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.

Medicine and the metaverse: current applications and future.

Innovative technologies such as the metaverse and chat GPT-4 (based on artificial intelligence) are present in the daily discourse of society; recently, they have been introduced into medical practice and are bringing about important changes. In the case of the metaverse ("beyond the universe"), various medical schools and departments around the world are beginning to use it as an innovative strategy for teaching subjects such as anatomy, histology, ophthalmology, and simulation in parallel (virtual) worlds for learning and supervision of surgeries, as well as for other applications in medical education and in the doctor-patient relationship. Although it should be regarded as an area of opportunity for the transformation of medicine, it is important to consider the various limitations and risks of the metaverse in medical practice, student training, and physicians' relationship with the health problems they have to deal with in their practice.

Las innovadoras tecnologías del metaverso y el chat GPT4 (basado en inteligencia artificial) están presentes en el discurso cotidiano de la sociedad; recientemente se han introducido en la práctica médica y están provocando importantes cambios. En cuanto al metaverso ("después del universo"), diversas escuelas y facultades de medicina del mundo comienzan a utilizarlo como una estrategia innovadora dirigida a la enseñanza de materias como anatomía, histología, oftalmología y simulación en mundos paralelos (virtuales) para el aprendizaje y supervisión de cirugías, así como para otras aplicaciones en educación médica y en la relación médico-paciente. Si bien debe tomarse en cuenta como un área de oportunidad para la transformación de la medicina, es importante considerar las diversas limitaciones y riesgos del metaverso en la práctica médica, la formación de estudiantes y la relación del médico con los problemas de salud a los que se enfrenta en su práctica.

La medicina y el metaverso: aplicaciones actuales y futuro / Medicine and the metaverse: current applications and future

Resumen Las innovadoras tecnologías del metaverso y el chat GPT4 (basado en inteligencia artificial) están presentes en el discurso cotidiano de la sociedad; recientemente se han introducido en la práctica médica y están provocando importantes cambios. En cuanto al metaverso ("después del universo"), diversas escuelas y facultades de medicina del mundo comienzan a utilizarlo como una estrategia innovadora dirigida a la enseñanza de materias como anatomía, histología, oftalmología y simulación en mundos paralelos (virtuales) para el aprendizaje y supervisión de cirugías, así como para otras aplicaciones en educación médica y en la relación médico-paciente. Si bien debe tomarse en cuenta como un área de oportunidad para la transformación de la medicina, es importante considerar las diversas limitaciones y riesgos del metaverso en la práctica médica, la formación de estudiantes y la relación del médico con los problemas de salud a los que se enfrenta en su práctica.

Abstract Innovative technologies such as the metaverse and chat GPT-4 (based on artificial intelligence) are present in the daily discourse of society; recently, they have been introduced into medical practice and are bringing about important changes. In the case of the metaverse ("beyond the universe"), various medical schools and departments around the world are beginning to use it as an innovative strategy for teaching subjects such as anatomy, histology, ophthalmology, and simulation in parallel (virtual) worlds for learning and supervision of surgeries, as well as for other applications in medical education and in the doctor-patient relationship. Although it should be regarded as an area of opportunity for the transformation of medicine, it is important to consider the various limitations and risks of the metaverse in medical practice, student training, and physicians' relationship with the health problems they have to deal with in their practice.

Health sciences undergraduate students academic track records.

BACKGROUND: Academic track record analysis is essential for evaluating the training of students and the structure of higher education study programs, which allows diagnosing and preventing educational lag and school dropout. OBJECTIVE: To analyze the differences in academic track records of UNAM health sciences undergraduate students from generations 2001 to 2016. MATERIAL AND METHODS: Study of real cohorts; graduation and lag rates were calculated. ANOVA was used to contrast the graduation rates between campuses by undergraduate program and time. To identify critical periods, survival functions were used with Kaplan-Meier's method. RESULTS: The lowest percentages of lag were observed in nursing and medicine students; nursing students had the highest graduation rates, especially at Zaragoza campus; dentistry students had the lowest graduation rates and the highest dropout and lag rates. Women showed higher graduation rates and lower risk of dropout and lag. CONCLUSIONS: Nursing, medicine and psychology undergraduate students at Zaragoza and Iztacala campuses, with modular programs, achieved the highest graduation percentages and the lowest dropout and lag rates.

ANTECEDENTES: El análisis de las trayectorias académicas es fundamental para evaluar la formación de los estudiantes y la estructura de los programas de estudio de educación superior, lo que permite diagnosticar y prevenir el rezago y abandono escolar. OBJETIVO: Analizar las diferencias en las trayectorias académicas de los estudiantes de las licenciaturas en ciencias de la salud de la UNAM de las generaciones 2001 a 2016. MATERIAL Y MÉTODOS: Estudio de cohortes reales; se calcularon tasas de egreso y rezago. Se realizó ANOVA para contrastar el egreso entre planteles por carrera y tiempo. Para identificar los períodos críticos se utilizaron funciones de supervivencia con el método de Kaplan-Meier. RESULTADOS: En las licenciaturas en enfermería y medicina se observaron los menores porcentajes de rezago; enfermería presentó los mayores porcentajes de egreso, sobre todo en la Facultad de Estudios Superiores Zaragoza; odontología mostró los menores índices de egreso y mayores índices de abandono y rezago. Las mujeres mostraron mayor egreso y menor riesgo de abandono y rezago. CONCLUSIONES: Los estudiantes de las licenciaturas en enfermería, medicina y psicología de las facultades de estudios superiores Zaragoza e Iztacala, con programas modulares, alcanzaron los mayores porcentajes de egreso y menores índices de abandono y rezago.

National examination for medical residency admission: academic performance in a high-stakes test and the need for continuing education.

INTRODUCTION: Performance and selection rate of non-newly graduated physicians in a medical residency admission test as an indicator for the need of continuing education. METHODS: A database comprising 153 654 physicians who took a residency admission test in the period 2014-2018 was analysed. Performance and selection rates were assessed in relation to year of graduation and performance in medical school. RESULTS: The whole sample scored at a mean of 62.3 (SD ±8.9; range 1.11-91.11). Examinees who took the test in their year of graduation performed better (66.10) than those who took the test after their year of graduation (61.84); p<0.001.Selection rates differed accordingly; 33.9% for newly graduated physicians compared with 24.8% in those who took the test at least 1 year after graduation; p<0.001. An association between selection test performance and medical school grades was established using Pearson's correlation: r=0.40 for newly graduated physicians and r=0.30 for non-newly graduated physicians. There were statistically significant differences in selection rates for every ranking group of grades in medical school based on the χ2 test (p<0.001). The selection rates are decreased years after graduation even for candidates with high grades in medical school. DISCUSSION: There is an association between performance in a medical residency admission test and academic variables of the candidates: medical school grades and time elapsed from graduation to test taking. The evidence of decrease in retention of medical knowledge since graduation highlights the pertinence of continuing education interventions.

Trayectorias académicas de los estudiantes de licenciaturas de ciencias de la salud / Health sciences undergraduate students academic track records

Resumen Antecedentes: El análisis de las trayectorias académicas es fundamental para evaluar la formación de los estudiantes y la estructura de los programas de estudio de educación superior, lo que permite diagnosticar y prevenir el rezago y abandono escolar. Objetivo: Analizar las diferencias en las trayectorias académicas de los estudiantes de las licenciaturas en ciencias de la salud de la UNAM de las generaciones 2001 a 2016. Material y métodos: Estudio de cohortes reales; se calcularon tasas de egreso y rezago. Se realizó ANOVA para contrastar el egreso entre planteles por carrera y tiempo. Para identificar los períodos críticos se utilizaron funciones de supervivencia con el método de Kaplan-Meier. Resultados: En las licenciaturas en enfermería y medicina se observaron los menores porcentajes de rezago; enfermería presentó los mayores porcentajes de egreso, sobre todo en la Facultad de Estudios Superiores Zaragoza; odontología mostró los menores índices de egreso y mayores índices de abandono y rezago. Las mujeres mostraron mayor egreso y menor riesgo de abandono y rezago. Conclusiones: Los estudiantes de las licenciaturas en enfermería, medicina y psicología de las facultades de estudios superiores Zaragoza e Iztacala, con programas modulares, alcanzaron los mayores porcentajes de egreso y menores índices de abandono y rezago.

Abstract Background: Academic track record analysis is essential for evaluating the training of students and the structure of higher education study programs, which allows diagnosing and preventing educational lag and school dropout. Objective: To analyze the differences in academic track records of UNAM health sciences undergraduate students from generations 2001 to 2016. Material and methods: Study of real cohorts; graduation and lag rates were calculated. ANOVA was used to contrast the graduation rates between campuses by undergraduate program and time. To identify critical periods, survival functions were used with Kaplan-Meier’s method. Results: The lowest percentages of lag were observed in nursing and medicine students; nursing students had the highest graduation rates, especially at Zaragoza campus; dentistry students had the lowest graduation rates and the highest dropout and lag rates. Women showed higher graduation rates and lower risk of dropout and lag. Conclusions: Nursing, medicine and psychology undergraduate students at Zaragoza and Iztacala campuses, with modular programs, achieved the highest graduation percentages and the lowest dropout and lag rates.

Simultaneous Schlieren-Shadowgraph Visualization and Temperature Measurement Fields of Fluid Flow Using One Color CCD Camera.

Visualizing two variables in the fluid flow requires a complex optical system to fulfill such a purpose. Furthermore, in these applications, measuring the temperature fields of the fluid is sometimes necessary. In this work, we use a color digital camera to record in one snapshot shadowgraph and two direction sensitivity Schlieren images. Furthermore, the Schlieren images obtained are used to measure temperature fields. The optical system, as main components, employs an rgb Light Emitting Diode (LED), two knife edges represented by shortpass and longpass ultra-thin filters, and a color digital camera. The results of this study show that shadowgraph images are contaminated with the crosstalk effect, and correction against it was applied. On the other hand, the reached resolution of the optical system to measure temperature values is approximately one degree.

Preoperative risk assessment and spirometry is a cost-effective strategy to reduce post-operative complications and mortality in Mexico.

AIM: Combining preoperative spirometry with the Assess Respiratory Risk in Surgical Patients in Catalunia (ARISCAT) risk scale can reduce post-operative complications and improve patient survival. This study aimed to assess the cost-effectiveness of performing spirometry or not in conjunction with the ARISCAT scale, to reduce post-operative complications and improve survival among adult patients undergoing elective surgery in Mexico. METHODS: A cost-effectiveness analysis (CEA) was performed to compare the specific cost and health outcomes associated with the combined use of the ARISCAT scale and preoperative spirometry (Group 1), and the use of the ARISCAT scale without preoperative spirometry (Group 2). The health outcomes evaluated were post-operative complications and survival. The perspective was from the health care provider (Hospital General de México) and direct medical costs were reported in 2019 US dollars. A decision tree with a time horizon of eight months was used for each health outcome and ARISCAT risk level. RESULTS: The combined use of the ARISCAT scale and spirometry is more cost-effective for reducing post-operative complications in the low and moderate-risk levels and is cost-saving in the high-risk level, than use of the ARISCAT scale without spirometry. To improve patient survival, ARISCAT and spirometry are also more cost-effective at the moderate risk level, and cost-saving for high-risk patients, than using the ARISCAT scale alone. CONCLUSIONS: The use of preoperative spirometry among patients with a high ARISCAT risk level was cost-saving, reduced post-operative complications, and improved survival. Our findings indicate an urgent need to implement spirometry as part of preoperative care in Mexico, which is already the standard of care in other countries.

Antibiotic prescription errors: the relationship with clinical competence in junior medical residents.

BACKGROUND: A large portion of prescribing errors can be attributed to deficiencies in medication knowledge. These errors are preventable and most often occur at the time of prescription. Antimicrobials are the drug class most common incorrectly prescribed. OBJECTIVE: To characterize the relationship between clinical competence and antibiotic prescription errors. We also investigated the frequency and severity of antibiotic prescription errors to identify items and attributes of clinical competence which are correlated with the antibiotic prescription error ratio. METHOD: A cross-sectional study was applied to assess clinical competence of junior medical residents in two reference academic hospitals and a regional hospital in Mexico City. It was conducted during February 2019. We used an infectious disease Objective Structured Clinical Examination (OSCE) to assess clinical competence and a measure of frequency, and severity of antibiotic prescription errors. RESULTS: The number of eligible participants was ~ 255 (hospital meeting attendance), and the number of residents in this study were 51 (~ 20%), 31 were female (60.8%). The mean OSCE score was 0.692 ± 0.073. The inter-item (Cronbach's alpha = 0.927) and inter-station internal consistency was adequate (Cronbach's alpha = 0.774). The G coefficient in generalizability theory analysis was 0.84. The antibiotic prescription error ratio was 45.1% ± 7%. The most frequent category of severity of antibiotic prescription errors was category E (errors that may contribute to or result in temporary harm to the patient and require intervention), 235 (65.2%). We observed a negative and significant correlation between clinical competence and antibiotic prescription errors (r = -0.33, p < 0.05, CI95% -0.57 to -0.07), which remained significant after controlling for the effect of gender and time since graduation from medical school (r = -0.39, p < 0.01, CI95% -0.625 to -0.118). Using exploratory factor analysis we identified two factors, which explained 69% of the variance in clinical competence, factor 1 evaluated socio-clinical skills and factor 2 evaluated diagnostic-therapeutic skills. Factor 2 was correlated with antibiotic prescription error ratio (r = -0.536, p < 0.001). CONCLUSIONS: We observed a negative correlation between clinical competence and antibiotic prescription error ratio in graduated physicians who have been accepted in a medical specialty. The therapeutic plan, which is a component of the clinical competence score, and the prescription skills had a negative correlation with antibiotic prescription errors. The most frequent errors in antibiotic prescriptions would require a second intervention.

Panoramic reconstruction of quasi-cylindrical objects with digital holography and a conical mirror.

In this work, we present a panoramic digital holographic system for the first time capable of obtaining 3D information of a quasi-cylindrical object by using a conical mirror. The proposed panoramic digital holographic system is able to scan the entire surface of the object to determine the amplitude and phase simultaneously. This paper demonstrates the feasibility of analyzing quasi-cylindrical objects in a short time (0.5 s) with a single camera and a minimum number of optical components. In addition, it can be applied to determine not only topographic measurement of the cylindrical surface but also measurements of radial deformations. Experimental results are presented at different magnifications, thus illustrating its capabilities and versatility.

National examination for medical residency admission: academic variables and performance among different schools / Examen Nacional de Aspirantes a Residencias Médicas: tipo de escuela y desempeño obtenido

Abstract: Objective: To identify medical school characteristics associated with performance in a medical residency admission test. Materials and methods: Performance and selection rates according to type of medical school (Student´s t-test, Chi-squared test), accreditation status (Student´s t-test) and geographic regions (Anova) were analyzed from a database comprising 153 654 physicians who took the residency admission test Examen Nacional de Aspirantes a Residencias Médicas (ENARM) in the period 2014-2018. Results: Performance was 62.5% for accredited programs and 61.4% for non-accredited programs (p<0.001); public schools reached 62.3% and private schools 62.2% (p<0.001). Northern regions performed above 63% while South-Southeast at 58.9% (p<0.001). Selection rate was 26.2% for accredited programs and 22.9% for non-accredited (p<0.001); 26.6% for public schools and 23.6% for private schools (p<0.001). North-East and North-West reached 31% while South-Southeast 20.7%. Conclusions: Type of school, accreditation status and geographic region may influence performance and selection rate.

Resumen: Objetivo: Identificar características de las escuelas de medicina asociadas con desempeño en un examen de admisión a residencias. Material y métodos. Utilizando una base de datos con 153 654 registros de aspirantes entre 2014-2018 se analizaron el desempeño y selección en el Examen Nacional de Aspirantes a Residencias Médicas (ENARM) y su relación con tipo de escuela y estatus de acreditación, así como región geográfica. Resultados: El desempeño fue 62.5% para programas acreditados y 61.4% para no acreditados (p<0.001); 62.3% para escuelas públicas y 62.2% para privadas (p<0.001). Las regiones del norte alcanzaron 63% y Sur-Sureste 58.9% (p<0.001). La tasa de selección fue 26.2% para programas acreditados y 22.9% para no acreditados (p<0.001); 26.6% para escuelas públicas y 23.6% para privadas (p<0.001). Las regiones del norte alcanzaron 31% mientras Sur-Sureste 20.7%. Conclusiones: Las características de la escuela de medicina influencian el desempeño en el ENARM.

National examination for medical residency admission: academic variables and performance among different schools.

OBJECTIVE: To identify medical school characteristics associated with performance in a medical residency admission test. MATERIALS AND METHODS: Performance and selection rates according to type of medical school (Student´s t-test, Chi-squared test), accreditation status (Student´s t-test) and geographic regions (Anova) were analyzed from a database comprising 153 654 physicians who took the residency admission test Examen Nacional de Aspirantes a Residencias Médicas (ENARM) in the period 2014-2018. RESULTS: Performance was 62.5% for accredited programs and 61.4% for non-accredited programs (p<0.001); public schools reached 62.3% and private schools 62.2% (p<0.001). Northern regions performed above 63% while South-Southeast at 58.9% (p<0.001). Selection rate was 26.2% for accredited programs and 22.9% for non-accredited (p<0.001); 26.6% for public schools and 23.6% for private schools (p<0.001). North-East and North-West reached 31% while South-Southeast 20.7%. CONCLUSIONS: Type of school, accreditation status and geographic region may influence performance and selection rate.

Specialty choice determinants among Mexican medical students: a cross-sectional study.

BACKGROUND: The choice of medical specialty is related to multiple factors, students' values, and specialty perceptions. Research in this area is needed in low- and middle-income countries, where the alignment of specialty training with national healthcare needs has a complex local interdependency. The study aimed to identify factors that influence specialty choice among medical students. METHODS: Senior students at the National Autonomous University of Mexico (UNAM) Faculty of Medicine answered a questionnaire covering demographics, personal experiences, vocational features, and other factors related to specialty choice. Chi-square tests and factor analyses were performed. RESULTS: The questionnaire was applied to 714 fifth-year students, and 697 provided complete responses (response rate 81%). The instrument Cronbach's alpha was 0.8. The mean age was 24 ± 1 years; 65% were women. Eighty percent of the students wanted to specialize, and 60% had participated in congresses related to the specialty of interest. Only 5% wanted to remain as general practitioners. The majority (80%) wanted to enter a core specialty: internal medicine (29%), general surgery (24%), pediatrics (11%), gynecology and obstetrics (11%) and family medicine (4%). The relevant variables for specialty choice were grouped in three dimensions: personal values that develop and change during undergraduate training, career needs to be satisfied, and perception of specialty characteristics. CONCLUSIONS: Specialty choice of medical students in a middle-income country public university is influenced by the undergraduate experience, the desire to study a subspecialty and other factors (including having skills related to the specialty and type of patients).

Educational experiences in a master of health professions education program at the National Autonomous University of Mexico: A qualitative study.

Background: Medical schools and healthcare institutions need leaders with formal training in education, in order to provide quality medical teaching. An answer to this need lies in the graduate programs of health professions education. Many programs exist, but there is a dearth of publications about their educational processes and experiences. The purpose of this study was to explore the teaching and learning experiences of students, teachers, and graduates of the Master in Health Professions Education (MHPE) program at the National Autonomous University of Mexico (UNAM). Methods: A qualitative approach was used with focus group discussions with students, graduates, and teachers, to explore their opinions, feelings, and experiences about the program. Purposeful sampling of participants was done. Focus group guides were developed for the different study groups; testimonies were codified and categorized with axial coding and a constant comparison method. Results: Testimonies from 19 participants in three focus groups were obtained (five graduates, seven current students, and seven teachers). The data were grouped in seven thematic categories: expectations, feedback of research projects, the tutorial process, teaching strategies, usefulness of what was learned, professional development, and assessment. Positive elements of the program were identified as well as areas in need of improvement. Discussion: The MHPE program at UNAM has been a positive experience for students and mostly fulfilled their expectations, they learned the basic theories and practical aspects of teaching, learning, and assessment in the health professions. Some areas need improvement, such as tutor performance and timely feedback to the students. Graduates think the competencies acquired in the program are useful for their professional practice. This information will be used to improve the program. There is a need to meet international standards in MHPE programs.

[La analítica del aprendizaje en educación médica: ¿punto de inflexión?]

La analítica del aprendizaje es una disciplina novedosa que tiene un enorme potencial para mejorar la calidad de la educación médica y la evaluación del aprendizaje. Se define como: "la medición, recopilación, análisis y reporte de datos sobre los alumnos y sus contextos, con el propósito de entender y optimizar el aprendizaje y los entornos en que ocurre". En las últimas décadas, la aparición de grandes volúmenes de datos (big data), acompañada de una rápida evolución en la minería de datos educativos, la aparición de tecnologías sofisticadas para analizar y visualizar datos de cualquier tipo, así como la disponibilidad de dispositivos móviles con conectividad permanente, mayor velocidad de procesamiento y capacidad de recuperación de información, han generado un contexto que favorece el uso de la analítica del aprendizaje en la medicina clínica y la educación médica. En este artículo se describe la historia reciente del concepto de analítica del aprendizaje, sus ventajas y desventajas en educación superior, así como sus aplicaciones en la enseñanza de las ciencias de la salud y la evaluación educativa. Es necesario que la comunidad de educadores médicos conozca la analítica del aprendizaje, para ser capaces de integrarla en su contexto eficaz y oportunamente.

Learning analytics is an innovative discipline that has an enormous potential to improve the quality of medical education and learning assessment. It is defined as: "the measurement, collection, analysis and reporting of data about learners and their contexts, for purposes of understanding and optimizing learning and the environments in which it occurs". In recent decades, the appearance of large volumes of data (big data), accompanied by a quick evolution of educational data mining techniques, the emergence of sophisticated technologies to analyze and visualize any type of data, as well as the availability of permanently-connected mobile electronic devices, higher processing speed and capacity of information retrieval, have generated a context that favors the use of learning analytics in clinical medicine and medical education. In this paper, the recent history of the concept of learning analytics is described, as well as its advantages and disadvantages in higher education, and its applications in the teaching of health sciences and educational assessment. It is necessary for the community of medical educators to be acquainted with learning analytics, in order to be able to integrate it to our context in an efficacious and timely manner.

La analítica del aprendizaje en educación médica: ¿punto de inflexión? / Learning analytics in medical education: turning point?

Resumen La analítica del aprendizaje es una disciplina novedosa que tiene un enorme potencial para mejorar la calidad de la educación médica y la evaluación del aprendizaje. Se define como: “la medición, recopilación, análisis y reporte de datos sobre los alumnos y sus contextos, con el propósito de entender y optimizar el aprendizaje y los entornos en que ocurre”. En las últimas décadas, la aparición de grandes volúmenes de datos (big data), acompañada de una rápida evolución en la minería de datos educativos, la aparición de tecnologías sofisticadas para analizar y visualizar datos de cualquier tipo, así como la disponibilidad de dispositivos móviles con conectividad permanente, mayor velocidad de procesamiento y capacidad de recuperación de información, han generado un contexto que favorece el uso de la analítica del aprendizaje en la medicina clínica y la educación médica. En este artículo se describe la historia reciente del concepto de analítica del aprendizaje, sus ventajas y desventajas en educación superior, así como sus aplicaciones en la enseñanza de las ciencias de la salud y la evaluación educativa. Es necesario que la comunidad de educadores médicos conozca la analítica del aprendizaje, para ser capaces de integrarla en su contexto eficaz y oportunamente.

Abstract Learning analytics is an innovative discipline that has an enormous potential to improve the quality of medical education and learning assessment. It is defined as: “the measurement, collection, analysis and reporting of data about learners and their contexts, for purposes of understanding and optimizing learning and the environments in which it occurs”. In recent decades, the appearance of large volumes of data (big data), accompanied by a quick evolution of educational data mining techniques, the emergence of sophisticated technologies to analyze and visualize any type of data, as well as the availability of permanently-connected mobile electronic devices, higher processing speed and capacity of information retrieval, have generated a context that favors the use of learning analytics in clinical medicine and medical education. In this paper, the recent history of the concept of learning analytics is described, as well as its advantages and disadvantages in higher education, and its applications in the teaching of health sciences and educational assessment. It is necessary for the community of medical educators to be acquainted with learning analytics, in order to be able to integrate it to our context in an efficacious and timely manner.

El residente como evaluador del desempeño docente en las especialidades médicas / The Resident as an assessor of clinical teacher performance in medical specialties

INTRODUCCIÓN: La evaluación del desempeño docente y -sobre todo- la valoración de sus competencias docentes y clínicas es un proceso vital en las residencias médicas. Con el fin de lograr una adecuada evaluación docente se han propuesto diversos modelos, sin embargo aquellos que involucran la opinión de los alumnos son los más accesibles y completos hasta ahora. OBJETIVO: Evaluar el desempeño docente a través de la opinión de los residentes por medio de un cuestionario estandarizado que tiene evidencia de validez y confiabilidad. MÉTODO: Estudio observacional, transversal. Lugar: hospital de segundo nivel. Se incluyeron las especialidades de medicina interna, cirugía general, anatomía patológica, oftalmología, otorrinolaringología, traumatología, imagenología diagnóstica, anestesiología y ginecología. Se incluyó a todos los docentes y alumnos de las especialidades médicas de un hospital de segundo nivel. Se aplicó el cuestionario de evaluación del desempeño docente desarrollado por Martínez-González et al., de manera anónima. Se eliminaron las variables demográficas y se añadió un comentario libre en cada evaluación. RESULTADOS: Se incluyeron 160 maestros y 100 alumnos. Se realizaron 703 encuestas. La media de cada dimensión fue: relación profesor-residente y motivación 4,66±0,78, metodología 4,58±0,88, evaluación 4,61±0,85, capacidad de solucionar problemas 4,68±0,81, conocimiento de la materia 4,68±0,78. El promedio global fue de 4,64±0,80. La evaluación más baja fue metodología. Los residentes de mayor jerarquía fueron los que evaluaron más alto a los docentes (p = 0,02). Las especialidades quirúrgicas contaron con evaluaciones inferiores que las especialidades médicas (4,60±0,84 vs 4,82±0,45, p=<0,001). CONCLUSIÓN: Los docentes cursaron con una buena evaluación global, encontrando como áreas de mejora las dimensiones de metodología y evaluación. Se recomienda eliminar las variables demográficas del instrumento y añadir comentarios libres en cada evaluación

INTRODUCTION: Clinical teacher performance evaluation, and above all the evaluation of teaching skills and clinical competences among medical teachers are of the utmost importance for medical residents. A number of different tools have been proposed in order to obtain a reasonable assessment of teacher performance. Nonetheless, residents?? appraisal is currenlty the most simple and complete measurement tool available. OBJECTIVE: To evaluate clinical tutor performance through the opinion of residents using a validated and reliable questionnaire. METHOD: Observational and cross-sectional study conducted in a secondary care hospital. The following specialties were included: internal medicine, general surgery, pathology, ophthalmology, ear, nose and throat, traumatology, radiology, anaesthesiology, and gynaecology. All medical teachers and residents were included. A standardised questionnaire, developed by Martínez-González et al., was completed anonymously by. RESULTS: The study included 160 teachers and 100 residents, with 703 questionnaires being answered. The dimension means were: teacher-resident relationship and motivation 4.66±0.78, methodology 4.58±0.88, evaluation 4.61±0.85, problem solving capacity 4.68±0.81, and subject knowledge 4.68±0.78. Mean overall assessment was 4.64±0.80. Methodology was the dimension with lowest scores. Residents with highest grades evaluated the teacher with higher scores (P=.02). Surgical residents had lower scores than medical residents (4.60±0.84 vs 4.82±0.45, P<.001). CONCLUSION: Medical teachers obtained a good overall evaluation by the students, although there are areas like methodology and assessment that need improvement. It is recommended to eliminate demographic variables from the evaluation tool, as well allowing to add free comments for each evaluation

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.

Dual-plane slightly off-axis digital holography based on a single cube beam splitter.

In order to recover the holographic object information, a method based on the recording of two digital holograms, not only at different planes but also in a slightly off-axis scheme, is presented. By introducing a π-phase shift in the reference wave, the zero-order diffracted term and the twin image are removed in the frequency domain during the processing of the recorded holograms. We show that the zero-order elimination by the phase-shifted holograms is better than working with weak-order beam and average intensity removal methods. For recording experimentally two π-shifted holograms at different planes slightly off-axis, a single cube beam splitter is used. Computer simulations and experimental results, carried out to validate our proposal, show a high accuracy of π/14 that can be comparable with phase-shifting digital holography. For high fringe spacing, our proposal could be applied in electron holography, avoiding high voltage in a biprism.

[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.