Teaching Medical Ethics in Graduate and Undergraduate Medical Education: A Systematic Review of Effectiveness.

OBJECTIVE: One objective was to identify and review studies on teaching medical ethics to psychiatry residents. In order to gain insights from other disciplines that have published research in this area, a second objective was to identify and review studies on teaching medical ethics to residents across all other specialties of training and on teaching medical students. METHODS: PubMed, EMBASE, and PsycINFO were searched for controlled trials on teaching medical ethics with quantitative outcomes. Search terms included ethics, bioethics, medical ethics, medical students, residents/registrars, teaching, education, outcomes, and controlled trials. RESULTS: Nine studies were found that met inclusion criteria, including five randomized controlled trails and four controlled non-randomized trials. Subjects included medical students (5 studies), surgical residents (2 studies), internal medicine house officers (1 study), and family medicine preceptors and their medical students (1 study). Teaching methods, course content, and outcome measures varied considerably across studies. Common methodological issues included a lack of concealment of allocation, a lack of blinding, and generally low numbers of subjects as learners. One randomized controlled trial which taught surgical residents using a standardized patient was judged to be especially methodologically rigorous. CONCLUSIONS: None of the trials incorporated psychiatry residents. Ethics educators should undertake additional rigorously controlled trials in order to secure a strong evidence base for the design of medical ethics curricula. Psychiatry ethics educators can also benefit from the findings of trials in other disciplines and in undergraduate medical education.

Fijación mínima percutánea en fracturas de platillos tibiales tipo V y VI de Shatzker: trabajo preliminar en 11 pacientes / Minimal percutaneous fixation for class V and VI of Schatzker fractures of the tibial plateau: preliminary report of 11 patients

Se trataron 11 pacientes con fracturas bicondíleas de platillos tibiales, 13 en total, con seguimiento de un año dos meses promedio. Se utilizó la clasificación de Schatzker, siete fracturas tipo V y seis tipo VI; tres mujeres, ocho hombres, provocadas por mecanismos de alta energía. La edad promedio fue de, 38.6 años. Dos fracturas fueron expuestas: una grado I tratada con aseo quirúrgico al llegar, colocación de tornillos percutáneos en un segundo tiempo quirúrgico y bota muslopodálica; una segunda fractura expuesta grado IIIA, tratada con aseo quirúrgico, colocación de tornillos percutáneos en un acto quirúrgico y bota muslopodálica; nueve fracturas cerradas tratadas con tornillos percutáneos y bota muslopodálica. Se logró reducción anatómica, consolidación ósea (ocho semanas), recuperación de funcionalidad de rodilla en tres meses con rehabilitación, disminución del tiempo quirúrgico, riesgo de infección y costos hospital-paciente. Se obtuvo 82 por ciento de buenos resultados logrando una flexión-extensión aceptable. Hubo dos complicaciones: un paciente con infección postquirúrgica que desarrolló artritis séptica, tratada de forma inmediata, terminando con excelente resultado; el segundo desarrolló una osteomielitis, siendo paciente psiquiátrica, terminando en una anquilosis fémoro-tibial. Hubo una paciente con disminución de flexo extensión por no rehabilitar. Con este estudio demostramos que es muy buena opción de tratamiento.