Anesthesia training: Are we doing enough in three years? Cross-sectional study

Introduction: The mínimum number of procedures required to be performed during anesthesia training has not been officially defined in Colombia. Although a number is no guarantee of acquired competencies, it does indicate the level of opportunity offered by the different programs. This study describes the practical training afforded to residents in a graduate anesthesia program in Colombia, and compares its results with international standards. Objective: Describe exposure to procedures performed by residents enrolled in a three-year anesthesia specialization program in Colombia between 2015 and 2020, and compare with the standards proposed by ASCOFAME and ACGME. Methods: Descriptive, cross-sectional study which included residents who did their specialization in a Colombian anesthesia program between 2015 and 2020. Complexity, anesthesia techniques, invasive monitoring and airway approach were described. Finally a descriptive comparison was made with the published references of the Colombian Association of Medical Schools (ASCOFAME) and the Accreditation Council for Graduate Medical Education (ACGME). Results: The results for 10 residents were included. Each resident had a median of 978 cases (IQR 942-1120), corresponding to 25 surgical specialties, the most frequent being general surgery (18%), orthopedics (16%), pediatric surgery (19%), and obstetrics (10.8%). According to the American Society of Anesthesiology (ASA) classification, the majority of patients were ASA II (39.63%) and ASA III (28.4%). Adequate exposure was achieved in 11 of the 15 categories proposed by ACGME and in 6 of the 15 proposed by ASCOFAME. Conclusions: A detailed description of the practice component acquired by the residents during their three years of training was obtained. This baseline provides insight into the national landscape and allows to describe the relationship with international standards.

Introducción: En Colombia no se encuentra oficialmente definido el número mínimo de procedimientos que se deben realizar durante el entrenamiento en anestesiología. Aunque el número no garantiza la adquisición de competencias de la especialidad, sí es un indicador de la oportunidad ofertada por parte de los programas. Este estudio describe el entrenamiento práctico que tienen los médicos residentes en un programa de posgrado de anestesiología en Colombia y compara sus resultados con estándares internacionales. Objetivo: Describir la exposición a procedimientos realizados por los médicos residentes de un programa de especialización en anestesiología de tres años en Colombia, entre 2015 y 2020, y compararlo con los estándares propuestos por ASCOFAME y el ACGME. Métodos: Estudio descriptivo de corte transversal; se incluyeron los residentes que cursaron su programa de especialidad en un programa colombiano de anestesiología entre 2015 y 2020. Se describieron la complejidad, técnicas anestésicas, monitoría invasiva y abordaje de la vía aérea. Finalmente, se compararon los resultados de manera descriptiva con lo referenciado por la Asociación Colombiana de Facultades de Medicina y el Accreditation Council for Graduate Medical Education (ACGME). Resultados: Se incluyeron los resultados de 10 médicos residentes. El número de casos por residente tuvo una mediana de 978 casos (RIQ942-1120), correspondientes a 25 especialidades quirúrgicas; cirugía general (18 %), ortopedia (16 %), cirugía pediátrica (19 %) y obstetricia (10,8 %) fueron las más frecuentes. Según la clasificación de la Sociedad Americana de Anestesiología (ASA), la mayoría de los pacientes tenían ASA 2 (39,63 %), ASA 3 (28,4 %). Se alcanzó una exposición adecuada en 11 de las 15 categorías propuestas por el ACGME y en 6 de las 15 propuestas por la Asociación Colombiana de Facultades de Medicina. Conclusiones: Se obtuvo una descripción detallada del aspecto práctico de los residentes de anestesiología durante sus tres años de formación. Esta línea de base permite ampliar el panorama a escala nacional y describir la relación con estándares internacionales.

Estratégias de ensino do raciocínio clínico nos cursos de Medicina do Brasil - revisão integrativa / Teaching strategies for clinical reasoning in Brazilian medical schools - an integrative review

Resumo: Introdução: O raciocínio clínico é considerado uma das principais habilidades que devem ser desenvolvidas pelos estudantes de Medicina, porque permite a elaboração de hipóteses diagnósticas e orienta estratégias investigativas e diagnósticas de forma racional. Embora os educadores tradicionalmente foquem o ensino no modelo hipotético-dedutivo ou analítico, muitos professores de medicina enfrentam no seu dia a dia o desafio de encontrar novas estratégias para ajudar seus estudantes a desenvolver o raciocínio clínico. Objetivo: Este estudo realizou uma revisão integrativa da literatura para identificar as estratégias utilizadas no processo ensino-aprendizagem do raciocínio clínico, nas escolas médicas brasileiras. Método: A metodologia utilizada consistiu em seis etapas: 1. elaboração da pergunta da pesquisa; 2. definição dos critérios de inclusão e exclusão; 3. elenco das informações a serem extraídas; 4. avaliação dos estudos incluídos; 5. interpretação dos resultados; e 6. apresentação da revisão. Resultado: A maioria dos trabalhos apontam que o ensino do raciocínio clínico é realizado por meio de discussões de casos clínicos, de maneira incidental, em diversas disciplinas ou por meio do uso de metodologias ativas, como PBL, TBL e CBL. Apenas três trabalhos apresentados em congressos demonstraram experiências relacionadas à implantação de uma disciplina curricular obrigatória voltada especificamente ao ensino do raciocínio clínico. O ensino do raciocínio clínico é priorizado no internato em relação às fases clínicas e pré-clínicas. Conclusão: Poucos são os estudos que analisam a maneira como se dá o processo ensino-aprendizagem do raciocínio clínico nas escolas médicas brasileiras. Embora mais estudos sejam necessários, podemos verificar a falta de conhecimento teórico sobre raciocínio clínico como uma das principais causas de dificuldade para o desenvolvimento dessa competência pelos estudantes.

Abstract: Introduction: Clinical reasoning is considered one of the main skills that must be developed by medical students, as it allows the establishment of diagnostic hypotheses and directs investigative and diagnostic strategies using a rational approach. Although educators have traditionally focused the teaching method on the analytical model, many medical professors face the challenge in their daily lives of finding new strategies to help their students develop clinical reasoning. Objective: To carry out an integrative literature review to identify the strategies used in the teaching-learning process of clinical reasoning in Brazilian medical schools. Method: The methodology used consists of six steps: 1. creation of the research question; 2. definition of inclusion and exclusion criteria; 3. list of information to be extracted; 4. evaluation of included studies; 5. interpretation of results and 6. presentation of the review. Results: Most studies indicate that the teaching of clinical reasoning is carried out through discussions of clinical cases, incidentally, in different disciplines or through the use of active methodologies such as PBL, TBL and CBL. Only three studies presented at conferences disclosed experiences related to the implementation of a mandatory curricular discipline specifically aimed at teaching clinical reasoning. The teaching of clinical reasoning is prioritized in internships in relation to the clinical and pre-clinical phases. Final considerations: There are few studies that analyze how clinical reasoning is taught to medical students in Brazilian medical schools. Although more studies are needed, we can observe the lack of theoretical knowledge about clinical reasoning as one of the main causes of the students' difficulty in developing clinical reasoning.

Escala de competencias clínicas básicas para psicoterapeutas (ECCBP). Construcción y fiabilidad para Argentina / Basic Clinical Competences Scale for Psychotherapists (BCCSP). Construction and reliability for Argentina

Resumen A nivel internacional, se han elaborado modelos e instrumentos de evaluación de competencias genéricas y específicas; sin embargo, en Argentina los desarrollos han sido menores. Un relevamiento de psicoterapeutas locales concluye que al menos siete competencias clínicas básicas y cinco indicadores asociados a su desarrollo serían esenciales para desempeñarse como terapeutas (Crocamo, 2019). El objetivo de este trabajo fue construir un instrumento para su evaluación, denominado Escala de Competencias Clínicas Básicas para Psicoterapeutas (ECCBP). Para ello, se utilizó un diseño no experimental, transversal de tipo exploratorio en cuatro fases: (1) elaboración del sistema de evaluación; (2) redacción de ítems; (3) revisión de la versión preliminar; y (4) desarrollo del instrumento definitivo. Se aplicó el instrumento a 534 psicoterapeutas argentinos con título de grado de psicólogo. La versión definitiva quedó conformada por 122 ítems y para completarlo se requirieren aproximadamente 45 minutos. La elaboración de un instrumento local favorece el estudio sistemático del área y permite valorar de manera confiable la efectividad de los programas de entrenamiento.

Abstract At the international level, models and instruments for the evaluation of generic and specific competences have been developed; however, in Argentina the developments have been fewer. A survey of local psychotherapists concludes that at least seven basic clinical competencies would be essential to perform as therapists: diagnostic process and design, interventions and techniques, therapeutic bond, professional role, contextual variables and diversity, interview management and evaluation and completion of the process. Furthermore, five activities and experiences would be linked to their training, called associated indicators: basic training and updating, personal development and work on oneself, belonging to institutions and network of professionals, supervision, and personal and professional experience (Crocamo, 2019). Therefore, the objective of this work was to construct an instrument for its evaluation called Basic Clinical Competences Scale for Psychotherapists (BCCSP). To do this, a non-experimental, cross-sectional exploratory design was used in four phases: (1) development of the evaluation system; (2) writing of items; (3) review of the preliminary version; and (4) development of the final instrument. The instrument was applied to 534 Argentine psychotherapists with a degree in psychology. To attend to the particularity of each phase, three samples were used. The first one was composed of three psychotherapists summoned to participate in the selection of the different methodologies to evaluate each competence and indicator. For the second one, reviewers of the instrument made up of five therapists with different levels of professional experience summoned to assess the preliminary version of the instrument. And the third, to study the psychometric properties of the BCCSP, a snowball sample was used composed of 534 psychotherapists from 19 provinces of Argentina. As a result, different evaluation formats were incorporated in order to favor the effective evaluation of the variables, clinical vignettes, self-evaluation of perception of competences and questionnaire. A systematized procedure was carried out to review and refine the pilot version. The percentage of agreement between the reviewers of the instrument (Herrera Rojas, 1993) and the Aiken's V coefficient were calculated using software called Basic Visual Program for Aiken's V, developed by Merino Soto and Livia Segovia (2009). The final version was made up of 122 items and it takes approximately 45 minutes to complete it. The first part is composed of three vignettes which offer clinical descriptions with 15 questions for each situation. Finally, the responses are scored as correct / complete (2 points), correct / partial (1 point) or incorrect (0 points). Next, the self-assessment scale presents the following Cronbach's alpha coefficients Therapeutic link α = .833; Professional role α = .715; Contextual variables and diversity α = .853; Interview management α = .845; Evaluation and completion of the process α = .845 and Design, interventions and techniques II α = .797. Finally, the questionnaire was made up of 22 items: basic training and updating (5 items), personal and professional experience (5 items), personal development and work on oneself (4 items), supervision (4 items), membership in institutions and professional network (5 items). The answers collected will allow to obtain qualitative information on experiences or activities associated with the development of clinical competencies for psychotherapy. In the first place, it should be noted that the BCCSP is an instrument specially constructed for the local population and the study area that can be generalizable to other similar sociocultural contexts since the vast majority of evaluation models and studies have been developed in Anglo-Saxon countries. At the same time, due to the lack of local evaluation instruments, the BCCSP could become a valuable tool, both to be used in research activities and in training programs and educational monitoring.

Las competencias del neurólogo en Colombia: una propuesta / The competencies of the neurologist in Colombia: a proposal

RESUMEN INTRODUCCIÓN: Tener claras las competencias profesionales permite dirigir adecuadamente los esfuerzos académicos, económicos y sociales para cumplir la vocación como neurólogos; hasta ahora, la bibliografía al respecto es escasa. OBJETIVO: Describir las competencias profesionales que debe tener un neurólogo clínico en Colombia. MÉTODOS Y MATERIALES: Es un estudio cualitativo exploratorio descriptivo, realizado según la teoría fundamentada, mediante una entrevista semiestructurada a 23 líderes de la especialidad en Colombia. RESULTADOS Y DISCUSIÓN: A partir de las entrevistas, se redactan según el modelo del Ministerio de Salud, competencias transversales y específicas que complementan las 8 planteadas previamente por ASCOFAME, para un total de 34 competencias divididas en cinco dominios. CONCLUSIONES: luego de conocer las competencias profesionales, deben diseñarse criterios de desempeño para medir el logro de esas habilidades. Dado que las competencias dependen de las condiciones de la sociedad, las cuales son cambiantes, su reevaluación debe ser continua.

SUMMARY INTRODUCTION: Having a clear idea of professional competencies allows to direct properly the academic economic and social efforts to accomplish the neurologist's vocation; neverthless, the literature is scarce. OBJECTIVE: Describe the professional competencies of clinical neurologists in Colombia. METHODS AND MATERIALS: It is a descriptive exploratory qualitative study, carried out according to grounded theory, through a semi-structured interview with 23 leaders of the specialty in Colombia. RESULTS AND DISCUSSION: From the interviews, transversal and specific competences are drawn up according to the model of the Ministry of Health, complementing the 8 previously proposed by ASCOFAME, for a total of 34 competencies divided into five domains. CONCLUSIONS: After knowing the neurologist's competencies, it's mandatory to design perfomance criteria to measure the achievement of those abilities. Since competencies depend on the conditions of society which are in constant change, their reassessment must be continuous.

Evaluación de competencias del proceso formativo de los residentes utilizando el portafolio: una revisión de la literatura / Assessment of competencies of the residents' training process using the portfolio: a literature review

In the dynamic process of curricular changes and improvements in the different specialties, knowledge, skills, attitudes and values have been taken into account; that is why new forms of study, supervision and evaluation of doctors in training have to be integrated. Recent experiences in our country try to introduce professional portfolios as assessment- learning tools in specialized postgraduate training. The portfolio is an instrument for evaluating the residents' training process that allows not only evaluating competencies, but fundamentally identifying what we should improve, allowing us to monitor the training media as they advance in the acquisition and development of competencies so that become a tool focused on helping us learn and at the same time provide elements to value the participation of tutors and their influence on learners. In the process of planning, designing and reviewing the portfolios, the training centers find an excellent opportunity to make a self-assessment of the consistency of their curricular structure, the clarity of the competences they seek to form and the evidence they may require in the training of its residents.

Selección de residentes en la formación de psiquiatría: ¿qué atributos buscan los docentes de un centro formador y por qué medios? / Resident selection in psychiatry: what attributes are sought and by what means?

Introducción: la formación en Psiquiatría tiene como primer desafío elegir los candidatos ideales para desempeñarse óptimamente como residentes, alcanzando las competencias necesarias para un posterior ejercicio de la especialidad. En general, no se cuenta con instrumentos específicos de selección de residentes, utilizándose diversas estrategias de elección de candidatos a la especialidad. El objetivo del presente estudio es identificar los atributos y los medios de selección que un grupo de académicos consideran necesarios al momento de seleccionar a los candidatos a sus programas de residencia en Psiquiatría. Metodología: se realizó una investigación cualitativa de tipo encuesta de percepción utilizando el Método Delphi. La encuesta se envió, por medio de una plataforma web, a todos los académicos del Departamento de Psiquiatría de la Pontificia Universidad Católica de Chile (n=39). Resultados: los atributos mencionados fueron agrupados en 8 dominios. Las principales categorías identificadas por los encuestados fueron: profesionalismo (41%), motivación por la especialidad (33%), habilidades de comunicación (13%) y estabilidad psicológica (12%). El principal instrumento mencionado para evaluar los atributos de los postulantes fue la entrevista personal. Las publicaciones científicas, las notas de pregrado y las cartas de recomendación son mencionadas secundariamente. Conclusiones: el actuar profesional en la acción médica, medido como profesionalismo, en este estudio es atributo esencial en un postulante a un programa de residencia en Psiquiatría. Aunque las entrevistas personales han demostrado poco valor predictivo con el rendimiento del residente durante su formación, siguen siendo un instrumento muy requerido en los procesos de selección de residentes.

Introduction: Training in Psychiatry has, as its first challenge, to choose the ideal candidates to perform optimally as residents, rea-ching the necessary skills for a subsequent exercise of the specialty. There are no specific instruments for selecting residents, but many different strategies are used to select proper candidates. The primary objective of this study is to recognize the attributes academics seek in a psychiatry residency applicant. The secondary objective was to identify the selection method academics thought as optimal.Methods: A qualitative investigation of perception was conducted using the Delphi Method. The perception survey was sent through a web platform to all academics of the Department of Psychiatry of the Pontificia Universidad Católica de Chile (n = 39).Results: Attributes were grouped into eight domains. The main identified categories were: professionalism (41%), specialty interest (33%), communication skills (13%), and psychological balance (12%). A personal interview was seen as the current optimal selection method. Publications, undergraduate scores, and letters of recommendation were also taken into account.Conclusions: Professionalism, is seen as an essential attribute in an applicant for a psychiatry residency program. Although personal interviews have shown little predictive value related to the resident's performance during their training, they are still a very common and valued instrument used in the resident selection processes.

Percepção do estudante sobre a influência do ambiente/clima educacional no processo ensino-aprendizagem: uma revisão integrativa / Student's perception of the influence of the educational environment / climate in the teaching-learning process: an integrative review

Trata-se de revisão integrativa que objetivou descrever o conceito de ambiente/clima educacional e identificar a influência do ambiente/clima educacional no processo ensino-aprendizagem sob a percepção do estudante. Ambiente educacional (AE) é todo e qualquer contexto em que se dá o ensino e o aprendizado. Foram selecionados doze artigos relevantes ao tema, nas bases de dados BVS e PubMed, com descritores, educação superior, competência clínica, procedimentos clínicos e aprendizagem. Emergiram três categorias: ambiente educacional e ensino clínico na saúde; percepção do estudante sobre o ambiente educacional e fatores do ambiente educacional que influenciam no processo ensino-aprendizagem. O AE pode afetar as habilidades e o desempenho acadêmico e deve propiciar confiança nas atividades diárias. Conclui-se que o AE tem influência no processo ensino-aprendizagem, fornece informações importantes para os educadores, estimulam a autoconfiança e aspectos afetivos.

Consideraciones sobre la necesidad de supervisión a los ingresantes a las residencias médicas / On the need for supervision of the entrants to medical residences

Según la Asociación Americana de Facultades de Medicina existen 13 actividades profesionales confiables que los graduados de medicina deberían poder realizar en su primer día de residencia sin supervisión directa. Esas actividades no están claramente definidas en nuestro país. Además, no existen datos locales sobre la necesidad de su supervisión. Nuestro objetivo fue evaluar la opinión de residentes y docentes acerca del nivel de supervisión que requieren los médicos ingresantes al sistema de residencias para realizar esas actividades. Se efectuó un estudio de corte transversal. Se incluyeron residentes de primer año de especialidades clínicas y quirúrgicas y sus docentes. Se enviaron encuestas electrónicas o en papel, con participación voluntaria y anónima. Se investigó la estimación sobre el nivel de supervisión que requerían los médicos ingresantes durante el primer mes de formación para 13 actividades. Se observaron diferencias significativas entre la evaluación hecha por residentes (n = 71) y los docentes (n = 39) en 11 de 13 de esas actividades. Más de la mitad de los docentes consideró que los residentes requerían supervisión directa para realizarlas, con las excepciones de formular interrogatorios clínicos y buscar evidencia. La mayoría de los residentes consideró que se requería supervisión directa solo en seis de ellas. En conclusión, los residentes estimaron requerir menor supervisión que sus docentes, quienes pensaban que los ingresantes al sistema de residencia no eran capaces de realizar la mayoría de las competencias clínicas de manera autónoma. Sería importante mejorar esta evaluación en los recién graduados, para definir con mayor precisión los niveles de supervisión.

According to the Association of American Medical Colleges, there are thirteen core Entrustable Professional Activities (EPAs) that medical graduates should be able to perform in their first day of residency, without direct supervision. In Argentina EPAs are not clearly defined. Moreover, there is no local data about the need of supervision regarding these activities. The aim of this study was to assess residents' and teaching physicians' estimations about the level of supervision that physicians in their first month of residency needed in order to perform EPAs. A cross-section study was conducted. First-year medical residents and teaching physicians were included. Electronic or paper surveys were sent, asking the level of supervision the participants estimated that residents needed to perform the 13 core EPAs, during their first month of residency. Participation was voluntary and anonymous. There were significant differences between the opinion of residents (n = 71) and teaching physicians (n = 39), for 11 out of 13 EPAs. More than half of the teaching physicians considered that residents needed direct supervision when performing EPAs, except for asking clinical questions and looking for evidence. Most residents thought that they required direct supervision in 6 EPAs. In conclusion, medical residents perceived the need of lower levels of supervision when compared to teaching physicians, who considered that medical graduates were not capable of performing most EPAs without direct supervision upon entering residency. Thus, it would be important to improve the procedures to evaluate the competences of medical graduates in order to establish more accurate supervision levels.

Competências para enfermeiras pediátricas de serviços hospitalares de oncologia / Competencies for pediatric nurses of oncology hospital services

OBJETIVO: Identificar as competências das enfermeiras pediátricas que atuam em oncologia. MÉTODO: Revisão integrativa, nas bases de dados: Biblioteca Virtual em Saúde, National Library of Medicine da U.S., portal de periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, busca livre em sites da Oncology Nurse Society e Library Online. Os critérios de inclusão: pesquisas originais, em português, inglês e espanhol, com os resumos nas bases selecionadas, no período de 2011 a 2018. RESULTADOS: Selecionados sete artigos com descrição das competências, sendo as principais: desenvolvimento profissional/educação, coordenação do cuidado, experiência e especialização, cuidados clínicos baseados em evidências, análise para recursos financeiros e acompanhamento do paciente em pesquisa clínica. CONCLUSÃO: Há limitação neste estudo, visto que há somente um documento internacional que abordada as competências em oncologia pediátrica, sendo necessário a tradução e validação desta matriz nas instituições brasileiras. (AU)

Objective: To identify the competencies of pediatric nurses working in oncology. Method: Integrative review in the databases: Virtual Health Library, U.S. National Library of Medicine, portal for journals of the Higher Education Personnel Improvement Coordination, free search on Oncology Nurse Society and Library Online websites. Inclusion criteria: original research and documents of International Society in Oncoloy, in Portuguese, English and Spanish, with abstracts in the selected bases, from 2011 to 2018. Results: Selected seven articles with description of competences, the main ones being: professional development/education, coordination of the care, experience and expertise, evidence-based clinical care, knowledge of financial resources and patient follow-up in clinical research. Conclusion: There is a limitation in this study, since there is only one international document that addresses the competences in pediatric oncology, requiring the translation and validation of this matrix in Brazilian institutions. (AU)

Objetivo: identificar las competencias de las enfermeras pediátricas que trabajan en oncología. Metodología: Revisión integradora en las bases de datos: Biblioteca Virtual en Salud, Biblioteca Nacional de Medicina de EE. UU., Portal para revistas de la Coordinación de Mejoramiento del Personal de Educación Superior, búsqueda gratuita en los sitios web de Oncology Nurse Society y Library Online. Criterios de inclusión: investigación original y documentos de Sociedades Internacionales de Oncología, en portugués, inglés y español, con resúmenes en las bases seleccionadas, de 2011 a 2018. Resultados: Siete artículos seleccionados con descripción de competencias, siendo los principales: desarrollo profesional / educación, coordinación de atención, experiencia y experiencia, atención clínica basada en evidencia, conocimiento de recursos financieros y seguimiento de pacientes en investigación clínica. Conclusión: Hay una limitación en este estudio, ya que solo hay un documento internacional que aborda las competencias en oncología pediátrica, que requiere la traducción y validación de esta matriz en las instituciones brasileñas. (AU)

Memorias del II Taller Nacional de Expertos en Atención al Neonato Grave / Memories of the II National Workshop of Experts in care of the Severely Ill Neonate

El II Taller Nacional de Expertos en Atención al Neonato Grave se desarrolló del 28 al 30 de mayo del 2018, auspiciado el Capítulo de la Sociedad Cubana de Enfermería, bajo el tema central, Validación de la estrategia de superación para el desarrollo de competencias específicas del licenciado de enfermería para la atención al neonato grave. Con la participación de 38 expertos de la especialidad de neonatología y 5 prestigiosas personalidades invitadas del área de las ciencias en Cuba, el taller marcó las pautas en cuanto a los objetivos propuestos, una vez que los expertos evaluaron y validaron en sección plenaria las competencias específicas de estos profesionales para la asistencia a esos recién nacidos, en aras de garantizar la calidad de la atención médica especializada

The II National workshop of Experts in care to the Severely Ill Neonate was developed from the May 28th to 30th, 2018, sponsored by the Chapter of the Cuban Society of Nursing, under the central topic, Validation of the training strategy for the development of specific competences in the care to the severely ill neonate. With the participation of 38 experts of the neonatology specialty and 5 invited outstanding personalities of sciences in Cuba, the workshop marked the rules as for the proposed objectives, once the experts evaluated and validated in plenary session the specific competences of these professionals for the care to these new born, for the sake of guaranteeing the quality of the specialized medical care.

Validación de competencias específicas de los profesionales de enfermería en la atención al neonato en estado grave / Validation of specific competences of the nursing professionals in the severely ill neonate care

Se efectuó la validación de las competencias específicas -- identificadas por expertos en un estudio previo -- de los profesionales de enfermería a cargo de la atención al recién nacido en estado grave en las unidades de cuidados intensivos neonatales. Para ello se aplicó un cuestionario a 38 expertos y 108 profesionales de la enfermería de los servicios de neonatología en la provincia de Santiago de Cuba y del Hospital General Docente Enrique Cabrera de La Habana, durante el 2017, quienes emitieron su juicio para ponderar las categorías establecidas al respecto. Las 12 competencias identificadas y propuestas por los expertos para ser desarrolladas en las unidades de cuidados intensivos neonatales, están en correspondencia con las tendencias internacionales, los protocolos y las indicaciones de la Dirección Nacional de Salud Materno-Infantil del Ministerio de Salud Pública, en cuanto a los conocimientos, las habilidades, las conductas, las actitudes, las aptitudes y las motivaciones de los profesionales de enfermería en la atención al neonato en los estados grave y crítico

The validation of specific competences -- identified by experts in a previous study -- of the nursing professionals in charge of the severely ill neonate care was carried out in the neonate intensive care units. Reason why, a questionnaire was carried out to 38 experts and 108 nursing professionals of the neonatology services in Santiago de Cuba and Enrique Cabrera Teaching General Hospital from Havana, during 2017 who expressed their opinion to consider the established categories on this respect. The 12 competences identified and proposed by the experts to be developed in the neonate intensive care units, are in correspondence with the international tendencies, protocols and indications of Maternal and Child Health National Management of the Public Health Ministry, as for knowledge, skills, behaviors, attitudes, aptitudes and motivations of nursing professionals for the severely and critically ill neonate care

Memorias del I Taller Nacional de Expertos en Atención al Neonato Grave / Memories of the Ist National Workshop of Experts in care of the Severely Ill Neonate

El I Taller Nacional de Expertos en Atención al Neonato Grave se desarrolló del 18 al 21 de julio del 2017, auspiciado por el Capítulo Provincial de la Sociedad Cubana de Pediatría y el Capítulo de la Sociedad Cubana de Enfermería, bajo el tema central Las competencias específicas del licenciado de Enfermería para la atención al neonato en estado grave. Con la participación de 38 expertos en el tema -- especialistas en Neonatología -- y 5 prestigiosas personalidades invitadas de las ciencias de la salud y de la enfermería en Cuba, el Taller marcó las pautas en cuanto a los objetivos propuestos, una vez que los expertos identificaron y propusieron en sesión plenaria las competencias específicas de los profesionales de la enfermería para la asistencia a estos recién nacidos, en aras de garantizar la calidad de la atención médica especializada y contribuir al desarrollo de la investigación

The I National Workshop of Experts in care of the Severely ill Neonate took place from July 18th to July 21st, 2017, sponsored by the Provincial Chapter of the Cuban Society of Pediatrics and the Chapter of the Cuban Society of Nursing, under the central topic The specific competences of the Nursing graduate for the care of the severely ill neonate. With the participation of 38 experts in the topic -- specialists in Neonatology -- and 5 invited prestigious personalities of the health sciences and nursing in Cuba, the Workshop marked the guidelines as for the proposed objectives, once the experts identified and proposed in plenary session the specific competences of nursing professionals to care these newborns, for the sake of guarantying the quality of the specialized medical care and contributing to the development of the investigation

Seguridad y destreza autoreportadas en la formación de competencias clínicas obstétricas en estudiantes de obstetricia / Self-reported confidence and skills in training for clinical-obstetric competences on Obstetrics students

Introducción: la educación en ciencias de la salud ha requerido adaptaciones de acuerdo a necesidades de la población, y así muchos programas de estudios han adoptado el modelo de competencias. Se hace necesario demostrar la adquisición del conocimiento práctico desarrollándose actividades con seguridad y destreza que permita la atención clínica efectiva. Objetivo: analizar niveles de destreza y seguridad autoreportados y rendimiento obtenido por estudiantes de la carrera de Obstetricia y Puericultura de la Universidad de Concepción, Chile, que entrenan competencias obstétricas, además con simulación clínica. Métodos: se realizó estudio no experimental, analítico y relacional, en 127 estudiantes de la carrera de Obstetricia y Puericultura de la Universidad de Concepción, en el año 2014. Se aplicó encuesta para medir destreza con escala tipo Likert posterior al entrenamiento de competencias obstétricas en modalidad preclínica, y la seguridad en modalidad clínica y se relacionó con el rendimiento obtenido. Se realizó análisis descriptivo y relacional. Resultados: 119 estudiantes respondieron las encuestas para destreza y 115 para seguridad. Las competencias obstétricas fueron 30, de complejidad variable, con resultados diversos. Las destrezas altas se relacionan con seguridad alta, sin embargo no todas las competencias siguen este curso. La destreza no se relaciona con rendimiento. Conclusiones: las competencias obstétricas son diversas en complejidad, con diferentes niveles de destreza y seguridad, algunas muy altas y otras más bajas, sin embargo algunas importantes presentan niveles más bajos que los esperados. Es necesario ordenar los niveles de complejidades. La evaluación de los estudiantes no se relaciona con el logro de competencias, se hace necesario establecer instrumentos adecuados(AU)

Introduction: The education of health sciences has required adjustments according to the needs of the general population and therefore most programs have adopted models based on competencies. It is necessary to demonstrate the acquisition of practical knowledge developed with regards to safety and skill that allows for more effective clinical care. Objective: To analyze the self-reported levels of skill and safety and the assessments obtained by students of midwifery at University of Concepcion, Chile. They train in obstetric skills mainly via clinical simulation. Method: Analytical and relational, non-experimental study with non-probabilistic by 119 volunteer midwifery students at the university at the University of Concepcion in 2014. A Likert type scale survey was administered post practical trainings in preclinical and clinical settings which was correlated with the student's performances. A descriptive and relational analysis was executed. Results: 119 students completed the surveys for skill level and 115 for security of procedures. There were 30 obstetric skills practical trainings, all of varying degrees of complexity with mixed results. High levels of skill are related to high levels of security but not all of their competencies follow this pattern. The level of skill does not relate to performance. Conclusions: Obstetric skills are diverse in terms of complexity, with diferent levels of skill and safety, mostly high for both, but some are not important. It is necessary to sort the levels of complexity. The evaluation of students is not related to the achievement of competencies. It is necessary to establish appropriate measuring instruments(AU)

Interdependencia de habilidades comunicativas y propias de la profesión para la elaboración de historias clínicas en estudiantes angloparlantes / Interdependence of communicative skills and others for the profession in the elaboration of clinical charts by English-speaking students

INTRODUCCIÓN: a partir del supuesto de que la elaboración de historias clínicas durante los estudios médicos requiere de habilidades propias de la profesión que formarán parte de las competencias clínicas del médico, a la vez que las habilidades comunicativas son consideradas como sub competencias de aquellas; pudieran generarse entonces limitaciones en la formación y desarrollo de determinadas competencias clínicas por fallos comunicativos. OBJETIVO: explorar las posibles afectaciones de cinco habilidades propias de la profesión que se expresan en la elaboración de historias clínicas en la universidad médica de Villa Clara. MÉTODOS: se realizó un estudio exploratorio de corte cualitativo sobre la percepción de profesores del área clínica y estudiantes angloparlantes de quinto año. RESULTADOS: se constató según sus valoraciones, que existe relación entre las habilidades comunicativas y las propias de la profesión médica estudiadas; con las mayores afectaciones en la relación médico paciente, la caracterización de la historia natural de la enfermedad y de los síntomas y signos en diferentes enfermedades. CONCLUSIONES: entre las competencias comunicativas de los estudiantes angloparlantes y las competencias clínicas a desarrollar en su formación médica existe una fuerte interdependencia que requiere de una mayor atención didáctica.

INTRODUCTION: Taking in to consideration the performance of clinical records during the medicine studies, it requires specific abilities of the profession that will take part in the clinical competence of the practitioner, although the communicative abilities are considered as sub competence; so there could be limitations in the development and formation of some clinical competences due to some communicative failures. OBJECTIVE: To explore the possible difficulties in some of the abilities of the profession which are used when performing clinical records in the medical university. METHODS: A qualitative and exploratory study was carried out by professors of the clinical area and English speaking students of fifth year. RESULTS: there is a relation between the abilities of the medical profession and the communicative abilities with a great affectation in the patient-doctor relation, the characterization of the nature of the disease and the signs and symptoms of different diseases. CONCLUSIONS: It is concluded that is strong interdependency between the clinical abilities and the communicative abilities in the English speaking students of fifth year which requires a greater didactic attention.

La importancia de la evaluación por competencias en contextos clínicos dentro de la docencia universitaria en salud / The importance of evaluation in clinical competence in the presence of college teaching in health / A importância da avaliação de competência clínica na presença de ensino colégio em saúde

La evaluación por competencias (ExC) ha renovado la manera de determinar el desempeño clínico de los profesionales en salud. Para tal efecto, el docente universitario requiere del dominio conceptual y metodológico de las distintas técnicas de evaluación formativa. Este artículo da cuenta de las principales técnicas de evaluación por competencias en escenarios clínicos, concibiéndola como una competencia fundamental para la docencia universitaria en salud.

Competency assessment (CA) has renewed the way to determine the clinical performance of health professionals. To this end, the university teaching requires conceptual and methodological domain on the various techniques of formative assessment. This article reports the main technical competency assessment in clinical settings, considering it as a core competency for university teaching in health.

Competência de avaliação (CA) renovou a maneira de determinar o desempenho clínico dos profissionais de saúde. Para o efeito, o ensino universitário requer domínio conceitual e metodológica sobre as várias técnicas de avaliação formativa. Este artigo relata a avaliação da competência técnica principal na prática clínica, considerando-a como uma competência essencial para o ensino universitário em saúde.

Nivel de competencia de las enfermeras para el cuidado del paciente sometido a trasplante hepático en el Hospital Infantil de México / Level of competence of nurses for the care of patients undergoing liver transplantation at the Children's Hospital of Mexico / Nível de competência de enfermeiros para o atendimento de pacientes submetidos a transplante hepático no Hospital Infantil do México

Introducción: El trasplante Hepático (TH) es un procedimiento muy dinámico que en la actualidad constituye el tratamiento de elección para un gran número de enfermedades hepatobiliares agudas y crónicas. Hoy en día continúa siendo un reto para el equipo de trabajo de las unidades de cuidados intensivos a pesar de los avances en las técnicas quirúrgicas, anestésicas, inmunosupresión e infecciones; lo que exige de este personal un alto nivel de preparación científico-técnico. Objetivo. Evaluar el nivel de competencia que tiene el personal de enfermería para el ciado del paciente sometido a trasplante hepático. Metodología. Se trata de una investigación de Nivel 2 de profundidad correlacional-comparativo y diseño transversal. Probabilística estratificada estuvo integrada por 63 enfermeras = 78.75 % de la población de los diferentes turnos del servicio de pediatría. Se utilizaron dos cuestionaros una guía de observación. Donde se comparó las respuestas del cuestionario con diga guía de observación, auditoría para evaluar habilidades y un cuestionario de autoevaluación para conocimientos y aptitudes. Los datos se analizaron en el programa estadístico SPSS versión 15, con uso de la estadística descriptiva e inferencial, los resultados obtenidos fueron presentados en cuadros y gráficas, posteriormente se realizó un análisis de lo encontrado y fue contrastado con la literatura. Resultados. En relación al cumplimiento de las dimensiones se encontró que en conocimientos obtuvieron un 3.4% encontrándose en el rango regular; en las aptitudes obtuvieron un 4.5% por lo que se encuentran en el rango de por arriba de todas las dimensiones; y finalmente en las habilidades se obtuvieron 3.2% encontrándose en un nivel de cumplimiento rango mínimo. Discusión. La práctica del cuidado en los pacientes sometidos a trasplante hepático debe estar enfocada desde sus raíces, esto es de la forma de enseñar en las escuelas dado que no se da herramientas solidas a los alumnos para enfre4ntar la práctica clínica. Es aquí donde se encontraron similitudes con la Organización Panamericana de la Salud, con su propuesta de reorganizar la educación del personal de salud. Donde debe de existir una vinculación formativa del profesional y su vida laboral. Coincidimos con Ibarra en la forma de conceptualizar las competencias capacidad productiva del profesional que se define en términos de desempeño en un determinado contexto laboral. No puede existir una separación educativa con la práctica del cuidado puesto que estas deben ser vistas como un binomio que permita de manera sólida ser la base para lograr de cada uno de los profesionales de la salud el desarrollo de sus competencias clínicas en su vida laboral. Conclusiones: Con fundamento en los resultados y la discusión planteada en este estudio realizado a las enfermeras del Hospital Infantil de México Federico Gómez, que atienden a los pacientes postrasplantado de hígado para determinar el nivel competencias clínicas que ellas tienen se establece, "no se acepta la primera hipóte4sis de investigación ya que los hallazgos enuncian que; las competencias de la enfermeras en regular en los conocimientos habilidades específicas estarán disminuidas. Aun cuando la dimensión de actitudes es alta o adecuada, la atención de calidad y de seguridad al paciente no radica en esta dimensión solamente ya que deberán estar acompañadas de competencias clínicas como las habilidades y conocimientos.

Introduction: Hepatic transplantation (HT) is a very dynamic procedure that currently constitutes the treatment of choice for a large number of acute and chronic hepatobiliary diseases. Today, it continues to be a challenge for the work team of intensive care units despite advances in surgical techniques, anesthetics, immunosuppression and infections; what demands of this personnel a high level of scientific-technical preparation. Objective. To assess the level of competence that nurses have for the treatment of the patient undergoing liver transplantation. Methodology. This is a Level 2 investigation of correlational-comparative depth and cross-sectional design. Stratified probabilistic was composed of 63 nurses = 78.75% of the population of the different shifts of the pediatric service. Two questionnaires were used an observation guide. Where the responses of the questionnaire were compared with say observation guide, audit to evaluate skills and a self-assessment questionnaire for knowledge and skills. The data were analyzed in the statistical program SPSS version 15, with the use of descriptive and inferential statistics, the results obtained were presented in tables and graphs, later an analysis of the findings was made and compared with the literature. Results In relation to the fulfillment of the dimensions, it was found that in knowledge they obtained a 3.4% finding themselves in the regular range; in the aptitudes they obtained 4.5% so they are in the range of above all the dimensions; and finally, in the skills, 3.2% were obtained, meeting a minimum level of compliance. Discussion. The practice of care in patients undergoing liver transplantation should be focused from its roots, this is the way of teaching in the schools given that no solid tools are given to students to confront clinical practice. This is where they found similarities with the Pan American Health Organization, with its proposal to reorganize the education of health personnel. Where there should be a formative link of the professional and their working life. We agree with Ibarra on the way to conceptualize the skills productive capacity of the professional that is defined in terms of performance in a specific work context. There can not be an educational separation with the practice of care since these should be seen as a binomial that allows in a solid way to be the basis to achieve each of the health professionals the development of their clinical skills in their work life. Conclusions: Based on the results and the discussion raised in this study to the nurses of the Children's Hospital of Mexico Federico Gómez, who care for post-transplant liver patients to determine the level of clinical competencies they have established, "it is not accepted the first hypothesis of investigation since the findings state that; The skills of nurses in regular knowledge-specific skills will be diminished. Even when the attitude dimension is high or adequate, quality care and patient safety do not lie in this dimension alone since they must be accompanied by clinical skills such as skills and knowledge.

Introdução: O transplante de fígado (TH) é um processo muito dinâmico que actualmente é o tratamento de escolha para um grande número de doenças hepatobiliares agudas e crónicas. Hoje continua a ser um desafio para a equipe de unidades de terapia intensiva apesar dos avanços na cirurgia, anestesia, imunossupressão e infecções técnicas; o que esta equipe requer um alto nível de preparação científica e técnica. Objetivo. Avaliar o nível de competição que tem enfermeiros ted para o transplante de fígado submetidos paciente. Metodologia. Esta é uma concepção comparativo e transversal investigação de Camada 2 correlação profundidade. probabilística estratificada constituída por 63 enfermeiros = 78,75% da população dos diferentes turnos de Pediatria. dois foram usadas cuestionaros guia de observação. Onde as respostas ao questionário em comparação a dizer guia de observação, auditoria para avaliar habilidades e questionário de auto-avaliação de conhecimento e habilidades. Os dados foram analisados ​​no SPSS versão 15, com o uso de estatística descritiva e inferencial, os resultados foram apresentados em tabelas e gráficos, em seguida, foi realizada uma análise do que foi encontrado e contrastava com a literatura. Resultados. Em conformidade com as dimensões descobriu que o conhecimento obtido em 3,4% na gama normal; habilidades obtidos em 4,5% de modo está na gama de acima de todas as dimensões; e, finalmente, 3,2% foram obtidas capacidades foram em nível de alcance mínimo cumprimento. Discussão. prática de cuidados em pacientes submetidos a transplante de fígado deve ser focada de suas raízes, esta é a maneira de ensinar nas escolas, uma vez que não é dado ferramentas robustas para os alunos enfre4ntar prática clínica. Isto é onde as semelhanças com a Organização Pan-Americana da Saúde reuniu-se com a sua proposta de reorganizar a educação do pessoal de saúde. Onde deve haver um elo formador do profissional e sua vida profissional. Ibarra concordar com a maneira de conceituar habilidades de capacidade profissional é definida em termos de desempenho em um determinado contexto de trabalho. não pode haver uma prática de cuidados de separação educacional uma vez que estes devem ser vistos como uma combinação que permite ser solidamente a base para atingir cada um dos profissionais de saúde desenvolver suas habilidades clínicas em suas vidas profissionais. Conclusões: Com base nos resultados e discussão levantada neste enfermeiras do estudo do Hospital Infantil do México Federico Gomez, que cuidam de pacientes que postrasplantado fígado para determinar as clínicas nível de competência que estabeleceram, "ele não é aceito a primeira hipótese de investigação desde que os achados afirmam que; As habilidades dos enfermeiros em habilidades específicas do conhecimento serão diminuídas. Mesmo quando a dimensão de atitudes é alta ou adequada, cuidados de qualidade e segurança do paciente não reside apenas nesta dimensão porque ele deve ser acompanhada de habilidades clínicas como habilidades e conhecimentos.

Eating Disorders

Therapist competency is fundamental to the success in treating most psychological disorders. However, the skills required to effectively treat eating disorders may be more demanding than many other problems, because competency requires mastery of considerable educational information about physical complications associated with eating-disorder symptoms and chronic weight suppression. The cognitive-behavioral model of treatment has become well-defined in recent years; however, the mark for therapist competency continues to rise as the knowledge base has expanded with the high level of clinical and research interest in eating disorders. The guidelines provided in this paper are intended to provide a springboard for the training and supervision to improve patient care.

La competencia del terapeuta es fundamental para el éxito en el tratamiento de los Trastornos Psicológicos. Sin embargo, las habilidades que se requieren para tratar eficazmente los Trastornos del Comportamiento Alimentarios pueden ser más demandantes que para otros problemas, porque la competencia requiere del dominio de considerable información educativa acerca de las complicaciones físicas asociadas con los síntomas de los Trastornos Alimentarios y la supresión crónica de peso. El modelo de tratamiento cognitivo-conductual se ha convertido en el mejor definido en recientes años, sin embargo, el marco de la competencia del terapeuta continúa aumentando, dado que, la base de conocimientos se ha ampliado con el alto nivel de interés en la investigación clínica y en los trastornos alimentarios. Las directrices que proporciona este artículo tiene objetivo servir de trampolín para la formación y supervisión para mejorar la atención al paciente.