General practitioner residents and patients end-of life: involvement and consequences.

BACKGROUND: The ageing of the population and the increased number of chronic diseases are associated with an increased frequency of end of life care in hospital settings. Residents rotating in hospital wards play a major part in their care, regardless of their specialty. General practitioner (GP) residents are confronted to such activities in hospital settings during their training. Our aim was to know how they feel about taking care of dying patients, as end-of-life care are very different from the clinical activity they are trained to. METHODS: We surveyed all GP trainees of "Ile de France". The survey was made of 41 questions regarding advanced directives divided in 7 sections about patients' care, communication, mentoring and repercussion on personal life. The survey was done one time, during two pre-specified days. RESULTS: 525 residents (53.8%) accepted to fulfill the survey. 74.1% of the residents thought that palliative care could have been better. Possible ways of improvements were: a reduction of unreasonable obstinacy (or therapeutic overkill, two terms defined in French law as curative treatment without reasonable hope of efficiency) (59.6%), patient's (210 answers, 40%) and relative's communication (information of patients and relatives about the severity of the disease and risk of death) (199 answers 37.9%). Residents also reported a lack of knowledge regarding end-of-life care specific treatments (411 answers, 79.3%) and 298 (47.2%) wished for better mentoring. Those difficulties were associated with repercussion on their private life (353 answers, 67.2%), particularly with their close relatives (55.4%). Finally, 56.2% of trainees thought that a systematic psychologic follow up should be instituted for those working in "at risk" hospital settings. CONCLUSION: Self-perception management of dying patients by GP resident emphasize their lack of training and supervision. The feeling of suboptimal care is associated with consequences on personal life.

Competencias profesionales en Psicología Clínica de la Infancia y la Adolescencia: revisión sistemática e implicaciones / Professional competences in Clinical Psychology of Childhood and Adolescence: systematic review and implications

La Psicología Clínica de la Infancia y la Adolescencia es reconocida internacionalmente como una especialidad profesional de la psicología. Ese reconocimiento de la especialidad conlleva la identificación precisa de sus competencias específicas y distintivas. El objetivo de este trabajo es revisar los modelos competenciales específicos propuestos en el ámbito de la Psicología Clínica de la Infancia y la Adolescencia. Se han identificado 16 publicaciones en bases de datos científicas ajustadas a los criterios de búsqueda. Para el análisis y sistematización de las competencias se ha tomado como referencia la clasificación del Modelo de Cubo de Rodolfa et al. En conjunto, se mencionan 22 grupos de competencias específicas del desempeño profesional de la Psicología Clínica de la Infancia y la Adolescencia, de los cuales 15 concitan un amplio consenso. Se concluye examinando las implicaciones de este trabajo para el desarrollo futuro de la profesión. (AU)

Clinical Child and Adolescent Psychology is internationally recognized as a professional specialty of psychology. This recognition of the specialty entails the precise identification of its specific and distinctive competencies. The aim of this paper is to review the specific competency models proposed in the field of Clinical Psychology of Childhood and Adolescence. Sixteen publications were identified in scientific databases that matched the search criteria. For the analysis and systematization of competencies, the classification of the Rodolfa et al. Cube Model has been used as ref-erence. Overall, 22 groups of competencies specific to the professional performance of Clinical Child and Adolescent Psychology are mentioned, of which 15 are widely agreed upon. It concludes by examining the implications of this work for the future development of the profession. (AU)

First steps towards international competency goals for residency training: a qualitative comparison of 3 regional standards in anesthesiology.

BACKGROUND: Competency-based medical education (CBME) has revolutionized approaches to training by making expectations more concrete, visible, and relevant for trainees. Designing, applying, and updating CBME requirements challenges residency programs, which must address many aspects of training simultaneously. This challenge also exists for educational regulatory bodies in creating and adjusting national competencies to standardize training expectations. We propose that an international approach for mapping residency training requirements may provide a baseline for assessing commonalities and differences. This approach allows us to take our first steps towards creating international competency goals to enhance sharing of best practices in education and clinical work. METHODS: We chose anesthesiology residency training as our example discipline. Using two rounds of content analysis, we qualitatively compared published anesthesiology residency competencies for the European Union (The European Training Requirement), United States (ACGME Milestones), and Canada (CanMEDS Competence By Design), focusing on similarities and differences in representation (round one) and emphasis (round two) to generate hypotheses on practical solutions regarding international educational standards. RESULTS: We mapped the similarities and discrepancies between the three repositories. Round one revealed that 93% of competencies were common between the three repositories. Major differences between European Training Requirement, US Milestones, and Competence by Design competencies involved critical emergency medicine. Round two showed that over 30% of competencies were emphasized equally, with notable exceptions that European Training Requirement emphasized Anaesthesia Non-Technical Skills, Competence by Design highlighted more granular competencies within specific anesthesiology situations, and US Milestones emphasized professionalism and behavioral practices. CONCLUSIONS: This qualitative comparison has identified commonalities and differences in anesthesiology training which may facilitate sharing broader perspectives on diverse high-quality educational, clinical, and research practices to enhance innovative approaches. Determining these overlaps in residency training can prompt international educational societies responsible for creating competencies to collaborate to design future training programs. This approach may be considered as a feasible method to build an international core of residency competency requirements for other disciplines.

Paediatric nursing clinical competences in primary healthcare: A systematic review.

AIMS: To identify and critically appraise the available evidence on paediatric nurses' clinical competencies performed autonomously regarding disease prevention and health promotion activities for children and adolescents in primary healthcare worldwide. DESIGN: A systematic review design in accordance with the Preferred Reporting Items Systematic Reviews and Meta-Analyses statement. DATA SOURCES: The search was conducted through MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, SCOPUS, The Cochrane Library, Scientific Electronic Library Online, Web of Science and The Joanna Briggs Institute EBP (Ovid) databases. The grey literature was reviewed at OpenGrey. Additional studies were located through a references list of selected studies identified on first search. REVIEW METHODS: Database search employed MeSH terms: (paediatric nursing) AND (primary healthcare) AND ((clinical skills) OR (clinical competences)). Studies published from inception to October 2019 exploring paediatric nurses' clinical competencies in primary healthcare were eligible for inclusion. No language restrictions were applied in the main search. Selection was made by two reviewers independently. Three independent reviewers assessed the methodological quality of included studies. RESULTS: Eighteen studies were included from six countries. The most common nursing competencies independently performed identified and described in studies were Health education and advice, Child and adolescent health and development assessment, Immunizations and Child health checks. CONCLUSION: Studies describe clinical competencies of nurses in children care. No consistent scientific evidence is available about clinical competencies of paediatric nurses performed autonomously in primary care. IMPACT: Few scientific studies identifying and assessing nurses' child primary healthcare skills were found and therefore recorded. Studies describe nurses' clinical skills in childhood, but results do not show firm consistency assessing their practice scope. Health policy-makers should encourage the development of nurses' competencies if they wish to preserve quality and equity of healthcare services to children. Therefore, the first step is to identify the autonomous competencies of paediatric nurses in primary care.

Development of Surgical Competence in Veterinary Students Using a Flipped Classroom Approach.

Clinical skills laboratory (CSL) training was recently introduced in the renewed veterinary curriculum at Ghent University, using models and simulators for teaching practical skills. However, time in the CSL is restricted due to the large number of students combined with limited availability of personnel. Therefore, a flipped classroom (FC) model was introduced to maximize learning experiences. The goal of the present study was to evaluate the effect of flipped classroom CSL training on students' self-efficacy and practical surgical skills. Flipped classroom CSL training was implemented for the third-year pre-clinical students (n = 196) in the 6-year veterinary medicine program. Prior to CSL sessions, students studied online 'learning paths,' including text, pictures, videos of the skills, links to background information, a forum, and a compulsory pre-class quiz. A pre- and post-test were administered before and after flipped classroom CSL training. The tests consisted of a self-efficacy scale consisting of 20 items and an objective structured clinical examination (OSCE) test of surgical skills performance. Flipped classroom CSL training resulted in significantly higher self-efficacy (score/100, pre-test 55 ± 14 vs. post-test 83 ± 8, p< .001) and surgical skills performance (score/20, pre-test 5 ± 3 vs. post-test 17 ± 3, p< .001). In conclusion, this study demonstrated the feasibility and value of implementing a flipped classroom approach in combination with CSL training.

A study on evaluator factors affecting physician-patient interaction scores in clinical performance examinations: a single medical school experience.

BACKGRUOUND: This study is an analysis of evaluator factors affecting physician-patient interaction (PPI) scores in clinical performance examination (CPX). The purpose of this study was to investigate possible ways to increase the reliability of the CPX evaluation. METHODS: The six-item Yeungnam University Scale (YUS), four-item analytic global rating scale (AGRS), and one-item holistic rating scale (HRS) were used to evaluate student performance in PPI. A total of 72 fourth-year students from Yeungnam University College of Medicine in Korea participated in the evaluation with 32 faculty and 16 standardized patient (SP) raters. The study then examined the differences in scores between types of scale, raters (SP vs. faculty), faculty specialty, evaluation experience, and level of fatigue as time passes. RESULTS: There were significant differences between faculty and SP scores in all three scales and a significant correlation among raters' scores. Scores given by raters on items related to their specialty were lower than those given by raters on items out of their specialty. On the YUS and AGRS, there were significant differences based on the faculty's evaluation experience; scores by raters who had three to ten previous evaluation experiences were lower than others' scores. There were also significant differences among SP raters on all scales. The correlation between the YUS and AGRS/HRS declined significantly according to the length of evaluation time. CONCLUSION: In CPX, PPI score reliability was found to be significantly affected by the evaluator factors as well as the type of scale.

[Overview on research in the field of medical education]. / Übersicht über die Forschung im Bereich der medizinischen Ausbildung.

Medical education is a relatively young field of research that has been characterized by many innovations over the last 20 years. The main topics were the preparation of students for their medical work and imparting of profound knowledge about scientific contexts in medicine. For a long time, the main focus was on learning the necessary knowledge and skills; however, this is no longer considered sufficient. In order to carry out the work as a physician well, other qualities are also necessary, such as communication, collaboration, professionalism, science and reflectivity. Worldwide these aspects are being increasingly integrated into the learning objectives of medical schools and residency programs. The structure of medical studies at many universities has also changed. So-called vertical integration strengthens the integration of theoretical preclinical training and the clinical phase. This means that in the preclinical phase training is more practice-oriented and in the clinical phase a more structured form of training takes place. In the first years of study, students are prepared for the clinical phase by discussing patient cases and practicing skills in simulation centers. In addition, the clinical working environment is increasingly used as a learning environment. Developments have also been made regarding examinations: in addition to knowledge and skills, students and residents are now also assessed regarding performance in practice. Using more realistic assessments, e.g., Objective Structured Clinical Examinations and Workplace-based Assessments, students are evaluated more on their actual performance in practice. By means of the Entrustable Professional Activities method, students are gradually given more responsibility in order to prepare them for their future tasks.

Memorias del II Taller Nacional de Expertos en Atención al Neonato Grave / Memories of the II National Workshop of Experts in care of the Severely Ill Neonate

El II Taller Nacional de Expertos en Atención al Neonato Grave se desarrolló del 28 al 30 de mayo del 2018, auspiciado el Capítulo de la Sociedad Cubana de Enfermería, bajo el tema central, Validación de la estrategia de superación para el desarrollo de competencias específicas del licenciado de enfermería para la atención al neonato grave. Con la participación de 38 expertos de la especialidad de neonatología y 5 prestigiosas personalidades invitadas del área de las ciencias en Cuba, el taller marcó las pautas en cuanto a los objetivos propuestos, una vez que los expertos evaluaron y validaron en sección plenaria las competencias específicas de estos profesionales para la asistencia a esos recién nacidos, en aras de garantizar la calidad de la atención médica especializada

The II National workshop of Experts in care to the Severely Ill Neonate was developed from the May 28th to 30th, 2018, sponsored by the Chapter of the Cuban Society of Nursing, under the central topic, Validation of the training strategy for the development of specific competences in the care to the severely ill neonate. With the participation of 38 experts of the neonatology specialty and 5 invited outstanding personalities of sciences in Cuba, the workshop marked the rules as for the proposed objectives, once the experts evaluated and validated in plenary session the specific competences of these professionals for the care to these new born, for the sake of guaranteeing the quality of the specialized medical care.

Validación de competencias específicas de los profesionales de enfermería en la atención al neonato en estado grave / Validation of specific competences of the nursing professionals in the severely ill neonate care

Se efectuó la validación de las competencias específicas -- identificadas por expertos en un estudio previo -- de los profesionales de enfermería a cargo de la atención al recién nacido en estado grave en las unidades de cuidados intensivos neonatales. Para ello se aplicó un cuestionario a 38 expertos y 108 profesionales de la enfermería de los servicios de neonatología en la provincia de Santiago de Cuba y del Hospital General Docente Enrique Cabrera de La Habana, durante el 2017, quienes emitieron su juicio para ponderar las categorías establecidas al respecto. Las 12 competencias identificadas y propuestas por los expertos para ser desarrolladas en las unidades de cuidados intensivos neonatales, están en correspondencia con las tendencias internacionales, los protocolos y las indicaciones de la Dirección Nacional de Salud Materno-Infantil del Ministerio de Salud Pública, en cuanto a los conocimientos, las habilidades, las conductas, las actitudes, las aptitudes y las motivaciones de los profesionales de enfermería en la atención al neonato en los estados grave y crítico

The validation of specific competences -- identified by experts in a previous study -- of the nursing professionals in charge of the severely ill neonate care was carried out in the neonate intensive care units. Reason why, a questionnaire was carried out to 38 experts and 108 nursing professionals of the neonatology services in Santiago de Cuba and Enrique Cabrera Teaching General Hospital from Havana, during 2017 who expressed their opinion to consider the established categories on this respect. The 12 competences identified and proposed by the experts to be developed in the neonate intensive care units, are in correspondence with the international tendencies, protocols and indications of Maternal and Child Health National Management of the Public Health Ministry, as for knowledge, skills, behaviors, attitudes, aptitudes and motivations of nursing professionals for the severely and critically ill neonate care

Identificación de las competencias específicas de los profesionales de enfermería en la atención al neonato en estado grave / Identification of the specific competences of the nursing professionals in the care to the severely ill neonate

Se realizó un estudio observacional y descriptivo en los profesionales a cargo de la atención al neonato en estado grave en las unidades de cuidados intensivos neonatales de la provincia de Santiago de Cuba, en el Hospital General Docente Enrique Cabrera de La Habana y el Centro Regional de Cirugía Neonatal del Hospital Pediátrico Docente de Holguín, durante el 2017, con vistas a caracterizarles según criterios establecidos al respecto, efectuar la selección de los expertos en el tema para determinar las competencias específicas de estos profesionales. La muestra inicial quedó constituida por los 43 profesionales que cumplían estrictamente los criterios, a los cuales se les aplicó un test de autovaloración para identificar sus coeficientes de conocimiento, de argumentación y de competencia; de esta manera quedaron seleccionados como expertos 38 profesionales con coeficientes medio y alto, los cuales participaron en un taller de socialización y expusieron las competencias específicas de los enfermeros en la atención al neonato en estado grave, las que serán validadas en otra fase de la investigación

An observational and descriptive study was carried out in the professionals in charge of the care to the severely ill neonates from intensive care units of Santiago de Cuba province, at Enrique Cabrera Teaching General Hospital from Havana and the Regional Center for Surgery in Neonates from Holguín Teaching Pediatric Hospital, during the 2017, with the aim of characterizing them according to established criteria on this respect, to make the selection of the experts in the topic to determine the specific competences of these professionals. The initial sample was constituted by the 43 professionals who fulfilled the criteria strictly, to whom a self-evaluation test was applied to identify their knowledge, argument and competence coefficients; in this way 38 professionals were selected as experts with middle and high coefficients, who participated in a socialization workshop, where they exposed the specific competences of the male nurses in the care to the severely ill neonate, which will be validated in another phase of the investigation

Memorias del I Taller Nacional de Expertos en Atención al Neonato Grave / Memories of the Ist National Workshop of Experts in care of the Severely Ill Neonate

El I Taller Nacional de Expertos en Atención al Neonato Grave se desarrolló del 18 al 21 de julio del 2017, auspiciado por el Capítulo Provincial de la Sociedad Cubana de Pediatría y el Capítulo de la Sociedad Cubana de Enfermería, bajo el tema central Las competencias específicas del licenciado de Enfermería para la atención al neonato en estado grave. Con la participación de 38 expertos en el tema -- especialistas en Neonatología -- y 5 prestigiosas personalidades invitadas de las ciencias de la salud y de la enfermería en Cuba, el Taller marcó las pautas en cuanto a los objetivos propuestos, una vez que los expertos identificaron y propusieron en sesión plenaria las competencias específicas de los profesionales de la enfermería para la asistencia a estos recién nacidos, en aras de garantizar la calidad de la atención médica especializada y contribuir al desarrollo de la investigación

The I National Workshop of Experts in care of the Severely ill Neonate took place from July 18th to July 21st, 2017, sponsored by the Provincial Chapter of the Cuban Society of Pediatrics and the Chapter of the Cuban Society of Nursing, under the central topic The specific competences of the Nursing graduate for the care of the severely ill neonate. With the participation of 38 experts in the topic -- specialists in Neonatology -- and 5 invited prestigious personalities of the health sciences and nursing in Cuba, the Workshop marked the guidelines as for the proposed objectives, once the experts identified and proposed in plenary session the specific competences of nursing professionals to care these newborns, for the sake of guarantying the quality of the specialized medical care and contributing to the development of the investigation

Relationships between Sedation Knowledge and Nurse Practice Competences in Intensive Care Unit / 임상간호연구

PURPOSE: For this study an examination was done of relationships between intensive care unit (ICU) nurses' knowledge related to sedation and their clinical competencies in sedation practice. METHODS: Ninety one ICU nurses were recruited from two tertiary hospitals in South Korea. A self-report questionnaire was used to examine the levels of knowledge related to sedation and nursing practice competence based on Ajzen's theory of planned behavior. Descriptive statistics, independent t-tests, one-way ANOVA, and Pearson correlations were performed using the IBM SPSS 21.0 RESULTS: ICU nurses are more knowledgeable about general information on sedation rather than up-to-date information. Continuing education on sedation was related to difference in knowledge levels. However, the levels of knowledge were not related to competence in sedation practice. Instead, a positive attitude toward sedation practice was significantly related to the subjective norms; orders and goals, perceived behavioral control, practice of sedation, and intention to use. CONCLUSION: The results of this study provide fundamental information on levels of knowledge related to sedation practices of Korean ICU nurses. Continuing education should emphasize up-to-date information on sedation practice and need for positive attitudes which influence all other competencies towards sedation practices to achieve optical care of sedation in the ICU.

Factors affecting acquisition of psychomotor clinical skills by student nurses and midwives in CHAM Nursing Colleges in Malawi: A qualitative exploratory study.

BACKGROUND: Acquisition of psychomotor clinical skills has been shown to improve the quality of care provided to patients when care providers are competent. The aim of this study was to explore students, nurses and tutors experience on factors affecting acquisition of psychomotor clinical skills. METHODS: The study employed an exploratory qualitative research design. The population was students, clinical nurses and tutors from a nursing College and mission hospital in the southern region of Malawi. In depth interviews using a semi structured guide was used to collect data. Thematic analysis method was employed to analyze the collected data. Ethical principles of respect of human dignity, beneficence and justice were observed. RESULTS: The findings have shown that acquisition of psychomotor skills is affected by: student motivation, lack of resources, learning environment, knowledge gap between the qualified nurses and tutors, and role modeling. CONCLUSION: In principle when student nurses have acquired necessary skills the quality of care provided to patients improve. Basing on the findings of this study it is recommended that Student should be well prepared before clinical placement Nurses and tutors should also update their knowledge and clinical teaching skills for them to adequately guide students. The clinical arena should have adequate resources.

Propuesta de competencias profesionales para el perfil del egresado en la especialidad de medicina interna en Cuba / Proposition of professional competences for the profile of the graduate in Internal Medicine's specialty in Cuba

Introducción: el programa vigente de la especialidad Medicina Interna todavía no cuenta con una definición de las competencias de la especialidad. Objetivo: Proponer las competencias profesionales para el perfil del egresado en la especialidad de Medicina Interna en Cuba. Material y Métodos: se trabajó en grupos nominales y seminarios-talleres, dirigidos a definir y normalizar las competencias a evaluar según norma la Comisión Nacional de competencia y desempeño del Ministerio de Salud Pública. Resultados: se definieron: 4 áreas de competencias; 5 competencias asistenciales centradas en el método clínico; 3 competencias docentes centradas en la estructura de la actividad; 4 competencias centradas en el ciclo de dirección y 4 competencias centradas en el ciclo de investigación. Además 19 elementos de competencias asistenciales. Conclusiones: la propuesta de competencias concibe la aplicación del análisis en matriz para lograr la validez de contenido y externa de los elementos de competencias(AU)

Introduction: the program in use of the specialty Internal Medicine not yet has a definition of the competitions of this specialty. Objective: Propose the professional competences for the profile of exit of the Internal Medicine's specialist in Cuba. Material and Methods: work at nominal groups and workshops in order to define and to normalize competences to evaluate according to standard of the National Commission for competence and performance of the Health Ministry. Results: It were defined: 4 areas of competence; 5 assistance competences centered in the clinical method; 3 teaching competences centered in the structure of the activity; 4 competences centered in the cycle of administration and 4 competences centered in the cycle of investigation. Besides 19 elements of competences y the assistance functions. Conclusions: the proposal of competences conceives the application of the analysis in matrix to achieve the contents and external validity of the elements of competences(AU)

Valoración del diseño por competencias del internado vertical en medicina interna en Cuba / Appraisal of the design by competences of the internal medicine sixth year vertical program in Cuba

Introducción: se confeccionó un programa vertical para internos en Medicina Interna, en el marco del perfeccionamiento del plan de estudio y han sido discutidos y valorados por profesores a lo largo del país. Objetivo: valorar el nuevo diseño por competencias del Programa del Internado Vertical en Medicina Interna.Material y Métodos: se realizó una investigación de corte cualitativo consistente en el análisis crítico de una propuesta inicial de Programa. Mediante rondas de discusión por vía electrónica centradas en la valoración del diseño por competencias. Resultados: se arribó al consenso en que el internado vertical suaviza el salto de la brecha en la preparación clínica que existe entre una carrera dirigida a formar un médico integral para la comunidad y una residencia dirigida a formar un médico integral para los hospitales. Se definen las competencias y se manifiesta su coherencia con las funciones del perfil de salida y diferentes componentes didácticos. El diseño evidencia flexibilidad adaptada a la situación asistencial dinámica del servicio de Medicina Interna en particular en la disponibilidad y calidad de los recursos.Conclusiones: el programa satisface en esencia el diseño por competencias que se ve evidenciado en sus componentes no personales. Su flexibilidad aspira a permitir que el currículo pensado y el vivido no difieran en lo fundamental y a que se puedan adoptar decisiones según exija cada situación del aprendizaje(AU)

Introduction: it has been elaborated an Internal Medicine's vertical program in the ambit of the improvement of the study program and it has been debated and assessed by professors along the length of the country. Objective: to appraise the new design for competence of the vertical program of sixth year medicine´s students in Internal Medicine. Material and Methods: the investigation was qualitative consisting of the critical analysis of the program using rounds of discussion for e-mails focusing in the assessment of the design by competences.Results: the authors arrive to consensus in that the vertical program softens the jump of the breach in the clinical preparation that exists between a career addressed to instruct an integral doctor for the community and a guided residence to instruct an integral doctor for the hospitals. Are defined the competences keeping his coherence with the functions of the profile of exit and different didactic components. The design evidences adapted flexibility to the dynamic situation of Internal Medicine's service in particular in availability and quality of the resources. Conclusions: the revised program fulfills in essence the designing for competences evidenced in its not personal components. Its flexibility pretend to allow that the thought and the lived curriculum not differ in it fundamental and to get decisions according to demand from each situat ion of learning(AU)

[Inter-rater reliability of healthcare professional skills' portfolio assessments: The Andalusian Agency for Healthcare Quality model]. / Fiabilidad inter-jueces en evaluaciones portafolio de competencias profesionales en salud: el modelo de la Agencia de Calidad Sanitaria de Andalucía.

UNLABELLED: This study aims to determine the reliability of assessment criteria used for a portfolio at the Andalusian Agency for Healthcare Quality (ACSA). DATA: all competences certification processes, regardless of their discipline. PERIOD: 2010-2011. Three types of tests are used: 368 certificates, 17 895 reports and 22 642 clinical practice reports (N=3 010 candidates). The tests were evaluated in pairs by the ACSA team of raters using two categories: valid and invalid. RESULTS: The percentage agreement in assessments of certificates was 89.9%; for the reports of clinical practice, 85.1%; and for clinical practice reports, 81.7%. The inter-rater agreement coefficients (kappa) ranged from 0.468 to 0.711. DISCUSSION: The results of this study show that the inter-rater reliability of assessments varies from fair to good. Compared with other similar studies, the results put the reliability of the model in a comfortable position. Criteria were reviewed and progressive automation of evaluations was done.

El objetivo de este estudio es analizar la fiabilidad inter-jueces de las calificaciones realizadas por el equipo de evaluadores, pertenecientes al programa de certificación de competencias profesionales de la Agencia de Calidad Sanitaria de Andalucía (ACSA). Se estudiaron todos los procesos de certificación de competencias profesionales durante el periodo 2010-2011, independientemente de su disciplina. Se han analizado tres tipos de pruebas: 368 certificados, 17.895 informes de reflexión y 22.642 informes de práctica clínica (N = 3.010 profesionales). El porcentaje de acuerdo en las evaluaciones de certificados fue de un 89,9% (k = 0,711); 85,1% para los informes de práctica clínica (k = 0,455); y 81,7% para los informes de reflexión (k = 0,468). Los resultados de este macro-estudio muestran que la fiabilidad inter-jueces de las evaluaciones varía de ajustada a buena. En comparación con otros estudios similares, los resultados sitúan la fiabilidad del modelo en una posición cómoda. Entre las mejoras incorporadas, se incluyen la revisión de criterios y una progresiva automatización de las evaluaciones.

Nivel de competencia de las enfermeras para el cuidado del paciente sometido a trasplante hepático en el Hospital Infantil de México / Level of competence of nurses for the care of patients undergoing liver transplantation at the Children's Hospital of Mexico / Nível de competência de enfermeiros para o atendimento de pacientes submetidos a transplante hepático no Hospital Infantil do México

Introducción: El trasplante Hepático (TH) es un procedimiento muy dinámico que en la actualidad constituye el tratamiento de elección para un gran número de enfermedades hepatobiliares agudas y crónicas. Hoy en día continúa siendo un reto para el equipo de trabajo de las unidades de cuidados intensivos a pesar de los avances en las técnicas quirúrgicas, anestésicas, inmunosupresión e infecciones; lo que exige de este personal un alto nivel de preparación científico-técnico. Objetivo. Evaluar el nivel de competencia que tiene el personal de enfermería para el ciado del paciente sometido a trasplante hepático. Metodología. Se trata de una investigación de Nivel 2 de profundidad correlacional-comparativo y diseño transversal. Probabilística estratificada estuvo integrada por 63 enfermeras = 78.75 % de la población de los diferentes turnos del servicio de pediatría. Se utilizaron dos cuestionaros una guía de observación. Donde se comparó las respuestas del cuestionario con diga guía de observación, auditoría para evaluar habilidades y un cuestionario de autoevaluación para conocimientos y aptitudes. Los datos se analizaron en el programa estadístico SPSS versión 15, con uso de la estadística descriptiva e inferencial, los resultados obtenidos fueron presentados en cuadros y gráficas, posteriormente se realizó un análisis de lo encontrado y fue contrastado con la literatura. Resultados. En relación al cumplimiento de las dimensiones se encontró que en conocimientos obtuvieron un 3.4% encontrándose en el rango regular; en las aptitudes obtuvieron un 4.5% por lo que se encuentran en el rango de por arriba de todas las dimensiones; y finalmente en las habilidades se obtuvieron 3.2% encontrándose en un nivel de cumplimiento rango mínimo. Discusión. La práctica del cuidado en los pacientes sometidos a trasplante hepático debe estar enfocada desde sus raíces, esto es de la forma de enseñar en las escuelas dado que no se da herramientas solidas a los alumnos para enfre4ntar la práctica clínica. Es aquí donde se encontraron similitudes con la Organización Panamericana de la Salud, con su propuesta de reorganizar la educación del personal de salud. Donde debe de existir una vinculación formativa del profesional y su vida laboral. Coincidimos con Ibarra en la forma de conceptualizar las competencias capacidad productiva del profesional que se define en términos de desempeño en un determinado contexto laboral. No puede existir una separación educativa con la práctica del cuidado puesto que estas deben ser vistas como un binomio que permita de manera sólida ser la base para lograr de cada uno de los profesionales de la salud el desarrollo de sus competencias clínicas en su vida laboral. Conclusiones: Con fundamento en los resultados y la discusión planteada en este estudio realizado a las enfermeras del Hospital Infantil de México Federico Gómez, que atienden a los pacientes postrasplantado de hígado para determinar el nivel competencias clínicas que ellas tienen se establece, "no se acepta la primera hipóte4sis de investigación ya que los hallazgos enuncian que; las competencias de la enfermeras en regular en los conocimientos habilidades específicas estarán disminuidas. Aun cuando la dimensión de actitudes es alta o adecuada, la atención de calidad y de seguridad al paciente no radica en esta dimensión solamente ya que deberán estar acompañadas de competencias clínicas como las habilidades y conocimientos.

Introduction: Hepatic transplantation (HT) is a very dynamic procedure that currently constitutes the treatment of choice for a large number of acute and chronic hepatobiliary diseases. Today, it continues to be a challenge for the work team of intensive care units despite advances in surgical techniques, anesthetics, immunosuppression and infections; what demands of this personnel a high level of scientific-technical preparation. Objective. To assess the level of competence that nurses have for the treatment of the patient undergoing liver transplantation. Methodology. This is a Level 2 investigation of correlational-comparative depth and cross-sectional design. Stratified probabilistic was composed of 63 nurses = 78.75% of the population of the different shifts of the pediatric service. Two questionnaires were used an observation guide. Where the responses of the questionnaire were compared with say observation guide, audit to evaluate skills and a self-assessment questionnaire for knowledge and skills. The data were analyzed in the statistical program SPSS version 15, with the use of descriptive and inferential statistics, the results obtained were presented in tables and graphs, later an analysis of the findings was made and compared with the literature. Results In relation to the fulfillment of the dimensions, it was found that in knowledge they obtained a 3.4% finding themselves in the regular range; in the aptitudes they obtained 4.5% so they are in the range of above all the dimensions; and finally, in the skills, 3.2% were obtained, meeting a minimum level of compliance. Discussion. The practice of care in patients undergoing liver transplantation should be focused from its roots, this is the way of teaching in the schools given that no solid tools are given to students to confront clinical practice. This is where they found similarities with the Pan American Health Organization, with its proposal to reorganize the education of health personnel. Where there should be a formative link of the professional and their working life. We agree with Ibarra on the way to conceptualize the skills productive capacity of the professional that is defined in terms of performance in a specific work context. There can not be an educational separation with the practice of care since these should be seen as a binomial that allows in a solid way to be the basis to achieve each of the health professionals the development of their clinical skills in their work life. Conclusions: Based on the results and the discussion raised in this study to the nurses of the Children's Hospital of Mexico Federico Gómez, who care for post-transplant liver patients to determine the level of clinical competencies they have established, "it is not accepted the first hypothesis of investigation since the findings state that; The skills of nurses in regular knowledge-specific skills will be diminished. Even when the attitude dimension is high or adequate, quality care and patient safety do not lie in this dimension alone since they must be accompanied by clinical skills such as skills and knowledge.

Introdução: O transplante de fígado (TH) é um processo muito dinâmico que actualmente é o tratamento de escolha para um grande número de doenças hepatobiliares agudas e crónicas. Hoje continua a ser um desafio para a equipe de unidades de terapia intensiva apesar dos avanços na cirurgia, anestesia, imunossupressão e infecções técnicas; o que esta equipe requer um alto nível de preparação científica e técnica. Objetivo. Avaliar o nível de competição que tem enfermeiros ted para o transplante de fígado submetidos paciente. Metodologia. Esta é uma concepção comparativo e transversal investigação de Camada 2 correlação profundidade. probabilística estratificada constituída por 63 enfermeiros = 78,75% da população dos diferentes turnos de Pediatria. dois foram usadas cuestionaros guia de observação. Onde as respostas ao questionário em comparação a dizer guia de observação, auditoria para avaliar habilidades e questionário de auto-avaliação de conhecimento e habilidades. Os dados foram analisados ​​no SPSS versão 15, com o uso de estatística descritiva e inferencial, os resultados foram apresentados em tabelas e gráficos, em seguida, foi realizada uma análise do que foi encontrado e contrastava com a literatura. Resultados. Em conformidade com as dimensões descobriu que o conhecimento obtido em 3,4% na gama normal; habilidades obtidos em 4,5% de modo está na gama de acima de todas as dimensões; e, finalmente, 3,2% foram obtidas capacidades foram em nível de alcance mínimo cumprimento. Discussão. prática de cuidados em pacientes submetidos a transplante de fígado deve ser focada de suas raízes, esta é a maneira de ensinar nas escolas, uma vez que não é dado ferramentas robustas para os alunos enfre4ntar prática clínica. Isto é onde as semelhanças com a Organização Pan-Americana da Saúde reuniu-se com a sua proposta de reorganizar a educação do pessoal de saúde. Onde deve haver um elo formador do profissional e sua vida profissional. Ibarra concordar com a maneira de conceituar habilidades de capacidade profissional é definida em termos de desempenho em um determinado contexto de trabalho. não pode haver uma prática de cuidados de separação educacional uma vez que estes devem ser vistos como uma combinação que permite ser solidamente a base para atingir cada um dos profissionais de saúde desenvolver suas habilidades clínicas em suas vidas profissionais. Conclusões: Com base nos resultados e discussão levantada neste enfermeiras do estudo do Hospital Infantil do México Federico Gomez, que cuidam de pacientes que postrasplantado fígado para determinar as clínicas nível de competência que estabeleceram, "ele não é aceito a primeira hipótese de investigação desde que os achados afirmam que; As habilidades dos enfermeiros em habilidades específicas do conhecimento serão diminuídas. Mesmo quando a dimensão de atitudes é alta ou adequada, cuidados de qualidade e segurança do paciente não reside apenas nesta dimensão porque ele deve ser acompanhada de habilidades clínicas como habilidades e conhecimentos.

Diseño para la Evaluación Clínica estructurada por objetivos en la asignatura Clínica I / A design for structured clinical assessment by aims in subject of Clinic I

La evaluación de las competencias clínicas en el Nuevo Programa de Formación de Médicos (NPFM) ha constituido un dilema desde los inicios de este programa. La Evaluación Clínica Estructurada por Objetivos (ECOE) viene a dar solución a esta problemática en este nuevo contexto educacional. Teniendo en cuenta todas las ventajas de este método se aplicó en el Policlínico Facultad José Maceo Grajales como examen práctico ordinario de la asignatura Clínica I. Para el diseño de esta evaluación se tuvieron en cuenta distintas fases (Planificación, el día previo al examen, el día del examen y el día después del examen). Se explica cómo se llevo a cabo cada fase de las anteriores.

The assessment of clinical competences in the New Program of Physician Training Program (NPPT) is dilemma from its onset. The Structural Clinical Assessment by OBJECTIVE (SCAA) solves this problem in this new educational context. Considering all advantages of this method, it was applied in José Maceo Grajales Faculty Polyclinic like a usual practical examination of Clinic I as subject. For design of this assessment we took into account different phases (planning, prior day, the present day, and the day after examination). We explain how each phase of the previous ones was carried out.