[Selection of medical graduates for residency posts. A comparative study of the methodologies used in different countries]. / La selección de los graduados en Medicina para los puestos de residencia. Estudio comparativo de los métodos usados en diferentes países.

INTRODUCTION: The design of an appropriate method for the selection of medical graduates for residency posts is extremely important, not only for the efficiency of the method itself (accurate identification of most competent candidates), but also for its influence on the study and teaching methodologies operating in medical schools. Currently, there is a great variation in the criteria used in different countries and there is no definitively appropriate method. The use of isolated or combined criteria, such as the marks obtained by students in medical schools, their performance in tests of theoretical knowledge and evaluations of clinical competence, or personal interviews, have a limited value for identifying those candidates who will perform better during the residency and later on during independent practice. OBJECTIVES: To analyse the variability in the methodologies used for the selection of residents employed in different countries, in particular those used in the United Kingdom and USA, where external agencies and medical schools make systematic analyses of curriculum development. The advantages and disadvantages of national or transnational licensing examinations on the process of convergence and harmonization of medical degrees and residency programmes through Europe are discussed. The present analysis is used to design a new and more efficient multi-criteria methodology for resident selection in Spain, which will be published in the next issue of this journal. CONCLUSIONS: Since the multi-criteria methods used in UK and USA appear to be most consistent, these have been employed for designing the new methodology that could be applied in Spain. Although many experts in medical education reject national examinations for awarding medical degrees or ranking candidates for residency posts, it seems that, when appropriately designed, they can be used to verify the level of competence of graduating students without necessarily distorting curriculum implementation or improvement.

[The method of selection of the residents in Spain. Analysis of the examination MIR and offer of a new methodology]. / El método de selección de los residentes en España. Análisis del examen MIR y propuesta de una nueva metodología.

INTRODUCTION: The method for selecting medical graduates for residency positions has a strong influence on teaching and learning strategies in medical schools. The methodology currently used in Spain does not seem appropriate for ranking the candidates or improving curriculum development. Thus, and taking into account the most consistent methodologies used in the United Kingdom and USA, we have designed a new method to be used in our country. OBJECTIVES: To analyze the limitations of the methodology used in Spain, and propose a new one aimed to improve the accuracy of selection itself and avoiding the negative influence of the current method on curricular development. In addition, we emphasize the necessity of improving teaching and learning in the clinical context to assure that graduating students reach an adequate level of clinical competence. CONCLUSIONS: The method for selecting candidates to residency post currently used in Spain, which relies mainly on testing theoretical knowledge, should be changed for an alternative methodology taking into account student,s performance through the course and assessing his/her ability for clínical contextualization of knowledge and level of clinical competence.

Paediatric interventional radiology: it's not child's play.

Pediatric interventional radiology is a dynamic and growing subspecialty. The new training pathways in interventional radiology, the maintenance of skills with a small volume of cases or complex procedures, the limited availability of specific pediatric equipment and materials pose significant challenges and opportunities.

Reliability of the Mental Health Nurse Competency Assessment Tool (ECOEnfSM): A pilot study.

AIM: To evaluate the reliability of the ECOEnfSM scale as a tool to assess the professional competencies of Mental Health Nurse Practitioners (MHNP) in their clinical practice. METHOD: A pilot study, observational, descriptive and cross-sectional, focuses on MHNP who have completed their Specialized Health Training Program (SHTP) in Spain. The data were collected by general and collaborators mentors of the Multiprofessional Teaching Units (MTUs). The Mental Health Nursing Competency Assessment Tool (ECOEnfSM) was used, which consists of three subscales and eight Competence Units (CU). A reliability and validity analysis were conducted (Cronbach's alpha and Spearman's correlation coefficient). RESULTS: The Rotation Assessment subscales showed excellent reliability (r > 0.90) with high and very high correlations (r > 0.6) in all UCs with high levels of significance (P < .01). The Annual Assessment subscale showed good reliability (r > 0.80) with a medium and very high correlation (r > 0.4) with high levels of significance (P < .01). All UCs showed a good to excellent consistency (r > 0.80). The "Home Visits" assessment criterion showed heterogeneity of data due to there are few MTUs that fully develop it. CONCLUSION: The ECOEnfSM scale showed very high reliability in MHNP during their training program in Spain. The ECOEnfSM is considered the only objective tool in Spain to assess the professional competencies in this population.

[Clinician and researcher at the time. Is it possible?] / Clínico e investigador a la vez, ¿se puede?

Research in clinical practice arises as a constant need for improvement to provide better care to patients, train better human resources and make a daily reflection on the amount of scientific information we receive every day. We want to reflect on how the Centro de Adiestramiento en Investigación Clínica (CAIC) from our healthcare activity changed our practice.

La investigación en la práctica clínica surge como una necesidad constante de mejora, a fin de dar una atención de mayor calidad a los pacientes, formar recursos humanos más preparados y hacer una reflexión diaria ante la cantidad de información científica que recibimos todos los días. Queremos hacer una reflexión de como el Centro de Adiestramiento en Investigación Clínica (CAIC) desde nuestra actividad asistencial cambió nuestra práctica.

Professional competencies of oncology nurses: Recognizing advanced practice in nursing.

OBJECTIVE: To identify the competency profile of advanced practice nurses involved in the care process of cancer patients. METHODS: Cross-sectional and descriptive study. The study included all nurses involved in the cancer patient care process in a tertiary hospital in Barcelona. Competence profile data were collected using the instrument for defining the role of the advanced practice nurse (APRD), as well as sociodemographic and occupational variables. Sociodemographic and occupational data were compared against the performance of advanced practice activities. RESULTS: A total of 29 (82.9%) nurses participated with a mean age of 42.6±12.54 years. 9 (31%) nurses were identified as meeting the standard in all 6 domains on the APRD scale to be considered advanced practice nurses. Of these 9 (31%) nurses, 7 (24.1%) met the training standards required by the International Council of Nurses (ICN) with an official master's degree and 2 (6.9%) with a PhD. CONCLUSIONS: There are nurses who carry out their activity in the oncology field of the hospital analyzed with the EPA profile. The identification of advanced practice nurses (APNs) in our health system is essential to be able to recognize the competencies of these professionals and create specific positions that help to address chronicity, patients' quality of life, their survival, and the optimization of health resources. Our study highlights the importance of chronicity and cancer as areas for the development of the APNs.

Validation in Spanish of the Ottawa scale for non-technical skills in health personnel in crisis situations.

INTRODUCTION: Non-technical skills are related to morbi-mortality in medicine; it has been proposed that 46% of fatal outcomes are explained to limitations in non-technical skills and only 5% to technical skills deficiencies, however, there is no validated instrument or scale in spanish that allows its evaluation in the management of medical crisis. OBJECTIVE: To evaluate the psychometric properties of a Spanish-adapted version of the "Ottawa crisis resource management (CRM) global rating scale (GRS)" in medical staff involved in critical decision-making based in high-fidelity simulation, which could be beneficial to impact patient safety and improve clinical outcomes. METHODS: Transversal cultural instrument validation and adaptation study, included 91 participants who simulated a medical crisis between 2018 and 2019, and to whom the Spanish version of the CRM-GRS was applied in order to evaluate its psychometric properties. RESULTS: A cultural adaptation with translation into Spanish of the CRM-GRS was made. Subsequently, the scale was applied to 91 participants. An internal consistency (Cronbach's alpha) greater than 0.9 was found in each dimension. The level of inter-rater reliability, evaluated by the interclass coefficient was 0.59 to 0.69, and test-retest reliability with an interclass coefficient greater than 0.7. The validity of the convergent construct was moderate (interclass coefficient between 0.6 and 0.7 for all domains) and the validity of the divergent construct between 0.4 and 0.5 was found adequate. CONCLUSION: The translated and adapted Spanish version of the CRM-GRS in crisis had adequate internal consistency, reliability, and construct validity.

Validation in spanish of the Ottawa scale for non-techical skills in health personnel in crisis situations. / Validación en castellano de la escala de Ottawa para habilidades no técnicas en personal de salud en situación de crisis.

INTRODUCTION: Non-technical skills are related to morbi-mortality in medicine; it has been proposed that 46% of fatal outcomes are explained to limitations in non-technical skills and only 5% to technical skills deficiencies, however, there is no validated instrument or scale in spanish that allows its evaluation in the management of medical crisis. OBJECTIVE: To evaluate the psychometric properties of a Spanish-adapted version of the "Ottawa crisis resource management (CRM) global rating scale (GRS)" in medical staff involved in critical decision-making based in high-fidelity simulation, which could be beneficial to impact patient safety and improve clinical outcomes. METHODS: Transversal cultural instrument validation and adaptation study, included 91 participants who simulated a medical crisis between 2018 and 2019, and to whom the Spanish version of the CRM-GRS was applied in order to evaluate its psychometric properties. RESULTS: A cultural adaptation with translation into Spanish of the CRM-GRS was made. Subsequently, the scale was applied to 91 participants. An internal consistency (Cronbach's alpha) greater than 0.9 was found in each dimension. The level of inter-rater reliability, evaluated by the interclass coefficient was 0.59 to 0.69, and test-retest reliability with an interclass coefficient greater than 0.7. The validity of the convergent construct was moderate (interclass coefficient between 0.6 and 0.7 for all domains) and the validity of the divergent construct between 0.4 and 0.5 was found adequate. CONCLUSION: The translated and adapted Spanish version of the CRM-GRS in crisis had adequate internal consistency, reliability, and construct validity.

Competências para o atendimento multiprofissional da PCR em pediatria: percepções da equipe de enfermagem / Skills for multiprofissional care for cardiorespiratory arrests in pediatrics: perceptions of the nursing team / Habilidades para el cuidadod multiprofesional de las paradas cardiorrespiratorias en pediatria: percepciones del equipo de enfermería

Estudo exploratório descritivo, quantitativo, realizado em um hospital pediátrico filantrópico, com objetivo de compreender as competências profissionais da enfermagem no atendimento da parada cardiorrespiratória em pediatria, além de investigar suas percepções. Participaram 30 profissionais da equipe de enfermagem e a coleta de dados foi realizada por meio de um questionário fechado. Os resultados, analisados por meio de estatística descritiva, mostraram que os profissionais de enfermagem, em sua maioria, apresentaram conhecimento sobre o atendimento da emergência investigada. Em relação às suas percepções sobre as habilidades técnicas necessárias, notou-se que a maioria dos participantes se perceberam seguros para as manobras de ressuscitação e para a administração de medicações durante o atendimento; contudo, ao abordar o manuseio do desfibrilador e a realização de punção venosa, a maior parte da amostra afirmou não se sentir totalmente segura para estas atividades. Concluiu-se que a maioria dos participantes apresentam conhecimento teórico-prático para a execução do atendimento.

Descriptive, quantitative exploratory study, carried out in a philanthropic pediatric hospital, with the objective of understanding the nursing professional competencies in the care of cardiorespiratory arrests in pediatrics, besides investigating. 30 professionals from the nursing team participated and data was collected using a closed questionnaire. The results, analyzed using descriptive statistics, showed that the majority of nursing professionals had knowledge about the care of the investigated emergency. In relation to their perceptions about the necessary technical skills, the majority of participants perceived themselves to be confident in resuscitation maneuvers and the administration of medications during care. However, when approaching the handling of the defibrillator and performing a venipuncture, most of the sample stated that they did not feel complete confidence for these activities. Study concluded that the majority of participants had theoretical-practical knowledge to perform the service.

Estudio exploratorio descriptivo, cuantitativo, realizado en un hospital pediátrico filantrópico, con el objetivo de comprender las competencias profesionales de enfermería en el cuidado de la parada cardiorrespiratoria en pediatría, además de investigar sus percepciones. Participaron 30 profesionales del equipo de enfermería y la recolección de datos se realizó mediante cuestionario cerrado. Los resultados, analizados mediante estadística descriptiva, mostraron que la mayoría de los profesionales de enfermeira tenían conocimiento sobre la atención de la emergencia investigada. En relación a sus percepciones sobre las habilidades técnicas necesarias, se observa que la mayoría de los participantes se observó que la mayoría de los participantes se percibió confiada en las maniobras de reanimación y la administración de medicamentos durante la atención. Sin embargo, al abordar el manejo del desfibrilador y realizar una punción venosa, la mayoría de la muestra manifestó no sentirse completamente segura para estas actividades. Estudio concluyó que la mayoría de los participantes presentó conocimientos teórico-prácticos para realizar el servicio.

Experience of emergency healthcare professionals in cardiopulmonary resuscitation and its relationship with self-efficacy: A qualitative approach. / La experiencia de los profesionales sanitarios en la reanimación cardiopulmonar y su relación con su autoeficacia: una aproximación cualitativa.

AIM: To gain a deeper knowledge of the phenomenon of cardiopulmonary resuscitation by capturing the meanings that professionals attach to the behaviour of reanimation and its relationship with Social Cognitive Theory. METHOD: Qualitative research from a phenomenological approach focussing on field work with a focus group of professionals from Madrid (doctors, nurses and technicians), as well as a previous study. After the transcription of the data, it was coded, categories were formed and it was grouped into dimensions, interpreting the data according to the Social Cognitive Theory. Data was collected from other sources, experience of professionals and family members who had witnessed a cardiopulmonary resuscitation, until the saturation of the data. RESULTS: The phenomena that affect the people involved in a cardiopulmonary resuscitation were explored holistically. The relevant aspects to feel able to perform cardiopulmonary resuscitation, as well as those that may hinder the behaviour were identified. Two dimensions were found, personal and situational factors, as well as several categories in each dimension related to Bandura's theory of self-efficacy. CONCLUSIONS: Professionals' self-efficacy in a cardiopulmonary resuscitation does not always depend on the technical skills acquired. Personal and situational factors influence the professional being able to vary their behaviour cognitively and emotionally. This knowledge enables cardiopulmonary resuscitation competencies in a clinical situation to be improved and individualized training programmes to be designed in teaching practice.

Competências para a produção do cuidado integral: análise dos processos avaliativos no internato de Medicina da Universidade Federal Fluminense / Competencias para la producción de cuidados integrales: análisis de los procesos de evaluación en el internado de Medicina de la Universidad Federal Fluminense / Competencies for the production of comprehensive health care: analysis of the assessment processes in Medicine Internship at Fluminense Federal University

O objetivo deste estudo foi analisar a priorização e valorização de competências para a produção do cuidado integral no internato obrigatório (IO) da faculdade de Medicina da Universidade Federal Fluminense. O percurso metodológico contou com análise documental das competências para o IO e suas formas de avaliação, seguido de entrevistas remotas com docentes. A análise de conteúdo categorizou unidades temáticas de acordo com o momento da produção do cuidado integral no encontro com o paciente e nos demais encontros ocorridos para além deste. Foram evidenciadas priorização e valorização da integração de habilidades de comunicação e de técnicas semióticas; e raciocínio clínico com atitudes éticas e humanísticas e de competências relacionadas ao trabalho em equipe; participação em espaços coletivos de discussão; gestão do cuidado; abordagem comunitária; e processo de produção do conhecimento baseado nos signos do "ser médico(a)".(AU)

El objetivo de este estudio es analizar la priorización y valorización de las competencias para la producción de cuidados integrales en el Internado Obligatorio de la Facultad de Medicina de la Universidad Federal Fluminense. La metodologia incluye análisis documental y entrevistas con profesores. El análisis de contenido fue categorizado en unidades temáticas según el momento de producción de la atención integral: en el encuentro y en los encuentros necessários a partir de este encuentro com el paciente. Em el encuentro, se priorizó la integración de habilidades comunicativas y técnicas semióticas y de razonamiento clínico con actitudes éticas y humanísticas, y en los demás encuentros, las habilidades relacionadas con el trabajo en equipo, participación en espacios colectivos de discusión, gestión del cuidado, enfoque comunitario, además del propio proceso de producción de conocimiento, todos basado en la idea de lo que significa ser médico.(AU)

The objective of this study is to analyze the prioritization and valorization of competences within the production of comprehensive care at Mandatory Internship at the Faculty of Medicine at Fluminense Federal University. The methologic included analysis of the documents that contained the competencies and its forms of assessment at the Mandatory Internship, and remote interviews with professors. The analysis of the content was categorized into thematic units according to the moment of the production of comprehensive care: in the encounter with patient and beyond others encounters needed after this first one. By the encounter, there was a prioritization of the integration of communication skills and semiotic techniques and clinical reasoning with ethical and humanistic attitudes, and in the second one the competencies related to teamwork, participation in collective spaces for discussion, care management, community approach, in addition of the knowledge production process itself, based on the idea of being a doctor.(AU)

Current Approach to Training and Assessing New Generations of Endoscopists / Enfoque actual para enseñar y evaluar a las nuevas generaciones de endoscopistas

Abstract Esophagogastroduodenoscopy (EGD) is a diagnostic and therapeutic study for various upper gastrointestinal tract diseases. It is a fundamental part of the education and training fellows receive in gastroenterology programs, focusing on developing skills to perform it safely, effectively, and efficiently and master the technique. Historically, value has been attached to the number of procedures required to acquire skills; there is a discrepancy in the recommendations by scientific societies regarding the "ideal" number to meet the minimum requirements and learn the necessary skills. However, each student has different innate and developed abilities that make this process asymmetric. Adopting a combined training approach (observation, clinical practice, and simulation) is the best method to learn diagnostic EGD. We are facing a generation with forms of learning different from those traditionally implemented, which implies an ongoing process of training and updating for endoscopists dedicated to teaching.

Resumen La esofagogastroduodenoscopia (EGD) es un estudio diagnóstico y terapéutico para diferentes enfermedades del tracto gastrointestinal superior, que hace parte fundamental de la formación y el entrenamiento que reciben los fellows en los programas de gastroenterología, y se centra en el desarrollo de capacidades para llevarla a cabo de manera segura, eficaz, eficiente y con un claro dominio de la técnica. Históricamente, se le ha dado un valor fundamental a la cantidad de procedimientos requeridos para la adquisición de las habilidades y existe discrepancia en la recomendación dada por las diferentes sociedades científicas respecto a la cantidad "ideal" para cumplir con las exigencias mínimas y lograr las destrezas necesarias; sin embargo, cada estudiante tiene unas habilidades innatas y desarrolladas diferentes que hacen que ese proceso sea asimétrico en cada caso. La adopción de un enfoque de entrenamiento combinado (observación, práctica clínica y simulación) es el mejor método para aprender EGD diagnóstica, dado que estamos frente a una generación que tiene formas de aprendizaje diferentes a las implementadas tradicionalmente, lo cual implica un proceso de entrenamiento y actualización constante de los endoscopistas que se dedican a la docencia.

Competências do enfermeiro no cuidado a pacientes com acidente vascular cerebral elegíveis à terapia trombolítica / Competencias de enfermería en el cuidado de personas con accidente cerebrovascular elegibles para terapia trombolítica / Nursing competencies in the care of patients with stroke who are eligible for thrombolytic therapy

Resumo Introdução: O acidente vascular cerebral isquêmico tem como tratamento a terapia trombolítica, aplicada ainda na fase aguda, promovendo melhora importante nas sequelas acarretadas por este agravo. Considerando a complexidade da terapia trombolítica, torna-se necessário que os enfermeiros compreendam suas competências para auxiliar no cuidado. Objetivo: Identificar evidências científicas acerca das competências do enfermeiro no cuidado a pacientes com acidente vascular cerebral elegíveis à terapia trombolítica. Metodologia: Revisão integrativa composta por seis etapas em seis etapas (elaboração da questão, busca na literatura, coleta de dados, análise, discussão e apresentação da revisão), realizada nas bases de dados MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase e CINAHL. A busca foi realizada entre agosto e setembro de 2022 adotando como critérios de inclusão estudos primários; gratuitos, disponíveis eletronicamente na íntegra; nos idiomas inglês, português e espanhol. Foram obtidos inicialmente 2.830 estudos, os quais passaram por uma seleção, onde foram incluídos aqueles que atendiam os critérios previamente estabelecidos. Resultados: Com base nos doze estudos incluídos nesta revisão identificaram-se competências voltadas à três atividades do cuidado: gestão do cuidado como trabalho em equipe, códigos, fluxos e protocolos, assistência ao paciente antes, durante e após a utilização da terapia trombolítica e educação em saúde para equipe, pacientes e familiares. Conclusão: Os achados desta revisão puderam evidenciar as competências do enfermeiro no cuidado aos pacientes elegíveis a terapia trombolítica, as quais perpassam diferentes áreas de atuação do enfermeiro. Para este estudo prevaleceram as competências assistências, seguida por competências gerenciais.

Resumen Introducción: El accidente cerebrovascular isquémico se trata con terapia trombolítica, aplicada incluso en la fase aguda, que promueve una mejoría significativa de las secuelas provocadas por este padecimiento. Considerando la complejidad de la terapia trombolítica, es necesario que las personas profesionales de enfermería comprendan sus competencias para ayudar en el cuidado. Objetivo: Identificar evidencias científicas sobre las competencias del personal de enfermería en el cuidado de pacientes con accidente cerebrovascular elegibles para terapia trombolítica. Metodología: Revisión integradora que consta de seis etapas (elaboración de la pregunta, búsqueda bibliográfica, recolección de datos, análisis, discusión y presentación de la revisión), realizada en las bases de dados MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase y CINAHL. La búsqueda se realizó entre agosto y septiembre de 2022. Los criterio de inclusión fueron: estudios primarios, gratuito, disponible electrónicamente en su totalidad, en inglés, portugués y español. Inicialmente se obtuvieron 2830 estudios, los cuales fueron sometidos a un proceso de selección, que incluyó aquellos que cumplían con los criterios previamente establecidos. Resultados: A partir de los doce estudios incluidos en esta revisión, se identificaron competencias centradas en tres actividades asistenciales: gestión del cuidado como trabajo en equipo, códigos, flujos y protocolos, atención a pacientes antes, durante y después del uso de la terapia trombolítica y educación en salud para personal, pacientes y familias. Conclusión: Los hallazgos de esta revisión pudieron resaltar las competencias de las personas profesionales en enfermería en el cuidado de personas elegibles para terapia trombolítica, que abarcan diferentes áreas de actuación del personal de enfermería. Para este estudio, prevalecieron las habilidades asistenciales, seguidas de las competencias gerenciales.

ABSTRACT Introduction: Ischemic stroke is treated with thrombolytic therapy, applied even in the acute phase, promoting a significant improvement in the after-effects caused by this condition. Considering the complexity of thrombolytic therapy, it is necessary for nurses to understand the skills required to assist in care. Objective: To identify scientific evidence about the competencies of nurses in the care of patients with stroke who are eligible for thrombolytic therapy. Methodology: An integrative review consisting of six stages (elaboration of the question, literature review, data collection, analysis, discussion, and presentation), conducted in MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase, and CINAHL databases. The search was carried out between August and September 2022 using primary studies as the inclusion criteria: free of charge, fully available electronically, published in English, Portuguese, or Spanish. Initially, 2.830 studies were obtained, which underwent a selection process that included only those studies that met the previously established criteria. Results: Based on the twelve studies included in this review, competencies focused on three care activities were identified: care management such as teamwork; codes; flows and protocols; patient care before, during, and after the use of thrombolytic therapy; and education health education for staff, patients, and families. Conclusion: The findings of this review highlighted the nurses' competencies in the care of patients eligible for thrombolytic therapy, which encompass different areas of the nurse's work. For this study, assistance competencies prevailed, followed by management competencies.

Factors to Effective Clinical Experience, Willingness to pursue Career in Rural Health Facilities among Nursing Students on Clinical Placement in Southeast Nigeria and Rural Development / Factores para una experiencia clínica eficaz, voluntad de seguir una carrera en instalaciones de salud rurales entre estudiantes de enfermería en prácticas clínicas en el sudeste de Nigeria y desarrollo rural / Fatores para experiência clínica eficaz, vontade de seguir carreira em unidades de saúde rurais entre estudantes de enfermagem em estágios clínicos no sudeste da Nigéria e desenvolvimento rural

Objective. To describe the Factors to Effective Clinical Experience and Willingness to pursue Career in Rural Health Facilities among Nursing Students on Clinical Placement in southeast Nigeria. Methods. The study was conducted among 48 rural health centres and general hospitals with 528 respondents from different higher institutions of learning serving in these health facilities for their clinical experience. The study applied survey design and utilized questionnaire instrument for data collection. Results. Majority of the students (60%) agreed that their school lacked functional practical demonstration laboratory for students' clinical practice, 66.7% agreed that their school lab lacked large space for all the students to observe what is being taught, 79.9% that their school lab lacked enough equipment that can enable many students to practice procedures; majority of the students (79.9%) answered that the hospitals where they are on clinical placement lacked enough equipment needed for the students on each shift of practice, 59.9% agreed that student/client ratio in each ward during clinical experience periods was not enough for students' practice under supervision, while 73.3% indicated that their school lacked library with current nursing texts for references. Personal, socioeconomic and institutional factors explain the 76% of the variance of effective clinical experience and the 52% of the variance of the willingness to work in rural health facilities in the future if offered employment. Conclusion. The factors surrounding effective clinical experience in rural healthcare facilities in southeastern Nigeria are unfavorable and could discourage future nurses from working there. It is necessary to implement strategies to improve the management of these centers in order to promote the perspective of improving sustainable rural health in this region.

Objetivo. Describir la experiencia clínica efectiva entre los estudiantes de enfermería en prácticas clínicas en las instalaciones sanitarias rurales en el sudeste de Nigeria. Métodos. Este estudio descriptivo se llevó a cabo entre 48 centros de salud rurales y hospitales generales con 528 encuestados de diferentes instituciones de enseñanza superior que prestaban servicio en estas instalaciones sanitarias para su experiencia clínica. Resultados. 60% de los estudiantes comentaron que su centro carecía de un laboratorio de simulación para las prácticas clínicas de los estudiantes, el 66.7% indicó que el laboratorio de su centro carecía de un espacio para que todos los estudiantes pudieran observar lo que se enseñaba. Un 79.9% indicó que el laboratorio de su centro no disponía de equipos suficientes para practicar los procedimientos, y otro porcentaje igual (79.9%) manifestaron que los hospitales carecían del equipo necesario para realizar adecuadamente las prácticas clínicas. El 59.9% indicaron que la razón de estudiantes por paciente en cada sala durante los periodos de experiencia clínica era insuficiente para que los estudiantes realizaran prácticas bajo supervisión, y el 73.3% indicaron que los recursos de la biblioteca en textos de enfermería eran insuficientes para sus necesidades. Los factores personales, socioeconómicos e institucionales explican el 76% de la varianza en la experiencia clínica efectiva y el 52% en la disposición a trabajar en centros sanitarios rurales en el futuro. Conclusión. Los factores que rodean la experiencia clínica efectiva en los centros sanitarios rurales del sudeste de Nigeria son desfavorables y podrían desanimar a los futuros enfermeros a trabajar en ellos. Es necesario implementar estrategias de mejoramiento de la gestión de estos centros con el fin de impulsar la perspectiva de mejorar la salud rural sostenible en esta región.

Objetivo. Descrever a experiência clínica eficaz entre estudantes de enfermagem em estágios clínicos em unidades de saúde rurais no sudeste da Nigéria (África). Métodos. Este estudo descritivo foi realizado em 48 centros de saúde rurais e hospitais gerais com 528 entrevistados de diferentes instituições de ensino superior que atendem essas unidades de saúde pela sua experiência clínica. Resultados. 60% dos alunos comentaram que seu centro não possuía laboratório de simulação para as práticas clínicas dos alunos, 66.7% indicaram que o laboratório de seu centro carecia de espaço para que todos os alunos pudessem observar o que estava sendo ensinado. 79.9% indicaram que o laboratório do seu centro não possuía equipamentos suficientes para a realização dos procedimentos e outro percentual igual (79.9%) afirmou que os hospitais não possuíam os equipamentos necessários para a realização adequada das práticas clínicas. 59.9% indicaram que a proporção de estudantes por pacientes em cada sala durante os períodos de experiência clínica era insuficiente para que os estudantes realizassem as práticas sob supervisão e 73.3% indicaram que os recursos da biblioteca em textos de enfermagem eram insuficientes para suas necessidades. Fatores pessoais, socioeconómicos e institucionais explicam 76% da variação na experiência clínica efetiva e 52% na vontade de trabalhar em centros de saúde rurais no futuro. Conclusão. Os fatores que rodeiam a experiência clínica eficaz em unidades de saúde rurais no sudeste da Nigéria são desfavoráveis e podem desencorajar futuros enfermeiros de trabalhar lá. É necessário implementar estratégias para melhorar a gestão destes centros, a fim de promover a perspectiva de melhorar a saúde rural sustentável nesta região.

Breaking bad news in ophthalmology: a literature review / Comunicação de más notícias em oftalmologia: uma revisão de literatura

ABSTRACT Medical specialties have recognized that breaking bad news assists clinical practice by mitigating the impact of difficult conversations. This scenario also encourages various studies on breaking bad news in ophthalmology since certain ocular diagnoses can be considered bad news. Thus, the objective is to review the scientific literature on breaking bad news in ophthalmology. The literature databases like MEDLINE/PUBMED, EMBASE, LILACS, SCOPUS, COCHRANE, and SCIELO, were screened for related research publications. Two independent reviewers read all the articles and short-listed the most relevant ones. Seven articles, in the formats of original article, review, editorial, oral communication, and correspondence, were reviewed. Conclusively it reveals that ophthalmologists are concerned with communicating bad news effectively but lack related studies. Nevertheless, there is a growing realization that training in breaking bad news can increase physicians' confidence during communication, thus, benefiting the therapeutic relationship with the patient and his family. Therefore, it would be valuable to include breaking bad news training in the curriculum of residencies.

RESUMO O reconhecimento sobre a comunicação de más notícias como mitigadora de conversas difíceis por outras especialidades médicas, incentiva o estudo desta temática na oftalmologia. Sendo assim, o objetivo deste estudo é revisar a produção de pesquisas científicas sobre a comunicação de más notícias em oftalmologia. Para isso, foi realizada uma revisão de literatura. As bases de dados utilizadas foram MEDLINE/PUBMED, EMBASE, LILACS, SCOPUS, COCHRANE e SCIELO. Dois revisores independentes leram todos os artigos e selecionaram a amostra final. Sete artigos foram escolhidos nos formatos de artigo original, revisão, editorial, comunicação oral e correspondência. Os oftalmologistas estão preocupados em comunicar as más notícias de forma eficaz, mas faltam estudos sobre o tema. No entanto, há uma crescente percepção de que o treinamento de comunicação de más notícias aumenta a confiança dos médicos na comunicação, beneficiando a relação terapêutica. Portanto, seria valioso incluir este treinamento no currículo das residências.

Como estamos avaliando competências? Projeto de intervenção nos instrumentos avaliativos de um programa de residência medicina intensiva / How are we assessing competencies? Experience report of an intervention project in the evaluation instruments of an intensive care medicine residency program

RESUMO Introdução: O ensino baseado em competências no âmbito das residências médicas tornou evidente o descompasso dos processos de avaliação tradicionais com os objetivos educacionais dos projetos pedagógicos alinhados às matrizes de competências de cada especialidade. A matriz de competência para o Programa de Residência em Medicina Intensiva (acesso direto em três anos) foi aprovada em 2021. O objetivo deste artigo é descrever o relato de experiência de um projeto de intervenção nos instrumentos de avaliação de desempenho dos residentes no Programa em Residência em Medicina Intensiva de um hospital público universitário em São Luís, no Maranhão. Relato de experiência: Após a organização do grupo de estudo e de trabalho para a intervenção, houve a escolha do objeto "ferramentas de avaliação de competências" e a seleção do Programa de Residência de Medicina Intensiva. Inicialmente, foi aplicado um questionário a todos os médicos preceptores e residentes, com atuação no cenário da unidade de terapia intensiva (UTI), com o objetivo de aferir as percepções deles acerca do instrumento avaliativo vigente, seguindo a pergunta norteadora: "A avaliação atual atende à concepção do programa traduzido pela matriz de competência da Comissão Nacional de Residência Médica?". Discussão: Embora a maioria dos preceptores e residentes tenha considerado que os métodos de avaliação atendiam à concepção do programa, havia pontos frágeis em relação ao feedback e à avaliação de desempenho dos residentes. Como intervenção, propusemos adaptação da ferramenta existente, adequando-a aos desempenhos previstos na matriz de competências da especialidade com formalização do feedback e introdução de avaliação de desempenho em cenário real utilizando o Miniexercício Clínico Avaliativo (Mini-Cex). Conclusão: Os limites entre a avaliação e a aprendizagem são tênues. Com base em indicadores sobre a percepção de preceptores e residentes de fragilidades na avaliação utilizada de longa data, foi proposta uma intervenção de modificação dos instrumentos avaliativos com o intuito de adequar/melhorar a avaliação de competências.

ABSTRACT Introduction: Competency-based teaching in medical residencies has evidenced the mismatch between traditional assessment processes and the educational objectives of pedagogical projects aligned with the competency matrices of each specialty. The competency matrix for the Intensive Care Medicine Residency Program (3-year direct admission) was approved in 2021. The objective of this article is to describe an experience report of an intervention project in the performance assessment instruments of residents attending the Intensive Care Medicine Residency Program at a university hospital in São Luís-Maranhão. Experience Report: After organizing the study and working group for the intervention, the object "skills assessment tools" was chosen and the Intensive Care Medicine Residency Program was selected. Initially, a questionnaire was applied to all preceptors and residents working in the intensive care unit (ICU) setting with the aim of evaluating their perceptions regarding the current assessment tool, following the guiding question: does the current assessment meet the conception of the program translated by the competency matrix of the National Medical Residency Commission? Discussion: Although the majority of the preceptors and residents considered that the evaluation methods met the Program design, there were weaknesses in relation to feedback and evaluation of the residents' performance. As an intervention, we proposed adapting the existing tool, making it adequate to the performance predicted in the specialty competency matrix with formalization of feedback and introduction of performance assessment in a real scenario using the Mini Clinical Assessment Exercise (Mini-CEX). Conclusion: The boundaries between assessment and learning are blurred. Based on indicators on the perception of preceptors and residents of weaknesses in the assessment used for a long time, an intervention was proposed to modify the assessment instruments with the aim of adapting/improving the assessment of skills.

Transformando la educación médica del siglo xxi: El rol de la educación médica basada en competencias / Transforming medical education in the 21st century: The role of competency-based medical education

RESUMEN Introducción: Con el panorama cambiante de la educación médica, es crucial examinar críticamente los enfoques y marcos existentes. La educación médica basada en competencias (EMBC) surge como un prometedor cambio de paradigma, que prioriza el desarrollo de habilidades, conocimientos y actitudes explícitas centrado en el alumno y orientado a los resultados. Objetivo: Identificar los ajustes estructurales y procedimentales esenciales necesarios para una implementación eficaz de la EMBC. Se subraya la importancia de reorganizar las instituciones educativas, adaptar las técnicas de instrucción y evaluación y fomentar la adopción de la EMBC en el aula. Resultados: Para impartir con eficacia la EMBC, es imperativo reestructurar las instituciones educativas para que se centren en planes de estudios basados en competencias y en la enseñanza personalizada. Asimismo, es necesario modificar las estrategias de enseñanza y evaluación para facilitar la evaluación continua y el aprendizaje activo. Conclusiones: Adoptar los principios de EMBC puede permitir que la educación médica produzca profesionales equipados con las habilidades necesarias para satisfacer las demandas dinámicas de la medicina moderna.

ABSTRACT Introduction: With the changing landscape of medical education, it is crucial to critically examine existing approaches and frameworks. competency-based medical education (CBME) emerges as a promising paradigm shift, which prioritizes learner-centered, outcome-oriented development of skills, knowledge, and attitudes. Objective: To identify the essential structural and procedural adjustments needed for effective implementation of CBME. It underscores the importance of reorganizing educational institutions, adapting instructional and assessment techniques, and fostering acceptance of CBME in the classroom. Results: To effectively deliver CBME, it is imperative to restructure educational institutions to focus on competency-based curricula and personalized instruction. Also, there is a need to modify teaching and assessment strategies to facilitate continuous assessment and active learning. Conclusions: Adopting CBME principles can enable medical education to produce professionals equipped with the skills necessary to meet the dynamic demands of modern medicine.

Desenvolvimento da competência clínica por estudantes graduandos no ensino baseado em simulação: estudo quase experimental / Development of clinical competence by undergraduate students in simulation-based teaching: quasi-experimental study

OBJETIVO: Avaliar o ensino baseado em simulação no desenvolvimento da competência clínica de estudantes. MÉTODO: Estudo quase experimental realizado em uma universidade pública que participaram 62 estudantes. Para coleta de dados utilizou-se um Teste de Conhecimento e um Checklist. Os dados foram apresentados em percentual e comparados com a ANOVA. RESULTADOS: A média do percentual do conhecimento, antes, durante e após as estratégias teóricas (estudo de caso e aula teórica dialogada), foi 67,6%, 76,7% e 88,1% respectivamente e 87,6% após 30 dias. Na simulação, a habilidade "comunicou-se com fala nítida e tom de voz controlado" obteve 93,5% de acertos; "acoplou oxímetro de pulso" e "administrou o antiagregante plaquetário" 100%; 75% dos estudantes classificaram o paciente em um dos três grupos de síndrome coronariana e 83,7% relacionaram com o melhor tratamento. CONCLUSÃO: O ensino baseado em simulação possibilitou o desenvolvimento da competência clínica dos estudantes no atendimento de síndrome coronariana.

OBJECTIVE: To evaluate simulation-based teaching in the development of students' clinical competence. METHOD: Quasi-experimental study carried out at a public university with the participation of 62 students. A Knowledge Test and a Checklist were used for data collection. Data were presented as percentages and compared using ANOVA. RESULTS: The average percentage of knowledge, before, during and after the theoretical strategies (case study and dialogued theoretical class), was 67.6%, 76.7% and 88.1% respectively and 87.6% after 30 days. In the simulation, the skill "communicated with clear speech and controlled tone of voice" obtained 93.5% of correct answers; "attached pulse oximeter" and "administered platelet antiaggregant" 100%; 75% of the students classified the patient in one of the three groups of coronary syndrome and 83.7% related it to the best treatment. CONCLUSION: Simulation-based teaching enabled the development of students' clinical competence in treating coronary syndromes.

Competencia clínica del personal de enfermería para el manejo de la hipotensión arterial intradialítica en el servicio de hemodiálisis del Centro Médico Naval / Clinical competence of nursing staff for the management of intradialytic hypotension in the hemodialysis service of the Naval Medical Center

Introducción: el correcto manejo de la hipotensión arterial durante la hemodiálisis es fundamental en la formación y trabajo del personal de enfermería nefrológica del Centro Médico Naval. El personal debe tener conocimientos suficientes sobre la hipotensión y sus factores asociados que le ayuden a predecirla y actuar de manera preventiva, así como con habilidades instrumentales para llevar a cabo medidas en la práctica. Objetivo: analizar la competencia clínica del personal de enfermería en el servicio de hemodiálisis del Centro Médico Naval con respecto a su formación académica y experiencia profesional en el manejo de la hipotensión arterial intradialítica. Metodología: estudio prospectivo, descriptivo y observacional. Se emplearon dos instrumentos: una adaptación del Cuestionario de conocimientos para el manejo de hemodiálisis de Miller y la Guía de observación de habilidades instrumentales en el personal de enfermería de Murillo. Resultados: se contó con una muestra de doce enfermeros pertenecientes al servicio de hemodiálisis. El 33.3% mostró un nivel regular de competencia clínica y 66.7% un nivel bueno. En promedio, la competencia clínica se ubicó en 78%. Discusión: los resultados obtenidos difieren de los reportados en otras investigaciones, tanto por el año de aplicación como de los sujetos evaluados. Limitaciones: se contó con una muestra baja debido a que el personal del servicio no es numeroso. Conclusiones: es necesario reforzar los conocimientos del personal sobre el tema. Sin embargo, se observó que las habilidades instrumentales fueron excelentes en todos los casos. No se observa relación con el nivel de estudios o la experiencia profesional.

Introduction: the correct management of arterial hypotension during hemodialysis is fundamental in the training and work of the nephrological nursing staff at the Naval Medical Center. The staff must have sufficient knowledge about hypotension and its associated factors to help them predict it and act preventively, as well as instrumental skills to carry out measures in practice. Objective: to analyze the clinical competence of the nursing staff in the hemodialysis service of the Naval Medical Center concerning their academic training and profesional experience in the management of intradialytic arterial hypotension. Methodology: a prospective, descriptive, and observational study. Two instruments were used: an adaptation of Miller's Hemodialysis Management Knowledge Questionnaire and Murillo's Guide to Observation of Instrumental Skills in Nursing Personnel. Results: There was a sample of twelve nurses belonging to the hemodialysis service. 33.3% percent showed a fair level of clinical competence and 66.7% a good level. On average, clinical competence was 78%. Discussion: the results obtained differ from those reported in other studies, in terms of both the year of application and the subjects evaluated. Limitations: there was a low sample size due to the small number of service personnel. Conclusions: it is necessary to reinforce the knowledge of the personnel on the subject. However, it was observed that instrumental skills were excellent in all cases. No relationship was observed with the level of studies or professional experience.

[Reliability study on the interpretation of electrocardiograms by general practitioners and trainees]. / Estudio de fiabilidad en la interpretación del electrocardiograma por médicos de familia y médicos residentes.

OBJECTIVE: To determine the reliability of the interpretation of electrocardiograms (ECG) by general practitioners and those in training by making a comparison with the interpretation made by the cardiologist. MATERIAL AND METHODS: An observational study was conducted that included general practitioners working in the Toledo Health Area, physicians during their training in Family and Community Medicine, and cardiologists in their first 3 years of specialist training (R1-R3). A questionnaire was used that included 13 ECGs with no clinical details of the patient. The 13 ECGs were selected and their diagnoses made by consensus by 2 cardiologists from the Toledo Hospital Complex. RESULTS: The highest percentage of correct answers (82.3%) was obtained for ECG 5 (atrial fibrillation), and the lowest (26.5%) for ECG 11 (junctional rhythm). The highest diagnostic skill was achieved by the resident cardiologists, general practitioners, medical tutors, and doctors who had worked in hospital emergency departments. The highest odds ratio for a higher diagnostic skill was to work in an emergency department and be a practising general practitioner, both with almost significant results (P<.10). CONCLUSIONS: Family physicians and those in training have a medium level of reliability in the interpretation of an ECG compared to the cardiologist.