El estudiante de Medicina: Un ficus en formación

Actualmente, la formación universitaria en el Grado en Medicina consta de la realización de seis años durante los cuales se adquieren una serie de conocimientos teóricos y prácticos mediante la asistencia a las prácticas clínicas en los diferentes centros asociados a las instituciones universitarias en cuestión. Concretamente la formación ofertada por la Universidad de Alcalá consta de un plan estructurado en el que la formación práctica se reduce a un sexto del total de horas invertidas para lograr alcanzar el título de graduado. Ante ello, se nos plantean una serie de preguntas ¿Son estas suficientes horas de prácticas y son aprovechadas? ¿Cómo es la realidad de las prácticas clínicas? ¿Es posible que el estudiante pueda realizar una formación adicional al currículum y disposiciones de su Grado? La realidad es que, en ocasiones, las prácticas clínicas no son aprovechadas, ya que los estudiantes se convierten en elementos decorativos del espacio sanitario como consecuencia de errores en la capacidad de integración del mismo en el equipo asistencial siendo prioritaria la asistencia al paciente sobre la formación del estudiante; así mismo, asumimos la falta de motivación, cooperación e interés por parte del estudiantado, tanto en el ámbito de las prácticas clínicas como en el de la formación humanista, investigadora y profesional. Por tanto, el estudiante de medicina ¿es un ficus en formación? Hemos pretendido abordar en el presente trabajo dicha resolución realizando una revisión de los diferentes planes de estudios de las universidades nacionales e internacionales, resaltando aquellos más llamativos.Nowadays, it takes six years to obtain a medical degree. During their time at university, the students acquire theoretical and practical knowledge through clinical rotations in partner institutions. Regarding the University of Alcalá, these rotations were reduced by one sixth in its study plan. The student is the said to have acquired the skills necessary to graduate from university. In the light of these considerations, some questions arise: Are these training hours enough? Are students being adequately trained during their clinical rotations? What is current situation of the clinical rotations? Is it feasible for the student to receive additional training outside the established study plan? The truth is, this practical training is not always helpful for the students, as the feel useless in an environment where their skills are not strengthened and used. This is due to their lack of integration in the health-care team, as patient care is of greater importance than student training. Moreover, it is also noteworthy the lack of motivation, cooperation and interest among students during their practical, humanistic, research and professional training. In order to analyze what has been said heretofore, this study is going to examine the different study plans of national and international universities, emphasizing those with the most conspicuous features

Towards a Change in the Diagnostic Algorithm of Autism Spectrum Disorders: Evidence Supporting Whole Exome Sequencing as a First-Tier Test

Autism spectrum disorder (ASD) is a prevalent and extremely heterogeneous neurodevelopmental disorder (NDD) with a strong genetic component. In recent years, the clinical relevance of de novo mutations to the aetiology of ASD has been demonstrated. Current guidelines recommend chromosomal microarray (CMA) and a FMR1 testing as first-tier tests, but there is increasing evidence that support the use of NGS for the diagnosis of NDDs. Specifically in ASD, it has not been extensively evaluated and, thus, we performed and compared the clinical utility of CMA, FMR1 testing, and/or whole exome sequencing (WES) in a cohort of 343 ASD patients. We achieved a global diagnostic rate of 12.8% (44/343), the majority of them being characterised by WES (33/44; 75%) compared to CMA (9/44; 20.4%) or FMR1 testing (2/44; 4.5%). Taking into account the age at which genetic testing was carried out, we identified a causal genetic alteration in 22.5% (37/164) of patients over 5 years old, but only in 3.9% (7/179) of patients under this age. Our data evidence the higher diagnostic power of WES compared to CMA in the study of ASD and support the implementation of WES as a first-tier test for the genetic diagnosis of this disorder, when there is no suspicion of fragile X syndrome

Patient-Level, Institutional, and Temporal Variations in Use of Imaging Modalities to Confirm Pulmonary Embolism

International audienceBackground: The choice of the imaging modality for diagnosis of pulmonary embolism (PE) could be influenced by provider, patient or hospital characteristics, or over time. However, little is known about the choice of the diagnostic modalities in practice. The aim of this study was to evaluate the variations in the use of imaging modalities for patients with acute PE. Methods: Using the data from Registro Informatizado Enfermedad TromboEmbolica (RIETE), a prospective international registry of patients with venous thromboembolism (March 2001–January 2019), we explored the imaging modalities used in patients with acute PE. The imaging modalities included computed tomography pulmonary angiography, ventilation/perfusion scanning, pulmonary angiography, a combination of these tests, or PE signs and symptoms plus imaging-confirmed proximal deep vein thrombosis but no chest imaging. Results: Among 38 025 patients with confirmed PE (53.1% female, age: 67.3±17 years), computed tomography pulmonary angiography was the dominant modality of diagnosis in all RIETE enrollees (78.2% [99% CI, 77.6–78.7]); including pregnant patients (58.9% [99% CI, 47.7%–69.4%]) and patients with severe renal insufficiency (62.5% [99% CI, 59.9–65.0]). A greater proportion of patients underwent ventilation/perfusion scanning in larger hospitals compared with smaller hospitals (13.1% versus 7.3%, P <0.001). The use of computed tomography pulmonary angiography varied between 13.3% and 98.3% across the countries, and its use increased over time (46.5% in 2002 to 91.7% in 2018, P <0.001). Conclusions: In a large multinational PE registry, variations were observed in the use of imaging modalities according to patient or institutional factors and over time. However, computed tomography pulmonary angiography was the dominant modality of diagnosis, even in pregnancy and severe renal insufficiency. The safety, costs, and downstream effects of these tests on PE-related and non-PE-related outcomes warrant further investigation