array:23 [ "pii" => "S217357351830036X" "issn" => "21735735" "doi" => "10.1016/j.otoeng.2017.04.004" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "803" "copyright" => "Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Acta Otorrinolaringol Esp. 2018;69:187-200" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 291 "formatos" => array:3 [ "EPUB" => 39 "HTML" => 180 "PDF" => 72 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001651917301267" "issn" => "00016519" "doi" => "10.1016/j.otorri.2017.04.001" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "803" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Acta Otorrinolaringol Esp. 2018;69:187-200" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 384 "formatos" => array:3 [ "EPUB" => 25 "HTML" => 296 "PDF" => 63 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ARTÍCULO ORIGINAL</span>" "titulo" => "Evaluación de la capacidad formativa del libro del residente de Otorrinolaringología español (FORMIR) como portafolio electrónico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "187" "paginaFinal" => "200" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Evaluation of the training capacity of the Spanish Resident Book of Otolaryngology (FORMIR) as an electronic portfolio" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:2 [ 0 => array:1 [ "imagen" => "gr3a.jpeg" ] 1 => array:1 [ "imagen" => "gr3b.jpeg" ] ] "descripcion" => array:1 [ "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A) Formación y aprendizaje de los MIR de ORL en España. Cuestionario estructurado y entrevista semiestructurada sobre el conocimiento de los residentes acerca de su formación y metodología del aprendizaje. B) Formación y aprendizaje de los MIR de ORL en España. Herramientas de evaluación. Cuestionario estructurado y entrevista semiestructurada sobre el conocimiento de los residentes acerca de su formación y metodología del aprendizaje.</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">DT: desviación típica; LR: libro del residente; P25: percentil 25; P50: percentil 50; P75: percentil 75; x: media aritmética; SEORL: Sociedad Española de Otorrinolaringología.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Manuel Maza Solano, Gustavo Benavente Bermudo, Francisco José Estrada Molina, Jesús Ambrosiani Fernández, Serafín Sánchez Gómez" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Juan Manuel" "apellidos" => "Maza Solano" ] 1 => array:2 [ "nombre" => "Gustavo" "apellidos" => "Benavente Bermudo" ] 2 => array:2 [ "nombre" => "Francisco José" "apellidos" => "Estrada Molina" ] 3 => array:2 [ "nombre" => "Jesús" "apellidos" => "Ambrosiani Fernández" ] 4 => array:2 [ "nombre" => "Serafín" "apellidos" => "Sánchez Gómez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S217357351830036X" "doi" => "10.1016/j.otoeng.2017.04.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357351830036X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651917301267?idApp=UINPBA00004N" "url" => "/00016519/0000006900000004/v1_201807050425/S0001651917301267/v1_201807050425/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173573518300346" "issn" => "21735735" "doi" => "10.1016/j.otoeng.2017.06.014" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "817" "copyright" => "Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Acta Otorrinolaringol Esp. 2018;69:201-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 349 "formatos" => array:3 [ "EPUB" => 25 "HTML" => 243 "PDF" => 81 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Efficacy of Particle Repositioning Manoeuvres in Benign Positional Paroxysmal Vertigo: A Revision of 176 Cases Treated in a Tertiary Care Centre" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "201" "paginaFinal" => "207" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eficacia de las maniobras de reposicionamiento canalicular en el vértigo posicional paroxístico benigno: revisión de 176 casos tratados en un centro hospitalario de tercer nivel" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1328 "Ancho" => 1610 "Tamanyo" => 73738 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Lempert (or “barbeque”) manoeuvre: the affected left ear (black). 1. In the first movement the patient is in a lateral decubitus position towards the affected side. 2. The body is then rotated 90° towards the right. 3. The body is then rotated 180° towards the right. 4. Lastly the body is rotated 270° towards the right, so that the patient is face down. 5. The next step is to turn the body 360° towards the right, with the patient being in the original position.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Claudio Carnevale, Diego J. Arancibia-Tagle, Elena Rizzo-Riera, Guillermo Til-Perez, Pedro L. Sarría-Echegaray, Julio J. Rama-Lopez, Santiago Quer-Canut, German Fermin-Gamero, Manuel D. Tomas-Barberan" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Claudio" "apellidos" => "Carnevale" ] 1 => array:2 [ "nombre" => "Diego J." "apellidos" => "Arancibia-Tagle" ] 2 => array:2 [ "nombre" => "Elena" "apellidos" => "Rizzo-Riera" ] 3 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Til-Perez" ] 4 => array:2 [ "nombre" => "Pedro L." "apellidos" => "Sarría-Echegaray" ] 5 => array:2 [ "nombre" => "Julio J." "apellidos" => "Rama-Lopez" ] 6 => array:2 [ "nombre" => "Santiago" "apellidos" => "Quer-Canut" ] 7 => array:2 [ "nombre" => "German" "apellidos" => "Fermin-Gamero" ] 8 => array:2 [ "nombre" => "Manuel D." "apellidos" => "Tomas-Barberan" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001651917301565" "doi" => "10.1016/j.otorri.2017.06.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651917301565?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573518300346?idApp=UINPBA00004N" "url" => "/21735735/0000006900000004/v1_201807220439/S2173573518300346/v1_201807220439/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Evaluation of the Training Capacity of the Spanish Resident Book of Otolaryngology (FORMIR) as an Electronic Portfolio" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "187" "paginaFinal" => "200" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Juan Manuel Maza Solano, Gustavo Benavente Bermudo, Francisco José Estrada Molina, Jesús Ambrosiani Fernández, Serafín Sánchez Gómez" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Juan Manuel" "apellidos" => "Maza Solano" "email" => array:1 [ 0 => "juan.maza.solano@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Gustavo" "apellidos" => "Benavente Bermudo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Francisco José" "apellidos" => "Estrada Molina" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Jesús" "apellidos" => "Ambrosiani Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Serafín" "apellidos" => "Sánchez Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Anatomía, Universidad de Sevilla, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación de la capacidad formativa del libro del residente de Otorrinolaringología español (FORMIR) como portafolio electrónico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:2 [ 0 => array:1 [ "imagen" => "gr4a.jpeg" ] 1 => array:1 [ "imagen" => "gr4b.jpeg" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">(A) Training and knowledge of the ENT residents in Spain. Distribution by percentages (%) according to the scores from each response and their accumulated percentages (%a): 1 (completely disagree), 2 (do not agree much), 3 (neutral or intermediate response), 4 (quite agree) and 5 (completely agree). (B) Training and knowledge of the ENT residents in Spain. Assessment tools. Structured questionnaire and semi-structured interview on the residents’ knowledge about his or her training and learning methodology. Distribution by percentages (%) according to the scores from each response and their accumulated percentages (%a): 1 (completely disagree), 2 (do not agree much), 3 (neutral or intermediate response), 4 (quite agree) and 5 (completely agree).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The medical specialisation model in Spain is based the residents’ system of learning within an employment context. Access is through a national exam and the ranking of scores obtained allows the candidate to choose their speciality and hospital in centres which have been authorised by the Ministry of Health and which are submitted to periodic audits. The National Commission of Otorhinolaryngology designed a programme which was obligatory for all otorhinolaryngology (ENT) training centres with the theoretical and practical objectives to be attained by the ENT residents. The lack of a final exam for certification as a specialist results in a “tea bag”<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> learning model where the quality of training is supported by the centre's accreditation and the resident's activities. In 2008 the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-<span class="elsevierStyleSmallCaps">CCC) (for its initials in Spanish</span>) carried out a study on the teaching capacity of 65 centres accredited for ENT teaching, and detected broad variations with regards to the infrastructure, activity and results of the ENT residents.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> This study was also able to determine with precision what the appropriate numeric requirements for the different training activities were.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The most advanced teaching methods have advanced from the simple acquisition of knowledge to the demonstration of competence, defined as the regular and judicious use in daily clinical practice of communication, knowledge, technical skills, clinical reasoning, emotions, values and reflection for the benefit of the patients and society as a whole.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4,5</span></a> Following the publication of <span class="elsevierStyleItalic">Tomorrow's Doctor</span> in 1993, medical education began its transition from a system based on time and processes to a learning environment based on competence.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> The process required valid and accurate assessment tools.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> The previous training book of ENT residents was in paper format<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> and functioned like a logbook, simply recording the execution of the residents’ activities. Spanish ENT residents were required to acquire similar skills during their period of specialised training regardless of the teaching centre. For this reason, the residents’ training book was designed to combine in a single tool both the recording and assessment of skills recommended by institutions such as the Accreditation Council for Graduate Medical Education (ACGME),<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> European Union of Medical Specialists (UEMS)<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> and the National Programme, in addition to the actual scientific and technical skills of the speciality. The methodology of a portfolio is appropriate for assessing professional competence through several areas of competences and for achieving the highest level of the Miller pyramid<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> as an assessment tool. Electronic portfolios are gradually replacing those based on paper, although the incorporation of technological tools into educational practices does not guarantee that an improvement in learning occurs and sometimes does not even reinforce the dominant models already established in teaching and learning.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> One of the strengths of electronic portfolios should be the external feedback the resident receives on their work. The majority of electronic portfolios currently in use offer limited feedback which is mainly focused on the assessment of generic skills and which does not provide quantification of progress. A recent study on medical education of ENT specialists showed that the portfolios were not integrated into the training programmes, were rarely used and only a minority of residents considered they had enhanced their training.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Given the above-mentioned situation, there was a need to examine the ENT resident's view of their own training, to gain an understanding of what their knowledge of the objectives of the different programmes were, their knowledge of new teaching methods and the training tools available to them. The aim of our study was to assess the proposal for a new ENT residents’ training book in electronic portfolio format to be used by all ENT residents, where summative and formative objects could coexist.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> The new residents’ training book (FORMIR) would encourage learning through self-assessment and the planning of skills which the ENT residents would be capable of planning and executing within a personalised and individual education managed by them themselves, with personal reflection combined with that of their mentors.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">The electronic portfolio was designed in accordance with a competence management model. The skills the future ENT specialist must acquire and demonstrate through their learning (knowledge, abilities and approach) were identified from the following sources: (a) official programme of the ENT speciality (8th May 2007); (b) the logbook of the UEMS and (c) that of the ACGME.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A retrospective, multimodal, temporal, transversal qualitative research study was carried out which comprised a structured questionnaire (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B) based on a Likert 5 point scale of graded responses to questions: (1) completely disagree, (2) do not agree much, (3) neutral or intermediate score, (4) quite agree and (5) completely agree, and a semi-structured interview. All ENT services were included in the study, of the Spanish National Health System hospitals with accredited teaching capacity for the training of ENT residents between 2009 and 2012. The total number of hospitals included in the study was 63 and the total number of residents was 182.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">For the descriptive study of the variables a frequency study was performed with percentage distribution measurements and their accumulated values. Software available in Excel was used for this, and a data processing procedure was performed using contingencies tables for the information recorded in FORMIR with respect to whether this was or was not obtained from the resident responses in the survey. Comparison of statistical measurements of centrality and dispersion (mode, median, arithmetic mean, standard deviation and percentiles) the <span class="elsevierStyleItalic">χ</span><span class="elsevierStyleSup">2</span> test was applied and in those cases where it was necessary, the exact Fisher test.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The triangulation technique was used for questionnaire validation. The interview followed the same structure as the questionnaire, with probing particularly in the points designed as free fields in the survey, aimed at validating the questionnaire and better explaining the results which were unclear, in the light of the absences of previous experiences in this field. After validation of the questionnaire during the II Nasosinus Endoscopic Surgery Course in the Hospital Universitario Virgen Macarena in Seville during the month of March 2011 with the residents who attended, the questionnaire was handed out for completion to the ENT residents who had attended the III Nasosinus Endoscopic Surgery Course celebrated in March 2012 and in the V Temporal Bone Dissection Course celebrated in the same hospital. The interview was conducted with the respondents of the questionnaire from these meetings. During the second phase, the questionnaire was sent for completion by electronic mail to the remainder of the ENT residents who formed part of the members of the ENT service staff, according to the SEORL-CCC databases. In several cases it was necessary to send the questionnaire using the regular postal service. To improve questionnaire validity and avoid a high number of losses from the study, 4 waves were made so that on 4 occasions the questionnaire was resent to respondents who had not responded. Both the questionnaire respondents and the interviewees expressly authorised the use of the content for research purposes, in compliance with that stipulated in law 15/1999 of 13th December, on personal data protection.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Of the 182 residents registered in the SEORL-CCC and distributed among 63 hospitals, 103 participated in the study (56.5%) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The hospitals with the most participative residents in the study were the Hospital Gregorio Marañón in Madrid with 7 residents, the Hospital Virgen Macarena in Seville with 7, the Hospital Santa Creu i Sant Pau de Barcelona with 6, the Hospital Central de Asturias in Oviedo with 6 residents and the Hospital de Puerto Real with 6 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The number of residents who participated in the study who used FORMIR compared with the total registered in the SEORL was 57 (31.3%). Furthermore, of the 103 residents who participated in the study and were registered in the electronic portfolio, a total of 46 (44.7%) used it on a regular basis. Regional distribution of participates was similar to hospital distribution, with participation from the following provinces being outstanding: Madrid, Barcelona, Valencia and Seville (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">ENT residents in Spain are highly confident that the learning objectives are well defined in the National ENT programme (section 1.1. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A), regardless of whether the residents use the electronic portfolio or not, with a mean score of 4.42 out of 5 (from now onwards this will be referred to as <span class="elsevierStyleItalic">x</span>=4.42). The residents considered that learning these objectives was established in a multidisciplinary manner and although they emphasised the figure of the teaching tutor as most important, they also included the head of service, the resident him or herself and the residents who were in their final years of training. It was particular noteworthy that the residents who used FORMIR were better able to self-guide their own objectives (<span class="elsevierStyleItalic">x</span>=4.13) compared with those who had not registered in the portfolio (<span class="elsevierStyleItalic">x</span>=3.53) (section 1.4. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). The level of knowledge regarding theoretical, practical and relational knowledge that the ENT residents should have acquired during their training period was higher for theoretical and relational objectives among the residents who used FORMIR compared with those who had not (section 3. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). Furthermore, the residents were aware of the possibilities offered by the hospitals where they trained, but were not so much aware of the opportunities offered by the National Healthcare system (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). In both cases, the results were similar among residents who used the electronic portfolio and those who did not. In the Spanish services the theoretical–practical programme was partially complied with by the National ENT Commission (section 3.1. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A), but in those services where the residents had registered in FORMIR, compliance of the programme was more complete, since within the group of residents who did not use FORMIR, only 34.6% gave a score of 4 or more points in the questionnaire, whilst 87.8% of those who used the platform gave a score of ≥4 points (section 3.1. <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>A). Among the causes referred to by the residents regarding learning difficulties were lack of materials, or devices which hindered them from doing some type of activity (<span class="elsevierStyleItalic">x</span>=3.75), the fact that their training services and hospitals did not carry out several procedures (or they only learned from what they had done) (<span class="elsevierStyleItalic">x</span>=3.97) and the existing staff pressures (<span class="elsevierStyleItalic">x</span>=4.18) (section 4. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). Also, the residents registered in FORMIR were more critical of some of the training deficiencies being due to the lack of attention by their tutors (sections 4.4. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A and 4.4. <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>A), compared with the residents who did not use the said portfolio (<span class="elsevierStyleItalic">x</span>=2.69). The residents had little detailed comparative information about the training their Spanish and foreign peers received (section 5. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). In this context, they indicated that the little information obtained came from the colleagues who had finalised their period of residence (sections 5.6. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A and 5.6. <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>A) and from contact with other residents in courses and congresses (especially in the National SEORL-CCC Congress) (section 5.7. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). In contrast, the official sources and organisms did not provide data on the overall level of learning of the residents (<span class="elsevierStyleItalic">x</span>=1.65) (sections 5.5. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A and 5.5. <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>A). The figure of the tutor as the facilitator of learning and his methodology was much more important to the residents, on comparing this with contributions to this effect that both the Ministry of Health and the ENT services exercised on specialised training of residents (section 6. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). The Spanish residents’ training book in paper format was not highly appreciated by the residents themselves or by their tutors (<span class="elsevierStyleItalic">x</span>=1.81) due to the limitations in recording evidence (<span class="elsevierStyleItalic">x</span>=2.44), in revising learning progress (<span class="elsevierStyleItalic">x</span>=2.15), in showing work to others (<span class="elsevierStyleItalic">x</span>=2.2) or in taking official exams or being presented for work interviews (<span class="elsevierStyleItalic">x</span>=2.91). The book in paper format scored more poorly in general terms among residents who had used FORMIR (section 7. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B). Furthermore, the ENT residents, whether or not they had used the portfolio, considered that the residents’ training book in paper format was inappropriate for justification of their knowledge as an ENT on the European Board, and this was reflected in up to 73.1% of residents interviewed who gave this option a score of 2 points or less out of a 5 point maximum (section 7.4. <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>B).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The ENT residents in Spain were not aware of the existence of other recording systems which were different from the residents’ training book created in other teaching services, hospitals and abroad (section 8. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B). The residents indicated that they were mostly interested in the options which improved the residents’ training book in paper format, provided that some use was made of this (<span class="elsevierStyleItalic">x</span>=4.22), whether or not they were obligatory (<span class="elsevierStyleItalic">x</span>=3.36) (section 9. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B). 85.7% of the group of residents who had registered in FORMIR considered that they had used a portfolio adapted to their needs with a score equal or above 4 points, unlike those who were not recorded in the portfolio (section 9.4. <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>B). Over 80% of the residents interviewed were aware of the portfolio (section 10. <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>B), but we were unable to establish precisely which was the most used route of dissemination. None of the routes outshone any others, neither SEORL-CCC, nor tutors, nor communications or publications of FORMIR, nor diffusion among residents (section 10. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B). The residents registered in FORMIR used it initially occasionally, but later stopped doing so (section 11.3. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B). Comments of the ENT residents indicated that the main reason for abandoning use was not finding the necessary support from their tutors for validation of the activities. Other residents considered that they stopped using it to dedicate the time it consumed to other activities, since FORMIR is not an obligatory assessment tool. In general, the residents proposed that FORMIR should be the new ENT residents’ training book (86.5% of scores equal to or higher than 3 out of a total score of 5 on the Likert scale) (section 12.8. <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>B), since it would help them to reach their learning goals even if their tutors were not involved in their learning process (<span class="elsevierStyleItalic">x</span>=3.41) (section 12.7. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B). Those who used them did not consider that they took up too much of their time in completing them, but they proposed that they be obligatory to achieve a more extended usage (section 12.5. <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>B).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Qualitative methodology from data analysis<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> was considered an appropriate tool for examining the perception of the ENT residents on the extension and depth of postgraduate medical learning, because its contribution and approach seeks out elements which can ead to answers and explanations regarding the events that surrounded and are approached by the resident that are unable to be measured in any explicit, quantitative way. Thus, by observation, induction-deduction and conceptualisation of what had been perceived, judgements and criteria could be established. Furthermore, with this type of qualitative research, use was made of a representative and numerical distribution which is just another way of codifying data and giving it a value for improving its objectivity.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> In this sense, in the light of this research the questionnaire response rate (56.5%) was considered sufficient because the knowledge of Spanish residents’ behaviour regarding assessment and learning was new and because the use of the FORMIR electronic portfolio among Spanish ENT residents is not currently obligatory.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The resident trained in Spain is currently regarded as a national and international specialist,<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> but the results of the study by Suárez et al.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> put forward enough uncertainties to consider it likely that this complacency hides a much less satisfactory reality. ENT resident training in Spain has traditionally been an externally guided process using the available infrastructure and structure. The actual training process has often been executed thanks to the willingness and motivation of the residents themselves and their tutors rather than through actions which were decided and planned in teaching units. The willingness of many tutors has simultaneously been the driving force and the hindrance to a more actively programmed ENT training and above all, uniform throughout the nation. The efforts of the SEORL-CCC for discovering the current state of the accredited teaching units for specialised ENT training has led to the availability of valuable information for the establishment of realistic objectives to learning, guided in a practical manner for the assessment of basic and excellent levels of competency.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The responses of the residents in specialised training follow a defined demographic pattern. Most residents who participated in the study are concentrated in Spanish autonomous communities with high population rates, where the hospitals with the most residents are trained each year: Madrid, Catalonia, Andalusia and Valencia. These hospitals generally have the minimum accreditation criteria for specialised training<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> and these residents are therefore considered to have a more advantageous situation for learning than those who are trained in units which do not provide enough criteria for sufficient accreditation.</p><p id="par0070" class="elsevierStylePara elsevierViewall">A central component of competence-based medical education (CBME) is to have an environment with a maximum level aimed at teaching and learning where the most important competences are addressed.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> CBME has been criticised for being reductionist, i.e. for focusing on atomistic skills and failing to capture the essence of professional activities appreciable through complex and integrated abilities. However, the complex skills are constructed from essential, vital skills and this is supported by the theory and exams present in the learning sciences.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> Effective performance of the aforesaid is refined and integrated by components using repetition of the execution of the skill within a real context, whilst feedback is provided. The CBME does not propose specific methods for learning skills.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> Motivation learned and its skills for self-regulation would also have an impact on its commitment with the learning process which results in the integration of knowledge and skills in more complex competences. By definition CBME, requires a solid, multifaceted assessment system, based on criteria, aimed at development, carried out in work environments if possible which use tools and methods which are both quantitative and qualitative.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> Being an expert, rather than merely competent, is the ultimate goal.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Complacency shown by ENT residents with the quality of their training from Spanish teaching units is consistent with a Spanish resident system which does not use formal and objective assessment of the levels of teaching objective achievement required by the official programme of the specialty,<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> and is limited to very general subjective assessments from the Ministry of Health assessment records.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> This complacency contrasts with the high awareness they show regarding the number and complexity of these teaching objectives and, above all, the doubtful capacity of their teaching units, given their human resources, materials and activity, to offer them the opportunity to achieve all their aims. The ENT residents adapt perfectly to the new requirements of the andragogy and are actively willing to be self-guided in their learning when training tools and support from their tutors permits this. The higher the training capacity offered by the teaching unit, the greater the residents’ willingness to use new teaching tools, even when they are not obligatory, and to be more demanding in fully completing their educational programme.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">For the first time in the history of Spanish ENT training FORMIR provides structured, planned and organised management of competences linked to the CBME model. Explicit, accessible, comprehensive, complete and nationally consistent training is carried out throughout Spain. The feedback provided by FORMIR shows the residents their progress and points out which gaps need to be covered. This focus has a direct impact on educational equity by the use of a global base for all Spanish ENT residents. FORMIR consolidates summative and reflexive aspects of learning for the ENT residents in a single software application in Internet so that they have a new tool for reflection on their learning and for the development of attitudes. This had been lacking up until now. The versatility of FORMIR means that it acts simultaneously as a logbook and as a portfolio of reflection. It is also able to certify evidence and produce a curriculum vitae with validation by the teaching tutor from evidence provided by the resident. FORMIR converts unwieldy paper into a totally computerised web environment thanks to the electronic hyperlinks which have replaced files full of papers that are difficult to order and index. Information management in web-based portfolios is more user-friendly and encouraging for the residents and the tutors, and is more able to combine tests in an orderly manner, than paper format, although content quality level remain similar.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The use of the reflexive portfolio and its usefulness for self-perception among ENT residents is very low in most countries.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> Many articles refer to contradictory results regarding portfolio use, without clearly demonstrating that the effects obtained or measurable are due to portfolio usage. It is possible that the portfolios may improve learning more in some medical specialities than in others. Variations in teaching models, tutorials, national or local requirements of learning, certifications and rubrics may also explain the differences. Despite this, the Spanish ENT residents are grateful that the skills they need to acquire are established as are their levels of success.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> This applies not only to technical and scientific skills but also skills involving reflection and in particular when local resources do not offer sufficient tutoring or it is unsatisfactory in this regard. If the portfolios are not formally assessed, their usage drops.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> Tests show that a well-informed tutor may be a critical factor for portfolio acceptance and may have an influence on the degree of their usefulness, especially when specific periodical information is provided, but sustained use of the portfolio long-term is not guaranteed. The national and innovative scope of FORMIR fills in the gaps where tutoring is not sufficient, as automatic feedback is provided on completing activities.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Several references appear to generate tension between balancing reliability and validity of portfolio assessment regarding learning. The FORMIR method of electronic portfolio assessment may still be considered a transition between the “tea-bag” learning model and assessment of competence. Today's academic system is immature, as is the infrastructure or the training for true assessment of competence (level IV of Miller's pyramid). However, the design of an assessment method based on activity completion and achievements gained is a major step forward in learning. Quantification of student participation in required activities, without being a measure of procedures instead of skill assessment, establishes the bases for the next step, avoids quantification of work and focuses on acquired skills.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The voluntary nature of the portfolio is an essential defining trait which directly affects the user attitude, acceptance and the amount of time they are willing to spend on it. There is evidence that users may be simultaneously irritated by the use of a portfolio and also positive about it on discovering its potential when using it on an individual basis.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> The advantage of FORMIR is that it can combine formative and summative assessments in a single tool for the ENT resident and in doing so make it their preferred option to replace the current, obsolete paper format book. Its electronic format offers assessment at all levels of Miller's pyramid and its mass acceptance<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> is based on the fact it improves any other current assessment tool due to its simple and intuitive interface, the ease and convenience of recording activities, its numerical and automatic feedback when activities are recorded and display of how many competences have been acquired and how many have yet to be acquired Also its storage capacity, the little time it takes to fill in activities and its capacity to provide visualisation in the logbook format of the UEMS, as well as in the format of a curriculum vitae.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0100" class="elsevierStylePara elsevierViewall">ENT residents were greatly appreciative of the training offered by the FORMIR electronic web portfolio which had been made available by SEORL-CCC, and in particular its simple and intuitive interface, the ease and convenience of recording their activities, the numerical and automatic feedback when they recorded their activities and which showed them how many skills they had acquired and how many and which ones remained to be acquired. Also its storage capacity, the little time it took to fill in their activities and its capacity to provide visualisation in the logbook format of the UEMS, as well as in the format of a curriculum vitae. FORMIR ‘s capacity to include reflections of the residents on their own learning enabled tutors to carry out formative assessment to complete the summative assessment provided by the automatic feedback algorithms. All these characteristics make FOMIR a training and assessment tool which outperformed the offer and acceptance of other similar tools made available to the residents of other healthcare specialties. Moreover, all levels of the Miller pyramid may be assessed, so that the ENT residents did not hesitate to propose it as the ideal residents’ training book for specialised training and would use it regularly if it became obligatory. Lastly, the pilot study revealed that it was being used voluntarily by many residents and was useful as a learning tool in a wide CBME context, which is equitative for all ENT residents.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of Interests</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1063358" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1011595" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1063359" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1011594" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of Interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-03-11" "fechaAceptado" => "2017-04-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1011595" "palabras" => array:6 [ 0 => "Medical education" 1 => "Clinical competence" 2 => "Otolaryngology" 3 => "Internship and residency" 4 => "Outcome and process assessment (health care)" 5 => "Programme evaluation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1011594" "palabras" => array:6 [ 0 => "Educación médica" 1 => "Competencia clínica" 2 => "Otorrinolaringología" 3 => "Médico interno residente" 4 => "Resultados y evaluación en salud" 5 => "Programa de evaluación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">and objectives We have evaluated the training capacity of the Spanish resident training book as an electronic portfolio to achieve the learning objectives of otorhinolaryngology (ENT) residents.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A multi-method qualitative investigation with transversal characteristics, temporal and retrospective guidance was performed on Spanish ENT residents using a structured questionnaire, a semi-structured interview, and a computer application on the FORMIR website.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A 56.5% of ENT-residents specialising in one of the 63 accredited Spanish hospitals between 2009 and 2012 participated in the study. The results obtained show that the ENT residents who used the e-portfolio were better able to implement self-guided study, were more aware of their learning objectives, fulfilled the training programme more efficiently, identified the causes of learning gaps more clearly, and considered FORMIR in e-portfolio format to be an ideal training tool to replace the resident training book in paper format.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The ENT residents greatly appreciated the training benefits of FORMIR as an e-portfolio, especially its simple and intuitive interface, the ease and comfort with which they could record their activities, the automatic and numeric feedback on the acquisition of their competencies (which facilitates self-guided learning), its storage capacity for evidence, and its ability to be used as UEMS logbook as well as a standard curriculum vitae. All these features make FORMIR a training and evaluation tool that outperforms similar instruments available to ENT residents. They do not hesitate to identify it as the ideal resident training book for facilitating their specialised training.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar la capacidad formativa del libro del residente español como portafolio electrónico para alcanzar los objetivos de aprendizaje de los MIR de Otorrinolaringología (ORL).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realizó una investigación cualitativa multimétodo de características tranversal, temporal y de orientación retrospectiva sobre los MIR de ORL mediante un cuestionario estructurado y una entrevista semiestructurada, sobre la aplicación informática web FORMIR.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Participaron el 56,5% de los MIR de ORL de alguno de los 63 hospitales españoles acreditados para impartir formación en ORL entre 2009 y 2012. Los resultados obtenidos demostraron que los MIR de ORL que utilizaban el portafolio electrónico eran capaces de autoguiar mejor su aprendizaje, conocían mejor sus objetivos de aprendizaje, cumplían más eficientemente el programa de formación, identificaban más claramente las causas de sus carencias en el aprendizaje y consideraban que FORMIR como portafolio electrónico constituía una herramienta formativa idónea para sustituir al libro del residente en formato papel.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los MIR de ORL apreciaban de forma muy relevante las prestaciones formativas de FORMIR como portafolio electrónico, especialmente su interfaz, el <span class="elsevierStyleItalic">feedback</span> numérico y automático sobre la adquisición de competencias, su capacidad de almacenamiento de evidencias y su capacidad de visualizarse como <span class="elsevierStyleItalic">logbook</span> de la Unión Europea de Médicos Especialistas o como un <span class="elsevierStyleItalic">curriculum vitae</span> estándar. Este <span class="elsevierStyleItalic">feedback</span> automático facilita el aprendizaje autoguiado. Todo esto hace de FORMIR una herramienta formativa y evaluativa que supera las prestaciones y aceptación de instrumentos similares puestos a disposición de los residentes, que no dudan en proponerlo como el libro del residente más idóneo para facilitar su formación especializada.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Maza Solano JM, Benavente Bermudo G, Estrada Molina FJ, Ambrosiani Fernández J, Sánchez Gómez S. Evaluación de la capacidad formativa del libro del residente de Otorrinolaringología español (FORMIR) como portafolio electrónico. Acta Otorrinolaringol Esp. 2018;69:187–200.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:2 [ 0 => array:1 [ "imagen" => "gr1a.jpeg" ] 1 => array:1 [ "imagen" => "gr1b.jpeg" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Training and knowledge of the ENT residents in Spain. Assessment tools. Structured questionnaire and semi-structured interview on the residents’ knowledge about his or her training and learning methodology.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3649 "Ancho" => 3098 "Tamanyo" => 1769397 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribution by hospitals and provinces of the residents registered in the Spanish Society of Otorhinolaryngology (SEORL) and in FORMIR between years 2009 and 2012.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:2 [ 0 => array:1 [ "imagen" => "gr3a.jpeg" ] 1 => array:1 [ "imagen" => "gr3b.jpeg" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">(A) Training and knowledge of the ENT residents in (A) Structured questionnaire and semi-structured interview on the residents’ knowledge about his or her training and learning methodology. (B) Training and knowledge of the ENT residents in Spain. Assessment tools. Structured questionnaire and semi-structured interview on the residents’ knowledge about his or her training and learning methodology. SD: standard deviation; RM: residents’ training book; P25: percentile 25; P50: percentile 50; P75: percentile 75; <span class="elsevierStyleItalic">x</span>: arithmetic mean; SEORL: Spanish Society of Otorhinolaryngology (from its initials in Spanish).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:2 [ 0 => array:1 [ "imagen" => "gr4a.jpeg" ] 1 => array:1 [ "imagen" => "gr4b.jpeg" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">(A) Training and knowledge of the ENT residents in Spain. 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Evaluation of the Training Capacity of the Spanish Resident Book of Otolaryngology (FORMIR) as an Electronic Portfolio
Evaluación de la capacidad formativa del libro del residente de Otorrinolaringología español (FORMIR) como portafolio electrónico