¿Tienes lo que hay que tener?: un análisis de los factores asociados con la intención de optar por una carrera en cirugía entre estudiantes de medicina / Do you have what it takes? An analysis of the factors associated with the intention to choose a surgical career among medical undergraduates

Resumen Introducción Los cambios en la práctica profesional han transformado la intención de los estudiantes de medicina de optar por una carrera en cirugía. Objetivo Evaluar los factores asociados con esta intención en un contexto de acelerada dinámica educativa y sanitaria. Materiales y Método Evaluamos la intención de los estudiantes de diez facultades de medicina en Colombia, y los factores asociados, mediante un cuestionario (escala de Likert) desarrollado a partir de la revisión de la literatura. Identificamos la asociación entre los factores y la intención mediante un análisis de regresión lineal. Los resultados de la regresión se presentan mediante coeficientes β (p < 0,05). Resultados Un total de 252 estudiantes (65,87% mujeres) fueron incluidos en el análisis. El promedio de la intención fue 3,15 ± 1,34 (1-5). Los factores significativamente asociados fueron: identificación con el estilo de vida quirúrgico (β = 0,25); identificación con modelos (β = 0,18); atributos personales (β = 0,25) e identificación con la práctica profesional del cirujano (β = 0,16). No encontramos asociación significativa con el género (mujeres en la especialidad), prestigio, dinámica del posgrado ni recompensa futura. Conclusión Existe una intención moderada de elegir una carrera de cirugía entre estudiantes de medicina colombianos. Optar por esta carrera requiere atributos personales, modelos e identificación con el estilo de vida y práctica profesional del cirujano. Se requieren estudios cualitativos que exploren en profundidad estos resultados e intervenciones focalizadas a estimular esta intención entre los estudiantes.

Introduction The changes in the professional practice have transformed the intention of medical students to choose a surgical career. Aim Evaluate the factors associated with this intention in a context of accelerated educational and health dynamics. Materials and Method We evaluated the intention of the students of ten medical schools in Colombia, and the associated factors, through a questionnaire (Likert scale) settled from a literature review. We identify the association between the factors and the intention by using linear regression analysis. The results of the regression are presented by β coefficients (p < 0.05). Results A total of 252 students (65.87% women) were included in the analysis. The average of the intention was 3.15 ± 1.34 (1-5). The factors significantly associated were: identification with the surgical lifestyle (β = 0.25); identification with models (β = 0.18); personal attributes (β = 0.25) and identification with the professional practice of the surgeon (β = 0.16). We did not find significant associations with gender (women in the specialty), prestige, postgraduate dynamics and future rewards. Conclusion There is a moderate intention to choose a career in surgery among Colombian medical undergraduates. Choosing this career requires personal attributes, models and identification with the lifestyle and professional practice of the surgeon. Further qualitative studies are necessary to explore these results in depth, as well as interventions to stimulate this intention among students.

Actividades profesionales confiables en cirugía mínimamente invasiva: iniciando el camino para lograr competencias en el futuro graduado de medicina / Entrustable professional activities in minimally invasive surgery: starting the way to achieve competencies in the future medical graduate

Objetivos: El desarrollo de actividades profesionales confiables (APROC) para el graduado de medicina en Cirugía Mínimamente Invasiva (CMI) es una necesidad en Colombia. La evidencia disponible es limitada. Este estudio describe la experiencia preliminar con una intervención orientada a esta necesidad, en el marco de un modelo de educación basada en competencias (EBC). Materiales y Métodos: Se diseñó una intervención orientada al desarrollo de actitudes, conocimientos y habilidades prácticas en CMI para estudiantes de medicina, mediante un enfoque de aula invertida extendida. Se realizaron evaluaciones pre y posintervención mediante el cuestionario Team-STEPPS (actitudes), exámenes de conocimiento y OSATS (habilidades prácticas). Se realizaron comparaciones pre y posintervención (t-test (p < 0,05) y mediciones del tamaño del efecto de la intervención (prueba d Cohen). Finalmente se evaluó la satisfacción estudiantil. Resultados: Un total de 99 estudiantes participaron en el estudio. Se encontraron diferencias estadísticamente significativas (p < 0,05) entre las mediciones pre y posintervención, y gran efecto en las actitudes, conocimientos y habilidades prácticas (d > 0,80). Se evidenció alta satisfacción estudiantil. Discusión: El diseño instruccional a través de metodologías interactivas permite desarrollar APROC en CMI, desde el pregrado. Estos resultados son similares a los reportados en otras intervenciones en el marco de la EBC. Conclusión: Nuestra intervención demostró efectos positivos sobre competencias estudiantiles orientadas al desarrollo de APROC en CMI para el futuro graduado. Aun es necesario medir estas competencias en la práctica real y al finalizar la carrera, para determinar si estas actividades pueden ser totalmente confiables a los participantes en su futura práctica profesional.

Aims: The development of entrustable professional activities (EPAs) in minimally invasive surgery (MIS) for undergraduates is a need in Colombia. The available evidence is limited. This study aims to describe the preliminary experience with an intervention oriented to this need, embedded in the framework of a competence-based education model (CBE). Materials and Methods: An intervention was designed for the development of EPAs in MIS oriented to the development of attitudes, knowledge and practical skills in medical students. Intervention was delivered through an extended inverted classroom approach. Pre- and postintervention measures were performed by using the Team-STEPPS questionnaire (attitudes), knowledge assessments and OSATS (practical skills). Comparisons were performed by t-test tests (p < 0.05) and the effect size of the intervention was calculated by the Cohen d test. Finally, the student's satisfaction was evaluated. Results: A total of 99 students participated in the study. The intervention showed statistically significant differences (p < 0.05), and great effect on attitudes, knowledge and practical skills (d > 0.80). Likewise, high student satisfaction was evidenced. Discussion: Interactive instructional design fosters development of EPAs in MIS for medical undergraduates. These results are similar to those reported in other interventions under the CBE model. Conclusion: Our intervention showed positive effects on competences oriented to the development of EPAs in MIS for the future graduate. Still is necessary to assess these competencies in real practice and at the end of medical career, in order to evaluate if these activities can be totally reliable to the participants in their future professional practice.

¿Cómo perciben los estudiantes el clima de aprendizaje en el aula invertida en cirugía?: lecciones aprendidas y recomendaciones para su implementación / How do students perceive the learning climate during the inverted classroom in surgery? Lessons learned and recommendations for their implementation

Resumen Introducción/objetivos: El uso del aula invertida como enfoque de enseñanza en el currículo de cirugía se encuentra en una etapa inicial de desarrollo. Existe la necesidad de estudios que soporten su efectividad y demuestren su relación con el clima de aprendizaje. El objetivo de este estudio es presentar la medición longitudinal (2013-2016) del clima de aprendizaje en el aula invertida en cirugía, y ofrecer algunas recomendaciones para su implementación. Material y Método: Las percepciones del clima de aprendizaje fueron evaluadas mediante el instrumento Dundee Ready Educational Enviroment Measure (DREEM). Se calculó el puntaje global del instrumento, así como el de cada uno de sus cinco dominios. Resultados: Un total de 444 estudiantes fueron incluidos. El puntaje global del DREEM indicó un clima de aprendizaje de excelencia. En general la enseñanza fue bien evaluada por los estudiantes, quienes se sintieron seguros de sus habilidades académicas, percibieron a sus profesores como modelo, identificaron una actitud positiva en la atmosfera, y percibieron el ambiente social como aceptable. Discusión: El enfoque de enseñanza de aula invertida en cirugía se asocia con un clima de aprendizaje productivo. Estos resultados aportan nueva evidencia a los altos niveles de satisfacción estudiantil y adecuadas percepciones sobre la autoconfianza estudiantil para el aprendizaje en cirugía demostrados en otros estudios. Conclusiones: La medición longitudinal del clima de aprendizaje en cirugía, utilizando el modelo de aula invertida demuestra puntaciones de excelencia en la población evaluada. Se requieren nuevos estudios que exploren en profundidad sus efectos sobre el aprendizaje y las habilidades cognitivas en los estudiantes.

Introduction/Aims: The use of the inverted classroom as a teaching approach in the surgical curriculum is under development. There is a need for studies informing about their effectiveness and relationship with the learning climate. The aim of this study is to present the accumulated measurement of the learning climate in the inverted classroom in surgery, and share some recommendations for its implementation. Material and Method: The Dundee Ready Educational Environment Measure (DREEM) evaluated the student's perceptions about the learning climate. The overall score of instrument, as its five domains were calculated. Results: A total of 444 students were included. The overall DREEM score indicated a learning climate of excellence. In general, teaching was well perceived by the students, who felt confident about their academic abilities, perceived their teachers as models, identified a positive attitude in the learning atmosphere, and perceived an acceptable social environment. Discussion: The approach of inverted classroom in surgery is associated with a productive learning climate. These results provide new evidence to the high levels of student satisfaction and adequate perceptions about student self-confidence for learning in surgery showed in other studies. Conclusions: The longitudinal measurement of the learning climate in surgery by using the inverted classroom model demonstrates scores of excellence in the evaluated population. Further studies are needed to explore in depth their effects on learning and cognitive abilities in students.

Adenoma pleomoroo gigante en glandulas salivale mayores. hospital parirenyatwaa: Zimbabwe. 2005 reporte de un caso / Giant pleomoric adenoma in the major salivar glands: parirenyatwa hospital.. Zimbabwe, 2005

Se muestra a través de un estudio descriptivo con carácter retrospectivo un caso inusual de Adenoma Pleomorfo en Glándulas Salivares Mayores, operado en el Hospital Parirenyatwa de Zimbabwe en diciembre del 2005.

To show an unusual case of Pleomorphic Adenoma in Major Salivary Gland operated in the Parirenyatwa Hospital in December 2005. Patient: It was a 74 year-old case, black man with history of two masses in different side in his neck, from 5 years ago, the size of the tumour of the right side was 19 x 11cm and the left side was 10 x 11cm. The patient doesn’t refer anymore symptoms. The ENT Examination was negative, except for the neck, which was just referred above. The diagnosis was made by biopsy. The histopathology report was MIXED TUMOUR OF the left Parotid and right submandibular glands. The Pleomorphic Adenoma is the most frequent tumour of the salivary glands, but it is not common to find it with these dimensions without transformation into malignancy. This case was a challenge for me as head and neck surgeon, so I decided to present it.

Airway pressure release ventilation in pediatrics.

OBJECTIVES: The purpose of this study was to determine the effectiveness of airway pressure release ventilation in children. DESIGN: Prospective, randomized, crossover clinical trial. SETTING: This study was conducted in our 33-bed pediatric intensive care unit at The Children's Hospital of Philadelphia. PATIENTS: Patients requiring mechanical ventilatory support and weighing >8 kg were considered for enrollment. Patients were excluded if they required mechanical ventilatory support for >7 days or required >.50 Fio(2) for >7 days before enrollment. Patients with documented obstructive airway disease and congenital or acquired heart disease were excluded as well. INTERVENTIONS: Each patient received both volume-controlled synchronized intermittent mechanical ventilation (SIMV) and airway pressure release ventilation (APRV) via the Drager Evita ventilator (Drager, Lubeck, Germany). Measurements were obtained after the patient was stabilized on each ventilation mode. Stabilization was defined as oxygenation, ventilation, hemodynamic variables, and patient comfort within the acceptable range for each patient as determined by the bedside physician. After measurements were obtained on the initial mode of ventilation, the subjects crossed over to the alternative study mode. Stabilization was again achieved, and measurements were repeated. After completion of the second study measurements, patients were placed on the ventilation modality preferred by the bedside clinician and were followed through weaning and extubation. Measurements: Vital signs, airway pressures, minute ventilation, Spo(2), and E(T)CO(2) were recorded at enrollment and at each study condition. MAIN RESULTS: APRV provided similar ventilation, oxygenation, mean airway pressure, hemodynamics, and patient comfort as SIMV. Inspiratory airway pressures were lower with APRV when compared with SIMV. CONCLUSIONS: Using APRV in children with mild to moderate lung disease resulted in comparable levels of ventilation and oxygenation at significantly lower inspiratory peak and plateau pressures. Based on these findings, we plan to evaluate APRV in children with significant lung disease.

[Efficacy and safety of fexofenadine and cetirizine in the treatment of allergic rhinitis]. / Eficacia y seguridad de la fexofenadina y la cetirizina en el tratamiento de la rinitis alérgica.

BACKGROUND: Allergic rhinitis affects 20 million of people in United States and a higher figure all around the world. OBJECTIVE: To evaluate the efficacy and safety of fexofenadine compared with certirizine in the treatment of allergic rhinitis. MATERIAL AND METHOD: It was carried out a prospective, double blind, comparative, randomized and multicentric study in patients with allergic rhinitis, with ages between 12 and 65 years. In the first phase, placebo was administered during three days to all the patients; and then, they were randomly allocated to receive fexofenadine 120 mg or cetirizine 10 mg in one dose a day during 14 days. Laboratory and cabinet tests at the beginning and at the end were performed to value security, as well as a global evaluation of the researcher to estimate effectiveness. RESULTS: 176 patients were included, 63.6% were women, average age was 27 years (+/- 12), 47.7% received fexofenadine and 52.2%, cetirizine. There was not significant difference in parameters of effectiveness nor of security in the studied group. CONCLUSION: The results of the present study confirm the efficacy and safety of the antihistaminic fexofenadine in the treatment of allergic rhinitis.

Comparación in vitro de antiácidos líquidos de uso comercial / In vitro comparison of commercial liquid antiacids

El objetivo del presente estudio fue comparar la capacidad de diversos antiácidos de elevar el pH de una solución de ácido clohídrico. Se diseño un modelo experimental para medir la capacidad de elevar el pH de una solución de HCl de diferentes antiácidos de uso comercial. Se registró la variación del pH de una solución de HCl a la cual se agregó cada uno de los antiácidos líquidos estudiados. Encontramos diferencias entre los 4 antiácidos a base de OHMg-OHAl. Encontramos diferencias entre las 2 presentaciones de magaldrato existentes en nuestro medio; pero estas son mínimas.