How to cite this article: Salas-Flores R, González-Pérez B. [Implementation of the academic day for undergraduate interns]. Rev Med Inst Mex Seguro Soc. 2016 May-Jun;54(3):386-90.
Received: March 31st 2015
Judged: September 10th 2015
Ricardo Salas-Flores,a Brian González-Pérezb
aCoordinación Clínica de Educación en Salud e Investigación, Hospital General Regional 6, Instituto Mexicano del Seguro Social, Ciudad Madero
bUnidad de Medicina Familiar 38, Instituto Mexicano del Seguro Social/Instituto de Ciencias y Estudios Superiores de Tamaulipas, A.C.,Tampico
Communication with: Brian González-Pérez
Background: Medical internship is an important period in the formation of a general (or medical) practitioner, in which the student becomes a member of the “health community” and also applies all the knowledge he or she has received during the university lectures. The present study aims to evaluate the impact of the implementation of the academic day programme designed for undergraduate medical interns within the Mexican second level healthcare Hospital General Regional No. 6 “Dr. Ignacio García Téllez”.
Methods: A comparative and also a prospective study were applied to a sample of 56 medical interns who participated in the academic day implementation. The impact of the scheme was assessed using the notes of the different exams at the beginning and end of the medical internship. The non-parametrical Wilcoxon test was used for the statistical analysis for comparison between the initial and final notes.
Results: A positive difference was observed in the notes of the modules of internal medicine, pediatrics, gynecology, emergency, general surgery, and family medicine applied at the beginning and end of the implementation of the academic day (p = 0.000).
Conclusions: Basic guidelines should be established for educational training from an active-participative perspective as the academic day scheme; these rules should significatively increase the medical intern learning process and, as a logical consequence would have a positive influence on healthcare quality.
Keywords: Undergraduate medical education; Program development
Internship is an academic cycle of the curriculum of medical schools and faculties that is a key step in the formation of the general practitioner. In this cycle, the student becomes a member of the health team. Through tutelary teaching targeted and programmed by trained personnel, interns obtain meaningful learning and experience in the study and treatment of the most common diseases in humans, according to the stage of life. Thus, interns integrate their own criteria, consolidate the basic knowledge acquired in previous years, and develop skills for future performance as health professionals.1,2 At Instituto Mexicano del Seguro Social (IMSS), together with medical schools and faculties, the intern applies operational undergraduate internship programs. The duration of the internship is one year and it takes place in different venues, for example, primary and secondary care units.3 Interns must make six rotations of two months each in the following services: Internal Medicine, Pediatrics, Gynecology and Obstetrics, Emergency Medicine, General Surgery, and Outpatient Family Medicine. The venues must have the minimum infrastructure of 30 hospital beds, as well as a clinical analysis laboratory, radiology services, and a pathology laboratory. They should also have classrooms, an auditorium, a library, rest areas with bathroom, and audiovisual equipment.4
The practices that derive from the educational program for undergraduate medical interns (UMI), which is applied at IMSS Hospital Regional General No. 6, are generally routine, are performed dissociated from the theory and with little or no guidance from the tutors; these practices occur in environments poorly equipped for learning and reflection. Much of the UMI’s learning takes place individually and they also have to participate in integration seminars, clinical sessions, and other hospital academic activities; however, there is no compliance with this due to excessive workload at the hospital. This implies that interns often work alone and unsupervised, which means that they come to be considered auxiliary personnel and not in training. This situation leads to demerit in the development of educational activities for interns.5 The aim of this study was to evaluate the impact of the implementation of the academic day in undergraduate medical interns at the IMSS secondary care Hospital General Regional No. 6 "Dr. Ignacio Garcia Tellez".
A comparative and prospective study was done in a generation (year 2012) of 56 undergraduate medical interns who participated in the implementation of the academic day. It included the interns of that generation who signed informed consent and were available on the days that the initial and final exams were applied; interns who did not meet at least 80% of the total classroom hours were excluded. The academic day consisted of the implementation of seminar themes, clinical and bibliographic sessions, and clinical case methods, as well as the opportunity to develop clinical skills and abilities (with the use of material learning resources), and interns’ attitudes and interpersonal relationships with teaching leaders and coordinators of the rotation and internship cycle; finally, the final assessment was made. Its implementation took six hours in the hospital auditorium, one day per week throughout the internship year. The impact of the academic day was determined by the grade obtained in the examination of the different modules applied at the beginning and end of the undergraduate internship. Other variables were the type of school of origin, the academic average obtained in undergraduate medicine, the final grade of the intern, and participation during the teaching of subjects. For analysis of the results, measures of central tendency and dispersion were used. In addition, to assess the impact of the academic day Wilcoxon’s test was used for intragroup comparison of the results from the initial and the final exam. The database and analysis were done using the program SPSS for Windows (version 19; SPSS Inc, Chicago IL, USA). The project was evaluated and approved by the IMSS Local Committee on Health Research 2801.
The average age of undergraduate medical interns was 22.7 + 1 years. Distribution by sex was greater for women (n = 30%). All interns were single, and none worked and did their internship at the same time. Most came from public schools (n = 36%). The average academic average was 83.6 ± 4.6 (Table I). As for the averages of the scores obtained from different modules in the test applied at the beginning and end of the implementation of the academic day, a positive difference was observed in all modules at the end of this day (p = 0.000) (Table II). The participation of interns during the teaching of subjects was 92.9% (Table III). As for interns’ opinions about whom they most frequently consulted about the subjects taught in the academic day, 57.2% said the staff doctors, 32.1% said it was the department head, 7.1% said it was the clinical coordinator of Education and Research, and 3.6% stated that it was medical residents (Table IV).
|Table I General characteristics of undergraduate medical interns *|
|Age (in years)||22.5 ± 0.7||22.8 ± 1.3||22.7 ± 1|
|Undergraduate academic average||83.3 ± 3.7||83.9 ± 5.5||83.6 ± 4.6|
|* Continuous variables were expressed as mean ± SD and categorical variables as number (n) and percentage (%)|
|Table II Comparison at beginning and end of implementation of the academic day|
|Mean ± SD||Mean ± SD|
|Internal medicine||52.6 ± 13.4||73 ± 15.9||0.000|
|Pediatrics||53.7 ± 17.2||73.6 ± 12.9||0.000|
|Gynecology and obstetrics||56.8 ± 11.7||77.3 ± 20.6||0.000|
|Emergency medicine||54.4 ± 14.4||77.5 ± 11.2||0.000|
|General Surgery||55.6 ± 18||75.4 ± 12.3||0.000|
|Family medicine||51.2 ± 11.3||79.8 ± 11.9||0.000|
|* The Wilcoxon test was used for statistical significance|
|Table III Participation of medical interns in sessions|
|Table IV Most frequent advice on subjects of the academic day|
|Clinical coordinator of health education and research||4||7.1|
|Hospital staff doctors||32||57.2|
The undergraduate medical internship is an integral part of the curriculum of most medical schools and faculties in the country, and it is considered a compulsory period prior to social service that is essential for medical students to integrate and consolidate theoretical and practical knowledge acquired during school cycles before undergraduate.6
During this stage students are expected to be part of health services to develop new skills in the field of comprehensive care for the health problems of individual and society. They are also expected, with a strong ethical and humanist sense, to take on the physician’s responsibility in the diagnosis, treatment, prevention, and rehabilitation in major health problems of pediatrics, obstetrics and gynecology, internal medicine, general surgery, emergency medicine, and family or general medicine.6,7
In the hospital a single general classroom session is set every week in which subjects are presented by different specialties. This session has a short duration of one hour a day; in addition, each department gives bibliographical sessions once a week, but these are often suspended due to excess activity during the workday, and sometimes interns are forced to perform tasks not always related to their professional training, which is why we suggest the academic day, to intervene in the training of the interns.8
The implementation of the academic day showed a positive impact on undergraduate medical interns. This impact was seen by comparing scores from the initial and final exams on each service modules, and in the total of the generation of interns, which established that they managed to increase their knowledge of the different areas. The academic day was developed in the classroom as a stage for learning by using teaching techniques and teaching-learning strategies with the active participation of the undergraduate interns, which helps the construction of their own knowledge through the development of frames of reference, critical analysis, reflection, and reasoning of clinical cases taught in the classroom, so it is an important learning experience for the regulation of student learning.9
Among the features of the implementation of the academic day in undergraduate interns, the involvement of staff doctors in educational counseling on subjects stands out, which was very satisfactory, since this is the most experienced staff; in addition, almost all subjects in the academic day are consistent with the clinical practice of the hospital department where medical interns are rotating. Escamilla et al. suggest that the development of clinical competence can be hampered by inauspicious environments for participatory educational activities. This happens for different reasons, including the lack of teaching professionals.10 The teacher plays a major role in coordinating the learning activities, and the medical education office is responsible for full compliance with the academic program of the undergraduate intern to achieve educational goals. This underlines the importance of the person occupying this position having training in the area of teaching. Regarding human resources available in the hospital locations where undergraduate internship is done at IMSS, a medical director, a clinical coordinator of health education, and core staff interested in participating as a teachers must all be on staff. Would-be teachers should have teacher training.11,12 At IMSS, the Coordination of Health Education assumes the responsibility to train, shape, and develop health care staff.1 According to statistics from the Coordination of Health Education for 2010 in relation to teacher training and updating activities, 4178 courses were given in different modalities: monographs, workshops, in-service training, diplomas, and highly specialized courses (aimed at personnel in the health area).13 Regarding training activities for that year, 5227 undergraduate medical interns graduated from IMSS. This reflects the magnitude and significance of educational activities as well as the relevance of the teaching work.14 The year 2011 had a record 5103 teachers distributed in different primary and secondary health care units, as well as high specialty areas.
Overall, the results of the implementation of the academic day were satisfactory for the learning of the undergraduate medical interns. The contents in each session were adjusted according to the students’ demands and requirements. The sessions generally served as time of culmination of a particular learning exercise, whether it be expanding, deepening, or summarizing the achievements.
This study is important because of the problem of putting the fulfillment of hospital service activities and functions first and leaving the actual educational activities in the background, which strays from the educational purpose of the internship. Schemes should be established to do educational interventions from the active-participatory perspective, such as the academic day, to increase the development of meaningful learning that will impact the quality of patient care.
We appreciate the participation of Ricardo L. Barajas, Betzabé Gonzalez, and Alejandra Salas for their valuable support.
Conflict of interest statement: The authors have completed and submitted the form translated into Spanish for the declaration of potential conflicts of interest of the International Committee of Medical Journal Editors, and none were reported in relation to this article.