Use of teaching methods in clinical-pathological meetings and fresh pieces
RESEARCH PAPER

 

Use of teaching methods in clinical-pathological meetings and fresh pieces

 

Empleo de los métodos de enseñanza en reuniones clínico-patológicas y de piezas frescas

 

 

Ygnacio Ygualada Correa, María Obdulia Benítez Pérez, Teresa Gómez Leiva

Villa Clara University of Medical Sciences. Cuba.

 

 

ABSTRACT

The autopsy is the most complete study of the patient and the disease; from its results derive a series of scientific-educational events in medical education, which means that general clinical-pathological meetings and fresh pieces are essential for the training of health professionals, because they contribute to the quality of care of the services, they reduce the clinical-pathological discrepancies to the minimum degree and point out the deviations of the treatments and the possible appearance of new or unexpected diseases. The exchange carried out is of great medical care, teaching and scientific importance, that is why it is necessary to insist on the teaching methods to be used in order to continue raising their quality in the acquisition of knowledge and skills needed to develop the scientific thinking that links the school with life.

MeSH: autopsy, students, education, medical.

RESUMEN

La autopsia es el estudio más completo del enfermo y la enfermedad; de sus resultados derivan una serie de eventos científico-docentes en la enseñanza médica, lo que significa que las reuniones clínico-patológicas generales y de piezas frescas, son indispensables para la formación de los profesionales sanitarios, porque contribuyen a la calidad asistencial de los servicios, reducen al grado mínimo las discrepancias clínico-patológicas y señalan las desviaciones de los tratamientos y la posible aparición de patologías nuevas o no esperadas. El intercambio realizado tiene gran importancia asistencial, docente y científica, por lo que se hace necesario insistir en los métodos de enseñanza a utilizar con el objetivo de continuar elevando su calidad en la adquisición de conocimientos y habilidades necesarias para desarrollar el pensamiento científico que vincula la escuela con la vida.

DeSC: autopsia, estudiantes, educación médica.

 

 

The autopsy and its results originate a series of teaching-scientific events in medical education, which means that general clinical-pathological meetings and those of fresh pieces are essential for the training of health professionals; from this derives the scientific importance that represents the practice of post-mortem meetings, as a learning method for acquiring skills that strengthen knowledge throughout life.

The training of the health professional in Cuba and the future Doctor of Medicine determines that the student who enters the medical university develops skills in the intensive study of the human body and its functioning, and regulates their behavior from the beginning of the career with high ethical and professionals values, typical of the medical sciences.1

The autopsy is the most complete study of the patient and the disease, so the Pathological Anatomy in the two levels of medical education: undergraduate and postgraduate has a fundamental incidence.2 This means that post-mortem meetings are essential for training of the health professionals because they contribute to the quality of care of services, reduce to a minimum the clinical-pathological discrepancies and point out the deviations of treatments and the possible appearance of new or unexpected diseases.3

It is essential to take into account the direct and intermediate causes of death, which often go unnoticed and their knowledge contributes to internal quality control in institutions.4 The post-mortem meeting is a teaching and research activity that must be given great support from all the factors that intervene in the institutional direction.5 The quality of the actions aimed at training focuses on the work of the teacher and the learner, who must be prepared and engaged in building learning under the principles of medical and pedagogical ethics.6

The benefits of autopsy and post-mortem activities offer knowledge in Anatomy, Physiology and other preceding subjects, as well as training in the correct filling of the death certificate and correlation with diagnoses of causes of death, reveals the discrepancies of medical diagnoses and familiarizes the student with the clinical-pathological correlation; it also allows the pathologist to receive feedback with the information obtained as a guarantee of quality in the medical work.1

A teaching method is the set of techniques and activities that a teacher uses in order to achieve one or several educational objectives, makes sense as a whole and responds to a name known and shared by the scientific community.7 It supposes the indispensable interrelation of teacher and student, where the first organizes the activity of the second on the object of study, which results in a process of assimilation of the content of teaching.8

Clinico-pathological meetings and fresh pieces develop skills, which for some authors such as Danilov and Skatkin (1980), referenced by Sixto Fuentes et al.9 constitute a very complex and broad pedagogical concept, since: "Skill is the capacity acquired by man to creatively use his knowledge and habits both during the process of theoretical and practical activities". These authors classified the teaching methods in:

  1. Reproductive: includes the explanatory-illustrative method.
  2. Productive: includes the method of problem-solving presentation of partial or heuristic search and researching.

The teaching method selected for the post-mortem meetings is the productive one, and within this one the problem-solving presentation of partial or heuristic search, where the students, guided by the professor, are introduced in the process of searching for solutions. The selected method offers didactic advantages, among them: it attracts the attention of the participants, it arouses the cognitive interest with an accessible activity, it allows to discover the contradiction between the cognitive need that has arisen and the impossibility of satisfying it through the knowledge and skills that they possess, and help to determine the cognitive task and the ways of solution, which stimulates searching.2,10

To carry out these teaching activities the summary of the clinical history by the participants is discussed based on the events of death, general data of the deceased is collected, the diagnosis on admission, its evolution and diagnostic procedures performed, as well as direct, intermediate, basic causes of death and the contributing cause. The activity is guided by the professor of Internal Medicine, who exchanges criteria based on its experiences and those of the staff, while the pathologist shows the macroscopic study, with the anatomical and histological count of the organ and the morphological damage that relates to the failure of the organs functions, clinical events and causes of death. Finally, the chronopathogram of the events of death is concluded and the diagnostic coincidences are analyzed until arriving at the dialogic conclusions that include: the definition of the set of fundamental characteristics that allow the identification of a disease and location in the eight groups of disorders in which Pathological Anatomy is divided into, which includes: classification according to the form of onset (primary or secondary), etiological agent (bacteria, viruses, fungi), evolution (acute or chronic), morphological alterations, frequency of diseases when taking into account geographic localization, affected organs, apparatuses, age, sex, race, etiological-pathogenesis, morphology with macroscopic alterations of shape, size, weight, color and consistency and the microscopic study of the structures of the organ studied, and the clinic with the summary of symptoms and clinical signs of the deceased patient.2,10

The interdisciplinary exchange between specialists and students generates the maximum use of the results of the autopsy, enhances the individual talent and creates a kind of collective intelligence with great power of analysis and resolution capacity that improve the quality of education and medical work, guarantee undergraduate and postgraduate teaching, reinforce the scientific knowledge acquired in the different levels of education, familiarize and train in the correct filling of the medical certificate of death and clinical history, contribute to the appreciation of the inaccuracies of the medical diagnoses of cause of death, death is accepted as a real possibility in the management of the patient and training is achieved in the use of the clinical-pathological correlation as a mechanism to evaluate the quality of medical practice.

The authors consider that these meetings guarantee the expansion of possibilities and opportunities for access to medical education because they multiply knowledge, contribute to the formation of a comprehensive general culture and a gradual increase in higher scientific levels, favoring the teaching-learning process and development. Of human resources in the health system, so they should be exploited with the participation of undergraduate and graduate students, also facilitate their motivation and improve the quality of medical care work. Because of its importance, it is necessary to insist on the teaching methods to be used and the methodological aspects. The method must pay tribute to acquire knowledge and skills to develop scientific thinking that links school with life.

 

Declaration of interests

The authors declare no conflict of interest.

 

BIBLIOGRAPHIC REFERENCES

1. Columbié Reyes JL, Piña Batista O, Salazar Cutiño B, Melian Savigñón C, Columbié Ortiz FJ. Requerimientos metodológicos generales para la implementación de estrategias encaminadas a la formación en valores de estudiantes de las ciencias médicas. MEDISAN [Internet]. 2016 [citado 29 Ene 2018];20(7):[aprox. 8 p.]. Disponible en: http://scielo.sld.cu/pdf/san/v20n7/san19207.pdf

2. Hurtado de Mendoza Amat J. Autopsia. Garantía de Calidad en Medicina. La Habana: Editorial Ciencias Médicas; 2009.

3. Lerma E. Guía/itinerario formativo tipo [Internet]. España: Universidad de Barcelona; 2016.

4. Vega Jiménez J, Hurtado de Mendoza Amat J, Vega Candelario R. ¿La correlación clínico-patológica es un indicador útil en las unidades de atención al grave? Rev Cubana de Med Intensiva y Emergencia [Internet]. 2017 [citado 29 Ene 2018];16(2):[aprox. 3 p.]. Disponible en: http://www.revmie.sld.cu/index.php/mie/article/view/225 /html_101

5. Martínez Navarro J. La reunión clínico-patológica: una actividad necesaria. Medisur [Internet]. 2017 [citado 29 Ene 2018];15(2):[aprox. 3 p.]. Disponible en: http://scielo.sld.cu/pdf/ms/v15n2/ms04215.pdf

6. Herrera Miranda GL, Horta Muñoz DM. La superación pedagógica y didáctica, necesidad impostergable para los profesores y tutores del proceso de especialización. EDUMECENTRO [Internet]. 2016 [citado 29 Ene 2018];8(2):[aprox. 13 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S2077-28742016000200003&lng=es&nrm=iso&tlng=es

7. Navarro Lores D, Samón Matos M. Redefinición de los conceptos método de enseñanza y método de aprendizaje. EduSol [Internet]. 2017 [citado 29 Ene 2018];17(60):[aprox. 6 p.]. Disponible en: http://www.redalyc.org/jatsRepo/4757/475753184013/475753184013.pdf

8. Ortiz-Díaz MI. Vías para el tratamiento metodológico a las habilidades teóricas. Rev Dom. Cien [Internet]. 2016 [citado 29 Ene 2018];2(Extra 3):[aprox. 11 p.]. Disponible en: https://dialnet.unirioja.es/descarga/articulo/5802934.pdf

9. Sixto Fuentes S, Márquez Marrero L. Tendencias teóricas en la conceptualización de las habilidades: Aplicación en la didáctica de la Oftalmología. Rev Ciencias Médicas de Pinar del Río [Internet]. 2017 [citado 29 Ene 2018];21(3):[aprox. 10 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1561-31942017000300020&lng=es

10. García Batista G. Compendio de Pedagogía. La Habana: Editorial Ciencias Médicas; 2002.

 

 

Submitted: February 23 2018.
Accepted: November 22 2018.

 

 

Ygnacio Ygualada Correa. Villa Clara University of Medical Sciences. Cuba. E-mail: ygualada@infomed.sld.cu

 

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