Introduction: The literature shows an optimistic landscape for the effectiveness of games in medical education. Nevertheless, games are not considered mainstream material in medical teaching. Two research questions that arise are the following: What pedagogical strategies do developers use when creating games for medical education? And what is the quality of the evidence on the effectiveness of games? Methods: A systematic review was made by a multi-disciplinary team of researchers following the Cochrane Collaboration Guidelines. We included peer-reviewed journal articles which described or assessed the use of serious games or gamified apps in medical education. We used the Medical Education Research Study Quality Instrument (MERSQI) to assess the quality of evidence in the use of games. We also evaluated the pedagogical perspectives of such articles. Results: Even though game developers claim that games are useful pedagogical tools, the evidence on their effectiveness is moderate, as assessed by the MERSQI score. Behaviourism and cognitivism continue to be the predominant pedagogical strategies, and games are complementary devices that do not replace traditional medical teaching tools. Medical educators prefer simulations and quizzes focused on knowledge retention and skill development through repetition and do not demand the use of sophisticated games in their classrooms. Moreover, public access to medical games is limited. Discussion: Our aim was to put the pedagogical strategy into dialogue with the evidence on the effectiveness of the use of medical games. This makes sense since the practical use of games depends on the quality of the evidence about their effectiveness. Moreover, recognition of said pedagogical strategy would allow game developers to design more robust games which would greatly contribute to the learning process.

Many countries are experimenting with public hospital reform - both increasing the managerial autonomy with which hospitals conduct their affairs, and separating 'purchaser' and 'provider' sides of the health system, thus increasing the degree of market pressure brought to bear on hospitals. Evidence suggesting that such reform will improve hospital performance is weak. From a theoretical perspective, it is not clear why public hospitals should be expected to behave like firms and seek to maximize profits as this model requires. Empirically, there is very slight evidence that such reforms may improve efficiency, and reason to be concerned about their equity implications. In Colombia, an ambitious reform programme includes among its measures the attempt to universalize a segmented health system, the creation of a purchaser-provider split and the transformation of public hospitals into 'autonomous state entities'. By design, the Colombian reform programme avoids the forces that produce equity losses in other developing countries. This paper reports the results of a study that has tried to track hospital performance in other dimensions in the post-reform period in Bogotá. Trends in hospital inputs, production and productivity, quality and patient satisfaction are presented, and qualitative data based on interviews with hospital workers are analyzed. The evidence we have been able to collect is capable of providing only a partial response to the study question. There is some evidence of increased activity and productivity and sustained quality despite declining staffing levels. Qualitative data suggest that hospital workers have noticed considerable changes, which include greater responsiveness to patients but also a heavier administrative burden. It is difficult to attribute specific causality to all of the changes measured and this reflects the inherent difficulty of judging the effects of large-scale reform programmes as well as weaknesses and gaps in the data available.

This paper analyzes the main advances in health coverage and health services demand in IntroducciónEl primero de enero de 1995 entró en vigencia en Colombia una profunda reforma del sistema de seguridad social en salud (que había sido aprobada por ley en 1993), la cual pretendía el aseguramiento universal en salud con eficiencia, calidad y acceso a los servicios de salud. Establecía dos regímenes de aseguramiento: uno contributivo para quienes tienen un empleo formal o la forma de pagar y uno subsidiado para los pobres.La última información disponible sobre cobertura del aseguramiento antes de dicha reforma nos informa que durante el período 1986-1989 existe una cobertura de la seguridad social en salud del 23,8%, que sumada a la de otros tipos de seguros alcanzaba al 30,4% de la población 1 .

El objetivo fue explorar los determinantes para la no implementación de los Grupos Relacionados de Diagnóstico (GRD) en hospitales en Colombia. Se realizó un enfoque cualitativo de estudio de casos, para analizar las percepciones de los directores de seis hospitales con y sin GRD en Bogotá. La teoría de difusión de la innovación fue el fundamento teórico de la entrevista aplicada. Los directores tuvieron percepciones similares frente a los determinantes. Aunque los GRD se percibieron como positivos, se encontraron obstáculos para implementarlos a nivel organizacional e institucional. A no ser que haya una política pública que apalanque el tema, la posibilidad de GRD en Colombia no se ve en el futuro cercano.

Objetivos: Caracterizar el estado de la cultura innovadora y la actitud del personal hospitalario frente a los grupos relacionados de diagnóstico (GRD) como innovación para el sector de la salud en Colombia. Métodos: Estudio de caso mediante una muestra por conveniencia realizada entre el personal clínico y administrativo de quienes depende el éxito del proyecto de los GRD. El análisis estadístico se realiza por medio de la estadística descriptiva, la regresión y el análisis de correspondencia. Resultados: El estado de la cultura innovadora en el hospital es favorable para la innovación. No se observan diferencias significativas entre las perspectivas a la innovación que tienen el personal clínico y el administrativo. El personal administrativo y los médicos jóvenes desconocen los GRD. En cambio, los médicos con experiencia y los que ocupan puestos de mando, conocen los GRD. Se encontró una correlación significativa entre la cultura innovadora y la actitud frente a los GRD. Conclusiones: La homogeneidad de la cultura innovadora en el hospital augura un ambiente favorable para implementar los GRD. Univ. Méd. ISSN 0041-9095. Bogotá (Colombia), 53 (4): 352-364, octubre-diciembre, 2012Palabras clave: cultura organizacional, innovación organizacional, gestión clínica. AbstractObjectives: To characterize the state of the innovative culture and attitude of hospital staff towards Diagnosis Related Groups (DRG) like an innovation for the Colombian health care. Methods: A case study through convenience sampling among clinical and administrative staff who determine the success of the DRG. Statistical analysis was performed using descriptive statistics, regression and correspondence analysis. Results: The state of innovative culture in the Hospital is favorable for the innovation. There were no significant differences between the views on the innovation of the clinical and administrative staff. The administrative staff and junior doctors are unaware of the DRG. In contrast, experienced doctors and those in management positions know DRG. Significant correlation was found between innovative culture and attitude to the DRG. Conclusions: The homogeneity of the innovative culture in the Hospital predicts a favorable climate for DRG implementation.