Una revisión sistemática del uso de la inteligencia artificial en la educación / A systematic review of the use of artificial intelligence in education

Introducción. El uso de la inteligencia artificial (IA) en la educación ha sido objeto de una creciente atención en los últimos años. La IA se ha utilizado para mejorar la personalización del aprendizaje, la retroalimentación y la evaluación de los estudiantes. Sin embargo, también hay desafíos y limitaciones asociados. El objetivo de este trabajo fue identificar las principales tendencias y áreas de aplicación de la inteligencia artificial en la educación, así como analizar los beneficios y limitaciones de su uso en este ámbito. Métodos. Se llevó a cabo una revisión sistemática que exploró el empleo de la inteligencia artificial en el ámbito educativo. Esta revisión siguió una metodología de investigación basada en la búsqueda de literatura, compuesta por cinco etapas. La investigación se realizó utilizando Scopus como fuente de consulta primaria y se empleó la herramienta VOSviewer para analizar los resultados obtenidos. Resultados. Se encontraron numerosos estudios que investigan el uso de la IA en la educación. Los resultados sugieren que la IA puede mejorar significativamente la personalización del aprendizaje, proporcionando recomendaciones de actividades y retroalimentación adaptadas a las necesidades individuales de cada estudiante. Conclusiones. A pesar de las ventajas del uso de la IA en la educación, también hay desafíos y limitaciones que deben abordarse, como la calidad de los datos utilizados por la IA, la necesidad de capacitación para educadores y estudiantes, y las preocupaciones sobre la privacidad y la seguridad de los datos de los estudiantes. Es importante seguir evaluando los efectos del uso de la IA en la educación para garantizar su uso efectivo y responsable.

Introduction. The use of artificial intelligence (AI) in education has been the subject of increasing attention in recent years. AI has been used to improve personalized learning, feedback, and student assessment. However, there are also challenges and limitations. The aim of this study was to identify the main trends and areas of application of artificial intelligence in education, as well as to analyze the benefits and limitations of its use in this field. Methods. A systematic review was carried out on the use of artificial intelligence in education, using a literature search research methodology with five stages, based on the Scopus query and the tool for analyzing results with VOSviewer. Results. Numerous studies investigating the use of AI in education were found. The results suggest that AI can significantly improve personalized learning by providing activity recommendations and feedback tailored to the individual needs of each student. Conclusions. Despite the advantages of using AI in education, there are also challenges and limitations that need to be addressed, such as the quality of data used by AI, the need for training for educators and students, and concerns about the privacy and security of student data. It is important to continue evaluating the effects of AI use in education to ensure its effective and responsible use.

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

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

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

Eureka: um programa de mentoria de alunos de Medicina com engajamento e alta adesão / Eureka: a mentoring program for medical students with high levels of commitment and attendance

Resumo: Introdução: A mentoria vem sendo utilizada como instrumento para o desenvolvimento profissional e pessoal de estudantes de medicina. Relatamos a evolução do grupo de mentoria de alunos de graduação em medicina da Universidade Federal da Grande Dourados (UFGD), que perdura por longo tempo, com excelente aderência e amplo aproveitamento, e satisfação dos participantes com o processo. Relato de experiência: O programa de mentoria de alunos de medicina da UFGD se iniciou no quinto ano de existência do curso, encontrando-se em contínua atividade por mais de 15 anos. Há três anos, tornou-se projeto de extensão universitária. São realizadas discussões semanais sobre assuntos práticos, morais e éticos relacionados à profissão médica. Os participantes são mentorados por tempo variável, eventualmente até alguns anos após a graduação. A atividade é voluntária para mentora e mentorados. Muito raramente ocorrem faltas aos encontros, e semanalmente os participantes escrevem sobre suas reflexões advindas das sessões de mentoria, recebendo respostas individuais. Também assumem as responsabilidades pela realização operacional das reuniões e pela indicação de novos participantes. Sessões adicionais de mentoria individual são frequentes. Discussão: Programas de mentoria pequenos ou informais, se bem executados, podem ser bem-sucedidos, obtendo resultados positivos significativos, sem custo para as instituições. Os alunos que participam do programa Eureka sentem-se acolhidos e atendidos em suas necessidades de orientação, e se mostram comprometidos e satisfeitos com o processo. Não observamos nesse grupo problemas de assiduidade, de engajamento, nem de falta de feedback. Conclusão: O programa Eureka, com regras de funcionamento claras e constantes, mentoria adequada e alunos bem selecionados, constitui eficiente ferramenta em nossa universidade, contribuindo, assim, para a formação de estudantes e médicos mais motivados, preparados, realizados e úteis à sociedade.

Abstract: Introduction: Mentorship has been used as an instrument for professional and personal development of medical students. This article reports on the development of the medical student mentorship program at the Federal University of Grande Dourados (UFGD), which has been active for many years with excellent adherence and high levels of satisfaction and progress of the participants. Experience report: The UFGD medical student mentorship program began in the fifth year of the medical course's existence and has been continuously active for over 15 years. Three years ago, it became a university extension project. Weekly discussions regarding practical, moral and ethical aspects of the medical profession take place. The participants are mentored for varying periods of time, possibly up to a few years after undergraduate training. The activity is voluntary for both mentor and mentees. Absences from the meetings are very rare and the mentees write a weekly log about their reflections from the mentoring sessions, to which the mentor replies individually. They also take on the responsibilities of organizing the meetings and of indicating new participants. Additional individual mentoring sessions are frequent. Discussion: Small or informal mentorship programs, if well executed, can be successful, obtaining positive results at no cost to the institution. The students who take part in the Eureka program feel welcome, guided and show commitment and satisfaction with the process. We have not observed in this group any issues with engagement and attendance, or lack of feedback. Conclusion: The Eureka program, with its clear and constant rules, adequate mentoring and well selected students, constitutes an efficient tool in our university, therefore, contributing to the education of more motivated, prepared and self-fulfilled students and physicians.

Clinical skills assessment and feedback in pediatric residency / Avaliação de habilidades clínicas e feedback na residência médica em Pediatria

Abstract: Introduction: A medical residency is the specialization par excellence in medical training and the program is responsible for ensuring that the recently graduated doctor reaches the established level of competence. A well-prepared assessment system with feedback is an effective tool to enhance the performance of future specialists and guarantee their qualification. Objective: To analyze the assessment system for pediatric residents at a university hospital, aiming to promote teaching training in assessment methods. Methodology: educational action research (research-teaching), conducted with teachers and preceptors in the pediatric residency of a university hospital. The stages consisted of: a) the application of a questionnaire on participant profile and assessment methods used to evaluate the medical residents; b) intervention (workshop) on the assessment of clinical skills and feedback; c) immediate assessment after the workshop, by applying another questionnaire based on level 1 of the Kirkpatrick model. Simple statistical analysis was used for the objective data and the content analysis, according to recommendations by Malheiros (2011) and Bardin (2013), for the qualitative part. Result: Ten (48%) of the 21 participants declared not being formally trained in assessment and that they applied the more traditional methods learned from personal experience. Regarding the assessment methods, 81% (17/21) of the participants used more than one, aiming to obtain a more encompassing and reliable assessment. However, none of the teachers/preceptors used a systematized assessment of the clinical skills or provided feedback to the medical residents. After the workshop, with a focus on assessing performance in a simulated 'Objective Structured Clinical Examination' (OSCE) environment, all the participants were favorable to apply the OSCE in their teaching-learning practice with residents and undergraduate students, reaching Kirkpatrick level 3. Conclusion: The action research helped identify limitations in the assessment and feedback system of the pediatric resident physician. The methodology used revealed an aggregating effect and contributed to the development of the collaborative and integrative sense in the group. However, it was not enough to positively interfere with the pediatric medical residency assessment in the short term.

Resumo: Introdução: A residência médica é a especialização por excelência na formação do médico, e cabe ao programa assegurar que o residente egresso atinja o nível almejado de competência. Um sistema avaliativo bem elaborado e com feedback é ferramenta efetiva para aprimorar o desempenho do futuro especialista e garantir a qualificação dele. Objetivo: Este estudo teve como objetivo analisar o sistema de avaliação do médico residente em pediatria de um hospital universitário, com o intuito de promover a formação docente em métodos avaliativos. Método: Trata-se de uma pesquisa-ação educacional (pesquisa-ensino) realizada com docentes e preceptores da residência médica em pediatria de um hospital universitário. As etapas consistiram em: 1. aplicação de questionário sobre o perfil dos participantes e os métodos avaliativos utilizados com os residentes; 2. intervenção com a realização de um workshop sobre avaliação de habilidades clínicas e feedback; 3. avaliação imediata, após o workshop, com aplicação de outro questionário, elaborado com base no nível 1 do método Kirkpatrick. Utilizaram-se a análise estatística simples, para os dados objetivos, e a análise de conteúdo, segundo recomendações de Malheiros e Bardin, para a parte qualitativa. Resultado: Dos 21 participantes, dez (48%) informaram que não tinham capacitação formal em avaliação e que utilizavam métodos avaliativos mais tradicionais. Quanto aos métodos, 81% (17/21) dos participantes informaram que utilizavam mais de um, com finalidade somativa, para obter uma avaliação mais abrangente e fidedigna. No entanto, nenhum utilizava uma avaliação sistematizada de habilidades clínicas com fornecimento de feedback. Após o workshop com enfoque em avaliação de desempenho em ambiente simulado, em que se adotou o Objective Structured Clinical Examination (OSCE), os participantes utilizaram, com os internos, o método avaliativo do aprendizado na sua prática cotidiana, e, dessa forma, o treinamento atingiu o nível 3 de Kirkpatrick. Conclusão: A pesquisa-ação propiciou identificar limitações no sistema de avaliação e feedback do médico residente em pediatria. A metodologia utilizada revelou um efeito agregador e contribuiu para desenvolver o sentido colaborativo e integrativo no grupo. No entanto, não foi suficiente para interferir positivamente, em curto prazo, na avaliação da residência médica em pediatria.

Feedback formativo e aprendizagem do aluno de Medicina no contexto pediátrico: uma revisão narrativa da literatura / Formative feedback and medical student learning in pediatrics: a narrative literature review / Feedback formativo y aprendizaje del alumno de medicina en el contexto pediátrico: una revisión narrativa de la literatura

O feedback formativo é central na educação médica. Contudo, estudos sobre a aplicação da estratégia na Pediatria são escassos. Objetivando compreender como o feedback pode ser incorporado ao aprendizado do estudante de Medicina no contexto pediátrico, conduziu-se uma revisão narrativa da literatura. A partir da consulta às bases de dados Medline, Lilacs, SciELO, Embase e Scopus e Web of Science, selecionaram-se 13 artigos, publicados entre 1986 e 2020, focados em feedback de alunos de Pediatria na graduação. A análise da literatura evidenciou a utilidade do feedback de múltiplas fontes e a importância de ferramentas como formulários e cartões de encontro clínico para fornecer feedback quanto às habilidades necessárias ao bom exercício da Pediatria. Os trabalhos pouco exploraram o feedback com auxílio da internet, o que deve ser tema de pesquisas futuras. (AU)

Formative feedback is central to medical education. However, studies on the application of the technique in pediatrics are scarce. We conducted a narrative literature review to understand how feedback can be incorporated into medical student training in pediatrics. Searches of the MEDLINE, LILACS, SciELO, Embase, Scopus and Web of Science databases resulted in the selection of 13 articles focusing on feedback and pediatrics graduate students published between 1986 and 2020. The findings highlight the usefulness of multiple-source feedback and importance of tools such as forms and clinical meeting cards for providing feedback on necessary pediatrician skills. The articles paid little attention to feedback with the help of the internet, which should be the theme of future studies. (AU)

El feedback formativo es central en la Educación Médica; sin embargo, son escasos los estudios sobre la aplicación de la estrategia en la Pediatría. Con el objetivo de comprender cómo el feedback puede incorporarse al aprendizaje del estudiante de medicina en el contexto pediátrico, se realizó una revisión narrativa de la literatura. A partir de la consulta a la base de datos de MEDLINE, Lilacs, SciELO, EMBASE, Scopus y Web of Science, se seleccionaron 13 artículos, publicados entre 1986 y 2020, enfocados en feedback y alumnos de Pediatría en la graduación. El análisis de la literatura puso en evidencia la utilidad del feedback de múltiples fuentes y la importancia de herramientas como formularios y tarjetas de encuentro clínico para proporcionar feedback con relación a las habilidades necesarias para el buen ejercicio de la Pediatría. Los trabajos exploraron poco el feedback con el auxilio de internet, lo que debe ser tema de investigaciones futuras. (AU)

Teachers and students' perceptions about feedback in clinical internships in medical school / Percepções de docentes e discentes sobre feedback em estágios práticos no curso de medicina

Abstract: Introduction: In medical education, feedback is considered one of the main types of formative assessment. Feedback can be defined as the transmission of information by observing students in action aiming to provide improvement for the acquisition of medical skills that constitute medical professionalism. Objective: The aim of this study was to assess if there are difficulties in transmitting and receiving feedback by preceptors and students during the practical stages of medical training. Methods: This qualitative / quantitative design study involved all students who completed the internship from March 2018 to August 2019 (n = 50), as well as all preceptors responsible for the internships (n = 9) at Universidade Municipal de São Caetano do Sul. Knowledge about feedback, according to the viewpoint of students and preceptors, was assessed using adapted questionnaires with categorical and open questions. Descriptive analyses were used for the quantitative data and the content technique for the qualitative data. Results: The preceptors report that the objectives of providing feedback are to point out improvement, critical reflection, and opportunity for adjustments. Meanwhile, students report: clarification of doubts, planning for improvements and knowledge of positive points. Half of the preceptors claim to provide very frequent feedback, but students would like to receive feedback more often. Students want feedback to be constructive and private. Half of the preceptors find it difficult to give negative feedback; however, 60% of the students report handling criticism well. Conclusion: The preceptors declare to have knowledge of and know about the objectives of giving feedback; however, they have difficulties communicating it, especially when it involves criticisms for the correction of behaviors and attitudes. The students accept criticism and would like feedback to be conveyed more often in the practical stages. It is necessary to improve the process of providing and receiving feedback.

Resumo: Introdução: No ensino médico, feedback - ou devolutiva - é um dos componentes principais da avaliação formativa. Feedback pode ser definido como transmissão de uma informação quando se observam os estudantes em ação, a fim de propiciar melhorias para aquisição de competências médicas que compõem o profissionalismo médico. Objetivo: Este estudo teve como objetivo avaliar se há dificuldades de transmissão e recepção de feedback pelos preceptores e estudantes durante os estágios práticos do curso de Medicina. Método: Este estudo de delineamento misto qualitativo/ quantitativo envolveu todos os discentes que concluíram os estágios no período de março de 2018 a agosto de 2019 (n = 50), assim como todos os preceptores responsáveis pelos estágios práticos (n = 9) da Universidade Municipal de São Caetano do Sul. O conhecimento sobre feedback, na visão dos discentes e preceptores, foi avaliado por meio de questionários adaptados com perguntas categóricas e abertas. Utilizaram-se análise descritiva nos dados quantitativos e técnica de conteúdo nos dados qualitativos. Resultado: Os preceptores relataram que os objetivos de fornecer feedback são: apontamento de melhoria, reflexão crítica e oportunidade de adequações. Por sua vez, os estudantes relataram: esclarecimento de dúvidas, planejamento de melhorias e conhecimento de pontos positivos. Metade dos preceptores afirmou fornecer feedback, porém os estudantes gostariam de recebê-lo de forma mais contínua. Os estudantes desejam que o feedback seja construtivo e feito em local privado. Metade dos preceptores tem dificuldade em dar feedback negativo, porém 60% dos estudantes relataram lidar bem com críticas. Conclusão: Os preceptores afirmaram ter conhecimento dos objetivos do feedback. Porém, eles têm dificuldades para transmiti-lo, principalmente quando envolve críticas para correções de comportamentos ou atitudes. Os estudantes aceitam críticas e requerem que o feedback seja transmitido com mais frequência nos estágios práticos. Há a necessidade de melhorar o processo de fornecer e receber feedback.

Self-reported assessment of outcome-based education in Philippine Otolaryngology - Head and Neck Surgery residency training programs by consultants and residents

Objective@#To determine the self-reported assessment of initial implementation of the 3 domains of Outcome-Based Education in accredited Otolaryngology - Head and Neck Surgery residency training programs in the Philippines by consultants and residents and explore any associations between their demographic profiles and assessments. @*Methods@#Design: Mixed Method Research Design Setting: Multicenter - 30 accredited ORL-HNS residency training institutions in the Philippines- National Capital Region (NCR) 19, Luzon 7, Visayas 2, and Mindanao 2. Participants: A total of 129 consultants and 82 second to fourth year residents in training were included in the study by convenience sampling. First-year residents who started their residency training in January 2020 were excluded. Respondents answered self-reported questionnaires to assess implementation of the 3 domains of OBE: intended learning outcomes (ILO), teaching and learning activities (TLA) and assessment tasks (AT) using the 4-point scale score from “fully implemented” (4) to “not implemented” (1). Results of questionnaires were confirmed using open-ended questions on the challenges of OBE with a focused group discussion among 4 consultants and 1 resident. @*Results@#The self-reported assessment of respondents on OBE implementation was “fully implemented” in the 3 domains. However, low numerical scores were seen for “managing community health and social need” in the ILO and “laboratory activities and workshops” in the TLA for both consultants and residents, in the assessment task (AT “multisource feedback by nurses and administrative staff” for the consultants, and “direct observation of performance skills for patient encounter” for residents. Among the 7 modules, “research methodology” had the lowest score for both consultants’ and residents’ self-perception. Challenges of OBE revealed included “mastery,” “time” and “data keeping.” Consultants younger than 60 years of age who had been in the department longer than 3 years and residents who attended an OBE workshop / lecture tended to give higher scores. @*Conclusion@#Two years after distribution of the manual on OBE to ORL-HNS residency training institutions, the consultants’ and residents’ self-reported assessment on implementation in all the 3 domains of OBE was “fully implemented.

Registro Clínico Baseado em Problemas como instrumento para desenvolver competências em programa de residência médica / Problem-based clinical record as an instrument to develop competences in a medical residency program

Resumo: Introdução: As competências relevantes ao ensino médico atual são divididas em sete dimensões: cognitiva, técnica, contextual, integrativa, afetiva, relacional e hábitos da mente. No presente estudo, um instrumento de aprendizagem nomeado Registro Clínico Baseado em Problemas (RBP), composto por uma lista de problemas on-line dos pacientes com suas respectivas investigações e intervenções, foi desenvolvido e aplicado em um programa de residência médica em clínica médica. Objetivo: Este estudo teve como objetivo investigar a percepção dos médicos residentes e preceptores sobre a utilização do RBP no processo ensino-aprendizagem e no desenvolvimento de competências em suas várias dimensões. Método: Participaram do estudo 21 residentes e oito preceptores de uma enfermaria de clínica médica, distribuídos em três grupos focais, em que dialogaram sobre a utilização do RBP no serviço. Para a interpretação da fala dos participantes, utilizou-se a análise de conteúdo de Bardin. Resultados: Na percepção dos residentes, o RBP influenciou na organização do conhecimento e na motivação dentro da dimensão cognitiva. A dimensão integrativa foi a mais citada pelos participantes, visto que o RBP levou à reflexão e à estruturação do raciocínio por problemas, atuando positivamente na organização do conhecimento e na definição dos problemas mais relevantes. Na dimensão contextual, não houve consenso entre os residentes sobre o impacto na solicitação racional de exames, e os preceptores relacionaram a falta de impacto do RBP à falta de feedback. Na dimensão relacional, preceptores e residentes relataram que o RBP trabalhou a síntese e organização do pensamento. No discurso dos residentes, o RBP influenciou os hábitos da mente relacionados à capacidade do médico de autoavaliação e reflexão sobre sua prática. Conclusão: O RBP atuou como instrumento de aprendizagem, principalmente por estar associado a fatores psicopedagógicos relacionados à facilitação da aprendizagem. As dimensões de competências cognitiva, integrativa, contextual, relacional e hábitos da mente foram desenvolvidas pelo RBP. A visão dos residentes e preceptores sobre a relevância do RBP para a aprendizagem de competências foi divergente. As dimensões cognitiva, integrativa e hábitos da mente tiveram maior diferença entre os participantes. Para que o RBP gere um aprendizado mais eficaz, os preceptores precisam interagir mais com o instrumento e realizar regularmente o feedback com os residentes.

Abstract: Introduction: Competencies relevant to current medical education are classified into cognitive, technical, contextual, integrative, affective, relational, and habits of mind. In the present study, a learning instrument, called Problem-Based Clinical Record (RBP), composed of a list of patients' online problems with their respective investigations and interventions was developed and applied in a Medical Residency Program in internal medicine. Objectives: To investigate the perception of resident physicians and tutors on the use of RBP in the teaching-learning process and the development of skills in its various dimensions. Method: 21 residents and 8 preceptors of a Medical Clinic ward participated in the study, distributed into 3 focus groups, where they discussed the use of RBP in the service. The participants' oral accounts were interpreted using Bardin's content analysis. Results: In the residents' view, RBP influenced the organization of knowledge and motivation within the cognitive dimension. The integrative dimension was the most cited by the participants, since RBP led to reflection and the structuring of reasoning by problems, acting positively in the organization of knowledge and definition of relevant problems. In the contextual dimension, no consensus was found among residents regarding impact on the rational request for exams and the preceptors related to the lack of impact of RBP to the lack of feedback. In the relational dimension, preceptors and residents reported that RBP worked on the synthesis and organization of thought. The residents argued that RBP influenced habits of the mind, related to the physician's ability to self-assess and reflect on his practice. Conclusion: RBP acted as a learning tool, mainly because it is associated with psycho-pedagogical factors related to the facilitation of learning. The dimensions of cognitive, integrative, contextual, relational, and habits of the mind were developed by the RBP. The view of residents and tutors on the relevance of RBP for learning skills was divergent. The cognitive, integrative, and habits of the mind dimensions had a greater difference between the participants. For RBP to generate more effective learning, preceptors need to interact more with the instrument and regularly provide feedback to residents.

Habilidades de comunicação clínica dos preceptores de medicina de família e comunidade em Florianópolis, Santa Catarina, Brasil / Clinical communication skills of preceptors of family and community medicine in Florianópolis, Santa Catarina, Brazil / Habilidades de comunicación clínica de los preceptores de medicina de familia y comunidad en Florianópolis, Santa Catarina, Brasil

Objetivo: Este estudo investigou a autoavaliação dos preceptores (versão resumida do Guia Observacional Calgary-Cambridge) sobre quanto aplicam e ensinam HCC, bem como sobre oportunidades de ensino e qualidade do feedback. Métodos: Realizou-se um estudo transversal com 44 preceptores ativos do internato e da residência de medicina de família e comunidade de Florianópolis, Santa Catarina, Brasil. Resultados: Os preceptores se autoavaliaram positivamente em relação à aplicação e ao ensino de HCC, mas as oportunidades de ensino de HCC são escassas e a qualidade do feedback é mediana. Conclusão: É preciso melhorar a estrutura física e a educação permanente sobre feedback e métodos de ensino, incluindo videogravação de consulta, para ampliar as oportunidades de ensino de HCC.

Objective: This study investigated self-assessment of preceptors (short version of the Calgary-Cambridge Observation Guide) about how much they apply and teach CCS, as well as about teaching opportunities and feedback quality. Methods: A cross-sectional study was carried out with 44 active preceptors of the internship and of the family and community medicine residency of Florianópolis, Santa Catarina, Brazil. Results: Preceptors self-assessed positively regarding CCS application and teaching, but CCS teaching opportunities are scarce and feedback quality is medium. Conclusion: Physical structure and permanent education on feedback and teaching methods, including video recording, need to be improved to expand CCS teaching opportunities.

Objetivo: Este estudio investigó la autoevaluación de los preceptores (versión resumida del Guía Observacional Calgary-Cambridge) acerca de cuánto aplican y enseñan HCC, así como de oportunidades de enseñanza y calidad de la retroalimentación. Métodos: Se realizó un estudio transversal con 44 preceptores activos del Internado y de la Residencia de Medicina de Familia y Comunidad de Florianópolis, Santa Catarina, Brasil. Resultados: Los preceptores se autoevaluaron de forma positiva con relación a la aplicación y la enseñanza de HCC, pero las oportunidades de enseñanza de HCC son escasas, y la calidad de la retroalimentación es regular. Conclusión: Es necesario mejorar la estructura física y la educación permanente sobre retroalimentación y métodos de enseñanza, incluyendo la videograbación de consulta, para ampliar las oportunidades de enseñanza de HCC.

Devolución facilitadora, la clave de una evaluación formativa en la enseñanza clínica: lo necesario, lo real, lo posible / Facilitating return, the key to a formative evaluation in clinical education: the necessary, the real, the possible

La devolución facilitadora, también conocida como feedback, es una herramienta fundamental de la evaluación formativa, mediante la cual el docente le acerca al alumno información sobre su desempeño con el objetivo de destacar fortalezas, identificar debilidades y planificar cómo superarlas. La forma en la cual se lleva a cabo es fundamental y tiene un impacto directo sobre el resultado del proceso. El objetivo de este trabajo es abordar conceptualizaciones sobre la retroalimentación formativa a partir de un relato autobiográfico de una docente en el ámbito de la salud que involucra la enseñanza clínica en la sala de internación de residentes de Dermatología. El análisis de las experiencias previas de la evaluación formativa a la luz de los conocimientos construidos durante la formación como docente, pone en evidencia que es crucial que se aprenda a educar y a dar feedback para poder contar con herramientas que permitan acompañar a los alumnos en la construcción del conocimiento. (AU)

Formative feedback is considered an important tool of formative evaluation, that allows the teacher to provide information to the students about their performance, in order to highlight their strengths, identify weaknesses and plan how to overcome them. The way in which this is carried out is fundamental and has a direct impact on the outcome of the process. We sought to evaluate the perceptions and ideas on the training feedback loop, based on the autobiographical report of a Senior Faculty whose core activities are directed towards the teaching of Medical Residents and Dermatology trainees. The analysis of past experiences in light of knowledge constructed while becoming a Teacher shows the crucial need and interrelationship of teaching and timely feedback. The latter provide much needed tools for Students during their learning process. (AU)

El laboratorio de práctica profesional, como estrategia educativa, en el marco del cambio curricular / The professional practice laboratory, as a strategy educational, within the framework of curricular change

En vista de la transformación que se está produciendo en la educación universitaria en general y en la educación para profesionales de la salud en particular, el Instituto Universitario del Hospital Italiano plantea un cambio curricular para la carrera de Medicina. Esto implica, una forma de cambio sociocultural profunda, que afecta los distintos aspectos de la vida institucional. Se propone dejar atrás, el "sistema flexneriano" de enseñanza, proponiendo el sistema Aprendizaje Basado en Problemas (ABP), sumado a talleres y laboratorios donde el conocimiento y las habilidades se irán adquiriendo con diferente grado de complejidad en forma espiralada. El Laboratorio de Práctica Profesional (LPP) es el espacio y el ambiente educacional donde ocurre la máxima integración, trabajando sobre todos los conocimientos necesarios para llevar adelante la actividad profesional correspondiente. En el primer módulo, el enfoque fue guiado, fundamentalmente, hacia lo comunicacional persiguiendo como objetivo que el alumno desarrolle habilidades que le permitan establecer una adecuada relación médico-paciente-familia, así como vínculos adecuados con el equipo de trabajo y la comunidad . Se evaluó el taller en sí mismo y a los tutores mediante encuestas a los estudiantes, y estos últimos a su vez fueron evaluados periódicamente por los tutores y al final del módulo con un examen escrito y un examen tipo evaluación clínica objetiva estructurada. Por lo trabajado creemos que el LPP, como estrategia de enseñanza, contribuye a la formación de habilidades complejas; el resultado de las evaluaciones y el feedback rsultan indispensables para establecer un plan de mejoras. (AU)

In view of the transformation that is taking place in university education in general and in education for health professionals in particular, it is that the University Institute of the Italian Hospital proposes a curricular change for the Medicine career. This implies a socio-cultural change that affects the different aspects of institutional life. It is proposed to leave behind the "Flexnerian system", proposing a system based on: Problem Based Learning, in addition to workshops and laboratories where knowledge and skills will be acquired with a different degree of complexity in spiral form. The Professional Practice Laboratory is the space and educational environment where maximum integration occurs, working on all the necessary knowledge to carry out the corresponding professional activity. In the first module the focus was guided, fundamentally, to the communicational pursuing as objective: that the student develops skills that allow him to establish an adequate doctor-patient-family relationship, as well as adequate links, with the work team and the community. The evaluation was carried out to workshop itself and to the tutors through students' quiz. The students were periodically evaluated by the tutors and at the end of the module with a written exam and a structured Objective Clinical Evaluation type test. For what we have worked to this moment, we believe that: The laboratory of professional practice, as a teaching strategy, contributes to the formation of complex skills; being the result of the evaluations and the feedback, fundamental to establish an improvement plan. (AU)

Relationship among mental models, theories of change, and metacognition: structured clinical simulation / Relación entre modelos mentales, teorías del cambio y metacognición: Simulación clínica estructurada

Abstract Learning is a change in the way of thinking that lasts over time and allows for solving problems; on the other hand, education based on structured clinical simulation is a pedagogic mediation between the classroom and clinical practice, which allows experience, reflection, monitoring, control, and restructuring of thought, which can contribute to deep and lasting learning. It is desirable that students, both undergraduate and graduate, are given the opportunity to be trained under structured simulation.

Resumen El aprendizaje es el cambio en el pensamiento que perdura en el tiempo y permite la solución de problemas; por su parte, la educación basada en simulación clínica estructurada es una mediación pedagógica entre el aula de clase y la práctica clínica, que permite experiencia, reflexión, monitoreo, control y reestructuración del pensamiento, lo que puede aportar en aprendizajes profundos y duraderos. Es deseable que los estudiantes, tanto en pregrado como en posgrado, tengan la oportunidad de ser formados con simulación estructurada.

O uso do Miniex como ferramenta de feedback continuado para residente de medicina de família e comunidade em estágio na atenção primária à saúde / The use of Miniex as a continuous feedback tool for a family and community medicine resident in internship at primary health care / El uso de Miniex como herramienta de feedback continuado para residente de medicina de familia y comunidad en práctica en la atención primaria a la salud

Introdução: A consulta é central no trabalho do médico de família e comunidade. A avaliação da performance do residente e discussões acerca da adequada condução deve ser estimulada. Objetivo: Discutir sobre o uso do Miniex para avaliação sequenciada de performance do residente durante consultas. Métodos: Explanação sobre as discussões teóricas acerca do desenvolvimento de consulta médica seguidas de aplicação do Miniex com avaliação focada nas competências esperadas do médico de família e comunidade. Discussão: Manuais de programas de residências e associações relacionadas têm por vezes citado o Miniex como possibilidade de avaliação do residente, mas não orientam seu uso sistematizado, o que poderia deixar pouco eficiente e descolada sua aplicação. Ademais, pouca discussão existe sobre a interpretação dos componentes do método e o modelo esperado de consulta ideal nas diferentes especialidades. Conclusão: O Miniex é potente instrumento de mudança, mas seu uso deve apontar para um modelo profissional e ser estimulado ao longo de todo o programa de residência.

Introduction: The consultation is central in the work of the family doctor. The assessment of the resident's performance and discussions about right guidance should be encouraged. Objective: To discuss the use of Miniex to evaluate the resident's sequenced performance during consultations. Methods: Explanation about the theoretical discussions about the development of medical consultation followed by application of Miniex with evaluation focused on the expected competencies of the family and community doctor. Discussion: Manuals of residential programs and related associations have sometimes cited the Miniex as a possibility of evaluation of the resident but do not guide their systematic use, which could leave little efficient and detached its application. In addition, little discussion exists on the interpretation of the components of the method and the expected model of ideal consultation in the different specialties. Conclusion: Miniex is a powerful tool for change but its use should point to a professional model and be stimulated throughout the residency program.

Introducción: La consulta es central en el trabajo del médico de familia y comunidad. La evaluación del desempeño del residente y las discusiones sobre la adecuada conducción debe ser estimulada. Objetivo: Discutir sobre el uso de Miniex para la evaluación secuenciada de desempeño del residente durante las consultas. Métodos: Explanación sobre las discusiones teóricas sobre el desarrollo de consulta médica seguida de aplicación del Miniex con evaluación enfocada en las competencias esperadas del médico de familia y comunidad. Discusión: Los manuales de programas de residencias y asociaciones relacionadas tiene a veces citado el Miniex como posibilidad de evaluación del residente, pero no orientan su uso sistematizado, lo que podría dejar poco eficiente y despegado su aplicación. Además, poca discusión existe sobre la interpretación de los componentes del método y el modelo esperado de consulta ideal en las diferentes especialidades. Conclusión: Miniex es un potente instrumento de cambio pero su uso debe apuntar a un modelo profesional y ser estimulado a lo largo de todo el programa de residencia.

Transferencia de aprendizajes desde el aula formal hacia la práctica clínica: una reflexión sobre la formación de fonoaudiólogos en Chile / Transferring learning from the formal classroom to the clinical practice: A reflection on the training of speech therapists in Chile

En el presente artículo se reflexiona sobre el proceso de transferencia de los aprendizajes desde el aula formal hacia la práctica clínica y sobre el desafío que implica esta tarea en la formación de fonoaudiólogos en instituciones de educación superior chilenas. Para ello, se inicia con un análisis sobre los tres niveles del sistema educacional actual en Chile, el macrosistema (modelo educativo general), mesosistema (modelo educativo asumido por cada una de las instituciones de educación superior) y microsistema (currículo adoptado por cada carrera universitaria), con el fin de entregar un marco referencial. Posteriormente, se describe el Modelo de Enseñanza para la Comprensión, se plantea evidencia de aplicación en instituciones de educación superior de Latinoamérica y se reflexiona sobre el aporte que significaría la implementación de este modelo para el proceso de transferencia de los aprendizajes. Por último, se plantean los alcances de esta propuesta y las posibles limitaciones en su ejecución.

In this paper, we present some reflections on the process of learning-transfer from formal classrooms to clinical practices, and the challenges involved for the training of speech therapist in Chilean higher-education institutions. We begin by analyzing the three levels of the current educational system in Chile: the macrosystem (general educational model), the mesosystem (educational models assumed by each higher -education institution), and microsystem (curricula adopted at universities), in order to provide a reference framework. Subsequently, we describe the Teaching Model for Understanding, we present evidence of application in institutions of higher education in Latin America and we reflect on the impact that the implementation of this model might have for the process of transfer of learning. Finally, we considerthe scope of the proposal and the possible limitations in its execution.

Impacto de la retroalimentación y la evaluación formativa en la enseñanza-aprendizaje de Biociencias / The impact of feedback and formative evaluation on Biosciences teaching-learning

Introducción: En nuestros días, la identificación y sistematización de la evaluación del aprendizaje en las universidades está encaminada a garantizar la pertinencia, eficacia y eficiencia de las mismas, co25nformando un marco de referencia para la reflexión y toma de decisiones encaminadas a la mejora de los procesos enseñanza-aprendizaje. En este sentido, es fundamental la información acerca de las percepciones, las actitudes, las experiencias y las expectativas en relación con la implementación de la evaluación formativa como una herramienta que permite generar diversas estrategias para los planes de mejora curricular. Objetivo: Obtener información acerca de las percepciones, las actitudes, las experiencias y las expectativas en relación con la evaluación formativa y el impacto de la retroalimentación a estudiantes de Medicina de primer semestre de la Universidad de La Sabana que cursan Biociencias. Métodos: Se realizó un estudio cualitativo mediante el empleo de la técnica de los grupos focales. Se preparó un guion en torno las inquietudes obtenidas a partir de la retroalimentación y se formularon varias preguntas que fueron grabadas en audio. Se evidenciaron cuatro categorías emergentes de exploración. Resultados: Las argumentaciones de los participantes se realizaron a partir de las memorias obtenidas en el audio del grupo focal; desde el guion inicial, surgen subcategorías en las que se ordenaron los hallazgos. Se evidenciaron 4 categorías que abarcan la comprensión del estudiante respecto de la función formativa de la evaluación, el empoderamiento de los estudiantes frente al proceso de evaluación formativa, el manejo de conflictos derivados de la evaluación y algunas sugerencias para mejorar los procesos de evaluación desde la perspectiva del estudiante. Conclusiones: Para que estas evaluaciones tengan la resonancia que se espera de ellas, deben estar inmersas en el pensamiento pedagógico contemporáneo, los objetivos de los cursos y los resultados esperados del aprendizaje, donde se halle una total congruencia entre los mismos(AU)

Introduction: Nowadays, identification and systematization of the evaluation of learning in universities is aimed at guaranteeing its pertinence, effectiveness and efficiency, creating a reference framework for reflection and decision-making aimed at the improvement of the teaching-learning processes. In this respect, information about perceptions, attitudes, experiences and expectations about the implementation of formative evaluation as a tool that allows generating different strategies for curricular improvement plans is fundamental. Objective: To obtain information about the perceptions, attitudes, experiences and expectations about formative evaluation and the feedback impact on first-semester medical students of University of La Sabana in the Biosciences course. Methods: A qualitative study was carried out using the technique of focus groups. A script was prepared about the concerns obtained from feedback and several questions were formulated that were recorded in audio. Four emerging categories of exploration were evidenced. Results: The arguments of the participants were produced from the memories obtained in the audio of the focus group. From the initial script, subcategories appear in which the findings were ordered. There were four categories that include the student's understanding of the formative function of the evaluation, the students' empowerment in the formative evaluation process, managing of conflicts derived from evaluation, and some suggestions to improve the evaluation processes from the student's perspective. Conclusions: In order for these evaluations to have the impact expected from them, they must be immersed in the contemporary pedagogical thought, the objectives of the courses and the expected results of the learning process, where there is a total congruence among them(AU)

Percepción de estudiantes de pregrado de Medicina de talleres de simulación de procedimientos médico-quirúrgicos / Undergraduate student's perception of clinical simulation workshops: assessment of an instrument

Background: Simulation is a useful training tool for undergraduate medical students. A valid instrument is needed to assess students' perception of simulation workshops. Aim: To adapt and validate an instrument to assess the undergraduate medical student's perception of simulation workshops of clinical procedures. Material and Methods: Delphi Methodology was used to adapt the instrument. Exploratory and confirmatory analyses were performed to determine the construct validity and Cronbach's Alpha (0 to 1) for internal consistency of the instrument. Results: A Delphi panel of 10 experts adapted a seven-item questionnaire (Likert scale 1-5; ranging from 7 to 35) and four open-questions. After 3-delphi-rounds, the instrument was administered to 210 students in six simulation training programs (Paracentesis, Cardiopulmonary Resuscitation, Airway management, Sutures, Thoracentesis and Nursing Procedures). The instrument was considered unidimensional in the factorial analysis. The overall median (Q1-Q3) score was 34 ranging from 32 to 35 and the Cronbach Alpha coefficient was 0.72, indicating a good reliability. Conclusions: The perception questionnaire is a useful and reliable instrument to assess students' perceptions of clinical simulations.

Formative feedback from the first-person perspective using Google Glass in a family medicine objective structured clinical examination station in the United States / 보건의료교육평가

PURPOSE: This case study explored the use of Google Glass in a clinical examination scenario to capture the first-person perspective of a standardized patient as a way to provide formative feedback on students' communication and empathy skills ‘through the patient's eyes.' METHODS: During a 3-year period between 2014 and 2017, third-year students enrolled in a family medicine clerkship participated in a Google Glass station during a summative clinical examination. At this station, standardized patients wore Google Glass to record an encounter focused on communication and empathy skills ‘through the patient's eyes.' Students completed an online survey using a 4-point Likert scale about their perspectives on Google Glass as a feedback tool (N= 255). RESULTS: We found that the students' experiences with Google Glass ‘through the patient's eyes' were largely positive and that students felt the feedback provided by the Google Glass recording to be helpful. Although a third of the students felt that Google Glass was a distraction, the majority believed that the first-person perspective recordings provided an opportunity for feedback that did not exist before. CONCLUSION: Continuing exploration of first-person perspective recordings using Google Glass to improve education on communication and empathy skills is warranted.

Providing Effective Feedback within Pharmacy Practice Education

Experiential education is a core curriculum of pharmacy education. In experiential education, formative feedback is an integral component of learning and teaching process. Feedback is defined as information provided by a preceptor regarding student's performance based on direct observation. With effective feedback, students can have opportunities to reinforce or correct behaviors and to acquire knowledge or skills. Students highly value and appreciate feedback. They rank provision of effective feedback as one of the most important qualities of preceptors. Preceptors, however, lack an understanding of feedback or practical skills necessary for providing effective feedback. As a result in reality, the feedback provided to students can be differentially effective in improving students' learning. This article describes a theoretical understanding of feedback including definition and value, as well as types of feedback. In addition, practical aspects in providing feedback, such as contents, timing, techniques, and models, are addressed. By understanding the value of feedback and mastering various feedback skills, preceptors will promote students' learning and enhance educational outcomes of experiential education.

Effect of Debriefing Based on the Clinical Judgment Model on Simulation Based Learning Outcomes of End-of-Life Care for Nursing Students: A Non-Randomized Controlled Trial

PURPOSE: This study was conducted to identify effects of debriefing based on the clinical judgment model for nursing students on their knowledge, skill performance, clinical judgment, self-confidence and learner satisfaction during simulation based end-of-life care (ELC) education. METHODS: Simulation based ELC education was developed in six steps as follows: selection of learning subjects and objects, development of learning tools, a trial run of simulation-based education, students' skill training, and evaluators' training. Forty-eight senior nursing students (25 in the experimental group and 23 in the control group) participated in the simulation-based ELC education using a high-fidelity simulator. Debriefing based on the clinical judgment was compared with the usual debriefing. RESULTS: ANCOVA showed that there were differences in knowledge (F=4.81, p=.034), skill performance (F=68.33, p < .001), clinical judgment (F=18.33, p < .001) and self-confidence (F=4.85, p=.033), but no difference in satisfaction (t=−0.38, p=.704) between the experimental and control groups. CONCLUSION: This study found that debriefing based on the clinical judgement model is effective for supporting nursing students for reflecting on clinical judgment and improving their diverse competencies in complex clinical settings such as ELC.