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

Imaginarios Colectivos: ¿El médico de la actualidad?

Imaginarios Colectivos: ¿El médico de la actualidad?