Training of general practitioners, a Mexican medical school curriculum evaluation / Formación de médicos generales, evaluación curricular en una escuela mexicana de medicina

Background: Educational curricula require constant improvement to respond to the needs of students, institutions and society. Objective: To evaluate the Plan de Estudios 2010 of the Facultad de Medicina de la Universidad Nacional Autónoma de México. Methods: Documentary and qualitative study of three phases. First, revision of trends of general medicine in special databases and comparison of curricula between universities. Second, focus groups with clinical teachers and basic sciences to investigate experiences and opinions in relation to trends in general medicine. Third, a "Generalists Committee" was convened to whom the results were presented (phase one and two) and the recommendations were adapted to adapt the results to the general practitioner's context. The participants were informed about the research objective and their participation was voluntary, the anonymity of theirs comments was protected. Results: The trend towards specialization in clinical practice defines the future of general medicine, and the administrative uses have an impact on the practices of the general practitioner and on the patient's medical relationship. Conclusion: Various aspects mainly educational and assistance hindered the quality of the practice of general medicine.

Introducción: los currículos educativos requieren estar en constante perfeccionamiento para responder a las necesidades de estudiantes, instituciones y de la sociedad. Objetivo: evaluar el Plan de Estudios 2010 de la carrera de medicina de la Facultad de Medicina de la Universidad Nacional Autónoma de México. Métodos: estudio documental y cualitativo, de tres fases. En la primera se revisaron las tendencias de la medicina general en bases de datos especializadas y se compararon los planes de estudios entre universidades. En la segunda, se realizaron grupos focales con docentes clínicos y de ciencias básicas para indagar experiencias y opiniones en relación con las tendencias de la medicina general. En la tercera, se convocó a un "Comité de Generalistas" a quienes se les presentaron los resultados de las fases anteriores, y se realizaron las recomendaciones pertinentes para adecuar los resultados al contexto del médico general. La participación de los entrevistados fue voluntaria, fueron informados sobre el objetivo de investigación y se resguardó el anonimato de sus testimonios. Resultados: la tendencia hacia la especialidad en la práctica clínica define el futuro de la medicina general; asimismo, los intereses administrativos repercuten en las prácticas del médico general y en la relación médico-paciente. Conclusión: diversos aspectos, principalmente educativos y asistenciales, obstaculizan la calidad de la práctica de la medicina general.

Efecto de la implementación de un nuevo plan de estudios en la percepción del ambiente educativo en los estudiantes de la Facultad de Medicina de la Universidad Nacional Autónoma de México / Effect of the implementation of a new curriculum in the perception of the educational environment in students of the Faculty of Medicine of the National Autonomous University of Mexico

Introducción. El Plan de Estudios 2010 de la Facultad de Medicina de la Universidad Nacional Autónoma de México plantea un proceso de evaluación continuo que involucra múltiples factores, como profesores, compañeros o pares, así como las expectativas que los estudiantes tienen de su proceso de aprendizaje. El ambiente educativo es muy importante para el logro de los objetivos educacionales de este plan y por lo mismo repercute en el éxito académico y en la motivación de los estudiantes. Sujetos y métodos. El cuestionario Dundee Ready Education Environment Measure (DREEM) evalúa la percepción del aprendizaje, la percepción de los profesores, la autopercepción académica, la percepción del ambiente y la autopercepción social. Se aplicó a una cohorte inicial de 755 estudiantes y se hizo el seguimiento anual durante los primeros cuatro años de la carrera. Resultados. Se aplicó un total de 2.288 cuestionarios en los cuatro años de la carrera de medicina. Los resultados de primero, tercero y cuarto años se interpretan como un ‘ambiente educacional con aspectos más positivos que negativos’, y el segundo año, con una puntuación total de 74,2, como un ‘ambiente educacional con muchos problemas’. Conclusiones. Conforme a los resultados cualitativos y cuantitativos encontrados en la aplicación de la encuesta DREEM, se ponen en evidencia las áreas de oportunidad y posiblemente algunas fortalezas con las que cuenta el Plan de Estudios 2010. Estos hallazgos invitan a líneas de investigación que den seguimiento a este plan a los seis años de su implementación y ejecución (AU)

Introduction. The Curriculum 2010 of the Medical Faculty of the National Autonomous University of Mexico poses a continuous assessment process involving multiple factors such as teachers, companions or peers, as well as expectations that students have of their learning process. The educational environment is very important for achieving the educational objectives of this plan and therefore affects academic success and motivation of students. Subjects and methods. The questionnaire Dundee Ready Education Environment Measure (DREEM) assesses: perception of learning, perception of teachers, academic self-perception, perception of the environment and social self-perception. It was applied to an initial cohort of 755 students, making the annual monitoring during the first four years of the career. Results. A total of 2288 questionnaires were applied in the four years of medical school. The results demonstrate first, third and fourth years are interpreted as ‘educational environment with more positives than negatives’ and the second year with a total score of 74.2 as an ‘educational environment with many problems’. Conclusions. According to the qualitative and quantitative results in the application of the DREEM survey, highlights the areas of opportunity and possibly some strength that comprise the Curriculum 2010, these findings lead to research to follow up this Curriculum to 6 years of implementation and execution (AU)

[The undergraduate program in forensic science: a national challenge]. / La Licenciatura en Ciencia Forense, un reto nacional.

The challenge in achieving an ideal state of justice is that each "proof" has the highest degree of reliability. This is the main responsibility of the forensic scientist. Up to now, criminal investigations in Mexico have been supported by forensic work from a wide variety of disciplinary backgrounds that give testimony in a particular area, even though they may have become forensic witnesses in a complementary and experiential manner. In January 2013, the Universidad Nacional Autónoma de México (UNAM) approved the "Forensic Science" undergraduate program that, in collaboration with various academic entities and government institutions, will develop forensic scientists trained in science, law, and criminology. This is focused on contributing to the national demand that the justice system has more elements to procure and administer justice in dealing with crime.

Medical education accreditation in Mexico and the Philippines: impact on student outcomes.

CONTEXT: Accreditation of medical education programmes is becoming increasingly prevalent worldwide, but beyond the face validity of these quality assurance methods, data linking accreditation to improved student outcomes are limited. Mexico and the Philippines both have voluntary systems of medical education accreditation and large numbers of students who voluntarily take components of the United States Medical Licensing Examination (USMLE). We investigated the examination performance of Mexican and Philippine citizens who attended medical schools in their home countries by medical school accreditation status. METHODS: The sample included 5045 individuals (1238 from Mexico, 3807 from the Philippines) who took at least one of the three USMLE components required for Educational Commission for Foreign Medical Graduates (ECFMG) certification. We also separately studied 2702 individuals who took all three examinations (589 from Mexico, 2113 from the Philippines). The chi-squared statistic was used to determine whether the associations between outcomes (first attempt pass rate on USMLE components and rate of ECFMG certification) and medical school accreditation (yes/no) were statistically significant. RESULTS: For the sample of registrants who took at least one USMLE component, first attempt pass rates on all USMLE components were higher for individuals attending accredited schools, although there were differences in pass rates among the components and between the two countries. The distinction was greatest for USMLE Step 1, for which attending an accredited school was associated with increases in first attempt pass rates of 15.9% for Mexican citizens and 29.2% for Philippine citizens. In registrants from the Philippines who took all three examinations, attending an accredited medical school was also associated with increased success in obtaining ECFMG certification. CONCLUSIONS: These findings support the value and usefulness of accreditation in Mexico and the Philippines by linking accreditation to improved student outcomes.

Inflammation, oxidative stress, and obesity.

Obesity is a chronic disease of multifactorial origin and can be defined as an increase in the accumulation of body fat. Adipose tissue is not only a triglyceride storage organ, but studies have shown the role of white adipose tissue as a producer of certain bioactive substances called adipokines. Among adipokines, we find some inflammatory functions, such as Interleukin-6 (IL-6); other adipokines entail the functions of regulating food intake, therefore exerting a direct effect on weight control. This is the case of leptin, which acts on the limbic system by stimulating dopamine uptake, creating a feeling of fullness. However, these adipokines induce the production of reactive oxygen species (ROS), generating a process known as oxidative stress (OS). Because adipose tissue is the organ that secretes adipokines and these in turn generate ROS, adipose tissue is considered an independent factor for the generation of systemic OS. There are several mechanisms by which obesity produces OS. The first of these is the mitochondrial and peroxisomal oxidation of fatty acids, which can produce ROS in oxidation reactions, while another mechanism is over-consumption of oxygen, which generates free radicals in the mitochondrial respiratory chain that is found coupled with oxidative phosphorylation in mitochondria. Lipid-rich diets are also capable of generating ROS because they can alter oxygen metabolism. Upon the increase of adipose tissue, the activity of antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), was found to be significantly diminished. Finally, high ROS production and the decrease in antioxidant capacity leads to various abnormalities, among which we find endothelial dysfunction, which is characterized by a reduction in the bioavailability of vasodilators, particularly nitric oxide (NO), and an increase in endothelium-derived contractile factors, favoring atherosclerotic disease.

[The 2010 curriculum of the faculty of medicine at the National University of Mexico]. / Plan de Estudios 2010 de la facultad de medicina de la Universidad Nacional Autónoma de México.

The 2010 undergraduate medical degree curriculum at the faculty of medicine of the Universidad Nacional Autonoma de Mexico (UNAM) constitutes an important curricular reform of medical education in our country. It is the result of an institutional reflective process and academic dialog, which culminated in its approval by UNAM's Academic Council for the Biology, Chemistry, and Health Sciences areas on February 2nd, 2010. Some distinguishing characteristics of the new academic curriculum are: organization by courses with a focus on outcome competencies; three curricular axes that link three knowledge areas; four educational phases with achievement profiles; new courses (biomedical informatics, basic-clinical and clinical-basic integration, among others); and core curriculum. The aforementioned curriculum was decided within a framework of effective teaching strategies, competency oriented learning assessment methods, restructuring of the training of teaching staff, and establishment of a curriculum committee follow-up and evaluation of the program. Curricular change in medical education is a complex process through which the institution can achieve its mission and vision. This change process faces challenges and opportunities, and requires strategic planning with long-term foresight to guarantee a successful dynamic transition for students, teachers, and for the institution itself.

The resident-as-teacher educational challenge: a needs assessment survey at the National Autonomous University of Mexico Faculty of Medicine.

BACKGROUND: The role of residents as educators is increasingly recognized, since it impacts residents, interns, medical students and other healthcare professionals. A widespread implementation of resident-as-teacher courses in developed countries' medical schools has occurred, with variable results. There is a dearth of information about this theme in developing countries. The National Autonomous University of Mexico (UNAM) Faculty of Medicine has more than 50% of the residency programs' physician population in Mexico. This report describes a needs assessment survey for a resident as teacher program at our institution. METHODS: A cross-sectional descriptive survey was developed based on a review of the available literature and discussion by an expert multidisciplinary committee. The goal was to identify the residents' attitudes, academic needs and preferred educational strategies regarding resident-as-teacher activities throughout the residency. The survey was piloted and modified accordingly. The paper anonymous survey was sent to 7,685 residents, the total population of medical residents in UNAM programs in the country. RESULTS: There was a 65.7% return rate (5,186 questionnaires), a broad and representative sample of the student population. The residents felt they had knowledge and were competent in medical education, but the majority felt a need to improve their knowledge and skills in this discipline. Most residents (92.5%) felt that their role as educators of medical students, interns and other residents was important/very important. They estimated that 45.5% of their learning came from other residents. Ninety percent stated that it was necessary to be trained in teaching skills. The themes identified to include in the educational intervention were mostly clinically oriented. The educational strategies in order of preference were interactive lectures with a professor, small groups with a moderator, material available in a website for self-learning, printed material for self-study and homework, and small group web-based learning. CONCLUSIONS: There is a large unmet need to implement educational interventions to improve residents' educational skills in postgraduate educational programs in developing countries. Most perceived needs of residents are practical and clinically oriented, and they prefer traditional educational strategies. Resident as teachers educational interventions need to be designed taking into account local needs and resources.

[Ethics in contemporary medicine]. / Etica en la medicina actual.

Medical practice has been traditionally ruled by the principles of medical ethics and the scientific aspects that define it. However, today's medical practice is largely influenced by other aspects such as: economic interests, abuse of therapeutics, defensive medicine, unnecessary surgeries and conflicts of interests without excluding alterations in the application of the informed consent, the relation with the pharmaceutical industry, respect of confidentiality, organizational ethics, and the ethical practice that escapes the will of the medical professional.

Etica en la medicina actual / Ethics in contemporary medicine

El ejercicio de la medicina se ha regido tradicionalmente por los principios de la ética médica y los aspectos científicos que la definen. Sin embargo, la medicina actual se ve fuertemente influida por aspectos de otra índole como el interés económico, el encarnizamiento terapéutico, la medicina defensiva, la cirugía innecesaria, los conflictos de interés, las alteraciones en la aplicación del consentimiento informado, la relación con la industria farmacéutica, el respeto a la confidencialidad, la ética organizacional, y el ejercicio ético que escapa a la voluntad del profesional médico.

Medical practice has been traditionally ruled by the principles of medical ethics and the scientific aspects that define it. However, today's medical practice is largely influenced by other aspects such as: economic interests, abuse of therapeutics, defensive medicine, unnecessary surgeries and conflicts of interests without excluding alterations in the application of the informed consent, the relation with the pharmaceutical industry, respect of confidentiality, organizational ethics, and the ethical practice that escapes the will of the medical professional.