ABSTRACT
Resumen: El aprendizaje de los estudiantes de Medicina de Pregrado en ambiente simulado constituye una alternativa en la obtención de competencias técnicas y no técnicas. Objetivo: Desarrollar un fantoma e implementar un taller modular de entrenamiento de paracentesis abdominal en ambiente simulado para estudiantes de Medicina. Métodos: Se diseñaron y desarrollaron modelos para la realización de paracentesis abdominal en la Escuela de Diseño de la Pontificia Universidad Católica de Chile (PUC) y se implementó un taller para alumnos de 4to año de Medicina de la PUC, utilizando un enfoque constructivista, sesiones de entrenamiento simulado con debriefing basadas en el modelo plus-delta y evaluación pre y post-procedimiento siguiendo los principios de evaluación para el aprendizaje. Resultados: Se desarrollaron 3 prototipos hasta llegar a un modelo definitivo de alta fidelidad basado en la percepción de 20 expertos. 237 alumnos asistieron a un taller de paracentesis abdominal en el Centro de Cirugía Experimental y Simulación Universidad Católica (UC). Este consistió en una actividad práctica grupal (7-8 alumnos por sesión) que incluyó: una evaluación pre-sesión, un vídeo instruccional, una demostración en tiempo real en el fantoma por parte de un docente, la realización guiada del procedimiento por parte de los alumnos, debriefing y cierre de la sesión. Conclusiones: Un modelo de enseñanza en ambiente simulado es posible de ser diseñado e implementado exitosamente en un centro educacional para estudiantes de Medicina de Pregrado. Este taller de paracentesis permite entrenar a los alumnos en la realización de paracentesis abdominal en un ambiente seguro para los alumnos y pacientes y puede ser implementado a bajo costo en otros centros o instituciones. (AU)
Abstract: Simulated environments are an option in the learning process of undergraduate medical students in order to obtain technical and non-technical. Aim: To develop a mannequin for abdominal paracentesis and the implementation of a training workshop to perform abdominal paracentesis in a simulated environment for undergraduate medical students. Methods: The prototypes were designed and developed to perform abdominal paracentesis at the School of Design at the Pontificia Universidad Católica de Chile (PUC) and a workshop was implemented in a course with 4-year medical students at the PUC, using a constructivist approach and simulated training sessions and providing debriefing (based on plus-delta model) and pre-post training assessment following the principles of Assessment for Learning. Results: Three prototypes were developed until the final high-fidelity-mannequin was achieved. The abdominal paracentesis workshop was attended by 237 students at the Universidad Católica (UC) Experimental Surgery and Simulation Center. This was a hands-on group activity (7-8 students per session) including pre-session assessment, instructional video-tape, real-time demonstration of abdominal paracentesis procedure by the clinical teacher, followed by abdominal paracentesis performed by the students, debriefing and closing session. Conclusions: A teaching model in a simulated environment is feasible to be successfully designed and implemented in an educational center for undergraduate medical students. This workshop allows students training process to perform abdominal paracentesis in a safe environment for students and patients and it can be implemented in other centers or institutions with low cost.(AU)
Subject(s)
Humans , Male , Female , Adaptive Clinical Trials as Topic , Students, Medical , Paracentesis , Education, Medical , AbdomenABSTRACT
Introduction: There is plenty of scientific evidence regarding the management of esophageal varices, but sometimes it is contradictory. International consensuses carried out in America and Europe are evidence based, however these do not include a comprehensive analysis on the quality of the studies. The purpose of this review is to establish a national consensus, by means of relevant questions regarding the management of gastroesophageal varices, to provide detailed information on related evidence, thus, establishing reasonable behaviors based on the national scenario. Methodology: The guidelines are organized following 15 clinically relevant questions on the management of gastroesophageal varices, including primary prophylaxis, interventional pharmacological, endoscopical and radiological treatment of variceal hemorrhage until secondary prophylaxis. Quality assessment of the evidence supporting each asseveration will be descriptive and will be based mainly in the design of the studies, adapted from the recommendations of the U.S. Preventive Services Task Force. Then, the group of experts will make a recommendation for each intervention in response to each question. The consensus will be achieved by a Delphi approach of 2 rounds, and the third round will be achieved in the national consensus to be carried out in June 2010 during the Course on Advances in Gastroenterology, with the participation of the audience, using an electronic board where the questions will be answered in actual time. Preliminary results: The survey includes 15 open questions which were distributed among the 12 experts who will provide responses according to levels/degrees of evidence and recommendations. Conclusions: Definitive results of the national consensus will be presented during the Course on Advances in Gastroenterology 2010 and will be published in the Gastroenterología Latinoamericana journal. This methodology can be replicated in the future in other areas ...
Introducción: La evidencia científica en relación al manejo de las várices gastroesofágicas es abundante y muchas veces contradictoria. Los consensos internacionales realizados en América y Europa son basados en la evidencia, sin embargo, no incluyen un análisis detallado de la calidad de los estudios incluidos. El objetivo de la presente revisión es establecer un consenso a nivel nacional, a través de preguntas relevantes en el manejo de las varices gastroesofágicas, detallar la evidencia relacionada y establecer así conductas racionales, considerando la realidad nacional. Metodología: Las guías están organizadas en relación a 15 preguntas clínicas relevantes en el manejo de las várices gastroesofágicas que incluyen la profilaxis primaria, tratamiento farmacológico, endoscópico y radiológico intervencional de la hemorragia variceal hasta la profilaxis secundaria. La evaluación de la calidad de la evidencia que sustenta cada afirmación se realizará en forma descriptiva, fundamentándose primordialmente en el diseño de los estudios, adaptado de las recomendaciones realizadas por la U.S. Preventive Services Task Force. Luego el panel de expertos realizará una recomendación para cada intervención en respuesta a cada pregunta clínica. El consenso se realizará mediante una técnica Delfi de 2 rondas y la tercera ronda se realizará durante el consenso nacional a realizarse en el curso de avances en gastroenterología en junio de 2010 con participación de la audiencia mediante teclera electrónica con respuestas en tiempo real. Resultados preliminares: La encuesta incluye 15 preguntas abiertas distribuidas entre el panel de 12 expertos nacionales que deberán responder de acuerdo a la pauta de niveles de evidencia y grados de recomendación. Conclusión: Los resultados definitivos del consenso nacional serán expuestos durante el curso de avances en gastroenterología 2010 y publicados en la Revista Gastroenterología Latinoamericana. Esta metodología puede ser...
Subject(s)
Humans , Consensus , Gastroenterology/methods , Evidence-Based Medicine , Esophageal and Gastric Varices , Chile , Practice Guidelines as Topic , Data Collection/methods , Decision Making , Delphi TechniqueABSTRACT
Background: Cholelithiasis is the second cause of hospital admissions in Chile. Aim: To study the prevalence of symptomatic gallstone disease and opportunity of cholecystectomy in La Florida, Santiago and among Mapuche Indians in Huapi Island. Patients and methods: In the period 2000-2001, we contacted to 71 percent (1127 subjects) and to 61 percent (145 subjects) patients of La Florida and Huapi Island, respectively, that had previously participated in an epidemiological study on cholelithiasis in 1993. We defined symptomatic gallstone patients as those with a history of biliary colic. Each patient was subjected to gallbladder ultrasound. Results: In 1993, 30-35 percent of gallstone patients were symptomatic (&70 percent women). During the lapse 1993-2001, only 50 percent of subjects from La Florida and 25 percent of patients from Huapi Island were cholecystectomized (p <0.05). Fifty percent of cholecystectomies were emergency operations. In 38 symptomatic Mapuche Indians from Huapi, cholecystectomy was indicated in 2001. After five months of the indication, only one of these subjects had been operated. Laparoscopic cholecystectomy represented 40 percent of all cholecystectomies performed in the National Health Service Hospitals. Conclusions: This study demonstrates an unacceptable high prevalence of symptomatic gallstone patients remaining non-operated in both the urban and rural communities. This reciprocally correlates with the high frequency of emergency cholecystectomies and the high incidence of gallbladder cancer among Chileans. This study contrasts negatively with the situation of Scotland, where 73.5 percent of cholecystectomies were laparoscopic in 1998-1999. To reach Scotland standards, the Chilean Public Health System should increase the number of cholecystectomies from 27,000 in 2001 to 57,510