Fiabilidad y validez de un portafolio reflexivo en la evaluación de la práctica clínica de los estudiantes del capítulo de Cirugía Oncológica del curso de Cirugía

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Sujetos y métodos: Este estudio prospectivo correlacional-descriptivo tuvo como objetivos determinar la correlación bivariada entre las puntuaciones del examen teórico, la práctica clínica, el aprendizaje virtual y el examen clínico objetivo estructurado (ECOE) de la serie total con el portafolio; la ecuación de regresión para predecir la puntuación del portafolio a partir del examen teórico y ECOE de Cirugía Oncológica; la correlación entre el aprendizaje autorreflexivo del portafolio con la nota final del curso; las puntuaciones del portafolio con el test Inventory y la fiabilidad interevaluador de la estructura del portafolio y de su nota global. Resultados: Hubo correlación significativa entre el portafolio con el examen teórico (r = 0,410; p = 0,0001), la práctica clínica (r = 0,258; p = 0,003), el caso clínico virtual (r = 0,260; p = 0,003) y el ECOE (r = 0,204; p = 0,020). El análisis de regresión lineal múltiple determinó la ecuación de regresión para predecir la puntuación del portafolio y su relación con el examen teórico (p = 0,001) y el ECOE de Cirugía Oncológica (p = 0,010). Hubo correlación significativa entre el aprendizaje autorreflexivo (r = 0,305; p = 0,0001) con la nota teórica final del curso. La fiabilidad interevaluador del portafolio fue significativa en: caso clínico real (α = 0,486; p = 0,006), incidente crítico (α = 0,702; p = 0,0001), aprendizaje autorreflexivo (α = 0,664; p = 0,0001) y estructura del lenguaje (α = 0,431; p = 0,017). Hubo acuerdo aceptable entre los dos evaluadores con respecto a la nota del portafolio (α = 0,67; p = 0,0001) y con el test Inventory (α = 0,632; p = 0,001). Conclusiones: El portafolio se puede utilizar en el pregrado porque es fiable y tiene validez predictiva y concurrente, de manera que permite que el estudiante reflexione sobre sus necesidades de aprendizaje.

Translated abstract

Subjects and methods: This prospective correlational and descriptive study aimed to determine: the bivariate correlation among test scores of theoretical exam, clinical practice, virtual learning and objective structured clinical examination (OSCE) of the total series with portfolio; the regression equation to predict the score of portfolio from the theoretical and OSCE of chapter of surgical oncology; the correlation between self-reflective learning of portfolio with the final grade and portfolio scores with Inventory; and inter-rater reliability of the structure and its overall portfolio note. Results: There was significant correlation between portfolio and theoretical examination (r = 0.410; p = 0.0001), clinical practice (r = 0.258; p = 0.003), virtual clinical case (r = 0.260; p = 0.003) and OSCE (r = 0.204; p = 0.020). The multiple linear regression analysis determined the regression equation to predict the score of portfolio and its relation to the theory test (p = 0.001) and the OSCE of Surgical Oncology chapter (p = 0.010). There was significant correlation between self-reflective learning (r = 0.305; p = 0.0001) with the final theoretical note of the course. The rater reliability of portfolio was significant in: real clinical case (α = 0.486; p = 0.006), critical incident (α = 0.702; p = 0.0001), self-reflective learning (α = 0.664; p = 0.0001) and language structure (α = 0.431; p = 0.017). There was a correlation between the two raters with respect to the note of portfolio (α = 0.67; p = 0.0001) and the test Inventory (α = 0.632; p = 0.001). Conclusions: The portfolio can be used in undergraduate because it is a reliable instrument and has predictive and concurrent validity, allowing students to reflect on their learning needs.

Related collections

Most cited references 91

Record: found
Abstract: found
Article: not found

Defining and assessing professional competence.

Ronald M Epstein (2002)

Current assessment formats for physicians and trainees reliably test core knowledge and basic skills. However, they may underemphasize some important domains of professional medical practice, including interpersonal skills, lifelong learning, professionalism, and integration of core knowledge into clinical practice. To propose a definition of professional competence, to review current means for assessing it, and to suggest new approaches to assessment. We searched the MEDLINE database from 1966 to 2001 and reference lists of relevant articles for English-language studies of reliability or validity of measures of competence of physicians, medical students, and residents. We excluded articles of a purely descriptive nature, duplicate reports, reviews, and opinions and position statements, which yielded 195 relevant citations. Data were abstracted by 1 of us (R.M.E.). Quality criteria for inclusion were broad, given the heterogeneity of interventions, complexity of outcome measures, and paucity of randomized or longitudinal study designs. We generated an inclusive definition of competence: the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and the community being served. Aside from protecting the public and limiting access to advanced training, assessments should foster habits of learning and self-reflection and drive institutional change. Subjective, multiple-choice, and standardized patient assessments, although reliable, underemphasize important domains of professional competence: integration of knowledge and skills, context of care, information management, teamwork, health systems, and patient-physician relationships. Few assessments observe trainees in real-life situations, incorporate the perspectives of peers and patients, or use measures that predict clinical outcomes. In addition to assessments of basic skills, new formats that assess clinical reasoning, expert judgment, management of ambiguity, professionalism, time management, learning strategies, and teamwork promise a multidimensional assessment while maintaining adequate reliability and validity. Institutional support, reflection, and mentoring must accompany the development of assessment programs.

0 comments Cited 201 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Virtual patients: a critical literature review and proposed next steps.

Marc M Triola, Bruce Cook (2009)

The opposing forces of increased training expectations and reduced training resources have greatly impacted health professions education. Virtual patients (VPs), which take the form of interactive computer-based clinical scenarios, may help to reconcile this paradox. We summarise research on VPs, highlight the spectrum of potential variation and identify an agenda for future research. We also critically consider the role of VPs in the educational armamentarium. We propose that VPs' most unique and cost-effective function is to facilitate and assess the development of clinical reasoning. Clinical reasoning in experts involves a non-analytical process that matures through deliberate practice with multiple and varied clinical cases. Virtual patients are ideally suited to this task. Virtual patients can also be used in learner assessment, but scoring rubrics should emphasise non-analytical clinical reasoning rather than completeness of information or algorithmic approaches. Potential variations in VP design are practically limitless, yet few studies have rigorously explored design issues. More research is needed to inform instructional design and curricular integration. Virtual patients should be designed and used to promote clinical reasoning skills. More research is needed to inform how to effectively use VPs.

0 comments Cited 146 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

The effectiveness of self-directed learning in health professions education: a systematic review.

Mohammad Murad, Fernando Coto-Yglesias, Prathibha Varkey … (2010)

Given the continuous advances in the biomedical sciences, health care professionals need to develop the skills necessary for life-long learning. Self-directed learning (SDL) is suggested as the methodology of choice in this context. The purpose of this systematic review is to determine the effectiveness of SDL in improving learning outcomes in health professionals. We searched MEDLINE, EMBASE, ERIC and PsycINFO through to August 2009. Eligible studies were comparative and evaluated the effect of SDL interventions on learning outcomes in the domains of knowledge, skills and attitudes. Two reviewers working independently selected studies and extracted data. Standardised mean difference (SMD) and 95% confidence intervals (95% CIs) were estimated from each study and pooled using random-effects meta-analysis. The final analysis included 59 studies that enrolled 8011 learners. Twenty-five studies (42%) were randomised. The overall methodological quality of the studies was moderate. Compared with traditional teaching methods, SDL was associated with a moderate increase in the knowledge domain (SMD 0.45, 95% CI 0.23-0.67), a trivial and non-statistically significant increase in the skills domain (SMD 0.05, 95% CI-0.05 to 0.22), and a non-significant increase in the attitudes domain (SMD 0.39, 95% CI-0.03 to 0.81). Heterogeneity was significant in all analyses. When learners were involved in choosing learning resources, SDL was more effective. Advanced learners seemed to benefit more from SDL. Moderate quality evidence suggests that SDL in health professions education is associated with moderate improvement in the knowledge domain compared with traditional teaching methods and may be as effective in the skills and attitudes domains. © Blackwell Publishing Ltd 2010.