Designing feedback processes in the workplace-based learning of undergraduate health professions education: a scoping review.

BACKGROUND: Feedback processes are crucial for learning, guiding improvement, and enhancing performance. In workplace-based learning settings, diverse teaching and assessment activities are advocated to be designed and implemented, generating feedback that students use, with proper guidance, to close the gap between current and desired performance levels. Since productive feedback processes rely on observed information regarding a student's performance, it is imperative to establish structured feedback activities within undergraduate workplace-based learning settings. However, these settings are characterized by their unpredictable nature, which can either promote learning or present challenges in offering structured learning opportunities for students. This scoping review maps literature on how feedback processes are organised in undergraduate clinical workplace-based learning settings, providing insight into the design and use of feedback. METHODS: A scoping review was conducted. Studies were identified from seven databases and ten relevant journals in medical education. The screening process was performed independently in duplicate with the support of the StArt program. Data were organized in a data chart and analyzed using thematic analysis. The feedback loop with a sociocultural perspective was used as a theoretical framework. RESULTS: The search yielded 4,877 papers, and 61 were included in the review. Two themes were identified in the qualitative analysis: (1) The organization of the feedback processes in workplace-based learning settings, and (2) Sociocultural factors influencing the organization of feedback processes. The literature describes multiple teaching and assessment activities that generate feedback information. Most papers described experiences and perceptions of diverse teaching and assessment feedback activities. Few studies described how feedback processes improve performance. Sociocultural factors such as establishing a feedback culture, enabling stable and trustworthy relationships, and enhancing student feedback agency are crucial for productive feedback processes. CONCLUSIONS: This review identified concrete ideas regarding how feedback could be organized within the clinical workplace to promote feedback processes. The feedback encounter should be organized to allow follow-up of the feedback, i.e., working on required learning and performance goals at the next occasion. The educational programs should design feedback processes by appropriately planning subsequent tasks and activities. More insight is needed in designing a full-loop feedback process, in which specific attention is needed in effective feedforward practices.

Association of nine pathobionts with periodontitis in four South American and European countries.

Aim: Our aim was to compare the prevalence and load of nine pathobionts in subgingival samples of healthy individuals and periodontitis patients from four different countries. Methods: Five hundred and seven subgingival biofilm samples were collected from healthy subjects and periodontitis patients in Belgium, Chile, Peru and Spain. The prevalence and load of Eubacterium brachy, Filifactor alocis, Fretibacterium fastidiosum, Porphyromonas endodontalis, Porphyromonas gingivalis, Selenomonas sputigena, Treponema denticola, Tannerella forsythia and Treponema socranskii were measured by quantitative PCR. Results: The association with periodontitis of all species, except for T. socranskii, was confirmed in all countries but Peru, where only P. endodontalis, P. gingivalis and T. denticola were found to be significantly associated. Moreover, most species showed higher loads at greater CAL and PPD, but not where there was BOP. Through Principal Component Analysis, samples showed clearly different distributions by diagnosis, despite observing a smaller separation in Peruvian samples. Conclusions: Unlike prevalence, relative load was found to be a reliable variable to discriminate the association of the species with periodontitis. Based on this, F. alocis, P. endodontalis, P. gingivalis, T. denticola and T. forsythia may be biomarkers of disease in Belgium, Chile and Spain, due to their significantly higher abundance in periodontitis patients.

A comprehensive approach to identify challenges for clinical reasoning development in undergraduate dental students and their potential solutions.

INTRODUCTION: Clinical reasoning is a core competence in health professions that impacts the ability to solve patients' health problems. Due to its relevance, it is necessary to identify difficulties arising from different sources that affect clinical reasoning development in students. The aim of this study was to explore a comprehensive approach to identify challenges for clinical reasoning development in undergraduate dental students and their potential solutions. METHODS: Mixed methods were used in four stages: (1) students and clinical teachers focus groups to identify challenges to clinical reasoning development; (2) literature review to explore potential solutions for these challenges; (3) Delphi technique for teacher consensus on pertinence and feasibility of solutions (1-5 scale); and (4) teachers' self-perception of their ability to implement the solutions. RESULTS: Three categories and seven subcategories of challenges were identified: (I) educational context factors influencing the clinical reasoning process; (II) teacher's role in clinical reasoning development; and (III) student factors influencing the clinical reasoning process. From 134 publications identified, 53 were selected for review, resulting in 10 potential solutions. Through two Delphi rounds, teachers rated the potential solutions very highly in terms of relevance (4.50-4.85) and feasibility (3.50-4.29). Finally, a prioritisation ranking of these solutions was generated using their scores for relevance, feasibility, and teachers' self-perception of their ability to implement them. CONCLUSIONS: The present comprehensive approach identified challenges for clinical reasoning development in dental students and their potential solutions, perceived as relevant and feasible by teachers, requiring further research and follow-up actions to address them.

[Intercultural Competences in Chilean Dental Education for Inclusive Healthcare]. / Identificación de contenidos de pertinencia intercultural para la atención de salud para el plan de estudios de odontología.

INTRODUCTION: Cultural diversity in Chile and inequities in access and quality of care require the development of cultural competencies in health professionals. Internationally, cultural competence has been integrated into the curricula of health professional programs; however, in Chile it is still in its early stages. METHODS: A mixed methodology included documentary review (searches and analysis in databases and official documents), key informant interviews and expert consensus. The interviews were transcribed verbatim, and thematic analysis was carried out using ATLAS.ti software. RESULTS: The documentary review identified domains, objectives and instruments used to measure cultural competence in dentistry. The interviews revealed four main categories: conceptions of health, facilitators and barriers, and characteristics of health professionals. Experts developed, evaluated and agreed upon content and learning outcomes. CONCLUSION: Including cultural competence in dental curricula is essential for more inclusive and culturally safe health care. Its longitudinal integration into various courses, employing effective teaching and assessment methodologies, is recommended. The results of this study provide a guide to identifying the knowledge, skills, and attitudes needed to train health professionals who ultimately deliver appropriate health care with cultural pertinence.

Evaluación de la Susceptibilidad Antimicrobiana de Porphyromonas gingivalis Aisladas de Pacientes Periodontales en Población Chilena

RESUMEN: Porphyromonas gingivalis (P. gingivalis) es un microorganismo frecuentemente aislado en pacientes con periodontitis, en los que también se incluye los de la población chilena. El modelo de "Keystone bacteria" demostró que P. gingivalis induce la disbiosis del biofilm subgingival y permite el desarrollo de algunas especies sobre otras, modulando la patogenicidad de la comunidad microbiológica completa. El tratamiento de la periodontitis es principalmente mecánico, pero en condiciones específicas es necesario el complemento con antibioterapia. Los estudios globales de antibióticos evaluados en ensayos clínicos y estudios in vitro han mostrado resultados mixtos en cuanto a eficacia y susceptibilidad. Este estudio descriptivo tuvo como objetivo evaluar el perfil de susceptibilidad antimicrobiana in vitro a metronidazol, clindamicina, amoxicilina más ácido clavulánico, moxifloxacino y azitromicina de P. gingivalis aisladas de pacientes periodontales chilenos. Se obtuvieron muestras microbiológicas de pacientes con diagnóstico de periodontitis estadíos III y IV generalizada, las que se sometieron a procesos de identificación mediante un espectrómetro de masas (MALDI-TOF MS). Posteriormente, a cada muestra positiva a P. gingivalis se aplicó el protocolo gold standard de susceptibilidad para los cinco antimicrobianos evaluados (Dilución en Agar Sangre Brucella- McFarland 0.5). Se seleccionaron 50 pacientes (25 mujeres, 25 hombres) entre 34-69 años. Finalmente, se recuperaron 25 cepas de P. gingivalis (50 %) para el análisis de susceptibilidad y todas ellas fueron sensibles a todos los antibióticos evaluados (100 % susceptibilidad). Las cepas de P. gingivalis fueron altamente sensibles a los cinco antibióticos evaluados en esta población, lo que podría implicar contar con diferentes alternativas de tratamiento farmacológico antimicrobi ano como complemento al tratamiento mecánico convencional en pacientes específicos.

ABSTRACT: Porphyromonas gingivalis (P. gingivalis) is a microorganism frequently isolated in patients with periodontitis, which also include those of Chilean population. The "Keystone bacteria" model demonstrated that P. gingivalis induces dysbiosis of the subgingival biofilm and allows the development of some species over others, modulating the pathogenicity of the entire microbiological community. The treatment of periodontitis is mainly mechanical; nevertheless, under specific conditions the complement with antibiotherapy is needed. Global studies of antibiotics evaluated in clinical trials and in vitro studies have shown mixed results in terms of efficacy and susceptibility. This descriptive study aimed to evaluate antimicrobial susceptibility profile in vitro to metronidazole, clindamycin, amoxicillin plus clavulanic acid, moxifloxacin and azithromycin of P. gingivalis isolated from Chilean periodontal patients. Microbiological samples were obtained from patients with a diagnosis of generalized periodontitis stages III and IV, which were exposed to identification processes by a mass spectrometer (MALDI-TOF MS). Subsequently, the gold standard susceptibility protocol for the five antimicrobials evaluated was applied to each P. gingivalis- positive sample (Dilution in Brucella-McFarland Blood Agar 0.5). 50 patients (25 women, 25 men) between 34-69 years old were selected. Finally, 25 P. gingivalis strains (50 %) were recovered for susceptibility testing and all of them were susceptible to all antibiotics tested (100 % susceptibility). P. gingivalis strains were highly susceptible to the five antibiotics evaluated in this population, which could implies counting different antimicrobial pharmacological treatment alternatives as a complement to conventional mechanical treatment in specific patients.

The best mirror of the students' longitudinal performance: Portfolio or structured oral exam assessment at clerkship?

OBJECTIVE: This study aimed to compare the strength of association (i.e., explained variability) of the cumulative grade point average (GPA) with the grades obtained in the clerkship portfolio and the final structured oral exam by dental students. METHODS: A prospective longitudinal study was designed to analyze quantitative data from three cohorts of dental school students. Univariate and multivariate linear regression models were built to evaluate the association between the students' cumulative GPA with the grades obtained in their clerkship portfolio and the final structured oral exam. RESULTS: In total, 171 students in the last year of the undergraduate program were considered (76% women, age average 24.8 ± 1.6 years). The dental students' grades of both portfolio and structured oral exam were significantly associated with the GPA score but with different strengths of association. The clerkship portfolio was more strongly associated with cumulative GPA than the structured oral exam (R2  = 19.6% versus R2  = 7.6%). On the opposite, the association between the structured oral exam and GPA can be interpreted as a lower precision in its practical significance and thus reflecting different concurrent validity. CONCLUSIONS: Considering the results of this study, it could probably incline the balance toward the portfolio because it may be closer to a programmatic assessment model, with timely feedback, development of metacognition, and the achievement of formative process measurement rather than evidence of a single instance of examination.

Evaluación para el aprendizaje: diseño e implementación de un mini-CEX en el internado profesional de la carrera de kinesiología / Assessment for learning: design and implementation of the Mini-CEX to the physiotherapy clerkship

Introducción: la evaluación kinesiológica contempla la realización de una rigurosa historia clínica y examen físico que orientan a establecer un diagnóstico, un pronóstico funcional, y es la base del plan de intervención. Esta competencia requiere de experiencia y razonamiento clínico para la toma de buenas decisiones terapéuticas. Los resultados históricos de las evaluaciones de aprendizajes del internado, concluyen que esta competencia tiene bajo nivel de desempeño, por lo que se deben mejorar las estrategias utilizadas para su aprendizaje durante el internado. El mini-CEX, es un instrumento de evaluación para el aprendizaje, que promueve la observación y feedback en el sitio de trabajo. Objetivo: diseñar e implementar un instrumento de evaluación para el aprendizaje de la evaluación kinesiológica durante el internado profesional de la Carrera de Kinesiología de la PUC. Método: estudio prospectivo, utilizando la me-todología de investigación acción, diseñado en 4 etapas. Resultados: se obtuvo un instrumento de evaluación para el aprendizaje, el mini-CEX, adaptado a las necesidades del internado profesional de kinesiología. El estudio piloto reportó buena aceptación entre estu-diantes y docentes. La percepción de los internos es que son más observados y que las destrezas asociadas a la evaluación kinesiológica mejoraron luego del estudio. Conclusiones: el instrumento reportó un tiempo de aplicación bajo (35 min.), lo que beneficiaría instancias de observación directa y feedback dentro de los internados. Es necesaria una aplicación a gran escala, que contribuya a determinar su validez y confiabilidad. Se requiere una capacitación formal a los docentes evaluadores y ajustar la escala.

Introduction: The physiotherapy clinical assessment competence includes the performance of a rigorous clinical history and physical examination that guides the establishment of a diagnosis and a functional prognosis, and is the basis of the intervention plan. This competence requires experience and clinical reasoning to make good therapeutic decisions. The historical global clerkship assessments conclude that this competency has a low level of performance, so the strategies used for its learning the clerkship must be improved. The mini-CEX is an assessment for learning, which promotes observation and feedback in the workplace. Objective: To design and im-plement an assessment for learning mini-CEX to the Physiotherapy PUC clerkship. Method: Prospective study, using an action research methodology, designed in 4 stages. Results: The main result was the mini-CEX, adapted to the Physiotherapy clerkship needs. The pilot study reported good acceptance among students and teachers. In addition, clerks' perception is that they feel more observed and that the skills associated with the physiotherapy assessment improved after its implementation.

[Educational impact after 10 years of implementation of a portfolio for undergraduate medical students]. / Portafolio en pregrado de Medicina: impacto educacional a 10 años de su implementación.

BACKGROUND: A portfolio is a compilation of academic work that demonstrates student's knowledge, reflection and critical thinking. AIM: To describe the development and implementation of an undergraduate portfolio in the School of Medicine at the Pontificia Universidad Católica de Chile, its temporal evolution and its educational impact after 10 years of experience. MATERIAL AND METHODS: The development and implementation of a portfolio for 4th-year undergraduate medical student was analyzed. Its design, teaching and learning methodologies, results and perceptions of students and teachers were assessed. The educational impact was measured using Kirkpatrick's levels. RESULTS: A total of 1,320 students participated between 2007 and 2017, supported by six teachers and 190 assistant-students. The portfolio included clinical cases, narrative medicine, palliative care and evidence-based medicine (EBM). The overall student's perception was positive, highlighting the development of critical analysis, clinical reasoning and professionalism. The delivery of feedback and learning assessment, allowed students to obtain excellent grades. There were only two cases of plagiarism reported. Fifteen EBM articles and two books with 52 narrative medicine essays were published. The greatest organizational impact of this teaching innovation, was that it evolved to become an established and continuous assessment instrument in 10 consecutive years. CONCLUSIONS: This portfolio is a project with a high educational impact, with a favorable perception by students and tutors, excellent results related to grades, stimulating both scientific writing and reflective practice.

[Experience of continuing online education in gastroenterology for non specialist medical doctors]. / Experiencia de educación continua en línea en gastroenterología para médicos no especialistas.

BACKGROUND: Continuing education is essential for health professions and online courses can be a good way for professional development. AIM: To describe the experience with online courses for continuing education in hepatology and gastroenterology and to analyze their educational impact. MATERIAL AND METHODS: A three years' experience in courses on liver diseases and digestive tract is described. Their curricular design, methodology, and the educational impact was analyzed using the four levels of the Kirkpatrick's model. RESULTS: On average, there were 321 students per course (2015-2017). 94% were Chilean and 6% from abroad (20 countries). In the educational impact analysis, in level 1 "reaction": 93% said that the course fulfilled their expectations and 92% would recommend it. In level 2 "learning": 42% approved the courses. Level 3 "behavior" was not evaluated and level 4 "organizational change" highlighted that the traditional face-to-face continuing education model of Chilean Gastroenterology Society (SChG) changed to full distance model in these three courses, with 1284 students from South America, Asia and Europe, in a 3-years-period. Additionally, these programs were included in the Medical Society of Santiago (SMS) continuing education agenda. CONCLUSIONS: The alliance between the SMS and the SChG generated on line courses that meet the educational needs of physicians and medical students, with excellent results and student perception.

Experiencia de educación continua en línea en gastroenterología para médicos no especialistas / Experience of continuing online education in gastroenterology for non specialist medical doctors

Background: Continuing education is essential for health professions and online courses can be a good way for professional development. Aim: To describe the experience with online courses for continuing education in hepatology and gastroenterology and to analyze their educational impact. Material and Methods: A three years' experience in courses on liver diseases and digestive tract is described. Their curricular design, methodology, and the educational impact was analyzed using the four levels of the Kirkpatrick's model. Results: On average, there were 321 students per course (2015-2017). 94% were Chilean and 6% from abroad (20 countries). In the educational impact analysis, in level 1 "reaction": 93% said that the course fulfilled their expectations and 92% would recommend it. In level 2 "learning": 42% approved the courses. Level 3 "behavior" was not evaluated and level 4 "organizational change" highlighted that the traditional face-to-face continuing education model of Chilean Gastroenterology Society (SChG) changed to full distance model in these three courses, with 1284 students from South America, Asia and Europe, in a 3-years-period. Additionally, these programs were included in the Medical Society of Santiago (SMS) continuing education agenda. Conclusions: The alliance between the SMS and the SChG generated on line courses that meet the educational needs of physicians and medical students, with excellent results and student perception.

Portafolio en pregrado de Medicina: impacto educacional a 10 años de su implementación / Educational impact after 10 years of implementation of a portfolio for undergraduate medical students

Background: A portfolio is a compilation of academic work that demonstrates student's knowledge, reflection and critical thinking. Aim: To describe the development and implementation of an undergraduate portfolio in the School of Medicine at the Pontificia Universidad Católica de Chile, its temporal evolution and its educational impact after 10 years of experience. Material and Methods: The development and implementation of a portfolio for 4th-year undergraduate medical student was analyzed. Its design, teaching and learning methodologies, results and perceptions of students and teachers were assessed. The educational impact was measured using Kirkpatrick's levels. Results: A total of 1,320 students participated between 2007 and 2017, supported by six teachers and 190 assistant-students. The portfolio included clinical cases, narrative medicine, palliative care and evidence-based medicine (EBM). The overall student's perception was positive, highlighting the development of critical analysis, clinical reasoning and professionalism. The delivery of feedback and learning assessment, allowed students to obtain excellent grades. There were only two cases of plagiarism reported. Fifteen EBM articles and two books with 52 narrative medicine essays were published. The greatest organizational impact of this teaching innovation, was that it evolved to become an established and continuous assessment instrument in 10 consecutive years. Conclusions: This portfolio is a project with a high educational impact, with a favorable perception by students and tutors, excellent results related to grades, stimulating both scientific writing and reflective practice.