Estrategias educativas y aprendizaje significativo en los cursos de investigación para médicos residentes: una mirada desde la literatura

Autores/as

  • Licet Villamizar-Gomez Profesor titular Fundación Universitaria de Ciencias de la Salud
  • Claudia Ibañez Antequera Instructor asociado, Fundación Universitaria de Ciencias de la Salud
  • Rosangela Casanova Libreros Instructor asociado, Fundación Universitaria de Ciencias de la Salud https://orcid.org/0000-0001-6063-277X
DOI: https://doi.org/10.6018/edumed.526931
Palabras clave: Aprendizaje, educación de postgrado en medicina, medicina basada en la evidencia, investigación biomédica, revisión sistemática

Resumen

Antecedentes: El aprendizaje de la apreciación crítica de la literatura e investigación es fundamental en la formación de los médicos residentes. Objetivo: identificar las estrategias educativas y las categorías de aprendizaje significativo según la taxonomía de Fink reflejadas en los cursos de bioestadística, epidemiología, investigación o medicina basada en la evidencia (MBE) en los programas de residencias médicas. Método: Se realizó una revisión de revisiones sistemáticas en MEDLINE, EMBASE, ERIC, The Cochrane Database of Systematic Reviews y LILACS sin restricciones de tiempo o idioma. Las referencias fueron revisadas independientemente por dos evaluadores y los desacuerdos resueltos por un tercer evaluador. La evaluación de la calidad global de las revisiones fue hecha con la herramienta AMSTAR. Las categorías de aprendizaje se clasificaron según la taxonomía de Fink. Resultados: Se encontraron 14 revisiones sistemáticas; cuatro calificadas como de alta calidad, seis como de media y cuatro como de baja calidad. Las estrategias educativas más utilizadas fueron el club de revistas, seguida del seminario y taller sobre medicina basada en la evidencia Los aprendizajes más evaluados fueron los conocimientos, la aplicación, la dimensión humana y el cuidado. Hay evidencia limitada sobre la integración y el aprender a aprender. Conclusiones: Se requieren estrategias educativas que involucren la planeación, aplicación y evaluación enfocadas en la interacción de aprendizajes significativos que promueva tanto el aprendizaje cognitivo como la parte humana de la práctica médica en investigación y apreciación crítica de la literatura.

Descargas

Los datos de descargas todavía no están disponibles.

Citas

Burke AE, Benson B, Englander R, Carraccio C, Hicks PJ. Domain of Competence: Practice-Based Learning and Improvement. Acad Pediatr. 2014; 14(2 Suppl), S38-S54. DOI: 10.1016/j.acap.2013.11.018.

Seelig CB. Affecting residents' literature reading attitudes, behaviors, and knowledge through a journal club intervention. J Gen Intern Med, 1991,6, 330-4. DOI: 10.1007/BF02597431.

Ahmadi-Abhari S, Soltani A, Hosseinpanah F. Knowledge and attitudes of trainee physicians regarding evidence-based medicine: a questionnaire survey in Tehran, Iran. J Eval Clin Pract, 2008,14(5),775-9. DOI: 10.1111/j.1365-2753.2008.01073.x.

Akl EA, Maroun N, Neagie G, Guyatt G, Schunemann HJ. EBM user and practitioner models for graduate medical education: what do residents prefer? Med Teach, 2006,28(2),192-4. DOI: 10.1080/01421590500314207.

Al Omari M, Khader Y, Jadallah K, Dauod AS, Al-Shdifat AA, Khasawneh NM. Evidence-based medicine among hospital doctors in Jordan: awareness, attitude and practice. J Eval Clin Pract, 2009,15(6),1137-41. DOI: 10.1111/j.1365-2753.2009.01260.x.

Bechtold JE, Williams BR, Weinstein SL, Polly DW, Pugely AJ, Buckwalter JA, et al. The pursuit of scholarship: Why we should care about resident research. J Bone Joint Surg Am,2017,99(22),e119. DOI: 10.2106/JBJS.16.01502.

Ausubel, D., Novak., J, D., y Hanesian, H. Psicología educativa: un punto de vista cognoscitivo, 2ª ed.; Trillas: México,2003.

Fink,L.D. Creating Significant Learning Experiences: An Integrated Approach to Designing College Courses, Revised and Updated; Jossey-Bass: San Francisco, 2013.

Centro Cochrane Iberoamericano, traductores. Manual Cochrane de Revisiones Sistemáticas de Intervenciones, versión 5.1.0 [actualizada en marzo de 2011] [Internet]. Barcelona: Centro Cochrane Iberoamericano; 2012. Disponible online en: http://www.cochrane.es/?q=es/node/269

Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med, 2009,18(151),264-9. DOI: 10.7326/0003-4819-151-4-200908180-00135.

Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007,15(7),10. DOI: 10.1186/1471-2288-7-10.

Jin YH, Wang GH, Sun YR, Li Q, Zhao C, Li G, et al. A critical appraisal of the methodology and quality of evidence of systematic reviews and meta-analyses of traditional Chinese medical nursing interventions: a systematic review of reviews. BMJ Open,2016,6:e011514. DOI:10.1136/bmjopen-2016- 011514. DOI: 10.1136/bmjopen-2016-011514.

Akl EA, Kairouz VF, Sackett KM, Erdley WS, Mustafa RA, Fiander M, et al. Educational games for health professionals. Cochrane Database Syst Rev,2013,(1),CD00641. DOI:10.1002/14651858.CD006411.pub3.

Blackmore C, Austin J, Lopushinsky SR, Donnon T. Effects of postgraduate medical education "Boot Camps" on clinical skills, knowledge, and confidence: A Meta-Analysis. J Grad Med Educ,2014,6(4),643-52. DOI: 10.4300/JGME-D-13-00373.1.

Green ML. Graduate medical education training in clinical epidemiology, critical appraisal, and evidence-based medicine: a critical review of curricula. Acad Med,1999,74(6),686-94. DOI: 10.1097/00001888-199906000-00017.

Gordon M, Findley R. Educational interventions to improve handover in health care: a systematic review. Med Educ,2011,45(11),1081-9. DOI: 10.1111/j.1365-2923.2011.04049.x.

Greenhalgh T, Toon P, Russell J, Wong G, Plumb L, Macfarlane F. Transferability of principles of evidence based medicine to improve educational quality: Systematic review and case study of an online course in primary health care. Br Med J,2003,326(7381),142-5. DOI: 10.1136/bmj.326.7381.142.

Webster F, Krueger P, MacDonald H, Archibald D, Telner D, Bytautas J, et al. A scoping review of medical education research in family medicine. BMC Med Educ,2015,15,79. DOI: 10.1186/s12909-015-0350-1.

Albarqouni L, Hoffmann T, Glasziou P. Evidence-based practice educational intervention studies: a systematic review of what is taught and how it is measured. BMC Med Educ,2018,18(1),177. DOI: 10.1186/s12909-018-1284-1.

Alguire PC. A review of journal clubs in postgraduate medical education. J Gen Intern Med,1998,13(5),347-53. DOI: 10.1046/j.1525-1497.1998.00102.x. URL (visitado 25 de febrero de 2022).

Agrawal S, Szatmari P, Hanson M. Teaching evidence-based psychiatry: integrating and aligning the formal and hidden curricula. Acad Psychiatry,2008,32(6),470-4. DOI: 10.1176/appi.ap.32.6.470.

Perry JJ, Snider CE, Artz JD, Stiell IG, Shaeri S, McLeod S, et al. CAEP 2014 Academic Symposium: "How to make research succeed in your emergency department: How to develop and train career researchers in emergency medicine". CJEM,2015,17(3),334-43. DOI: 10.1017/cem.2015.63.

Harris J, Kearley K, Heneghan C, Meats E, Roberts N, Perera R, et al. Are journal clubs effective in supporting evidence-based decision making? A systematic review. BEME Guide No. 16. Med Teach,2011,33(1),9-23. DOI: 10.3109/0142159X.2011.530321.

Richards D. Integrating evidence-based teaching into to clinical practice should improve outcomes. Evid Based Dent,2005,6(2),47. DOI: 10.1038/sj.ebd.6400332.

Audet N, Gagnon R, Ladouceur R, Marcil M. How effective is the teaching of critical analysis of scientific publications? Review of studies and their methodological quality. CMAJ,1993,148(6),945-52. URL Disponible en: https://www.cmaj.ca/content/148/6/945 (visitado 25 de febrero de 2022).

Norman GR, Shannon SI. Effectiveness of instruction in critical appraisal (evidence-based medicine) skills: A critical appraisal. Can Med Assoc J,1998,158(2),177-81. URL Disponible en https://www.cmaj.ca/content/cmaj/158/2/177.full.pdf (visitado 25 de febrero de 2022).

Taylor R, Reeves B, Ewings P, Binns S, Keast J, Mears R. A systematic review of the effectiveness of critical appraisal skills training for clinicians. Med Educ,2000,34(2),120-5. DOI: 10.1046/j.1365-2923.2000.00574.x.

Hyde C, Parkes J, Deeks J, Milne R. Systematic review of effectiveness of teaching critical appraisal. Institute of Health Sciences, Centre for Statistics in Medicine: Oxford, 2000.

Ebbert JO, Montori VM, Schultz HJ. The journal club in postgraduate medical education: A systematic review. Med Teach,2001,23(5),455-61. DOI: 10.1080/01421590120075670.

Garg A, Turtle KM. Effectiveness of training health professionals in literature search skills using electronic health databases-a critical appraisal. Health Info Libr J,2003,20(1),33-41. DOI: 10.1046/j.1471-1842.2003.00416.x.

Coomarasamy A, Taylor R, Khan KS. A systematic review of postgraduate teaching in evidence-based medicine and critical appraisal. Med Teach,2003,25(1),77-81. DOI: 10.1080/0142159021000061468.

Coomarasamy A, Khan KS. What is the evidence that postgraduate teaching in evidence-based medicine changes anything? A systematic review. BMJ,2004,329(7473),1017. DOI: 10.1136/bmj.329.7473.1017.

Nabulsi M, Harris J, Letelier L, Ramos K, Hopayian K, Parkin C, et al. Effectiveness of education in evidence-based healthcare: the current state of outcome assessments and a framework for future evaluations. Int J Evid Based Healthc,2007,5(4),468-76. DOI: 10.1111/j.1479-6988.2007.00084.x.

Flores-Mateo G, Argimon JM. Evidence based practice in postgraduate healthcare education: A systematic review. BMC Health Serv Res,2007,7,119. DOI: 10.1186/1472-6963-7-119.

Ilic D. Teaching evidence-based practice: Perspectives from the undergraduate and post-graduate viewpoint. Ann Acad Med Singapore,2009,38(6),559-63.

Horsley T, O’Neill J, McGowan J, Perrier L, Kane G, Campbell C. Interventions to improve question formulation in professional practice and self-directed learning. Cochrane Database of Systematic Reviews, 2010,5,No CD007335. DOI:10.1002/14651858.CD007335.pub2.

Ahmadi N, McKenzie ME, Maclean A, Brown CJ, Mastracci T, McLeod RS. Teaching evidence based medicine to surgery residents-is journal club the best format? A systematic review of the literature. J Surg Educ,2012,69(1):91-100. DOI: 10.1016/j.jsurg.2011.07.004.

Ilic D, Maloney S. Methods of teaching medical trainees evidence-based medicine: a systematic review. Med Educ,2014,48(2):124-35. DOI: 10.1111/medu.12288.

Gehlbach SH, Boluba JA, Dickinson JC. Teaching residents to read the medical literature. J Med Educ, 1980;55(4):362-5. DOI: 10.1097/00001888-198004000-00007.

Kitchens JM, Pfeifer MP. Teaching residents to read the medical literature: a controlled trial of a curriculum in critical appraisal/clinical epidemiology. J Gen Intern Med,1989,4(5),384-7. DOI: 10.1007/BF02599686.

Kellum JA, Rieker JP, Power M, Powner DJ. Teaching critical appraisal during critical care fellowship training: a foundation for evidence-based critical care medicine. Crit Care Med,2000,28(8),3067-70. DOI: 10.1097/00003246-200008000-00065.

Thurnau GR, Fishburne JI. Format of an obstetrics and gynecology journal club and four years' experience. Am J Obstet Gynecol,1989,160(2),313-6. DOI: 10.1016/0002-9378(89)90432-8.

Baum DK. The impact of an Evidence-Based Medicine workshop on residents' attitudes towards and self-reported ability in evidence-based practice. Med Educ Online,2003,8(1),4329. DOI: 10.3402/meo.v8i.4329.

Schoenfeld P, Cruess D, Peterson W. Effect of an evidence-based medicine seminar on participants' interpretations of clinical trials: a pilot study. Acad Med,2000,75(12),1212-4. DOI: 10.1097/00001888-200012000-00019.

Ross R, Verdieck A. Introducing an evidence-based medicine curriculum into a family practice residency-is it effective? Acad Med,2003,78(4),412-7. DOI: 10.1097/00001888-200304000-00019.

Bradley DR, Rana GK, Martin PW, Schumacher RE. Real-time, evidence-based medicine instruction: a randomized controlled trial in a neonatal intensive care unit. J Med Lib Assoc,2002,90(2),194-201. URL Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC100764/pdf/i0025-7338-090-02-0194.pdf (visitado 30 de mayo de 2022).

Bazarian JJ, Davis CO, Spillane LL, Blumstein H, Schneider SM. Teaching emergency medicine residents evidence-based critical appraisal skills a controlled trial. Ann Emerg Med,1999,34(2),148-54. DOI: 10.1016/s0196-0644(99)70222-2.

Caudill TS, Johnson MMS, Rich EC. The effect of journal club on medicine resident interaction with original research literature. Clin Res,1993,41,816A.

Dinkevich E, Markinson A, Ahsan S, Lawrence B. Effect of a brief intervention on evidence-based medicine skills of pediatric residents. BCM Med Educ,2006,6:1. DOI: 10.1186/1472-6920-6-1.

Erickson S, Warner ER. The impact of an individual tutorial session on MEDLINE use among obstetrics and gynaecology residents in a academic training programme: a randomised trial. Med Educ,1998,32(3),269-73. DOI:10.1046/j.1365-2923.1998.00229.x.

Fu CFY, Hodges B, Regehr G, Goldboom DS, Garfinkel P. Is a journal club effective for teaching critical appraisal skills? A controlled trial with residents in psychiatry. Acad Psychiatry,1999,23,205-9. URL Disponible en: https://link.springer.com/article/10.1007/BF03340056 (visitado 30 de mayo de 2022).

Haidet P, Morgan RO, O'Malley K, Morgan BJ, Richards BF. A controlled trial of active versus passive learning strategies in a large group setting. Adv Health Sci Educ Theory Pract,2004,9(1),15-27. DOI: 10.1023/B:AHSE.0000012213.62043.45.

Khan KS, Dwarakanath LS, Pakkal M, Brace V, Awonuga A. Postgraduate journal club as a means of promoting evidence-based obstetrics and gynaecology. J Obstet Gynaecol,1999,19(3),231-4. DOI: 10.1080/01443619964968.

Kulier R, Coppus SF, Zamora J. The effectiveness of a clinically integrated e-learning course in evidence-based medicine. A cluster randomised controlled trial. BMC Med Educ,2009,9: 21. DOI: 10.1186/1472-6920-9-21.

McLeod RS, MacRae HM, McKenzie ME, Victor JC, Brasel KJ, Evidence based reviews in surgery steering committee. A moderated journal club is more effective than an internet journal club in teaching critical appraisal skills: results of a multicenter randomized controlled trial. J Am Coll Surg,2010,211,769-76. DOI: 10.1016/j.jamcollsurg.2010.08.016.

Stevermer JJ, Chambliss ML, Hoekzema GS. Distilling the literature: a randomized, controlled trial testing an intervention to improve selection of medical articles for reading. Acad Med,1999,74(1),70-2. DOI: 10.1097/00001888-199901000-00021.

Cheatham ML. A structured curriculum for improved resident education in statistics. Am Surg,2000,66(6),585-8.

Langkamp DL, Pascoe JM, Nelson DB. The effect of a medical journal club on residents' knowledge of clinical epidemiology and biostatistics. Fam Med,1992,24(7),528-30.

Linzer M, DeLong ER, Hupart KH. A comparison of two formats for teaching critical reading skills in a medical journal club. J Med Educ,1987,62,690-2. DOI: 10.1097/00001888-198708000-00014.

Markert RJ. A research methods and statistics journal club for residents. Academic Medicine,1989,64(4),223-4. DOI: 10.1097/00001888-198904000-00014.

Cabell CH, Schardt C, Sanders L, Corey GR, Keitz SA. Resident utilization of information technology. J Gen Intern Med,2001,16(12),838-44. DOI: 10.1111/j.1525-1497.2001.10239.x.

Grad R, Macaulay AC, Warner M. Teaching evidence-based medical care: description and evaluation. Fam Med,2001,33(8),602-6. URL Disponible en: https://fammedarchives.blob.core.windows.net/imagesandpdfs/fmhub/fm2001/sep01/re1.pdf (visitado 30 de mayo de 2022).

Green ML, Ellis PJ. Impact of an evidence-based medicine curriculum based on adult learning theory. J Gen Intern Med,1997,12,742-50. DOI: 10.1046/j.1525-1497.1997.07159.x

Hillson SD, Schlossberg LA. Effects of journal club on critical review. Clin Res,1993,41:559A. URL (visitado 30 de mayo de 2022).

Lee AG, Boldt HC, Golnik KC, Arnold AC, Oetting TA, Beaver HA. Structured Journal club as a tool to teach and assess resident competence in practice-based learning and improvement. Ophthalmology,2006,113(3),497-500. DOI: 10.1016/j.ophtha.2005.12.010.

Smith CA, Ganschow PS, Reilly BM, Evans AT, McNutt RA, Osei A, et al. Teaching residents evidence-based medicine skills: a controlled trial of effectiveness and assessment of durability. J Gen Intern Med. 2000,15(10),710-5. DOI:10.1046/j.1525-1497.2000.91026.x.

Toedter LJ, Thompson LL, Rohatgi C. Training surgeons to do evidence-based surgery: A collaborative approach. J Am Coll Surg,2004,199(2),293-9. DOI:10.1016/j.jamcollsurg.2004.04.006.

Haines SJ, Nicholas JS. Teaching evidence-based medicine to surgical subspecialty residents. J Am Coll Surg,2003,197(2),285-9. DOI: 10.1016/S1072-7515(03)00114-5.

Young T, Rohwer A, Volmink J, Clarke M. What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PLoS One,2014,9(1),e86706. DOI: 10.1371/journal.pone.0086706.

Borrelli B, Sepinwall D, Ernst D, Bellg AJ, Czajkowski S, Breger R, et al. A new tool to assess treatment fidelity and evaluation of treatment fidelity across 10 years of health behavior research. J Consult Clin Psychol,2005,73(5),852-60. DOI: 10.1037/0022-006X.73.5.852.

Bala MM, Poklepović Peričić T, Zajac J, Rohwer A, Klugarova J, Välimäki M, Lantta T, Pingani L, Klugar M, Clarke M, Young T. What are the effects of teaching Evidence-Based Health Care (EBHC) at different levels of health professions education? An updated overview of systematic reviews. PLoS One,2021 22,16(7),e0254191. DOI: 10.1371/journal.pone.0254191.

Publicado
22-07-2022
Cómo citar
Villamizar-Gomez, L., Ibañez Antequera, C. ., & Casanova Libreros, R. (2022). Estrategias educativas y aprendizaje significativo en los cursos de investigación para médicos residentes: una mirada desde la literatura. Revista Española de Educación Médica, 3(3). https://doi.org/10.6018/edumed.526931

Artículos más leídos del mismo autor/a