Evaluación de motivación y satisfacción en la intervención educativa "Diseño de Casos Clínico Patológicos": estudio piloto en estudiantes de medicina / Motivation and satisfaction of medical students participating in an educational intervention on Pathology

BACKGROUND: Undergraduate Pathology training in medicine is based on modalities centered on the teacher and associated with controlled motivation, with low satisfaction with the educational process. According to the Self-determination Theory, an early participation with responsibilities in clinical practice and an educational environment that promotes autonomy and basic psychological needs satisfaction (BPNS), would generate intrinsic motivation. AIM: To develop an educational intervention based on the pathologists' workplace model, which supports a learning environment intended to the satisfaction of BPNS in medical students. To evaluate the results of the intervention on the levels of motivation and satisfaction. MATERIAL AND METHODS: In the first phase of the study, an educational modality focused on the student was planned, consisting of the design of a pathological clinical case (DPC), performing the specialist's steps under minimal supervision and a contextualized environment. In the second phase, the level of satisfaction (Scale of student experience) and intrinsic motivation in 3rd year medical students was evaluated. RESULTS: After the intervention, 99 students showed high levels of satisfaction (94% of agreement) and intrinsic motivation (6.7 of 7 points), including all sub-scales. They considered that their competences had increased and assessed the intervention as useful. CONCLUSIONS: DPC is an innovative, feasible and attractive methodology for Pathology learning, with a high degree of satisfaction and intrinsic motivation. This experience can be extended to similar disciplines.

[Motivation and satisfaction of medical students participating in an educational intervention on Pathology]. / Evaluación de motivación y satisfacción en la intervención educativa "Diseño de Casos Clínico Patológicos": estudio piloto en estudiantes de medicina.

BACKGROUND: Undergraduate Pathology training in medicine is based on modalities centered on the teacher and associated with controlled motivation, with low satisfaction with the educational process. According to the Self-determination Theory, an early participation with responsibilities in clinical practice and an educational environment that promotes autonomy and basic psychological needs satisfaction (BPNS), would generate intrinsic motivation. AIM: To develop an educational intervention based on the pathologists' workplace model, which supports a learning environment intended to the satisfaction of BPNS in medical students. To evaluate the results of the intervention on the levels of motivation and satisfaction. MATERIAL AND METHODS: In the first phase of the study, an educational modality focused on the student was planned, consisting of the design of a pathological clinical case (DPC), performing the specialist's steps under minimal supervision and a contextualized environment. In the second phase, the level of satisfaction (Scale of student experience) and intrinsic motivation in 3rd year medical students was evaluated. RESULTS: After the intervention, 99 students showed high levels of satisfaction (94% of agreement) and intrinsic motivation (6.7 of 7 points), including all sub-scales. They considered that their competences had increased and assessed the intervention as useful. CONCLUSIONS: DPC is an innovative, feasible and attractive methodology for Pathology learning, with a high degree of satisfaction and intrinsic motivation. This experience can be extended to similar disciplines.

[New perspectives in the management of arterial hypertension]. / Nuevas perspectivas en el manejo de la hipertensión.

Arterial hypertension is one of the biggest public health problems. The research in this area has been relentless and productive, allowing to identify new pathophysiological mechanisms from which new therapeutic options are under development. Despite the recognized efficacy and tolerability of currently available drugs, a high number of patients still do not comply with treatment and maintain inadequate blood pressure levels. This review summarizes the literature about new pharmacological alternatives to treat hypertension. The development state of these new medications ranges from a preclinical state to their clinical use in hypertensive patients. Technological strategies aiming at increasing the compliance with anti-hypertensive medications are also mentioned.

Nuevas perspectivas en el manejo de la hipertensión / New perspectives in the management of arterial hypertension

Arterial hypertension is one of the biggest public health problems. The research in this area has been relentless and productive, allowing to identify new pathophysiological mechanisms from which new therapeutic options are under development. Despite the recognized efficacy and tolerability of currently available drugs, a high number of patients still do not comply with treatment and maintain inadequate blood pressure levels. This review summarizes the literature about new pharmacological alternatives to treat hypertension. The development state of these new medications ranges from a preclinical state to their clinical use in hypertensive patients. Technological strategies aiming at increasing the compliance with anti-hypertensive medications are also mentioned.

Blended learning y predisposición al aprendizaje autodirigido en un programa de especialización dental / Blended learning and self-directed learning in a dental specialization program

INTRODUCCIÓN: Uno de los retos de la educación superior es formar un profesional capaz de mantener un aprendizaje permanente. Para ello, la integración de TIC mediante estrategias que involucran el aprendizaje en línea es esencial. Sin embargo, el éxito de su implementación depende de la capacidad que tenga el estudiante de autogestionar su proceso de aprendizaje. Por ello, el objetivo de este estudio fue relacionar los niveles de predisposición al aprendizaje autodirigido de los alumnos de un programa de especialización al iniciar un taller en comunicación científica con el grado de satisfacción con la metodología implementada y con su efectividad sobre el desarrollo de competencias en comunicación científica. MATERIALES Y MÉTODOS: Se aplicaron 3 instrumentos: Escala de Fisher, King y Tague para la medición de la predisposición al aprendizaje autodirigido, Cuestionario de satisfacción con metodología b-learning y Cuestionario de autopercepción en competencias de comunicación científica. Se evaluó la relación entre los resultados de la medición de la predisposición al aprendizaje autodirigido y los resultados de los otros cuestionarios. RESULTADOS: Se observaron correlaciones positivas entre los niveles de deseo de aprender y las dimensiones actividades presenciales (p < 0,01), interacción en actividades presenciales (p < 0,05) y actividades de enseñanza aprendizaje (p < 0,05); entre los niveles de deseos de aprender y la dimensión lectura de artículos científicos (p < 0,01) y entre los niveles de autoconfianza y la dimensión lectura del artículo científico (p < 0,05). CONCLUSIONES: La autodirección en el aprendizaje cumplió un papel importante en la implementación de la estrategia educativa en esta cohorte en particular

INTRODUCTION: One of the challenges in higher education is to train professionals capable of maintaining lifelong learning. Because of it, the incorporation of ICT through strategies that involve online learning is essential. However, the success of its implementation depends on the ability of the student to self-manage their learning process. Therefore, the aim of this study was to relate levels of self-directed learning readiness of a specialization program students at the beginning of a scientific communication course with their satisfaction with the methodology implemented and it effectiveness on developing scientific communication competencies. MATERIALS AND METHODS: Three instruments were applied: Fisher, King & Tague's self-directed learning readiness scale B-learning strategy satisfaction questionnaire and Self-perceived scientific communication skills questionnaire. The relation between self-directed learning readiness and the results of the other questionnaires was evaluated. RESULTS: Positive correlations were observed between levels of willingness to learn and the dimensions of classroom activities (P < .01), interaction in face-to-face activities (P < .05) and teaching-learning activities (P < .05); between the levels of willingness to learn and the reading dimension of scientific articles (P < .01) and between the levels of self-confidence and the reading dimension of the scientific article (P < .05). CONCLUSIONS: Self-direction in learning played an important role in the implementation of the educational strategy for these particular students

Basic suture techniques for medicine students: comparative results according to training by surgeons versus peers.

OBJETIVO: Comparar la adquisición de habilidades básicas de sutura en estudiantes de medicina según la enseñanza práctica por cirujanos o por pares. MÉTODO: Estudio preexperimental antes y después. Se realizó un taller práctico de suturas para 46 estudiantes de medicina de octavo semestre de la Universidad de Concepción, entre noviembre y diciembre de 2017. Se distribuyó aleatoriamente a los participantes. La mitad de ellos fueron entrenados por cirujanos subespecialistas y la otra mitad por estudiantes de medicina (monitores de sutura). Se evaluaron la sutura continua y discontinua sobre un modelo biológico mediante la escala "The Objective Structured Assessment Of Technical Skills" (OSATS). Se aplicó una encuesta de satisfacción al finalizar el taller. Se comparan los resultados de la escala OSATS antes y después del taller. Se utilizó SPSS24â para el análisis estadístico mediante la prueba t de Student para muestras independientes, y se consideró significativo un valor de p < 0.05. RESULTADOS: Ambos grupos progresaron significativamente en la escala OSATS al comparar los resultados antes y después del taller: 13.0 vs. 26.0 (p < 0.001) para cirujanos y 16.8 vs. 28.0 (p < 0.001) para monitores de sutura. Los resultados después del taller no presentan diferencias significativas. CONCLUSIÓN: Los participantes adquieren habilidades básicas de sutura evidenciando una progresión significativa y similar grado de satisfacción independientemente de si son entrenados por cirujanos subespecialistas o por pares entrenados.

OBJECTIVE: To compare the acquisition of basic procedural suture skills in medical students according to practical teaching by surgeons versus peers. METHODS: Pre-experimental study before and after, a practical suture workshop was held for 46 eighth-semester medical students of the University of Concepción between November and December 2017. Participants were randomly distributed in such a way that half of them were trained by sub-specialists surgeons and the other by medical students (suture instructor). The continuous and discontinuous suture was evaluated on the biological model using the "the objective structured assessment of technical skills" (OSATS) scale. A satisfaction survey was applied at the end of the workshop. Results of the OSATS scale are compared before and after the workshop, SPSS24® was used for statistical analysis by Student's t-test for independent samples, considering significant p < 0.05. RESULTS: Both groups progressed significantly on the OSATS scale (13.0 vs. 26.0, p < 0.001 for surgeons and 16.8 vs. 27.9, p < 0.001 for suture instructors) when comparing pre- versus post-workshop results, respectively. The post-workshop results do not show significant differences. CONCLUSION: Participants acquire basic surgical suture skills evidencing significant progression and similar degree of satisfaction regardless of whether they are trained by subspecialist surgeons or trained peers.

Consideraciones en torno a las Guías USA 2017 de hipertensión arterial / A word of caution about the 2017 hypertension management guidelines

The 2017 Guidelines on hypertension of the American College of Cardiology and American Heart Association, which proposed values of 130/80 mmHg as the cutoff points for the onset of hypertension, aroused great interest. This recommendation is based in the SPRINT study (The Systolic Pressure Intervention Trial), which included hypertensive patients over 50 years of age, non-diabetic, without a history of stroke and with a low representation of subjects with a history of coronary artery disease (16%). A group with intensive anti-hypertensive therapy (pressure achieved 121.5 mmHg) achieved a significantly lower cardiovascular risk as compared with a group with standard therapy (pressure achieved 134.6 mmHg). The Guide proposes immediate pharmacological therapy in diabetic hypertensive patients, in those with stage 3 chronic kidney disease or with persistent albuminuria, and in patients with atherosclerotic disease. The Guideline does not include the management of isolated systolic hypertension of the elderly and did not consider studies that show an increased risk when pressure is reduced below 130/80 mmHg in patients with coronary disease, peripheral vascular disease, diabetes mellitus or chronic renal failure. The new classification of hypertension would increase the number of hypertensive patients in our country by more than one million, would increase the risk associated with diastolic pressure reductions in older adults and ignores the evidence indicating a risk associated with reductions below 130/80 mmHg in patients with diabetes, with chronic renal failure or with atherosclerotic disease. Therefore, it is advisable to maintain a threshold of 140/90 mmHg and perform a careful and gradual management of blood pressure in the latter group of hypertensive patients.

Relación de antecedentes académicos y expectativas iniciales con el bienestar académico de alumnos de primer año de medicina / Relationship between previous academics background and initial expectations with academic well-being of first year of medical students

Introducción: Los estudiantes de primer año de medicina deben afrontar altas exigencias académicas y personales que influyen en el bienestar y el desempeño académico. Esta investigación analiza la relación de los antecedentes académicos y las expectativas académicas iniciales con el bienestar académico de alumnos de primer año de medicina. Sujetos y métodos: Estudio cuantitativo, transversal y correlacional. Se aplicaron los cuestionarios UWES-S17, MBI-HSS e involucramiento académico, versión expectativas. Se obtienen los antecedentes académicos y sociodemográficos de una base de datos oficial. Resultados: Se encontró una relación directa entre las notas de enseñanza media y la dimensión de involucramiento en los estudios del compromiso académico (engagement), una relación inversa con la falta de realización personal del desgaste académico (burnout) y relaciones directas entre las tres dimensiones de las expectativas académicas y el compromiso académico e inversas con la dimensión falta de realización personal del desgaste académico. Conclusión: Tanto los antecedentes académicos previos como las expectativas académicas iniciales se relacionan con el bienestar académico tras el primer semestre

Introduction: First year medical students face personal and high academic standards impacting the well-being and academic performance. This research examines the relationship of the academic background and the initial academic expectations with the academic well-being of first year medical students. Subjects and methods: Quantitative, transversal and correlational study. Applied the questionnaire UWES-S17, MBI-HSS and Academic Involvement, version Expectations. Academic and socio-demographic basis of official data are obtained. Results: We found direct relationships between the high school grades and dimension of involvement in studies of the academic engagement and inverse with the lack of fulfillment of academic burnout and direct relationships between the three dimensions of the academic expectations and academic engagement and reverse with the lack of personal fulfillment dimension of academic burnout. Conclusion: Both the previous academic background and initial academic expectations relate to the academic well-being after the first semester

[Relationship between self-directed learning and value profile in Chilean medical students]. / Aprendizaje autodirigido y su relación con el perfil valórico en estudiantes de medicina.

BACKGROUND: Medical education should prepare students to face a dynamic environment, through competencies that allow them to learn independently. AIM: To evaluate the relationship between self-directed learning and value profile of undergraduate first year students in a medical school in Chile. MATERIAL AND METHODS: Self-Directed Learning Scale and Schwartz's Values Questionnaire were applied to 235 medical students from the University of Concepción, Chile. RESULTS: Self-direction and Security are value types that correlate directly and significantly with the overall scale and with the five subscales of Self-Directed Learning. CONCLUSIONS: In first year medical students ofUniversity of Concepcion, Chile, Self-direction and Security are values that facilitate Self-directed Learning.

Aprendizaje autodirigido y su relación con el perfil valórico en estudiantes de medicina / Relationship between self-directed learning and value profile in Chilean medical students

Background: Medical education should prepare students to face a dynamic environment, through competencies that allow them to learn independently. Aim: To evaluate the relationship between self-directed learning and value profile of undergraduate first year students in a medical school in Chile. Material and Methods: Self-Directed Learning Scale and Schwartz's Values Questionnaire were applied to 235 medical students from the University of Concepción, Chile. Results: Self-direction and Security are value types that correlate directly and significantly with the overall scale and with the five subscales of Self-Directed Learning. Conclusions: In first year medical students ofUniversity of Concepcion, Chile, Self-direction and Security are values that facilitate Self-directed Learning.

[Professionalism of physicians from the point of view of physicians and students]. / Atributos del profesionalismo estimados por estudiantes de medicina y médicos. Análisis mediante el modelo de disponibilidad léxica.

BACKGROUND: Professionalism should be included as a fundamental component in the curriculum of undergraduate as well as graduate students of Medicine. Future physicians should be aware of the attributes that a professional should possess. AIM: To analyze the ideal medical doctor attributes from the point of view of physicians and students of Medicine. MATERIAL AND METHODS: One hundred four physicians (MD) and 47 students answered a free association test on the attributes they would assign to a good physician. The test was applied via Internet to professionals, and students were tested in group dynamics at the beginning of the class on Bioethics and Professionalism. Data were processed according to the Lexical Availability Model (LAM) which provides quantitative as well as qualitative evaluations. RESULTS: The attributes with higher scores among MD's were honesty (0.379), regular academic updating (0.373), ability (0.325) and empathy (0.241). Among students, the selected attributes were excellence (0.625), empathy (0.511), responsibility (0.280) and ability (0.209). A general agreement was found among physicians and students, excepts by the fact that MD's consider continuing academic updating as the most important attribute. CONCLUSIONS: The attributes that physicians and medical students evaluate as essential in professionalism were identified using the LAM approach. At the beginning of the career, students have a definite humanistic approach to their future profession.

Atributos del profesionalismo estimados por estudiantes de medicina y médicos: análisis mediante el modelo de disponibilidad léxica / Professionalism of physicians from the point of view of physicians and students

Background: Professionalism should be included as a fundamental component in the curriculum of undergraduate as well as graduate students of Medicine. Future physicians should be aware of the attributes that a professional should possess. Aim: To analyze the ideal medical doctor attributes from the point of view of physicians and students of Medicine. Material and methods: One hundred four physicians (MD) and 47 students answered a free association test on the attributes they would assign to a good physician. The test was applied via Internet to professionals, and students were tested in group dynamics at the beginning of the class on Bioethics and Professionalism. Data were processed according to the Lexical Availability Model (LAM) which provides quantitative as well as qualitative evaluations. Results: The attributes with higher scores among MD's were honesty (0.379), regular academic updating (0.373), ability (0.325) and empathy (0.241). Among students, the selected attributes were excellence (0.625), empathy (0.511), responsibility (0.280) and ability (0.209). A general agreement was found among physicians and students, excepts by the fact that MD's consider continuing academic updating as the most important attribute. Conclusions: The attributes that physicians and medical students evaluate as essential in professionalism were identified using the LAM approach. At the beginning of the career, students have a definite humanistic approach to their future profession.

Trends in prevalence, awareness, treatment and control of hypertension in urban communities in Chile.

OBJECTIVES: To evaluate the changes experienced over 15 years in the prevalence, state of awareness, treatment and control of hypertension, in urban communities of the VIII Region of Chile. METHODOLOGY: In order to ensure an objective analysis in comparison of the indicators, the methodological design used in 1988 was replicated: a representative, non-institutionalized sample, considering age, gender and socio-economic level. Blood pressure was measured using mercury manometers during two visits carried out on different days. Hypertension criteria: systolic blood pressure>or=140 mmHg and/or diastolic blood pressure>or=90 mmHg, or patients under treatment. RESULTS: A sample of 8472 residents was obtained, based on the previously defined stratification. Hypertension prevalence increased from 18.6% in 1988 to 21.7% in 2004. This occurred in all age groups and in both genders. The state of awareness remained stable: 66.9% in 1988 and 66.6% in 2004. The state of treatment increased from 35.6% (1988) to 59.9% (2004), and the state of hypertension control from 7.5 to 30.7%, respectively. CONCLUSION: This study demonstrated an increase in hypertension prevalence from 1988 to 2004. Meanwhile the state of awareness remained stable but there was a significant increase in the state of treatment and control, which were in accordance with public policies and changes in antihypertensive treatment.

[Inspiratory muscle function, hemodynamic parameters and dyspnea in patients with mitral valve stenosis]. / Función de los músculos inspiratorios, parámetros hemodinámicos y disnea en pacientes con estenosis mitral.

BACKGROUND: The mechanism involved in dyspnea in patients with mitral valve stenosis (MS) is not completely understood. AIM: To evaluate in patients with MS, changes in hemodynamic parameters during the assessment of inspiratory muscle endurance (IME) and the relationship between IME, hemodynamics and dyspnea. SUBJECTS AND METHODS: We studied 13 patients (9 in NYHA class II and 4 in class III). Endurance was evaluated using a two minute incremental threshold loading test, to obtain the maximal sustainable inspiratory pressure (SIP), and maximal inspiratory load (MIL). During the test, cardiac output (CO), mean pulmonary and capillary pressures (PAP and PCP, respectively), were evaluated. RESULTS: Compared to six normal subjects, MS patients had reduced SIP and MIL (p <0.01), which correlated with baseline index of dyspnea (r= 0.57 and r=0.52, respectively, p <0.05). At the end of the test period, basal CO, cardiac index (CI), PAP and PCP increased from 3.4 to 4.0 l/min-1; 2.1 to 2.5 l/min-1/m-2; 15 to 25 and 11 to 18 mmHg, respectively (p <0.01). No relationship between IME and hemodynamic parameters was found. CONCLUSIONS: IME is reduced and is closely related to dyspnea in these patients with MS. The observed low CI, suggests that muscle underperfusion could contribute to this dysfunction during the inspiratory.

Función de los músculos inspiratorios, parámetros hemodinámicos y disnea en pacientes con estenosis mitral / Inspiratory muscle function, hemodynamic parameters and dyspnea in patients with mitral valve stenosis

Background: The mechanism involved in dyspnea in patients with mitral valve stenosis (MS) is not completely understood. Aim: To evaluate in patients with MS, changes in hemodynamic parameters during the assessment of inspiratory muscle endurance (IME) and the relationship between IME, hemodynamics and dyspnea. Subjects and methods: We studied 13 patients (9 in NYHA class II and 4 in class III). Endurance was evaluated using a two minute incremental threshold loading test, to obtain the maximal sustainable inspiratory pressure (SIP), and maximal inspiratory load (MIL). During the test, cardiac output (CO), mean pulmonary and capillary pressures (PAP and PCP, respectively), were evaluated. Results: Compared to six normal subjects, MS patients had reduced SIP and MIL (p <0.01), which correlated with baseline index of dyspnea (r= 0.57 and r=0.52, respectively, p <0.05). At the end of the test period, basal CO, cardiac index (CI), PAP and PCP increased from 3.4 to 4.0 l/min-1; 2.1 to 2.5 l/min-1/m-2; 15 to 25 and 11 to 18 mmHg, respectively (p <0.01). No relationship between IME and hemodynamic parameters was found. Conclusions: IME is reduced and is closely related to dyspnea in these patients with MS. The observed low CI, suggests that muscle underperfusion could contribute to this dysfunction during the inspiratory effort.

[Prevalence of symptoms associated with blood pressure in normal and hypertensive population]. / Prevalencia de síntomas habitualmente asociados a la hipertensión arterial en población normotensa e hipertensa.

BACKGROUND: High blood pressure should be symptomless. However, popular knowledge attributes some symptoms such as headache, epistaxis or dizziness to high blood pressure. AIM: To compare the prevalence of headache, epistaxis, subconjunctival hemorrhages and dizziness in people with normal or high blood pressure. SUBJECTS AND METHODS: A representative sample of an urban population in Chile was studied. Each subject with high blood pressure was paired with a non-related individual of the same sex and age. These subjects were interrogated about the presence of symptoms. RESULTS: One thousand forty eight subjects with high blood pressure (481 male) and 1052 individuals with normal pressure (483 male), were studied. In subjects with high or normal blood pressure, the prevalence of headache was 22 and 21.8% respectively, epistaxis was 11.6 and 11% respectively, dizziness was 7.4 and 7.6% respectively, tinnitus was 9.1 and 9.4% respectively and subconjunctival hemorrhage was 2.9 and 3.1% respectively (p = NS). CONCLUSIONS: No differences in the prevalence of symptoms, popularly attributed to hypertension, were observed between subjects with normal or high blood pressure.

Efectos de la supresión de un programa especial de control y tratamiento de pacientes hipertensos / Effects of the suppression of a special program of control and treatment for hypertensive patients

Se efectúa una revaluación de 91 hipertensos después de 4 años de suprimido el Programa de Control y Tratamiento al que habían permanecido adscritos por 32 meses. La evaluación consistió en un examen físico con determinación de presión arterial según normas de la OMS, un electrocardiograma (ECG) de 12 derivaciones y una encuesta orientada a conocer la adhesividad al tratamiento, la modalidad de control adoptada y el grado de conocimientos sobre la enfermedad. Los niveles de presión arterial, tanto sistólica como diastólica, fueron tan altos como al momento de su incorporación al Programa original pero eran normales en el grupo que declaró terapia ininterrumpida controlada por especialistas. Estos sujetos poseían el mayor nivel de escolaridad y demostraron un alto conocimiento de su enfermedad. Los índices de hipertrofia ventricular izquierda (HVI) estudiados por el ECG sufrieron cambios: aquéllos que normalizaron el ECG presentaban cifras normales de presión arterial mientras que éstas seguían elevadas en quienes mantuvieron o desarrollaron HVI. Se llama la atención sobre la necesidad de propiciar Programas especiales para pacientes hipertensos, con especial atención en los contenidos educativos

Evaluación de un programa de control y tratamiento de pacientes hipertensos / Evaluation of a program for control and treatment of hypertensive patients

Se presenta la experiencia de un programa de control y tratamiento de 222 pacientes hipertensos seguidos entre 24 y 32 meses. Entre las características de la población de estudio destacan el elevado número de hombres (72%) y el adecuado nivel de escolaridad. El rendimiento del programa se mide a través del análisis complementario de la adhesividad a los controles y el comportamiento de las cifras tensionales. Para utilizar una medida comparable del índice de casos perdidos o que abandonan se propone el método actuarial que en este estudio fue de 7,2 por mil meses-persona. Se analiza el comportamiento de la presión arterial logrando reducciones significativas tanto para la sistólica (29,5 mmHg) como para la diastólica (21,5 mmHg) en un corte a los 2 años que englobó a los 222 casos. Se pone de relieve la importancia de la motivación del equipo de salud y la labor educativa sobre los pacientes