Competencias en medicina legal para médicos recién egresados: opinión de experto / Competences in legal medicine to recently graduated doctors: expert opinions / Competências em medicina jurídica a médicos recentemente graduados: opiniões de expertos

El escenario actual en el ámbito de la salud y del derecho, plantea cambios que ponen de manifiesto la necesidad de mayor conocimiento en materias concernientes a la medicina legal: la judicialización del ejercicio médico y el aumento exponencial de reclamaciones por malpraxis, demandan una profundización en la formación deontológica. Además, la implementación de la Reforma Procesal Penal, exige fortalecer el nivel judicial y forense, máxime cuando varias disposiciones legales establecen que la actividad pericial no es privativa de los especialistas que laboran en el Servicio Médico Legal. Con el propósito de contribuir a la formación de los futuros médicos en el ámbito de la Medicina Legal considerando las actuales normativas jurídicas involucradas en el área de la salud, se realizó una investigación cualitativa, exploratoria, descriptiva, con una muestra no probabilística, intencionada, por conveniencia, conformada por un médico especialista en Medicina Legal, previa firma Consentimiento Informado. Para recolectar los datos se recurrió a una entrevista en profundidad. El análisis y recogida de ellos se realizó en forma simultánea a través del método de comparación constante, siguiendo un esquema de reducción progresiva. La rigurosidad científica del estudio estuvo determinada por cuatro criterios de rigor: valor de verdad (credibilidad), aplicabilidad (transferibilidad), consistencia (dependencia) y neutralidad (confirmabilidad), realizándose la triangulación por investigadores. En el nivel 1 se encontraron 9 categorías: "muerte", "autopsia", "lesiones", "salud mental", "sexología", "laboratorio forense", "documentos medicolegales", "reforma procesal" y "competencia genérica". En el Nivel 2 se identificaron tres núcleos temáticos "Requisitos de Tanatología en el Plan de Estudio", "Aspectos a considerar en el Plan de Estudio con respecto a Lesionología" y "Relación teórico práctica de los contenidos de Medicina Legal". En el Nivel 3: emerge un dominio cualitativo: "Competencias disciplinares y genéricas a considerar en el Plan de Estudio con respecto a contenidos de la Asignatura de Medicina Legal". Lo disciplinar incluye la Tanatología, Lesionología, Sexología Forense, Evidencia Física. Lo genérico en función a la relación médico paciente y su responsabilidad profesional. Considerando que el propósito del estudio es contribuir a la formación de los futuros médicos en el ámbito de la Medicina Legal mediante el rediseño del programa de la asignatura, a través del experto, se puede deducir que todos los contenidos están explícitos en la actividad curricular. Además, es importante señalar que la terminología utilizada es similar a la consignada a nivel nacional. Sin embargo, las actividades prácticas de estos aprendizajes no están claramente explicitadas. Los resultados corroboran la inexistencia de las competencias disciplinares y genéricas en el ámbito de la Medicina Legal para la labor asistencial de un médico que se desempeña en un Servicio de Urgencia o en la Atención Primaria de Salud. Esto induce a continuar la línea de trabajo en orden a consultar a los egresados(as), en relación a su formación de pregrado en todos los aspectos forenses considerando diferentes áreas y ámbitos laborales.

The current scenario in the field of health and law, poses changes which seek for more knowledge in matters concerning legal medicine: the prosecution of medical practice and the exponential increase in claims for malpractice, seeking a deepening of ethics training. In addition, the implementation of the Criminal Procedure Reform requires strengthening the judicial and forensic level, especially when several statutory provisions establish the expert activity is not exclusive to the specialists working in the Legal Medical Service. In order to contribute the training of future doctors in the field of Legal Medicine considering the current legal regulations involved in the area of health, a qualitative research was conducted, exploratory, descriptive, with a non-probabilistic, intentional sample, convenience, made by a medical specialist in Legal, Medicine prior Informed Consent signature. To collect the data an in-depth interview was used to. The analysis and collection of them was conducted simultaneously through the constant comparison method, following a progressive reduction scheme. The scientific rigor of the study was determined by four criteria of rigor: truth value (credibility), applicability (portability), consistency (dependence) and neutral (Confirmability), carried out by researcher's triangulation. At level 1, 9 categories were found: "Death," "autopsy", "injury", "mental health," "sexology", "forensic laboratory", "legal medical documents", "judicial reform" and "generic competition". At Level 2 three important thems were identified "Thanatology requirements in the Curriculum", "Aspects to consider in the Study Plan regarding "damage" (Lesionología) and "practical theoretical ratio of the contents of Legal Medicine". In level 3: qualitative domain emerges: "Disciplinary competences and generic to be considered in the Study Plan regarding contents of the Subject of Legal Medicine". The discipline includes Thanatology, Damage (Lesionología), Forensic Sexology, Physical Evidence. The generic depending on the doctor-patient relationship and professional responsibility. Whereas the purpose of the study is to contribute to the training of future doctors in the field of Legal Medicine by redesigning the program of the subject, through the expert, one can deduce that all of the contents are explicit in the curricular activity. It is also important to point out that the terminology used is similar to that recorded nationally. However, the practical activities of these learnings are not clearly explicit. The results confirm the existence of disciplinary and generic in the field of Legal Medicine for the welfare work of a doctor who serves on an emergency service or primary health care. This leads to continue the line of work in order to consult graduates (as), in relation to their undergraduate training in all aspects forensic considering different areas and fields of work.

O cenário atual no campo da saúde e do direito, Propõe mudanças que procuram mais conhecimentos em matéria de medicina legal: O julgamento da prática médica eo aumento exponencial de reclamações por negligência, Buscando um aprofundamento do treinamento em ética. Além, a implementação da Reforma Processual Penal requer o fortalecimento do nível judicial e forense, especialmente quando várias disposições legais estabelecem que a actividade de peritos não é exclusiva dos especialistas que trabalham no Serviço Jurídico Médico. A fim de contribuir com a formação de futuros médicos no campo da Medicina Legal considerando as atuais normas legais envolvidas na área de saúde, foi realizada uma investigação qualitativa, exploratório, descritivo, com uma amostra não-probabilística, intencional, conveniência, feita por um médico especialista em Legal, Medicina assinatura de Consentimento Livre e Esclarecido. Para recopilar os dados são utilizados numa entrevista em profundidade. A análise e coleta dos mesmos foi realizada simultaneamente através do método de comparação constante, Seguindo um esquema de redução progressiva. O rigor científico do estudo foi determinado por quatro critérios de rigor: valor de verdade (credibilidade), aplicabilidade (portabilidade), consistência (dependência) e neutro (Confirmabilidade), realizado pela triangulação do investigação No nível 1, foram encontradas 9 categorias: "morte", "autópsia", "lesão", "saúde mental", "sexologia", "laboratório forense", "documentos médicos legais", "reforma judicial" e "concorrência genérica". No Nível 2 foram identificados três temas importantes "requisitos de Tanatologia no Currículo", "Aspectos a considerar no Plano de Estudo referentes ao" dano "(Lesionología) e" razão teórica prática dos conteúdos da Medicina Legal "". No nível 3: domínio qualitativo emerge: "Competências disciplinares e genéricas a serem consideradas no Plano de Estudo sobre os conteúdos do Sujeito de Medicina Legal". A disciplina inclui Thanatology, daño (Lesionología), Sexología Forense, Evidencia Física. El genérico depende de la relación médico-paciente y de la responsabilidad profesional. Considerando que o objectivo do estudo é contribuir para a formação dos futuros médicos no campo da medicina forense por redesenhar o programa do assunto através do perito, se pode deduzir a totalidade do conteúdo são explícitos na actividade curricular. Também é importante ressaltar que a terminologia utilizada é semelhante à registrada nacionalmente. No entanto, as atividades práticas desses aprendizados não são claramente explícitas. Os resultados confirmam a existência de disciplina e genéricos no campo da Medicina Legal para o trabalho assistencial de um médico que presta serviços de emergência ou cuidados primários de saúde. Isto leva a continuar a linha de trabalho, a fim de consultar os graduados, em relação à sua formação de graduação em todos os aspectos Considerando diferentes áreas forense e campos de trabalho.

Aprendizaje basado en problemas (ABP) como estrategia para adquisición de competencias genéricas: estudiantes de nutrición y dietética, Universidad de La Frontera / Problem-based learning as a strategy for acquisition of generic skills: students of nutrition and dietetics, Universidad de La Frontera

The study of generic skills in the training of health professionals has become an instrument of increasing value to the institutions of higher education and health centers. In order to know in detail the opinions of students of the career of nutrition and dietetics of the Faculty of Medicine, Universidad de La Frontera, Temuco-Chile related to the generic competences acquired during their training process, 5th year students took part in two focus groups, after signing an informed consent. The analysis of data followed a scheme of progressive reduction of them, validating by triangulation of researchers. The results represent the consistency that must exist between study and educational plan didactics in the development of the generic competences, so necessary nowadays for the work insertion of health professionals.

El estudio de competencias genéricas en la formación de profesionales de la salud se ha convertido en un instrumento de valor creciente para las instituciones de educación superior y centros asistenciales. Con el objetivo de conocer en detalle las opiniones del alumnado de la Carrera de Nutrición y Dietética, de la Facultad de Medicina de la Universidad de La Frontera, Temuco-Chile relacionadas con las competencias genéricas adquiridas durante su proceso de formación, se realizó una investigación cualitativa, mediante estudio de caso. Participaron estudiantes de 5° año en dos grupos focales, previa firma de consentimiento informado. El análisis de datos siguió un esquema de reducción progresiva de ellos, validándose por triangulación de investigadores. Los resultados representan la congruencia que debe existir entre el plan de estudio y didáctica educativa en el desarrollo de competencias genéricas, tan necesarias en el mundo actual para la inserción laboral de profesionales de la salud.

Opinión de estudiantes de enfermería sobre el examen clínico objetivo estructurado / Nursing students’ opinion about the objective structured clinical examination

Investigación educativa bajo el paradigma cualitativo, a través de un estudio de caso, cuyo objetivo es conocer el significado que tiene para los estudiantes de segundo año de la Carrera de Enfermería el sistema de evaluación ECOE al finalizar la práctica clínica, Módulo Enfermería Básica del Niño, Adolescente y Adulto, del cuarto nivel académico, año 2007. Los estudiantes a partir de sus historias personales individuales, al final del ECOE respondieron una encuesta semiestructurada donde debían mencionar ventajas, desventajas, sugerencias. El análisis de datos siguió el esquema de Miles y Huberman, a través de la reducción progresiva de ellos (separación de unidades, agrupamiento, identificación y clasificación de elementos), disposición, transformación y obtención de conclusiones verificables, validándose a través de la triangulación por investigadores. En las ventajas se identificaron 88 unidades de significado, finalizando en tres dominios cualitativos “proceso de evaluación”, “reconocimiento de competencias genéricas adquiridas en el proceso de evaluación ECOE” y “proceso de gestión y administración del ECOE”. En las desventajas hubo 139 unidades de significado, originando dos dominios cualitativos “reconocimiento de competencias genéricas adquiridas en el proceso de evaluación ECOE” y “proceso de gestión y administración del ECOE”. Los resultados evidencian que el ECOE al igual que cualquier sistema de evaluación provoca en los estudiantes ansiedad, estrés. Reconocen que mide destrezas, actitudes y favorece la retroalimentación con el examinador. Para futuros ECOE, de acuerdo a las opiniones de los educandos, se debe considerar el momento de su aplicación y minimizar el tiempo de espera para ser examinados.

Educational research under qualitative paradigm through a case study aiming to raise awareness of the meaning that OSCE assessment system has for second year Nursing students at the end of the clinical practice of Basic Nursing in child, adolescent and adult modules, given in the fourth level, 2007. At the end of the OSCE and from their own personal stories the students answered a semi-structured survey where they had to mention advantages, disadvantages and suggestions. Data analysis followed the scheme proposed by Miles and Huberman (1994), through the progressive reduction of the data (separate units, clustering, identification and classification of items), provision, processing and obtaining verifiable findings, validating them through researcher triangulation. As for the advantages, 88 units of meanings were identified, ending up in three qualitative domains “evaluation process”, “recognition of generic skills acquired in the OSCE assessment process” and “administration and process management of the OSCE.” 139 units of meanings were identified as disadvantages, creating two qualitative domains: “recognition of generic skills acquired in the OSCE assessment process” and “process management and administration of the OSCE”. The results of this study show that the OSCE as well as any system of student assessment results in anxiety and stress. However, they recognize that measures skills, attitudes and encourages feedback from the examiner. For future, according to the student opinions OSCE should consider the time of application and minimize the time out for examination.

Aprendizaje basado en problemas multiprofesional: Estudio cualitativo desde la perspectiva de los tutores / Problem based learning from the perspective of tutors

Background: Problem based learning is a student centered learning technique that develops deductive, constructive and reasoning capacities among the students. Teachers must adapt to this paradigm of constructing rather than transmitting knowledge. Aim: To interpret the importance of tutors in problem based learning during a module of Health research and management given to medical, nursing, physical therapy, midwifery, technology and nutrition students. Material and methods: Eight teachers that participated in a module using problem based learning accepted to particípate in an in depth interview. The qualitative analysis of the textual information recorded, was performed using the ATLAS software. Results: We identiñed 662 meaning units, grouped in 29 descriptive categories, with eight emerging meta categories. The sequential and cross-generated qualitative analysis generated four domains: competence among students, competence of teachers, student-centered learning and evaluation process. Conclusions: Multiprofessional problem based learning contríbutes to the development of generic competences among future health professionals, such as multidisciplinary work, critical capacity and social skills. Teachers must shelter the students in the context of their problems and social situation.

Factores de riesgo cardiovascular en 15 nefrópatas de la ciudad de Temuco en diálisis crónica: comparación descriptiva con la población general chilena / Cardiovascular risk factors in 15 nephrology patients in maintenance dialysis of Temuco city: comparison with chilean general population

Patients in chronic hemodialysis have a high mortality due to cardiovascular diseases. To study cardiovascular risk factors and nutritional status in a group of patients in maintenance hemodialysis, body mass index, blood pressure, serum levels of total cholesterol, HDL cholesterol, triglycerides and albumin were measured in 15 patients (8 males). Data were compared with available figures for the normal chilean population. Age ranged from 33 to 60 years oldin female patients and from 22 to 63 years old in males. Thirteen subjects (87 percent) has a high blood pressure, all had HDL cholesterol levels below 35 mg/dl, 4 (27 percent) had a total cholesterol over 200 mg/dl, 3 had triglyceride levels over 200 mg/dl, 2 (13 percent) smoked and none were diabetic. Mean body mass index was normal, albumin levels were 4.16 and 4.02 g/dl and serum creatinine was 11.64 and 9.68 mg/dl in males and females respectively. The estimated prevalence of high blood pressure, hypercholesterolemia and smoking in the general chilean population range from 9 to 22 percent, from 50 to 52 percent and from 45 to 51 percent respectively. In conclusion, this group of patients has a high frequency of high blood pressure and low HDL cholesterol levels