Validez y confiabilidad de los resultados del instrumento MEDUC-PG14 para medir el desempeño docente en la residencia médica en Perú / Performance of the MEDUC-PG14 instrument to evaluate teaching performance in medical residency programs

Background: There are few instruments to evaluate teachers' performance during medical residency in Spanish. Aim: To determine the validity and reliability of the MEDUC-PG14 instrument to evaluate teaching performance in the medical residency programs of the Faculty of Medicine, Universidad Peruana Cayetano Heredia (UPCH). Material and Methods: An open question about positive aspects that characterize a good teacher was added to the MEDUC-PG14 questionnaire. A pilot test was carried out with 15 residents to assess the correct comprehension of each question and carry out necessary changes. Subsequently, the instrument was sent by email to 366 residents of the UPCH Department of Medical Clinics. The reliability of the instrument was evaluated using Cronbach's Alpha. Construct validity was assessed by factor analysis, and the validity of content by a qualitative analysis of the answers to the open question added. Results: Seventy residents answered the questionnaire evaluating 46 teachers. Each resident evaluated one teacher. The factor analysis showed two dimensions explaining 83% of the variance: the dimension "Teaching and Evaluation" (11 items) and the dimension "Respectful Behavior" (three items). The global Cronbach's Alpha was 0.97 (0.97 for the Teaching Dimension 0.96 and for the Behavioral Dimension). The concept of "professional competence as a medical specialist" was rescued from the responses to the open question. Conclusions: The MEDUC-PG14 is an instrument with valid and highly reliable results. It is useful and easy to apply to evaluate teaching performance in postgraduate studies. Its use is recommended in residency programs of Spanish-speaking countries. However, the inclusion of an item referring to the professional competence of the teacher is suggested.

Adherencia y cumplimiento de las recomendaciones de cuidado y prevención del pie diabético por parte de médicos tratantes en dos hospitales de Lima, Perú / Physicians' adherence and compliance with recommendations for care and prevention of diabetic foot, in two hospitals from Lima, Peru

RESUMEN Objetivo: Comparar el cumplimiento por parte de los médicos de las recomendaciones que establecen las guías de manejo y prevención de pie diabético entre un hospital público y uno privado. Materiales y métodos: Realizamos un análisis secundario de la base de datos del estudio transversal "Calidad del control metabólico en pacientes ambulatorios con diabetes mellitus tipo 2 atendidos en dos hospitales generales de Lima". Se utilizaron dos cuestionarios, el primero para recolectar datos demográficos y un segundo de 5 preguntas aplicados al terminar su cita en el consultorio externo de endocrinología: 1) Pedido del médico de retirarse los zapatos, 2) Evaluación de sensibilidad en extremidades inferiores, 3) Recomendación de zapatos especiales, 4) Derivación al servicio de pie diabético y 5) Uso de zapatos especiales por el paciente. Para el análisis de datos se calculó la proporción y los intervalos de confianza al 95% del cumplimiento de las recomendaciones y se usó chi cuadrado o la prueba exacta de Fisher par a evaluar asociación entre tipo de hospital y cumplimiento de las recomendaciones. Resultados: Se encontró una diferencia significativa entre el hospital público y el hospital privado (p <0,05) en el cumplimiento de cuatro de las cinco recomendaciones. En los cuatro casos el cumplimiento fue mayor en el hospital privado que en el hospital público. Las recomendaciones con diferencia significativa fueron: 1. Participante afirmó haberse retirado los zapatos por pedido del médico (37% hospital público vs 77% hospital privado p <0,001); 2. Paciente recibió recomendación de usar calzado especial (16% hospital público vs 61% hospital privado p <0,001) 3. Paciente fue derivado a un servicio de pie diabético (3% hospital público vs 18% hospital privado p =0,001); 4. Paciente afirmaba usar calzado especial (64% hospital público vs 82% hospital privado p =0,012). La única recomendación que no tuvo una diferencia significativa fue el examen de búsqueda de neuropatía (45% hospital público vs 54% hospital privado). Conclusiones: El cumplimiento de las recomendaciones por parte de los médicos de cuidado de pies en pacientes con Diabetes mellitus tipo 2, fue significativamente mayor en la institución privada vs. La pública. Sin embargo, incluso en la institución privada el resultado distó de ser idóneo. La mejor performance en el hospital privado, sugiere que existirían diferencias de la calidad de la atención, lo que tendría repercusiones en la salud de las personas

ABSTRACT Objective: To compare physicians' compliance with the recommendations established by the guides for diabetic foot management and prevention in a public hospital and a private hospital. Materials and methods:: This is a secondary analysis study of the data base from the 'Quality of Metabolic Control in Type 2 Diabetes Outpatients Managed in Lima General Hospitals'. Two questionnaires were used, the first one for collecting demographic data, and the second with 5 questions, and both were administered at the end of their appointment in the endocrinology clinic. The second questionnaire requested the following information: i. Request from the physician to take out their shoes. ii. Sensitivity assessment in the legs. iii. Recommending the use of special shoes. iv. Referring patients to the diabetic foot service, and v. Use of special shoes by the patients. The rates and the 95% confidence intervals for compliance with the aforementioned recommendations were calculated, and chisquare test and Fisher's exact method were used for determining an association between the hospital type and compliance with the recommendations. Results: A significant difference was found between the public hospital and the private hospital (p<0.05) in complying with four of five recommendations (in these four cases compliance was higher in the private hospital). These were as follows: 1. The participants declared having taken out their shoes at the physicians' request (37% public vs. 77% private, p<0.001); 2. The patients received a recommendation about using special shoes (16% public vs. 61% private, p<0.001); 3. Patients were referred to a diabetic foot service (3% public vs. 18% private, p= 0.001); 4. Patients reported using special shoes (64% public vs. 82% private, p= 0.012). Conclusions: Compliance with physicians' recommendations regarding feet care in patients with type 2 diabetes mellitus was significantly higher in a private hospital compared to a public hospital. However, even in the private institution the result was far from being optimal. The best performance in the private hospital suggests there are differences in quality of care, which may have consequences in people's health