Educación Médica (Jun 2006)
Competencias médicas y su evaluación al egreso de la carrera de medicina en la Universidad Nacional de Cuyo (Argentina) Medical competences and their assessment at the end of the undergraduate medical program at the National University of Cuyo (Argentina)
Abstract
Los alumnos de la Carrera de Medicina, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, deben aprobar para su egreso, una Prueba Global de Ciclo Clínico. Con el objeto de analizar qué evaluar y qué instrumentos utilizar, se diseñó este trabajo tomando como marco teórico la Educación Basada en Competencias, en la que el curriculum debe ajustar el proceso de aprendizaje a los resultados esperados. Se entrevistó a médicos, pacientes, enfermeros, empleadores, docentes y alumnos (N=147). Se definieron seis competencias médicas y 51 componentes en total. Con esta información se realizó una encuesta a docentes (N=50) y se evaluó la significatividad de las diferencias de las respuestas obtenidas. Esto permitió reestructurar y reducir a 27 los componentes de las competencias. Se realizó una última consulta con la técnica Delphi (N=40), con el objeto de elegir el instrumento para evaluar cada componente y el momento de la carrera para hacerlo. De los veintisiete, veinticuatro deberían evaluarse durante el ciclo clínico, dieciséis al finalizar la carrera y tres en primer año. Los instrumentos más elegidos fueron: observación del desempeño con pacientes, evaluación continua con retroalimentación y exámenes orales y escritos. A partir de estos resultados, se dispone de una definición de las competencias y sus componentes para el ejercicio profesional, una selección de los instrumentos y el momento de la carrera en que deben evaluarse, el aval de la comunidad educativa para ambos productos y una base para establecer un sistema de evaluación para todo el curriculum.In order to graduate, medical students at the National University of Cuyo have to pass a mandatory global clinical exam. This research project was designed to analyze what that exam should assess as well as the instruments to be used. The project employed the paradigm of Outcome-Based Education, which establishes that the curriculum must adjust the learning process and the assessment tools to the expected outcomes. An interview, conducted with physicians, patients, nurses, employers, faculty members and students (n=147) defined six competences with a total of fifty-one components. The six competences were: Clinical skills; Medical knowledge; Communication skills; Personal and professional update and development; Ethical and legal aspects of the profession; and Social context and health system. A survey was drafted to select the essential components of the six competences. This survey was applied to fifty faculty members. The significance of the differences was studied. As a result the competence components were reordered and reduced to twenty-seven. A second survey, based on the Delphi technique, was submitted to another group of faculty members (n=40), in order to select the most appropriate assessment instrument for each component and to determine the most adequate timetable for such assessments during the course of the medical program. Twenty-four of the twenty-seven components were to be evaluated during the clinical years (sixteen of them to be assessed after the internship, at the end of the medical program) and three were to be appraised during the first year. Observation of the students' performance with patients, continuous evaluation with feedback, and oral and written exams were the instruments deemed most appropriate by the faculty. In conclusion, this project served to define the most appropriate competences and their components for a professional medical practice, as well as determining the assessment instruments and the timetable for their application. It also obtained faculty support and established the framework of a global system for student assessment across the curriculum.
