Sunday, June 29, 2008

How To Draw Real Fire

Future perspectives of anesthesiology programs in Colombia

INTRODUCTION
To inaugurate this blog I post the article I sent to the Colombian magazine anesthesiology and resuscitation can read in pdf.

The transition from a public health assistance to other social security policies as the new ministry of education and new educational paradigms require a rethinking of our programs to find the necessary balance to facilitate the training of an anesthesiologist that corresponds to a modern country. In addition, modern society is characterized by changes fast, because the conditions of operation change before acting forms are consolidated into habits and a certain routine, ie the conditions of action and strategies designed to respond to them quickly grow old and are obsolete before officers have the option even know properly.
However, despite this, the programs remain frozen and are guided by their attachments and commitments. The programs and their natural leaders are beset by the problem of identity where the model does not fit the realities of the sector. His laziness is actually chosen, it is by nature, because we know that is easy and natural for the mind is likely to change during the first years of life but this change becomes more difficult as the years go by because we develop some points of view and opinions very strong and resistant to change.
In most programs, this resistance is manifested by a disconnect between the rhetoric bound by the standards defined by the standard and practice of the programs. That is, the information in the documents corresponds to a large extent to the new requirements but these are faithfully imitated without an epistemological reflection, to deliver information to the MEN and avoid destabilizing pressures, while maintaining an excessive attachment to past and practical world of things are running well. Figure 1 shows the possible dissociation between what is reported to the ministry and what is found in the evaluations with respect to the required quality standards.
Others try to rely on the model, but it fit extrapolating past experience, as its ideational content is well established and these transformations are not subject to debate and discussion in academic communities and with external peers.
This report aims to present some relevant problem situations identified by the author as evaluator and describes two points of view that can make the foreseeable future or to be addressed critically and with construction collective because education is too important to leave solely in the hands of the teacher, the student, the higher council of a university, the ministry of education, neuro-scientific community or any other person or group. Ultimately, decisions about education are decisions about goals and values, and these decisions relate to the whole community.

Figure 1. Octagon quality: differences between what is reported and what is in the evaluations. The chart shows eight quality standards relevant to the program required by Decree 1665 of 2002 of the Ministry of National Education. In the polygon "A" represents the area where they meet 100% of the requirements in the business park "B" the percentage of compliance is reported and in the polygon "C" findings from the assessments. This graph is a quantitative approach to the qualitative evaluation is performed.
What have been the dominant curriculum guidelines in the program?
in the past and even today, many programs focus on curriculum reform criteria or concepts that are not well part of a whole and must not ignore, are addressed as a single model or strategy for reform.
The dominant model for curriculum guidelines anesthesiology programs in the country is one that illustrates the structure of the curriculum only as a curriculum.
This criterion requires only to remove or include rotations, or simply time to change their intensities, the sequence of these and their contents. This model is based on new scientific developments, new anesthetic techniques or dominant positions of academic leaders.
In this scenario, students enter and exit the maze and must take all rotations with the same objectives and strategies methodology. Likewise, the academic community meetings focused on choices relating to the content and its duration without a vision of the ways of learning, appropriate teaching strategies and the results expected under the desired profile of future professionals and individuality of students.
Within this concept, we define criteria to manage the time for career development, practice hours, space and the distribution of teachers. It is assumed that the achievement of competencies depends on the proportion that the student is exposed to the case problem and develop cognitive skills. In essence, the medical communities assumes that "the greater the exposure to the case problem is more likely to approach the appropriate level of competence required for professional practice." Therefore, medical communities have established that exposure to these practices for a specified time (measured in weeks rotations) or making and / or resolution of a number of cases in a hospital where there is high demand for services increases highly likely to achieve the expected results for the proper professional performance. These criteria are set according to the experience of experts in education, as pressures of scientific societies or limited cases, for studies reported in the literature. How
knowledge are greater every day, and teachers develop their desires or training in specialized subfields, each teacher tries to teach the maximum amount of content too limited in time and end up promoting the acquisition of knowledge so extensive, not intensive without penetrating the proper objects of specialization until the domain expert from the foundations, principles, theories, insights and explanatory frameworks particular professional field, disciplinary, interdisciplinary and transdisciplinary that are relevant to proper training.
This pressure always results in an extension of time training or sometimes a new specialty that emerged from our field of expertise.
The conception of curriculum and curriculum corresponds to the characterization of professional fields: Professions are characterized by having a clearly defined area of \u200b\u200bexpertise, highly developed, specialized and theoretical full-time to a specialized field of work, control formation processes and whose center is the vocation of service and not with the academic vocation. In this context, the justification of the training should be directed to the specialist, as an expert who will be in a particular area of \u200b\u200bcompetence, must be controlled in their manner of exercise, by their teachers, who have the knowledge and know the code of ethics governing the profession of base.
The conception of curriculum and curriculum reflects the prevailing stigma of program development. Education is based more on doing or care, the quality requirements of the programs in the past were down more scientific society which brings the profession and not by the government, training is based mostly accompanied teachers with dedication to service-minded and very few teachers without teacher education and wage more emotional than financial.
addition, the large percentage of the training is left to random, where the unhappy student is inevitably forced to dip into their own resources to collect at random and by chance, here or there, disorganized fragments of knowledge as well as fragments of methods not validated by scientific research. And when the student became a professional, and did not possess the necessary education and training, walking awkwardly in the darkness, following roads closed and expensive and sometimes making use of continuing education or peer support trained with the same scheme.
These stigmas down unsolvable paradoxes and contradictions between those who prefer learning in breadth and not depth, accumulation and construction of knowledge between the uniform teaching and learning according to individual conditions of students, including education that ignores or merge the disciplines and an education that emphasizes mastery of them, between education that minimizes or critical evaluation of programs and one that is based on it, including an education based on the teacher and an education based on the learner, including levels of demand relative and nuanced and high standards and universal. Figure 2 shows the different levels of demand.

Figure 2. Models of support and advice on postgraduate training. The ideal quadrant is three, which brings a lot of help and advice to students and will have a high level of demand. Many programs work with the outline of quadrant two.


The model based on "Curriculum" evidence too narrow a view on curriculum development and is far-away of the great mission assigned by society to higher education: "Education for the higher in the top."
In short, you can say that current practices are not working properly because world conditions have changed in a substantial and education is still basically a preparation for the world of the past rather to be a preparation for tomorrow's world. What
environment requires us? What are the current trends?, Who do we respond?
anesthesiology programs must meet the requirements that make the society, the state, the institutions providing health services and family among others.
society requires its integrity programs that train professionals to solve the health problems of relevance, ie, with security and opportunity and that their practices go beyond the use of knowledge to this generation.
With regard to the comprehensiveness of training, the training processes programs can not be depleted in the focal accumulation of knowledge and technical skills development in the specific area of \u200b\u200banesthesia. While the development of cognitive and psychomotor skills are very important, given the nature of these programs are required of other socio-emotional competence and ethics, and a complexity of the concept of cognitive competence that exceeds the level of education and training . It takes a curriculum more formative than informative, so as to overcome the proposed professionalizing the proposed curriculum and provide a learning proposal that gets the students not only master the art in question, but have the possibility to grow as a person in all its dimensions. With respect to this type of training Gardner writes: "Education for every human being should explore in some depth a set of fundamental human achievements that include the true, beautiful and good. We need an education that is deeply rooted in two considerations or two anchors: what is known about the human condition and timeless aspects of what is known about the pressures, challenges and opportunities of the contemporary scene (and come). In this sense, he adds, the two main goals of education over time and space are the adult role modeling and transmission of cultural values. "
With regard to research and knowledge generation should be based on the intentions of training in a specialist to determine whether anesthesiology programs should involve and conduct research as defined in the master's and doctoral programs.
The organization of postgraduate studies takes about two axes that define, in the first instance the intention of each of the levels of training, both majors, master's and doctoral degrees. Those areas are: on the one hand, the professional or "calling service" and secondly, the production and circulation of knowledge or academic vocation. " In Strictly speaking, any program should have clear relationships with some of these two poles: the professional majors, with the first, and masters and doctorates, with the second, since the generation of knowledge is more typical of the disciplines that of the professions.
disciplines involving a body of knowledge with defined borders, a specific language, some theories and techniques of their own, and the preferred to build the research and development, while occupations are the re-contextualization of the major disciplines units that operate both in the intellectual field of disciplines and in the field of practices or exercise. A profession is made up of several disciplines that contribute to the concepts, methods, procedures, epistemology and terms to the organization and formation of a field of practice. Professions emphasize the provision of services through professional practice, developing a social service vocation, and its deepening occurs through specialized courses, which explores the basics of practices and applications are validated knowledge generated in the disciplines.
In this sense, specialized programs should not have high requirements regarding the generation knowledge in their training and master's or doctoral programs should not consider fields of work or vocation of service.
But the distinction between the professions, such as practice fields and disciplines as fields of knowledge are becoming increasingly complex. Languages, theories and methods of the professions are used as instances of validation of the disciplines, in turn, languages, theories and methods of the disciplines are applied to re-signify the professional practices. The boundaries between one or the other are becoming increasingly blurred. For example, the starting point of scientific research discipline is not always theory, in some cases, it has its origin in the staging of knowledge in occupational settings. Similarly, many problems that give rise to processes of applied research in occupational settings are based on theoretical approaches developed in disciplines.
Furthermore, although the first instance suggested disciplines engaged in fields of knowledge are also working fields or practice fields, within which research is one of them, that constitutes the most important, as directed the very development of the disciplines, inextricably linked with knowledge.
practical scenarios of disciplines and professions also begin to have fuzzy boundaries. Workers favor research disciplines as its scope, but shift to vocational training courses or social service professions turn privilege scenarios own professional practice, but there is clear movement toward disciplinary practices such as proper participation in academic communities to develop research.
In particular, the concept of profession has been historically and socially constructed, in a complex manner. This concept has been linked to the base of professional work, the development of science and technology, ie the professions as medicine and anesthesia, seen as practical knowledge, also must be able to explain the why and the how of events and audit of them, the scientific basis of its fundamentals.
Therefore, today emphasized the need theory of professions, formed from processes of research and specialized nature. Therefore, the professions can be defined as "that set of specific activities based on scientific and technical knowledge are applied to solving social problems."
This complexity of occupational context for the development of scientific knowledge and technology professions demand the specialization of knowledge that, while having a common in the professions, are creating the new fields of knowledge and practice more restrictive and requires therefore anesthesia programs in some fields of activity more restricted than the profession that gave birth (medicine).
Therefore, anesthesiologists should be trained highly qualified to apply the conceptual and methodological, as profound and relevant to their profession, prior training, to solve specific problems in context of performance. This is accomplished through research, systematization, innovation and diffusion of knowledge to configure a defined field of knowledge, problems and methods to solve them.
These signals require to implement research in postgraduate anesthesia. Research in the majors should be aimed at the appropriation of knowledge methods for the solution of social problems related to the staging during practice. This involves recognizing that "to return a specific academic problem requires a social need translation process: translation of the language of academia to the interests and needs, translation of social interests interests academic knowledge translation techniques and procedures, translation of theoretical significance in social meanings.
In this context, students enter the program, first, to perfect and deepen professional competencies and, second, to develop other skills related to the nature of knowledge that address.
For this scenario possible, teachers need specializations are conceptual domain experts and professional training area, that is, they are trained in the vocation of service, plus they are experts in research and pedagogy, ie they are formed for the academic vocation. It also requires that the programs are backed by research groups and lines of research to ensure the conceptual discussion and the location of the developments in the global knowledge regarding building academic tradition. Defined
and things, the group of teachers and the existence of research groups and lines are the support of student interaction, which may be related to applied research in various ways, participating in some stage of an ongoing project led by teachers, making a sub-project within the framework of larger projects, developing a project on its own context of performance, among others.
Hence, to achieve the above requirements is necessary that the program has a group of teachers of mixed nature to support the academic processes. These are groups formed by teachers from plant research institution with tradition and teaching pedagogy and guests, ad honors or by agreements that can provide skilled experience built from the practice, according to program requirements.
This ensures that the teaching should be organized not only in teaching, but research activity, therefore, is targeting academics and channeling efforts and utilization of financial resources. It also allows the program set in the future various training routes in the area of \u200b\u200bexpertise, according to the wishes of the student. These routes are shown in Figure 3.

Figure 3. Possible routes of formation of a student of anesthesia. These paths arise only if the institution which offers the program, including joint research training. Route one is when the student chooses to be anesthesiologist Overall, the track two is when you choose a second specialty of anesthesia, the route three and four is when you choose for the future have a vocation of service and academic vocation.
The state currently enforces quality standards in response to new educational paradigms extracted academia. These standards are: academic name of the program, reasons for the program, curriculum foundations, academic activities, strengthening research, social screening, selection and evaluation of students, student assessment, teaching resources, infrastructure, media and educational aids, practice scenarios, academic and administrative structure, self, graduates, university welfare, advertising specialty programs medical and surgical.
In our country there are tensions over the coordination of standards between academic communities and the state. That is, as Burton Clark raises the question exists in the education-economy-society. From this analysis model recognizes three types of agents: The coordination of the higher education system, with the recognition of agents among which are academic, government bureaucracy and the market, leading to three ideal types of coordination. The author designed a triangular pattern where each vertex is the predominance of one form of coordination and a low component of the other two. At the present time, and from this perspective higher education in our country is governed from the state bureaucracy, the market and less academic. This model also
place where academics intermediate situations, the market and the state play an important role.
For example, the academic community of anesthesiology has influenced the coordination of programs because it has a strong core of power endowed with resources, which Clark called "academic oligarchy." This model has sometimes been fragmented, sometimes by an expert or corporate authority, guided by knowledge or interest positional players.
Current trends require that programs are structured according to the quality standards imposed by the standard, but conceived from critical positions, and new conceptual models requires a deconstruction of the already experienced a rebirth and new beginnings that meet current demands .
This scenario is only possible if there are partnerships to ensure quality through teacher exchange (each academic vocation, other service-oriented) system of referencing and conceptual encounters between various programs. In this context, programs should humanize the training to use active teaching methods, a balance to promote comprehensive education and include research in communities that offer the programs.


Figure 4. Dos ASA and continuing the cycle of training and professional development cycle. The graphic shows the works of the society from the scientific conception union.

Finally, the remaining tasks that have the Colombian Society of Anesthesiology and Reanimation to intervene in this process are: Make a consensus to define the common profile of the anesthesiologist for the country, continue to support education seminars as opportunities for reflection and preparedness for change, engage in the analysis of union respects the employment status of educators and anesthesiologists make alliances with the state to promote the functioning of the observatory of human resources in health.
The ASA, as leader of the academic community should act as adviser to the actor training cycle and as a major player in the cycle of professional performance of anesthesiologists as shown in Figure 4.
Recommended Reading.

1. Alvarado, Sara Victoria. Quality Series No. 5 Higher Education: Specialization-Diagnosis, conceptualization and policy guidelines. Icfes. Ministry of Education. P. 78. 2002.
2. Clark, Burton, The Higher Education System. Academic Organization in Cross-National Perspective, University of California Press, 1983, ch. 5.
3. Ospina, Julio Enrique. Curricular perspectives of medical education for the XXI century. Ascofame. Bogotá DC 1995.
4. Gardner, Howard. Flexible minds: the art and science of knowing how to change our view and that of others. Paidós Ed. Barcelona 2004.
5. Gardner, Howard. Mind education and knowledge of the disciplines. Paidós Ed. Barcelona 2000.
6. Bauman, Zygmunt. Liquid Life. Paidós Ed. Barcelona 2005.
7. Ministry of Social Protection. University of Antioquia. Supply and demand of human resources in health in Colombia. Scripto Ed ltda. Pars Library. Bogotá 2007.




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