ABSTRACT
Resumen Chile tiene una alta prevalencia de tabaquismo en población general. Esta patología es un factor de riesgo en numerosas enfermedades crónicas no transmisibles como el cáncer, enfermedades cardiovasculares y respiratorias y diabetes. La Guía Chilena del Tratamiento del Tabaquismo recomienda fuertemente usar consejería breve para todos los fumadores. Se describe las bases teóricas de una consejería efectiva y diferentes estrategias para la realizar esta consejería. Para la consejería breve se describe el ABCd, estrategia recomendada en las Guías Chilenas. Las 5As son muy similares al ABC; también las 5Rs pueden ayudar a motivar fumadores para dejar de fumar. Se propone algunas de las estrategias de la entrevista motivacional para ayudar a motivar el cambio, tanto cuando se realiza consejería breve como para cuando el profesional disponga de más tiempo. Estas intervenciones son para todo fumador, aunque, se debe priorizar en grupos de alto riesgo.
Chile has a high prevalence of smoking in the general population. Smoking is a risk factor in numerous chronic diseases such as cancer, cardiovascular disease, respiratory disease and diabetes. The Chilean Guidelines for the Treatment of Smoking strongly recommend brief advice for all smokers. This article describes the theoretical basis for effective advice and also different counselling strategies for all of the health team. For brief advice, the ABCd, the strategy recommended in the Chilean Guidelines, is described together with the 5As strategy. The 5Rs strategy is proposed to help motivate smokers who are not ready to quit smoking. Some of the strategies of the motivational interview are proposed to help motivate behavioural change during brief advice and when the professional has a little more time. These interventions are for all smokers, although high-risk groups should be given priority.
Subject(s)
Humans , Adult , Tobacco Use Disorder/physiopathology , Tobacco Use Disorder/epidemiology , Smoking Cessation , Motivational Interviewing , Chile/epidemiology , Chronic Disease , Health Strategies , Practice Guidelines as Topic , CounselingABSTRACT
Simulated patients (SP) are now used in the majority of the institutions that train health care professionals in patient-centered care. This article summarizes the information about the use of SP in health education using information from the literature and from the 15 years experience in the medical school of the Pontificia Universidad Católica de Chile. It describes the different definitions in use, the roles and scenarios that can be used when teaching with SP and the organization that any institution working with SP should have in order to promote the optimal use of SP. Working with SP allows faculty to center their teaching on their students while keeping the focus on the patient. Students appreciate learning with SP and particularly value feedback from the patients perspective.
Subject(s)
Humans , Patient Simulation , Patient-Centered Care , Education, Medical, Undergraduate/methods , Learning , ChileABSTRACT
Objetivos. Describir la experiencia y resultados de la implementación de un programa de formación en docencia para profesores de Medicina del Diplomado en Educación Médica, desarrollado en la Escuela de Medicina de la Pontificia Universidad Católica de Chile. Materiales y métodos. Estudio descriptivo, transversal, de carácter cuantitativo y cualitativo. La población estuvo compuesta por todos los graduados del programa hasta el 2011. Se aplicó un cuestionario con preguntas abiertas y cerradas explorando diferentes niveles de impacto, utilizando el modelo de evaluación de Kirkpatrick. Resultados. Sobre el 97% expresó un alto grado de satisfacción (nivel 1 Kirkpatrick). La mayoría reportó cambios en el aprendizaje de conocimientos y competencias docentes (nivel 2 Kirkpatrick) con diferencias pre y posretrospectivas estadísticamente significativas. El 93% refirió haber mejorado globalmente su desempeño docente y sobre el 85% en desempeños específicos (nivel 3 Kirkpatrick). En el nivel 4 de Kirkpatrick, la mayoría percibió un incremento del interés por la docencia y 69% reconoció una mayor valoración a nivel institucional. Del análisis cualitativo emergieron cinco categorías: valoración de la docencia y de la formación en docencia, relevancia de las habilidades docentes, aporte de la docencia al rol profesional, contribución al desarrollo personal y fortalecimiento de la comunidad académica. Conclusiones. Los efectos de este programa de formación en educación médica han sido positivos. Los profesores de Medicina, además de perfeccionar sus desempeños docentes, perciben cambios en el desarrollo personal, en su rol de médico, en la comunidad académica y en la institución...
Objectives. To describe the experience and results of the implementation of a faculty development program for professors of Medicine in the Medical Education Certificate program developed at the School of Medicine, Pontificia Uniersidad Catolica de Chile. Materials and methods. This was a descriptive, cross-sectional, quantitative and qualitative study. The population consisted of all graduates of the program until 2011. A questionnaire with open and closed-ended questions was applied, exploring different levels of impact using the Kirkpatrick evaluation model. Results. Over 97% expressed a high degree of satisfaction (Kirkpatrick level 1). Most respondents reported changes in learning, knowledge and teaching skills (Kirkpatrick Level 2) with statistically significant differences in retrospective pre-post questionnaires 93% reported having improved their teaching performance generally, and 85% in a specific performance (Kirkpatrick Level 3). At level 4 of the Kirkpatrick evaluation model, most perceived an increased interest in teaching and 69% reported being valued more highly at the institutional level. Five categories emerged from the qualitative analysis: value given to teaching and of training in teaching, importance of teaching skills, the contribution of teaching to the professional role, contribution to personal development and strengthening of the academic community. Conclusions. The effects of this faculty development program in medical education have been positive. Professors of Medicine, in addition to improving their teaching performance, perceived changes in personal development, in their role as physicians, in the academic community and in the institution...
Subject(s)
Humans , Male , Adult , Female , Staff Development , Faculty, Medical , Education, Medical , Teaching , Chile , Epidemiology, Descriptive , Cross-Sectional StudiesABSTRACT
Background: In medical education there has been increasing emphasis on faculty development programs aimed at the professionalization of teaching and increasing students' learning. However, these programs have been shown to have an impact beyond improvement in teaching skills. The medical school of the Pontificia Universidad Católica de Chile (EMUC) has been running a faculty development program (DEM) since 2000. Aim: To explore the perception of graduates on the effects of having participated in DEM on their development as teachers and clinicians. Material and Methods: Using an exploratory, descriptive and qualitative design, the 79 teachers who graduated from DEM from 2004-2008 were sent a questionnaire containing three open questions. Their answers were analyzed using the Constant Comparative Method of Qualitative Analysis of Glaser and Strauss by four researchers. Results: Faculty development, becoming a better clinician, personal development, appreciation of the value of teaching and strengthening of the academic community were the five categories that emerged from the answers. Graduates felt that, besides learning new educational skills, they changed their attitude towards teaching. DEM was perceived as facilitating self-awareness and refection about the graduates' role as doctors and teachers. The graduates also valued meeting other faculty. Conclusions: Faculty development programs can have an impact far beyond the learning objectives. The planning and design of programs contributes to their wider impact. This should be taken into consideration in the design, planning, and evaluation of faculty development programs. Care should be taken to protect time for participation, refection and for interaction with other academics.
Subject(s)
Female , Humans , Male , Education, Medical/standards , Faculty, Medical , Program Development/standards , Staff Development , Chile , Qualitative Research , Schools, MedicalABSTRACT
Background: Since 2000, the medical school of the Catholic University of Chile (EMUC) has offered courses for its faculty as part of a Diploma in Medical Education (DEM). However by 2009, 41% of faculty had never taken any courses. Aim: To explore the reasons why faculty choose not to participate in these courses. Material and Methods: Semi-structured interviews to seven faculty members, all of whom have an active role in teaching but who had not taken any DEM courses. The sampling was intentional and guided by theory. Based on Grounded theory, the data was analyzed using open, axial and selective coding. Results: Three categories emerged from the analysis. First, the characteristics of a "good teacher" and what it means to be a good teacher. Second, the current status of teaching. Third, the barriers to participate in courses of DEM. Non-attendance is multifactorial; teaching is seen as a natural skill that is difficult to be trained, teaching has a lower priority than other activities, and there are many barriers perceived for attendance. Conclusions: With these results we developed a model to explain the reasons why faculty choose not to participate in these courses. The lower value of teaching and the multiple roles that teachers have, are highlighted.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Education, Medical , Faculty, Medical/standards , Program Development/methods , Schools, Medical , Staff Development/standards , Chile , Qualitative ResearchABSTRACT
Background: The first part of the medical interview is perhaps one of the most significant components of the doctoras role. How to collect relevant information and how to build a therapeutic relationship with the patient must be taught during the undergraduate curriculum. Clinical teachers have little experience in the teaching skills required to help students learn about doctor-patient communication. Aim: To measure outcomes and perceptions of using a co-teaching model in a course on interviewing during the third year of medical school in the Pontificia Universidad Católica de Chile. Material and Methods: A mixed methods controlled study in which the intervention group participated in a co-teaching workshop with a clinical teacher and a specialist in doctor-patient communication skills (SDPC). The control group participated in a workshop with one clinical teacher. All students completed a questionnaire measuring perception of their learning in communication skills. Semi-structured interviews were used to collect the clinical teachers' perception. At the end of the course, the clinical and communication skills of all the students were measured in an objective structured clinical examination. Results: Students and teachers agreed that co-teaching allows greater emphasis and practice in communication skills. The results of the objective structured clinical examination show that despite this greater emphasis, no deleterious effect on the clinical skills was demonstrated during the exam. Conclusions: The use of co-teaching in a course on interviewing allows students to perceive a higher level of learning in communication skills, and possibly enhances their skills. The clinical teachers felt that the co-teacher was an important support.
Subject(s)
Humans , Communication , Education, Medical, Undergraduate , Medical History Taking/methods , Physician-Patient Relations , Teaching/methods , ChileABSTRACT
Cada vez más se acepta que la atención integral en salud requiere un foco de abordaje que esté puesto en la persona y su familia y no solo en la enfermedad o sus consecuencias. En concordancia con esta idea, con los objetivos propuestos para los Programas de Postítulo de Medicina Familiar de la Pontificia Universidad Católica de Chile, con las necesidades percibidas por docentes y residentes y con la literatura disponible en relación con el currículo de esta especialidad, se trabajó en la revisión de la formación que los residentes de estos programas recibían con respecto a aspectos psicosociales y familiares. En respuesta a este análisis, se trabajó en la definición de las competencias específicas en el ámbito psicosocial familiar deseables para los egresados de nuestros Programas de Postítulo. De acuerdo con las conclusiones de este trabajo, se revisó y replanteó el currículo vigente. Este artículo resume y presenta el proceso de diseño e implementación de un programa docente específico para la formación en competencias del ámbito psicosocial familiar para los residentes de los programas mencionados. (AU)
- Increasingly it is accepted that comprehensive health care approach requires that the focus has to be placed on the person and his family and not just the disease or its consequences. Consistent with this idea, the proposed objectives of the post graduate programs of Family Medicine at Pontifical Catholic University of Chile, focused on the perceived needs of teachers and residents based on the literature available on this area, we worked in reviewing the training that residents of these programs received regarding family, and psychosocial aspects.In response to this analysis, we worked on the definition of specific skills in the family psychosocial environment desirable for graduatesfrom our post graduate programs. According to the findings of this work the current curriculum was reviewed and reconsidered.This article summarizes and presents the process of designing and implementing a specific educational program for training in skills offamily psychosocial environment for the residents of these programs.(AU)
Subject(s)
Humans , Male , Female , Psychosocial Support Systems , Health , Comprehensive Health Care , Family PracticeABSTRACT
Background: Medical practice in Chile has changed dramatically over the last few years. Patients have raised their expectations and there is a growing number of complaints, and malpractice lawsuits. The doctor-patient relationship plays a fundamental role in patient satisfaction and has also been identified as an issue in most medical lawsuits. Aim: To analyze the importance of doctor-patient communication in the complaints received in a university hospital in Chile. Material and Methods: Review ofall complaints received at the office for quality of care at a university hospital. Complaints classified in delay, manners and information categories were selected for further analysis. Results: Of a total of8931 complaints registered between 2001 and 2008, 635 (19 percent) involved a doctor. Fifty one per cent of the latter, were related to the doctor-patient relationship. Of these, 146 cases (45 percent) were further classified as "Dysfunctional delivery of Information", 74 cases (23 percent) as "Not understanding the patient/'family's perspective", 54 cases (17 percent) as "Discrediting the patient or family's views" and 49 cases (15 percent) as "Lack of communication". Conclusions: The percentage of complaints related to communication with the doctor is high, though lower than cited in other studies. The most common complaint is the dysfunctional delivery of information.
Subject(s)
Humans , Communication , Malpractice/statistics & numerical data , Patient Satisfaction/statistics & numerical data , Physician-Patient Relations , Chile , Dissent and Disputes , Hospitals, University , Surveys and Questionnaires , Retrospective StudiesABSTRACT
Effective Communication Skills form part of what is being a good doctor. There is a solid evidence base that defines the components of effective communication. This article offers a practical conceptual framework to improve physician patient communication to a professional level of competence. There are six goals that physicians and patients work to achieve through their communication with each other. These are to construct a relationship, structure an interview, start the interview, gather information, explain, plan and close the interview. The outcomes that can be improved with an effective communication and the "first principles" of communication are described. A brief look at the historical context that has influenced our thinking about communication in health care is carried out. Finally, the Calgary Cambridge Guide, an approach for delineating and organizing the specific skills required of an effective communication with patients is described. It is clear from the literature that better communication skills improve patient satisfaction and clinical outcomes.
Subject(s)
Humans , Clinical Competence , Communication , Physician-Patient Relations , Practice Guidelines as TopicABSTRACT
Effective clinical teaching is an imperative of medical education. Clinical teachers and faculty development initiatives as well as Medical Schools, need to focus their efforts to pursue common outcomes: effective learning in students, future competent physicians and healthy patients. Excellence in quality of teaching needs scholars in education. To achieve this objective, institutions must recruit a core of medical faculty according to its mission, define the attributes and teaching competences, implement faculty development programs, and finally, support academic vitality. This article describes the three main issues of medical teaching: faculty, faculty development and its organization.
Subject(s)
Humans , Education, Medical/organization & administration , Faculty, Medical/standards , Staff Development/methods , Teaching/standards , Education, Medical/standards , Professional RoleABSTRACT
Community Acquired Pneumonia (CAP) is the first cause of death by respiratory disease in Chile and the first specific cause of death in people over 80 years of age. The geriatric population has a greater risk of suffering pneumonia, its complications and consequently dying. This is not only related to chronological age but also to certain factors related to ageing such as the presence of comorbidity, malnutrition, and cognitive impairment. An atypical presentation that delays the diagnosis and treatment also increases the risk of complications. CAP in the elderly is caused by the same pathogens that cause it in younger patients. S pneumoniae is the main pathogen followed by viral infections particularly in winter. An important strategy to reduce CAP related health costs, is the identification of patients who are at low risk of complications and who therefore could be managed at home. Optimum management of CAP in the elderly includes early diagnosis and the definition of clinical severity, early antibiotic treatment at the right dose and for an adequate length of time and a correct decision whether the patient should be managed in hospital or at home.