Assessing student perceptions of the clinical teachers' performance during early clinical exposure / Evaluación de la percepción de los estudiantes acerca de los atributos de sus tutores en los primeros cursos clínicos

ABSTRACT BACKGROUND: The clinical teachers' attributes can be grouped into physician competencies, teacher competencies, and personal characteristics. Global performance is considered the clinical teacher's capacity to facilitate an active and stimulating learning process for medical students and a warm, supportive, and pleasant environment. AIM: To determine which attributes of the clinical teacher influence their global performance from the students' point of view. MATERIAL AND METHODS: The Role Model Apperception Tool questionnaire (RoMAT) was answered by 133 second-year medical students at the University of Chile during 2018. RESULTS: The students assessed 37 clinical teachers. Teaching competencies had the higher influence in global performance. Personal characteristics also had a significant influence. Physician competencies had an indirect influence on teaching competencies. The model obtained 88% of the explained variance of the teacher's global performance. CONCLUSIONS: This study showed that teacher competencies, personal characteristics, and physician competencies are qualities that influence the perception of the global performance of clinical teachers.

ANTECEDENTES: Los atributos de un tutor clínico pueden agruparse en competencias clínicas, competencias docentes y características personales. En el desempeño global del tutor se considera su capacidad de facilitar un proceso de aprendizaje activo y estimulante y generar un ambiente cálido y de soporte. OBJETIVO: Determinar qué atributos del tutor clínico, evaluados por los estudiantes, influyen sobre su desempeño global. MATERIAL Y MÉTODO: La escala "Role Model Apperception Tool" fue contestada por 133 estudiantes de segundo año de medicina en la Universidad de Chile durante el 2018. RESULTADOS: Los estudiantes evaluaron 37 tutores clínicos. Las competencias docentes tuvieron la mayor influencia sobre el desempeño global. Las características personales también mostraron influencia significativa. Las competencias clínicas influyeron indirectamente a través de las competencias docentes. El modelo logró explicar 88% de la varianza del desempeño global del tutor clínico. CONCLUSIONES: El estudio muestra que las competencias docentes, características personales y competencias clínicas influyen sobre la evaluación de los estudiantes sobre el desempeño global del tutor.

Hiponatremia grave secundaria a la exposición a veneno de Phyllomedusa Bicolor (Rana Kambó): caso clínico / Severe hyponatremia secondary to Phyllomedusa bicolor (Kambó frog) poisoning: report of one case

Phyllomedusa bicolor or Kambo is a frog that lives in the Amazon rainforest. It can release through its skin a substance used in healing rituals that are common among South-American tribes, as well as in urban people of America and Europe. We report a 41-year-old female patient who, during a healing ritual consumed ayahuasca (a drink obtained from the mixture of Banisteriopsis caapi, Psychotria viridis and Mimosa hostilis) and 12 hours later received the poison of Kambo Frog (Phyllomedusa bicolor) on superficial right shoulder skin burns. The ritual included a minimum of six-liter water intake over a few hours period. She evolved with clouding of sensorium, motor agitation, frequent vomiting, and generalized tonic-clonic seizures. She presented lethargic to the emergency room, with a weak pupillary light reflex, generalized stiffness, moving all four limbs. Laboratory showed severe hyponatremia (120 mEq/L) and a creatine kinase level of 8,479 UI/L, that increased 107,216 IU/L within few days. An admission CT Brain scan was normal. The toxicological screening did not identify the presence of other substances. During hospitalization the patient developed severe psychomotor agitation controlled by a dexmedetomidine infusion, hyponatremia, low plasma osmolality (248 mOsm/kg), and disproportionately high urinary osmolality (448 mOsm/kg), suggestive of inappropriate antidiuretic hormone secretion syndrome (SIADH). With correction of hyponatremia, the patient gradually recovered consciousness. Rhabdomyolysis was assumed to be secondary to seizure and managed by volume and bicarbonate infusions with a positive response.

Control glicémico de pacientes diabéticos hospitalizados en un Servicio de Medicina Interna / Glycemic control in diabetic patients hospitalized in a non-critical care hospital setting

Background: During hospitalization, hyper and hypoglycemia impairs the prognosis of diabetic patients. Strict glycemic control improves survival in intensive care units. There is no evidence to support it for patients in non-critical wards. Aim: To evaluate the glycemic control of diabetic patients in a non-critical medical unit, and estimate its effect on hospitalization and survival. Material and Methods: Prospective study of all patients admitted to a non-critical ward with a fasting blood glucose (BG) > 126 mg/dl or > 200 mg /dl at any time, and patients with known diabetes. Age, sex, type of diabetes, time since diagnosis, chronic complications, prior treatment, length of stay, admission and discharge diagnosis were registered. All capillary BG levels obtained from each patient until discharge, death or transfer, were registered. Results: Ninety nine patients aged 63 ± 13.4 years (42 males,) were included. Ninety one percent had a type 2 diabetes with a mean duration of 13.8 years. Mean hospital stay was 10.9 days. At least one hypoglycemia below 70 mg/dl occurred in 21% of patients and 39.4% had at least one episode with blood glucose over 300 mg/dl. Median hospital stay of patients with no episode of BG > 200 mg/dl was 6 days, 10.5 days among patients with at least one episode of BG > 300 mg/dl and 13 days among patients that had at least one episode of hypoglycemia (p = 0.02). Diabetes lasted nine years more among the latter (p < 0.01). Three patients that suffered hypoglycemia and two in the rest of the groups, died (NS). Conclusions: Two of three diabetic patients admitted to our non-critical medical ward have a non-optimal glycemic control. Appearance of hypoglycemia is associated with a longer hospital stay.