Competências do enfermeiro no cuidado a pacientes com acidente vascular cerebral elegíveis à terapia trombolítica / Competencias de enfermería en el cuidado de personas con accidente cerebrovascular elegibles para terapia trombolítica / Nursing competencies in the care of patients with stroke who are eligible for thrombolytic therapy

Resumo Introdução: O acidente vascular cerebral isquêmico tem como tratamento a terapia trombolítica, aplicada ainda na fase aguda, promovendo melhora importante nas sequelas acarretadas por este agravo. Considerando a complexidade da terapia trombolítica, torna-se necessário que os enfermeiros compreendam suas competências para auxiliar no cuidado. Objetivo: Identificar evidências científicas acerca das competências do enfermeiro no cuidado a pacientes com acidente vascular cerebral elegíveis à terapia trombolítica. Metodologia: Revisão integrativa composta por seis etapas em seis etapas (elaboração da questão, busca na literatura, coleta de dados, análise, discussão e apresentação da revisão), realizada nas bases de dados MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase e CINAHL. A busca foi realizada entre agosto e setembro de 2022 adotando como critérios de inclusão estudos primários; gratuitos, disponíveis eletronicamente na íntegra; nos idiomas inglês, português e espanhol. Foram obtidos inicialmente 2.830 estudos, os quais passaram por uma seleção, onde foram incluídos aqueles que atendiam os critérios previamente estabelecidos. Resultados: Com base nos doze estudos incluídos nesta revisão identificaram-se competências voltadas à três atividades do cuidado: gestão do cuidado como trabalho em equipe, códigos, fluxos e protocolos, assistência ao paciente antes, durante e após a utilização da terapia trombolítica e educação em saúde para equipe, pacientes e familiares. Conclusão: Os achados desta revisão puderam evidenciar as competências do enfermeiro no cuidado aos pacientes elegíveis a terapia trombolítica, as quais perpassam diferentes áreas de atuação do enfermeiro. Para este estudo prevaleceram as competências assistências, seguida por competências gerenciais.

Resumen Introducción: El accidente cerebrovascular isquémico se trata con terapia trombolítica, aplicada incluso en la fase aguda, que promueve una mejoría significativa de las secuelas provocadas por este padecimiento. Considerando la complejidad de la terapia trombolítica, es necesario que las personas profesionales de enfermería comprendan sus competencias para ayudar en el cuidado. Objetivo: Identificar evidencias científicas sobre las competencias del personal de enfermería en el cuidado de pacientes con accidente cerebrovascular elegibles para terapia trombolítica. Metodología: Revisión integradora que consta de seis etapas (elaboración de la pregunta, búsqueda bibliográfica, recolección de datos, análisis, discusión y presentación de la revisión), realizada en las bases de dados MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase y CINAHL. La búsqueda se realizó entre agosto y septiembre de 2022. Los criterio de inclusión fueron: estudios primarios, gratuito, disponible electrónicamente en su totalidad, en inglés, portugués y español. Inicialmente se obtuvieron 2830 estudios, los cuales fueron sometidos a un proceso de selección, que incluyó aquellos que cumplían con los criterios previamente establecidos. Resultados: A partir de los doce estudios incluidos en esta revisión, se identificaron competencias centradas en tres actividades asistenciales: gestión del cuidado como trabajo en equipo, códigos, flujos y protocolos, atención a pacientes antes, durante y después del uso de la terapia trombolítica y educación en salud para personal, pacientes y familias. Conclusión: Los hallazgos de esta revisión pudieron resaltar las competencias de las personas profesionales en enfermería en el cuidado de personas elegibles para terapia trombolítica, que abarcan diferentes áreas de actuación del personal de enfermería. Para este estudio, prevalecieron las habilidades asistenciales, seguidas de las competencias gerenciales.

ABSTRACT Introduction: Ischemic stroke is treated with thrombolytic therapy, applied even in the acute phase, promoting a significant improvement in the after-effects caused by this condition. Considering the complexity of thrombolytic therapy, it is necessary for nurses to understand the skills required to assist in care. Objective: To identify scientific evidence about the competencies of nurses in the care of patients with stroke who are eligible for thrombolytic therapy. Methodology: An integrative review consisting of six stages (elaboration of the question, literature review, data collection, analysis, discussion, and presentation), conducted in MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase, and CINAHL databases. The search was carried out between August and September 2022 using primary studies as the inclusion criteria: free of charge, fully available electronically, published in English, Portuguese, or Spanish. Initially, 2.830 studies were obtained, which underwent a selection process that included only those studies that met the previously established criteria. Results: Based on the twelve studies included in this review, competencies focused on three care activities were identified: care management such as teamwork; codes; flows and protocols; patient care before, during, and after the use of thrombolytic therapy; and education health education for staff, patients, and families. Conclusion: The findings of this review highlighted the nurses' competencies in the care of patients eligible for thrombolytic therapy, which encompass different areas of the nurse's work. For this study, assistance competencies prevailed, followed by management competencies.

Paediatric interventional radiology: it's not child's play.

Pediatric interventional radiology is a dynamic and growing subspecialty. The new training pathways in interventional radiology, the maintenance of skills with a small volume of cases or complex procedures, the limited availability of specific pediatric equipment and materials pose significant challenges and opportunities.

Radiología intervencionista en pediatría: no es un juego de niños / Pediatric interventional radiology: It's not a child's play

La radiología intervencionista pediátrica es una subespecialidad dinámica y en crecimiento. Las nuevas vías de formación en radiología intervencionista, el mantenimiento de las competencias con un pequeño volumen de casos o procedimientos complejos, la disponibilidad limitada de equipos y material pediátrico específico, los efectos de la sedación o de la anestesia sobre el neurodesarrollo y la protección radiológica suponen importantes retos y oportunidades.(AU)

Pediatric interventional radiology is a dynamic and growing subspecialty. The new training pathways in interventional radiology, the maintenance of skills with a small volume of cases or complex procedures, the limited availability of specific pediatric equipment and materials, the effects of sedation or anesthesia on neurodevelopment or radiological on neurodevelopment or radiation protection pose significant challenges and opportunities.(AU)

Toma de decisiones de encomienda y evaluación de las actividades profesionales confiables en la educación médica basada en competencias: una revisión de alcance y análisis temático / Entrustment decision-making and evaluation of entrustable professional activities in the competency- based medical education: a scoping review and thematic analysis

Introducción: La evaluación de las actividades profesionales confiables implica que el tutor tome decisiones de encomienda que posibiliten el desarrollo de competencias adecuadas de los futuros especialistas. Objetivo. El objetivo es conocer los componentes que sustentan la toma de decisiones de encomienda como herramienta de evaluación efectiva, segura y eficaz de las actividades profesionales confiables en la educación médica basada en competencias. Materiales y métodos: Se realizó una revisión sistemática en las bases de datos PubMed, BIREME-BVS y Web of Science. Se procedió al análisis y síntesis de los artículos, de acuerdo con la metodología JBI para las revisiones de alcance; el análisis se profundizó en otros artículos de revistas especializadas y citas bibliográficas relacionadas; y el manuscrito final se efectuó con base en las recomendaciones PRISMA-ScR. Resultados: La toma de decisiones de encomienda se centra en la relación tutor-estudiante, con base principalmente en la proactividad, la integridad, la capacidad y la humildad del estudiante, que confluyen en la confianza del tutor para sobrepasar la ‘zona de desarrollo próximo’ y alcanzar un siguiente nivel. Aunque eso signifique un determinado riesgo inicial sobre la seguridad de la atención médica, permite gradualmente generar la autonomía del estudiante. Conclusiones: No cabe duda de que la toma de decisiones de encomienda se basa en la confianza, la encomienda, la supervisión y la autonomía. Una escala retrospectiva-prospectiva que incluya la confianza-encomienda-supervisión-autonomía permite una adecuada evaluación de las actividades profesionales confiables y, por ende, la evaluación de las competencias.(AU)

Introduction: The evaluation of entrustable professional activities implies that the tutor makes assignment decisions that enable the development of appropriate competencies of future specialists. Aim. The aim of this work is to recognize the components that support entrustment decision making as an effective, safe and efficient evaluation tool of entrustable professional activities, in competency-based medical education. Materials and methods: A systematic review was carried out in the PubMed, BIREME-BVS and Web of Science databases. The analysis and synthesis of the articles was carried out in accordance with the JBI methodology for scoping reviews; and was further conducted including other articles from specialized journals and related bibliographic citations. The final manuscript was prepared based on the PRISMA-ScR recommendations.Results: Entrustment decision-making focuses on the tutor-student relationship, based mainly on the student’s proactivity, integrity, ability and humility, which converge in the tutor’s confidence to surpass the ‘zone of proximal development’ and reach the next level. Although this means a certain initial risk to the safety of medical care, it gradually generates the student’s autonomy. Conclusions: There is no doubt that entrustment decision-making is based on trust, entrustment, supervision and autonomy. A retrospective-prospective scale that includes trust-entrustment-supervision-autonomy allows for an adequate evaluation of entrustable professional activities and, therefore, the evaluation of competencies.(AU)

Breaking bad news in ophthalmology: a literature review / Comunicação de más notícias em oftalmologia: uma revisão de literatura

ABSTRACT Medical specialties have recognized that breaking bad news assists clinical practice by mitigating the impact of difficult conversations. This scenario also encourages various studies on breaking bad news in ophthalmology since certain ocular diagnoses can be considered bad news. Thus, the objective is to review the scientific literature on breaking bad news in ophthalmology. The literature databases like MEDLINE/PUBMED, EMBASE, LILACS, SCOPUS, COCHRANE, and SCIELO, were screened for related research publications. Two independent reviewers read all the articles and short-listed the most relevant ones. Seven articles, in the formats of original article, review, editorial, oral communication, and correspondence, were reviewed. Conclusively it reveals that ophthalmologists are concerned with communicating bad news effectively but lack related studies. Nevertheless, there is a growing realization that training in breaking bad news can increase physicians' confidence during communication, thus, benefiting the therapeutic relationship with the patient and his family. Therefore, it would be valuable to include breaking bad news training in the curriculum of residencies.

RESUMO O reconhecimento sobre a comunicação de más notícias como mitigadora de conversas difíceis por outras especialidades médicas, incentiva o estudo desta temática na oftalmologia. Sendo assim, o objetivo deste estudo é revisar a produção de pesquisas científicas sobre a comunicação de más notícias em oftalmologia. Para isso, foi realizada uma revisão de literatura. As bases de dados utilizadas foram MEDLINE/PUBMED, EMBASE, LILACS, SCOPUS, COCHRANE e SCIELO. Dois revisores independentes leram todos os artigos e selecionaram a amostra final. Sete artigos foram escolhidos nos formatos de artigo original, revisão, editorial, comunicação oral e correspondência. Os oftalmologistas estão preocupados em comunicar as más notícias de forma eficaz, mas faltam estudos sobre o tema. No entanto, há uma crescente percepção de que o treinamento de comunicação de más notícias aumenta a confiança dos médicos na comunicação, beneficiando a relação terapêutica. Portanto, seria valioso incluir este treinamento no currículo das residências.

Conocimientos en cuidados paliativos de las enfermeras de Atención Primaria de Cantabria / Knowledge regarding palliative care by primary care nurses in Cantabria

Objetivo: determinar el nivel de conocimientos en cuidados paliativos (CP) de las enfermeras de Atención Primaria (AP) de Cantabria.Método: estudio descriptivo transversal cuya población de estudio fueron las enfermeras de equipo y de urgencias de AP. Se estimó una muestra de 171 enfermeras y se realizó muestreo por conveniencia y en bola de nieve. Se midieron variables sociodemográficas, laborales y de formación y se evaluó el conocimiento global en CP mediante el cuestionario validado PCQN (mín. 0 a máx. 10 puntos) con sus tres subescalas (filosofía y principios de CP; aspectos psicosociales; manejo del dolor y otros síntomas). Se llevó a cabo estadística descriptiva y bivariante.Resultados: participaron 180 enfermeras. La media global de conocimientos fue de 5,7 puntos (DE= 1,3) (subescala principios y filosofía [x–= 6,1; DE= 2,5]; manejo del dolor y síntomas [x–= 6,0; DE= 1,5]; aspectos psicosociales [x–= 3,7; DE= 2,9]). Se encontraron diferencias estadísticamente significativas en el nivel de conocimientos en función de los años de experiencia profesional global (menor o igual de 5 [x–= 5,2; DE= 1,3]; de 6 a 20 [x–= 5,4; DE= 1,4] o mayor de 20 [x–= 6; DE= 1,2]; valor p= 0,012) y los años de experiencia en AP (menor o igual de 5 [x–= 5,5; DE= 1,3], de 6 a 20 [x–= 5,6; DE= 1,4] o mayor de 20 [x–= 6,3; DE=1]; valor p= 0,004).Conclusiones: en las enfermeras de AP de Cantabria se encontró un nivel medio de conocimientos. Los conocimientos aumentaban junto a la experiencia profesional. El área con menor nivel fue la relacionada con aspectos psicosociales. Es necesaria la formación en el ámbito de cuidados paliativos entre ellas. (AU)

Objective: to determine the level of knowledge regarding palliative care (PC) by Primary Care nurses in Cantabria.Method: a descriptive cross-sectional study on a population formed by Primary Care team and emergency nurses. The sample was estimated in 171 nurses, and there was convenience and snowball sampling. Sociodemographic, occupational and training variables were measured, and there was an evaluation of the overall knowledge about PC through the PCQN validated questionnaire (from 0 and up to 10 points), with its three sub-scales (PC philosophy and principles; psychosocial aspects, management of pain and other symptoms). Descriptive and bivariate statistics was conducted.Results: the study included 180 nurses. The overall mean knowledge was of 5.7 points (SD= 1.3) (principles and philosophy sub-scale [x–= 6.1; SD= 2.5]; management of pain and symptoms [x–= 6.0; SD= 1.5]; psychosocial aspects [x–= 3.7; SD= 2.9]). Statistically significant differences in the level of knowledge were found, based on the years of overall professional experience (5 or lower [x–= 5.2; SD= 1.3]; from 6 to 20 [x–= 5.4; SD= 1.4] or over 20 [x–= 6; SD= 1.2]; p value= 0.012), and on the years of experience at Primary Care (5 or lower [x–= 5.5; SD= 1.3], from 6 to 20 [x–= 5.6; SD= 1.4] or over 20 [x–= 6.3; SD=1]; p value= 0.004).Conclusions: a medium level of knowledge was found in the Primary Care nurses from Cantabria. Knowledge increased at the same time as professional experience. The area with a lower level was the one associated with psychosocial aspects. Training in the palliative care setting is needed for these nurses. (AU)

Implementación del mini-CEX en el pregrado médico: Una experiencia con simulación / Implementation of the Mini-CEX in Medical Undergraduate Education: A Simulation-Based Experience

Resumen La evaluación es un proceso sistemático que resulta en un juicio de valor para tomar decisiones. Los instrumentos empleados para obtener datos sobre el desempeño de los estudiantes requieren de un proceso sistemático y objetivo para su implementación. El mini-CEX es un instrumento de observación directa que ha sido empleado para la evaluación de la competencia clínica en los estudiantes de pre y posgrado desde su invención en 1955. Cuenta con diferentes evidencias de validez para su uso en distintos contextos educativos y clínicos. Permite realizar evaluaciones rápidas, acompañadas de realimentación y que proporcionan información relevante del desarrollo de la competencia clínica. El objetivo de este escrito es exponer la experiencia de la implementación del mini-CEX en el pregrado médico para la evaluación formativa de los estudiantes utilizando la simulación con pacientes estandarizados. Para lograr este objetivo se empleó la siguiente secuencia: búsqueda, planeación, integración y aplicación. Posterior a estos pasos se dan una serie de recomendaciones para la implementación del mini-CEX. Se concluye que la evaluación de la competencia clínica es importante para la mejora continua y permanente de los estudiantes de pre y posgrado. Es necesario sistematizar la evaluación ajustada siempre a objetivos y necesidades específicas de la evaluación.

Abstract Evaluation is a systematic process that results in a judgment to make decisions. The instruments used to obtain data on student performance require a systematic and objective process for their implementation. The mini-CEX is a direct observation tool that has been used for the evaluation of clinical competence in undergraduate and postgraduate students since its invention in 1955. It has different validity evidence for use in different educational and clinical contexts. It allows rapid evaluations, accompanied by feedback and providing relevant information on the development of clinical competence. The objective of this paper is to expose the experience of the implementation of the mini-CEX in the medical undergraduate for the formative evaluation of students using simulation with standardized patients. To achieve this goal, the following sequence was used: search, planning, integration, and application. After these steps we make some recommendations for the implementation of the mini-CEX. Its is concluded that the evaluation of clinical competence is important for the continuous and permanent improvement of undergraduate and graduate students. It is necessary to systematize the evaluation always adjusted to objectives and specific needs of the evaluation.

[Clinician and researcher at the time. Is it possible?] / Clínico e investigador a la vez, ¿se puede?

Research in clinical practice arises as a constant need for improvement to provide better care to patients, train better human resources and make a daily reflection on the amount of scientific information we receive every day. We want to reflect on how the Centro de Adiestramiento en Investigación Clínica (CAIC) from our healthcare activity changed our practice.

La investigación en la práctica clínica surge como una necesidad constante de mejora, a fin de dar una atención de mayor calidad a los pacientes, formar recursos humanos más preparados y hacer una reflexión diaria ante la cantidad de información científica que recibimos todos los días. Queremos hacer una reflexión de como el Centro de Adiestramiento en Investigación Clínica (CAIC) desde nuestra actividad asistencial cambió nuestra práctica.

Competencias profesionales de las enfermeras oncológicas: reconociendo la Práctica Avanzada en Enfermería / Professional competencies of oncology nurses: Recognizing advanced practice in nursing

Objetivo: Identificar el perfil competencial de las enfermeras de práctica avanzada que intervienen en el proceso asistencial del paciente oncológico. Método: Estudio descriptivo transversal. El estudio incluyó a todas las enfermeras que intervienen en el proceso asistencial del paciente oncológico en un hospital terciario de Barcelona. Se recogieron los datos del perfil competencial a través del instrumento de definición del rol de la enfermera de práctica avanzada (IDREPA), así como las variables sociodemográficas y laborales. Se compararon datos sociodemográficos y laborales con el desempeño de actividades de práctica avanzada. Resultados: Participaron un total de 29 (82,9%) enfermeras con una media de edad de 42,6± 12,54 años. Se han identificado 9 (31%) enfermeras que alcanzan el estándar en los 6 dominios en la escala IDREPA para considerarse enfermeras de práctica avanzada (EPA). De estas 9 (31%), cumplían los estándares de formación requeridos por el CIE, 7 (24,1%) con máster oficial y 2 (6,9%) con doctorado. Conclusiones: Existen enfermeras que desarrollan su actividad en el ámbito oncológico del Hospital del Mar con perfil de EPA. La identificación de EPA en nuestro sistema de salud es esencial para poder reconocer las competencias de dichas profesionales y crear puestos específicos que ayuden a abordar la cronicidad, la calidad de vida de los pacientes, su supervivencia y la optimización de los recursos sanitarios. Este estudio pone en relieve la importancia de la cronicidad y el cáncer como ámbitos para el desarrollo de la EPA.(AU)

Objective: To identify the competency profile of advanced practice nurses involved in the care process of cancer patients. Methods: Cross-sectional and descriptive study. The study included all nurses involved in the cancer patient care process in a tertiary hospital in Barcelona. Competence profile data were collected using the instrument for defining the role of the advanced practice nurse (APRD), as well as sociodemographic and occupational variables. Sociodemographic and occupational data were compared against the performance of advanced practice activities. Results: A total of 29 (82.9%) nurses participated with a mean age of 42.6±12.54 years. Nine (31%) nurses were identified as meeting the standard in all 6 domains on the APRD scale to be considered advanced practice nurses. Of these 9 (31%) nurses, 7 (24.1%) met the training standards required by the International Council of Nurses (ICN) with an official master's degree and 2 (6.9%) with a PhD. Conclusions: There are nurses who carry out their activity in the oncology field of the Hospital del Mar with the EPA profile. The identification of advanced practice nurses (APNs) in our health system is essential to be able to recognize the competencies of these professionals and create specific positions that help to address chronicity, patients’ quality of life, their survival, and the optimization of health resources. Our study highlights the importance of chronicity and cancer as areas for the development of the APNs.(AU)

Evaluación de residentes de pediatría con una modalidad virtual durante la pandemia COVID 19: presentación de una experiencia / Using a virtual mode for the pediatric residents evaluation during the COVID 19 pandemic: report of an experience

El examen clínico objetivo estructurado (ECOE) es una herramienta válida para medir competencias clínicas. En el contexto de la pandemia por COVID-19 se debieron adaptar las evaluaciones, habitualmente presenciales, a un formato virtual. El objetivo de este artículo es comunicar la experiencia de utilizar una modalidad virtual del ECOE para residentes de primer año de pediatría durante la pandemia por COVID-19. El ECOE comprendió 12 estaciones utilizando casos simulados en línea y consultas virtuales a distancia. Participaron del ECOE 115 residentes, aprobaron 110 (95,7%) y solo 17 participantes aprobaron el 100% de las estaciones. Las estaciones con mejor rendimiento fueron las referidas a alimentación complementaria, abordaje del traumatismo encéfalo craneano, interpretación de resultados de laboratorio y de imágenes radiológicas. El menor rendimiento se observó en uso de equipo de protección personal y vacunas. La encuesta de satisfacción fue respondida por 80/115 participantes (69,5%). El 91% de los participantes encontró fácil de utilizar la plataforma virtual. La mayoría (73/80) consideró que los temas fueron acordes al nivel de formación. La estación de pautas madurativas fue identificada como la más difícil. El 57% refirió que el ECOE les resultó útil para identificar puntos débiles en su formación. La implementación de una modalidad virtual del ECOE fue posible y presentó buena aceptación de los participantes.

The objective structured clinical examination (OSCE) is a helpful tool for assessing clinical competencies. During the COVID-19 pandemic, assessments usually carried out in person had to be adapted to a virtual format. We aim to report our experience using a virtual OSCE administered to first-year pediatric residents during the COVID-19 pandemic. The OSCE included 12 stations, including online simulated cases and virtual remote consultations. In total 115 residents participated in the OSCE; 110 (95.7%) passed the test, but only 17 participants passed all stations. The stations with the highest performance were related to complementary feeding, management of traumatic head injury, interpretation of lab test results and imaging. The lowest performance was observed using personal protective equipment and checking vaccine schedules. The user satisfaction survey was completed by 80 out of 115 participants (69.5%); 91 % of the participants found the virtual platform easy to use. Most of the residents (73/80) considered the topics to be appropriate for their training level. The station related to child development guidelines was identified as the most challenging. 57% reported that the OSCE was helpful for identifying weaknesses in their training. Conclusion: the implementation of a virtual OSCE was feasible and it was well accepted by the participants.

Professional competencies of oncology nurses: Recognizing advanced practice in nursing.

OBJECTIVE: To identify the competency profile of advanced practice nurses involved in the care process of cancer patients. METHODS: Cross-sectional and descriptive study. The study included all nurses involved in the cancer patient care process in a tertiary hospital in Barcelona. Competence profile data were collected using the instrument for defining the role of the advanced practice nurse (APRD), as well as sociodemographic and occupational variables. Sociodemographic and occupational data were compared against the performance of advanced practice activities. RESULTS: A total of 29 (82.9%) nurses participated with a mean age of 42.6±12.54 years. 9 (31%) nurses were identified as meeting the standard in all 6 domains on the APRD scale to be considered advanced practice nurses. Of these 9 (31%) nurses, 7 (24.1%) met the training standards required by the International Council of Nurses (ICN) with an official master's degree and 2 (6.9%) with a PhD. CONCLUSIONS: There are nurses who carry out their activity in the oncology field of the hospital analyzed with the EPA profile. The identification of advanced practice nurses (APNs) in our health system is essential to be able to recognize the competencies of these professionals and create specific positions that help to address chronicity, patients' quality of life, their survival, and the optimization of health resources. Our study highlights the importance of chronicity and cancer as areas for the development of the APNs.

Modelo para el desarrollo de competencias profesionales específicas en la atención a pacientes con enfermedades estomatognáticas / Model for the development of specific professional competence in the care of patients with stomatognathic diseases i: en

Introducción: Las competencias profesionales son cualidades humanas que permiten una visión personalizada en un individuo, el cual se desempeña en un contexto único y, a la vez, cambiante, buscando desarrollar los recursos personológicos que debe utilizar en su vida laboral. Objetivo: Valorar la implementación de un modelo para el desarrollo de competencias profesionales específicas en la atención a pacientes con enfermedades estomatognáticas. Métodos: Se realizó un estudio en educación médica en la Facultad de Estomatología de la Universidad de Ciencias Médicas en Santiago de Cuba, durante el curso 2018-2019. La población estuvo constituida por los 59 residentes que cursaban el primer año de la especialidad de Estomatología General Integral, en quienes se aplicó un modelo para el desarrollo de competencias profesionales específicas. Durante la investigación se usaron métodos teóricos y empíricos, así como estadísticos, particularmente la distribución de frecuencias absoluta y relativa y la prueba de McNemar para determinar el nivel de desarrollo después de implementado el modelo. Resultados: Se obtuvieron opiniones positivas en el taller de socialización luego de la implementación práctica del modelo. De los residentes en estomatología, 96,4 % aprobó su pertinencia, mientras que 83,1 % estuvo muy satisfecho con él. Conclusiones: Luego de aplicado el modelo propuesto, se evidenció el desarrollo de las competencias profesionales específicas en la atención a pacientes con afecciones odontológicas.

Introduction: Professional competencies are human qualities that allow a personalized vision in an individual, who performs his functions in an unique, and at the same time, changing context, and seeks to develop the personological features that he must use in his working life. Objective: To assess the implementation of a model for the development of specific professional competence in the care of patients with stomatognathic diseases. Methods: A study in medical education was conducted at the Faculty of Dentistry in the University of Medical Sciences from Santiago de Cuba, during the 2018-2019 academic year. The population consisted of the 59 residents who were in the first year of the specialty of Comprehensive General Dentistry, in whom a model for the development of specific professional competence in dental care was applied. During the investigation theoretical and empirical methods were used, as well as statistics, particularly the distribution of absolute and relative frequencies, and McNemar test to evaluate the level of development after the model has been implemented. Results: In the socialization workshop, after the practical implementation of the model, positive opinions were obtained. Among the residents in dentistry, 96.4% approved the relevance of the model, while 83.1% were very satisfied. Conclusions: After applying the proposed model, the development of specific professional competence in the care of patients with dental conditions was evidenced.

Padrão documental dos cuidados de enfermagem à pessoa em situação paliativa / Documentary standard of nursing care for people in a palliative situation

O aumento da esperança média de vida e o consequente envelhecimento populacional, aliados ao aumento da prevalência de doenças crónicas, progressivas e limitantes tem-se traduzido em mudanças importantes no contexto das políticas de saúde, objetivando-se um fim de vida digno e com qualidade. Neste contexto, os Cuidados Paliativos representam a proposta terapêutica mais adequada, uma vez que procuram melhorar a qualidade de vida dos doentes, das suas famílias e cuidadores pela prevenção e alívio do sofrimento, através da identificação precoce, diagnóstico e tratamento adequado da dor e de outros problemas, sejam estes físicos, psicológicos, sociais ou espirituais. No âmbito do I Curso de Mestrado em Enfermagem à Pessoa em Situação Paliativa da Escola Superior de Saúde do Instituto Politécnico de Viana do Castelo, realizou-se o estágio de natureza profissional no Serviço Integrado de Cuidados Paliativos da Unidade Local de Saúde do Alto Minho, no período compreendido entre o dia 03 de março a 31 de agosto de 2022. Ao longo do estágio foram desenvolvidas atividades em diversos domínios, nomeadamente na prestação de cuidados à pessoa em situação paliativa; no domínio da gestão dos cuidados, dos recursos materiais e humanos em estreita colaboração com a enfermeira gestora do serviço; no planeamento de atividades de formação como meio de dar resposta aos projetos do serviço; na promoção da melhoria da qualidade dos cuidados colaborando no projeto de candidatura à acreditação da idoneidade formativa do contexto da prática clínica. Foi desenvolvido, também, um trabalho de investigação que respondeu à necessidade de uma sistematização dos registos de enfermagem do referido serviço recorrendo a linguagem classificada, através da construção de um Padrão Documental dos Cuidados de Enfermagem à Pessoa em Situação Paliativa. Optou-se por um estudo metodológico, com recurso à Técnica de Delphi. Através da pesquisa bibliográfica e da consulta dos profissionais de enfermagem do serviço, foram identificados os fenómenos de enfermagem mais relevantes para a prática de cuidados de qualidade à pessoa em situação paliativa. Posteriormente, foram identificados todos os diagnósticos e intervenções associados a esses mesmos fenómenos passíveis de serem integrados no SClínico através da parametrização nacional de diagnósticos/intervenções de enfermagem. O painel de peritos validou uma versão de consenso composta por 176 itens (diagnósticos e intervenções de enfermagem). Este Padrão Documental permitirá implementar no serviço registos uniformizados, possibilitando a monitorização de indicadores e assegurando dois requisitos fundamentais no âmbito da candidatura à acreditação da idoneidade formativa do contexto da prática clínica pela Ordem dos Enfermeiros: um documento orientador dos registos clínicos de enfermagem de acordo com a linguagem classificada, bem como um Sistema de Informação em Enfermagem mapeado para a referida linguagem. Com a realização do estágio foi possível desenvolver competências especializadas na área da enfermagem à pessoa em situação paliativa, através da prestação de cuidados sob orientação dos enfermeiros especialistas do serviço, da partilha de experiências, da reflexão, e da pesquisa bibliográfica baseada em evidência científica. Estas estratégias revelaram-se fundamentais como forma de suprimir as questões que foram surgindo no decorrer deste percurso. Adquiriram-se competências técnicas, científicas e relacionais alicerçadas numa abordagem estruturada dos cuidados nos princípios da compaixão, humildade e honestidade. Compreendeu-se, também, a extrema relevância da investigação, que deve ser contínua e acompanhar a evolução e as necessidades dos Cuidados Paliativos, na produção de conhecimento e na prática de cuidados de qualidade.

The increase in average life expectancy and the consequent aging of the population, with the increase in the prevalence of chronic, progressive and limiting diseases, has resulted into important changes in the context of health policies, aiming for a dignified and quality end of life. In this context, Palliative Care represents the most appropriate therapeutic proposal, as it seeks to improve patient's quality of life as well as their families and caregivers by preventing and relieving suffering, through early identification, diagnosis, and appropriate treatment of pain and other problems, whether physical, psychological, social or spiritual. As part of the first Master´s Course in Nursing for People in Palliative Situations at the Escola Superior de Saúde do Instituto Politécnico de Viana do Castelo, a professional internship was carried out at the care unit Serviço Integrado de Cuidados Paliativos of Unidade Local de Saúde do Alto Minho, from March 03 to August 31, 2022. Throughout this internship, activities were carried out in several areas, namely in the provision of care to the person in a palliative situation and family; in the domain of care management, material and human resources in close collaboration with the head nurse of the care unit; in planning training activities as a mean of responding to service projects; in the promotion of the improvement of the quality of care by collaborating on the application project "acreditação da idoneidade formativa do contexto da prática clínica". A research work was also carried out, focused on a need of the care unit for a systematization of the nursing records of the care unit using classified language, through the construction of a Documentary Pattern of Nursing Care for People in Palliative Situations. We opted for a methodological study, using the Delphi technique. Through bibliographical research and consultation with nursing professionals from the service, the most relevant nursing phenomena for the practice of quality care for people in palliative situations were identified. Subsequently, all diagnoses and interventions associated with these same phenomena were identified, which could be integrated into SClínico through the national parameterization of nursing diagnoses/interventions. A panel of experts validated a consensus version consisting of 176 items (nursing diagnoses and interventions). This Documentary Pattern will allow the implementation of standardized records in the service, enabling the monitoring of indicators and ensuring two fundamental requirements in the scope of the application for the accreditation of the formative suitability of the clinical practice context: a guiding document for clinical nursing records in accordance with classified language, as well as a Nursing Information System mapped to that language. This professional internship enabled to develop specialized skills in the area of nursing for people in palliative situations, through the provision of care under the guidance of the specialist nurses of the care unit, sharing experiences, reflection, and bibliographic research based on scientific evidence. These strategies proved to be fundamental as a way of suppressing the questions that arose during this journey. Technical, scientific and relational skills were acquired based on a structured approach to care based on the principles of compassion, humility and honesty. The extreme relevance of research was also understood, which must be continuous and accompany the evolution and needs of Palliative Care, in the production of knowledge and in the practice of quality care.

Competencias enfermeras y grado de seguridad de estudiantes y profesionales en el cuidado del paciente crítico / Level of nursing skills and confidence among students and professionals regarding critical patient care

Objetivo: describir el nivel competencial y el grado de seguridad percibido en el cuidado al paciente crítico de estudiantes de Enfermería, y de profesionales de Enfermería de nueva contratación; analizar la influencia del sexo sobre ambas capacidades; y analizar las diferencias entre el nivel competencial calculado por los estudiantes/profesionales y sus responsables (tutores/supervisores).Método: estudio descriptivo transversal con estudiantes de cuarto año de Grado Universitario de Enfermería y profesionales de Enfermería con experiencia < 2 años. Se recogieron variables sociodemográficas, el grado de seguridad autopercibido en una escala Likert de 0 a 10, y para la evaluación de competencias se administró el cuestionario validado COM-VA©. Las competencias de cada participante fueron evaluadas por ellos mismos y por sus responsables (tutores/supervisores).Resultados: participaron 54 estudiantes, 22 profesionales y cuatro responsables. La autopercepción del grado de seguridad de los alumnos tutorizados fue superior al de los nuevos profesionales (p= 0,001), el nivel competencial autopercibido fue similar: 22,2% de los estudiantes y 18,2% de los profesionales se autopercibían como competentes. Aunque el nivel competencial fue similar según el cuestionario COM-VA© autocumplimentado (media de 7,2 y 7,8 sobre 10 para estudiantes y profesionales respectivamente), el nivel competencial de los profesionales fue superior según lo valorado por sus supervisores y tutores (p< 0,001). No se dieron diferencias por sexo.Conclusión: los resultados obtenidos muestran que los estudiantes de Enfermería de último año presentan un mayor grado de seguridad que los nuevos profesionales, pero que el nivel competencial de los profesionales es mayor que el de los estudiantes según sus responsables.(AU)

Objective: to describe the level of skills and confidence perceived regarding care for critical patients among Nursing students and newly recruited Nursing professionals; to analyse the influence of gender on both skills, and to analyse the differences between the competence level estimated by students / professionals and their persons in charge (academic tutors / supervisors).Method: a descriptive cross-sectional study with students in the 4th year of their University Nursing Degree and Nursing professionals with <2 years of experience. Sociodemographic variables were collected, as well as the self-perceived confidence level in a Likert scale from 0 to 10; and the COM-VA© validated questionnaire was administered for skill assessment. The skills of each participant were evaluated by themselves and by their academic tutors / supervisors.Results: the study included 54 students, 22 professionals and four persons in charge. The self-perception of the level of confidence by tutored students was higher than that by new professionals (p= 0.001); their self-perceived level of skills was similar: 22.2% of the students and 18.2% of professionals perceived themselves as competent. Even though their competence level was similar according to the self-completed COM-VA© questionnaire (mean of 7.2 and 7.8 out of 10 for students and professionals, respectively), the competence level of professionals was higher according to the evaluation by their supervisors and tutors (p< 0.001). There were no differences by gender.Conclusion: the outcomes obtained showed that Nursing students in their last year presented a higher level of confidence than new professionals, but that the competence level of professionals was higher than that of students according to their tutors / supervisors.(AU)

Desarrollo de la habilidad en el diagnóstico precoz del cáncer bucal durante las prácticas preprofesionales de Estomatología / Development of the competence in oral cancer early diagnosis during pre-professional training in Dentistry i: en

Introducción: La creciente aparición del cáncer bucal en etapas avanzadas revela la necesidad de egresar profesionales preparados que contribuyan a su prevención y diagnóstico precoz. Objetivo: Evaluar un sistema de tareas docentes para el desarrollo de la habilidad en el diagnóstico precoz del cáncer bucal. Métodos: Se realizó un preexperimento en 32 estudiantes y 10 profesores vinculados al proceso de enseñanza-aprendizaje de la asignatura Atención Integral a la Población de la carrera de Estomatología en la Universidad de Ciencias Médicas de Guantánamo, en el curso escolar 2022-2023. A tal efecto, se determinó la variable el desarrollo de la habilidad para el diagnóstico precoz del cáncer bucal, con sus dimensiones e indicadores, y se comprobó la significación de un sistema de tareas docentes para este fin a través de la prueba de Wilcoxon. Resultados: De acuerdo con los rangos de Wilcoxon, el sistema de tareas docentes resultó confiable para contribuir al desarrollo de la habilidad objeto de estudio (p<0,05). Los estudiantes consideraron que dicho sistema constituye la vía idónea para su preparación en el tema; de igual forma, todos los profesores coincidieron en cuanto a su pertinencia, factibilidad, efectividad, utilidad práctica y relevancia. Conclusiones: El sistema de tareas docentes aplicado durante la práctica preprofesional de los estudiantes de estomatología demostró ser factible para el desarrollo de la habilidad en el diagnóstico precoz del cáncer bucal.

Introduction: The increasing appearance of advanced oral cancer reveals the need of graduating professionals, prepared to contribute to its prevention and early diagnosis. Objective: To evaluate a system of teaching tasks for the development of competence in oral cancer early diagnosis. Methods: A pre-experiment was carried out with 32 students and 10 professors, who were involved in the teaching-learning process of the subject Comprehensive Dental Care for the Population of Dentistry degree in the University of Medical Sciences from Guantánamo, in the 2022-2023 academic year. For this purpose, the development of competence in oral cancer early diagnosis was determined as the variable, with its dimensions and indicators, and the significance of a system of teaching tasks for this objective was verified through the Wilcoxon test. Results: According to the Wilcoxon ranks, the teaching task system was reliable in contributing to the development of the competence under study (p<0.05). The students considered that this system is the ideal way for their training on the subject; in the same way, all teachers agreed regarding the relevance, feasibility, effectiveness, and practical utility of the teaching task system. Conclusions: The teaching task system applied during pre-professional practice of dentistry students proved to be feasible for the development of competence in oral cancer early diagnosis.

Perfil de competências do enfermeiro coordenador de um serviço de urgência / What if disaster strikes..... How prepared are emergency room nurses?

A crescente procura por mais e melhores cuidados de saúde tem levado a um aumento significativo na ultima década do numero de episódios em serviço de urgência, uma situação que é transversal a todos os níveis de atuação. Do lado oposto a este aumento estão equipas reduzidas em número, com dificuldade em dar resposta perante serviços sobrelotados, na maior parte das vezes por situações pouco ou não urgentes, situação explicada por alguma ineficiência dos cuidados de saúde primários e pelo fácil acesso aos serviços hospitalares de urgência. Esta é uma situação que sobrecarrega os serviços de saúde e os profissionais, colocando em causa a segurança e a qualidade dos cuidados. Neste mesmo contexto, a gestão de cuidados ganha uma elevada importância, pelo que é imperativo entregar essa função a profissionais capazes e preparados para a mesma. Num ambiente de grande complexidade como o serviço de urgência, dinámico e com um fluxo de utentes mantido durante as 24 horas do dia, e onde o enfermeiro gestor não está em permanente presença física, é ao enfermeiro coordenador de equipa que cabe essa gestão de cuidados e até a gestão do serviço, na ausência do enfermeiro gestor do mesmo. Ainda que a figura do enfermeiro coordenador de equipa não esteja contemplada na carreira de Enfermagem, ela existe em praticamente todos os serviços de urgência. Desta forma, é imperativo definir qual o perfil de competências destes elementos, fundamentais para o bom funcionamento dos serviços e para o garante da segurança e qualidade dos cuidados de enfermagem em contexto de urgência. Neste sentido, realizamos um estudo com base na técnica de Delphi, que começou pela construção de uma proposta de perfil de competências, composta por 21 competências, agrupadas por tipologia (comportamentais, técnico-profissionais e de liderança e gestão). A elaboração deste instrumento foi suportada pela revisão bibliográfica, e posteriormente colocada sob escrutínio de um painel de peritos, conforme preconizado para a técnica de Delphi. Na primeira ronda, os peritos que integraram o painel, também contribuíram individualmente com sugestões de competências a acrescentar à proposta de perfil. A proposta final deste perfil de competências do enfermeiro coordenador de equipa, constituído por 28 competências, obteve concordância máxima em 92,9% delas (26 competências), e com um grau de consenso MUITO ELEVADO em 21 competências e ELEVADO nas restantes sete. Foi, assim, possível construir uma versão de consenso para a qual se sugere validação e que se espera servir de catalisador para a mudança de paradigma, legislando e regulamentando a figura do enfermeiro coordenador de equipa, com domínios de competências bem definidos e que permitam o desenvolvimento adequado dessas mesmas competências.

The growing demand for more and better health care has led to a significant increase in the last decade of the number of episodes in emergency services, a situation that cuts across all levels of activity On the opposite side of this growth are teams that are reduced in number, with difficulty in responding to overcrowded services, most often due to low or non-urgent situations, a situation explained by some inefficiency of primary health care services and by the easy access to hospital emergency services. This is a situation that overloads health services and professionals, putting the safety and quality of care at risk. In this context, care management gains a great importance, which is why it is imperative to deliver this task to professionals who are capable and prepared for it. In highly complex environment such as the emergency room, which is dynamic, has a flow of users 24 hours a day, and where the nurse manager is not physically present all the time, it is the nursing team coordinator who is responsible for the care management and even the management of the service. Although the figure of the nursing team coordinator is not included in the nursing career, it exists in practically all emergency services. Thus, it is imperative to define the competence profile of these elements, which are fundamental for the proper functioning of services and for guaranteeing the safety and quality of nursing care in an emergency context. Taking this into account, we carried out a study base on the Delphi technique, which began with the construction of a proposal for a competences profile, comprising 21 competences, grouped by typology (behavioral, technical-professional and leadership and management). The elaboration of this instrument was supported by the bibliographical review, and later placed under the scrutiny of a panel of experts, as recommended for the Delphi technique. In the first round, the experts who were part of the panel also contributed individually with suggestions of competences to be added to the profile's proposal. The final draft of the competences profile of the nursing team coordinator, consisting of 28 competences, obtained maximum agreement in 92.9% of them (26 competences). and with a degree of consensus VERY HIGH in 21 competences and HIGH in the remaining seven. Thus, it was possible to build a version of consensus for which validation is suggested and which is expected to serve as a catalyst for a paradigm shift, legislating and regulating the figure of the nursing team coordinator, with well-defined domains of competences that allow for the adequate development of these same skills.

Concepción didáctica del proceso formativo interdisciplinar de la habilidad diagnosticar enfermedades para residentes de Dermatología / Didactic Concept of the Interdisciplinary Formation Process of the Diagnostic Ability of Dermatology Residents

Fundamento: El estudio teórico, el diagnóstico realizado y la experiencia de los investigadores, posibilitan formular como problema de la presente investigación: limitaciones en el desarrollo de la habilidad diagnosticar enfermedades dermatológicas en los residentes de la especialidad de Dermatología del Hospital General Provincial Docente "Dr. Antonio Luaces Iraola" de Ciego de Ávila. Objetivo: Elaborar una concepción didáctica del proceso de formación interdisciplinar de la habilidad diagnosticar enfermedades dermatológicas en los residentes de la especialidad de Dermatología, a partir de la caracterización del estado actual de esta habilidad. Metodología: Se realizó una investigación educativa con un componente descriptivo en el Hospital General Provincial Docente "Dr. Antonio Luaces Iraola" de Ciego de Ávila, en los cursos escolares desde 2016 al 2020. La población de estudio fueron los 16 residentes de 1.er año que matricularon la especialidad de Dermatología en el período de estudio. Se emplearon métodos del nivel teórico y empírico. Resultados: La caracterización realizada reveló limitaciones en el desarrollo de la habilidad diagnosticar enfermedades dermatológicas en los laboratorios de Anatomía Patológica, Microbiología y Parasitología Médica, por los residentes (100 %). La concepción didáctica del proceso de formación interdisciplinar de la habilidad diagnosticar orienta el proceso desde las actividades docentes-atencionales y prácticas de laboratorio en una consecutividad lógica y sistematización desde las diferentes formas de enseñanza y tipologías de clase. Integra la interdisciplinariedad y la utilización del método investigativo establecido en las ideas rectoras. Conclusiones: La concepción didáctica como aporte de la investigación resuelve la contradicción dialéctica entre la aplicación del método clínico y los procedimientos en la práctica de laboratorio que se da en ese proceso formativo y constituye un soporte didáctico que respalda las actividades prácticas en los laboratorios para cumplir con los objetivos del Plan de estudio de la especialidad.

Background: The theoretical study, the diagnosis conducted and the experience of the researchers make possible to formulate the problem of the present research: limitations in the development of the ability to diagnose dermatological diseases in residents of the Specialty of Dermatology of the General Provincial Teaching Hospital "Dr. Antonio Luaces Iraola" of Ciego de Avila. Objective: To elaborate a didactic conception of the interdisciplinary training process of the ability to diagnose dermatological diseases in residents of the specialty of Dermatology, based on the characterization of the current state of that ability. Methodology: An educational research with a descriptive component was conducted at the Provincial General Teaching Hospital "Dr. Antonio Luaces Iraola" of Ciego de Avila, in the 2016-2020 school years. The study population consisted of the 16 first-year dermatology residents who enrolled in the specialty during the study period. Results: The characterization conducted showed limitations in the development of the ability to diagnose dermatological diseases in anatomic pathology laboratories, Microbiology and Medical Parasitology, by residents (100%). The didactic conception of the interdisciplinary training process of diagnostic ability focuses on teaching and learning activities and laboratory practices in a logical consecutiveness and systematization from the different forms of teaching and class typologies. It integrates the interdisciplinary and the use of the research method that is established in the guiding ideas. Conclusions: The didactic conception, as a research contribution, resolves the dialectic contradiction between the application of the clinical method and the procedures in laboratory practice that occurs in this formative process which is a didactic support that backs up the practical activities in the laboratories in order to achieve the objectives of the study plan of the specialty.

Concepções sobre clínica na formação médica: análise de um curso derivado do programa Mais Médicos / Conceptions about clinical practice in medical education: analysis of a course derived from the Mais Médicos Program / Concepciones sobre la clínica en la educación médica: análisis de un curso derivado del Programa Más Médicos

Introdução: Principalmente após a instituição das Diretrizes Curriculares Nacionais dos cursos de graduação em Medicina, espera-se que seja predominante na formação médica a clínica ampliada, ou seja, aquela que tem como foco central o sujeito e suas particularidades. Objetivo: Buscou-se compreender as concepções sobre clínica presentes no imaginário de estudantes e professores de um curso de graduação em Medicina de uma universidade federal localizada no Sul do país. Métodos: Trata-se de estudo de caráter exploratório e qualitativo aprovado pelo Comitê de Ética em Pesquisa de uma universidade federal, sob o Parecer nº 2.950.932, de 9 de outubro de 2018. A coleta de dados deu-se com base em entrevistas com docentes médicos (n=21) e grupos focais com acadêmicos (n=43) que, posteriormente, foram tratados pela análise de conteúdo de Bardin. Resultados: Aspectos inerentes à clínica ampliada foram levantados, sobretudo no que diz respeito ao estabelecimento de uma boa relação médico-paciente, à necessidade de desenvolver habilidades comunicativas e de haver um equilíbrio entre os componentes técnico, ético e humanístico. Contudo, alguns discursos característicos da clínica tradicional foram notados, principalmente relacionados à clínica focada no diagnóstico e tratamento de doenças. Conclusões: Com esses resultados é possível concluir que, apesar de a clínica ampliada estar presente no curso em questão, isso ainda não se efetivou completamente.

Introduction: After the institution of National Curriculum Guidelines for Medicine undergraduate courses, it is expected that the extended clinical practice will predominate in medical training, that is, one that has as its central focus individuals and their particularities. Objective: Through this study, we sought to comprehend the conceptions about clinical practice in the minds of students and professor of an undergraduate course in Medicine at a federal university located in the south of the country. Methods: This is an exploratory and qualitative study approved by the Research Ethics Committee of a federal university, under the opinion No. 2.950.932, of October 9th, 2018. Data collection was based on interviews with medical professors (n=21) and academics focal groups (n=43) that, subsequently, were processed by Bardin's content analysis. Results: Aspects inherent to the extended clinical practice were brought up, mainly those regarding a good doctor-patient relationship, the need to develop communication skills, and the balance between the humanistic, ethical and technical components. However, some statements aligned to the traditional clinical practice have been noticed, mostly related to the practice focused on diagnosis and treatment. Conclusions: Through these results, it is possible to conclude that, despite the presence of the extended clinical practice in the medical degree, it has not yet been fully implemented.

Introducción: Después del establecimiento de las Directrices Curriculares Nacionales (DCN) de los cursos de Medicina en Brasil, se espera que la clínica tradicional deje de ser predominante en la formación médica para que se priorice la clínica ampliada, es decir, la que tiene como enfoque central la persona y sus particularidades. Objetivo: A través de este estudio se buscó comprender las concepciones sobre clínica presentes en la carrera de pregrado en medicina de una universidad federal ubicada en el sur del país. Métodos: Se trata de un estudio exploratorio y cualitativo aprobado por el Comité de Ética en Investigación de una universidad federal, bajo el número 2.950.932, del 9 de octubre de 2018. La recolección de datos se realizó a partir de entrevistas con profesores de medicina (n=21) y grupos focales con académicos (n=43), que posteriormente fueron tratados por el análisis de contenido de Bardin. Resultados: Se plantearon aspectos inherentes a la clínica ampliada, especialmente en lo que respecta al establecimiento de una buena relación médico-paciente, la necesidad de desarrollar habilidades comunicativas y el equilibrio entre los componentes técnico, ético y humanístico. Sin embargo, se notaron algunos discursos característicos de la clínica tradicional, principalmente relacionados con una clínica enfocada al diagnóstico y tratamiento de enfermedades. Conclusiones: A través de esos resultados es posible concluir que la clínica ampliada está presente en el curso en cuestión, aún no se ha implementado en su totalidad.

Diagnóstico sobre la preparación de los estudiantes de Medicina para la identificación de alteraciones electrocardiográficas

Introducción: el electrocardiograma constituye un examen de gran utilidad clínica. Por tal motivo, se necesita lograr en los estudiantes habilidades que permitan su interpretación correcta. Objetivo: caracterizar la preparación de los estudiantes de Medicina para la identificación de las alteraciones electrocardiográficas durante la educación en el trabajo. Materiales y métodos: se realizó un estudio observacional descriptivo transversal en el Hospital General Docente Dr. Antonio Luaces Iraola, Ciego de Ávila, en el curso escolar 2020-2021. La población de estudio fue de 21 estudiantes de tercer año de Medicina del Grupo Básico de Trabajo asignado a la Sala de Cardiología, a quienes se aplicó una encuesta de autoevaluación. Resultados: el 52 % se autoevaluaron de Mal, y el 43 % de Regular, en la identificación del electrocardiograma normal y patológico. En cuanto a la relación entre método clínico e interpretación del electrocardiograma para el diagnóstico de diferentes enfermedades cardiovasculares, un 48 % se evaluaron de Regular y un 43 % de Mal. En la precisión al reconocer el origen de cada onda, segmentos e intervalos, y cada una de sus desviaciones patológicas, el 71 % se evaluó de Mal y el 29 % de Regular. En la precisión para el diagnóstico de síndromes electrocardiográficos potencialmente vitales, el 91 % se evaluó de Mal; de igual manera lo hizo el 95 % en el reconocimiento de los criterios electrocardiográficos para el diagnóstico de las hipertrofias de las cavidades. Conclusiones: el diagnóstico reveló dificultades, demostradas en las autoevaluaciones de los estudiantes, de Regular y Mal en todos los indicadores.

Introduction: electrocardiogram is a very useful clinical examination. For that reason, it is necessary to achieve in the students skills allowing its correct interpretation. Objective: to characterize the training of Medicine students for identifying electrocardiographic alterations during their education at work. Materials and methods: a cross-sectional descriptive observational study was carried out at the General Teaching Hospital Dr. Antonio Luaces Iraola, of Ciego de Avila, during the 2020-2021 school year. The study population was 21 third-year Medicine students from the Basic Work Team assigned to the Cardiology Ward, to whom a self-assessment survey was applied. Results: 52% of students self-evaluated Unsatisfactory, and 43% Acceptable in the identification of normal and pathological electrocardiogram. Regarding the relationship between the clinical method and the interpretation of the electrocardiogram for the diagnosis of different cardiovascular diseases, 48% was evaluated Acceptable and 43% Unsatisfactory. In the accuracy when recognizing the origin of each wave, segments or intervals, and each of their pathological deviations, 71% was evaluated Unsatisfactory and 29% Acceptable. In the precision for the diagnosis of potentially life-threatening electrocardiographic syndromes, 91% was evaluated Unsatisfactory; 95% was also evaluated Unsatisfactory in recognizing the electrocardiographic criteria for the diagnosis of cavity hypertrophies. Conclusions: the diagnosis revealed difficulties assessed as acceptable and unsatisfactory in all indicators, exposed in the students' self-evaluations.