La competencia pedagógica del tutor de especialidades médicas / The educational competence of the medical specialties tutor

OBJETIVO: Obtener los elementos necesarios para el diseño de un instrumento de evaluación del desempeño pedagógico de los tutores de especialidades médicas que desarrollan su función básicamente en la educación en el trabajo. MÉTODOS: Se realizó una investigación cualitativa en el Hospital Militar Central Dr. Luis Díaz Soto. Se utilizaron los métodos teóricos de análisis documental e histórico lógico, el enfoque sistémico y la sistematización. Los componentes de la competencia pedagógica se obtuvieron a partir de la aplicación de las esencias del análisis funcional, estructurados en dimensiones e indicadores. RESULTADOS: Se pudieron integrar organicamente los conocimientos de la competencia pedagógica del tutor. Estos resultados ofrecen la base teórica y algunos elementos necesarios para el diseño de un instrumento de evaluación del desempeño pedagógico, mediante la competencia. CONCLUSIONES: La estructura obtenida de la competencia pedagógica del tutor de especialidades médicas, estructurada en dimensiones y desglosada derivativamente en indicadores, permite la estructuración de un instrumento de evaluación del desempeño pedagógico, que facilitará su redireccionalidad en aras de la calidad y la excelencia en los procesos formativos del médico especialista

OBJECTIVE: To obtain the elements needed for the design of a assessment instrument of educational performance of medical specialties tutor developing a basic function in the working education. METHODS: A qualitative research in the Dr. Luis Díaz Soto: Central Military Hospital. Authors used the theoretical methods of documentary analysis and logical historical, the systemic approach and the systematitation. The educational competence components were obtained from the application of functional analysis essences, structured in dimensions and as well as the indicators. RESULTS: It was possible to integrate organically the knowledges of the tutor's educational competence. These results offer the theoretical basis and some elements necessary for the design of assessment instrument of educational performance according to the competence. CONCLUSIONS: The structure obtained from the tutor's educational competence related to the medical specialties structured in dimensions and breaked down in a derivative way in indicators, allows the structuration of a educational performance assessment instrument allowing to redirect for the sake of quality and the excellence in the formative processes of specialist physician

Criterios de evaluación de la variable pertinencia e impacto social específicos para la carrera de Medicina / Variable appropriateness and the social impact specific for Medicine career: assessment criteria

OBJETIVO: determinar los criterios de evaluación específicos para la variable pertinencia e impacto social de la carrera de medicina. MÉTODOS: se aplicó una encuesta, dos tipos de entrevistas a profundidad y un grupo nominal a expertos. RESULTADOS: se realizó una propuesta de criterios de evaluación de la variable pertinencia e impacto social específicos para la acreditación de la carrera de medicina. CONCLUSIONES: se proponen criterios de evaluación sobre participación de estudiantes, profesores y egresados en la solución de problemas de salud, cumplimiento de programas y funciones de atención médica integral con énfasis en las acciones del programa de medicina familiar, desarrollo de la carrera en el policlínico, aplicación de la educación en el trabajo, uso de las tecnologías de la información y las comunicaciones en el proceso docente, así como la evaluación de indicadores de salud seleccionados. También criterios para explorar satisfacción de actores del proceso docente y la población así como la calidad del graduado

OBJECTIVE: to determine specific evaluation criteria for the appropriateness as variable and the social impact of Medicine career. METHODS: we applied a survey, two types of a deep interview, and a nominal group for experts. RESULTS: we propose the evaluation criteria of appropriateness variable and social impact specific accrediting the Medicine career. CONCLUSIONS: we propose evaluation criteria on students, professors, and graduates involvement in health problems solution, fulfillment of programs and tasks of integral medical care emphasizing in actions of family medicine program, development of career at the polyclinic, application of work education, use of information and communication technologies in teaching process, as well as the assessment of selected health indicators and also the criteria to explore actors satisfaction of teaching process and the community as well as graduate quality

A residência médica: articulações entre a prática e o ensino / Medical residence: articulations between practice and teaching

O objetivo desta tese de doutorado é o estudo da residência médica e de suas articulações com o campo educacional e o da saúde. Propõe-se uma análise histórico - dialética, tomando como ponto de partida a articulação da medicina e da educação na estrutura social. Parte-se da concepção segundo a qual a prática e o saber no campo educacional e na saúde estão ligados à transformação histórica do processo de produção econômica. Essa compreensão remete à chamada determinação em última instância: a estrutura econômica determina o lugar e a forma de articulação da medicina e da educação na estrutura social. Para compreender as peculiaridades do ensino e da residência médica no Brasil faz-se uma caracterização da assistência médica, sobretudo do papel assumido pelo Estado na configuração do campo: primeiro, a adoção de um sistema em que compete ao Estado a responsabilidade pela universalização da atenção básica, através de serviços próprios ou em parceria com organizações não governamentais; segundo, a atenção especializada, com maior incorporação tecnológica, seria prestada pelo setor privado, mediante incentivos concedidos pelo Estado. Dessa divisão, resulta, no desenho atual, ao invés de um único sistema, a conformação de dois ou mais sistemas de saúde, em que a segmentação da assistência implica em práticas diferenciadas. O efeito desta divisão no mercado de trabalho repercute na escola e na residência médicas. A residência, em particular, por suas características de treinamento em serviço, responde diretamente aos condicionantes do mundo do trabalho, reproduzindo o modelo de prática hegemônica.

La actual formación de médicos especialistas en Chile / The current training of specialist physicians in Chile

En Chile, la formación de médicos especialistas se desarrolló exitosamente a partir de la década de 1950, lo que permitió dotar de especialistas a los hospitales complejos en todo el país. Lamentablemente, la rigurosidad y calidad de la formación se ha deteriorado con el transcurso del tiempo. Esto es más grave aún porque la demanda por especialización será creciente en función del aumento significativo de estudiantes de medicina. El objetivo de este documento es llamar la atención sobre este serio problema invitando a los involucrados a aunar voluntades y contribuir a que la formación de especialistas retome la senda que tuvo por años y que representó un gran aporte a la medicina nacional.

Medical students' perceptions of their development of `soft skills' Part I : A qualitative research methodology

Background: Following the introduction of a new; integrated; problem-oriented undergraduate medical curriculum at the University of Pretoria (UP) in 1997; a research project was undertaken to study interpersonal skills; professional attitudes; teamwork; ethics and related topics - which have come to be known collectively as `soft skills'. This contribution is the first of two articles on the professional socialisation of medical students and their development of `soft skills'. It describes the particular qualitative methodology developed for; and applied to; the study of soft skills among medical students at UP. Methods: This paper describes the aim of the study; reasons for adopting a qualitative research approach to achieve this aim; the theoretical orientation underpinning the qualitative approach that we considered most suitable; the design; the sampling; the data management and analysis; and the methods that we deployed to ensure the credibility of the findings. Research Design: The aim of the study was to explore the subjective meanings that students attributed to soft skills; as they understood them. These subjective meanings involve the way students interact meaningfully with fellow students; lecturers and other individuals participating in the medical and clinical education programme; and the way they construct shared conceptualisations of soft skills and medical education in their lives and social world. A qualitative approach was considered most appropriate; as this study set out to uncover subjective and diverse meanings that do not necessarily amount to generalisable truths. The particular qualitative strategy or design used was that of an extended case study; or `casing'; within the modernist theoretical orientation of symbolic interactionism. Elements of process evaluation were incorporated into the design to account for the process of curriculum reform within which this study was embedded.We recruited participants for this study from two cohorts of students. The first group; who completed their studies in 2001; had followed the traditional curriculum; while the second group; who completed their programme in 2002; had followed the reformed curriculum. The data collection tools were face-to-face individual interviews; focused group interviews and solicited autobiographical sketches. The utilisation of more than one method or data source enabled triangulation or cross-checking of findings. We followed an inductive reasoning approach; which means that we did not search for data to test any hypotheses that had been formulated prior to commencing the study; but focused instead on building constructs that were grounded in or reflected intimate familiarity with the students' world. Conclusion:The modernist qualitative research approach enabled us to uncover; describe and illuminate the subjective points of view on soft skills as expressed by final-year medical students before and after curriculum reform. More specifically; by carrying out an extended case study we were able to perform a process evaluation of the curriculum reform in terms of soft skills and the professional socialisation of the students. This paper outlines how qualitative research methods enabled us to capture and explore aspects of the inner life (social worlds) of these students. Whether they would be the same; similar or different in another setting are questions for further exploration or research - questions prompted by our study in a manner that illuminates the qualities that may be inherent in these subjective meanings

Medical students' perceptions of their development of 'soft skills' Part II: the development of 'soft skills' through 'guiding and growing'

Background: This paper reports on medical students' views on the ways in which their `soft skills' were developed. It is the result of a study on soft skills among two groups of students before and after curriculum reform at the School of Medicine of the University of Pretoria. One of the aims of the reform was to provide more teaching and learning opportunities for the development of soft skills. Soft skills include professional interpersonal and social skills; communication skills; and professional and ethical attitudes.Methods: As symbolic interactionism was used as the theoretical framework to guide the research; qualitative methods were used to collect the data. A purposive-theoretical sample of 42 final-year medical students from the traditional curriculum and 49 from the reformed curriculum was recruited. Data were collected by means of focus groups; individual in-depth interviews and autobiographical sketches.ResultsThe same categories of comments emerged from the data collected from the study participants from both the traditional and the reformed curriculum. The students ascribed their behaviour related to soft skills to personality and innate features. They had varying opinions on whether soft skills could be taught; but there was as a strong feeling that teaching should focus on principles and guidelines for dealing with difficult situations. They believed that; in the end; they should take responsibility for their own development of soft skills. Most participants felt they could at least grow through exposure to teaching activities and the observation of role models. They also indicated that they had developed their soft skills and constructed their own identity through their interaction with others. Their definition of situations was shaped by their interactions with doctors and educators; fellow students and other health professionals. Interaction with patients was considered the most important. For both groups of students their third year was a watershed; as it is the first year of more intensive patient contact and the beginning of serious learning from interaction with patients. The views on the development of soft skills differed very little between the traditional and reformed curriculum groups; except that students who had followed the reformed curriculum felt more prepared through the increased teaching and training efforts. Further consideration needs to be given to the intention of the changed curriculum compared to the actual effect.The way in which the participants in the study described their development of soft skills could be categorised as a complex interplay between `being' and `becoming'. Instead of using the word `acquisition' of soft skills; `development' seemed to be more appropriate. The metaphor of `guiding' and `growing' also captures the development of these skills better than the terms `teaching' and `learning'. Conclusion: Teaching activities in the clinical years should be adapted with a view to facilitating the students' professional growth. New models for the development of medical educators should be created and institutional barriers should be investigated

Formative Assessment Promotes Learning in Undergraduate Clinical Clerkship

INTRODUCTION: Clinical clerkships; typically situated in environments lacking educational structure; form the backbone of undergraduate medical training. The imperative to develop strategies that enhance learning in this context is apparent. This study explored the impact of longitudinal bedside formative assessment on student learning in a medical clerkship.METHODS: We studied a class of 4th-year students completing a 14-week medical clerkship at the University of Cape Town in South Africa. Clinician educators assessed student performance during weekly bedside teaching sessions using blinded patient encounters (in which students had no prior knowledge of the patient's diagnosis or access to the clinical records). Student feedback was standardised using performance rating scales. The impact of formative assessment on student learning was determined from questionnaire responses. RESULTS: A total of 575 formative assessments took place during the study period. Students perceived blinded patient encounters to be a valuable learning activity that improved their clinical reasoning skills and assessed progress fairly. They reported that feedback helped inform them of their level of competence and learning needs; motivated them to read more; and significantly improved their participation in patient-centred learning activities. Participating clinicians agreed that this formative assessment strategy enhanced the learning potential of bedside teaching sessions. CONCLUSIONS: Longitudinal formative assessment; using blinded patient encounters; was successfully integrated into undergraduate clerkship bedside teaching. According to both students and staff this assessment strategy enhanced bedside learning and improved student participation in patient-centred learning activities during the clerkship

Influencia de la personalidad y el estilo de aprendizaje en la elección de especialidad médica / Influence of personality and learning styles in the choice of medical specialty

Background: Several studies indicate that doctors who work in the same area of the medical profession tend to behave somehow similarly. Thus, it has been suggested that personality relates to the medical specialty choice. However, it is not known whether people self-select into the medical specialties according to their personality or the professional practice in a particular field influences their behavior. Aim: To explore the possible association between the graduate's personality features and learning styles and their chosen specialty. Subjects and Methods: The psychological preferences and learning styles of 65 students of the 2001-graduating cohort of the Pontificia Universidad Católica de Chile School of Medicine were evaluated with the Myers Briggs Type Indicator and the Kolb Learning Style Inventory, respectively. These variables were correlated with the information of their specialty choice or occupation two years after graduation. Results: Graduates distributed unevenly in different areas of the medical profession. Surgical specialties concentrated a larger proportion of extraverted, intuitive and structured doctors, whereas in Pediatrics and Internal Medicine predominated intuitive and people-oriented MD's. Primary Care concentrated individuals with introverted, intuitive and flexible attitudes. Convergent learners (interested in problem-solving) preferred Surgery and Primary Care whereas Assimilator learners (abstract-reflexive) chose more frequently Internal Medicine, Pediatrics and Psychiatry. Conclusions: According to their personality and learning style, graduates tend to self-select into different medical specialties. This information may help medical graduates to guide their specialty choice process, and medical educators to develop learning experiences that take into account the individual differences of their residents.

Status of speciality training in ophthalmology in India.

PURPOSE: To systematically evaluate the quality of ophthalmology training in India. METHODS: Questionnaires were sent to existing medical schools and accredited training institutions. Institutions were followed up thrice to obtain responses. Data were analysed using Stata 8.0. RESULTS: Responses were received from 128 (89.5%) of the 143 institutions. Each year, 900 training slots were available across the country. Faculty: student ratios were better in accredited training institutions than in postgraduate medical schools. Fifty three (41.4%) of 128 institutions subscribed to more than 2 international journals. Fewer than 1 in 6 institutions conducted research projects. 11 (8.6%) institutions reported more than five publications in international peer-reviewed journals over three years. Only a third of the responding institutions had a wet lab. CONCLUSIONS: There is a need to improve the training facilities and optimally utilise the infrastructure available in postgraduate medical schools.

Formação de Oftalmopediatras no Brasil / Pediatrics ophthalmology training in Brazil

RESUMO: Este estudo teve como objetivo analisar a formação de oftalmopediatras nos Cursos de Especialização em Oftalmologia, credenciados pelo Conselho Brasileiro de Oftalmologia, verificando-se a presença de departamentos especializados para o atendimento da população peiátrica tais como: estrabismo, visão sub-normal e catarata congênita. Foi realizada uma survey nos serviços que oferecem Curso de Especialização em Oftalmologia credenciado pelo Conselho Brasileiro de Oftalmologia (CBO). Os questionários foram enviados via eletrônica, pelo correio, por fax e feito contato telefônico. Os dados foram expressos por suas freqüências. Foram respondidos 33 questionários. Em quatro serviços existe curso formal de oftalmologia pediátrica; nos quais, nos últimos seis anos, foram formados 40 profissionais nesta área. Dos entrevistados, cinco não Possuíam Departamento de Oftalmopediatria, sendo o atendimento às crianças realizado pelo oftalmologista generalista. Isto reflete uma deficiência importante, tendo em vista ser de consenso, que o atendimento oftalmológico das crianças deve ser realizado por profissionais com treinamento específico

O residente ideal em radiologia e diagnóstico por imagem / The ideal medical resident for radiology and imaging diagnosis

A Comissão Nacional de Residência Médica, em 2003, estabeleceu novos critérios para o credenciamento de programas de Residência Médica em Radiologia e Diagnóstico por Imagem. Apesar dessas normas representarem um avanço no treinamento do residente, outras competências e habilidades específicas deverão ser desenvolvidas no sentido de acompanhar o rápido desenvolvimento técnico e científico, e para atender as novas exigências do mercado de trabalho. Os autores apresentam as principais competências e habilidades que complementam a formação do radiologista, sugerindo modificação nos atuais programas para que os residentes possam adquiri-las.

Ensino em mastologia: proposta de um programa de residência médica / Mastology teaching: residence program proposal

A mastologia foi reconhecida como especialidade médica no Brasil. Este fato assegura o direito à criação e ao reconhecimento oficial da residência médica nesta área da medicina no país. Neste artigo os autores apresentam, em nome da Sociedade Brasileira de Mastologia, uma proposta para a Comissão Nacional de Residência Médica que deverá servir de base para a normatização da estruturação dos programas de residência médica nas instituições interessadas.

Mastology is currently a medical speciality in Brazil. This fact assures the official creation of medical residency programmes in this area in our country. On the behalf of the Brazilian Society of Mastology, the authors hereby present a proposal to the Comissão Nacional de Residência Médica, with the aim of orientating the organization of medical residency programmes in mastology in interested institutions.