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Background: Antimicrobial resistance is a growing health problem worldwide. One strategy to face this problem in a reasonable way is training health personnel for the rational use of antimicrobials. There are some difficulties associated with medical staff to receiving training with E-learning education, but there is a lack of studies and insufficient evidence of the effectiveness of this method compared to face-to-face learning. Methods: An educational intervention on antimicrobial resistance (AMR) and antimicrobial prescription practice (APP) was designed and implemented using two approaches: face-to-face and E-learning among physicians of the intensive care unit (ICU) and internal medicine ward (IMW) at Eugenio Espejo Hospital in Quito. Modalities of interventions were compared to propose a strategy of continuous professional development (CPD) for all hospital staff. An interventional study was proposed using a quasi-experimental approach that included 91 physicians, of which 49 belong to the IMW and 42 to the ICU. All of them received training on AMRhalf in a face-to-face mode and the other half in an asynchronous E-learning mode. They then all participated on APP training but with switched groups; those who previously participated in the face-to-face experience participated in an E-learning module and vice-versa. We evaluated self-perception about basic knowledge, attitudes and referred practices towards AMR and APP before and after the intervention. A review of medical records was conducted before and after training by checking antimicrobial prescriptions for all patients in the ICU and IMW with bacteremia, urinary tract infection (UTI), pneumonia, and skin and soft tissue infection. The study received IRB clearance, and we used SPSS for statistical analysis. Results: No statistically significant difference was observed between the E-learning and the face-to-face methodology for AMR and APP. Both methodologies improved knowledge, attitudes and referred practices. In the case of E-learning, there was a self-perception of improved attitudes (p < 0.05) and practices (p < 0.001) for both AMR and APP. In face-to-face, there was a perception of improvement only in attitudes (p < 0.001) for APP. In clinical practice, the use of antimicrobials significantly improved in all domains after training, including empirical and targeted treatment of bacteremia and pneumonia (p < 0.001) and targeted treatment of UTI (p < 0.05). For the empirical treatment of pneumonia, the mean number of antibiotics was reduced from 1.87 before to 1.05 after the intervention (p = 0.003), whereas in the targeted management of bacteremia, the number of antibiotics was reduced from 2.19 to 1.53 (p = 0.010). Conclusions: There was no statistically significant difference between the effect of E-learning and face-to-face strategy in terms of teaching AMR and APP. Adequate self-reported attitudes and practices in E-learning exceed those of the face-to-face approach. The empiric and targeted use of antimicrobials improved in all reviewed cases, and we observed an overall decrease in antibiotic use. Satisfaction with training was high for both methods, and participants valued the flexibility and accessibility of E-learning.
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Introducción: En la última década ha existido una evolución conceptual y documental que abarca desde la educación médica continua, el desarrollo profesional continuo hasta el desarrollo profesional basado en competencias. Objetivo: Revisar el estado actual de la educación médica continua en el mundo, su evolución y las posibilidades de su perfeccionamiento en Cuba. Métodos: Se realizó una revisión bibliográfica en las bases de datos MedLine, PubMed, SciELO, LILACS mediante los descriptores: "educación médica continua" y "desarrollo profesional continuo". Se priorizaron las revistas internacionales de educación médica y los artículos de los últimos 5 años. Asimismo, se revisó el sitio web de la federación mundial de educación médica. Resultados: La educación médica continua y permanente constituye un principio de la educación médica. Esta transita desde la educación médica continua hasta el desarrollo profesional continuo, y luego al desarrollo profesional continuo basado en competencias y a la educación continua interprofesional. Se muestra la evolución conceptual, y se relaciona la educación médica basada en competencias con el desarrollo profesional continuo. Se mencionan las características de una efectiva educación médica continua y un desarrollo profesional continuo, que pudieran ser aplicables a nuestro contexto. Conclusiones: La necesidad de perfeccionar y mejorar el nuevo modelo económico y social del país ha requerido nuevas resoluciones ministeriales y estatales acerca del desarrollo profesional continuo de los trabajadores y profesionales del país, incluidos los del sector de la salud. Se requiere actualizar los conceptos y las prácticas en este orden para estar a tono con las tendencias internacionales(AU)
Introduction: In the last decade, there has been a conceptual and documental evolution that ranges from continuous medical education and continuous professional development to competence-based professional development. Objective: To review the updated theory about continuous medical education worldwide, its evolution and the possibilities for its improvement in Cuba. Methods: A bibliographic review was carried out in the databases MedLine, PubMed, SciELO, and LILACS, using the descriptors educación médica continua [continuous medical education] and desarrollo profesional continuo [continuous professional development]. We prioritized international medical education journals and articles within the last five years. We also reviewed the website of the World Federation for Medical Education. Results: Continuous and permanent medical education is a principle of medical education. It evolves from continuous medical education to continuous professional development, and then to continuous competence-based professional development and continuous interprofessional education. The conceptual evolution in this area is shown, and competence-based medical education is presented with a focus on its relation with continuous professional development. The characteristics are mentioned corresponding to effective continuous medical education and continuous professional development, which could be applied in our setting. Conclusions: The need to perfect and improve the new economic and social model of the country has required new ministerial and state resolutions concerning continuous professional development of the country's workers and professionals, including those in the health sector. Updating concepts and practices in this respect is required in order to be in tune with international trends(AU)
Assuntos
Humanos , Redes de Comunicação de Computadores , Competência Mental , Educação Médica ContinuadaRESUMO
En el presente artículo se valora la importancia adquirida en los últimos tiempos por el concepto de formación en radiología en sus distintas facetas: formación especializada, continuada y pregraduada, considerando las peculiaridades y características de cada una de ellas. Se analizan, a la luz de la experiencia acumulada durante más de 20 años de actividades relacionadas con las mismas, su evolución y perspectivas actuales y futuras, consignando este capítulo como un reto y a la vez un compromiso que debemos asumir.
In this article it is evaluated the importance acquired lately by the concept of formation on radiology in its different aspects: specialized, continuous and pregraduated, taking into account the specific features and characteristics of every one of them. They are analized, from the perspective of an experience accumulated for more than 20 years of activities related to them, their evolution and current and future possibilities, considering this chapter as a challenge and at the same time a commitment that we must assume.