Comparison of flipped learning and traditional lecture method for teaching digestive system diseases in undergraduate medicine: A prospective non-randomized controlled trial.

INTRODUCTION: This study examined the effects of a large-scale flipped learning (FL) approach in an undergraduate course of Digestive System Diseases. METHODS: This prospective non-randomized trial recruited 404 students over three academic years. In 2016, the course was taught entirely in a Traditional Lecture (TL) style, in 2017 half of the course (Medical topics) was replaced by FL while the remaining half (Surgical topics) was taught by TL and in 2018, the whole course was taught entirely by FL. Academic performance, class attendance and student's satisfaction surveys were compared between cohorts. RESULTS: Test scores were higher in the FL module (Medical) than in the TL module (Surgical) in the 2017 cohort but were not different when both components were taught entirely by TL (2016) or by FL (2018). Also, FL increased the probability of reaching superior grades (scores >7.0) and improved class attendance and students' satisfaction. CONCLUSION: The holistic FL model is more effective for teaching undergraduate clinical gastroenterology compared to traditional teaching methods and has a positive impact on classroom attendances.

Rotura no traumática del bazo: experiencia con 10 casos / Atraumatic rupture of the spleen: experience of 10 cases

La rotura espontánea del bazo es una situación clínica infrecuente que puede atribuirse a diferentes causas. Se presenta la experiencia recopilada retrospectivamente de 10 casos de rotura esplénica acumulados durante 12 años. En nuestra serie de 10 pacientes con rotura atraumática hubo 7 casos de rotura patológica. En los 3 pacientes restantes, la rotura se consideró espontánea. Sin embargo, 2 de estos pacientes eran obesos mórbidos, cuya posible asociación aún no se ha descrito en la literatura médica. Realizamos una revisión de la bibliografía para discutir la etiología, la patogenia y el tratamiento óptimo de esta afección clínica

The most common cause of splenic rupture is trauma. Less frequently the spleen ruptures due to an ongoing hematologic, infectious or tumoral disease (pathologic rupture). We present a series of 10 patients with atraumatic splenic rupture: in seven patients there was a pathologic rupture. Two of the remaining three patients with spontaneous rupture were morbidly obese; this association has not previously been reported. The present review discusses the etiology, pathogenesis and optimal treatment of this entity

[Atraumatic rupture of the spleen: experience of 10 cases]. / Rotura no traumática del bazo: experiencia con 10 casos.

The most common cause of splenic rupture is trauma. Less frequently the spleen ruptures due to an ongoing hematologic, infectious or tumoral disease (pathologic rupture). We present a series of 10 patients with atraumatic splenic rupture: in seven patients there was a pathologic rupture. Two of the remaining three patients with spontaneous rupture were morbidly obese; this association has not previously been reported. The present review discusses the etiology, pathogenesis and optimal treatment of this entity.

Gastroschisis: primary closure using umbilical cord strengthened by a polypropylene mesh.

AIMS: We present a new method of repairing gastroschisis, where the disproportion between the size of the eviscerated intestine and the hypoplastic abdominal cavity could dangerously elevate abdominal pressure if primary closure of the abdominal wall is attempted. METHODS: We used umbilical cord graft strengthened by a polypropylene mesh to achieve definitive closure of the abdominal wall in a single operation. RESULTS: This technique provides a mesothelial surface in contact with the intestines, strengthened by a fibrous reaction that prevents future herniation. Five-year follow-up in four patients showed no umbilical hernias and overall excellent results. CONCLUSIONS: The technique described is useful and easily applicable in children with abdominal wall defects when primary anatomic closure is not feasible. It also prevents future herniation through the anatomical defect of the abdominal wall.

Introducción del sistema europea de transferencia de créditos (ECTS) en la Facultad de Medicina de La Laguna / Introduction of the European Credit Transfer System (ECTS) in the medical school of the University of La Laguna

Para la convergencia europea se deben modificar los planes de estudios de las facultades de medicina de forma que el Sistema de Transferencia de Créditos Europeo (ECTS) esté incorporado a los nuevos planes del estudio antes del 2010 Objetivos: Experimentar la introducción del ECTS en el segundo cuatrimestre de quinto curso, modificando la metodología docente. Diseño del estudio: Se adaptaron los programas teóricos y prácticos y se establecieron unos objetivos docentes y un sistema de evaluación para las asignaturas de Patología Médica de la Sangre y de la Hematopoyesis, de las Enfermedades Infecciosas y del Sistema Endocrino y Nutrición, Pediatría y Patología Quirúrgica de Cara, Cuello, Mama y Glándulas Endocrinas. Se realizaron encuestas a los alumnos en el transcurso de cuatrimestre, utilizando para las respuestas una escala de tipo Likert con cinco grados. Se analizó la priorización de las competencias genéricas y específicas de los alumnos. Para el análisis de los resultados se aplicaron pruebas no paramétricas. Resultados: Los 37 créditos actuales se transformaron en 29.5 ECTS, con 736.5 horas de trabajo para los alumnos. Se redujeron los programas teóricos de 186 lecciones en total a 134 (reducción del 27.96 %). Los alumnos prepararon y presentaron 58 casos clínicos bajo la supervisión de sus tutores. Los profesores consideraron que el aprendizaje teórico había sido similar al de cursos anteriores (66.6 %) y el práctico había sido mejor (73.3 %). El 73.3 % de los alumnos contestaron que el proyecto debía mejorarse, mediante la reducción de la carga de trabajo de los alumnos y mejora del sistema de evaluación. Los alumnos apreciaron de forma estadísticamente significativa que mejoró la docencia práctica y su capacidad para preparar y presentar casos clínicos. El rendimiento académico de los alumnos fue significativamente mejor que el de los alumnos del curso anterior. Los estudiantes estuvieron de acuerdo con la prioridad de competencias de la CND para 9/9 de las generales y 4/17 de las específicas. Conclusiones: La introducción experimental del ECTS mejoró el rendimiento académico, la formación práctica y el autoaprendizaje de los alumnos. La experiencia fue satisfactoria para profesores y alumnos. La estimación de la carga de trabajo de los alumnos fue subestimada (AU)

Introduction: To comply with the requirements of European convergence, faculties of medicine must modify their curricula and incorporate the European Credit Transfer System (ECTS) before 2010. Objectives: To test the introduction of ECTS in the 2nd term of the 5th year medicine course and the appropriately modified teaching methodology. Study design: Theoretical and practical programs were adapted; academic objectives and student evaluation system were established for the following subjects: medical pathology of blood and haematopoiesis, infectious diseases and endocrine system and nutrition, paediatrics and surgical pathology of the face, neck, breast and endocrine glands. Students were surveyed during the term, using a 5-point Likert-type scale. We recorded student priorities for general and specific parameters, and the results were analyzed using non-parametric tests. Results: Thirty-seven credits were converted into 29.5 ECTS credits, representing 736.5 student working hours. The theory program was reduced from 186 to 134 lectures (a reduction of 28%). Students presented 58 tutor-supervised clinical cases. The teaching staff considered that learning of theory was similar to previous years (66.6%) but that practical learning improved (73.3%). Most students (73.2%) thought the program should be improved, especially the examination system, and the workload reduced. Students reported a statistically significant improvement in practical teaching and in their capacity to present clinical cases. Academic performance was significantly higher than that of the 5th year students the previous year. Students agreed with the National Deans Conference priorities for the 9/9 general and 4/17 specific competences. Conclusions: Introducing ECTS improved academic performance, practical training and self-learning. The project proved satisfactory for staff and students. Student workload was underestimated in the new plan (AU)