Análisis del éxito de las números uno en la prueba MIR de 2022 y 2023. El impacto de la preparación y el efecto del azar / Analysis of the success of the highest scoring candidates in Spain’s Resident Medical Intern (MIR) examinations of 2022 and 2023. The impact of preparation and the effect of serendipity

Introducción: El examen de médico interno residente (examen MIR) es la prueba que permite el acceso a la formación médica especializada en España. Su objetivo es distribuir las plazas disponibles para las diferentes especialidades médicas entre los graduados en Medicina, teniendo en cuenta para ello tanto su expediente como los resultados de la prueba. La realización de un examen de test tiene un cierto componente de aleatoriedad.Objetivos: Analizar el rendimiento de las números uno de las convocatorias de 2021-2022 y 2022-2023 a lo largo de su preparación, así como conocer qué resultados podrían obtener en caso de que repitieran el mismo examen un millón de veces. Material y métodos: Se hizo uso de la información relativa al rendimiento de los estudiantes que prepararon las pruebas con cursos intensivos MIR Asturias, así como de los principios de la teoría de respuesta al ítem.Resultados. En 11 (33,3%) y 14 (42,4%) de las 33 pruebas realizadas a lo largo de la preparación, las números uno se clasificaron entre los 10 primeros. A partir de las simulaciones de las pruebas MIR de 2022 y 2023, se obtuvo que la primera clasificada de 2022 quedaría entre los 185 primeros de la prueba, y la de 2023, entre los 92 primeros.Conclusiones: Para obtener un número de orden entre los primeros clasificados es necesario disponer de un ability elevado, el cual se consigue a través de una preparación sólida. Además, el azar tiene un cierto nivel de influencia sobre los resultados de los opositores presentados a la prueba.(AU)

Introduction: The MIR exam is the test that allows access to specialized medical training in Spain. Its objective is to distribute the available places for the different medical specialties among Medicine graduates, taking into account both their record and the results of the test. Taking a test exam has a certain element of randomness.Objectives: Analyze the performance of the number ones of the 2021-2022 and 2022-2023 calls throughout their preparation, as well as know what results they could obtain if they repeated the same exam one million times. Material and methods: Information related to the performance of the students who prepared the tests with MIR Asturias Intensive Courses was used, as well as the principles of item response theory.Results. In 11 (33.3%) and 14 (42.4%) of the 33 tests carried out throughout the preparation, number one was classified among the top 10. From the simulations of the 2022 and 2023 MIR tests, it was obtained that the first classified in 2022 would be among the top 185 in the test and in 2023 among the top 92. Conclusions: To obtain an order number among the first classified it is necessary to have a high ability, which is achieved through solid preparation. In addition, randomness has a certain level of influence on the results of the opponents presented to the test.(AU)

Estudio psicométrico de la prueba MIR de 2022 / Psychometric analysis of the 2022 MIR test

Introducción: En España, para ejercer como especialista de cualquier especialidad médica es necesario tener la titulación correspondiente. Para poder acceder a la formación como especialista es obligatorio superar la prueba MIR. En este artículo se ha realizado un análisis psicométrico de la prueba MIR de 2022, celebrada en enero de 2023, utilizando tanto la teoría clásica de los test como la teoría de respuesta al ítem. Material y métodos: Se hizo uso de un subconjunto formado por 3.229 médicos que se presentaron a la prueba MIR de 2022 y que introdujeron su plantilla de respuestas en una aplicación informática puesta a su disposición para tal efecto. Los datos se analizaron mediante la teoría clásica de los test y la teoría de la respuesta al ítem. Concretamente, se calcularon el alfa de Cronbach, la fórmula número 21 de Kuder y Richardson, el índice de dificultad, el índice de dificultad con corrección de los efectos del azar, el índice de discriminación, el índice de correlación biserial puntual, así como los índices de dificultad y discriminación según la teoría de respuesta al ítem. Resultados: La prueba MIR de 2022, al igual que las de años anteriores, presenta una alta fiabilidad. Se analizan tanto los resultados globales de la prueba como detallados por asignaturas y bloques de asignaturas. Conclusión: Los resultados obtenidos en el presente estudio permiten afirmar que el examen MIR es un examen objetivo, de dificultad y discriminación adecuadas, así como relativamente estable de una convocatoria a otra.(AU)

Introduction: In Spain, to practice as a specialist in any medical specialty, it is necessary to have the corresponding qualification. In order to access training as a specialist, it is mandatory to pass the MIR test. In this article, a psychometric analysis of the 2022 MIR test, held in January 2023, has been carried out using both classical test theory and item response theory. Materials and methods: A subset made up of 3,229 doctors who took the MIR test in 2022 and who entered their response template in a computer application made available for this purpose. Data were analyzed using classical test theory and item response theory. Specifically, Cronbach's alpha, Kuder and Richardson's formula number 21, the difficulty index, the difficulty index corrected for chance effects, the discrimination index, the biserial-point correlation index, as well as the difficulty and discrimination indices according to item response theory were calculated. Results: The 2022 MIR test, like those of previous years, shows high reliability. Both the overall results of the test and those detailed by subjects and subject blocks are analyzed. Conclusion: The results obtained in this study allow us to affirm that the MIR exam is an objective exam, of adequate difficulty and discrimination, as well as relatively stable from one call to another.(AU)

Estudio psicométrico de las pruebas MIR de 2020 y 2021 / Psychometric study of the MIR tests of 2020 and 2021

Introducción: En España, el ejercicio de cualquier especialidad médica exige disponer del título de especialista. El acceso a la formación como especialista se realiza a través de la prueba MIR. Esta prueba es obligatoria para poder optar a una plaza de formación en cualquier especialidad médica. El presente artículo realiza un estudio psicométrico tanto a través de la teoría clásica de los test como de la teoría de la respuesta al ítem de las pruebas MIR de 2020 y 2021 (de 175 y 200 preguntas, respectivamente).Material y métodos.La base de datos utilizada en el presente trabajo contiene las respuestas de un total de 4.810 opositores que se examinaron en 2020 y 3.888 que lo hicieron en 2021. La información disponible se analizó haciendo uso de indicadores como el alfa de Cronbach, la fórmula número 21 de Kuder y Richardson, el índice de dificultad, el índice de dificultad con corrección de los efectos del azar, el índice de discriminación, el índice de correlación biserial puntual, así como los índices de dificultad y discriminación según la teoría de respuesta al ítem.Resultados.Las pruebas MIR de 2020 y 2021 presentan una alta fiabilidad, con variaciones pequeñas de un año a otro en el comportamiento de las distintas asignaturas y bloques de preguntas en lo relativo a los índices utilizados en el presente estudio.Conclusiones.Los resultados obtenidos en el presente estudio permiten afirmar que el examen MIR es un examen objetivo, de dificultad y discriminación adecuadas, así como estable de una convocatoria a otra. (AU)

Introduction: In Spain, in order to practise any medical speciality, it is necessary to have qualified as a specialist. Access to training as a specialist is gained through the MIR test. This test is mandatory to qualify for a training position in any medical specialty. This article carries out a psychometric study of the 2020 and 2021 MIR tests (with 175 and 200 questions, respectively) through both the classical test theory and the item response theory.Material and methods.The database used in this study contains the responses from a total of 4,810 individuals who took the exam in 2020 and 3,888 who did so in 2021. The information available was analysed using indicators such as Cronbach's alpha, the formula number 21 of Kuder and Richardson, the difficulty index, the difficulty index corrected for random effects, the discrimination index and the point biserial correlation index. The difficulty and discrimination indices were also used, according to item response theory.Results.The MIR tests of 2020 and 2021 present high reliability, with only slight variations from one year to another in the behaviour of the different subjects and question blocks in terms of the indices used in the present study.Conclusions.The results obtained in the present study allow us to affirm that the MIR exam is objective, of appropriate difficulty and discrimination, as well as stable from one year to another. (AU)

Resultados obtenidos en la prueba MIR de 2021, según nacionalidad y baremo académico / Results obtained in the 2021 MIR test according to nationality and academic scale

Introducción: En España, el acceso a la formación médica especializada se hace a través de la prueba MIR. Esta prueba la convocan anualmente desde 1978 los Ministerios de Sanidad, y Educación y Formación Profesional. Así, teniendo en cuenta tanto el resultado que se obtiene en la prueba como el baremo promedio del grado, se asigna un número de orden a los médicos que quieren acceder a una plaza de formación como especialistas. El objetivo de este trabajo es el análisis de los resultados obtenidos por los médicos que se presentaron a la prueba de 2021 en función de su baremo académico y de si son españoles o extranjeros.Materiales y métodos.Para esta investigación se ha hecho uso de la información oficial pública relativa al baremo académico, la nacionalidad y los resultados obtenidos en la prueba por todos los aspirantes presentados a ella.Resultados.Entre los 5.000 primeros números de orden se situaron el 90,61% de los médicos presentados con un baremo de sobresaliente, el 79,59% de los baremos de notable igual o superior a 8, el 42,21% de los baremos de notable inferior a 8 y únicamente un 7,16% de los médicos con baremo de aprobado.Conclusiones.Este estudio confirma que existe una relación directa entre el baremo de los médicos aspirantes a una plaza de formación médica especializada y el resultado que obtienen en la prueba MIR, más allá de la ponderación de éste sobre la nota final de la prueba MIR. (AU)

Introduction: In Spain, access to specialized medical training is done through the MIR test. This test is convened annually since 1978 by the Ministries of Health and Education and Vocational Training. Thus, taking into account both the result obtained in the test and the average degree scale, an order number is assigned to doctors who want to access a training position as specialists. The objective of this work is the analysis of the results obtained by the doctors who took the 2021 test based on their academic scale and whether they are Spanish or foreign.Materials and methods.For this research, the official public information regarding the academic scale, nationality and the results obtained in the test by all the applicants presented to has been employed.Results.The 90.61% of those doctors that obtained in their degrees an average mark of 9 or more can be found among the 5,000 first order numbers, the same happen to the 79.59% of those who obtained a mark from 8 to 8.99, the 42.21% of those with a mark from 7 to 7.00 and only the 7.16% of those doctors with an average mark in their degrees under 7.Conclusions.This study confirms that there is a direct relationship between the marks obtained in their degree of doctors aspiring to a specialized medical training position and the result they obtain in the MIR test, beyond the weighting of this on the final grade of the MIR test. (AU)

Análisis psicométrico de las preguntas repetidas en los simulacros de la prueba MIR / Psychometric analysis of the questions repeated in the MIR test mockups

Introducción: El presente trabajo analiza 13 preguntas que se repitieron dos veces en distintas pruebas que simulan el examen MIR, separadas en el tiempo entre dos y 15 semanas. A partir de los resultados obtenidos, se ha analizado el proceso de aprendizaje de los estudiantes que se preparan para la prueba MIR.Material y métodos.Para el presente estudio se hizo uso de una base de datos formada por un total de 2.600 preguntas respondidas en promedio por 1.585 alumnos de características relativamente homogéneas.Resultados.En general, resulta posible afirmar que entre la primera y la segunda exposición de los alumnos a la misma pregunta se produjo una mejora de los índices analizados. De los resultados obtenidos, se observa que, en promedio, a lo largo de la preparación, la dificultad de las preguntas para el grupo de estudiantes se reduce a la mitad. En lo referente al índice de discriminación, éste se incrementa cerca del 60%, lo que supone que, según transcurre la preparación, aumenta la proporción de personas que aciertan la pregunta en el grupo fuerte con respecto a las que la aciertan en el grupo débil. Finalmente, también se produce una mejora en el valor del coeficiente de correlación biserial puntual, lo que supone una mejora de la capacidad discriminativa de las preguntas.Conclusiones.Según transcurre la preparación, las preguntas analizadas se vuelven más fáciles y más discriminativas. Además, se observa cómo no todos los alumnos consiguen el mismo aprovechamiento del proceso de aprendizaje. (AU)

Introduction: The present work analyses 13 questions that were repeated twice in different tests that simulate the MIR exam, separated in time between 2 and 15 weeks. From the results obtained, the learning process of the students preparing for the MIR test has been analysed.Material and methods.For the present study, a database made up of a total of 2,600 questions which were answered on average by 1,585 students with relatively homogeneous characteristics was employed.Results.In general, it is possible to affirm that between the first and second exposure of the students to the same question there was an improvement in the indexes analysed. From the results obtained, it is observed that, on average, throughout the preparation, the difficulty of the questions for the group of students is reduced by half. Regarding the discrimination index, this increases by about 60%, which means that as the preparation progresses, the proportion of people who get the question right in the strong group increases with respect to those who get it right in the weak group. Finally, there is also an improvement in the value of the biserial point correlation coefficient, which implies an improvement in the discriminative capacity of the questions.Conclusions.As the preparation progresses, the analysed questions become easier and discriminating. In addition, it is observed how not all students obtained the same performance. (AU)

Usefulness of circulating microRNAs miR-146a and miR-16-5p as prognostic biomarkers in community-acquired pneumonia.

INTRODUCTION: Patients with community-acquired pneumonia (CAP) undergo a dysregulated host response that is related to mortality. MicroRNAs (miRNAs) participate in this response, but their expression pattern and their role as biomarkers in CAP have not been fully characterized. METHODS: A prospective observational study was performed in a cohort of 153 consecutive patients admitted to hospital with CAP. Clinical and analytical variables were collected, and the main outcome variable was 30-day mortality. Small RNA was purified from plasma of these patients obtained on the first day of admission, and miRNA expression was analyzed by RT-PCR. Univariate and multivariate analyses were carried out through the construction of a logistic regression model. The proposed model was compared with established prognostic clinical scales using ROC curve analysis. RESULTS: The mean age of the patients included was 74.7 years [SD 15.9]. Their mean PSI was 100.9 [SD 34.6] and the mean modified Charlson index was 2.9 [SD 3.0]. Both miR-146a and miR-16-5p showed statistically significant association with 30-day mortality after admission due to CAP (1.10 vs. 0.23 and 51.74 vs. 35.23, respectively), and this association remained for miR-16-5p in the multivariate analysis adjusted for age, gender and history of bronchoaspiration (OR 0.95, p = 0.021). The area-under-the-curve (AUC) of our adjusted multivariate model (AUC = 0.954 95%CI [0.91-0.99]), was better than those of prognostic scales such as PSI (AUC = 0.799 [0.69-0.91]) and CURB-65 (AUC = 0.722 [0.58-0.86]). CONCLUSIONS: High levels of miR-146a-5p and miR-16-5p upon admission due to CAP are associated with lower mortality at 30 days of follow-up. Both miRNAs could be used as biomarkers of good prognosis in subjects hospitalized with CAP.

The MIR 2018 Exam: Psychometric Study and Comparison with the Previous Nine Years.

Background and Objectives: The aim of the present research is to study the questions used in the 2018 MIR exam (a test that allows access to specialized medical training in Spain), describe their psychometric properties, and evaluate their quality. Materials and Methods: This analysis is performed with the help of classical test theory (CTT) and item response theory (IRT). The answers given to the test questions by a total of 3868 physicians are analyzed. Results: According to CTT, the average difficulty index for all of the test questions was 0.629, which falls into the acceptable category. The average difficulty index with correction for random effects was 0.515, which corresponds to a value within the optimal range. The mean discrimination index was 0.277, which is in the good category, while the mean point biserial correlation coefficient, with a value of 0.275 fits in the regular category. The values of difficulty and discrimination calculated according to the model of two parameters of the IRT seem adequate with average values of -0.389 and 0.677. The Cronbach alpha score obtained for the overall test was 0.944. This value is considered as very good. Conclusions: A decrease was observed in the average values of discrimination in the last three calls, which may be related to the greater proportion of Spanish graduates that take the exam in the same year of finalization of their studies in Medicine.

Estudio del porcentaje de neutrófilos y el cociente de neutrófilos-linfocitos como marcadores pronósticos en pacientes hospitalizados por neumonía adquirida en la comunidad / Neutrophil Count Percentage and Neutrophil-Lymphocyte Ratio as Prognostic Markers in Patients Hospitalized for Community-Acquired Pneumonia

Introducción: La neumonía adquirida en la comunidad (NAC) es una infección frecuente y grave. El objetivo de este trabajo es estudiar la utilidad pronóstica del porcentaje de neutrófilos (NCP) y del cociente neutrófilos/linfocitos (NLR) en pacientes con NAC. Métodos: Estudio retrospectivo de pacientes hospitalizados por NAC con analítica al ingreso y una segunda extracción de control a los 3-5 días. Se consideraron variables desenlace la mortalidad a 30 y 90 días. Resultados: Se incluyó a 209 pacientes. Los pacientes que sobrevivieron redujeron significativamente el NCP y el NLR entre la analítica al diagnóstico y la de control (desde el 85,8 hasta el 65,4% para NCP y de 10,1 a 3,2 para NLR). Fallecieron 25 pacientes en los primeros 90 días. En ellos hubo un menor descenso no significativo para el NCP (del 84,8 al 74,0%) y para NLR (de 9,9 a 6,9). Los valores de NCP y NLR en la analítica de control fueron significativamente mayores en los pacientes fallecidos que en los supervivientes. Aquellos pacientes que presentaron en la analítica de control un NCP superior al 85% o un NLR superior a 10, presentaron un riesgo de mortalidad superior tras ajuste multivariable (HR para NCP 12 y para NLR 6,5). Conclusión: NCP y NLR son parámetros sencillos y de bajo coste, con utilidad pronóstica especialmente al medirse a los 3-5 días del diagnóstico de NAC. Niveles altos de NLR o NCP se asocian con mayor riesgo de mortalidad a los 90 días

Introduction: Community-acquired pneumonia (CAP) is a common serious infection. This study aimed to evaluate the prognostic utility of neutrophil count percentage (NCP) and neutrophil-lymphocyte ratio (NLR) in patients with CAP. Methods: Retrospective study of hospitalized patients with CAP. Patients had a blood test at admission and 3-5 days after hospitalization (early-stage test). The main outcome variables were 30-day and 90-day mortality. Results: Two hundred and 9 patients were included. Patients who survived had significant reductions in both NCP and NLR between admission and the day 3-5 blood tests (from 85.8% to 65.4% for NCP and from 10.1 to 3.2 for NLR). Twenty-five patients died in the first 90 days. Patients who died had lower, non-significant reductions in NCP (from 84.8% to 74%) and NLR (from 9.9 to 6.9) and significantly higher early-stage NCP and NLR than those who survived. NCP values higher than 85% and NLR values higher than 10 in the early-stage blood test were associated with a higher risk of mortality, even after multivariate adjustment (HR for NCP: 12; HR for NLR: 6.5). Conclusion: NCP and NLR are simple, low-cost parameters with prognostic utility, especially when measured 3-5 days after CAP diagnosis. High NLR and/or NCP levels are associated with a greater risk of mortality at 90 days

Neutrophil Count Percentage and Neutrophil-Lymphocyte Ratio as Prognostic Markers in Patients Hospitalized for Community-Acquired Pneumonia. / Estudio del porcentaje de neutrófilos y el cociente de neutrófilos-linfocitos como marcadores pronósticos en pacientes hospitalizados por neumonía adquirida en la comunidad.

INTRODUCTION: Community-acquired pneumonia (CAP) is a common serious infection. This study aimed to evaluate the prognostic utility of neutrophil count percentage (NCP) and neutrophil-lymphocyte ratio (NLR) in patients with CAP. METHODS: Retrospective study of hospitalized patients with CAP. Patients had a blood test at admission and 3-5 days after hospitalization (early-stage test). The main outcome variables were 30-day and 90-day mortality. RESULTS: Two hundred and 9patients were included. Patients who survived had significant reductions in both NCP and NLR between admission and the day 3-5 blood tests (from 85.8% to 65.4% for NCP and from 10.1 to 3.2 for NLR). Twenty-five patients died in the first 90 days. Patients who died had lower, non-significant reductions in NCP (from 84.8% to 74%) and NLR (from 9.9 to 6.9) and significantly higher early-stage NCP and NLR than those who survived. NCP values higher than 85% and NLR values higher than 10 in the early-stage blood test were associated with a higher risk of mortality, even after multivariate adjustment (HR for NCP: 12; HR for NLR: 6.5). CONCLUSION: NCP and NLR are simple, low-cost parameters with prognostic utility, especially when measured 3-5 days after CAP diagnosis. High NLR and/or NCP levels are associated with a greater risk of mortality at 90 days.

Correction: Inflammation biomarkers in blood as mortality predictors in community-acquired pneumonia admitted patients: Importance of comparison with neutrophil count percentage or neutrophil-lymphocyte ratio.

[This corrects the article DOI: 10.1371/journal.pone.0173947.].

Comparison between inferior vena cava ultrasound, lung ultrasound, bioelectric impedance analysis, and natriuretic peptides in chronic heart failure.

BACKGROUND: Heart failure (HF) is an important healthcare problem. Knowing volume status in outpatients with chronic HF to adjust treatment and to avoid decompensations is a challenge. The aim of this study is comparing the usefulness of inferior vena cava (IVC) ultrasound, lung ultrasound, bioelectrical impedance analysis (BIA), and natriuretic peptides in the follow-up of outpatients with chronic HF. METHODS: This was a prospective cohort study. Ninety-nine patients with chronic HF were included consecutively as they attended scheduled medical visits. The different techniques were performed on the day of the clinic visit, and the result was hidden from the patients and the responsible medical team. Follow-up time was 1 year. Outcome events checked were a combination of death or hospitalization, due to HF. RESULTS: Thirty-six patients (36.4%) died or were hospitalized for HF. They had a significantly lower IVC collapse, and a greater number of lung B-lines and higher NTproBNP levels compared to patients who remained stable. There were no differences in the BIA parameters. After multivariable analysis, cut-off points of IVC collapse <30%, number of pulmonary B lines greater than 5, and NTproBNP levels greater than 2000 pg/ml were associated with increased risk of HF death or admission. NTproBNP had the best area under the curve. CONCLUSION: Evaluation of congestion in outpatients with chronic HF may be based on NTproBNP, IVC ultrasound, or lung ultrasound; they are useful in identifying patients at high risk of hospitalization or death due to HF.

Evolución de los parámetros dificultad y discriminación en el ejercicio de examen MIR. Análisis de las convocatorias de 2009 a 2017 / Evolution of the difficulty and discrimination of the MIR test in recent years. A study of the calls since 2009 to 2017

Introducción: En España, el procedimiento reglado de acceso a la formación médica especializada tipo MIR exige la superación de un examen. El examen es un ejercicio tipo test de respuesta múltiple. Superado éste, se bareman los méritos académicos previos de los aspirantes. La ponderación de ambos valores permite sumarlos y ordenar a los aspirantes por su puntuación total. Los aspirantes tienen la oportunidad de elegir especialidad y centro de formación en función del número de orden obtenido. Sujetos y métodos: La base de datos utilizada en el presente trabajo contiene las respuestas de un total de 23.809 candidatos presentados a los exámenes MIR de las convocatorias comprendidas entre 2009 y 2017. La información disponible se analizó utilizando el índice de dificultad, índice de dificultad con corrección de los efectos del azar, índice de discriminación e índice de correlación puntual biserial, y las dificultades y discriminaciones se calcularon usando el modelo de dos parámetros de la teoría de respuesta al ítem. Resultados: Los resultados obtenidos en la serie temporal analizada permiten afirmar que la dificultad del examen ha disminuido en las tres últimas convocatorias. Además, la discriminación alcanza el valor mínimo en la convocatoria de 2016. Conclusiones: Dado el incremento en los últimos años del número de médicos españoles recién graduados que se presentan al examen, sería deseable mejorar la calidad psicométrica de las preguntas con el fin de que resulten al menos de la misma calidad como lo eran en los exámenes de convocatorias previas. La inclusión, por parte de la comisión calificadora, de criterios psicométricos de anulación de preguntas ayudaría a conseguir este objetivo

Introduction: In Spain, the regulated procedures of specialized medical training impose the passing of the MIR test. After this, the candidates choose the preferred specialty according to the order number obtained. The order number depends on the score of the applicant in the MIR exam and their academic record. Subjects and methods: The database used in the present research contains the responses of a total of 23,809 candidates submitted to the MIR exams since 2009 to 2017. The available information was analyzed using the difficulty index, difficulty index with correction of random effects, discrimination index, biserial point correlation index, as well as the difficulties and discriminations calculated using a two parameters model of the Item Response Theory. Results: The results obtained let us to say that the difficulty of the MIR test has decreased in the last three calls. In addition, the discrimination reaches the minimum value of the time series in the 2016 MIR test. Conclusions: Given the increase in recent years in the number of recently graduated Spanish doctors who take the MIR exam, it would be desirable to try to improve the psychometric quality of the questions in order to be at least as discriminative as the tests of previous calls. The inclusion by the committee of psychometric criteria of cancellation of questions would help achieve this objective

Usefulness of inferior vena cava ultrasonography in outpatients with chronic heart failure.

BACKGROUND: Inferior vena cava (IVC) ultrasonography has been used for the diagnosis and prognosis of acute heart failure (HF). Its usefulness in chronic HF is less known. HYPOTHESIS: IVC ultrasonography is a useful tool in the care of patients with chronic HF. METHODS: For this prospective cohort study, 95 patients with chronic HF were included consecutively as they attended scheduled medical visits. Ultrasound was done with a 5-MHz convex probe device, calculating IVC collapse index (IVCCI). Follow-up time was 1 year. Outcome events were worsening HF, hospital admission for HF, HF mortality, and all-cause mortality. RESULTS: Worsening HF occurred in 70.9% of patients with IVCCI <30% and 39.1% of patients with IVCCI >50%, with a hazard ratio (HR) of 2.8 (95% CI: 1.3-6.2) adjusted by multivariable analysis. Regarding hospitalization, 45.3% of patients with IVCCI <30% required admission, compared with 5.9% of patients with IVCCI >50%; the adjusted HR was 13.9 (95% CI: 1.7-113.0). Mortality was higher in the IVCCI <30% group, with 25.7% all-cause mortality and 18.6% HF mortality, whereas in the IVCCI >50% group these values were 13% and 4.7%, respectively. However, these differences did not reach statistical significance. ROC analysis was performed and the AUC for IVCCI was not higher than that for NTproBNP for any of the outcomes studied. CONCLUSIONS: IVC ultrasonography is a useful tool in follow-up of patients with chronic HF, allowing identification of patients at high risk of worsening and hospitalization. However, its usefulness is not higher than that of NTproBNP.

Aparato Digestivo: evolución de la elección de la especialidad en los últimos años / Gastroenterology - Evolution of specialty choice in recent years

Introducción: Aparato Digestivo es una de las especialidades ofertadas a los opositores que acceden a la formación sanitaria especializada cada año. Este proyecto analiza los datos de elección de Aparato Digestivo en los últimos años. Material y métodos: los datos de la elección se han obtenido de la publicación oficial de los actos de asignación de plazas del Ministerio de Sanidad, Servicios Sociales e Igualdad. Se ha recabado información de los distintos centros docentes a través de sus guías formativas, el Catálogo Nacional de Hospitales y la Organización Nacional de Trasplantes. Resultados: la mediana de elección de número de orden para Aparato Digestivo ha descendido anualmente, situando la especialidad en 2015 entre las cinco más populares en la elección. La mediana de los hospitales con mayor número de camas, actividad de trasplante hepático en adultos y Unidad de Sangrantes es significativamente menor. Lo mismo sucede al analizar los centros en base a la presencia de guardias específicas de Aparato Digestivo para residentes o vinculación con facultades de Medicina. Los datos de los últimos cinco años sitúan a Madrid, Aragón y Euskadi como las comunidades autónomas más populares. Los centros con menor mediana de número de orden para el periodo 2011-2015 fueron los hospitales universitarios Ramón y Cajal, Santiago de Compostela y Gregorio Marañón. Conclusiones: Aparato Digestivo ha ido mejorando de manera progresiva en la elección de plazas de especialización hasta llegar a situarse entre las cinco más populares. Los electores se decantan por centros grandes, de mayor complejidad asistencial y elevada actividad investigadora (AU)

Introduction: Gastroenterology is one of the medical specialties offered to residency training candidates each year. This project analyzes the data associated with the choice of a Gastroenterology residency program in recent years. Material and methods: Data related to specialty selection were obtained from official reports with regard to the allocation of residency places by the Spanish Ministry of Health, Social Services and Equality. Information was collected from various teaching centers via their training guides, the Spanish National Catalogue of Hospitals and the National Transplant Organization. Results: The median consecutive number involved in the choice of Gastroenterology training has decreased year after year, and this specialty is now positioned among the five most commonly selected residency programs in 2015. The median number of hospitals with a higher number of beds, adult liver transplantation activities and dedicated GI bleeding units is significantly lower. This is also true when centers are analyzed according to the presence of specific Gastroenterology on-call shifts for residents or their association with medical schools. Data from the past five years highlight Madrid, Aragón and the Basque Country as the autonomous communities where Gastroenterology is the most popular. Centers selected by candidates with the lowest median consecutive numbers from 2011-2015 included the university hospitals Ramón y Cajal, Santiago de Compostela and Gregorio Marañón. Conclusions: Gastroenterology has gradually escalated in the ranking of residency choices and is now one of the five most popular options. Potential residents prefer larger centers with complex-care patients and more research activity (AU)

Propuesta metodológica para la detección de preguntas susceptibles de anulación en la prueba MIR. Aplicación a las convocatorias 2010 a 2015 / A methodological proposal for questions that would be withdrawn from the MIR test. Applied to the exams from 2010 to 2015

Introducción. El Ministerio de Sanidad, Servicios Sociales e Igualdad de España convoca anualmente el examen de acceso a la formación sanitaria especializada. La comisión calificadora de esta prueba es la encargada de aprobar el cuaderno de preguntas de examen e invalidar las preguntas que considere improcedentes. El presente trabajo propone una metodología de ayuda a la detección de preguntas susceptibles de anulación basándose en métricas de la teoría clásica de los test y de la teoría de respuesta al ítem. Sujetos y métodos. Para la realización del presente trabajo se usaron las respuestas a las preguntas del examen MIR de muestras de un total de 13.984 examinados de las convocatorias comprendidas entre 2010 y 2015. Resultados. Se obtuvieron 26 preguntas que, sin haber sido anuladas, serían susceptibles de serlo en función de los valores obtenidos de sus coeficientes de correlación biserial puntual y de discriminación en el modelo logístico de dos parámetros. Conclusiones. Existe una serie de preguntas que no son anuladas y cuya pobre calidad psicométrica empeora ligeramente la calidad global de la prueba MIR. Dado que esta prueba se realiza con el fin de ordenar en función de sus conocimientos a los médicos que desean acceder a una plaza de formación especializada, desde el punto de vista de los autores, sería recomendable que la comisión calificadora anulase todas las preguntas que presentan una mala calidad psicométrica, aun a costa de que el número final de preguntas válidas fuera ligeramente inferior a 225 (AU)

Introduction. Every year, the Spanish Ministry of Health, Social Services and Equality convenes the examination for access to specialized medical health training. The Qualification Commission of the exam is responsible for approving the test questionnaire and withdrawing the questions they consider to be inappropriate. The present work proposes a methodology to help detect questions that might be withdrawn based on the metrics of the Classical Test Theory and the Item Response Theory. Subjects and methods. For the accomplishment of the present work, the answers given by a total of 13,984 examinees to the questions of the MIR exam have been analyzed, using the exams between 2010 and 2015. Results. The authors propose the removal of 26 questions which, whilst not having been withdrawn by the Qualification Commission, would be susceptible to withdrawal based on the values of their point-biserial correlation coefficients and on discrimination in the two-parameter logistical model. Conclusions. There are a number of questions that have not been withdrawn whose poor psychometric quality slightly reduces the overall quality of the MIR test. Given that this test is done in order to classify physicians who want to gain a specialized training place, from the authors’ point of view it would be advisable for the Qualification Commission to withdraw all questions that present poor psychometric quality, even at the cost of making the final number of valid questions slightly fewer than 225 (AU)

Gastroenterology - Evolution of specialty choice in recent years.

INTRODUCTION: Gastroenterology is one of the medical specialties offered to residency training candidates each year. This project analyzes the data associated with the choice of a Gastroenterology residency program in recent years. MATERIAL AND METHODS: Data related to specialty selection were obtained from official reports with regard to the allocation of residency places by the Spanish Ministry of Health, Social Services and Equality. Information was collected from various teaching centers via their training guides, the Spanish National Catalogue of Hospitals and the National Transplant Organization. RESULTS: The median consecutive number involved in the choice of Gastroenterology training has decreased year after year, and this specialty is now positioned among the five most commonly selected residency programs in 2015. The median number of hospitals with a higher number of beds, adult liver transplantation activities and dedicated GI bleeding units is significantly lower. This is also true when centers are analyzed according to the presence of specific Gastroenterology on-call shifts for residents or their association with medical schools. Data from the past five years highlight Madrid, Aragón and the Basque Country as the autonomous communities where Gastroenterology is the most popular. Centers selected by candidates with the lowest median consecutive numbers from 2011-2015 included the university hospitals Ramón y Cajal, Santiago de Compostela and Gregorio Marañón. CONCLUSIONS: Gastroenterology has gradually escalated in the ranking of residency choices and is now one of the five most popular options. Potential residents prefer larger centers with complex-care patients and more research activity.

Endocrinología y nutrición: evolución de la elección de la especialidad en los últimos años / Endocrinology and nutrition: Evolution of the choice of specialty in the last years

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