Adquisición de competencias clínicas en el grado en Medicinaevaluación de un programa formativo

Abstract

Objectives: to evaluate the implementation, execution and results of a formative program focused on improving competencies in anamnesis and physical examination in the degree in Medicine, as well as to assess the perception of the students who participated in the program. Methods: an analytical, experimental, prospective and longitudinal study was designed, following a before-after intervention study type, which was applied to students in the last year of the degree in Medicine at the University of Murcia in the subject Rotatorio de Medicina I. Prior to its implementation, the formative actions and the evaluation instruments of the Formative Program were designed and validated. The formative actions designed were: a clinical rotation, the writing of a clinical case, a virtual web learning environment, a physical examination seminar and training in anamnesis with artificial intelligence through conversational agents, also known as chatbots. The evaluation of competences, carried out before and after applying the Formative Program, was done through the use of three clinical stations with a simulated patient instructor. After completing the Formative Program, the students completed a voluntary satisfaction survey carried out using a semi-quantitative Likert-type scale (1 to 5 points) and a global evaluation of the activities (maximum 10 points). Results: a total of 74 students completed the Formative Program during the 2019-2020 academic year. The areas evaluated within the professional competence of anamnesis and the results obtained in the first and second evaluation (maximum of 10 points), were: general antecedents (5.08; 8.89; p<0.001), organic antecedents (2 .71; 8.98; p<00.001), other antecedents (5.69; 7.31; p<0.001), baseline status (4.32; 7.67; p<0.001) and current disease (6.42, 8.3, p<0.001). The global results in anamnesis improved from 5.12 points to 8.49 points (p<0.001). The areas evaluated within the professional competence of physical examination and the results obtained were: head and neck (5.95; 9.23; p<0.001), cardiac auscultation (8.02; 9.23; p<0.001), pulmonary auscultation (7.46; 9.07; p<0.001) and abdominal examination (6.77; 9.17; p<0.001). The global results in physical examination improved from 7.09 points to 9.13 points (p<0.001). In the perception study, all the formative actions obtained average results above 4 points on the Likert scale, except for the writing of a clinical case report (mean of 3.8 points). The global evaluations of the simulated patient instructor evaluation and the formative actions were: simulated patient instructor (first evaluation) (9.44 points), clinical rotation (8.44 points), training with artificial intelligence (8.6 points), physical examination seminar (8 .75 points), writing a clinical case (7.6 points), virtual web learning environment (8.47 points), simulated patient instructor (second evaluation) (9.3 points). Conclusions: 1. The professional competences in anamnesis and physical examination of Medicine students improved after applying the proposed Formative Program. 2. Active learning of medical students was encouraged using formative assessment with simulated patient instructors. 3. The acquisition of professional competences in Medicine improved with the use of artificial intelligence. 4. Medicine students show high levels of satisfaction with the implementation of a formative program using new learning and evaluation methodologies, giving the best rating to the instructor simulated patients’ assessment. 5. Despite the human and material resources required for its development, the implementation of the proposed Formative Program in the faculties of Medicine is feasible.