Evaluación de competencias clínicas en los contextos médicos curriculares actuales

Autores/as

DOI:

https://doi.org/10.18270/rsb.v8i1.2375

Palabras clave:

Educación médica, Evaluación educacional, Competencia clínica, Educación basada en competencias, Métodos, Estándares

Resumen

La introducción de los nuevos modelos curriculares en la enseñanza de la medicina en todos sus niveles, ha traído consigo grandes cambios que han llevado a la consolidación de nuevas formas de enseñar y de evaluar. En el aprendizaje basado en competencias las evaluaciones únicas ya no son prácticas, por lo que hay una exigencia de distintas aproximaciones a los conocimientos y al quehacer del estudiante en su proceso formativo.

En esta revisión se busca hacer una síntesis de las herramientas de evaluación de competencias clínicas más difundidas a nivel mundial. Se presentan las diferentes aproximaciones a la dura tarea de consolidar un cuerpo integrado de distintos puntos de vista, que permitan al docente y a las instituciones co­nocer qué tanto se acercan los estudiantes al perfil establecido por cada una de ellas y cómo están preparando a los profesionales que exige esta época.

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Biografía del autor/a

Rodrigo Castro-Rebolledo, Dirección académica y científica. Teamekia SAS Bogotá, Colombia

Dirección académica y científica.
Teamekia SAS
Bogotá, Colombia

Referencias bibliográficas

van der Veken J, Valcke M, De Maeseneer J, Derese A. Impact of the transition from a conventional to an inte¬grated contextual medical curriculum on students’ learning patterns: A longitudinal study. Med Teach. 2009;31:433-41.

Brauer DG, Ferguson KJ. The integrated Curricu¬lum in medical education. AMEE Guide No. 96. Med Teach. 2015;37:312-22.

Cooke M, Irby DM, Sullivan W, Ludmerer KM. American medical education 100 years after the Flexner report. N Engl J Med. 2006;355:1339-44.

Klement BJ, Paulsen DF, Wineski LE. Anatomy as the back¬bone of an integrated first year medical curriculum: Design and implementation. Anat Sci Educ. 2011;4:157-69.

Wijnen-Meijer M, Cate OT, Rademakers JJ, van der Scha¬af M, Borleffs JC. The influence of a vertically integrated curriculum on the transition to postgraduate training. Med Teach. 2009;31:e528-32.

Bandiera G, Boucher A, Neville A, Kuper A, Hodges B. Integration and timing of basic and clinical sciences edu¬cation. Med Teach. 2013;35:381-7.

Harden RM, Stamper N. What is a spiral curriculum? Med Teach. 1999;21:141-3.

Harden RM. Curriculum mapping: A tool for transparent and authentic teaching and learning. AMEE Guide No. 21. Med Tech. 2001;23:123-37.

Harden RM, Sowden S, Dunn WR. Educational strategies in curriculum development: The spices model. Med Educ. 1984;18:284-97.

Regehr G, Norman GR. Issues in cognitive psycholo¬gy: Implications for professional education. Acad Med. 1996;71:988-1001.

O’Neill PA. The role of basic sciences in a problem based learning clinical curriculum. Med Educ. 2000;34:608-13.

Whitcomb ME. Transforming medical education: Is com¬petency-based medical education the right approach? Acad Med. 2016;91:618-20.

O´Keefe M, Henderson A, Chick R. Defining a set of com¬mon interprofessional learning competencies for health profession students. Med Teach. 2017;39:463-8.

Gruppen LD, Burkhardt JC, Fitzgerald JT, Funnell M, Haf¬tel HM, Lypson ML, et al. Competency-based education: Programme design and challenges to implementation. Med Educ. 2016;50:532-9.

Holmboe ES, Realizing the promise of Competency-Based Medical Education. Acad Med. 2015;90:411-3.

Frank JR, Snell LS, Cate OT, Holmboe ES, Carraccio C, Swing SR, et al. Competency-based medical education: Theory to practice. Med Teach. 2010;32:638-45.

Logio LS. Shifting approaches for evaluation of resident performance. From competencies to milestones. JAMA. 2016;316:2197-9.

ACGME-Accreditation Council for Graduate Medical Edu¬cation. Milestones. Fecha de consulta: 20 de agosto de 2017. Disponible en: http://www.acgme.org/What-We-Do/ Accreditation/Milestones/Overview.

Albanese MA, Mejicano G, Mullan P, Kokotailo P, Grup¬pen L. Defining characteristics of educational competen¬cies. Med Educ. 2008;42:248-55.

Council on Linkages between Academia and Public Health Practice. Core competencies for public health pro¬fessionals. 2014. Fecha de consulta: 18 de noviembre de 2017. Disponible en: http://www.phf.org/resourcestools/ Documents/Core_Competencies_for_Public_Health_ Professionals_2014June.pdf.

Des Cruser A, Brown SK, Ingram JR, Papa F, Podawiltz AL, Lee D, et al. Medical Science Educator Practitioner Research Literacy Skills in Undergraduate Medical edu¬cation: Thinking Globally, acting locally. Med Sci Educ. 2012;22:162-84.

Kassebaum DG, Eaglen RH. Shortcomings in the evalua¬tion of student’s clinical skills and behaviors in medical school. Acad Med. 1999;74:842-9.

Casey PM, Goepfert AR, Espey EL, Hammound MM, Kacz¬maczyk JM, Katz NT, et al. To the point: Reviews in medi¬cal education –the Objective Structured Clinical Examina¬tion. Am J Obst Gynecol 2009;200:25-34.

Branch WP, Paranjape A. Feedback and reflection: Teaching methods for clinical settings. Acad Med. 2002;77:1185-8.

Holmboe ES, Sherbino J, Long DM, Swing SR, Frank JR. The role of assessment in competency-based medical edu¬cation. Med Teach. 2010;32:676-82.

Gipps C. Socio-cultural aspect of assessment. Rev Educ Res. 1999;24:355-92.

Gibbs G, Simpson C. Conditions under which assessment supports student learning. Learn Teach Higher Educ. 2004- 2005;1:3-31.

Kirch W, Schafii C. Misdiagnosis at a university hospital in 4 medical eras. Medicine (Baltimore). 1996;75:29-40.

Chellis M, Olson J, Agustine J, Hamilton G. Evaluation of missed diagnoses for patients admitted from the emergen¬cy department. Acad Emerg Med. 2001;8:125-30.

Kachalia A, Gandhi TK, Puopolo AL, Yoon C, Thomas EJ, Griffey R, et al. Missed and delayed diagnoses in the emer¬gency department: A study of closed malpractice claims from 4 liability insurers. Ann Emerg Med. 2007;49:196-205.

Beck RS, Daughtride R, Sloane PD. Physician-patient com¬munication in the primary care office: A systematic review. J Am Board Fam Med. 2002;15:25-38.

Dean MD, Oetzel J, Sklar DP. Communication in acute ambulatory care. Acad Med. 2014;89:1617-22.

Finset A. 50 years of research on the effect of physician communication behavior on health outcomes. Patient Educ Couns. 2014;96:1-2.

Norcini J, Burch V. Workplace-based assessment as an educational tool: AMEE Guide No. 31. Med Teach. 2007;29:855-71.

Miller GE. The assessment of clinical skills/competence/ performance. Acad Med. 1990;65:S63-7.

Case SM, Swanson DB. Cómo elaborar preguntas para evaluaciones escritas en el área de ciencias básicas y clí¬nicas. National Board of Medical examiners. 3ª edición. Philadelphia; 2006.pp.71-97.

Lake FR, Vickery AW, Ryan G. Teaching on the run tips 7: Effective use of questions. Med J Aust. 2005;182:126-7.

Germain F, Vicente J, Pérez-Rico C, Villa P. Formulación de preguntas de respuesta múltiple: un modelo de aprendiza¬je basado en competencias. FEM. 2016;19:27-38.

Beullens J, Struyf E, van Dame B. Do extended matching multiple-choice questions measure clinical reasoning? Med Educ. 2005;39:410-7.

Dory V, Gagnon R, Charlin B. Is case-specificity content-specificity? An analysis of data from extended-matching questions. Adv in Health Sci Educ. 2010;15:55-63.

Harden RM, Stevenson M, Downie WW, Wilson GM. As¬sessment of clinical competence using objective structured examination. Br Med J. 1975;1:447-51.

Harden RM, Gleeson FA. Assessment of clinical compe¬tence using an objective structured clinical examination (OSCE). Med Educ. 1979;13:41-54.

Harden RM. Revisiting “Assessment of clinical competence using an objective structured clinical examination (OSCE)”. Med Educ. 2016;50:376-9.

Abdelaziz A, Hany M, Atwa H, Talaat W, Hosny S. Deve¬lopment, implementation, and evaluation of an integrated multidisciplinary Objective Structured Clinical Examina¬tion (OSCE) in primary health care settings within limited resources. Med Teach. 2016;38:272-9.

Lucchetti G, Ezequiel OS, Lucchetti ALG. An OSCE with very limited resources: Is it posible? Med Teach. 2017;39:227.

Graf J, Smolka R, Simoes E, Zipfel S, Junne F, Holderried F, et al. Communication skills of medical students during the OSCE: Gender-specific differences in a longitudinal trend study. BMC Med Educ. 2017;17:1-9.

ACGME. Outcome Project. Fecha de consulta: 20 de julio de 2017. Disponible en: http://www.acgme.org/outcome/ assess/toolbox.asp.

Pugh D, Bhanji F, Cole G, Dupre J, Hatala R, Humphrey- Murto S, et al. Do OSCE progress test scores predict perfor¬mance in a national high-stakes examination? Med Educ. 2016;50:351-8.

Yang YY, Lee FY, Hsu HC, Huang CC, Chen JW, Lee WS, et al. A core competence-based objective structured clinical examination (OSCE) in evaluation of clinical performance of postgraduate year-1 (PGY1) residents. J Chin Med Assoc. 2011;74:198-204.

Short MW, Jorgensen JE, Edwards JA, Blankenship RB, Roth BJ. Assessing intern core competencies with an Ob¬jective Structured Clinical Examination. J Grad Med Educ. 2009;1:30-6.

Lafleur A, Laflamme J, Leppink J, Coté L. Task demands in OSCEs influence learning strategies. Teach Learn Med. 2017;29:286-95.

Lafleur A, Leppink J, Coté L. Clinical examination in the OSCE era: Are we maintaining the balance between OS and CE? Postgrad Med J. 2017;93:241.

Ben-David MF. AMEE Guide No. 18: Standard setting in student assessment. Med Teach. 2000;22:120-30.

Wilby KJ, Diab M. Key challenges for implementing a Canadian-based objective structured clinical examina¬tion (OSCE) in a Middle Eastern context. Can Med Educ J. 2016;7:e4-9.

Lowry S. Assessment of students. BMJ. 1993;306:51-4.

Frank C. Evidence based checklist for objective structured clinical examinations. BMJ. 2006;333:546-8.

Selby C, Osman L, Davis M, Lee M. Set up and run an objective structured clinical exam. BMJ. 1995;310:1187-90.

Schleicher I, Leitner K, Juenger J, Moeltner A, Ruesseler M, Bender B, et al. Does quantity ensure quality? Stan¬dardized OSCE-stations for outcome-oriented evaluation of practical skills at different medical faculties. Ann Anat. 2017;212:55-60.

Schleicher I, Leitner K, Juenger J, Moeltner A, Ruesseler M, Bender B, et al. Examiner effect on the objective structured clinical exam – a study at five medical schools. BMC Med Educ. 2017;17:71-7.

Wilkinson TJ, Frampton CM, Thompson-Fawcet M, Egan T. Objectivity in objective structured clinical examinations: Checklists are no substitute for examiner commitment. Acad Med. 2003;78:219-23.

Walsh E, Foley T, Sinnot C, Boyle S, Smithson H. Develo¬ping and piloting a resource for training assessors in use of the Mini-CEX (mini clinical evaluation exercise). Educ Prim Care. 2017;28:243-5.

Norcini JJ, Blank LL, Fortna GS. The Mini-CEX: A method for assessing clinical skills. Ann Intern Med. 2003;138:476-81.

Brazil V, Ratcliffe L, Zhang J, Davin L. Mini-CEX as a work¬place-based assessment tool for interns in an emergency.department – Does cost outweigh value? Med Teach. 2012;34:1017-23.

Holmboe ES, Huot S, Chung J, Norcini JJ, Hawkins RE. Construct validity of the mini Clinical Evaluation Exercise (MiniCEX). Acad Med. 2003;78:826-30.

Kim S, Willett LR, Noveck H, Patel MS, Walker JA, Terre¬gino CA. Implementation of Mini-CEX requirement across all third-year clerkships. Teach Learn Med, 2016;28:424-31.

Hill F, Kendall K, Galbraith K, Crossley J. Implemen¬ting the undergraduate mini-CEX: A tailored approach at Southampton University. Med Educ. 2009;43:326-34.

Baños JE, Gomar-Sancho J, Guardiola E, Palés-Argullós J. La utilización del Mini Clinical Evaluation Exercise (mini- CEX) en estudiantes de medicina. FEM. 2015;18:417-26.

Eggleton K, Goodyear-Smith F, Paton L, Falloon K, Wong C, Lack L, et al. Reliability of Mini-CEX assessment of me¬dical students in general practice clinical attachments. Fam Med. 2016;48:624-30.

Lau-Yanting S, Sinnathamby A, Wang D, Tan Mon Heng M, Wen Hao JL, Shing Lee S, et al. Conceptualizing work place based assessment in Singapore: Undergraduate Mi¬ni-Clinical Evaluation Exercise experiences of students and teachers. Tzu Chi Med J. 2016;28:113-20.

Mortaz Hejri S, Jalili M, Shirazi M, Masoomi R. The utility of mini-Clinical Evaluation Exercise (mini-CEX9 in under¬graduate and postgraduate medical education:

protocol for a systematic review. Syst Rev. 2017;6:146.

Khalil S, Aggarwal A, Mishra D. Implementation of a Mini- Clinical Evaluation Exercise (Mini-CEX) program to assess the clinical competence of postgraduate trainees in pedia¬trics. Indian Pediatr. 2017;54:284-87.

Joshi MK, Singh T, Badyal DK. Acceptability and feasibi¬lity of mini-clinical evaluation exercise as a formative as¬sessment tool for workplace-based assessment for surgical postgraduate students. J Postgrad Med. 2017;63:100-5.

Castanelli DJ, Jowsey T, Chen Y, Weller JM. Perceptions of pur¬pose value and process of the mini-Clinical Evaluation Exercise in anesthesia training. Can J Anesth. 2016;63:1345-56.

Goel A, Singh T. The usefulness of Mini Clinical Evaluation Exercise as a learning tool in different pediatric clinical set¬tings. Int J Appl Basic Med Res. 2015;5:S32-4.

Abadie Y, Battolla J, Zubieta A, Dartiguelongue J, Pascual C, Elias Costa C, et al. Uso de descriptores durante la im-plementación de Mini-CEX en la residencia de pediatría. Medicina (Bs As). 2015;75:289-96.

Davies H, Archer J, Southgate L, Norcini J. Initial evalua¬tion of the first year of the foundation assessment program¬me. Med Educ. 2009;43:74-81.

Montagne S, Rogausch A, Gemperli A, Berendonk C. The mini-clinical evaluation exercise during medical clerkships: Are learning needs and learning goals aligned? Med Educ. 2014;48:1008-19.

Lee V, Brain K, Martin J. Factors influencing Mini-CEX rater judgments and their practical implications: A systematic li¬terature review. Acad Med. 2017;92:880-8.

Weston P, Smith C. The use of mini-CEX in UK foundation training six years following its introduction: Lessons still to be learned and the benefit of formal teaching regarding its utility. Med Teach. 2014;36:155-63.

Foley T, Walsh E, Sweeney C, James M, Maher B, O’Flynn S. Training the assessors: A Mini-CEX workshop for GPs who assess undergraduate medical students. Educ Prim Care. 2015; 26:446-7.

Arora V, Berthie S, Horwitz LI, Saathof M, Staisiunas P, Far¬nan JM. Using standardized videos to validate a measure of handoff quality: The handoff Mini-Clinical Examination Exercise. J Hosp Med. 2014;7:441-6.

Moore K, Vaughan B. Students today… educators tomo¬rrow. The Clin Teach. 2016;13:1-5.

Rogausch A, Beyeler C, Montagne S, Jucker-Kupper P. The influence of students’ prior clinical skills and context cha-racteristics on mini-CEX scores in clerkships – a multilevel analysis. BMC Med Educ. 2015;15:1-10.

Hattie J, Timperley H. The power of feedback. Rev Educ Res. 2007;77:81-112.

Telio S, Regehr G, Ajjawi R. Feedback and the educational alliance: Examining credibility judgements and their conse-quences. Med Educ. 2016;50:933-42.

Ende J. Feedback in medical education. JAMA. 1983;250:777-81.

Kumar N, Kant Singh N, Rudra S, Pathak S. Effect of for¬mative evaluation using direct observation of procedural skills in assessment of postgraduate students of obstetrics and gynecology: Prospective study. J Adv Med Educ Prof. 2017;5:1-5.

Batty L, McKinnon K, Skidmore A, McKinnon M, Faculty Workplace-Based Assessment Advisory Group. Supervi¬sed learning events: Direct observation of procedural skills pilot. Occup Med. 2016 Aug 6. pii: kqw090. [Epub ahead of print]

McLeod R, Mires G, Ker J. Direct observed procedural skills assessment in the undergraduate setting. The Clin Teach. 2012;9:228-32.

Profanter C, Perathoner A. DOPS (Direct Observation of Procedural Skills) in undergraduate skills-lab: Does it work? Analysis of skills-performance and curricular side effects. GMS Zeitschrift für Medizinische Ausbildung. 2015;32:1-14.

Reddy ST, Endo J, Gupta S, Tekian A, Soo Park Y. A ca¬se for caution: Chart-Stimulated Recall. J Grad Med Educ. 2015;7:531-5.

Schipper S, Ross S. Structured teaching and assessment. A new chart-stimulated recall worksheet for family medicine residents. Can Fam Phys. 2010;56:958-9.

Williamson JML, Osborne AJ. Critical analysis of case ba¬sed discussions. BJMP. 2012;5:a514

Nadeem N, Mueed Zafar A, Haider S, Zuberi RW, Na¬deem Ahmad M, Ojili V. Chart-stimulated recall as a lear¬ning tool for improving radiology residents’ reports. Acad Radiol. 2017;24:1023-6.

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Publicado

2018-08-30

Cómo citar

Castro-Rebolledo, R. (2018). Evaluación de competencias clínicas en los contextos médicos curriculares actuales. Revista Salud Bosque, 8(1), 64–84. https://doi.org/10.18270/rsb.v8i1.2375

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