program of Combined Studies in Medicine, Faculty of Medicine, National Autonomous University of Mexico

Introducción: El Plan de Estudios Combinados en Medicina está diseñado para que alumnos sobresalientes que cursan la carrera de medicina estudien el doctorado simultáneamente. Las exigencias para culminar el posgrado involucran situaciones de estrés que podrían llevar al desgaste. El burnout es un síndrome con tres dimensiones: agotamiento emocional, cinismo e ineficacia, que pueden disminuir las expectativas de éxito, satisfacción y rendimiento académico. Objetivo: Determinar la frecuencia de burnout y sus dimensiones en estudiantes de seis generaciones del programa, así como su correlación con características sociodemográficas, académicas y hábitos. Sujetos y métodos: Los alumnos respondieron voluntariamente un cuestionario autoaplicado y el Maslach Burnout Inventory-Student Survey. Se calculó la prevalencia de las dimensiones del burnout y se correlacionaron con variables evaluadas en el cuestionario usando la prueba exacta de Fisher. Resultados: Los 56 participantes no presentaron burnout y un 61% tampoco las dimensiones del síndrome. Solas o combinadas, un 27% mostró ineficacia; un 11%, cinismo, y un 7%, agotamiento. La prevalencia de dos dimensiones fue del 5%. Se encontraron diferencias significativas (p < 0,05) para la relación con el grupo, tocar un instrumento, cantar o actuar, sitio de residencia y la violencia en el traslado. Conclusiones: La ausencia de burnout en los participantes posiblemente refleja satisfacción y compromiso académico. La pésima relación con compañeros y la violencia en el traslado son frecuentes en alumnos con agotamiento. Es posible que tocar un instrumento, cantar o actuar constituya una respuesta al agotamiento y al cinismo, así como otras estrategias de afrontamiento no exploradas en este estudio

Introduction: Combined Studies in Medicine is a program in which outstanding students pursue a career in Medicine and simultaneously a doctorate. The requirements to complete the graduate course involve stress situations that could lead to burnout. Burnout is a syndrome with three dimensions: emotional exhaustion, cynicism and inefficiency, which can diminish the expectations of success, satisfaction and academic performance. Aim: To determine the frequency of burnout and its dimensions in students of six generations of the program as well as its correlation with habits, sociodemographic and academic characteristics. Subjects and methods: Students voluntarily answered a self-applied questionnaire and the Maslach Burnout InventoryStudent Survey. The prevalence of the dimensions and burnout were calculated and were correlated with variables evaluated in the questionnaire using the Fisher's exact test. Results: The 56 participants were negative to burnout and 61% to the dimensions; 27% had inefficiency, 11% cynicism and 7% exhaustion, combined or alone. The prevalence of two dimensions was 5%. Significant differences were found (p < 0.05) for the relationship with colleagues, playing instruments, singing/acting, place of residence and violence on the way to the stay. Conclusions: The absence of burnout in the participants possibly reflects satisfaction and academic commitment. The bad relationship with colleagues and the violence on their way to the stay are frequent in students with exhaustion. It is possible that playing instruments, singing or acting was a response to exhaustion and cynicism, as well as other coping strategies not explored in this study

Avances del Modelo Educativo para Desarrollar Actividades Profesionales Confiables (MEDAPROC) / Advances of an Educational Model to Develop Entrustable Professional Activities (MEDAPROC)

El Modelo Educativo para Desarrollar Actividades Profesionales Confiables (MEDAPROC) surge como respuesta a la implementación de la educación basada en competencias. Es un proyecto multidisciplinario fundamentado en la epistemología interpretativa, el paradigma constructivista, las transformaciones del Sistema Nacional de Salud y el contexto del ejercicio actual de la medicina. Su meta es favorecer la adquisición de conocimientos, habilidades y actitudes indispensables por parte del estudiante de medicina. Integra la tendencia internacional de las Entrustable Professional Activities y las naturaliza como las Actividades Profesionales Confiables (APROC). MEDAPROC propone que el desarrollo de las APROC se promueva de manera inversa, desde el perfil de egreso hasta el inicio de los estudios de pregrado, por lo tanto, se involucra en diversas fases y procesos de aprendizaje y enseñanza (planeación, didáctica, evaluación y realimentación) por medio de proyectos para implementar estrategias didácticas y recursos de evaluación, con el apoyo de la formación docente, la investigación educativa y la tecnología. Su objetivo es lograr la mejora de la educación médica y de las ciencias de la salud, con el firme propósito de generar un cambio positivo en la calidad de la atención desde el entorno educativo

The Educational Model to Develop Entrustable Professional Activities (MEDAPROC) arises as a response to the implementation of competency-based education. It is a multidisciplinary project based on interpretative epistemology, the constructivist paradigm, the transformations of the national health system, and the context of the current practice of medicine. Its purpose is to encourage the acquisition of essential knowledge, skills, and attitudes by the medical student. It integrates the international trend of the entrustable professional activities and converts them into entrustable professional activities (APROC). MEDAPROC proposes that the development of the APROC be promoted in an inverse manner, from the profile of the graduate to the beginning of the undergraduate studies. Therefore, it is involved in several phases of the learning and teaching process (planning, didactics, assessment, and feedback) through projects to implement didactic strategies and assessment resources, with the support of teacher training, educational research, and technology. Its aim is to improve medical and health sciences education, with the firm purpose of making a positive change in the health care quality from the educational environment

Las consideraciones éticas del uso de las redes sociales virtuales en la práctica médica / Ethical considerations in the use of virtual social networks in medical practice

Resumen El uso de los sitios web denominados redes sociales es cada vez más frecuente en la práctica médica. El objetivo de este artículo es proporcionar a los médicos y estudiantes de medicina algunas recomendaciones éticas para tomar en cuenta antes de publicar contenido en la internet. Para ello, ofrece un panorama histórico de la evolución de las redes sociales y presenta diversos ejemplos de los beneficios de usarlas como medios de actualización, de comunicación entre colegas, con pacientes, como medios de promoción de los servicios profesionales y de difusión de eventos. Al final provee de recomendaciones puntuales a tomar en cuenta para hacer un uso efectivo, profesional y ético de ellas.

Abstract The use of Social Networking sites has become very frequent in medicine. This article aims to provide physicians and medical students with ethical recommendations to consider before publishing Web content. For that purpose, we provide a historical overview of the evolution of social networks, and we present several examples of the benefits acquired by using them for knowledge updating, promoting professional services and events, and as communication tools among colleagues and patients. Finally, specific recommendations for an effective, professional and ethical use of these media are given.

A typology of uncertainty derived from an analysis of critical incidents in medical residents: A mixed methods study.

BACKGROUND: Medical uncertainty is inherently related to the practice of the physician and generally affects his or her patient care, job satisfaction, continuing education, as well as the overall goals of the health care system. In this paper, some new types of uncertainty, which extend existing typologies, are identified and the contexts and strategies to deal with them are studied. METHODS: We carried out a mixed-methods study, consisting of a qualitative and a quantitative phase. For the qualitative study, 128 residents reported critical incidents in their clinical practice and described how they coped with the uncertainty in the situation. Each critical incident was analyzed and the most salient situations, 45 in total, were retained. In the quantitative phase, a distinct group of 120 medical residents indicated for each of these situations whether they have been involved in the described situations and, if so, which coping strategy they applied. The analysis examines the relation between characteristics of the situation and the coping strategies. RESULTS: From the qualitative study, a new typology of uncertainty was derived which distinguishes between technical, conceptual, communicational, systemic, and ethical uncertainty. The quantitative analysis showed that, independently of the type of uncertainty, critical incidents are most frequently resolved by consulting senior physicians (49 % overall), which underscores the importance of the hierarchical relationships in the hospital. The insights gained by this study are combined into an integrative model of uncertainty in medical residencies, which combines the type and perceived level of uncertainty, the strategies employed to deal with it, and context elements such as the actors present in the situation. The model considers the final resolution at each of three levels: the patient, the health system, and the physician's personal level. CONCLUSIONS: This study gives insight into how medical residents make decisions under different types of uncertainty, giving account of the context in which the interactions take place and of the strategies used to resolve the incidents. These insights may guide the development of organizational policies that reduce uncertainty and stress in residents during their clinical training.

Evaluation of a Biomedical Informatics course for medical students: a pre-posttest study at UNAM Faculty of Medicine in Mexico.

BACKGROUND: Biomedical Informatics (BMI) education in medical schools is developing a sound curricular base, but there are few published reports of their educational usefulness. The goal of this paper is to assess knowledge change and satisfaction in medical students after a BMI curriculum. METHODS: The National Autonomous University of México Faculty of Medicine (UNAM) recently implemented a curricular reform that includes two BMI sequential courses (BMI-1 and BMI-2). The research design was one-group pretest-posttest. An objective test with evidence of validity was used for knowledge measurement. A satisfaction questionnaire was applied at the end of the courses. Two-tailed paired Student's t-tests were applied, comparing knowledge scores in the pre and post-test for each course. RESULTS: The study included student cohorts during two consecutive academic years. The 2013 BMI-1 course (n = 986 students) knowledge pretest score was 43.0 ± 8.6 (mean percent correct ± SD), and the post-test score was 57.7 ± 10.3 (p < 0.001); the 2014 BMI-1 (n = 907) pretest score was 43.7 ± 8.5, and the post-test was 58.1 ± 10.5 (p < 0.001). The 2012 BMI-2 course (n = 683) pretest score was 26.3 ± 7.9, the post-test score was 44.3 ± 13.3 (p < 0.001); the 2013 BMI-2 (n = 926) pretest score was 27.5 ± 7.5, and the post-test was 42.0 ± 11.0 (p < 0.001). The overall opinion of the students regarding the course was from good to excellent, with a response rate higher than 90%. The satisfaction questionnaires had high reliability (Cronbach's alpha of 0.93). CONCLUSIONS: The study shows a significant increase in BMI knowledge after an educational intervention in four medical student cohorts, and an overall positive evaluation by the students. Long-term follow-up is needed, as well as controlled studies of BMI educational interventions using performance endpoints.

La motivación: elemento indispensable en la formación de los médicos / Motivation: Esential element in medical training

El presente artículo inicia señalando el descuido que existe en la educación médica en torno a la motivación en el aula, y como respuesta a dicha problemática se revisa la evolución de los estudios de este tema para arribar de manera puntual en 4 enfoques de la motivación: 1) la teoría de la atribución, 2) las creencias de autoeficacia, 3) las metas de aprendizaje y de desempeño y 4) la teoría de la motivación de logro. Las perspectivas analizadas coinciden en señalar que las tendencias internas llevan a comprender y enfrentar al mundo para explorarlo, curiosearlo y manipularlo, además destacan la relación entre motivación y cognición, y afirman que ésta se relaciona con las creencias, experiencias y auto explicaciones sobre la situación de aprendizaje. La revisión de dichas perspectivas desemboca en sugerencias prácticas y concretas que permiten a profesores y estudiantes crear situaciones de aprendizaje y de enseñanza que conlleven a disfrutar los procesos y obtener resultados satisfactorios.

We resume in this document the neglecting attitude towards motivation in medical education. Reviews of the evolution of the studies in motivation lead us to resume four tendencies: Attrition oriented, self-efficacy oriented, learning oriented, and goal oriented motivation. All these theories converge in that the individual internal tendencies leads to comprehend and confront the world, and then to explore, to be interested and to manipulate the world. Also, motivation is associated with life experiences, beliefs and self-experiences about learning. At the end of this document we summarized some suggestions to make the teaching-learning interaction an enjoyable experience.