Validity, reliability and adaptation of the DREEM in Colombian Spanish and an integrated curriculum

Introducción: En la evaluación de los currículos médicos ha sido importante medir el ambiente educativo con la ayuda de algunos instrumentos como el DREEM. Sin embargo, varios estudios han identificado problemas con sus propiedades psicométricas. La consistencia interna de sus 5 dominios es bastante variable y, en ciertos casos, la confiabilidad es baja. Para tomar decisiones sobre cambios curriculares en nuestro contexto es necesario validar este instrumento. Objetivo: Validar el DREEM en español colombiano y su adaptación a un currículo integrador. Método: Estudio cuantitativo, no experimental, exploratorio, transversal. La validación del contenido se realizó con juicio de 12 expertos. Participaron 308 estudiantes de medicina respondiendo el DREEM. La validación de constructo y la confiabilidad se determinaron con Análisis Factorial Exploratorio (AFE) y ? de Cronbach. Resultados: Se adecuaron sintáctica y semánticamente los ítems y se movilizaron 7 ítems de un dominio a otro. El puntaje total del DREEM mostró un nivel de confiabilidad excelente (? = 0.91), pero 2 de sus dominios tuvieron un nivel cuestionable de consistencia interna. La validez de constructo indicó que 26 ítems serían suficientes para medir el ambiente educativo. Los ítems del dominio 5 y el ítem 17 quedaron excluidos del AFE. Conclusiones: El DREEM adaptado en español colombiano es un instrumento confiable y válido, pero algunos de sus dominios son cuestionables, lo que pone en duda sus soportes teóricos. Excluir el análisis independiente de estos dominios puede dificultar la comprensión de los resultados del DREEM y obstaculizar la toma de decisiones en áreas concretas del currículo. Por tanto, es necesaria una reconstrucción teórica del ambiente educativo y, en consecuencia, una reconceptualización de las subescalas de este constructo.Introduction: Measurement of the educational environment has become of key importance in medical curriculum evaluation. The DREEM has been developed for this purpose. However, a number of studies have identified issues with the psychometric properties of the DREEM. The internal consistency of the 5 domains is rather variable and, in some cases, the reliability is low. Since information obtained from the DREEM can be used to change the curriculum in our context, it is necessary to validate this instrument. Objective: To validate the DREEM in Colombian Spanish considering an integrated curriculum. Method: Quantitative, non-experimental, exploratory, cross-sectional study. 12 experts in education validated the DREEM content. 308 medical students participated. Exploratory Factorial Analysis (EFA) and Cronbach’s ? determined construct validity and reliability. Results: Syntactic and semantic adaptations were made to the items. Seven items were mobilized from one domain to another. Although the total DREEM score had an excellent reliability level (? = 0.91), domain analysis showed 2 questionable domains. The analysis indicated that 26 items may be enough for measuring the educational climate. Domain V items and item 17 were excluded. Conclusions: The adapted DREEM to Colombian Spanish is reliable and valid. However, some of the domains were questionable. Findings suggest the original theory of the DREEM domains embodies debatable assumptions. Excluding the independent analysis of the domains may harden scores understanding, which in turn may obstruct decision making in specific areas of the curriculum. Therefore, A new theory of the educational climate domains is needed

Medical education and the healthcare system - why does the curriculum need to be reformed?

Medical education has been the subject of ongoing debate since the early 1900s. The core of the discussion is about the importance of scientific knowledge on biological understanding at the expense of its social and humanistic characteristics. Unfortunately, reforms to the medical curriculum are still based on a biological vision of the health-illness process. In order to respond to the current needs of society, which is education's main objective, the learning processes of physicians and their instruction must change once again. The priority is the concept of the health-illness process that is primarily social and cultural, into which the biological and psychological aspects are inserted. A new curriculum has been developed that addresses a comprehensive instruction of the biological, psychological, social, and cultural (historical) aspects of medicine, with opportunities for students to acquire leadership, teamwork, and communication skills in order to introduce improvements into the healthcare systems where they work. © 2014 Quintero

Paradigm shift in current medical education

La educación médica necesita adaptarse a los cambios propuestos en la reforma a la salud. Es necesario un nuevo paradigma que se fundamente en una definición del proceso salud-enfermedad que incluya lo biológico, lo psicológico, lo social y lo cultural; es decir, que no sea puramente biologista. Pero también se requiere de un cambio en la forma como se enseña y como se aprende medicina. Todo esto fundamentado en la aplicación transcurricular de la atención primaria renovada, entendida como aquella que integra los niveles de atención.Medical education needs to adapt to the proposed changes of health reform. We need a new paradigm based on a new definition of the health-disease process that includes biological, psychological, social and cultural issues rather than purely biologist. But it also requires a change in how medicine is taught and how it is learned and for what medicine is taught. All this based on the implementation of the concept of renewed primary health care, understood as one that integrated levels of care

Efectos económicos de los cierres por COVID-19: una perspectiva regional.

Distintos trabajos han estimado los efectos del confinamiento, como consecuen­cia del COVID-19, sobre la producción y el empleo a nivel nacional, pero pocos a nivel regional. Así, utilizando una matriz insumo producto regional para Colom­bia, y mediante una variación de un método de extracción hipotética, se estima­ron los efectos regionales del confinamiento sobre la producción y el empleo. Se encontró que los choques negativos sobre la economía impactan la producción, esta disminuyó 8,2 %, lo que conllevó una caída en el empleo de 3,5 millones de puestos de trabajo, esto es consecuencia de heterogeneidad de los efectos entre los departamentos

Integración curricular mecanicista versus sistémica

Introduction: Curricular integration has been a fundamental factor in the development of modern medical curricula; however, in its more well-known models, including horizontal and vertical integrations, the learning of medicine around subjects, as it is done in traditional curricula, continues to be understood. This way of conceiving learning does not allow methodological analysis of the design of integrated/integrative curricula that involve other ways of learning. Objective: To stimulate a theoretical and methodological reflection on curriculum integration in medical education, with the aim of orienting the design and assessment of integrated/integrative curricula and to discuss how innovative vertical and horizontal integrations are. Development: Horizontally and vertically integrated curricula are similar to traditional curricula fragmented in their design linear conception, while in systemic curricular integration, examples of which can be visualized in curricula designed through problem-based learning, curricular design is addressed in a circular way by connecting issues that feed back to one another; therefore, learning activities could be designed and assessed simultaneously. Conclusions: Thinking about curricular integration as a strategy of educational innovation implies discussing what we are understanding as integrated/ integrative curricula, how we are analyzing the practice of our medical curricula, with which theoretical frameworks we are doing that analysis, and what implications this has in curricula design and assessment. © 2017, Editorial Ciencias Medicas. All rights reserved

El nuevo trívium en la formación médica más allá de la comunicación médico-paciente

One of the innovative elements of medical curricula in recent decades is the emphasis on the doctor-patient communication. However, communicative competences go further; they involve cognitive-linguistic skills that support active listening, reading, writing and orality in the context of learning and practicing medicine. We believe that limiting the teaching of communication to the doctor-patient encounter leaves the cognitive processes and the fundamental linguistic manifestations aside to ensure the communicative success of the doctor within the society. In other words, in addition to the techniques for better communication, cognitive-linguistic skills are essential at the time of choosing, organizing, classifying and categorizing the information that must be provided both to the patient and his family and to the medical community for the improvement of the health of individuals and populations. In this article, we intend to argue why it is important to comprehensively learn the communication skills, exemplifying the case of the new trivium of the medicine curriculum of Universidad del Rosario, which constitutes a favorable space for the students to develop cognitive-linguistic skills for the clinical communication in their scientific community. © 2017, Editorial Ciencias Medicas. All rights reserved

Costo-efectividad de la colecistectomía laparoscópica y de la abierta en una muestra de población colombiana

Introduction: Cholecystectomy has been the subject of several clinical and cost comparison studies. Objective: The results of open or laparoscopy cholecystectomy were compared in terms of cost and effectiveness from the perspective of healthcare institutions and from that of the patients. Materials and methods: The cost-effectiveness study was undertaken at two university hospitals in Bogotá, Colombia. The approach was to select the type of cholecystectomy retrospectively and then assess the result prospectively. The cost analysis used the combined approach of micro-costs and daily average cost. Patient resource consumption was gathered from the time of surgery room entry to time of discharge. A sample of 376 patients with cholelithiasis/cystitis (May 2005-June 2006) was selected-156 underwent open cholecystectomy and 220 underwent laparoscopic cholecystectomy. The following data were tabulated: (1) frequency of complications and mortality, post-surgical hospital stay, (2) reincorporation to daily activities, (3) surgery duration, (4) direct medical costs, (5) costs to the patient, and (6) mean and incremental cost-effectiveness ratios. Results: Frequency of complications was 13.5% for open cholecystectomy and 6.4% for laparoscopic cholecystectomy (p=0.02); hospital stay was longer in open cholecystectomy than in laparoscopic cholecystectomy (p=0.003) as well as the reincorporation to daily activities reported by the patients (p less than 0.001). The duration of open cholecystectomy was 22 min longer than laparoscopic cholecystectomy (p less than 0.001). The average cost of laparoscopic cholecystectomy was lower than open cholecystectomy and laparoscopic cholecystectomywas more cost-effective than open cholecystectomy (US$995 vs. US$ 1,048, respectively). The patient out-of-pocket expenses were greater in open cholecystectomy compared to laparoscopic cholecystectomy (p=0.015). Mortality was zero. Conclusions: The open laparoscopy procedure was associated with longer hospital stays, whereas the cholecystectomy procedure required a longer surgical duration. The direct cost of the latter was lower for both for the healthcare institution and patients. The cost-effectiveness for both procedures was comparable

Integrated Medical Curriculum: Advantages and Disadvantages

Most curricula for medical education have been integrated horizontally and vertically--vertically between basic and clinical sciences. The Flexnerian curriculum has disappeared to permit integration between basic sciences and clinical sciences, which are taught throughout the curriculum. We have proposed a different form of integration where the horizontal axis represents the defined learning outcomes and the vertical axis represents the teaching of the sciences throughout the courses. We believe that a mere integration of basic and clinical sciences is not enough because it is necessary to emphasize the importance of humanism as well as health population sciences in medicine. It is necessary to integrate basic and clinical sciences, humanism, and health population in the vertical axis, not only in the early years but also throughout the curriculum, presupposing the use of active teaching methods based on problems or cases in small groups

The influence of different curriculum designs on students' dropout rate : a case study

The relationship between students' withdrawal and educational variables has generated a considerable number of publications. As the explosion of information in sciences and integration theories led to creating different curriculum designs, it has been assumed that differences among designs explain academic success and, therefore, students' retention. However, little attention has been given to examine explicitly how diverse designs influence dropout rates in practice, which questions if decisions to reform curricula are sufficiently informed. This article describes our curriculum reform, which exposes our former and current curriculum designs as having had dissimilar dropout percentages. Furthermore, we aimed to explore the influence of different curriculum designs on students' dropout rates. The conclusion is that dropout variations may be explained not only because of the curriculum design itself, but also because of the power relationship changes between teachers and students that brought out the design change. Consequently, more research is needed to fully understand the political implications of different curriculum designs and their influence on dropout rates

Transformative Research

Decanos de la Universidad del Rosario hablan sobre la transformación de la investigación desde cada facultadDeans of the University of Rosario talk about the transformation of research from each facult