New beginnings in post graduate medical education. Latin American Medical Education Leaders Forum / Nuevos comienzos en la educación médica de postgrado. Foro Latinoamericano de Líderes en Educación Médica

Introduction: The consequences of the Covid-19 epidemic have been catastrophic for Latin America in 2021. This study explores experiences, lessons learned, and practice changes during this critical time in post-graduate medical education in Latin America. Me-thods: A panel of 53 post-graduate medical education leaders from 8 Latin American countries and Canada was invited to participate in the 2021 Latin American Medical Education Leaders Forum to share their experiences, lessons learned, and main educational practice changes given the Covid-19 pandemic scenario. Participants were selected following a snowball technique with the goal of obtaining a diverse group of experts. Small group discussions were conducted by bilingual facilitators based on a semi-structured questionnaire. The plenary session with the main conclusions of each group was recorded and fully transcribed for a thematic analysis using a framework methods approach. Results: Participants ́ profiles included 13 experienced clinician-educators, 19 program directors, and 23 deans or organizational representatives. Seven specific themes emerged. They followed a pattern that went from an initial emotional reaction of surprise to a complex collective response. The responses highlighted the value of adaptability, the application of new digital skills, a renovated residents' protagonism, the strengthening of humanism in medicine, the openness of new perspectives in wellness, and finally, an unresolved challenge of assessment in medical education in a virtual post-pandemic scenario. Conclusion: A diverse panel of medical educators from Latin America and Canada identified changes triggered by the Covid-19 pandemic that could transform postgraduate medical education in the region.

Introducción: la pandemia de Covid-19 ha tenido consecuencias catastróficas para América Latina en el año 2021. Este estudio explora las experiencias, lecciones aprendidas y nuevas prácticas surgidas durante este crítico período en la educación médica de postgrado en América Latina. Métodos: un panel de 53 líderes de 8 países de América Latina y Canadá fue invitado a participar en el Foro Latinoame-ricano de Líderes en Educación Médica 2021 para compartir sus experiencias, lecciones aprendidas y cambios de prácticas educativas en el escenario de pandemia. Los participantes fueron seleccionados mediante la técnica de bola de nieve con el objetivo de obtener un grupo diverso de expertos. El Foro incluyó discusiones de pequeños grupos conducidos por facilitadores bilingües basadas en un cuestionario semiestructurado. La sesión plenaria con las principales conclusiones de los grupos fue grabada y transcrita para el análisis temático posterior utilizando la metodología de marco analítico. Resultados: el perfil de participantes incluyó 13 experimentados edu-cadores, 19 directores de programa y 23 decanos o representantes institucionales. Siete tópicos emergieron durante la discusión. Ellos siguieron un patrón que transitó desde una reacción emocional de sorpresa por la pandemia hasta una respuesta colectiva compleja. Las respuestas enfatizaron el valor de la adaptabilidad, la aplicación de nuevas habilidades digitales, un renovado protagonismo de los residentes, el fortalecimiento del humanismo en medicina, la apertura a nuevas perspectivas de bienestar y, finalmente, un desafío no resuelto respecto de la evaluación en educación médica en escenarios de pandemia. Conclusión: un panel diverso de educadores médicos latinoamericanos y canadienses identificó cambios claves gatillados por la pandemia de Covid-19 que pueden transformar la educación médica de postgrado en la región.

Academic excellence in Latin America: Social accountability of medical schools.

Context: Social accountability of medical schools has emerged as a standard of excellence in medical education during the last decade. However, the lack of valid and reliable instruments to estimate social accountability has limited the possibility of measuring the impact that medical schools have in society. Our aim was to develop an instrument and validate its use for assessing social accountability in Latin American countries.Methods: We used a three-phase mixed methods research design to develop, validate and estimate social accountability in a diverse convenient sample of 49 medical schools from 16 Latin American countries. We used a qualitative framework approach and a Delphi consensus method to design an instrument with high content validity. Finally, we assessed the psychometric properties of the instrument.Results: The Social Accountability Instrument for Latin America (SAIL) contained 21 items in four domains: mission and quality improvement, public policy, community engagement, and professional integrity. Its reliability index, estimated using Cronbach's alpha, was very high (0.96). Most of the medical schools that had ranked over the 80th percentile on traditional national academic estimates did not reach the 80th percentile using SAIL.Conclusions: There are validity arguments (content and reliability) to support the measurement of social accountability using the SAIL instrument. Its application showed that it provides a complementary dimension to that traditionally obtained when estimating quality in medical schools.

Revisión de la educación médica en Chile: logros y desafíos / Review of medical education in Chile: achievements and challenges

La educación médica en Chile ha tenido un importante desarrollo en las últimas décadas. El esfuerzo de distintas instituciones, universidades, sociedades científicas y organizaciones públicas y privadas ha empujado su avance y la han posicionado en un alto estándar de funcionamiento. Esto permite a estudiantes de pre y posgrado el acceso a la formación en salud acorde a un país que quiere avanzar en dar a su población la mejor atención posible. Los avances en áreas de formación con nuevos currículos, el uso de evaluación docente, la acreditación nacional e internacional de los programas, el uso de simulación, la innovación docente y el liderazgo en iniciativas regionales auguran un futuro prometedor y los desafíos se centran en el desarrollo de nuevas estrategias para mejorar el acceso desde una red de instituciones aún dispar en su progreso y de una planificación que regule y potencie el trabajo de la red de educación médica en el ámbito nacional e internacional. El objetivo de este trabajo es detallar el estado actual de la formación médica en Chile y las áreas de trabajo que tienen las más importantes entidades de educación médica del país, destacando las áreas de mayor proyección para articular un proyecto de formación para las futuras generaciones de médicos en Chile

Chilean medical education has developed greatly in the last decade. Different institutions, such as universities, scientific societies and private and public organizations have pushed this development forward, and have allowed and encouraged the high standards at which Chilean medical education is now working. As a consequence undergraduate and postgraduate students have access to health related training that continues to raise the country's medical standard, and goes hand in hand with the country's aim of delivering the best possible health care to its population. Improved training standards, the development of new curricula, regular faculty assessment, national and international accreditation, the use of simulation, teaching innovation and leadership in regional initiatives hold a promising future. Future challenges center on the development of new strategies that allows a network of institutions, at dissimilar stages of progress, improved access to training. And a plan that regulates and enhances the work of the medical education network at a national and international level. The purpose of this paper is to detail the state medical education in Chile, as well as highlighting the most promising areas of development that the best regarded institutions in medical education in Chile are working on, thus articulating a training project for the future generations of medical doctors in Chile

Role of Personality Functioning in the Quality of Life of Patients with Depression.

Depression is associated with reduced quality of life (QoL), and personality pathology is associated with higher impairment and poorer treatment outcomes in patients with depression. This study aims to analyze the effects of personality functioning on the QoL of patients with depression. Severity of depressive symptoms (Beck Depression Inventory), level of personality functioning (Operationalized Psychodynamic Diagnosis Structure Questionnaire), and QoL (Medical Outcome Study 36-item Short-Form) were assessed in a sample of 84 depressive outpatients. Personality functioning showed main effects on both the mental and physical components of QoL. A moderating effect of personality functioning on the relationship between depressive symptoms and QoL was tested but not confirmed. Severity of depressive symptoms was found to mediate the effect of personality functioning on the mental component of QoL. These results suggest that the effect of personality functioning on the QoL of patients with depression may be related to the higher severity of depressive symptoms found in patients with lower levels of personality functioning.

[Domestic violence in Chile]. / Violencia intrafamiliar en Chile y su impacto en la salud: una revisión sistemática.

According to recent surveys, there is a high prevalence of domestic violence (DV) in Chile. A systematic review was conducted in PubMed, Scielo, and Lilacs with the MesH terms "Chile", "Mental Health", "Health", "Domestic Violence", to explore the impact of DV on health in Chile. Eleven studies fulfilled the inclusion criteria. Two studies were prospective, exploring the influence of DV on maternal-infant health. Nine studies explored the influence of DV on mental health in adults. DV was associated with deranged mental health indicators specially anxiety and depressive symptoms and suicidal ideation. Similar results were observed among mothers who were victims of violence and their children. It is concluded that DV is a complex phenomenon with serious effects on health. However the number of studies on the subject is low and new follow up studies are required. Predictive models for DV and effective preventive measures are urgently needed.

Violencia intrafamiliar en Chile y su impacto en la salud: una revisión sistemática / Domestic violence in Chile

According to recent surveys, there is a high prevalence of domestic violence (DV) in Chile. A systematic review was conducted in PubMed, Scielo, and Lilacs with the MesH terms “Chile”, “Mental Health”, “Health”, “Domestic Violence”, to explore the impact of DV on health in Chile. Eleven studies fulfilled the inclusion criteria. Two studies were prospective, exploring the influence of DV on maternal-infant health. Nine studies explored the influence of DV on mental health in adults. DV was associated with deranged mental health indicators specially anxiety and depressive symptoms and suicidal ideation. Similar results were observed among mothers who were victims of violence and their children. It is concluded that DV is a complex phenomenon with serious effects on health. However the number of studies on the subject is low and new follow up studies are required. Predictive models for DV and effective preventive measures are urgently needed.