BackgroundMedical 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.MethodsWe 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.ResultsFrom 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.ConclusionsThis 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 materialThe online version of this article (doi:10.1186/s12909-015-0459-2) contains supplementary material, which is available to authorized users.

¿Qué son los grupos focales?, ¿cuándo surgen?, ¿cuáles son sus fundamentos teóricos?, ¿cómo se lleva a cabo esta técnica?, ¿qué utilidad presta a la educación médica? Son las preguntas que guían el presente artículo, cuya finalidad es ofrecer un panorama de la técnica de grupos focales. Es una herramienta de la investigación cualitativa, que ha demostrado ser una fuente de información de enorme riqueza, para la investigación en educación médica, por su sensibilidad para indagar conocimientos, normas y valores de determinados grupos.

BackgroundCompetency-based education has been considered the most important pedagogical trend in Medicine in the last two decades. In clinical contexts, competencies are implemented through Entrustable Professional Activities (EPAs) which are observable and measurable. The aim of this paper is to describe the methodology used in the design of educational tools to assess students´ competencies in clinical practice during their undergraduate internship (UI). In this paper, we present the construction of specific APROCs (Actividades Profesionales Confiables) in Surgery (S), Gynecology and Obstetrics (GO) and Family Medicine (FM) rotations with three levels of performance.MethodsThe study considered a mixed method exploratory type design, a qualitative phase followed by a quantitative validation exercise. In the first stage data was obtained from three rotations (FM, GO and S) through focus groups about real and expected activities of medical interns. Triangulation with other sources was made to construct benchmarks. In the second stage, narrative descriptions with the three levels were validated by professors who teach the different subjects using the Delphi technique.ResultsThe results may be described both curricular and methodological wise. From the curricular point of view, APROCs were identified in three UI rotations within clinical contexts in Mexico City, benchmarks were developed by levels and validated by experts’ consensus. In regard to methodological issues, this research contributed to the development of a strategy, following six steps, to build APROCs using mixed methods ConclusionsDeveloping benchmarks provides a regular and standardized language that helps to evaluate student’s performance and define educational strategies efficiently and accurately. The university academic program was aligned with APROCs in clinical contexts to assure the acquisition of competencies by students.

recepción 2 de junio de 2013; aceptación 27 de junio de 2013 PALABRAS CLAVEMétodos mixtos; investigación educativa en ciencias de la salud; desarrollo de instrumentos; triangulación; modelo explicativo; México.Resumen los métodos mixtos (MM) combinan la perspectiva cuantitativa (cuanti) y cualitativa (cuali) en un mismo estudio, con el objetivo de darle profundidad al análisis cuando las preguntas de investigación son complejas. Más que la suma de resultados cuanti y cuali, la metodología mixta es una orientación con su cosmovisión, su vocabulario y sus propias técnicas, enraizada en la filosofía pragmática con énfasis en las consecuencias de la acción en las prácticas del mundo real. En este artículo se presentan los cuatro modelos de MM más utilizados en estudios relacionados con las ciencias de la salud en las últimas dos décadas, estos son: 1) modelo para desarrollar instrumentos; 2) modelo explicativo o aclaratorio; 3) modelo de triangulación; y 4) modelo de transformación longitudinal, así como algunos lineamientos para su utilización en la investigación educativa. los MM permiten ampliar las preguntas y las teorías para dar cuenta de la realidad e incidir en los procesos de enseñanza y aprendizaje. las respuestas obtenidas a través de la aplicación de MM son ricas, significativas y aportan a la comprensión de los fenómenos educativos que a su vez hacen surgir nuevas preguntas. los MM le ofrecen al investigador la oportunidad de descubrir orientaciones novedosas, ensayar con variadas estrategias y encontrar sentidos que van más allá de aquellos derivados del uso de un solo método.