Curvas de aprendizaje en Educación Médica

La curvas de aprendizaje , representaciones gráficas que muestran la relación entre esfuerzos y logros de aprendizaje, son referidas con frecuencia en las publicaciones de investigación en el campo de la educación, sin embargo, no son empleadas habitualmente en los procesos de enseñanza - aprendizaje.

Un artículo publicado en el último número de la revista Academic Medicine presenta una revisión del tema en que se analiza el concepto y sus posibles aplicaciones a la formación de talento humano en salud, gracias a la correlación que guardan con el desarrollo progresivo de las competencias profesionales.

Referencia 

Pusic M, Boutis K, Hatala R, Cook D. Learning Curves in Health Professions Education. Acad Med. 2015; 90 (8): 1034 - 1042.

Nuevo Plan Obligatorio de Salud

Con el Acuerdo 028 de 2011, la Comisión Reguladora de Salud, estableció las nuevas condiciones del Plan Obligatorio de Salud para los regimenes contributivo y subsidiado, los cuáles entran en vigencia a partir del 1 de diciembre de este año.

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Resúmenes: Análisis de las Redes Sociales como método de evaluación de la Cultura Institucional

Purpose: To describe the basic concepts of social network analysis (SNA), which assesses the unique structure of interrelationships among individuals and programs, and introduce some applications of this technique in assessing aspects of institutional culture at a medical center.

Method: The authors applied SNA to three settings at their institution: team function in the intensive care unit, interdisciplinary composition of advisory committees for 53 federal career development awardees, and relationships between key function directors at an institution-wide Clinical Translational Sciences Institute (CTSI). (Key functions are the major administrative units of the CTSI.)

Results: In the ICU setting, SNA provides interpretable summaries of aspects of clinical team functioning. When applied to membership on mentorship committees, it allows for summary descriptions of the degree of interdisciplinarity of various clinical departments. Finally, when applied to relationships among leaders of an institution-wide research enterprise, it highlights potential problem areas in relationships among academic departments. In all cases, data collection is relatively rapid and simple, thereby allowing for the possibility of frequent repeated analyses over time.

Conclusions: SNA provides a useful and standardized set of tools for measuring important aspects of team function, interdisciplinarity, and organizational culture that may otherwise be difficult to measure in an objective way.

La construcción del carácter: Un modelo para la Práctica Reflexiva de la Medicina

In 1950, Harrison and colleagues proposed that the physician's ultimate and sufficient destiny should be to "build an enduring edifice of character." Recent work in philosophy underscores the importance of character ethics (virtue ethics) as a complement to ethical systems based on duty (deontology) or results (consequentialism).

Recent work in psychology suggests that virtues and character strengths can, to at least some extent, be analyzed and taught. Building character might be enhanced by promoting among students, residents, and faculty a four-step method of reflective practice that includes (1) the details of a situation, (2) the relevant virtues, (3) the relevant principles, values, and ethical frameworks, and (4) the range of acceptable courses of action. Exercises using such a model bring together the major goals of ethics education in U.S. medical schools-teaching the set of skills needed for resolving ethical dilemmas and promoting virtue and professionalism among physicians.

Reference

Building Character: A Model for Reflective Practice. Academic Medicine. 2009; 84(9):1283-1288.

Resúmenes: Medical Student Perceptions of Education in Health Care Systems

Purpose: Undergraduate medical education has been criticized for not keeping pace with the increasing complexity of the U.S. health care system. The authors assessed medical students' perceptions of training in clinical decision making, clinical care, and the practice of medicine, and the degree to which the intensity of education in health care systems can affect perceptions.

Method: The authors studied data from 58,294 U.S. medical graduates who completed the Association of American Medical Colleges annual Medical School Graduation Questionnaire (2003-2007). In a second analysis, they compared responses of 1,045 medical school graduates (2003-2007) from two similar medical schools with curricula of different intensity in health care systems.

Results: The percentage of students reporting "appropriate" training was 90% to 92% for clinical decision making, 80% to 82% for clinical care, and 40% to 50% for the practice of medicine. Students from the school with a higher-intensity curriculum in health care systems reported higher satisfaction than students from the school with a lower-intensity curriculum for training in four of five practice of medicine components: medical economics, health care systems, managed care, and practice management. Importantly, the high commitment to education in health care systems in the higher-intensity curriculum did not lead to lower perceived levels of adequate training in other domains of instruction.

Conclusions: Nationally, students consistently reported that inadequate instructional time was devoted to the practice of medicine, specifically medical economics. A higher-intensity curriculum in health care systems may hold substantial potential to overcome these perceptions of training inadequacy.

Reference

Medical Student Perceptions of Education in Health Care Systems. Academic Medicine. 2009; 84(9):1301-1306.

Libros: The nonphysician medical educator (El educador médico, no médico)

"The nonphysician medical educator" by Riesenberg and colleagues includes three topics: the history of medical education, the participation of nurses and allied health professionals as medical educators, and the growth of medical education programs.

Each introduced a set of questions deserving further inquiry that might be categorized into the following themes: defining history, linking to conceptual models, cataloguing master's programs, and establishing evidence. In terms of history, it is useful to look at the broader context of the early 20th century and reflect on why physicians reached out to nonphysician educators.

Riesenberg and colleagues' illustrative review of teaching by nurses and allied health professionals raised multiple interesting possibilities for linking to conceptual models stemming from, for example, communication, teamwork, and coteaching theories. Regarding the multitude of master's in medical education programs and certificates, perhaps it is time to develop and maintain a listing of programs with detailed descriptions of target audiences and curricula.

Finally, there are multiple ways that the observations made by Riesenberg and colleagues might be better informed by data. Why is there not more literature that documents the importance of and contributions by nonclinician nonphysician educators? Several potential reasons are provided. Overall, the message that clinical nonphysicians can be successful educators came through loud and clear.

Resúmenes: The Development of a New Method of Knowledge Assessment: Tailoring a Test to a Doctor's Area of Practice

The practice of clinical medicine is becoming increasingly specialized, and this change has increased the challenge of developing fair, valid, and reliable tests of knowledge, particularly for single candidates or small groups of candidates. The problem is particularly relevant to the UK's General Medical Council's Fitness to Practice procedures, which investigate individual doctors, in such cases, there is a need for an alternative to the conventional approach to reliability estimation that will still allow the delivery of reproducible and standardized tests.

This report describes the three-year process (starting in 2005) of developing a knowledge test that can be tailored for individual doctors practicing in narrowly specialized fields or at various stages in their training.

The process of test development for this study consisted of five stages: item writing, to create individual questions; blueprinting, to establish the content and context that each item might test; standard setting, to calculate for each question a theoretical probability that a doctor of just-adequate capability would answer the question correctly; reference data collection, to determine for each item the distribution of scores to be expected from a large population of doctors in good standing; and test assembly, to select sets of questions that together formed complete and balanced tests. Tailored testing is a valid, feasible, and reproducible method of assessing the knowledge of one doctor or small groups of doctors who are practicing in narrow or subspecialty areas.

Reference

The Development of a New Method of Knowledge Assessment: Tailoring a Test to a Doctor's Area of Practice. Academic Medicine. 2009; 84(8):1003-1007.

Crisis de valores

Creatividad en el aula ...

Teoría del Infierno

La siguiente pregunta fue hecha en un examen trimestral de química en laUniversidad de Toronto.

La respuesta de uno de los estudiantes fue tan"profunda" que el profesor quiso compartirla con sus colegas, vía Internet,razón por la cual podemos todos disfrutar de ella.Pregunta: ¿Es el Infierno exotérmico (desprende calor) o endotérmico (loabsorbe)?La mayoría de estudiantes escribieron sus comentarios sobre la Ley de Boyle(el gas se enfría cuando se expande y se calienta cuando se comprime).

Un estudiante, sin embargo, escribió lo siguiente:"En primer lugar, necesitamos saber en qué medida la masa del Infiernovaría con el tiempo. Para ello hemos de saber a que ritmo entran las almasen el Infierno y a que ritmo salen. Tengo sin embargo entendido que, unavez dentro del Infierno, las almas ya no salen de él. Por lo tanto, no seproducen salidas.En cuanto a cuantas almas entran, veamos lo que dicen las diferentesreligiones. La mayoría de ellas declaran que si no perteneces a ellas,irás al Infierno. Dado que hay más de una religión que así se expresa ydado que la gente no pertenece a más de una, podemos concluir que todas lasalmas van al Infierno.Con las tasas de nacimientos y muertes existentes, podemos deducir que elnúmero de almas en el Infierno crece de forma exponencial.

Veamos ahoracómo varía el volumen del Infierno. Según la Ley de Boyle, para que latemperatura y la presión del Infierno se mantengan estables, el volumendebe expandirse en proporción a la entrada de almas.Hay dos posibilidades:(1) Si el Infierno se expande a una velocidad menor que la de entrada dealmas, la temperatura y la presión en el Infierno se incrementarán hastaque éste se desintegre.(2) Si el Infierno se expande a una velocidad mayor que la de la entradade almas, la temperatura y la presión desminuirán hasta que el Infierno secongele.

¿Qué posibilidad es la verdadera?:Si aceptamos lo que me dijo Lucía en mi primer año de carrera ("hará frío en el Infierno antes de que me acueste contigo"), y teniendo en cuenta que me acosté con ella ayer noche, la posibilidad número 2 es la verdadera.Doy por tanto como cierto que el Infierno es exotérmico y que ya estácongelado.

El corolario de esta teoría es que, dado que el Infierno ya está congelado, ya no acepta más almas y está, por tanto, extinguido...dejandoal Cielo como única prueba de la existencia de un ser divino, lo queexplica por qué, anoche, Lucía no paraba de gritar "¡Oh, Dios mío! "

Dicho estudiante fue el único que sacó sobresaliente.