Evaluación del formato remoto en tiempos de pandemia / Evaluation of a remote format in times of pandemic

En el contexto de la pandemia de COVID 19 durante el año 2020 y hasta la fecha se diseñó un formato de evaluación para nuestros alumnos de pre y posgrado bajo el alero de los exámenes clínicos objetivos estructurados (ECOE) en un formato remoto. Se revisó la literatura al respecto y se diseñó un instrumento que diera cuenta en forma oportuna y estandarizada del desempeño de nuestros alumnos y residentes. Estas experiencias están siendo evaluadas en estudios con metodología mixta. Sin embargo, decidimos compartir esta experiencia, por su impacto en el desarrollo docente de las ciencias de la salud.

In the context of the COVID-19 pandemic during 2020 and to date, an evaluation format has been designed for our undergraduate and graduate students under the design of the objective structured clinical examinations (OSCE) in a remote format. The literature was reviewed, and an instrument was designed to account for the performance of our students and residents in a timely and standardized manner. These experiences are being evaluated in studies with mixed methodology. However, we wanted to convey this experience due to its impact on the educational development of health sciences.

Contacto clínico precoz: experiencia de diseño e implementación de un curso de servicio comunitario en medicina / Early clinical contact: Experience in the design and implementation of a community service course in medicine

INTRODUCCIÓN: En el año 2015 la Escuela de Medicina de la Pontificia Universidad Católica de Chile inició un proceso de reforma curricular que favorece la inmersión temprana de los estudiantes al oficio de la medicina y espera fortalecer el aprendizaje de competencias transversales. OBJETIVOS: Describir la experiencia de diseñar, implementar y evaluar un curso de Medicina Comunitaria en el primer año de la carrera de Medicina de la Pontificia Universidad Católica de Chile destinado a promover el contacto precoz de los estudiantes y el desarrollo de competencias transversales. MÉTODOS: Descripción del diseño e implementación del curso siguiendo el modelo de diseño curricular de Kern et al. RESULTADOS: El análisis por etapas de Kern mostró una falta de contacto precoz de los estudiantes con la clínica, falta de conocimiento en áreas de promoción y prevención en salud y una falta de formación curricular explícita en algunas áreas de profesionalismo. El curso propuso el desarrollo de competencias transversales a través de la realización de actividades preventivas con pacientes de la Atención Primaria de Salud. Se diseñó un curso de 5 semanas de duración que utiliza la metodología de aprendizaje y servicio. El curso lleva 3 años de implementación (376 estudiantes), un logro de cumplimiento de objetivos de 95,6% y las competencias transversales de responsabilidad social y trabajo en equipo son mencionadas como desarrolladas en el curso por la mayoría de los estudiantes. CONCLUSIONES: La exposición precoz de los estudiantes de medicina a la clínica en Atención Primaria de Salud asociada a una metodología de aprendizaje y servicio proporciona un espacio para el logro de los objetivos del curso y el desarrollo de competencias transversales

INTRODUCTION: In 2015, the UC School of Medicine initiated a process of curriculum reform. This showed, among other aspects, the need to expose students to the medical profession early, and to strengthen the learning of transversal competences. OBJECTIVES: To describe the experience of designing, implementing, and assessing a Community Medicine course in the first year of the Medical degree of the Pontificia Universidad Católica de Chile, in order to promote early contact and transversal competences. METHODS: A descriptive study was conducted with a quantitative and qualitative analysis following the 6-steps approach of Kern et al, describing the steps taken for each stage in the curriculum design of the Community Medicine module. RESULTS: They are described based on the Kern stages. A lack of early contact of students was identified, including a lack of knowledge in areas of promotion and prevention in health, as well as lack of explicit curriculum training in some areas of professionalism. The course proposes the development of transversal competences through preventive activities, all this inserted into a Primary Health Care system. A 5-week course with Service and Learning methodology was designed, through which students developed skills through community service. The course lasted 3 years (376 students), a goal achievement of 95.6% and the transversal competences of social responsibility and teamwork are mentioned, as developed in the course, by the majority of students. CONCLUSIONS: Early exposure of medical students to Primary Health Care, with a service learning methodology, provides a space for the acquisition of transversal competences

Brief interventions to promote behavioral change in primary care settings, a review of their effectiveness for smoking, alcohol and physical inactivity. / Intervenciones breves para promover cambios conductuales en el ámbito de la atención primaria: revisión de su efectividad en consumo de tabaco, alcohol y sedentarismo.

The brief intervention is a therapeutic strategy suggested to address behavioral changes associated with risk factors for chronic non-communicable diseases and there is ample evidence of its effectiveness. However, this evidence is sustained by various definitions of “brief intervention”, a fact that makes the clinical application of this strategy difficult. This literature review article aimed to conduct a search for systematic reviews in the Epistemonikos database in order to identify common factors in the definition of “brief intervention” and summarize some brief intervention strategies frequently used in primary health care. It also seeks to describe their effectiveness, for three risk factors: tobacco, alcohol and physical activity, within this clinical context.

La intervención breve en salud es una estrategia terapéutica, sugerida para abordar cambios conductuales asociados a factores de riesgo de enfermedades crónicas no transmisibles. Existe amplia evidencia sobre su efectividad. Sin embargo, esta evidencia se sustenta en distintas definiciones de intervención breve, lo que dificulta su aplicación clínica. Este artículo de revisión de literatura, se propuso realizar una búsqueda de revisiones sistemáticas en la base de datos Epistemonikos con el fin de identificar factores comunes en su definición y resumir algunas estrategias de intervención breve usadas con frecuencia en la atención primaria de salud. Asimismo, se busca describir su efectividad en este contexto clínico, para tres factores de riesgo: tabaco, alcohol y actividad física.

Communication skills training for healthcare professionals working with people who have cancer.

BACKGROUND: This is an updated version of a review that was originally published in the Cochrane Database of Systematic Reviews in 2004, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses have been proposed and are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES: To assess whether CST is effective in improving the communication skills of HCPs involved in cancer care, and in improving patient health status and satisfaction. SEARCH METHODS: We searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2012, MEDLINE, EMBASE, PsycInfo and CINAHL to February 2012. The original search was conducted in November 2001. In addition, we handsearched the reference lists of relevant articles and relevant conference proceedings for additional studies. SELECTION CRITERIA: The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In this updated version, we limited our criteria to RCTs evaluating 'CST' compared with 'no CST' or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real and/or simulated patients with cancer, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects model and, for continuous data, we used standardised mean differences (SMDs). MAIN RESULTS: We included 15 RCTs (42 records), conducted mainly in outpatient settings. Eleven studies compared CST with no CST intervention, three studies compared the effect of a follow-up CST intervention after initial CST training, and one study compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists (six studies), residents (one study) other doctors (one study), nurses (six studies) and a mixed team of HCPs (one study). Overall, 1147 HCPs participated (536 doctors, 522 nurses and 80 mixed HCPs).Ten studies contributed data to the meta-analyses. HCPs in the CST group were statistically significantly more likely to use open questions in the post-intervention interviews than the control group (five studies, 679 participant interviews; P = 0.04, I² = 65%) and more likely to show empathy towards patients (six studies, 727 participant interviews; P = 0.004, I² = 0%); we considered this evidence to be of moderate and high quality, respectively. Doctors and nurses did not perform statistically significantly differently for any HCP outcomes.There were no statistically significant differences in the other HCP communication skills except for the subgroup of participant interviews with simulated patients, where the intervention group was significantly less likely to present 'facts only' compared with the control group (four studies, 344 participant interviews; P = 0.01, I² = 70%).There were no significant differences between the groups with regard to outcomes assessing HCP 'burnout', patient satisfaction or patient perception of the HCPs communication skills. Patients in the control group experienced a greater reduction in mean anxiety scores in a meta-analyses of two studies (169 participant interviews; P = 0.02; I² = 8%); we considered this evidence to be of a very low quality. AUTHORS' CONCLUSIONS: Various CST courses appear to be effective in improving some types of HCP communication skills related to information gathering and supportive skills. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', patients' mental or physical health, and patient satisfaction.

Entrevista motivacional: ¿cuál es su efectividad en problemas prevalentes de la atención primaria? / Motivational interviews: what are their effectiveness in prevalent primary care problems?

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