EXAMEN CLÍNICO OBJETIVO ESTRUCTURADO como innovación pedagógica y como parte del Examen Final de competencias de la carrera de Medicina. Universidad Nacional Nordeste-Corrientes, Argentina / STRUCTURED OBJECTIVE CLINICAL EXAMINATION as a pedagogical innovation and as part of the Final Competency Exam of the Medicine degree. National Northeast University-Corrientes, Argentina

Actualmente la tendencia en educación médica, es construir los proyectos pedagógicos basados en competencias. El aprendizaje en competencias posibilita la articulación teoría y práctica, y favorece la adquisición de aprendizajes significativos, lo que permitevalorar los procesos cognitivos de orden superior, tales como, razonamiento clínico, resolución de problemas, pensamiento crítico y habilidades de comunicación. Esta investigación se desarrolló en la Práctica Obligatoria Final de la Carrera de Medicina de la Universidad Nacional del Nordeste,situada en la provincia de Corrientes, Argentina.Tuvo como objetivo determinar lavalidez y confiabilidad del Examen Clínico Objetivo Estructurado (ECOE), como instrumento de evaluación, para constatar la adquisición de las competencias del egresado. Para ello se utilizó el Examen denominado (ECOE), Objective Structured Clinical Examination (OSCE por las siglas en inglés). Lainvestigación fuedescriptiva y de corte transversal. La población en estudio estuvo constituida por302estudiantes, que rindieron su examen final profesional, en el período diciembre 2005 a septiembre de 2008, desarrolladosen 14 turnos.Los resultadosmuestranla correlación entre el promedio de calificaciones de los 6 años de la carrera yel de competencia clínica (ECOE) en cada turno de examen y en cada área evaluada: Clínica, Cirugía, Pediatría y Obstetricia. Los resultados muestran que los exámenes, son de alta confiabilidad, con un rango entre 0,45 y 0,82 deAlfa de Cronbach. El promedio entre las correlaciones es de 0,65 lo que demuestra significancia estadística. Se demostró además, la validez en los catorce exámenes aplicados, con las pruebas de Anova, pruebas de Mann Whitney y Kruskal-Wallis lo cual indica que el número de estaciones fueron suficientes para lograr lo esperado de los estudiantes. Conclusión: el ECOE es una alternativa de evaluación de las competencias del futuro profesional médico que demostró confiabilidad y validez.Currently the trend in medical education is to build pedagogical projects based on competencies. Competency learning enables the articulation of theory and practice, and favors the acquisition of significant learning, which makes it possible to assess higher order cognitive processes, such as clinical reasoning, problem solving, critical thinking and communication skills. This research was developed in the Final Compulsory Practice of the Medicine Course of the National University of Norwest, located in the province of Corrientes, Argentina. Its objective was to determine the validity and reliability of theStructured Objective Clinical Exam (ECOE), as an evaluation instrument, to verify the acquisition of the graduate's competencies. For this, the so-called Test (ECOE), Objective Structured Clinical Examination (OSCE) was used. The investigation was descriptive and cross-sectional. The study population consisted of 302 students, who took their final professional exam, in the period December 2005 to September 2008, developed in 14 career and the clinical competence (ECOE) in each exam shift and in each area evaluated: Clinic, Surgery, Pediatrics and Obstetrics. The results show that the exams are highly reliable, with a range between 0.45 and 0.82 of Cronbach's Alpha. The average between the correlations is 0.65 which demonstrates statistical significance. In addition, the validity of the fourteen exams applied was demonstrated, with the Anova tests, Mann Whitney and Kruskal-Wallis tests, which indicates that the number of stations was sufficient to achieve what was expected of the students. Conclusion: ECOE is an alternative for evaluating the competencies of the future medical professional who demonstrated reliability and validity.Atualmente, a tendência na educação médica é construir projetos pedagógicos baseados em competências. O aprendizado por competência possibilita a articulação entre teoria e prática e favorece a aquisição de aprendizado significativo, o que possibilita avaliar processos cognitivos de ordem superior, como raciocínio clínico, resolução de problemas, pensamento crítico e habilidades de comunicação. Esta pesquisa foi desenvolvida na Prática Compulsória Final do Curso de Medicina da Universidade Nacional del Nordeste, localizada na província de Corrientes, Argentina. O seu objetivo foi determinar a validade e a confiabilidade do Exame Clínico Objetivo Estruturado (ECOE), como instrumento de avaliação, para verificar a aquisição das competências do graduado. Para isso, foi utilizado o chamado Teste (ECOE), Exame Clínico Objetivo Estruturado (OSCE). A investigação foi descritiva e transversal. A população do estudo foi composta por 302 alunos, que fizeram o exame profissional final, no período de dezembro de 2005a setembro de 2008, desenvolvido em 14 turnos.Os resultados mostram a correlação entre a média de notas da carreira de 6 anos e a competência clínica (ECOE) em cada turno de exame e em cada área avaliada: Clínica, Cirurgia, Pediatria e Obstetrícia. Os resultados mostram que os exames são altamente confiáveis, com intervalo entre 0,45 e 0,82 do Alpha de Cronbach. A média entre as correlações é de 0,65, o que demonstra significância estatística. Além disso, foi demonstrada a validade dos quatorze exames aplicados, com os testes Anova, Mann Whitney e Kruskal-Wallis, o que indica que o número de estações foi suficiente para atingir o que era esperado dos alunos. Conclusão: o ECOE é uma avaliação alternativa das competências do futuro profissional médico que demonstrou confiabilidade e validade

Competencias de los residentes de Atención Primaria en el manejo de los problemas prevalentes de oído, nariz y garganta / Competencies of Primary Care residents in the management of prevalent problems of the ear, nose and throat

Los problemas de oído, nariz y garganta son un motivo frecuente de consulta en Atención Primaria. Numerosos estudios han reportado que los médicos de Atención Primaria perciben una capacitación insuficiente en el manejo de estos problemas. El objetivo de este estudio fue evaluar las competencias en el diagnóstico y tratamiento de problemas prevalentes de Otorrinolaringología de médicos residentes de Atención Primaria en un hospital universitario, en Buenos Aires, Argentina, mediante la implementación de un examen clínico objetivo estructurado. Participaron 25 residentes, de Pediatría (7), de Medicina Interna (10) y de Medicina Familiar (8). Los de Medicina Familiar y Pediatría tuvieron mejor desempeño que los de Medicina Interna. Los residentes de Atención Primaria demostraron competencias disímiles en el manejo de problemas prevalentes de Otorrinolaringología. Se detectaron áreas de oportunidad de mejora comunes para los tres grupos, que proporcionaron dirección y motivación en futuros aprendizajes, tanto en conocimientos como en habilidades.

Ear, nose and throat problems are very common in Primary Care settings. Numerous studies have reported that Primary Care physicians feel dissatisfied with their performance and insufficient training to diagnose and manage these problems. The objective of this study was to assess the competency in diagnosis and management of prevalent ear, nose and throat problems in medical residents of Family Medicine, Internal Medicine and Pediatrics at a University Hospital in Buenos Aires, Argentina, using an Objective Structured Clinical Examination. The participants were 25 residents of Pediatrics (7), Internal Medicine (10) and Family Medicine (8). Residents of Family Medicine and Pediatrics showed better performance than residents of Internal Medicine. Residents of Primary Care demonstrated dissimilar competencies in the management of prevalent ear, nose and throat problems. Areas of common improvement opportunities were detected for the three groups, which provided direction and motivation in future learnings in both knowledge and skills.

Evaluación de habilidades transversales de comunicación y colaboración a través de un examen clínico objetivo estructurado de radiología de urgencias para residentes de un programa universitario de especialidad en radiología / Assessment of generic skills in communication and collaboration through an objective structured clinical examination in emergency radiology in a university residency program in Chile

Introducción: La Radiología de Urgencias es una unidad de aprendizaje longitudinal a toda la residencia. En ella los residentes se enfrentan a patología de urgencia en distintas modalidades de imagen. Además del dominio cognitivo, los residentes deben desarrollar habilidades de comunicación y colaboración que les permitan enfrentar adecuadamente los turnos de residencia. Previo a incorporarse a los turnos nocturnos, los residentes deben aprobar un Examen Clínico Objetivo Estructurado (ECOE). Propósito: Evaluar competencias de comunicación y colaboración a través de estaciones de ECOE de Radiología de Urgencias aplicado a residentes de 2º año de residencia. Metodología: Se seleccionaron objetivos específicos a evaluar para las competencias de comunicación y colaboración y contenidos de Radiología Abdominal, Osteoarticular y Pediátrica para diseñar tres estaciones de ECOE, las cuales fueron incorporadas en el instrumento de evaluación aplicado el año 2017. Se calcularon porcentajes de logro por estación y tipo de pauta de evaluación. Para evaluar la implementación de las estaciones, se diseñó y aplicó una encuesta de percepción a los residentes. Resultados: Se diseñaron tres estaciones, dos para el rol Comunicador y una para el rol Colaborador. La validez de contenido se aseguró a través de un panel de expertos. Los porcentajes de logro global en las estaciones fluctuaron entre 74,7% y 95,6%. Las estaciones fueron bien evaluadas por parte de los residentes, quienes valoraron la incorporación de competencias diferentes al dominio cognitivo en el instrumento de evaluación. Conclusión: El ECOE permite certificar habilidades transversales como comunicación y colaboración de manera apropiada

Introduction: Emergency radiology (ER) is taught and learned throughout the entire residency. Trainees are exposed to different subspecialties ER cases and through varied imaging techniques. In addition to the "medical expert" domain, residents must develop communication and collaboration skills that will help them during their call schedule. Before they can take night-call, radiology residents must pass an Objective Structured Clinical Examination (OSCE). Purpose: To evaluate communication and collaboration competencies on an ER-OSCE applied to second-year radiology residents. Methods: Specific learning objectives were defined to evaluate communication and collaboration skills in abdominal, musculoskeletal and pediatric ER. Three OSCE stations were designed for this purpose and added to the evaluation instrument in 2017. On each station, resident performance was assessed with a specific template and percentage of goal achievement was calculated. Trainee´s opinion of this new modality was obtained through a perception survey. Results: Three stations were designed, two for the communicator role and one for the collaborator competency. Validity of content confirmed through an expert panel. Percentages of goal achievement on each station varied between 74,7% and 96,6. The new stations were positively evaluated by residents, which valued that competencies other than "medical expert" were being assessed. Conclusion: ER-OSCE allows the appropriate assessment of generic competencies such as communication and collaboration in radiology.

Performance of an objective structured clinical examination in a national certification process of trainees in rheumatology.

OBJECTIVE: To assess reliability and validity of the objectively-structured clinical examination (OSCE) applied in postgraduate certification processes by the Mexican Board of Rheumatology. METHOD: Thirty-two (2013) and 38 (2014) Rheumatology trainees (RTs) underwent an OSCE consisting of 12 and 15 stations respectively, scored according to a validated check-list, as well as 300-multiple-choice 300 question examination (MCQ). Previously, 3 certified rheumatologists underwent a pilot-OSCE. A composite OSCE score was obtained for each participant and its performance examined. RESULTS: In 2013, OSCE mean score was 7.1±0.6 with none RT receiving a failing score while the MCQ score was 6.5±0.6 and 7 (21.9%) RTs receiving a failing (< 6) score. In 2014, the OSCE score was 6.7±0.6, with 3 (7.9%) RTs receiving a failing score (2 of them also failed MCQ) while the MCQ score was 6.4±0.5 and 7 (18.5%) RTs were disqualified (2 of them also failed OSCE). A significant correlation between the MCQ and the OSCE scores was observed in the 2013 (r=0.44; P=0.006). Certified rheumatologists performed better than RTs at both OSCE. Overall, 86% of RTs obtaining an OSCE passing score also obtained a MCQ passing score, while this was only 67% (P=.02) among those who obtained an OSCE failing score. Nine stations were applied at both consecutive years. Their performance was similar in both certification processes, with correlation coefficients ranging from 0.81 to 0.95 (P≤0.01). CONCLUSION: The OSCE is a valid and reliable tool to assess the Rheumatology clinical skills in RTs.

Examen Clínico Objetivo Estructurado como instrumento para evaluar la competencia clínica en Pediatría. Estudio piloto / Objective Structured Clinical Examination as an instrument for evaluation of clinical competence in pediatrics. A pilot study

Introducción. La evaluación es un componente esencial del proceso enseñanza-aprendizaje que motiva y dirige al alumno hacia sus objetivos y permite a los docentes conocer si los educandos poseen la destreza y el grado de conocimientos necesarios para una práctica profesional competente. En medicina no existe el método ideal de evaluación, por eso se recomienda el uso de diversos instrumentos como el Examen Clínico Objetivo Estructurado (ECOE) que ha mostrado su utilidad para evaluar las destrezas clínicas. El objetivo de este trabajo fue describir la experiencia de docentes y alumnos en la elaboración y la aplicación de un ECOE en un hospital pediátrico. Métodos. Se preparó un ECOE de 20 estaciones que se aplicó en un estudio piloto a 20 alumnos (2 residentes de primer año, 7 de segundo y 11 de tercero). Para cada estación se definieron los criterios de evaluación y el punto de corte. Con los datos obtenidos se calcularon los promedios por estación y por año de residencia. Resultados. El ECOE se llevó a cabo durante 2 horas con 20 minutos. Las estaciones aprobadas por los alumnos, de manera global, fueron doce. El valor promedio de las 20 estaciones fue 6.53, con una desviación estándar (DE) de 0.62 [R1 = 6.13 (DE 0.43), R2 = 6.26 (DE 0.60) y R3 = 6.76 (DE 0.59)]. Conclusiones. El ECOE es un método válido y confiable que permite evaluar la competencia clínica de manera integral. La experiencia de su uso en programas de posgrado ha sido limitada; sin embargo, el presente estudio muestra que es una herramienta factible que puede resultar de gran valor tanto para los pediatras en formación como para sus profesores.

Background. Assessment is an essential component of the teaching-learning process that stimulates and leads learners towards their goals and allows teachers to ascertain whether the students have acquired the necessary knowledge and clinical skills to be professionally competent. In medicine, the ideal assessment method does not exist; therefore, the use of several assessment instruments is advised; among them, the Objective Structured Clinical Examination (OSCE) has proven its advantage assessing clinical skills. The aim of this work is to describe the experience of teachers and learners developing and applying an OSCE in a children's hospital. Methods. Twenty OSCE stations were designed and applied in a pilot study. The assessment criteria for each station were defined. Individual marks were recorded and means for each station and year of residency were calculated (two first-year residents, seven second-year residents and 11 third-year residents). Results. The OSCE lasted 2 h and 20 min. Overall, 12 stations were accredited. The overall mean was 6.53, standard deviation (SD) 0.62; the mean for first-year residents was 6.13 (SD 0.43), for second-year residents 6.26 (SD 0.60) and 6.76 for third-year residents (SD 0.59). Conclusions. The OSCE isa valid and reliable method that permits an integral evaluation of clinical competence. The experience with this instrument has been limited to assessing postgraduate students. This study, however, shows that it is a useful tool that may be valuable for resident pediatricians and their professors.