ABSTRACT
OBJECTIVE: To evaluate the clinical competence of first-year residents on the course specialising in family medicine, by applying a structured objective clinical test (SOCT) for simultaneous assessment of cognitive, affective and psychomotor areas. DESIGN: Observational and descriptive. SETTING: Family medicine clinics in the metropolitan area of Mexico City.Participants. 89 doctors on the specialist course in Family Medicine at the Autonomous University of Mexico (UNAM). MAIN MEASUREMENTS: After prior design of comparison lists, expert validation of content, and design of support material for the evaluation and pilot study, a SOCT with ten themes or sections, eight dynamic and two static, was administered. The cut-off point for competent performance was 60 out of 100, both in each section and in the overall average. The statistical analysis was univariate, using descriptive statistics. RESULTS: The overall average of scores in all sections was under 60. The highest average was 73, in the section for monitoring healthy children. In the five highest-scoring sections, the scattering was lower than in the other five. There were low scores in the family study section. CONCLUSIONS: Academic performance, as evaluated by a SOCT measuring clinical competence, was low. This kind of test enabled clinical competence to be assessed more objectively. Interval evaluation scales need to be tested so as to evaluate better the quality of the performance of clinical activities.
Subject(s)
Clinical Competence , Family Practice/education , HumansABSTRACT
OBJECTIVE: To determine the construct validity of FACES III in spanish (México). DESIGN: Cross-sectional study, descriptive, confirmatory. SETTING: Mexico City, South of Federal District, Tlalpan area, divided into geo- statistical zones of a primary care unit. PATIENTS AND OTHER PARTICIPANTS: A random sample of 270 families selected in their dwellings with proportional coverage based on 17 895 dwellings of the influence area. Measurements and main results. Domicile survey applying FACES III (Family Adaptability and Cohesion Evaluation Scales) in spanish, México. Twelve criteria for evaluate the construct validity of FACES III trough confirmatory factor analysis were established by the researchers. Eight criteria were surpassing appropriately and four do not surpass the minimum values established. CONCLUSIONS: FACES III in spanish (México) is an instrument with reliability of 70% with Cronbach alfa and validity measured using confirmatory Factor Analysis. Nevertheless, we found four limitations that should be analyzed and evaluated in the planning of future studies.
Subject(s)
Adaptation, Psychological , Family/psychology , Surveys and Questionnaires , Cross-Sectional Studies , Delivery of Health Care/statistics & numerical data , Health Status , Humans , Language , Mexico , Random Allocation , Reproducibility of Results , TranslationsABSTRACT
OBJECTIVE: To determine through five methods (Cronbach's alpha, split, Guttman method, parallel and strict parallel) the confidence coefficient of FACES III, instrument validated on spanish version, and to evaluate it's consistency with these five statistical methods. DESIGN: Descriptive, cross-sectional. SETTING: Tlalpan Area, south of Federal District, México, divided into geo-statistical zones. PATIENTS AND OTHER PARTICIPANTS: A randomised sample of 270 dwellings with proportional coverage, based on 17,895 ordinary dwellings of the area. INTERVENTION: Domicile survey using FACES III (Family Adaptability and Cohesion Evaluation Scales); April-May 1995. MEASUREMENTS AND MAIN RESULTS: The confidence coefficient of FACES III spanish version was calculated using no standardised Cronbach's Alpha = 0.69; split I = 0.73 and split II = 0.66; Guttman method = 0.75; parallel = 0.69 and strict parallel = 0.53. CONCLUSIONS: Cronbach's coefficient demonstrated more advantages than the other statistical methods in relation with the ordinal measurement scale of FACES III. We suggest to take into consideration three important aspects for the correct confidence analysis of this kind of instruments: Variance analysis depending on the scale of items (F test, Friedman or Cochran) Inter-items interactions analysis (nonadditivity) and the use of the balance value as purge element of error' source. Analysis of Tukey estimate, coefficient of concordance (W) and Hotelling's T squared. It's necessary the evaluation and analysis of this aspects before the report of confidence's coefficient values whose can have hidden skew.
Subject(s)
Adaptation, Psychological , Family/psychology , Surveys and Questionnaires , Analysis of Variance , Confidence Intervals , Cross-Sectional Studies , Female , Humans , Male , Mexico , Primary Health Care/statistics & numerical data , Random Allocation , Reproducibility of ResultsABSTRACT
OBJECTIVE: Evaluation of social determinants which are characteristics of balanced (functional) and extreme (dysfunctional) families regarding cohesion and flexibility dimensions. DESIGN: Observational, randomised survey. SETTING: Dr. José Castro Villagrana Primary Care Centre, Health Ministry, Mexico. PATIENTS: 270 randomised families of Tlalpan, Mexico City, who answered FACES III. MEASUREMENTS AND RESULTS: Using discriminant analysis statistical technique, 15 independent variables (social, demographic and familiar determinants) and two dependent variables (balanced and extreme types of families) were analysed and related with cohesion and adaptability dimensions. CONCLUSION: There is accordance of these results with others which were obtained using different family assessment instruments like Family Apgar. However using FACES III and Circumplex Model the analysis of variable's interaction were possible.
Subject(s)
Family , Adolescent , Adult , Child , Child, Preschool , Discriminant Analysis , Evaluation Studies as Topic , Family Characteristics , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Socioeconomic Factors , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To identify the needs of medical care and to determine priorities in the delivery of health services by the factorial analysis of the health indicators obtained from study of the demographic, economic and family features of those registered at a Primary Care Centre. DESIGN: Descriptive and crossover. SETTING: Tlalpan area, Federal District, Mexico, divided into geo-statistical zones. Patients and other participants. A randomised sample of 590 dwellings, with proportional coverage, based on 173,000 inhabitants and 17,895 ordinary dwellings. INTERVENTION: Survey conducted in the home (April-July, 1993). MEASUREMENTS AND MAIN RESULTS: 16 health markers were classified into four categories, demographic, social, health-damaging and family. Nine markers with a reading on the Pearson's correlation index over 0.40 were chosen. Factorial analysis determined two main factors. CONCLUSIONS: The identification of the main risk factors by means of factorial analysis helped in diagnosing community health. A project needs to be worked out to define a methodology for studying medically dysfunctional families and to introduce a prevention and early diagnosis programme for Diabetes Mellitus.
Subject(s)
Health Services Needs and Demand , Health Status , Cross-Over Studies , Factor Analysis, Statistical , Humans , Mexico , Primary Health CareABSTRACT
This is a brief exposition of some aspects that we consider important to know about in terms of general health characteristics of Mexico, their relationship to the health system and the critical situation of family medicine in Mexico. In addition, we consider that the bases for solution of this crisis are both administrative and educational.
