Made available in DSpace on 2014-07-22T13:16:47Z (GMT). No. of bitstreams: 2 Leda Aquino.pdf: 1215972 bytes, checksum: d6849b437cbcdfb285c102b0f46a07ad (MD5) license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5) Previous issue date: 2011 / Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil. / Essa tese tem como objeto de estudo os entendimentos que médicos ao término de um Programa de Residência Médica demonstram ter acerca das características do ofício, da Semiologia Médica e do desenvolvimento do raciocínio clínico, tendo como ponto de partida o questionamento da compreensão do papel de narrativa na construção do conhecimento médico. O objetivo geral foi analisar e discutir as características da Medicina, da Semiologia Médica e do desenvolvimento do raciocínio clínico, e os específicos: 1) investigar qual a compreensão acerca do ofício médico e os principais atributos que o constituem; 2) identificar e debater o papel auferido à Semiologia e a partir dela o desenvolvimento do raciocínio clínico e, por fim, 3) analisar o lugar dado à narrativa na construção do conhecimento médico. Para tanto adotou-se uma abordagem qualitativa, utilizando-se entrevistas semi estruturadas baseadas num roteiro temático. A análise dos dados seguiu a análise de conteúdo, na modalidade temática, conjugada a um outro tipo de análise envolvendo processos de codificação aberta e fechada. Os resultados foram divididos em dois artigos. O primeiro expõe como os médicos centraram sua caracterização da Medicina, como uma ciência e uma arte, enfatizando a humanização, o cuidar e a integralidade como inerentes à profissão, assim como o dom, o sacerdócio e o pastorado como atributos essenciais ao exercício do ofício. O segundo aborda a importância e a compreensão da Semiologia Médica, assim como o desenvolvimento do raciocínio clínico, deixando claro como o conhecimento médico contém uma espistemologia narrativa sem, contudo, os médicos entrevistados possuírem consciência disso. Conclui-se que o ofício da Medicina está absolutamente imbricado à narratologia, porque o exercício da clínica, o ensino e a pesquisa estão marcadas com o contar, escutar ou criar histórias. É a competência narrativa que dá ao médico meios para compreender o paciente e a própria doença que o acomete, pois pensando narrativamente ordena os eventos no tempo e no espaço, que o leva a formular hipóteses diagnósticas e buscar a conduta terapêutica mais adequada. / This thesis’s object of study is the understanding that doctors who are finishing the Medical Residency Program demonstrate about professional attributes, Medical Semiology and management clinical reasoning, from questioning the comprehension about the importance of the narrative in the construction of the medical knowledge. The general objective was to analyze and discuss the particularities of medicine, Medical Semiology and development of clinical reasoning. The specific objectives are: i) investigate what is the comprehension of the medical practice and its main attributes; ii) identify and discuss the role given to the Semiology into the development of clinical reasoning and finally iii) analyze the place reserved to the narrative in the construction of medical knowledge. Therefore, it was adopted a qualitative approach, using interviews based on a thematic guide. The data analysis followed the content analysis, in the thematic modality, gathered with other kind of analysis involving open and closed codification processes. The results were divided in two articles. The first shows how doctors centered their characterization of medicine, as a science and an art, emphasizing the humanization, the care and the integrality as inherent to the profession, just as gift, priesthood and pastorate as essential attributes to the exercise of medical practice. The second article expresses the importance and the comprehension of the Medical Semiology, as well as the development of clinical reasoning, clearing out that the medical knowledge contains a narrative epistemology, without, however, the interviewed doctor’s having conscience of it. The conclusion is that the Medical profession is absolutely entangled to narratology, because the clinical exercise, the teaching and the research are marked with the telling, listening or creating stories. It’s the narrative competency that gives the doctor the means to comprehend the patient and the illness that affects him, because thinking narratively puts an order to the events in time and in space, which takes him to formulate differencial diagnosis and to seek the most accurate therapeutic conduct.

Submitted in fulfillment of the requirements for the Degree of Master of Health Sciences: Nursing, Duban University of Technology, Durban, South Africa, 2018. / Introduction: The shortage of skilled health professionals in public health care facilities is the main reason why compulsory community service was started by the South African government. The change in the disease pattern over the past two decades coupled with the mass exodus of health care professionals to overseas countries resulted in severe staff shortages especially in rural areas. Nursing community service practitioners (NCSPs) lack experience in dealing with complex clinical problems especially at primary health care level. They need experienced health professionals to offer clinical support to them. Aim of study: The aim of the study was to establish the degree of clinical support that is offered to NCSPs who are placed for compulsory community service within the Ugu district. Methodology: A qualitative study was conducted using an exploratory­ descriptive design. Purposive sampling was utilized to select eight NCSPs from a regional hospital and a community health centre. Semi-structured interviews were conducted and data was recorded verbatim for accurate analysis. Content analysis of data was employed where data was analyzed into meaningful themes. Results: The study revealed gaps in the clinical support offered to NCSPs. Lack of clinical support was reported more in the hospital than at the community health centre.·organizational problems such as lack of orientation, absence of in-service education and lack of proper rotation to different departments were some of the main concerns that were reported. Conclusion: Nursing community service practitioners need clinical support from experienced health professional to guide and teach them until they develop confidence. / M

Thesis (MTech (Emergency Medical Care))--Cape Peninsula University of Technology, 2016. / Background - As emergency medical care students approach the exit level of their four-year qualification, additional focus get placed on assessment of their ability provide patient care in the real world pre-hospital emergency care environment. Upon graduation, there is no opportunity for newly graduated emergency care practitioners to complete an internship programme. The assessment of clinical competence is therefore regarded as a critically important and invaluable activity within the academic unit. Academic staff within the Emergency Medical Care department at UJ recognised the need for the development of a standardised assessment instrument to purposefully assess pre-hospital clinical performance and developed an assessment instrument referred to as the University of Johannesburg Clinical Performance Assessment Instrument (UJ CPAI). Having developed the UJ CPAI it became necessary and important to scientifically investigate and evaluate the extent to which the CPAI (as a newly developed instrument) meets the requirements of what is considered to be a "good assessment instrument". For this reason investigation of the validity, reliability and end-user support for the implementation of the UJ CPAI became the central aim and focus of this study.

Introdução: O ser humano na sua condição social, precisa necessariamente da intervenção de outro ser nas suas funções. Na área da saúde, o profissional, vivencia situações e diante do acúmulo de informações recuperadas na Internet, necessita de um mediador que torne possível transformar essa informação em conhecimento. Nos últimos 20 anos, temos verificado um aumento gradativo e descontrolado na quantidade de documentos bibliográficos em todas as áreas do conhecimento, mas especialmente na biomédica. Objetivo: Considerando que a internet e a tecnologia da informação são amplamente disponíveis atualmente, alguns estudos sugerem que as bibliotecas e os bibliotecários podem vir a se tornar instituições obsoletas no cenário acadêmico. O objetivo do presente estudo foi analisar o perfil de usuários da biblioteca em nossa instituição, além de tentar verificar o papel da mediação informal desempenhada pelos bibliotecários neste contexto. Métodos: 570 usuários da Biblioteca da FMUSP, que visitaram nossa biblioteca no período de dezembro de 2012 a Abril de 2013, foram convidados a responder um breve questionário, sobre seus hábitos de busca de conhecimentos na literatura. O questionário foi mandado e respondido por e-mail. O perfil destes usuários foi analisado e a seguir, os participantes foram divididos em 2 grupos. Grupo 1 (n=190): receberam qualquer auxilio do bibliotecário durante suas buscas, grupo 2 (n= 52): acessaram a informação de maneira independente, sem a mediação do bibliotecário. Analisamos algumas características destes dois grupos. Resultados e conclusões: O presente estudo permitiu caracterizar que a maioria dos usuários que compareceu à biblioteca era do sexo feminino e que estão na faixa etária entre trinta e quarenta anos, sendo na maioria médicos jovens e estudantes de medicina, habituados a usar as bases de dados. A maioria recebeu algum tipo de mediação formal ou informal dos bibliotecários no acesso à informação. Sendo que este auxílio pode ter influenciado no uso de descritores em suas buscas. Com esta pesquisa, foi possível avaliar algumas das necessidades informacionais dos respondentes. Tais informações aliadas à extensa revisão da literatura podem ser úteis para balizar futuras intervenções dos profissionais da biblioteca para otimizar seu papel na mediação. Não foram observadas diferenças entre os grupos / Introduction: Human beings in their social condition necessarily need the intervention of another being in his duties. In healthcare, professional, experiences and situations before the accumulation of information retrieved on the Internet, you need a broker that makes it possible to transform this information into knowledge. Over the past 20 years, we have seen a gradual and uncontrolled increase in the amount of bibliographic documents in all areas of knowledge, but especially in biomedical. AIMS: Considering that the internet and the information technology are widely available nowadays, some studies suggest that libraries and librarians may become obsolete in the academic scenery. The purpose of the present study was to access the profile of library users in our institution, as well as to evaluate the need for mediation by the librarians in a Medical School. METHODS: 570 individuals that visited our library from December 2012 to April 2013 were invited to respond to a brief questionnaire addressing their habits when pursuing scientific information. The questionnaire was sent and responded by email. 419 participants were post graduate students and the others were physicians from our institution. The population was divided in two groups. Group 1 (n= 190): submitted to library training in searching information, group 2 (n= 52): accessed information by themselves without mediation. We analyzed the differences in behavior between those two groups. RESULTS AND CONCLUSIONS: The majority of individuals that used our library were, females, with a mean age of 39 years and most of them physicians or medical students. The great majority were frequent users and had personal experience in the library before. No differences in behavior were observed between groups in terms of frequency, data base, or use of key words. The present work has inumerous limitations, but may useful inhelping librarians improve their technique facing the new era of information

A formação do médico durante a graduação é um longo processo de aquisição de competências referentes ao domínio técnico, ético e relacional da profissão, que reafirmam valores históricos, e ganham contornos atuais no discurso da humanização das práticas de saúde. As diretrizes curriculares para o curso médico preconizam desenvolver habilidades de comunicação, valores éticos, e atitudes de sensibilidade e compreensão com o sofrimento alheio, pois se sabe que, na medicina, relações sem o legítimo interesse e preocupação com o outro comprometem a qualidade da própria realização técnica do ato médico. Entretanto, os estudos evidenciam grandes dificuldades nesse aspecto da humanização das práticas. Uma das causas dessa aridez afetiva e das dificuldades na relação com o paciente seria a formação centrada na aquisição de competência técnico-científica de forma tecnicista. Como contraponto, tentou-se incluir disciplinas de humanidades médicas nos currículos, o que tem se mostrado tarefa árdua. A difícil inclusão de temas humanísticos e desenvolvimento de competência ético-relacional nas escolas médicas fazem pensar que aspectos mais sutis na construção da identidade médica podem estar corroborando com tais fatos. A subjetividade contemporânea (valores, modelos, inscrições de significado), redimensionada na cultura médica, moldaria relações entre as pessoas no ambiente de ensino que dificultaria a experiência intersubjetiva, resultando em uma educação médica que ressalta a tecnologia e se abstém do seu potencial interativo. Com base nessa tese, nosso estudo buscou identificar as dimensões culturais mais importantes na construção das subjetividades contemporâneas no tocante à medicina e investigar o encontro intersubjetivo (professor-aluno, aluno-aluno, professor-professor) no contexto da formação médica. Pela abordagem qualitativa, buscamos interpretar-compreender como um conjunto mais amplo de aspectos da contemporaneidade, combinados na forma de três núcleos temáticos - o Eu, a Tecnologia e a Interatividade -, imprimiam-se no cotidiano de professores e de alunos em momentos diferentes do aprendizado. Percebemos que as dificuldades para a experiência intersubjetiva se manifestam e se reforçam nos processos interativos já durante a graduação. Comportamentos narcísicos, relações instrumentais, violência, e a baixa qualidade organizacional da gestão das práticas assistenciais sobressaem na análise dos dados. Concluímos, com base nesses resultados, que a formação humanística melhor se desenvolverá por meio de: 1. o aprimoramento das disciplinas de humanidades médicas; 2. a integração de sua temática com a prática clínica; 3. a conscientização dos professores quanto ao seu papel de modelo junto aos alunos e quanto à importância de saber trabalhar temas humanísticos em sua área de atuação; 4. a humanização dos serviços de saúde que participam do ensino médico; 5. e, essencialmente, por meio de um processo educacional que permita a aproximação da educação com a ética no viver institucional / The medical training during undergraduation is a long process of acquiring competences related to the technical, ethical and relational aspects of the profession, reaffirming historic values, and, in the present, the themes of the so called \"humanization of the health practices\". The curricular guidelines for medical school indicates the development of communication skills, ethical values and attitudes of sensitivity and understanding towards the suffering of others, because, it is known that in medicine, relationships without a legitimate interest and concern for others compromise the quality of the technical realization of the medical act. However, studies show great difficulties in this aspect of the humanization of practices. One of the causes of the resistance and emotional difficulties in the doctor-patient relation would be the training focused on the acquisition of technical and scientific competence in a technicist way. As a counterpoint, it has been tried to include humanities in the medical curriculum, not an easy task. The difficult in the inclusion of humanistic issues and development of ethical and relational competence in the medical schools suggests that there are possibly some more subtle aspects in the construction of medical identity corroborating these facts. The contemporary subjectivity (figures, models, meanings), reflected on the medical culture, would shape personal and professional relations in the educational environment in such a way that it would make difficult the intersubjective experiences, resulting in a medical education that emphasizes the technology and decreases the importance of the interactivity. Our purpose in this study was to identify the most important cultural dimensions in the construction of contemporary subjectivities in relation to medicine, and study the intersubjective meeting (teacher-student, student-student, teacher-teacher) in the context of the medical undergraduate. By the qualitative approach, we seek to understand or interpret some contemporary aspects united in three groups of themes - the Self, the Technology and the Interactivity - and their influence in the daily life of teachers and students at different moments of learning. It was felt that the difficulties in the intersubjective experience were manifested and reinforced in the interactive processes during undergraduation. Narcissistic behaviors, instrumental relationships, violence, and poor quality of organizational management of the care practices emerged in the data analysis. We concluded that the humanistic training could develop better by: 1. an improvement in medical humanities disciplines; 2. the integration of its program with clinical practice; 3. the awareness of teachers about being a model to the students and the importance of inserting humanistic issues in its own area of learning; 4. the humanization of health services that take part in medical education; 5. and, primarily, by an educational process that approaches ethics and education in the institutional environment.

Clinical performance assessment (CPA), which includes performance criteria, that define what students are expected to learn and practically demonstrate, is used to declare students competent by determining their level of skill. The purpose of this research was to explore student perceptions on the clinical assessment and how assessment contributed to enhancement of competency, and was driven by the question “How do oral hygiene students’ perceptions on clinical performance assessment (CPA) influence their learning experience?” A qualitative approach was followed, rooted in an interpretivist paradigm, using a case study design. The sample consisted of all 19 second-year oral hygiene students who wrote a narrative, and four of the 19 students with whom semi-structured interviews were held. Data was collected by asking the students to write the narratives, and after analysis thereof, the interviews were held. Data was analyzed throughout the data collection process, using a coding framework. The oral hygiene students understood that CPA tested their clinical skills as well as their theoretical knowledge, measures progression and improvement. They expressed negativity about the assessors' inconsistent use of performance criteria, inadequate feedback, and the unprofessional relationship of certain assessors with them. These issues led to frustration, confusion, and demotivation, and impacted negatively on students' learning and competency. Being humiliated in front of the patient or being shouted at led to demotivation. Students coped with assessment by adapting to what an assessor wanted, focusing on patient feedback, and just accepting the results. Students recommended that there be more feedback and discussion with the assessor about strengths and weaknesses. This was how they learned and became competent. They should be allowed to express an opinion and discuss issues with the assessor. / Dissertation (MEd)--University of Pretoria, 2008. / Curriculum Studies / unrestricted

Submitted by Kely Alves (kely.alves@unifenas.br) on 2018-07-31T16:56:35Z No. of bitstreams: 1 Dissertação Flávia Matos.pdf: 868333 bytes, checksum: 75207be4679ddfd22055131d0846333d (MD5) / Approved for entry into archive by Kely Alves (kely.alves@unifenas.br) on 2018-07-31T16:57:10Z (GMT) No. of bitstreams: 1 Dissertação Flávia Matos.pdf: 868333 bytes, checksum: 75207be4679ddfd22055131d0846333d (MD5) / Approved for entry into archive by Kely Alves (kely.alves@unifenas.br) on 2018-07-31T16:58:19Z (GMT) No. of bitstreams: 1 Dissertação Flávia Matos.pdf: 868333 bytes, checksum: 75207be4679ddfd22055131d0846333d (MD5) / Made available in DSpace on 2018-07-31T16:58:49Z (GMT). No. of bitstreams: 1 Dissertação Flávia Matos.pdf: 868333 bytes, checksum: 75207be4679ddfd22055131d0846333d (MD5) Previous issue date: 2018-02-26 / Although the objective structured clinical examination (OSCE) is considered golden standard for the assessment of clinical skills, the exam is both expensive and complex. On the other hand, structured oral examinations (SOE) have much simpler application and lower cost. Nonetheless, SOE may have lower validity and reliability. Objective: To compare Medical students’ academic performance and perception in regard of assessing skills through OSCE and SOE. Method: Two tests were designed (OSCE and SOE) to evaluate five obstetrical skills in a mannequin (the first three Leopold maneuvers, fundal height measurement, and fetal heart rate auscultation). The SOE assessed skills separately and the OSCE evaluated the skills after the analysis of a contextualized case. Students of the 4th term of Medical School were distributed into two groups. In the first phase of the study, Group 1 performed SOE, and Group 2, OSCE. Three weeks later, in the second phase, the same tests were applied inversely. Tests were applied by the same teacher, who employed the same checklist in both tests. In the second phase, a survey about students’ perception towards both test types was also applied. The mean score in each question was compared, as well as the final score, concerning the following crossings: test type in each of the two phases; test type regardless of phase; intragroup OSCE and SOE, and scores of the first and second stages, regardless of test type, as well as between groups, regardless of phase. Students’ perception was analyzed according to frequency distribution and grouping of open-ended answers by similarity. Results: 21 students participated in the study: 13 in Group 1, and 8 in Group 2. No difference was found in all the other crossings, except for the scores between phases. As for the intragroup comparison, the final score and the question 2 (fundal height measurement) score were superior in the second phase in both groups. The comparison between mean scores of the first and second phases, regardless of test type, demonstrated that the scores of the second phase were superior in the final score and in all questions, except for the second and third Leopold maneuvers. The scores’ improvement on the second day may be related to the testing effect. Conclusion: the test type did not influence students’ performance. Most candidates preferred the OSCE type. / Apesar do exame clínico objetivo estruturado (OSCE) ser considerado padrão ouro para avaliação de habilidades clínicas, ele é uma prova de organização complexa e de alto custo. Por outro lado, as provas do tipo prática-oral estruturada (POE) são de aplicação mais simples e de menor custo, ainda que possam apresentar menor validade e confiabilidade. Objetivo: comparar o desempenho acadêmico e a percepção de alunos de Medicina na avaliação de habilidades por OSCE e POE. Método: foram elaboradas duas provas (OSCE e POE) para avaliação de cinco habilidades obstétricas em manequim (três primeiras manobras de Leopold, medida de útero-fita e ausculta de batimentos cardíacos fetais). A POE avaliou as habilidades isoladamente e o OSCE avaliou as habilidades após a análise de um caso clínico contextualizado. Estudantes do 4º período do curso de Medicina foram distribuídos em dois grupos. Na primeira fase, o Grupo 1 realizou a POE e o Grupo 2 o OSCE. Na segunda fase, 3 semanas após, aplicou-se novamente as mesmas provas, de modo invertido. As provas foram aplicadas por um único avaliador, que utilizou o mesmo checklist nas duas provas. Na segunda fase, aplicou-se também um questionário sobre a percepção dos alunos em relação aos dois tipos de prova. Comparou-se a nota média em cada questão e a nota total nos seguintes cruzamentos: tipo de prova em cada uma das fases; tipo de prova independentemente da fase; OSCE e POE intragrupo e notas da primeira e da segunda fases, independentemente do tipo de prova, bem como entre os grupos, independentemente da fase. A percepção do aluno foi analisada por distribuição de frequência e agrupamento das respostas abertas por semelhança. Resultados: 21 alunos participaram do estudo, sendo 13 do Grupo 1 e oito do Grupo 2. Não houve diferença entre as notas das questões e a nota total, entre os dois tipos de prova, nas duas fases do estudo. Também não se observou diferenças em todos os outros cruzamentos, exceto quando se comparou as notas entre as fases do estudo. Na comparação intragrupo, a nota total e a nota da questão 2 (útero-fita) foi superior na segunda fase nos dois grupos. A comparação entre as médias das notas na primeira fase e na segunda fase, independentemente do tipo de prova, demonstrou que as notas da segunda fase foram superiores na nota total e em todas as questões, exceto na 2ª e 3ª manobras de Leopold. A melhora das notas, no segundo dia, pode estar relacionada ao efeito teste. Conclusão: o tipo de prova não influenciou o desempenho do aluno. A maioria dos alunos preferiu a prova tipo OSCE.

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OBJECTIVE: Because training in pediatric disaster medicine (PDM) is neither required nor standardized for pediatric residents, we designed and integrated a PDM course into the curriculum of a pediatric residency program and assessed if participation increased participants' knowledge of managing disaster victims. METHODS: We adapted and incorporated a previously studied PDM course into a small-sized pediatric residency program. The curriculum consisted of didactic lectures and experiential learning via simulation with structured debriefing. With IRB approval, the authors conducted a longitudinal series of pretests and posttests to assess knowledge and perceptions. RESULTS: Sixteen eligible residents completed the intervention. Before the course, none of the residents reported experience treating disaster victims. Pairwise comparison of scores revealed a 35% improvement in scores immediately after completing the course (95% confidence interval, 22.73%-47.26%; P < 0.001) and a 23.73% improvement 2 months later (95% confidence interval, 7.12%-40.34%; P < 0.01). CONCLUSIONS: Residents who completed this course increased their knowledge of PDM with moderate retention of knowledge gained. There was a significant increase in perceived ability to manage patients in a disaster situation after this educational intervention and the residents' confidence was preserved 2 months later. This PDM course may be used in future formulation of a standardized curriculum.