Evaluación de docentes en programas de posgrado / Assessment of teachers in postgraduate programs

Los profesores son parte fundamental de una escuela de medicina. A nivel de la residencia médica, la evaluación de la docencia clínica es una estrategia de mejoramiento de la educación que permite identificar las deficiencias que existen para superarlas mediante capa-citación, así como reconocer las buenas prácticas docentes. Los modelos de evaluación docente utilizados en distintas facultades de medicina comprenden: la evaluación por pares, la autoevaluación, la evaluación basada en la opinión de los estudiantes y el portafolio docente. Con el fin de mejorar la calidad de la enseñanza y la calidad de los programas formativos en la residencia médica es necesario contar instrumentos de evaluación válidos, confiables, factibles y que cuenten con la aceptación de los profesores y residentes. Esta evaluación debe ser devuelta al docente mediante un proceso de retroalimentación efectiva y conectarse a un plan de desarrollo do-cente, de capacitación y de reconocimiento, enmarcado dentro de la carrera profesional. El sistema de evaluación y desarrollo docente debe partir de la institución universitaria responsable de la formación del médico residente.

Teachers are a substantial part of a medical school. In medical residency, the evaluation of clinical teaching is a strategy for improving education that allows establishing the deficiencies to overcome them through training and also to recognise good teachers. Teaching evaluation models used in different medical schools include peer evaluation, self-evaluation, evaluation based on the opinion of students and the teaching portfolio. To improve the quality of teaching and the quality of training programs in medical residences, it is necessary to have a valid, reliable, feasible teacher evaluation system that has the acceptance of teachers and residents. This evaluation must be returned to the teacher through an effective feedback process and also linked to a faculty development program and a recognition plan framed within the professional career. The teaching assessmente and development system must come from the university responsible for the resident training.

[Performance of the MEDUC-PG14 instrument to evaluate teaching performance in medical residency programs]. / Validez y confiabilidad de los resultados del instrumento MEDUC-PG14 para medir el desempeño docente en la residencia médica en Perú.

BACKGROUND: There are few instruments to evaluate teachers' performance during medical residency in Spanish. AIM: To determine the validity and reliability of the MEDUC-PG14 instrument to evaluate teaching performance in the medical residency programs of the Faculty of Medicine, Universidad Peruana Cayetano Heredia (UPCH). MATERIAL AND METHODS: An open question about positive aspects that characterize a good teacher was added to the MEDUC-PG14 questionnaire. A pilot test was carried out with 15 residents to assess the correct comprehension of each question and carry out necessary changes. Subsequently, the instrument was sent by email to 366 residents of the UPCH Department of Medical Clinics. The reliability of the instrument was evaluated using Cronbach's Alpha. Construct validity was assessed by factor analysis, and the validity of content by a qualitative analysis of the answers to the open question added. RESULTS: Seventy residents answered the questionnaire evaluating 46 teachers. Each resident evaluated one teacher. The factor analysis showed two dimensions explaining 83% of the variance: the dimension "Teaching and Evaluation" (11 items) and the dimension "Respectful Behavior" (three items). The global Cronbach's Alpha was 0.97 (0.97 for the Teaching Dimension 0.96 and for the Behavioral Dimension). The concept of "professional competence as a medical specialist" was rescued from the responses to the open question. CONCLUSIONS: The MEDUC-PG14 is an instrument with valid and highly reliable results. It is useful and easy to apply to evaluate teaching performance in postgraduate studies. Its use is recommended in residency programs of Spanish-speaking countries. However, the inclusion of an item referring to the professional competence of the teacher is suggested.

Validez y confiabilidad de los resultados del instrumento MEDUC-PG14 para medir el desempeño docente en la residencia médica en Perú / Performance of the MEDUC-PG14 instrument to evaluate teaching performance in medical residency programs

Background: There are few instruments to evaluate teachers' performance during medical residency in Spanish. Aim: To determine the validity and reliability of the MEDUC-PG14 instrument to evaluate teaching performance in the medical residency programs of the Faculty of Medicine, Universidad Peruana Cayetano Heredia (UPCH). Material and Methods: An open question about positive aspects that characterize a good teacher was added to the MEDUC-PG14 questionnaire. A pilot test was carried out with 15 residents to assess the correct comprehension of each question and carry out necessary changes. Subsequently, the instrument was sent by email to 366 residents of the UPCH Department of Medical Clinics. The reliability of the instrument was evaluated using Cronbach's Alpha. Construct validity was assessed by factor analysis, and the validity of content by a qualitative analysis of the answers to the open question added. Results: Seventy residents answered the questionnaire evaluating 46 teachers. Each resident evaluated one teacher. The factor analysis showed two dimensions explaining 83% of the variance: the dimension "Teaching and Evaluation" (11 items) and the dimension "Respectful Behavior" (three items). The global Cronbach's Alpha was 0.97 (0.97 for the Teaching Dimension 0.96 and for the Behavioral Dimension). The concept of "professional competence as a medical specialist" was rescued from the responses to the open question. Conclusions: The MEDUC-PG14 is an instrument with valid and highly reliable results. It is useful and easy to apply to evaluate teaching performance in postgraduate studies. Its use is recommended in residency programs of Spanish-speaking countries. However, the inclusion of an item referring to the professional competence of the teacher is suggested.

Curso de docencia para residentes: evaluación de un programa / Teaching course for residents: Evaluation of a program

OBJETIVO: Describir la evaluación de un curso de docencia en el campo clínico para residentes según los niveles 1, 2 y 3 del modelo de evaluación de programas educacionales de Kirkpatrick. MATERIAL Y MÉTODOS: Se implementó un curso para capacitar a residentes en docencia. El curso fue evaluado mediante: una encuesta de satisfacción global, desempeño docente y calidad (Kirkpatrick 1-Reacción); un examen de conocimientos y encuesta de actitudes hacia la docencia realizados antes y después del curso (Kirkpatrick 2-Aprendizaje) y una encuesta realizada 3 meses después del curso sobre la aplicación de lo aprendido (Kirkpatrick 3-Conducta). RESULTADOS: Kirkpatrick 1: De los 19 residentes que llevaron el curso, el 100% manifestó estar satisfecho con el curso y el desempeño docente; el 100% recomendaría los docentes a otros residentes. Kirkpatrick 2: Las calificaciones en el examen de conocimientos antes y después del curso fueron 8,7 (DE 2,7) y 15,5 (DE 3,4), p < 0,0005. Dieciocho (94%) de los residentes consideró estar preparado para ser docente después del curso. Kirkpatrick 3: 3 meses después del curso, 18 (94,7%) de los residentes habían realizado sesiones de docencia en grupo pequeño, mejorado el clima de aprendizaje y promovido el autoaprendizaje. Diecisiete (89,5%) impartían clases y realizaban feedback con residentes de años inferiores e internos. CONCLUSIONES: El curso de docencia en el campo clínico para residentes fue factible de implementar, tuvo un alto grado de satisfacción entre los residentes, la mayoría reportó haber perfeccionado sus habilidades docentes y aplicó lo aprendido 3 meses después de haber llevado el curso

OBJETIVE: To describe the evaluation of a clinical teaching course for residents according to Kirkpatrick educational program evaluation model. MATERIAL AND METHODS: A clinical teaching course for residents was implemented. The course was evaluated by: a questionnaire of global satisfaction, teaching performance and quality (Kirkpatrick 1- Reaction); a knowledge test and a questionnaire of attitudes toward teaching, both of them carried out before and after the course (Kirkpatrick 2-Learning) and a questionnaire, carried out 3 months after the course, about the application of the concepts (Kirkpatrick 3-Behavior). RESULTS: Kirkpatrick 1: Nineteen residents who took the course (100%) expressed their satisfaction with the course and the teaching performance; 100% would recommend teacher's course to other residents. Kirkpatrick 2: The qualifications in the knowledge test before and after the course were 8.7 (SD 2.7) y 15.5 (SD 3,4), p < 0.0005. Eighteen (94.7%) of residents considered being prepared to be a teacher after the course. Kirkpatrick 3: Three months after the course, eighteen (94.7%) of residents had conducted small group teaching sessions, improved the learning climate and promoted self-learning. Seventeen (89.5%) gave classes and provided feedback to lower year's residents and interns. CONCLUSIONS: The Clinical Teaching Course for Residents was feasible to implement, had a high degree of satisfaction among residents, most of them reported had improved their teaching skills and applied what they have learned three months after taking the course

Aplicación longitudinal del Mini Clinical Examination (Mini-CEX) en médicos residentes / Longitudinal use of the Mini Clinical Examination (Mini-CEX) in medical residents

OBJETIVO: Se aplicó el Mini-CEX, que es un método de evaluación de habilidades clínicas, en un programa de residentado médico, para evaluar sus resultados en el tiempo y determinar su validez y confiabilidad. MATERIAL Y MÉTODOS: Se estandarizó el sistema de evaluación con tres aplicaciones del Mini-CEX a lo largo de un año, en los médicos residentes del primer año de medicina interna y especialidades clínicas de la Facultad de Medicina de la Universidad Peruana Cayetano Heredia, Lima, Perú. Se buscó diferencias entre las tres evaluaciones con la prueba Kruskall-Wallis. Se midió el grado de confiabilidad con la prueba alfa de Cronbach y la validez de constructo con análisis factorial. Se capacitó a 20 docentes. Se evaluaron 14 residentes y cada uno tuvo tres evaluaciones. RESULTADOS: Las observaciones duraron 46,5 ± 26,1 min y el feedback 20,1±11,1 min. El análisis factorial mediante la prueba de componentes principales encontró un solo factor. La prueba alfa de Cronbach global fue 0,92. Se observó una mejoría significativa de los residentes en examen físico 6 (5,8-7,0) a 7,5 (6,8-8,0) p = 0,028; juicio clínico 6 (6,0-7,2) a 8 (7,0-8,2) p = 0,021; y, valoración global 7 (6,0-7.6) a 8 (7,0-8,0) p = 0,043. Los niveles de satisfacción del residente y del docente con el método fueron 8/9 y 9/9. CONCLUSIÓN: La prueba fue bien aceptada por residentes y docentes, tuvo un alto nivel de confiabilidad y validez de constructo por lo que se recomienda su uso en programas de residentado médico

OBJECTIVE: The Mini-CEX, which is an evaluation method of clinical skills, was used in a medical residency program for assessing its results over time and to determine its validity and reliability. MATERIALS AND METHODS: The evaluation system was standardised with three the Mini-CEX being applied over one year to first-year medical residents of internal medicine and sub-specialties in the Faculty of Medicine of Universidad Peruana Cayetano Heredia, Lima, Perú. Differences between the three evaluations were measured using the Kruskal-Wallis test. The degree of reliability was measured using the Cronbach alpha test, and construct validity with factor analysis. Twenty teachers were trained. Each one of fourteen residents was evaluated three times. RESULTS: The observations lasted 46.5 ± 26.1 minutes and feedback 20.1 ± 11.1 minutes. The factor analysis found one dimension. The overall Cronbach alpha score was 0.92. A significant improvement was observed in the residents in Physical Examination, from 6 (5.8-7.0) to 7.5 (6.8-8.0) p = . 028, clinical judgment, from 6 (6.0-7.2) to 8 (7.0-8.2) p = .021, and overall rating, from 7 (6, 0-7.6) to 8 (7-8) p = . 043. The satisfaction levels of residents and teachers with the method were 8/9 and 9/9, respectively. CONCLUSION: The test was well accepted by residents and teachers, and as it had a high level of reliability and construct validity, its use is recommended in medical residency programs

Global causes of diarrheal disease mortality in children <5 years of age: a systematic review.

Estimation of pathogen-specific causes of child diarrhea deaths is needed to guide vaccine development and other prevention strategies. We did a systematic review of articles published between 1990 and 2011 reporting at least one of 13 pathogens in children <5 years of age hospitalized with diarrhea. We included 2011 rotavirus data from the Rotavirus Surveillance Network coordinated by WHO. We excluded studies conducted during diarrhea outbreaks that did not discriminate between inpatient and outpatient cases, reporting nosocomial infections, those conducted in special populations, not done with adequate methods, and rotavirus studies in countries where the rotavirus vaccine was used. Age-adjusted median proportions for each pathogen were calculated and applied to 712 000 deaths due to diarrhea in children under 5 years for 2011, assuming that those observed among children hospitalized for diarrhea represent those causing child diarrhea deaths. 163 articles and WHO studies done in 31 countries were selected representing 286 inpatient studies. Studies seeking only one pathogen found higher proportions for some pathogens than studies seeking multiple pathogens (e.g. 39% rotavirus in 180 single-pathogen studies vs. 20% in 24 studies with 5-13 pathogens, p<0.0001). The percentage of episodes for which no pathogen could be identified was estimated to be 34%; the total of all age-adjusted percentages for pathogens and no-pathogen cases was 138%. Adjusting all proportions, including unknowns, to add to 100%, we estimated that rotavirus caused 197 000 [Uncertainty range (UR) 110 000-295 000], enteropathogenic E. coli 79 000 (UR 31 000-146 000), calicivirus 71 000 (UR 39 000-113 000), and enterotoxigenic E. coli 42 000 (UR 20 000-76 000) deaths. Rotavirus, calicivirus, enteropathogenic and enterotoxigenic E. coli cause more than half of all diarrheal deaths in children <5 years in the world.