Valencia-Sánchez Jesús Salvador, Leyva-González Félix Arturo, Viniegra-Velázquez Leonardo
Hospital de Cardiología Centro Médico Nacional Siglo XXI, IMSS, DF México.
Rev Invest Clin. 2007 Jul-Aug;59(4):268-77.
To search the reach of educative strategy promoting the participation, to estimate the development of clinical aptitude and critical reading attaching the appropriate use of clinic research in cardiology residents.
Prospective study. The instrument of clinical aptitude was constructed with five cases and 170 items and the instrument of critical reading was developed with five summaries of articles of clinical research in cardiology by 120 items. The strategy was performed with activities one a week during six months by two hours per class, in the period: March and September, 2005. Reading guides were delivered to the participants a week before that included a clinical case and clinic research of cardiology. During the activities in class we were promoting the participation and discussion. Both measuring instruments were performed in the first (initial measuring) and final session (final measuring). Non parametric test were used because the variable of the subjects were not normal distribution and the scale was ordinal.
The reliability coefficient in both instruments with the Kuder-Richardson was 0.90 and 0.85 respectively. After educative strategy was observed a significant advance in the global calcifications, such as in critical reading and in clinical aptitude (p = 0.001 and 0.5 respectively). Analyzing in an independent manner the components of critical reading we found significant advancement in the indicators interpretation and judgment. In clinical aptitude we found significant progress in the indicators: the suitable use of paraclinics resources, the appropriate use of therapeutics measurement and iatropatogenic decisions for omission.
The educative strategy promoting the participation, permitted to get a change in the clinical aptitude and critical reading attaching the appropriate use of sources of investigation in cardiology residents.
探寻促进参与的教育策略的效果，评估心脏病学住院医师临床能力的发展以及批判性阅读能力，并注重临床研究的恰当应用。
前瞻性研究。临床能力评估工具由5个病例和170个项目构成，批判性阅读评估工具则基于120个项目，由5篇心脏病学临床研究文章的摘要编制而成。该策略于2005年3月至9月期间实施，每周开展一次活动，每次课2小时，共持续6个月。在活动前一周向参与者发放阅读指南，其中包含一个临床病例和心脏病学临床研究内容。在课堂活动中，我们促进参与者的参与和讨论。在第一次（初始测量）和最后一次（最终测量）课程中均使用这两种测量工具。由于受试者变量不呈正态分布且量表为有序量表，因此使用非参数检验。
两种工具使用库德 - 理查森信度系数分别为0.90和0.85。实施教育策略后，在整体钙化方面观察到显著进步，如在批判性阅读和临床能力方面（p分别为0.001和0.5）。独立分析批判性阅读的各个组成部分，我们发现指标解释和判断方面有显著进步。在临床能力方面，我们发现以下指标有显著进展：辅助检查资源的恰当使用、治疗措施的合理运用以及避免医源性决策失误。
促进参与的教育策略使心脏病学住院医师在临床能力和批判性阅读方面发生了变化，且注重临床研究资源的恰当应用。
