Browsing by Author "Cisternas, Marcela"

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    Curriculum reform at the Pontificia Universidad Catolica de Chile School of Medicine
    (SOC MEDICA SANTIAGO, 2016) Cisternas, Marcela; Rivera, Solange; Sirhan, Marisol; Thone, Natalie; Valdesa, Claudia; Pertuze, Julio; Puschel, Klaus
    The career of Medicine at the Pontificia Universidad Catolica de Chile was established from the beginning (1929), with a classical Flexner curriculum design. In seven years, the career is divided in three cycles: basic sciences, clinics and internship. It obtained Chilean accreditation and fulfilled American Association of Medical Colleges accreditation requirements. Changes in the Chilean epidemiological profile and health system, and new teaching methods in medicine, stimulated a process of deep curricular analysis, identifying strengths and weaknesses of the medical career. The curricular strengths were well-developed scientific and clinical components, fully committed students and faculties, well defined learning objectives and excellent clinical campuses. Curricular weaknesses included a poor vertical and horizontal integration, few student centered methodologies and a weak emphasis concerning doctor's professionalism. Subsequently, the whole community of teachers, students and medical educators worked on the design of a new curriculum, establishing a new graduate profile and designed it oriented by learning objectives, of six years of duration, with an optimized course sequence that melds basic science and clinical concepts, with strong emphasis on humanities and professionalism. It prioritizes an early contact with patients from the first year and expands teaching methods. The main objective of this process was to achieve a new curriculum with an integrative structure. This was implemented in 2015 with an approved protocol to evaluate the outcomes.
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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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    Erdheim-Chester disease. Report of one case
    (SOC MEDICA SANTIAGO, 2011) Vega, Jorge; Cisternas, Marcela; Bergoeing, Michel; Espinosa, Roberto; Zapico, Alvaro; Chadid, Pedro; Santamarina, Mario
    We report a 76-year-old male who was admitted due to progressive congestive heart failure lasting several months. An echocardiogram showed a large pericardial effusion with early signs of pericardial tamponade and an irregular surface suggestive of cancer infiltration. The patient was operated, creating a pericardial window and draining 1,200 ml of a brownish yellow fluid with abundant cellularity. Pericardial biopsy showed infiltration by CD68 (+), CD1a (-) and S100 (-) cells. Twenty-eight months earlier, due to fatigue, dyspnea, and a non-specific inflammatory process, an enhanced-contrast-scan showed that aorta was coated with a hypodense tissue that began near the aortic valve and extended until the inferior mesenteric artery, with stenosis of the left subclavian, celiac axis, renal and upper mesenteric arteries. An angioplasty and stent placing was carried out in the last two arteries. Both kidneys had the appearance of "hairy kidneys". A bone scan showed increased uptake in femurs and tibiae and X-ray examination showed osteosclerosis in metaphysis and diaphysis. The diagnosis of Erdheim-Chester disease (non-Langerhans-cell histiocytosis) was made and the patient was treated with steroids and methotrexate. (Rev Med Chile 2011; 139: 1054-1059).
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    Implementación de la reforma curricular de la Escuela de Medicina de la Pontificia Universidad Católica de Chile: analizando la experiencia
    (2022) Cisternas, Marcela; Rodríguez, Javier; Llanos, Carolina; Garrido Cisterna, Francisco Javier; Nazar Jara, Claudio; Thone, Natalie; Sirhan Nahum, Marisol; Gana Ahumada, Natalia; Valdés, Claudia; Rivera Mercado, Solange
    The accelerated scientific, technological, and social advances in recent years have posed new challenges for professional training institutions, where universities play a leading role. Medical schools have not been oblivious to this process. This is how Pontificia Universidad Católica de Chile implemented in 2015 a curricular reform derived from the joint work of academics, students and graduates. For this purpose, a model consisting of stages was followed, including the identification of the problem, general assessment of needs, definition of purpose and learning objectives. We worked with surveys, focus groups and committees of academics and students to identify and map content within the mesh, review terminal learning objectives while creating and reviewing courses for the vertically and horizontally integrated delivery of content and competencies. The first cohort of the new curriculum entered in 2015, consisting of 126 students. The implementation required constant follow-up and monitoring, establishing changes and adjustments according to educational needs and unforeseen conditions such as the COVID-19 pandemic. The implementation process of the new curriculum has been positive, adjusting to the defined strategic planning and responding to unexpected events.
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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.
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    TNF-alpha Blocker Therapy and Solid Malignancy Risk in ANCA-Associated Vasculitis
    (SPRINGER, 2012) Silva, Francisco; Cisternas, Marcela; Specks, Ulrich
    ANCA-associated vasculitides (AAV) are small vessel systemic vasculitis syndromes associated with the potential for high morbidity and mortality. This group includes granulomatosis with polyangiitis (Wegener's, GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (Churg-Strauss, EGPA). The standard treatment consists of a combination of glucocorticoids and potent immunosuppressant drugs. These have broad mechanisms of action as well as important adverse effects. Efforts have been made to investigate novel agents with better-defined and narrower mechanisms of action, such as biologics, including TNF-alpha blockers. Etanercept, a well-known TNF-alpha blocker evaluated for GPA in the Wegener's Granulomatosis Etanercept Trial (WGET), was associated with an increase in the development of solid malignancies in comparison to placebo during that trial period. A 5-year follow-up after the WGET trial showed a sustained increase in incidence of solid malignancies, but this could no longer be solely attributed to etanercept exposure. These studies raised concerns about the use of the family of TNF-alpha blockers in AAV. Here, we review the evidence about the association between therapeutic inhibition of tumor necrosis factor (TNF-alpha) by etanercept and other TNF-alpha blockers with the development of solid malignancies in GPA and other AAV.