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Resumen: Introducción: La interacción de los profesores con los estudiantes, la supervisión de las prácticas clínicas y el profesionalismo son temas que explora el instrumento de evaluación del desempeño docente que recoge la opinión de los residentes sobre las competencias educativas de profesores titulares y adjuntos. Objetivo: 1) Recuperar los testimonios de los residentes sobre el modelo de rol y el compromiso de sus profesores con su aprendizaje; 2) reconocer las estrategias educativas empleadas por los docentes en contextos clínicos; 3) visibilizar las dificultades de contratación en la planta académica actual del PUEM que afectan el proceso educativo, y 4) reportar las menciones de maltrato y percepción de injusticia de los residentes por sus profesores. Material y método: Estudio cualitativo que consideró los comentarios a pregunta abierta de 1.628 residentes sobre el desempeño docente en las residencias médicas. Se clasificaron en 10 categorías con subcategorías y se cuantificaron las tendencias positiva y negativa. Posteriormente se analizaron los testimonios de acuerdo a los 3 temas del cuestionario. Resultados: Para los residentes, las categorías del profesor como modelo a seguir y el compromiso académico del docente obtuvieron el mayor número de opiniones positivas, mientras que la contratación del profesor y las estrategias educativas empleadas por este último reportaron el mayor número de comentarios negativos. Discusión: Los comentarios libres que plasmaron los residentes sobre el desempeño docente reflejan las fortalezas y debilidades del proceso educativo en contextos hospitalarios, lo que permite un acercamiento cualitativo a la relación con sus profesores. Abstract: Introduction: Teacher and student interaction, the monitoring of clinical practices, and professionalism are the issues that the teaching performance assessment tool examines by gathering the opinions of the residents on the educational skills of teaching staff and lecturers. Objective: The aim of this study was to: (i) gathering the comments of the residents about the role model and commitment of tutors to their training; (ii) to determine the educational strategies used by teachers in clinical settings; (iii) to show the current recruitment difficulties of the Medical Specialisations Plan (PUEM) affect the educational process, and (iv) to report the residents mentions of abuse and perceived unfairness by their teachers. Material and method: Qualitative study that considered the written comments by 1,628 residents in an open question regarding teaching performance in medical residencies. They were classified into 10 categories with sub-categories and the positive and negative trends were quantified. The comments were analysed according to the 3 topics of the questionnaire. Results: For residents, the categories of the educator as role model and academic commitment of the teacher obtained the largest number of positive reviews, while hiring of teachers and educational strategies employed by the latter reported the highest number of negative comments. Discussion: The free comments expressed by the residents on the teaching performance reflect the strengths and weaknesses of the teaching process in hospital contexts, which provides a qualitative approach to the relationship with their teachers. Palabras clave: Evaluación docente, Residentes, Profesores, Enfoque cualitativo, Satisfacción de los estudiantes, Keywords: Faculty evaluation, Resident, Teacher, Qualitative approach, Student satisfaction

ResumenIntroducciónLa relación entre las escuelas de medicina que dependen de las universidades y las sedes donde los estudiantes de pregrado realizan sus prácticas clínicas vinculan a las instituciones educativas con los centros de atención a la salud que forman parte del Sistema Nacional de Salud.ObjetivoSe analizaron las relaciones y las tensiones en las relaciones de los sujetos posicionados de la educación clínica a partir de las transformaciones introducidas por el Plan de Estudios 2010 de la Facultad de Medicina de la Universidad Nacional Autónoma de México.MétodoEstudio cualitativo interpretativo cuya muestra recuperó la experiencia narrada por estudiantes y profesores relativa a la gestión académica y la relación interinstitucional entre la Facultad de Medicina de la Universidad Nacional Autónoma de México y las sedes clínicas. Se realizaron 39 grupos focales donde participaron 321 personas (180 estudiantes y 141 profesores) entre octubre de 2013 y marzo de 2014.ResultadosSe identificaron 3 temas relevantes relativos a la gestión académica presentes en las relaciones interinstitucionales: 1) la implementación del Plan 2010, estructurado en cursos intensivos por especialidad; 2) los nuevos criterios para la contratación del personal académico y la redistribución de horas laborales de los profesores por asignaturas en la clínica, y 3) cambios en las relaciones de poder entre los sujetos pedagógicos.ConclusionesLa implementación del Plan 2010, estructurado en cursos intensivos por especialidad, los nuevos criterios para la contratación del personal académico y la redistribución de horas laborales de los profesores por asignatura en la clínica alteraron la dinámica de las relaciones entre los sujetos pedagógicos, así como la distribución del poder en las mismas.AbstractIntroductionThe relation between the schools of medicine that depend on the universities and the hospitals where undergraduate students carry out their clinical practice link educational institutions with the healthcare centers that are part of the National System of Health.ObjectiveAnalyze the joints and tensions in relations between the clinical education positioned subjects following the changes introduced by the Curriculum 2010 of the Faculty of Medicine at the Universidad Nacional Autonoma de Mexico.MethodInterpretive qualitative study where the sample recovers the experience narrated by students and teachers relative to the academic management and the interinstitutional relation between the Faculty of Medicine at the Universidad Nacional Autonoma de Mexico and the hospitals. Thirty-nine focus groups participated with 321 people (180 students and 141 teachers) between October 2013 and March 2014.ResultsThree relevant issues present in academic management interinstitutional relations were identified: 1) implementation of the Curriculum 2010, structured in intensive courses by specialty; 2) new criteria for the recruitment of academic staff and the recount of working hours of teachers per subject in the clinic; and 3) changes in the power relations between the pedagogical subject.ConclusionsThe implementation of the Curriculum 2010 structured in intensive courses by specialty, the new criteria for the hiring of the teaching staff and the redistribution of working hours of the teachers per subject in the clinic altered the dynamics of the relations between the pedagogic subjects, as well as their distribution of power.

ResumenLa Facultad de Medicina de la UNAM inició en 2010 la implementación de un nuevo plan de estudios cuya característica básica fue la de incorporar en las asignaturas el modelo pedagógico de las competencias. El denominado Plan 2010, está centrado en el estudiante y pone énfasis en el autoaprendizaje, lo que de facto transforma los roles que desempeñan los profesores en el proceso educativo. La escasa orientación y capacitación a los docentes provocó tensiones en el interior de los departamentos encargados del diseño curricular de las asignaturas y de coordinar a los alumnos y profesores. Este trabajo analiza, a partir de las siete estrategias de formación docente de Jolly, las variadas respuestas de los sujetos docentes ante los cambios educativos y los desafíos que enfrentan los profesores en los ciclos básicos (dos primeros años de la licenciatura). También aborda las representaciones y las prácticas que desarrollan los docentes en las interacciones cotidianas en el contexto de la reestructuración del campo de la educación médica. En la discusión se contrastan las propuestas de Jolly con el proceso de transformación docente en la Facultad de Medicina.AbstractIn 2010, the Faculty of Medicine of the UNAM began implementing a new curriculum that has as its basic feature the incorporation of the teaching model of skills by subjects. The so-called 2010 Plan is student-focused and places emphasis on self-learning, which de-facto transforms the roles that teachers play in the educational process. The lack of guidance and training of teachers caused tensions within the departments, who are in charge of the curriculum design of the subjects and coordinate student and teacher activities. This work analyses, using the seven teaching training strategies of Jolly, the varied responses of teaching subjects to educational changes and the challenges teachers are facing at the basic levels (first two years of the undergraduate medical course). It also discusses the representations and practices that teachers develop in daily interactions in the context of the restructuring of the medical education field. In the discussion, the proposals of Jolly are contrasted with the process of educational transformation in the UNAM's Faculty of Medicine.

Background Medical uncertainty is inherently related to the practice of the physician and generally affects his or her patient care, job satisfaction, continuing education, as well as the overall goals of the health care system. In this paper, some new types of uncertainty, which extend existing typologies, are identified and the contexts and strategies to deal with them are studied. Methods We carried out a mixed-methods study, consisting of a qualitative and a quantitative phase. For the qualitative study, 128 residents reported critical incidents in their clinical practice and described how they coped with the uncertainty in the situation. Each critical incident was analyzed and the most salient situations, 45 in total, were retained. In the quantitative phase, a distinct group of 120 medical residents indicated for each of these situations whether they have been involved in the described situations and, if so, which coping strategy they applied. The analysis examines the relation between characteristics of the situation and the coping strategies. Results From the qualitative study, a new typology of uncertainty was derived which distinguishes between technical, conceptual, communicational, systemic, and ethical uncertainty. The quantitative analysis showed that, independently of the type of uncertainty, critical incidents are most frequently resolved by consulting senior physicians (49 % overall), which underscores the importance of the hierarchical relationships in the hospital. The insights gained by this study are combined into an integrative model of uncertainty in medical residencies, which combines the type and perceived level of uncertainty, the strategies employed to deal with it, and context elements such as the actors present in the situation. The model considers the final resolution at each of three levels: the patient, the health system, and the physician’s personal level. Conclusions This study gives insight into how medical residents make decisions under different types of uncertainty, giving account of the context in which the interactions take place and of the strategies used to resolve the incidents. These insights may guide the development of organizational policies that reduce uncertainty and stress in residents during their clinical training. Electronic supplementary material The online version of this article (doi:10.1186/s12909-015-0459-2) contains supplementary material, which is available to authorized users.