Cómo afectan los incidentes críticos a los residentes de Medicina Familiar y Comunitaria / How critical incidents affect Family and Community Medicine residents

Objetivo: conocer y analizazr las repercusiones que tienen los incidentes críticos (IC) identificados y recogidos por los residentes Medicina Familiar y Comunitaria (MFyC) en su portafolio formativo de formación reglada. Métodos: estudio cuanti-cualitativo, retrospectivo, descriptivo y analítico, multicéntrico, de los informes de IC de los residentes. Emplazamiento: Atención Primaria. Centros de salud docentes de la Unidad Docente AFyC 695 de Murcia. Se incluyen 62 del total de 76 residentes en formación en 2015, y sus portafolios formativos. Los casos son los informes de IC en los que constan respuestas manuscritas de respuesta abierta. Se obtiene consentimiento informado de los residentes. Las respuestas se codifican, agrupan y tabulan, analizándose las consecuencias. Los resultados se presentan en cifras absolutas y porcentajes. Resultados: se incluyen 150 de los 165 informes de IC obtenidos (90,91%), en los que constan respuestas cualitativas y manuscritas a la pregunta: ¿Qué consecuencias ha tenido para ti el incidente crítico? Se obtienen 311 respuestas con una media de 5,01 (+/- 2,71) respuestas por residente. Se clasifican en 42 grupos diferentes. La mayoría de los IC analizados tienen repercusiones para los residentes. Son negativas 36,33%. Ambivalentes, aquellas que potencialmente pueden ser positivas o negativas, 40,19%. Y positivas 23,47%. Conclusiones: Los IC analizados tienen importantes repercusiones para casi todos los residentes, que pueden ser negativas, ambivalentes o positivas. Se identifican 42 grupos de consecuencias. Los residentes muestran una alta motivación respecto a estas repercusiones. La identificación precoz de los IC del residente, la caracterización y la reflexión sobre las repercusiones tienen un gran interés como oportunidades para mejorar su formación.(AU)

Objectives: To ascertain and analyze the consequences of the critical incidents (CI) that have been identified and collected by Family and Community Medicine (FCM) residents in their training portfolio, as part of this programmed teaching task. Materials and methods: This is a descriptive, quantitative-qualitative, retrospective, analytical and multicentre study on the CIs reported by the residents. Setting: Primary Care. Specialized health training. Health Centres belonging to a Teaching Unit in Murcia. From a total of 76 FCM residents who were training in the Teaching Unit in 2015, a total of 62 residents and their training portfolios were included. Cases are the CI reports that contain qualitative and handwritten answers in the open response sections. Residents were asked for informed consent to access their CIs and data for this research. The most outstanding characteristics presented by the CIs were analyzed by collecting the open answers from the CI reports, which were then discreetly coded. These characteristics were collected and tabulated and data were presented in absolute and percentages figures. Responses were collected, grouped, encoded, tabulated and the consequences of the CIs were analyzed. Results are shown in absolute figures and percentages. Results: a total of 150 out of 165 CI reports (90.91%) were included in this study, which encompass those containing qualitative and handwritten answers to the question “What consequences did the critical incident have for you? A total of 311 responses were obtained, which can be classified into 42 different groups, with an average of 5.01 (+/- 2.71) responses per resident. Most analyzed CIs had important consequences and repercussions for residents.(AU)

Prevalencia del síndrome de burnout en profesionales de medicina y enfermería de Atención Primaria en centros de salud acreditados para Formación Sanitaria Especializada de dos áreas de salud de Alicante / Prevalence of burnout syndrome in Primary Care medicine and nursing professionals in accredited health centres for specialized training in two Alicante health areas

Objetivo: estimar la prevalencia del síndrome de burnout en profesionales de medicina y enfermería de los centros de salud acreditados para formación sanitaria especializada de las Áreas de Salud de Elda y Alicante-San Juan. Diseño: estudio descriptivo observacional transversal. Emplazamiento: estudio multicéntrico realizado en equipos de Atención Primaria de dos áreas de salud de la Comunidad Valenciana. Participantes: profesionales de enfermería y medicina de Atención Primaria de las Áreas de Salud participantes.Mediciones principales: prevalencia de burnout a través del cuestionario validado Maslach Burnout Inventory y variables sociodemográficas y laborales. Análisis descriptivo de las variables cualitativas mediante cálculo de frecuencias y comparación de proporciones (test chi-cuadrado) para el análisis de la asociación entre las mismas. Resultados: se analizaron 125 cuestionarios (porcentaje de respuesta 54%). La prevalencia de burnout fue alta en la población estudiada: el 56,8% mostró agotamiento emocional (siendo la dimensión más afectada); 39,2%, alto grado de despersonalización, y 36%, realización personal baja. La afectación de dos subescalas (burnout moderado-grave) fue mayor en los profesionales de medicina de forma estadísticamente significativa (p = 0,002). No se objetivó asociación estadísticamente significativa entre el burnout y las variables sociodemográficas y laborales. Conclusiones: la prevalencia de burnout es elevada en los profesionales de medicina y enfermería de Atención Primaria.(AU)

Objective: to estimate the prevalence of burnout syndrome in physicians and nurses of accredited health centres for Specialized Health Training in Elda and Alicante-San Juan Health Areas. Design: Descriptive observational cross-sectional study. Location: a multicentre study performed by Primary Care professionals of two Health Departments in the Valencian Community. Participants: primary care healthcare professionals (physicians and nurses) from the Health Departments taking part. Main measurements: prevalence of burnout using the validated Maslach Burnout Inventory questionnaire and socio-demographic and work-related variables. A descriptive analysis of the qualitative variables was performed by calculating frequencies and comparison of proportions (Chi-square test) to analyze the association between them. Results: a total of 125 questionnaires were analyzed (response rate 54%). The prevalence of burnout was high: 56.8%, 39.2% and 36.0% revealed a high degree of emotional exhaustion (the most affected dimension), depersonalization and low personal fulfilment, respectively. The involvement of two subscales (moderate-severe burnout) was statistically significantly higher in medical professionals (P=0.002). No statistically significant association was observed between burnout and sociodemographic and work-related variables. Conclusions: the prevalence of burnout is high in primary care medical and nursing professionals.(AU)

Developing and implementing a co-curricular IPE program: AHEC Scholars Program.

As part of a new directive, the Human Resources Services Administration (HRSA) mandated Area Health Education Center (AHEC) Programs across the nation to implement an interprofessional education (IPE) program for health professional students, with the goal of fostering collaborative practice among health profession students and motivating students to work in medically underserved areas post-graduation. The South Texas AHEC Program collaboratively developed and implemented a co-curricular IPE initiative, the AHEC Scholars Program, including didactic and practicum components, focused on the needs of communities in our area. A pre-post quasi-experimental design was used to evaluate the student outcomes related to IPEC Competencies and knowledge and preparation for the practice of core topic areas mandated by HRSA. Student outcomes showed statistically significant improvement in all measures. In order to obtain more detailed accounts of students' practicum experiences, students were asked to complete reflective journals after each practicum. The AHEC Scholars Program provides students with opportunities to work with underserved populations and enables students to explore the benefits of team-based care. This article summarizes the collaborative process of the development and implementation of the AHEC Scholars Program; secondly, it details student outcomes from a 3-month pilot study.

Academies in Health Professions Education: A Scoping Review.

PURPOSE: Thirty years ago, academies were conceived as a sociocultural approach to revitalize the teaching mission of medical schools and to promote educators' career advancement. The academy movement has grown rapidly and now reaches a broad range of health professions education organizations. The authors conducted a scoping review to map the literature and describe the evidence that guides the formation of new academies and justifies the continuation of existing ones. METHOD: The authors searched MEDLINE (via Ovid), Embase (via Elsevier and Ovid), CINAHL (via EBSCOhost), and Web of Science (via Clarivate Analytics) from inception through March 6, 2020, for publications regarding academy-like organizations. They mapped the relevant literature using logic modeling as an organizing framework and included the mission, resources, activities, output, outcomes, and impact of the included academies. RESULTS: Of the 513 publications identified, 43 met the inclusion criteria, the oldest of which was published in 2000. Most publications were either case reports or perspective/opinion pieces (26, 57.8%), while studies presenting empirical findings were less common (11, 24.4%). Publications showed that academies were diversifying and increasingly were part of a broad range of organizations, including departments, hospitals, health science campuses, and national organizations. The mission, resources, and activities were similar across academies. Evaluation studies were largely limited to process measures, and rigorous studies examining outcomes (i.e., changes in academy participants) and impact on the organization at large were rare. CONCLUSIONS: The increase in the number of academy-related publications parallels the accelerating speed of the academy movement. To sustain this movement, rigorous studies must provide evidence that academies contribute to the revitalization of organizations' teaching mission and bring about an academic culture where educators thrive and where education is a legitimate career path.

Preparing a Health Literate Workforce: The Role of Area Health Education Centers.

Area Health Education Centers (AHEC) play a vital role in creating health literate organizations. In this report, we highlight the work of three AHECs. The Massachusetts AHEC trains oral language healthcare interpreters who can effectively convey complex medical information to patients with limited English proficiency (LEP). The University of Kentucky AHEC trains providers to use the Universal Precautions Health Literacy Toolkit. Finally, the Wisconsin AHEC prepares community health workers (CHWs) to play a vital role in making it easy for people to navigate the healthcare system. These three AHECs serve as models of health literacy's diffusion.

Homelessness: Understanding unmet needs and identifying resources.

BACKGROUND: Graduate occupational therapy students collaborated with an Area Health Education Center (AHEC) to address occupational therapy's role in intervening for individuals who are homeless. OBJECTIVE: The purpose was to provide educational resources on specific needs related to health and wellbeing to individuals who are homeless. METHODS: A variety of methods were used to gather information on common needs of the homeless population related to health and wellbeing, community integration, and development of routines. Initial data was collected through the use of a needs assessment for nine participants with thirteen questions followed with a weekly visit to a homeless shelter. The weekly visits allowed the students to build rapport and trust with the residents to gain an understanding of individual perspectives and barriers to occupation. RESULTS: The students worked with residents how to best access community based resources and services related to occupational needs. Specific needs were identified, and further resources were provided to support community integration, independent living, and self-management. CONCLUSIONS: Preliminary findings provided a basic understanding of the foundational needs of individuals to be used to support future research linking occupational therapy to the homeless population to achieve individual goals, improve health and wellbeing, and enhance life skills management.

Extracurricular activities: a comparative perspective among health colleges in Brazil and Ireland / Atividades extracurriculares: uma perspectiva comparativa entre faculdades de saúde no Brasil e na Irlanda

INTRODUCTION: University influences psychosocial and cognitive development of students, shaping their overview about professional career. Extracurricular activities (EAs) represent a complementary training in university context, which can enhance critical and technical skills. OBJECTIVE: Describe the profile of extracurricular activities developed in two different colleges: Universidade do Estado do Pará (UEPA), in northern Brazil, and Waterford Institute of Technology (WIT), in Southeast Ireland, in the period from March to May 2015. METHODS: This study is characterized as descriptive, cross-sectional, observational, with a sample of 452 academics from 5 courses: Medicine, Physiotherapy and Occupational Therapy in UEPA (n=306) and Health Promotion and Exercise and Health Studies at WIT (n=146). Data collection was conducted through self-administered questionnaires. RESULTS: Most of students have performed extracurricular activities (80%), with greater female participation (60%). Students also believe that EAs contribute to their training (87%), and have satisfied their initial motivations (97%). The most performed activities are academic leagues, internships and scientific research in UEPA and extension activities (volunteering) and athletic associations in WIT. CONCLUSION: This study demonstrated that the extracurricular activities most frequently performed by undergraduates from Universidade do Estado do Pará are professional internships, academic leagues and research. However, undergraduates' participation in volunteering and athletic associations predominates in Waterford Institute of Technology. Such divergences reflect social, cultural and economic issues of the respective societies, and may have an impact on professional profile.

INTRODUÇÃO: A universidade influencia o desenvolvimento psicossocial e cognitivo dos estudantes, moldando sua visão geral acerca da carreira profissional. As atividades extracurriculares (AEs) representam formação complementar no contexto universitário, aprimorando habilidades críticas e técnicas. OBJETIVO: Descrever o perfil das atividades extracurriculares desenvolvidas em duas diferentes universidades: Universidade do Estado do Pará (UEPA), no norte do Brasil, e o Waterford Institute of Technology (WIT), no sudeste da Irlanda, no período de Março a Maio de 2015. MÉTODO: O estudo caracteriza-se como descritivo, transversal e observacional, com casuística de 452 universitários de 5 cursos: Medicina, Fisioterapia, Terapia Ocupacional na UEPA (n=306), Promoção de Saúde e Estudos de Saúde, Exercício no WIT (n=146). Os dados foram coletados por meio de questionário autoaplicável. RESULTADOS: Os resultados mostraram que a maioria dos estudantes desenvolvia atividades extracurriculares (80%), com maior participação feminina (60%). Os estudantes acreditam que as AEs contribuem para sua formação (87%) e tiveram suas motivações iniciais satisfeitas (97%). Entre as atividades mais desenvolvidas estão ligas acadêmicas, estágios e pesquisa científica na UEPA e voluntariado e associações atléticas no WIT. CONCLUSÃO: Este estudo demonstrou que as atividades extracurriculares mais frequentemente desenvolvidas pelos graduandos da Universidade do Estado do Pará são estágios profissionais, ligas acadêmicas e pesquisa, enquanto entre os graduandos do Waterford Institute of Technology predominam a participação em voluntariado e associações atléticas. Tais divergências refletem questões de ordem social, cultural e econômicas das respectivas sociedades, podendo ter impacto no perfil de profissional formado.

Estudio Transversal: Prevalencia del Estrés Académico en Estudiantes de Medicina, Asociado al Rendimiento Académico, Universidad de Cuenca, Cuenca ­ Ecuador, 2015 / Cross-Section Research: Prevalence of Academic Stress in Medicine Students, Associated with Academic Performance, University of Cuenca, Cuenca - Ecuador, 2015

INTRODUCCIÓN: El estrés académico es la respuesta ante las demandas de la institución académica, se cree que el nivel de estrés influye de manera directa sobre el académico de forma positiva o negativo. El objetivo del estudio fue determinar la prevalencia de estrés académico y su asociación con el rendimiento escolar de los estudiantes de medicina. MÉTODO: Se realizó un estudio transversal, el universo estuvo conformado por 1 060 alumnos, desde primero hasta décimo ciclo en el año 2015, de los cuales se tomó una muestra de 285 alumnos, de forma aleatoria y se aplicó el inventario SISCO de Estrés Académico (modificado). El rendimiento académico se determinó por el promedio del último año cursado. Para el análisis de los datos se utilizó Microsoft Excel V15.0 y el servidor SPSS Statistics V 15.0. La asociación estadística se obtuvo con pruebas de Chi2 entre el nivel de estrés académico y el promedio. RESULTADOS: El 91.58 % de los estudiantes refirieron cierto grado de estrés académico; 46.7 % moderada intensidad y un 36.48 % percibieron un nivel de alta intensidad. La prevalencia de estrés académico en mujeres (95.45 %), fue mayor al sexo masculino (85 %). Se demostró que no existe una asociación significativa entre el estrés académico y el rendimiento académico. CONCLUSIONES: La prevalencia de estrés académico en los estudiantes es alta y no existe asociación con el rendimiento académico, afectando mayoritariamente al sexo femenino. Sería importante realizar un estudio sobre la forma en que los estudiantes afrontan el estrés académico.

BACKGROUND: Academic stress is the answer at the demands of the academic institution. It is believed that the level of stress affects directly in the academic performance in positive or negative ways. The objective of the study was to determine the prevalence of academic stress and the association on the academic performance of medical students. METHODS: It is a cross-sectional study. The universe was performed of 1 060 students, from the first to the tenth cycle in 2015, the sample was taken of 285 students; randomized and It was applied the SISCO Inventory of Academic (modified). The academic performance was determined by the average of the last year studied. Microsoft Excel V15.0 and SPSS Statistics V 15.0 server were used to analyze the data. The statistical association was obtained with Chi2 tests between the level of academic stress and the average. RESULTS: The 91.58 % of the students reported a certain degree of academic stress; 46.7 % moderate intensity and 36.48 % perceived a high intensity level. The prevalence of academic stress in women (95.45 %) was higher than the man (85 %). It was shown that academic stress is not significantly associated with academic performance. CONCLUSIONS: The prevalence of academic stress in students is high and It is not significantly associated with academic performance, affecting mainly the women. It would be important to conduct a study on how students deal with academic stress.

El Sistema de Evaluación y Acreditación de Especialidades de Postgrado en la Universidad de Ciencias Médicas de Matanzas / The Evaluation and Accreditation System of Post-grade Specialties in the University of Medical Sciences of Matanzas

La acreditación es el resultado de la aplicación de un sistema de autoevaluación y de evaluación externa, dirigido a reconocer públicamente que una institución o programa reúne determinados requisitos de calidad y se exponen algunas consideraciones sobre ello. Se revisaron los documentos básicos aprobados del Sistema de Evaluación y Acreditación de Especialidades de Postgrado de la República de Cuba, los que están constituidos por el Reglamento, el Patrón de Calidad y la Guía de Evaluación, considerando que durante muchos años las especialidades de postgrado han tenido como columna vertebral la actividad profesional en organismos como el Ministerio de Salud Pública. Se exponen algunos aspectos sobre cómo está preparándose la Universidad de Ciencias Médicas de Matanzas para realizar sus procesos de evaluación de la calidad y las diferentes especialidades que están en condiciones de realizar su autoevaluación y someterse al proceso de evaluación externa para logar ser acreditadas (AU).

The acreditation is the result of applying an auto-evaluation system and an external evaluation directed to publicly recognizing that an institution or program fulfills definite requirements of quality, and several considerations on that are exposed. The main documents of the Evaluation and Accreditation System of the Post-grade Specialties of the Republic of Cuba were reviewed. They include the Regulations, the Pattern of Quality and the Evaluation Guideline, considering that during many years the post-grade specialties have been the main pillar of the professional activities in organizations like the Ministry of Public Health. There are exposed several aspects on how the Medical University of Matanzas is being prepared to carry out the evaluation processes of the quality and of the different specialties that are in conditions of performing their own evaluation and undergoing the external evaluation to be accreditated (AU).

El Sistema de Evaluación y Acreditación de Especialidades de Postgrado en la Universidad de Ciencias Médicas de Matanzas / The Evaluation and Accreditation System of Post-grade Specialties in the University of Medical Sciences of Matanzas

La acreditación es el resultado de la aplicación de un sistema de autoevaluación y de evaluación externa, dirigido a reconocer públicamente que una institución o programa reúne determinados requisitos de calidad y se exponen algunas consideraciones sobre ello. Se revisaron los documentos básicos aprobados del Sistema de Evaluación y Acreditación de Especialidades de Postgrado de la República de Cuba, los que están constituidos por el Reglamento, el Patrón de Calidad y la Guía de Evaluación, considerando que durante muchos años las especialidades de postgrado han tenido como columna vertebral la actividad profesional en organismos como el Ministerio de Salud Pública. Se exponen algunos aspectos sobre cómo está preparándose la Universidad de Ciencias Médicas de Matanzas para realizar sus procesos de evaluación de la calidad y las diferentes especialidades que están en condiciones de realizar su autoevaluación y someterse al proceso de evaluación externa para logar ser acreditadas (AU).

The acreditation is the result of applying an auto-evaluation system and an external evaluation directed to publicly recognizing that an institution or program fulfills definite requirements of quality, and several considerations on that are exposed. The main documents of the Evaluation and Accreditation System of the Post-grade Specialties of the Republic of Cuba were reviewed. They include the Regulations, the Pattern of Quality and the Evaluation Guideline, considering that during many years the post-grade specialties have been the main pillar of the professional activities in organizations like the Ministry of Public Health. There are exposed several aspects on how the Medical University of Matanzas is being prepared to carry out the evaluation processes of the quality and of the different specialties that are in conditions of performing their own evaluation and undergoing the external evaluation to be accreditated (AU).

Invarianza factorial del Cuestionario para Evaluar Clima Social del Centro Escolar en estudiantes chilenos y colombianos / Factorial invariance of the Questionnaire for evaluating School Social Climate in Chilean and Colombian students

Resumen La investigación tuvo como objetivo estudiar el grado de equivalencia psicométrica del Cuestionario para Evaluar Clima Social del Centro Escolar (CECSCE) en adolescentes chilenos y colombianos. Los participantes fueron seleccionados a partir de un muestreo no probabilístico intencionado en 11 establecimientos públicos y particulares subvencionados de Chile y Colombia. Participaron 1233 adolescentes de ambos sexos, con una edad promedio de 14.82 (DT = 1.83). Los resultados obtenidos a partir de los análisis factoriales confirmatorios ratificaron la estructura de 2 factores correlacionados en la muestra chilena con el índice chi-cuadrado de Satorra Bentler(76) = 175.664, p < .001; índice de ajuste comparativo = .956; índice de Tucker-Lewis = .948; error cuadrático medio de aproximación = .044 (IC90% = .035-.052) y en la muestra colombiana con el índice chi-cuadrado de Satorra Bentler (76) = 131.508, p < .001; índice de ajuste comparativo = .942; índice de Tucker-Lewis = .931; error cuadrático medio de aproximación = .037 (IC90% = .026-.047). El análisis de invarianza factorial evidenció que el grado de equivalencia transcultural del instrumento se presenta plausible a nivel de invarianza de configuración (M1 = _ índice chi-cuadrado de Satorra Bentler = 35.583; ∆gl = 12; p < .001; _índice de ajuste comparativo = .007). La escala presentó adecuados índices de fiabilidad por consistencia interna y homogeneidad.

Abstract This study aims to determine the degree of psychometric equivalence of the questionnaire for evaluating School Social Climate in Chilean and Colombian adolescents. Using an intentional non-probability sampling, the adolescents were selected from 11 public schools and subsidised private schools in Chile and Colombia. The study involved 1,233 adolescents of both sexes, with a mean age of 14.82 years (SD = 1.83). The results from confirmatory factor analysis ratified the correlated two-factor structure in the Chilean sample Satorra Bentler's chi-square(76) = 175.664, P < .001; comparative fit index = .956; Tucker-Lewis index = .948; root mean square error of approximation = .044 (90% CI = .035-.052), and in the Colombian sample Satorra Bentler's chi-square(76) = 131.508, P < .001; comparative fit index = .942; Tucker-Lewis index = .931; root mean square error of approximation = .037 (90% CI = .026-.047). Invariance factorial analysis showed that the cross cultural level of the instrument is plausible at invariance configuration level (M1 = _Satorra Bentler's chi-square = 35.583;∆gl = 12; P < .001; _comparative fit index = .007). The resulting scale depicted adequate indices of reliability for internal consistency and homogeneity.

Using area health education centers to promote interest in rural practice.

INTRODUCTON: In the USA, area health education centers (AHECs) work to recruit and educate students to serve in medically underserved communities, primary care, and rural settings. One important aspect of their work is connecting students with rural clinical experiences. Within these experiences, AHECs incorporate a community health/socioeconomic experience within the family medicine clerkship that may not be as prevalent in the standard family medicine clerkship experiences. The purpose of the study was to assess the relationship between AHEC-sponsored family medicine clerkships with a self-reported intent to practice in a rural setting upon graduation. METHODS: The study compared third-year medical students with the Indiana University School of Medicine, which participated in AHEC-sponsored family medicine clerkships to the standard family medicine clerkship. Following the 4-week clerkship, students were asked to report their intent to work in a rural setting using a five-point Likert scale. A χ2 test was used to determine the association of AHEC sponsorship, clerkship site location (rural/urban) and intent to practice in a rural setting. RESULTS: The study consisted of 587 students. There was a statistically significant association between self-reported intent and rural clerkship site, χ2 (1, N=587)=6.542, p=0.01. Furthermore, 21.6% (n=25) of students with a rural clerkship experience reported a greater intent compared to 12.3% (n=58) of students with non-rural clerkship experience. CONCLUSIONS: The study confirmed a significantly positive association between participation in medical clerkship experiences in a rural primary care setting and the intent to practice in a rural setting upon graduation. The results also support the potential value-added benefits through academic-community partnerships with AHECs, family medical and other primary care specialty clerkship programs may perhaps succeed in increasing student interest in pursuing a practice serving in rural communities upon graduation.

Factores que facilitan u obstaculizan el aprendizaje basado en problemas en grupo pequeño, vistos por los estudiantes de la Facultad de Medicina de la Universidad de La Frontera, Temuco, Chile / Fatores que facilitam ou dificultam a aprendizagem baseada em problema no pequeno grupo, visto pelos alunos da Faculdade de Medicina da Universidad de la Frontera, Temuco, Chile / Factors that facilitate or make difficult the problembased learning in small groups, as seen by students at the Faculty of Medicine, University of La Frontera, Temuco, Chile

El objetivo del presente estudio fue develar factores que facilitan u obstaculizan el proceso tutorial del aprendizaje basado en problemas (ABP) en grupo pequeño, según los destacan los estudiantes de la Facultad de Medicina de la Universidad de La Frontera. Se desarrolló la investigación bajo el paradigma cualitativo mediante un estudio de caso. La muestra estuvo constituida por 15 estudiantes informantes claves de los dos últimos niveles curriculares. La información se obtuvo mediante seis entrevistas y un grupo focal. Se hizo triangulación por investigador, juicio de experto y comprobación con participantes en el estudio. Se identificaron 574 unidades de significado, de las cuales 542 se agruparon en 22 categorías. Se destacan entre ellas: Desarrollo del tutorial, Tutor experto en la metodología, Manejo del grupo, Características personales del estudiante y Responsabilidad del estudiante. Emergieron cuatro macro categorías: Competencias propias del tutor, Relaciones humanas y ambiente de aprendizaje, Características y participación de los estudiantes y Aspectos organizacionales. Los estudiantes consideraron relevantes en el proceso tutorial las características del tutor y su experiencia y responsabilidad; también le dieron importancia a las características personales, la experiencia en la metodología, el trabajo colaborativo, las relaciones interpersonales y el ambiente de aprendizaje. Asimismo, a los aspectos administrativos y de gestión que influyen en el desarrollo del ABP...

The objective of the study was to explore factors that facilitate or make difficult the tutorial process in problem-based learning (PBL) in small groups, atthe Faculty of Medicine, University of La Frontera. Research was done under the qualitative paradigm through a case study. The sample consisted of 15 key informant students of the last two curricular levels. Information was collected through six interviews and a focus group. Triangulation was conducted by researcher, expert judgment and verification with study participants. We identified 574 meaning units, out of which 542 were grouped in 22 categories, among them: Tutorial group development, Tutor as an expert in methodology, Group management, Personal characteristics of the student, and Student responsibility. Four macro-categories emerged, namely: Competences of the tutor, Human relationships and learning environment, Characteristics and participation of the students and Organizational aspects. Students considered that the characteristics of the tutor and his/her experience and responsibility are relevant in the tutorial process. They also emphasized on collaborative work, interpersonal relationships, learning environment, and the administrative aspects that may influence the development of PBL...

O objetivo do presente estudo foi detectar os fatores que facilitam ou dificultam o processo tutorial de aprendizagem baseada em problemas (ABP) em pequeño grupo, de acordó com o suporte aos alunos da Faculdade de Medicina da Universidad de la Frontera. A pesquisa é desenvolvimento no âmbito do paradigma qualitativo por meio de um estudo de caso. A amostra constituiu-se de 15 alunos informanteschave no último dois níveis curriculares. As informaçõesb foram obtidas através de seis entrevistas e um focus group. Triangulação foi feita pelo pesquisador, o julgamento dos peritos e os testes com os participantes do estudo. Foram identificados 574 unidades de significado, das quais 542 foram agrupados em 22 categorias. Se destaca estre elas: Desenvolvimento do tutorial, especialista tutor da metodologia, a gestão do grupo, características pessoais do aluno e a responsabilidade do aluno. Quatro macrocategorias surgiram: competências próprias do tutor, relações humanas, e um ambiente de aprendizagem, características e a participação dos alunos e os aspectos organizacionais. Os Estudantes considerados relevantes no proceso tutor características e sua experiência eresponsabilidade; também deram importância para as características pessoais, a experiência da metodologia,trabalho colaborativo, o relacionamento interpessoal e o ambiente de aprendizagem. Além disso,aspectos administrativos e gerenciais que influenciam o desenvolvimento da ABP...

A educação interprofissional e o Pró PET-Saúde USP-Capital 2012/2014: a percepção de tutores, preceptores e estudantes / Interprofessional education and the Pró PET-Saúde USP-Capital 2012/2014: the tutors, preceptors and students perception

Nos últimos trinta anos, pesquisadores da área da saúde tem dado especial atenção ao tema da educação interprofissional (EIP), por esta estar relacionada com uma maior satisfação dos usuários e a oferta de uma assistência em saúde mais resolutiva e satisfatória. A necessidade de adotarmos a EIP como uma ferramenta para a formação de profissionais da saúde surge a partir do momento que percebemos que nosso sistema de saúde presta cuidados fragmentados e pouco resolutivos. Atualmente, estudos científicos comprovam que a prática colaborativa e um cuidado ofertado com qualidade é facilmente alcançável se os profissionais trabalharem em equipe com objetivos comuns, sendo imprenscindível o desenvolvimento de habilidades de comunicação interprofissional e prática colaborativa desde o início da graduação. Desta forma, este estudo tomou como objeto de investigação a educação interprofissional, no contexto da atenção primária a saúde e na perspectiva da integração do ensino com os serviços públicos de saúde, por meio do programa Pró PET-Saúde USP-Capital 2012/2014. A escolha do programa para o presente estudo foi devido a natureza interprofissional do projeto, visto que engloba estudantes, preceptores e tutores de diversos cursos da área da saúde e por este ter constituído um espaço privilegiado de aprendizado e aperfeiçoamento na formação

em saúde, dando origem a outras iniciativas interprofissionais na Universidade de São Paulo (USP). A coleta de dados ocorreu de duas formas, sendo a primeira por meio de questionários individuais destinado aos profissionais de saúde (preceptores) e estudantes, com trechos da obra de Lewis Carroll "As Aventuras de Alice no País das Maravilhas", e por meio de um roteiro de entrevista destinado aos docentes (tutores) participantes do programa. Os dados obtidos foram analisados através da análise temática proposta por Minayo. Os resultados mostram que assim como a personagem Alice do livro de Carroll, muitas vezes ficamos confusos sobre quais opções escolher para aperfeiçoar a nossa formação em saúde. Se não soubermos onde queremos chegar, qualquer caminho se torna o certo, porém as evidências comprovam que a escolha por oportunidades de educação interprofissional na graduação e na pós graduação em saúde podem minimizar estereótipos e preconceitos formados pelos estudantes em relação as outras categorias profissionais e desenvolver habilidades de comunicação interprofissional e resolução de conflitos que contribuirá para uma prática colaborativa e a melhor assistência em saúde. Como produto do mestrado profissional foi elaborado um plano de aula destinado aos estudantes da USP com a finalidade de problematizar e permitir uma breve experiência da educação interprofissional.

For the last thirty years, healthcare researchers were giving special attention to the interprofessional education subject (IPE), for it being related to a more positive feedback from the user and a more accurate and satisfactory health care assistance. The need to adopt the IPE as a tool for the formation of professionals on the health area comes from moment where we realize that our health system is delivering a fragmented and less accurate health care. Nowadays, scientific studies show that collaborative practice and the quality of the offered care is more likely if professionals work in a team with common aim, being necessary to develop interprofessional communication skills and collaborative practice since the beginning of the course. Thus, this study took as investigation object the interprofessional education, in the context of the primary health care and the perspective of the integration between education and the public health services, through the program Pró PET-Saúde USP-Capital 2012/2014. The choice of the program for this study was due the interprofessional nature of the project, since it includes students, preceptors and tutors from many healthcare courses and for it being structured in a privileged space for learning and improvement in health training, promoting development to other interprofessional initiatives at Universidade de São Paulo (USP). Data collection

occurred in two ways, the first one being through an individual questionnaire with quotes from the book of Lewis Carroll "Alice in Wonderland" designed for the students who attended to the program, another individual questionnaire intended for health professionals (preceptors) and an interview script destined the professors (tutors) who participated on the program. The data collected were analyzed by the researcher using the thematic analysis proposed by Minayo. Results show that likewise the character Alice from "Alice in wonderland", often we get confused about which options should we chose in order to improve our health training. If we don't know where we want to get to, any path would suffice, however, evidences show that a choice for an opportunity in interprofessional education while in health training could minimize the stereotypes and prejudices formed by students in relation to other professional categories and develop interprofessional communication abilities and conflict management, which will contribute to a collaborative practice and a better health care. As result of the professional master's degree, it was developed a class plan for the students at USP in order to problematize and allow a brief interprofessional education experience.

Propuesta de sistema de trabajo metodológico para la formación técnico profesional en Enfermería / Proposal of methodological work for technical and professional Nursing formation

Introducción: el trabajo metodológico para la formación de técnicos de enfermería en la Facultad de Ciencias Médicas de Mayabeque se ha estado desarrollando a partir de las estructuras propias de la educación superior, por lo que no están instituidos pertinentemente los niveles organizativos funcionales reglamentados para ese trabajo en ese tipo de enseñanza, ni el sistema de tareas básicas para los colectivos metodológicos, por lo que se requiere de las adecuaciones convenientes.Objetivos: elaborar las adecuaciones necesarias de los niveles organizativos funcionales reglamentados para el trabajo metodológico en la educación técnica y profesional y diseñar un sistema de tareas básicas para los colectivos metodológicos a nivel de sede central y sede universitaria municipal.Método: se conformó una propuesta teórica de Sistema de trabajo metodológico para cuya elaboración fueron analizados los principales documentos normativos del Ministerio de Educación y del Área de Docencia e Investigación del Ministerio de Salud Pública. Se constituyó un grupo de expertos seleccionados a partir de la determinación de los coeficientes de competencia y argumentación por autovaloración. Los expertos tuvieron una fase inicial de preparación individual, seguida de una sesión de trabajo colectivo. Una vez conformada la propuesta teórica se hizo una ronda de consulta individual para el ajuste final del modelo y se obtuvo respuesta satisfactoria de la totalidad de los expertos participantes en el estudio.Resultados: propuesta de sistema de trabajo metodológico para la formación técnico profesional en Enfermería.Conclusiones: esta propuesta garantiza el enfoque en sistema y el uso racional de recursos humanos y de reuniones (AU)

Introduction: the methodological work for the formation of technicians in Nursing at Mayabeque Faculty of Medical Sciences have been developing following the structures of High Education, because neither the ruled functional organization levels were properly instituted in this kind of teaching , nor the system of basic tasks for the methodological collectives, so, the appropriate modifications are needed.Objectives: to elaborate the appropriate modifications of the ruled functional organization levels for the methodological work in technical and professional education and to design a system of basic tasks for the methodological collectives at municipal and Central centers levels. Method: a theoretical proposal System of Methodological work was conformed and for its elaboration the main normative documents of the Ministry of Education and the documents of the teaching and investigation area belonging to the Ministry of Public Health were analyzed. A group of experts was constituted selecting them, taking into account their competence and argumentation by self-assessing. The experts had an initial phase of individual preparation followed by a collective work session. Once the theoretical proposal was conformed, a round of individual discussion was developed for the final version of the model and an agreeable answer of the total of the experts who participated in the study was obtained.Results: proposal of Methodological work for technical and professional nursing formation. Conclusions: this proposal warrants a system approach and the rational use of the Human Resources and of meetings (AU)

Does an AHEC-Sponsored Clerkship Experience Strengthen Medical Students' Intent to Provide Care for Medically Underserved Patients?

The mission of Area Health Education Centers (AHECs) is to recruit and educate students to serve as practicing health care professionals in rural, primary care, and medically underserved communities. We sought to determine if participation in an AHEC-sponsored family medicine clerkship experiences during medical school are significantly associated with a self-reported intent to practice primary care in a medically underserved environment upon graduation. The study was a prospective cohort study comparing third-year family medicine students with the Indiana University School of Medicine who participated in either an AHEC-sponsored family medicine clerkship to those who completed their required family medicine clerkship outside of the AHEC setting. Following the 160-h clinical clerkship, all students completed a mandatory, electronic survey and were asked to self-report their intent to the following question: "Which of the following statements best describes the impact of the family medicine clerkship on your intention to provide care to underserved patients when you complete residency training?" The question was integrated into a mandatory post-clerkship evaluation form required by the Indiana University School of Medicine, Department of Family Medicine. A Chi square test of independence as well as a multivariate logistic regression analysis was used to determine the independent association of AHEC clerkship participation and reported intent. A total of 1138 students completed the survey. There were not significant differences in age, gender, race, and ethnicity between students that completed an AHEC clerkship and those that did not. After adjusting for gender, race, and ethnicity, AHEC participants were significantly more likely to report an intention to practice primary care in a medically underserved setting upon graduation. Female students were found to be 1.2-3.4 times as likely to report increased intent compared to male students (95 % CI 1.241-3.394). Participation in an AHEC-supported clerkship was associated with a significant increase in self-reported intent to practice primary care in a medically underserved setting. Additional research is required to determine if participation and/or reported intent are predictive of practice selection after graduation.

La formación masiva de médicos como factor clave en la cobertura sanitaria universal en Cuba / Massive medical training as a key factor of universal health coverage in Cuba

La formación integral de recursos humanos en salud es requisito para lograr una cobertura universal.El objetivo de este trabajo es lograr un acercamiento histórico a la correspondencia que han tenido las políticas educacionales en la Revolución con la formación de médicos y las acciones relevantes desarrolladas en la educación médica, y cómo esta ha sido un factor clave para lograr la cobertura sanitaria universal, expresada en los indicadores sanitarios de la población cubana. Se utilizó el método histórico-lógico, se efectuaron entrevistas en profundidad, revisión bibliográfica, análisis documental; se estudiaron documentos normativos, curriculares y discursos. Se identificaron los momentos que marcaron políticas educacionales para la formación de médicos: Reforma Universitaria, Resolución de Política Educacional del Primer Congreso del Partido Comunista de Cuba, Constitución de la República de Cuba y distintas intervenciones de Fidel. Se analizaron momentos planteados en la Reforma Universitaria sobre la formación de médicos: las nacientes escuelas de medicina, los nuevos escenarios docentes, hechos relevantes en la formación de médicos, cifras de médicos titulados, requisitos de selección, tipo de médico a graduar con unaformación integral. Se analizaron indicadores sanitarios y la cobertura en salud. Se graduaron la cantidad necesaria de médicos con la formación integral para cumplimentar las políticas de salud,garantizar la cobertura sanitaria universal y cumplir misiones internacionalistas. Utilizar los recursos materiales y humanos del sistema de salud es una fortaleza de la educación médica cubana(AU)

The comprehensive formation of human resources for health is a requirement for universal coverage. The objective of this paper was to make a historical approach to the educational policies of the revolution related to the formation of physicians, the relevant actions taken in the medical education and how it has become a key factor to achieve universal health coverage as expressed in health indicators of the population. The historical-logical method, the in-depth interviews, the literature review and the documentary analysis were all used together with the study of regulatory and curricular documents and speeches. The periods in which educational policies for the formation of physicians had been encouraged were identified as follows: University Reform, Educational Policy Resolution of the First Congress of the Communist Party of Cuba, Constitution of the Republic of Cuba and various speeches delivered by Commander in Chief Fidel Castro Ruz. Some aspects of the University Reform about the medical training were also analyzed such as the new medical school, new teaching settings, relevant events in the medical formation, number of graduates as doctors, eligibility requirements, types of doctor to be graduated with the new comprehensive formation. Health indicators and health coverage were also examined. The required number of physicians with comprehensive training to implement the health policies, to ensure universal coverage and to accomplish internationalist missions has graduated from the medical schools. Utilizing the human and material resources of the health system is one of the strengths of the Cuban medical education(AU)