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2.
Gait Posture ; 74: 212-217, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31561119

RESUMEN

BACKGROUND: A growing body of literature supports the promising effect of real-time feedback to re-train runners. However, no studies have comprehensively assessed the effects of foots trike and cadence modification using different forms of real-time feedback provided via wearable devices. RESEARCH QUESTION: The purpose of the present study was to determine if a change could be made in foot strike pattern and plantar loads using real-time visual, auditory and combined feedback provided using wearable devices. METHODS: Visual, auditory and combined feedback were provided using wearable devices as fifteen recreational runners ran on a treadmill at self-selected speed and increased cadence. Plantar loads and location of initial contact were measured with a flexible insole system. Repeated measures ANOVAs with Bonferroni adjusted pair-wise comparisons were used to assess statistical significance. RESULTS AND SIGNIFICANCE: A significant effect of condition was noted on location of center of pressure (p < 0.01). Bonferroni-adjusted post-hoc comparisons showed that feedback conditions differed from baseline as well as the new cadence conditions, however did not differ from each other. A significant interaction effect (region x feedback) was found for plantar loads (maximum force P < 0.001). Significant effects of feedback were noted at the heel (P < 0.001), medial midfoot (P < 0.001), lateral midfoot (P < 0.001), medial forefoot (P = 0.003), central forefoot (P = 0.003), and great toe (P = 0.004) but not at the lateral forefoot (P = 0.6) or lateral toes (P = 0.507). SIGNIFICANCE: The unique findings of our study showed that an anterior shift of the center of pressure, particularly when foot strike modification was combined with 10% increased cadence. We found lower heel and midfoot loads along with higher forefoot and great toe loads when foot strike modification using real-time feedback was combined with increased cadence. Our findings also suggest that auditory feedback might be more effective than visual feedback in foot-strike modification.


Asunto(s)
Pie/fisiología , Retroalimentación Formativa , Carrera/fisiología , Dispositivos Electrónicos Vestibles , Soporte de Peso/fisiología , Adulto , Análisis de Varianza , Prueba de Esfuerzo , Femenino , Talón/fisiología , Humanos , Masculino , Actividad Motora/fisiología , Zapatos , Dedos del Pie/fisiología , Adulto Joven
3.
Med Educ Online ; 24(1): 1648944, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31370754

RESUMEN

Background: Physician assistants (PAs) are an integral part of inpatient care teams, but many PAs do not receive formal education on authoring discharge summaries. High-quality discharge summaries can mitigate patient risk during transitions of care by improving inter-provider communication. Objective: To understand the current state of discharge summary education at our institution, and describe a novel curriculum to teach PA students to write effective discharge summaries. Design: Students completed a pre-survey to assess both knowledge and comfort levels regarding discharge summaries. They wrote a discharge summary and received feedback from two evaluators, an inpatient provider (IPP) familiar with the described patient and a simulated primary care provider (PCP). Students completed a post-survey reassessing knowledge and comfort. Results: Prior to instituting this curriculum, the majority of students (92.9%) reported rarely or never receiving feedback on discharge summaries. Eighty-four of 88 (95.5%) eligible students participated. There was discordance between IPP and simulated PCP feedback on their assessment of the quality of discharge summaries; simulated PCPs gave significantly lower global quality ratings (7.9 versus 8.5 out of 10, p = 0.006). Key elements were missing from >10% of discharge summaries. Student response was favorable. Conclusion: Clinically relevant deficiencies were common in students' discharge summaries, highlighting the need for earlier, structured training. IPPs and simulated PCPs gave discordant feedback, emphasizing differing needs of different providers during transitions of care. This novel curriculum improved students' knowledge and confidence.


Asunto(s)
Curriculum , Alta del Paciente , Asistentes Médicos/educación , Escritura , Comunicación , Retroalimentación Formativa , Humanos , Encuestas y Cuestionarios , Cuidado de Transición
4.
J Grad Med Educ ; 11(4): 454-459, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31440341

RESUMEN

Background: Formative feedback from residents is essential to improve residency programs, and focus groups may provide rich information. However, residents may withhold information due to fear of retaliation or speak less candidly to please focus group moderators. Objective: We assessed participant perceptions and utility of feedback obtained from a confidential focus group exchange between 2 residency programs. Methods: Anesthesiology and pediatric programs at the same institution participated in 2017. Residents voluntarily provided program feedback during 1 of 2 confidential focus groups for each program. Each focus group was moderated by the program director (PD) of the other specialty. The PDs used thematic analysis to identify themes for use by the respective programs in improvement efforts. An anonymous survey was distributed after the focus groups to collect participant perceptions (quantitative and narrative) on this approach. Results: Thirteen residents of 140 (9.3%) participated (7 anesthesiology, 6 pediatrics). Thematic feedback from focus groups was largely consistent with known issues, although novel information was also obtained (eg, pediatric interns wanted earlier one-on-one meetings with their PD). Survey data suggest that residents were able to share more meaningful feedback than they would otherwise, and they did not feel that having an external moderator (a PD who may have been unfamiliar with the specialty) was a barrier to discussion. The approach required 6 hours of time for each PD and approximately $200 for dinners. Conclusions: The focus group exchange required modest resources, was perceived as safe by residents, and generated robust, actionable feedback for the programs.


Asunto(s)
Anestesiología/educación , Retroalimentación Formativa , Internado y Residencia , Pediatría/educación , Médicos/psicología , Educación de Postgrado en Medicina , Grupos Focales , Humanos , Evaluación de Programas y Proyectos de Salud/tendencias , Encuestas y Cuestionarios
6.
BMC Med Educ ; 19(1): 321, 2019 Aug 23.
Artículo en Inglés | MEDLINE | ID: mdl-31443705

RESUMEN

BACKGROUND: Peer evaluation can provide valuable feedback to medical students, and increase student confidence and quality of work. The objective of this systematic review was to examine the utilization, effectiveness, and quality of peer feedback during collaborative learning in medical education. METHODS: The PRISMA statement for reporting in systematic reviews and meta-analysis was used to guide the process of conducting the systematic review. Evaluation of level of evidence (Colthart) and types of outcomes (Kirkpatrick) were used. Two main authors reviewed articles with a third deciding on conflicting results. RESULTS: The final review included 31 studies. Problem-based learning and team-based learning were the most common collaborative learning settings. Eleven studies reported that students received instruction on how to provide appropriate peer feedback. No studies provided descriptions on whether or not the quality of feedback was evaluated by faculty. Seventeen studies evaluated the effect of peer feedback on professionalism; 12 of those studies evaluated its effectiveness for assessing professionalism and eight evaluated the use of peer feedback for professional behavior development. Ten studies examined the effect of peer feedback on student learning. Six studies examined the role of peer feedback on team dynamics. CONCLUSIONS: This systematic review indicates that peer feedback in a collaborative learning environment may be a reliable assessment for professionalism and may aid in the development of professional behavior. The review suggests implications for further research on the impact of peer feedback, including the effectiveness of providing instruction on how to provide appropriate peer feedback.


Asunto(s)
Educación de Pregrado en Medicina , Retroalimentación Formativa , Estudiantes de Medicina , Humanos , Grupo Paritario , Aprendizaje Basado en Problemas , Profesionalismo , Estudiantes de Medicina/psicología , Enseñanza
7.
Educ Prim Care ; 30(5): 301-308, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31362601

RESUMEN

Longitudinal clinical placements are increasingly adopted by medical training institutions. However, there seems to be little evidence regarding their implementation in primary care settings in the developing world. This paper explored medical students' perceptions of their learning experiences in longitudinal placements in primary care clinics. The Manchester clinical placement index (MCPI) survey was offered to second-year medical students at the University of Botswana to determine perceptions of their 16 weeks clinical placement in primary care clinics. The MCPI provided data on eight aspects of clinical placements which were analysed to gain insight into students learning experiences while on placement. The eight items in the tool were grouped into four themes, namely, teaching and learning, learning environment, relationships and organisation of placements. Students cited the feedback they received whilst on placement and the learning environment in primary care clinics as aspects of clinical placements which could be improved to enhance their learning experience. For an enriched learning experience in primary care settings in a developing world context, there are critical aspects to be considered. Based on the students' perspective we suggest an approach of how learning in such placements could be enhanced.


Asunto(s)
Educación de Pregrado en Medicina/métodos , Aprendizaje , Estudiantes de Medicina/psicología , Botswana , Competencia Clínica , Centros Comunitarios de Salud , Estudios Transversales , Retroalimentación Formativa , Humanos , Atención Primaria de Salud , Encuestas y Cuestionarios
8.
Tidsskr Nor Laegeforen ; 139(11)2019 Aug 20.
Artículo en Noruego, Inglés | MEDLINE | ID: mdl-31429231

RESUMEN

BACKGROUND: Students and education authorities are expressing an increasing demand for educational quality and student involvement in higher education. We present a descriptive observational study of a student-initiated system for evaluation of lectures in the medical degree programme at the University of Oslo. MATERIAL AND METHOD: Criteria-based student evaluations of 445 lectures in the first and second year of the medical degree programme were conducted in spring and autumn 2017 and spring 2018; after each lecture, three students completed a questionnaire about the lecture. The responses were sent by email to the lecturer on the same day. We performed an analysis of the evaluations, a group interview with the cohort's elected representatives, and a questionnaire survey among the lecturers who received an evaluation. RESULTS: The lecturers received generally good feedback, but the student evaluations also indicated a clear potential for improvement: 21 % of the lectures were not adapted to the volume of information, 32 % did not point out the association with the learning outcomes, 31 % failed to activate the students and 40 % did not provide a summary at the end of the lecture. The cohort's elected representatives had a positive attitude to the evaluation scheme, but requested a simpler technical solution. Almost all the lecturers welcomed the student evaluation, and more than half had used the evaluations to improve their lectures. INTERPRETATION: This quality development project shows how students, teachers, administration and management can collaborate to improve the teaching.


Asunto(s)
Educación de Pregrado en Medicina/normas , Evaluación de Programas y Proyectos de Salud/métodos , Estudiantes de Medicina/psicología , Encuestas y Cuestionarios , Retroalimentación Formativa , Humanos , Entrevistas como Asunto , Noruega , Mejoramiento de la Calidad
9.
Gait Posture ; 73: 14-19, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31299499

RESUMEN

BACKGROUND: Social-comparative feedback informs an individual that their performance was better or worse than the group. Previous studies have found that compared to knowledge of results alone, social-comparative feedback produces a valence response that results in larger improvements in balance performance. However, the neural processes contributing to these motor improvements have not yet been examined. RESEARCH QUESTION: Does social-comparative feedback alter corticospinal excitability and consequently, balance performance? METHODS: Thirty-six healthy young adults stood and maintained their balance on a stabiliometer for eight trials. After three of the trials, the neutral (i.e., only knowledge of results) group received their performance feedback (i.e., time on balance) while the other two groups also received positive (i.e., performed better than the group) or negative (i.e., performed worse than the group) social-comparative feedback. To measure corticospinal excitability, soleus motor-evoked potentials were elicited using transcranial magnetic stimulation at the beginning of the experiment, after the presentation of feedback, and at the end of the experiment. Pre- and post- ratings of confidence, perceived skill, motivation, and anxiety were also collected. RESULTS: The negative feedback group reported decreases in perceived skill (43 ± 29%) and balance confidence (26 ± 28%), while the positive group reported a 13 ± 17% increase in perceived skill. Despite these group differences in feedback perception, all three groups improved their balance performance by ≈35% (p < 0.001) by the eighth trial. However, this improvement in balance performance was not matched by any changes in corticospinal excitability over time (19.2 ± 55.9% change; p = 0.340) or between groups (p = 0.734). SIGNIFICANCE: Our findings suggest that social-comparative feedback, as presented in this study, does not affect corticospinal excitability and balance performance differently than knowledge of results (neutral feedback) alone. More arousing and more frequent forms of social-comparative feedback may be necessary for observing larger changes in the functional or neural control of balance.


Asunto(s)
Ansiedad , Potenciales Evocados Motores/fisiología , Retroalimentación Formativa , Motivación , Músculo Esquelético/fisiología , Estimulación Magnética Transcraneal , Adulto , Emociones , Femenino , Humanos , Masculino , Tractos Piramidales/fisiología , Adulto Joven
10.
BMC Med Educ ; 19(1): 272, 2019 Jul 22.
Artículo en Inglés | MEDLINE | ID: mdl-31331310

RESUMEN

BACKGROUND: In the United States, post-cardiac arrest debriefing has increased, but historically it has occurred rarely in our pediatric intensive care unit (PICU). A fellow-led debriefing tool was developed as a tool for fellow development, as well as to enhance communication amongst a multidisciplinary team. METHODS: A curriculum and debriefing tool for fellow facilitators was developed and introduced in a 41-bed cardiac and medical PICU. Pre- and post-intervention surveys were sent to multidisciplinary PICU providers to assess effectiveness of debriefings using newly-trained leaders, as well as changes in team communication. RESULTS: Debriefing occurred after 84% (63/75) of cardiac arrests post-intervention. Providers in various team roles participated in pre-intervention (129 respondents/236 invitations) and post-intervention (96 respondents /232 invitations) surveys. Providers reported that frequently occurring debriefings increased from 9 to 58%, pre- and post-intervention respectively (p < .0001). Providers reported frequent identification and discussion of learning points increased from 32% pre- to 63% post-intervention. In the 12 months post-intervention, 62% of providers agreed that the overall quality of communication during arrests had improved, and 61% would be more likely to request a debriefing after cardiac arrest. CONCLUSION: The introduction of a fellow-led debriefing tool resulted in regularly performed debriefings after arrests. Despite post-intervention debriefings being led by newly-trained facilitators, the majority of PICU staff expressed satisfaction with the quality of debriefing and improvement in communication during arrests, suggesting that fellow facilitators can be effective debrief leaders.


Asunto(s)
Competencia Clínica , Retroalimentación Formativa , Paro Cardíaco/terapia , Relaciones Interprofesionales , Grupo Paritario , Niño , Preescolar , Femenino , Humanos , Lactante , Unidades de Cuidado Intensivo Pediátrico , Masculino , Grupo de Atención al Paciente , Mejoramiento de la Calidad , Estados Unidos
12.
Educ Prim Care ; 30(5): 275-281, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31354078

RESUMEN

The James Cook University (JCU) medical school has a mission to produce doctors who are willing to work across northern Australia and may choose generalist rather than specialist careers. In addition to real-life placements in primary healthcare settings, the medical school has developed simulated General Practice (GP) clinics (simGPclinic) for Year 5 (Y5) students. This study compares the simGPclinic with actual GP placements for authenticity, teaching clinical skills, and preparation for real-life primary healthcare settings. Y5 students were administered a survey following their simGPclinic (n = 65; response rate = 97%). Students rated the simGPclinic's authenticity as 77 out of 100, and were more likely to rate the simGPclinic as being 'better' than their real-life GP placement in teaching them to: 'formulate a medical management plan and order correct pathology tests'; 'rule out the "red flags" for the key clinical problem'; 'undertake a patient-centred history and examination'; 'make a differential diagnosis for the key clinical problem'; and, 'develop communications skills'. The simGPclinic provided medical students with authentic and positive learning experiences in primary healthcare that were at least as beneficial as those provided in real-life settings, as well as being more reliable and better structured.


Asunto(s)
Educación de Pregrado en Medicina/métodos , Medicina General/educación , Simulación de Paciente , Competencia Clínica , Estudios Transversales , Retroalimentación Formativa , Humanos , Queensland , Estudiantes de Medicina , Encuestas y Cuestionarios
13.
Educ Prim Care ; 30(4): 254-256, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31309860

RESUMEN

In GP training, educational supervisors are responsible for collating evidence of a trainee's performance and progress to allow them to progress to the next stage of training. In hospital posts, they rely upon a clinical supervisor's report to help assess progress. Clinical supervisors are clinicians from various specialties who may not have an in-depth knowledge of the GP training programme, and anecdotally, our impression was that clinical supervisor reports were impersonal and not helpful in assessing a trainee's performance. We set out to evaluate the usefulness of a clinical supervisor's report in the context of completing and educational supervisor report for trainees in hospital posts. We reviewed clinical supervisor and educational supervisor reports for a cohort of 30 trainees in the Wessex Deanery, and conducted a questionnaire for their educational supervisors. All educational supervisors valued the clinical supervisor reports in completing their report, those with personal comments being the most useful. The majority of reports had a mixture of personal and generic comments. Overall, clinical supervisor reports provide additional information to evaluate performance, and they should continue to be used. To improve their use further, guidance can be given to clinical supervisors about the value of personal comments for trainees.


Asunto(s)
Educación de Postgrado en Medicina/métodos , Retroalimentación Formativa , Competencia Clínica , Educación de Postgrado en Medicina/normas , Humanos , Reino Unido
14.
Med Educ Online ; 24(1): 1620544, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31184288

RESUMEN

PROBLEM: This study used the principles of feedback in a faculty development curriculum to enable clinical teachers to conduct objective structured teaching exercises for performance assessment. INTERVENTION: the Flanders System of Interaction Analysis (FIA) was given to analysis of the data collected from a particular situation, to videotapes of simulated clinical teaching skills. CONTEXT: The Sparse K-Means clustering method, one-way ANOVA and post hoc tests were employed to cluster the most commonly used skills by teachers and compare the features of different clusters were then discussed. OUTCOME: The evaluation method employed in this study can be extended to more teaching methods and skills. LESSONS LEARNED: that through teaching observation, clinical teaching skills and reflection teaching can be improved.


Asunto(s)
Competencia Clínica/normas , Evaluación Educacional/normas , Docentes Médicos/organización & administración , Retroalimentación Formativa , Enseñanza/organización & administración , Femenino , Humanos , Masculino
15.
Pediatr Clin North Am ; 66(4): 867-880, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31230628

RESUMEN

Feedback is an integral part of medical education. However, there is great variation of training and effectiveness of feedback delivery, especially in the inpatient setting. The unique learning environment provided in hospital medicine allows teachers the opportunity to provide feedback on learner performance under several longitudinal observations in areas such as direct patient care, procedural tasks, and interdisciplinary team leadership skills. Most important, feedback should occur on more than one occasion to truly empower change in knowledge, attitude, and skills. This article aims to provide the reader with foundational theories on feedback and strategies to use best practices for delivery.


Asunto(s)
Educación Médica/métodos , Retroalimentación Formativa , Medicina Hospitalar/educación , Médicos Hospitalarios , Atención Dirigida al Paciente , Pediatría/educación , Rondas de Enseñanza , Humanos
16.
Pediatr Clin North Am ; 66(4): 881-889, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31230629

RESUMEN

Resident and attending concern about the potential for decreased teaching has been cited as one of the drawbacks to the adoption of family-centered rounds (FCR). Despite these concerns, FCR can enhance clinical education through direct exposure to multiple patients by all team members, as well as by allowing faculty to teach, model, observe, and assess learners' clinical skills more effectively than in nonbedside settings. This article provides many strategies and approaches to bedside teaching designed to enhance education and communication among care team members as well as patients and their families.


Asunto(s)
Educación Médica/métodos , Medicina Hospitalar/educación , Atención Dirigida al Paciente , Pediatría/educación , Relaciones Profesional-Familia , Rondas de Enseñanza , Competencia Clínica , Retroalimentación Formativa , Médicos Hospitalarios , Humanos
17.
BMC Med Educ ; 19(1): 194, 2019 Jun 11.
Artículo en Inglés | MEDLINE | ID: mdl-31185971

RESUMEN

BACKGROUND: Self-explanation without feedback has been shown to improve medical students' diagnostic reasoning. While feedback is generally seen as beneficial for learning, available evidence of the value of its combination with self-explanation is conflicting. This study investigated the effect on medical students' diagnostic performance of adding immediate or delayed content-feedback to self-explanation while solving cases. METHODS: Ninety-four 3rd-year students from a Canadian medical school were randomly assigned to three experimental conditions (immediate-feedback, delayed-feedback, control). In the learning phase, all students solved four clinical cases by giving i) the most likely diagnosis, ii) two main arguments supporting this diagnosis, and iii) two plausible alternative diagnoses, while using self-explanation. The immediate-feedback group was given the correct diagnosis after each case; delayed-feedback group received the correct diagnoses only after the four cases; control group received no feedback. One week later, all students solved four near-transfer (i.e., same final diagnosis as the learning cases but different scenarios) and four far-transfer cases (i.e., different final diagnosis from the learning cases and different scenarios) by answering the same three questions. Students' diagnostic accuracy (score for the response to the first question only) and diagnostic performance (combined score of responses to the three questions) scores were assessed in each phase. Four one-way ANOVAs were performed on each of the two scores for near and far-transfer cases. RESULTS: There was a significant effect of experimental condition on diagnostic accuracy on near-transfer cases (p < .05). The immediate-feedback and delayed-feedback groups performed equally well, both better than control (respectively, mean = 90.73, standard deviation =10.69; mean = 89.92, standard deviation = 13.85; mean = 82.03, standard deviation = 17.66). The experimental conditions did not significantly differ on far-transfer cases. CONCLUSIONS: Providing feedback to students in the form of the correct diagnosis after using self-explanation with clinical cases is potentially beneficial to improve their diagnostic accuracy but this effect is limited to similar cases. Further studies should explore how more elaborated feedback combined with self-explanation may impact students' diagnostic performance on different cases.


Asunto(s)
Diagnóstico , Educación Médica/métodos , Retroalimentación Formativa , Estudiantes de Medicina , Competencia Clínica , Femenino , Humanos , Masculino , Estudiantes de Medicina/psicología , Encuestas y Cuestionarios , Adulto Joven
18.
Lakartidningen ; 1162019 May 07.
Artículo en Sueco | MEDLINE | ID: mdl-31192435

RESUMEN

Entrustable Professional Activities (EPAs) define observable key tasks that a doctor should be able to do independently after having completed a certain level of education. Progression is facilitated by frequent assessments of the defined activities, with increased degree of independence. The observations should be supported by constructive feed-forward. EPA is currently used in several countries both in undergraduate and post graduate education. In the context of pending changes in Swedish legislation regarding undergraduate education qualifications ordinance and medical licensing, a Swedish national work group has begun to define Swedish EPA for the future undergraduate education.


Asunto(s)
Competencia Clínica/normas , Educación Basada en Competencias , Educación de Pregrado en Medicina , Educación Basada en Competencias/métodos , Educación Basada en Competencias/organización & administración , Educación de Pregrado en Medicina/métodos , Educación de Pregrado en Medicina/organización & administración , Evaluación Educacional , Retroalimentación Formativa , Humanos , Médicos/normas , Suecia , Confianza
19.
Med Ref Serv Q ; 38(2): 181-186, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31173567

RESUMEN

Maintaining regular engagement with audiences through various forms of social media is becoming more important as library users and the general public increasingly rely on social media for news, updates, and feedback. While large corporations have been monitoring social media for more than a decade, libraries have recently begun to use social listening to stay abreast of trends and assess user needs as voiced directly by their communities. This column will explain what social listening is, explore concerns over its widespread application, consider examples of social media listening software currently available, and offer an overview of its application in library settings.


Asunto(s)
Retroalimentación Formativa , Bibliotecas Médicas , Evaluación de Necesidades , Medios de Comunicación Sociales , Bibliotecas Médicas/organización & administración , Mejoramiento de la Calidad
20.
A A Pract ; 12(11): 412-415, 2019 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-31162172

RESUMEN

Feedback in clinical education is essential but challenged by multiple barriers. This report describes the use of myTIPreport, a web-based tool, which streamlines the dual purpose of milestone evaluation and real-time feedback from faculty to residents in a US anesthesiology program. In a 6-month trial, faculty members and residents used myTIPreport for daily clinical feedback. We believe myTIPreport will be a valuable tool for clinical feedback given further refinement of the tool and improved faculty and resident development on program use.


Asunto(s)
Educación a Distancia/métodos , Educación de Postgrado en Medicina/métodos , Acreditación , Competencia Clínica , Docentes Médicos , Retroalimentación Formativa , Humanos , Internado y Residencia
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