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Realimentacion -Feedback

Feedback, Realimentacion

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Realimentacion -Feedback

  1. 1. REALIMENTACIÓN RETROALIMENTACIÓN
  2. 2. Sesiones con/de/para Medicina Interna y Radiología
  3. 3. Sesiones con/de/para Medicina Interna y Radiología
  4. 4. Sesiones con/de/para Medicina Interna y Radiología
  5. 5. Sesiones con Medicina Interna / Radiología
  6. 6. Abraham Verghese, MD. Senior associate chair for the theory and practice of medicine at Stanford, University, Stanford, CA.
  7. 7. Subha Ramani, MD. Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, 715 Albany Street, Boston, Massachusetts-02118, USA, 617-638-7985, 617-414- 4676 sramani@bu.edu
  8. 8. Subha Ramani, MD. is a general internist with a major interest in medical education. She is currently an Assistant Professor, Department of Medicine, at the Boston University School of Medicine. She completed Internal Medicine residencies at the Postgraduate Institute of Medical Education and Research (PGIMER), India as well as East Tennessee State University, USA, and a fellowship in General Internal Medicine at Boston University.
  9. 9. Vijay Rajput, MD. MBBS, FACP, SFHM, is Professor of Medicine and Assistant Dean for Curriculum at Cooper Medical School of Rowan University in Camden, New Jersey. Head for Division of Medical Education in the Department of Medicine.
  10. 10. Sesiones con Medicina Interna / Radiología
  11. 11. REALIMENTACIÓN RETROALIMENTACIÓN
  12. 12. REALIMENTACIÓN Feedback is one of the most powerful influences on learning and achievement, but this impact can be either positive or negative. Hattie J and Timperley H. Power of Feedback. Review of Educational Research 2007;77(1):81–112
  13. 13. El gran descubrimiento de mi generación es que los seres humanos pueden cambiar su vida, cambiando la actitud de su mente. WILLIAM JAMES
  14. 14. Sigmund Freud
  15. 15. CARENCIAS, RETOS PERSONALES  Inteligencia emocional y social: Formar parte de “algo” que es superior a cada uno de nosotros.  Lectura critica de información biomédica  Destrezas sociales, de intercomunicación interpersonal  Destrezas docentes
  16. 16. Dos “cosas” que los seres humanos tenemos y perdemos: TIEMPO, imperdonable y VIDA, irremediable.
  17. 17. REALIMENTACIÓNThe Two-Minute Teacher. aid to making the most of educational opportunities as they arise on the fly at the point of care. a) Haz, favorece la conexión, b) Explora lo que el alumno sabe o conoce, c) Genera una contrato de aprendizaje: education is most effective when it is focused on what learners most want or need to know. d) Conecta con emociones y/o experiencias, e) Favorece el espíritu de colaboración y de responsabilidad, f) Promueva la atención centrada en el paciente, g) Reconoce el desempeño laboral y colaborativo. Gunderman RB, Bedi HS. The Two-Minute Teacher. Acad Radiol 2013; 20:1610–1612.
  18. 18. “La mayor parte del error médico proviene no del mal raciocinio basado en hechos bien observados, sino del buen raciocinio basado en hechos mal observados”. BLAISE PASCAL (1623-1662), filósofo y matemático francés
  19. 19. We are focusing more on deciding what the best study is for a patient based on evidence-based guidelines and the clinical conditions they present with.
  20. 20. Quality is when a radiologist evaluates the need to expose a patient to radiation based on the patient’s condition, the patient’s age, and the value of the imaging procedure.
  21. 21. Giving feedback is a critical skill for effective teaching and learning, the “heart of medical education” . A recent review of the social science literature defined feedback in clinical education as “specific information about the comparison between a trainee’s performance and a standard, given with intent to improve the trainee’s performance” REALIMENTACIÓ N Kruidering-Hall M, O’Sullivan PS, and Chou CL. Teaching feedback to first-year medical students: Long-term skill retention and accuracy of student self-assessment. J Gen Intern Med 2009;24(6):721–726.
  22. 22. Generally accepted characteristics of effective formative feedback include aspects of structure, content, and format. Structural requirements encompass location, time, and orientation of the learner to the process and to the goal of the process. REALIMENTACIÓ N Kruidering-Hall M, O’Sullivan PS, and Chou CL. Teaching feedback to first-year medical students: Long-term skill retention and accuracy of student self-assessment. J Gen Intern Med 2009;24(6):721–726.
  23. 23. Ideally, the provider and recipient are allies and operate in a culture of mutual respect, while feedback is co-constructed through loops of dialogue and information and reflective practice. As for the content of feedback, studies have validated that effective feedback is constructive, specific, and non- judgmental. Useful formats for feedback include oral, written, graphic, and video. REALIMENTACIÓ N Kruidering-Hall M, O’Sullivan PS, and Chou CL. Teaching feedback to first-year medical students: Long-term skill retention and accuracy of student self-assessment. J Gen Intern Med 2009;24(6):721–726.
  24. 24. Kruidering-Hall M, O’Sullivan PS, and Chou CL. Teaching feedback to first-year medical students: Long-term skill retention and accuracy of student self-assessment. J Gen Intern Med 2009;24(6):721–726.
  25. 25. Kruidering-Hall M, O’Sullivan PS, and Chou CL. Teaching feedback to first-year medical students: Long-term skill retention and accuracy of student self-assessment. J Gen Intern Med 2009;24(6):721–726.
  26. 26. Teaching feedback to early medical students resulted in improved skills of delivering corrective specific feedback and enhanced comfort with feedback. However, students’ overall ability to deliver specific feedback decreased over time. Kruidering-Hall M, O’Sullivan PS, and Chou CL. Teaching feedback to first-year medical students: Long-term skill retention and accuracy of student self-assessment. J Gen Intern Med 2009;24(6):721–726. REALIMENTACIÓ N
  27. 27. REALIMENTACIÓ N
  28. 28. The feedback exchange model between clinical supervisors and learners has shifted to include the role of the learner in seeking and accepting feedback The feedback exchange process and resident feedback-seeking are influenced by multiple factors. Both faculty and learner roles require attention Delva D, Sargeant J, Miller S, Holland J, Brown PA, Leblanc C, Lightfoot K & Mann K. Encouraging residents to seek feedback. Medical Teacher 2013;35:12, e1625-e1631. REALIMENTACIÓ N
  29. 29. N
  30. 30. Resident feedback-seeking activities appear to be dependent on four – 4 - central factors: 1. learning/workplace culture/climate, 2. relationships, 3. purpose and quality of feedback, 4. emotional responses to feedback REALIMENTACIÓ N Delva D, Sargeant J, Miller S, Holland J, Brown PA, Leblanc C, Lightfoot K & Mann K. Encouraging residents to seek feedback. Medical Teacher 2013;35:12, e1625-e1631.
  31. 31. Delva D, Sargeant J, Miller S, Holland J, Brown PA, Leblanc C, Lightfoot K & Mann K. Encouraging residents to seek feedback. Medical Teacher 2013;35:12, e1625-e1631. REALIMENTACIÓ N
  32. 32. Further research is needed to determine how to reduce the tensions between faculty and learner perceptions of the feedback exchange process and how to encourage residents to take an active role in seeking feedback from their clinical supervisors. REALIMENTACIÓ N Delva D, Sargeant J, Miller S, Holland J, Brown PA, Leblanc C, Lightfoot K & Mann K. Encouraging residents to seek feedback. Medical Teacher 2013;35:12, e1625-e1631.
  33. 33. I do not recall residents really coming forward and saying, ‘Hey, listen, how was I?’ Delva D, Sargeant J, Miller S, Holland J, Brown PA, Leblanc C, Lightfoot K & Mann K. Encouraging residents to seek feedback. Medical Teacher 2013;35:12, e1625-e1631. REALIMENTACIÓ N
  34. 34. Ramani S, Post SE, Könings K, Mann K, Katz JT & van der Vleuten C. “It's Just Not the Culture”: A qualitative study exploring residents‘ perceptions of the impact of institutional culture on feedback. Teaching and Learning in Medicine. 2016 http://dx.doi.org/10.1080/10401334.2016.1244014 REALIMENTACIÓN 1. Does feedback provided by faculty facilitate performance improvement? 2. What are the strengths and weaknesses of the current feedback system in our residency program? 3. Can you describe challenges encountered when yo give or receive feedback? 4. Can you suggest strategies to improve the feedback culture in our department?
  35. 35. Ramani S, Post SE, Könings K, Mann K, Katz JT & van der Vleuten C. “It's Just Not the Culture”: A qualitative study exploring residents‘ perceptions of the impact of institutional culture on feedback. Teaching and Learning in Medicine. 2016 http://dx.doi.org/10.1080/10401334.2016.1244014 REALIMENTACIÓN
  36. 36. St-Onge C, Martineau B, Harvey A, Bergeron L, Mamede S & Rikers R. From See One Do One, to See a Good One Do a Better One: Learning Physical Examination Skills Through Peer Observation. Teaching and Learning in Medicine, 2013,25:3, 195-200. REALIMENTACIÓ N From See One Do One, to See a Good One Do a Better One: Learning Physical Examination Skills Through Peer Observation. Group learning activities that allow students to observe their peers during physical examination should be favored.
  37. 37. REALIMENTACIÓ N Ramani S & Orlander JD. Human Dimensions in Bedside Teaching: Focus Group Discussions of Teachers and Learners. Teaching and Learning in Medicine. 2013;25:4, 312-318, DOI: 10.1080/10401334.2013.827979 Human Dimensions in Bedside Teaching: Focus Group Discussions of Teachers and Learners. Teachers and learners regard the bedside as a valuable venue in which to learn core values of medicine. Strategies to preserve these humanistic values and improve bedside teaching. These strategies are essential for true patient-centered care.
  38. 38. Bedside teaching is valuable but underutilized. Including the patient, collaborating with learners, faculty development, and promoting a supportive institutional culture can redress several barriers to bedside teaching. REALIMENTACIÓ N Williams KN, Ramani S, Fraser B, and Orlander JD. Improving Bedside Teaching: Findings from a focus group study of learners. Acad Med. 2008; 83:257–264.
  39. 39. Williams KN, Ramani S, Fraser B, and Orlander JD. Improving Bedside Teaching: Findings from a focus group study of learners. Acad Med. 2008; 83:257–264.
  40. 40. Bedside teaching: Trabajo en equipo Orientación del equipo Discusión de casos Destrezas de comunicación Destrezas educativas Educación de personal paramédico Éxito del programa REALIMENTACIÓ N
  41. 41. REALIMENTACIÓ N
  42. 42. EFECTIVA Proveer al estudiante de información oportuna para reflexionar en sus errores y aciertos, le permite reconocer las consecuencias de sus acciones y la permanente superación. Vives-Varela T, Varela-Ruiz M. Realimentación efectiva. Inv Ed Med 2013;2(6):112-114
  43. 43. REALIMENTACIÓN EFECTIVA Vives-Varela T, Varela-Ruiz M. Realimentación efectiva. Inv Ed Med 2013;2(6):112-114
  44. 44. REALIMENTACIÓN EFECTIVA Vives-Varela T, Varela-Ruiz M. Realimentación efectiva. Inv Ed Med 2013;2(6):112-114
  45. 45. REALIMENTACIÓ N
  46. 46. REALIMENTACIÓN Hattie J and Timperley H. The Power of Feedback. Review of Educational Research 2007;77(1):81–112
  47. 47. REALIMENTACIÓ N 1. Prepare the team before entering the patient’s room. 2. Prepare the patient. 3. Listen and respond to the patient and the family. 4. Think out loud. 5. Find the teaching moments. 6. Involve nurses and other health care professionals. 7. Feel comfortable saying “I don’t know.” 8. Let the patient share a personal story. 9. Explain the next steps involved in the patient’s treatment.
  48. 48. REALIMENTACIÓ N 1. Preparation is a key element to conducting effective rounds and increasing teacher comfort at the bedside, 2. Draw a road map of what you plan to achieve at the bedside for each encounter, 3. Orient the learners to your plans for the session and negotiate goals and objectives for the session. Tell the learners what is to be taught, 4. Introduce yourself and the team to the patient; emphasize the teaching nature of the encounter, 5. Role-model a physician-patient interaction, 6. Stepping out of the limelight and keen observation is a necessary part of learner-centred bedside teaching, Ramani S. Twelve tips to improve bedside teaching. Medical Teacher. 203;25(2):112–115.
  49. 49. REALIMENTACIÓ N Ramani S. Twelve tips to improve bedside teaching. Medical Teacher. 203;25(2):112–115.
  50. 50. REALIMENTACIÓ N 7. Challenge the learners’ minds without humiliating, augmented by gentle correction when necessary. Do the teaching. 8. Tell the learners what they have been taught, 9. Leave time for questions, clarifications, assigning further readings, etc. 10. Find out what went well and what did not, 11. Think about the bedside encounter; evaluate what went well and what went badly and what you would do the next time, 12. Start your preparation for the next encounter with insights from your reflection phase. Ramani S. Twelve tips to improve bedside teaching. Medical Teacher. 203;25(2):112–115.
  51. 51. REALIMENTACIÓ N The physical examination is a critical component of medical practice. However, residents demonstrate considerable deficiencies in skills deemed important by program directors and during residency, and these skills do not typically improve beyond those of senior medical students. McMahon GT, Marina O, Kritek PA, Katz JT. Effect of a physical examination teaching program on the behavior of medical residents. J Gen Intern Med 2005; 20:710–714.
  52. 52. REALIMENTACIÓ N The physical examination is a critical component of medical practice. However, residents demonstrate considerable deficiencies in skills deemed important by program directors and during residency, and these skills do not typically improve beyond those of senior medical students. McMahon GT, Marina O, Kritek PA, Katz JT. Effect of a physical examination teaching program on the behavior of medical residents. J Gen Intern Med 2005; 20:710–714.
  53. 53. REALIMENTACIÓ N Frequency of physical examination, although not the depth of examination, can be increased through a skills based educational program delivered to medical trainees. Important aspects appeared to be the use of expert clinician educators, the recruitment of appropriate and willing patients, using small groups for the learning exercises, and the creation of a safe environment where participating residents could practice their clinical and teaching skills and receive immediate McMahon GT, Marina O, Kritek PA, Katz JT. Effect of a physical examination teaching program on the behavior of medical residents. J Gen Intern Med 2005; 20:710–714.
  54. 54. N Bedside teaching is declining in the medical curriculum. Reasons include an increased patient turnover in hospitals, the availability of high quality diagnostic other than physical diagnosis, and practical and personal impediments. Bedside teaching has been found to improve certain clinical skills in students and residents. Bedside teaching is still valued by patients, as well as students, residents and clinical teachers as a very useful teaching method. Because of its value for students/residents, patients and medical teachers, obstacles to bedside teaching should be overcome. Solutions vary from practical guidelines to using residents and interns as bedside teachers. Peters M, ten Cate O. Bedside teaching in medical education: a literature review. Perspect Med Educ 2014;3:76–88.
  55. 55. N La medicina, se aprende según algunos preceptos: a) Aprender haciendo, b) motivación basada en la responsabilidad, c) Supervisión y asesoría, d) Vinculación teoría-práctica, e) Ambiente académico, f) Investigación como estrategia educativa y g) Experiencias significativas Lifshitz A. Mentores. Med Int Méx. 2017;33(2):147-149.
  56. 56. REALIMENTACIÓN
  57. 57. Miller’s Learning Pyramid is an often-cited guide to describe different levels of knowledge and skills acquisition which distinguishes four levels of competence or training objectives: 1. Knows 2. Knows how 3. Shows how 4. Does Accordingly, the first two levels describe cognitive aspects, i.e. the acquisition of factual knowledge (level 1) and the application knowledge (level 2). The third and fourth levels refer to procedural skills. Skills lab training takes place on Miller’s Pyramid’s 3rd competence level, in detail on the level “shows how”/“show as if”. REALIMENTACIÓN
  58. 58. REALIMENTACIÓN see one, do one, teach one. Vozenilek J, Huff JS, Reznek M, Gordon JA. See One, Do One, Teach One: Advanced Technology in Medical Education. Acad Emerg Med 2004;11:1149–1154. see one, simulate many, do one competently, and teach everyone. ‘‘learning by doing’’
  59. 59. N
  60. 60. REALIMENTACIÓN COMUNICACIÓN
  61. 61. REALIMENTACIÓN MOTIVACIÓN En educación médica, la realimentación constituye un instrumento que informa al estudiante sobre su proceso de aprendizaje y facilita los cambios necesarios. Busca las propias percepciones del alumno respecto a su desempeño y cómo mejorarlo, desarrollando habilidades de aprendizaje permanentes, vital para la práctica autónoma.
  62. 62. REALIMENTACIÓN MOTIVACIÓN Si se realiza de forma efectiva resulta útil para mejorar el rendimiento, las habilidades clínicas y de comunicación, y el trato hacia los pacientes. Si se entrega de mala forma produce desmotivación y un quiebre en la relación docente-alumno. La relación interpersonal docente-residente, cuando se basa en una colaboración y en una apertura al diálogo, es fundamental para una retroalimentación efectiva.
  63. 63. REALIMENTACIÓN Bedside teaching is the process through which learners acquire the skills of communication by asking patients’ permission, establishing ground rules, setting time limit, introducing the team,diagnosing learner, diagnosing patient, conducting focused teaching, using simple language, asking patient if there is any question, closing with encouraging thanks, and giving feedback privately. Abdus Salam A, Halizah-Siraj H, Mohamad N, Das S, Rabeya Yousuf3 Bedside teaching in Undergraduate Medical Education: Issues, strategies, and new models for better preparation of new generation doctors. Iran J Med Sci 2011; 36(1): 1-6.
  64. 64. Bugaj TJ, Nikendei C. Practical clinical training in skills labs: theory and practice. GMS Journal for Medical Education 2016;33(4):1-21. REALIMENTACIÓN

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