ABSTRACT
Background: Practice is essential in clinical training and can be carried out with simulations. The medical school of the University of Chile performs Objective Structured Clinical Examinations (OSCE) using standardized simulated patients for interns. Aim: To report the experience with OSCE in an environment with a high number of students. Material and Methods: Four hundred sixty-two students, participated in three OSCEs during 2016 and 2017, during their internal medicine clerkship. Each OSCE consisted of five scenarios of ambulatory care patients with prevalent medical conditions. Every student had to perform history taking, physical examination and deliver a diagnostic hypothesis, and a plan for management and counseling. Simulated patients provided feedback. To assess validity and reliability, in an argument-based model, planning and activity development were declared. The results were evaluated according to students' and organization variables, internal consistency, interobserver and theoretical concordance tests. Results: No significant bias was found by demographic features or evaluation moment. Internal consistency was good (Cronbach 0.8). Simulated patient evaluators had a high correlation with medical evaluators (r = 0.7). There was a low correlation between OSCE results and theoretical tests. Conclusions: OSCE's continuously assess competences during internal medicine clerkship in an environment with a high number of students.
Subject(s)
Humans , Internal Medicine , Physical Examination , Students, Medical , Reproducibility of Results , Clinical Clerkship , Clinical Competence , Educational MeasurementABSTRACT
La cirrosis hepática es una patología frecuentemente que reconoce varias etiologías, siendo la más frecuente el consumo de alcohol. Independiente de su casa, su presentación clínica y sus complicaciones son similares y responsables de varios cuadros clínicos que provocan un deterioro de la calidad de vida del paciente, motivando su hospitalización y disminuyendo su sobrevida. El diagnóstico y manejo de las principales complicaciones de la cirrosis hepática ha progresado bastante, mejorando las perspectivas de vida los pacientes que las sufren. En el presente trabajo se presenta una revisión bibliográfica de los avances en el diagnóstico y manejo de las complicaciones de la cirrosis; el diagnóstico y tratamiento según la evidencia disponible.
Subject(s)
Humans , Liver Cirrhosis/complications , Liver Cirrhosis/diagnosis , Liver Cirrhosis/therapy , Ascites/diagnosis , Ascites/etiology , Ascites/therapy , Carcinoma, Hepatocellular/diagnosis , Carcinoma, Hepatocellular/etiology , Carcinoma, Hepatocellular/therapy , Liver Cirrhosis/etiology , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Peritonitis/diagnosis , Peritonitis/etiology , Peritonitis/therapyABSTRACT
La enfermedad tromboembólica venosa comprende la trombosis venosa profunda y el tromboembolismo pulmonar, con patogénesis y prevención comunes. El impacto de esta enfermedad se refleja en una considerable morbimortalidad que ha motivado a estudiar su patogénesis en busca de mejores métodos diagnósticos y terapéuticos. Fruto de lo anterior es que se ha reforzado el concepto de que la profilaxis es la medida más conveniente desde todo punto de vista, especialmente si se hace considerando una estratificación de riesgo y usando medidas comprobadamente útiles. Se exponen los grupos de riesgo definidos en la actualidad con sus correspondientes recomendaciones preventivas.