[Introducing formative portfolio as a tool for Internal Medicine residents mentoring: review of a pilot project, 2005-2006]. / Introducción del portafolio formativo como instrumento de tutorización de residentes de Medicina Interna: revisión de una experiencia piloto, 2005-2006.

Recent educational projects in our country have been trying to introduce professional portfolios as assessment/learning tools on the undergraduate and specialized post-graduate education levels. The approval of a new formative program for the Internal Medicine specialty in an effort to adapt to the present health care needs offers an opportunity to apply these formative and evaluative methodologies in the learning process of future internists. During the 2005-2006 academic year, the Formative Work Group of the Spanish Internal Medicine Society (SEMI) developed a pilot study on portfolio application as a tool for formative assessment and mentoring. This article describes the project of designing, developing, applying and assessing an electronic portfolio for first year Internal Medicine residents. It presents an analysis of the SEMI Portfolio strengths and weaknesses and finally makes suggestions for future development.

Formación del residente desde su abordaje como adulto / Resident’s education from his adult’s perspective

La formación pregrado, posgrado y la formación continuada en medicina podemos encuadrarlas dentro de la educación para adultos. Si en la formación pregrado predomina la transmisión de conocimientos, la formación posgrado debería basarse en un asentamiento de esos conocimientos y en la adquisición de habilidades. Estas tareas, en el caso de la especialización médica vía MIR, se desarrollarán en un contexto concreto donde el residente se encontrará ante la necesidad de la resolución de problemas. Como adulto podrá responsabilizarse de su propia formación, pero necesita de la guía y orientación de un tutor, pieza clave en la educación y evaluación que no sólo mide los objetivos alcanzados, sino que permite mejorar las estrategias de aprendizaje. Tanto el tutor como los posibles profesionales sanitarios que participen en la formación son de vital importancia y merecen un reconocimiento, unos recursos y una formación acorde a su labor. En el presente artículo haremos un repaso del proceso formativo desde el pregrado hasta la residencia, y también destacaremos los aspectos evaluativos como indispensables en dicho proceso (AU)

Undergraduate, postgraduate and continuing medical education must be considered as adult education. If in undergraduate medical education dominates the transmission of knowledge, postgraduate education should be based on quantitative and qualitative increase of these knowledge and on acquisition of specific skills. These tasks, in medical specialization through residency programs will be developed in a concrete context where residents will face the need to solve real problems. As adult, he/she will be able to take responsibility on its own training but, at the same time, he/she will need guidance and orientation from the tutor. Tutorial methodology is a key piece in training and its evaluation; it doesn’t only measures specific training achievements, but enhances the improving of individual learning strategies. Both tutor and other health professionals who play a role in residency program, are essential and deserve professional recognition, enough learning resources and specific c teaching skills to cope with this responsibility. In this article, a revision is presented of the formative process from undergraduate to postgraduate education level in which evaluation as an unavoidable aspect in the above mentioned process is emphasized (AU)

Feedback en educación médica / Feedback in medical education

La propuesta de un modelo centrado en la persona que aprende y el desarrollo de estrategias de aprender a aprender se persigue que los estudiantes sean más reflexivos y más autónomos en su propio proceso de aprendizaje y que se conviertan en los protagonistas de dicho proceso. Se trata, en definitiva, de dar los elementos necesarios a los estudiantes para que puedan autogestionar un proceso de aprendizaje permanente a lo largo de toda su vida profesional, una cuestión crucial en un contexto de evolución constante de los conocimientos. El feedback sería el retorno de informaicón sobre su proceso de aprendizaje de acuerdo con unos objetivos preestablecidos. El feedback presenta información y no juicio, a diferencia de la evaluación, en consecuencia siempre es formativo. El feedback no es un fin en sí mismo sino un instrumento que informa al estudiante sobre su proceso de aprendizaje y facilita los cambio necesarios. El feedback estructurado y centrado en quien aprende se caracteriza por: autoreflexivo del estudiante, centrado en quien aprende, preparación previa y relación de confianza tutor-residente (AU)

The proposal of a learner-centered model and the development of strategies for learning to learn, intends that students are more reflective and more independent in their own learning process and that they become the protagonists of this process. It really tries to give the students the necessary elements so that they can self-manage a process of permanent learning throughout their professional life, a crucial question in a context of constant evolution on the knowledge. The return of information on the process of learning, in agreement with pre-established objectives. Feedback presents/displays information and is non-judgemental, unlike the evaluation. Feedback always is formative. Feedback is not an aim in itself, but and instrument that informs the student on its process of learning and facilitates the necessary changes. Structured and centered learning feedback is characterized by: student self reflection, centered in the learning person, previously prepared and a confident relationship between tutor and student (AU)

Aspectos comunicacionales: el reto de la competencia de la profesión médica / Aspects of communication: the challenge of competition in the medical profession

No disponible

Evaluación clínica objetiva y estructurada en geriatría. Resultados del primer proyecto realizado en España / Objetive and structured clinical evaluation in geriatrics. Results of the first project performed in Spain

OBJETIVO: Presentar los resultados de la primera prueba piloto de evaluación clínica objetiva y estructurada (ECOE) para evaluar los conocimientos y habilidades en geriatría desarrollada por la Sociedad Catalano-Balear de Geriatría y Gerontología (SCBGG) .MATERIAL Y MÉTODOS: Expertos de la SCBGG, con el asesoramiento técnico del Institut d'Estudis de la Salut (IES), diseñaron la prueba que consistió en un circuito de 22 situaciones clínicas paradigmáticas de la especialidad y en las que se utilizaron diversos instrumentos evaluativos. Participaron voluntariamente 38 médicos invitados por la SCBGG, que al finalizarla cumplimentaron un cuestionario de opinión a propósito de la misma. Para el análisis de los datos se utilizó el programa estadístico SPSS/PC+ para Windows. RESULTADOS: La puntuación media (desviación estándar [DE]) en la edición de 2000 fue de 52,6 (5,8) y en la de 2001, de 49,1 (8,6). El estadístico alfa de Cronbach (coeficiente global de fiabilidad) fue de 0,71 en la primera y de 0,84 en la segunda. En 2001 se realizó el análisis de resultados según la formación de los participantes, y obtuvieron mejores resultados aquellos formados por vía MIR. La opinión de los participantes en las dos ediciones fue muy positiva. CONCLUSIONES: La primera prueba ECOE en geriatría se presenta como un método evaluativo de la competencia profesional fiable, válido, factible y bien aceptado por los profesionales que han participado en ella (AU)

Primeras experiencias en evaluación de la competencia clínica de los médicos de familia de Catalunya / First experiences in evaluation of the clinical competence of family doctors in catalonia

Objetivo. Construir un instrumento válido para evaluar la competencia clínica de los médicos de familia y establecer el estándar de la profesión. Diseño. Construcción de una prueba de evaluación clínica objetiva y estructurada por parte del Comité de Prueba de la Societat Catalana de Medicina Familiar i Comunitària (SCMFiC) con 27 situaciones clínicas representativas de la práctica de atención primaria, utilizando diversos instrumentos evaluativos, con una duración total de 5 horas y 30 minutos. Emplazamiento. Dos áreas básicas de salud de Barcelona para la realización de las dos ediciones de la prueba. Participantes. Médicos de familia, miembros de la SCMFiC, que participaron voluntariamente tras haber sido invitados por carta. Mediciones y resultados principales. En la primera edición de la prueba participaron 23 médicos, con una edad media de 36,6 años (DE, 6,9), siendo un 52,2 por ciento mujeres. En la segunda edición participaron 46 médicos, con una edad media de 30,9 (DE, 2,1), siendo un 76,1 mujeres. La prueba tuvo un coeficiente global de fiabilidad, alfa de Cronbach, de 0,83 en su primera edición y 0,65 en su segunda. La puntuación media global de los participantes de la primera edición fue de 56,9 (DE, 19,2), siendo 100 la puntuación máxima obtenible y la de los participantes de la segunda edición, 62,1 (DE, 4,1). Conclusiones. La experiencia de la SCMFiC es la primera por lo que refiere a la evaluación de la competencia clínica de los médicos de familia en nuestro ámbito, y se trata de una prueba fiable y válida para valorar la competencia de nuestros profesionales (AU)

[Evaluation of clinical competence. The immediate future of nursing]. / Evaluar la competencia clínica. Futuro inmediato para enfermería.

In this article, the authors analyze the concept of professional competence and they describe some of the methods destined to be used in the evaluation of said competence in nursing professionals. The authors describe different levels of professional performance to which an evaluation may be carried out according to the conceptual model developed by Miller. Special emphasis is placed on the third level of evaluation which is based on simulations of professional practice whose protagonists are the so called simulated or role-playing/standardized sick. One type of very novel evaluation test is the Objective Structured Clinical Examination (OSCE) which makes use of, besides the simulated or role-playing/standardized sick, other mediums such as manikins, standardized tests, open-ended short answer questions, etc. This is one of the most complete clinical competence evaluation methods currently available, although one should not forget that this evaluation is carried out in a simulated, laboratory, setting.

Gender, sequence of cases and day effects on clinical skills assessment with standardized patients.

OBJECTIVE: Clinical skills assessment using standardized patients (SPs) is an accepted method of professional testing, but some factors can threaten the validity of the scores obtained. OBJECTIVE: The main objective of this work was to test whether the gender of the patients, the sequence of cases and the day of the examination have any impact on the scores of the examinees. MATERIALS: Data from examinations conducted at three Medical Schools are used. Each student encountered 10 different SPs (5 men and 5 women). METHODS: Analysis of variance was used to test the existence of association between the variables. RESULTS: The results showed no significant differences or association between the scores and the three variables analysed. CONCLUSIONS: The results are coherent with the studies that show that performance based examination using SPs can be used without introducing biases into students score.

Clinical skills assessment with standardized patients.

Previous projects (Combell I & II) to assess clinical skills were conducted in medical schools in Catalonia, in order to introduce a model of such an assessment using standardized patients (SP). The aim of this study (Combell III) was to measure selected characteristics of our model. Seventy-three medical students in the final year at the Bellvitge teaching unit of the University of Barcelona participated in a clinical skills assessment (CSA) project that used 10 SP cases. The mean group scores for the four components of clinical skills for each day of testing were studied, and ratings for each student in the 10 sequential encounters were checked. The study also compared the clinical skills scores with their academic grades. The total case mean score (mean score of history-taking, physical examination and patient notes scores) was 51.9%, and the mean score for communication skills was 63.6%. The clinical skills scores over the 8 testing days showed no day-to-day differences. The study did not find differences among the sequential encounters for each student (training effect). There was a lack of correlation between clinical skills scores and academic grades. The project demonstrated the feasibility of the method for assessing clinical skills, confirmed its reliability, and showed that there is no correlation between scores with this method and academic examinations that mainly reflect knowledge.

[The COMBELL project. Analysis of the medical clinical competence]. / El proyecto COMBELL. Un análisis de la competencia clínica médica.

BACKGROUND: The most frequent tests for evaluate medical education in Spain, do not analyze clinical competence. The aims of this project was to introduce a method for the assessment of clinical skills using the simulation methodology with standardized patients. METHODS: All 83 first-year medical residents were evaluated. Three evaluation exercises were used in all study. The first was 10 standardized patients encounters, the second was 100 multiple choice questions, and the third 60 clinical images. Sixty-four last year medical students were evaluated using the same 10 standardized patients. RESULTS: The global mean score for the residents was 56.7% for all the encounters, and was lower in physical examination and patients notes. The global mean score for the students was 57.1% and was also lower in physical examination. We did not find correlations between clinical competence assessment, multiple choice-questions, MIR exam and clinical images. CONCLUSIONS: Our results show that: this assessment method was successful; the clinical competence levels of our residents and students, and the lack of statistical correlation between this method and other methods, which, basically analyze cognitive capacities.

[An evaluation of the clinical competence of a population of specialist physicians educated by the medical internship and residency system]. / Evaluación de la competencia clínica de una población de médicos especialistas formados por el sistema MIR.

BACKGROUND: The quality of physicians who have undergone resident official training (MIR) should logically be better than that of the remaining physicians who were not able to enter into this official training. The present study was designed with the aim of verifying this hypothesis. METHODS: A sample of physicians who underwent the MIR examination in 1982 and who upon passing the same were permitted to initiate the MIR training in 1983 was selected. The group was subdivided into MIR and no MIR and according to the specialty followed. When the physicians were practicing as specialists two types of surveys were carried out with one being by telephone and the other personal in which the personal characteristics, preparation for the MIR test, professional satisfaction and personal motivation were analyzed. The pharmaceutic prescriptions of both groups were analyzed according to indicators of the Servei Català de la Salut (Catalonian Health Service) and the opinion of colleagues of each of the members of each group was evaluated with another questionnaire. The written resolution of hypothetical clinical cases were given to each of the individuals included. A level of global competence defined as a percentage for the following components was identified using: curricular evaluation (10%), professional satisfaction (20%), personal motivation (10%), hypothetical case resolution (35%) and peer opinion (25%). RESULTS: The global competence of the physicians trained under the MIR system was greater than that of the no MIR group (p < 0.01). On analysis by sections the differences of greatest note were observed in the resolution of hypothetical cases (p < 0.0001), curricular evaluation (p < 0.0001) and the quality of pharmaceutical prescription (p < 0.0001). The differences were less of note in comparison of personal motivation (p < 0.02) and professional satisfaction (p < 0.02). No differences were observed in peer opinion. CONCLUSIONS: The professional quality of physicians trained by MIR who presented for the 1982 examination in Catalonia and practiced in medical specialties is greater than that of a comparable group with regard to professional practice.

[Response of the autonomous nervous system of the heart in diabetes mellitus (author's transl)]. / Afección del sistema nervioso autónomo del corazón en la diabetes mellitus.

The vegetative response of the heart in 80 diabetic patients and 24 controls was evaluated by means of four tests: cyclic variations, Valsalva's maneuver, static muscular exercises and postural hypotension. This methodology indicates that vegetative alterations of the heart in the diabetic subjects are frequent (56.25 per cent). The parameters which are first affected are the cyclic variations and the Valsalva's maneuver, and that this disorder increases with the duration of the diabetes, showing a clear correlation with the appearance of peripheral somatic polyneuropathy. Although from a clinical point of view orthostatic hypotension is the more obvious manifestation, its implication in other situations, such as unexplained tachycardia, silent myocardial infarction and sudden death in the diabetic patient, lends great importance to this little-known form of degenerative disorder in diabetes mellitus.