Good morning amiga. Good morning amigos. I'm thankful for you suavecita :-! Thank you chico.. I'm thankful for you too. Hola Luis :-! Geezz I can understand how you felt. Wasting their money.
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Can I take her to the horse races???? Life is full of uncertainty but that's what makes it fun! It would be dull otherwise. That pic is a blast from the past :-! The third picture is for Daniela. Antes de que elijas, sabes. Antes de que sepas, elijes lo que saber. A thought provoker. I'm "breaking bad" over Heisenberg ;-0!
9789500516556 - El Principio De La Incertidumbre Spanish Edition by Gustavo Soler
I like the last picture.. Me gustan las fotos, graficos tambien - languagenut, Mar 16, There is a 'doin't' somewhere : - Pablo, Mar 17, Thank you, Pablo, for the correction to my English. Thanks, Bosque, for the picture. La cara del Dr. He is one that is on the side that believes quantum effects provide the basis for free wheel, the picture I think is from those who disagree, but I could be wrong. La incertidumbre es una parte de la vida. Uncertainty is a part of life. It is for sure, David. We never really know :-!
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I think you need two la's, lal la la. Pablo will pass by, I hope. La la la is a Swedish sort of humming, by the way. Gracias Pablo. La la la, Gracias Annie. The uncertainty about the perilous day weighed on the man as he drank hot cups of cocoa. Are you writing a story too? Check my bio- I already wrote one : - Matjam, Mar 16, The way forward is a Competency-based model for medical education with assessment of these Competencies using simple instruments, validated and accepted by all the stakeholders.
The institutions involved hospitals, medical centres and other healthcare services should trial different approaches within the general framework established by the current legislation and be conscious of the duty they have to society as accredited training organisations. Accordingly, they should consolidate their teaching and learning structures and the various different educational roles directors of studies, tutors, and other teaching positions , showing the leadership necessary to allow proper implementation of training programmes.
For this, the Spanish regional governments must develop their own legislation regulating Medical Specialty Training.
So, medical professionals should receive training, based on ethical values, behaviours and attitudes that considers humanistic, scientific and technical factors, developing an understanding of the scientific method and ability to put it into practice; skills to manage complexity and uncertainty; a command of scientific, technical and IT terminology, to facilitate independent learning; and a capacity for initiative and teamwork, as well as skills for personal activities and for making an effective, democratic contribution both within health organisations and in the wider society..
Los profesionales precisan nuevas competencias para nuevos tiempos. Can we and should we continue training our residents with the same professional profile of as little as three years ago? What new skills must we introduce and work with in training to make future professionals more responsible and capable of managing universal and growing healthcare demands, with limited resources; professionals who have to continue acquiring knowledge both scientific and technical in a globalised world, full of uncertainty that should be moving towards greater equality?.
We live in a delicate, historic time due to the major changes that society has experienced in recent years. Our lives revolve around problems occurring elsewhere on the planet, distant each from each other and thousands of kilometres from us. Just three years ago we were far less conscious of the impact that the decisions of others could have on our lives, with consequences the current economic crisis that are significant for our society and that will permanently affect the political, sociocultural, and moral environment of all societies.
We are seeing the other side of the coin of globalisation; a phenomenon of economic interdependence that has been intensely experienced since the s and that has resulted in the neoliberal politics we see today. Globalisation is taking place in the financial sector, but also effects politics, science, culture, education and healthcare In terms of the training of healthcare professionals of any kind we should ask ourselves: For what world and for whom people are we doing this training?
In this respect, a goal of the process of training professionals must be to encourage a consciousness of universal citizenship, which will facilitate the process of change towards a new understanding of citizenship. Some time ago, organisations such as the World Health Organisation WHO recommended that, within the teaching environment and the practice of medicine, measures must be taken to provide education aiming to achieve equitable, efficient and comprehensive care for patients, families and communities, according to the needs and values of their society..
Medical training must undergo certain changes if it is to contribute to the amelioration of some of the deficits resulting from globalisation. The commitment of training institutions must be to enable the training of professionals by and for the community, teaching them about community values of solidarity and empathy, and to be able to put themselves in the shoes of others.
This commitment must not be on paper alone, but should manifest itself through training programmes and the actions of teachers. This commitment should focus on training that strengthens, among other aspects, the bonds between different cultures, life-long learning, autonomy and personal and professional responsibility, a universal vision, and, lastly, caring, creative and critical thinking 1.
Training based around competencies and their evaluation allows us to tackle these challenges and commitments.. Medical training in Spain is facing new challenges resulting from an important change in the educational scene in Europe: the European Higher Education Area Bologna Declaration of 3. A process of convergence has begun that has as its aim to facilitate the mobility of graduates and adapt the content of university studies to social demands.
It is an attempt to create a Europe of knowledge a knowledge society , an expression coined by Peter Drucker in 4 , not linked to the quantity of knowledge but rather to its productivity, that is, its economic impact. In addition, continuously changing social needs require dynamic health systems that must offer safe, effective, efficient, and high quality responses to the needs and expectations of citizens 5. The competency profile for health professionals should take into account the need for this responsiveness. Specifically, the profile must continuously be adapted and developed with new competencies, which in turn lead to modifications in learning and evaluation systems.
Regarding these changes, A. Jovell and M. To that, we must add the collectivisation of the provision of health services as a strategy to guarantee equitable access. This idea has been replaced by the understanding that professional competency is a complex phenomenon which expresses the potential of individuals to direct their actions in the exercise of their profession with initiative, flexibility and autonomy, in diverse scenarios, based on the integration of knowledge, skills, motives and values, and is demonstrated by efficient, ethical, and socially committed professional work.
It is within this context of ever greater and more complex transformations that competency-based training CBT emerges to enable the better adaptation and development of individuals 10 , in this case, physicians.
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CBT focuses on learning and not on teaching, and on reaching specific objectives, i. Training medical specialists involves the gradual integration of recent graduates in medicine into the care activities of a health centre or hospital with growing responsibility and decreasing supervision over time. Is it possible to carry out this professional training without having the tools and resources necessary to guarantee that this integration is appropriately planned and supervised, and that the final result a competent medical specialist is the consequence of completing a programme designed to meet current healthcare demands?
It is based on learning on-the-job and has been one of the most important drivers of the modernisation of medical practice in Spain. The system, as regulated in , has a strong state structure controlled from the Spanish Ministry of Health and Social Policy The following characteristics of the system should be highlighted: the accreditation of healthcare centres and teaching units clinical departments , whose guarantee of quality training is monitored through regular audits; a universal entrance exam; and the definition and classification of specialties and associated programmes, as regulated by the corresponding National Specialty Commissions and a National Council.
However, there are considerable weaknesses in the way in which the system is put into practice within healthcare institutions. The Order on Teaching Commissions of 15 , which regulates their powers and operation, as well as those of the directors of studies and tutors educational supervisors , has not been thoroughly implemented and the evaluation system it proposed, the one currently operating, is more a system of certification of completion of a series of rotations or placements in certain care units, than a true training and assessment of competencies.
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A study by the National Commission on Nephrology revealed some of these weaknesses in the training of specialists, from irregular allocation of human and material resources within teaching units, to failures to fulfil teaching objectives and the role of mentoring tutor , run on a voluntary basis, being little recognised You must first be a doctor and only then a specialist.. However, as noted by J. Cobo-Reinoso, the mere passing of legislation does not guarantee its successful implementation 18 ; this author highlights the elements that should comprise a residency programme for it to be both effective: 1 the definition of a training programme consistent with training objectives; 2 establishment of monitoring protocols ; 3 adequate communication with tutors; 4 a comprehensive assessment system, essentially educational, and more demanding; and 5 quality control by the Teaching Commission.
This is not possible without funding and a definitive consolidation of healthcare organisations, educational structures and training agents directors of studies, tutors, trainers and other teaching staff , and, in Spain, this is the responsibility of the regional governments.. Bunk defines competence as behaviour resulting from a set of attitudes, skills, abilities, knowledge and values that people use to deal with specific situations related to their life and profession It is, in short, the effective ability to successfully carry out a clearly specified work activity.
Professional competence is not a measure of the probability of success in the execution of a profession; it is a real and demonstrated ability that can be evaluated based on results.. The start of the competency movement can be traced back to a paper published in by David McClelland, who asserted that not only aspects such as knowledge and skills, but also feelings, beliefs, attitudes and behaviours can predict high work performance We are referring to empathy, intuition, integrity, perception of reality, the spirit of community, self-confidence, flexibility, and the domain of the individual.
These concepts are fully applicable to the world of healthcare and indeed are today recognised as being fundamental aspects of the competencies of a medical practitioner. A Gual et al 9 agree with this, stating that for the future we require: physicians who adopt a critical approach, who are communicative and empathetic, individually and socially responsible, make decisions which are good for the patient and the health care system, leaders of the health team, competent, effective and safe, honest and reliable, committed to patients and the organisation; physicians who treat patients, not diseases.
In summary, the competencies of a professional combine knowledge Know , skills and abilities know-how , attitudes and behaviours how to act , and values and beliefs how to be.. The competency domains defined in these models are perfectly applicable to any specialty.
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These approaches do not mean that doctors, to date, have not been trained in such competencies; the difference is that in the CBPME project they are made explicit, and those competencies necessary to address changing social and healthcare needs are emphasised Working with such a model facilitates the development and adaptation of the learning process learning objectives derived from the competencies, activities, specific tasks, training plans, schedules, methodologies and teaching resources and the implementation of a final competency assessment outcome-based assessment.
To bring about the changes required, it is very important that all professionals adopt the same approach and language, a task that will take time.. Training in the workplace professionalises the resident by developing their understanding of the knowledge, skills, abilities, attitudes and values that are present, these days, in the medical profession. However, it can also de-professionalise, as it is difficult to implement educational practices in each and every care setting in which residents train. The workload and other factors associated with healthcare organisations and their management do not facilitate interaction between tutors and residents.
Though the residents should not forget that they are primarily responsible for their own training and must be proactive, this climate occasionally leads tutors and staff to forget their teaching role and that the residents are professionals in training. Institutions must guarantee: 1 the exercise of leadership from senior and middle management directors of studies, heads of department, tutors ; 2 the planning and development of a teaching strategy, with the involvement of all relevant parties tutors and staff , facilitating decision-making and accountability, including on the part of residents; 3 the resources structural, material, financial and organisational ; 4 the development of programmes integrated into the care system in accordance with a defined profile of medical specialist; and 5 the qualitative and quantitative measurement of results.
It is within this scheme that the tutor is essential as a manager of a programme of specialisation within the teaching strategy of the centre. Duties and training tasks should be specified in the training programme contracts of the centres and in the portfolio of services of teaching units. This is a reflection of the duty they have to society as accredited teaching institutions Before provides for the social environment of the specialty, the skills to be developed by level, the role of the tutor, the resident, the other trainers and the institution.
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During interaction includes training contexts, how learning will be enhanced in each of the contexts; specific, joint and individual tasks; methodological strategies; and ongoing or formative evaluation. After, involves evaluation of the learning of the resident, tutor performance, the development of the training process, the programme, the trainers and other agents of the support structure The tutor, as the pivotal figure in this complex process, with a high level of social responsibility, must acquire and develop certain teaching competencies Rigorous and transferable evaluation is the great unmet challenge in the specialised training system, and it will never be possible if all training agents not just the tutors are not sure what to evaluate, i.
The evaluation the after is a moral obligation to society, the institution, and the resident it is their right, for the purpose of guiding and supporting them in their learning, and in the acquisition and improvement of their competencies. Evaluation forms part of a complex training process and should be well defined a priori. Indeed, it is also a process in itself that generates data through assessment applying reference criteria, and this information is used to make judgments and decisions.
This latter type of evaluation allows the candidate to understand their strengths and weaknesses and create plans for improvement it is known as formative assessment. Both demand an equal degree of rigor in their procedure and documentation. Son ellas:. La Tabla 3 muestra, de forma resumida, los resultados de incertidumbre obtenidos.
Las Tablas muestran los resultados obtenidos. Resultados similares fueron obtenidos para los tres niveles de corriente considerados, como muestra la Figura 1. Los mismos son mostrados en la Tabla 7. En la Tabla 7 se observa que el Rendimiento superior se obtiene con la menor intensidad de corriente de soldadura. Rio de Janeiro, CONEM , 10 p. Regulating splashing of electrode metal in manual arc welding, Welding International n. The effect of wollastonite on operational characteristics of AWS E electrodes.