Medical ethics teaching in the new undergraduate physiology competency-based curriculum in medical institutions in Delhi: A pilot, feasibility study

Background: Medical ethics teaching has received little attention in India's undergraduate medical curriculum, so the National Medical Commission’s formal inclusion of medical ethics in the new competency-based curriculum (CBME) is creditable. However, the policymakers have left out the most crucial stakeholders — the teachers. This study was conducted to find out how physiology educators in Delhi felt about the implementation of ethics teaching in physiology in the CBME. Methods: This was a pilot, cross-sectional, observational, feasibility study conducted using a questionnaire, involving faculty and senior residents (post-MD) in the departments of Physiology at nine medical colleges in Delhi, conducted over the period from February to October 2020. Results: The response rate was 76% (60/79), of which 40% (24/60) were senior residents and 60 (36/60) were faculty. Around 55% (n=33) felt bioethics and clinical ethics are not synonymous; 53% (n=32) believed ethics education can be accomplished in a large group setting; 75% (n=45) believed it should be the responsibility of the physiology faculty, rather than the clinical faculty, and 61.7% (n=37) wanted it to be included in the formative assessment. The respondents shared ethical concerns that should be included in the physiology curriculum and the best candidates to teach them to achieve integration. Despite the challenges, the majority 65% (n=39) felt ethics in the physiology CBME should be an inseparable part of teaching in all instructional modalities. Conclusion: Early clinical exposure was considered preferable to the Attitude, Ethics, and Communication (AETCOM) programme. Using the five W’s and one H method, we talk about how our findings can be used as a road map to help physiologists teach ethics to medical students in the new CBME.

An ophthalmology professionalism survey tool: Outcomes from a multi-center study in Central India

Purpose: To describe a professionalism survey tool and its use to assess knowledge of medical professionalism in ophthalmology training programs in Central India. Settings and Design: Multi?center survey study. Methods: A validated 33?question, scenario?based survey addressing professionalism attributes was administered at five centers in central India. The attributes tested included “personal characteristics,” “physician–patient relationships,” “workplace practice and relationships,” and “socially responsible behaviors.” A mean attribute score (%) was calculated and compared to “gold standard” responses by a group of expert senior ophthalmologists (100% agreement for responses). Results: A total of 225 participants completed the survey; 124 residents, 47 fellows, and 54 consultants (98.4% response rate). The total mean attribute score was 80.7 ± 9.1 (min 16.67, max 100). There was variation in the mean attribute score by professionalism attribute (P < 0.001), and a trend toward higher mean attribute scores for consultants compared to trainees across all attribute groups. The scores for “personal characteristics” (93 ± 9.7) and “physician?patient relationship” (82 ± 15.8) were the highest, whereas scores for “socially responsible behaviors” (73.9 ± 18.6) and “workplace practices” were low (72 ± 13). Conclusions: There is a generally high level of professionalism knowledge among ophthalmologists in central India. The results suggest that experience does impact knowledge of professionalism. Potential for improvement in professionalism exists in around "workplace practices", and around "socially responsible behaviors". These findings may serve as a valuable discussion starter and teaching tool to enhance professionalism in ophthalmology training programs.

A Study of the Current Scenario of the Obstetrics and Gynecology Residency during the COVID-19 Pandemic / Um estudo do cenário atual da residência em obstetrícia e ginecologia durante a pandemia de COVID-19

Abstract Objective To analyze the impact of the COVID-19 pandemic on the residency of gynecology and obstetrics in São Paulo. Methods Cross-sectional study developed by representatives of residents of the Association of Gynecology and Obstetrics of the State of São Paulo (SOGESP, in the Portuguese acronym). Data were collected from questionnaires applied to gynecology and obstetrics residents registered on the SOGESP website in February 2022. The interviewees answered about the repercussions of the pandemic on medical residency and whether they had technical and psychological support during the period. Results A total of 247 questionnaires were collected from residents of gynecology and obstetrics. The residents had an age of 28.3 ± 3 years old, and most of them were female (88.4%). The displacement to COVID care was reported by 62.34% of the students, but only 35.6% reported completely adequate personal protective equipment and only 7.7% reported complete theoretical and technical instruction to support these patients. Almost all of the interviewees stated that the gynecology sector was the most affected. The majority of the interviewees considered that the second-year residents had the greatest loss, and more than half of the residents in the 1st and 2nd year said they wished to give up their residency during the pandemic. More than 80% of the residents reported online theoretical classes and/or presentation of articles, reinforcing the fact that virtual activities gained a greater space within the medical residency. Conclusion The pandemic impacted the residency in greater proportion in outpatient clinics and gynecological surgeries, also interfering with the physician's desire to continue with the program.

Resumo Objetivo Analisar o impacto pandemia de COVID-19 sobre a residência de ginecologia e obstetrícia do Estado de São Paulo. Métodos Estudo transversal desenvolvido por representantes dos residentes da Associação de Ginecologia e Obstetrícia do Estado de São Paulo (SOGESP). Foram coletados dados de questionários aplicados aos residentes de ginecologia e obstetrícia cadastrados no site da SOGESP em fevereiro de 2022. Os entrevistados responderam sobre repercussões da pandemia sobre a residência médica e se tiveram suporte técnico e psicológico durante o período. Resultados Foram levantados 247 questionários de residentes de ginecologia e obstetrícia. Os residentes apresentaram idade de 28,3 ± 3 anos, sendo a maioria do sexo feminino (88,4%). O deslocamento para "covidários" foi referido por 62,34% dos avaliados, porém somente 35,6% referiram equipamento de proteção individual completamente adequado e apenas 7,7% referiram instrução completa teórica e técnica para o suporte destes pacientes. Quase a totalidade dos entrevistados afirmou que o setor de ginecologia foi o mais afetado. A maioria dos entrevistados considerou que o os residentes do segundo ano foram os que tiveram maior prejuízo, sendo que mais da metade dos residentes do 1° e 2° ano afirmou ter desejado desistir da residência durante a pandemia. Mais de 80% dos residentes referiram aulas teóricas e/ou apresentação de artigos online, reforçando o fato de que as atividades virtuais ganharam um espaço maior dentro da residência médica. Conclusão A pandemia impactou nas residências em maior proporção nos ambulatórios e cirurgias ginecológicas, interferindo também sobre o desejo do médico de seguir com o programa.

Educational Research and Scholarship in India: The Way Forward

Medical education research (MER) aims to improve the practice of medical education by applying the theory of educational research. Internationally, medical education research has grown exponentially and has established itself as a distinct field. In contrast, in India, the medical faculty is either bogged down by clinical responsibilities, or is busy with biomedical research. The recent initiatives such as implementation of competency-based medical education (CBME) for medical undergraduates, and push coming from regulatory agencies besides National Education Policy have become game changers. The emerging concept of scholarship, takes in to account all scholarly activities in a fair manner. The scholarship of teaching and learning (SoTL) is helpful in connecting teaching with better patient care outcomes through evidence based approach. It also promotes a community of practice to boost research and publication activities. Finally, there is a need to enlarge the scope of research from treating sick children to promoting total wellbeing, which requires interdisciplinary and interprofessional approach to research.

Afinal, quem é "difícil"? Revisão integrativa sobre pacientes, médicos e relações difíceis / In the final analysis, who is "problematic"? An integrative review of patients, physicians and problematic relationships

Resumo O objetivo deste estudo foi sintetizar a literatura sobre as características de pacientes, médicos e relações médico-paciente consideradas "difíceis". Foi realizada uma revisão integrativa de estudos primários publicados entre janeiro de 2016 e setembro de 2021, em português, inglês e espanhol. De 3.414 artigos identificados nas bases Embase, PubMed, Scopus e Lilacs, 19 foram analisados qualitativamente. Sete estudos foram efetuados na Europa, oito na América do Norte, dois na América do Sul e dois na China, totalizando 1.694 pacientes, 1.903 médicos assistentes, 101 residentes e 160 acadêmicos de medicina. Médicos e/ou acadêmicos de medicina consideravam difíceis os pacientes com: condições clínicas como doenças psicossomáticas e crônicas; sintomas e queixas como dor; emoções fortes; problemas na obtenção e no compartilhamento de informações, nas tomadas de decisão, na adesão ao plano terapêutico e no seu autocuidado; e certas características sociodemográficas e de vulnerabilidade. Pacientes ou seus familiares consideravam difíceis os médicos que não os escutavam, eram preconceituosos e pareciam não se importar com seus filhos, entre outros aspectos. Sugere-se o ensino de comunicação médica e intervenções sistêmicas para melhorar as relações médico-paciente.

Abstract The scope of this study was to assess the literature on the characteristics of patients, physicians, and physician-patient relationships considered 'problematic.' An integrative review of primary studies published between January 1, 2016, and September 30, 2021, in Portuguese, English and Spanish was conducted, Of the 3,414 papers identified in the PubMed, Embase, Scopus and Lilacs databases, 19 were selected for qualitative analysis. Seven studies were carried out in Europe, eight in North America, two in South America and two in China, totaling 1,694 patients, 1,903 assistant physicians, 101 residents and 160 medical academics. Physicians and academics considered the following to be problematic: patients with clinical conditions such as psychosomatic and chronic illnesses; symptoms and complaints such as pain; powerful emotions; problems in obtaining and sharing information, in decision-making, in the adherence to the therapeutic plan and in their self-care; and some sociodemographic and vulnerability characteristics. Among other aspects, patients, or their relatives, considered physicians to be problematic when they did not listen to them or appear to care about their children, Teaching medical communication and systemic interventions are recommended to improve physician-patient relationships.

Assessment of Educational Environment of Newly Established Medical College by UG Medical Students: A Mixed Method Study

Introduction: Educational environment always play a crucial role in the development of students as well as faculty of any institution. In India, there is a continuous increase in the number of medical colleges and the number of MBBS seats, but the quality of education with quantity is questionable. To answer this question, the present study was planned to know the educational environment in a new Medical Institution that ejected its alumni in 2018. Aim: To analyze the educational environment of a newly established Medical College in eastern Uttar Pradesh. Materials and Methods: The present study was a descriptive cross-sectional which took six months to complete. This study used the Dundee Ready Education Environment Measure (DREEM) questionnaire, open-ended questions and focus group discussions (FGDs). The study was conducted on MBBS students in Government Medical College, Azamgarh, UP. Results: The batch-wise Global DREEM scores were 169.08 (alumni), 156.23 (interns), 168.76 (2015), 164.16 (2016), 176.23 (2017), 176.94 (2018). This demonstrates that the educational environment is satisfactory in all domains and comes under the 3rd category of the educational environment index. The FGDs showed a positive response in all batches but with high variability in scores, which indicates lack of standardization in Medical Education. The open-ended questions’ responses revealed many merits and demerits about five domains. Conclusion: The variability of DREEM score, FGDs and open ended questions denotes the lack of standardization in the Medical Education system and the scores of the Education Environment Index (all domains) must move from category III (satisfactory) to category IV (excellence).

Perception of first MBBS students toward online formative assessment in biochemistry

Background: The COVID-19 pandemic affected all the educational activities including medical education and there is a substantial shift from direct classes to online platforms.In competency-based medical education (CBME), the formative assessment orchestrates a prominent role in increasing the student’s capacity of learning. This method of teaching guides the students to measure the performance over a period of time and also improves the students’ knowledge gap. Aim and Objectives: The present study was carried to evaluate the perception and attitude of students toward online assessment during the formative assessment in 1st year MBBS degree in biochemistry subject. The study also aimed to assess practical difficulty and feasibility of conducting online assessment as a part of formative assessment as per CBME curriculum. Materials and Methods: The study was conducted on 124 1st year MBBS students and the students were informed about the assessment in 15 days advance. The perception and attitude of the students toward online assessment was done using 20 items structured questionnaire administered through Google forms. The students’ response was measured using 5-point Likert scale. Results: Among the 124 students, 42 (39.6%) were aware about online assessment. About 57.5% of students preferred any type of gadgets such as desktops, laptops, and smart phones. Most of the students 84.5% obtained 50–75% for a total score of 25. Around, 51.9% of students responded that online teaching is more feasible, and 74.5% reported that there is connectivity problem during online platform. In this study, 46.2% online assessment is safe and 41.5% strongly disagree that distraction from home environment did not affect the online assessment. Conclusion: The present study concludes that the students are more interested in MCQ-based question assessment for the knowledge assessment. Further, they opined in favor of online education but with some demerits.

Effectiveness of case-based learning among medical interns using microbiology laboratory report as a tool

Background: Due to lack of consensus of teaching learning methods during undergraduate period, intern doctors face many challenges in clinical settings. Knowledge gaps related to clinical application of laboratory medicine leads to poor case management. Active learner centered training with real clinical cases is a need to help the interns to link their basic science knowledge into a practical context. Aims and Objectives: The present study was done to evaluate the effect of case based learning (CBL) on the interns’ knowledge and clinical decision-making skill of interpretation of laboratory investigation reports and to assess perception of participants about CBL. Materials and Methods: CBL method was used to train the interns in clinical application microbiology reports. This is a pre- and post-test type study, carried out for 2 months with 43 Medical interns, willing to participate. The process included evaluation of CBL by pre-validated questionnaires by multiple choice questions, clinical case scenarios before, immediately after and 10 days after the intervention and perception toward CBL was assessed. Statistical analysis was done using Student’s t-test and SPSS 17 software. The value of P < 0.05 was considered as significant. Results: A significant improvement in the interns’ knowledge and problem solving following CBL sessions had been observed in present study. The post-test scores of all the CBL sessions were significantly higher than pre-test scores (P < 0.05). The perception of interns toward CBL was assessed and it was responded positively. It helped in strengthening the critical skills of interns such as problem solving, critical thinking, and teamwork. Conclusion: The present study proved that interns during internship require to be trained in laboratory medicine. CBL is an effective teaching method to train interns in enhancing their problem solving skill with correct use of laboratory test results and strengthening critical thinking, teamwork, and time management skills.

Flipped classrooms in teaching pharmacology for medical undergraduate students – A comparative study

Background: The new competency-based medical education curriculum envisages the need to adopt newer teaching-learning methods. There is a growing concern about the effective dissemination of knowledge to a large group of students through conventional didactic lectures. Flipped classroom teaching has evolved as an innovative method and is a systematic approach to improving the student learning experience. Aims and Objectives: The present study was undertaken (1) to compare the effectiveness of flipped classroom methods with that of the lecture as a teaching learning method in pharmacology for undergraduate medical students and (2) evaluate the students’ perception of the flipped method. Materials and Methods: This study was done in the Department of Pharmacology in a tertiary care teaching hospital in Kerala after ethics committee approval. Two groups of students enrolled using the convenient sampling method, received three flipped classes and three lectures on the topics after crossover. Feedback was collected using a validated structured questionnaire and a common evaluation after each topic was done with a pre-validated multiple choice questions questionnaire. Results: This study has examined the perceptions of students about flipped teaching method using various teaching materials on a Likert 5-point scale. The findings indicate that flipped classroom was a better teaching method. The mean scores of flipped classrooms were high and it was found to be significant (P < 0.05). Conclusion: The results of the study indicate that flipped classroom is more effective for students when compared to lectures. An implication of this is the possibility that it can be used as an adjunctive method in the new curriculum.

De una idea a una publicación original en cirugía: Una guía para futuros cirujanos académicos. Capítulo Futuros Cirujanos, Asociación Colombiana de Cirugía / From an idea to an original publication in surgery: A guide for future academic surgeons. Future Surgeons Chapter, Colombian Surgical Association

Introducción. Recientemente, se ha evidenciado un crecimiento exponencial de artículos de estudiantes y autores jóvenes; sin embargo, la mayoría de esos artículos no han sido citados. El objetivo de este artículo fue presentar un manual de fácil interpretación, aplicable durante el proceso de construcción de un manuscrito académico original en cirugía. Métodos. Se realizó una revisión sistemática de la literatura en las bases de datos académicas, utilizando las palabras clave "manuscrito académico", "cirugía", "investigación" y "how to do it", así como sinónimos. Se incluyeron estudios originales, revisiones y las directrices STROCSS 2021, publicadas hasta marzo de 2023. Resultados. Se logró recopilar una guía empírica, con recomendaciones y directrices útiles para la creación de un manuscrito académico en cirugía, óptima para uso en todos los niveles académicos. Conclusión. Se deben brindar herramientas que sean aplicables en todos los niveles educativos, desde un estudiante hasta cirujano graduado. Con este artículo se buscan dar a conocer un camino para transformar una idea en una publicación científica original de alto impacto, de forma metódica y fácil de entender, actuando como un incentivo y facilitador para la producción científica y académica en cirugía para Colombia y Latinoamérica

Introduction. Recently, there has been an exponential growth of articles by students and young authors; however, most of the articles have not been cited. This review presents an easy-to-interpret manual, applicable during the process of writing an original academic manuscript in surgery. Methods. A systematic literature review was performed in academic databases using the keywords "Academic Manuscript", "Surgery", "Research" and "How to do it", as well as synonyms; the search date was performed until March 2023, where original studies, reviews and STROCSS 2021 guidelines were included. Results. It was possible to compile an empirical guide, with useful recommendations and guidelines for the creation of an academic manuscript in surgery, optimal for use at all academic levels. Conclusion. Tools should be provided that are applicable at all educational levels, from a student to a graduate surgeon. The authors seek to show a way to transform an idea into an original scientific publication of high impact, in a methodical and easy to understand way, so this article acts as an incentive and facilitator for scientific and academic production in surgery in Colombia and Latin America

Low-cost versus high-fidelity pediatric simulators for difficult airway management training: a randomized study in continuing medical education

Abstract Background: High-fidelity (HF) pediatric patient simulators are expensive. This randomized study aimed to compare the quality and educational impact of a full-scale simulation workshop with an HF infant simulator (SimBaby™, Laerdal) or with a low-cost (LC) simulator composed of an inert infant manikin with SimBaby™ software that displays respiratory/hemodynamic parameters on a monitor for medical education in pediatric difficult airway management. Methods: After written informed consent, anesthetists and emergency or ICU physicians participated in teams (4 to 6 participants) in a training session that included direct participation and observation of two difficult intubation scenarios. They were randomized into two groups (HF group, n = 65 and LC group, n = 63). They filled out a simulation quality score (SQS, 0 to 50), self-evaluated their anesthetists' non-technical skills (ANTS) score (15 to 60), and an educational quality score (EQS, 0 to 60) immediately (T0, main criteria), as well as 3 (T3) and 6 (T6) months after the training session. Results: We enrolled 128 physicians. Direct participation SQS (39 ± 5 HF group versus 38 ± 5 LC group), observation SQS (41 ± 4 H F group versus 39 ± 5 LC group), ANTS scores (38 ± 4 HF group versus 39 ± 6 LC group), T0 SQS (44 ± 5 HF group versus 43 ± 6 LC group), T3 and T6 SQS were not different between groups. Conclusion: Our low-cost simulator should be suggested as a less expensive alternative to an HF simulator for continuing medical education in pediatric difficult airway management.

Medical student competence in ophthalmology assessed using the Objective Standardized Clinical Examination

Purpose: To assess pre?clerkship and clerkship medical student performance in an ophthalmology Objective Standardized Clinical Examination (OSCE) station. Methods: One hundred pre?clerkship medical students and 98 clerkship medical students were included in this study. The OSCE station consisted of a common ocular complaint – blurry vision with decreased visual acuity – and students were asked to take an appropriate history, provide two or three differential diagnoses to explain the symptoms, and perform a basic ophthalmic examination. Results: Generally, clerks performed better than pre?clerks in the history taking (P < 0.01) and ophthalmic examination (P < 0.05) sections, with few specific exceptions. In the history?taking section, more pre?clerkship students asked about patient age and past medical history (P < 0.00001) and for the ophthalmic examination, more pre?clerkship students performed the anterior segment examination (P < 0.01). Interestingly, more pre?clerkship students were also able to provide two or three differential diagnoses (P < 0.05), specifically diabetic retinopathy (P < 0.00001) and hypertensive retinopathy (P < 0.00001). Conclusion: The performance of both groups was generally satisfactory; however, many students in both groups had scores that were unsatisfactory. Notably, pre?clerks also outperformed clerks in certain areas, which emphasizes the importance of revisiting ophthalmology content through clerkship. Awareness of such knowledge can allow medical educators to incorporate focused programs into the curriculum

Student’s perception on teaching and learning methods in pharmacology and changes recommended

Background: Understanding the changing trends in medical education technology helps to improve the teaching learning methods for medical graduates which can further help to improve the quality of health-care system. Apart from the conventional methods, several new methods of teaching are being introduced according to the changing medical curriculum. Most of these techniques are well accepted by the medical students. Aim and Objectives: The aim of the study was to collect feedback from the students to understand their perception on teaching and learning methods in the subject of pharmacology. Materials and Methods: This observational, cross-sectional, and questionnaire-based study was conducted in the Department of Pharmacology at Government Medical College, Thrissur, during the period 2017–2018. Pre-validated questionnaire was distributed among 2nd-year MBBS students, attending pharmacology classes and responses were collected and analyzed using a 5-point Likert scale. Results: Major responses from students perspective regarding teaching and learning methods in Pharmacology subject were that learning pharmacology is very important before going to clinics (96.5%), brief description about the clinical scenario is essential before discussing about the drugs (95.5%), knowledge of pharmacy and drug dispensing methods are necessary for patient care (94.5%). Pharmacology should be taught along with clinical subjects (93%) and also problem-based learning and prescriptions are extremely useful in clinics (90.5%). Conclusion: Regular and systematic feedback from the learners side can significantly improve the quality of medical education and health-care system. Clinically oriented teaching methods can impart more interest in studying Pharmacology.

The impact of COVID-19 pandemic on medical students: A cross-sectional study

Background: The coronavirus disease (COVID-19) pandemic has affected the medical education throughout the world. A study was done to assess the effect of education and psychological behavior on medical students. Aims and Objectives: The objective of the study is to evaluate the effect of COVID-19 on medical graduates in various aspects such as education, effect on clinical rotations, impact on the technology used for online classes, effect on quality of life, loneliness, sleep, and depressive symptoms. Materials and Methods: A set of questions were distributed to Government Medical college, Suryapet students during November 2021–January 2022. Questionnaire aimed to study students’ viewpoint of COVID-19’s impact on their education, mental health, and willingness to participate clinically. Results: One hundred medical students from Government Medical College, Suryapet participated in this study. Most students (88%) agreed that pandemic had disrupted their medical education. About 64% agreed to attend clinical rotations and 68% of students accepting the risk of contracting COVID-19 in clinical rotations. COVID-19 had an impact on technology tools used for medical education. Students reported that COVID-19 had moderate impact on quality of life, sleep quality, anxiety, and depressive symptoms. Conclusion: The COVID-19 had an overall significant negative impact on undergraduate medical education. It is recommended that measures need to be taken to relieve students’ stress.

Afrontamiento al estrés académico en la carrera de Estomatología

Introducción: el estrés académico es un proceso sistémico, adaptativo y esencialmente psicológico; es la manera de reaccionar de una persona frente a ciertos estímulos. El del artículo es evaluar el estrés académico en estudiantes de primer y segundo años de la carrera Estomatología. Método: investigación analítica de corte pedagógico en la Facultad de Estomatología de Camagüey. El universo estuvo constituido por los 42 estudiantes matriculados en primer y segundo año de la carrera; a los que se les aplicó el inventario SISCO de Estrés Académico, diseñado para establecer los niveles de estrés en estudiantes universitarios. Los datos fueron procesados mediante estadística descriptiva e inferencial. Resultados: Predominó el nivel moderado de estrés en ambos grupos, con el 70 y 72,7 % en primer y segundo año respectivamente. Los estresores que más influyeron fueron las evaluaciones de los profesores y el tiempo limitado para realizar el trabajo que solicitan con puntuaciones por encima de 10 en primer año y 9 en segundo. Predominaron las reacciones psicológicas y físicas en segundo año y la estrategia de afrontamiento predominante fue la elaboración de un plan y ejecución de sus tareas con puntuación de 9 en segundo año y 11,4 en primero (p=0,006). Discusión: el ingreso a la universidad y los cambios que suscita, la adopción gradual de responsabilidades y la percepción individual además de los efectos de la pandemia se consideran factores que influyen en el estrés manifestado por los estudiantes; situación que afrontan fundamentalmente mediante la elaboración de un plan y la ejecución de sus tareas.

Introduction: Academic stress is a systemic, adaptive and essentially psychological process; it is the way people react to certain stimuli. Aim: to assess the academic stress in first and second year students of Dentistry. Method: analytic research with pedagogical kind, conducted in Camaguey Faculty of Dentistry involving the 42 students of first and second year of the program. SISCO tool of academic stress was applied since it allows to establish the levels of stress in university students. Data were processed through both descriptive and analytic statistics. Results: Moderate levels of stress were predominant in both years with 70% and 72,7 % in first and second respectively. The most influent stressors were the evaluations and the limited time for accomplishment of assigned tasks with figures above 10 in first year and 9 in second one. Psychological and physical reactions were predominant in second year students, and the most used strategy to face up to stress was elaboration of a plan and carry out its tasks which exhibited figures of 9 in second year and 11,4 in first year (p=0,006). Discussion: university admission and changes associated combined, the gradual responsibilities assumed and individual perception together with the impact of the pandemics are the main factors contributing to the stress exhibited by students; issue faced by elaborating a plan and develop its tasks as it is the preferred strategy.

Códigos QR en Educación Médica - Parte 3. Una Innovación en el Proceso de Enseñanza - Aprendizaje / QR Codes in Medical Education - Part 3. An Innovation in the Teaching-Learning Process

En esta tercera y última parte de la serie Códigos QR en Educación Médica analizaremos una nueva forma de Código QR con complementos de función y los distintos contextos educativos en los que se pueden emplear como una herramienta tecnológica innovadora durante el proceso de enseñanza ­ aprendizaje. Nuestro objetivo es lograr que los educadores se familiaricen con esta tecnología y puedan incorporarla al material educativo utilizado tanto en el aula tradicional como en los cursos virtuales.

In this third and last section of the series QR Codes in Medical Education we will analyze a new form of QR Code with complements of function and the different educational contexts in which they can be used as an innovative technological tool during the teaching-learning process. The final purpose is to ensure that all educators feel familiar with this technology and can incorporate it into the educational material used both in the traditional classroom and in virtual courses.

Scale to measure medical, nursing and midwifery students' engagement in an e-learning histology course / Escala para medir la participación de estudiantes de medicina, enfermería y obstetricia en un curso de histología e-learning

SUMMARY: E-learning courses become increasingly important and relevant in medicine and health sciences over the last decade. However, there are few teaching experiences of e-learning histology courses published in the literature worldwide. Moreover, most of these studies focus on the didactic aspects of the course without exploring student participation. The study presented below aimed to validate a scale to measure student participation in an e-learning histology course. We provide evidence of validity of the instrument based on its internal structure for use with medical, nursing, and midwifery students. The participants in this study were a group of 426 Chilean medical, nursing and midwifery students from a public university who completed the questionnaire in two consecutive semesters (2020-2021). Data from the first group of students were used to perform an exploratory factor analysis (EFA), while data from the second group of participants were used to perform a confirmatory factor analysis (CFA). The three factors identified according to the CFA were: "Habits of online," "Motivation for online learning," and "Interaction of online". After eliminating one of the initial items of the instrument, the scale showed acceptable psychometric properties suggesting that it is a useful instrument to measure students' perception of their participation in e-learning histology courses. The factors identified through the validation of the instrument provide relevant information for teachers and curriculum developers to create and implement different ways of encouraging student participation in e- learning histology courses to support online learning.

Los cursos e-learning han tomado mayor importancia y relevancia durante la ultima década en carreras de medicina y ciencias de la salud. No obstante, existen escasas experiencias docentes de cursos de histologia e-learning publicadas en la literatura mundial. Además, la mayoría de estos estudios se centran en los aspectos didácticos del curso sin explorar la participación de los estudiantes. El estudio que presentamos a continuación tuvo por objetivo validar una escala para medir la participación de los estudiantes en un curso de histología e-learning. Aportamos evidencia de validez del instrumento basada en su estructura interna para su uso con estudiantes de medicina, enfermería y obstetricia. Los participantes de este estudio fueron un grupo de 426 estudiantes chilenos de medicina, enfermería y obstetricia de una universidad pública quienes completaron el cuestionario en dos semestres consecutivos (año 2020-2021). Los datos del primer grupo de estudiantes se utilizaron para realizar un análisis factorial exploratorio (AFE), mientras que los datos del segundo grupo de participantes se utilizaron para realizar un análisis factorial confirmatorio (AFC). Los tres factores identificados según el AFC fueron: "Hábitos de los estudiantes en línea", "Motivación por el aprendizaje en línea", "Interacción de los estudiantes en línea". Luego de la eliminación de uno de los ítems iniciales del instrumento, la escala mostró propiedades psicométricas aceptables sugiriendo que es un instrumento útil para medir la percepción de los estudiantes sobre su participación en cursos de histología en formato e-learning. Los factores identificados mediante la validación del instrumento entregan información relevante para que los profesores y curriculistas desarrollen e implementen diferentes formas de estimular la participación de los estudiantes en cursos de histología e- learning y así apoyar el aprendizaje en formato online.

Effectiveness evaluation of online Mindfulness in mental health and alcohol consumption in medical students during the COVID-19 pandemic / Evaluación de la eficacia del Mindfulness online en la salud mental y el consumo de alcohol en estudiantes de medicina durante la pandemia de COVID-19

Abstract Introduction As a result of the COVID-19 pandemic, the prevalence of stress, anxiety, depression, and alcohol consumption has increased among medical students. Mindfulness is an intervention to decrease these psychopathologies and alcohol consumption; however, evidence has shown unclear results regarding its efficacy. Objective To evaluate the effectiveness of an online Mindfulness-based intervention (MBI) on stress, anxiety, and depression symptomatology levels, as well as on alcohol consumption and mindfulness status in medical students during the COVID-19 pandemic. Method A quasi-experimental study was conducted on 237 students, obtaining sociodemographic data. In addition the levels of psychopathology, alcohol consumption, and state of mindfulness: were measured pre-and post-intervention through the DASS-21, AUDIT, and MASS instruments. Eight online Mindfulness sessions were conducted once a week for approximately one hour each. Results MBI did not reduce levels of psychopathologies or alcohol consumption, nor did the mindfulness status improve. High levels of psychopathologies, dropout rate, and lack of voluntary participation were the main factors limiting the effectiveness of the online MBI. Discussion and conclusion The online MBI wasn't effective among the population under study: we recommend generation strategies where students are involved in and complete intervention programs. Results from this research will help enhance future online mindfulness interventions.

Resumen Introducción Derivado de la pandemia del COVID-19, la prevalencia de estrés, ansiedad, depresión y consumo de alcohol ha incrementado entre los estudiantes de medicina. La intervención por Mindfulness ha reportado disminuir estas psicopatologías y el consumo de alcohol; no obstante, la evidencia muestra resultados poco claros respecto a su eficacia. Objetivo Evaluar la eficacia de la intervención basada en Mindfulness online (IBM) sobre los niveles de sintomatología de estrés, ansiedad y depresión, así como en el consumo de alcohol y el estado de atención plena en estudiantes de medicina durante la pandemia por COVID-19. Método Se realizó una investigación cuasi-experimental en 237 estudiantes de medicina, de los cuales se obtuvieron datos sociodemográficos; además, se midieron los niveles de psicopatologías, consumo de alcohol, y el estado de atención plena pre y post intervención a través de los instrumentos DASS-21, AUDIT, y MASS. Se llevaron a cabo ocho sesiones de Mindfulness online, una vez por semana, de aproximadamente una hora cada una. Resultados La IBM no redujo los niveles de psicopatologías ni de consumo de alcohol ni mejoró el estado de atención plena. Los altos niveles de psicopatologías, la tasa de abandono y la falta de participación voluntaria, fueron los principales factores que limitan la eficacia del IBM online. Discusión y conclusión La IBM online no fue efectiva entre la población estudiada: se recomienda la generación de estrategias en las que los estudiantes se involucren y completen los programas de intervención, los resultados de esta investigación ayudarán a mejorar futuras intervenciones de mindfulness online.