When should we perform a repeat training on adrenaline auto-injector use for physician trainees?

BACKGROUND: Studies demonstrate that both doctors and patients may use adrenaline auto-injector improperly and the usage skills are improved by training. In this study, we aimed to determine the appropriate frequency of training to maintain skills for adrenaline auto-injector use. METHODS: We invited all interns of 2011-2012 training period. At baseline, all participants were given theoretical and practical training on adrenaline auto-injector use. The participants were randomly assigned into two groups. We asked those in group 1 to demonstrate the use of adrenaline auto-injector trainer in the third month and those in group 2 in the sixth month. RESULTS: One hundred and sixty interns were enrolled. Compared with the beginning score, demonstration of skills at all the steps and total scores did not change for the group tested in the third month (p = 0.265 and p = 0.888, respectively). However; for the group examined in the sixth month; the demonstration of skills for proper use of the auto-injector at all steps and the mean time to administer adrenaline decreased (p = 0.018 and p < 0.001, respectively). Besides, the group which was tested in the third month was better than the group which was tested in the sixth month in terms of demonstrating all steps (p = 0.014), the total score (p = 0.019), mean time of change to administer adrenaline (p < 0.001) and presumptive self-injection into thumb (p = 0.029). CONCLUSIONS: Auto-injector usage skills of physician trainees decrease after the sixth month and are better in those who had skill reinforcement at 3 months, suggesting continued education and skill reinforcement may be useful

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Training currently practicing members of the ethics consultation service: one institution's experience.

Most hospitals and nursing homes have individuals who engage in ethics consultation, and most do so with very little, if any, training. The goal of this article is not to advance the scholarly literature on training clinical ethics consultants, but instead to provide a road map for individuals doing ethics consultation who would like more training. In this way, I hope to advance the field in some small way, by educating, empowering, and encouraging small- to medium-sized hospitals to train the members of their ethics committee who engage in ethics consultation.

La metasíntesis reflexiva: un método de autoaprendizaje semipresencial para construir esquemas mentales y cosmovisiones tecnocientíficas personales / Reflective Meta-synthesis: A method of self - learning to create mental ideas and techno scientific, personal worldview

En el marco del megaproyecto territorial de desarrollo e innovación tecnológica se han realizado importantes aportes andragógicos con el fin de darle salida a la tarea referente a la educación y promoción ortopreventiva de salud. En este sentido se han instrumentado varios métodos para el aprendizaje semipresencial donde se destacan: el árbol histórico-tendencial problémico, la escala de teorías opuestas, la mesa servida, el proyecto tecnológico perspectivo y el radiante conceptual problémico; todos publicados en diferentes revistas electrónicas nacionales e internacionales. Estas innovaciones en el campo de la didáctica educativa se realizan con el fin de poner en manos de los actores principales de los programas tecno-científicos GEMDITPS herramientas eficaces capaces de asegurar una verdadera transformación e impactar y asegurar los resultados y las salidas de dicho megaproyecto para la infancia(AU)

Taking into account, the territorial megaproject development and technological innovation have made significant and andragogical contributions to way out the work related to education and orthopreventive health promotion. In this way, it has implemented several methods for blended learning which include: the historical trend tree problem, the scale of opposing theories, the table set, the technological conceptual perspective project and the heating problem, all are published in different national and international electronic journals. These innovations in the educational field are made to put in the hands of the main actors of the techno-scientific programs GEMDITPS effective tools that can ensure real transformation and impact about results and outputs of the mega-project to childhood

Iniciativa interdisciplinar y de enfoque transversal en la enseñanza de la química analítica / Interdisciplinary initiative and transversal approach in the teaching of analytical chemistry

El proceso de aprendizaje puede favorecerse mediante el uso de metodologías docentes que fomentenel tratamiento transversal de los temas, resultando más adecuado para el estudiante si es abordadodesde diferentes vertientes. Este tratamiento implica el trabajo conjunto de profesores con distintasformaciones que muestren la solución del problema de forma interdisciplinar. La disciplina AnálisisQuímico está en relación continua con otras áreas de conocimiento lo que la hace idónea para laimplementación de experiencias docentes mediante las cuales los alumnos experimenten la parteaplicada de la asignatura con el fin de favorecer la comprensión desde un punto de vista global.Este trabajo se ha desarrollado en un contexto real, poniendo en contacto a los alumnos con unproyecto de investigación con el fin de conseguir su implicación en la comprensión de la asignaturapermitiendo una visión real del planteamiento y resolución de problemas analíticos y favoreciendo laadquisición de competencias específicas y trasversales. Se ha contado con la participación dediferentes profesores y se ha desarrollado en varias etapas: Impartición de charlas, establecimiento delproblema analítico, colocación de material en plataforma virtual, análisis de muestras reales,información de resultados, encuesta opinión/satisfacción, evaluación y calificación.La utilización de esta herramienta de aprendizaje ha permitido fomentar en los alumnos la capacidadde aplicar los conocimientos teóricos adquiridos a la práctica, el trabajo en grupo, la identificación yresolución de problemas, la interdisciplinariedad y la colaboración. Y a los profesores evaluar losresultados del aprendizaje expresados en términos de competencias(AU)

The learning process can be favoured by using teaching methodologies that encourage the transversaltreatment of the issues, resulting more adequate for the student if it is approached from differentaspects. This treatment implies the joined work of professors with different trainings showing thesolution of the problem from an interdisciplinary way. Analytical Chemistry is continuously related toother knowing areas which make it suitable for the implementation of teaching experiences thatfavours the students to know the applied part of the subject with the aim of facilitating thecomprehension from a global point of view.This work has been developed in a real context, putting the students in contact with a research projectwith the aim of getting their implication in the comprehension of the subject and favouring theacquisition of specific and transversal competencies. The initiative has relied on the participation ofdifferent professors and has been developed in several stages: oral teaching, setting the analyticalproblem, putting material in the virtual platform, analysis of real samples, giving information of theresults, evaluation and grading.The use of this learning tool has allowed to encourage the students the ability to apply the theoreticalknowing to the practice, the making of decisions, the identification and solving of problems, theinterdisciplinary and the collaboration. And to the professors to evaluate the results of the learningprocess in terms of competencies(AU)

Metodología CUSUM en la curva de aprendizaje de la punción epidural obstétrica en un hospital universitario / Monitoring skill acquisition in obstetric epidural puncture at a university hospital using the cumulative sum method

INTRODUCCIÓN: El aprendizaje de las habilidades enanestesia muestra una amplia variabilidad interindividual.Nuestro objetivo fue establecer y probar unaherramienta individualizada de monitorización de lacapacitación técnica (CUSUM), que permitiera establecerde forma objetiva si un individuo alcanzaba un nivelmínimo y cuándo ocurría esto.MATERIAL Y MÉTODOS: Participaron 9 médicos residentesde Anestesiología y Reanimación en su tercer añode residencia, para que recogiesen sus 100 primeros procedimientosde analgesia epidural obstétrica, anónimamenteen una base de datos. Estos datos, fueron analizadoscon el método CUSUM. Se tomó como una tasa deéxito aceptable 80% al primer intento y una necesidadde ayuda del 20%.RESULTADOS: Se analizaron 765 bloqueos, 84,7±22,8por residente, rango 47-100. Tres de los residentes nocompletaron los 100 bloqueos. Siete de ellos alcanzaronla destreza con 23 bloqueos y 2 residentes no alcanzaronla destreza. En tres residentes, la supervisión fue necesariaen más del 20% de casos al final del periodo de estudio.La recogida de datos, parece variable entre los residentes,infra o sobreestimando los fallos y/o la necesidadde ayuda. La punción dural accidental se dio en 6 casos(0,78%) y la hemática en 40 (5,2%).DISCUSIÓN: Aunque la tasa de éxito es alcanzada rápidamentepor algunos residentes de tercer año, creemosque el elevado grado de supervision es útil para controlarel progreso de la curva de aprendizaje en casos individualesque precisen más control(AU)

BACKGROUND AND OBJECTIVE: Skill acquisition inanesthesiology is subject to a great deal ofinterindividual variability. Our aim was to developand test an individualized tool for monitoringacquisition of technical skills based on the cumulativesum (CUSUM) approach. This system objectivelyassesses whether an individual has acquired aminimum skill level and identifies the moment whenthe skill has been learned.MATERIAL AND METHODS: Nine third-year residentsin anesthesiology and postoperative recovery careparticipated. The residents anonymously recordedtheir first 100 obstetric epidural analgesiaprocedures in a database. The data were thenanalyzed with the CUSUM method. We consideredacceptable skill acquisition to be reflected by a firstattemptsuccess rate of 80% and a rate of successwith help of 20%.RESULTS: A total of 765 epidural blocks wereanalyzed, giving a mean (SD) of 84.7 (2.8) proceduresper resident (range, 47-100 procedures per resident).Seven residents became competent with the skill after23 procedures and 2 residents were not successful inlearning the skill. At the end of the study, 3 residentshad required help with more than 20% of theprocedures. Data collection from the trainees seemed tovary, leading to possible under- or overestimation offailures and/or need for help. Accidental dural punctureoccurred 6 times (0.78%) and blood vessel puncture 40times (5.2%).CONCLUSIONS: Although some third-year residentsreach the targeted rate of success quickly, we believethat close supervision is useful to control progress alongthe learning curve for individuals who need more help(AU)

Self-learning digital modules in dermatology: a pilot study.

BACKGROUND: Dermatological diseases are one of the most common problems in outpatient departments. Dermatology teaching unfortunately is facing two major issues: (i) a shortage of trained faculty and (ii) inadequate teaching time. Various methods utilizing modern information technology have been studied to overcome these problems. OBJECTIVES: We attempted to evaluate the use of a digital self-learning module in the teaching of dermatology. METHODS: We created digital modules of dermatology topics, which included power-point presentations, instructive videos demonstrating signs in dermatological examination, interactive quizzes and images. The module was pilot tested on 48 third semester students, each posted for 2 weeks in dermatology. Evaluation was performed using a 5-point Likert scale questionnaire for the students. Actual knowledge acquisition was evaluated using a post-test with two components: section A comprising questions from the sections covered by the digital module and a section B comprising questions from topics taught only in the conventional method. RESULTS: The questionnaire analysis revealed that a majority of the students were comfortable using the module and felt that it encouraged them towards further in-depth self-learning on the concerned topics. The results from the post-test were compared between the test and control sections, using the Student's t-test, which gave a P-value of 0.084 (5% significance level) suggesting that the difference was not significant. Conclusion To conclude, we would like to suggest that the use of a 'play area' like concept coupled with an interactive information technology-based self-learning module might improve dermatology teaching.

Virtual medical and pedagogical applicability of human dermatome patterns: critical review of the literature

Dermatome is an area of skin supplied by the posterior (sensory) root of a spinal nerve derived from a single cord segment, which is a particular aspect of the peripheral distribution of sensory fibers. Its topographic study is important to identify nerve, radicular, or medullary damage. When mapped, these dermatomes are outlined on the body surface and their assessment poses a special challenge to physicians once the distinguished imaging methods are not concordant in some aspects. Computers have taken over increasingly importance as transmitters of anatomical information in both clinical and educational sceneries. The present study concerning the virtual teaching and learning of the human dermatome patterns carries out an update of the literature and its clinical and radiological applicability. Computed-based anatomy programs do not only complement conventional instructions methods, but also provide the groundbreaking means to represent, standardize, and disseminate knowledge of dermatomes. Computer-based programs capable of standardizing a tridimensional map of human dermatomes still need to be developed.

Seguimiento de niños con syndrome de Down en el Hospital Materno Intantil “Ramón Sardᔠde Buenos Aires, Argentina / Follow up of the children seen at the “Ramon Sardᔠmaternal hospital of Buenos Aires, Argentina

Se presentan los resultados del programa de seguimiento de niños con síndrome de Down (SD), Grupo A.t.i.e.n.d.o (Atención interdisciplinaria en niños con SD) nacidos en su mayoría en el Hospital Materno-Infantil “Ramón Sardᔠ(HMIRS) de Buenos Aires, Argentina. Se describe el programa, características de la población estudiada, resultados, incidencia de las patologías más frecuentes y modalidades de intervención para favorecer la integración social y familiar (AU)

We show the results of the following program in children with Down Syndrome (DS), seen by the ATIENDO group (Interdisciplinary Attention in children with DS) in the Maternal Hospital Ramón Sardá of Buenos Aires Argentina. We describe the program, the study population, associated illness, the results, and ways to intervention to promote familiar and social integration in these children (AU)

[Electronic learning: interactive learning in medicine or Socrates in electronic guise]. / Electronic learning: apprentissage interactif en médecine ou Socrate en habits électroniques.

E-learning has been widely used for training in different fields. More recently, it was introduced during medical studies or for continuous medical education. The Canadian Universities are pioneers in e-learning creating special departments dedicated to pedagogy. Developing countries like Brazil or Central Europe have made some pilot experiments, which were successful. Several electronic companies have given a free access to the programmes and sites. The use of electronic media leads to an adaptation of teaching methods making them more interactive.

[Continued training of elderly workers with reference to changes in the organization of continuing vocational training]. / Weiterbildung älterer Arbeitskräfte angesichts einer veränderten Weiterbildungsorganisation.

In the following contribution the under-proportional participation rate of older workers in vocational training is analyzed. Regarding the changes concerning the organization of vocational training to more job-integrated, self-directed and computer-based learning the consequences for training opportunities, motivation to learn and performance possibilities as well as institutional basic conditions to optimize the participation of elderly workers in further training are discussed.

Incorporating active learning into a traditional curriculum.

During the past three academic years, "self-learning exercises" (SLEs) have been incorporated into the Medical Physiology course for first-year students at the Morehouse School of Medicine. Roughly 20-30% of the material covered in the course is presented to the students in the form of these exercises, instead of in lectures. The exercises are intended to help the students develop skills in active learning and problem solving. Formal analysis of student performances on multiple-choice exam questions showed that the SLEs did not significantly impair learning evaluated by this traditional means. Student feedback was strongly negative the first year and prompted a number of revisions in the format of the SLEs, which seem to have made them more palatable, without negating their emphasis on active learning and application of material.

Role of distance learning in health manpower training.

In order to meet the challenges of training of the health workers at various levels, there is a definite requirement of the involvement of various disciplines. Distance education can meet the need for training of the medical and para-medical personnel by utilising a variety of educational technology. Distance education has tremendous potential in training of the medical and para-medical workers in the health sector.

Beyond the classroom: self-direction in professional learning.

Against the backdrop of a rapidly changing profession, the context for professional thinking among medical librarians is changing. Competent performance increasingly is linked with the educational efforts of self-directed adult learners. This paper examines strategies that facilitate self-direction, including skills development, organizational learning, learner-based decision making, and alternative teaching models. The analysis provides the basis for a recommended agenda for redesign and development of educational programs.

Problem-based learning in American medical education: an overview.

The recent trend toward problem-based learning (PBL) in American medical education amounts to one of the most significant changes since the Flexner report motivated global university affiliation. In PBL, fundamental knowledge is mastered by the solving of problems, so basic information is learned in the same context in which it will be used. Also, the PBL curriculum employs student initiative as a driving force and supports a system of student-faculty interaction in which the student assumes primary responsibility for the process. The first PBL medical curriculum in North America was established at McMaster University in Toronto in 1969. The University of New Mexico was the first to adopt a medical PBL curriculum in the United States, and Mercer University School of Medicine in Georgia was the first U.S. medical school to employ PBL as its only curricular offering. Many interpretations of the basic PBL plan are in use in North American medical schools. Common features include small-group discussions of biomedical problems, a faculty role as facilitator, and the student's relative independence from scheduled lectures. The advantages of PBL are perceived as far outweighing its disadvantages, and the authors conclude that eventually it will see wider use at all levels of education.