Educational and evaluation strategies in the training of physician specialists / Estrategias educativas y de evaluación en la formación de médicos especialistas

Background: Teaching strategies have been defined as procedures, means or resources that teachers used to promote meaningful learning. Aim: Identify teaching strategies and evaluation used by the professor with residents in tertiary hospitals health care. Methods: This is a cross-sectional study conducted with full, associate and assistant professors of various medical specialties. A questionnaire was applied to evaluate the strategies used by professors to teach and evaluate students. Results: We included a sample of 90 professors in 35 medical specialties. The most frequent teaching activities were: organizing students to develop presentations on specific subjects, followed by asking questions on previously reviewed subjects, In terms of the strategies employed, the most frequent "always" option was applied to case analyses. The most frequent methods used for the evaluation of theoretical knowledge were: participation in class, topic presentation and exams. Conclusions: Teaching activities were primarily based on the presentation of specific topics by the residents. The most commonly used educational strategies were clinical case analyses followed by problem-based learning and the use of illustrations. Evaluation of the residents' performance in theory knowledge, hinged on class participation, presentation of assigned topics and exams.

Antecedentes: Las estrategias didácticas se han definido como procedimientos, medios o recursos que el docente utiliza para promover el aprendizaje significativo. Objetivo: Identificar las estrategias de enseñanza y de evaluación que utiliza el profesor con residentes en hospitales de tercer nivel de atención médica. Método: Estudio transversal, con profesores de diversas especialidades, en el Centro Médico Nacional La Raza. Se aplicó un cuestionario que valora las estrategias utilizadas en la enseñanza y la evaluación. Resultados: En una muestra de 90 profesores, 35 especialidades médicas con profesores ayudantes, adjuntos y titulares, las actividades de enseñanza que más realizan son organizar a los alumnos a exponer temas, seguido de realizar preguntas sobre temas vistos. Respecto a las estrategias educativas, la más frecuente fue análisis de casos y aprendizaje basado en problemas. Para evaluación del desempeño teórico, los métodos más utilizados fueron participación en clase, exposición de temas y exámenes. Conclusiones: las actividades de enseñanza están basadas en la exposición de temas por los médicos residentes. La estrategia educativa más utilizada fue llevar a cabo análisis de casos clínicos, seguido por aprendizaje basado en problemas. La evaluación del desempeño en aspectos teóricos se realiza a partir de la participación en clase, la exposición de temas y exámenes.

[Knowledge of the Advance Directive (AD) in Physicians at Tertiary Care Hospitals]. / La «voluntad anticipada¼ y su conocimiento por médicos en hospitales de tercer nivel.

UNLABELLED: The Advance Directive is generally conceptualized as the respect that all human beings deserve in the use of their faculties, to deliberate, choose, and decide upon everything that pertains to their existence, including their life goals and personal health. OBJECTIVE: To identify knowledge about the AD that Medical Residents at tertiary care facilities of the Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS) in the District Capital (Mexico City), possess. METHOD: Written survey with 10 questions for Medical Residents (MR) of different specialties at tertiary care hospitals. STUDY DESIGN: Survey. RESULTS: The questionnaire was applied to 280 MR of more than ten different specialties, at the La Raza and the S XXI Medical Centres (Centro Médico La Raza y Centro Médico Siglo XXI). The majority of respondents were first-year MR (67.5%), and the minority were sixth-year Residents (1.9%). Incomplete knowledge about the Federal AD Law exists. DISCUSSION: In Mexico, like on an international plane, the contemporary, social dynamic has fundamentally influenced the practice of healthcare professions. The responsibilities that health care professionals take on obligate them to be current in areas like the rights of healthy and sick individuals to be involved in and decide on aspects related to the phase at the end of their lives. The AD, Vital Testament, Living Will, will push doctors to improve the doctor-patient relationship since the establishment of an AD is not possible without a good patient-doctor rapport.

The epidemiology of fungemia in an infectious diseases hospital in Mexico city: A 10-year retrospective review.

The epidemiology of invasive fungal infections has recently changed in immunosuppressed populations as a result of HIV infection, organ transplant, chemotherapy and in elderly patients. The diagnosis of invasive fungal infections by culture is prolonged since fungi grow slowly in vitro. we wanted to estimate the frequency of fungemia diagnoses established through the Clinical Mycology Laboratory over the past 10 years; through a retrospective study; data was obtained from the laboratory patient registry in the Infectious Disease Hospital's laboratory registry of patients with a systemic fungal isolate between 2005 and 2014. One hundred and thirty two (132) systemic fungal infections were identified. They were more prevalent in males, in the age group between 20 and 59 years and in patients with a diagnosis of AIDS. The most frequently isolated agents belonged to the genus Candida and others such as Histoplasma sp., Cryptococcus sp., Aspergillus sp., and Coccidioides sp. Of all blood and bone marrow cultures received 17.9% had fungal development; of these, in 70% of cases it was through blood cultures. In general, fungal agents were not diagnostically suspected. We identified that Sixty percent (60%) of fungemias developed in AIDS patients, followed by patients with sepsis. The most common agents belonged to the genus Candida, predominantly the albicans species. They were more frequently identified by blood culture than by bone marrow culture. Invasive fungal infections have not followed a usual clinical pattern and are not easily recognizable.

[Expression of the concept of death by residents of a tertiary hospital]. / Expresión del concepto de muerte por médicos residentes de un hospital de tercer nivel.

INTRODUCTION: Attitudes of health professionals are based on their conditions and personal life experiences about life and death and are part of their professional behavior. Medical training relies mainly on physical-biological sciences and, to a lesser extent, on social-medical aspects, thus forming the physician's concept about death. These concepts may present themselves as a result of culture and as factors that model or limit the cognitive development of the physicians. OBJECTIVE: To determine the concept of death of medical residents in a high-specialty hospital. METHODS: A cross-sectional, prospective survey of physicians in training from the first to the sixth year from different specialties. Descriptive statistical analysis was carried out. RESULTS: We made 174 surveys; 61% were in the first year of the specialty; 149 practiced some religion. Women were 3.5 times more likely to have a concept of death that was not that of a biologist, unlike men. Women were 25% more likely to have had an influence of religion on their concept of death. CONCLUSIONS: The personality of the physician is versatile. It has a relationship with professional and human experiences. As training progresses, medical influence transforms biological or religious views. The concept of death and its influence on the idea appeared to be different between male and female physicians.

Interferon γ in patients with HIV/AIDS and suspicion or latent tuberculosis infection.

OBJECTIVE: To assess the usefulness of IGRA test (QuantiFERON(®)-Cell mediated immune) compared with the tuberculin skin test. METHODS: A cross-sectional study was carried out in Mexico, 25 infected patients with HIV-AIDS and the suspicion or with latent tuberculous infection (LTBI) who were >18 years of age and without treatment for tuberculosis (TB), were enrolled in the study. RESULTS: Median cluster of differentiation (CD4) count was 364 cells/µ L and median HIV viral load was 50 copies/mL. Overall, 20 patients (80%) had at least one positive diagnostic test for LTBI: four (16%) had a positive tuberculin skin test and 19 (76%), a positive QuantiFERON(®)-tuberculosis. CONCLUSIONS: No agreement is found between the two diagnostic tests: k = -0.004, 95% confidence interval (-0.2219, 0.2210). Additional longitudinal studies among HIV-infected populations with high prevalence of TB are needed to further assess the usefulness of IGRAs in this patient population.

Anti-chlamydophila pneumoniae antibodies as associated factor for carotid atherosclerosis in patients with AIDS.

Atherosclerosis is a multifactor disease. Lately, infectious factors such as C. pneumoniae have been found to be involved. To determine whether the infection by C. pneumoniae is a risk factor for atherosclerosis in patients with AIDS. Case-control study on 43 patients with AIDS under HAART (16 cases and 27 controls). To document atherosclerosis, a carotid and transcranial Doppler ultrasound was performed. Anti-C pneumoniae antibodies were searched using a microimmunofluorescence test for IgM and IgG levels. To study the associations with risk of atherosclerosis, Odds Ratios were calculated for each IgG anti-C. pneumoniae antibody titre. A titre of 1:64 significantly increased the risk of atherosclerosis. These results suggest that hypertriglyceridemia and C. pneumoniae infection coexistence significantly increases the risk of atherosclerosis. The inverse geometric average of the antibodies titre against C. pneumoniae in individuals with atheromatous plaque fell to 64, two titres above the controls. This difference turned out to be statistically significant. Exposure to C. pneumoniae with antibodies (IgG) should be considered in any HIV diagnosed patient as a risk factor for atherosclerosis, having found that the inverse geometric averages of antibodies titre are significantly different comparing cases and controls, especially in patients with dyslipidemia, hypertriglyceridemia or in patients whose treatments could cause these conditions. In patients with concomitant hypertriglyceridemia, the association increases up to three times. It is advisable that AIDS patients take a serological test to determine exposure to C. pneumoniae, and to assess treatment options.

Posaconazole therapy for chronic refractory coccidioidomycosis.

BACKGROUND: Coccidioides infections often result in chronic relapsing disease that presents a challenge to the currently available therapy. Posaconazole, an oral extended-spectrum triazole agent, has been shown in vitro and in vivo to have potent activity against this fungus. METHODS: An open-label multinational study of posaconazole, 800 mg/d, administered in divided doses for the treatment of invasive fungal infection that has been refractory to previous therapy was conducted. The data were reviewed by an independent data review committee (DRC). Fifteen patients met the criteria for proven coccidioidal infection and disease refractory to previous therapy. Success was a complete or partial response; nonsuccess was stable disease, lack of response to therapy, or undetermined response. RESULTS: The sites of coccidioidal infection were pulmonary (seven patients) and disseminated (eight patients). Patients were refractory to previous therapy (including amphotericin B with or without an azole) for a median duration of 306 days. At the end of treatment (posaconazole treatment duration, 34 to 365 days), therapy for 11 of 15 patients (73%) was considered to be successful by the DRC. Four responses were complete and seven were partial; these included five patients with pulmonary sites and six patients with disseminated sites. In responders, improvement was seen within months of the initiation of therapy. Five patients received therapy for >or= 12 months. The side effects were minimal. CONCLUSIONS: Therapy for coccidioidomycosis remains a clinical challenge, especially when patients have not responded to therapy with drugs that were recommended in treatment guidelines. The success rate (73%) achieved in this case series suggests that oral posaconazole should be considered as an important agent for the treatment of refractory coccidioidomycosis.

Safety of long-term oral posaconazole use in the treatment of refractory invasive fungal infections.

BACKGROUND: Invasive fungal infections are found most frequently in immunosuppressed and critically ill hospitalized patients. Antifungal therapy is often required for long periods. Safety data from the clinical development program of the triazole antifungal agent, posaconazole, were analyzed. METHODS: A total of 428 patients with refractory invasive fungal infections (n = 362) or febrile neutropenia (n = 66) received posaconazole in 2 phase II/III open-label clinical trials. Also, 109 of these patients received posaconazole therapy for > or = 6 months. Incidences of treatment-emergent, treatment-related, and serious adverse events and abnormal laboratory parameters were recorded during these studies. RESULTS: Treatment-emergent, treatment-related adverse events were reported in 38% of the overall patient population. The most common treatment-related adverse events were nausea (8%) and vomiting (6%). Treatment-related serious adverse events occurred in 8% of patients. Low rates of treatment-related corrected QT interval and/or QT interval prolongation (1%) and elevation of hepatic enzymes (2%) were reported as adverse events. Treatment-emergent, treatment-related adverse events occurred at similar rates in patients who received posaconazole therapy for < 6 months and > or = 6 months. CONCLUSIONS: Prolonged posaconazole treatment was associated with a generally favorable safety profile in seriously ill patients with refractory invasive fungal infections. Long-term therapy did not increase the risk of any individual adverse event, and no unique adverse event was observed with longer exposure to posaconazole.