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To implement the ability to question different hypotheses is to simplify the path to the final diagnosis

DR. MARIA LAURA MINGO

Cardiologist in private practice in Salta (Argentina)

Maria Laura Mingo is a cardiologist in Salta (Argentina). She has been a physician since 2011 and a professor since 2013. Dr. Mingo emphasizes the value of Practicum Script as a collaborative learning network and a vast forum for debate and reflection. She likes to quote the French physiologist Claude Bernard and mentions that “those who do not know what they are looking for will not understand what they find.” Also according to her, “to develop the mental ability to question different hypotheses and request different complementary tests helps and simplifies the path to the final diagnosis.” She also believes that the fact that we "know that [Practicum] is a simulator brings a bit of tranquility."

Cardiovascular health is a significant problem. What is the situation in Argentina? And how does it translate to your care practice?

In Argentina, the increasing prevalence of risk factors continues to concern. The latest survey regarding risk factors, from 2013, showed the following active indices in this regard:

  • Smoking has decreased (25.1% vs. 27.1% in 2009), but we are one of the countries with the highest consumption [of cigarettes].
  • Hypertension has remained stable (34.1% vs. 35.5% in 2009) but is one of the highest rates in Latin America.
  • Overweight and obesity have increased significantly (57.9% vs. 53.4% in 2009).
  • Diabetes has not shown substantial changes (9.8% vs. 9.6% in 2009), but the trend continues to increase.
  • Physical inactivity has increased (55.1 vs. 54.9% in 2009). Following the same line, according to a 2012 national school health survey, less than 20% of adolescents aged 13 to 15 years practice the recommended physical activity for their age.

Salta still has a long way to go regarding cardiovascular prevention, despite the changes that are already evident in people’s behaviors.

Additionally, poor eating habits and sedentary lifestyle are increasing in children, which is worrisome.

What is the value of a virtual athenaeum like Practicum Script in this context?

Today, virtual athenaeums have a substantial value. Sometimes, we are unable to attend conferences, so the opportunity to take online courses makes learning much more accessible. Doctors must train continuously.

In Medicine, we know a lot of data and numbers, but little or sometimes nothing about the spaces between them. Do you think that Practicum Script helps to cover these gaps?

Specifically for this type of patients, Practicum has helped me. Following one’s reasoning, the inclination is first to try to think about the most common rationalization, which is why several cases had diagnostic probabilities that were not close to the definitive diagnoses. The truth is that implementing the mental ability to question different hypotheses and, with them, carry out different complementary tests, helps and simplifies the path towards a definitive diagnosis. "He who does not know what he is looking for will not understand what he finds." (Claude Bernard)

The value of this tool lies not only in maintaining the content current but also in improving thinking skills. Should we make more mistakes?

Professionals study a case a thousand times, especially the difficult or complicated ones, to see if everything was done right, consult colleagues, and try to do the best for the patient. However, like every human being, something can escape us or may go unstudied, and mistakes can happen while we know that the patients’ life and quality of life is in our hands. For this reason, knowing that we are working on a simulation, in which we can make mistakes and start over again, and that we can reflect on our clinical and diagnostic reasoning, brings a bit of tranquility. However, this does not mean that there is no concern or regret for not having thought on this or that pathology or not having requested the necessary tests in some of the cases presented. 

During the course, has any case been especially relevant to you? Which resource has been most useful? Would you change anything?

A case of arteritis was one of the most relevant [cases] for me because we don’t see this condition on a daily basis, so it is not in our minds as a primary diagnosis. I answered the case at the time and I realized that [this condition] should be taken into account from now on. 

I would change the subject of the hypotheses. There were many complaints concerning them because they had to be reviewed every time the proper word was not there. There were several cases in which my hypotheses were coincidental but were not considered a "coincidental hypothesis."

Testimonies

For me, the program is very interesting, since it allows me to sharpen my interrogation and direct it more towards a specific pathology and to have more knowledge of laboratory and cabinet exams. I think it is very important that we keep our medical sagacity throughout our practice and that in the few minutes it takes to answer any of the cases that Practicum Script presents, you acquire more knowledge.

Dr. Miguel Olivares Alcocer

Pediatrician in Guanajuato (Mexico)

I would like to express my gratitude to the Practicum Institute of Health Sciences Research for the opportunity given to Latin American physicians  to access and take different courses of our specialty for the benefit of our dear patients, in my case in Mexico. It has encouraged me to improve myself and keep abreast of the advances in Pediatrics and put into practice the knowledge acquired in the hospital where I work. Thanks friends and congratulations to this valuable team of Practicum Script Education.

Dr. Heriberto Fuentes García

Pediatrician in Sonora (Mexico)

I am grateful for this study tool that, through Nestlé and with this method, allows us to review different issues with cases that confront us in decision-making and serve us in the daily consultation.

Dr. Josué Refugio de León Padilla

Pediatrician in Jalisco (Mexico)

It is an excellent educational support platform for the pediatrician, offers very specific clinical challenges with alternatives for diagnosis and differential diagnoses, with the support of experts, a bibliography and a forum to share opinions. It's easy to navigate and it's fun, a tool that's worth using and making the most of it.

Dr. Guillermo Yanowsky-Reyes

Surgery Pediatrician in Guadalajara (Mexico)
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