Browsing by Author "Zuniga, Denisse"

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    CEACLIN, an instrument suited to identify medical students' strategies to learn in pre-clerkship years
    (SOC MEDICA SANTIAGO, 2015) Bitran, Marcela; Padilla, Oslando; Zuniga, Denisse; Leiva, Isabel; Calderon, Maribel; Riquelme, Arnoldo
    Background: Upon the beginning of pre-clerkship years, medical students must develop strategies to learn from experience and to improve their relational skills to communicate with patients. Aim: To develop an instrument to identify the strategies used by medical students to learn in clinical contexts. Material and Methods: Using a Delfi technique to reach consensus, a national panel of students and clinical teachers from 15 Chilean medical schools analyzed an 80-item questionnaire built from perceptions of Chilean students and teachers from one medical school. After two Delfi rounds and a pilot application, a 48-item questionnaire was obtained. Its reliability and construct validity were assessed by Cronbach alpha coefficient and factor analysis, respectively, on the base of an application to 336 medical students. Results: The questionnaire developed, named CEACLIN, is highly reliable (alpha = 0.84). Its inner structure is made of eleven factors: Autonomy, Solving doubts and problems, Searching and organizing information, Proactivity, Reaching to others, Paying attention and emotions, Searching for trust, Evading burden, Coping with burden, Motivation and Postponing the personal life. All together, these factors account for 47.4 % of the variance. Conclusions: CEACLIN is a valid, reliable and easy to use instrument suited to identify students' strategies to learn in pre-clerkship years. Many of its items allude to concepts of theories of experiential learning and motivation. We hope that CEACLIN will be of value to medical students and clinical teachers to improve the learning and teaching of clinical reasoning and communication skills.
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    Dispositional Mindfulness Reduces Burnout and Promotes Flourishing in Medical Students: a Two-Wave Latent Change Score Model
    (2022) Zuniga, Denisse; Torres-Sahli, Manuel; Rigotti, Attilio; Pedrals, Nuria; Echeverria, Guadalupe; Padilla, Oslando; Lagos, Alejandra; McColl, Peter; Trucco, Olivia; Cisternas, Marcela; Gonzalez, Carolina; Bogado, Justo; Moraga, Ana Maria; Altamirano, Patricio; Duran, Esperanza; Mansilla, Marcela; Berrios, Carolina; Epstein, Ronald; Bitran, Marcela
    Objectives Many studies document the high prevalence of burnout among medical students. This syndrome may lead to depression, suicidal ideation, and increased academic dropout. However, there is a scarcity of evidence-based interventions to prevent it. The aim of this longitudinal study was to identify factors that may reduce students' burnout and foster their well-being, and upon which effective interventions can be developed. Methods A total of 1,117 medical students from eight Chilean universities were asked to complete a set of validated scales in 2015 and 2 years later, in 2017. The measures included distress, burnout, positive mental health, academic engagement, and dispositional mindfulness. Using logistic regressions and a two-wave latent change score model, the predictive power of these variables on burnout and flourishing (an optimal state of mental health) was studied, as well as their covariance across time. Results In total, 639 (57.2%) students answered the questionnaires in T1 and T2; 54.4% reported burnout in T1 and 56.2% in T2. Levels of dispositional mindfulness (the ability to pay attention to one's sensations, thoughts, and emotions in everyday life) predicted lower probabilities of burning out at 2 years, whereas having experienced burnout in T1 doubled these odds. Dispositional mindfulness, academic engagement, and flourishing at T1 predicted greater odds of flourishing 2 years later, while depression decreased these odds. Conclusions Dispositional mindfulness was the most powerful predictive factor of students' burnout and flourishing. As dispositional mindfulness can be nurtured through practice, incorporating mindfulness training into undergraduate medical programs may help reduce burnout and promote students' well-being as health professionals.
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    Disruptive behavior in the operating room: Systemic over individual determinants
    (ELSEVIER SCI LTD, 2022) Campos, Mauricio; Lira, Maria Jesus; Mery, Pamela; Calderon, Maribel; Sepulveda, Macarena; Pimentel, Fernando; Zuniga, Denisse
    Background: The operating room (OR) environment presents specific conditions that put stress on work dynamics. Disruptive behavior among members of the health team is recognized to affect work dynamics and patient outcomes. As surgeons have been syndicated as frequent disruptors, the objective was to explore their perceptions about OR working dynamics and the occurrence of disruptive behavior. Study design: Qualitative exploratory study, based on semi-structured individual interviews. Twenty participants were sampled until data saturation. For better context, we also included in the sample anesthesiologists, nurses, and technicians, among others. Using grounded theory framework, investigators extracted data from verbatim transcriptions with qualitative software. Results: Problems of infrastructure, interpersonal relationships, and organizational failures had most density of citations and trigger the most disruptive behavior narrated events. Although personality traits were noted to promote some disruptive behavior occurrence, systemic determinants were critical, such as poorly defined working roles and a plethora of personal ways to cope or avoid disruptive behavior. Conclusion: Our results suggest that disruptive behavior events are not just a matter of a surgeon's personality traits but also substantiated by systemic normalization, informal communication strategies, and undefined roles, making teams less resilient to unexpected events.
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    Narrative and faculty development: results of a five years experience with a creative writing workshop
    (SOC MEDICA SANTIAGO, 2012) Rosa Walker, Maria; Zuniga, Denisse; Trivino, Ximena
    Background: Narrative medicine has showed to be a powerful instrument to reinforce relationships, identity, and self-knowledge among health professionals. Subjective issues have been recently recognized as relevant for faculty development in addition to the technical aspects. Since 2006 a creative writing workshop has been included as part of the Diploma in Medical Education at the medical school of the Pontificia Universidad Catolica de Chile. Aim: To describe the experience and results of the creative writing workshop (2006-2010). Material and Methods: Descriptive and retrospective study with a qualitative and quantitative design. Thirty-six teachers of the School of Medicine attended a 12-hour workshop. The Kirkpatrick model for evaluation of educational outcomes was used to report the data obtained in the course evaluation survey and in the stories produced. Results: There were positive results at the four levels of Kirkpatrick evaluation model. The learning objectives of the workshop were achieved and 83 stories were created, compiled and published. Conclusions: The creative writing workshop can provide faculty with protected time for reflective practice about academic experiences and produce educational outcomes at different levels of the Kirkpatrick model. (Rev Med Chile 2012; 140: 659-666).
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    Reduced burnout and higher mindfulness in medical students after a self-care program during the COVID-19 pandemic
    (2021) Zuniga, Denisse; Torres-Sahli, Manuel; Nitsche, Pia; Echeverria, Guadalupe; Pedrals, Nuria; Grassi, Bruno; Cisternas, Marcela; Rigotti, Attilio; Bitran, Marcela
    Background: Medical students experience high levels of psychological stress during clinical training. However, most medical curricula do not teach self-care skills. The COVID-19 pandemic has disrupted medical education causing increased distress among students. Aim: To report the implementation and impact of an eight-week multifaceted mindfulness-based self-care program on medical students' distress and well-being during the COVID-19 pandemic. Material and Methods: One hundred twenty-three fourth-year medical students attended the program as part of a mandatory course from April to May 2020, during the rising phase of COVID-19 in Chile. They were evaluated using validated tests before and immediately after the program. The measures included burnout, dispositional mindfulness, perceived stress, traumatic stress reactions, general well-being, resilience, and stress coping strategies. Results: Burnout prevalence decreased from 48% to 24%, whereas students with high dispositional mindfulness increased from 25% to 44%. Burnout reduction was mostly due to decreased emotional exhaustion. Additionally, students reported lower levels of stress, self-blaming, and traumatic stress reactions alongside an increased use of active coping strategies and resilience levels after the program. Conclusions: A formal educational intervention, teaching self-awareness and self-regulation skills can help reduce medical students' distress and promote their well-being even amidst a pandemic.