Conflictos éticos en el aprendizaje de los médicos internos residentes de Medicina Física y Rehabilitación / Ethical conflicts in training of the medical residents of physical medicine and rehabilitation

Objetivo. Intentar identificar el lugar que ocupa el concepto ético en la actuación diaria de los médicos internos residentes (MIR) de Medicina Física y Rehabilitación. Material y método. Se realizó un estudio prospectivo en el que participaron 13 MIR de Medicina Física y Rehabilitación con el objetivo de identificar los conflictos éticos que pueden producirse durante el aprendizaje de la especialidad. Realizamos un documento para el análisis de las habilidades éticas que consistía en 10 casos clínicos de situaciones habituales en rehabilitación. Todas las preguntas tenían cinco respuestas posibles en las que se incluían los indicadores para la evaluación de la ética médica. Las respuestas podían ser: a) respeto o actitud basada en los principios de autonomía, beneficencia, ausencia de maleficencia y justicia; b) evasión en la que se subroga el compromiso de actuar a una autoridad o a otros colegas, y c) falta de respeto, que es la ausencia de respeto a la autonomía del paciente, las actitudes no beneficientes, la maleficencia o la injusticia. Resultados. Sobre un rango máximo total de todos los participantes de 1.300 puntos se obtuvieron 1.008,5 puntos, lo que significa el 77,6% y está situado en el mejor cuartil. Resultados. La media del grupo fue de 25,2 puntos (desviación estándar de 2,8) con un rango situado entre 22,5–27,1 puntos. Las preguntas con resultados más inadecuados fueron la 8 y la 9, referidas a la falta de colaboración del paciente y a las actitudes inadecuadas de otros profesionales del equipo multidisciplinario de rehabilitación. Conclusión. El estudio indica la necesidad de institucionalizar programas de formación específicos para los MIR en el apartado ético(AU)

Objective. To attempt to identify the place occupied by the ethical concept in the daily performance of resident physicians (RP) of Physical Medicine and Rehabilitation (PMR). Material and methods. A prospective study involving 13 RP of PMR was performed in order to identify the ethical conflicts that may occur during the specialty training. We elaborated a document for the analysis of ethical skills, which consisted of 10 clinical cases of common situations in Rehabilitation. All the questions had 5 possible answers that included indicators for the evaluation of medical ethics. The answers could be: a) Respect or attitude based on the principles of autonomy, beneficence, non-malfeasance and justice, b) avoidance in which commitment to act is subrogated to an authority or other colleagues, c) lack of respect, which is the absence of respect of the patient's autonomy, non-beneficence, malfeasance or injustice attitudes. Results. On a total maximum range for all the participants of 1300 points, 1008.5 points were obtained. This accounts for 77.6%, which would be located in the best quartile. The group average was 25.2 points (SD 2.8), with a range located between 22.5 and 27.1 points. The questions having the most inadequate results were numbers 8 and 9, concerning lack of patient cooperation and inappropriate attitudes of other professionals in the multidisciplinary rehabilitation team. Conclusion. The study indicates the need to institutionalize specific training programs for the Resident Physician within the ethics section(AU)

¿Cuál es la evidencia científica en los programas de prevención de la lesión muscular? / No disponible

Las lesiones musculares son frecuentes en muchos tipos dedeporte si la carga biomecánica pasa a ser superior a latolerancia del músculo. Esto puede ocurrir tanto si la cargabiomecánica es demasiado alta como si la tolerancia delmúsculo frente a este aumento de carga se reduce. La prevenciónde las lesiones musculares debería centrarse en lapreparación de los atletas para soportar la carga biomecánicaque requiere el tipo específico de deporte. Los estudioshan demostrado que los programas de entrenamientodirigidos al deporte específico y a la mejora en la toleranciaa la fatiga muscular reducen la incidencia de lesiones en isquiosurales.Un entrenamiento específico como proporcionanlos "Nordic hamstring lowers" también ha demostradoreducir la incidencia de lesiones musculares en isquiosurales.Mejorar la función lumbo-pélvica en los movimientos dealta velocidad también podría ser de importancia. Igualmente,una rehabilitación de calidad tras la lesión muscular podríareducir el índice de re-lesiones. En el ámbito de la prevenciónde las lesiones musculares se requieren másevidencias de cuáles son las medidas óptimas de prevención.Se precisan un mayor número de estudios e investigacionesbien dirigidos sobre la prevención de lesiones enlos diferentes tipos de deporte(AU)

Muscle strains are common in many types of sport if thebiomechanical load becomes higher than the tolerance ofthe muscle. This can occur either if the biomechanical loadis too high or if the tolerance against the biomechanicalload in the muscle is reduced. Prevention of muscle strainsshould focus on preparing the athletes for the biomechanicalload required by the specific type of sport. Studies haveshown that sport specific prevention programs aimed atimproving training specificity and fatigue resistance reducethe rate of hamstring strains. Specific training as providedby the “Nordic hamstring lowers” has also been shown toreduce the incidence of hamstring strains. Improving lumbarand pelvic function in high speed movements could also beof importance and high quality rehabilitation after musclestrains might reduce the rate of recurrent injuries. In thefield of preventing muscle strains more evidence is neededto find the optimal prevention measures. There is need formore, well-conducted research on injury prevention in differenttypes of sport(AU)

Training mechanical engineering students to utilize biological inspiration during product development.

The use of bio-inspiration for the development of new products and devices requires new educational tools for students consisting of appropriate design and manufacturing technologies, as well as curriculum. At the University of Maryland, new educational tools have been developed that introduce bio-inspired product realization to undergraduate mechanical engineering students. These tools include the development of a bio-inspired design repository, a concurrent fabrication and assembly manufacturing technology, a series of undergraduate curriculum modules and a new senior elective in the bio-inspired robotics area. This paper first presents an overview of the two new design and manufacturing technologies that enable students to realize bio-inspired products, and describes how these technologies are integrated into the undergraduate educational experience. Then, the undergraduate curriculum modules are presented, which provide students with the fundamental design and manufacturing principles needed to support bio-inspired product and device development. Finally, an elective bio-inspired robotics project course is present, which provides undergraduates with the opportunity to demonstrate the application of the knowledge acquired through the curriculum modules in their senior year using the new design and manufacturing technologies.

A novel approach to physiology education for biomedical engineering students.

It is challenging for biomedical engineering programs to incorporate an indepth study of the systemic interdependence of cells, tissues, and organs into the rigorous mathematical curriculum that is the cornerstone of engineering education. To be sure, many biomedical engineering programs require their students to enroll in anatomy and physiology courses. Often, however, these courses tend to provide bulk information with only a modicum of live tissue experimentation. In the Electrical, Computer, and Biomedical Engineering Department of the University of Rhode Island, this issue is addressed to some extent by implementing an experiential physiology laboratory that addresses research in electrophysiology and biomechanics. The two-semester project-based course exposes the students to laboratory skills in dissection, instrumentation, and physiological measurements. In a novel approach to laboratory intensive learning, the course meets on six Sundays throughout the semester for an 8-h laboratory period. At the end of the course, students are required to prepare a two-page conference paper and submit the results to the Northeast Bioengineering Conference (NEBC) for consideration. Students then travel to the conference location to present their work. Since the inception of the course in the fall of 2003, we have collectively submitted 22 papers to the NEBC. This article will discuss the nature of the experimentation, the types of experiments performed, the goals of the course, and the metrics used to determine the success of the students and the research.

Professional practice in exercise science : the need for greater disciplinary balance.

This article describes the current outlook for professional practice for graduates majoring in exercise science. A review of professional and experimental literature reveals that graduates of undergraduate programmes in exercise science are not as prepared as they should be in order to provide professional and comprehensive advice on exercise and human performance, because of the focused academic and professional requirements of exercise physiology. In contrast to the direction of training in other allied health professions, this trend of narrowing of the exercise science curriculum to focus on exercise physiology, at the expense of other subdisciplines in kinesiology, has contributed to a decreasing scope of practice and lack of uniqueness, and has reduced the effectiveness of exercise science graduates. This review focuses on an accumulating body of evidence indicating that improving the training in biomechanics and motor behaviour could increase the professional expertise of exercise science graduates. Small improvements in the exercise science curriculum in biomechanics and motor behaviour are proposed that would move toward greater balance and integration of the academic disciplines in kinesiology and better professional practice in exercise science. The drift away from a balance and integration of academic preparation in exercise science represents a threat to the acceptance of exercise science graduates as exercise professionals that needs to be corrected for the field to advance.

Biomechanics teachers can be animals.

The aim of this study was to determine whether a constructivist approach, in particular a visit to a zoo, could be effective in consolidating mechanical concepts and applying those concepts to coaching and teaching. Ten students in their final year of their Bachelor of Physical Education at the University of Edinburgh participated in a visit to Edinburgh Zoo. During the visit students completed a worksheet of questions and engaged interactively in discussing how various animals are adapted mechanically to survive in their environments. Immediately after the visit they completed a questionnaire with four sections. The first section assessed whether they could apply the mechanical concepts discussed during the visit to human sports performance. The second canvassed their opinions on whether the visit was effective in reinforcing mechanical concepts, in developing 'lateral thinking' about mechanical concepts, and in improving their ability to apply mechanical concepts to coaching and teaching. The third canvassed their opinions on whether the visit would be effective for senior high school Physical Education and Sports Science students for developing mechanical concepts and applying them to coaching. The fourth section canvassed their opinions on when the visit should be conducted for Physical Education and Sports Science students in universities and in senior high schools. The results indicated that the visit was effective in reinforcing mechanical concepts and in applying them laterally to improve understanding of human sports performance. Participants believed that the visit would also be effective for senior high school students. All participants believed that the visit would be most beneficial after at least one course in biomechanics that covers the basic biomechanical principles.

Bio-fluids educational issues: an emerging field aims to define its next generation.

There are numerous processes in the body under healthy and pathologic conditions in which bio-fluid mechanics play a central role. The delivery of various substances to and from tissues is accomplished through a combination of complex active and passive mass transfer processes. Bio-fluid mechanics also play a central role in locomotion, from water-bound amoeba and fish to the soaring of birds. Educating undergraduate and graduate students in such wide-ranging fluid mechanical phenomena has proved challenging within the typical context of a biomedical engineering program. The diversity of biomedical engineering topics entails increased biological sciences curricular content, possibly limiting the opportunities to provide a fundamental knowledge base in fluid mechanics which may be expected in the more traditional engineering disciplines. The lack of textbooks in the area, while problematic in the past, is being alleviated with some recent texts and several new ones are due to appear soon. Today's bio-fluids educators are presented with the challenge of providing sufficient fundamental knowledge in bio-fluid mechanics within one- or two-semester courses. The richness of this topic has led to a variety of approaches to course development. This article outlines some of the current approaches and presents some strategies that we hope would help in constructing effective bio-fluids courses.

The effectiveness of job specific training on the occupational performance of student nurses.

Body mechanic checklist scores during a one-person pivot transfer, and boosting up in bed were evaluated to determine the effectiveness of training on the work performance of female student nurses from a local college. Thirty subjects participated in the study and were divided into a control group, an experimental group that received basic body mechanic training, and an experimental group that received job specific training. A one-way ANCOVA was calculated to examine the effects of the experimental procedures on the subjects' performance. This revealed a statistically significant difference between the groups (patient transfer F = 10.11, p value < 0.001; boosting F = 38.62, p value < 0.001). A post hoc analysis (Bonferroni procedure) indicated that the job specific training group (mean 11.65, SD 0.66) demonstrated a statistically significant improvement in their performance compared to the other two groups (control group mean 7.5, SD 0.67; BBMT mean 9.66, SD 0.67).

Experiment demonstrating skeletal muscle biomechanics.

Many students have limited opportunities to develop scientific expertise. This is caused, in part, by the scarcity of scientific educational materials and the expense of supplies and equipment. To address these concerns, we developed an inexpensive laboratory experience that introduces students to the scientific process. Our objective was to create an interactive experiment that requires minimal equipment. To this end, we created an exercise that examines muscle biomechanics. The students conduct a hands-on experiment as researchers and as subjects by investigating the physiological concepts of muscle biomechanics using only supplies that can be found at any school. Questions are interspersed throughout the text to highlight key principles and challenge student thinking on the important concepts. This exercise not only provides an opportunity for students to interact and discuss the important physiological principles but also provides a window through which students may see a future in science.