[The perception of ethics from the point of view of medical students]. / Percepción de lo ético desde el punto de vista de los estudiantes de medicina.

BACKGROUND: The present study was conducted to characterize the ethical environment in which medical students and internal are trained. The aim of this article is to identify the perception of ethics in medical students. METHODS: The instrument was constructed by pairs: the socially desirable and socially undesirable exploring 10 principles and 24 ethical values. Through rounds of experts the instrument was validated with 35 pairs with 70 statements. The internal consistency of the instrument with the coefficient of determination "r2" reached a "p" value of < 0.025. RESULTS: In the overall analysis to compare means, students gave higher scores than interns with "p" value of < 0.002. A comparison of the principal differences was found in seven of the ten principles explored and in three (freedom, honesty and solidarity) no differences were noted in the rate of perception of the ethics (RPE). The were statistically significant differences between groups with a "p" value of < 0.04 in which students perceive higher scores with interns. CONCLUSIONS: We conclude that learning environments are not prone to ethical reflection and changes depending on the degree in training in medical school, with a worse perception in greater degrees.

Introducción: el presente estudio se realizó con el propósito de caracterizar el ambiente ético en el que se forman los estudiantes de medicina y médicos internos. El objetivo de este estudio es conocer la percepción de lo ético en estudiantes de medicina. Métodos: se construyó un instrumento con duplas: lo socialmente deseable y lo socialmente no deseable, que exploran 10 principios y 24 valores éticos. A través de rondas de expertos se validó el instrumento que comprendió 35 duplas con 70 enunciados. La consistencia interna del instrumento con el coeficiente de determinación "r2" alcanzó una p < 0.025. Resultados: en el análisis global, al comparar las medias, los estudiantes dieron mayor puntuación que los médicos internos con una p < 0.002. En la comparación por principios, se encontraron diferencias en 7 de los diez principios explorados y en tres (libertad, honradez y solidaridad) no se encontraron diferencias en el índice de percepción de lo ético (IPE). Hubo diferencias estadísticas significativas entre ambos grupos con una p < 0.04 en donde los estudiantes la perciben con mejores puntuaciones que los internos. Conclusiones: se concluye que los ambientes de aprendizaje son poco propicios para la reflexión ética y que cambian dependiendo del grado académico de formación en la carrera de medicina, en donde a mayor grado peor percepción.

[Scope of two educational strategies to develop the clinical aptitude of the family physician]. / Alcance de dos estrategias educativas para desarrollar la aptitud clínica del médico familiar.

BACKGROUND: The evaluation of the clinical aptitude is expressed in challenging clinical situations and the scope of learning is conditioned by the quality of the educational strategy. The aim of this study was to value the scope of two different educational approaches, in order to develop the clinical aptitude of 20 family physicians. METHODS: Quasi experimental design, in which 20 general physicians in training process of Family Medicine were randomized: a teaching-centered strategy (TCS) was applied in 10, and a learning-centered strategy (LCS) in the remaining 10. The application of both strategies lasted 24 hours, and the same content was used on them. While applying TCS, it was employed an exposition with questions (which privileged the transmission of information). While implementing LCS, it was used discussion in small groups (which favored the point of view and the confrontation). To validate the evaluation, it was used the Kuder-Richardson formula 20, with a reliability of 0.91. RESULTS: Before the intervention, TCS group had a median of 124 and LCS group, 105 (p = 0.19). After the intervention, TCS group showed a median of 126, and LCS group of 156 (p = 0.012). Both groups were compared using Mann Whitney U, and the same subjects were also compared with the matched pairs Wilcoxon test. The differences were statistically significant, which it does not differ from earlier studies. CONCLUSION: The clinical aptitude reaches best development in the LCS when tested against TCS.

Introducción: la evaluación de la aptitud clínica se manifiesta en situaciones clínicas problematizadas y el alcance del aprendizaje depende de la cualidad de la estrategia educativa. El objetivo de este estudio fue valorar el alcance de dos enfoques educativos distintos, a fin de desarrollar la aptitud clínica del médico familiar. Métodos: diseño cuasi-experimental, en el que se sortean al azar veinte médicos generales en formación para Medicina Familiar: 10 quedan en estrategia educativa tradicional (EET) y 10 en estrategia educativa promotora de la participación (EEPP). Ambas estrategias se aplicaron durante 24 horas con el mismo contenido. En la EET se aplicó exposición con preguntas; en la EEPP discusión en pequeños grupos. El instrumento de evaluación validado tuvo una confiabilidad de 0.91 con la prueba 20 de Kuder-Richardson. Resultados: antes de la intervención, el grupo EET tuvo una mediana de 124 y el de EEPP, 105 (p = 0.19). Después, el grupo EET tuvo una mediana de 126 y el de EEPP una de 156 (p = 0.012). Se compararon ambos grupos con la prueba U de Mann Whitney. También se compararon los mismos sujetos antes y después de las intervenciones con la prueba de pares igualados de Wilcoxon. Las diferencias encontradas fueron estadísticamente significativas, lo cual no difiere de estudios previos. Conclusión: la aptitud clínica alcanzó mayor desarrollo en la EEPP al ser comparada con la EET.

[Ethics and teaching medicine. A principles declaration]. / Declaración de principios éticos del educador en medicina.

Medicine is an old profession, having existed for twenty-four centuries. The ethical principles assumed since the beginning and have been enriched through time, culture and tradition. The stone corner of the moral commitment of physicians with the patient and medical students has deteriorated due to a values crisis. This is due to a lack of personalized and humanized care in "altars of progress," characterized by fragmentation of medical care, excessive use of the technology and merchandizing of medicine, where profits is a priority over human need. The effects are unconsciousness and a lack of professional values, which are expressed as disloyalty, deficient solidarity, diminution of confidence, inequality and lack of honesty, affecting the patients and the whole medical relation. The problem also extends to medical education, when the students follow the same way to practice of physicians. To be a real educating physician in medicine implies an indissoluble educational symbiosis (teacher-student). When there is an ethical deterioration the immediate task is to propose alternative ethical and morals rules in medical education, which feed on values and traditional medicine principles.

[The educational reach of discussion in small groups. The role of the professor's differential experience]. / El alcance educativo de la discusión en pequeños grupos. Papel de la experiencia diferencial del profesor.

INTRODUCTION: The teachers' formation program at IMSS includes the methodological diplomate in teaching level I (DMDI) and level II (DMDII). This program is based in educational strategies that promote the participation (guide towards knowledge elaboration). The importance of discussion in small groups (subgroups) to increase learning has been showed as part of such strategies. OBJECTIVE: To evaluate the influence in learning of the professors' experience in coordinating the subgroup discussion. MATERIAL AND METHODS: Three groups of students were included (professors in teaching formation) that had consecutively studied the DMDI: DMDIa, DMDIb, and DMDIc. There was also included a group of DMDII whose students had participated in DMDI as coordinators of the subgroup discussion of DMDIb and DMDIc (DMDIa did not count with coordinators). Two instruments previously validated were used to evaluate the development of a position about education and scientific work (indicator of both: % of consequence). Evaluations were made at the beginning and end of each DMDI. RESULTS: Position in education: at the beginning DMDIa = 36; DMDIb = 30, DMDIc = 31, without differences among them (p 0.65). After the interventions the increases were: DMDIa from 36 to 75 (p < 0.01), DMDIb from 30 to 91 (p < 0.01), DMDIc from 31 to 90 (p < 0.01). When comparing the groups among themselves, differences were found between DMDIa and DMDIb, DMDIa and DMDIc, and no differences were found between DMDIb and DMDIc. Position about scientific work: at the beginning DMDIa = 20; DMDIb = 14; DMDIc = 15 (p. 0.35). After the interventions the increases were: DMDIa from 20 to 35 (p < 0.05); DMDIb from 14 to 53 (p < 0.02), DMDIc from 15 to 79 (p < 0.001). When comparing the groups among themselves, difference was found between DMDIb and DMDIc (p < 0.02) and from these two and DMDIa. DISCUSSION: The results support the hypothesis that the professor's experience in the coordination of subgroup discussion has a notorious influence in learning. The DMDIa group that did not have this support showed lower advances with both instruments. The DMDIb group that had coordinating professors with little experience had equivalent advances to DMDIc in position about education, and lower advances in the position about scientific work. The DMDIc group whose coordinating professors had a previous experience with the DMDIb group showed the greatest increases. Features of educational strategy promoting the participation are described as well as the importance of the experience of the professor in coordinating the discussion, to increase learning.

[A continuing-education strategy oriented to clinic learning]. / Una estrategia de educación continua orientada al aprendizaje de la clínica.

A strategy of continuing medical education is proposed, oriented to the learning of the clinic known as professors' visit, which includes five activities that give it a theoretical practice support. 1. Advice at the clinic to solve diagnosis, treatment and interconsultation problems. 2. Reading of medical literature to extend the information of the theme. 3. Discussion at the classroom of problem cases to improve clinical reasoning. 4. Tutor-patient, a patient with the studied problem to deepen in the questioning and exploration, and to discuss the ethical behavior. 5. Discussion of the clinical file to evaluate its extent and limitations, and to propose alternatives for improvement.

[Evaluation of the clinical aptitude in physicians of the first level of attention]. / Evaluación de la aptitud clínica en médicos de primer nivel de atención.

OBJECTIVE: To evaluate the development through time of the clinical aptitude in physicians of the first level of attention and the influence of categories of first level physicians. MATERIAL AND METHODS: In a cross-section design the clinical aptitude was studied in three categories of physicians of the first level of attention: general practitioners with functions of family medicine, family physicians, and family physicians working as head of a clinical department in Family Medicine Units with 10 or more consulting rooms. To evaluate the clinical aptitude, an instrument with 12 real clinical cases and 412 questions was used with nine indicators; this instrument was validated in a previous study. RESULTS: 499 physicians of the three categories were included, the scores range was between 52 and 245, with an average of 169 (41%). When comparing the categories of physicians, significant differences were found, in favor of the physicians with a specialty. There were no differences among heads of clinical departments and family physicians. In the global analysis among indicators no differences were found. When correlating the clinical aptitude with the years of experience, without considering the category, a correlation of 0.02 was obtained. CONCLUSIONS: Experience seems to have no influence in the development of clinical aptitude; passive continuing education seems to have little influence in the physicians deepening into frequent health-problem solving in their practice.

Disyuntivas en la evaluación del aprenizaje en medicina [editorial] / Disjunction in the evaluation for learning in medicine [editorial]

La evaluación formativa, orientada a mejorar la calidad del aprendizaje, se percibe como un elemento fundamental de apoyo al desarrollo de la educación médica. Para lograr este propósito, es necesario que la evaluación sea global, sistemática, metodológica, fenomenológica, crítica, vinculada con la práctica, relacionada con la clínica más que con el conocimiento abstracto, que explore competencias más que conocimientos y memoria, que tome en cuenta los daños provocados por las decisiones médicas, que no se limite a los participantes en el proceso y que sus resultados trasciendan

Diseño y validación de un instrumento para evaluar la satisfacción del personal que asiste a cursos de educación continua (SIESEC) / Design and validation of an instrument to evaluate satisfaction in continuing education courses

Se diseño, validó y automatizó un instrumento con el propósito de buscar indicadores que nos permitieran medir el grado de satisfacción del personal del área médica que asiste a cursos de educación continua. El diseño del instrumento se inició con un inventario de opiniones a partir de las respuestas del personal de dos preguntas abiertas relacionadas con los aspectos que más les satisfacieron del curso al que habían asistido recientemente. El instrumento preliminar constó de 10 indicadores, que se sometieron a la consideración de seis expertos para su validación. La consistencia interna se calculó con la prueba de Kuder Richardson y se elaboró un programa para microcomputadora con el fin de analizar con oportunidad y rapidez los resultados. El instrumento preliminar se redujo a cuatro indicadores después de ser considerado por los expertos con consenso de 100 por ciento. Para calcular la consistencia interna, se aplicó el instrumento a 41 alumnos de tres cursos de enfermería de la Delegación 3 del Distrito Federal (consistencia de 0.96). El instrumento validado se automatizó con DBase IV y proporcionó información nacional y por región, además de calificaciones por indicadores y categoría laboral. El instrumento, SIESEC, es válido y confiable. Por su consistencia interna, se pueden realizar con él investigaciones de campo en personal del área médica que asiste a cursos de educación continua y probar hipótesis relacionadas con su grafo de satisfacción con esta modalidad educativa

Habilidades de lectura en médicos familiares / Reading abilities of family physicians

Objetivos. Conocer el grado de desarollo de las habilidades de comprensión e interpretación de textos médicos en médicos familiares del primer nivel de atención; además, explorar en qué medida los años de experiencia clínica influyen en tales habilidades. Material y métodos. Se construyó un instrumento de dos textos (sociomédico y ético-médico). A través de rondas de 10 expertos, se validó el constructo y el contenido del instrumento que comprendió 40 enunciados de comprensión y 40 de interpretación. Se aplicó el instrumento a 104 médicos de ocho clínicas del IMSS en la delegación de la ciudad de México seleccionados al azar de entre 408 médicos. Se usaron las pruebas de Mann-Withney y de Kruskal-Wallis para evaluar diferencias de dos y de tres o más grupos, respectivamente. Resultados. Hubo puntajes superiores de comprensión vs interpretación globalmente (p<0.0001) y también cuando se partieron por tener o no estudios de posgrado (mayor en mujeres p 0.03), pero no la hubo entre clínicas. En ninguna comparación se observaron diferencias en la interpretación. Conclusiones. La habilidad interpretativa está menos desarrollada que la de comprensión y no cambió con la experiencia. Parece existir un estancamiento o un deterioro de la comprensión con los años de experiencia