Experiencias en la implementación de un programa de formación en docencia para profesores de medicina en una Universidad de Chile / Experiences in the implementation of a faculty development program for teching for professors of a University of Medicine in Chile

Objetivos. Describir la experiencia y resultados de la implementación de un programa de formación en docencia para profesores de Medicina del Diplomado en Educación Médica, desarrollado en la Escuela de Medicina de la Pontificia Universidad Católica de Chile. Materiales y métodos. Estudio descriptivo, transversal, de carácter cuantitativo y cualitativo. La población estuvo compuesta por todos los graduados del programa hasta el 2011. Se aplicó un cuestionario con preguntas abiertas y cerradas explorando diferentes niveles de impacto, utilizando el modelo de evaluación de Kirkpatrick. Resultados. Sobre el 97% expresó un alto grado de satisfacción (nivel 1 Kirkpatrick). La mayoría reportó cambios en el aprendizaje de conocimientos y competencias docentes (nivel 2 Kirkpatrick) con diferencias pre y posretrospectivas estadísticamente significativas. El 93% refirió haber mejorado globalmente su desempeño docente y sobre el 85% en desempeños específicos (nivel 3 Kirkpatrick). En el nivel 4 de Kirkpatrick, la mayoría percibió un incremento del interés por la docencia y 69% reconoció una mayor valoración a nivel institucional. Del análisis cualitativo emergieron cinco categorías: valoración de la docencia y de la formación en docencia, relevancia de las habilidades docentes, aporte de la docencia al rol profesional, contribución al desarrollo personal y fortalecimiento de la comunidad académica. Conclusiones. Los efectos de este programa de formación en educación médica han sido positivos. Los profesores de Medicina, además de perfeccionar sus desempeños docentes, perciben cambios en el desarrollo personal, en su rol de médico, en la comunidad académica y en la institución...

Objectives. To describe the experience and results of the implementation of a faculty development program for professors of Medicine in the Medical Education Certificate program developed at the School of Medicine, Pontificia Uniersidad Catolica de Chile. Materials and methods. This was a descriptive, cross-sectional, quantitative and qualitative study. The population consisted of all graduates of the program until 2011. A questionnaire with open and closed-ended questions was applied, exploring different levels of impact using the Kirkpatrick evaluation model. Results. Over 97% expressed a high degree of satisfaction (Kirkpatrick level 1). Most respondents reported changes in learning, knowledge and teaching skills (Kirkpatrick Level 2) with statistically significant differences in retrospective pre-post questionnaires 93% reported having improved their teaching performance generally, and 85% in a specific performance (Kirkpatrick Level 3). At level 4 of the Kirkpatrick evaluation model, most perceived an increased interest in teaching and 69% reported being valued more highly at the institutional level. Five categories emerged from the qualitative analysis: value given to teaching and of training in teaching, importance of teaching skills, the contribution of teaching to the professional role, contribution to personal development and strengthening of the academic community. Conclusions. The effects of this faculty development program in medical education have been positive. Professors of Medicine, in addition to improving their teaching performance, perceived changes in personal development, in their role as physicians, in the academic community and in the institution...

Logros más alla de los objetivos: evaluación cualitativa de un programa de formación en educación médica / Impact beyond the objectives: a qualitative study of a faculty development program in medical education

Background: In medical education there has been increasing emphasis on faculty development programs aimed at the professionalization of teaching and increasing students' learning. However, these programs have been shown to have an impact beyond improvement in teaching skills. The medical school of the Pontificia Universidad Católica de Chile (EMUC) has been running a faculty development program (DEM) since 2000. Aim: To explore the perception of graduates on the effects of having participated in DEM on their development as teachers and clinicians. Material and Methods: Using an exploratory, descriptive and qualitative design, the 79 teachers who graduated from DEM from 2004-2008 were sent a questionnaire containing three open questions. Their answers were analyzed using the Constant Comparative Method of Qualitative Analysis of Glaser and Strauss by four researchers. Results: Faculty development, becoming a better clinician, personal development, appreciation of the value of teaching and strengthening of the academic community were the five categories that emerged from the answers. Graduates felt that, besides learning new educational skills, they changed their attitude towards teaching. DEM was perceived as facilitating self-awareness and refection about the graduates' role as doctors and teachers. The graduates also valued meeting other faculty. Conclusions: Faculty development programs can have an impact far beyond the learning objectives. The planning and design of programs contributes to their wider impact. This should be taken into consideration in the design, planning, and evaluation of faculty development programs. Care should be taken to protect time for participation, refection and for interaction with other academics.

Barreras para la formación en docencia de los profesores de medicina: una aproximación cualitativa / Barriers for faculty development in medical education: a qualitative study

Background: Since 2000, the medical school of the Catholic University of Chile (EMUC) has offered courses for its faculty as part of a Diploma in Medical Education (DEM). However by 2009, 41% of faculty had never taken any courses. Aim: To explore the reasons why faculty choose not to participate in these courses. Material and Methods: Semi-structured interviews to seven faculty members, all of whom have an active role in teaching but who had not taken any DEM courses. The sampling was intentional and guided by theory. Based on Grounded theory, the data was analyzed using open, axial and selective coding. Results: Three categories emerged from the analysis. First, the characteristics of a "good teacher" and what it means to be a good teacher. Second, the current status of teaching. Third, the barriers to participate in courses of DEM. Non-attendance is multifactorial; teaching is seen as a natural skill that is difficult to be trained, teaching has a lower priority than other activities, and there are many barriers perceived for attendance. Conclusions: With these results we developed a model to explain the reasons why faculty choose not to participate in these courses. The lower value of teaching and the multiple roles that teachers have, are highlighted.

Narrativa y formación docente: la experiencia de 5 años de un taller de escritura / Narrative and faculty development: results of a five years experience with a creative writing workshop

Background: Narrative medicine has showed to be a powerful instrument to reinforce relationships, identity, and self-knowledge among health professionals. Subjective issues have been recently recognized as relevant for faculty development in addition to the technical aspects. Since 2006 a creative writing workshop has been included as part of the Diploma in Medical Education at the medical school of the Pontificia Universidad Católica de Chile. Aim: To describe the experience and results of the creative writing workshop (2006-2010). Material and Methods: Descriptive and retrospective study with a qualitative and quantitative design. Thirty-six teachers of the School of Medicine attended a 12-hour workshop. The Kirkpatrick model for evaluation of educational outcomes was used to report the data obtained in the course evaluation survey and in the stories produced. Results: There were positive results at the four levels of Kirkpatrick evaluation model. The learning objectives of the workshop were achieved and 83 stories were created, compiled and published. Conclusions: The creative writing workshop can provide faculty with protected time for reflective practice about academic experiences and produce educational outcomes at different levels of the Kirkpatrick model.

Análise de um sistema de avaliação de aprendizagem para internato em pediatria baseado em exame clínico objetivo estruturado, observação de prática clínica e exame escrito / Analysis of a learning assessment system for pediatric internship based upon objective structured clinical examination, clinical practice observation and written examination

OBJETIVO: Descrever e analisar três ferramentas usadas no sistema de avaliação aplicado ao internato em pediatria por um período de 7 anos na Faculdade de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. MÉTODOS: Pesquisa observacional retrospectiva projetada para as modalidades de avaliação usadas de 2001 a 2007 que foram implementadas no internato em pediatria. As ferramentas foram as seguintes: exame clínico objetivo estruturado (objective structured clinical examination, OSCE), exame escrito e diretrizes de observação de prática clínica diária (DOPCD). Os métodos de avaliação foram aplicados ao internato em pediatria do sexto ano, com um total de 697 alunos. A análise estatística incluiu uma avaliação descritiva, com correlação e regressões linear simples e múltipla (ANOVA), teste de Bonferroni e coeficiente alfa de Cronbach. O nível de significância foi de 5 por cento. RESULTADOS: Escores de sucesso com a OSCE foram atingidos em 75,7±8 por cento, com melhor média entre o sexo feminino (p < 0,001). Os escores de OSCE melhoraram após o terceiro ano de implementação. O coeficiente alfa de Cronbach foi de 0,11-0,78. O exame escrito teve escore médio de 79,8±10 por cento, e não houve diferenças quanto a gênero. O escore médio de DOPCD 97,1±3 por cento, com melhores resultados entre as mulheres (p < 0,005). A correlação entre os três métodos de avaliação mostrou uma relação positiva moderada, exceto no ano de 2007, quando a correlação foi maior (p < 0,001). CONCLUSÕES: Análise do sistema de avaliação da aprendizagem foi realizada usando OSCE, exame escrito e DOPCD, que são complementares entre si, gerando bons resultados.

OBJECTIVE: To describe and analyze three tools used in the assessment system applied to the pediatric internship over a 7-year period at the School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. METHODS: Retrospective observational research design for the assessment modalities implemented in the pediatric internship from 2001 through 2007. The tools were as follows: objective structured clinical examination (OSCE), written examination and daily clinical practice observation guidelines (DCPOG). The assessment methods were applied to the sixth-year pediatric internship with a total of 697 students. Statistical analysis included a descriptive assessment, with correlation and simple linear and multiple regressions (ANOVA), Bonferroni test and Cronbach's alpha coefficient. Significance level was set at p < 0.05. RESULTS: OSCE success scores were reached in 75.7±8 percent, with a better mean among females (p < 0.001). OSCE scores improved after the third year of implementation. Cronbach's alpha coefficient was 0.11-0.78. Written examination had a mean score of 79.8±10 percent and there were no sex differences. Mean DCPOG score was 97.1±3 percent and the results were better among females (p < 0.005). Correlation between the three assessment methods showed a moderate positive relationship except in the year of 2007, where the correlation was higher (p < 0.001). CONCLUSIONS: Analysis of the learning assessment system was performed using OSCE, written examination and DCPOG, which are complementary to each other, and yielded good results.

Formación en educación de los docentes clínicos de medicina / Faculty development for clinicaI teachers in medicine

Effective clinical teaching is an imperative of medical education. Clinical teachers and faculty development initiatives as well as Medical Schools, need to focus their efforts to pursue common outcomes: effective learning in students, future competent physicians and healthy patients. Excellence in quality of teaching needs scholars in education. To achieve this objective, institutions must recruit a core of medical faculty according to its mission, define the attributes and teaching competences, implement faculty development programs, and finally, support academic vitality. This article describes the three main issues of medical teaching: faculty, faculty development and its organization.

Toxocarosis en Chile: serie clínica en un centro de pediatría ambulatoria / Toxocarosis in Chile: clinical serie in a pediatric ambulatory center

Este trabajo tuvo como objetivo averiguar la frecuencia y presentación clínica de la toxocarosis en una población infantil. Para ello se realizó entre febrero y agosto de 1997, un estudio descriptivo en una población menor de 15 años, consultante a la Unidad de pediatría Ambulatoria del Centro Médico San Joaquín de la Universidad Católica de Chile. Los niños con eosinofilia (400 o más cel/mm) fueron elegidos para el estudio. La infección por toxocara se diagnosticó mediante la medición del antígeno somático por técnica de ELISA, con dilución de al menos 1/64. Durante el período se realizaron 7.898 consultas, tomándose 364 hemogramas. Se encontró eosinofilia en 24 niños (6,6 por ciento) (rango: 400-9.135 cel/mm). Ocho de éstos fueron positivos para toxocara (30 por ciento). El promedio de edad del grupo de estudio fue 4 años 6 meses (rango: 2 años 4 meses). Todos vivían en centros urbanos y habían tenido contacto con perros, gatos y 5 de los ocho practicaban geofagia. El hemograma fue tomado por adenitis (n=2), mal incrementado ponderal (n=2), bronquitis obstructiva (n=2), exatema (n=1). Sólo en un caso fue positivo el examen oftalmológico, 6/8 pacientes tenían otra parasitosis

Tratamiento de la vejiga hipertónica e hiperactiva en la infancia con sulfato de N-metil hioscina / Treatment of hyperreflexive and hypertonic bladder in children with N-methylhioscine sulfate

Se presentan 21 niños con vejiga hiperactiva y 9 con vejiga hipertónica que consultaron por enuresis, incontinencia o encopresis en forma aislada o asociada y que recibieron durante 90 días tratamiento con sulfato de N-Metil Hioscina. Todos aquellos pacientes que presentaban infección urinaria recurrente se trataron durante todo el estudio con Nitrofurantoína 2mg. x kg/día. En todos se efectuó registro urodinámico al inicio y al término del tratamiento farmacológico. El estudio clínico se prolongó durante 90 días de suspendido el tratamiento. Se comprobó un aumento no significativo (P > 0.005) en la capacidade vesical y en el residuo promedio, una menor amplitud del segmento de reflexia y desaparición o disminución de las contracciones no inhibidas en las vejigas hiperactivas, al término de la terapia. Se observó una respuesta clínica satidfactoria en los pacientes con vejigas hiperactivas independientes del registro urodinámico al término del tratamiento sobre incontinencia, enuresis y encompresis, resultado que se prolongó hasta los 90 días de seguimiento. En los pacientes con vejiga hipertónica, la respuesta clínica fue satisfactoria sobre la enuresis. Esta respuesta se matuvo durante todo el tiempo de observación. No se apreció efectos colaterales indeseables por acción del medicamento

Capacidad vesical, edad, peso, talla y superficie corporal en niños / Vesical capacity, age, weight and body surface area in children

En 30 niños de 4 años 5 meses a 13 años 6 meses de edad con antecedentes de infección urinaria e incontinencia, enuresis o ambas, se midió la capacidad vesicalintentando relacionarla con el peso, la estatura y la superficie corporal. La mejor relación ocurrió con la estatura (r= 0,406; p < 0.05), que con el peso (r=0,389; p < 0.05) y la edad (r= 0,217; p > 0.05). La ecuación que relaciona la capacidad vesical con la estatura, está representada en la fórmula: Capacidad Vesical (ml) = 1,7 x talla (cm) - 0,4

La vejiga inestable en la infancia / Unstable bladder in childhood

En cincuenta niños entre 4 y 13 años de edad, neurológicamente normales, con infección urinaria recurrente, y que además sufrían de enuresis, incontinencia o ambas, se efectuaron pielografías de eliminación, urectrocistografías, cistometrías y en algunos de ellos electromiografía esfinteriana. En el 70% de los casos la cistometría era normal, en 20% había vejiga hipertónica, en 4% ésta era hipotónica y en 6% hiperactiva. Se discute la correlación entre edad y capacidad vesical en función de la cistometría. Se definen las diferencias alteracionales vesicales desde el punto de vista cistométrico según la intensidad de la contracción del detrusor en el momento de la micción