Factores que afectan al ambiente educativo en la formación preclínica de medicina según sus docentes / Factors affecting the educational environment in undergraduate medical schools

Background: Educational environment has an important effect on the quality of learning and student satisfaction in medicine. Most of previous studies have been conducted using questionnaires that assess the phenomenon considering overall dimensions, without paying attention to the specific manifestations of this topic, especially those aspects that are related to the protagonists of the learning process: teachers and students. Aim: To describe factors that affect the educational environment in the preclinical Medical formation, according to Medical teachers in Concepción, Chile. Material and Methods: Qualitative study, using the Grounded theory method. Semi-structured interviews were performed to 10 medical teachers in Concepcion, Chile. They were selected by theoretical sampling. Data were analyzed using open coding. Results: Four emerging categories about the factors that affect the learning environment were identified: Personal factors of students, academic factors of students, personal factors of teachers and academic factors of teachers. Conclusions: According to interviewed teachers, both personal factors in teachers and students that promote a positive learning environment are related with an attitude oriented towards others and communication skills. Academic factors are related with the responsible exercise of student and teacher roles and with the promotion of participation in the educational process.

[Motivation and self-directed learning among medical students]. / Aspectos motivacionales involucrados en el aprendizaje autodirigido en estudiantes de medicina. Un enfoque cualitativo.

BACKGROUND: Motivation is an essential aspect in the training process of medical students. The association that motivation can have with learning self-regulation is of utmost importance for the design of curriculum, teaching methods and evaluation. AIM: To describe the motivational aspects of self-directed learning among medical students from a traditional Chilean University. MATERIAL AND METHODS: A qualitative, descriptive study based on grounded theory of Strauss and Corbin. Twenty 4th and 5th year medical students were selected using a maximum variation sampling technique. After obtaining an informed consent, semi-structured interviews and field notes were carried out. Data were analyzed to the level of open coding through Atlas-ti 7.5.2. RESULTS: From the student point of view, personal motivational aspects are linked to the search for information, constant updating, the perception of the physician-patient relationship and interest in subject matters. From the scope of teachers, a main issue is related to their ability to motivate students to develop independent study skills. CONCLUSIONS: Personal motivational aspects facilitate the development of independent study skills, specifically in the search of information. The role of teachers is crucial in promoting these skills and the perception of medical students from their learning process.

Aspectos motivacionales involucrados en el aprendizaje autodirigido en estudiantes de medicina. un enfoque cualitativo / Motivation and self-directed learning among medical students

Background: Motivation is an essential aspect in the training process of medical students. The association that motivation can have with learning self-regulation is of utmost importance for the design of curriculum, teaching methods and evaluation. Aim: To describe the motivational aspects of self-directed learning among medical students from a traditional Chilean University. Material and Methods: A qualitative, descriptive study based on grounded theory of Strauss and Corbin. Twenty 4th and 5th year medical students were selected using a maximum variation sampling technique. After obtaining an informed consent, semi-structured interviews and field notes were carried out. Data were analyzed to the level of open coding through Atlas-ti 7.5.2. Results: From the student point of view, personal motivational aspects are linked to the search for information, constant updating, the perception of the physician-patient relationship and interest in subject matters. From the scope of teachers, a main issue is related to their ability to motivate students to develop independent study skills. Conclusions: Personal motivational aspects facilitate the development of independent study skills, specifically in the search of information. The role of teachers is crucial in promoting these skills and the perception of medical students from their learning process.

[Factors affecting the educational environment in undergraduate medical schools]. / Factores que afectan al ambiente educativo en la formación preclínica de medicina según sus docentes.

BACKGROUND: Educational environment has an important effect on the quality of learning and student satisfaction in medicine. Most of previous studies have been conducted using questionnaires that assess the phenomenon considering overall dimensions, without paying attention to the specific manifestations of this topic, especially those aspects that are related to the protagonists of the learning process: teachers and students. AIM: To describe factors that affect the educational environment in the preclinical Medical formation, according to Medical teachers in Concepción, Chile. MATERIAL AND METHODS: Qualitative study, using the Grounded theory method. Semi-structured interviews were performed to 10 medical teachers in Concepcion, Chile. They were selected by theoretical sampling. Data were analyzed using open coding. RESULTS: Four emerging categories about the factors that affect the learning environment were identified: Personal factors of students, academic factors of students, personal factors of teachers and academic factors of teachers. CONCLUSIONS: According to interviewed teachers, both personal factors in teachers and students that promote a positive learning environment are related with an attitude oriented towards others and communication skills. Academic factors are related with the responsible exercise of student and teacher roles and with the promotion of participation in the educational process.

[Factors associated with self-directed learning among medical students]. / Predictores afectivos y académicos del aprendizaje autodirigido en estudiantes de medicina.

BACKGROUND: Self-directed learning is a skill that must be taught and evaluated in future physicians. AIM: To analyze the association between self-directed learning, self-esteem, self-efficacy, time management and academic commitment among medical students. MATERIAL AND METHODS: The self-directed learning, Rosemberg self-esteem, general self- efficacy, time management and Utrecht work engagement scales were applied to 297 first year medical students. RESULTS: A multiple regression analysis showed a significant association between self-efficacy, time management and academic commitment with self-directed learning. Self-esteem and satisfaction with studies did not enter in the model. CONCLUSIONS: self-esteem, academic commitment and a good time management were associated with self-directed learning in these students.

Predictores afectivos y académicos del aprendizaje autodirigido en estudiantes de medicina / Factors associated with self-directed learning among medical students

Background: Self-directed learning is a skill that must be taught and evaluated in future physicians. Aim: To analyze the association between self-directed learning, self-esteem, self-efficacy, time management and academic commitment among medical students. Material and methods: The self-directed learning, Rosemberg self-esteem, general self- efficacy, time management and Utrecht work engagement scales were applied to 297 first year medical students. Results: A multiple regression analysis showed a significant association between self-efficacy, time management and academic commitment with self-directed learning. Self-esteem and satisfaction with studies did not enter in the model. Conclusions: self-esteem, academic commitment and a good time management were associated with self-directed learning in these students.

[Learning strategies of autonomous medical students]. / ¿Cómo abordan su aprendizaje los estudiantes de medicina autónomos? Una aproximación cualitativa.

BACKGROUND: Understanding how autonomous students are capable of regulating their own learning process is essential to develop self-directed teaching methods. AIM: To understand how self-directed medical students approach learning in medical schools at University of Concepción, Chile. MATERIAL AND METHODS: A qualitative and descriptive study, performed according to Grounded Theory guidelines, following Strauss & Corbin was performed. Twenty medical students were selected by the maximum variation sampling method. The data collection technique was carried out by a semi-structured thematic interview. Students were interviewed by researchers after an informed consent procedure. Data were analyzed by the open coding method using Atlas-ti 7.5.2 software. RESULTS: Self-directed learners were characterized by being good planners and managing their time correctly. Students performed a diligent selection of contents to study based on reliable literature sources, theoretical relevance and type of evaluation. They also emphasized the discussion of clinical cases, where theoretical contents can be applied. This modality allows them to gain a global view of theoretical contents, to verbalize knowledge and to obtain a learning feedback. CONCLUSIONS: The learning process of autonomous students is intentional and planned.

Aprendizaje autodirigido y su relación con estilos y estrategias de aprendizaje en estudiantes de medicina / Relationship between self-directed learning with learning styles and strategies in medical students

Background: Self-directed learning (SDL) skills are particularly important in medical education, considering that physicians should be able to regulate their own learning experiences. Aim: To evaluate the relationship between learning styles and strategies and self-directed learning in medical students. Material and Methods: One hundred ninety nine first year medical students (120 males) participated in the study. Preparation for Independent Learning (EPAI) scale was used to assess self-direction. Schmeck learning strategies scale and Honey and Alonso (CHAEA) scales were used to evaluate learning styles and strategies. Results: Theoretical learning style and deep processing learning strategy had positive correlations with self-direct learning. Conclusions: Medical students with theoretical styles and low retention of facts are those with greater ability to self-direct their learning. Further studies are required to determine the relationship between learning styles and strategies with SDL in medical students. The acquired knowledge will allow the adjustment of teaching strategies to encourage SDL.

Evaluación de componentes del currículum oculto en estudiantes de medicina / Assessment of hidden curriculum components by medical students

Background: Hidden curriculum refers to the unwritten, unofficial, and often unintended lessons, values, and perspectives that students learn at the university, which influences the acquisition of professional skills. Aim: To analyze the perception about the influence of the hidden curriculum in the education of medical students at the Universidad de Concepción, Chile. Material and Methods: Qualitative investigation with case study approach. Seventeen graduated medical students were selected by probability sampling. A semi-structured interview was used to collect the information and a content analysis was applied. Results: Forty seven percent of participants recognized having fulfilled their academic expectations. As favorable factors for academic achievement the students underlined clinical practice, access to patients and to clinical fields. As negative factors, they identified the lack of commitment, educational support and over-specialization of their mentors. Conclusions: The results show the strengths and weaknesses of the educational environment of undergraduated medical students. This information should be used to modify teaching environments.

[Assessment of hidden curriculum components by medical students]. / Evaluación de componentes del currículum oculto en estudiantes de medicina.

BACKGROUND: Hidden curriculum refers to the unwritten, unofficial, and often unintended lessons, values, and perspectives that students learn at the university, which influences the acquisition of professional skills. AIM: To analyze the perception about the influence of the hidden curriculum in the education of medical students at the Universidad de Concepción, Chile. MATERIAL AND METHODS: Qualitative investigation with case study approach. Seventeen graduated medical students were selected by probability sampling. A semi-structured interview was used to collect the information and a content analysis was applied. RESULTS: Forty seven percent of participants recognized having fulfilled their academic expectations. As favorable factors for academic achievement the students underlined clinical practice, access to patients and to clinical fields. As negative factors, they identified the lack of commitment, educational support and over-specialization of their mentors. CONCLUSIONS: The results show the strengths and weaknesses of the educational environment of undergraduated medical students. This information should be used to modify teaching environments.

[Relationship between self-directed learning with learning styles and strategies in medical students]. / Aprendizaje autodirigido y su relación con estilos y estrategias de aprendizaje en estudiantes de medicina.

BACKGROUND: Self-directed learning (SDL) skills are particularly important in medical education, considering that physicians should be able to regulate their own learning experiences. AIM: To evaluate the relationship between learning styles and strategies and self-directed learning in medical students. MATERIAL AND METHODS: One hundred ninety nine first year medical students (120 males) participated in the study. Preparation for Independent Learning (EPAI) scale was used to assess self-direction. Schmeck learning strategies scale and Honey and Alonso (CHAEA) scales were used to evaluate learning styles and strategies. RESULTS: Theoretical learning style and deep processing learning strategy had positive correlations with self-direct learning. CONCLUSIONS: Medical students with theoretical styles and low retention of facts are those with greater ability to self-direct their learning. Further studies are required to determine the relationship between learning styles and strategies with SDL in medical students. The acquired knowledge will allow the adjustment of teaching strategies to encourage SDL.

Relación entre perímetro abdominal, nivel socioeconómico y presión arterial / Relation of abdominal circumference and socio-economic status to blood pressure

Objetivos: Relacionar perímetro abdominal y condición socioeconómica con presión arterial (PA) en comunidad urbana de Concepción. Métodos: Se midió el perímetro abdominal (PeA) de 8472 residentes mayores de 15 años de edad, proporcionados por edad, género y nivel socioeconómico. La PA fue medida con normas estandarizadas, realizando dos visitas en diferentes días, la segunda si la PA era mayor de 140/90 mm Hg. Los Pe A se distribuyeron en cuartiles, relacionando cada cuartil con los respectivos promedios de presión sistólica y diastólica y se establecieron coeficientes de correlación lineal mediante "r" de Pearson entre PeA y PA. Además, se estableció la frecuencia de cada cuartil de Pe A por nivel socioeconómico. Resultados: Los Pea tuvieron la siguiente distribución (cm): 1er cuartil, < 78; 2º cuartil, 78- 87; 3er cuartil, 88-96 y 4º cuartil, > 96. La prevalencia de hipertensión para niveles socioeconómicos alto, medio y bajo fue 17,9 por ciento, 19,5 por ciento y 24,5 por ciento, respectivamente. La PA promedio (mmHg) en hombres y en mujeres del 1er cuartil de PeA fue 112 y 109; en el 2º cuartil 118 y 118; en el 3er cuartil 123 y 122 y en el 4º cuartil 129 y 129, respectivamente. Los coeficientes de correlación entre PeA y presión sistólica y presión diastólica resultaron significativos en ambos géneros: r = 0,343, p<0.00001 y r = 0,281, p<0.00001, respectivamente. La distribución ( por ciento) de PeA fue inversa al nivel socioeconómico: en el nivel social bajo, el 22 por ciento estaba en el 1er cuartil de PeA, y el 28,8 por ciento en el 4º cuartil. En el nivel social alto se observó lo inverso: 38,9 por ciento estaba en el 1er cuartil de PeA, y sólo el 15.5 por ciento en el 4º cuartil (p<0.0001). Conclusiones: Hubo correlación positiva entre PeA y PA en ambos géneros. La frecuencia de mayor PeA en el nivel socioeconómico bajo podría explicar la mayor prevalencia de hipertensión en este grupo.

Aim: To correlate abdominal circumference (AC) and socio-economic status with blood pressure( BP) in an urban community of Concepción, Chile Methods: AC was measured in 8472 subjects above 15years of age, stratified by age, gender and socio-economic status. BP was measured by standard procedures, with a repeat recording when the initial value was > 140/90mmHg. BP was compared in quartiles of abdominal circumference and according to socio-economic status. Pearson "r" was used to correlate BP and AC Results: Cut points for quartiles of AC were 78, 87, and 96 cm. Prevalence of hypertension in high, medium and low socio-economic status was 17.9 percent, 19.5 percent and 24.5 percent, respectively Mean systolic BP was 112 - 109 mmHg (males - females) in the first AC quartile, 118 - 118, 123-122 and 129-129 in the second, third and fourth quartiles, respectively. A significant correlation between AC and BP (systolic and diastolic) was observed in both genders (r 0.345 and 0.281 for males and females, respectively, p<0.00001). 22 percent of low socio-economic subjects belonged in the first AC quartile compared to 28.8 percent in the 4th quartile. In contrast 38.9 percent of high socio-economic subjects belonged in the first AC quartile while 15.5 percent did so in the 4th quartile (p<0001). Conclusion: A positive correlation of AC and blood pressure was shown in both genders. A greater AC in low socio-economic subjects maybe related to a higher prevalence of hypertension in this group.

Evaluación del rendimiento educacional mediante la utilización de diferentes opciones metodológicas aplicadas a estudiantes de medicina, en el área de la hipertensión arterial / Assessment of educational performance of different teaching methodologies applied to medical students

Background: Modernization of medical teaching includes the use of new teaching methodologies and among these, computer assisted tutorials. Previous experience has shown that this type of methodology is associated with better student performances. Aim: To assess the cognitive performance of fourth year medical students using different teaching methodologies. Material and methods: During the hypertension course, medical students were allowed to choose to receive a printed booklet (group A), to receive the booklet and attend lectures (group B), to receive the booklet and use a multimedial educational program (group C) and to use all three methodologies (group D). Cognitive performance was evaluated with a multiple choice test scored from 0 to 100. Results: The mean scores obtained by students were 84.5 in group A, 82.4 in group B. 88.9 in group C and 84.4 in group D. This overall score of 83.6 in hypertension was significantly better than the mean score of 72.5 obtained in the cardiology test. Conclusions: Allowing students to choose the most suitable method to learn according to their personal preferences, results in a better cognitive performance

Evaluación de la aplicabilidad de un programa de educación médica a distancia / Assessment of the feasibility of a distance medical education program

To assess the feasibility of a distance medical education program prepared in a written format, 90 physicians aged 25 to 29 years old and with 1 to 4 years of medical practice, working mostly in rural locations, participed in the program. The sending of 10 ussues with medical topics was programmed. The topics were selected according to the results of an survey done among physicians of the region. Each issue contained an evaluation that had to be returned to the authors. Eigthy two physicians completed the program and 59 returned the evaluations. The mean obtained score in the cognitive evaluation was 80ñ6 points (range 68 to 97 points) of a scale from 0 to 100. The qualitative survey revealed a high degree of approval of the issue's format, contents and evaluation system. The favorable effect on patients' management and on the detection and control of chronic diseases was emphasized. This distance medical education program had a good receipt and compliance among physicians and contributed to continuing medical training

Evaluación de un programa de estudio independiente basado en la computación, aplicado a estudiantes de IV año de medicina / Assessment of an independent study program based in computation, applied to medicine students of IV grade

The aim of this work was to assess an independent study program on hypertension using a computer multimedia program developed by the authors. Twenty-four randomly chosen students participated in the program and 76 students that continued to attend to classical lectures were used as controls. At the end of the program, a cognitive test with 40 multiple choice questions and an opinion questionnaire were applied. The experimental group had higher grades in the test than controls (71,4 and 64,6 percent respectively p<0,001) and a highly favourable opinion of the program. It is concluded that computer teaching programs are useful and feasible alternative to lectures

Estudio controlado del efecto de anticonceptivos orales sobre la presión arterial / Controlled study of oral contraceptive effect over arterial pressure

The possible hypertensive effect of oral contraceptives is a controversial issue. We studied 371 women, admitted to the family planning program of a atate funded outpatient clinic, that were followed during 12 months. These women were divided in 4 groups. Group 1 was constituted by 98 women that used intrauterine devices. Group 2 by 98 women taking 30 µg of estrogen and 300 µg of progestogen. Group 3 by 83 women taking 35 µg of estrogen and 500 µg of progestogen and Group 4 by 92 puerperal women taking 30 µg of levonorgestrel, that after six month started to use an intrauterine device (n=35) or the contraceptives of group 2 (n=38) or group 3 (n=19). Age, initial blood pressure and weight were similar in the 4 groups. There was no significant change in blood pressure after 6 or 12 centrations up to 35 µg and progestogen concentrations between 300 and 500 µg do not induced changes in blood pressure

Resultados de una experiencia educacional basada en problemas aplicada a estudiantes de primer año de medicina / Results of a problem-based learning experience applied to first year medical students

The aim of this work was to study the feasibility of applying problem-based learning methodologies to first year medical students. During 1992, they participated in tutorial gruops composed by ten students, that undertook the study of 3 clinical problems from biological, psychological and social perspective. Cognitive tests that included multiple choice and developmental questions were used for assesment. An anonymous enquiry about the students opinion towards the educational experience was also applied. Students achieved 76 percent of the predetermined goals for each problem. Scoring was better for developmental than multiple choice questions. The experience had a great acceptance among students, that considered as positive features the learning motivation, the stimulus for active participation, the achievement of personal expectancies, the integration of knowledge areas and the encouragement of team work and information seeking