[La analítica del aprendizaje en educación médica: ¿punto de inflexión?]

La analítica del aprendizaje es una disciplina novedosa que tiene un enorme potencial para mejorar la calidad de la educación médica y la evaluación del aprendizaje. Se define como: "la medición, recopilación, análisis y reporte de datos sobre los alumnos y sus contextos, con el propósito de entender y optimizar el aprendizaje y los entornos en que ocurre". En las últimas décadas, la aparición de grandes volúmenes de datos (big data), acompañada de una rápida evolución en la minería de datos educativos, la aparición de tecnologías sofisticadas para analizar y visualizar datos de cualquier tipo, así como la disponibilidad de dispositivos móviles con conectividad permanente, mayor velocidad de procesamiento y capacidad de recuperación de información, han generado un contexto que favorece el uso de la analítica del aprendizaje en la medicina clínica y la educación médica. En este artículo se describe la historia reciente del concepto de analítica del aprendizaje, sus ventajas y desventajas en educación superior, así como sus aplicaciones en la enseñanza de las ciencias de la salud y la evaluación educativa. Es necesario que la comunidad de educadores médicos conozca la analítica del aprendizaje, para ser capaces de integrarla en su contexto eficaz y oportunamente.

Learning analytics is an innovative discipline that has an enormous potential to improve the quality of medical education and learning assessment. It is defined as: "the measurement, collection, analysis and reporting of data about learners and their contexts, for purposes of understanding and optimizing learning and the environments in which it occurs". In recent decades, the appearance of large volumes of data (big data), accompanied by a quick evolution of educational data mining techniques, the emergence of sophisticated technologies to analyze and visualize any type of data, as well as the availability of permanently-connected mobile electronic devices, higher processing speed and capacity of information retrieval, have generated a context that favors the use of learning analytics in clinical medicine and medical education. In this paper, the recent history of the concept of learning analytics is described, as well as its advantages and disadvantages in higher education, and its applications in the teaching of health sciences and educational assessment. It is necessary for the community of medical educators to be acquainted with learning analytics, in order to be able to integrate it to our context in an efficacious and timely manner.

La analítica del aprendizaje en educación médica: ¿punto de inflexión? / Learning analytics in medical education: turning point?

Resumen La analítica del aprendizaje es una disciplina novedosa que tiene un enorme potencial para mejorar la calidad de la educación médica y la evaluación del aprendizaje. Se define como: “la medición, recopilación, análisis y reporte de datos sobre los alumnos y sus contextos, con el propósito de entender y optimizar el aprendizaje y los entornos en que ocurre”. En las últimas décadas, la aparición de grandes volúmenes de datos (big data), acompañada de una rápida evolución en la minería de datos educativos, la aparición de tecnologías sofisticadas para analizar y visualizar datos de cualquier tipo, así como la disponibilidad de dispositivos móviles con conectividad permanente, mayor velocidad de procesamiento y capacidad de recuperación de información, han generado un contexto que favorece el uso de la analítica del aprendizaje en la medicina clínica y la educación médica. En este artículo se describe la historia reciente del concepto de analítica del aprendizaje, sus ventajas y desventajas en educación superior, así como sus aplicaciones en la enseñanza de las ciencias de la salud y la evaluación educativa. Es necesario que la comunidad de educadores médicos conozca la analítica del aprendizaje, para ser capaces de integrarla en su contexto eficaz y oportunamente.

Abstract Learning analytics is an innovative discipline that has an enormous potential to improve the quality of medical education and learning assessment. It is defined as: “the measurement, collection, analysis and reporting of data about learners and their contexts, for purposes of understanding and optimizing learning and the environments in which it occurs”. In recent decades, the appearance of large volumes of data (big data), accompanied by a quick evolution of educational data mining techniques, the emergence of sophisticated technologies to analyze and visualize any type of data, as well as the availability of permanently-connected mobile electronic devices, higher processing speed and capacity of information retrieval, have generated a context that favors the use of learning analytics in clinical medicine and medical education. In this paper, the recent history of the concept of learning analytics is described, as well as its advantages and disadvantages in higher education, and its applications in the teaching of health sciences and educational assessment. It is necessary for the community of medical educators to be acquainted with learning analytics, in order to be able to integrate it to our context in an efficacious and timely manner.

Focused Critical Care Echocardiography: Development and Evaluation of an Image Acquisition Assessment Tool.

OBJECTIVES: Little attention has been placed on assessment tools to evaluate image acquisition quality for focused critical care echocardiography. We designed a novel assessment tool to objectively evaluate the image acquisition skills of critical care trainees learning focused critical care echocardiography and examined the tool for evidence of validity. DESIGN: Prospective observational study. SETTING: Medical-surgical ICUs at a tertiary care teaching hospital. SUBJECTS: Trainees in our critical care medicine fellowship program. INTERVENTIONS: Six trainees completed a focused critical care echocardiography training curriculum followed by performing 20 transthoracic echocardiograms on patients receiving invasive mechanical ventilation. At three assessment intervals (the 1st and 2nd examinations, 10th and 11th examinations, and 19th and 20th examinations), echocardiograms performed by trainees were compared with those of critical care physicians certified in echocardiography and scored according to the focused critical care echocardiography assessment tool. The primary outcome was an efficiency score (overall assessment tool score divided by examination time). Differences in mean efficiency scores between echocardiographers of differing skill levels and changes in trainees' mean efficiency scores with increasing focused critical care echocardiography experience were compared by using t tests. MEASUREMENTS AND MAIN RESULTS: On the initial assessment, mean efficiency scores (SD) for trainees and experienced physicians were 1.55 (0.95) versus 2.78 (1.38), respectively (p = 0.02), and for the second and third assessments, the corresponding efficiency ratings for trainees and experienced physicians were 2.48 (0.97) versus 4.55 (1.32) (p < 0.01) and 2.61 (1.37) versus 4.17 (2.12) (p = 0.04), respectively. CONCLUSIONS: Trainees' efficiency in focused critical care echocardiography image acquisition improved quickly in the first 10 studies, yet, it could not match with the performance of experienced physicians after 20 focused critical care echocardiography studies. The focused critical care echocardiography assessment tool demonstrated evidence of validity and could discern changes in trainees' image acquisition performance with increasing experience.

Improving prevention, early recognition and management of acute kidney injury after major surgery: results of a planning meeting with multidisciplinary stakeholders.

PURPOSE OF REVIEW: Acute kidney injury (AKI) is common after major surgery, and is associated with morbidity, mortality, increased length of hospital stay, and high health care costs. Although recent guidelines for AKI provide recommendations for identification of patients at risk, monitoring, diagnosis, and management of AKI, there is lack of understanding to guide successful implementation of these recommendations into clinical practice. SOURCES OF INFORMATION: We held a planning meeting with multidisciplinary stakeholders to identify barriers, facilitators, and strategies to implement recommendations for prevention, early identification, and management of AKI after major surgery. Barriers and facilitators to knowledge use for peri-operative AKI prevention and care were discussed. FINDINGS: Stakeholders identified barriers in knowledge (how to identify high-risk patients, what criteria to use for diagnosis of AKI), attitudes (self-efficacy in preventive care and management of AKI), and behaviors (common use of diuretics, non-steroidal anti-inflammatory drugs, withholding of intravenous fluids, and competing time demands in peri-operative care). Educational, informatics, and organizational interventions were identified by stakeholders as potentially useful elements for future interventions for peri-operative AKI. LIMITATION: Meeting participants were from a single centre. IMPLICATIONS: The information and recommendations obtained from this stakeholder's meeting will be useful to design interventions to improve prevention and early care for AKI after major surgery.

OBJECTIF DE L'ÉTUDE: L'insuffisance rénale aiguë (IRA) est fréquente à la suite d'une chirurgie importante et elle est associée à une morbidité, à une mortalité, à une hospitalisation prolongée et à des coûts élevés liés aux soins de santé. Bien que les lignes directrices récentes concernant l'IRA fournissent des recommandations pour déterminer les patients à risque, de même que pour contrôler, diagnostiquer et prendre en charge l'IRA, la compréhension fait défaut pour mener leur mise en place réussie dans la pratique clinique. SOURCES D'INFORMATION: Nous avons tenu une réunion de planification avec des acteurs pluridisciplinaires afin de cibler les obstacles, les appuis et les stratégies de mise en œuvre des recommandations pour la prévention, l'identification précoce et la prise en charge de l'IRA suite à une chirurgie importante. On a abordé les obstacles et les appuis à l'utilisation des connaissances dans la prévention périopératoire de l'IRA et les soins qui s'y rattachent. RÉSULTATS: Les acteurs ont déterminé les obstacles à la connaissance (comment identifier les patients à risque élevé, le choix de critères diagnostiques pour l'IRA), les attitudes (l'auto-efficacité dans les soins préventifs et la prise en charge de l'IRA), et les comportements (l'usage courant de diurétiques, d'anti-inflammatoires non stéroïdiens, la non-administration de solutés intraveineux, et les contraintes de temps dans les soins périopératoires). Les acteurs ont défini les interventions éducatives, informatiques et organisationnelles comme des éléments potentiellement utiles dans les interventions futures en soins périopératoires pour l'IRA. LIMITES DE L'ÉTUDE: Les participants à la réunion provenaient d'un seul et même centre. IMPACTS: Les informations et recommandations obtenues au cours de la réunion des acteurs seront utiles pour l'élaboration des interventions afin d'améliorer la prévention et les soins précoces relatifs à l'IRA suite à une chirurgie majeure.

Treatment of medically refractory hypercalcemic crisis.

INTRODUCTION: A 58-year-old patient was admitted to the intensive care unit for severe hypercalcemia (total Ca 5.30 mmol/L) complicated with status epilepticus, hypertensive crisis and acute renal failure. Renal replacement therapy was explored as a method for treating medically refractory hypercalcemia. METHODS: Because of hemodynamic instability during intermittent hemodialysis (IHD), continuous venovenous hemofiltration (CVVH) with high rates of calcium-free replacement fluids was instituted. Epoprostenol rather than citrate was used as anticoagulation to ensure adequate extracorporeal anticoagulation. RESULTS: CVVH was continued for 40 hours total during which ionized calcium decreased from 2.19 to 1.07 mmol/L. The etiology of the hypercalcemia was from autoinfarction of a parathyroid adenoma. CONCLUSIONS: This is the first case of hypercalcemia treated with CVVH with epoprostenol anticoagulation. This method avoids some of the pitfalls of using intermittent hemodialysis. It is also a rare example of hypercalcemia induced posterior reversible encephalopathy syndrome (PRES).