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Objetivo: Determinar el desarrollo de habilidades, los conocimientos y los niveles de confianza en el campo de la cirugía abierta en un grupo de estudiantes de pregrado de medicina que pretendan realizar una especialidad quirúrgica., Método: Se llevó a cabo un estudio en un grupo de estudiantes de sexto año de medicina con el enfoque de realizar una especialidad quirúrgica. Todos los participantes recibieron un entrenamiento teórico-práctico de habilidades en cirugía abierta. Se emplearon métodos de evaluación previamente validados. Se utilizó la prueba estadística t de Student para muestras pareadas., Resultados: La media en la evaluación previa al entrenamiento fue del 28%, mientras que la media en la evaluación final del entrenamiento fue del 63%. Durante el procedimiento quirúrgico se empleó el método de evaluación OSATS (Objective Structured Assessment of Technical Skills), del cual se obtuvo un promedio del 70 ± 14%. De acuerdo con el nivel de confianza de los participantes, antes de haber recibido el entrenamiento el 60% se autopercibió como ligeramente confiado, y al finalizarlo, el 80% se autopercibió como muy confiado., Conclusiones: La implementación de este tipo de entrenamientos en estudiantes de pregrado podría ser costo-efectiva y permitiría que los cirujanos en formación alcanzarán en menor tiempo las competencias necesarias., Objective: To determine the development of skills, knowledge, and trust levels in the field of open surgery among a group of undergraduate students enrolled in the medicine curricula who intend to undergo further training in a surgical specialty., Method: A quasi-experimental study with a pre-post test design was performed upon a group of sixth-year medical students who intend to undergo surgical specialty training. All participants had previously received a 2-week theoretical and practical open-surgery skills training; previously validated evaluation methods were enforced. A paired sample T-test was used for this analysis., Results: Median pre-training score for the 13 basic skills was 28%, whereas post-training median score was 63%. During the surgical procedure, OSATS (Objective Structured Assessment of Technical Skills) method was applied, with average results of 70 ± 14%. Regarding self-confidence levels among participants, 60% of the participants referred as being slightly confident before undergoing training, as opposed to an 80% of students perceiving themselves as highly confident after completing training., Conclusion: The implementation of skill training for undergraduate students could prove cost-effective in the medical environment, allowing surgeons-to-be to reach the necessary competences in less time in accordance to current study plans., (Copyright: © 2018 Permanyer.)

Background: "Surgical scrub" of the hands and arms is a fundamental procedure for reducing infection risk. We undertook this study in order to compare different antiseptics and their microbicidal effects, costs and times of the procedures., Methods: Thirty students followed the surgical scrub procedure using benzalkonium chloride. Seven days later the students used povidone-iodine and, 7 days after that, they used chlorhexidine/alcohol. After the surgical scrub, cultures were obtained from the palms of their hands and from their nail beds. The students wore sterile gloves, which were removed 30 min later to obtain new cultures from the same sites. The cost of the products was calculated in Mexican pesos and the time of each procedure was measured in minutes., Results: There was a statistically significant difference in the number of colony-forming units (CFUs). The number of CFUs was lower in the groups of students who used chlorhexidine/alcohol and povidone-iodine as compared to the benzalkonium chloride group. There was no difference between chlorhexidine/alcohol and povidone-iodine. Costs were higher for povidone-iodine and benzalkonium chloride compared to chlorhexidine/alcohol. Procedure times were similar with povidone-iodine and benzalkonium chloride but the time was reduced approximately five times when using chlorhexidine/alcohol., Conclusions: It is a proven fact that the lack of surgical scrub favors wound infections, longer hospital stays and increased costs. Therefore, further studies are needed to determine the best antiseptic according to cost/benefit. Chlorhexidine/alcohol proved to be the superior antiseptic in terms of cost/benefit compared to povidone-iodine and benzalkonium chloride.

Background: Ingestion of foreign bodies represents a common feature in psychiatric patients and prisoners. Bezoar is a conglomeration of partially or undigested foreign material in the gastrointestinal tract. These are classified into several types according to the materials which they are composed of, the least frequent being metals. There are few cases reported in the literature., Clinical Case: We report a case of a patient with a pathological history of mental disorder. The patient complained of abdominal pain 24 h prior, and there were no other symptoms. Physical examination revealed pain in the upper quadrant without peritoneal irritation. Laboratory tests were normal and plain x-ray of the abdomen showed several metallic foreign bodies, some sharp, >5 cm in length and with intestinal prolongation. Surgical intervention was performed several hours later: gastrotomy to remove the gastric bezoar that was composed of several screws, nails, scrap metal, lighters, clothespins, radio antennas and one coin. Four metallic foreign bodies were found in the small bowel after reviewing the abdominal cavity, so enterotomy was also performed to remove them. Postoperative course was uneventful., Conclusions: Surgical treatment must be considered in cases of multiple, large, sharp objects or complications. An exhaustive study of the case is essential to avoid delay in treatment and potential complications.

We present the development and validation of a measurement instrument intended to estimate the degree of vinculation between the theoretical and practical learning activities of medical residents in their usual working conditions in hospitals. The main reason for residents to read medical literature is to find support to their decisions when treating patients. Based on this perspective we designed a self-applied questionnaire that explores diverse circumstances in which the vinculation between theory and practice may be expressed. This instrument was validated through rounds of experts in terms of its construction and content. Its external validity was explored with two groups of internal medicine residents with a different degree of vinculation between theory and practice: one high and the other with a low vinculation. In addition, we designed a guide for the direct observation of the theoretical and practical clinical learning activities in order to estimate its concordance with the results of the questionnaire. The questionnaire was able to discriminate the group differences and showed a satisfactory concordance with the information provided by direct observation. A copy of the questionnaire is available by request to the authors. We conclude that in its present stage of development, the instrument has shown internal and external validity and may be used to explore the process training of medical residents.

A new phase in the development of an instrument designed for the measurement of clinical competence is presented. The instrument (exam type) was previously validated; we report its use in three generations of students of a specialization course in internal medicine: those recently admitted to the course (group I); those finishing their first training year (group II) and those finishing the second year (group III). In the exam 304 out of the 600 questions included were classified as "experimental" (dealing with knowledge in internal medicine) and the remaining 296 questions corresponded to "control" questions (dealing with knowledge in other specialties). The variables considered in the exam were: 1) global result; 2) usage of diagnostic indicators; 3) omission of necessary procedures without a iatrogenic effect; 4) commission of unnecessary procedures without a iatrogenic effect; 5) omission of necessary procedures with resulting iatrogenic consequences; 6) commission of unnecessary procedures with resulting iatrogenic consequences; 7) global omission (variables 3 and 5); 8) global commission (variables 4 and 6); 9) global iatrogenesis (variables 5 and 6); 10) knowledge in nosology. Scores obtained by the three groups on the experimental questions differed in accordance with the respective time of clinical experience (group I obtained the lowest scores, group II showed intermediate scores, and group III showed the highest scores). Analysis of variance was significant (p less than 0.05) in variables 1, 2, 6, 8 and 9. The scores obtained by the three groups on the control questions were similar. In conclusion, we believe that this instrument is capable of detecting learning dependent on the time of clinical experience.(ABSTRACT TRUNCATED AT 250 WORDS)

The study is divided in two parts. The first one deals with theoretical aspects of evaluation. In the second part, the development of an instrument intended to explore clinical competence is presented. The importance of considering evaluation as part of a research process is emphasized in the first part. The diverse theoretical and action trends in the field of education are synthetized in two main tendencies: the active-participating and the passive-receptive. The influence of these two tendencies in the selection the objects for evaluation is also discussed. An evaluation instrument developed by us to explore clinical competence is placed within the active-participating tendency of education; the present state of this instrument is given in the second part. The instrument consists of multiple choice options of the true, false, don't know type. The instrument in its present version is the result of a long validation process. It explores particularly iatrogenic behaviors by omission or commission. The sample studied were 457 applicants for specialization courses in medicine. Of these, 127 were foreign applicants. The instrument was applied to the whole sample in one single session. The results showed a low general clinical competence, with similar results in mexican and foreign applicants. A clear difference was found in commission iatrogenia which was significantly more frequent than omission iatrogenia. The theoretical superiority of our test in relation the others is discussed.