Descontrol glucémico: desafío de salud pública en prepandemia y pandemia.

OBJETIVO: Comparar el control glucémico entre pacientes con diabetes mellitus tipo 2 prepandemia vs pandemia de Covid-19 que acudieron a unidades de salud de primer nivel de atención de la Ciudad de México. Material y métodos. Se analizaron los registros de 23 912 pacientes con diabetes; 78.7% fueron del grupo prepandemia (2016 a 2020) y 21.3% del grupo pandemia (marzo 2020 a julio 2021). Se calcularon medidas de tendencia central y de dispersión, pruebas t de Student y se ajustó un modelo de regresión logística múltiple. RESULTADOS: La mayoría de los pacientes con diabetes fueron mujeres (66.6 y 62.6%) con edad promedio de 59 y 58 años, respectivamente, y con hemoglobina glucosilada (HbA1) final de 7.7 vs el grupo pandemia (8.0). Las variables asociadas con el descontrol glucémico incluyeron periodo, nivel de HbA1, sobrepeso, obesidad, antecedente de padres con diabetes, número de medicamentos y tipo de insulina. CONCLUSIONES: La mayoría de los pacientes con diabetes en ambos grupos tuvieron descontrol glucémico. Los pacientes del grupo pandemia tuvieron mayor descontrol glucémico de HbA1 comparados con los del grupo prepandemia. Después de recibir atención médica en ambos grupos, los pacientes mejoraron su control glucémico.

Diagnostic accuracy in Family Medicine residents using a clinical decision support system (DXplain): a randomized-controlled trial.

BACKGROUND: Clinical reasoning is an essential skill in physicians, required to address the challenges of accurate patient diagnoses. The goal of the study was to compare the diagnostic accuracy in Family Medicine residents, with and without the use of a clinical decision support tool (DXplain http://www.mghlcs.org/projects/dxplain). METHODS: A total of 87 first-year Family Medicine residents, training at the National Autonomous University of Mexico (UNAM) Postgraduate Studies Division in Mexico City, participated voluntarily in the study. They were randomized to a control group and an intervention group that used DXplain. Both groups solved 30 clinical diagnosis cases (internal medicine, pediatrics, gynecology and emergency medicine) in a multiple-choice question test that had validity evidence. RESULTS: The percent-correct score in the Diagnosis Test in the control group (44 residents) was 74.1±9.4 (mean±standard deviation) whereas the DXplain intervention group (43 residents) had a score of 82.4±8.5 (p<0.001). There were significant differences in the four knowledge content areas of the test. CONCLUSIONS: Family Medicine residents have appropriate diagnostic accuracy that can improve with the use of DXplain. This could help decrease diagnostic errors, improve patient safety and the quality of medical practice. The use of clinical decision support systems could be useful in educational interventions and medical practice.

[Level of teaching competence at the Undergraduate Medical Internship of UNAM's Faculty of Medicine]. / Nivel de competencia docente en el Internado Médico de Pregrado de la Facultad de Medicina de la UNAM.

BACKGROUND: There is no systematic evaluation of teaching performance in the clinical area at UNAM Faculty of Medicine. The study purpose is to assess the teaching competence level in the Undergraduate Medical Internship (UMI). METHODS: The paper describes the process of psychometric validity for the instrument designed to evaluate teaching competence in the UMI. This instrument was constructed from two previously developed instruments. The final version with 54 items in a Likert scale was studied with exploratory factorial analysis. Four dimensions were obtained: Solution of clinical problems, Psychopedagogy, Mentoring, and Evaluation. The instrument had a reliability of 0.994, with an explained variance of 77.75%. RESULTS: To evaluate the teaching competence level, we administered 844 questionnaires to a sample of students with a response rate of 89%. We obtained an overall global score of 89.4 ± 9.6 (mean ± SD). The dimension Solution of clinical problems was the one with a greater value, in contrast with the dimension of Evaluation, which had a lower score. CONCLUSION: The teachers of the UMI are considered educators with high level of teaching competence, according to the perceptions of the undergraduate internal doctors. The evaluation of teaching competence level is very important for institutions that look for the continuous professional development of its faculty.

Introducción: en la Facultad de Medicina de la Universidad Nacional Autónoma de México (UNAM) no hay una evaluación sistemática del desempeño docente del área clínica. El propósito de este estudio fue evaluar el nivel de competencia docente en el Internado Médico de Pregrado (IMP). Método: se describe el proceso de la validación psicométrica de un instrumento diseñado para evaluar la competencia docente en el IMP. El instrumento se construyó a partir de dos instrumentos previamente desarrollados y con base en el análisis factorial exploratorio de un instrumento con 54 reactivos y una escala tipo Likert, se obtuvieron cuatro dimensiones. El instrumento tuvo una confiabilidad de 0.994, con una varianza explicada de 77.75%. Resultados: para evaluar en nivel de competencia docente, se utilizaron 844 cuestionarios, lo que constituye la muestra de estudiantes, con una tasa de respuesta del 89%. Se obtuvo una media global de 89.4 ± 9.6 de desviación estándar. La Solución de problemas clínicos fue la que obtuvo mayor valoración, en contraste con la dimensión de Evaluación, que observó menor valoración. Conclusiones: los docentes del IMP son considerados educadores con alto nivel de competencia docente, según las percepciones de los médicos internos de pregrado. Se advierte cómo la evaluación de la competencia docente es indispensable en cualquier institución que busque el desarrollo profesional continuo de sus profesores.

[Diagnostic and formative assessment of competencies at the beginning of undergraduate medical internship]. / valuación diagnóstica y formativa de competencias en estudiantes de medicina a su ingreso al internado médico de pregrado.

INTRODUCTION: Research on diagnostic and formative assessment competencies during undergraduate medical training is scarce in Latin America. OBJECTIVE: To assess the level of clinical competence of students at the beginning of their medical internship in a new curriculum. METHODS: This was an observational cross-sectional study in UNAM Faculty of Medicine students in Mexico City: a formative assessment of the second class of Curriculum 2010 students as part of the integral evaluation of the program. The assessment had two components: theoretical and practical. RESULTS: We assessed 577 students (65.5%) of the 880 total population that finished the 9th semester of Curriculum 2010. The written exam consisted of 232 items, with a mean of 61.0 ± 19.6, a difficulty index of 0.61, and Cronbach's alpha of 0.89. The mean of the objective structured clinical examination (OSCE) was 62.2 ± 16.8, with a mean Cronbach's alpha of 0.51. Results were analyzed by knowledge area and exam stations. CONCLUSIONS: The overall results provide evidence that students achieve sufficiently the competencies established in the curriculum at the beginning of the internship, that they have the necessary foundation for learning new and more complex information, and integrate it with existing knowledge to achieve significant learning and continue their training.

Las consideraciones éticas del uso de las redes sociales virtuales en la práctica médica / Ethical considerations in the use of virtual social networks in medical practice

Resumen El uso de los sitios web denominados redes sociales es cada vez más frecuente en la práctica médica. El objetivo de este artículo es proporcionar a los médicos y estudiantes de medicina algunas recomendaciones éticas para tomar en cuenta antes de publicar contenido en la internet. Para ello, ofrece un panorama histórico de la evolución de las redes sociales y presenta diversos ejemplos de los beneficios de usarlas como medios de actualización, de comunicación entre colegas, con pacientes, como medios de promoción de los servicios profesionales y de difusión de eventos. Al final provee de recomendaciones puntuales a tomar en cuenta para hacer un uso efectivo, profesional y ético de ellas.

Abstract The use of Social Networking sites has become very frequent in medicine. This article aims to provide physicians and medical students with ethical recommendations to consider before publishing Web content. For that purpose, we provide a historical overview of the evolution of social networks, and we present several examples of the benefits acquired by using them for knowledge updating, promoting professional services and events, and as communication tools among colleagues and patients. Finally, specific recommendations for an effective, professional and ethical use of these media are given.

[Teaching performance assessment in Public Health employing three different strategies]. / Evaluación del desempeño docente en Salud Pública mediante tres estrategias.

INTRODUCTION: The educational system depends upon the quality and performance of their faculty and should therefore be process of continuous improvement. OBJECTIVE: To assess the teaching performance of the Public Health professors, at the Faculty of Medicine, UNAM through three strategies. METHODS: Justification study. The evaluation was conducted under a mediational model through three strategies: students' opinion assessment, self-assessment and students' academic achievement. We applied descriptive statistics, Student t test, ANOVA and Pearson correlation. RESULTS: Twenty professors were evaluated from the Public Health department, representing 57% of all them who teach the subject. The professor's performance was highly valued self-assessment compared with assessment of student opinion, was confirmed by statistical analysis the difference was significant. The difference amongst the three evaluation strategies became more evident between self-assessment and the scores obtained by students in their academic achievement. CONCLUSIONS: The integration of these three strategies offers a more complete view of the teacher's performance quality. Academic achievement appears to be a more objective strategy for teaching performance assessment than students' opinion and self-assessment.