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Background: the stratification of patients is a very useful procedure in medical practice. Objective: To assess the implementation of an instrument for the stratification of patients with community-acquired pneumonia in the Emergency Department. Methods: A descriptive study was conducted at the General University Hospital of Cienfuegos. The instrument was applied to 394 (hospitalized or already discharged from the institution) with a diagnosis of community-acquired pneumonia between June 2009 and December 2010. As part of the assessment, indicators for process and results were used. Results: The instrument that has been developed is based on comprehensive clinical information and supported by complementary radiological information. It allows the classification of patients into six different stratifying layers. Of the 394 patients admitted because of pneumonia, more than 85% was stratified. The stratification was correct in 82% of them. There was a high rate of adherence to the suggested location on the instrument (99%). Adherence to antimicrobial therapy was of 73%. Patients with moderate pneumonia and a high probability of poor outcome (60%) predominated. The highest mortality was found in cases with severe pneumonia and little chance of recovery (74%). The overall mortality was 31%. Conclusions: Although susceptible of improvement, this tool is considered to be very useful for the decision making process when dealing with patients suffering from community-acquired pneumonia attended in the Emergency Department. It reduces hospitalization criteria variability and influences in-hospital patients’ location and antimicrobial therapy.

A task system for training the medical decision-making skill was applied to the educational process of the Internal Medicine course as part of a pilot study. In order to assess the degree of skill training, the degree of satisfaction of teachers and students and the feasibility of applying these tasks, several methods were used: participant observation, surveys, Iadov’s technique and pedagogical test. The triangulation of the results obtained by these methods allowed demonstrating the usefulness of the tasks system that had been developed, the feasibility of implementing such a system and the desirability of continuing its use in the educational process of Internal Medicine, extending it to other disciplines and subjects of the profession.

Un sistema de tareas docentes para la formación de la habilidad toma de decisiones médicas fue aplicado con carácter experimental en el proceso docente educativo de la asignatura Medicina Interna. En la valoración del grado de formación de la habilidad, el grado de satisfacción de profesores y estudiantes y la factibilidad de aplicación del sistema de tareas docentes fueron utilizados varios métodos: observación participante, encuestas, técnica de Iadov y prueba pedagógica. La triangulación de los resultados obtenidos por dichos métodos permitió poner en evidencia la utilidad del sistema de tareas docentes elaborado, la factibilidad para la aplicación de dicho sistema y la conveniencia de continuar su utilización en el proceso docente educativo de Medicina Interna, con extensión al resto de las disciplinas y asignaturas de la profesión.

This article allows professors of clinical courses in the Medicine career to incorporate a number of psycho-educational and didactic elements. Those elements are necessary for the comprehension and implementation of a teaching tasks system aimed at developing in students the essential skill of "medical decision making" that all medicine doctors should master. This article complements others that have already been published. In those articles arguments can be found as to the importance of this skill, as well as the previously mentioned teaching tasks system.

This article shows a theoretical model of the solution state or tretament of the medical attention process as a complementary phase of diganosis of the mentioned process.the development of this stage has been carried out according to the medical assistance conception as a taken decisions process and which is formed by the following elements, 1) Development of solution options, 2) Evaluation, selection, and application of options, 3) Evaluation of taken solutions. Diferences between behaviour options and therapeutic management are established, and the importance of using diverse factors to give individuality to the process is reinforced. Some limitations of this elaborated model is also shown.

Taking as a starting point the logic of the professional’s performance of the comprehensive general doctor and the relationship between medical decision taking and the abilities in the curricular design of the Medical Career it is possible to identify the essence of the main professional abilities in medical decision taking. The considerations that medical decision taking first deal with diagnostic actions related to the patient’s health problem and a later with actions to restore the patient’s health by solving their medical problem, make medical decision taking abilities as the core of the professional logic abilities that allows doctors to fulfill with their function of giving comprehensive medical assistance to their patients. References about medical decision taking as a professional ability and its main essence has not been found in the medical literature up to the present.

This article shows a theoretical model of the solution state or tretament of the medical attention process as a complementary phase of diganosis of the mentioned process.the development of this stage has been carried out according to the medical assistance conception as a taken decisions process and which is formed by the following elements, 1) Development of solution options, 2) Evaluation, selection, and application of options, 3) Evaluation of taken solutions. Diferences between behaviour options and therapeutic management are established, and the importance of using diverse factors to give individuality to the process is reinforced. Some limitations of this elaborated model is also shown.

The use of a systemic approach in the theoretical analysis of the clinical method has allowed the elaboration of an schematic and synthetic representation of the new model of clinical diagnostic- therapeutic method developed from the conception of the medical assistance as a taking decisions process. The identification of the main components of the clinical method system, as well as of the interrelations established among these, facilitate the understanding of the medical attention process, and also allows the establishment of some of the regularities whose knowledge by the student is of great importance for the learning and application of the method by our Medicine students.

This article deepens on other aspects related to decision making, describing the relationships that are established between the types of problems and of decisions, as well as the qualities to make decisions effectively : experience,judge and creativeness and the relative importance of these qualities Other elements that affect decision making are also analyzed such as style of decision making and level of moral development. Emphasis is made on the ethical dimension.

This article deals with methods and techniques for assessing and selecting opinions. Among the ones used by the doctors investigation and analysis are used by the doctors and as a most concrete technique the cost-benefit analysis as well as the so called the tree decision in which subjective probabilities are assessed as a qualitative category not as a quantitative one. These methods and techniques allow to elicit options in risky conditions that characterise the decision making process in the medical field.

This article is aimed at deepening on the consequences of the deficient development of abilities in decision making in the speciality of medicine, analysed from the prospective of the Comprehensive General Doctor . A psychological and professional characterisation of the Comprehensive General Doctors are developed from the analysis of their environment and on these bases the paper presents how these problems are reflected in the professional assistance. The conclusions are good to recognise how dangerous is to trust the development of this ability in the post-graduate stage so it seems to be wiser to work in its formation and development in the pre professional stage.

The use of a systemic approach in the theoretical analysis of the clinical method has allowed the elaboration of an schematic and synthetic representation of the new model of clinical diagnostic- therapeutic method developed from the conception of the medical assistance as a taking decisions process. The identification of the main components of the clinical method system, as well as of the interrelations established among these, facilitate the understanding of the medical attention process, and also allows the establishment of some of the regularities whose knowledge by the student is of great importance for the learning and application of the method by our Medicine students.

Decision Making Theory contributes many useful elements for General Comprehensive Doctors, associated with their function of integral attention, mainly related with treatment. In this article we present as core elements: the need for logic to make decisions, the usefulness of programmed and non-programmed decisions concepts and the importance of make individual decisions using determination factors.

This article has as objective to base the narrow relationship that settles down among the activity of taking of decisions and the doctor's basically curative assistance activity. In a general way, the exhibition of the elements is guided to the recognition of the taking of decisions, like an implicit feature in the way of the doctor's professional performance, in her/his curative assistance function, that which has important implications in the formation of the treatment ability.

The determination of the main elements that forms the decision taking process in medical assistance facilitates the comprehension of the process to be put in practice by the physician, as well as the evaluation of the professional performance. In this article the most outstanding characteristics of the medical decision taking are identified: the decisions transcendence, great influence of time factor; probabilistic character of Medicine as a science, ¨relative¨ predictability of pathologic phenomena, variability of medical knowledge, patient involving in decisions, and limited objectivity of problems and decisions. For being the auxiliary medical attention a decision taking process, this elements determine by far the medical professional performance.

The general theory about decision taking makes reference mainly to those concepts related to decision taking for the individual. The present article is aimed at group decision taking and at stating the principal advantages and disadvantages in group decision taking and at analyzing the implications of these aspects in medical decisions.