Validación de un cuestionario de competencias en medicina basada en la evidencia en médicos de familia
- Autores: María del Carmen Sánchez López
- Directores de la Tesis: Enrique Aguinaga Ontoso (dir. tes.)
- Lectura: En la Universidad de Murcia ( España ) en 2015
- Idioma: español
- Tribunal Calificador de la Tesis: Francisco Guillén Grima (presid.), José Miguel Sáez Gómez (secret.), Francisco Jose Perez Bautista (voc.), Inés Aguinaga Ontoso (voc.), Isabel Maria Hidalgo Garcia (voc.)
- Materias:
- Enlaces
- Tesis en acceso abierto en: DIGITUM
- Resumen
- español
Objetivo: En nuestro entorno se carece de herramientas validadas que permitan la adecuada evaluación de competencias en Medicina Basada en la Evidencia (MBE). El objetivo de este trabajo es el diseño y validación de un instrumento, en español, de evaluación de competencias en MBE en Médicos de Familia (MF).
Sujetos y método: El estudio se realizó en tres fases: 1) identificación, selección y adaptación de un conjunto de ítems; 2) pilotaje de las primeras versiones del cuestionario; y 3) evaluación de las propiedades psicométricas (fiabilidad y validez) del instrumento tras su aplicación a la población diana (MF con práctica clínica en el Servicio Murciano de Salud).
Resultados: El instrumento final, tras los trabajos de análisis y depuración de los ítems, quedó constituido por 31 ítems distribuidos en tres sub-escalas: actitud (14 ítems), conocimientos (8 ítems) y habilidades (9 ítems) hacia la MBE. Se utilizó una escala tipo Likert con 5 opciones de respuesta para la medición de los ítems. Los valores de fiabilidad obtenidos para cada una de las sub-escalas fueron: alfa de Cronbach 0,863, 0,845 y 0,880. Las distintas pruebas de validez que se llevaron a cabo aseguraron la relevancia y la representatividad de los resultados de la herramienta para el fin con que se pretendía utilizar. El análisis factorial, con rotación varimax, de la sub-escala de actitud halló 3 factores que explicaban el 49,477% de la varianza total; en el caso de las sub-escalas de conocimientos y habilidades, el análisis factorial reveló una estructura monofactorial que explicaba el 40,829% y el 45,223% de la varianza total.
Conclusiones: El trabajo realizado ha proporcionado una herramienta de evaluación de competencias en MBE que ha mostrado tener una excelente fiabilidad, y evidencias de validez que hacen prometedora su aplicación para los objetivos propuestos. Se trata, además, de una herramienta de diseño sencillo y amigable en la cual el formato de auto-complementación y de respuestas de opción múltiple, se estima facilitan su utilización.
- English
Abstract This study focuses on analyzing the intervention of psychologists from the Justice Administration in Child Custody assessments, focusing on the methodology used, the areas explored, and the criteria in decision-making as well as the structure and content of the reports submitted. These official reports will be evaluated in their compliance to the existing evaluation standards in the Spanish legal system and the "Guidelines for Good Practice" To do so, we proceeded to the study of 502 reports issued by psychologists from the public sector. This allowed us to compare the work of these professionals in different professional groups from different regions of Spain, and with affiliations to the Family Court or the Domestic Violence Court.
In the data collection process, information was gathered through the use of a template. This template included the research design within the category of retrospective comparative studies or ex post facto studies. Thereafter, the data was analyzed using the SPSS 22.0 statistic program, performing a descriptive analyzes and comparing the different groups of our sample.
The conclusions found that, overall, the reports written by psychologists working at the public sector follow the existing standards and guidelines created for these types of evaluations in Spain. These reports showed their compliance to the procedures that appear on the "Guidelines." However, small differences were found between our groups of participants.
This study shows that, in the initial phase of the Child Custody process, the majority of mothers requested sole custody to them. The proportion of fathers requesting sole custody was fifty percent while the other half requested shared custody.
The Child Custody assessments focus on highlighting the positive elements of the parents in contrast to their limitations. These assessments usually find an appropriate level of adaptation in the children. Different guidelines take place in the Child Custody process depending on the type of custody. In shared custody or sole custody to the mother, this guidance is based on finding the positive aspects. When the custody is oriented toward the father, these guidelines focus on stating the limitations of the other parent.
The evaluation of both parents in the sample of psychologists working at the Domestic Violence settings presented worse results, which were more evident in men participants.
The results of the variables studied regarding both parents and children showed better outcomes in the shared custody option. This option showed the inclusion of more positive aspects of both parents in comparison with negative aspects. It also showed better communication between the two adults and a lower level of conflict. Furthermore, the children showed a better level of adjustment, being less involved in their parents' conflict. Our findings also showed that more negative outcomes, for the previously mentioned variables, were shown in the option of starting custody. In these cases, the power of children was higher and the rejection to one of the parent was present.
When the custody is toward the mother, the criteria commonly used are the consistency of the history background and the environmental stability of the children. However, in custodies toward the father, a higher amount of criteria is used such as the availability of social support, positive attachment of the children. In comparison, the custodies toward the father are based on the negative aspects of the mother, being this the reason why the custody is offered to the father.
Finally, the key elements identified in the shared custody are the good bonding and positive attachment of children with both parents and the appropriate adjustment of both parents in all aspects and areas of functioning.
- English
ABSTRACT Objective: In our environment there is a lack of validated tools that allow adequate assessment of skills in Evidence Based Medicine (EBM). The aim of this work is the design and validation of an instrument (in Spanish) for competency assessment in EBM in Family Physicians (MF).
Subjects and method: The study was conducted in three phases: 1) identification, selection and adaptation of a set of items; 2) piloting of the first versions of the questionnaire; and 3) evaluation of the psychometric properties (reliability and validity) of the instrument after application to the target population (MF with clinical practice in the Murcia Health Service).
Result: The final instrument, through the work of analysis and debugging of the items, was composed of 31 items divided into three subscales: attitude (14 items), knowledge (8 items) and skills (9 items) to the EBM. A Likert scale with five response options for the measurement of the items was used. Reliability values obtained for each of the subscales were: Cronbach's alpha 0.863, 0.845 and 0.880. The various tests of validity were conducted ensured the relevance and representativeness of the results of the tool for the purpose for which it was intended use. The factor analysis with varimax rotation of the attitude subscale found three factors that explained 49.477% of the total variance; in the case of the sub-scales of knowledge and skills, the factor analysis revealed a single factor structure that explained 40.829% and 45.223% of the total variance.
Conclusions: This research has provided a tool for the evaluation of competence in EBM. The questionnaire has been shown to have excellent reliability and validity evidence that make promising application for the proposed objectives. It is also a tool with simple and user-friendly design in which the format of self-complementarily and multiple choice answers, it is estimated facilitate its use.
- español
