In a few years, I imagine a completely regionalized program with universal reach

DR. GERARDO ALBERTO ÁLVAREZ ESCALANTE

Medical Specialist in Pediatrics at Petróleos Mexicanos

Dr. Gerardo Alberto Álvarez Escalante is a pediatrician in Villahermosa, capital of the southern state of Tabasco, Mexico. The specialist considers Practicum Script to be a valuable tool to implement clinical reasoning and predicts an exponential growth of its use within the health care practice. This could greatly benefit Mexico, which has a rate of adverse events of around 10.5% of the hospitalizations.

Madrid, June 11, 2018. “Continuing medical development requires internationalized platforms where information, research, and technology enable us to improve clinical reasoning; this will translate into higher health indices around the world.” These are the words of Dr. Gerardo Alberto Álvarez Escalante, a Mexican pediatrician graduated from the National Autonomous University of Mexico with almost twenty years of experience and user of the Practicum Script simulator. The specialist points out that the Pediatrics program that he currently studies, with more than 70% of coincident hypotheses and scenarios, “goes out of the traditional formats and brings us cases close to the everyday clinical practice.” In addition, “having real cases enriches the experience and foster analytical thinking and a humanistic feeling.”

For Dr. Álvarez, who is part of the medical service of Petróleos Mexicanos (PEMEX) as a pediatrician since 2001, in a globalized world, the cross-border vocation of Practicum Script plays in its favor. In this regard, he believes that the program has evolved at a high rate and “in a few years, I imagine a program completely regionalized and, at the same time, with a higher propagation worldwide.” He explains: “Regionalized with professors and advisors from different parts of the world who understand the pathology and the available resources for the medical practice; and with a worldwide reach, encompassing each country in different languages.” He is not wrong about that: currently, Practicum Script is offered in Spanish, English, and Portuguese, and is present in Spain, Portugal, Great Britain, and a good part of the countries in Latin America, including Mexico, Peru, Ecuador, Colombia, Brazil and Argentina, in addition to six other countries in Central America.

In his opinion, “Five years ago the cases were very restricted to the nomenclature of the Iberian Peninsula and today we can see the opening to other realities, since the scenarios are, for the most part, cosmopolite and with room for debate and revision of hypotheses among peers and before a panel of experts.” He, who is also the coordinator of the outpatient clinic at PEMEX's first-level clinic and in charge of pediatric hospitalizations at the homologous regional hospital since this year, is convinced that Practicum Script has stimulated his healthcare practice, “including with regard to residents in training.” As an adjunct professor at the Regional Hospital of Petróleos Mexicanos, in the capital of Tabasco, Dr. Álvarez says that he adopted the method of elaborating hypotheses to achieve a precise diagnosis and treatment of the patients he cares for.

Local note
“I believe that the traditional medical teaching of memorization has been left behind in a historical context, and I also believe that hypothetical-deductive thinking fits perfectly into our practical application,” points Dr. Álvarez. Specifically, he practices in Villahermosa, capital of the southern state of Tabasco and an energy exponent of the country for its wealth of hydrocarbons. “Here we count with the most resources and technologies in health and a second-level hospital, although we have some third-level pediatric subspecialties such as neonatology and pediatric surgery, allergology, hematology, nephrology, and infectology.” Therefore, “we are a reference center and receive patients from the southern and southeastearn regions of the country; we see many tropical diseases such as dengue, zika, malaria and chikungunya, and we have a high rate of allergic and hemato-oncological diseases, trauma, surgical pathology, and nephritis.”

During the time of his pediatrics training in Practicum Script, Dr. Álvarez claims to have perceived “progress towards practicality.” He feels, perhaps, more secure and confident in making decisions, more supported by the scientific evidence he reads and by the thinking skills in which he has been training. In a country that registers an adverse event rate of around 10.5%, this issue isn’t trivial. In 2009, the Ibero-American Study of Adverse Events (IBEAS) estimated at this average the rate of adverse events in five Latin American countries, including Mexico, and the National Medical Arbitration Commission registers more than fifteen thousand annual complaints, mainly in relation to diagnosis, doctor-patient relationship and medical-surgical treatment.

The IBEAS project, a result of collaboration between the World Health Organization, the Pan American Health Organization, the Ministry of Health and Social Policy of Spain and the Ministries of Health and institutions of Argentina, Colombia, Costa Rica, Mexico, and Peru, announced that “in order to advance in patient safety, it is necessary to implement mechanisms that allow the identification of human errors and system failures, developing policies that affect the preventive and non-punitive nature of adverse effects identification, as well as through the development of risk management and the inclusion of appropriate technology to detect problems and implement solutions.“ In turn, Dr. Álvarez bets on Practicum Script.