ABSTRACT
Durante la segunda mitad del siglo 20 se produjeron enormes avances en las ciencias naturales y en su aplicación tecnológica a la medicina, lo que trajo consigo espectaculares progresos en el diagnóstico y tratamiento. Sin embargo, este proceso de tecnificación de la actividad clínica ha tenido también consecuencias perjudiciales para el ejercicio profesional de la medicina y, muy en especial, para su enseñanza: fraccionamiento en múltiples especialidades inconexas, deshumanización y aumento desproporcionado de su costo Afortunadamente, estos graves problemas están siendo enfrentados por la Educación Médica mediante la incorporación al currículo del concepto de Profesionalismo y de disciplinas de valor general como la Ética Clínica, la Comunicación, la Medicina Basada en Evidencia y la Medicina Paliativa. En este artículo se abordan algunos de los principios y métodos en los que se recomienda fundar tanto la formación en ciencias básicas como en el razonamiento clínico, y los desafíos a los que se enfrentan los docentes en ambas áreas del currículo. Se describen los progresos en la evaluación de competencias y se enfatiza su rol como instrumento formativo. Se analizan las causas de la falta de continuidad en la relación docente-alumno que repercute tan negativamente en la formación profesional y se proponen soluciones para este serio problema. Finalmente se destaca el valor del docente como profesional de la enseñanza universitaria y su impacto sobre el nivel académico de una Escuela de Medicina.
During the second half of 20th century, there were prodigious advances in the field of natural sciences and their technological application to medicine and patient health care with spectacular progress in diagnosis and treatment of diseases. Nevertheless, this hi-tech approach of clinical care has also brought prejudicial consequences to professional practice and teaching in medicine: their break in multiple unconnected specialties, dehumanization, and a disproportionate increase of health expenses. Fortunately, Medical Education is facing these serious problems, developing the concept of Professionalism as a general competence in the curricula in addition to other related disciplines of general value such as Clinical Ethics, Communication, Evidence Based Medicine, and Palliative care. This article describes some educational principles and teaching methods useful for teaching the basic sciences as well as clinical reasoning, and the challenges that teachers in both areas of curricula have to face. It summarizes progress in assessment of general competences and its role in formative assessment. Also, discuss causes of lack of continuity in teacher-student relationship and their negative impact in professional training, and offers some possible solutions to fix it. Finally, develops some reflections about the value of clinical teachers as professionals of undergraduate medical teaching and its impact for academic life in a school of Medicine.
Subject(s)
History, 21st Century , Education, Medical/historyABSTRACT
During the last ten years different institutions from the medical, educational, political and administrative settings have performed studies and made recomendations towards a health reform in Chile. In spite of frequent and sometimes strong ideological differences, most of these studies share the diagnosis of the main deficiencies and shortcomings of our public and private health systems. Furthermore, many of their recommendations are converging towards broad solutions -based on technical reasons- for the insurance systems and for the primary, secondary and tertiary care leveles. This article tries to identify these convergences and describes the vital role of the Medical Schools in their eventual implementation
Subject(s)
Humans , Health Care Reform , Education, Medical/trends , Schools, Medical , Chile , Health Care Reform/trends , Health Facilities/organization & administration , Health Facilities/trends , Education, Medical/methods , Medicine/trendsSubject(s)
Humans , Certificate of Need , Medicine , Accreditation , Clinical Competence , PediatricsABSTRACT
The need to improve the quality of health care and to contain its costs has become mandatory. Simultaneously we are confronted by a growing body of clinical information, most of it irrelevant. This paper discribes the origin and methods of Evidence-Based Madicine, a new alternative to the usual ways of medical information. The recent development of computarized data bases in permitting the rapid location of relevant clinical information concerning specific questions on diagnosis, therapy or prognosis. Critical analysis is then used to determine the validity of the evidence obtained, which can be employed in clinical decision making. The future role of Evidence-Based Medicine in education and clinical practice seems highly promissory
Subject(s)
Humans , Evidence-Based Medicine/trends , Randomized Controlled Trials as Topic/trends , Evidence-Based Medicine , Quality of Health Care , Meta-Analysis , Publication BiasABSTRACT
Gallbladder stats apparently plays an important role in the pathogenesis of cholelithiasis during pregnancy. On the other hand, gallstones diagnosed immediatly after delivery disappear spontaneously during late puerperium in one third of these patients. Gallbladder emptying was assessed by biliary scintigraphy and ultrasonography in normal, multiparous volunteers. The two methods had an excellent correlation: thence, we used ultrasonography to determine gallbladder volume and contraction in pregnant and puerperal women. Fasting and postpandrial residual volumes were significantly larger during pregnancy, while the kinetics of gallbladder emptying was similar in nulliparous and pregnant women. During puerperium, gallbladder volume returned to the values observed in nulliparae; but the kinetics of emptying was significantly faster, suggesting an increased sensitivity of gallbladder muscle to physiologic stimuli
Subject(s)
Humans , Female , Pregnancy , Adult , Cholelithiasis , Gallbladder Emptying/physiology , Gallbladder/anatomy & histology , Pregnancy Complications , Pregnancy Trimester, Third/physiology , Ultrasonography , Postpartum Period/physiologyABSTRACT
The crisis of internal medicine is universal and its fragmentation is an increasing number of sub-specialties is still taking place, with the undesirable results of dehumanization, excesive technification and increasing costs. Recent data indicate the growing and worrisome shortage of general internists in our country. The Medical disadvantages of predominant care by sub-specialists are analized. The main features of the modern general internist are described. Changes in medical education and health policies to increase their number and professional quality are suggested