Patient’s autonomy and decision making in health: acquaintance by Peruvian medicalinterns - 2010Objectives: To determine acquaintance on patient’s autonomy and decision making in health care in medical interns from five cities of Peru. Design: Opinion poll type study. Setting: Institute of Ethics in Health, Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru. Participants: Medical interns. Methods: Five cases from the literature with multiple choice questions were used as the instrument; its validity and reliability was established by both a group of experts and Cronbach alpha. Participants in the study were medical interns from five Peruvian cities: Lima (n=48), Huacho (n=21), Ica (n=24), Trujillo (n=132), and Huancayo (n=47). Main outcome measures: Correct ethical answers. Results: From the interns participating 61,4% were male, mean age 26 (SD 2,8) min 21 and...

Objective. To identify factors associated to medical interview, physician-patient relationship and communication skills of medical graduates Design: Survey type study. Setting: Faculty of Medicine, Universidad Nacional Mayor de San Marcos. Participants: Medical graduates. Methods: Data base of a survey to medical graduates on their training in core clinical skills was used. Main outcome measures: Medical interview, physician patient relatioship and communication skills. Results: The data base was obtained from 917 graduates, 59 % male, 56% between 25-29 years old. A quarter was graduated from the Universidad Nacional Mayor de San Marcos, one third graduated in 2003; 85% responded that they had been trained in core clinical skills. The highest score in clinical skills was related to have had training in those skills in bi and multivariate analysis and to be graduated before 2003, in multi...

Objective: To assess the perception of medical graduates in regards to their training in medical interview, physician-patient relationship and communication skills. Materials and Methods: Applicants to a 2005-residency post at the Universidad Nacional Mayor de San Marcos participated in the study. The questionnaire was designed adapting three instruments. Validity and reliability studies were carried out. Results: A total of 917 graduates completed the questionnaire, 59% were male; 56% between 25-29 years old; 85% responded to having had training in core clinical skill, but various deficiencies were identified: a) clinical method; b) psychosocial data gathering; c) patient´s comprehension examination; d) emotions management; e) non verbal communication. The time as limiting factor for adequate relationship/communication with the patient was identified in respondents´ comments. Conclusi...

Objectives: 1) To assess the effectiveness of a medical ethics course; 2) to explore the factors that influence in moral reasoning; 3) to explore the perception of the most frequent ethical problems in clinics. Materials and Methods: Thirtyone general hospital first year medical residents participated in the study. A randomized pre test/post test crossover design was used with two groups, A and B. A questionnaire with two sections was administered: 1) close ended questions about personal data, factors that influence ethical decision and the most frequent ethical problems perceived in clinics; 2) open ended questions to vignettes. Results: Sixty-two per cent of all first year medical residents participated in the study. Mean age of the group was 29,6 (DE 3,90). Both A and B groups were similar in proportion of gender and age. Following the course respondents used less directive tone and m...

OBJECTIVE: To assess quality of the scientific production of UNMSM Medical School researchers. MATERIAL AND METHODS: San Marcos Research Activities Registry (RAIS) database and full text articles of journals 1991-2000 registered in RAIS. Four hundred and sixty-two articles were categorized and those corresponding to studies were separated. From these a random sample of 20% (n=59) was selected and peer reviewed using Vancouver style as quality standard. Score was assigned to each part of the publication in order to measure inter-rater reliability and to categorize results of the assessment. RESULTS: Inter-rater reliability coefficient varied among sections of the publication; 71,2% of the studies were rated as good-excellent but 80% did not describe statistical procedure and 85% did not communicate ethical issues. CONCLUSION: Vancouver guidelines for the format of articles was useful in o...

OBJECTIVE: To identify personal, institutional and contextual factors involved in the scientific papers production process by Medical School researchers. MATERIAL AND METHODS: 1) The San Marcos University Research Activities Registry (RAIS) data base created by the Research Council (CSI); and 2) In depth interviews of intentionally selected informers inquiring about various aspects of the scientific production process. RESULTS: During the period 1990 through 2001 from 994 faculty members, 149 (15%) published scientific papers in journals and registered them in the RAIS. Their profile was: males 62%; mean age 58; physicians 2 out of 3; with Doctor or Master Degree and either exclusive dedication or full time faculty 1 of every 2; attached to Research Center/ Institute 60%. The interviews qualitative analysis highlighted the consensus that scientific studies results should be published, bu...

Objective: To describe trends in scientific production by reviewing articles published by Medical School researchers. Materila and method: San Marcos Research Activities Registry (RAIS) database and RAIS registered articles file were analyzed in relation to number of authors, participating institutions and funding sources. Qualitative analysis of key informants interviews database was done as well. Results: Four hundred sixty-two articles were published between 1991-2000. Trends between the first and second five-year period were characterized by decline in: 1) volume of articles; 2) number of articles with both one single author and six or more authors; 3) cooperation between institutions; 4) funds, notwithstanding university funding increased in 60%. Qualitative information describes some research characteristics at different times of the institution’s history. Conclusions: Scientific...

Objective. To identify teaching of professionalism (excellence, humanism, accountability and altruism) in the medical curricula of the Universidad Nacional Mayor de San Marcos. Design. Qualitative, specifically encoded qualitative study. Setting. Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru. Material. Medical education syllabi. Methods. Thirty-eight syllabi of courses corresponding to the six years of medical education were examined. A panel of experts was settled and the content analysis method was used. The inter-rater reliability was established and principles of professionalism were identified in competencies, contents, teaching methods and syllabi assessment. Main outcome measures. Teaching of professionalism. Results. Fifty-eight per cent of courses mentioned some elements of professionalism; the most frequent competencies were related to excellence fol...

Objective: To determine the medical interns training in medical ethics. Design: Qualitative in cipher study of professional skill tests. Setting: Universidad Nacional Mayor de San Marcos’ Human Medicine Professional Academic School. Participants: Interns of medicine, year 2003. Interventions: Secondary source of information related to the results of professional skills examination taken to medical interns graduated in 2003, at Universidad Nacional Mayor de San Marcos was used. Responses to the question in regards to information to patients and their families, and ethical issues of the clinical cases were analyzed. Classification criteria was designed and each was quantified from 0 = no mention to 3 = much mention. Two researchers participated in the classification process. Main outcome measures: Information to patients and their families, and ethical issues. Results: The proportion mal...

Objetivo. Describir la frecuencia y características de los procesos ético-disciplinarios derivados de actos médicos resueltos por el Consejo Nacional del Colegio Médico del Perú, así como las características de los médicos implicados. Material y métodos. Se analizaron las resoluciones emitidas por el Consejo Nacional del Colegio en procesos ético-disciplinarios instaurados por denuncias de pacientes en el periodo 1991-2015. Resultados. Los procesos ético-disciplinarios instaurados por denuncias de pacientes aumentaron 4,3 veces entre 1991-2000 y 2006-2015; la mayoría (87%) provino de Lima y Callao. La tasa de incidencia de médicos involucrados en los procesos éticos fluctuó entre 1,5/1000-3,36/1000 en el periodo de estudio. La demanda más frecuente fue por mala atención (55%) seguida de certificado médico irregular (12%), delitos (11%) y no obtener consentimient...

Objetivo. Describir la frecuencia y características de los procesos ético-disciplinarios derivados de actos médicos resueltos por el Consejo Nacional del Colegio Médico del Perú, así como las características de los médicos implicados. Material y métodos. Se analizaron las resoluciones emitidas por el Consejo Nacional del Colegio en procesos ético-disciplinarios instaurados por denuncias de pacientes en el periodo 1991-2015. Resultados. Los procesos ético-disciplinarios instaurados por denuncias de pacientes aumentaron 4,3 veces entre 1991-2000 y 2006-2015; la mayoría (87%) provino de Lima y Callao. La tasa de incidencia de médicos involucrados en los procesos éticos fluctuó entre 1,5/1000-3,36/1000 en el periodo de estudio. La demanda más frecuente fue por mala atención (55%) seguida de certificado médico irregular (12%), delitos (11%) y no obtener consentimient...

Objective: To describe and compare the medical students’ mental health of two Peruvian Public Universities. Material and method: Two medical student populations participated in the study: 1) 1115 students registered in 1997 at San Marcos University School of Medicine; and, 2) 508 students registered in 1998 at Trujillo University School of Medicine. Results: Male proportion was higher than female; mean age was 24 years in both populations. Mental health problems detected indicate high levels of stress, high lifetime prevalence of alcohol and cigarettes use/abuse, dissocial and violent behaviors. Besides the students’ lifestyle was affected by the medical career demands with few opportunities for social entertainments. Cconclusions: The study highlighted the presence of mental health problems in both populations. Students would be helped if a stress prevention program is established.

OBJECTIVE: To examine the mental health of 12 to 18 year-old adolescent population. MATERIAL AND METHODS: A mental health household survey was carried out in a sample randomly selected from two areas of Las Delicias, District of Moche, Trujillo City, Peru: 32 subjects from Taquila (a rural area) and 43 from the North Zone (an area in process of urbanization). RESULTS: Problems related to substance abuse, mainly alcohol, were more predominant in Taquila while symptoms of distress and depression with lower family and social support were evident in the North Zone; the differences between the two subsamples were statistically significant. CONCLUSION: Stressors related to the described problems are probably immerse in the macrovariables associated to the urbanization process of that population.

Objectives: To determine physicians applicants to the medical residency´s knowledge on informed consent. Design: Questionnaire on informed consent. Setting: Faculty of Medicine, Universidad Nacional Mayor de San Marcos. Participants: Physicians applying to postgraduate medical residency. Methods: A multiple choice examination was elaborated. One thousand four hundred and eighty six (95 %) applicants to the Universidad Nacional Mayor de San Marcos 2009 medical residency participated in the study. An Excel data base was prepared and SPSS 15 for statistic frequency analysis and Atlas-ti for qualitative analysis were used. Participation in the study was voluntary and anonymous. Main outcome measures: Knowledge on informed consent. Results: Fifty-six per cent of participants were male with a mean age of 31.5 (S.D. 5.1) and range between 23 and 58. They graduated in 26 national medical school...

Objectives: To identify factors associated to the informed consent acquaintance in Peruvian physicians. Design: Retrospective study, based in a comprehensive exam. Setting: Universidad Nacional Mayor de San Marcos. Participants: Physicians postulating medical specialization. Methods: A data base of 1 486 physicians applying to the 2009 residency program at San Marcos University who answered an informed consent acquaintance examination was used. Sex, age, university of origin and year of graduation were classified in two categories and the total score obtained in the examination in three categories, in order to procedure with bi and multivariate analysis. SPSS 15 program for chi square and multivaried analysis and Atlas ti program for comments qualitative analysis were used. Main outcome measures: Theoretical knowledge on informed consent. Results: Significant statistical differences in t...