El trabajo en equipo y la seguridad del paciente / Teamwork and patient safety

En este artículo se relaciona el trabajo en equipo con la seguridad del paciente y la importancia de su enseñanza en las carreras universitarias. Esto surge ante la creciente complejidad del sistema de salud que presenta mayores posibilidades de error. De esta manera aparece el trabajo en equipo como una herramienta fundamental para el ejercicio profesional. El avance tecnológico llevó a una transformación cultural y a la horizontalización de la estructura organizacional, aunque la figura del líder sigue resultando de importancia para no perder el tradicional enfoque humanístico. La enseñanza universitaria debe tratar este problema desde que el estudiante ingresa hasta que egresa para mejorar las tomas de decisiones y brindar seguridad

This article relates teamwork to patient safety and the importance of teaching it in university courses. This arises due to the growing complexity of the health system, which presents greater possibilities of error. In this way, teamwork appears as a fundamental tool for professional practice. Technological advancement led to a cultural transformation and the horizontalization of the organizational structure, although the figure of the leader continues to be important so as not to lose the traditional humanistic approach. University education must address this problem from the moment the student enters until he or she graduates to improve decision-making and provide security

Solutions, enablers and barriers to online learning in clinical medical education during the first year of the COVID-19 pandemic: A rapid review.

AIMS: The COVID-19 pandemic has seen a major disruption to undergraduate and postgraduate clinical medical education. The aim of this rapid review was to identify and synthesize published literature relating to the solutions, enablers and barriers to online learning implemented in clinical medical education during the first year of the COVID-19 pandemic. METHODS: All articles published before March 2021 in peer-reviewed journals, including MedEdPublish, that described authors' experience of online learning in response to the COVID-19 pandemic. A descriptive analysis of the solutions and a qualitative template analysis of enablers and barriers. RESULTS: 87 articles were identified for inclusion. Face to face teaching was maintained with interactive approaches between learners and/or learners and teachers. Several innovative solutions were identified. The enablers were a readiness and rapid response by institutions, with innovation by teachers. The barriers were the lack of planning and resources, usability problems and limited interactivity between teachers and students. CONCLUSIONS: Important and timely evidence was obtained that can inform future policy, practice and research. The findings highlighted the urgent need to use rapid design and implementation methods with greater explicit descriptions in published articles to ensure applicability to other contexts.

Bridging Learning in Medicine and Citizenship During the COVID-19 Pandemic: A Telehealth-Based Case Study.

BACKGROUND: COVID-19 presented great challenges for not only those in the field of health care but also those undergoing medical training. The burden on health care services worldwide has limited the educational opportunities available for medical students due to social distancing requirements. OBJECTIVE: In this paper, we describe a strategy that combines telehealth and medical training to mitigate the adverse effects of the COVID-19 pandemic. METHODS: A toll-free telescreening service, Telecoronavirus, began operations in March 2020. This service was operated remotely by supervised medical students and was offered across all 417 municipalities (14.8 million inhabitants) in the Brazilian state of Bahia. Students recorded clinical and sociodemographic data by using a web-based application that was simultaneously accessed by medical volunteers for supervision purposes, as well as by state health authorities who conducted epidemiological surveillance and health management efforts. In parallel, students received up-to-date scientific information about COVID-19 via short educational videos prepared by professors. A continuously updated triage algorithm was conceived to provide consistent service. RESULTS: The program operated for approximately 4 months, engaging 1396 medical students and 133 physicians. In total, 111,965 individuals residing in 343 municipalities used this service. Almost 70,000 individuals were advised to stay at home, and they received guidance to avoid disease transmission, potentially contributing to localized reductions in the spread of COVID-19. Additionally, the program promoted citizenship education for medical students, who were engaged in a real-life opportunity to fight the pandemic within their own communities. The objectives of the education, organization, and assistance domains of the Telecoronavirus program were successfully achieved according to the results of a web-based post-project survey that assessed physicians' and students' perceptions. CONCLUSIONS: In a prolonged pandemic scenario, a combination of remote tools and medical supervision via telehealth services may constitute a useful strategy for maintaining social distancing measures while preserving some practical aspects of medical education. A low-cost tool such as the Telecoronavirus program could be especially valuable in resource-limited health care scenarios, in addition to offering support for epidemiological surveillance actions.

Práticas de integração ensino-serviço comunidade: demandas e reformulação do currículo médico / Integration practical of community-teaching-service: demands and medical curriculum reformulation

A participação coordenada das instituições de educação médica com o Sistema Único de Saúde, por meio das diretrizes e dos programas desenvolvidos por este, é fundamental para possibilitar o desenvolvimento de habilidades profissionais que valorizem o sujeito. Objetivo: Analisar as Práticas de Integração Ensino-Serviço Comunidade (PIESC) na reestruturação da formação médica, por meio de uma revisão de literatura. Métodos: Para análise desse fato, os descritores "Práticas de Integração Ensino-Serviço Comunidade" e "Atenção Primária" foram usados para pesquisa na Biblioteca Virtual em Saúde, com isso encontraram-se 21 artigos, dos quais 12 foram selecionados, pois descrevem a implementação e a importância das práticas, assim como seus obstáculos. Resultados: As principais abordagens dessa disciplina perpassam: a percepção do estudante; os obstáculos, a inserção e a implementação desta; os impactos do GraduaSUS. Discussão: Nota-se a necessidade de adaptação do currículo das escolas médicas, com o objetivo de adequar a formação profissional à Estratégia da Saúde da Família, a qual se resulta do fortalecimento da Atenção Primária à Saúde, fruto das demandas sociais contemporâneas. Conclusão: A disciplina Práticas de Integração Ensino-Serviço Comunidade torna-se ferramenta preponderante à transformação e ao emprego das matrizes curriculares dessa graduação em âmbito nacional

The coordinated participation of medical education institutions with the Unified Health System, through guidelines and programs applied by it, is fundamental to enable the development of professional skills that value the subject. Objective: Analyze the Practices of Teaching-Service Community Integration (PCTSI) in the medical formation restructuration, through a literature review. Method: To analyze this fact, the descriptors "Practices of Teaching-Service Community Integration" and "Primary Health Care" were used for research in the Biblioteca Virtual em Saúde, thus 21 articles were found, from which 12 were selected, because they describe the implementation and the significance of the practices, as well as their obstacles. Results: The main approaches of this discipline run through: the student's perception; the obstacles, its insertion and implementation; the impacts of GraduaSUS. Discussion: Note that it is necessary to adjust the curriculum of medical schools, with the objective of adapting professional training to the Family Health Strategy, that results of strengthening Primary Health Care, the fruit of contemporary social demands. Conclusion: The discipline Practices of Teaching-Service Community Integration of Medicine becomes a preponderant tool for the transformation and the use of the curricular matrices of this graduation nationally

El funcionamiento del equipo de autoevaluación como garantía de la calidad en la carrera de Medicina / The functioning of the self-assessment team as a guarantee of quality in the Medicine career

RESUMEN La mejora continua de la calidad en la carrera de Medicina constituye no solo un reto, sino un compromiso para las actuales y futuras generaciones. En este sentido, la autoevaluación resulta trascendental. Para ello, es preciso contar con un equipo que lidere el proceso de forma efectiva. El presente artículo tiene como propósito reflexionar acerca de la estructura, funcionamiento, roles y responsabilidades del equipo de autoevaluación. Las valoraciones realizadas permiten precisar elementos en cuanto a su composición, y cualidades que deben distinguir a sus integrantes y al coordinador. Se presentan y ejemplifican funciones a desarrollar en el orden de la planificación y organización, de la ejecución y del control del proceso. Por otra parte, se señalan condiciones o requisitos que deben ser atendidos para el cumplimiento exitoso de las funciones enunciadas. Se enfatiza en la necesidad de la observancia de los aspectos señalados, para contribuir a la mejora continua de la calidad en la carrera de Medicina.

ABSTRACT The continuous improvement of quality in the Medicine career constitutes not only a challenge, but also a commitment for current and future generations. In this sense, self-evaluation is crucial. For this, it is necessary to have a team that leads the process effectively. The purpose of this article is to reflect on the structure, operation, roles and responsibilities of the self-assessment team. The evaluations made allow to specify elements regarding its composition, and qualities that should distinguish its members and the coordinator. Functions to be developed are presented and exemplified in the order of planning and organization, execution and control of the process. On the other hand, conditions or requirements are indicated that must be met for the successful fulfillment of the stated functions. Emphasis is placed on the need to observe the aforementioned aspects, to contribute to the continuous improvement of quality in the Medicine career.

Bases académicas en la enseñanza de la hipertensión arterial en una facultad pública de Medicina: diseño del estudio / Academic bases in the teaching of high blood pressure in a public medical school: study design

La hipertensión arterial (HTA) es uno de los principales factores de riesgo para la enfermedad cardio-cerebrovascular. Actualmente, coexisten múltiples guías y consensos de práctica clínica, lo que puede conducir a una variabilidad exagerada en el proceso de aprendizaje de esta patología. El presente estudio busca evaluar la variabilidad existente en la enseñanza de la HTA de la Facultad de Ciencias Médicas de la Plata, estimar la percepción sobre la necesidad de elaborar un consenso interno y evaluar la implementación de un consenso propio de la facultad. El estudio se realizará en cuatro fases: armado de la encuesta, implementación de la encuesta, armado de un documento-consenso e implementación del documento consenso. Durante la primera fase del estudio se elaboró la encuesta, incluyendo la referencia a ocho documentos científico-académicos relacionados con la problemática de la HTA. Se realizó la implementación de la encuesta en el último trimestre de 2019. Se espera que el desarrollo del presente proyecto de investigación y sus productos ayude no solamente a perfeccionar los procesos de enseñanza de los alumnos en el manejo de la HTA, sino también a sentar las bases para iniciar procesos similares en otras patologías asociadas con alta carga de enfermedad para la población. (AU)

High blood pressure (HT) is one of the main risk factors for cardio-cerebrovascular disease. Currently, multiple clinical practice guidelines and consensus co-exist that can lead to exaggerated variability in the learning process of this pathology. The present study seeks to evaluate the variability existing in the teaching of the HTA of the Faculty of Medical Sciences of La Plata, to estimate the perception of the need to elaborate an internal consensus and to evaluate the implementation of a consensus of the faculty. The study will be carried out in four phases: assembling the survey, implementing the survey, assembling a consensus document and implementing the consensus document. During the first phase of the study, the survey was prepared including a reference to eight scientific-academic documents related to the problem of HT. The implementation of the survey was carried out in the last quarter of 2019. The development of this research project and its products is expected to help not only to improve the teaching processes of the students in the management of the HTA, but also will lay the foundations to initiate similar processes in other pathologies associated with a high disease burden for the population. (AU)

Violence against trainees: urgent ethical challenges for medical educators and academic leaders in perinatal medicine.

Objectives Violence against medical trainees confronts medical educators and academic leaders in perinatal medicine with urgent ethical challenges. Despite their evident importance, these ethical challenges have not received sufficient attention. The purpose of this paper is to provide an ethical framework to respond to these ethical challenges. Methods We used an existing critical appraisal tool to conduct a scholarly review, to identify publications on the ethical challenges of violence against trainees. We conducted web searches to identify reports of violence against trainees in Mexico. Drawing on professional ethics in perinatal medicine, we describe an ethical framework that is unique in the literature on violence against trainees in its appeal to the professional virtue of self-sacrifice and its justified limits. Results Our search identified no previous publications that address the ethical challenges of violence against trainees. We identified reports of violence and their limitations. The ethical framework is based on the professional virtue of self-sacrifice in professional ethics in perinatal medicine. This virtue creates the ethical obligation of trainees to accept reasonable risks of life and health but not unreasonable risks. Society has the ethical obligation to protect trainees from these unreasonable risks. Medical educators should protect personal safety. Academic leaders should develop and implement policies to provide such protection. Institutions of government should provide effective law enforcement and fair trials of those accused of violence against trainees. International societies should promulgate ethics statements that can be applied to violence against trainees. By protecting trainees, medical educators and academic leaders in perinatology will also protect pregnant, fetal, and neonatal patients. Conclusions This paper is the first to provide an ethical framework, based on the professional virtue of self-sacrifice and its justified limits, to guide medical educators and academic leaders in perinatal medicine who confront ethical challenges of violence against their trainees.

Formación científica en el pregrado de medicina en Chile: ¿dónde estamos? y ¿hacia dónde vamos? / An analysis of scientific formation in medical schools

For more than a century the training of medical professionals has been organized according to the Flexnerian model, which comprises three cycles: basic, clinical and clerkship. On the other hand, the accelerated development of biomedical sciences modified the competences of the first cycle. Additionally, new skills required for medical practice, such as teamwork and innovation as a tool to solve health problems, challenged in recent years the classic paradigm of medical education. Therefore, the medical schools have developed multiple strategies to deal with it, such as curricular integration using competency-based education models, incorporating basic and clinical sciences in parallel during the curriculum, ensuring a relevant and applicable scientific knowledge throughout the training process. Although in Chile the Flexner prototype is still followed, the basic sciences are taught as single or integrated courses or using a systems approach. In this article we report a diagnosis about the local integration of fundamental sciences in medical training. We also compare our schools with those of Canada, Europe and Latin America. Recommendations aimed at modernizing medical school curricula are made.

Medical Students' Response to the COVID-19 Pandemic: Experience and Recommendations from Five Countries.

The COVID-19 pandemic has provided medical students around the globe with unique challenges and opportunities. With formal medical school education and training interrupted, medical students sought innovative ways to contribute to their health-care systems and communities. Their responses could be organized into three categories: clinical (remote clinical care and triage, helping in COVID testing or treatment centers, and contact tracing), nonclinical (PPE acquisition, COVID-related policy and research, and supporting vulnerable groups in the community), and educational (creating materials to educate peers, the community, or community health workers). We present examples of responses developed by students from five countries: Brazil, Nepal, the Philippines, Rwanda, and the United States. We discuss the challenges, outcomes, and recommendations for each case. One critical opportunity for growth is strengthening international collaborations. We hope that these examples provide a framework for medical students to plan coordinated and effective responses to the next pandemic, and further medical student engagement in international collaboration.

[An analysis of scientific formation in medical schools]. / Formación científica en el pregrado de medicina en Chile: ¿dónde estamos? y ¿hacia dónde vamos?

For more than a century the training of medical professionals has been organized according to the Flexnerian model, which comprises three cycles: basic, clinical and clerkship. On the other hand, the accelerated development of biomedical sciences modified the competences of the first cycle. Additionally, new skills required for medical practice, such as teamwork and innovation as a tool to solve health problems, challenged in recent years the classic paradigm of medical education. Therefore, the medical schools have developed multiple strategies to deal with it, such as curricular integration using competency-based education models, incorporating basic and clinical sciences in parallel during the curriculum, ensuring a relevant and applicable scientific knowledge throughout the training process. Although in Chile the Flexner prototype is still followed, the basic sciences are taught as single or integrated courses or using a systems approach. In this article we report a diagnosis about the local integration of fundamental sciences in medical training. We also compare our schools with those of Canada, Europe and Latin America. Recommendations aimed at modernizing medical school curricula are made.

La COVID-19 por SARS-CoV-2 también ha afectado a la educación médica / COVID-19 by SARS-CoV-2 has also affected medical education

El virus SARS-CoV-2, además de provocar una pandemia con centenares de miles de enfermos y con decenas de miles de fallecidos, ha tenido la capacidad ("el poder") de romper las prácticas educativas estándar. Esto ha tenido, o puede tener, un beneficio: reconsiderar lo que es realmente importante y lo que no lo es tanto. Y eso tiene un gran valor para el docente y para el discente. Y también ha servido para reconocer y encontrar formas alternativas con las que se puede transmitir el saber. En definitiva, el profesor ha tenido la oportunidad de contribuir a crear un modelo educativo capaz de impulsar el desarrollo de nuevas formas y métodos de aprendizaje. Ciertas técnicas y recursos educativos han podido ser reconocidos como presentes o ausentes de nuestro sistema educativo. Esto implica que ciertos recursos han de estar presentes o que es preciso optimizar los que ya están disponibles para enseñar, para aprender o para evaluar. La tecnología permite facilitar el contacto directo entre profesor y alumno, entre profesores, y entre alumnos. Pero sobra decir que la tecnología ha de estar disponible.

The SARS-CoV-2 virus, besides causing a pandemic, with hundreds of thousands ill, and tens of thousands dead, has caused a major shift in standard education practices. This has had, or may have, one benefit: to reconsider what is ultimately relevant or not in the classroom. And this is of great value for the teacher and for the student. And it has also served to recognise and find alternative ways to transmit the knowledge. All things considered, the teacher has had the opportunity to contribute in creating an education with the aim of developing new ways and methods of learning. Certain educational techniques and resources have been recognised as present or absent in our education system. It is necessary for certain resources used to teach, learn and evaluate to be available and those that are already present, require optimization. Technology helps to provide direct contact between teacher and student, between teachers and between students. But it goes without saying that this technology has to be available.