BackgroundMedical uncertainty is inherently related to the practice of the physician and generally affects his or her patient care, job satisfaction, continuing education, as well as the overall goals of the health care system. In this paper, some new types of uncertainty, which extend existing typologies, are identified and the contexts and strategies to deal with them are studied.MethodsWe carried out a mixed-methods study, consisting of a qualitative and a quantitative phase. For the qualitative study, 128 residents reported critical incidents in their clinical practice and described how they coped with the uncertainty in the situation. Each critical incident was analyzed and the most salient situations, 45 in total, were retained. In the quantitative phase, a distinct group of 120 medical residents indicated for each of these situations whether they have been involved in the described situations and, if so, which coping strategy they applied. The analysis examines the relation between characteristics of the situation and the coping strategies.ResultsFrom the qualitative study, a new typology of uncertainty was derived which distinguishes between technical, conceptual, communicational, systemic, and ethical uncertainty. The quantitative analysis showed that, independently of the type of uncertainty, critical incidents are most frequently resolved by consulting senior physicians (49 % overall), which underscores the importance of the hierarchical relationships in the hospital. The insights gained by this study are combined into an integrative model of uncertainty in medical residencies, which combines the type and perceived level of uncertainty, the strategies employed to deal with it, and context elements such as the actors present in the situation. The model considers the final resolution at each of three levels: the patient, the health system, and the physician’s personal level.ConclusionsThis study gives insight into how medical residents make decisions under different types of uncertainty, giving account of the context in which the interactions take place and of the strategies used to resolve the incidents. These insights may guide the development of organizational policies that reduce uncertainty and stress in residents during their clinical training.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-015-0459-2) contains supplementary material, which is available to authorized users.
Resumen La investigación con enfoque cuantitativo es el paradigma dominante en el campo de la educación médica, y sus criterios de validez son ampliamente aceptados por la comunidad científica, en tanto que la investigación de tipo cualitativo enfrenta el reto de defender la credibilidad y el rigor de sus métodos. El propósito de este artículo es reflexionar en torno a los criterios de autenticidad o calidad en el proceso de elaboración de un estudio cualitativo. Para ello se revisan las diferencias paradigmáticas entre los enfoques cuantitativo y cualitativo. Se describen tres momentos en el camino que ha seguido la investigación cualitativa para establecer sus criterios de rigor científico: 1) convencionales, 2) paralelos y 3) paradigmáticos propios. Desde los inicios de la investigación cualitativa a la época actual se han presentado múltiples perspectivas teóricas y epistemológicas. Se han descrito más de 20 tipos de investigación cualitativa.Se presentan múltiples voces, diferencias y propuestas para entender el rigor de la investigación cualitativa. Se realiza una guía reflexiva de criterios de autenticidad en torno a la fundamentación epistemológica, al método, a las voces que se escuchan, a la implicación en la acción, a los aspectos éticos y al investigador. El momento presente del enfoque cualitativo es de debate, diálogo y controversias marcadas por la multivocalidad. Hay una tendencia a los valores ecológicos y de justicia; de respeto al ambiente y a las comunidades; de considerar en los textos todas las voces, incluyendo las marginadas, para que sus historias se representen con imparcialidad y equidad.
BackgroundBiomedical Informatics (BMI) education in medical schools is developing a sound curricular base, but there are few published reports of their educational usefulness. The goal of this paper is to assess knowledge change and satisfaction in medical students after a BMI curriculum.MethodsThe National Autonomous University of México Faculty of Medicine (UNAM) recently implemented a curricular reform that includes two BMI sequential courses (BMI-1 and BMI-2). The research design was one-group pretest-posttest. An objective test with evidence of validity was used for knowledge measurement. A satisfaction questionnaire was applied at the end of the courses. Two-tailed paired Student’s t-tests were applied, comparing knowledge scores in the pre and post-test for each course.ResultsThe study included student cohorts during two consecutive academic years. The 2013 BMI-1 course (n = 986 students) knowledge pretest score was 43.0 ± 8.6 (mean percent correct ± SD), and the post-test score was 57.7 ± 10.3 (p < 0.001); the 2014 BMI-1 (n = 907) pretest score was 43.7 ± 8.5, and the post-test was 58.1 ± 10.5 (p < 0.001). The 2012 BMI-2 course (n = 683) pretest score was 26.3 ± 7.9, the post-test score was 44.3 ± 13.3 (p < 0.001); the 2013 BMI-2 (n = 926) pretest score was 27.5 ± 7.5, and the post-test was 42.0 ± 11.0 (p < 0.001). The overall opinion of the students regarding the course was from good to excellent, with a response rate higher than 90%. The satisfaction questionnaires had high reliability (Cronbach’s alpha of 0.93).ConclusionsThe study shows a significant increase in BMI knowledge after an educational intervention in four medical student cohorts, and an overall positive evaluation by the students. Long-term follow-up is needed, as well as controlled studies of BMI educational interventions using performance endpoints.
Se argumenta que el proceso de autorregulación se ha convertido en una competencia transversal común a todas las profesiones de la salud por su importancia para el aprendizaje y el desempeño profesional. Se menciona su definición sustentada en la teoría educativa cognitivo social, la cual resalta el valor del compromiso y actuación personal de quien aprende para hacerlo de forma autónoma, independiente y permanente. Además, se describen sus elementos y ventajas. Cómo se enseña y cómo se evalúa el aprendizaje autorregulado, son dos cuestiones que se examinan con múltiples ejemplos y estudios llevados a cabo en los últimos cinco años.
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