Evaluación mediante script concordance test del razonamiento clínico de residentes en Atención Primaria / Clinical reasoning evaluation using script concordance test in primary care residents

Introducción: Actualmente desconocemos el razonamiento clínico objetivo de los residentes durante su formación, lo que impide orientar su reciclaje formativo a solventar los déficits detectados. El script concordance test (SCT) evalúa el razonamiento clínico planteando situaciones clínicas reales, pero aún no ha sido utilizado en España con contenidos propios de Atención Primaria. Por ello consideramos relevante diseñar un SCT de Atención Primaria que cumpla los criterios de validez, fiabilidad y aceptabilidad descritos en la bibliografía. Métodos: Elaboración, corrección y validación de un SCT para evaluar el razonamiento clínico en Atención Primaria de los residentes y que incluya variables sociolaborales para estudiar su posible relación con la puntuación obtenida. Resultados: Nuestro cuestionario fue aprobado por un comité de expertos, alcanzó una fiabilidad y accesibilidad adecuadas, y distinguió a los expertos de los residentes. No se observaron diferencias estadísticamente significativas en función de la edad, género, tipo y duración de la formación recibida en Atención Primaria, y la realización de un curso sobre dicha formación. Conclusiones: Se construyó un SCT que obtuvo la aprobación por parte de un comité de expertos, cumplió con los criterios de fiabilidad y accesibilidad, y permitió objetivar diferencias significativas en el razonamiento clínico de los expertos y residentes. Excepto en el 2.o año de residencia, no se observaron diferencias estadísticamente significativas respecto al año formativo dentro de la residencia, la edad, el género, la realización y duración de la rotación en Atención Primaria y la realización de un curso sobre dicha formación. (AU)

Introduction: Actual unawareness about paediatric resident's residency program factual clinical reasoning precludes professional retraining directed to solve deficiencies. Script concordance test (SCT) evaluates clinical reasoning due to its orientation to usual clinical practice but surprisingly it has not been used in Spain for Paediatric Primary Care clinical reasoning evaluation so far. Due to this we consider to be of relevance to design a paediatric primary care SCT which meets validity, reliability and accessibility criteria described in bibliography.Methods: Development, validation and application of an SCT questionnaire for clinical reasoning analysis in paediatric primary care applied on a population of paediatric residents and which includes demographic and employment data in order to study possible relationship between them and achieved scores.Results: Our SCT was approved by an experts committee. It met reliability and accessibility criteria and it allowed distinguishing experts from paediatric internal residents. No statistically significant differences were found concerning age, gender, type and duration of the training received in Primary Care, and the completion of a course on that training.Conclusions: We developed an SCT that was approved by a Paediatric Experts Committee, it met reliability and accessibility criteria and it allowed distinguishing clinical reasoning from experts and paediatric internal residents. Except second year residency program, we did not objectified relevant differences in residency program year, age, gender, duration and realization of Paediatric Primary Care rotation, and training course realisation. (AU)

Clinical reasoning evaluation using script concordance test in primary care residents.

INTRODUCTION: Actual unawareness about paediatric resident's residency program factual clinical reasoning precludes professional retraining directed to solve deficiencies. Script Concordance Test (SCT) evaluates clinical reasoning due to its orientation to usual clinical practice but surprisingly it has not been used in Spain for Paediatric Primary Care clinical reasoning evaluation so far. Due to this we consider it to be of relevance to design a Paediatric Primary Care SCT which meets validity, reliability and accessibility criteria described on bibliography. METHODS: Development, validation and application of an SCT questionnaire for clinical reasoning analysis in Paediatric Primary Care applied on a population of paediatric residents and which includes demographic and employment data in order to study possible relationship between them and achieved scores. RESULTS: Our SCT was approved by an experts committee. It met reliability and accessibility criteria and it allowed distinguishing experts from paediatric internal residents. No statistically significant differences were found concerning age, gender, type and duration of the training received in Primary Care, and the completion of a course on that training. CONCLUSIONS: We developed a SCT that was approved by a Paediatric experts committee, it met reliability and accessibility criteria and it allowed distinguishing clinical reasoning from experts and paediatric internal residents. Except second year residency program, we didn't objectified relevant differences in residency program year, age, gender, duration and realization of Paediatric Primary Care rotation, and training course realization.

Effects of Gamification on the Benefits of Student Response Systems in Learning of Human Anatomy: Three Experimental Studies.

This paper presents three experiments to assess the impact of gamifying an audience response system on the perceptions and educational performance of students. An audience response system called SIDRA (Immediate Audience Response System in Spanish) and two audience response systems with gamification features, R-G-SIDRA (gamified SIDRA with ranking) and RB-G-SIDRA (gamified SIDRA with ranking and badges), were used in a General and Descriptive Human Anatomy course. Students participated in an empirical study. In the academic year 2019-2020, a total of 90 students used RB-G-SIDRA, 90 students employed R-G-SIDRA in the academic year 2018-2019, and 92 students used SIDRA in the academic year 2017-2018. Statistically significant differences were found between final exam grades obtained by using RB-G-SIDRA and SIDRA, U = 39.211 adjusted p = 0.001 and RB-G-SIDRA and R-G-SIDRA U = 31.157 adjusted p = 0.015, thus finding strong evidence with respect to the benefit of the badges used in RB-G-SIDRA. Moreover, in the students' SIDRA systems scores, statistically significant differences were found between RB-G-SIDRA and SIDRA, U = -90.521 adjusted p < 0.001, and between R-G-SIDRA and SIDRA, U = -87.998 adjusted p < 0.001. Significant correlations between individual and team scores were also found in all of the tests in RB-G-SIDRA and G-SIDRA. The students expressed satisfaction, engagement, and motivation with SIDRA, R-G-SIDRA, and RB-G-SIDRA, thus obtaining a final average assessment of 4.28, 4.61, and 4.47 out of 5, respectively. Students perform better academically with gamified versus non-gamified audience response systems. Findings can be used to build a gamified adaptive learning system.

The evaluation of i-SIDRA - a tool for intelligent feedback - in a course on the anatomy of the locomotor system.

OBJECTIVE: This paper presents an empirical study of a formative mobile-based assessment approach that can be used to provide students with intelligent diagnostic feedback to test its educational effectiveness. METHOD: An audience response system called SIDRA was integrated with a neural network-based data analysis to generate diagnostic feedback for guided learning. A total of 200 medical students enrolled in a General and Descriptive Anatomy of the Locomotor System course were taught using two different methods. Ninety students in the experimental group used intelligent SIDRA (i-SIDRA), whereas 110 students in the control group received the same training but without employing i-SIDRA. RESULTS: In the students' final exam grades, a statistically significant difference was found between those students that used i-SIDRA as opposed to a traditional teaching methodology (T(162)=2.597; p=0.010). The increase in the number of correct answers during the feedback guided learning process from the first submission to the last submission in four multiple choice question tests was also analyzed. There were average increases of 20.00% (Test1), 11.34% (Test2), 8.88% (Test3) and 13.43% (Test4) in the number of correct answers. In a questionnaire rated on a five-point Likert-type scale, the students expressed satisfaction with the content (M=4.2) and feedback (M=3.5) provided by i-SIDRA and the methodology (M=4.2) used to learn anatomy. CONCLUSIONS: The use of audience response systems enriched with feedback such as i-SIDRA improves medical degree students' performance as regards anatomy of the locomotor system. The knowledge state diagrams representing students' behavior allow instructors to study their progress so as to identify what they still need to learn.

An Empirical Study of Neural Network-Based Audience Response Technology in a Human Anatomy Course for Pharmacy Students.

This paper presents an empirical study of a formative neural network-based assessment approach by using mobile technology to provide pharmacy students with intelligent diagnostic feedback. An unsupervised learning algorithm was integrated with an audience response system called SIDRA in order to generate states that collect some commonality in responses to questions and add diagnostic feedback for guided learning. A total of 89 pharmacy students enrolled on a Human Anatomy course were taught using two different teaching methods. Forty-four students employed intelligent SIDRA (i-SIDRA), whereas 45 students received the same training but without using i-SIDRA. A statistically significant difference was found between the experimental group (i-SIDRA) and the control group (traditional learning methodology), with T (87) = 6.598, p < 0.001. In four MCQs tests, the difference between the number of correct answers in the first attempt and in the last attempt was also studied. A global effect size of 0.644 was achieved in the meta-analysis carried out. The students expressed satisfaction with the content provided by i-SIDRA and the methodology used during the process of learning anatomy (M = 4.59). The new empirical contribution presented in this paper allows instructors to perform post hoc analyses of each particular student's progress to ensure appropriate training.

A study of the movements of the human temporomandibular joint complex in the cadaver.

The objective of this study was to define the movements in the sagittal plane of the articular disk relative to the temporal bone and the mandibular condyle respectively, on jaw-opening in the absence of loads. Four temporomandibular joints from two human cadavers were used as materials in the study. Ten steel needles were placed in the lateral plane. Lateral photographs were taken of the articular area in different mandibular positions. OXY reference systems were adapted to the temporal and condylar points. The movements of the disk relative to the temporal bone are statistically different from those relative to the condyle. These findings are consistent with the new concept that the mandible joins the skull through two Temporomandibular Joint Complexes (TMJCs), one on each side and each one made up of a reciprocally fitting temporodiskal joint and a disko-condyle of the condylar type.