Retenció i assimilació de coneixements en l'assignatura de Pregrau d'anestesiologia, reanimació i terapèutica del dolor després d'un any mitjançant l'aprenentatge basat en problemes

Introducció: L'aprenentatge basat en problemes (ABP) implica als estudiants en un procés educatiu en el que es desenvolupa la seva capacitat per a resoldre problemes i assolir una educació autònoma necessària per a confrontar-se amb èxit als reptes de la vida professional. Presentem la nostra experiència docent dels últims 6 anys basada en l'ABP en l'assignatura optativa d'Anestesiologia, Reanimació i Terapèutica del Dolor en l'Hospital Germans Trias i Pujol, Badalona. Objectiu: Comprovar el grau de retenció i assimilació dels coneixements anestèsics adquirits pels alumnes mitjançant l'ABP després d'un any. Material i mètode: Un cop definits i repartits els objectius docents de l'assignatura en 12 sessions, els 12 tutors vam dissenyar una avaluació tipus test a realitzar pels mateixos estudiants de forma anònima i voluntària al finalitzar el curs i un any més tard. Resultats: El test final de curs fou realitzat per tots els alumnes (19 dones i 5 homes) amb una edat mitja de 23,5 anys. Un any després el test fou complimentat per 10 dones i 4 homes del mateix grup. La nota global del test al finalitzar l'assignatura fou de 7,2 i la de l'any següent fou de 7,96 que supera a l'inicial en 0,76 punts. Conclusió: L'ABP sembla contribuir a una millor retenció i assimilació de coneixements a llarg termini; és una forma eficaç i vàlida per a impartir educació mèdica en un programa coherent i integrat oferint avantatges sobre els mètodes d'ensenyament tradicionals i representa la nostra aportació al intent d'adaptar el currículum a la innovació metodològica exigida des d'Europa a partir de l'any 2010 dins del marc de l'Espai Europeu d'Educació Superior.Problem based learning (PBL) makes the student be part of an educational process where he may develop his solving problems-capacity and gain self-education in order to face with success professional life in the future. We present our 6-years PBL experience on Anesthesiology-teaching as an optional course in the University Hospital Germans Trias i Pujol in Badalona. Objective: To evaluate the retention and assimilation levels of anesthesiological knowledge acquired by the students with PBL after one year. Material and methods: Educational objectives were defined and included in 12 PBL-cases. At the end of the teaching programme the students were asked to undergo a voluntary and anonymous test (100 true/false sentences) in order to evaluate the understanding and assimilation levels of theoretical knowledge acquired with the PBL method. The same test was repeated with the same students one year later. Results: Immediately after the course the test was filled in by all the students (19 women and 5 men) with an average age of 23.5 years. One year later 10 women and 4 men of the same group filled in the test. The final score of the test after the course was 7.2 and the score one year later was 7.96, that means a score increase of 0.76. Conclusion: PBL seems to contribute to a better retention and assimilation of knowledge as a long term effect. PBL is an effective and valid teaching method for medical education in a coherent and integrated way and offers advantages compared to other traditional teaching methods. It represents our attempt to adapt our curriculum to the methodological innovation asked from 2010 as described in the "Bologna Process"

Autoavaluació de competències transversals a l'assignatura d'anestesiologia mitjançant l'ABP

L'EEES incideix en la necessitat de contemplar les competències transversals en la formació de pregrau. A l'assignatura optativa de pregrau d'Anestesiologia apliquem l'ABP des de l'any 2001, i ens qüestionem cóm són les competències basals dels estudiants i si les fomentem. Objectiu: Mesurar l'autoavaluació dels estudiants de les competències transversals i analitzar el seu grau de progressió al llarg del nostre curs. Mètode: Estudi prospectiu i descriptiu amb estudiants de cinquè. Es sol·licita consentiment informat. Segons el projecte "Tuning" s'ha dissenyat un qüestionari on cada estudiant autoavalua al primer i a l'últim dia del curs les seves competències instrumentals, interpersonals i sistèmiques. La valoració va del 0 (incapaç) al 5 (molt capaç). Resultats: Tots els estudiants (13 dones i 1 home; edat mitja 23,78 anys) que participat en l'estudi han experimentat un increment de les seves competències amb una mitjana de 0,9 punts. Les competències millor valorades han estat la capacitat en la presa de decisions, el compliment de compromisos adquirits, la habilitat per treballar de forma autònoma, sent la més valorada la motivació per la consecució d'objectius d'aprenentatge. Les més deficitàries han estat el coneixement d'anglès i les habilitats per a investigar. Les de major progressió han estat: l'habilitat en recerca d'informació, capacitat d'expressió i per dissenyar i gestionar treballs. Conclusió: Cal conèixer el perfil basal de l'estudiant i quines són les seves mancances competencials per a després dissenyar un enfocament de l'educació basada en competències. L'autoavaluació i l'ABP ens ajuda a fomentar les competències transversals de l'estudiant.According to the Bologna Declaration transversal competencies should be improved in undergraduate education. In our optional course of Anesthesiology we apply PBL since 2001 and now we ask ourselves what kind of transversal competencies our students have and if we can help students to improve them. Objective: To measure students' self-evaluation of their transversal competencies and to analyze their progression throughout our course. Method: Prospective, descriptive study with 5th year medical students. Informed consent was asked. As described in the "Tuning" project, we designed a self-evaluation questionnaire on their instrumental, interpersonal and systemic competencies to be filled in by every student on the first and last day of class. We used a Likert scale going from 0 (unable) to 5 (excellent) for this purpose. Results: All students (13 women and 1 man; mean age 23.78 years old) filled in the questionnaire and showed a mean increase of their competencies of 0.9. The best evaluated competencies were the capacity of taking decisions, the realization of acquired compromises and the ability to work in an independent way. The best evaluated one was the motivation for the prosecution of learning objectives. The English knowledge and the ability to investigate were very deficient. The competencies that showed the most progression throughout the course were: the ability of searching information, the capacity of oral and written expression and finally their work management capacity. Conclusion: It is important to know the baseline profile of our students in terms of deficiencies of transversal competencies to design a competence-based education. PBL and self-evaluation help us to improve transversal competencies in our classes

Retenció i assimilació de coneixements en l'assignatura de Pregrau d'anestesiologia, reanimació i terapèutica del dolor després d'un any mitjançant l'aprenentatge basat en problemes

Introducció: L'aprenentatge basat en problemes (ABP) implica als estudiants en un procés educatiu en el que es desenvolupa la seva capacitat per a resoldre problemes i assolir una educació autònoma necessària per a confrontar-se amb èxit als reptes de la vida professional. Presentem la nostra experiència docent dels últims 6 anys basada en l'ABP en l'assignatura optativa d'Anestesiologia, Reanimació i Terapèutica del Dolor en l'Hospital Germans Trias i Pujol, Badalona. Objectiu: Comprovar el grau de retenció i assimilació dels coneixements anestèsics adquirits pels alumnes mitjançant l'ABP després d'un any. Material i mètode: Un cop definits i repartits els objectius docents de l'assignatura en 12 sessions, els 12 tutors vam dissenyar una avaluació tipus test a realitzar pels mateixos estudiants de forma anònima i voluntària al finalitzar el curs i un any més tard. Resultats: El test final de curs fou realitzat per tots els alumnes (19 dones i 5 homes) amb una edat mitja de 23,5 anys. Un any després el test fou complimentat per 10 dones i 4 homes del mateix grup. La nota global del test al finalitzar l'assignatura fou de 7,2 i la de l'any següent fou de 7,96 que supera a l'inicial en 0,76 punts. Conclusió: L'ABP sembla contribuir a una millor retenció i assimilació de coneixements a llarg termini; és una forma eficaç i vàlida per a impartir educació mèdica en un programa coherent i integrat oferint avantatges sobre els mètodes d'ensenyament tradicionals i representa la nostra aportació al intent d'adaptar el currículum a la innovació metodològica exigida des d'Europa a partir de l'any 2010 dins del marc de l'Espai Europeu d'Educació Superior.Problem based learning (PBL) makes the student be part of an educational process where he may develop his solving problems-capacity and gain self-education in order to face with success professional life in the future. We present our 6-years PBL experience on Anesthesiology-teaching as an optional course in the University Hospital Germans Trias i Pujol in Badalona. Objective: To evaluate the retention and assimilation levels of anesthesiological knowledge acquired by the students with PBL after one year. Material and methods: Educational objectives were defined and included in 12 PBL-cases. At the end of the teaching programme the students were asked to undergo a voluntary and anonymous test (100 true/false sentences) in order to evaluate the understanding and assimilation levels of theoretical knowledge acquired with the PBL method. The same test was repeated with the same students one year later. Results: Immediately after the course the test was filled in by all the students (19 women and 5 men) with an average age of 23.5 years. One year later 10 women and 4 men of the same group filled in the test. The final score of the test after the course was 7.2 and the score one year later was 7.96, that means a score increase of 0.76. Conclusion: PBL seems to contribute to a better retention and assimilation of knowledge as a long term effect. PBL is an effective and valid teaching method for medical education in a coherent and integrated way and offers advantages compared to other traditional teaching methods. It represents our attempt to adapt our curriculum to the methodological innovation asked from 2010 as described in the "Bologna Process"

Autoavaluació de competències transversals a l'assignatura d'anestesiologia mitjançant l'ABP

L'EEES incideix en la necessitat de contemplar les competències transversals en la formació de pregrau. A l'assignatura optativa de pregrau d'Anestesiologia apliquem l'ABP des de l'any 2001, i ens qüestionem cóm són les competències basals dels estudiants i si les fomentem. Objectiu: Mesurar l'autoavaluació dels estudiants de les competències transversals i analitzar el seu grau de progressió al llarg del nostre curs. Mètode: Estudi prospectiu i descriptiu amb estudiants de cinquè. Es sol·licita consentiment informat. Segons el projecte "Tuning" s'ha dissenyat un qüestionari on cada estudiant autoavalua al primer i a l'últim dia del curs les seves competències instrumentals, interpersonals i sistèmiques. La valoració va del 0 (incapaç) al 5 (molt capaç). Resultats: Tots els estudiants (13 dones i 1 home; edat mitja 23,78 anys) que participat en l'estudi han experimentat un increment de les seves competències amb una mitjana de 0,9 punts. Les competències millor valorades han estat la capacitat en la presa de decisions, el compliment de compromisos adquirits, la habilitat per treballar de forma autònoma, sent la més valorada la motivació per la consecució d'objectius d'aprenentatge. Les més deficitàries han estat el coneixement d'anglès i les habilitats per a investigar. Les de major progressió han estat: l'habilitat en recerca d'informació, capacitat d'expressió i per dissenyar i gestionar treballs. Conclusió: Cal conèixer el perfil basal de l'estudiant i quines són les seves mancances competencials per a després dissenyar un enfocament de l'educació basada en competències. L'autoavaluació i l'ABP ens ajuda a fomentar les competències transversals de l'estudiant.According to the Bologna Declaration transversal competencies should be improved in undergraduate education. In our optional course of Anesthesiology we apply PBL since 2001 and now we ask ourselves what kind of transversal competencies our students have and if we can help students to improve them. Objective: To measure students' self-evaluation of their transversal competencies and to analyze their progression throughout our course. Method: Prospective, descriptive study with 5th year medical students. Informed consent was asked. As described in the "Tuning" project, we designed a self-evaluation questionnaire on their instrumental, interpersonal and systemic competencies to be filled in by every student on the first and last day of class. We used a Likert scale going from 0 (unable) to 5 (excellent) for this purpose. Results: All students (13 women and 1 man; mean age 23.78 years old) filled in the questionnaire and showed a mean increase of their competencies of 0.9. The best evaluated competencies were the capacity of taking decisions, the realization of acquired compromises and the ability to work in an independent way. The best evaluated one was the motivation for the prosecution of learning objectives. The English knowledge and the ability to investigate were very deficient. The competencies that showed the most progression throughout the course were: the ability of searching information, the capacity of oral and written expression and finally their work management capacity. Conclusion: It is important to know the baseline profile of our students in terms of deficiencies of transversal competencies to design a competence-based education. PBL and self-evaluation help us to improve transversal competencies in our classes

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

International audienceBackground: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society