Evaluación para el aprendizaje: diseño e implementación de un mini-CEX en el internado profesional de la carrera de kinesiología / Assessment for learning: design and implementation of the Mini-CEX to the physiotherapy clerkship

Introducción: la evaluación kinesiológica contempla la realización de una rigurosa historia clínica y examen físico que orientan a establecer un diagnóstico, un pronóstico funcional, y es la base del plan de intervención. Esta competencia requiere de experiencia y razonamiento clínico para la toma de buenas decisiones terapéuticas. Los resultados históricos de las evaluaciones de aprendizajes del internado, concluyen que esta competencia tiene bajo nivel de desempeño, por lo que se deben mejorar las estrategias utilizadas para su aprendizaje durante el internado. El mini-CEX, es un instrumento de evaluación para el aprendizaje, que promueve la observación y feedback en el sitio de trabajo. Objetivo: diseñar e implementar un instrumento de evaluación para el aprendizaje de la evaluación kinesiológica durante el internado profesional de la Carrera de Kinesiología de la PUC. Método: estudio prospectivo, utilizando la me-todología de investigación acción, diseñado en 4 etapas. Resultados: se obtuvo un instrumento de evaluación para el aprendizaje, el mini-CEX, adaptado a las necesidades del internado profesional de kinesiología. El estudio piloto reportó buena aceptación entre estu-diantes y docentes. La percepción de los internos es que son más observados y que las destrezas asociadas a la evaluación kinesiológica mejoraron luego del estudio. Conclusiones: el instrumento reportó un tiempo de aplicación bajo (35 min.), lo que beneficiaría instancias de observación directa y feedback dentro de los internados. Es necesaria una aplicación a gran escala, que contribuya a determinar su validez y confiabilidad. Se requiere una capacitación formal a los docentes evaluadores y ajustar la escala.

Introduction: The physiotherapy clinical assessment competence includes the performance of a rigorous clinical history and physical examination that guides the establishment of a diagnosis and a functional prognosis, and is the basis of the intervention plan. This competence requires experience and clinical reasoning to make good therapeutic decisions. The historical global clerkship assessments conclude that this competency has a low level of performance, so the strategies used for its learning the clerkship must be improved. The mini-CEX is an assessment for learning, which promotes observation and feedback in the workplace. Objective: To design and im-plement an assessment for learning mini-CEX to the Physiotherapy PUC clerkship. Method: Prospective study, using an action research methodology, designed in 4 stages. Results: The main result was the mini-CEX, adapted to the Physiotherapy clerkship needs. The pilot study reported good acceptance among students and teachers. In addition, clerks' perception is that they feel more observed and that the skills associated with the physiotherapy assessment improved after its implementation.

The relationship between medical students' eagerness in clinical clerkships and their interest in medical departments / 医学教育

Medical students must have motivation to participate in medical care during clinical clerkships. How much interest students have in each department might be a factor in making them more active in clerkships. To make clerkships more effective, we performed a questionnaire survey to investigate the relationship between students' interest in each department and their eagerness in clinical clerkships and to investigate factors to increase their eagerness.<br>1) Questionnaires were distributed to 92 sixth-year medical students at the University of Tsukuba. The questionnaire consisted of 6-point Likert scales of 4 specific student attitudes in clerkships. We asked the same questions about clerkships at medical departments that each student found more or less interesting.<br>2) We asked the students to report anecdotes about when they were motivated to learn more in the clerkships. We grouped similar answers into categories.<br>3) The response rate was 94%. The students were more eager in departments they found more interesting than in departments they found less interesting.<br>4) Thirty-eight students reported a total of 56 anecdotes. Among the categories, questions or words of encouragement from patients were mentioned in 29 anecdotes, and devoted faculty members were mentioned in 9 anecdotes.<br>5) These results suggest that medical students' eagerness in clinical clerkships could be increased by deepening their interest in medical departments and by improving communication with patients and physicians.

Current Situation of Medical Student Abuse / 医学教育

1) To our knowledge, medical student abuse has not previously been studied in Japan.<BR>2) In our survey, 68.5% of respondents experienced medical student abuse.<BR>3) Several students reported that they had been frequently neglected or ignored by teaching physicians during clinical clerkships and that such attitudes discouraged them and decreased their motivation.<BR>4) To improve the learning environment, medical educators must take action to resolve this serious issue.

El tiempo de los estudiantes de medicina en las rotaciones clínicas y el sistema de créditos / Medical Student's Use of Time during Clinical Clerkships and the Credits Based System

Introducción: La formación en ciencias clínicas del pregrado de medicina se fundamenta en rotaciones clínicas. Para implementar el sistema de créditos es necesario conocer cómo se llevan a cabo estas experiencias. Objetivo: Describir cómo los estudiantes utilizan el tiempo durante las rotaciones clínicas, el valor académico y el grado de disfrute que le asignan a las actividades. Metodología: Estudio descriptivo con una muestra aleatoria estratificada de cien estudiantes de los semestres clínicos. Se recolectó información sobre el tiempo empleado durante una semana, el valor educativo y el grado de disfrute de las actividades de las rotaciones clínicas. Los datos fueron analizados en Excel® 98 y SPSS. Resultados: Las actividades de un día ocuparon en promedio 10.8 h, con 7.3 h (69%) dedicadas a actividades académicas. La actividad asistencial con docente representó el mayor porcentaje de utilización del tiempo (15.4%). Durante una semana, el 56% (28 h) del tiempo efectivo estuvo dedicado al trabajo asistencial y 22.4 h (44.5%) al trabajo independiente en el sitio de práctica. El tiempo dedicado al aprendizaje en la rotación clínica corresponde a 19 créditos para un semestre de 18 semanas. Las actividades calificadas con mayor valor educativo fueron el estudio independiente por fuera de la institución (4.6) y las actividades académicas con el docente (4.5). Las calificadas como de mayor disfrute fueron las extracurriculares y la docencia formal. Conclusiones: Los estudiantes tienen mayor tiempo de contacto con los pacientes que el reportado en la literatura. El trabajo presencial de nuestros estudiantes es mayor al reportado en estudios similares.

Introduction: Comprehensive undergraduate education in clinical sciences is grounded on activities developed during clerkships. To implement the credits system we must know how these experiences take place. Objectives: to describe how students spend time in clerkships, how they assess the educative value of activities and the enjoyment it provides. Method: We distributed a form to a random clustered sample of a 100 students coursing clinical sciences, designed to record the time spent, and to assess the educative value and the grade of enjoyment of the activities in clerkship during a week. Data were registered and analyzed on Excel® 98 and SPSS. Results: mean time spent by students in clerkship activities on a day were 10.8 hours. Of those, 7.3 hours (69%) were spent in formal education activities. Patient care activities with teachers occupied the major proportion of time (15.4%). Of the teaching and learning activities in a week, 28 hours (56%) were spent in patient care activities and 22.4 hours (44.5%) were used in independent academic work. The time spent in teaching and learning activities correspond to 19 credits of a semester of 18 weeks. The activities assessed as having the major educational value were homework activities (4.6) and formal education activities (4.5). The graded as most enjoyable were extracurricular activities, formal educational activities and independent academic work. Conclusion: our students spend more time in activities with patients than the reported in literature. The attending workload of our students is greater than the one reported in similar studies.

Elective Overseas Clinical Clerkships and Related Problems / 医学教育

At this university, an overseas component has been included in the elective clinical clerkship program for sixth-year students since 1998. Since that time, 28 students have done short-term clinical clerkships in various foreign countries. This report presents results of a questionnaire survey of students who have done overseas clerkships. The questionnaire comprised 8 items, including the reason for selecting the clerkship location and the contents of the training program. Questionnaires were returned by 68% of students. Most of the 28 students did clerkships in English-speaking countries. The average duration of study was 2.3 months (range, 1 to 3 months). All students were satisfied with their training experience; however, many felt their language skills were insufficient for participating in overseas training programs. In addition, more comprehensive arrangements, including establishing close contact with the receiving institutions and insurance provisions, are needed to maintain and further develop overseas clinical clerkships.

Is The Assessment of Knowledge, Skills, and Attitudes in Anesthesiology Clerkships Balanced? / 한국의학교육

PURPOSE: This study was performed to evaluate whether the student knowledge, skills, and attitudes in anesthesiology clerkships were properly assessed in 18 medical schools. METHODS: The author examined the survey questionnaire returned from anesthesiology professors of 8 medical schools planning to be accredited and self-assessed reports published by 10 accredited medical schools. RESULTS: The student knowledge (50%) was given a higher value in the evaluation than skills (25%) and attitudes (25%). The student knowledge was mainly evaluated using oral/written examinations, reports, recording of patient's data, and case/article presentations. The student attitude was assessed using only attitudes and attendance items. At more than half of the 13 schools, student skills were assessed based on 15 skills including insertion of iv line, intubation, blood pressure measurement, airway keep, CPR, monitoring, iv fluid /transfusion setting, arterial blood gas and Ambu 'bagging' in order of frequency. However, student skills were not evaluated in 3 of the 18 schools. CONCLUSION: The evaluation process should be performed adequately for student knowledge, skills and attitudes in anesthesiology clerkships. Moreover, It is inappropriate to include attendance in the student's attitude evaluation as attendance is mandatory in clinical clerkship. These results suggest that the student's clinical performance (i.e., skills and attitudes) should be evaluated objectively by using OSCE, or CPX.