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Background: Objective structured clinical examination has advantages over traditional oral examinationt of medical student. However, it is not routinely used in Chile. Aim: To describe the objective structured clinical examination system and report the results of its first use with Chilean medical students. Material and methods: Thirteen interns ware evaluated at the end of their surgical rotation, using the objective structured clinical examination. Thirteen stations were structured for this examination: one for history taking, two for physical examination, four for problem solving and knowledge, one for radiological interpretation, one for instrumental recognition, one for skills and one for text comprehension. There were a total of 88 questions. Results: All students exceeded 60% of requirements. Mean approval score was 73%. The higher score was 80% and the lower 61%. Ten students had a score over 70%. The method was well accepted by teachers and students. Conclusions: This first local experience with the objective structured clinical examination was successful (Rev Méd Chile 2000; 128: 1039-44).

Background: Objective structured clinical examination has advantages over traditional oral examinationt of medical student. However, it is not routinely used in Chile. Aim: To describe the objective structured clinical examination system and report the results of its first use with Chilean medical students. Material and methods: Thirteen interns ware evaluated at the end of their surgical rotation, using the objective structured clinical examination. Thirteen stations were structured for this examination: one for history taking, two for physical examination, four for problem solving and knowledge, one for radiological interpretation, one for instrumental recognition, one for skills and one for text comprehension. There were a total of 88 questions. Results: All students exceeded 60% of requirements. Mean approval score was 73%. The higher score was 80% and the lower 61%. Ten students had a score over 70%. The method was well accepted by teachers and students. Conclusions: This first local experience with the objective structured clinical examination was successful (Rev Méd Chile 2000; 128: 1039-44).

Introducción La formación en Geriatría en estudiantes de pregrado de Medicina en Colombia aún es limitada. El corto tiempo de rotaciones en clínica obliga a adopción de estrategias didácticas más eficientes. Se diseñó un estudio para evaluar el desarrollo de competencias mediante una estrategia de aprendizaje basado en problemas comparado con la metodología tradicional en estudiantes de una universidad de Bucaramanga, Colombia. Metodología Estudio experimental, con enfoque metodológico mixto (cuantitativo y cualitativo). Estudiantes de sexto semestre de Medicina que iniciaban rotación de Geriatría clínica fueron aleatorizados a una estrategia de ABP (intervención) o de seminarios (control). Se definieron competencias, desde el enfoque socioformativo, para el abordaje de dos problemas clínicos (delirium y caídas/osteoporosis). El desarrollo de las competencias se evaluó a través de un examen clínico objetivo estructurado (ECOE) y una prueba escrita. Se realizó entrevista semiestructurada y grupo focal para evaluar percepciones de estudiantes y evaluadores sobre la estrategia didáctica y técnica de evaluación. Resultados Se incluyeron 18 estudiantes (9 por grupo), con edad media de 21 (19-24). 55.6% mujeres. El resultado de la prueba escrita final en el grupo ABP fue de 4.02 vs 3.02 en el control (p0.0053). El puntaje del ECOE en el grupo ABP fue de 2.72 vs 2.03 en control (p 0,0624). Solo 4 estudiantes aprobaron el ECOE, los cuales pertenecieron al grupo ABP. La competencia de trabajo interprofesional tuvo mayor desarrollo en el grupo ABP (3.58 vs 2.04 p 0.0051). La apreciación respecto a la realización de seminarios es que solo demanda conocimiento memorístico; el ABP fortalece el desarrollo de competencias cognitivas y trabajo colaborativo. Respecto a la técnica de evaluación ECOE se resaltó que enfrenta al estudiante a un ambiente más cercano al ejercicio profesional. Conclusiones El ABP favoreció un mayor desarrollo de competencias en Geriatría tanto en la prueba escrita como en el ECOE. Hubo una mejor resolución de las estaciones concernientes a capacidad de interrogatorio, realización de pruebas funcionales y trabajo interprofesional. RESUMEN 11 ABSTRACT 13 INTRODUCCIÓN 15 1. PROBLEMA DE INVESTIGACIÓN 18 1.1. Descripción del problema 18 1.2. Limitaciones y delimitaciones 21 1.3. Objetivos de la investigación 21 1.3.1. Objetivo general: 21 1.3.2. Objetivos específicos: 22 1.4. Justificación 22 1.5. Antecedentes 24 1.5.1. Experiencias de ABP en el mundo 24 1.5.2. Experiencias de ABP en España 28 1.5.3. ABP en Colombia 29 2. MARCO DE REFERENCIA 34 2.1. Marco teórico 34 2.1.1. La teoría experiencial de Dewey 34 2.1.2. Aprendizaje significativo 35 2.1.3. Interacción social-cognitiva. 35 2.1.4. ABP y razonamiento clínico 37 2.1.5. Enfoque socio formativo 38 2.1.5.1. Evaluación de competencias: método matricial complejo 39 2.1.5.2. Niveles de dominio de las competencias 42 2.1.6. Competencias en Medicina clínica 44 2.1.6.1. Examen Clínico Objetivo Estructurado (ECOE) 46 2.2. Marco contextual 48 2.3. Marco legal 49 2.4. Marco conceptual 51 2.4.1. Didáctica 51 2.4.2. Aprendizaje Basado en Problemas 52 2.4.3. Competencia 53 2.4.4. Geriatría 54 2.4.5. Caída 54 2.4.6. Delirium 54 2.4.7. Seminario 56 3. METODOLOGÍA 57 3.1. Enfoque metodológico 57 3.2. Métodos de investigación 58 3.2.1. Tipo de estudio: estudio experimental. Ensayo educativo. 58 3.2.2. Población y muestra 58 3.2.2.1. Tamaño de la muestra 59 3.2.2.2. Criterios de inclusión 59 3.2.2.3. Criterios de exclusión 60 3.2.3. Técnicas e instrumentos de medición 60 3.2.4. Validación de instrumentos 61 3.2.5. Consideraciones éticas 63 3.2.6. Desarrollo de la investigación 64 3.2.6.1. Rotación de Geriatría Clínica 64 3.2.6.2. Procedimiento y aleatorización 65 3.2.6.3. Competencias en Geriatría Medicina UNAB 66 3.2.6.4. Evaluación del desarrollo de competencias 69 3.2.6.4.1. Prueba escrita 69 3.2.6.4.2. Evaluación ECOE 74 3.2.6.4.3. Autoevaluación 78 4. ANÁLISIS Y RESULTADOS 79 4.1. Análisis estadístico 80 4.1.1. Variables del estudio 81 4.1.2. Mapa de variables y categorías 84 4.2. Resultados 85 4.2.1. Estudio cuantitativo 85 4.2.1.1. Características demográficas 86 4.2.1.2. Secuencias didácticas 90 4.2.1.3. Prueba de conocimiento escrita 92 4.2.1.4. Examen Clínico Objetivo Estructurado (ECOE) 95 4.2.1.5. Nivel de dominio de las competencias 104 4.2.1.6. Autoevaluación 107 4.2.2. Estudio cualitativo 108 4.2.2.1. Entrevista semiestructurada 109 4.2.2.2 Grupo FOCAL 119 5. CONCLUSIONES Y RECOMENDACIONES 123 Referencias bibliográficas 129 Anexos 137 Maestría Introduction Geriatric education in undergraduate students of Medicine in Colombia is still limited. The short time of clinic rotations forces the adoption of more efficient teaching strategies. A study was designed to evaluate the development of skills through a problem-based learning (PBL) strategy compared to the traditional methodology in students of a university in Colombia. Methodology Experimental study, with a mixed methodological approach (quantitative and qualitative). Sixth semester students of Medicine who began clinical Geriatrics rotation were randomized to an PBL strategy (intervention) or seminars (control). Skills were defined, from the socioformative approach, to address two clinical problems (delirium and falls / osteoporosis). The evaluation consisted of a objetive structured clinical evaluation (OSCE) and a written test. Semi-structured interview and focal group were conducted to evaluate perceptions of students and evaluators on the didactic strategy and evaluation technique. Results 18 students (9 per group) were included, with a media age of 21 (19-24). 55.6% women. The final written test result in the PBL group was 4.02 vs. 3.02 in control (p0.0053). The OSCE score in PBL group was 2.72 vs. 2.03 in control (p 0.0624). Only 4 students approved the OSCE, which belonged to the PBL group. The interprofessional work skill had greater development in the PBL group (3.58 vs. 2.04 p 0.0051). The appreciation regarding the realization of seminars is that it only demands memorial knowledge; PBL strengthens the development of cognitive skills and collaborative work. Regarding the OSCE evaluation technique, it was highlighted that the student faces an environment closer to the professional practice. Conclusions The PBL favored a greater development of geriatrics skills both in the written test and in OSCE. There was a better resolution of the stations concerning interrogation skill, performance of functional tests and interprofessional work.

Background: Outcomes-based education is a trend in medical education and its assessment is one of the main challenges. The Objective Structured Clinical Examination (OSCE) is one of the tools used to assess clinical competencies. Although Chilean medical schools have used OSCEs for 18 years, there is a vast variability in the way these examinations are administered. Aim: To design and implement an integrated OSCE to assess clinical competencies at the end of the medical program in Chilean medical schools, aiming to reduce variability between these schools. Material and Methods: Seven medical schools, supported by experts from the National Board of Medical Examiners, designed a 12 station OSCE to measure clinical outcomes at the end of the seventh year of medical training. Unlike traditional OSCEs, this new examination incorporated the assessment of clinical reasoning and communication skills, evaluated from patients’ perspective. Results: One hundred twenty-five volunteers took the same exam at five different venues. The internal consistency was 0.62. Following a compensatory approach, 85% of students passed the exam. Communication assessment showed poorer results than those reported in the literature. Conclusions: Among Chilean medical students, the assessment of clinical outcomes in a collaborative way, through a valid and reliable exam, is feasible. A consensus on how to teach and assess clinical reasoning across the medical curriculum is required. The assessment of students’ communication skills requires further development.

Introducción: La valoración preanestésica (VP) es una competencia compleja que debe adquirir el residente de anestesia tempranamente. La incorporación de enfermería especializada en la VP ha demostrado ser segura y eficaz. No existen recomendaciones para el entrenamiento en VP. La simulación puede ser una metodología apropiada para acortar el tiempo de adquisición de la competencia. Objetivo: Describir detalladamente el diseño y aplicación de un taller de simulación para formar residentes de anestesiología y enfermeras posgraduadas en la competencia VP. Sujetos y métodos: Taller de dos horas de duración con casos clínicos en formato video y ejecutados mediante técnica de role-playing. Los componentes fueron dos videos de grabación propia (el primero, de una VP con errores, y el otro, con una VP correctamente realizada), una plantilla para que cada alumno valorara en los videos los componentes técnicos y no técnicos de las competencias de la VP y una encuesta de satisfacción para alumnos e instructores. En el grupo de residentes se añadieron tres escenarios de VP de pacientes complejos. Resultados: Se analizaron las encuestas de los 10 residentes de dos promociones y de 60 enfermeras. La satisfacción de los dos tipos de alumnos y de los instructores sobre el aprendizaje fue muy alta. En el caso de las enfermeras, más del 85% de las alumnas de las promociones que recibieron el taller superaron la estación VP de la evaluación clínica objetiva estructurada (ECOE) frente a sólo el 20% de la promoción anterior. Conclusiones: El taller de VP con formato video y role-playing permite entrenar la competencia VP a residentes de anestesia y enfermeras posgraduadas, mejorando el rendimiento de éstas en la ECOE. Introduction: Preoperative anesthetic assessment (PA) is a complex competence that anesthesia residents should acquire early in their training. Participation of specialized nurses in the PA is increasing since it is safe and efficacious. There is not an established curriculum in PA. Simulation may be an adequate methodology to train PA. Aim: To describe in detail the design and application of a simulation workshop for training residents and postgraduate nurses in the competence PA. Subjects and methods: Workshop of 2 hours duration, with clinical cases combining videotapes and role-playing. Workshop components were two homemade videos, one with a PA with errors and the other one with a correct PA, a checklist in which each participant assesses technical and non-technical components of the PA and a satisfaction survey for students and instructors. Three simulation scenarios of PA in complex patients were added for residents. Results: 10 residents and 60 nurses participating in the workshop were surveyed. Satisfaction with the methodology applied was high for students and instructors. The percentage of passing the PA station of the final objective structured clinical examination (OSCE) of two promotions of nurses that had participated in the workshop was over 85% compared with only 20% of the previous promotion. Conclusions: A simulation workshop based on videos and role-playing allows to train the competence PA in anesthesia residents and postgraduate nurses, improving the performance of the latter in the OSCE.

Background: The University of Chile, backed by its extensive experience in Objective Structured Clinical Examinations (OSCEs), performs the practical exam to graduates of foreign medical school in this format. This test format would give more guarantees of validity and fairness as compared with the previous oral examination that was required for title revalidation. Aim: To compare the performance of graduates of foreign medical schools and last year medical students of the University of Chile in the same internal medicine OSCE. Material and Methods: Seventy-seven last year medical students and thirty-three graduates of foreign medical schools participated in the same Internal Medicine OSCE, but in different moments. At the end of the examination, graduates of foreign medical schools answered a questionnaire about their prior experience with OSCEs and about their perception about this type of examination. Results: The performance of graduates of foreign medical schools was lower than those of our last year medical students in four of the eight stations of the examination. Graduates of foreign medical schools considered the examination objective, fair, and that it assessed skills adequately and that the degree difficulty was homogeneous for all examinees. Conclusions: The possibility of obtaining comparable results in a transparent process makes the OSCE the assessment tool of choice for title revalidation of physicians migrating from foreign countries.

Background: The University of Chile, backed by its extensive experience in Objective Structured Clinical Examinations (OSCEs), performs the practical exam to graduates of foreign medical school in this format. This test format would give more guarantees of validity and fairness as compared with the previous oral examination that was required for title revalidation. Aim: To compare the performance of graduates of foreign medical schools and last year medical students of the University of Chile in the same internal medicine OSCE. Material and Methods: Seventy-seven last year medical students and thirty-three graduates of foreign medical schools participated in the same Internal Medicine OSCE, but in different moments. At the end of the examination, graduates of foreign medical schools answered a questionnaire about their prior experience with OSCEs and about their perception about this type of examination. Results: The performance of graduates of foreign medical schools was lower than those of our last year medical students in four of the eight stations of the examination. Graduates of foreign medical schools considered the examination objective, fair, and that it assessed skills adequately and that the degree difficulty was homogeneous for all examinees. Conclusions: The possibility of obtaining comparable results in a transparent process makes the OSCE the assessment tool of choice for title revalidation of physicians migrating from foreign countries.

Las nuevas necesidades derivadas de los actuales cambios sociales, económicos, tecnológicos, científicos, etc..., han hecho que distintos organismos hayan sugerido a los estamentos educativos la necesidad de desarrollar cambios en las estrategias educativas orientados al desarrollo de un profesional eficaz con competencias adaptadas a estas necesidades. Dentro de las estrategias "modernas" se encuentra la enseñanza basada en problemas o aprendizaje por problemas (PBL), mediante la cual el estudiante busca y selecciona la información, razona e integra los conocimientos previos y adquiridos, dando finalmente unas posibilidades diagnósticas y terapéuticas al problema planteado, tal y como se va a enfrentar en su actividad profesional. Los conocimientos previos y la actividad constituyen los pilares fundamentales del aprendizaje. El PBL incorpora algunos de los aspectos de la psicología cognitiva, modelo cuya parte principal determina la naturaleza de las estructuras del conocimiento que se encuentran en la memoria activa, en los procesos de almacenamiento y recuperación de la información y los diversos factores que lo activan. La urología en la Facultad de Medicina de la Universidad de Castilla-La Mancha forma parte de una asignatura troncal (Patología Médica y Quirúrgica II) que se imparte durante el quinto curso. La urología se desarrolla integrada con nefrología. El número de alumnos por curso es aproximadamente 75 divididos en 5 grupos. La "rotación" dura seis semanas durante las cuales los estudiantes tienen una media de 2 horas diarias de teoría (ya sean de nefrología y/o urología) y el resto son rotatorias por distintas actividades: tres semanas en nefrología y tres semanas en urología. Al finalizar la rotación los estudiantes realizan un examen teórico conjunto con 100 preguntas de respuestas múltiple (50 de urología) y un examen práctico de las habilidades. A final de curso existe otra prueba práctica (OSCE: examen clínico objetivo y estructurado) con la utilización de pacientes estandarizados, debiendo el profesor evaluar de forma directa el nivel de competencias adquiridas ante un "caso real". Ongoing changes in the social, economic, technological and scientific realms have generated new needs and led various organizations to suggest that educational institutions should reorient their educational strategies toward developing effective professionals with the skills to meet these needs. These "modern" strategies include problem-based learning, in which the student seeks and selects information, analyzes the data obtained, integrates both prior and newly acquired knowledge, and, finally, offers diagnostic and therapeutic options to resolve the problem posed, as would occur in professional practice. With this approach, prior skills and practical experience form the foundation of learning. Problem-based learning incorporates some aspects of cognitive psychology, a model that mainly centers on the nature of the knowledge structures found in active memory, the processes involved in information storage and retrieval and the various factors that activate these processes. At the Faculty of Medicine of the Universidad de Castilla-La Mancha, urology is part of a core subject (Medical and Surgical Pathology II) taught in the fifth year of coursework together with nephrology. Each course includes approximately 75 students, divided into five groups. The rotation lasts six weeks, with students spending a mean of two hours a day on theory (nephrology and/or urology) and the remaining time on rotations in the various activities: three weeks in nephrology and three weeks in urology. Upon completion of the rotation, the students write a combined theoretical examination with 100 multiple-choice questions (50 on urology) and take a practical skills examination. At the end of the course, another practical test consisting of an objective, structured clinical examination is taken, in which standard patients are used and the professor directly assesses the level of skills acquired with a "real" case.