Aprendizaje en investigación clínica: experiencia de enseñanza híbrida con estudiantes de medicina / Learning in Clinical Research: Hybrid Teaching Experience with Medical Students

Introducción: la pandemia de COVID-19 indujo un cambio en nuestro sistema de salud y de educación. Los programas formativos también tuvieron que adaptarse y exigieron un cambio rápido. Objetivos: describir una experiencia educativa de enseñanza virtual/híbrida en investigación clínica, entre docentes del Servicio de Clínica de un hospital universitario y estudiantes de Medicina de una institución privada, que participaron del Programa ESIN (EStudiantes en INvestigación). Metodología: los contenidos y las estrategias educativas incluyeron las clases teóricas audiograbadas o videograbadas (asincrónicas y autoadministradas), el aprendizaje basado en proyectos, los talleres prácticos (encuentros sincrónicos virtuales y grupales), mediante la adopción de modelos de aprendizaje como el aula invertida, y la tutoría individual entre docente-estudiante. Los datos se recopilaron mediante la observación en contextos académicos, y basándonos en elementos de encuestas anónimas de satisfacción, previo consentimiento informado de los participantes. Resultados: participaron 14 estudiantes, 6 durante el año 2021 y 8 durante 2022. Todas mujeres y estudiantes de medicina (50% de cuarto año, 35% de sexto año y 15% de quinto año). Las técnicas implementadas favorecieron la participación y promovieron el aprendizaje activo, basado en proyectos. Mencionaron aspectos positivos como el enfoque académico práctico, la disponibilidad del equipo docente para atender cualquier duda, el tiempo y el entusiasmo por enseñar y fomentar la participación. Los videos teóricos resultaron útiles como herramientas de repaso, y los encuentros grupales fueron especialmente valorados, si bien los encuentros individuales fueron destacados como ayuda y apoyo previo a los congresos científicos. En general, manifestaron que fue una experiencia enriquecedora que demostró que se puede lograr lo que se creía imposible. Todas participaron activamente de al menos un congreso científico, y el 50% resultó coautora de una publicación académica. Conclusión: los estudiantes asumieron compromisos y responsabilidades, e incorporaron competencias y habilidades en la implementación y en la difusión de los proyectos. Esta experiencia educativa facilitó que el tiempo de clase pudiera optimizarse para intercambio, discusión y dudas. Los recursos producidos, las actividades desarrolladas y los contenidos abordados quedan disponibles a nivel institución. (AU)

Introduction: the COVID-19 pandemic brought about a change in our health and education system. Training programs also had to adapt and required rapid change. Objectives: to describe an educational experience of virtual/hybrid teaching in clinical research between teachers of the Clinical Service of a university hospital and medical students of a private institution who participated in the ESIN Program (Students in Research). Methodology: the contents and educational strategies included audio or videotaped lectures (asynchronous and self-administered), project-based learning, practical workshops (virtual and group synchronous meetings) by adopting learning models such as the inverted classroom, and individual tutoring between teacher and student. We gathered the data through observation in academic contexts and based on elements of anonymous satisfaction surveys, with prior informed consent of participants. Results: fourteen students participated, six in 2021 and eight in 2022. All were women and medical students (50% fourth year, 35% sixth year, and 15% fifth year). The techniques implemented favored participation and promoted active, project-based learning. They mentioned positive aspects such as the practical academic approach, the availability of the teaching team for any doubts, the time and enthusiasm for teaching, and encouraging participation. The theory videos were a valuable review tool, and team meetings received high praise even if the one-on-one meetings received much attention as help and support before the scientific congresses. In general, they stated that it was an enriching experience that showed that you can achieve what you thought impossible. All of them actively participated in at least one scientific congress, and 50% were co-authors of an academic publication. Conclusion: the students assumed commitments and responsibilities and incorporated competencies and skills in project implementation and dissemination. This educational experience helped to optimize class time for exchange, discussion, and doubts. The resources produced, the activities developed, and the contents addressed are now available at the institutional level. (AU)

Confiabilidad de una escala de valoración de resúmenes para congresos

Introducción: En 2013, desarrollamos una escala, para evaluar resúmenes de congresos de la Sociedad de Cirujanos de Chile (SOCICH). Objetivo: Determinar consistencia interna y confiabilidad interobservador de una escala para evaluar resúmenes de congresos. Material y Método: Estudio de confiabilidad. Doce cirujanos fueron capacitados de forma virtual durante 8 horas, para aplicar la escala. Una vez finalizado el entrenamiento, se les envió un cuestionario para evaluar contenidos de la capacitación, y varios resúmenescasos para ser evaluados con la escala antes señalada. Se aplicó estadística descriptiva, luego se estimó el grado de acuerdo entre observadores para cada ítem de la escala. Posteriormente, se evaluó el coeficiente de correlación (CCI), utilizando un modelo de dos factores mixtos en el que los efectos de los evaluadores son aleatorios y los ítems fijos; utilizando una definición de acuerdo absoluto. Además, se evaluó la consistencia interna de los ítems utilizando alfa de Cronbach, considerando intérvalos de confianza del 95% (IC 95%). Resultados: Luego de analizar las mediciones de los 9 ítems por los 12 observadores, se verificó que el CCI fue de 0,871; con un IC 95% de 0,700; 0,965. El valor de la consistencia interna fue de 0,7 considerando los 9 ítems, no se recomienda eliminar ningún ítem. Conclusión: La escala tiene buena confiabilidad interobservador y los ítems son consistentes entre sí; por lo que puede ser considerada como un instrumento confiable para la valoración de resúmenes de congresos.

Background: In 2013, we developed a scale to evaluate the abstracts of the congresses of the Society of Surgeons of Chile (SOCICH). Objective: To determine internal consistency and interobserver reliability of a scale to evaluate conference abstracts. Material and Methods: Reliability study. Twelve surgeons were trained virtually for 8 hours, to apply the scale. Once the training was finished, they were sent a questionnaire to evaluate the contents of the training, and several summaries-cases to be evaluated with the aforementioned scale. Descriptive statistics were applied, then the degree of agreement between observers was estimated for each item of the scale. Subsequently, intraclass correlation coefficient (ICC) was evaluated, using a mixed two-factor model where the effects of the evaluators are random and the items are fixed, using a definition of absolute agreement. In addition, the internal consistency of the items was evaluated using Cronbach's alpha, considering 95% confidence intervals (95% CI). Results: After analyzing the measurements of the 9 items by the 12 observers, it was verified that the ICC was 0.871; with a 95% CI of 0.700; 0.965. The internal consistency value was 0.7 considering the 9 items, it is not recommended to delete any item. Conclusions: The scale has good internal consistency and interobserver reliability. Therefore, it can be considered as reliable instrument to be used in the evaluation of abstracts for congresses.

Presencia de las distintas áreas quirúrgicas en el Congreso Nacional de Cirugía. Análisis de los últimos 12 años

Introducción: Los trabajos científicos permiten divulgar, compartir y contrastar resultados a terceros. Una de las formas de ver la actividad investigativa de cada especialidad es a través de las presentaciones que realizan en reuniones científicas. Objetivo: Describir el número de presentaciones de las distintas especialidades o áreas quirúrgicas en Chile en el principal congreso realizado a nivel nacional y evaluar si el comportamiento fue distinto durante los años de pandemia por coronavirus. Material y Método: Estudio bibliométrico del Congreso Chileno de Cirugía entre los años 2010 y 2021 evaluando el número total de presentaciones por área quirúrgica, año de presentación y período categorizado en 2010 a 2019 y 2020 a 2021. Se realiza estadística descriptiva y análisis de asociación de medias de publicaciones por área y período. Resultados: Se identificaron 4.462 presentaciones, incluyendo resúmenes orales, póster, videos y jornada de residentes. La media total fue 371,8 trabajos anuales. Coloproctología y Cirugía Gastroesofágica aportaron un total de 616 (13,8%) y 598 (13,4%) respectivamente. La media de presentaciones anuales previo a la pandemia por coronavirus fue de 414, en contraste a los 160 trabajos anuales durante ella, existiendo una disminución significativa de medias de presentaciones por área de 27,6 (± 18,8) a 10,7 (± 8,69) (p < 0,001), sin diferencias sus porcentajes de participación respecto del total (p = 0,776). Conclusión: Coloproctología y Cirugía Gastroesofágica son las áreas quirúrgicas más representadas. Si bien en el período contemporáneo a la pandemia por coronavirus significó una disminución en las presentaciones, no se observó una modificación en el porcentaje de participación de algún área en particular.

Introduction: Scientific studies allow the disclosure, sharing and comparison of results with third parties. One of the ways to see the investigative activity of each medical specialty is through the presentations they make at scientific meetings. Aim: To describe the number of presentations of the different surgical specialties or areas in Chile in the main congress held at a national level and to assess whether the behavior was different during the years of the coronavirus pandemic. Material and Method: Bibliometric study of the Chilean Congress of Surgery between 2010 and 2021, evaluating the total number of presentations by surgical area, year of presentation and two categorized periods (2010 to 2019 and 2020 to 2021). Descriptive statistics and association analysis of publication means by area and period are performed. Results: 4,462 presentations were identified, including oral summaries, posters, videos, and residents' sessions, with a mean of 371.8 per year. Coloproctology and Gastroesophageal Surgery contributed a total of 616 (13.8%) and 598 (13.4%) respectively. The mean number of annual presentations prior to the coronavirus pandemic was 414, in contrast to the 160 annual works during it, with a significant decrease in the mean number of presentations per area from 27.6 (± 18.8) to 10.7 (± 8.69) (p < 0.001), without differences in their percentages of participation with respect to the total (p = 0.776). Conclusion: Coloproctology and Gastroesophageal Surgery are the most represented surgical areas. Although the contemporary period of the coronavirus pandemic meant a decrease in presentations, no change was observed in the percentage of participation in any particular area.

Crossing the Death Valley of publication process in cornea and ocular surface diseases: from abstracts presented at the Association for Research in Vision and Ophthalmology annual meeting to full-text manuscripts / Atravessando o Vale da Morte do processo de publicação sobre doenças da córnea e da superfície ocular: de resumos apresentados no Encontro Anual da Associação de Pesquisa em Visão e Oftalmologia até artigos completos

ABSTRACT Purpose: This study was conducted to analyze the profile and publication rate of abstracts in indexed journals presented in the cornea section at the Association for Research in Vision and Ophthalmology Annual Meeting and to further identify potential predictive factors for better outcomes. Methods: Abstracts accepted for presentation at the 2013 Association for Research in Vision and Ophthalmology Annual Meeting in the cornea section were sought via PubMed and Scopus to identify whether they had been published as full-text manuscripts. First author's name, time of publication, journal's name, and impact factor were recorded. A multivariate regression was performed to explore the association between variables and both the likelihood of publication and the journal's impact factor. A Kaplan-Meier analysis was performed to evaluate the time course of publication of abstracts. Results: Of the 939 analyzed abstracts, 360 (38.3%) were published in journals with a median impact factor of 3.4. The median time interval between abstract submission and article publication was 22 months. The multivariate analysis revealed that abstracts were more likely to be published if they were funded (OR=1.482, p=0.005), had a control group (OR=1.511, p=0.016), and had a basic science research scope (OR=1.388, p=0.020). The journal's impact factor was higher in funded studies (β=0.163, p=0.002) but lower in multicenter studies (β=-0.170, p=0.001). The Kaplan-Meier analyses revealed significant differences in the publication time distribution for basic science vs clinical abstracts (χ2=7.636), controlled vs uncontrolled studies (χ2=6.921), and funded vs unfunded research (χ2=13.892) (p<0.05). Conclusion: Almost 40% of Association for Research in Vision and Ophthalmology abstracts were published within 5 years from submission. Funding support, basic research scope, and controlled design were the determinants of better outcomes of publication.(AU)

RESUMO Objetivo: Analisar o perfil e a taxa de publicação em periódicos indexados de resumos apresentados na seção de córnea da reunião anual da Association for Research in Vision and Ophthalmology - ARVO, para identificar potenciais fatores preditivos com objetivo de obter melhores resultados. Métodos: Artigos que foram aceitos para apresentação no encontro anual da Association for Research in Vision and Ophthalmology - ARVO 2013 na seção de córnea foram pesquisados via PubMed e Scopus para identificar se haviam sido publicados como manuscritos com texto integral. Nome do primeiro autor, data de publicação, nome da revista e fator de impacto foram registrados. Foi feita uma regressão multivariada para estabelecer uma associação entre as variáveis e a chance de publicação e o fator de impacto da revista. Foi utilizado o método Kaplan-Meier para analisar o tempo da apresentação até a publicação dos artigos. Resultados: Dos 939 artigos analisados, 360 (38.3%) foram publicados em revistas com um fator de impacto médio de 3.4. O intervalo de tempo entre a submissão do resumo e a publicação do artigo teve como mediana 22 meses. Na análise multivariada, resumos tinham mais chance de publicação se tinham algum tipo de financiamento (OR=1.482, p=0.005), tinham grupo controle (OR=1.511, p=0.016) e estavam no âmbito da pesquisa científica básica (OR+1.388, p=0.020). O fator de impacto da revista era maior em estudos financiados (β=0.163, p=0.002) e mais baixo naqueles multicêntricos (β=-0.170, p=0.001). A análise Kaplan-Meier mostrou diferenças significativas na distribuição de tempo até a publicação de resumos de ciência básica vs clínicos (χ2=7.636), com grupo controle vs sem grupo controle (χ2=6.921) e financiados vs não financiados (χ2=13.892) (p<0.05). Conclusão: Aproximadamente 40% dos resumos apresentados no encontro da Association for Research in Vision and Ophthalmology - ARVO foram publicados dentro de 5 anos da submissão. Financiamento, pesquisa no âmbito da ciência básica e presença de grupo controle foram fatores determinantes para melhores resultados em relação à chance de publicação.(AU)

Las prácticas de laboratorio en la enseñanza de las ciencias básicas biomédicas ¿antes o después de los seminarios? / Laboratory practices in the teaching of basic biomedical sciences. Before or after seminars?

RESUMEN En este artículo se plantea la necesidad de reflexionar acerca de la ubicación que las prácticas de laboratorio tienen en el programa de las asignaturas básicas biomédicas. Se ofrecen algunas valoraciones sobre las bondades de esta forma organizativa para que los estudiantes adquieran conocimientos procedimentales y desarrollen capacidades que les permitan mayor independencia cognoscitiva sobre todo en semestres más avanzados de la carrera. Se dejan abiertas nuevas interrogantes acerca de si este posicionamiento pudiera modificar o no, la postura del docente como investigador en el aula y en consecuencia ejercer influencias autónomas para el desarrollo de las comentadas capacidades en los estudiantes, en concordancia con las exigencias de los nuevos planes de estudio.

ABSTRACT This article raises the need to reflect on laboratory practice location in the program of basic biomedical subjects. Some elements are offered about the benefits of this organizational form so that students acquire procedural knowledge and develop capacities that allow more cognitive independence, especially in more advanced semesters of the academic program. New questions are made about whether this positioning could modify or not, the teacher´s position as a classroom researcher and consequently exercise autonomous influences for the development of the aforementioned abilities in the students, in accordance with the requirements of the new academic formation plans.

Diseño, construcción y validación inicial de un instrumento de medición para la evaluación de resúmenes para presentaciones en congresos / Assessment of summaries presented in congresses: study of validation

Objetivo Presentar el nuevo instrumento de valoración de resúmenes que se aplica desde 2014 en los congresos de la SCCh, de forma tal de estandarizar su aplicación ítem por ítem. Material y método Estudio bietápico con metodología cualitativa para generación de ítems y construcción de instrumentos de medición. En la primera etapa se realizó recopilación de ítems a partir de una revisión de la literatura. En la segunda se construyó el instrumento, aplicando reducción de ítems a través de un panel de expertos. Así, se generó la validación de contenido. El panel de expertos estuvo compuesto por 6 integrantes (3 epidemiólogos clínicos y 3 académicos, miembros de la SCCh), todos con grado de Magíster o Doctor y experiencia en investigación. Se aplicó estrategia cualitativa mediante técnica Delphi; luego se presentó el borrador a un panel de expertos distinto al anterior, oportunidad en la que se discutió la propuesta, se afinó la fraseología de los ítems y dominios y se definió el instrumento definitivo. Resultados Los ítems generados en la primera etapa (15), se agruparon en 5 dominios: introducción, material y método, resultados, conclusión, importancia, originalidad e interes del estudio; y presentación general. Al aplicar el cuestionario al segundo panel de expertos, se redujeron ítems y se adicionó otro. Así, se construyó el instrumento definitivo, compuesto por 10 ítems, agrupados en 6 dominios. Conclusión Se presenta una descripción pormenorizada de la escala y una guía para su aplicación, lo que permitirá conferir una adecuada confiabilidad de las mediciones.

Objective The aim of this article is to present the new instrument for evaluating congress abstracts of SCCh, in use from 2014, so as to standardize its application item by item. Material and method Two-stage study with qualitative methodology for generating items and construction of the measuring instrument. In the first stage a collection of items was based on a review of the literature. In the second, the instrument was built by applying reduction items through a panel of experts. Thus, content validity was determined. The expert panel consisted of 6 members. Three clinical epidemiologists and three members of the SCCh. All with Master's degree or PhD and research experience. Qualitative strategy is applied by Delphi technique; after the draft was presented to a panel of experts other than the above, at a meeting of ad-hoc working group, organized by the SCCh; at which time the proposal was discussed, the wording of items and domains was refined based on examples and the final instrument defined. Results The items generated in the first stage (n = 15), who finished with the second draft; were grouped into 5 domains: introduction, material and method, results, conclusion, importance, originality and interest of the study; and overall presentation. When applying the questionnaire to the second panel of experts, a reduction items was generated and an item is added. Thus, the final instrument was composed of 10 items, grouped into 6 domains was constructed. Conclusion A detailed description of the scale and guidelines for its implementation is presented, which will confer adequate reliability of the measurements.

Série temporal da apresentação de trabalhos brasileiros no San Antonio Breast Cancer Symposium / Temporal series of Brazilian papers presented at San Antonio Breast Cancer Symposium

Objetivos: Avaliar a taxa de trabalhos brasileiros (TB) apresentados no San Antonio Breast Cancer Symposium (SABCS), nos últimos 11 anos; e predizer a participação nos próximos 5 anos (2014–2018). Métodos: Os dados foram coletados manualmente nos Abstract Books de 2003 a 2013. Os TB foram divididos em uni-institucionais (UI) e multi-institucionais (MI), os quais foram subdivididos conforme centro primário brasileiro (MICPB) ou centro primário internacional (MICPI). Foi utilizada a regressão de Poisson, através do programa JointPoint para avaliar a tendência da mudança percentual anual (MPA) dos TB apresentados no SABCS. Através da MPA, foi calculado o número de trabalhos que devem ser apresentados entre 2014 e 2018. Resultados: O número total de trabalhos apresentados no SABCS teve aumento anual de 7,22% (IC95% 5,0–9,5), assim como os TB (MPA=11,83; IC95% 3,3–21,1). A taxa de TB em relação ao total de trabalhos mostrou tendência à estabilização. Quanto aos UI (MPA=7,22, IC95% -31,3–67,4), MI (MPA=2,8, IC95% -10,8–18,3) e MICPB (MPA=19,2, IC95% -31,1–106,1), também foi observada tendência à estabilização. Para MICPI, houve tendência de crescimento (MPA=112,6, IC95% 54,9–191,9). Estimou-se que em 2018 os TB representem 2,8% dos trabalhos apresentados, sendo 29,27% de MICPI. Conclusões: A taxa de trabalhos brasileiros apresentados no SABCS possui tendência à estabilização, apesar da participação de instituições brasileiras em MICPI ter aumentado consideravelmente, refletindo o aumento dos centros de pesquisa do Brasil na participação nos estudos clínicos internacionais.

Objectives: This paper aimed to verify where Brazil stands as to the amount of Brazilian papers presented at the San Antonio Breast Cancer Symposium (SABCS) in the last 11 years; and to predict participation in the next 5 years (2014–2018). Methodology: The total number of papers presented at the SABCS was manually counted from the abstract books from 2003 to 2013. From those, the Brazilian papers (BPs) were divided into uni-institutional (UI) and multi-institutional (MI), that was subdivided in multi-institutional with a Brazilian primary center (MIBPC) and multi-institutional with an international primary center (MIIPC). The Poisson’s regression through JointPoint software was used to analyze the trend of the annual percentage change (APC) of Brazilian papers within the total yearly number of papers, and its rate. Through the APC, the number of papers to be submitted between 2014 and 2018 was also calculated. Results: The number of total papers in SABCS increased 7.22% per year (95%CI 5.0–9.5) so did BPs (APC=11.83, 95%CI 3.3–21.1); however when taking into account the rate of BPs over the total papers (APC=4.28, 95%CI -3.1–12.2), it indicates that the trend tends to stabilize. As for the UI (APC=7.22, 95%CI -31.3–67.4), MI (APC=2.8, 95%CI-10.8–18.3) and MIBPC (APC=19.2, 95%CI -31.1–106.1) it is observed that the trends also tend to stabilize. For MIIPC there was an increasing trend (APC=112.6, 95%CI 54.9–191.9). It was estimated that in 2018 the TB will represent 2.8% of all papers presented, being 29.27% of MICPI. Conclusions: The rates of Brazilian papers at SABCS are tending to stabilize throughout the years, although the participation of Brazilian institutions at MIIPC has increased considerably due to the Brazilian’s centers being more involved in international clinical trials.

Internal medicine, art and science in the third millennium / Medicina interna, arte y ciencia en el tercer milenio

Internal medicine, art and science in the third millennium is a statement that Medicine is not only science. It acts on the sick individual to reestablish a natural state as a curative art. Medical art, commissioned by an individual or a society, is service. It requires vocation to obtain satisfaction. However due to the incidence of value changes, market globalization, technological and industrial development, the patient/physician relationship is becoming a user/provider relationship. Physician-related factors such as a higher health care demand, resource shortage and a progressive specialization have also influenced this change of paradigm. This is causing dissatisfaction, loss of self-esteem and a lower ethical commitment among professionals. We need to recover a professional repertoire of ideas in the context of a global ethics. Responsibility and co-responsibility are ethical principles addressed to technological civilizations and their collateral effects on people and environment that lead to a "responsible globalization". We also need a scientific futurology to define risks and avoid errors. In this era of progressive specialization, Internal Medicine, with its holistic vision of mankind, may play a fundamental role in the field of bioethics.

Medicina Interna, Arte y Ciencia en el Tercer Milenio", expresa que la medicina no es exclusivamente ciencia. Tiene de sí actuar hábilmente sobre el hombre enfermo, (arte curativo), buscando restablecer un estado natural. El arte médico, comisionado por el enfermo o por la sociedad, es servicio. Requiere vocación, obteniendo su propia satisfacción. Sin embargo, la relación "paciente / médico", se ha visto transformada actualmente en "usuario /prestador", Incidiendo factores generales, tales como cambios valóricos, preeminencia del mercado (globalización), desarrollo de la tecnología e industria, y además factores propiamente médicos: mayor demanda asistencial, escasez de recursos, progresiva especialización, presencia de gestores no médicos, y otros. Ello ha provocado en los médicos insatisfacción, pérdida de autoestima y menor compromiso ético. Necesitamos recuperar un ideario profesional, en el contexto de una "ética global". El "principio de la responsabilidad" (Jonas) o la "corresponsabilidad" (Apel), son éticas destinadas a la civilización tecnológica y a sus efectos colaterales sobre las personas y el medio ambiente, conducentes a una "globalización responsable". Necesitamos, además, estimular el desarrollo de una "futurología científica" que permita definir los riesgos a evitar o los errores a corregir. En esta era de creciente especialización, la Medicina Interna, beneficiaria de la mejor tradición médica por su visión holística del hombre, puede y debe jugar un rol fundamental en el campo de la Bioética.