Enseñanza centrada en el estudiante / Student centered teaching

A diferencia de la enseñanza centrada en el profesor, en la cual el foco está en la entrega de información a los estudiantes, la enseñanza centrada en el estudiante es una forma de docencia en que el foco está en el aprendizaje. En esta forma de docencia los estudiantes adquieren un papel más activo, con mayores responsabilidades en el proceso. En lugar de solo entregar información, el profesor se transforma en un facilitador de los aprendizajes, lo que hace posible que su rol formador de personas se potencie. Este cambio de paradigma implica el empleo de una variedad de métodos de enseñanza y de evaluación. Junto con aprender información los estudiantes aprenden a emplearla en un contexto para resolver problemas y adquieren autonomía para adquirir nueva información en el futuro.

Rather than a professor centered method, in which the focus is set in giving out information to the students, a student centered approach is a way that focuses on learning. In this way the students acquire an active role with greater responsibilities in the process. Instead of only transmitting information, the teacher becomes a learning coach, which stimulates him in his role of forming people. This change of paradigma involves different teaching and evaluation methods. Apart from learning information, the students learn to use it in a context in order to solve problems, and achieve autonomy to acquire new information in the future.

Educación por competencias: implicancias para el pregrado de medicina / Competence- based education: implications for undergraduate medical education

La educación médica por competencias, planteada hace ya varios años, ha resurgido como un modelo de enseñanza-aprendizaje que explicita y destaca la evaluación de resultados educacionales como el eje central de acción con estudiantes y pacientes. En este artículo se actualizan algunas definiciones de competencia desde la perspectiva de la educación médica, se analizan las fortalezas potenciales de la educación por competencias y se describen ejemplos de algunos modelos empleados en otras latitudes. A continuación se propone una clasificación operacional de las competencias que ha servido para comenzar a analizar la enseñanza por competencias en el pregrado de Medicina, aspectos relacionados a la planificación general e implementación. Finalmente, se hace un breve análisis desde esta perspectiva de la situación actual del currículo de la Escuela de Medicina de la Pontificia Universidad Católica de Chile.

Competence-based medical education, described several years ago, has re-arisen as a model of teaching and learning that remarks and emphasizes the evaluation of educational outcomes as the backbone of action with students and patients. In this article, some definitions of competence are updated from the perspective of the medical education as well as potential strengths of competence-based education and curricular models used in other latitudes, are analyzed. Then, we propose an operational classification for competences, which could be used in our Medical School for development, implementation and follow up of competences at different levels in the undergraduate medical education at our Medical School. Finally, a brief analysis is done from the perspective of current curricular development at our School of Medicine.

Mejoría en el desempeño académico de estudiantes de medicina en tiempos de reforma curricular / Improvement of medical studentïs academic performances in times of curricular reform

Background: During the last decade, academic life at the medical school of the Pontificia Universidad Cat-lica de Chile has been thoroughly affected by a curricular reform process. Changes started in 1993 and have continued up until now. This reform did not have an experimental design to allow for a scientific evaluation of its effects. However, it seems interesting to study the evolution of indices of academic performance of our students during this period. Aim: To evaluate the academic performance of medical students between 1989 and 1999. Subjects and Methods: All undergraduate students enrolled between 1989 and 1999. Academic performance was evaluated by 1) failure to pass one or more courses, 2) delay to complete the third year of studies, 3) withdrawal from school and 4) medical school grades. Results: All indices of academic performance changed during the period of study. Failure to pass, delay and withdrawal from school significantly decreased, whereas medical school grades improved, particularly in basic and pre-clinical subjects. Conclusions: Academic performance of medical students improved consistently between 1989 and 1999. While specific causal relationships cannot be established, we believe that this improvement is likely related to the curricular reform. This reform included horizontal and vertical integration of academic contents, greater emphasis in problem-based learning and additional instances of evaluation such as the repetition exam

Manejo ambulatorio de la EPOC: informe de una Reunión de Consenso / Ambulatory management of chronic obstructive pulmonary disease COPD: a consensus report

Based on the Consensus of the Chilean Respiratory Society, this article summarizes the main topics of the ambulatory management of patients with COPD. The Consensus proposes operative definitions in order to prevent the most frequent conceptual errors, specially those related to the confusion between patients with chronic bronchitis without chronic obstruction and those with COPD. Among the diagnostic criteria, the consensus emphasizes the importance of demonstrating irreversible airway obstruction through spirometry, as well as strategies to the differential diagnosis between COPD and asthma. The Consensus summarizes the therapeutic interventions used in the ambulatory setting, including smoking cessation, bronchodilators, corticosteroids, antibiotics, vaccination, oxygen therapy, respiratory rehabilitation and environmental management. The Consensus emphasizes the importance of patient education in order to involve them in their own management. Some criteria for referral of patients are given and the role of exceptional therapeutical interventions, such as non invasive mechanical ventilation and lung reduction surgery are mentioned. The Consensus states that a significative improvement of the quality of life can be achieved with a proper combination of therapeutic interventions

Chlamydia pneumoniae en pacientes con neumonías adquiridas en la comunidad en Santiago de Chile / Incidence of community acquired pneumonia caused by chlamydia pneumoniae in Chilean subjects

Background: The prevalence of Chlamydia pneumoniae infection varies according to the population and geografic area studied. Aim: To evaluate the incidence of Chlamydia pneumoniae infection in Chilean subjects with community acquired pneumonia. Patients and methods: Between 1995 and 1997, patients with community acquired pneumonia attending two emergency rooms in Santiago, were studied. The diagnosis of Chlamydia pneumoniae infection was based on the detection of Chlamydia pneumoniae specific IgG antibody in samples from both the acute and convalescent phase, using an indirect microimmunofluorescent technique. Evidence of present infection was defined as seroconversion, a significant increase in the titer of the second sample and an initial titer equal or greater than 1/512. Results: During the study period, 160 patients consulted and seven (six male), aged 54ñ27 years old, complied with the diagnostic criteria of present Chlamydia pneumoniae infection. These patients had no special clinical or radiological features. Five of seven patients improved without any specific treatment. Conclusions: Eight percent of this sample of patients with community acquired pneumonia had Chlamydia pneumoniae infection. This agent should be included in the design of empiric treatment schemes, although our results cast doubt on the pathogenic role of Chlamydia pneumoniae in pneumonia

Enfisema pulmonar experimental en la rata: fenómenos inflamatorios y progresión del daño pulmonar / Experimental pulmonary emphysema in the rat: inflammatory phenomena and progression of lung damage

Background: Although the hamster model of elastase induced emphysema is well characterized, the rat model has received less attention. Aim: To evaluate the effect of a single intratracheal elastase dose on lung pathological changes of Sprague-Dawley rats. Material and methods: Rats were injected with a single intratracheal elastase dose of 28 U/100 g body weight or saline and studied 7, 15, 30 and 365 days after injection. Results: Forty percent of rats died in the first 48 hours after injection, six were sacrificed at 7 days, 6 at 15 days, 7 at 30 days and 12 at 365 days. Progressive centroacinar emphysema was found from day 7 after elastase, with a persistent inflammatory reaction in the vicinity of emphysematous areas. Conclusions: Present findings differ from the panacinar emphysema described in the hamster using a similar elastase dose

Neumonia por chlamydia pneumoniae, TWAR / Chlamydia pneumoniae, TWAR, pneumonia

Se revisan sumariamente las publicaciones respecto a cuadro clínico, diagnóstico, epidemiología y tratamiento de las neumonias por C. pneumoniae, incluyendo los datos chilenos. Los estudios respecto a este nuevo agente causal de neumonias son todavía escasos y limitados, por lo que la información es aún incompleta y cambiante. El conjunto de los datos sugiere que C. pneumoniae causa frecuentemente neumonias adquiridas en la comunidad de carácter leve, las que se pueden complicar con coinfecciones por otras bacterias, tomando en este caso un curso más grave que requiere de hospitalización. Por su frecuencia, este agente debe ser contemplado en nuestro país en la terapia antimicrobiana de las neumonias adquiridas en la comunidad. Si se considera que el cuadro clínico radiográfico es poco característico, que el diagnóstico etiológico es lento y adolece de falta de sensibilidad y especificidad y que los exámenes no están disponibles en la mayoría de los servicios, es razonable concluir que en la gran mayoría de los casos el tratamiento deberá indicarse sobre bases empíricas. El esquema de manejo de la American Thoracic Society hace posible un manejo adecuado en la mayoría de los enfermos

Reforma del curriculum de pregrado en la Escuela de Medicina de la Pontificia Universidad Católica de Chile: objetivos, metodología y estado de avance / Undergraduate curriculum reform at the Pontifical Catholic University Medical School. Aims, methodology and advance status

The Medical School of the Pontifical Catholic University is devoted to a reform process aiming to adequate undergraduate training to scientific, technological, cultural and social changes in medical practice in Chile and to incorporate novel teaching methodology. One of the main modifications is the change of the resulting professional from "a general physician capable of resolving most medical problems of rural or urban populatins" to "a physician with a solid general training but qualified for a subsequent specialization". This requires curricular flexibility to obtain different professional profiles. Other important changes are a reduction in curricular contents and their vertical and horizontal integration, modernization of teaching methodologies with the incorporation of computing techniques and problem oriented teaching and the incorporation of new subjects such as molecular biology, clinical genetics, health economics. To achieve these objectives, a semi-flexible curriculum was devised, the curricular mesh has been modified extensively, an outpatient and a nine months elective internship were added. Most modifications have been implemented, remaining changes in 4th and 5th years. These changes required a reorganisation of academic structure, the use of new selection, training and perfecting criteria for teachers, better salaries for outstanding professors and improvement of teaching infrastructure. This reform must be seen as a medium term integral change in the context of an integral academic development plan

Seroprevalencia de infección por Chlamydia pneumoniae en población sana de Santiago de Chile / Seroprevalence of chlamydia pneumoniae infection in healthy population from Santiago, Chile

La evidencia de exposición previa a Chlamydia pneumoniae fue evaluada en 353 sujetos sanos de Santiago de Chile. Se efectuó determinación sérica de anticuerpos (IgG) específicos anti-Chlamydia pneumoniae con antígenos de la cepa AR-39 proporcionados por la Washington Research Foundation, con técnica de inmunofluorescencia indirecta. Títulos iguales o mayores de 1:16 fueron considerados positivos. 134 sueros fueron positivos para Chlamydia penumoniae, con título máximo de 1:256. Concluimos que en esta muestra la seroprevalencia fue de 38 por ciento y que en un título igual o mayor de 1:512 sugiere el diagnóstico de infección aguda por Chlamydia pneumoniae