Glossary Part II- Version February 25, 2015-
The Scientific Societies bring together professionals from different specialties, have academic and social prestige, are entities that develop knowledge and advise governments, universities and different organizations. They promote and stimulate professional training, emphasizing the importance of the ethical and moral values of the profession.
In the Scientific Societies, the development of knowledge is stimulated to achieve the improvement of its members, which is reflected in the ultimate goal of achieving the greatest benefit for patients. To this end, continuous education activities are implemented, such as: congresses, courses, conferences, publications of Journals and Bulletins; as lifelong learning programs.
The Scientific Societies have put in place mechanisms for the evaluation of doctors, which are called certifications and recertifications (also called “quality maintenance”). These evaluations are voluntary, periodic, and are carried out by the peers.
The certifications and recertifications install the need to guarantee the professional quality.
QUALITY OF HEALTH SERVICES – QUALITY ASSESSMENT – QUALITY ASSURANCE – QUALITY IMPROVEMENT
Quality: the degree to which health services increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
Quality evaluation and control: these are the processes and results that include systematic observation, the comparison with a standard or parameters, the monitoring of processes and an associated feedback that prevents or minimizes the error. Its application has the purpose of improving quality.
Quality Assurance: global set of procedures, checks, audits and specific corrective measures used to ensure the highest possible quality in research tests, diagnostic studies, control tests, sampling studies, analysis and other technical and information activities. It includes the control of processes and the control of results. Quality assurance facilitates a good level of care and allows better results.
Quality improvement: is the optimization of resources to improve medical care through monitoring and evaluation of the elements of diagnosis, treatment and results. The improvement of the quality is linked to processes of optimization of the performance of the individual effectors and of the systems in which they work. Examples of quality improvement are: morbidity and mortality athenaeums, preventive deaths review panel, follow-up of … .. audit, complications, errors, adverse events and sentinel events, mortality affected by risks, corrective strategies to through … pathways and protocols, targeted education and the role of medical records.
RESIDENCES – PROGRAMMATIC CONCURRENCES – FELLOW
It is a regular system of comprehensive postgraduate training for the recent graduate in the disciplines that make up the health team. It is exhaustive and exercises it in the responsible and effective performance of the corresponding discipline, under the modality of supervised training in gradual work and of increasing responsibility.
It is distinguished by the possibilities of intensive practice and immersion in the hospital environment. There is a generalized agreement that supervised training in service enhances the appropriation of the practices of each specialty, their knowledge, their codes and those of the health institutions.
The learning conditions offered by direct daily contact with colleagues, patients and family members and other professionals of the health team in a real work environment are insurmountable; its quality can only be guaranteed through the control of the processes and results of the training programs that must be permanently reviewed and updated in the light of the advances in knowledge and health policies. The residence includes instances of periodic evaluation that must be approved to remain in the system. The granting of a scholarship, the exclusive dedication, the transparency of the selection process by open competition, through a written examination, which can be complemented with interviews, language test and evaluation of the academic background, are conditions that characterize the current residence model .
Programmatic Concurrences: it is a training system that shares certain characteristics with the residences, it is carried out in the same place as the residences, with the same training activities but with a lower workload and more years of training. It has the same degree of supervision and complies with the same responsibilities as the resident, although it is not developed with exclusive dedication nor is remuneration received.
Fellow or post-specialization residence: specialized supervised training system in a specific area after completion of basic or post-basic second-level residence, to obtain an aggregate grade.
CONEAUNational Comission of University Evaluation and Accreditation is a decentralized public body, with budgetary autonomy and functional autonomy, which develops its activities within the jurisdiction of the Ministry of Education and assumes responsibility for institutional evaluation and accreditation of careers, in order to guarantee quality of university education. All its decisions are made public, strengthening its independence and pluralism. The CONEAU is composed of twelve members, appointed by the National Executive Power at the proposal of the following organizations:
- three by the National Interuniversity Council
- one by the Council of Rectors of Private Universities
- one by the National Academy of Education
- three for each of the Chambers of the Honorable National Congress
- one by the Ministry of Education.
- Coordinate and carry out external evaluations of university institutions, with the participation of academic peers of recognized competence
- To accredit degree careers corresponding to professions regulated by the State
- Accredit graduate careers, whether specialization, masters and doctorate, whatever the field in which they develop
- Accredit University Institutions: Issue on the consistency and viability of the institutional project required for the Ministry of Education to authorize the implementation of a new national university institution after its creation by law of the National Congress and recognition of a Provincial
- Prepare the reports required to grant or not the provisional authorization and the definitive recognition of the private and foreign university institutions, as well as the reports by means of which the provisional operating period of said institutions is evaluated annually
- Issue on the proposals for the constitution of Private Entities for the purposes of University Evaluation and Accreditation -EPEAU- prior to the decision of the Ministry of Education
- Issue on offers of undergraduate and postgraduate university institutions outside the scope of the Planning Council of Higher Education (CPRES) to which they belong
- Ponderar la trayectoria, nivel y jerarquía de los Centros de Investigación e Instituciones de Formación Profesional Superior que solicitan ser incorporados al Registro Público
- To weigh the trajectory, level and hierarchy of the Research Centers and Higher Vocational Training Institutions that request to be incorporated into the Public Registry.
CONVENTION – CONSORTIUM – COALITION
In most cases these terms are used interchangeably.
Are Agreements between two or more people or entities on a matter.
Underlie an agreement of wills, in whose text the duties and obligations assumed by the parties are reflected. The responsibilities that each one has, the actions that derive from it, the expected results and the period in which it is convenient are detailed.
MEDICAL EDUCATIONMedical Education includes the processes of teaching, learning and training students, with a progressive integration of knowledge, experiences, skills, attitudes, responsibility and values so that they can finally practice medicine. Classically it is divided into undergraduate, postgraduate and continuing education, although it is increasingly insisted that medical education is a continuum. Postgraduate education or training of specialists is the more or less continuous period of learning after the basic training period that allows acquiring competences for the exercise in the chosen medical specialty.
EVALUATION – STANDARDS – EXAM
The evaluation is a process by which you try to verify that the expected quality levels have been reached. In the field of Education, educational evaluation includes the evaluation of apprentices, students and professionals; the evaluation of teaching, that is, the teaching performance and the quality of the educational programs; the institutional evaluation that covers the fulfillment of its functions and its mission in the system and the accreditation of careers. The evaluation of the impact of education policies designed and implemented at local, national and regional level closes the complex “world” that includes educational evaluation. Thus, within the framework of the educational evaluation are included concepts such as: measure, compare, assess, categorize, enter, admit, approve, promote, qualify, rate, qualify, accredit, certify, recertify and others, official recognition, provisional or definitive, standards, standards, criteria, objectives, tests, instances and evaluation instruments, peer evaluators, and so on. Every evaluation includes the search for information, with valid and reliable instruments, whose results are compared with a standard parameter; the assessment of this comparison allows decisions to be made to improve quality. It also goes through an evaluation process when, after a test -instrument- where they try to know -search for information- the learning achieved by a student whose frame of reference are the proposed objectives -parameters- with which to compare and qualify to the student -valuation-, it is decided to promote it -make decisions- or to fail it and make changes in teaching such as reinforce and expand the proposed bibliography or implement new teaching strategies, etc. -Decision making to improve the quality of teaching-. In this way, these moments can be transposed to the evaluation of the teaching performance and the quality of the programs and careers as well as to the fulfillment of the functions and mission of the educational institution that are proposed as goals.
Standards: These are the parameters with which the information obtained in the first moment of the evaluation is compared with the objective of making a value judgment on quality and making decisions. The standards are agreed before starting the evaluation process and can be modified or calibrated after the process, as a result of the evaluation of the same process itself.
Exam: These are the evaluation instruments that are selected or constructed to be applied in the evaluation process. They must be valid, relevant and guarantee objectivity and confidentiality. There are different types of exams according to characteristics and the objectives to be evaluated:
Oral clinical examination: The unstructured and oral clinical examination has constituted the traditional form of clinical examination and continues to be very popular in many parts of the world. Face to face, the examiner assesses the breadth and depth of a student’s understanding of a real-life clinical situation. Competency aspects such as the ability to respond to new information, interpersonal communication skills, and competencies that can not be measured by more objective methods, such as ECOES (OSCE) can be evaluated. The variability can be reduced by involving only a small group of patients who present the same disease and similar symptoms, or by using simulated patients. The value of this form of examination can be increased by videotaping the long-term exams so that the examiner subsequently establishes the score and discusses the results with the examinee. The concision and experience on the part of the examiners, as well as the highly structured approach of the examination score, contribute to the quality of this form of examination.
Objective structured clinical examination (ECOE): Method introduced in 1972 to standardize clinical competence. It is a standardized method for the evaluation of the abilities to carry out the clinical history, the physical examination, the communication skills with patients and their relatives, the breadth and depth of knowledge, the ability to summarize and document the findings, and the ability to establish a differential diagnosis or a therapeutic plan. The examiner must carefully plan the areas and objectives of the evaluation with their corresponding identification and registration. The clinical competence is fragmented into different components such as the performance of the clinical history, cardiac auscultation, the interpretation of an electrocardiogram (ECG) or the establishment of conclusions according to the findings obtained in all tests. Candidates rotate through a series of “stations”, usually 12 to 20, and perform standardized tasks in a specified period of time. The format of the individual ECOE can vary significantly. Clinical models and standardized or simulated patients can be used to examine a large number of students with the same clinical problem without causing fatigue or stress to real patients. Direct or indirect observations, as well as checklists and rating scales, allow determining the performance of the examinees against predetermined standards, which facilitates a more objective assessment than that achieved with traditional methods. In this way, an examination with greater validity and reliability can be carried out that, more than determining the knowledge of the examinee, reveals his competence in a wide range of clinical aspects. It is possible to eliminate to a large extent the variables corresponding to the examinee and the patient. The ECOE test is indicated especially in situations in which it is necessary to make a pass / fail decision or when a decision must be made about whether the student has reached a pre-established standard. This test is cost-effective when examining many candidates at the same time, since it is difficult to develop and apply, and requires resources and experience. In subsequent exams, less time is required and it is possible to decrease both time and effort when maintaining a bank of objective questions and checklists. The use of the ECOE test for formative assessment has great value because students can learn the elements that constitute the clinical competence and can know their strengths and weaknesses. However, in the ECOE exam the knowledge and skills of the student are checked in a compartmental manner, so that the capacity of the examinee to attend to the patient as a whole is not determined. In addition, the ECOE test should be combined with other forms of assessment, such as the assistance of cases in a real clinical context. The term that was previously used for this evaluation method was the Multiple Station Exams / Exam (MSE).
Programmed oral examination evoking the knowledge: Instrument for assessing the clinical decision-making capacity and the application of medical knowledge using real patients and a standardized oral examination. An expert doctor / examiner asks the examinee about the management of the patient, about the reasons on which the diagnosis has been established, how he has interpreted the clinical findings and the therapeutic plans. The specialist evaluates the examinee through an established protocol and with a predetermined scoring procedure. In efficient CSR systems, each patient (each item of the test) is studied for 5 to 10 minutes. A typical CSR scan consists of conducting exam sessions performed by one or two physicians / examiners and separated into periods of 30 to 60 minutes. Afterwards, the results obtained by the examinee are determined by combining the scores of all the cases studied through an apt / unfit method or by scoring each exam session. It has been noted that the reliability of the exam score ranges from 0.65 to 0.88. For the assessment of memory of medical knowledge, multiple-choice questions (PRM) are more effective than CSR exams.
Standardized oral examination: Evaluation of performance through the use of real patient cases and performed by an experienced examining doctor who asks the examinee in a standardized manner. These tests allow us to assess the capacity for clinical decision making and the application or use of medical knowledge about real patients. The examination begins with the presentation of a clinical problem in the context of a patient and asking the examinee to handle the case. The examinee can be evaluated through a selection of different clinical cases. The examiner should have experience in the provision of patient data in each clinical context, in asking questions to the examinee and in the evaluation and scoring of the examiner’s responses. To elaborate this type of examinations, abundant resources and experience are necessary.
Examination with answers of true-false type: Exam in which the questions are propositions on which the student must indicate if they are true or false. This method of examination presents three weak points that must be taken into account: a high level of correct answers due to chance, ambiguity regarding the level of certainty of the statements that constitute the questions, and the various criteria for proposition such as “true”. However, there are methods to solve these problems. First, because the answer option is binary, the formal level of probability of indicating the correct answer is 50%. This high rate of success by intuition means that it is necessary that the exam is constituted by a relatively high number of propositions or questions of this type so that a reasonable identification of the student’s performance above the degree of success due to chance is possible. Secondly, the degree of certainty of some of the propositions that constitute the questions can be ambiguous, susceptible of interpretation or dependent on subtle aspects of the question itself. To minimize these problems, examiners should make the proposals as clear as possible.
The third problem refers to the individual differences in the criteria to consider that a proposition is “true” or “false”. Students have varying degrees of confidence that a proposition is true, so that two students with the same perception of the “degree of truth” of a statement – for example, “true in 85%” – can have used different criteria so that one of them answered “true” and the other “false”. To facilitate maximum discrimination, the test should be developed so that 50% of the questions are true and the students know they should mark as “true” 50% of the questions that may seem more true.
Una ventaja importante de este examen es que su elaboración es fácil; además, estos tests son también fáciles de corregir y pueden cubrir los contenidos de cualquier materia.
Examen con pacientes estandarizados: Exam used to evaluate the skills to perform the clinical history and physical examination, communication skills and to establish the differential diagnosis, use the analytical tests and indicate the treatment. This test consists of different encounters of 10-12 minutes duration with multiple standardized patients each of which presents a different situation. The examinee performs the clinical history and physical examination, indicates the analytical tests, establishes a diagnosis, develops a therapeutic plan and advises the patient. By means of a checklist or assessment form or list, the examiner or the standardized patient himself carries out the evaluation of the student’s behavior. Reproducible scores can easily be established with respect to obtaining the medical history, performing the physical examination and communication skills. In order to obtain reliable scores, the participation of experienced examiners is essential, whether they are doctors or patients or other people. The elaboration and development of this type of exam usually takes a long time.
Gestión de casos Coordinación de distintos servicios para dar respuesta a las necesidades asistenciales de un paciente, generalmente cuando este paciente requiere servicios múltiples proporcionados por distintos proveedores. Este término también es utilizado para denominar la coordinación asistencial durante y después de un período de hospitalización.
Gestión de la información Método utilizado para gestionar la información de manera que no se produzca un exceso de la misma, y para mantenerla en un formato que permita su recuperación eficiente siempre que sea necesario. Los sistemas de archivos, los manuales y las bases electrónicas de datos son ejemplos de instrumentos que pueden ser útiles para la gestión de la información. Una red de consultores es una forma adicional de asegurar que la información necesaria estará rápidamente disponible.
Gestión sanitaria Aplicación sistemática de toda la gama de recursos humanos, técnicos y económicos del sistema sanitario mediante la planificación, organización, dirección y control del trabajo de los miembros del sistema para conseguir los objetivos establecidos y prestar el servicio óptimo con el coste económico mínimo. Los gestores sanitarios alcanzan los objetivos establecidos dirigiendo e influyendo en sus subordinados y organizándolos para que realicen las tareas esenciales que garantizan que el sistema se está moviendo en la dirección adecuada para alcanzar su objetivo de mejorar la salud.
Período de tiempo durante el cual se adquiere una experiencia clínica amplia mediante la práctica de las habilidades clínicas básicas y del juicio clínico. Este término se utiliza normalmente para referirse al período de rotatorio hospitalario.
En la República Argentina todos los alumnos de las carreras de medicina están obligados a transitar por un periodo de formación llamado Internado Anual Obligatorio o Práctica Final Obligatoria, por lo que constituye un requisito necesario para la obtención del título de grado.
Una vez obtenido el título de grado -título universitario habilitante con validez nacional- otorgado por una Institución Universitaria, como paso previo al ejercicio profesional, el médico necesita obtener la matrícula en la jurisdicción –provincia o Capital Federal- donde desarrollará la práctica.
La matrícula es obligatoria y solo es válida para esa jurisdicción.
La matriculación es la inscripción en un Registro Oficial que habilita al profesional para ejercer en el marco de la norma vigente establecida por la autoridad de aplicación en cada jurisdicción.
La mayoría de los profesionales poseen más de una matrícula ya que muchas veces ejercen en más de una jurisdicción.
La misma entidad y organismo que otorga la matrícula da la autorización para anunciarse como especialista.
En la Ciudad de Buenos Aires ha sido tradicionalmente el Ministerio de Salud el que otorga ambos permisos. En muchas provincias, el gobierno local ha delegado esas funciones en “entidades médicas de ley” habitualmente llamadas Consejos o Colegios de Ley; estas son entidades de derecho público en las que el Estado delega la vigilancia del ejercicio de las profesiones liberales y el otorgamiento de la matrícula.
Entonces, para ejercer en el país, es necesario inscribirse y matricularse en los Colegios Profesionales o, en la Capital Federal, en el Ministerio de Salud, y si se desea ejercer o anunciarse como especialista hay que obtener autorización especial.
Los Colegios fueron caracterizados como “personas jurídicas públicas no estatales” que pueden aplicar sanciones y hasta cancelar la matrícula, si bien sus decisiones son recurribles ante la Justicia.
El Portfolio es un método de enseñanza, aprendizaje y evaluación que consiste en la aportación de producciones de diferente índole por parte del estudiante a través de las cuáles se pueden juzgar sus capacidades en el marco de una disciplina o materia de estudio.
Estas producciones informan del proceso personal seguido por el estudiante, permitiéndole a él y los demás ver sus esfuerzos y logros, en relación a los objetivos de aprendizaje y criterios de evaluación establecidos previamente.
El portfolio como modelo de enseñanza y de aprendizaje, se fundamenta en la teoría de que la evaluación marca la forma cómo un estudiante se plantea su aprendizaje.
El portfolio del estudiante responde a dos aspectos esenciales implica toda una metodología de trabajo y de estrategias didácticas en la interacción entre docente y discente; y, por otro lado, es un método de evaluación que permite unir y coordinar un conjunto de evidencias para emitir una valoración lo más ajustada a la realidad que es difícil de adquirir con otros instrumentos de evaluación más tradicionales, los que aportan una visión más fragmentada.