La enseñanza clínica: el caso de la recorrida de sala
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Resumen
Resumen
Posiblemente la enseñanza al lado de la cama del paciente sea tan antigua como la medicina misma. Grandes maestros de la medicina como F. Silvio o Sir W. Osler abogaron por un uso intenso de la misma destacando sus virtudes. En la era moderna se le reconoce a la enseñanza en las recorridas múltiples aspectos que no pueden ser enseñados en el aula, como el aprendizaje de las habilidades de la comunicación, de la exploración física, la enseñanza de los aspectos humanísticos, etc., pero también múltiples barreras que dificultan una exitosa implementación. En este artículo se detallan las barreras que con mayor frecuencia impiden que el docente promueva un aprendizaje significativo y profundo, y una serie propuestas prácticas que favorecen su adecuada implementación.
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1.
Giannasi SE, Durante E. La enseñanza clínica: el caso de la recorrida de sala. Rev Arg de Ter Int. [Internet]. 19 de diciembre de 2012 [citado 22 de diciembre de 2024];29(4). Disponible en: https://revista.sati.org.ar/index.php/MI/article/view/318
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Citas
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20. Frisch SR, Boucher FG, Charbonneau S, et al. Increasing the effectiveness of clinical supervision. Can Med Assoc J.1984;131(6):569-72.
21. Rees J. Take a teaching ward round. Br Med J (Clin Res Ed). 1987;295(6595):424-5.
22. Stanley P. Structuring ward rounds for learning: can opportunities be created? Med Educ. 1998;32(3):239-43.
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28. Ramani S, Leinster S. AMEE Guide nº.34: Teaching in the clinical environment. Med Teach. 2008;30(4):347-64.
29. Boor K, Scheele F, van der Vleuten CP, et al. How undergraduate clinical learning climates differ: a multi-method case study. Med Educ. 2008;42(10):1029-36.
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31. Hoff TJ, Pohl H, Bartfield J. Creating a learning environment to produce competent residents: the roles of culture and context. Acad Med. 2004;79(6):532-9.
32. Maudsley RF. Role models and the learning environment: essential elements in effective medical education. Acad Med. 2001;76(5):432-4.
33. Teunissen PW, Stapel DA, Scheele F, et al. The influence of context on residents' evaluations: effects of priming on clinical judgment and affect. Adv Health Sci Educ Theory Pract. 2009;14(1):23-41.
34. Teunissen PW, Scheele F, Scherpbier AJ, et al. How residents learn: qualitative evidence for the pivotal role of clinical activities. Med Educ. 2007;41(8):763-70.
35: Taylor EW, Tisdell EJ, Gusic ME. Teaching beliefs of medical educators: perspectives on clinical teaching in pediatrics. Med Teach.
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36. Harden RM, Crosby J. The good teacher is more than a lecturer - the twelve roles of the teacher. Med Teach. 2000;22(4):334-7.
37. Spencer JA, Jordan RK. Learner centred approaches in medical education. BMJ. 1999;318(7193):1280-3.
38. Lake FR, Ryan G. Teaching on the run tips 3: planning a teaching episode. Med J Aust. 2004;180(12):643-4.
39. Spencer J. Learning and teaching in the clinical environment. BMJ. 2003;326(7389):591-4.
40. Mazmanian PE, Davis DA. Continuing medical education and the physician as a learner: guide to the evidence. JAMA. 2002;288(9):1057-60.
41. Wolpaw TM, Wolpaw DR, Papp KK. SNAPPS: a learner-centered model for outpatient education. Acad Med. 2003;78(9):893-8.
42. Kane R, Sandretto S, Heath C. An investigation into excellent tertiary teaching: enphasising reflective practice. Higher Educ. 2004;47(3):283-310.
43. Lake FR, Vickery AW, Ryan G. Teaching on the run tips 7: Effective use of questions. Med J Aust. 2005;182(3):126-7.
44. Mangrulkar RS, Saint S, Chu S, et al. What is the role of the clinical "pearl"? Am J Med. 2002;113(7):617-24.
45. Duvivier RJ, van Dalen J, Muijtjens AM, et al. The role of deliberate practice in the acquisition of clinical skills. BMC Med Educ. 2011;11:101.
46. Sachdeva AK. Use of effective feedback to facilitate adult learning. J Cancer Educ. 1996;11(2):106-18.
47. Teunissen PW, Dornan T. Lifelong learning at work. BMJ. 2008;336(7645):667-9.
48. Salerno SM, O'Malley PG, Pangaro LN, et al. Faculty development seminars based on the one-minute preceptor improve feedback in the ambulatory setting. J Gen Intern Med. 2002;17(10):779-87.
49. Davis DA, Mazmanian PE, Fordis M, et al. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA. 2006;296(9):1094-102.
2. Fitzgerald FT. Bedside teaching. West J Med. 1993;158(4):418-20.
3. LaCombe MA. On bedside teaching. Ann Intern Med. 1997;126(3):217-20.
4. Whitman N. Creative medical teaching. Salt Lake City: University of Utah School of Medicine; 1990.
5. Whitman N, Schwenk T. The physician as a teacher. 2nd ed. Salt Lake City; Whitman Associates; 1997.
6. Anvik T, Grimstad H, Baerheim A, et al. Medical students' cognitive and affective attitudes towards learning and using communication skills a nationwide cross-sectional study. Med Teach. 2008;30(3):272-9.
7. Thibault GE. Bedside rounds revisited. N Engl J Med. 1997;336(16):1174-5.
8. Reuler JB, Girard DE, Nardone DA. The attending physician. Privilege and pitfalls. JAMA. 1980;243(3):235-6.
9. Williams KN, Ramani S, Fraser B, et al. Improving bedside teaching: findings from a focus Group study of learners. Acad Med. 2008;83(3):257-64.
10. Nair BR, Coughlan JL, Hensley MJ. Impediments to bed-side teaching. Med Educ. 1998;32(2):159-62.
11. Chauke HL, Pattinson RC. Ward rounds bedside or conference room? S Afr Med J. 2006;96(5):398-400.
12. Walton JM, Steinert Y. Patterns of interaction during rounds: implications for workbased learning. Med Educ. 2010;44(6):550-8.
13. Dornhorst A, Cripps J, Goodyear H, et al. Improving hospital doctors' working lives: online questionnaire survey of all grades. Postgrad
Med J. 2005;81(951):49-54.
14. Bhangu A, Hartshorne G. Ward rounds: missed learning pportunities in diagnostic changes? Clin Teach. 2011;8(1):17-21.
15. Qureshi NS, Swamy NN. Postgraduate trainees' assessment of the educational value of ward rounds in obstetrics and gynaecology.
J Obstet Gynaecol. 2008;28(7):671-5.
16. Claridge A. What is the educational value of ward rounds? A learner and teacher perspective. Clin Med. 2011;11(6):558-62.
17. Tariq M, Motiwala A, Ali SU, et al. The learners' perspective on internal medicine ward rounds: a cross-sectional study. BMC Med Educ. 2010;10:53.
18. Deprest J, Marchal G, Brosens I. Obstructive uropathy secondary to endometriosis. N Engl J Med. 1997;337(16):1174-5.
19. McLeod PJ. A successful formula for ward rounds. CMAJ. 1986;134(8):902-4.
20. Frisch SR, Boucher FG, Charbonneau S, et al. Increasing the effectiveness of clinical supervision. Can Med Assoc J.1984;131(6):569-72.
21. Rees J. Take a teaching ward round. Br Med J (Clin Res Ed). 1987;295(6595):424-5.
22. Stanley P. Structuring ward rounds for learning: can opportunities be created? Med Educ. 1998;32(3):239-43.
23. Biggs J, Tang C. Teaching for quality learning at university. Maidenhead: McGraw Hill; 2007.
24. Lehmann LS, Brancati FL, Chen MC, et al. The effect of bedside case presentations on patients' perceptions of their medical care.
N Engl J Med. 1997;336(16):1150-5.
25. Janicik RW, Fletcher KE. Teaching at the bedside: a new model. Med Teach. 2003;25(2):127-30.
26. Ramani S, Orlander JD, Strunin L, et al. Whither bedside teaching? A focusgroup study of clinical teachers. Acad Med. 2003;78(4):384-90.
27. Jeffree RL, Clarke RM. Ten tips for teaching in the theatre tearoom: shifting the focus from teaching to learning. World J Surg. 2010;34(11):2518-23.
28. Ramani S, Leinster S. AMEE Guide nº.34: Teaching in the clinical environment. Med Teach. 2008;30(4):347-64.
29. Boor K, Scheele F, van der Vleuten CP, et al. How undergraduate clinical learning climates differ: a multi-method case study. Med Educ. 2008;42(10):1029-36.
30. Boor K, Teunissen PW, Scherpbier AJ, et al. Residents' perceptions of the ideal clinical teacher--a qualitative study. Eur J Obstet Gynecol
Reprod Biol. 2008;140(2):152-7.
31. Hoff TJ, Pohl H, Bartfield J. Creating a learning environment to produce competent residents: the roles of culture and context. Acad Med. 2004;79(6):532-9.
32. Maudsley RF. Role models and the learning environment: essential elements in effective medical education. Acad Med. 2001;76(5):432-4.
33. Teunissen PW, Stapel DA, Scheele F, et al. The influence of context on residents' evaluations: effects of priming on clinical judgment and affect. Adv Health Sci Educ Theory Pract. 2009;14(1):23-41.
34. Teunissen PW, Scheele F, Scherpbier AJ, et al. How residents learn: qualitative evidence for the pivotal role of clinical activities. Med Educ. 2007;41(8):763-70.
35: Taylor EW, Tisdell EJ, Gusic ME. Teaching beliefs of medical educators: perspectives on clinical teaching in pediatrics. Med Teach.
2007;29(4):371-6.
36. Harden RM, Crosby J. The good teacher is more than a lecturer - the twelve roles of the teacher. Med Teach. 2000;22(4):334-7.
37. Spencer JA, Jordan RK. Learner centred approaches in medical education. BMJ. 1999;318(7193):1280-3.
38. Lake FR, Ryan G. Teaching on the run tips 3: planning a teaching episode. Med J Aust. 2004;180(12):643-4.
39. Spencer J. Learning and teaching in the clinical environment. BMJ. 2003;326(7389):591-4.
40. Mazmanian PE, Davis DA. Continuing medical education and the physician as a learner: guide to the evidence. JAMA. 2002;288(9):1057-60.
41. Wolpaw TM, Wolpaw DR, Papp KK. SNAPPS: a learner-centered model for outpatient education. Acad Med. 2003;78(9):893-8.
42. Kane R, Sandretto S, Heath C. An investigation into excellent tertiary teaching: enphasising reflective practice. Higher Educ. 2004;47(3):283-310.
43. Lake FR, Vickery AW, Ryan G. Teaching on the run tips 7: Effective use of questions. Med J Aust. 2005;182(3):126-7.
44. Mangrulkar RS, Saint S, Chu S, et al. What is the role of the clinical "pearl"? Am J Med. 2002;113(7):617-24.
45. Duvivier RJ, van Dalen J, Muijtjens AM, et al. The role of deliberate practice in the acquisition of clinical skills. BMC Med Educ. 2011;11:101.
46. Sachdeva AK. Use of effective feedback to facilitate adult learning. J Cancer Educ. 1996;11(2):106-18.
47. Teunissen PW, Dornan T. Lifelong learning at work. BMJ. 2008;336(7645):667-9.
48. Salerno SM, O'Malley PG, Pangaro LN, et al. Faculty development seminars based on the one-minute preceptor improve feedback in the ambulatory setting. J Gen Intern Med. 2002;17(10):779-87.
49. Davis DA, Mazmanian PE, Fordis M, et al. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA. 2006;296(9):1094-102.