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Investigación en Educación Médica

2019, Number 30

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Inv Ed Med 2019; 8 (30)

A century of curricular and instruccional changes in medical education (part 1)

González-Floresa P, Luna LV

Language: Spanish
References: 55
Page: 95-109
PDF size: 625.35 Kb.


ABSTRACT

Medical education has transformed teaching and learning practices in the last century in order to respond to the social, cientifical and technological challenges of each moment. Some of the innovations are still being implemented and have even been adapted to other contexts (i.e. problem-based learning), while others have been discarded. In order to present a broad perspective of the educational innovations in medicine, the authors undertook a critical review of the literature and identified the new approaches that impact curriculum, teaching and learning, and assessment of this practice. This article covers the findings regarding the first two dimensions. In regards to curriculum, the different models for defining and organizing the medical education curriculum that were proposed as an alternative to the Flexner structure are discussed (i.e. modular structure, flexible curriculum, competency based education). Then, teaching strategies that have tried to promote active learning and foster student-centered approaches for developing clinical skills in students will be described (such as, Problem-based Learning, One Minute Preceptor and SNAPPS). Curriculum and teaching innovations have influenced one another and have also had an impact on assessment practices. In another article, innovations in this area will be analyzed as well as the role that technology has played in the implementation of innovations in medical education.


REFERENCES

  1. Chimal C. Fábrica de colores. La vida del inventor Guillermo González Camarena. Primera ed. México: Fondo de Cultura Económica; 2017.

  2. Facultad de Medicina. Hace 50 años, la primera transmisión de la TV a colores desde la Escuela Nacional de Medicina [Internet]. Gaceta Facultad de Medicina UNAM. Disponible en: http://www.facmed.unam.mx/_gaceta/gaceta/nov102k1/ hace50.htm

  3. Tierney WG, Lanford M. Conceptualizing innovation in higher education. Vol. 25, Higher Education: Handbook of Theory and Research. Springer, Cham; 2010 [citado 2018 Jun 6]. 425- 48 p. Disponible en: http://link.springer.com/10.1007/978-3- 319-26829-3_1

  4. Schumpeter JA. The process of creative destruction. En: Capitalism, Socialism and Democracy [Internet]. London and New York: Routledge; 2003. p. 81-6. Disponible en: http:// digamo.free.fr/capisoc.pdf

  5. Poirier V, Schwartz LH, Eddy D, Berman R, Chacour S, Wynne JJ, et al. Thoughts on Improving Innovation : What Are the Characteristics of Innovation and How Do We Cultivate Them ? Technol Innov [Internet]. 2017;18(4):319-30. Disponible en: http://www.ingentaconnect.com/content/nai/ ti/2017/00000018/00000004/art00013

  6. Barraza Macías A. Una conceptualización comprehensiva de la innovación educativa. Innovación Educ [Internet]. 2005 [citado 2018 Jun 6];5(28):19-31. Disponible en: http://www. redalyc.org/pdf/1794/179421470003.pdf

  7. Rogers EM. Diffusion of innovations [Internet]. 3a edición. Macmillian Publishing Co. New York: The Free Press; 1983. 453 p. Disponible en: http://hollis.harvard.edu/?itemid=%- 7Clibrary/m/aleph%7C006256656

  8. Christensen CM, Horn MB, Johnson CW. Disrupting Class: How Disruptive Innovation Will Change the Way the World Learns. primera ed. Nueva York: McGraw-Hill Education; 2008. (McGraw Hill professional).

  9. López, C. & Heredia Y. Innovación educativa — Observatorio de Innovación Educativa [Internet]. 2017 [citado 2018 Ago 15]. Disponible en: https://observatorio.itesm.mx/innovacioneducativa/

  10. Díaz-Barriga F. Los profesores ante las innovaciones curriculares. Rev Iberoam Educ Super [Internet]. 2010 [citado 2018 Jun 6];1(1):37-57. Disponible en: http://www.redalyc. org/pdf/2991/299128587005.pdf

  11. Malagón Plata L. Malagon Plata Luis Alberto_El curriculo. Sophia [Internet]. 2005;(1):83-102. Disponible en: http:// www.redalyc.org/articulo.oa?id=413740777007

  12. Glossary of Education Reform [Internet]. Great Schools Partnership. 2014. Disponible en: https://www.greatschoolspartnership. org/resources/glossary-of-education-reform/

  13. Eisner EW. The educational imagination: on the design and evaluation of school programs [Internet]. primera. New York: Macmillan; London: Collier Macmillan; 1979. 293 p. Disponible en: https://books.google.com.mx/books?id=gEsmAQAAIAAJ

  14. Flexner A. Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching [Internet]. Carnegie Foundation for the Advancement of Teaching 1910, editor. Carnegie Bulletin. New York; 1910 [citado 2018 Jun 21]. 364 p. Disponible en: http://archive.carnegiefoundation.org/pdfs/elibrary/Carnegie_ Flexner_Report.pdf

  15. Berliner HS. A Larger Perspective on the Flexner Report. Int J Heal Serv [Internet]. 1975;5(4):573-92. Disponible en: http:// journals.sagepub.com/doi/10.2190/F31Q-592N-056K-VETL

  16. Oriol Bosch A. De Flexner a Bolonia. Educ Médica. 2010; 13(4):193-5.

  17. Takeuchi JS, Smith NM, Mortimer AM. Innovative models of medical education in the United States today: An overview with implications for curriculum and program evaluation. In: Medicine I of, editor. Medical Education and Societal Needs: A Planning Report for the Health Professions [Internet]. Washington, D.C.: National Academies Press (US); 1983. Disponible en: https://www.ncbi.nlm.nih.gov/books/ NBK217683/

  18. Fernández Pérez JA. Las carreras de medicina en México. Perfiles Educ [Internet]. 1996;XVIII(73). Disponible en: http://www.redalyc.org/pdf/132/13207307.pdf

  19. Ten Cate O. Nuts and bolts of entrustable professional activities. J Grad Med Educ [Internet]. 2013 Mar [citado 2018 Jun 21];5(1):157-8. Disponible en: http://www.ncbi.nlm.nih. gov/pubmed/24404246

  20. Maggio LA. Educating physicians in evidence based medicine: current practices and curricular strategies. Perspect Med Educ [Internet]. 2016;5(6):358-61. Disponible en: http:// link.springer.com/10.1007/s40037-016-0301-5

  21. Steinert Y, Naismith L, Mann K. Faculty development initiatives designed to promote leadership in medical education. A BEME systematic review: BEME Guide No. 19 [Internet]. Vol. 34, Medical Teacher. Taylor & Francis; 2012 [citado 2018 Jun 22]. p. 483-503. Disponible en: http://www.tandfonline. com/doi/full/10.3109/0142159X.2012.680937

  22. Shortliffe EH. Biomedical Informatics in the Education of Physicians. JAMA [Internet]. 2010 Sep 15 [citado 2018 Ago 20];304(11):1227. Disponible en: http://jama.jamanetwork. com/article.aspx?doi=10.1001/jama.2010.1262

  23. Sánchez Mendiola M. La Informática Biomédica y la educación de los médicos: un dilema no resuelto. Educ Médica [Internet]. 2015;16(1):28-34. Disponible en: http://www.elsevier. es/es-revista-educacion-medica-71-articulo-la-informaticabiomedica- educacion-los-S1575181315000145#elsevierItem sResumenes

  24. Irby DM, Wilkerson L. Teaching rounds: Teaching when time is limited. Bmj. 2008;336(7640):384-7.

  25. Association AM. Creating a community of Innovation: The work of the AMA Accelerating Change in Medical Education Consortium. Chicago, IL; 2017.

  26. Skochelak SE, Hawkins RE, Lawson LE, Starr SR, Borkan J, Gonzalo JD. Health Systems Science [Internet]. Philadelphia: Elsevier; 2016. Disponible en: https://books.google.com.mx/ books?id=q8-fDQAAQBAJ

  27. Fulton J. History of Medical Education. Br Med J [Internet]. 1953;2(4834)(1943):457-461. Disponible en: https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC2029428/pdf/ brmedj03405-0017.pdf

  28. Mourad A, Jurjus A, Hajj Hussein I. The What or the How: a Review of Teaching Tools and Methods in Medical Education. Med Sci Educ [Internet]. 2016;26(4):723-8. Disponible en: http://link.springer.com/10.1007/s40670-016-0323-y

  29. Bowen JL. Educational Strategies to Promote Clinical Diagnostic Reasoning. Nejm. 2006;355:2217-25.

  30. Schwartzstein RM, Roberts DH. Saying Goodbye to Lectures in Medical School -- Paradigm Shift or Passing Fad. N Engl J Med [Internet]. 2017;377(7):605-7. Disponible en: https:// www.ncbi.nlm.nih.gov/pubmed/28813217

  31. Bernstein L. Medical school without the ‘sage on a stage’ - The Washington Post. Washington Post [Internet]. 2017; Disponible en: https://www.washingtonpost.com/news/toyour- health/wp/2017/07/29/medical-school-without-thesage- on-a-stage/?utm_term=.00b5e086f95b

  32. Sánchez Mendiola M, Lifshitz Guinzberg A, Vilar Puig P, Martínez González A, Varela Ruiz ME, Graue Wierchers E. Educación médica: teoría y práctica [Internet]. [citado 2018 ago 20]. Disponible en: https://tienda.elsevierhealth.com/ educacion-medica-teoria-y-practica-9788490229651.html? gclid=EAIaIQobChMIxqT8jfb83AIVDY7ICh0iGgO_EAQYAiABEgLuAfD_ BwE

  33. Custers EJFM. Thirty years of illness scripts: Theoretical origins and practical applications. Med Teach. 2015;37(5):457-62.

  34. Wolpaw TM, Papp DR, Klara K. Academic Medicine : SNAPPS : A Learner ‐ centered Model for Outpatient Education. 2016; 78(9):1-7.

  35. Neher JO, Stevens NG. The one-minute preceptor: Shaping the teaching conversation. Fam Med. 2003;35(6):391-3.

  36. Lubarsky S, Dory V, Audétat M-C, Custers E, Charlin B. Using script theory to cultivate illness script formation and clinical reasoning in health professions education. Can Med Educ J [Internet]. 2015;6(2):e61-70. Disponible en: http:// www.pubmedcentral.nih.gov/articlerender.fcgi?artid=479 5084&tool=pmcentrez&rendertype=abstract

  37. Levin M, Cennimo D, Chen S, Lamba S. Teaching Clinical Reasoning to Medical Students: A Case-Based Illness Script Worksheet Approach. MedEdPORTAL Publ. 2016;1-6.

  38. Teherani A, O’Sullivan P, Aagaard EM, Morrison EH, Irby DM. Student perceptions of the one minute preceptor and traditional preceptor models. Med Teach. 2007;29(4):323-7.

  39. Cayley WE. Effective clinical education: Strategies for teaching medical students and residents in the office. Wis Med J [Internet]. 2011;110(4):178-81. Disponible en: http://www. scopus.com/inward/record.url?eid=2-s2.0-80051907623&pa rtnerID=40&md5=c43a5736285ecbbb1529dcee2e9fe802

  40. Joyce MF, Berg S, Bittner EA. Practical strategies for increasing efficiency and effectiveness in critical care education. World J Crit Care Med [Internet]. 2017;6(1):1. Disponible en: http://www.wjgnet.com/2220-3141/full/v6/i1/1.htm

  41. Wilkerson L, Sarkin RT. Teaching the teachers: Is it Effective. Arrows in the Quiver: Evaluation of a Workshop on Ambulatory Teaching. Acad Med [Internet]. 1998;73(10):S67-9. Disponible en: https://journals.lww.com/academicmedicine/ Citation/1998/10000/TEACHING_THE_TEACHERS__IS_ IT_EFFECTIVE_Arrows_in.48.aspx

  42. Smith CA, Hart AS, Sadowski LS, Riddle J, Evans AT, Clarke PM, et al. Teaching cardiac examination skills: A controlled trial of two methods. J Gen Intern Med. 2006;21(1):1-6.

  43. Jones F, Passos-neto CE, Freitas O, Braghiroli M. Simulation in Medical Education : Brief history and methodology. Ppcr. 2015;1(2):56-63.

  44. Chen F, Lui AM, Martinelli SM. A systematic review of the effectiveness of flipped classrooms in medical education. Med Educ. 2017;51(6):585-97.

  45. Street SE, Gilliland KO, McNeil C, Royal K. The Flipped Classroom Improved Medical Student Performance and Satisfaction in a Pre-clinical Physiology Course. Med Sci Educ [Internet]. 2015;25(1):35-43. Disponible en: http://link. springer.com/10.1007/s40670-014-0092-4

  46. Amin Tabish S. Assessment methods in medical education. Int J Health Sci (Qassim) [Internet]. 2008 Jul [citado 2018 Ago 20];2(2):3-7. Disponible en: http://www.ncbi.nlm.nih. gov/pubmed/21475483

  47. Neufeld VR, Barrows HS. The “McMaster Philosophy”: An Approach to Medical Education. J Med Educ [Internet]. 1974;49(11):1040-50. Disponible en: https://journals.lww. com/academicmedicine/Abstract/1974/11000/The__McMaster_ Philosophy___an_approach_to_medical.4.aspx

  48. Neville AJ. Problem-Based Learning and Medical Education Forty Years On. Med Princ Pract [Internet]. 2009;18(1):1-9. Disponible en: http://www.karger.com/doi/10.1159/000163038

  49. Vernon DT, Blake RL. Does problem-based learning work? A meta-analysis of evaluative research. Acad Med [Internet]. 1993;68(7):550-63. Disponible en: http://content.wkhealth. com/linkback/openurl?sid=WKPTLP:landingpage& an=00001888-199307000-00015

  50. Albanese M, Mitchell S. Problem based learning: A Review of Literature on its Outcomes and Implementation Issues. Acad Med [Internet]. 1993;68(1):52-81. Disponible en: https:// journals.lww.com/academicmedicine/pages/articleviewer.as px?year=1993&issue=01000&article=00020&type=abstract

  51. Dochy F, Segers M, Van den Bossche P, Gijbels D. Effects of problem-based learning: A meta-analysis. Learn Instr. 2003;13(5):533-68.

  52. Beal MD, Kinnear J, Anderson CR, Martin TD, Wamboldt R, Hooper L. The effectiveness of medical simulation in teaching medical students critical care medicine. Simul Healthc. 2017;12(2):104-16.

  53. Chen M, Ni C, Hu Y, Wang M, Liu L, Ji X, et al. Meta-analysis on the effectiveness of team-based learning on medical education in China. BMC Med Educ 2018 [Internet]. 2018; 18(1):77. Disponible en: https://bmcmededuc.biomedcentral. com/articles/10.1186/s12909-018-1179-1

  54. Durán-Pérez VD. Esquema CARAIPER: una estrategia de enseñanza- aprendizaje del razonamiento clínico. Educ Médica [Internet]. 2017;(71). Disponible en: http://www.elsevier.es/ es-revista-educacion-medica-71-avance-esquema-caraiperuna- estrategia-ensenanza-aprendizaje-S1575181317300633

  55. Hayward J, Cheung A, Velji A, Altarejos J, Gill P, Scarfe A, et al. Script-theory virtual case: A novel tool for education and research. Med Teach. 2016;38(11):1130-8.




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