Opinion Article
New Information Technologies in Dermatology Education: Dermaconsulta—a Virtual Patient Tool
Nuevas tecnologías de la información en la enseñanza de la dermatología: dermaconsulta. El paciente dermatológico virtual
Read
5254
Timeswas read the article
2037
Total PDF
3217
Total HTML
Share statistics
array:23 [ "pii" => "S1578219015002796" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.10.017" "estado" => "S300" "fechaPublicacion" => "2015-12-01" "aid" => "1246" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2015" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2015;106:781-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 827 "formatos" => array:3 [ "EPUB" => 35 "HTML" => 447 "PDF" => 345 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731015003506" "issn" => "00017310" "doi" => "10.1016/j.ad.2015.08.004" "estado" => "S300" "fechaPublicacion" => "2015-12-01" "aid" => "1246" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2015;106:781-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 507 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 254 "PDF" => 251 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artículo de opinión</span>" "titulo" => "Nuevas tecnologías de la información en la enseñanza de la dermatología: dermaconsulta. El paciente dermatológico virtual" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "781" "paginaFinal" => "784" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "New Information Technologies in Dermatology Education: Dermaconsulta—a Virtual Patient Tool" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1037 "Ancho" => 1950 "Tamanyo" => 193311 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Ejemplo de la segunda fase del PDV. El alumno ha llegado a la conclusión de la necesidad de un tratamiento quirúrgico con la técnica de Mohs. El enlace le acerca al vídeo donde se explica cómo se realiza.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Guerra-Tapia, R. Segura-Rodríguez, E. González-Guerra" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Guerra-Tapia" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Segura-Rodríguez" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "González-Guerra" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219015002796" "doi" => "10.1016/j.adengl.2015.10.017" "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/S1578219015002796?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015003506?idApp=UINPBA000044" "url" => "/00017310/0000010600000010/v1_201512080105/S0001731015003506/v1_201512080105/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219015002802" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.10.018" "estado" => "S300" "fechaPublicacion" => "2015-12-01" "aid" => "1249" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Actas Dermosifiliogr. 2015;106:785-94" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2617 "formatos" => array:3 [ "EPUB" => 50 "HTML" => 1620 "PDF" => 947 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Calcinosis Cutis and Calciphylaxis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "785" "paginaFinal" => "794" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Calcinosis cutis y calcifilaxis" ] ] "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" => 727 "Ancho" => 995 "Tamanyo" => 156030 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Histopathology of calciphylaxis. Biopsy showing calcification of the medial layer of the vessels of the subcutaneous cell tissue (hematoxylin and eosin ×<span class="elsevierStyleHsp" style=""></span>200) (courtesy of Dr. Natalia Navas García).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Jiménez-Gallo, L. Ossorio-García, M. Linares-Barrios" "autores" => array:3 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Jiménez-Gallo" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Ossorio-García" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Linares-Barrios" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015003750" "doi" => "10.1016/j.ad.2015.09.001" "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/S0001731015003750?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015002802?idApp=UINPBA000044" "url" => "/15782190/0000010600000010/v1_201512060022/S1578219015002802/v1_201512060022/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Opinion Article</span>" "titulo" => "New Information Technologies in Dermatology Education: Dermaconsulta—a Virtual Patient Tool" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "781" "paginaFinal" => "784" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Guerra-Tapia, R. Segura-Rodríguez, E. González-Guerra" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Guerra-Tapia" "email" => array:1 [ 0 => "auroraguerratapia@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" => "R." "apellidos" => "Segura-Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "González-Guerra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Veterinaria Redactora de Textos y Contenidos Científicos, Universidad Complutense de Madrid, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nuevas tecnologías de la información en la enseñanza de la dermatología: dermaconsulta. El paciente dermatológico virtual" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 955 "Ancho" => 1950 "Tamanyo" => 250314 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Example of the first stage of the virtual digital patient. Clinical image that the student must visually examine in order to establish a diagnosis. The photograph is accompanied by a link to a lesson on elementary clinical lesions, which provides theoretical knowledge that leads to the practical answer.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">“To build tall towers, you have to spend a lot of time on the foundations.” (Anton Bruckner, 1824-1896)</p></span></p><p id="par0010" class="elsevierStylePara elsevierViewall">Learning is an arduous task for medical students. From the moment they choose a major until the day they graduate, they must complete multiple levels of study by harmoniously combining the scientific fundamentals, their own skills in the art of medicine, and the humanistic attitudes and values that illuminate the doctor-patient relationship and imbue it with meaning. After a few years, just when they begin to perceive relationships between the pathologic processes covered in the various subjects and discover areas of overlap that simplify their studies, along comes dermatology, a new subject where nearly everything is unfamiliar: the introductory material, the interpretation of clinical signs, the therapeutics, etc. Therefore, many medical degree programs have recently cut back on the number of dermatology credits, leaving less time for both theoretical and practical training in this specialty.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Faced with these obvious difficulties, students who plan to follow other career paths may see little need for knowledge of dermatology and may be tempted to approach their training in this specialty with only superficial interest. To do so, however, would be a serious mistake. Dermatology is essential to the proper practice of any doctor. Many skin diseases are extremely frequent; others are associated with systemic diseases of different organs and systems, and many arise as side effects of various treatments. It could almost be said, therefore, that a specialist in any branch of medicine could benefit from a good education in dermatology.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Secure in this conviction, many university faculty—including ourselves—wish to improve our performance as educators by findings ways to get closer to our students, not only to transmit knowledge but also to help our students acquire knowledge efficiently. Faculty must teach students to learn, and students must learn to learn.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Theoretical content is easily accessible: university libraries have made books, monographs, journals, online academic publications, and even lectures—often reviled but necessary—available to everyone. However, clinical practice—i.e. contact between students and patients—tends to be lacking for various reasons, including a lack of time on the part of faculty who teach practical classes, the complexity of university hospital infrastructure in terms of space, and other logistical concerns.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Against this backdrop, in 2011 a group of educators from the Faculty of Medicine, Pharmacy and Veterinary Science at the Complutense University of Madrid (UCM) developed the first stage of Dermaconsulta, a new virtual learning tool for an undergraduate dermatology subject. We submitted the tool to the university's Projects for Innovation and Improvement of Teaching Quality in the Health Sciences initiative during the 2011-2012 academic year and received a high score. In 2015-2016, the project was approved<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> for the fourth time with a score that, together with other merits, prompted the UCM to award its Diploma of Teaching Excellence to the project's director.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Dermaconsulta uses an innovative computer-based educational format based on the virtual patient (VP) model, which we define<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> as an interactive computer simulation of real-life clinical scenarios designed for the purpose of medical training, education, and/or evaluation—in this case, dermatology training with a virtual dermatology patient (VDP).</p><p id="par0040" class="elsevierStylePara elsevierViewall">According to Bearman's classification,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Dermaconsulta is a VP with a “problem-solving” structure: students are presented with a raw, unfiltered medical history and must decide what information is relevant and what is not in order to establish a diagnosis. The first stage is linear. The student is shown images of lesions and is asked to identify them (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). On the basis of the observed lesions and the medical history, the student must decide whether to order additional tests or establish a definitive clinical diagnosis. Finally, after collecting all the information, the student advances to the second stage, which has a branching structure. The student must learn to establish the correct treatment and adapt it to the specific circumstances of the case (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The student is presented with various options, some correct and others incorrect. On the basis of clarifications revealed progressively in the VDP interface as the decision-making process advances, the student must determine the most appropriate medical or surgical treatment. Students who choose a correct path progress from one screen to the next, advancing towards the conclusion in a logical sequence. If an incorrect path is chosen, the student receives an explanation as to why the choice was incorrect and is taken back to the previous screen; this process repeats itself until the student gives the expected answer. The software is preloaded with explanations of each possible decision, allowing students to learn/discover and/or clarify their knowledge. In short, it is for good reason that Dermaconsulta is considered a self-directed learning tool.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Doctors tailor their clinical approach to each patient and to the real-life context of each consultation. Our VDP therefore eschews the notion that there is a single right or wrong answer. Instead, as in real life, it admits various solutions and paths—except when it comes to establishing a diagnosis and identifying lesions (in those cases, only 1 correct answer is accepted).</p><p id="par0050" class="elsevierStylePara elsevierViewall">With this format, the VDP ran the risk of becoming a game of chance in which students could advance by trial and error without ever acquiring the necessary theoretical knowledge. Our teaching group found it very challenging to blend theoretical knowledge with practical exploration—a combination more typical of residency training. With the aim of achieving both objectives, we considered various alternatives. We ultimately decided that the VDP also needed to be a tool for teaching theory using the Socratic method: we would act as midwives, guiding students in their theoretical discovery/learning<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> of new diseases (constructive learning). As the students advance in the resolution of a particular clinical situation, they gain access to new diseases indicated clearly in the subject syllabus.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In addition to the explanatory information included in each node of the VDP's clinical process—which supports the student in making a reasoned and adequate choice regarding which steps to take in a specific medical situation—we included a “return trip”: lessons on specific curricular topics, divided into sections coinciding with the clinical nodes, designed to help students assimilate the curriculum's theoretical concepts and practical training.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In short, our VDP is built on virtual real-life clinical cases that also allow students to acquire theoretical knowledge of the subject.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Dermaconsulta is a computer tool developed in, and forming part of, the UCM virtual campus.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> It was created and published using a custom-designed open-source software program that follows the international interoperability standards supported by the learning management systems used in the UCM curriculum—specifically, Moodle, the most recent versions of which contain improvements that facilitate self-, peer-, and hetero-assessment. Moodle is a free web-based virtual learning environment and course-management system that helps educators create online learning communities. Technology platforms of this sort are also known as learning content management systems. Moodle 2.9 is the most recent version.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Dermaconsulta has allowed us to provide our dermatology students with a real and safe environment in which to learn and practice on dermatology cases, and to assess their knowledge and abilities as many times as they feel is necessary. In short, it is a venue for learning, studying, and evaluating. For faculty, it is also a tool for monitoring students: it allows the professor to document the students’ progress through the curricular objectives of the dermatology subject and to identify areas in which classroom instruction should be improved or modified.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Our students responded well to the tool and gave it positive evaluations in the anonymous, voluntary feedback survey that is distributed in all editions of the program.</p><p id="par0080" class="elsevierStylePara elsevierViewall">As part of our Project for Innovation and Improvement of Teaching Quality in the Health Sciences, we also created an element designed to motivate students: a virtual journal entitled <span class="elsevierStyleItalic">Principios en Dermatología</span> (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The title conveys the notion that the journal contains the basics of dermatology—in other words, the first content that students must master (<span class="elsevierStyleItalic">principios</span> means both “principles” and “beginnings”). This annual publication is open only to students who are enrolled at the Hospital Universitario Doce de Octubre and registered with Moodle. Student-authored presentations are published in the journal after being presented orally and discussed at seminars in the dermatology subject. We have been pleasantly surprised to see the enthusiastic effort that our students have put into their often interesting contributions to the journal.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Our work group is convinced that dermatology training requires an interactive setting that can sustain educational processes and facilitate alternatives that allow students to have contact with patients. The social implications of insufficient dermatology training—from the dramatic repercussions of disregarding malignant lesions that can be fatal if not treated in time to the unnecessary morbidity and social cost associated with superfluous treatment of benign lesions—are obvious and well documented.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">It is also evident, however, that students spend too little time face-to-face with real patients, and that neither medical school curricula nor the management of student training facilities are currently in a position to correct this deficiency. Moreover, assessment of learning outcomes is usually limited, and the professor's feedback for students is often too little, too late.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Like Prober and Heath,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> we have no doubt that it is “time to change the way we educate doctors.”</p><p id="par0100" class="elsevierStylePara elsevierViewall">In this context, we believe that the VDP is a good tool for the acquisition and development of clinical and dermatologic reasoning, as well as for student self-assessment. We also believe that it reinforces the development of students’ reflective capacities, and that it can be used in faculties of medicine at other universities. This tool represents yet another step towards the excellence in teaching to which all professors should aspire.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Guerra-Tapia A, Segura-Rodríguez R, González-Guerra E. Nuevas tecnologías de la información en la enseñanza de la dermatología: dermaconsulta. El paciente dermatológico virtual. Actas Dermosifiliogr. 2015;106:781–784.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 955 "Ancho" => 1950 "Tamanyo" => 250314 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Example of the first stage of the virtual digital patient. Clinical image that the student must visually examine in order to establish a diagnosis. The photograph is accompanied by a link to a lesson on elementary clinical lesions, which provides theoretical knowledge that leads to the practical answer.</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" => 1037 "Ancho" => 1950 "Tamanyo" => 194452 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Example of the second stage of the virtual digital patient. The student has concluded that treatment with Mohs surgery is necessary. The link leads to a video that explains how Mohs surgery is performed.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 927 "Ancho" => 1500 "Tamanyo" => 210210 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Title page of the first issue of the journal <span class="elsevierStyleItalic">Principios en Dermatología</span>, accessed from the virtual campus of the Complutense University of Madrid.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A new pathway in teaching dermatology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Mühlstädt" 1 => "P. Thomas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1610-0387.2010.07434.x" "Revista" => array:5 [ "tituloSerie" => "J Dermatol Dtsch Ges" "fecha" => "2010" "volumen" => "8" "paginaInicial" => "490" "paginaFinal" => "494" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "E-prints Complutense. Universidad Complutense de Madrid, <a href="http://eprints.ucm.es/28331/">http://eprints.ucm.es/28331/</a> [accessed 06.06.15]." ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Random comparison of ‘virtual patient’ models in the context of teaching clinical communication skills" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Bearman" 1 => "B. Cesnik" 2 => "M. Liddell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Educ" "fecha" => "2001" "volumen" => "35" "paginaInicial" => "824" "paginaFinal" => "832" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11555219" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of virtual patients in medical school curricula" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Cendan" 1 => "B. Lok" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1152/advan.00054.2011" "Revista" => array:6 [ "tituloSerie" => "Adv Physiol Educ" "fecha" => "2012" "volumen" => "36" "paginaInicial" => "48" "paginaFinal" => "53" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22383412" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of medical students’ proficiency in dermatology: Are medical students adequately prepared to diagnose and treat common dermatologic conditions in the United States?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.A. Ulman" 1 => "S.B. Binder" 2 => "N.J. Borges" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3352/jeehp.2015.12.18" "Revista" => array:5 [ "tituloSerie" => "J Educ Eval Health Prof" "fecha" => "2015" "volumen" => "12" "paginaInicial" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25989840" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lecture halls without lectures—A proposal for medical education" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.G. Prober" 1 => "C. Heath" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMp1202451" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2012" "volumen" => "366" "paginaInicial" => "1657" "paginaFinal" => "1659" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22551125" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000010/v1_201512060022/S1578219015002796/v1_201512060022/en/main.assets" "Apartado" => array:4 [ "identificador" => "6152" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Opinion Article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010600000010/v1_201512060022/S1578219015002796/v1_201512060022/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015002796?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 8 | 16 |
| 2024 October | 66 | 38 | 104 |
| 2024 September | 79 | 30 | 109 |
| 2024 August | 110 | 64 | 174 |
| 2024 July | 76 | 34 | 110 |
| 2024 June | 98 | 28 | 126 |
| 2024 May | 69 | 26 | 95 |
| 2024 April | 84 | 32 | 116 |
| 2024 March | 90 | 44 | 134 |
| 2024 February | 60 | 32 | 92 |
| 2024 January | 55 | 33 | 88 |
| 2023 December | 62 | 14 | 76 |
| 2023 November | 88 | 27 | 115 |
| 2023 October | 66 | 20 | 86 |
| 2023 September | 77 | 23 | 100 |
| 2023 August | 64 | 17 | 81 |
| 2023 July | 52 | 34 | 86 |
| 2023 June | 59 | 23 | 82 |
| 2023 May | 56 | 27 | 83 |
| 2023 April | 51 | 27 | 78 |
| 2023 March | 65 | 34 | 99 |
| 2023 February | 67 | 26 | 93 |
| 2023 January | 52 | 26 | 78 |
| 2022 December | 57 | 45 | 102 |
| 2022 November | 33 | 36 | 69 |
| 2022 October | 27 | 19 | 46 |
| 2022 September | 21 | 40 | 61 |
| 2022 August | 21 | 41 | 62 |
| 2022 July | 26 | 41 | 67 |
| 2022 June | 28 | 41 | 69 |
| 2022 May | 32 | 41 | 73 |
| 2022 April | 76 | 36 | 112 |
| 2022 March | 101 | 42 | 143 |
| 2022 February | 50 | 25 | 75 |
| 2022 January | 62 | 40 | 102 |
| 2021 December | 19 | 34 | 53 |
| 2021 November | 36 | 38 | 74 |
| 2021 October | 30 | 45 | 75 |
| 2021 September | 22 | 41 | 63 |
| 2021 August | 26 | 26 | 52 |
| 2021 July | 16 | 36 | 52 |
| 2021 June | 30 | 18 | 48 |
| 2021 May | 38 | 22 | 60 |
| 2021 April | 39 | 77 | 116 |
| 2021 March | 43 | 19 | 62 |
| 2021 February | 56 | 21 | 77 |
| 2021 January | 40 | 18 | 58 |
| 2020 December | 42 | 10 | 52 |
| 2020 November | 32 | 24 | 56 |
| 2020 October | 22 | 11 | 33 |
| 2020 September | 33 | 14 | 47 |
| 2020 August | 25 | 27 | 52 |
| 2020 July | 20 | 14 | 34 |
| 2020 June | 47 | 25 | 72 |
| 2020 May | 20 | 17 | 37 |
| 2020 April | 19 | 24 | 43 |
| 2020 March | 25 | 17 | 42 |
| 2020 February | 3 | 1 | 4 |
| 2020 January | 4 | 2 | 6 |
| 2019 December | 4 | 2 | 6 |
| 2019 November | 4 | 4 | 8 |
| 2019 October | 0 | 1 | 1 |
| 2019 September | 0 | 1 | 1 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 5 | 9 |
| 2019 June | 4 | 3 | 7 |
| 2019 May | 5 | 24 | 29 |
| 2019 April | 9 | 1 | 10 |
| 2019 March | 2 | 4 | 6 |
| 2019 January | 3 | 0 | 3 |
| 2018 December | 1 | 0 | 1 |
| 2018 November | 5 | 0 | 5 |
| 2018 October | 4 | 0 | 4 |
| 2018 September | 3 | 0 | 3 |
| 2018 April | 0 | 3 | 3 |
| 2018 February | 16 | 3 | 19 |
| 2018 January | 22 | 4 | 26 |
| 2017 December | 29 | 9 | 38 |
| 2017 November | 23 | 10 | 33 |
| 2017 October | 19 | 6 | 25 |
| 2017 September | 19 | 34 | 53 |
| 2017 August | 24 | 31 | 55 |
| 2017 July | 19 | 23 | 42 |
| 2017 June | 23 | 15 | 38 |
| 2017 May | 27 | 10 | 37 |
| 2017 April | 26 | 20 | 46 |
| 2017 March | 17 | 28 | 45 |
| 2017 February | 15 | 12 | 27 |
| 2017 January | 15 | 7 | 22 |
| 2016 December | 29 | 14 | 43 |
| 2016 November | 34 | 17 | 51 |
| 2016 October | 26 | 23 | 49 |
| 2016 September | 0 | 6 | 6 |
| 2016 August | 0 | 1 | 1 |
| 2016 July | 3 | 1 | 4 |
| 2016 June | 4 | 1 | 5 |
| 2016 May | 0 | 13 | 13 |
| 2016 March | 0 | 1 | 1 |
| 2016 February | 0 | 3 | 3 |
| 2016 January | 0 | 2 | 2 |
Show all
