A propósito del artículo Integración de la dimensión ambiental en la formación académica / About the article Integration of the Environmental Dimension in Academic Training

La Revista Cubana de Salud Pública en su vol. 44(4) de 2018 publicó al artículo titulado Integración de la dimensión ambiental en la formación académica en hospitales del municipio de Holguín. Este trabajo tenía como objetivo proponer un sistema de indicadores para evaluar la eficacia de la integración de la dimensión ambiental en la formación de los recursos humanos en hospitales holguineros. Lo que permitió a sus autores concluir que este tipo de integración constituye una herramienta metodológica efectiva para mejorar el desempeño de la organización, asegurar...(AU)

Entrustable Professional Activities: Una propuesta innovadora para la evaluación de competencias médicas / Entrustable professional activities: a new proposal for the evaluation of the medical competencies

Medical education migrated from a practice-based to a knowledge-based discipline after the publication of the Flexner Report. The emergence of competence-based medical education led to a greater standardization of teaching, allowing students to integrate knowledge, skills and attitudes for the execution of a given task. A challenge is the evaluation of learning. Complex evaluation systems and a consequent atomization that independently assesses different competence components. However, the evaluation carried out at the clinical practice sites allows assessing the overall level of learning. Supervisors observe students' performance and decide if the apprentice can execute a specific task independently. This decision is based upon the trust that the tutor places on the student. Consequently, Ten Cate (2005) proposed the term Entrustable Professional Activities (EPAs), as a framework for professional practice tasks or responsibilities that can be fully entrusted to students, when they demonstrate the competences that are necessary to execute such activity with an increasing level of autonomy.

[Entrustable professional activities: a new proposal for the evaluation of the medical competencies]. / Entrustable Professional Activities: Una propuesta innovadora para la evaluación de competencias médicas.

Medical education migrated from a practice-based to a knowledge-based discipline after the publication of the Flexner Report. The emergence of competence-based medical education led to a greater standardization of teaching, allowing students to integrate knowledge, skills and attitudes for the execution of a given task. A challenge is the evaluation of learning. Complex evaluation systems and a consequent atomization that independently assesses different competence components. However, the evaluation carried out at the clinical practice sites allows assessing the overall level of learning. Supervisors observe students' performance and decide if the apprentice can execute a specific task independently. This decision is based upon the trust that the tutor places on the student. Consequently, Ten Cate (2005) proposed the term Entrustable Professional Activities (EPAs), as a framework for professional practice tasks or responsibilities that can be fully entrusted to students, when they demonstrate the competences that are necessary to execute such activity with an increasing level of autonomy.

Desarrollo de una matriz conceptual para la innovación curricular en profesiones de la salud / Concept frame for curricular innovation in health care schools

We herein describe the conceptual dimension of the curricular innovation process carried out in the Faculty of Medicine of the University of Chile. We describe the context of innovation. The theoretical pertinence and relevance of a competence driven curriculum for health care professionals is discussed. The epistemological, ontological and didactic dimensions of the curricular innovation are examined. A main issue is the notion of competence and its significance in professional training. The curriculum is essentially considered as a moral endeavor, especially for health care professionals and their quest to improve the quality of life of the population.

[Concept frame for curricular innovation in health care schools]. / Desarrollo de una matriz conceptual para la innovación curricular en profesiones de la salud.

We herein describe the conceptual dimension of the curricular innovation process carried out in the Faculty of Medicine of the University of Chile. We describe the context of innovation. The theoretical pertinence and relevance of a competence driven curriculum for health care professionals is discussed. The epistemological, ontological and didactic dimensions of the curricular innovation are examined. A main issue is the notion of competence and its significance in professional training. The curriculum is essentially considered as a moral endeavor, especially for health care professionals and their quest to improve the quality of life of the population.

Construction of a competence-based curriculum for internship in obstetrics and gynecology within the medical course at the Federal University of Ceará (Sobral campus).

CONTEXT AND OBJECTIVE: This research project arose from a proposal made to the teachers by the students of a medical course at a federal university in Brazil, from their personal experiences regarding the skills and competencies that should be developed during the obstetrics and gynecology (OBG) stage of the internship. The objective here was to develop the matrix of skills necessary for training good general physicians in the medical course. DESIGN AND SETTING: Exploratory qualitative study conducted in a federal university in Brazil. METHODS: The basis for developing these competencies among OBG interns was "The Competency Matrix for Medical Internship" developed by Bollela and Machado. The instrument was presented to, analyzed by and modified by a set of OBG specialists, at two sessions. RESULTS: The specific competencies expected from students over the internship in OBG were framed within overall topics that had previously been determined and listed: healthcare, decision-making, communication and interpersonal relationships, management and organization of the Brazilian National Health System (Sistema Único de Saúde, SUS) and professionalism. CONCLUSIONS: A competency matrix that standardizes the minimum requirements that interns should be capable of putting into practice after concluding the OBG stage is a valuable tool for ensuring student performance and a fair and rigorous assessment for them, thereby seeking to train good general physicians who meet the community's needs.

Assessing Technical Competence in Surgical Trainees: A Systematic Review.

OBJECTIVE: To systematically examine the literature describing the methods by which technical competence is assessed in surgical trainees. BACKGROUND: The last decade has witnessed an evolution away from time-based surgical education. In response, governing bodies worldwide have implemented competency-based education paradigms. The definition of competence, however, remains elusive, and the impact of these education initiatives in terms of assessment methods remains unclear. METHODS: A systematic review examining the methods by which technical competence is assessed was conducted by searching MEDLINE, EMBASE, PsychINFO, and the Cochrane database of systematic reviews. Abstracts of retrieved studies were reviewed and those meeting inclusion criteria were selected for full review. Data were retrieved in a systematic manner, the validity and reliability of the assessment methods was evaluated, and quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation classification. RESULTS: Of the 6814 studies identified, 85 studies involving 2369 surgical residents were included in this review. The methods used to assess technical competence were categorized into 5 groups; Likert scales (37), benchmarks (31), binary outcomes (11), novel tools (4), and surrogate outcomes (2). Their validity and reliability were mostly previously established. The overall Grading of Recommendations Assessment, Development and Evaluation for randomized controlled trials was high and low for the observational studies. CONCLUSIONS: The definition of technical competence continues to be debated within the medical literature. The methods used to evaluate technical competence predominantly include instruments that were originally created to assess technical skill. Very few studies identify standard setting approaches that differentiate competent versus noncompetent performers; subsequently, this has been identified as an area with great research potential.

Formación y desarrollo de competencias en la educación superior cubana / Competence-based training and development in the cuban higher education

La formación basada en competencias es una orientación educativa que pretende dar respuestas a las necesidades de la sociedad contemporánea; el término competencia, a pesar de su amplia utilización y reconocimiento desde las Ciencias Pedagógicas, ha tenido diversas significaciones y es objeto de múltiples interpretaciones a partir de las disímiles posturas epistemológicas de los investigadores. En el artículo fueron valoradas algunas de las propuestas realizadas en el último decenio por varios autores sobre la formación de competencias, lo cual permitió asumir posiciones acerca de esta problemática de acuerdo con los retos y problemas del contexto social, comunitario, profesional y organizacional de la universidad cubana(AU)

The competency-based learning and development is an educational orientation that seeks to respond to the needs of the contemporary society, the term "competence", despite its widespread use and recognition from the Pedagogical Sciences with different meanings and subject to multiple interpretations given the dissimilar epistemological positions of researchers. The article examined some of the proposals made in the last decade by several authors on competence formation that helped to assume scientific positions about this problem according to the challenges and problems of the social, community, professional and organizational of Cuban universities(AU)

Competence-based curricula for the education of speech-language pathologists and audiologists in Brazil.

OBJECTIVE: The aim of this paper is to present the academic requirements for the education of speech-language pathologists (SLPs) and to discuss some of the challenges in providing quality supervised practice and the solutions proposed by some programs in Brazil. METHODS: Brazilian proposals regarding the training of SLPs are reviewed, with guidelines provided by the International Association of Logopedics and Phoniatrics (IALP) and the Comité Permanent de Liaison des Orthophonistes-Logopèdes de l'UE (CPLOL), and descriptions of the specific experience of the oldest Brazilian program are provided. RESULTS: The bachelor's degree is the minimum level required for the independent practice of speech-language pathology and audiology in Brazil, where there are 75 undergraduate programs. In several programs, students are encouraged to enjoy the diversity at their university, enrolling in courses of different areas to broaden their experience. The basic areas of the undergraduate program are mandatory as per recommendation of the Ministry of Education and include competences related to the health system, decision making, communication, leadership and continued education. Since practice training is part of the undergraduate programs, it is incorporated into the pedagogical concept and has a major role in it. CONCLUSION: The structure of the programs allows the dissociation of theory from practice to be attenuated; both educational strategies are used together as part of the pedagogical concept.

[Relationship between self-directed learning and value profile in Chilean medical students]. / Aprendizaje autodirigido y su relación con el perfil valórico en estudiantes de medicina.

BACKGROUND: Medical education should prepare students to face a dynamic environment, through competencies that allow them to learn independently. AIM: To evaluate the relationship between self-directed learning and value profile of undergraduate first year students in a medical school in Chile. MATERIAL AND METHODS: Self-Directed Learning Scale and Schwartz's Values Questionnaire were applied to 235 medical students from the University of Concepción, Chile. RESULTS: Self-direction and Security are value types that correlate directly and significantly with the overall scale and with the five subscales of Self-Directed Learning. CONCLUSIONS: In first year medical students ofUniversity of Concepcion, Chile, Self-direction and Security are values that facilitate Self-directed Learning.

Aprendizaje autodirigido y su relación con el perfil valórico en estudiantes de medicina / Relationship between self-directed learning and value profile in Chilean medical students

Background: Medical education should prepare students to face a dynamic environment, through competencies that allow them to learn independently. Aim: To evaluate the relationship between self-directed learning and value profile of undergraduate first year students in a medical school in Chile. Material and Methods: Self-Directed Learning Scale and Schwartz's Values Questionnaire were applied to 235 medical students from the University of Concepción, Chile. Results: Self-direction and Security are value types that correlate directly and significantly with the overall scale and with the five subscales of Self-Directed Learning. Conclusions: In first year medical students ofUniversity of Concepcion, Chile, Self-direction and Security are values that facilitate Self-directed Learning.

Breaking barriers: a competency-based framework for promoting the integration of the pediatrician's education.

OBJECTIVE: To describe the process of integration and revision of a pediatric program curriculum which resulted in the creation of a competency-based framework recommended in the Brazilian National Curricular Guidelines. METHODS: Quali-quantitative analysis of an intervention evaluating the students and professors' perception of the pediatric program curriculum (focus groups and semi-structured interviews). Results were discussed during teaching development workshops. A competency-based framework was suggested for the pediatric program from the 3rd to the 6th year. The new curriculum was approved, implemented, and reevaluated six months later. RESULTS: Twelve students (12%) from the 3rd to the 6th year participated in the focus groups, and 11 professors (78.5%) answered the questionnaire. Most participants reported lack of integration among the courses, lack of knowledge about the learning goals of the internships, few opportunities of practice, and predominance of theoretical evaluation. In the training workshops, a competency-based curriculum was created after pediatrics and collective health professors reached an agreement. The new curriculum was focused on general competency, learning goals, opportunities available to learn these goals, and evaluation system. After six months, 93% (104/112) of students and 79% (11/14) of professors reported greater integration of the program and highlighted the inclusion of the clinical performance evaluation. CONCLUSION: The collective creation of a competency-based curriculum promoted higher satisfaction of students and professors. After being implemented, the new curriculum was considered to integrate the teaching practices and contents, improving the quality of the clinical performance evaluation.

Quebrando barreiras: integração do currículo de pediatria a partir da criação de uma matriz de competências / Breaking barriers: a competency-based framework for promoting the integration of the pediatrician's education

OBJETIVO: Descrever o processo de revisão e de integração curricular de um programa de pediatria por meio da criação de uma matriz de competências referenciada nas Diretrizes Curriculares Nacionais. MÉTODOS: Estudo quali-quantitativo de intervenção que avaliou a percepção de estudantes e docentes em relação ao currículo existente (grupos focais e entrevistas semiestruturadas). Discutiram-se os resultados em oficinas de desenvolvimento docente, o que propôs uma matriz baseada em competências para todo o programa de pediatria do 3º ao 6º ano. O novo currículo foi aprovado, implementado e reavaliado após 6 meses. RESULTADOS: Doze estudantes (12%) do 3º ao 6º ano participaram dos grupos focais, e 11 dos 14 professores (78,5%) responderam ao questionário. A maioria referiu falta de integração entre as disciplinas, desconhecimento dos objetivos de aprendizagem dos estágios, poucas oportunidades de práticas e avaliação predominantemente teórica. Nas oficinas de capacitação, foi criada uma matriz curricular integrada por competências após a pactuação entre professores da pediatria e da saúde coletiva. A matriz destacava a competência geral, os objetivos de aprendizagem, oportunidades disponíveis para aprendê-los e o sistema de avaliação. Após 6 meses, 93% (104/112) dos alunos e 79% (11/14) dos professores relataram que percebiam maior integração do programa e destacaram a incorporação da avaliação de desempenho clínico. CONCLUSÃO: A construção coletiva da matriz curricular por competências levou à maior satisfação de docentes e discentes com a nova proposta que, após a implementação, foi percebida como integradora de conteúdos e práticas de ensino da pediatria, tendo qualificado a avaliação de desempenho clínico.

OBJECTIVE: To describe the process of integration and revision of a pediatric program curriculum which resulted in the creation of a competency-based framework recommended in the Brazilian National Curricular Guidelines. METHODS: Quali-quantitative analysis of an intervention evaluating the students and professors' perception of the pediatric program curriculum (focus groups and semi-structured interviews). Results were discussed during teaching development workshops. A competency-based framework was suggested for the pediatric program from the 3rd to the 6th year. The new curriculum was approved, implemented, and reevaluated six months later. RESULTS: Twelve students (12%) from the 3rd to the 6th year participated in the focus groups, and 11 professors (78.5%) answered the questionnaire. Most participants reported lack of integration among the courses, lack of knowledge about the learning goals of the internships, few opportunities of practice, and predominance of theoretical evaluation. In the training workshops, a competency-based curriculum was created after pediatrics and collective health professors reached an agreement. The new curriculum was focused on general competency, learning goals, opportunities available to learn these goals, and evaluation system. After six months, 93% (104/112) of students and 79% (11/14) of professors reported greater integration of the program and highlighted the inclusion of the clinical performance evaluation. CONCLUSION: The collective creation of a competency-based curriculum promoted higher satisfaction of students and professors. After being implemented, the new curriculum was considered to integrate the teaching practices and contents, improving the quality of the clinical performance evaluation.

[Competence of senior medical students in diagnosing tuberculosis based on chest X-rays]. / Competência de estudantes de medicina seniores na interpretação de radiografias de tórax para o diagnóstico de tuberculose.

OBJECTIVE: To evaluate the competence of senior medical students in diagnosing tuberculosis (TB) based on their reading of chest X-rays, as well as to identify the factors associated with high scores for the overall interpretation of chest X-rays. METHODS: In October 2008, a convenience sample of senior medical students who had undergone formal training in radiology at the Federal University of Rio de Janeiro School of Medicine, in the city of Rio de Janeiro, Brazil, were invited to participate in the study. Six chest X-rays (three of TB patients and three of patients without TB) were selected. Participants were asked to choose one of the three probable radiological interpretations, and one of the four subsequent suitable clinical approaches. They also completed a questionnaire designed to collect data related to demographics, career of interest, time spent in emergency rooms and year of study. The sensitivity and specificity related to competence in the radiological diagnosis of TB, as well as a score for the overall interpretation of chest X-rays, were calculated. RESULTS: The sensitivity of the probable radiological diagnosis of pulmonary TB, based on the three chest X-rays of patients with TB (minimal, moderate and extensive) was 86.5%, 90.4% and 94.2%, respectively, and the specificity was 90%, 82% and 42%. The only factor associated with a high score for the overall radiological interpretation was the year of study. CONCLUSIONS: In this sample of medical students, who had received formal training in radiology early in their medical school course, the competence in interpreting the chest X-rays of TB patients was good. The year of study seems to influence overall chest X-ray reading skill.

Competence of senior medical students in diagnosing tuberculosis based on chest X-rays / Competência de estudantes de medicina seniores na interpretação de radiografias de tórax para o diagnóstico de tuberculose

OBJECTIVE: To evaluate the competence of senior medical students in diagnosing tuberculosis (TB) based on their reading of chest X-rays, as well as to identify the factors associated with high scores for the overall interpretation of chest X-rays. METHODS: In October 2008, a convenience sample of senior medical students who had undergone formal training in radiology at the Federal University of Rio de Janeiro School of Medicine, in the city of Rio de Janeiro, Brazil, were invited to participate in the study. Six chest X-rays (three of TB patients and three of patients without TB) were selected. Participants were asked to choose one of the three probable radiological interpretations, and one of the four subsequent suitable clinical approaches. They also completed a questionnaire designed to collect data related to demographics, career of interest, time spent in emergency rooms and year of study. The sensitivity and specificity related to competence in the radiological diagnosis of TB, as well as a score for the overall interpretation of chest X-rays, were calculated. RESULTS: The sensitivity of the probable radiological diagnosis of pulmonary TB, based on the three chest X-rays of patients with TB (minimal, moderate and extensive) was 86.5 percent, 90.4 percent and 94.2 percent, respectively, and the specificity was 90 percent, 82 percent and 42 percent. The only factor associated with a high score for the overall radiological interpretation was the year of study. CONCLUSIONS: In this sample of medical students, who had received formal training in radiology early in their medical school course, the competence in interpreting the chest X-rays of TB patients was good. The year of study seems to influence overall chest X-ray reading skill.

OBJETIVO: Avaliar a competência de estudantes de medicina seniores na interpretação de radiografias de tórax para o diagnóstico de tuberculose (TB) e determinar fatores associados com altos escores na interpretação de radiografias de tórax em geral. MÉTODOS: Em outubro de 2008, uma amostra de conveniência de estudantes de medicina seniores da Faculdade de Medicina da Universidade Federal do Rio de Janeiro (RJ), que receberam educação formal em radiologia, foi convidada a participar do estudo. Seis radiografias de tórax foram selecionadas, das quais três eram de pacientes com TB. Os participantes escolheram uma entre três possíveis interpretações radiológicas e uma entre quatro condutas clínicas a serem seguidas. Eles também responderam um questionário relativo a dados demográficos, carreira de interesse, tempo de treinamento na emergência e ano de estudo em medicina. A sensibilidade e especificidade para a competência no diagnóstico radiológico da TB, assim como um escore de acertos em radiografia do tórax em geral, foram calculados. RESULTADOS: A sensibilidade para o diagnóstico radiológico provável de TB pulmonar, baseado nas três radiografias de tórax de pacientes com TB (lesões menos extensas, moderadas e mais extensas) foi de 86,5 por cento, 90,4 por cento e 94,2 por cento, respectivamente, e a especificidade foi de 90 por cento, 82 por cento e 42 por cento. O único fator associado a um alto escore no diagnóstico radiológico geral foi o ano de estudo em medicina. CONCLUSÕES: A competência na interpretação de radiografias de tórax de pacientes com TB entre esta amostra de estudantes de medicina, que tiveram treinamento formal em radiologia no início do curso médico, foi boa. O ano de estudo médico parece contribuir com a habilidade geral de leitura de radiografias de tórax.

Periodización de la formación de posgrado del médico en etapa de especialización en medicina general integral: dimensiones, variables y claves hermenéuticas / Division into periods of the post degree training for the doctor in the specialization stage in General Comprehensive Medicine: volume, variables and hermeneutical keys

Los profesionales que ejercen la medicina general integral, han tenido a su cargo la enorme responsabilidad de transformar la atávica concepción de la medicina prevaleciente durante varios lustros en un nuevo esquema con enfoque integral del individuo, su familia y la comunidad. Para este trabajo se identificaron 3 hitos de periodización e igual número de etapas; pero también dimensiones, variables y claves hermenéuticas del proceso de formación de posgrado del médico en etapa de especialización en medicina general integral, con especial énfasis en el desarrollo de competencias investigativas(AU)

The professionals who practice the General Comprehensive Medicine, have been in charge of the enormous responsibility of transforming the atavistic idea of the prevalent medicine during several years into a new outline with a comprehensive approach to the individual, his family and the community. For this work 3 landmarks for a division into periods and the same number of stages were identified, as well as, dimensions, variables and hermeneutical keys of the post degree training process for the doctor in specialization stage in General Comprehensive Medicine, with special emphasis in the development of investigative power(AU)

Periodización de la formación de posgrado del médico en etapa de especialización en medicina general integral: dimensiones, variables y claves hermenéuticas / Division into periods of the post degree training for the doctor in the specialization stage in General Comprehensive Medicine: volume, variables and hermeneutical keys

Los profesionales que ejercen la medicina general integral, han tenido a su cargo la enorme responsabilidad de transformar la atávica concepción de la medicina prevaleciente durante varios lustros en un nuevo esquema con enfoque integral del individuo, su familia y la comunidad. Para este trabajo se identificaron 3 hitos de periodización e igual número de etapas; pero también dimensiones, variables y claves hermenéuticas del proceso de formación de posgrado del médico en etapa de especialización en medicina general integral, con especial énfasis en el desarrollo de competencias investigativas.

The professionals who practice the General Comprehensive Medicine, have been in charge of the enormous responsibility of transforming the atavistic idea of the prevalent medicine during several years into a new outline with a comprehensive approach to the individual, his family and the community. For this work 3 landmarks for a division into periods and the same number of stages were identified, as well as, dimensions, variables and hermeneutical keys of the post degree training process for the doctor in specialization stage in General Comprehensive Medicine, with special emphasis in the development of investigative power.

Percepções de competência: um estudo com crianças e adolescentes do ensino fundamental / Perceptions of competence: an study with children and adolescents from elementary school

Este estudo teve o objetivo de investigar como as crianças expressam suas percepções de competência nos diferentes domínios do comportamento humano. Foi utilizada a Escala de Percepção de Competência para Crianças com 96 crianças do ensino fundamental público. Os resultados sugerem que: a) crianças mais velhas apresentam níveis menores de percepção de competência; b) as percepções de competência de meninos e meninas nos diferentes domínios foram semelhantes; c) a percepção de competência escolar é mais baixa para as crianças mais velhas e repetentes; e, d) a menor competência escolar percebida, parece não afetar os níveis de competência nos demais domínios.

The objective of this study was to investigate how children perceived their competence in the different domains of human behavior. The Perceived Competence Scale was used with 96 children from elementary public school. The results suggested that: a) older children showed lower levels of perceived competence; b) boys and girls perceived competence in the different domains were similar; c) cognitive perceptions of competence were lower in older children as well as in children that repeated school year; e, d) the lower perceptions of cognitive competence appears have no effect in the perceptions of competence in the others domains.

El objetivo de este estudio fue investigar cómo niños expresan sus percepciones de competencia en los diferentes dominios del comportamiento humano. Se ha utilizado la Escala de Percepción de Competencia para Niños con 96 niños de la enseñanza fundamental pública. Los resultados sugieren que a) niños mayores presentan niveles de percepción de competencia más bajos; b) las percepciones de competencia de niños y niñas en los diferentes dominios han sido semejantes; c) la percepción de competencia escolar es inferior para los niños mayores y repitentes; y d) la menor competencia escolar percibida parece no afectar los niveles de competencia en los demás domínios.