Cultura organizacional y clima: el aprendizaje situado en las residencias médicas.

Organizational culture and climate: situated learning in the Medical residencies
Alicia Hamui-Suttona, Tania Vives-Varelab, Samuel Gutiérrez-Barretoa, Senyasen Castro-Ramíreza, Carlos Lavalle-Montalvoc, Melchor Sánchez-Mendiolad

a Departamento de Investigación Educativa, División de Estudios de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, México D.F., México
b Coordinación de Investigación, Departamento de Informática Biomédica, Facultad de Medicina, Universidad Nacional Autónoma de México, México D.F., México
c Subdivisión de Especializaciones Médicas, División de Estudios de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, México D.F., México
d Secretaría de Educación Médica, Facultad de Medicina, Universidad Nacional Autónoma de México, México D.F., México

Recepción 26 de septiembre de 2013; aceptación 13 de enero de 2014

Palabras Clave

Cultura institucional; clima educativo; médico residente; incidente crítico; México.

Keywords

Organizational culture; educational climate; medical resident; climate critical incident; Mexico.

Abstract

Introduction: Culture and climate are issues that shape interactions, beliefs systems, ways of making, values and perceptions of what is happening in the organizational context in which medical residents work. The study of these areas allows you to delve into the subculture of residents and recognize what facilitates or restricts their learning.

Objective: Analyze through testimonies of residents on critical incidents (CI), aspects of organizational culture and climate of the sub-culture that foster or limit learning.

Method: Qualitative and interpretative study whose sample considered testimonies of critical incidents from 135 residents enrolled in the Plan Único de Especializaciones Médicas (PUEM) of the Faculty of Medicine at the UNAM, in the academic cycle (March 2012-February 2013), from four core specialties: Internal Medicine, Surgery, Pediatrics and Gyneco- bstetrics at a private hospital (36.3%) and a public one (63.7%) in Mexico City.

Results: For the residents of the public hospital prevailing hierarchies in the clinical context had positive effect on the efficiency of medical care, although there were references of abuse of power, negative mentions alluded to a lack of resources. In the private hospital, the patient safety excelled in the stories.

Discussion: The construction of a shared vision acted as support for the culture of the group, the values and standards allowed the response to uncertainty in a CI to be more effective, also strengthened institutional culture and favored learning. Some of the differences in the organizational culture among the public hospital and the private were the availability of material resources, coordination between the specialty services, and autonomy in decisionmaking, which had different effects on residents learning opportunities.

Conclusions: Institutional culture was present in the climate of the subgroup and was expressed in the described IC. The particularities in the learning of both hospitals were evident, especially in the coordinated response of the services and the degree of autonomy in decision-making.