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Percepción de los docentes sobre la enseñanza de la toma de decisiones clínicas a los residentes de Medicina Interna en el contexto de la Medicina Basada en la Evidencia

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dc.contributor.advisorVergel Guerrero, John Alexander
dc.creatorPulido Beltrán, Mónica Liliana
dc.creatorCalderón Novoa, Wilmer José
dc.creator.degreeMagíster en Educación para Profesionales de la Salud
dc.date.accessioned2025-01-20T16:04:20Z
dc.date.available2025-01-20T16:04:20Z
dc.date.created2024-09-10
dc.date.embargoEndinfo:eu-repo/date/emabergoEnd/2027-01-21
dc.descriptionEste estudio parte del enfoque de la teoría constructivista, empleando una metodología cualitativa de tipo estudio de caso instrumental donde se realizaron entrevistas semiestructuradas a 15 docentes en dos hospitales de Bogotá durante octubre y noviembre de 2024. Estas entrevistas exploraron sus percepciones sobre la MBE y los métodos que emplean para enseñar sus principios en un entorno clínico. Mediante análisis temático, se identificaron los principales enfoques pedagógicos y los desafíos que enfrentan los docentes al enseñar MBE. Los resultados muestran cuatro temas clave. Primero, las estrategias de enseñanza se basan en rondas clínicas, clubes de revistas y análisis de casos, con un fuerte énfasis en el análisis crítico de la literatura. Segundo, los docentes destacan la importancia de integrar la evidencia científica en la práctica clínica, incluyendo búsqueda y análisis exhaustivo de la literatura para respaldar decisiones. Tercero, reconocen la experiencia clínica como un complemento esencial de la MBE, pero encuentran dificultades para enseñar cómo equilibrar evidencia y juicio clínico en escenarios complejos. Cuarto, la integración de las preferencias del paciente se considera crucial, pero a menudo se reduce a explicar la conducta médica en lugar de fomentar una toma de decisiones verdaderamente compartida que refleje los valores y expectativas del paciente. Conclusiones: Las conclusiones indican que la enseñanza de la MBE se centra predominantemente en la evidencia científica, mientras que la integración de las preferencias del paciente y la experiencia clínica se considera indirecta o secundaria. Los docentes interpretan la consideración de las preferencias del paciente como una explicación de su estado de salud, sin una verdadera inclusión de sus valores o factores psicoemocionales en la toma de decisiones. Además, perciben la enseñanza de la experiencia clínica como algo que los residentes aprenden indirectamente mediante el ejemplo de los profesores, en lugar de una instrucción explícita sobre cómo equilibrar juicio clínico y evidencia científica. Este enfoque limitado podría restringir la comprensión integral de la MBE, dejando a los residentes sin una preparación completa para abordar las complejidades de la atención médica. Para mejorar la enseñanza de la MBE y formar médicos capaces de brindar atención integral, es esencial adaptar el currículo para incluir explícitamente habilidades de comunicación empática y toma de decisiones compartida, garantizando así que los futuros médicos puedan combinar adecuadamente la evidencia científica con las necesidades y valores individuales de sus pacientes.
dc.description.abstractThis study is based on the constructivist theory approach, employing a qualitative methodology in the form of an instrumental case study. Semi-structured interviews were conducted with 15 teachers in two hospitals in Bogotá during October and November 2024. These interviews explored their perceptions of Evidence-Based Medicine (EBM) and the methods they use to teach its principles in a clinical setting. Through thematic analysis, the main pedagogical approaches and challenges faced by teachers in teaching EBM were identified. The results highlight four key themes. First, teaching strategies rely on clinical rounds, journal clubs, and case analyses, with a strong emphasis on the critical appraisal of the literature. Second, teachers emphasize the importance of integrating scientific evidence into clinical practice, including thorough literature searches and analysis to support decision-making. Third, they recognize clinical experience as an essential complement to EBM but find it challenging to teach how to balance evidence and clinical judgment in complex scenarios. Fourth, while the integration of patient preferences is considered crucial, it often boils down to explaining medical conduct rather than fostering truly shared decision-making that reflects the patient’s values and expectations. Conclusions: The conclusions indicate that EBM teaching focuses predominantly on scientific evidence, while integrating patient preferences and clinical experience is regarded as indirect or secondary. Teachers interpret considering patient preferences as explaining their health status rather than truly including their values or psycho-emotional factors in decision-making. Additionally, they perceive the teaching of clinical experience as something residents learn indirectly by observing their instructors, rather than through explicit instruction on balancing clinical judgment and scientific evidence. This limited approach could constrain a comprehensive understanding of EBM, leaving residents inadequately prepared to address the complexities of healthcare. To enhance EBM teaching and train physicians capable of providing comprehensive care, it is essential to adapt the curriculum to explicitly include empathetic communication skills and shared decision-making, ensuring that future physicians can appropriately combine scientific evidence with the individual needs and values of their patients.
dc.format.extent37 pp
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.48713/10336_44744
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/44744
dc.language.isospa
dc.publisherUniversidad del Rosario
dc.publisherPontificia Universidad Javeriana. Facultad de Medicina
dc.publisher.departmentEscuela de Medicina y Ciencias de la Salud
dc.publisher.programMaestría en Educación para Profesionales de la Salud
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International*
dc.rights.accesRightsinfo:eu-repo/semantics/embargoedAccess
dc.rights.accesoRestringido (Temporalmente bloqueado)
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.source.bibliographicCitationAlbarqouni, L., Hoffmann, T., Straus, S., Olsen, N. R., Young, T., Ilic, D., Shaneyfelt, T., Haynes, R. B., Guyatt, G., & Glasziou, P. (2018). Core Competencies in Evidence-Based Practice for Health Professionals: Consensus Statement Based on a Systematic Review and Delphi Survey. JAMA network open, 1(2), e180281. https://doi.org/10.1001/jamanetworkopen.2018.0281
dc.source.bibliographicCitationBaghus, A., Giroldi, E., Muris, J., Stiggelbout, A., Van De Pol, M., Timmerman, A., & Van Der Weijden, T. (2021). Identifying Entrustable Professional Activities for Shared Decision Making in Postgraduate Medical Education: A National Delphi Study. Academic Medicine, 96(1), 126-133. https://doi.org/10.1097/ACM.0000000000003618
dc.source.bibliographicCitationBala, M., Poklepović Peričić, T., Joanna Zajac, Rohwer, A., Klugarova, J., Välimäki, M., Lantta, T., Pingani, L., Klugar, M., Clarke, M., & Young, T. (2021). What are the effects of teaching Evidence-Based Health Care (EBHC) at different levels of health professions education An updated overview of systematic reviews .2021..pdf. PLoS ONE, 16(7).
dc.source.bibliographicCitationCharles, C., Gafni, A., & Freeman, E. (2011). The evidence-based medicine model of clinical practice: Scientific teaching or belief-based preaching ? 17(i), 597–605. https://doi.org/10.1111/j.1365-2753.2010.01562.x
dc.source.bibliographicCitationChin‐Yee, B., & Upshur, R. (2018). Clinical judgement in the era of big data and predictive analytics. Journal of Evaluation in Clinical Practice, 24(3), 638-645. https://doi.org/10.1111/jep.12852
dc.source.bibliographicCitationCroskerry, P. (2009). Clinical cognition and diagnostic error: Applications of a dual process model of reasoning. Advances in Health Sciences Education, 14(S1), 27-35. https://doi.org/10.1007/s10459-009-9182-2
dc.source.bibliographicCitationDizon, J. M. R., Grimmer-Somers, K. A., & Kumar, S. (2012). Current evidence on evidence-based practice training in allied health a systematic review of the literature.pdf. International Journal of Evidence-Based Healthcare, 10, 347–360.
dc.source.bibliographicCitationDusin, J., Melanson, A., & Mische-Lawson, L. (2023). Evidence-based practice models and frameworks in the healthcare setting: A scoping review. BMJ Open, 13(5), e071188. https://doi.org/10.1136/bmjopen-2022-071188
dc.source.bibliographicCitationFeghali-Restrepo, A., & Estrada-Mesa, D. A. (2020). Problemas en la práctica clínica: Los retos de la medicina basada en la evidencia. Revista Médicas UIS, 33(1), 59-65. https://doi.org/10.18273/revmed.v33n1-2020007
dc.source.bibliographicCitationGluyas, H. (2015). Patient-centred care: Improving healthcare outcomes. Nursing Standard, 30(4), 50-59. https://doi.org/10.7748/ns.30.4.50.e10186
dc.source.bibliographicCitationGooberman-Hill, R. (2012). Qualitative Approaches to Understanding Patient Preferences. The Patient: Patient-Centered Outcomes Research, 5(4), 215-223. https://doi.org/10.1007/BF03262494
dc.source.bibliographicCitationGreenhalgh, T., Howick, J., Maskrey, N., & for the Evidence Based Medicine Renaissance Group. (2014). Evidence based medicine: A movement in crisis? BMJ, 348(jun13 4), g3725-g3725. https://doi.org/10.1136/bmj.g3725
dc.source.bibliographicCitationGuyatt, G. H., Cairns, J., & Churchill, D. (1992). Evidence-Based Medicine. JAMA, 268(17).
dc.source.bibliographicCitationHoward, B., Diug, B., & Ilic, D. (2022). Methods of teaching evidence‑based practice: A systematic review. BMC Medical Education, 22, 742.
dc.source.bibliographicCitationIlic, D. (2009). Teaching Evidence-based Practice: Perspectives from the Undergraduate and Post-graduate Viewpoint. Ann Acad Med Singapore, 38(6), 559–563.
dc.source.bibliographicCitationLam, W. W. T., Fielding, R., Johnston, J. M., Tin, K. Y. K., & Leung, G. M. (2004). Identifying barriers to the adoption of evidence-based medicine practice in clinical clerks: A longitudinal focus group study. Medical Education, 38(9), 987-997. https://doi.org/10.1111/j.1365-2929.2004.01909.x
dc.source.bibliographicCitationLarsen, C. M., Terkelsen, A. S., Fiala Carlsen, A.-M., & Kristensen, H. K. (2019). Methods for teaching evidence-based practice a scoping review. BMC Medical Education, 19, 259.
dc.source.bibliographicCitationLee, Y. K., Low, W. Y., & Ng, C. J. (2013). Exploring Patient Values in Medical Decision Making: A Qualitative Study. PLoS ONE, 8(11), e80051. https://doi.org/10.1371/journal.pone.0080051
dc.source.bibliographicCitationMontori, V. M., Ruissen, M. M., Hargraves, I. G., Brito, J. P., & Kunneman, M. (2023). Shared decision-making as a method of care. BMJ Evidence-Based Medicine, 28(4), 213-217. https://doi.org/10.1136/bmjebm-2022-112068
dc.source.bibliographicCitationPearce, W., Raman, S., & Turner, A. (2015). Randomised trials in context practical problems and social aspects of evidence-based medicine and policy. Trials, 16(394).
dc.source.bibliographicCitationRamani, S., & Leinster, S. (2008). AMEE Guide no. 34: Teaching in the clinical environment. Medical Teacher, 30(4), 347-364. https://doi.org/10.1080/01421590802061613
dc.source.bibliographicCitationRengerink, K. O., Thangaratinam, S., Barnfield, G., Suter, K., Weinbrenner, S., Horvath, A. R., Walczak, J., Min, A. W. E. L., Zanrei, G., Kunz, R., Meyerrose, B., Arvanitis, T. N., Rita, O., Arditi, C., Burnand, B., Gee, H., Khan, K. S., & Mol, B. E. N. W. J. (2011). How can we teach EBM in clinical practice? An analysis of barriers to implementation of on-the-job EBM teaching and learning. 33, 125–130. https://doi.org/10.3109/0142159X.2011.542520
dc.source.bibliographicCitationSackett, D. L. (1997). Evidence-based medicine. Semin Perinatol., 21(1), 3-5. https://doi.org/10.1016/s0146-0005(97)80013-4.
dc.source.bibliographicCitationSackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, B. R., & Richardson, S. W. (1996). Evidence based medicine: What it is and what it isn’t. British Medical Journal, 312, 71 – 72.
dc.source.bibliographicCitationStraus, S. E., Glasziou, P., Richardson, W. S., & Haynes, R. B. (2019). Evidence-Based Medicine: How to Practice and Teach EBM. Elsevier. https://books.google.com.co/books?id=yRx2uwEACAAJ
dc.source.bibliographicCitationSwennen, M. H. J., Boeije, H. R., Rheenen, N. V., Verheul, F. J. M., Graaf, Y. V. D., & Kalkman, C. J. (2013). Doctors’ Perceptions and Use of Evidence- Based Medicine: A Systematic Review and Thematic Synthesis of Qualitative Studies. 88(9), 1384–1396. https://doi.org/10.1097/ACM.0b013e31829ed3cc
dc.source.bibliographicCitationThomas, A., Chin-Yee, B., & Mercuri, M. (2022). Thirty years of teaching evidence-based medicine: Have we been getting it all wrong? Advances in Health Sciences Education, 27(1), 263–276. https://doi.org/10.1007/s10459-021-10077-4
dc.source.bibliographicCitationTikkinen, K. A. O., & Guyatt, G. H. (2021). Understanding of research results, evidence summaries and their applicability-not critical appraisal-are core skills of medical curriculum. BMJ Evidence-Based Medicine, 26(5), 231–233. https://doi.org/10.1136/bmjebm-2020-111542
dc.source.bibliographicCitationTringale, M., Stephen, G., Boylan, A.-M., & Heneghan, C. (2022). Integrating patient values and preferences in healthcare: A systematic review of qualitative evidence. BMJ Open, 12(11), e067268. https://doi.org/10.1136/bmjopen-2022-067268
dc.source.bibliographicCitationVan Der Weijden, T., Pieterse, A. H., Koelewijn-van Loon, M. S., Knaapen, L., Légaré, F., Boivin, A., Burgers, J. S., Stiggelbout, A. M., Faber, M., & Elwyn, G. (2013). How can clinical practice guidelines be adapted to facilitate shared decision making? A qualitative key-informant study. BMJ Quality & Safety, 22(10), 855-863. https://doi.org/10.1136/bmjqs-2012-001502
dc.source.bibliographicCitationvan Dijk, N., Hooft, L., & Wieringa-de Waard, M. (2010). What Are the Barriers to Residents’ Practicing Evidence-Based Medicine A Systematic Review. Academic Medicine, 85(7).
dc.source.bibliographicCitationWong, S. C., McEvoy, M. P., Wiles, L. K., & Lewis, L. K. (2013). Magnitude of change in outcomes following entry-level evidence-based practice training a systematic review.pdf. International Journal of Medical Education., 4, 107-114.
dc.source.bibliographicCitationYoung, T., Rohwer, A., Volmink, J., & Clarke, M. (2014). What Are the Effects of Teaching Evidence-Based Health Care (EBHC)? Overview of Systematic Reviews. PLoS ONE, 9(1), e86706. https://doi.org/10.1371/journal.pone.0086706
dc.source.bibliographicCitationZhang, Y., Coello, P. A., Brożek, J., Wiercioch, W., Etxeandia-Ikobaltzeta, I., Akl, E. A., Meerpohl, J. J., Alhazzani, W., Carrasco-Labra, A., Morgan, R. L., Mustafa, R. A., Riva, J. J., Moore, A., Yepes-Nuñez, J. J., Cuello-Garcia, C., AlRayees, Z., Manja, V., Falavigna, M., Neumann, I., … Schünemann, H. J. (2017). Using patient values and preferences to inform the importance of health outcomes in practice guideline development following the GRADE approach. Health and Quality of Life Outcomes, 15(1), 52. https://doi.org/10.1186/s12955-017-0621-0
dc.source.bibliographicCitationZwolsman, S. E., van Dijk, N., te Pas, E., & Wieringa-de Waard, M. (2013). Barriers to the use of evidence-based medicine knowledge and skills, attitude, and external factors.pdf. Perspect Med Educ, 2, 4-13.
dc.source.instnameinstname:Universidad del Rosario
dc.source.reponamereponame:Repositorio Institucional EdocUR
dc.subjectMedicina Basada en la Evidencia (MBE)
dc.subjectEducación médica
dc.subjectToma de decisiones clínicas
dc.subjectEnseñanza en medicina
dc.subjectPreferencias del paciente
dc.subjectExperiencia clínica
dc.subject.keywordEvidence-Based Medicine (EBM)
dc.subject.keywordMedical education
dc.subject.keywordClinical decision-making
dc.subject.keywordMedical teaching
dc.subject.keywordPatient preferences
dc.subject.keywordClinical experience
dc.titlePercepción de los docentes sobre la enseñanza de la toma de decisiones clínicas a los residentes de Medicina Interna en el contexto de la Medicina Basada en la Evidencia
dc.title.TranslatedTitlePerception of Teachers on Teaching Clinical Decision-Making to Internal Medicine Residents in the Context of Evidence-Based Medicine
dc.typebachelorThesis
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTrabajo de grado
local.department.reportEscuela de Medicina y Ciencias de la Salud
local.regionesBogotá
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