ABSTRACT
Introducción. La evaluación es un componente esencial del proceso enseñanza-aprendizaje que motiva y dirige al alumno hacia sus objetivos y permite a los docentes conocer si los educandos poseen la destreza y el grado de conocimientos necesarios para una práctica profesional competente. En medicina no existe el método ideal de evaluación, por eso se recomienda el uso de diversos instrumentos como el Examen Clínico Objetivo Estructurado (ECOE) que ha mostrado su utilidad para evaluar las destrezas clínicas. El objetivo de este trabajo fue describir la experiencia de docentes y alumnos en la elaboración y la aplicación de un ECOE en un hospital pediátrico. Métodos. Se preparó un ECOE de 20 estaciones que se aplicó en un estudio piloto a 20 alumnos (2 residentes de primer año, 7 de segundo y 11 de tercero). Para cada estación se definieron los criterios de evaluación y el punto de corte. Con los datos obtenidos se calcularon los promedios por estación y por año de residencia. Resultados. El ECOE se llevó a cabo durante 2 horas con 20 minutos. Las estaciones aprobadas por los alumnos, de manera global, fueron doce. El valor promedio de las 20 estaciones fue 6.53, con una desviación estándar (DE) de 0.62 [R1 = 6.13 (DE 0.43), R2 = 6.26 (DE 0.60) y R3 = 6.76 (DE 0.59)]. Conclusiones. El ECOE es un método válido y confiable que permite evaluar la competencia clínica de manera integral. La experiencia de su uso en programas de posgrado ha sido limitada; sin embargo, el presente estudio muestra que es una herramienta factible que puede resultar de gran valor tanto para los pediatras en formación como para sus profesores.
Background. Assessment is an essential component of the teaching-learning process that stimulates and leads learners towards their goals and allows teachers to ascertain whether the students have acquired the necessary knowledge and clinical skills to be professionally competent. In medicine, the ideal assessment method does not exist; therefore, the use of several assessment instruments is advised; among them, the Objective Structured Clinical Examination (OSCE) has proven its advantage assessing clinical skills. The aim of this work is to describe the experience of teachers and learners developing and applying an OSCE in a children's hospital. Methods. Twenty OSCE stations were designed and applied in a pilot study. The assessment criteria for each station were defined. Individual marks were recorded and means for each station and year of residency were calculated (two first-year residents, seven second-year residents and 11 third-year residents). Results. The OSCE lasted 2 h and 20 min. Overall, 12 stations were accredited. The overall mean was 6.53, standard deviation (SD) 0.62; the mean for first-year residents was 6.13 (SD 0.43), for second-year residents 6.26 (SD 0.60) and 6.76 for third-year residents (SD 0.59). Conclusions. The OSCE isa valid and reliable method that permits an integral evaluation of clinical competence. The experience with this instrument has been limited to assessing postgraduate students. This study, however, shows that it is a useful tool that may be valuable for resident pediatricians and their professors.
ABSTRACT
Introducción. La enfermedad granulomatosa crónica (EGC) es una inmunodeficiencia que se caracteriza por un defecto en la fagocitosis, por lo que generalmente sus manifestaciones iniciales son las de las infecciones con las que cursa. Se trata de una enfermedad poco frecuente cuyo diagnóstico siempre es un reto. Caso clínico. Se presenta el caso de un escolar previamente sano, quien acudió por presentar fiebre de origen oscuro. Se estableció el diagnóstico de neumonía persistente que requirió decorticación. En el cultivo de la biopsia pulmonar creció Burkholderia cepacia. Debido a que esta bacteria se ha relacionado con pacientes inmunodeficientes, se realizaron pruebas para descartar inmunodeficiencia, con lo que se estableció el diagnóstico de EGC. Conclusión. Se propone que el aislamiento de B. cepacia debe obligar al clínico a descartar inmunodeficiencia.
Introduction. Chronic granulomatous disease (CGD) is an immunodeficiency characterized by a defect of phagocitosis, so initial manifestations are those from the secondary infection. It is an uncommon disease, whose diagnosis is always a challenge. Case report. The case of a previously healthy boy who came to the hospital with fever of unknowns origin is presented. He was diagnosed with persistent pneumonia that required decortication. Burkholderia cepacia grew from the lung biopsy culture. Because this bacteria has been related to immunodeficient patients, screening for immunodeficiency were performed and the diagnosis of CGD was established. Conclusion. Immunodeficiency should be ruled out in patients with infections due to B. cepacia.
ABSTRACT
OBJECTIVE: The aim of the study was to analyze mothers home practices among children with acute diarrhea. METHODS: A cross sectional study was carried out in a group of 260 mothers of children with diarrhea. Mothers were requested to answer the "verbal biopsy" questionnaire to assess their practices concerning effective diarrhea management at home according to the World Health Organization and corresponding to the Norma Oficial Mexicana recommendations. Descriptive statistics and Chi square for differences were used. RESULTS: Two groups of mothers' were identified: those who had consulted a physician before attending the hospital (n = 191), and those who came to the hospital as their first choice (n = 69). The first group used antibiotics, antiemetics, breast-feeding and Oral Hydration Therapy more frequently than the second group (p < 0.05). CONCLUSIONS: The "verbal biopsy " instrument was useful to assess home management of children with diarrhea. This questionnaire was also useful to detect medical malpractice (unjustified prescription of antibiotics and antiemetics) as well as to identify best practices (continued breast feeding and oral hydration).