Hampering behaviors in a pioneer argentinean PBL medical curricular change / Conductas obstaculizadoras en un cambio curricular médico PBL argentino pionero

This communication records a series of obstructive behaviors not specified bibliographically detected in planners and/or executors from 2002 in a pioneering Argentine PBL medical curricular change. The results obtained were extracted mainly from the author's experience during his participation as a teacher in this process and from some related experiences recorded later in other Argentine medical schools that also develop curricular changes. In addition, he points to other design and implementation caveats not considered in a timely manner that negatively influenced that transformation. To date, unfortunately, all of this has contributed to the failure to meet the great expectations placed on it. This report may be useful for planners and implementers who pursue a successful PBL curriculum change by showing that, beyond the best intentions in this regard, particular behaviors, some of them linked to the human condition, can hinder its design and implementation. practice.

Esta comunicación registra una serie de conductas obstaculizadoras no especificadas bibliográficamente detectadas en planificadores y/o ejecutores a partir de 2002 en un cambio curricular médico PBL argentino pionero. Los resultados obtenidos se extrajeron principalmente de la experiencia del autor durante su participación como docente en este proceso y de algunas experiencias relacionadas registradas posteriormente en otras facultades de medicina argentinas que también desarrollan cambios curriculares. Además, señala otras advertencias de diseño e implementación no consideradas de manera oportuna que influyeron negativamente en esa transformación. Hasta la fecha, lamentablemente todo ello ha contribuido a que no se alcancen las grandes expectativas puestas en él. Este informe puede resultar útil para los planificadores e implementadores que persiguen un cambio curricular exitoso del ABP al evidenciar que, más allá de las mejores intenciones al respecto, comportamientos particulares, algunos de ellos vinculados a la condición humana, pueden dificultar su diseño y puesta en práctica.

Profesor Doctor Aníbal Humberto Daniel Castañé Decoud: un catedrático asunceno de prolongada gestión institucional / Professor Doctor Aníbal Humberto Daniel Castañé Decoud: a paraguayan professor with prolonged institutional management

Así como la memoria institucional permite valorar hechos rescatables y evitar pasados errores, la trayectoria académica, imitando la vida misma, sobrelleva tiempos apacibles y tormentosos. En este contexto, y cercanos al centenario de nuestra Facultad y de las tradicionales Cátedras de Anatomía Normal e Histología y Embriología, fue emprendida la tarea de evocar a quienes asumieron sucesivamente la máxima responsabilidad en esta última desde 1920 hasta mediados de los 70s. De esta manera, este artículo concluye con tal saga biográfica haciendo foco en el Profesor Doctor Aníbal Humberto Daniel Castañé Decoud, el catedrático asunceno quien, merced a su desempeño académico, pudo enfrentar y superar variados desafíos durante su prolongada gestión (AU)

As well as the institutional memory allows appreciating ancient facts and avoiding past faults, the academic trajectory, as life by itself, undergoes calm and turbulent times. Within this context, and close to the centenary of our Faculty and the ensuing traditional Chairs of Normal Anatomy and Histology and Embryology, a remembrance of those professors who successively assumed the highest responsibility in the latter one from 1920 to mid-70s was carried out. In this way, this article concludes that biographic saga focusing on Professor Doctor Aníbal Humberto Daniel Castañé Decoud, the Paraguayan professor who, endowed by his academic background, could face and overcome varied challenges during his prolonged management (AU)

Doctor Tomás Ocaña. Una trayectoria prolífica en años turbulentos / Doctor Tomás Ocaña, a prolific trajectory in turbulent years

Excediendo el contexto polémico que signó la trayectoria académica del Dr. Tomás Ocaña, este trabajo evoca su prolífica carrera en años turbulentos, preñados de divisiones y desencuentros, nada inusuales en nuestro país. Marginando cualquier improcedente apasionamiento, se considera que su paso por una Facultad y una Cátedra, próximas ambas a cumplir su Centenario, no puede ser ignorado.

Exceeding the controversial context signing Tomas Ocaña academic performance, this paper recalls his prolific career in troubled years, full of divisions and misunderstandings, nothing unusual in our country. Leaving aside any unruly passion, his passing through a Faculty and a Cathedra, both near to become centenaries, cannot be ignored.

Theoretical and behavioral features to be considered when planning and implementing a pbl curriculum.

This work complements former articles about an Argentinean PBL curriculum after twelve years of development. In this context, it points out determined inflexible features linked to its theoretical-pedagogical basis and certain counter-productive behaviors detected in some planners, teachers and students during its design and/or enduring implementation. Hence, reflections are made on learning and adult learning (andragogy) theories. Furthermore, related questions and some aspects to be overcome are presented and analyzed. In this way, it also intends to honestly and responsibly warn well-trained curriculum planners and executors to be cautious when choosing and managing learning theories. Likewise, it complementarily highlights the need of refocusing teachers that, pretending to be forward-looking ones, end up harming what at first proclaimed to benefit: the students.

Características e impacto del flujo aéreo en las bronquiectasias: una aproximación informática en ratas / Characteristics and impact of air flow in bronchiectasis: an informatics approach in rats / Características e impacto do fluxo aéreo nas bronquiectasias: uma aproximação informática em ratas

Las bronquiectasias, resultado final de distintas enfermedades, no constituyen una enfermedad en sí. Ampliando un estudio previo sobre bronquiectasias congénitas en ratas de laboratorio y dada su predominante localización en las post-bifurcaciones del árbol bronquial, aplicamos programas numéricos simuladores del comportamiento de flujos aéreos sobre bronquiectasias murinas, pues dicha localización podría influir sobre sus comportamientos cinemático y dinámico y sobre las características de la pared bronquial, e impactar, asimismo, en la producción y en el desarrollo de bronquiectasias. Se obtuvieron moldes de acrílico del árbol bronquial después de la inyección de una sustancia plástica en quince ratas macho Wistar de seis meses de edad. Bajo lupa estereoscópica (6 a 40 x), mediante compases de doble punta y calibres, se midió la longitud y el diámetro de las dilataciones respectivamente. Para los elementos más pequeños, se usaron grillas oculares. Los datos de las muestras, luego de obtenidos los respectivos modelos tridimensionales y discretización, se incorporaron al programa Comsol®, basado en el Método de Elementos Finitos. La interacción entre los remolinos detectados y las consiguientes presiones zonales y zonas muertas con aire estancado referidas, conformarían un círculo vicioso, que facilitaría la formación y el desarrollo de bronquiectasias, pudiendo agravar las eventuales sobre-infecciones que se dieren...

Bronchiectasia, the final result of different illnesses is not an illness in itself. Expanding on a previous study on congenital bronchiectasia in laboratory rats and considering that they locate mostly in the post-bifurcations of the bronchial tree, numerical programs, simulators of airflow behaviour, were applied for evaluating it cinematically and dynamically. Likewise its impact on the characteristics of the bronchial wall and consequently on the generation and development of bronchiectasia were analyzed. Acrylic casts of bronchial trees were obtained after injection in 15 male Wistar rats at 6 months of age. Under a stereoscopic microscope (6x to 40x), the lengths and diameters of bronchiectasia were measured with double point compasses and callipers, respectively, and ocular grids for the smaller structures. The sample data once tridimensionally modelled and discretized was subsequently incorporated into a Comsol® program, based on the Finite Element Method. The interaction among detected vortex, and the referred zone pressures and dead zones with still air could render a vicious cycle, making possible not only the generation and development of bronchiectasia but also the aggravation of eventual pre-existing super infections...

As bronquiectasias, resultado final de diferentes doenças, não constituem uma doença em si. Ampliando um estudo prévio sobre bronquiectasias congênitas em ratas de laboratório e dadas sua predominante localização nas pós-bifurcações da árvore brônquica, aplicamos programas numéricos simuladores do comportamento de fluxos aéreos sobre bronquiectasias murinas, pois dita localização poderia influir sobre seus comportamentos cinemáticos e dinâmicos e sobre as características da parede brônquica, e impactar, assim mesmo, na produção e no desenvolvimento de bronquiectasias. Obtiveram-se moldes de acrílico da árvore brônquica depois da injecção de uma substância plástica em quinze ratas macho Wistar de seis meses de idade. Sob lupa estereoscópica (6 a 40 x), mediante compassos de dupla ponta e calibres, mediu-se a longitude e o diâmetro das dilatações respectivamente. Para os elementos menores, usaram-se grillas oculares. Os dados das mostras, depois de obtidos os respectivos modelos tridimensionais, incorporaram-se ao programa Comsol ®, baseado no Método de Elementos Finitos. A interação entre os redemoinhos detectados e as conseguintes pressões zonais e zonas mortas com ar estancado referidas, conformariam um círculo vicioso, que facilitaria a formação e o desenvolvimento de bronquiectasias, podendo agravar as eventuais sobre-infecções que se derem...

Hemorheologic changes in type 2 diabetic patients with microangiopathic skin lesions. A linear discriminant categorizing analysis.

The development of diabetic microangiopathy may produce lesions in distinct organic territories (the skin, among others). With an intention of identifying hemorheologic variables for a better characterization of diabetic patients, we studied plasmatic and blood viscosities (P Visc at 2.30 s(-1) and B Visc at 4.60 and 230 s(-1)), fibrinogenemia, and erythrocytic aggregation in 40 type 2 diabetic patients (13 with microangiopathic skin lesions and 27 without) and in 30 healthy controls. Considering its alterations in diabetic patients and applying linear discriminant analysis, two models may be characterized: (a) discriminant function (Disc F)=0.58 aggregate shape parameter (ASP)-0.61 B Visc(230)+0.89 fibrinogenemia for discriminating healthy individuals from diabetic patients with microangiopathic skin lesions and (b) Disc F=6.325 ASP-0.347 B Visc(230)+0.013 fibrinogenemia for discriminating healthy controls from diabetic patients with and without microangiopathic skin lesions. Both models appear to be valid due to the following: (a) Model 1: a coefficient of canonic correlation of 0.924, a highly significant Mahalanobis distance (P<10(-3)), a correct percentage of classification (100%), and the centroids of each group (0.94 and 5.63); (b) Model 2: a coefficient of canonic correlation of 0.898, a highly significant Mahalanobis distance (P<10(-3)), a correct percentage of classification (85.7%), and the centroids of each group (-1.9, 1.9, and 2.4). Just as the alterations in the analyzed hemorheologic variables could be suggesting their possible involvement in the physiopathogenia of diabetic microangiopathic skin lesions, the proposed models could characterize a microcirculatory profile in diabetic patients for preventing irreversible damages.

La atención primaria de la salud y la especialización médica: ¿Categorías opuestas o complementarias? / Primary care and medical specialization: Complementary or mutually exclusive categories?

Fundamentos y Objetivos: Las conclusiones de Juan César García sobre especialización a fines de los 60s condujeron a describir aspectos actuales de la especialización; ampliarlos y cotejarlos con aquéllas e indagar las expectativas de los alumnos por ejercer o no en niveles de la Atención Primaria de la Salud – APS-) y su porqué. Material y Métodos: Para ello, fueron combinados métodos cualitativos y cuantitativos en ingresantes, alumnos avanzados y médicos. Resultados y Discusión: Entre ambas épocas, aumentó la intención por especializarse para el sistema de atención vigente (de 52 a 74 % en los ingresantes y de (..) (AU)

Background and Objectives: Juan César Garcia’s conclusions on specialization, reported in the late nineteen sixties, encouraged researchers to broaden their area of study and to investigate students ‘expectations regarding the practice of primary care. Material and Methods: Qualitative and quantitative methods were used to assess the attitudes of new students, advanced undergraduates and postgraduates regarding primary care and specialization (..) (AU)

Implementing a problem-based learning curriculum in an Argentinean medical school: implications for developing countries.

The authors review the difficulties that Argentina's medical schools, particularly the public ones, are likely to face when implementing a problem-based learning (PBL) curriculum, describe the barriers that were faced by their medical school as it implemented PBL, and point out the implications for medical education in developing countries with conditions and education programs similar to those in Argentina. Specifically, they (1) outline the basic requirements for successful implementation of a PBL curriculum, (2) describe the training contradiction in Argentina between a complex and heterogeneous health care system that forces specialization and medical schools' attempts to train generalists, and (3) review the effects on curriculum change of the size and the training levels of the student population and the availability of human and financial resources. This information indicates the context in which the Rosario University School of Medicine designed a new PBL curriculum and implemented it in 2002. The authors close by suggesting that schools in developing countries that are in circumstances similar to that of Rosario should consider whether a PBL curriculum is even appropriate for them, and should realize the difficulties (discussed in the article) they will have to overcome. Also, uncertainties about the efficacy of PBL create a case for exploring alternatives to PBL, including hybrid curricula. Considering the available research on curricular innovations such as PBL and the particular situations of their countries may help schools anywhere avoid wrong decisions about what curricula to implement.

Deserción intracurso en el primer año de la carrera médica / Student defection during the first trimester of the first year in the medical career

Dada la importancia de la deserción por sus repercusiones personales (en el alumno), institucionales (en la Facultad y Universidad) y sociales y sus elevados costos psicológicos y económicos, el presente trabajo analiza causas de deserción intracurso en el primer trimestre del primer año de la carrera médica, en una población masiva de ingreso irrestricto; coteja los datos registrados con otros recopilados en poblaciones acotadas y propone distintas alterantivas, susceptibles de representar salidas paliativas o soluciones de fondo. 116 ex-alumnos fueron citados por correo. Los 42 que respondieron voluntariamente a la convocatoria fueron entrevistados en forma individual mediante una ficha-encuesta. Esta, recabó información: (a) idenficatoria; (b) socioeconómico-cultural; (c) educacional y (d) causal de deserción. A. Las principales causas de deserción intracurso en el primer trimestre en esta muestra poblacional de ingreso irrestricto fueron: (a) Falta de tiempo por trabajo: 28%; (b) Insatisfacción de expectativas: 24% y (c) Inadaptación al proceso de enseñanza-aprendizaje: 12%. B. En épocas de ingreso acotado (1977-78-79) y contabilizando el promedio de los tres años, las causas salientes fueron: (a) Déficit vocacional: 32% (b) Falta de tiempo por trabajo: 22% y (c) Problemas familiares: 9%

Información y formación en las escuelas de medicinas / Information and education in medical schools

El presente trabajo redefine el valor de los términos: información-formación en las Escuelas de Medicina; analiza su adquisición y manejo actuales (caracterizando los rasgos esenciales a ser superados) y realiza propuestas conceptuales (subrayando las facetas superadoras) e instrumentales (enunciando las líneas de acción para concretarlas) para su optimización. Se hacen particular hincapié en aspectos formativos como el estudio independiente; la descripción; el trabajo individual y grupal y diagnóstico y toma de decisión (con grado de incertidumbre). En cada uno de ellos se remarcan las aptitudes integradoras que concurren a su dominio