RESUMO
BACKGROUND: Kohlberg's theory of moral development asserts that people progress through different stages of moral reasoning as their cognitive abilities and social interactions mature. Individuals at the lowest stage of moral reasoning (preconventional stage) judge moral issues based on self-interest, those with a medium stage (conventional stage) judge them based on compliance with rules and norms, and those at the highest stage (postconventional stage) judge moral issues based on universal principles and shared ideals. Upon attaining adulthood, it can be considered that there is stability in the stage of individuals' moral development; however, the effect of a global population crisis such as the one experienced in March 2020, when the World Health Organization (WHO) declared the COVID-19 pandemic, is unknown. The purpose of this study was to evaluate the changes in the moral reasoning of pediatric residents before and after one year of the COVID-19 pandemic and compare them with a general population group. METHODS: This is a naturalistic quasi-experimental study conducted with two groups, one comprised 47 pediatric residents of a tertiary hospital converted into a COVID hospital during the pandemic and another group comprised 47 beneficiaries of a family clinic who were not health workers. The defining issues test (DIT) was applied to the 94 participants during March 2020, before the pandemic initiated in Mexico, and later during March 2021. To assess intragroup changes, the McNemar-Bowker and Wilcoxon tests were used. RESULTS: Pediatric residents showed higher baseline stages of moral reasoning: 53% in the postconventional group compared to the general population group (7%). In the preconventional group, 23% were residents and 64% belonged to the general population. In the second measurement, one year after the start of the pandemic, the group of residents had a significant decrease of 13 points in the P index, unlike the general population group in which a decrease of 3 points was observed. This decrease however, did not equalize baseline stages. Pediatric residents remained 10 points higher than the general population group. Moral reasoning stages were associated with age and educational stage. CONCLUSIONS: After a year of the COVID-19 pandemic, we found a decrease in the stage of moral reasoning development in pediatric residents of a hospital converted for the care of patients with COVID-19, while it remained stable in the general population group. Physicians showed higher stages of moral reasoning at baseline than the general population.
Assuntos
COVID-19 , Grupos Populacionais , Humanos , Criança , Adulto , Pandemias , COVID-19/epidemiologia , Princípios Morais , Desenvolvimento MoralRESUMO
Resumen En la educación médica, la metacognición incide en diferentes aspectos: mejora el rendimiento académico, contribuye a la toma de decisiones, facilita el desarrollo de habilidades clínicas, permite combatir el exceso de confianza y disminuye errores diagnósticos. Por ello, se constituye en una habilidad necesaria en la formación del médico. En este sentido, el uso de estrategias que promuevan el desarrollo de juicios metacognitivos, es clave en los procesos de enseñanza y aprendizaje. Para profundizar en los aportes de los juicios metacognitivos en el campo de la educación médica, se construye el siguiente artículo producto de una revisión bibliográfica. En él se logra pasar de una dimensión macro de la metacognición (conocimiento o regulación), a una dimensión micro referida a los juicios metacognitivos, evidenciado cómo estos aportan al razonamiento clínico, a la toma de decisiones, a la disminución del error médico y a la seguridad del paciente. El artículo muestra una línea de trabajo denominada juicios metacognitivos, caracterizada por centrarse en la precisión entre las afirmaciones de desempeño en una tarea y el rendimiento real.
Abstract Metacognition contributes to medical education from different aspects: improve academic performance, contributes to decision making, facilitates the development of clinical skills, helps combat overconfidence and reduces diagnostic errors. This is why it becomes a necessary skill to develop in the training of the student medicine for which strategies such as metacognitive scaffolds are included, deliberate consideration of alternatives, and the reproduction of optimal actions. To understand these contributions for learning medicine, a bibliographic review article was developed, through a process that included searching databases through descriptors in Spanish and English, the selection of articles that will include the relationship of metacognition and the learning of medicine, to arrive at the construction of a text that would account for an understanding of the subject. The above allowed, not just delve into metacognition as a higher order skill in learning, but also guide a discussion that highlights a line of work called metacognitive judgments, which is characterized by focusing on the precision between performance claims on a task and actual performance.