This study determines the factors of abandonment of tuberculosis treatment in the public health network of Cali, Colombia, during years 2016 to 2018. We conducted an operational case-control investigation including 224 patients with tuberculosis (112 abandoned treatment and 112 completed it). We found that treatment abandonment for tuberculosis is driven by factors related to the individuals and health services that facilitate non-adherence and drive them away from the care provided in medical institutions. In 2019, there were 10 million cases, with 1.4 million deaths. This disease, with timely diagnosis and treatment in accordance with the international framework for tuberculosis control, guarantees survival for those affected, with a treatment success rate of 57% at world level1. Colombia, as a country, has a high disease burden of 19,000 cases of tuberculosis per year, and an incidence rate of 35.8 per 100,000 inhabitants2. Therefore, this study aims to determine the factors of abandonment of tuberculosis treatment in the public network in Cali, Colombia, which is responsible for the care of the poor and vulnerable population, in a city that has a mortality rate above the national rate and increasing tuberculosis mortality in the world2.Multidrug-resistant tuberculosis, resulting from drug reactions and loss of follow-up treatment, accounts for half a million cases around the world. Interrupted administration of the drug is a determining factor in this resistance, causing a threat to public health and the health system, blocking the initiative to put an end to tuberculosis worldwide, and to the achievement of the Sustainable Development Goals, in which a 90% coverage of treatment is expected in 2023Operational research with case-control design, carried out in the public health network of Santiago de Cali, with data provided by the tuberculosis program of the Municipal Public Health Secretariat. We included patients over 18 years old, residents of Cali, with a diagnosis of tuberculosis, who entered the program between January 1, 2016 and December 31, 2018, and presented a condition of abandonment of treatment or loss to follow-up. Abandonment was considered as not having started treatment or interruption of treatment for a period equal to or greater than one month.We used the formula for estimating proportions to calculate the sample size, considering: n = 721 subjects who abandoned treatment during the study period, confidence level of 95%, precision of 5% and expected proportion of 10% according to data from the Municipal Public Health Secretariat of Cali, which suggested a minimum sample of 112 people. Participants were selected from simple random probability sampling and were compared with 112 subjects who completed the treatment.The study variables included sociodemographic variables such as age, sex, ethnicity, municipality of residence and health system affiliation, as well as clinical factors such as HIV-positive diagnosis, diabetes, malnutrition, smoking, alcoholism and drug dependence. Finally, factors inherent to the health service were considered, such as bacteriological controls performed, months of treatment received, centralized tuberculosis program and multidisciplinary health team.Data analysis was performed using SPSS version 24 software. We used the Kolmogorov Smirnov test to determine the normality of the variables. Categorical variables were expressed as frequency and percentage and quantitative variables as mean plus standard deviation. In the univariate analysis, we used chi-square for differences in proportions and Student’s t-test for differences in means, assuming a p-value < 0.05 as statistically significant. In the bivariate analysis, to establish the crude association between the independent variables and tuberculosis treatment abandonment, we used contingency tables from which odds ratios with their respective 95% confidence intervals were estimated. Finally, we performed a binary logistic regression with Hosmer-Lemeshow Goodness of Fit and backward stepwise selection method, considering as elimination criterion the variables with a significance greater than 0.20.The research followed the ethical guidelines of Ministry of Health Decision 8430 and the Helsinki Declaration. The protocol was ethically endorsed by the Universidad Santiago de Cali and authorized by the Secretary of Public Health of the Municipality of Cali.We studied 224 subjects homogeneously distributed in the tuberculosis treatment abandonment and non-abandonment groups. The majority were male (70%), racially mixed (81%) and (56%) under 40 years old. Regarding affiliation to the General Social Security Health System, 77% were in the subsidized system and the rest were not affiliated. Finally, in the binary logistic regression model, factors associated with treatment abandonment were identified as male sex  age under 40 years  being part of a vulnerable population  not being insured  and not having been tested for HIV  .The study identified the factors of treatment abandonment in pulmonary tuberculosis, in which the variables considered correspond to aspects or factors related to adherence to tuberculosis treatment. Among the aspects are those related to the patient and the health services. The results showed that, among the patient-related factors in the abandonment of anti-tuberculosis treatment, are age, sex and vulnerable groups, which refer to drug addicts, prison inmates and street dwellers.3 and Arenas et al.4 identified similar results regarding the presence of tuberculosis, with a greater presence in men than in women, at ages below 40 years old. However, they do not establish associations with abandonment, probably due to the different contexts and the specific characteristics of the populations studied3. In Colombia, a study investigating the barriers associated with adherence to shortened, strictly supervised tuberculosis treatment showed that people who use tobacco, alcohol and illegal drugs have, respectively, a 3.41 times greater chance of abandoning treatment than those who did not report using these types of substances5. This is in contrast to what was found in this study, where alcohol and tobacco consumption have no association, unlike the consumption of illegal drugs, showing a relationship present in vulnerable groups.Regarding age and sex, the studies conducted by Arroyo et al.4.In addition, not having been tested for HIV is related to treatment abandonment (OR = 5.1), generating uncertainty in relation to the total number of people with a positive result. Authors cite in their studies that this comorbidity is related to the use of illicit drugs, which aggravates the situation by generating a poor level of follow-up to resistance4, showing that the abandoning population does not have an affiliation system.Regarding the abandonment factors related to the health service, there is evidence of the relationship between the absence of affiliation to the health system and treatment abandonment, similar to what was found in the study by Arenas et al.3. Regarding the abandonment related to health services, it could have an implicit component related to the characteristics of the health system, malnutrition present in vulnerable populations, becoming risk factors for treatment abandonment4. Currently, in the covid-19 emergency, aspects related to the patient and health services may have a greater impact on treatment abandonment. Due to the limited evidence, future research is needed to establish the relationship between treatment abandonment in the public network and covid-19.In our study, what could explain the relationship between abandonment and sociodemographic variables is the social crisis, in a city where the presence of extreme poverty and inequality makes it necessary for the economically active population to improve their daily income, which makes it difficult to adjust to the continuity of treatmentThe limitations of this study are related to its retrospective nature and the use of secondary sources, that is, some variables were not available to fully explain the outcome; among them are marital status, occupation, means of transportation, place of diagnosis and persons with whom the patient lives. We consider that the strength of the study is that it is the first to determine the factors leading to abandonment of tuberculosis treatment in the public network. This entity is made up of 5 social enterprises of the state, responding to the need to organize health care for the poor and vulnerable population of the municipality in strata 1 and 2, in a city classified as high risk for tuberculosis, where the incidence of this disease is twice higher than that of Colombia.In conclusion, we emphasize that the abandonment of tuberculosis treatment in the public network is driven by factors of the individual and of the health services, being determinant to evaluate the conditions that facilitate non-adherence, and distance the individual from the care provided in health institutions. However, it is necessary to rethink the strategies used so far in the control programs to allow vulnerable groups and the community in general to access care, since their living conditions represent a greater risk for increased tuberculosis transmission. 1.La tuberculosis es una de las diez principales causas de muerte en el mundo, suscitada por Mycobacterium tuberculosis, y afecta a todos los grupos de edad. En 2019, se presentaron 10 millones de casos, con 1.4 millones de muertes. Esta enfermedad, con un diagnóstico oportuno y tratamiento ajustado al marco internacional del control de la tuberculosis, garantiza una sobrevida a las personas afectadas, con una tasa de éxito en el tratamiento del 57% a nivel mundial1. Colombia, como país, aporta con una carga alta a la enfermedad de 19.000 casos de tuberculosis por año, y una tasa de incidencia de 35,8 por 100.000 habitantes2. Por lo anterior, el presente estudio tiene como objetivo determinar los factores de abandono al tratamiento de la tuberculosis en la red pública en Cali, Colombia, la cual responden por la atención de la población pobre y vulnerable, en una ciudad que tiene una tasa por encima de la nacional y contribuye a la mortalidad por tuberculosis en el mundo2.La tuberculosis multirresistente, derivada de las reacciones del medicamento, y pérdida del seguimiento del tratamiento, representa medio millón de casos en todo el mundo. La administración interrumpida del fármaco es un factor determinante a esta resistencia, acaeciendo una amenaza para la salud pública y el sistema de salud, al bloquear la iniciativa de poner fin a la tuberculosis en todo el mundo, y al cumplimiento de los objetivos del desarrollo sostenible, donde se espera para el año 2023 una cobertura del 90% en el tratamientoInvestigación operativa con diseño de casos y controles, realizada en la red pública de s0alud de la ciudad de Santiago de Cali, con datos suministrados por el programa de tuberculosis de la Secretaría de Salud Pública Municipal. Se incluyeron pacientes mayores de 18 años, residentes en Cali, con diagnóstico de tuberculosis, que ingresaron al programa entre el 1 de enero de 2016 hasta el 31 de diciembre de 2018, y presentaron condición de abandono al tratamiento o pérdida en el seguimiento. Se consideró abandono no haber iniciado el tratamiento o interrupción de este durante un periodo igual o mayor a un mes.Para calcular el tamaño de la muestra se usó la fórmula para estimación de proporciones, considerando: n = 721 sujetos con condición de abandono del tratamiento en el periodo de estudio, nivel de confianza de 95%, precisión de 5% y proporción esperada de 10% según datos de la Secretaría de Salud Pública Municipal de Cali, lo que sugirió una muestra mínima de 112 personas. Los participantes fueron seleccionados a partir de un muestreo probabilístico aleatorio simple y se compararon con 112 sujetos que sí completaron el tratamiento.Con relación a las variables de estudio, se contemplaron variables sociodemográficas como edad, sexo, etnia, comuna de residencia y régimen de afiliación al sistema de salud; además, factores clínicos a saber: diagnóstico de VIH positivo, diabetes, malnutrición, tabaquismo, alcoholismo y farmacodependencia. Finalmente, se consideraron factores inherentes al servicio de salud como controles bacteriológicos realizados, meses de tratamiento recibido, programa de tuberculosis centralizado y equipo multidisciplinario de salud.odds ratio con sus respectivos intervalos de confianza del 95%. Finalmente se realizó una regresión logística binaria con bondad de ajuste de Hosmer-Lemeshow y método de selección por pasos hacia atrás “backward”, considerando como criterio de eliminación las variables con significancia mayor a 0.20.El análisis de los datos se realizó en el software SPSS versión 24. Para determinar la normalidad de las variables se utilizó la prueba de Kolmogorov Smirnov. Las variables categóricas se expresaron en frecuencia y porcentaje y las cuantitativas en promedio más desviación estándar. En el análisis univariado, se implementó chi-cuadrado en caso de diferencia de proporciones y T de Student para diferencia de medias, asumiendo un valor p < 0,05 como estadísticamente significativo. En el análisis bivariado, para establecer la asociación cruda entre las variables independientes y el abandono al tratamiento de la tuberculosis, se utilizaron tablas de contingencia a partir de las cuales se estimaron los La investigación siguió los lineamientos éticos de la Resolución 8430 del Ministerio de Salud de Colombia y de la Declaración del Helsinki. El protocolo contó con el aval ético de la Universidad Santiago de Cali y la autorización de la Secretaría de Salud Pública del Municipio de Cali.Se estudiaron 224 sujetos distribuidos de manera homogénea en el grupo de abandono y no abandono al tratamiento de la tuberculosis. En su mayoría, eran de sexo masculino (70%), mestizos (81%) y (56%) menores de 40 años. Con relación al estado de afiliación al Sistema General de Seguridad Social en Salud, el 77% eran del régimen subsidiado y el resto no estaban vinculados. Finalmente, en el modelo de regresión logística binaria se identificaron como factores asociados al abandono del tratamiento el sexo masculino  la edad menor de 40 años  hacer parte de una población vulnerable  no estar asegurado  y no haberse realizado la prueba para VIH  .El estudio identificó los factores de abandono al tratamiento en la tuberculosis pulmonar, donde las variables consideradas corresponden a aspectos o factores atingentes a la adherencia al tratamiento de la tuberculosis. Entre los aspectos están los relacionados con el paciente y los servicios de salud. Los resultados mostraron, que, entre los factores relacionados con el paciente en el abandono del tratamiento antituberculoso, se encuentran la edad, sexo y grupos vulnerables, que hacen referencia a la población farmacodependiente, carcelaria y habitante de calle.3, y Arenas et al.4, identificaron resultados similares, en lo concerniente a la presencia de tuberculosis; con mayor presencia en hombres que en mujeres, en edades por debajo de los 40 años. Sin embargo, no establecen asociaciones con el abandono, probablemente sea producto de los diferentes contextos, y de las características específicas de las poblaciones estudiadas3. En Colombia, un estudio donde se indagaron las barreras asociadas a la adherencia al tratamiento acortado, estrictamente supervisado de tuberculosis, evidenció que las personas que consumen tabaco, alcohol y drogas ilegales presentan, respectivamente, una oportunidad de 3.41 veces mayor de abandonar al tratamiento que las que no reportaron consumo de este tipo de sustancias5. Esto se opone a lo encontrado en este estudio, donde el consumo de alcohol y tabaco no tienen una asociación, a diferencia del consumo de drogas ilegales, donde se evidencia una relación presente en los grupos vulnerables.En lo que respecta a la edad y el sexo, los estudios realizados por Arroyo et al.4.Además, no haberse realizado prueba de VIH se relaciona con el abandono al tratamiento (OR = 5.1), generando incertidumbre frente al total de personas con un resultado positivo. Autores citan en sus estudios que esta comorbilidad se relaciona con el uso de drogas ilícitas, que agrava la situación, al generar un pobre nivel de seguimiento a la resistencia4, donde la población que abandona no tiene un régimen de afiliación.En cuanto a los factores de abandono relacionados con el servicio de salud, queda en evidencia la relación de la ausencia de afiliación al sistema de salud y el abandono al tratamiento, similar a lo encontrado en el estudio de Arenas et al.3. En lo que respecta al abandono relacionado a los servicios de salud, podría tener implícito un componente relacionado con las características del sistema de salud, la desnutrición presente en poblaciones vulnerables, que se convierten en factores de riesgo para el abandono del tratamiento4. En la actualidad, ante la emergencia por covid-19, los aspectos relacionados con el paciente y los servicios de salud pueden repercutir con mayor impacto en el abandono al tratamiento. Debido a la evidencia limitada, se hacen necesarias futuras investigaciones que permitan establecer la relación entre el abandono al tratamiento en la red pública y el covid-19.En nuestro estudio, lo que podría explicar la relación del abandono con variables sociodemográficas es la crisis social, en una ciudad, donde la presencia de pobreza extrema e inequidad hace necesario que la población económicamente activa requiera mejorar sus ingresos diarios, siendo difícil ajustarse a una continuidad en un tratamientoLas limitaciones de este estudio se relacionan con su carácter retrospectivo y el uso de fuentes secundarias, es decir, no se contaba con algunas variables que permitieran explicar completamente el desenlace; entre ellas está el estado civil, la ocupación, el medio de transporte, el lugar del diagnóstico y las personas con quien convive. Consideramos que la fortaleza del estudio es ser el primero en determinar los factores de abandono al tratamiento de tuberculosis en la red pública. Entidad conformada por 5 empresas sociales del estado, que responden a la necesidad de organización de la atención en salud a la población pobre y vulnerable del municipio de los estratos 1 y 2, de una ciudad clasificada como de alto riesgo en tuberculosis, donde la incidencia de esta enfermedad es dos veces mayor que la de Colombia.En conclusión, destacamos que el abandono del tratamiento para la tuberculosis en la red pública está impulsado por factores del individuo y de los servicios de salud, siendo determinante para evaluar las condiciones que facilitan la no adherencia, y lo alejen de la atención brindada en las instituciones de salud. No obstante, es necesario replantear estrategias utilizadas hasta el momento en los programas de control, que permitan que los grupos vulnerables y la comunidad en general accedan a la atención, pues sus condiciones de vida representan un mayor riesgo para el aumento de la transmisión de la tuberculosis.


Apesar da ausência de dados epidemiológicos robustos, uma metanálise com 141 estudos incluindo países da América do Norte, Europa, Ásia e Oceania, demonstrou taxa de RCE abaixo de 30% nos casos de PCR extra-hospitalar, e concluiu que as chances de sucesso estavam ligadas ao fato da PCR ter sido testemunhada e em casos cuja RCP havia sido iniciada por um espectador da mesma.2 Por outro lado, no ambiente intra-hospitalar, paradoxalmente, as taxas de sobrevida são inferiores a 20%, provavelmente devido às condições clínicas associadas e à maior gravidade dos pacientes, que fazem da assistolia e da atividade elétrica sem pulso os ritmos mais prevalentes.2No Brasil, de acordo com a diretriz sobre Ressuscitação Cardiopulmonar e Cuidados Cardiovasculares de Emergência da Sociedade Brasileira de Cardiologia, as taxas de sobrevida de PCR extra-hospitalar, quando abordada dentro dos primeiros 5 minutos com desfibrilação precoce, variam entre 50% e 70%.2 e internacionais3 para a abordagem da PCR ressaltam a importância da execução da cadeia de sobrevivência, cuja sequência de ações envolve a RCP de alta qualidade. Por sua vez, promover uma RCP de alta qualidade envolve minimizar interrupções nas compressões torácicas, promover compressões torácicas com frequência e profundidade adequadas, permitir retorno total do tórax entre as compressões e evitar a hiperventilação.4Independentemente do ambiente, os protocolos nacionais4 o que requer treinamento e aprendizado constantes. Neste cenário, os mecanismos de feedback são cruciais para o aprimoramento das ações e devem fazer parte do conjunto de medidas que visam aumentar a sobrevida após uma PCR. Estes mecanismos são compostos por ações ou dispositivos que avaliam a qualidade da RCP e podem ser aparelhos eletrônicos, questionários, monitoramento por vídeo, supervisão humana ou qualquer outra estratégia com o mesmo objetivo. Abella et al.,5demostraram, por exemplo, em estudo observacional com 67 pacientes, que as manobras de RCP nos primeiros cinco minutos não atingiram as metas das diretrizes internacionais, com compressões lentas (<90bpm) e superficiais (<38mm). Estes achados foram possíveis devido ao uso de um dispositivo de feedback durante o atendimento a uma vítima de PCR intra-hospitalar.Desta forma, as taxas de sucesso da RCP estão ligadas diretamente à correta execução das manobras e ao cumprimento dos protocolos de atendimento à PCR,6 utilizaram monitoramento em tempo real das manobras de RCP intra-hospitalar e as ações eram revistas e apresentadas em feedback semanal aos membros dos times de ressuscitação.6 Zheng et al.,7 por meio de pesquisa com 1405 profissionais de 75 hospitais terciários na China, observaram que 91% reconheciam a necessidade de monitoramento da RCP e 67,3% entendiam que o principal problema durante a RCP era a qualidade das compressões torácicas, influenciada diretamente pela fadiga do operador.7 Esta influência da fadiga foi também observada por Trowbridge et al.,8 que demonstraram redução significativa da profundidade das compressões torácicas dentro dos dois primeiros minutos do início das manobras de RCP, ressaltando a importância do revezamento de socorristas.8Em outro estudo, Cheng et al.,9 Nele, os autores combinaram a utilização de um dispositivo de feedback com a escala de Borg10para a percepção do cansaço durante a realização de manobras de RCP, em hospital público de ensino da cidade de São Paulo (SP – Brasil).9 O estudo foi realizado utilizando cenário simulado com auxílio de manequins com dispositivo de feedback, incluiu 69 enfermeiros de áreas críticas e não críticas de atendimento à adultos do hospital e todos os participantes utilizaram frequencímetro para registro da frequência cardíaca durante a atividade.9Neste contexto, o artigo publicado na revista Arquivos Brasileiros de Cardiologia, traz informações importantes que podem contribuir para o aperfeiçoamento das equipes de atendimento à PCR.feedback apresentaram menores médias na escala de Borg no primeiro e no segundo minutos quando comparados ao grupo controle .9 Em relação à frequência cardíaca, observou-se comportamento semelhante, isto é, aqueles que realizaram a RCP em manequins com dispositivo de feedback apresentaram menores médias no primeiro e no segundo minutos em relação ao grupo controle (119 bpm e 121 bpm versus 121 bpm e 123 bpm).9 Apesar dos grupos apresentarem valores próximos, é importante destacar a tendência de apresentação, e quando combinados com a escala de Borg,10 permitem a mensuração de um dado objetivo, como a frequência cardíaca, em concomitância com um dado subjetivo, como a percepção de cansaço.Os autores observaram que os enfermeiros que efetuaram a RCP com dispositivo de versus 41,6%), e do fato da RCP ter sido realizada em manequim,9 os resultados do estudo demonstram com clareza a percepção de fadiga do operador, que é provavelmente o principal determinante do sucesso durante a realização da RCP. Além deste fato, Gandolfi et al.,11 em estudo semelhante, também em ambiente simulado e utilizando manequins com dispositivo de feedback, observaram melhora imediata da frequência e da profundidade das compressões torácicas quando o dispositivo era utilizado,11 permitindo aprimoramento em tempo real das manobras de RCP. Portanto, pode-se observar que o reconhecimento das limitações na execução das ações é fundamental para a realização das correções necessárias, e assim, os dispositivos de feedback podem impactar positivamente na qualidade da RCP.Apesar do número reduzido de participantes, do menor percentual de praticantes de atividade física no grupo controle  is the most serious event in the health area and its prompt recognition with the consequent initiation of cardiopulmonary resuscitation (CPR) maneuvers are essential for the return of spontaneous circulation (ROSC). Despite the absence of robust epidemiological data, a meta-analysis of 141 studies including countries in North America, Europe, Asia and Oceania, demonstrated a ROSC rate below 30% in cases of out-of-hospital CA, and concluded that the chances of success were linked to the fact that the CPR was witnessed and in cases where CPR had been initiated by a bystander.2 On the other hand, in the in-hospital environment, paradoxically, survival rates are less than 20%, probably due to associated clinical conditions and the greater severity of patients, which make asystole and pulseless electrical activity the most prevalent rhythms.2In Brazil, according to the guideline on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care of the Brazilian Society of Cardiology, the survival rates of out-of-hospital CPA, when addressed within the first 5 minutes with early defibrillation, vary between 50% and 70% two.2 and international3 protocols for approaching CRA emphasize the importance of executing the chain of survival, whose sequence of actions involves high-quality CPR. In turn, promoting high-quality CPR involves minimizing interruptions in chest compressions, providing chest compressions with adequate frequency and depth, allowing full chest recoil between compressions, and avoiding hyperventilation.4Regardless of the environment, national4 which requires constant training and learning. In this scenario, feedback mechanisms are crucial for improving actions and should be part of the set of measures aimed at increasing survival after cardiac arrest. These mechanisms are composed of actions or devices that assess the quality of CPR and can be electronic devices, questionnaires, video monitoring, human supervision or any other strategy with the same objective. Abella et al.5 demonstrated, for example, in an observational study with 67 patients, that CPR maneuvers in the first five minutes did not reach the goals of international guidelines, with slow compressions (<90bpm) and superficial compressions (<38mm).In this way, the success rates of CPR are directly linked to the correct execution of the maneuvers and compliance with the CRA care protocols,6 used real-time monitoring of in-hospital CPR maneuvers and the actions were reviewed and presented in weekly feedback to members of the resuscitation teams.6 Zheng et al.,7 through a survey of 1405 professionals from 75 tertiary hospitals in China, observed that 91% recognized the need for CPR monitoring and 67.3% understood that the main problem during CPR was the quality of chest compressions, directly influenced by operator fatigue.7 This influence of fatigue was also observed by Trowbridge et al.,8 who demonstrated a significant reduction in the depth of chest compressions within the first two minutes of starting CPR maneuvers, highlighting the importance of alternating rescuers.8In another study, Cheng et al.Arquivos Brasileiros de Cardiologia journal, brings important information that can contribute to the improvement of CRA care teams.9 In it, the authors combined the use of a feedback device with the Borg scale10 for the perception of tiredness while performing CPR maneuvers in a public teaching hospital in the city of São Paulo (SP – Brazil).9 The study was carried out using a simulated scenario with the aid of mannequins with a feedback device, including 69 nurses from critical and non-critical areas of adult care at the hospital and all participants used a frequency meter to record heart rate during the activity.9In this context, the article published in the 9 Although the groups present similar values, it is important to highlight the presentation tendency, and when combined with the Borg scale,10 they allow the measurement of objective data, such as heart rate, concomitantly with subjective data, such as the perception of tiredness.The authors observed that nurses who performed CPR with a feedback device had lower means on the Borg scale in the first and second minutes when compared to the control group (13.5 and 14.2 versus 14 and 14.9 respectively).9 Regarding heart rate, a similar behavior was observed, that is, those who performed CPR on mannequins with a feedback device had lower averages in the first and second minutes compared to the control group (119 bpm and 121 bpm versus 121 bpm and 123 bpm).9 the results of the study clearly demonstrate the perception operator fatigue, which is probably the main determinant of success when performing CPR. In addition to this fact, Gandolfi et al. in a similar study, also in a simulated environment and using mannequins with a feedback device, they observed an immediate improvement in the frequency and depth of chest compressions when the device was used,11 allowing real-time improvement of CPR maneuvers. Therefore, it can be observed that the recognition of limitations in the execution of actions is fundamental for carrying out the necessary corrections, and thus, feedback devices can positively impact the quality of CPR.Despite the reduced number of participants, the lower percentage of physical activity practitioners in the control group (33.3% versus 41.6%), and the fact that CPR was performed on a dummy,9 has the merit of focusing attention on the rescuer, demonstrating the importance of the device in their perception of fatigue combined with their response to exercise, both lower than the control group. Finally, it is important to emphasize the need to disseminate the results of studies in this scenario so that the data are transformed into actions and the natural history of CRP is consistently modified.Thus, the discussion on the use of feedback mechanisms when assisting a CRA victim becomes increasingly relevant, and the present study


To estimate the reliability of scripts designed for undergraduate Speech-Language Therapy students.A descriptive cross-sectional study was carried out. Qualitative variables were summarized by frequency or proportion and quantitative through means (CI 95%). Reliability was estimated through Cronbach's α coefficient, and inter-rater agreement was determined using Fleiss’s Kappa index. The analytical tests considered a significance level of p<0.05.80 scripts organized in four areas of speech-language therapy were validated by 41 speech-language pathologists. The average experience of the professionals was 17.1 years. The reliability of the corpus was α: 0.67 , and the inter-rater agreement κ: 0.29 .The corpus's reliability scores were similar to those reported by previous studies in different health professions. Having validated strategies aimed at developing proficiency and supporting classic training actions in undergraduate courses will contribute to increasing the quality of future health professionals. Students must develop proficiency involving knowledge, skills, behaviors, and values that allow them to approach users in diverse and uncertain contexts.The training of health professionals has become more complex to the extent that disciplinary and teaching knowledge has expanded, involving teaching-learning processes supported by evidence, centered on the student, and accompanied by the use of technologies, innovation, and high scientific standards. In the case of Speech-Language Therapy, a discipline in charge of addressing and preventing communication and swallowing disorders, undergraduate training requires the student to develop complex skills, among which is the CR, a challenging competence in terms of professional training. Despite the existence of heterogeneous definitions, it is accepted that CR implies using skills such as: analysis, problem-solving, contextual reasoning, and pattern recognition. Such tasks seem to happen automatically in the case of experts. However, novice students require training to achieve them.Among the skills that students must develop in their academic training, there is clinical reasoning (CR), a relevant component for developing competencies that allow inferring a diagnosis and choosing the most appropriate routes of action for each user.This way, CR is considered a fundamental skill in the approach to users, which must be incorporated into the study plans of health professionals. Within the strategies described in the literature, using scripts  has offered a framework to understand how thinking is organized when training CR, organizing themselves as a set of attributes that are more or less likely to happen and that contain symptoms and signs that are linked, forming generic structures that can represent any disease. This is how the scripts represent a decision-making model based on hypothesis generation. These are raised based on user signs and data that allow confirming or rejecting these assumptions through psychological or mental processes in which theoretical knowledge and accumulated practical experience participate.The scripts respond to schemes associated with sequences of events that occur in a particular order and as a valid and reliable evaluation tool.In this line, different studies have shown the effectiveness of scripts as a tool for teaching CR skills. This is how the script agreement test has been described as an appropriate tool for training the CR, since it allows exercising decision-making and data interpretation in situations of uncertainty. The scripts enable students to assess the change in the probability of a hypothesis, contrasted with new information, in scenarios focused on making diagnostic, study, or intervention decisions. These hypotheses are evaluated on a 5-point Likert scale, with positive, neutral, or negative response options. A methodology challenge points out that there is still little information on cut scores or their correlation with knowledge scores at the expert level. On the other hand, the literature highlights that experienced professionals tend to avoid extreme responses offered by the script, increasing test scores, with the consequent probability of generating biases in its construct. The script agreement test has been used in different health professions as a strategy for CR training; however, no studies validate its use in Speech-Language Therapy, which requires the development of scripts relevant to the profession and the need to determine specific psychometric properties. This research aimed to estimate the reliability of a corpus of clinical scripts designed for undergraduate Speech-Language Therapy students.It has been observed that the evaluation methods traditionally used to measure competencies are limited in assessing CRThe Scientific Ethics Committee of Santo Tomás University approved the research with code 153.20. Each participant signed an informed consent to enter the project.. The intervened career contemplates four core areas, namely: Child-Youth Communication and Language; Voice and Orofacial Motor Skills; Cognition and Communication in Adults and the Elderly; Audiology and Vestibular, for which the minimum n was projected in 40 speech-language therapists who were contacted at the national level through the sampling technique mentioned earlier, corroborating an intermediate professional experience, and with a gender distribution consistent with the professional profile of the practitioners in the country.A descriptive study of transverse cut. The universe was made up of professionals who worked in various clinical fields of speech-language therapy and had a degree in Speech-Language Therapy granted by a Chilean or foreign university. Sampling was done for convenience following the snowball strategy. The inclusion criteria were: having a minimum of 3 years of professional experience in the disciplinary area, having a Master's or Doctor's degree, and being authorized as an individual provider in the National Registry of the Health Superintendence (HS). The exclusion criteria were: working preferably in management or teaching tasks  and being currently inactive in labor terms due to retirement. The necessary number of experts was selected according to the recommendation of the literature for the validation of clinical scripts, estimating the incorporation of at least ten professionals per areaIn procedural terms and for creating the corpus, eight professionals (two per area) were invited to write the scripts to train and evaluate CR in diagnostic, study, and intervention tasks. These experts received synchronous training of three chronological hours, made online, through the Microsoft Teams platform.The training was facilitated by an academic with a doctorate in education and applied experience in the methodology, specifically for undergraduate and postgraduate medical training. Two speech-language therapists with clinical and educational experience advised the instance, belonging to the original undergraduate program. A theoretical presentation was made, followed by a workshop for creating scripts in virtual rooms according to area or field of training. Subsequently, the products were socialized, and feedback was provided by the facilitator to solve any procedural or theoretical doubts concerning the preparation of scripts. Each professional participating in the training was responsible for creating ten scripts.; in this case: students who completed the seventh and eighth semesters of the Speech-Language Therapy course at Santo Tomás University, at the Viña del Mar, Santiago, and Puerto Montt campuses, during the year 2021. For this research, the students did not use the scripts; however, their characterization is important, given their relevance as recipients of the final product. The identification of key contents for the corpus was made by analyzing learning results (LR) of subject programs that contributed to the four areas previously declared.Following the methodology reported in the literature, the population that would use the clinical scripts was determinedA corpus of 80 scripts was created, organized into four training areas, meaning 20 per area. The scripts for each area were classified as follows: eight diagnostic scripts, two study scripts, and ten intervention scripts.Once the scripts were generated in the established format, they were submitted to be reviewed by the research team made up of two speech-language therapists with master's degrees and experience in teaching and educational innovation, together with the expert with a doctorate degree from the medical training area, to standardize the texts and adapt them to the purposes of the study.For the response and validation of the clinical scripts , each Speech-Language therapist received a booklet with instructions and had to respond within a maximum of 2 weeks, depending on their area of expertise., the internal consistency was estimated from Cronbach's α coefficient, and inter-observer reliability was calculated with Fleiss's Kappa coefficient, considering a significance level of p<0.05. Responses were stratified by area, type of script, and type of response to control confounding variables. The incomplete scripts that presented very low response frequencies according to the outliers method were eliminated from the corpus.The responses of the speech pathologists were tabulated in Microsoft Excel. The response frequency was determined for descriptive purposes by the script to calculate the score later, transformed score, and final score according to the previously reported methodology. Quantitative variables were summarized by measures of central tendency and dispersion, considering a CI of 95%. According to the recommendation of the literatureThe statistical analysis was performed in Stata Statistical Software: Release 15. College Station, TX: StataCorp LLC.software.Forty-one speech pathologists answered the booklets delivered by area, with a minimum age of 28 years and a maximum of 61. Regarding the distribution by gender, 78% of the women were observed in the field of Child-Youth Communication and Language, and 60% of the males in Voice and Orofacial Motor Skills. 98% of the informants had a master's degree and 2% a doctorate. The average professional experience was recorded in a range of 10.6 to 17.2 years .The final scores added and stratified by area and type of script reveal consistent response trends among practitioners . It is eThe internal consistency of the corpus was α= 0.67. When analyzing by area and type of Script, low reliability was observed (α=0.60-0.70) for the diagnostic items in the four areas and the intervention scripts in the case of Cognition and Communication in Adults and the Elderly. It should be noted that insufficient reliability was recorded in the Audiology and Vestibular area case for the study scripts (α=0.34). On the other hand, the scripts of the same type in the remaining areas showed acceptable reliability (α=0.80-0.90) .The agreement between evaluators was estimated at κ= 0.29 (acceptable) for the corpus. When stratifying according to the variables of area and type of script, a slight concordance was observed in the areas of Voice and Orofacial Motor Skills (κ= 0.07), Cognition and Communication in Adults and the Elderly (κ= 0.08). The rest of the items presented an acceptable agreement (κ>0.20 and <0.41) and moderate agreement for the diagnostic scripts in Audiology and Vestibular (κ= 0.45) .. To date, experiences implementing the script agreement test have been reported in careers such as medicine and nursing, among others. The results of this study show variability in the judgment of the experts by area .The use of scripts implies certain challenges when thinking about their design, construction, and implementation, specifically related to the validity of the corpora, the handling of low scores, and the association of these results with other evaluation techniques. In this sense, and for practical purposes, as reported in the methodology, all the scripts that presented incomplete answers and those that did not have dominant agreements were eliminated from the corpus, that is, a considerably low frequency considered as such by the experts. In this way, it is verified that the dossier created has properties which make it functional for evaluating CR skills in Speech Pathology students, as the evidence highlights it in other areas of health.The consistency in the experts’ answers to the scripts, in general, is acceptable beyond chance , except . In this line, although the overall reliability score was low, it is important to highlight that the poor reliability result (α= 0.34) was maintained in the analysis in the case of the study scripts in the Audiology and Vestibular area, which affected the final calculation on the dossier on the one hand but avoided the confirmatory bias. Yet, the discrepancy between the experts is acceptable, considering that the validated instrument does not correspond to a diagnostic instrument.A limitation of this study is the variability in what is done and the professional judgment, which is expressed as the dispersion in response trends by experts in certain areas , H, J an.Concerning the sample size, it is important to note that the literature recommendation was considered, so although it is possible to expand the number of experts per field, this research adhered to what was suggested by previous research.As a projection, it is interesting to incorporate validation of the content of the dossier beyond the ascription to the learning results of the subject programs, as it is to add a second evaluative instance to determine the consistency of the intra-evaluator responses, increase the number of scripts per type, and increase the number of validators. Likewise, it will be essential to determine the impact and association of incorporating this strategy with respect to students' progress beyond clinical decision-making in scenarios with high uncertaintyThe corpus created presented a low global reliability. Still, the stratification by area and type of script offers a heterogeneous panorama, where it is possible to distinguish those items where a greater or lesser correlation was obtained, depending on the clinical reasoning task presented. Additionally, the inter-evaluator agreement was acceptable for the entire dossier. Determining the psychometric properties of scripts in the context of the script agreement test is the first formal approach to generating an innovative pedagogical tool for the training and authentic evaluation of CR in undergraduate students of the Speech-Language Therapy career. It is necessary to increase research and educational innovation in this field to offer relevant training instruments which are based on available scientific evidence and have validation to improve the development, monitoring and evaluation of professional proficiency in students of health careers, in preclinical instances and/or in early formative stages, complementing the strategies, instruments and tools already established in the curricula. The strategy developed is transferable, but it must be adjusted to the curricular frameworks of each house of study in terms of content and learning outcomes. . En este contexto, los estudiantes deben desarrollar competencias que implican conocimientos, habilidades, comportamientos y valores que les permitan abordar usuarios en diversos e inciertos escenarios.La formación de profesionales de la salud se ha complejizado en la medida en que se amplía el conocimiento disciplinar y docente, involucrando procesos de enseñanza - aprendizaje sustentados por la evidencia, centrados en el estudiante y acompañados del uso de tecnologías, innovación y elevados estándares científicos. En el caso de la fonoaudiología, disciplina encargada del abordaje y prevención de trastornos de la comunicación y deglución, la formación de pregrado requiere que el estudiante desarrolle destrezas complejas entre ellas, el RC, competencia retadora en lo que a la formación profesional respecta. A pesar de existir definiciones heterogéneas, se acepta que el RC implica el uso de habilidades cognitivas como: análisis, resolución de problemas, razonamiento contextual y reconocimiento de patrones. Dichas tareas parecen ocurrir de manera automática en el caso de los expertos, sin embargo, los estudiantes novatos requieren de entrenamiento para su alcance.Entre las destrezas que el estudiantado debe desarrollar en su formación académica, se encuentra el razonamiento clínico (RC), componente relevante para el desarrollo de competencias que permiten inferir un diagnóstico y elegir las rutas de acción más adecuadas a cada usuario.De esta forma, se considera al RC como una habilidad fundamental en el abordaje de usuarios, que debe ser incorporada en los planes de estudio de profesionales de la salud. Dentro de las estrategias descritas en la literatura, el uso de scripts (guiones clínicos), ha ofrecido un marco para comprender cómo se organiza el pensamiento a la hora de entrenar el RC, organizándose como un conjunto de atributos que tienen más o menos probabilidad de ocurrir y que contienen síntomas y signos que se vinculan, conformando estructuras genéricas que pueden representar cualquier enfermedad. Es así como los guiones estructuran un modelo de toma de decisiones basado en la generación de hipótesis. El guión es planteado a partir de señales y síntomas de los usuarios que estructuran una viñeta de alta incertidumbre, tres escenarios posibles y datos adicionales que permiten confirmar o desechar dichas suposiciones a través de procesos psicológicos o mentales, en los que participa el conocimiento teórico y la experiencia práctica acumulada.Los scripts responden a esquemas asociados con secuencias de eventos que ocurren en un orden determinado y a su vez como herramienta de evaluación válida y fiable.En esta línea, diversos estudios han demostrado la eficacia de los scripts como herramienta para enseñar habilidades de RC, es así como la prueba de concordancia de guiones (scripts) ha sido descrita como una herramienta apropiada para entrenar el RC, ya que permite ejercitar la toma de decisiones y la interpretación de datos en situaciones de incertidumbre. Los scripts permiten que los estudiantes valoren el cambio en la probabilidad de una hipótesis, contrastada con nueva información, en escenarios enfocados en la toma de decisiones diagnósticas, de estudio o intervención. Dichas hipótesis se evalúan en una escala Likert de 5 puntos con opciones de respuesta positiva, neutra o negativa. Un desafío de la metodología señala que aún existe poca información sobre los puntajes de corte o su correlación con los puntajes de conocimiento a nivel de expertos. Por otra parte, la literatura destaca que los profesionales con experiencia tienden a evitar las respuestas extremas ofrecidas por el guión, aumentando los puntajes de las pruebas, con la consecuente probabilidad de generar sesgos en su constructo. La prueba de concordancia de guiones ha sido utilizada en diferentes profesiones de la salud como estrategia para el entrenamiento del RC, sin embargo, no existen estudios que validen su uso en la fonoaudiología, lo que exige el desarrollo de guiones atingentes a la profesión y la necesidad de determinar ciertas propiedades psicométricas de los mismos. El objetivo de esta investigación fue estimar la confiabilidad de un corpus de guiones clínicos diseñado para estudiantes de pregrado de fonoaudiología.Se ha observado que los métodos de evaluación que tradicionalmente se utilizan para la medición de competencias son limitados en lo concerniente a la valoración del RCInvestigación aprobada por el Comité de Ética Científico de la Universidad Santo Tomás, con código 153.20. Cada participante firmó un consentimiento informado para ingresar al proyecto.. La carrera intervenida contempla 4 áreas troncales, a saber: Comunicación y Lenguaje Infanto-Juvenil; Voz y Motricidad orofacial; Cognición y Comunicación en Adultos y Personas Mayores; Audiología y Vestibular, por lo que el n mínimo se proyectó en 40 fonoaudiólogos quienes fueron contactados a nivel nacional a través de la técnica de muestreo antes señalada, corroborando una experiencia profesional intermedia y con distribución de género coherente con el perfil profesional de los practicantes en el país.Estudio descriptivo de corte transversal. El universo estuvo conformado por profesionales que se desempeñaban en diversos ámbitos clínicos de la fonoaudiología y contaban con un título de fonoaudiólogo, otorgado por una Universidad chilena o extranjera. El muestreo se realizó por conveniencia siguiendo la estrategia de bola de nieve. Los criterios de inclusión fueron: contar con un mínimo de experiencia profesional de 3 años en el área disciplinar, disponer de grado de magíster o doctor y encontrarse habilitado como prestador individual en el Registro Nacional de la Superintendencia de Salud (SIS). Los criterios de exclusión fueron: desempeñarse preferentemente en labores de gestión o docencia (sin actividad clínica) y encontrarse actualmente inactivo en términos laborales debido a jubilación. El número necesario de expertos se seleccionó según la recomendación de la literatura para la validación de guiones clínicos, estimando la incorporación de al menos 10 profesionales por áreaEn términos procedimentales y para la creación del corpus, se convocó a 8 profesionales (2 por área) que redactaron los guiones para el entrenamiento y evaluación de RC en tareas de diagnóstico, estudio e intervención. Dichos expertos recibieron una capacitación sincrónica de 3 horas cronológicas, vía online, a través de la plataforma Microsoft Teams.La capacitación fue facilitada por un académico con grado de doctor en educación y experiencia aplicada en la metodología, específicamente para la formación médica en pre y posgrado. La instancia fue asesorada por dos fonoaudiólogos con experiencia clínica y académica, pertenecientes al programa de pregrado de origen. Se realizó una exposición teórica, seguida de un taller para la creación de scripts en salas virtuales según área o ámbito formativo. Posteriormente, los productos fueron socializados y retroalimentados por parte del facilitador con objeto de resolver cualquier duda procedimental o teórica, en relación con la confección de guiones. Cada profesional participante de la capacitación tuvo la responsabilidad de crear 10 scripts., en este caso: estudiantes que cursaron los semestres séptimo y octavo de la carrera de fonoaudiología, de la Universidad Santo Tomás, en las sedes Viña del Mar, Santiago y Puerto Montt, durante el año 2021. Para los fines de esta investigación los educandos no utilizaron los guiones, sin embargo, la caracterización de estos es importante dada su relevancia como destinatarios del producto final. La identificación de contenidos clave para el corpus se hizo a través del análisis de resultados de aprendizaje (RA) de programas de asignaturas que tributaban a las cuatro áreas previamente declaradas.Siguiendo la metodología informada por la literatura, se determinó la población que utilizaría los guiones clínicosSe creó un corpus de 80 scripts, organizado en las cuatro áreas formativas, es decir, 20 por área. Los guiones de cada área se organizaron como sigue: 8 guiones de diagnóstico, 2 de estudio y 10 de intervención.Una vez generados los guiones en el formato establecido, se sometieron a revisión por parte del equipo investigador conformado por dos fonoaudiólogos con grado de magíster, experiencia en docencia e innovación educativa, en conjunto al experto con grado de doctor proveniente del área de formación médica, con objeto de homogeneizar los textos y adaptar estos a los fines del estudio.Para la respuesta y validación de los guiones clínicos , cada profesional fonoaudiólogo recibió un cuadernillo con instrucciones y debió responder en un plazo máximo de 2 semanas según su área de expertis. la consistencia interna se estimó a partir del coeficiente α de Cronbach y la confiabilidad inter observador se calculó con el coeficiente Kappa de Fleiss considerando un nivel de significancia p<0.05. Para controlar variables confundentes se estratificaron las respuestas por área, tipo de script y tipo de respuesta. Se eliminó del corpus aquellos guiones incompletos o que presentaran frecuencias de respuesta muy bajas según el método de outliers.Las respuestas de los fonoaudiólogos fueron tabuladas en Microsoft Excel y con fines descriptivos se determinó la frecuencia de respuesta por script para luego calcular la puntuación, puntaje transformado y puntaje final según la metodología reportada previamente. Las variables cuantitativas fueron resumidas mediante medidas de tendencia central y dispersión considerando un IC del 95%. De acuerdo con la recomendación de la literaturaEl análisis estadístico se realizó en el Stata Statistical Software: Release 15. College Station, TX: StataCorp LLC.software.Un total de 41 fonoaudiólogos dio respuesta a los cuadernillos entregados por área, con una edad mínima de 28 años y máxima de 61. En cuanto a la distribución según género, se observó un 78% del femenino en el ámbito de comunicación y lenguaje infanto juvenil y un 60% del masculino en voz y motricidad orofacial. El 98% de los informantes contó con grado académico de magíster y el 2% con doctorado. El promedio de experiencia profesional se registró en un rango de 10.6 a 17.2 años .Los puntajes finales agregados y estratificados por área y tipo de script dan cuenta de tendencias de respuesta coherentes entre los profesionales . Se evidLa consistencia interna del corpus fue α= 0.67. Al analizar por área y tipo de Script, se observó una confiabilidad baja (α=0.60-0.70) para los ítems diagnósticos en las cuatro áreas, así como para los guiones de intervención en el caso de Cognición y Comunicación en adultos y personas mayores. Cabe destacar que en el caso del área Audiología y Vestibular para los guiones de estudio, se registró una confiabilidad insuficiente (α=0.34). Por otra parte, los Scripts de igual tipo en las áreas restantes, mostraron una confiabilidad aceptable (α=0.80-0.90) .Se estimó el acuerdo entre evaluadores en κ= 0.29 (aceptable) para el corpus. Al estratificar según las variables de área y tipo de script, se observó una concordancia leve en las áreas de Voz y Motricidad Orofacial (κ= 0.07), Cognición y Comunicación en Adultos y Personas Mayores (κ= 0.08). El resto de los ítems presentaron un acuerdo aceptable (κ>0.20 y <0.41) y moderado, para los guiones de diagnóstico en Audiología y Vestibular (κ= 0.45) .. A la fecha se han reportado experiencias de implementación de la prueba de concordancia de guiones en carreras como medicina y enfermería, entre otras. Los resultados de este este estudio dan cuenta de una variabilidad en el juicio de los expertos por área .El uso de scripts implica ciertos desafíos cuando se piensa en su diseño, construcción e implementación, puntualmente en lo referido a validez de los corpus, al manejo de los bajos puntajes y la asociación de los resultados con otras técnicas de evaluación. En este sentido y para fines prácticos, como se informa en la metodología, se eliminaron del corpus todos los scripts que presentaron respuestas incompletas y a aquellos que no contaron con acuerdos dominantes, es decir una frecuencia considerablemente baja por parte de los expertos. De esta forma se constata que el dossier creado cuenta con propiedades que lo vuelven funcional para evaluar las habilidades de RC en estudiantes de fonoaudiología, tal como la evidencia lo destaca en otras áreas de la salud.La consistencia en las respuestas de los expertos de los guiones en general resulta aceptable más allá del azar  con exce. En esta línea, si bien el puntaje global de confiabilidad resultó bajo, es importante destacar que se mantuvo en el análisis el resultado de confiabilidad pobre (α= 0.34), para el caso de los scripts de estudio en el área audiología y vestibular, lo que afectó el cálculo final sobre el dossier por una parte, pero evitó el sesgo confirmatorio. Con todo, la discrepancia entre los expertos es aceptable, considerando que el instrumento validado no corresponde a un instrumento diagnóstico.Una limitación de este estudio es la variabilidad en el hacer y juicio profesional, lo que se expresa como dispersión en las tendencias de respuesta por parte de los expertos en determinadas áreas , H, J e .En relación con el tamaño muestral, es importante advertir que se consideró la recomendación de la literatura, por lo que si bien se puede proyectar ampliar el número de expertos por ámbito, esta investigación se apegó a lo sugerido por investigaciones previas.Como proyección resulta interesante incorporar una validación de contenido del dossier, más allá de la adscripción a los resultados de aprendizaje de los programas de asignatura, así mismo sumar una segunda instancia evaluativa para determinar la consistencia de las respuestas intraevaluador, incrementar el número de script por tipo, y aumentar el número de validadores. Así mismo resultará fundamental el determinar el impacto y asociación de la incorporación de esta estrategia con respecto al progreso de los estudiantes más allá de la toma de decisiones clínicas en escenarios con elevada incertidumbreEl corpus creado presentó una confiabilidad global baja, sin embargo, la estratificación por área y tipo de script ofrece un panorama heterogéneo, donde es posible distinguir aquellos ítems donde se obtuvo mayor o menor correlación, según la tarea de razonamiento clínico presentada. Adicionalmente, el acuerdo interevaluador resultó aceptable para todo el dossier. La determinación de propiedades psicométricas de scripts en el contexto de la prueba de concordancia de guiones es una primera aproximación formal a la generación de una herramienta pedagógica innovadora para el entrenamiento y la evaluación auténtica de RC en estudiantes del pregrado de la carrera de Fonoaudiología. Es necesario incrementar la investigación e innovación educativa en este ámbito, con objeto de ofrecer instrumentos formativos pertinentes, que estén basados en la evidencia científica disponible y cuenten con validación para mejorar el desarrollo, seguimiento y evaluación de competencias profesionales en estudiantes de carreras de la salud, ya en instancias preclínicas y/o en etapas formativas tempranas, complementando las estrategias, instrumentos y herramientas ya establecidos en los currículums. La estrategia desarrollada es transferible, pero debe ajustarse a los marcos curriculares de cada casa de estudio en cuanto a contenidos y resultados de aprendizaje.