ABSTRACT
INTRODUCTION: Rheumatologists are the primary healthcare professionals responsible for patients with rheumatic diseases and should acquire medical ethical competencies, such as the informed consent process (ICP). The objective clinical structured examination is a valuable tool for assessing clinical competencies. We report the performance of 90 rheumatologist trainees participating in a station designed to evaluate the ICP during the 2018 and 2019 national accreditations. METHODS: The station was validated and represented a medical encounter in which the rheumatologist informed a patient with systemic lupus erythematosus with clinically active nephritis about renal biopsy. A trained patient-actor and an evaluator were instructed to assess ICP skills (with a focus on kidney biopsy benefits, how the biopsy is done and potential complications) in obtaining formal informed consent, delivering bad news and overall communication with patients. The evaluator used a tailored checklist and form. RESULTS: Candidate performance varied with ICP content and was superior for potential benefit information (achieved by 98.9% of the candidates) but significantly reduced for potential complications (37.8%) and biopsy description (42.2%). Only 17.8% of the candidates mentioned the legal perspective of ICP. Death (as a potential complication) was omitted by the majority of the candidates (93.3%); after the patient-actor challenged candidates, only 57.1% of them gave a clear and positive answer. Evaluators frequently rated candidate communications skills as superior (≥80%), but ≥1 negative aspect was identified in 69% of the candidates. CONCLUSIONS: Ethical competencies are mandatory for professional rheumatologists. It seems necessary to include an ethics competency framework in the curriculum throughout the rheumatology residency.
Subject(s)
Accreditation , Clinical Competence , Ethics, Medical , Rheumatology/ethics , Accreditation/methods , Accreditation/standards , Biopsy/ethics , Clinical Competence/standards , Humans , Informed Consent/ethics , Informed Consent/standards , Kidney/pathology , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/pathology , Mexico , Physician-Patient Relations/ethics , Rheumatology/standardsABSTRACT
La fluorosis dental es un problema de salud pública que afecta una amplia zona de México, principalmente en las regiones centro y norte. El objetivo del presente estudio fue evaluar la efectividad clínica del tratamiento a base de peróxido de carbamida en casos de fluorosis dental. Un ensayo clínico fue llevado a cabo en 38 pacientes quienes fueron seleccionados a través de un método no probabilístico consecutivo; para el examen de fluorosis dental se utilizó el índice de superficie dental, las pruebas estadísticas empleadas fueron U de Mann-whitney y Kappa ponderada Los resultados muestran diferencias estadísticamente significativas entre antes y después del tratamiento (p < 0.05). El tratamiento de fluorosis dental con peróxido de carbamida ofrece ventajas como bajo costo, fácil aplicación y desgaste mínimo de esmalte