Person: Armijo-Rivera, Soledad
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Armijo-Rivera
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Publication Modelo de escenarios de simulación para el entrenamiento de razonamiento clínico en estudiantes de medicina(2023) Armijo-Rivera, Soledad; Labarca, Cristian; Pérez Villalobos, Cristian; Behrens Pérez, Claudia; Tamburrino Díaz, Catalina; Castro Pérez, Javiera; Díaz Guío, AndrésIntroducción: El razonamiento clínico es una tarea compleja que los médicos utilizan al momento de enfrentarse a los pacientes. Se puede llevar a cabo a través del sistema intuitivo y el analítico. La simulación clínica es una herramienta para entrenar el razonamiento clínico, sin embargo, su evaluación sigue siendo un desafío. En el presente estudio, se evaluó el formato de diseño de escenarios para razonamiento clínico, asociado al uso de una pauta de observación aplicada en estudiantes de medicina en dos escenarios de simulación secuenciales. Material y Métodos: Se diseñaron dos escenarios de simulación con 4 niveles de complejidad para el manejo de sepsis en paciente adulto, donde participaron 12 grupos de 8 estudiantes. Estas simulaciones fueron grabadas y posteriormente analizadas por observadores calificados a través de una pauta de observación de escenario basada en las propuestas conceptuales de Croskerry, Braun y Pennaforte. Resultados: Los escenarios se llevaron a cabo en un promedio de 12 minutos. La mayoría logró establecer el diagnóstico e instauración de manejo inicial a través de la recogida parcial de información, dando cuenta del dominio del razonamiento intuitivo en el 98 % de los casos, sin embargo, solo el 10,4 % utilizó el sistema analítico. Conclusión: El diseño de escenarios de simulación compuestos de distintos niveles de complejidad podría promover el desarrollo del razonamiento clínico. La utilización de una pauta de observación del escenario permitió el análisis del proceso del razonamiento clínico en un entorno realista y sin interrupciones, y podría ser utilizada para guiar el debriefing.Publication Simulación remota: Un estudio cualitativo sobre razonamiento clínico y errores cognitivos desde la perspectiva de los estudiantes(2023) Mir Bezanilla, Verónica; González-Bernstein, Antonia; Luer, Maria Ignacia; López-Leiva, Rosario; Díaz Schmidt, Joaquín Andrés; Armijo-Rivera, Soledad; Pérez-Villalobos, CristhianIntroduction: Clinical reasoning is a crucial competency for medical practice and also a complex theory that is susceptible to cognitive errors. It is usually taught with clinical cases, in clinical settings, without technologies and in a practical manner rather than from a conceptual perspective. Given the need to improve its teaching in the undergraduate medical curriculum during the pandemic, we hypothesized that medical students participating in an online simulation and reflective practice course could benefit from a practical and theoretical approach to the clinical reasoning process. Material and Methods: A four-week online course, based on synchronous and asynchronous online simulation and reflective practice, was developed to promote metacognition among participants. The course was delivered to 8 sixth-year medical students as an elective module. A questionnaire consisting of four open-ended questions was designed to explore knowledge about clinical reasoning and cognitive errors, and was administered at the beginning and end of the course. A qualitative analysis of the responses was carried out using Berelson's content analysis method. Results: At the end of the course, students changed their understanding of the concept of clinical reasoning, considering it more as a process and identifying the dual nature described in one of the theories of clinical decision making. They also changed their knowledge of cognitive errors, attributing them not only to lack of knowledge, and understanding that they can actively use some strategies to reduce cognitive biases. Discussion: This study confirms that undergraduate students positively change their concept of clinical reasoning and their knowledge about this cognitive process and the cognitive errors that occur in it after a course that includes online simulation and reflectionPublication Application of the Team Emergency Assessment Measure Scale in undergraduate medical students and interprofessional clinical teams: validity evidence of a Spanish version applied in Chile(2023) Armijo-Rivera, Soledad; Ferrada-Rivera, Sandra; Aliaga-Toledo, Marcela; Pérez, Leonardo A.Background: Teamwork is one of the competencies necessary for physicians to work effectively in health systems and is a competency that can be developed with simulation in professionals and medicine students. The Team Emergency Assessment Measurement (TEAM) was created to evaluate the non-technical performance of team members during resuscitation events in real teams. The TEAM scale includes items to assess leadership, teamwork, situational awareness, and task management. An objective evaluation tool in Spanish is valuable for training health professionals at all undergraduate and continuing education levels. This study aimed to generate evidence of the validity of the Team Emergency Assessment Measure (TEAM) in Spanish to measure the performance of medical students and adult, pediatric, and obstetric emergency clinical teams in simulated emergencies as a self-assessment tool. Methods: To develop the Spanish version of the instrument, a forward and backward translation process was followed by independent translators, native and fluent in English and Spanish, and a review by a panel of Chilean experts comprising three trained simulation instructors to verify semantics and cultural equivalence. High-fidelity simulations with debriefing were conducted with 5th-year medical students, in which students and instructors applied the Spanish version of the TEAM scale. In the second stage, adult, pediatric, and obstetric emergency management simulations were conducted using the TEAM scale for real clinical teams as a self-assessment tool. Findings: By applying the overall TEAM scale to medicine students and clinical teams, Cronbach's alpha was 0.921. For medical students' self-assessment, we obtained Cronbach's alpha of 0.869. No significant differences were found between the overall scores and the scores by dimensions evaluated by instructors and students (p > 0.05). In the case of clinical team training, Cronbach's alpha was 0.755 for adult emergency teams, 0.797 for pediatric emergency teams, and 0.853 for obstetric emergency teams. Conclusion: The validated instrument is adequate for evaluating teamwork in medical student simulations by instructors and peers and for self-assessment in adult, pediatric, and obstetric emergency clinical teams.