Anesthesia training: Are we doing enough in three years? Cross-sectional study

Introduction: The mínimum number of procedures required to be performed during anesthesia training has not been officially defined in Colombia. Although a number is no guarantee of acquired competencies, it does indicate the level of opportunity offered by the different programs. This study describes the practical training afforded to residents in a graduate anesthesia program in Colombia, and compares its results with international standards. Objective: Describe exposure to procedures performed by residents enrolled in a three-year anesthesia specialization program in Colombia between 2015 and 2020, and compare with the standards proposed by ASCOFAME and ACGME. Methods: Descriptive, cross-sectional study which included residents who did their specialization in a Colombian anesthesia program between 2015 and 2020. Complexity, anesthesia techniques, invasive monitoring and airway approach were described. Finally a descriptive comparison was made with the published references of the Colombian Association of Medical Schools (ASCOFAME) and the Accreditation Council for Graduate Medical Education (ACGME). Results: The results for 10 residents were included. Each resident had a median of 978 cases (IQR 942-1120), corresponding to 25 surgical specialties, the most frequent being general surgery (18%), orthopedics (16%), pediatric surgery (19%), and obstetrics (10.8%). According to the American Society of Anesthesiology (ASA) classification, the majority of patients were ASA II (39.63%) and ASA III (28.4%). Adequate exposure was achieved in 11 of the 15 categories proposed by ACGME and in 6 of the 15 proposed by ASCOFAME. Conclusions: A detailed description of the practice component acquired by the residents during their three years of training was obtained. This baseline provides insight into the national landscape and allows to describe the relationship with international standards.

Introducción: En Colombia no se encuentra oficialmente definido el número mínimo de procedimientos que se deben realizar durante el entrenamiento en anestesiología. Aunque el número no garantiza la adquisición de competencias de la especialidad, sí es un indicador de la oportunidad ofertada por parte de los programas. Este estudio describe el entrenamiento práctico que tienen los médicos residentes en un programa de posgrado de anestesiología en Colombia y compara sus resultados con estándares internacionales. Objetivo: Describir la exposición a procedimientos realizados por los médicos residentes de un programa de especialización en anestesiología de tres años en Colombia, entre 2015 y 2020, y compararlo con los estándares propuestos por ASCOFAME y el ACGME. Métodos: Estudio descriptivo de corte transversal; se incluyeron los residentes que cursaron su programa de especialidad en un programa colombiano de anestesiología entre 2015 y 2020. Se describieron la complejidad, técnicas anestésicas, monitoría invasiva y abordaje de la vía aérea. Finalmente, se compararon los resultados de manera descriptiva con lo referenciado por la Asociación Colombiana de Facultades de Medicina y el Accreditation Council for Graduate Medical Education (ACGME). Resultados: Se incluyeron los resultados de 10 médicos residentes. El número de casos por residente tuvo una mediana de 978 casos (RIQ942-1120), correspondientes a 25 especialidades quirúrgicas; cirugía general (18 %), ortopedia (16 %), cirugía pediátrica (19 %) y obstetricia (10,8 %) fueron las más frecuentes. Según la clasificación de la Sociedad Americana de Anestesiología (ASA), la mayoría de los pacientes tenían ASA 2 (39,63 %), ASA 3 (28,4 %). Se alcanzó una exposición adecuada en 11 de las 15 categorías propuestas por el ACGME y en 6 de las 15 propuestas por la Asociación Colombiana de Facultades de Medicina. Conclusiones: Se obtuvo una descripción detallada del aspecto práctico de los residentes de anestesiología durante sus tres años de formación. Esta línea de base permite ampliar el panorama a escala nacional y describir la relación con estándares internacionales.

Conocimientos, prácticas y actitudes del manejo programático de la tuberculosis en estudiantes de medicina de Colombia / Knowledge, practices and attitudes of the programmatic management of tuberculosis among Colombian medical students

Introducción: La tuberculosis es una enfermedad infecciosa con alta carga de la enfermedad en Colombia, por lo que se espera que la educación médica sea estándar en todas las regiones y los estudiantes de medicina tengan competencias en el manejo operativo de la tuberculosis. Este estudio evaluó los conocimientos, actitudes y prácticas en tuberculosis en estudiantes de medicina de Colombia y los factores relacionados. Métodos: Cuestionario de evaluación de conocimientos, actitudes y prácticas en tuberculosis en estudiantes de medicina en Colombia, que cursaban semestre clínico y se encontraban inscritos en la reunión anual 2020 de la Asociación de Sociedades Científicas de Estudiantes de Medicina de Colombia (ASCEMCOL) para establecer el nivel de conocimientos en tuberculosis. Resultados: Se evidenció que los estudiantes de regiones con mayor carga de la enfermedad como el Eje Cafetero presenta puntajes más altos de forma diferencial a las otras regiones. Por otra parte, se observó que la experiencia propia del estudiante en el tamizaje para tuberculosis (prueba cutánea de la tuberculina PPD - Mantoux) y la experiencia en la atención de pacientes con tuberculosis en el entorno clínico están relacionadas a los conocimientos del manejo programático de la tuberculosis. Conclusión: El estudio demuestra bajo nivel de conocimientos, actitudes y prácticas del manejo programático de la tuberculosis en los estudiantes de medicina que cursaban semestres clínicos en Colombia. (AU)

Background: The tuberculosis is an infectious disease with high disease burden in Colombia, so medical education is expected to be standard in all regions and medical students have competencies in the operative management of tuberculosis. This study evaluated the knowledge, attitudes, and practices in tuberculosis in medical students in Colombia and related factors. Methods: Questionnaire for the evaluation of knowledge, attitudes, and practices in tuberculosis in medical students in Colombia, who were in clinical semesters and were registered at the 2020 annual meeting of the Asociación de Sociedades Científicas de Estudiantes de Medicina de Colombia (ASCEMCOL) to establish the level of knowledge in tuberculosis. Result: The study found that students from regions with a higher burden of disease, such as the Eje Cafetero had higher scores that those from other regions. On the other hand, it was observed that the student´s own experience in tuberculosis screening (tuberculin skin test PPD – Mantoux) and the clinical experience in care patients with tuberculosis are related to the knowledge of the programmatic management of tuberculosis. Conclusions: The study shows a low level of knowledge, attitudes, and practices of programmatic management of tuberculosis in medical students in clinical semester in Colombia. (AU)

Estratégias de ensino do raciocínio clínico nos cursos de Medicina do Brasil - revisão integrativa / Teaching strategies for clinical reasoning in Brazilian medical schools - an integrative review

Resumo: Introdução: O raciocínio clínico é considerado uma das principais habilidades que devem ser desenvolvidas pelos estudantes de Medicina, porque permite a elaboração de hipóteses diagnósticas e orienta estratégias investigativas e diagnósticas de forma racional. Embora os educadores tradicionalmente foquem o ensino no modelo hipotético-dedutivo ou analítico, muitos professores de medicina enfrentam no seu dia a dia o desafio de encontrar novas estratégias para ajudar seus estudantes a desenvolver o raciocínio clínico. Objetivo: Este estudo realizou uma revisão integrativa da literatura para identificar as estratégias utilizadas no processo ensino-aprendizagem do raciocínio clínico, nas escolas médicas brasileiras. Método: A metodologia utilizada consistiu em seis etapas: 1. elaboração da pergunta da pesquisa; 2. definição dos critérios de inclusão e exclusão; 3. elenco das informações a serem extraídas; 4. avaliação dos estudos incluídos; 5. interpretação dos resultados; e 6. apresentação da revisão. Resultado: A maioria dos trabalhos apontam que o ensino do raciocínio clínico é realizado por meio de discussões de casos clínicos, de maneira incidental, em diversas disciplinas ou por meio do uso de metodologias ativas, como PBL, TBL e CBL. Apenas três trabalhos apresentados em congressos demonstraram experiências relacionadas à implantação de uma disciplina curricular obrigatória voltada especificamente ao ensino do raciocínio clínico. O ensino do raciocínio clínico é priorizado no internato em relação às fases clínicas e pré-clínicas. Conclusão: Poucos são os estudos que analisam a maneira como se dá o processo ensino-aprendizagem do raciocínio clínico nas escolas médicas brasileiras. Embora mais estudos sejam necessários, podemos verificar a falta de conhecimento teórico sobre raciocínio clínico como uma das principais causas de dificuldade para o desenvolvimento dessa competência pelos estudantes.

Abstract: Introduction: Clinical reasoning is considered one of the main skills that must be developed by medical students, as it allows the establishment of diagnostic hypotheses and directs investigative and diagnostic strategies using a rational approach. Although educators have traditionally focused the teaching method on the analytical model, many medical professors face the challenge in their daily lives of finding new strategies to help their students develop clinical reasoning. Objective: To carry out an integrative literature review to identify the strategies used in the teaching-learning process of clinical reasoning in Brazilian medical schools. Method: The methodology used consists of six steps: 1. creation of the research question; 2. definition of inclusion and exclusion criteria; 3. list of information to be extracted; 4. evaluation of included studies; 5. interpretation of results and 6. presentation of the review. Results: Most studies indicate that the teaching of clinical reasoning is carried out through discussions of clinical cases, incidentally, in different disciplines or through the use of active methodologies such as PBL, TBL and CBL. Only three studies presented at conferences disclosed experiences related to the implementation of a mandatory curricular discipline specifically aimed at teaching clinical reasoning. The teaching of clinical reasoning is prioritized in internships in relation to the clinical and pre-clinical phases. Final considerations: There are few studies that analyze how clinical reasoning is taught to medical students in Brazilian medical schools. Although more studies are needed, we can observe the lack of theoretical knowledge about clinical reasoning as one of the main causes of the students' difficulty in developing clinical reasoning.

Aprendizagem do cuidar a família na comunidade: Usabilidade do Modelo Dinâmico de Avaliação e Intervenção Familiar / Learning to care for the family in the community: Usability of the Dynamic Model of Family Assessment and Intervention / Aprendizaje del cuidado a la familia en la comunidad: Usabilidad del Modelo Dinámico de Evaluación e Intervención Familiar

Resumo Enquadramento: O Modelo Dinâmico de Avaliação e Intervenção Familiar é mobilizado no processo de ensino aprendizagem dos estudantes da licenciatura em enfermagem, como orientador no processo de cuidados às famílias na comunidade. Objetivo: Analisar as dimensões valorizadas pelos estudantes do curso de licenciatura em enfermagem, no desenvolvimento de competências na avaliação e intervenção familiar. Metodologia: Estudo exploratório-descritivo com 350 estudantes da licenciatura em Enfermagem. Uso de formulário para identificar aspetos valorizados na utilização do modelo referencial teórico e operativo em ensino clínico. Análise de conteúdo com categorização a priori e a posteriori. Cumpridos os pressupostos éticos. Resultados: Identificam-se cinco dimensões: Clareza (mais valorizada); Simplicidade; Generalidade; Consequências deriváveis (frequência de nomeação intermédia) e Precisão empírica (menos valorizada). Emerge interligação entre etapas do processo de cuidados e modelo como instrumento de mudança e referencial na tomada de decisão no contexto clínico. Conclusão: As dimensões confirmam a importância atribuída pelos estudantes à estrutura e sentido na aprendizagem dos cuidados à família sendo preditivas da aprendizagem integrada, entre teoria e prática em enfermagem.

Abstract Background: The Dynamic Model of Family Assessment and Intervention is used in the teaching-learning process of undergraduate nursing students to guide the process of caring for families in the community. Objective: To analyze the dimensions valued by undergraduate nursing students in the development of family assessment and intervention skills. Methodology: An exploratory-descriptive study was conducted with 350 undergraduate nursing students. A form was used to identify aspects valued in using the theoretical and operational model in clinical teaching. Data were subjected to content analysis, with a priori and a posteriori categorization. All ethical assumptions were met. Results: Five dimensions were identified: Clarity (most valued); Simplicity; Generality; Derivable consequences (intermediate frequency), and Empirical precision (least valued). Interconnection emerges between stages of the care process and the model as an instrument of change and reference in decision-making in clinical settings. Conclusion: The dimensions confirm the importance attributed by students to the structure and meaning in learning about family care and are predictors of integrated learning between nursing theory and practice.

Resumen Marco contextual: El Modelo Dinámico de Evaluación e Intervención Familiar se articula en el proceso de enseñanza-aprendizaje de los estudiantes del grado en Enfermería, como guía en el proceso de cuidados a las familias en la comunidad. Objetivo: Analizar las dimensiones valoradas por los estudiantes del grado en Enfermería en el desarrollo de competencias en la evaluación e intervención familiar. Metodología: Estudio exploratorio-descriptivo con 350 estudiantes del grado en Enfermería. Se utilizó un formulario para identificar los aspectos valorados en el uso del modelo referencial teórico y operativo en la enseñanza clínica. Análisis de contenido con categorización a priori y a posteriori. Se cumplieron todos los supuestos éticos. Resultados: Se identifican cinco dimensiones, Clareza (más valorada); Simplicidad; Generalidad; Consecuencias derivables (frecuencia intermedia) y Precisión empírica (menos valorada). Surge interconexión entre etapas del proceso de cuidados y modelo como instrumento de cambio y referencia para la toma de decisiones en el contexto clínico. Conclusión: Las dimensiones confirman la importancia atribuida por los estudiantes a la estructura y el significado en el aprendizaje de los cuidados a la familia, y son predictivas del aprendizaje integrado entre la teoría y la práctica en enfermería.

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)

Description of basic competencies in clinical ultrasound imaging for emergency departments. / Competencias básicas de la ecografía clínica en los servicios de urgencias y emergencias.

TEXT: Recent years have seen great advances in the use of clinical ultrasound imaging in both hospital emergency departments and out-of-hospital settings. However, all new techniques require up-to-date definitions of competencies relevant to the clinical realities of different specialties and the geographic settings in which specialists work. To that end, a group of experts in clinical ultrasound reviewed the evidence available in the literature and strictly applied the Delphi method to define the competencies relevant to emergency physicians. The group worked with the starting premise that clinical ultrasound imaging should be a common competency across the specialty.

TEXTO: En los últimos años, la ecografía clínica (EC) ha sufrido un avance muy importante en su implantación dentro de los servicios de urgencias, tanto hospitalarios como extrahospitalarios, pero como toda técnica requiere un ámbito competencial definido, actualizado y enmarcado, tanto en la realidad clínica de la especialidad que desempeñamos como en la geográfica del país donde ejercemos. Por ello, un grupo de expertos en la materia ha desarrollado el presente documento en el que basándose por un lado en la evidencia disponible en la bibliografía científica y por otro en una metodología Delphi, planteó el objetivo de establecer un claro marco competencial base para todos los urgenciólogos, asumiendo como premisa inicial que la EC debería ser una competencia transversal común.

Competencias básicas de la ecografía clínica en los servicios de urgencias y emergencias / Description of basic competencies in clinical ultrasound imaging for emergency departments

En los últimos años, la ecografía clínica (EC) ha sufrido un avance muy importante en su implantación dentro de los servicios de urgencias, tanto hospitalarios como extrahospitalarios, pero como toda técnica requiere un ámbito competencial definido, actualizado y enmarcado, tanto en la realidad clínica de la especialidad que desempeñamos como en la geográfica del país donde ejercemos. Por ello, un grupo de expertos en la materia ha desarrollado el presente documento en el que basándose por un lado en la evidencia disponible en la bibliografía científica y por otro en una metodología Delphi, planteó el objetivo de establecer un claro marco competencial base para todos los urgenciólogos, asumiendo como premisa inicial que la EC debería ser una competencia transversal común. (AU)

Recent years have seen great advances in the use of clinical ultrasound imaging in both hospital emergency departments and out-of-hospital settings. However, all new techniques require up-to-date definitions of competencies relevant to the clinical realities of different specialties and the geographic settings in which specialists work. To that end, a group of experts in clinical ultrasound reviewed the evidence available in the literature and strictly applied the Delphi method to define the competencies relevant to emergency physicians. The group worked with the starting premise that clinical ultrasound imaging should be a common competency across the special (AU)

Escala de competencias clínicas básicas para psicoterapeutas (ECCBP). Construcción y fiabilidad para Argentina / Basic Clinical Competences Scale for Psychotherapists (BCCSP). Construction and reliability for Argentina

Resumen A nivel internacional, se han elaborado modelos e instrumentos de evaluación de competencias genéricas y específicas; sin embargo, en Argentina los desarrollos han sido menores. Un relevamiento de psicoterapeutas locales concluye que al menos siete competencias clínicas básicas y cinco indicadores asociados a su desarrollo serían esenciales para desempeñarse como terapeutas (Crocamo, 2019). El objetivo de este trabajo fue construir un instrumento para su evaluación, denominado Escala de Competencias Clínicas Básicas para Psicoterapeutas (ECCBP). Para ello, se utilizó un diseño no experimental, transversal de tipo exploratorio en cuatro fases: (1) elaboración del sistema de evaluación; (2) redacción de ítems; (3) revisión de la versión preliminar; y (4) desarrollo del instrumento definitivo. Se aplicó el instrumento a 534 psicoterapeutas argentinos con título de grado de psicólogo. La versión definitiva quedó conformada por 122 ítems y para completarlo se requirieren aproximadamente 45 minutos. La elaboración de un instrumento local favorece el estudio sistemático del área y permite valorar de manera confiable la efectividad de los programas de entrenamiento.

Abstract At the international level, models and instruments for the evaluation of generic and specific competences have been developed; however, in Argentina the developments have been fewer. A survey of local psychotherapists concludes that at least seven basic clinical competencies would be essential to perform as therapists: diagnostic process and design, interventions and techniques, therapeutic bond, professional role, contextual variables and diversity, interview management and evaluation and completion of the process. Furthermore, five activities and experiences would be linked to their training, called associated indicators: basic training and updating, personal development and work on oneself, belonging to institutions and network of professionals, supervision, and personal and professional experience (Crocamo, 2019). Therefore, the objective of this work was to construct an instrument for its evaluation called Basic Clinical Competences Scale for Psychotherapists (BCCSP). To do this, a non-experimental, cross-sectional exploratory design was used in four phases: (1) development of the evaluation system; (2) writing of items; (3) review of the preliminary version; and (4) development of the final instrument. The instrument was applied to 534 Argentine psychotherapists with a degree in psychology. To attend to the particularity of each phase, three samples were used. The first one was composed of three psychotherapists summoned to participate in the selection of the different methodologies to evaluate each competence and indicator. For the second one, reviewers of the instrument made up of five therapists with different levels of professional experience summoned to assess the preliminary version of the instrument. And the third, to study the psychometric properties of the BCCSP, a snowball sample was used composed of 534 psychotherapists from 19 provinces of Argentina. As a result, different evaluation formats were incorporated in order to favor the effective evaluation of the variables, clinical vignettes, self-evaluation of perception of competences and questionnaire. A systematized procedure was carried out to review and refine the pilot version. The percentage of agreement between the reviewers of the instrument (Herrera Rojas, 1993) and the Aiken's V coefficient were calculated using software called Basic Visual Program for Aiken's V, developed by Merino Soto and Livia Segovia (2009). The final version was made up of 122 items and it takes approximately 45 minutes to complete it. The first part is composed of three vignettes which offer clinical descriptions with 15 questions for each situation. Finally, the responses are scored as correct / complete (2 points), correct / partial (1 point) or incorrect (0 points). Next, the self-assessment scale presents the following Cronbach's alpha coefficients Therapeutic link α = .833; Professional role α = .715; Contextual variables and diversity α = .853; Interview management α = .845; Evaluation and completion of the process α = .845 and Design, interventions and techniques II α = .797. Finally, the questionnaire was made up of 22 items: basic training and updating (5 items), personal and professional experience (5 items), personal development and work on oneself (4 items), supervision (4 items), membership in institutions and professional network (5 items). The answers collected will allow to obtain qualitative information on experiences or activities associated with the development of clinical competencies for psychotherapy. In the first place, it should be noted that the BCCSP is an instrument specially constructed for the local population and the study area that can be generalizable to other similar sociocultural contexts since the vast majority of evaluation models and studies have been developed in Anglo-Saxon countries. At the same time, due to the lack of local evaluation instruments, the BCCSP could become a valuable tool, both to be used in research activities and in training programs and educational monitoring.

[Impact of the Covid-19 pandemic on specialized healthcare training in a teaching center]. / Impacto de la pandemia COVID-19 en la formación sanitaria especializada en un centro docente.

OBJECTIVE: Evaluation of the impact of the health crisis caused by the Covid-19 pandemic on specialized healthcare training in a teaching center. METHODS: Cross-sectional descriptive study, by means of an electronic questionnaire sent to 167 residents in June 2020, to evaluate the burden of care, suspension of rotations and Covid-19 symptoms. The impact on the acquisition of professional competencies was measured using a four-level Likert scale (none, a little, quiet, a lot). The profile of acquired competencies was constructed and its association with the professional profile was studied using Generalized Linear Models. The qualitative approach was carried out through an open question on how it influenced their learning and the different categories were extracted through triangulation. RESULTS: The impact on learning was important for 94.8% of the residents. A total of 81.4% left the rotations they were doing and reported high workload, loss of training opportunities, uncertainty and ethical conflicts. They appreciated significant learning in the competencies of teamwork (93.2%), professionalism (86.2%), ethics (79.9%) and communication (78%). Technical competencies were deficient. The final balance of learning was perceived as positive by 54.4%, especially residents in central services and medical specialties. A total of 67.8% felt overwhelmed at times due to fatigue-emotional impact, care overload, ethical conflicts and lack of resources. CONCLUSIONS: The Covid-19 pandemic had an exceptional impact on specialized health care training. It is necessary to re-evaluate training programs to ensure the acquisition of the technical competencies that are lacking.

Percepción del estudiante de Odontología respecto al examen clínico objetivo estructurado como método de evaluación / Dental students' perception of the structured objective clinical examination as a method of evaluation

Introducción: El examen clínico objetivo estructurado (ECOE) se aplica desde la década de los setenta en la mayoría de las escuelas de medicina del mundo. Este examen consiste en una dinámica en la que los estudiantes rotan por estaciones, dotadas de todo lo necesario para realizar un procedimiento clínico en un tiempo determinado. Objetivo: Analizar la percepción del ECOE como instrumento de evaluación para estudiantes de tercer año de Odontología de la sede de Santiago de la Universidad San Sebastián de Chile en 2018. Sujetos y métodos: Se realizó una investigación exploratoria aplicando una encuesta que mide la percepción frente a la experiencia del ECOE por los estudiantes de tercer año de la carrera de Odontología. Resultados: Los resultados indicaron que los estudiantes percibieron que el ECOE estuvo bien implementado, la mayoría pensó que mide sus habilidades y conocimientos adquiridos en años anteriores, y consideran que lo evaluado es importante para los años posteriores de su carrera. Conclusión: Los estudiantes tienen una percepción adecuada del ECOE como instrumento evaluativo; se pudo obtener información para realizar mejoras en futuras implementaciones.(AU)

Introduction: The objective structured clinical examination (OSCE) has been used since the 1970s in most medical schools worldwide. It consists of students being tested at different workstations, where they must perform a clinical procedure. Each station is equipped with everything necessary to perform a clinical procedure within a certain time. Aim: The perception of the OSCE was analyzed as an evaluation instrument for third-year students of Dentistry at the San Sebastian University, Santiago, Chile in 2018. Subjects and methods: An exploratory research was carried out applying a survey that measures the perception of the experience of the OSCE by third-year students of the Dentistry career. Results: The results indicated that the students perceived was well implemented. The majority thought that the OSCE measured their skills and knowledge acquired in previous years and that what was asked was important for the later years of their careers. It was observed that they considered the fairest evaluation of the OSCE, the most difficult -the preclinical enabling tests. It was also reported that they preferred to be evaluated more frequently with the OSCE. Conclusion: The students have an adequate perception of the ECOE as an evaluation instrument and that information could be obtained to make improvements in future implementations.(AU)

Las competencias del neurólogo en Colombia: una propuesta / The competencies of the neurologist in Colombia: a proposal

RESUMEN INTRODUCCIÓN: Tener claras las competencias profesionales permite dirigir adecuadamente los esfuerzos académicos, económicos y sociales para cumplir la vocación como neurólogos; hasta ahora, la bibliografía al respecto es escasa. OBJETIVO: Describir las competencias profesionales que debe tener un neurólogo clínico en Colombia. MÉTODOS Y MATERIALES: Es un estudio cualitativo exploratorio descriptivo, realizado según la teoría fundamentada, mediante una entrevista semiestructurada a 23 líderes de la especialidad en Colombia. RESULTADOS Y DISCUSIÓN: A partir de las entrevistas, se redactan según el modelo del Ministerio de Salud, competencias transversales y específicas que complementan las 8 planteadas previamente por ASCOFAME, para un total de 34 competencias divididas en cinco dominios. CONCLUSIONES: luego de conocer las competencias profesionales, deben diseñarse criterios de desempeño para medir el logro de esas habilidades. Dado que las competencias dependen de las condiciones de la sociedad, las cuales son cambiantes, su reevaluación debe ser continua.

SUMMARY INTRODUCTION: Having a clear idea of professional competencies allows to direct properly the academic economic and social efforts to accomplish the neurologist's vocation; neverthless, the literature is scarce. OBJECTIVE: Describe the professional competencies of clinical neurologists in Colombia. METHODS AND MATERIALS: It is a descriptive exploratory qualitative study, carried out according to grounded theory, through a semi-structured interview with 23 leaders of the specialty in Colombia. RESULTS AND DISCUSSION: From the interviews, transversal and specific competences are drawn up according to the model of the Ministry of Health, complementing the 8 previously proposed by ASCOFAME, for a total of 34 competencies divided into five domains. CONCLUSIONS: After knowing the neurologist's competencies, it's mandatory to design perfomance criteria to measure the achievement of those abilities. Since competencies depend on the conditions of society which are in constant change, their reassessment must be continuous.

Evaluación de competencias del proceso formativo de los residentes utilizando el portafolio: una revisión de la literatura / Assessment of competencies of the residents' training process using the portfolio: a literature review

In the dynamic process of curricular changes and improvements in the different specialties, knowledge, skills, attitudes and values have been taken into account; that is why new forms of study, supervision and evaluation of doctors in training have to be integrated. Recent experiences in our country try to introduce professional portfolios as assessment- learning tools in specialized postgraduate training. The portfolio is an instrument for evaluating the residents' training process that allows not only evaluating competencies, but fundamentally identifying what we should improve, allowing us to monitor the training media as they advance in the acquisition and development of competencies so that become a tool focused on helping us learn and at the same time provide elements to value the participation of tutors and their influence on learners. In the process of planning, designing and reviewing the portfolios, the training centers find an excellent opportunity to make a self-assessment of the consistency of their curricular structure, the clarity of the competences they seek to form and the evidence they may require in the training of its residents.

Selección de residentes en la formación de psiquiatría: ¿qué atributos buscan los docentes de un centro formador y por qué medios? / Resident selection in psychiatry: what attributes are sought and by what means?

Introducción: la formación en Psiquiatría tiene como primer desafío elegir los candidatos ideales para desempeñarse óptimamente como residentes, alcanzando las competencias necesarias para un posterior ejercicio de la especialidad. En general, no se cuenta con instrumentos específicos de selección de residentes, utilizándose diversas estrategias de elección de candidatos a la especialidad. El objetivo del presente estudio es identificar los atributos y los medios de selección que un grupo de académicos consideran necesarios al momento de seleccionar a los candidatos a sus programas de residencia en Psiquiatría. Metodología: se realizó una investigación cualitativa de tipo encuesta de percepción utilizando el Método Delphi. La encuesta se envió, por medio de una plataforma web, a todos los académicos del Departamento de Psiquiatría de la Pontificia Universidad Católica de Chile (n=39). Resultados: los atributos mencionados fueron agrupados en 8 dominios. Las principales categorías identificadas por los encuestados fueron: profesionalismo (41%), motivación por la especialidad (33%), habilidades de comunicación (13%) y estabilidad psicológica (12%). El principal instrumento mencionado para evaluar los atributos de los postulantes fue la entrevista personal. Las publicaciones científicas, las notas de pregrado y las cartas de recomendación son mencionadas secundariamente. Conclusiones: el actuar profesional en la acción médica, medido como profesionalismo, en este estudio es atributo esencial en un postulante a un programa de residencia en Psiquiatría. Aunque las entrevistas personales han demostrado poco valor predictivo con el rendimiento del residente durante su formación, siguen siendo un instrumento muy requerido en los procesos de selección de residentes.

Introduction: Training in Psychiatry has, as its first challenge, to choose the ideal candidates to perform optimally as residents, rea-ching the necessary skills for a subsequent exercise of the specialty. There are no specific instruments for selecting residents, but many different strategies are used to select proper candidates. The primary objective of this study is to recognize the attributes academics seek in a psychiatry residency applicant. The secondary objective was to identify the selection method academics thought as optimal.Methods: A qualitative investigation of perception was conducted using the Delphi Method. The perception survey was sent through a web platform to all academics of the Department of Psychiatry of the Pontificia Universidad Católica de Chile (n = 39).Results: Attributes were grouped into eight domains. The main identified categories were: professionalism (41%), specialty interest (33%), communication skills (13%), and psychological balance (12%). A personal interview was seen as the current optimal selection method. Publications, undergraduate scores, and letters of recommendation were also taken into account.Conclusions: Professionalism, is seen as an essential attribute in an applicant for a psychiatry residency program. Although personal interviews have shown little predictive value related to the resident's performance during their training, they are still a very common and valued instrument used in the resident selection processes.

Percepção do estudante sobre a influência do ambiente/clima educacional no processo ensino-aprendizagem: uma revisão integrativa / Student's perception of the influence of the educational environment / climate in the teaching-learning process: an integrative review

Trata-se de revisão integrativa que objetivou descrever o conceito de ambiente/clima educacional e identificar a influência do ambiente/clima educacional no processo ensino-aprendizagem sob a percepção do estudante. Ambiente educacional (AE) é todo e qualquer contexto em que se dá o ensino e o aprendizado. Foram selecionados doze artigos relevantes ao tema, nas bases de dados BVS e PubMed, com descritores, educação superior, competência clínica, procedimentos clínicos e aprendizagem. Emergiram três categorias: ambiente educacional e ensino clínico na saúde; percepção do estudante sobre o ambiente educacional e fatores do ambiente educacional que influenciam no processo ensino-aprendizagem. O AE pode afetar as habilidades e o desempenho acadêmico e deve propiciar confiança nas atividades diárias. Conclui-se que o AE tem influência no processo ensino-aprendizagem, fornece informações importantes para os educadores, estimulam a autoconfiança e aspectos afetivos.

Consideraciones sobre la necesidad de supervisión a los ingresantes a las residencias médicas / On the need for supervision of the entrants to medical residences

Según la Asociación Americana de Facultades de Medicina existen 13 actividades profesionales confiables que los graduados de medicina deberían poder realizar en su primer día de residencia sin supervisión directa. Esas actividades no están claramente definidas en nuestro país. Además, no existen datos locales sobre la necesidad de su supervisión. Nuestro objetivo fue evaluar la opinión de residentes y docentes acerca del nivel de supervisión que requieren los médicos ingresantes al sistema de residencias para realizar esas actividades. Se efectuó un estudio de corte transversal. Se incluyeron residentes de primer año de especialidades clínicas y quirúrgicas y sus docentes. Se enviaron encuestas electrónicas o en papel, con participación voluntaria y anónima. Se investigó la estimación sobre el nivel de supervisión que requerían los médicos ingresantes durante el primer mes de formación para 13 actividades. Se observaron diferencias significativas entre la evaluación hecha por residentes (n = 71) y los docentes (n = 39) en 11 de 13 de esas actividades. Más de la mitad de los docentes consideró que los residentes requerían supervisión directa para realizarlas, con las excepciones de formular interrogatorios clínicos y buscar evidencia. La mayoría de los residentes consideró que se requería supervisión directa solo en seis de ellas. En conclusión, los residentes estimaron requerir menor supervisión que sus docentes, quienes pensaban que los ingresantes al sistema de residencia no eran capaces de realizar la mayoría de las competencias clínicas de manera autónoma. Sería importante mejorar esta evaluación en los recién graduados, para definir con mayor precisión los niveles de supervisión.

According to the Association of American Medical Colleges, there are thirteen core Entrustable Professional Activities (EPAs) that medical graduates should be able to perform in their first day of residency, without direct supervision. In Argentina EPAs are not clearly defined. Moreover, there is no local data about the need of supervision regarding these activities. The aim of this study was to assess residents' and teaching physicians' estimations about the level of supervision that physicians in their first month of residency needed in order to perform EPAs. A cross-section study was conducted. First-year medical residents and teaching physicians were included. Electronic or paper surveys were sent, asking the level of supervision the participants estimated that residents needed to perform the 13 core EPAs, during their first month of residency. Participation was voluntary and anonymous. There were significant differences between the opinion of residents (n = 71) and teaching physicians (n = 39), for 11 out of 13 EPAs. More than half of the teaching physicians considered that residents needed direct supervision when performing EPAs, except for asking clinical questions and looking for evidence. Most residents thought that they required direct supervision in 6 EPAs. In conclusion, medical residents perceived the need of lower levels of supervision when compared to teaching physicians, who considered that medical graduates were not capable of performing most EPAs without direct supervision upon entering residency. Thus, it would be important to improve the procedures to evaluate the competences of medical graduates in order to establish more accurate supervision levels.

Competências para enfermeiras pediátricas de serviços hospitalares de oncologia / Competencies for pediatric nurses of oncology hospital services

OBJETIVO: Identificar as competências das enfermeiras pediátricas que atuam em oncologia. MÉTODO: Revisão integrativa, nas bases de dados: Biblioteca Virtual em Saúde, National Library of Medicine da U.S., portal de periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, busca livre em sites da Oncology Nurse Society e Library Online. Os critérios de inclusão: pesquisas originais, em português, inglês e espanhol, com os resumos nas bases selecionadas, no período de 2011 a 2018. RESULTADOS: Selecionados sete artigos com descrição das competências, sendo as principais: desenvolvimento profissional/educação, coordenação do cuidado, experiência e especialização, cuidados clínicos baseados em evidências, análise para recursos financeiros e acompanhamento do paciente em pesquisa clínica. CONCLUSÃO: Há limitação neste estudo, visto que há somente um documento internacional que abordada as competências em oncologia pediátrica, sendo necessário a tradução e validação desta matriz nas instituições brasileiras. (AU)

Objective: To identify the competencies of pediatric nurses working in oncology. Method: Integrative review in the databases: Virtual Health Library, U.S. National Library of Medicine, portal for journals of the Higher Education Personnel Improvement Coordination, free search on Oncology Nurse Society and Library Online websites. Inclusion criteria: original research and documents of International Society in Oncoloy, in Portuguese, English and Spanish, with abstracts in the selected bases, from 2011 to 2018. Results: Selected seven articles with description of competences, the main ones being: professional development/education, coordination of the care, experience and expertise, evidence-based clinical care, knowledge of financial resources and patient follow-up in clinical research. Conclusion: There is a limitation in this study, since there is only one international document that addresses the competences in pediatric oncology, requiring the translation and validation of this matrix in Brazilian institutions. (AU)

Objetivo: identificar las competencias de las enfermeras pediátricas que trabajan en oncología. Metodología: Revisión integradora en las bases de datos: Biblioteca Virtual en Salud, Biblioteca Nacional de Medicina de EE. UU., Portal para revistas de la Coordinación de Mejoramiento del Personal de Educación Superior, búsqueda gratuita en los sitios web de Oncology Nurse Society y Library Online. Criterios de inclusión: investigación original y documentos de Sociedades Internacionales de Oncología, en portugués, inglés y español, con resúmenes en las bases seleccionadas, de 2011 a 2018. Resultados: Siete artículos seleccionados con descripción de competencias, siendo los principales: desarrollo profesional / educación, coordinación de atención, experiencia y experiencia, atención clínica basada en evidencia, conocimiento de recursos financieros y seguimiento de pacientes en investigación clínica. Conclusión: Hay una limitación en este estudio, ya que solo hay un documento internacional que aborda las competencias en oncología pediátrica, que requiere la traducción y validación de esta matriz en las instituciones brasileñas. (AU)

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(AU)

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(AU)

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

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(AU)

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(AU)