Satisfacción y desarrollo de competencias en escenarios de simulación clínica de alta fidelidad en estudiantes de Obstetricia / Satisfaction and development of skills in high-fidelity clinical simulation scenarios in Obstetrics students

Introducción: La simulación clínica ha surgido como un método de aprendizaje y de evaluación que genera la adquisición de destrezas y habilidades en las ciencias de la salud. El aprendizaje bajo escenarios de simulación clínica se asocia con mayores niveles de satisfacción, confianza y logro de contenidos al poder practicar las habilidades sin perjuicio al paciente, lo cual es una clara respuesta a la necesidad actual de proteger la seguridad del paciente, y asegurar una formación continua y eficiente. Este estudio busca analizar la relación entre la satisfacción y la adquisición de competencias generadas en estudiantes de Obstetricia de la Universidad Andrés Bello a través de escenarios de simulación clínica de alta fidelidad. Sujetos y métodos: Cuarenta y dos estudiantes de cuarto año de Obstetricia de la Universidad Andrés Bello se enfrentaron a seis escenarios de simulación de alta fidelidad que evaluaron la adquisición de habilidades técnicas para la asistencia del parto y una encuesta de satisfacción para escenarios de simulación de fidelidad.Resultados: La evaluación de las habilidades contó con un promedio de cumplimiento para el primer escenario de un 59,78%; para el segundo, de un 70,29%; para el tercero, de un 71,42%; para el cuarto, de un 81,32%; para el quinto, de un 87,71%; y para el sexto, de un 96,86%. Las estudiantes coinciden en que la simulación es un método útil para el aprendizaje (100%), que es una herramienta que mejora las habilidades técnicas (97,6%), que ha aumentado la seguridad y confianza (100%), y que los escenarios de alta fidelidad fueron satisfactorios (100%). Conclusiones: Los estudiantes de Obstetricia mejoraron sus competencias clínicas, que involucran habilidades comunicacionales y razonamiento clínico, y además perciben altos niveles de satisfacción al realizar seis escenarios de alta fidelidad.(AU)

Introduction: Clinical simulation has emerged as a learning and evaluation method that generates the acquisition of skills and abilities in the field of health sciences. Learning under clinical simulation scenarios is associated with higher levels of satisfaction, confidence, ability to provide information, and content achievement by being able to practice the skills without harming the patient, which is a clear response to the current need to protect the safety of the patient and ensure continuous and efficient training. This study seeks to analyze the relationship between satisfaction and the acquisition of competencies in Obstetrics students at the Andrés Bello University, through high-fidelity clinical simulation scenarios. Subjects and methods: Forty-two Obstetrics students from the Andrés Bello University faced six high-fidelity simulation scenarios that evaluated the acquisition of technical skills for childbirth assistance through an evaluation rubric and a satisfaction survey for high fidelity simulation scenarios.Results: The evaluation of the skills had an average compliance for the first scenario of 59.78%, for the second 70.29%, for the third 71.42%, the fourth 81.32%, the fifth 87 71% and the sixth 96.86%. Regarding the satisfaction in the highfidelity clinical simulation scenarios, the students agree that simulation is a useful method for learning (100%), that it is a tool that improves technical skills (97.6%), that has felt security and confidence (100%) and that the high-fidelity scenarios were satisfactory (100%). High fidelity simulation scenarios prove to be a satisfactory tool for skill acquisition. Conclusion: Obstetrics students improved their clinical competencies, which involve communication skills and clinical reasoning, and also, perceived high levels of satisfaction after 6 high-fidelity scenarios.(AU)

Adaptación a la vida universitaria de estudiantes indígenas de comunas rurales del Norte Grande de Chile. Un estudio cualitativo / The adaptation to university life of indigenous students from rural communities in the Norte Grande of Chile. A qualitative study

Introducción: La adaptación a la vida universitaria es un proceso multidimensional en el que se llevan a cabo conjuntamente diversas transiciones y desafíos a los que se enfrenta el estudiante. Las medidas de inducción adoptadas por las universidades se centran en un perfil generalizado del estudiantado y dejan fuera los aspectos particulares, como es el caso de los indígenas de zonas rurales. Objetivo: Analizar los factores asociados a la adaptación a la vida universitaria desde la perspectiva del estudiante indígena de comunas rurales del Norte Grande de Chile. Sujetos y métodos: La metodología de este estudio es cualitativa mediante la teoría fundamentada. Se realizaron entrevistas semiestructuradas a siete participantes estudiantes indígenas de pregrado y se presentan los resultados relacionales hasta la etapa de codificación axial. Resultados: Los resultados muestran factores condicionantes, como el cambio cultural, la separación familiar y las demandas académicas; y factores de éxito en la adaptación y el apoyo social, y en mejoras de las estrategias de aprendizaje y comunicativas, y estos dos elementos son esenciales para generar una sensación de superación. Conclusión: Los estudiantes que se adaptan exitosamente al ambiente educativo universitario integran un círculo social en el que pueden transmitir ideas e inquietudes; en el contexto académico aprenden y colaboran con el resto; y en un ambiente social descubren y conocen la vida urbana.(AU)

Introduction: The adaptation to university life is a multidimensional process in which various transitions and challenges are collectively undertaken by the students. The induction measures adopted by universities focus on a generalized profile of the student body, leaving out particular aspects such as indigenous students from rural areas. Aim: To analyze the factors associated with adaptation to university life from the perspective of indigenous students from rural communities in the Northern region of Chile. Subjects and methods: This study is qualitative, using Grounded Theory, and semi-structured interviews were conducted with seven indigenous undergraduate participants. The relational results up to the axial coding stage are presented. Results: The results show conditioning factors such as cultural change, separation from family, and academic demands. Success factors in adaptation include social support in improving learning and communication strategies, which are two essential elements for generating a sense of achievement. Conclusion: A student who successfully adapts to the university educational environment integrates into a social circle where they can convey ideas and concerns, learns and collaborates with others in an academic context, and discovers and learns about urban life in a social environment.(AU)

Identifying the Needs of Older Adults Associated with Daily Activities: A Qualitative Study.

INTRODUCTION: By 2050, older adults will constitute 16% of the world population; hence, there is an urgent demand and challenge to design solutions (products and services) that meet the needs of this age group. This study sought to analyse the needs that impact the well-being of Chilean older adults and present possible solutions through the design of products. METHODOLOGY: A qualitative study was used, where focus groups were held with older adults, industrial designers, health professionals, and entrepreneurs on the needs and design of solutions for older adults. RESULTS: A general map was obtained that linked the categories and subcategories related to the relevant needs and solutions, which were then classified in a framework. CONCLUSIONS: The resulting proposal places the needs in different fields of expertise; and thus, enables positioning, broadening, and expanding upon the map to share knowledge, between the user and key experts, to co-create solutions.

Inclusion in the university: Who assumes responsibility? A qualitative study.

Society challenges higher education institutions and their members to generate inclusive communities to enable the full development of all members. This study aims to analyze who is responsible for generating inclusion according to community members from a traditional Chilean University. We carried out qualitative research based on the Grounded Theory. We collected data through focus group and semi-structured Interviews, involving 14 undergraduate students, two post-graduate students, 17 faculty members, five non-teaching staff members, and nine executives officers. All of thembelonging to the three campuses of the University. We analyzed data using ATLAS.ti 7.5.7, using the constant comparison method and reaching an axial codification level. From the data analysis, 25 subcategories emerged, grouped into six categories. Later we organized them under the codification paradigm. Results highlighted the perception of the interaction and influence of the social, institutional, and personal fields in the inclusion phenomenon. Also, that inclusive practices must be a responsibility shared among different educational community members.

Well-being variations on students of health sciences related to their learning opportunities, resources, and daily activities in an online and on-crisis context: a survey-based study.

BACKGROUND: Universities' training process intensely relies on face-to-face education. The COVID-19 pandemic interrupted it and forced them to reinvent their process online. But this crisis seems not to be the last we will face, and we take it as a lesson to prepare for future crises. These critical contexts are especially challenging because they imply changing teaching strategies, and students may not have the technology access or the living conditions to connect as they need. They also lived through a pandemic where the virus and the life changes added stress to their learning process and threatened their well-being. So, this study aims to analyze how well-being variations reported by Health sciences students relate to their learning opportunities, access conditions, and daily activities. METHOD: We surveyed 910 Health sciences students from six different Chilean universities at the end of the first semester of 2020, the first in pandemic conditions. Respondents answered online questionnaires about 1) Remote teaching activities, 2) Learning resources availability, 3) Daily life activities, and 4) Well-being changes. We performed descriptive analysis and Structural Equation Modelling. RESULTS: Live videoconference classes were the most frequent teaching activity; only a third of the students had quiet spaces to study online, and most had to housekeep daily. More than two third reported some well-being deterioration. The structural equation model showed a good fit. CONCLUSION: Results show an online learning scenario that tries to emulate traditional learning focusing on expositive strategies. Most students reported that their well-being deteriorated during the semester, but tutorials, workplace availability, and social support were protective factors.

Trust in the physician: based-on-evidence advice to favor it / Confianza en el médico: recomendaciones para favorecerlo basadas en la evidencia

Introduction: Trust in physicians is associated with the observance of treatment, keeping the treating physician, willingness to recommend the physician, fewer disputes, perception of greater effectiveness of care, and improvement in health self-perception.Methods.The present narrative review explores factors that scientific literature relates to trust in physicians and organize them into those associated with patients' characteristics and those associated to physician's ones. The first group includes the patient's sociodemographic antecedents, health condition, selection of the physician, experience in the system, satisfaction, and symmetry of perspectives. The second group includes physician's sociodemographic characteristics, online information, physical appearance, communication, emotional intelligence, and humility.Results.From this revision, authors synthesize five bits of advice for physicians to improve patients' trust: a) be friendly to online information; b) take care of your personal aspect; c) show empathy, honesty, and competence; d) actively include patients in decision-making; and e) accept that we all make mistakes. (AU)

Introducción: La confianza en el médico se asocia con el cumplimiento del tratamiento, la permanencia del médico tratante, la disposición a recomendar al médico, la disminución de las disputas, la percepción de una mayor eficacia de la atención y la mejora de la autopercepción de la salud.Métodos.La presente revisión narrativa explora los factores que la literatura científica relaciona con la confianza en el médico y los organiza en los asociados a las características de los pacientes y los asociados a las del médico. El primer grupo incluye los antecedentes sociodemográficos del paciente, el estado de salud, la selección del médico, la experiencia en el sistema, la satisfacción y la simetría de perspectivas. El segundo grupo incluye las características sociodemográficas del médico, su apariencia física, la información en línea, la comunicación, la inteligencia emocional y la humildad.Resultados.A partir de esta revisión, los autores sintetizan cinco consejos de los médicos para mejorar la confianza de los pacientes: a) ser amable con la información en línea; b) cuidar el aspecto personal; c) mostrar empatía, honestidad y competencia; d) incluir activamente a los pacientes en la toma de decisiones; y e) aceptar que todos cometemos errores. (AU)

Building the physician: factors influencing trust in medical attention

Introduction: Trust is an inherent component of the physician-patient relationship. Although the factors that influence it have been examined in the literature, as well as the consequences that they may have for the patient’s health, there has been scant reflection towards the purpose of educating health professionals so that they become involved as active builders of this value. This is essential, since it emphasizes a more exhaustive anamnesis and physical examination, consented diagnosis procedures and patient trust in treatment decisions suggested and worked out together with the physician.Methods.This narrative review is an analysis of the literature on the subject.Results.This narrative review illustrates some of the factors that influence trust, such as communication style, body mass index, and information displayed on social networks by the physician. It also deals with some of the consequences that may appear and that are relevant to clinical practice and patient’s health, such as adherence to treatment, continuity of care with the physician, and changes in physical functioning after intensive therapies.Conclusions.In conclusion, the weight of the factors that influence trust is highlighted and it is established that there is lack of knowledge about the subject. Most of the data are from developed countries and about the role of the social networks as a reference element when choosing a physician to be consulted. (AU)

Introducción: La confianza es un componente inherente a la relación entre el médico y su paciente. Aunque se han examinado en la literatura los factores que influyen en ella, así como las consecuencias que pueden tener para la salud del paciente, apenas se ha reflexionado sobre el propósito de educar a los profesionales sanitarios para que se impliquen como constructores activos de este valor. Esto es fundamental, si se hace hincapié en una anamnesis y una exploración física más exhaustivas, en procedimientos diagnósticos consentidos y en que el paciente confíe en las decisiones terapéuticas sugeridas y elaboradas junto con el médico.Métodos.Esta revisión narrativa es un análisis de la bibliografía sobre el tema.Resultados.Esta revisión narrativa ilustra algunos de los factores que influyen en la confianza, como el estilo de comunicación, el índice de masa corporal y la información mostrada en las redes sociales por el médico. También aborda algunas de las consecuencias que pueden aparecer y que son relevantes para la práctica clínica y la salud del paciente, como la adhesión al tratamiento, la continuidad de la atención con el médico y los cambios en el funcionamiento físico tras las terapias intensivas.Conclusiones.Como conclusión, se destaca el peso de los factores que influyen en la confianza y se establece que existe desconocimiento sobre el tema. La mayoría de los datos son de países desarrollados y sobre el papel de las redes sociales como elemento de referencia a la hora de elegir un médico para ser consultado. (AU)

Profesionalismo y medicina narrativa / Professionalism and narrative medicine

This work is a bibliographical review of the challenges of professionalism in medical training. Medicine practiced with narrative competence, called narrative medicine, is proposed as a model for humane and effective medical practice. By virtue of the changes in the practice of medicine during the last years, professionalism values emerge as qualities that should reshape medicine. Several medical associations are redefining professionalism and insist that this issue should be included in the training curriculum. Thus, several medical education institutions are pursuing strategies to teach and assess professionalism. Modeling is still relevant as a learning strategy, but it must be tutored and directed. Also, timely and formative feedback appears as the most frequently suggested evaluative action. Both processes incorporate a personal reflective practice. Several recent studies suggest that a reflective experience is relevant for the formation of a professional identity. Narrative Medicine methodology emerges as an innovative strategy to address this issue, as it seeks to deliver valuable learning experiences to the students through reflection and the search for a new paradigm for medical practice.

The training of a new social-responsible generation of health professionals with a patient-centered vision / A formação de uma nova geração socialmente responsável de profissionais de saúde com uma visão centrada no paciente

Abstract The challenges that Latin America faces in health are deeply related to others, such as access to clean water, the right to education, and housing. Health professionals that work in an environment where the population faces constant barriers to accessing care in the public health system or has limited resources to pay for it in a private sector will face an ethical dilemma, the question of how to honor the call to care for patients when there is not enough support system or infrastructure to do so. Within the schools of medicine and health sciences, the question is how to train students to face or resolve these conflicts. The social responsibility approach is a proposal that allows the alignment of education for health professionals and health systems to contribute to the creation of an effective, equitable, and sustainable system. The present article aims to discuss this problem from the importance of training health professionals, ethical and committed to their communities, that have the skills and attitudes to implement a patient-centered vision. The involvement of universities and training institutions of the next generation of health professionals cannot be postponed.

Resumo Os desafios que a América Latina enfrenta em matéria de saúde estão profundamente relacionados a outros, como o acesso à água limpa, o direito à educação e à moradia. Os profissionais de saúde que trabalham em um ambiente onde a população enfrenta constantes barreiras ao acesso aos cuidados no sistema público de saúde ou tem recursos limitados para pagá-los em um setor privado enfrentarão um dilema ético, a questão de como honrar o chamado para cuidar dos pacientes quando não há sistema de apoio ou infraestrutura suficiente para fazê-lo. Dentro das escolas de medicina e ciências da saúde, a questão é como treinar os estudantes para enfrentar ou resolver estes conflitos. A abordagem da responsabilidade social é uma proposta que permite o alinhamento da educação dos profissionais de saúde e dos sistemas de saúde para contribuir para a criação de um sistema eficaz, equitativo e sustentável. O presente artigo visa discutir este problema a partir da importância de formar profissionais de saúde, éticos e comprometidos com suas comunidades, que tenham as habilidades e atitudes necessárias para implementar uma visão centrada no paciente. O envolvimento de universidades e instituições de treinamento da próxima geração de profissionais de saúde não pode ser adiado.

The training of a new social-responsible generation of health professionals with a patient-centered vision.

The challenges that Latin America faces in health are deeply related to others, such as access to clean water, the right to education, and housing. Health professionals that work in an environment where the population faces constant barriers to accessing care in the public health system or has limited resources to pay for it in a private sector will face an ethical dilemma, the question of how to honor the call to care for patients when there is not enough support system or infrastructure to do so. Within the schools of medicine and health sciences, the question is how to train students to face or resolve these conflicts. The social responsibility approach is a proposal that allows the alignment of education for health professionals and health systems to contribute to the creation of an effective, equitable, and sustainable system. The present article aims to discuss this problem from the importance of training health professionals, ethical and committed to their communities, that have the skills and attitudes to implement a patient-centered vision. The involvement of universities and training institutions of the next generation of health professionals cannot be postponed.

Inclusion at universities: Psychometric properties of an inclusive management scale as perceived by students.

INTRODUCTION: During the last century, the inclusion of all kinds of diversity became a social imperative in all social spaces but above all in some institutions such as the educational ones. Among these, inclusion has been least studied in the tertiary education organizations. This communication proposes and evaluates the psychometric properties of a new instrument, named Inclusive Management in Tertiary Institutions Scale (IMTIS), to assess inclusive management in universities. METHOD: The researchers used a quantitative research model through survey. We based on the Index for Inclusion to design the IMTIS. We first submitted it to the assessment of experts. Then we applied the resulting version in an online survey including a sample of 1557 students from two universities and 121 different undergraduate careers. A panel of experts judged the content validity of the instrument. Participants answered the IMTIS after informed consent. We used confirmatory factor analysis to assess the construct validity of the instrument. We also evaluated the reliability of the measurements. RESULTS: From a kit of 33 originally proposed items, we obtained a version of 22 items with CVR between 0.60 and 1.00, and a IVC = 0.78. The confirmatory factor analysis showed that the six-factor solution had a better adjustment than the one and three factors solutions (RMSEA = 0.059; CFI = 0.947; TLI = 0.937). The McDonald ω coefficients were between 0.864 and 0.922. CONCLUSION: The results deliver evidence that supports the validity and reliability of the IMTIS measurements to carry out research and diagnosis of inclusive management in higher education institutions.

[Professionalism and narrative medicine]. / Profesionalismo y medicina narrativa.

This work is a bibliographical review of the challenges of professionalism in medical training. Medicine practiced with narrative competence, called narrative medicine, is proposed as a model for humane and effective medical practice. By virtue of the changes in the practice of medicine during the last years, professionalism values emerge as qualities that should reshape medicine. Several medical associations are redefining professionalism and insist that this issue should be included in the training curriculum. Thus, several medical education institutions are pursuing strategies to teach and assess professionalism. Modeling is still relevant as a learning strategy, but it must be tutored and directed. Also, timely and formative feedback appears as the most frequently suggested evaluative action. Both processes incorporate a personal reflective practice. Several recent studies suggest that a reflective experience is relevant for the formation of a professional identity. Narrative Medicine methodology emerges as an innovative strategy to address this issue, as it seeks to deliver valuable learning experiences to the students through reflection and the search for a new paradigm for medical practice.

Poder y género en las relaciones entre docentes y estudiantes de la carrera de medicina

Background: Education is a continuous, critical, holistic process that not only intends to transmit knowledge, abilities, and skills, but also permeates attitudes, values and dispositions, becoming a decisive element to fight inequality in all its nuances. Aim: To characterize the type of power that is established in relation to gender, between teachers and students, from the perspective of students and medical teachers from two Chilean universities. Material and Methods: Qualitative study, according to Grounded Theory. Nine medical teachers were interviewed, and a focus group was conducted with ten medical students. Open coding was performed for the analysis. Results: The presence of five types of power and the gender of the receivers of such expressions was described. Power was expressed also as fair or unfair treatment, pressure, and sexual harassment. Conclusions: Power exercised by teachers over their students is differentiated according to the gender of students. The ways in which that power is exercised do not go unnoticed when they become arbitrary obstacles or benefits for the students and their learning process. It also affects the way in which they subsequently relate with their environment.

Necesidades de formación docente: ¿qué perciben los tutores de Fisioterapia? / Teaching training needs: what do physiotherapy tutors perceive?

Introducción: La docencia clínica se diferencia de la docencia de aula en que está más estrechamente vinculada al desarrollo del perfil de egreso de los profesionales de la salud y ocurre en espacios de atención directa al paciente. Por ello, requiere formación y competencias específicas de los tutores clínicos que guían ese momento formativo. Material y método: Se realizó un estudio cuantitativo, donde se encuestó a 70 tutores clínicos de Fisioterapia. A éstos se les aplicó el cuestionario de necesidades de formación docente, previo consentimiento informado. Resultados: Los tutores clínicos perciben como prioridad la formación en el desarrollo integral de los estudiantes en un 89%. Conclusión: Los resultados muestran que los tutores clínicos enfatizan sus necesidades del perfeccionamiento docente en el desarrollo de competencias clínicas y en el desarrollo integral de los estudiantes. Sin embargo, las percepciones de otras áreas de formación docente presentan menor relevancia para el período clínico.(AU)

Introduction: The clinical teaching differs from classroom teaching in that it is more closely linked to the development of the graduation profile of health professionals and occurs in areas of direct patient care. For the same, requires training and specific skills of the clinical tutors who guide this formative moment. Material and method: A quantitative study was carried, where 70 clinical tutors were surveyed. To these, the teacher training needs questionnaire was applied, with prior informed consent. Results: The clinical tutors perceive training in the integral development of students as a priority 89%. Conclusion: The results show that clinical tutors emphasize their needs for teacher improvement in the development of clinical skills and in the comprehensive development of students. However, the perceptions of other areas of teacher training are less relevant for the clinical period.(AU)

Utrecht work engagement scale: Construct validity and reliability in Chilean health science students.

OBJECTIVE: The Utrecht Work Engagement Scale-Student (UWES-S) has been extensively applied in different countries to assess engagement in students, but there are discrepancies about its factor structure outcomes. To analyse the factor structure of Utrecht Work Engagement Scale-Student as construct validity evidence and reliability in medical students. METHODS: The non-experimental cross-sectional study was conducted at the public-sector University of Concepción in the Bio-Bio region in central Chile at the end of the first academic semester, between July and August 2017, and comprised students of health science undergraduate degree programmes in Medicine, Kinesiology, Pharmacy, and Speech and Language Therapy. Data was collected using a sociodemographic proforma and the Utrecht Work Engagement Scale-Student. The subjects were randomly divided into groups A and B. With group A, exploratory factor analysis was performed using the method of extraction of the main axis analysis. With group B, confirmatory factor analysis was performed using the maximum likelihood method. Data was analysed using STATA 11 SE. RESULTS: Of the 898 students, 538(59.91%) were females and 360(40.09%) were males. The overall mean age was 21.29±2.51 years (range: 17-34 years). Two factors, 'involvement with studies' and 'enthusiasm for the career', with eigenvalues 7.59 and 1.18 were identified with the potential to explain majority of the total variance of items. Comparative fit index, Tucker-Lewis index and the root mean square error of approximation showed the solution having the best fit. CONCLUSIONS: Involvement with studies and enthusiasm for career were found to be critical factors, but did not show adequate adjustment even though confirmatory factor analysis found this to be the solution with the best fit.

[Relationship between occupational commitment and teaching practices among healthcare teachers]. / ¿Enseña diferente un docente comprometido? Relación entre compromiso docente y prácticas pedagógicas en académicos de carreras de la salud.

BACKGROUND: A central aspect of professional identity is occupational commitment, which has a significant relationship with motivation and positive mental states in healthcare environments. However, it is not clear how occupational commitment is related to teaching practices in universities. AIM: To apply the Occupational Commitment Questionnaire (OCQ) to university teachers and relate its results with the Teaching Practices Questionnaire. MATERIAL AND METHODS: OCQ and Teaching Practices Questionnaire were answered by 319 university teachers from 13 Chilean regions, who were selected through a non-probabilistic volunteer sampling. Data collection was done after informed consent. An exploratory factor analysis was performed for OCQ. The internal consistency of each factor was calculated with Cronbach's Alpha. Spearman correlations were used to explore the relationship between the two questionnaires. RESULTS: Two factors were identified in OCQ, namely Teacher Commitment and Ethical-Professional Commitment. Cronbach's Alpha was 0.85 for both factors. A moderate direct relationship between teacher commitment, ethical-professional commitment, and the Teaching Practices Questionnaire was found. CONCLUSIONS: OCQ showed an adequate internal consistency, and it was directly related with teaching practices. Committed teachers had better teaching practices. This confirms the importance of teachers' values and perceptions on their professional performance.

[Students' perception about mistreatment in undergraduate medical training]. / Maltrato en el pregrado de la carrera de Medicina: percepción de los estudiantes.

BACKGROUND: Alarms about mistreatment in medical education have been raised for almost 30 years. AIM: To describe the frequency of abuse reports among medical students at a university in Chile, investigating their association with age, sex, and educational level. MATERIAL AND METHODS: The Mistreatment by Teachers Questionnaire was applied to 264 first to seventh year medical students (54% males). An exploratory factorial analysis of the instrument was performed, a descriptive analysis was made and its relationship with age, sex and level of training were evaluated. RESULTS: Ninety eight percent of respondents reported having been mistreated at least once. Mistreatment was grouped into three factors with a confidence ranging between α = 0.79 and 0.93, namely demoralization, deregulated demands and physical aggression. The first two were associated with age and level of education. There were no differences by sex. CONCLUSIONS: Mistreatment is common in undergraduate medical education, as it has been found in other universities around the world.

When it is time to decide: factors associated to the choice of a medical specialty / Cuando es tiempo de decidir: factores asociados a la elección de especialidades médicas

Abstract After finishing their initial education, physicians can enter post-graduate training programs. In Chile, there are multiple medical specialties options. This review synthesizes the factors associated with the choice of specialty, according to international publications. Students coming from rural areas or small towns would tend to choose Family Medicine. Men prefer specialties such as Surgery. Having relatives in the medical profession, specializing in a specific field, also influence the choice. Concerning interests and preferences, these are linked to personal traits and some biological variables. The inclination towards clinical or surgical fields could be predicted. Academically, the curriculum, good learning experiences and teacher models favor choice, while the harassment suffered could contribute to avoidance. Besides, both prestige and economic prospects are influential factors in the choice and specialties such as Surgery are preferred. The choice of specialty must reach a balance between the students' interests and public health needs. Identifying these factors would allow a better understanding of the present shortfall (or surplus) in certain fields and contribute to the definition of policies and decision-making.

Concluida su formación, los médicos pueden acceder a programas de formación de postgrado; en Chile existen múltiples opciones de especialización médica. Esta revisión narrativa busca sintetizar los diversos factores asociados con la elección de especialidad médica según la literatura internacional. Entre los resultados se observa que los alumnos provenientes de zonas rurales o ciudades pequeñas tenderían a elegir Medicina Familiar. Los hombres tendrían mayor predilección por especialidades como Cirugía. También influiría ser hijos de médicos especialistas en un área específica. En cuanto a los intereses y preferencias, éstas se conjugan con rasgos de personalidad y algunas variables biológicas, que podrían predecir la elección de especialidades hacia el tipo clínico o quirúrgico. En lo académico, el curriculum, una buena experiencia y modelos docentes favorecen la elección, mientras el maltrato sufrido podría contribuir al descarte. Además, tanto el prestigio como el potencial económico de ciertas especialidades ha sido un factor influyente en la elección: se prefieren especialidades como Cirugía. La elección de especialidad debería encontrar un equilibrio entre los intereses del estudiante y las necesidades de salud pública. Identificar todos estos factores, permitiría una mejor comprensión de la actual escasez o sobrecarga en determinados campos, y contribuiría en la construcción de políticas y toma de decisiones, con el fin de mejorar el reclutamiento de estudiantes.

Psychometric properties of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) on Chilean women / Propiedades psicométricas del instrumento Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) en mujeres chilenas

Abstract Introduction: Pelvic floor dysfunctions have an impact on women's sexual function. A Chilean study found that 74% of women have pelvic floor dysfunctions, but there is no validated tool for them. Objective: To evaluate the psychometric properties of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) for assessing sexual function in Chilean women with pelvic floor dysfunctions. Methods: Cross-sectional study of psychometrics in 217 women with pelvic floor dysfunction, age 18 or older, and sexually active (last 6 months). Non-probability, convenience sampling. Tool: PISQ-12. Experts checked content validity, construct validity with confirmatory factor analysis, reliability with Cronbach's alpha, and discriminating capacity with Pearson and McDonald's omega. Results: Population is mainly perimenopausal, highly educated with no income and with urinary incontinence (89.4%). Psychometric analysis supports a three-factor structure: sexual response, female sexual problems, and male sexual problems, with a good (α= 0.85), acceptable (α= 0.73), and poor (α= 0.63) reliability, respectively, but McDonald's omega was acceptable for all three. These were related to age (rs: -0.33), education (rs: 0.36), number of pregnancies (rs: -0.18) and vaginal births (rs: -0.25). Conclusions: PISQ-12 is valid and reliable for measuring sexual dimension and problems. Age, education, and number of pregnancies and vaginal births are moderately correlated to sexual response.

Resumen Introducción: Las disfunciones del piso pélvico impactan la función sexual de mujeres que la padecen. En un estudio chileno un 74% de las mujeres presentó disfunción sexual sin tener un instrumento validado para esta población. Objetivo: Evaluar las propiedades psicométricas del Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ-12) para medir la función sexual en mujeres chilenas con disfunciones del piso pélvico. Métodos: Estudio transversal psicométrico de 217 mujeres con disfunción del piso pélvico, igual /mayor a 18 años, sexualmente activas (últimos 6 meses). Muestreo no probabilístico de conveniencia. Cuestionario: PISQ-12. Se realizó juicio de expertos para validez de contenido, análisis factorial confirmatorio para validez de constructo y el α de Cronbach para confiabilidad y capacidad discriminativa con Pearson y ω de McDonald. Resultados: Población principalmente perimenopáusica, alta escolaridad sin ingresos y con Incontinencia Urinaria (89.4%). El análisis psicométrico apoyó una estructura de tres factores: respuesta sexual, limitaciones sexuales femeninas y limitaciones sexuales masculinas, con confiabilidad buena (α= 0.85) aceptable (α= 0.73) y pobre (α= 0.63), respectivamente, aunque el ω de McDonald mostró valores aceptables para los tres. Éstos se relacionaron con edad (rs: -0.33), escolaridad (0.36), número de embarazos (-0.18) y partos vaginales (-0.25). Conclusiones: El PISQ-12 es válido y confiable, midiendo la dimensión sexual y limitaciones sexuales. La edad, escolaridad, número de embarazos y partos vaginales se correlaciona con la respuesta sexual en intensidad moderada.

Multidimensional scale of perceived social support: evidence of validity and reliability in a Chilean adaptation for older adults.

BACKGROUND: Given the relevance of social support on the mental health of older adults, having an instrument to evaluate this variable is essential for research in the area. However, mainly, having instruments with suitable evidence of their psychometric properties is critical. For this reason, this study sought to evaluate the factorial and reliability structure of the Multidimensional Scale of Perceived Social Support within autonomous older adults from the Province of Concepción, Chile. METHODS: We surveyed 399 older adults using quote sampling. They answered a Spanish version of the Multidimensional Scale of Perceived Social Support, plus a sociodemographic questionnaire. We performed confirmatory factor analysis using Weighted Least Squares Means and Variances adjusted estimation (WLSMV) to compare the factor models proposes by previous studies. To evaluate reliability, we calculated Cronbach's alpha and McDonald's omega. RESULTS: The Confirmatory factor analysis found that the 3-factors models showed the best fist index between the models with CFI = 0.991, TLI = 0.989, and SRMR = 0.035, even though RMSEA were over the cutoff point. The factors presented reliabilities from α = 0.858 to α = 0.941, and from ω = 0.937 to ω = 0.972. CONCLUSIONS: The results support the existence of three factors for the Multidimensional Scale of Perceived Social Support (MSPSS), differentiating the support perceived from Family, Friends, and significant others. All factors present good or excellent reliability. This solution is theoretically consistent and coherent with the literature, and it presents evidence in favor of the use of MSPSS as a measurement to distinguish the support perceived source.