Implementación del mini-CEX en el pregrado médico: Una experiencia con simulación / Implementation of the Mini-CEX in Medical Undergraduate Education: A Simulation-Based Experience

Resumen La evaluación es un proceso sistemático que resulta en un juicio de valor para tomar decisiones. Los instrumentos empleados para obtener datos sobre el desempeño de los estudiantes requieren de un proceso sistemático y objetivo para su implementación. El mini-CEX es un instrumento de observación directa que ha sido empleado para la evaluación de la competencia clínica en los estudiantes de pre y posgrado desde su invención en 1955. Cuenta con diferentes evidencias de validez para su uso en distintos contextos educativos y clínicos. Permite realizar evaluaciones rápidas, acompañadas de realimentación y que proporcionan información relevante del desarrollo de la competencia clínica. El objetivo de este escrito es exponer la experiencia de la implementación del mini-CEX en el pregrado médico para la evaluación formativa de los estudiantes utilizando la simulación con pacientes estandarizados. Para lograr este objetivo se empleó la siguiente secuencia: búsqueda, planeación, integración y aplicación. Posterior a estos pasos se dan una serie de recomendaciones para la implementación del mini-CEX. Se concluye que la evaluación de la competencia clínica es importante para la mejora continua y permanente de los estudiantes de pre y posgrado. Es necesario sistematizar la evaluación ajustada siempre a objetivos y necesidades específicas de la evaluación.

Abstract Evaluation is a systematic process that results in a judgment to make decisions. The instruments used to obtain data on student performance require a systematic and objective process for their implementation. The mini-CEX is a direct observation tool that has been used for the evaluation of clinical competence in undergraduate and postgraduate students since its invention in 1955. It has different validity evidence for use in different educational and clinical contexts. It allows rapid evaluations, accompanied by feedback and providing relevant information on the development of clinical competence. The objective of this paper is to expose the experience of the implementation of the mini-CEX in the medical undergraduate for the formative evaluation of students using simulation with standardized patients. To achieve this goal, the following sequence was used: search, planning, integration, and application. After these steps we make some recommendations for the implementation of the mini-CEX. Its is concluded that the evaluation of clinical competence is important for the continuous and permanent improvement of undergraduate and graduate students. It is necessary to systematize the evaluation always adjusted to objectives and specific needs of the evaluation.

Application of Mini-Clinical Evaluation Exercise combined with direct observation of procedural skills in standardized training of emergency medicine guided by professional physician qualification examination / 中华医学教育探索杂志

Objective:To investigate the application effect of Mini-Clinical Evaluation Exercise (Mini-CEX) combined with direct observation of procedural skills (DOPS) in standardized training of emergency medicine guided by professional physician qualification examination.Methods:Based on the time of emergency medicine teaching reform in Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, 32 standardized training residents in Emergency Department before September 2020 were included as control group and were given traditional teaching, and 32 standardized training residents after September 2020 were included as observation group and were given Mini-CEX combined with DOPS teaching under the guidance of professional physician qualification examination. The two groups were compared in terms of Mini-CEX score, DOPS score, assessment score of comprehensive emergency skills, pass rate of professional physician qualification examination, and comprehensive teaching quality. SPSS 25.00 was used to perform the t-test and the chi-square test. Results:Compared with the control group after training, the observation group had significantly higher scores of Mini-CEX, DOPS, and comprehensive emergency skill assessment ( P<0.05). There were no significant differences between the two groups in the pass rates of theoretical and practical examinations in professional physician qualification examination, and the observation group had a significantly higher total pass rate than the control group ( P<0.05). The observation group had significantly higher comprehensive teaching quality scores than the control group ( P<0.05). Conclusion:Mini-CEX combined with DOPS guided by professional physician qualification examination can help to improve the teaching effectiveness of standardized training residents in emergency, enhance their comprehensive skills and emergency professional skills, achieve a relatively high pass rate of professional physician qualification examination, and improve their post competency, and thus it holds promise for clinical application.

Application of modified DOPS as formative assessment in clinical skills training for professional graduate students / 中华医学教育探索杂志

Objective:To explore the application effect of modified direct observation of procedural skills (DOPS) as a formative assessment tool in clinical skills training of professional graduate students.Methods:A total of 130 professional graduate students of Batch 2019 were selected as the experimental group, and 127 graduate students of Batch 2018 were selected as the control group. Two groups of students received clinical general skills training after enrollment, the control group adopted the traditional skills teaching method, and the experimental group added DOPS as formative assessment on the basis of traditional teaching. The teaching effect of DOPS was evaluated by means of scores analysis and student self-assessment. SPSS 23.0 was used for t-test. Results:The score of the experimental group (84.35±3.41) was higher than that of the control group (77.58±2.68), which showed a statistically significant difference ( t=2.63, P<0.05). The scores of "skill operation ability" and "communication ability" were the lowest single indexes in the assessment of DOPS. The results of self-assessment showed that the scores of autonomous learning ability, clinical thinking ability, clinical practice ability and professional accomplishment of students in the experimental group were all higher than those in the control group ( P<0.05). Conclusion:Modified DOPS is helpful to improve clinical core ability, which is worth promoting for application.

Mini-CEX como herramienta de evaluación / Mini-CEX as an assessment tool

El mini-CEX (mini clinical evaluation exercise) es un instrumento de evaluación del desempeño profesional a través de la observación directa del residente mientras participa de un encuentro con un paciente, la valoración de una serie de habilidades y destrezas clínicas con posterior devolución constructiva en su ámbito de trabajo. Se centra en seis competencias que el residente debe demostrar duran-te el encuentro con un paciente y requiere que el docente documente ese desempeño. Es fácil de aplicar por los docentes porque se integra bien a la rutina del día a día en los diferentes escenarios clínicos. El tiempo estimado de esta interacción no debe superar los 20 minutos y debe repetirse al menos 8 veces al año con cada residente por diferentes docentes en caso de decisiones sumativas. Es de vital importancia consensuar su implementación como iniciativa estratégica desde la dirección de la institución de salud, que los docentes definan de antemano qué competencias se van a evaluar y cuáles son los estándares de desempeño mínimo que deberán alcanzar los residentes. La confección de una base de datos con la información de los formularios completados nos permitirá monitorizar el proceso de evaluación y efectuar las medidas correctivas pertinentes.

The mini-CEX (mini clinical evaluation exercise) is a tool for assessing the professional performance of residents through direct observa-tion of resident-patient encounters, evaluating clinical skills, and providing subsequent feedback in the work setting. The exam focuses on evaluating residents' skills during a resident-patient meeting. The evaluator must document the resident's performance in six areas of competence. The exam is easy to apply as it fits in real-life settings in different clinical scenarios. The evaluation should not take more than 20 minutes, and each resident should have eight mini-CEX per year of training with varying faculties for summative decisions. It is extremely important that the board of directors of the healthcare institution reach a consensus to implement the mini-CEX as a strategic initiative. Faculties should previously define the competence areas to evaluate, and the minimum standards of residents' performance. A database constructed with all the forms completed will be helpful to monitor the evaluation process and make the necessary corrections.

Application of typical case combined with practice teaching in pediatric clinical teaching / 中华医学教育探索杂志

Objective:To explore the application of typical case combined with practice teaching in the pediatric clinical teaching.Methods:A total of 80 clinical interns majoring in pediatrics who practiced in the Affiliated Hospital of Jining Medical University between September 2019 and January 2020 were selected as the research subjects, and they were randomly divided into observation group ( n=41) and control group ( n=39). The control group adopted conventional teaching while the observation group were given typical case combined with practice teaching model. After 16 weeks of training, the theoretical knowledge, practical operation [direct observation of procedural skill (DOPS) evaluation, and mini-clinical evaluation exercise (Mini-CEX)] and overall performance were analyzed in the two groups of students. SPSS 19.0 was used for t test, chi-square test and rank sum test. Results:After the internship, the theoretical scores of common pediatric diseases, clinical disease characteristics, etiopathogenesis, treatment regimen and complications were enhanced in the two groups, and the above scores in observation group were higher than those in control group ( P<0.05). Besides, the DOPS scores and Mini-CEX scores of the two groups were increased, and the scores were higher in observation group than in control group ( P<0.05). Furthermore, the overall excellent rate of the observation group was 87.80% (36/41), which was higher than 69.23% in control group (27/39). Survey found that the number of interns who believed that the teaching regimen could deepen the knowledge mastery degree, increase the internship interest and improve the comprehensive ability, internship efficiency and clinical thinking ability was more in observation group than in control group. Conclusion:Typical case combined with practice teaching can effectively deepen the interns' understanding of theoretical knowledge of clinical pediatrics, improve the practical operation ability and arouse the interest in learning.

Why tuberculosis patients under revised national tuberculosis control programme delay in health-care seeking? A mixed-methods research from Wardha District, Maharashtra

Background: Timely treatment of tuberculosis is imperative for its control. This can get delayed due to delay in care seeking, diagnosis or treatment initiation. Objectives: The study aims to find out the magnitude of delays in care seeking, diagnosis or treatment initiation, and understand the reasons behind these delays in Wardha district of Maharashtra, India. Methods: A mixed methods study was conducted among 275 patients selected from those enrolled under Revised National Tuberculosis Control Programme in 2014. We collected information regarding the duration of delays and generated a free list of reasons for delays in care seeking and diagnosis. The free list items were then subjected to pile sorting. Two-dimensional scaling and hierarchical clustering analysis were performed to identify the various domains of reasons for delays. Results: The median delay in initial care seeking and diagnosis was 10 days each, and that for treatment initiation was 2 days. The domains identified for delay in care seeking were negligence toward health, health conditions, facility-related issues, and household and social reasons. The domains identified for delay in diagnosis were system-related reasons; and patient-related reasons, each of them further having two subdomains. Conclusions: Interventions for reducing the knowledge gap and stigma, increasing the accessibility of services, active case finding; capacity building of providers, quality assured sputum microscopy, and communication skills will help reduce these delays.

The Effectiveness of Direct Feedback of Faculty and Standardized Patient after Medical Students’ Clinical Performance Examination / 의료커뮤니케이션

BACKGROUND: Clear and proper feedback is necessary to decrease the gap between knowledge and practice. Feedback can improve clinical competence of medical students up to expertise level.METHODS: A total of 180 4th-year students of Daegu-Kyungbuk consortium area participated in the scheduled feedback program of clinical performance examination on August 26th in 2017. Among them, 167 students filled out the questionnaire on helpfulness of the direct observation and feedback of faculty and standardized patient (SP), helpfulness for history taking (Hx), physical examination (PE), and patient-physician interaction (PPI), and any change of clinical competence and clinical reasoning of the students preand post-feedback. All the responses were measured on 5-point Likert scale.RESULTS: Among the total students, 88.6% responded that direct feedback at the practice is helpful, particularly 95.2% of faculty and 76.6% of SP. A 37.3% answered that it was helpful for all the categories of feedback, but only 25.3% for PE and 24.7% for Hx. A 56.3% responded that feedback is helpful for both disease questions and counseling practice. Mean score of self-assessment by the students increased from 2.52 to 3.36 for Hx, 2.30 to 3.24 for PE, 2.46 to 3.33 for clinical reasoning, 2.84 to 3.59 for PPI, and 2.44 to 3.28 for overall competence. And all these differences were found to be statistically significant (P <0.001)CONCLUSION: A majority of students responded that the direct feedback from faculty and SP was helpful at the clinical practice of Hx, PE, and PPI, and increased the level of clinical competence.

Application and evaluation of direct observation of procedural skills in anesthesia-related teaching / 中华医学教育探索杂志

Objective To explore the application of direct observation of procedural skills (DOPS) in anesthesia-related effects skills teaching. Methods Anesthesia students in the Department of Anesthe-siology, Clinical Medical College, Yangzhou University between June 2013 and June 2015, received an anesthesia-related DOPS examination at the mid-internship and pre-delivery. Through the DOPS assessment results, the analysis of teachers' and students' satisfaction degree on the evaluation results, the teaching effect of DOPS was evaluated. At the same time, the students were surveyed to find out the satisfaction degree of DOPS. SPSS 18.0 was applied to processing the date. Measurement data were expressed as mean plus or minus standard deviation, and t test was used in the comparison between groups. Results Interim assessment indicators for each individual average of more than four points , the individual departmental rotation examination scores were higher than the overall average score interim assessment results. Compared with interim assessment, satisfaction of teachers has made great progress in the end of assessment [(8.46 ± 0.32) vs. (8.14 ±0.60)], satisfaction of students was [(8.57 ±0.59) vs. (8.20 ±0.45)], satisfaction of the students was higher than the teachers [(8.57±0.59) vs. (8.46±0.32)], and the differences were statistically significant. Conclusion DOPS as an effective anesthesia-related skill of teaching and assessment method, can improve the level of anesthesia anesthesia-related skills of college students.

Workplace-Based Assessment: A Step to Promote Competency Based Postgraduate Training.

There has been an increasing emphasis on defining outcomes of medical education in terms of ‘performance’ of trainees. This is a step beyond the description of outcomes in terms of ‘competence’ that encompasses mostly ‘potential abilities’ rather than the ‘actual performance’. The contextual adaptations and behavior judgments of the trainees are best assessed by a program of in-training assessment. Workplace based assessment (WPBA) is one of the modalities, which assesses the trainee in authentic settings. Though Postgraduate (PG) medical training in India is said to be competency-based, most institutions do not have any formative or in-training assessment program for the same. The two cardinal elements of WPBA are ‘direct observation’ and ‘conducted in work place’ in addition to provision of ‘feedback’ to the trainee. The WPBA conforms to the highest (Level 4: ‘Does’) of Miller’s pyramid and also has the potential to assess at all four levels. Some of the tools used for WPBA are: Logbooks, Clinical Encounter Cards (CEC), mini-Clinical Evaluation Exercise (mini-CEX), Case based discussions, Direct Observation of Procedural Skills (DOPS), Multisource feedback (peers, co-workers, seniors, patients) etc. These can be documented in the form of a portfolio that provides a longitudinal view of experiences and progress of the trainee. The WPBA scores high on validity and educational impact by virtue of being based on direct observation in real situation and contextual feedback. The feasibility and acceptability is enhanced by making appropriate choices of tools, advance planning, building of mutual trust, and training of assessors. Given the established benefits of WPBA in shaping clinical learning, there is an imminent need for including this mode of assessment in our clinical training programs especially PG training.

Short-term training of direct observation procedural skills (DOPS) for community general practitioner trainers / 中华全科医师杂志

Objective To evaluate the efficacy of short-term training of direct observation procedural skills (DOPS) for community general practitioner (GP) trainers.Methods Thirty six GP trainers participated in one-day workshop of DOPS.The participants were interviewed with questionnaire before and after the training program and the training video was scored.Results 47.2％ (17/36) of GP trainers knew and briefly understood DOPS before the training.41.7％ (15/36)of them had a rough idea of how to use it and only 2.8％ (1/36) had used it before.All of these trainers wanted to learn how to perform DOPS.The vast majority of GP trainers completely or basically understood the standards for evaluation of 11 items of DOPS after the training.The accuracy rates of 4 items were close to or more than 50.0％ in 9-point scale and 7 items exceeded 50.0％ in 3-rank system.There was significant difference in accuracy rates of 6 items between the two scoring system(all P ＜ 0.01).Conclusions Community GP trainers recognize the advantages of DOPS in assessment of clinical skills and have strong intention of application.The efficacy of short-term workshop is satisfactory,but the evaluators need more training and practice.

Application of direct observation of procedural skills (DOPS) in teaching acupuncture manip-ulation skills / 中华医学教育探索杂志

Objective To explore the effect of direct observation of procedural skills (DOPS) in teaching acupuncture manipulation skills. Methods Sophomores of acupuncture and Tuina spe-ciality were divided into two groups based on their classes, 36 students in experimental group and 31 in control group. In experimental group, DOPS on filiform needling was done twice in the middle and at the end of the semester respectively. In control group, DOPS was done once at the end of semester. The final exam's DOPS score and satisfaction degree of teachers and students concerning the results of the assessment in two groups were compared by independent samples t-test. P<0.05 indicates signifi-cant differences. The teaching effect of DOPS was also evaluated by questionnaire survey of students in experimental group. Results The total score of DOPS (4.26 ±0.24), scores of needle insertion (4.18±0.42), and scores of reinforcing and reducing method (4.03±0.28) in experimental group were higher than those in control group ((4.14±0.25), (4.00±0.29) and (3.87±0.37), P<0.05). The teachers' satisfaction (8.38±0.51) and students' satisfaction (8.47±1.03) concerning the results of the assessment in experimental group were higher than those in control group ((8.05±0.78) and (7.94±1.15), P<0.05). More than 80% of students in experimental group supported the saying of‘DOPS promoting students' skills training and enhancing the ability of handwork ’ . Conclusions DOPS can be used as an effective teaching and examination method and can improve students' skills of acupuncture manipulation.

Exploration on evaluation system of case-based learning in teaching critical diseases / 中华医学教育探索杂志

Objective To explore the effective evaluation methods of case-based learning (CBL) in critical disease teaching.Methods Totally 53 undergraduate students in department of clinical medicine of Shanghai Jiao Tong University,who practiced in our hospital from 2010 to 2012,were divided into the traditional teaching group and CBL teaching group.We used traditional teaching combining with CBL teaching in CBL group.Common cases of critical illness(severe acute pancreatitis and multiple trauma)in intensive care unit (ICU) were selected for CBL cases.The evaluation of theoretical knowledge,mini-clinical evaluation exercise(Mini-CEX)and direct observation of procedural skills (DOPS) were continued after teaching and practice.Results These was no significant difference in the theoretical knowledge examination between the two groups. In Mini-CEX,the students in CBL group were better concerning the medical interview capacity (P=0.000),humanistic care (P=0.013),clinical diagnosis(P=0.035),counseling(P=0.009) and the overall clinical competence (P=0.008) than those in traditional teaching group.The DOPS scores of endotracheal intubation (P=0.016)and central venous catheterization (P=0.001)discussed in CBL teaching were significantly higher in CBL group.Conclusion Traditional theoretical knowledge examination has little significance in the assessment of CBL teaching,but Mini-CEX and DOPS can reflect the advantages of CBL teaching better in the assessment of clinical abilities and skills.

Mini-CEX: una herramienta que integra la observación directa y la devolución constructiva para la evaluación del desempeño profesional / Mini-CEX: A Method Integrating Direct Observation and Constructive Feedback for Assessing Professional Performance / Mini-CEX: A Method Integrating Direct Observation and Constructive Feedback for Assessing Professional Performance

El mini-CEX (mini clinical evaluation exercise) es un instrumento de evaluación del desempeño profesional a través de la observación directa del residente mientras participa de un encuentro con un paciente, la valoración de una serie de habilidades y destrezas clínicas con posterior provisión de feedback o devolución en su ámbito de trabajo. Se centra en una serie de habilidades que el residente debe demostrar durante el encuentro con un paciente y requiere que el docente documente ese desempeño en seis competencias. Es fácil de aplicar por los docentes porque se integra bien a la rutina del día a día en los diferentes escenarios clínicos. El tiempo estimado de esta interacción no debe superar los 20 minutos y debe repetirse al menos 8 veces al año con cada residente por diferentes docentes. Es de vital importancia que los docentes definan de antemano qué competencias se van a evaluar y cuáles son los estándares de desempeño mínimo que deberán alcanzar los residentes. La confección de una base de datos con la información de los formularios completados nos permitirá monitorizar el proceso de evaluación y efectuar las medidas correctivas pertinentes.

The mini-CEX (mini clinical evaluation exercise) is a tool for the assessment of professional performance of residents through direct observation of resident-patient encounter, evaluating clinical skills and providing subsequent feedback in the work setting. The exam focuses on the evaluation of resident's skills during resident-patient encounter. The evaluator must document resident's performance in six areas of competence. The exam is easy to apply as it fits in real life settings in the different clinical scenarios. The evaluation should not take more than 20 minutes and each resident should have 8 mini-CEX per year of training with different faculties. Faculties should previously define the areas of competence to evaluate and the minimum performance standards residents should reach. All the completed forms should be used to construct a database in order to monitor the evaluation process and make the necessary corrections.

Evaluación por competencias en formación de posgrado: implementación de una adaptación pediátrica del Examen de Ejercicio Clínico Reducido (Mini-Cex) / Assessment of competence in pediatric postgraduate education: implementation of a pediatric version of the Mini-Cex

Introducción. La observación directa de los alumnos por parte de distintos docentes en forma periódica, en diversos escenarios y en tiempo real, tiene gran valor en el proceso de formación. Objetivos. Evaluar la factibilidad en la implementación de una versión del Ejercicio de Examen Clínico Reducido adaptada a Pediatría, describir las evaluaciones realizadas según el ámbito de observación, la complejidad del paciente, el foco del encuentro y la situación pediátrica, y conocer la satisfacción de docentes y alumnos con respecto a esta herramienta. Método. Participaron en forma voluntaria todos los docentes y alumnos de la carrera. Las observaciones tenían carácter formativo. Las competencias evaluadas fueron: habilidades para la conducción de la entrevista, para el examen físico, para el asesoramiento, profesionalismo, criterio clínico, efciencia y competencia clínica global. Se defnió la factibilidad del estudio como la posibilidad de realizar cuatro observaciones en al menos 70% de los participantes y que se llevaran a cabo observaciones en todas las áreas de rotación. Resultados. Se realizaron 388 observaciones. Participaron 54 alumnos y 50 docentes. Se realizaron 7,18 observaciones por participante, en el ámbito ambulatorio en el 57% y con baja complejidad en el 60% de los casos. El 85% de los participantes fueron observados mientras conducían una consulta de supervisión en salud. La califcación por competencia específca fue uniforme. El foco del encuentro presentó variaciones según el ámbito de observación. Docentes y alumnos se mostraron satisfechos. Conclusión. El instrumento pudo aplicarse con la frecuencia preestablecida, en los ámbitos programados y fue bien aceptado.

Aims. Faced with the increased challenge of assessing competences in young doctors, the purpose of the study was to evaluate the implementation of a pediatric version of the Mini-Cex in pediatric trainees as well as the level of satisfaction of teachers and students with the new assessment tool. Methods and results. From July 2007 to August 2009, 54 pediatric trainees were periodically monitored in a variety of clinical settings by 50 teachers. The competences evaluated included medical interviewing, physical examination and counseling skills, humanistic qualities/ professionalism, clinical judgment, organization and overall clinical competence. The feasibility of this study was defned as an average 4 observations per participant, and observations in all clinical rotations. During the study, 388 observations were carried over 54 students (average of 7.18 observations per student); 57% took place in ambulatory settings, 60% were of low complexity and 85% involved healthy children programmed consultations. The ratings for specifc competences had little variation; the focus related to the setting. Conclusions. Used in a variety of settings, with different patient problems, the method was well accepted by both students and teachers.

Identificação de fatores que interferem na distribuição de panfletos em locais públicos / Characterization of factors wich affect the acceptance or refusal of pamphlet in public places / Identificación de los factores que influyen en La distribución de folletos en sítios de circulación pública

O objetivo deste estudo foi identificar fatores que interferem no comportamento de aceitar ou recusar panfletos em locais públicos. Foram observados 270 transeuntes, classificados por sexo e faixas de idade aproximada, além da observação e entrevista com 10 panfletistas em atividade. Os panfletos foram categorizados em: produto de consumo, de financiamento, eleitoral, de prestação de serviço e religioso. Organizou-se o comportamento dos transeuntes em quatro classes: recusar, ler, guardar e jogar fora. Foram as mulheres que mais recusaram e ou jogaram fora os panfletos recebidos. No caso das categorias “ler e guardar”, foram os homens que mais guardaram e/ou leram os panfletos recebidos. As categorias prestação de serviços e religioso apresentaram o maior percentual de panfletos distribuídos. O modo de se dirigir aos transeuntes, o local, o horário e outros fatores foram indicados como possíveis determinantes da interação entre panfletistas e transeuntes. Neste artigo, são abordadas as decorrências da alienação do trabalho apresentada pelos panfletistas.

The aim of this study was to identify factors which affect the acceptance or refusal pamphlets distribution in public places. Were observed 270 pedestrians classified by sex and estimately classes of age, beyond of the observation and interview with 10 pamphleteers working. The pamphlets were classified according to: consumption’s products, financing, electoral, service’s installment and religious rites; and the pedestrian’s behavior was classified in four categories: to refuse, to read, to keep and to throw out. The female pedestrians were the ones that refused the most and/or threw out the received pamphlets. In the class to read/keep pamphlets, the male pedestrians were the ones that kept and/or read the most the pamphlets they received. The classes service’s installment and religious rites are the ones which present the biggest percentage of pamphlets distributed. The way to address the pedestrians, the situation, the time, among other variables are indicated how possible determinants of the interaction between the pamphleteers and pedestrians. Are discussed the consequences of work’s alienation showed by the pamphleteers.

El proyecto buscó la identificación de factores que influyen en el comportamiento de aceptación o rechazo de folletos compartidos en sitios de circulación pública. Han sido observados 270 peatones, segun sexo y fajas etarias. Hubo, todavia, observación y entrevistas con 10 personas cargadas de hacer la distribución de los folletos. Los folletos han sido categorizados segun el tema de su texto: cosas de consumo, finanzas, elección de políticos, servicios profesionales y temas religiosos. Fueran establecidas cuatro clases de comportamiento: rechazar, leer, guardar y hechar fuera. Las mujeres han sido las que más negaran recibir o echaran fuera los folletos. En las clases de “leer y guardar”, hubo mayor concentración de hombres. Las categorías servicios y temas religiosos tienen el mayor porcentaje de folletos distribuidos. El modo de hablar a las personas, el sitio, La hora del dia así como otros factores han sido referidos como posibles factores determinantes de la interacción entre volantes y transeúntes. En este artículo, son referidos los impactos de la enajenación del trabajo de los volantes.

Comparação entre os questionários IT-MAIS e MUSS com vídeo-gravação para avaliação de crianças candidatas ao implante coclear / Comparison between the IT-MAIS and MUSS questionnaires with video-recording for evaluation of children who may receive a cochlear implantation

Existe uma grande dificuldade para determinar precocemente crianças que se beneficiariam ou não com o implante coclear, até porque devido à pouca idade são muito sutis as respostas apresentadas. OBJETIVO: Comparar os resultados obtidos através da vídeo-gravação de situações de interação de crianças candidatas ao implante coclear com os resultados obtidos através de protocolos de avaliação. MÉTODO: Fizeram parte da amostra 7 crianças com idade média de 39,7 meses, portadores de perda auditiva neurossensorial profunda. Foram aplicados os questionários IT-MAIS e MUSS aos pais e os resultados foram comparados com a observação da vídeo-gravação destas crianças. RESULTADOS: Foi possível observar que os dados são compatíveis no que se refere às etapas auditivas. No entanto, no que se refere ao questionário MUSS, os dados obtidos na observação lúdica são bastante diferentes. O questionário leva em consideração apenas a uso da linguagem oral e, portanto, a maioria das crianças apresentou um escore muito baixo. CONCLUSÃO: A observação lúdica permitiu traçar um perfil mais amplo do comportamento lingüístico e de aspectos relativos à linguagem apresentando diferenças do questionário.

There is a great difficulty in determining earlier on which children would benefit or not from cochlear implants, especially because of their young age, the responses they give are very subtle. AIM: To compare results obtained through video-recording of the interactions of children who may receive a cochlear implant with the results obtained through evaluation protocols. METHOD: Seven children, with an average age of 39.7 months, with profound hearing loss were selected for the study. IT-MAIS and MUSS questionnaires were given to their parents/guardians of these children and the results were compared with the observation of the video-recordings. RESULTS: It was possible to observe that the data is compatible with the auditory stages. However, the MUSS questionnaire data gathered during playful activities is very different . The questionnaire only takes into consideration the use of verbal language and therefore the majority of the evaluated children inevitably score low. CONCLUSION: Observing children play allows us to trace a better profile of linguistic behavior and aspects relative to language, that may presented differences in the questionnaire.