Thesis (M.H.S.A.)--University of Michigan, 1976.

Thesis (M.H.S.A.)--University of Michigan, 1976.

Thesis (M.Sc.)--Memorial University of Newfoundland, 2004. / Bibliography: leaves 84-90.

nÃo hà / The lack of a skills-based curriculum to guide and qualify the residents` education is a reality in several Residency programs in the country. This vulnerability has been discussed by residents, preceptors and coordination of the residency program of family and community medicine (PRMFC), which generated the need of the development of this research. This fact brings the following vulnerabilities: lack of clarity of the learning objectives, educational strategies and the evaluation to be addressed to the residents. Initially, a literature review of the competency-based curricula and a review of documents prepared by associations, societies and professional bodies were conducted. Then we conducted a teacher training course for the preceptors of the PRMFC, with discussions on the theoretical bases of the competency-based curriculum; active learning methodologies; planning and conducting educational activities and strategies; and learning evaluation. After this training, workshops were held for the development of an array of macro competencies. This work trained 12 preceptors of PRMFC and allowed the construction of an array of macro competencies. It will surely facilitate the teaching-learning process in a two-year Residency Program, evaluating the skills of the residents at the end of the course, which guarantees to society a professional able to develop its actions. With a competency-based curriculum specific designed for Family Medicine and for Primary Health Care, we wish to reorient the teaching-learning processes of residents and preceptors to qualify clinical practice. / A falta de um currÃculo baseado em competÃncias para nortear e qualificar o ensino dos residentes à uma realidade em vÃrios os Programas de ResidÃncia no paÃs. Esta vulnerabilidade foi problematizada por residentes, preceptores e coordenaÃÃo do Programa de ResidÃncia de Medicina de FamÃlia e Comunidade (PRMFC), o que gerou a necessidade do desenvolvimento deste estudo. Este fato traz as seguintes vulnerabilidades: falta de clareza dos objetivos de aprendizado, das estratÃgias educacionais e de avaliaÃÃo a serem abordadas. Inicialmente foi realizada uma revisÃo da literatura sobre os currÃculos baseados em competÃncia e uma anÃlise dos documentos elaborados por associaÃÃes, sociedades e entidades profissionais. Em seguida foi realizado um curso de formaÃÃo docente para os preceptores do PRMFC, com discussÃes sobre as bases teÃricas do currÃculo baseado em competÃncia; metodologias ativas de aprendizagem; planejamento e conduÃÃo de estratÃgias e atividades educacionais; e avaliaÃÃo da aprendizagem. ApÃs a capacitaÃÃo foram realizadas oficinas de desenvolvimento de uma matriz de macrocompetÃncias. Esta trabalho traz como produtos a capacitaÃÃo de 12 preceptores do PRMFC e a construÃÃo de uma matriz de macrocompetÃncias. Certamente irà para favorecer o processo de ensino-aprendizagem nos dois anos de programa, avaliando as competÃncias dos residentes no final do curso, o que garante para a sociedade um profissional apto para desenvolver as suas aÃÃes. Com um currÃculo baseado em competÃncias necessÃrias para MFC e APS desejamos reorientar os processos de ensino-aprendizagem dos residentes e preceptores para qualificar a prÃtica.

O objetivo deste estudo foi caracterizar o perfil dos candidatos ao Concurso de Residência Médica do Sistema Único de Saúde a partir do Concurso 1999, comparando-o com o concurso realizado 5 anos depois, Concurso SUS 2004. Trata-se de um estudo descritivo a partir da utilização de dados secundários contidos num banco organizado pela Fundação Carlos Chagas e disponibilizado para a Secretaria de Estado da Saúde de São Paulo. As variáveis dos candidatos analisadas foram: sexo, idade, opção de escolha, local de graduação, natureza jurídica da faculdade de graduação, bem como seu desempenho no Exame Nacional de Cursos - Provão, presença e situação de habilitação no concurso. O número de candidatos aumentou 18% no período, sendo a maioria dos inscritos do sexo masculino, embora as mulheres tenham aumentado seu percentual de participação. A maior parte dos candidatos encontra-se na faixa entre 22 e 24 anos, seguida por candidatos na faixa entre 25 e 27 anos, tendo havido um envelhecimento do perfil dos candidatos no período. A maioria dos inscritos origina-se da Região Sudeste, sobretudo do Estado de São Paulo, e as Regiões Norte e Centro-Oeste contribuem com o menor percentual de candidatos. De forma geral predominam candidatos graduados em faculdades públicas, principalmente federais e, no caso dos candidatos graduados no Estado de São Paulo, a maior parte graduou-se em faculdades privadas. As especialidades com maior número de candidatos são as das Áreas Básicas, sobretudo a Clínica Médica, seguida pelas especialidades com acesso direto, enquanto as especialidades que exigem cumprimento de pré-requisito anterior contam com o menor número de candidatos, apesar de ser o único grupo que apresentou incremento no percentual de candidatos no período. A maior parte dos inscritos graduou-se em faculdades com conceito C na avaliação do provão, sendo o percentual de candidatos oriundos de escolas com ótima avaliação no provão (conceitos A ou B) é um pouco superior ao de candidatos oriundos de escolas com avaliação ruim (conceitos D ou E). A relação entre o número de candidatos habilitados e o de presentes (índice de habilitação) é maior para a Região Sul, enquanto a Região Norte apresenta o menor índice entre as regiões. Este índice ainda é superior para candidatos oriundos de faculdades públicas assim como para os candidatos oriundos de escolas com melhor avaliação no provão. O índice de ausência sofreu redução de 50% no período, sendo maior para candidatos graduados em escolas públicas, assim como para os originários da Região Sul do país. / The objective of the study was to describe the applicants profile to Single Health System Medical Residency Contest in 1999, comparing to applicants profile to the contest placed five years later. This is a descriptive study, based on secondary data organized by Fundação Carlos Chagas and put available to Secretaria de Estado da Saúde de São Paulo. The applicants\' variables analyzed were: gender, age, medical specialty, place of graduation, legal nature of university\'s graduation course, performance at the Courses National Examination, attendance frequency and contest habilitation condition. The number of applicants increased 18% in the period and most of the applicants were men, although women had increased their relative participation. In 1999 and 2004, most of the applicants were between 22 and 24 years, followed by applicants between 25 and 27. However, the relative participation of this last group has increased in 2004, pointing to an ageing of the applicants profile in the period. Most of the applicants were from Brazil Southwest region, especially from São Paulo state; Brazilian North and Center regions contributed with the smallest number of applicants. In general terms, applicants that graduated from public universities (mainly federal universities) predominate and applicants from São Paulo state were, in most cases, graduated from private universities. The specialties that had the highest number of applicants were Basics Areas (mainly Medical Clinic), followed by direct access specialties, while specialties that requires a concluded program had the smallest number of applicants; however, this were the only group which relative number of applicants had increased during the period. Most of the applicants were from universities with grade C in the national examination, and the number of applicants from universities with a good performance (grade A or B) was a little higher than the applicants from universities with a bad performance (grade D ou E). The relationship between the number of applicants habilitated and the number of applicants that were present (index of habilitation) is higher in South Region, while the North Region presents the smallest index; this index is higher when considering applicants from public universities and universities with good performance in the Courses National Examination. The absence index had decreased 50% in the period, being higher in applicants from public universities than from private ones, as in applicants from the South of the country.

Orientador: Eliana Goldfarb Cyrino / Resumo: Introdução: A Residência Médica é considerada o padrão-ouro para a formação de médicos especialistas, tanto no Brasil quanto em outros países, sendo institucionalizada oficialmente a partir de 1977 no país. Um dos programas que mais cresceu nos últimos anos, em termos de vagas ofertadas, foi o de medicina de família e comunidade. Dentro da organização dos programas de residência consta a participação de um profissional responsável pela formação, o preceptor. Esse profissional pode ser considerado o principal responsável pelo residente em medicina de família e comunidade, pois estarão juntos por 2 anos consecutivos e exercerá a função de modelo, na prática do trabalho, na formação desse profissional. Contudo, o termo preceptor pode estar bem consolidado para outras residências, mas na medicina de família e comunidade há necessidade de maior exploração sobre o papel desse profissional. Assim, se reconhece a necessidade de se conhecer as características desse profissional, sua formação, tanto técnica (dentro da área) quanto pedagógica para exercer seu papel, quais as potencialidades e desafios que esse trabalho exige e se tem algum apoio pedagógico para tal. Objetivos: Identificar o perfil dos preceptores dos programas de residência médica em medicina de família e comunidade do estado de São Paulo, conhecendo suas características pessoais, profissionais e formação. Materiais e Métodos: Estudo exploratório, de caráter qualitativo e quantitativo, no qual foram aplicados questionár... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: The Medical Residency is considered the gold standard for the training of medical specialists, both in Brazil and in other countries, being officially institutionalized from 1977 in the country. One of the programs that most grew in recent years, in terms of vacancies offered, was the General Practice/Family Physician field. In the organization of the residency programs there is a professional responsible for the student training, the preceptor. This professional can be considered the main responsible for the resident in General Practice/Family Physician, as they will be together for two consecutive years and the preceptor will be the example, in the practice of work and in the training of this professional. However, the term “preceptor” may be well consolidated for other residences fields, but in the General Practice/Family Physician field there is a need for greater exploration on the role of this professional. Thus, it is necessary to know the characteristics of this professional, its formation, both technical (inside his area) and pedagogical, what the potentialities and challenges that this work requires and whether he has some pedagogical support. Aims: To identify the profile of preceptors in General Practice/Family Physician residency programs of the São Paulo state, knowing their personal, professional and training characteristics. Materials and Methods: This was a qualitative and quantitative exploratory study, in which questionnaires were applied to t... (Complete abstract click electronic access below) / Mestre

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Com a criaÃÃo e a expansÃo do Programa SaÃde da FamÃlia (PSF) no Brasil, a Medicina de FamÃlia e Comunidade (MFC), como especialidade mÃdica, ganhou destaque por ser a mais adequada para esse trabalho. Recentes parcerias entre os MinistÃrios da SaÃde e da EducaÃÃo tÃm procurado regular a formaÃÃo de recursos humanos em saÃde para atender Ãs demandas de consolidaÃÃo do Sistema Ãnico de SaÃde (SUS), no Ãmbito da graduaÃÃo e da pÃsgraduaÃÃo. Houve investimento no aumento no nÃmero de vagas de residÃncia em MFC, mas parece haver uma incongruÃncia entre o que os futuros mÃdicos almejam em suas carreiras e as necessidades do SUS, o que à demonstrado pelo nÃmero de vagas ociosas nesses programas. O objetivo inicial foi determinar fatores predisponentes à escolha da MFC como carreira. PorÃm, ao reconhecer o desinteresse por essa especialidade, buscou-se elencar hipÃteses explicativas para tal realidade. Foi, entÃo, realizado um estudo junto a 170 estudantes do Curso de Medicina de Sobral da Universidade Federal do CearÃ, que responderam um questionÃrio contendo 32 perguntas sobre dados sÃcio-demogrÃficos, escolha da especialidade, PSF e MFC e fatores que, na opiniÃo dos respondentes, influenciam a escolha da carreira a ser seguida. Encontrou-se que apenas um estudante referia jà ter escolhido a MFC como especialidade. Contudo, a grande maioria nÃo descarta a possibilidade de trabalhar provisoriamente no PSF. As provÃveis justificativas para esse desinteresse sÃo as precÃrias condiÃÃes de trabalho, desvalorizaÃÃo da atividade, baixos salÃrios, necessidade de interiorizar-se para ganhar melhor e poucas perspectivas de crescimento profissional. O currÃculo oculto, muito citado em trabalhos internacionais, tambÃm tem seu papel, mas nÃo foi adequadamente avaliado nesta pesquisa. Especialidades clÃnicas sÃo as mais almejadas por esses estudantes. Os fatores que mais influenciam a escolha da carreira, segundo os respondentes, sÃo interesses pessoais, compromisso Ãtico-social e possibilidade de realizar procedimentos diagnÃsticos ou terapÃuticos. Em conclusÃo, a escolha da carreira à multifatorial. O interesse pela MFC à modesto. Apesar de haver muitas propostas para aumentÃ-lo, estas nÃo trouxeram repercussÃo em alguns cenÃrios e nÃo estÃo confirmadas cientificamente. Mesmo assim, deve-se procurar identificar os fatores causais e sugerir ou ensaiar estratÃgias para reverter esse quadro. / The creation and expansion of the Family Health Program (FHP) in Brazil bring to Family Practice (FP), as medical specialty, highlight because itâs the more adequate one for that kind of work. Recent partnerships between Health and Education State Departments try to regulate the graduation and post graduation of health workers, attending the demands of consolidation of the National Health System of Brazil (NHS). Investments ware taken to increase FP residency position number, but maybe there is an incongruity between career intentions of future doctors and the needs of the Brazilian NHS, what is shown by the low number of positions filled in those programs. The initial objective of this research was to determine predisposing factors to choice of FP as career. However, upon recognizing the disinterest by that specialty, we try to list explanatory hypotheses for such reality. It was, then, carried out a study involving 170 medical students of Federal University of Cearà at Sobral, which answered a questionnaire containing 32 questions about demographic and social characteristics, choice of the specialty, FHP and FP and factors that, in the opinion of the students, influence the choice of career. It was found that only one student made a choice of FP as specialty. However, the great majority doesnât reject the possibility of work provisionally in the FHP. The probable justifications for this disinterest are the precarious conditions of work, depreciation of the activity, low income, better salaries in remote cities and few perspectives of professional growth. The hidden curriculum, cited by international articles, also play a role, but it was not evaluated accurately in this research. Clinical specialties are the most preferred by those students. The most influencing factors for career choice, according to students, are personal interests, ethical and social commitment and possibility of make diagnostic or therapeutic procedures. In conclusion, career choice has many influencing factors. The interest by FP is modest. Despite many proposals to increase interest, these did not bring repercussion in some settings and are not scientifically confirmed. Even so, such influencing factors it must be identified and strategies for revert that picture must be tried.

The purpose of this qualitative study was to explore intern's perspectives on how the professional environment impacts their well-being. In-depth, semi-structured interviews were conducted in March and April of 2009 with seventeen interns from residency programs in a variety of specialties at an urban teaching hospital. Investigators coded interview transcripts line-by-line, and identified recurrent themes through an iterative process of analyzing tagged quotations. Three themes (each with three sub-themes) characterized aspects of the professional environment that interns perceived as impacting their well-being: 1) high-quality education (workload, work hours, and quality and quantity of teaching), 2) professional development and satisfaction (making a meaningful contribution to patient care, positive feedback and extrinsic reward, and balance of autonomy and supervision), and 3) social and emotional support from colleagues (feeling supported by the residency program, cooperative team environment, and intern community). These aspects of the professional environment have the potential to significantly impact intern well-being, and should be taken into consideration when developing new systems, interventions and policies to improve the well-being of interns.

In November 1999, financial losses led the University of California at San Francisco Medical Center (UCSF) to close all inpatient services at Mount Zion Hospital, a community teaching hospital affiliated with UCSF since 1990. As a result of the closure, Mount Zions primary care residency program (MZPC) was merged with UCSFs university-based primary care program. We examined these events in the context of three major currents in U.S. health care: containment of rising health care costs, financial pressures on teaching hospitals, and the shifting priorities in graduate medical education with respect to subspecialty medicine and primary care. As part of this descriptive study, we investigated the impact of the Mount Zion closure on all UCSF internal medicine residents who were in training at the time. Using a cross-sectional survey, we found that a majority of residents felt the closure was harmful to their training, but that reasons varied by program affiliation. Many specific areas of training remained unaffected. Low morale correlated with abandonment of generalist career plans among some primary care residents (p=0.02). We concluded that the perception of harm reflected a temporary reaction to change rather than actual harm to the quality of the programs, and that while attrition from generalism may have resulted from disillusionment by some residents, it more likely reflected a national decline in interest in primary care since 1997. We also concluded that the closure of Mount Zion and its residency program was a consequence of the shifting emphasis toward subspecialization in the U.S. and is a harbinger of further changes in that direction.

Several studies have documented a deficiency in the delivery of preventive services to adolescents during physician visits in the United States. In many instances, a correlation has been noted between insufficient training and provision of adolescent medicine services in the practicing physician population. The American Medical Association, American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetrics and Gynecology and Society for Adolescent Medicine recommend adolescent providers deliver comprehensive health services to teenagers. This study sought to assess and compare Pediatric, Family Medicine and Obstetric-Gynecology resident perceptions of their responsibility, training, experience and comfort with providing comprehensive health care services adolescents. We asked residents to identify the following: (1) adolescent health services they considered part of their scope of practice in their respective field; (2) the level of training they had received with regard to select adolescent health services; (3) the experience they had performing select clinical activities with adolescents; and (4) their comfort with aspects of adolescent care. We further asked two questions to test resident knowledge of an adolescents right to consent to contraception or an abortion without parental notification in the state of their residency. A total of 87 residents (31 Obstetric-Gynecology, 29 Family Medicine and 27 Pediatric) were surveyed. Most residents from all three fields felt the full range of adolescent preventive and clinical services represented in the survey fell under the scope of their practice. Most residents also reported high levels of comfort with examined aspects of adolescent care. In regard to some activities, the positive scope and comfort responses were matched by high reported levels of training and experience, including defining confidentiality; counseling about eating, exercise and obesity; counseling about substance abuse; and discussing STDs, sexual partners and contraception. However, for multiple key adolescent services, considerable discrepancies existed between reported levels of training and experience and the positive responses concerning scope and comfort. In particular the results of study suggested all residents need considerably more training and experience with mental health issues, referring teenagers for substance abuse treatment, and addressing physical and sexual abuse. Overall, there were also significant differences between fields. Family Medicine residents reported the greatest potential for providing comprehensive health care. However, they suffered from the overall deficiencies in training and experience noted above. Obstetric-Gynecology residents reported deficiencies in the provision of several preventive counseling and general health services. Pediatric residents reported multiple deficiencies in the provision of sexual health services. Our results indicate, at this time and in the near future, it is unlikely that adolescents will be able to obtain the full range of recommended preventive and clinical services in a single physician visit unless residencies programs actively incorporate increased training in the full range of adolescent preventive and clinical health services.