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Pediatr Pulmonol ; 52(10): E58-E60, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-28440911


A 7 week old infant was admitted with respiratory failure. Chest X-ray showed an atelectatic right upper lobe, herniation of right middle and lower lobe into the left thorax, and compression-atelectasis of the left lung. Thoracic CT showed complete occlusion of the right superior bronchus with a radiopaque foreign material. Six weeks prior, an impression for a palate plate using polyvinylsiloxane was taken. The material was removed with a rigid endoscopy, in readiness of extracorporeal oxygenation in case of tracheal obstruction or bronchial rupture. After 4 months of follow-up a hyper reactive airway with recurrent upper and lower airway infections remains.

Cuerpos Extraños/complicaciones , Polivinilos , Atelectasia Pulmonar/etiología , Aspiración Respiratoria/complicaciones , Insuficiencia Respiratoria/etiología , Siloxanos , Materiales Biomédicos y Dentales , Broncoscopía , Femenino , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/cirugía , Humanos , Lactante , Pulmón/diagnóstico por imagen , Pulmón/cirugía , Paladar (Hueso) , Atelectasia Pulmonar/diagnóstico por imagen , Atelectasia Pulmonar/cirugía , Radiografía , Aspiración Respiratoria/diagnóstico por imagen , Aspiración Respiratoria/cirugía , Insuficiencia Respiratoria/diagnóstico por imagen , Insuficiencia Respiratoria/cirugía
Med Teach ; 39(5): 476-485, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28281369


BACKGROUND: It remains unclear which item format would best suit the assessment of clinical reasoning: context-rich single best answer questions (crSBAs) or key-feature problems (KFPs). This study compared KFPs and crSBAs with respect to students' acceptance, their educational impact, and psychometric characteristics when used in a summative end-of-clinical-clerkship pediatric exam. METHODS: Fifth-year medical students (n = 377) took a computer-based exam that included 6-9 KFPs and 9-20 crSBAs which assessed their clinical reasoning skills, in addition to an objective structured clinical exam (OSCE) that assessed their clinical skills. Each KFP consisted of a case vignette and three key features using a "long-menu" question format. We explored students' perceptions of the KFPs and crSBAs in eight focus groups and analyzed statistical data of 11 exams. RESULTS: Compared to crSBAs, KFPs were perceived as more realistic and difficult, providing a greater stimulus for the intense study of clinical reasoning, and were generally well accepted. The statistical analysis revealed no difference in difficulty, but KFPs resulted more reliable and efficient than crSBAs. The correlation between the two formats was high, while KFPs correlated more closely with the OSCE score. CONCLUSIONS: KFPs with long-menu exams seem to bring about a positive educational effect without psychometric drawbacks.

Prácticas Clínicas , Competencia Clínica , Evaluación Educacional/métodos , Humanos , Solución de Problemas , Estudiantes de Medicina
Med Teach ; 35(11): 920-9, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-24003850


CONTEXT: E-learning resources, such as virtual patients (VPs), can be more effective when they are integrated in the curriculum. To gain insights that can inform guidelines for the curricular integration of VPs, we explored students' perceptions of scenarios with integrated and non-integrated VPs aimed at promoting clinical reasoning skills. METHODS: During their paediatric clerkship, 116 fifth-year medical students were given at least ten VPs embedded in eight integrated scenarios and as non-integrated add-ons. The scenarios differed in the sequencing and alignment of VPs and related educational activities, tutor involvement, number of VPs, relevance to assessment and involvement of real patients. We sought students' perceptions on the VP scenarios in focus group interviews with eight groups of 4-7 randomly selected students (n = 39). The interviews were recorded, transcribed and analysed qualitatively. RESULTS: The analysis resulted in six themes reflecting students' perceptions of important features for effective curricular integration of VPs: (i) continuous and stable online access, (ii) increasing complexity, adapted to students' knowledge, (iii) VP-related workload offset by elimination of other activities, (iv) optimal sequencing (e.g.: lecture--1 to 2 VP(s)--tutor-led small group discussion--real patient) and (V) optimal alignment of VPs and educational activities, (vi) inclusion of VP topics in assessment. CONCLUSIONS: The themes appear to offer starting points for the development of a framework to guide the curricular integration of VPs. Their impact needs to be confirmed by studies using quantitative controlled designs.

Simulación por Computador , Comportamiento del Consumidor , Educación de Pregrado en Medicina/métodos , Aprendizaje , Pediatría/educación , Actitud del Personal de Salud , Competencia Clínica , Curriculum , Grupos Focales , Humanos
Med Educ ; 43(6): 580-8, 2009 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-19493183


OBJECTIVES: This study aimed to examine what students perceive as the ideal features of virtual patient (VP) design in order to foster learning with a special focus on clinical reasoning. METHODS: A total of 104 Year 5 medical students worked through at least eight VPs representing four different designs during their paediatric clerkship. The VPs were presented in two modes and differed in terms of the authenticity of the user interface (with or without graphics support), predominant question type (long- versus short-menu questions) and freedom of navigation (relatively free versus predetermined). Each mode was presented in a rich and a poor version with regard to the use of different media and questions and explanations explicitly directed at clinical reasoning. Five groups of between four and nine randomly selected students (n = 27) participated in focus group interviews facilitated by a moderator using a questioning route. The interviews were videotaped, transcribed and analysed. Summary reports were approved by the students. RESULTS: Ten principles of VP design emerged from the analysis. A VP should be relevant, of an appropriate level of difficulty, highly interactive, offer specific feedback, make optimal use of media, help students focus on relevant learning points, offer recapitulation of key learning points, provide an authentic web-based interface and student tasks, and contain questions and explanations tailored to the clinical reasoning process. CONCLUSIONS: Students perceived the design principles identified as being conducive to their learning. Many of these principles are supported by the results of other published studies. Future studies should address the effects of these principles using quantitative controlled designs.

Instrucción por Computador , Educación de Pregrado en Medicina/normas , Grupos Focales , Simulación de Paciente , Estudiantes de Medicina/psicología , Curriculum , Educación de Pregrado en Medicina/métodos , Humanos , Relaciones Médico-Paciente , Solución de Problemas