The development and pilot-testing of a training curriculum in adolescent medicine and health.

PURPOSE: To select and propose a set of knowledge, attitudes, and skills essential for the care of adolescents; to encourage the development of adolescent health multidisciplinary networks; and to set up training programs in as many European countries as possible. METHODS: The curriculum was developed by 16 physicians from 11 European countries with various professional specializations. In line with modern guidelines in medical education, it is a modular, flexible instrument which covers the main teaching areas in the field, such as basic skills (i.e. setting, rights and confidentiality, gender and cultural issues) as well as specific themes (i.e. sexual and reproductive health, eating disorders, chronic conditions). It consists of 17 thematic modules, each containing detailed objectives, learning approaches, examples, and evaluation methods. RESULT: Two international one-week summer schools were used to assess the feasibility and appropriateness of the curriculum. The overall evaluation was good, with most of the items surpassing three on a four-point Likert scale. However, it pointed to several aspects (process and content) which will need to be refined in the future, such as an increase in interactive sessions (role playing), and a better mix of clinical and public health issues.

Beyond the 'dyad': a qualitative re-evaluation of the changing clinical consultation.

OBJECTIVE: To identify characteristics of consultations that do not conform to the traditionally understood communication 'dyad', in order to highlight implications for medical education and develop a reflective 'toolkit' for use by medical practitioners and educators in the analysis of consultations. DESIGN: A series of interdisciplinary research workshops spanning 12 months explored the social impact of globalisation and computerisation on the clinical consultation, focusing specifically on contemporary challenges to the clinician-patient dyad. Researchers presented detailed case studies of consultations, taken from their recent research projects. Drawing on concepts from applied sociolinguistics, further analysis of selected case studies prompted the identification of key emergent themes. SETTING: University departments in the UK and Switzerland. PARTICIPANTS: Six researchers with backgrounds in medicine, applied linguistics, sociolinguistics and medical education. One workshop was also attended by PhD students conducting research on healthcare interactions. RESULTS: The contemporary consultation is characterised by a multiplicity of voices. Incorporation of additional voices in the consultation creates new forms of order (and disorder) in the interaction. The roles 'clinician' and 'patient' are blurred as they become increasingly distributed between different participants. These new consultation arrangements make new demands on clinicians, which lie beyond the scope of most educational programmes for clinical communication. CONCLUSIONS: The consultation is changing. Traditional consultation models that assume a 'dyadic' consultation do not adequately incorporate the realities of many contemporary consultations. A paradox emerges between the need to manage consultations in a 'super-diverse' multilingual society, while also attending to increasing requirements for standardised protocol-driven approaches to care prompted by computer use. The tension between standardisation and flexibility requires addressing in educational contexts. Drawing on concepts from applied sociolinguistics and the findings of these research observations, the authors offer a reflective 'toolkit' of questions to ask of the consultation in the context of enquiry-based learning.

Cinema i educació (social). Tres mirades pedagògiques d'una mateixa pel·lícula. El cas de «Sleepers»

La verificació que la vida acadèmica està patint una revolució formal i de contingut obliga a recrear el discurs pedagògic introduint-hi elements molt heterogenis. Ressaltar els valors culturals dels diferents mitjans de comunicació ens permet destacar les potencialitats i l¿ús del cinema com a instrument docent facilitador dels aprenentatges dels alumnes. Fa molts anys que cadascú de nosaltres hem incorporat el cinema en el nostre treball docent. D¿acord amb els continguts que desenvolupem en les nostres assignatures, l¿utilitzem com a font analítica i documental per a la intervenció pedagògica i social. Els relats filmogràfics ens permeten introduir pràctiques formatives i professionalitzadores a partir de l¿anàlisi de casos, una eina de treball molt utilitzada en l¿àmbit socioeducatiu. Amb aquest article, presentem, doncs, tres visions diferents desenvolupades en el marc de tres assignatures dels ensenyaments de Pedagogia i Educació Social, i ho fem a partir d¿una mateixa pel·lícula, Sleepers, de Barry Levinson (1996), tot demostrant el caràcter transversal de la nostra proposta.

Medical residents' feedback on needs and acquired skills following a short course on cross-cultural competence

Objectives The purpose of this study is to assess short and long term changes in knowledge, attitudes, and skills among medical residents following a short course on cultural competency and to explore their perspectives on the experience. Methods Eighteen medical residents went through a short training programme comprised of two seminars lasting 30' and 60' respectively over two days. Three months later, we conducted three focus groups, with 17 residents to explore their thoughts, perspectives and feedback about the course. To measure changes over time, we carried out a quantitative sequential survey before the seminars, three days after, and three months later using the Multicultural Assessment Questionnaire. Results Residents expressed a wide variety of perspectives on the main themes related to the content of the training - culture, trialogue, stereotypes, status, epidemiology, history and geopolitics - and related to its organization - relevance, volume, timing, target audience, training tools, and working material. Using the MAQ, we observed a higher global performance score (n=16) at three days (median=38) compared to results before the training (median=33) revealing a median difference of 5.5 points (z=2.4, p=0.015). This difference was still present at three months (∆=4.5, z=2.4, p=0.018), mainly due to knowledge acquisition (∆=3) rather than attitudes (∆=0) or skills (∆=1). Conclusions Cross-cultural competence training not only brings awareness of multicultural issues but also helps participants understand their own cultures, perception of others and preconceived ideas. Physicians' education should however also focus on improving implementation of acquired knowledge in cross-cultural competence.

Qüestionari de trajectòria educativa i capital social acadèmic

Projecte de recerca (EDU2011-25960) Ministerio de Economía y Competitividad

Needs, expectations, and concerns of medical students regarding end-of-life issues before the introduction of a mandatory undergraduate palliative care curriculum.

BACKGROUND: In the past, implementation of effective palliative care curricula has emerged as a priority in medical education. In order to gain insight into medical students' needs and expectations, we conducted a survey before mandatory palliative care education was introduced in our faculty. METHODS: Seven hundred nine students answered a questionnaire mainly consisting of numeric rating scales (0-10). RESULTS: Participants attributed a high importance to palliative care for their future professional life (mean, 7.51 ± 2.2). For most students, symptom control was crucial (7.72 ± 2.2). However, even higher importance was assigned to ethical and legal issues (8.16 ± 1.9). "Self-reflection regarding their own role as a physician caring for the terminally ill along with psychological support" was also regarded as highly important (7.25 ± 2.4). Most students were moderately concerned at the prospect of being confronted with suffering and death (5.13 ± 2.4). This emotional distress was rated significantly higher by female students (5.4 ± 2.4 versus 4.6 ± 2.4; p < 0.001). Seventeen percent of all students rated their distress as being 7 of 10 or higher, which indicates a considerable psychological strain in terms of dealing with end-of-life issues in the future. Professional or personal experience with terminally ill persons lowered these anxieties significantly (4.99 ± 2.34 versus 5.47 ± 2.5, p < 0.05). CONCLUSIONS: Medical students stated a remarkably high interest in learning palliative care competencies. Responding to their specific concerns and needs-especially with regard to the acquisition of emotional coping skills-may be key for the development of successful palliative care curricula.

Les diplomades i els diplomats en Educació Social a la Universitat de Barcelona: més d'una dècada de trajectòria en el mercat laboral

Aquesta investigació parteix del fet que el coneixement dels processos d"inserció laboral en l"educació superior és una informació clau per millorar el pla d"estudis i adequar la formació universitària a les demandes reals del mercat laboral. La recerca està contextualitzada en la diplomatura d"Educació Social en el moment just d"elaboració del nou grau d"Educació Social, i pretén conèixer quines han estat les trajectòries al mercat laboral dels seu diplomats i diplomades. Per aquest motiu, s"ha portat a terme un estudi descriptiu i complet. La població de referència correspon a les promocions de la diplomatura des del curs 1995-1996 fins al 2004 2005. La mostra final ha estat de 369 estudiants. Dins d"aquesta mostra s"han analitzat separadament els resultats del col lectiu d"estudiants immigrants. Els resultats obtinguts fan un recorregut des de com són i qui són fins a com ha estat la seva inserció en tots aquests anys. A partir d"aquí, les conclusions que es presenten s"estructuren en tres apartats: el perfil d"inserció, la professió i la situació del col lectiu d"estudiants immigrants. Finalment, l"equip investigador fa una sèrie de propostes de millora que caldria tenir presents en el nou context educatiu.

ESH-ESC guidelines for the management of hypertension.

The following is a brief statement of the 2003 European Society of Hypertension (ESH)-European Society of Cardiology (ESC) guidelines for the management of arterial hypertension.The continuous relationship between the level of blood pressure and cardiovascular risk makes the definition of hypertension arbitrary. Since risk factors cluster in hypertensive individuals, risk stratification should be made and decision about the management should not be based on blood pressure alone, but also according to the presence or absence of other risk factors, target organ damage, diabetes, and cardiovascular or renal damage, as well as on other aspects of the patient's personal, medical and social situation. Blood pressure values measured in the doctor's office or the clinic should commonly be used as reference. Ambulatory blood pressure monitoring may have clinical value, when considerable variability of office blood pressure is found over the same or different visits, high office blood pressure is measured in subjects otherwise at low global cardiovascular risk, there is marked discrepancy between blood pressure values measured in the office and at home, resistance to drug treatment is suspected, or research is involved. Secondary hypertension should always be investigated.The primary goal of treatment of patient with high blood pressure is to achieve the maximum reduction in long-term total risk of cardiovascular morbidity and mortality. This requires treatment of all the reversible factors identified, including smoking, dislipidemia, or diabetes, and the appropriate management of associated clinical conditions, as well as treatment of the raised blood pressure per se. On the basis of current evidence from trials, it can be recommended that blood pressure, both systolic and diastolic, be intensively lowered at least below 140/90 mmHg and to definitely lower values, if tolerated, in all hypertensive patients, and below 130/80 mmHg in diabetics.Lifestyle measures should be instituted whenever appropriate in all patients, including subjects with high normal blood pressure and patients who require drug treatment. The purpose is to lower blood pressure and to control other risk factors and clinical conditions present.In most, if not all, hypertensive patients, therapy should be started gradually, and target blood pressure achieved progressively through several weeks. To reach target blood pressure, it is likely that a large proportion of patients will require combination therapy with more than one agent. The main benefits of antihypertensive therapy are due to lowering of blood pressure per se. There is also evidence that specific drug classes may differ in some effect or in special groups of patients. The choice of drugs will be influenced by many factors, including previous experience of the patient with antihypertensive agents, cost of drugs, risk profile, presence or absence of target organ damage, clinical cardiovascular or renal disease or diabetes, patient's preference.

Medical and pharmacological direct costs of a 9-week smoking cessation programme.

Background: Medical and pharmacological direct costs of cigarette smoking cessation programmes are not covered by health insurance in several countries despite documented cost-effectiveness. Design: prospective cost identification study of a 9-week programme in Switzerland. Methods: A total of 481 smokers were followed-up for 9 weeks. Socio-demographic characteristics, number of outpatient visits, dosage and frequency of use of nicotine replacement therapy (NRT) as well as date of relapse were prospectively collected. Individual cost of care until relapse or programme end as well as cost per week of follow-up were computed. Comparisons were carried out between the groups with or without relapse at the end of the programme. Results: Of the 209 men and 272 women included, 347 patients (72%) finished the programme. Among them, 240 patients (70%) succeeded in quitting and 107 patients (30%) relapsed. As compared with the group relapsing by the end of the programme, the group succeeding in quitting was more often living in a couple (68% vs. 55%, p = 0.029). Their mean weekly costs of visits were higher (CHF 81.2 ± 6.1 vs. 78.4 ± 7.6, p = 0.001), while their mean weekly costs for NRT were similar (CHF 24.2 ± 12.6 vs. 25.4 ± 15.9, p = 0.711). Mean total costs per week were similar (CHF 105.4 ± 15.4 vs. 103.8 ± 19.4, p = 0.252). More intensive NRT at week 4 increased the probability not to relapse at the end of the programme. Conclusions: Over 9 weeks, medical and pharmacological costs of stopping smoking are low. Good medical and social support as well as adequate NRT seem to play a role in successful quitting.

Análisis bibliométrico sobre el Aprendizaje Basado en Problemas (ABP) en la educación superior a partir de la base de datos ERIC

[spa]El estudio bibliométrico descriptivo que sigue presenta tendencias de investigación sobre el aprendizaje basado en problemas entre 1974 y 2009. Se sirve de la base de datos ERIC y trabaja con una muestra de 1007 documentos. Se analizan los registros a tenor de cuatro variables: el año de publicación o realización, la titulación, el área de conocimiento y la tipología de investigación. En cuanto a la producción científica, pueden diferenciarse tres fases: la primera, de 1974 a 1989, supone el inicio de las publicaciones y muestra escasa relevancia estadística; la segunda, de crecimiento, durante la década de los 90 del pasado siglo; y la última, de maduración, desde el año 2000 hasta el año 2009. La distribución de los registros por sectores de conocimiento destaca Ciencias de la Salud, Ciencias Sociales y Enseñanzas Técnicas. Las titulaciones en las que más ha proliferado el ABP son Medicina, Económicas, Empresariales, Pedagogía, Formación del Profesorado y el conjunto de las ingenierías.

Una proposta de treball educatiu en centres oberts des de l'aproximació al disseny curricular en educació social

El Centre obert apareix com una resposta idònia per a l'atenció social a la població infantil compresa entre els 3/4 i 16/18 anys. Parlar de Centre Obert és fer referencia a l'exercici d'una important responsabilitat pública, a saber: aportar nous models i oportunitats de socialització a subjectes amb certes dificultats de normalització. Les dites dificultats corresponen a diferents reptes que avui planteja el social.

La mediación artística: un modelo de educación artística para la intervención social a través del arte.

Los talleres de educación artística, desde el modelo que denominamos Mediación Artística, constituyen una valiosa herramienta educativa para trabajar con colectivos en situación de vulnerabilidad o exclusión social, fomentando su autonomía personal y el proceso de reinserción social. Este modelo educativo se alimenta de diversas fuentes que proceden de la psicología, de la filosofía, de la educación artística y del arteterapia. Planteamos un marco metodológico organizado en tres puntos: la planificación de los talleres, el desarrollo de los talleres, y la intervención educativa y el rol del educador artístico.

Educació Ambiental i cooperació internacional, una relació pdagògico-social

Des de l'Educació Ambiental es pot treballar de moltes maneres. En cadascuna d'elles hi ha una determinada interpretació del medi, de la seva definició i caracterització, de com cal abordar-ne l'estudi i el tractament, de l'abast de les accions educatives que s'hi refereixen, etc.

Sectors i àmbits d'intervenció de l"Educació Social. Aproximació conceptual

En aquest article desenvolupem una aproximació als sectors i àmbits d'intervenció de l'educació social. Pensem, però, que és bo que, en primer lloc, intentem definir què és el que entenem per educació social i pedagogia social.