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OBJETIVO. Construir y validar un Caso Clínico Simulado-Online (CCS-Online) como herramienta de evaluación de Habilidades Clínicas de Comunicación (HCC) y Razonamiento Clínico (RC) en un Examen de Competencias Objetivamente Estructurado (ECOE) dirigido a estudiantes de medicina de la asignatura de Ginecología. MATERIAL Y MÉTODOS. Estudio cuantitativo descriptivo, en una prueba piloto se puso a consideración de jueces expertos y estudiantes un Caso Clínico Simulado-Online (CCS-Online) con 3 componentes básicos del diseño de Casos Clínicos Simulados con fines evaluativos: 1) Correlación entre objetivos de la evaluación y la herramienta evaluativa, 2) Coherencia interna de los elementos que conforman el CCS y 3) Fidelidad del Escenario Simulado, todos ellos recogidos en un cuestionario estructurado de 16 elementos, con asignación de rangos ordinales del 1 al 5 en una escala de Likert. Se utilizó el coeficiente Kappa de Fleiss y la escala de Landis para determinar el grado de acuerdo y la fuerza de concordancia entre los expertos consultados; y el test U de Mann-Whitney para comparar diferencias entre grupos. RESULTADOS. Jueces expertos y estudiantes concuerdan que el instrumento CCS-Online contiene en su diseño componentes y elementos que permiten evaluar las competencias de RC y HCC en un escenario virtual (Kappa 0,688 /0,757 p<0,001). La valoración media global fue de 4,65/5 y 4,41/5, para jueces y estudiantes respectivamente. CONCLUSION. Jueces expertos y estudiantes calificaron al CCSOnline como una herramienta de evaluación que cumple con un buen nivel los criterios de diseño necesarios para evaluar las competencias de Habilidades Clínicas de Comunicación (HCC) y el Razonamiento Clínico (RC) en el área de Ginecología.
OBJECTIVE. Build and validate a Simulated Clinical Case-Online (SCC-Online) as an evaluation tool for Clinical Communication Skills (CCS) and Clinical Reasoning (CR) in medical students of Gynecology, in an Objectively Structured Competency Examination (OSCE). Material and methods. Quantitative descriptive study, in a pilot test a Simulated Clinical Case-Online (SCC-Online) was submitted to the judment of a group of expert judges and students, the following 3 basic components of the design of Simulated Clinical Cases were presented 1) Correlation between the evaluation objectives and the evaluation tool, 2) Internal coherence of the elements that make up the SCC and 3) Fidelity of the Simulated Scenario, all of them collected in a structured questionnaire of 16 elements, with assignment in an ordinal ranks from 1 to 5 on a Likert scale. The Fleiss Kappa coefficient and the Landis scale were used to determine the degree of agreement and the strength of concordance between the experts consulted; and the Mann-Whitney U test to compare differences between groups. RESULTS. Expert judges and students agree that the SCC-Online is an instrument that contains in its design components and elements that allow the evaluation of CR and CCS competencies in a virtual scenario (Kappa 0.688 /0.757 p<0.001). The overall mean score was 4.65/5 and 4.41/5, for judges and students, respectively. CONCLUSION. Expert judges and students qualified the SCC Online as a good level evaluation tool, that meets the necessary design criteria to evaluate Clinical Communication Skills and Clinical Reasoning competences in the area of Gynecology.
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Simulation Exercise , StudentsABSTRACT
RESUMO Este ensaio destaca a importância das competências de comunicação clínica (CCC) nas ciências da saúde. Estas competências podem ser ensinadas, aprendidas e avaliadas, e vários estudos evidenciam para as vantagens de uma formação específica nesta área, potenciando a relação que os profissionais da área da saúde estabelecem com os pacientes, cuidadores informais e equipas de saúde, com resultados melhorados nos indicadores de saúde e cuidados mais humanizados. Confrontados com dificuldades na integração de programas específicos de comunicação nos curricula, assim como um défice no processo de avaliação e feedback estruturado, é crucial um investimento na formação pedagógica e no desenvolvimento curricular. Conscientes da escassez de trabalhos sistemáticos que apontam para um consenso sobre as competências e objetivos de ensino-aprendizagem das CCC, o sub-grupo Core Curriculum do comité de ensino (tEACH) da Associação Europeia de Comunicação em Saúde (EACH) desenvolveu e alcançou um consenso para um currículo nuclear nas diferentes áreas da saúde. Neste contexto, surgiu o Health Professions Core Communication Curriculum – HPCCC, que pode servir como referencial flexível de acordo com as necessidades específicas e contribuir para uma maior sistematização das iniciativas de CCC em saúde em língua portuguesa.
ABSTRACT This essay addresses the importance of clinical communication skills (CCC) in the health sciences. These skills can be taught, learned and assessed, and several studies have shown the advantages of specific training in this area, enhancing the relationship that healthcare professionals establish with patients, informal careers and health teams, with improved results in health indicators and more humanized care. Faced with difficulties in integrating specific communication programs in the curricula, as well as a deficit in the assessment process and structured feedback, an investment in teacher training and curriculum development is crucial. Aware of the lack of systematic studies that point to a consensus on the skills and CCC teaching-learning objectives, the Core Curriculum sub-group of the Teaching Committee (tEACH) of the European Association of Communication in Health (EACH) developed and achieved a consensus for a core curriculum in the different areas of healthcare. In this context, the Health Professions Core Curriculum Communication – HPCCC emerged, which can serve as a flexible framework in accordance with the specific needs and contribute to greater systematization of CCC initiatives in healthcare spoken in Portuguese.
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This article compares the methods which assess clinical communication skills home and abroad,and expresses the essential of the evaluation reform of our undergraduate medical students'clinical communication skills.