Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 172-186).

Thesis (Ed.D.)--Georgia Southern University, 2006. / "A dissertation submitted to the Graduate Faculty of Georgia Southern University in partial fulfillment of the requirements for the degree Doctor of Education" ETD. Includes bibliographical references (p. 101-108) and appendices.

Dissertation (Ph.D.)--The University of North Carolina at Greensboro, 2010. / Directed by Heidi Carlone; submitted to the Dept. of Educational Leadership and Cultural Foundations. Title from PDF t.p. (viewed Jul. 9, 2010). Includes bibliographical references (p. 208-221).

Thesis (M. D.)--University of Hong Kong, 2006. / Title proper from title frame. Also available in printed format.

Introduction: Dyslexia is the most common specific learning difficulty, affecting of about 6% of the population. In medicine, the numbers of learners disclosing a diagnosis of dyslexia is rising. Small-scale studies have begun to venture into the effects of dyslexia on the education of medical students, and doctors in foundation year training and beyond. There is a call for research to develop a more nuanced understanding of how dyslexia affects doctors during their training and practice. Methodology: Using interpretative phenomenological analysis, this project aimed to develop a greater understanding of the ways in which dyslexia affects the training and practice of doctors. The data collection followed a three-phase approach, employing semi-structured interviews, a Self-Characterisation Sketch exercise, and Critical Incident Reflection audio-diaries. Analysis: In-depth, idiographic analysis of anonymised case studies for 10 doctors in training across a variety of specialties, from England and Wales was undertaken. The detail of the analysis cannot be adequately captured in a short summary but the overarching themes identified in the data included: Self; Belonging; and Coping. Each theme is supported by subthemes: good enough, chaos and power of the label; black sheep, conformity, and community; and difficulties and capabilities, agency and attribution, and strategies and risk, respectively. Notable ‘pearls’ within the data included the notion of partitioning, and that of brute failure. Discussion: The in-depth analysis of these doctors’ experience of their dyslexia, with reference to their education, training and practice, provides a unique insight into an unstudied aspect of lived experience of doctors. The analysis of the data from these doctors offers a unique understanding of self-concept, attribution and learned helplessness. These findings bear significance for engaging with, and seeking help from the team and wider structures in medical education. Synthesis of this analysis with wider literature would suggest a role for self-compassion and individual counselling approaches in medical education.

Contribution The main contribution offered by my research is an increased understanding of medical students’ perceptions of empathy and the factors that influence this. By using an innovative method in medical education research, the study contributes to research methodology. Background Empathy is accepted as a fundamental part of the patient-doctor relationship and essential for effective clinical care. Current societal opinions are that some healthcare professionals lack empathy and that medical students become less empathetic during their training, although the reasons for this are not understood. If this perceived decline is to be addressed, medical educators need to understand students’ perspectives of the factors that influence their empathy. Aims of the research The study sought to gain a deeper understanding of the development of medical students’ empathy and the factors influencing this during their undergraduate training. It is hoped that this understanding may lead to improvements in medical education and patient care. Methods Ethical approval for the study was granted by the University. A phenomenological approach was adopted, which involved listening to the students’ views and experiences of their course. Serial, semi-structured, indepth, interviews were conducted with sixteen medical students. Each year the student completed an hour-long interview over three years. One group of eight students were followed during the preclinical years of the course (years 1-3) and the other group, during the clinical years (years 4-6). The interviews were audio-recorded, transcribed, coded using qualitative data analysis software (N Vivo), and analysed using an interpretative phenomenological approach. Findings The students in the preclinical years described empathy as a personal attribute, emphasising its emotional dimension. In the clinical years, students viewed empathy differently: as a complex relational process with the patient, which varied in depth and quality according to the clinical context. They described the tensions between connecting with and detachment from a patient. Students indicated influences which enhanced their empathy, including patient contact and positive role models. They also identified barriers to empathy, including: the medical school culture, a biomedical bias in the curriculum, a lack of patient contact, negative role models and teaching of professionalism as distancing from patients. The preclinical group of students reported gaining in self-confidence during their course. The clinical group described how their empathy with patients had increased but they detected a conflict between empathy and efficiency. Conclusions The use of an innovative longitudinal, phenomenological approach in medical education research generated new understanding of a complex interpersonal view of empathy and highlighted aspects of a ‘hidden curriculum’. The students maintained that their contact with patients was the most useful way of developing empathy. They expressed a desire to connect emotionally with patients but were uncertain how to balance this connection with professional detachment. They described a marked biomedical emphasis in their course and perceived that teaching on professionalism encouraged a distancing from patients. In contrast to the widely-reported opinion that there has been a decline in medical students’ empathy, this study suggested that students perceived that their empathy increased during their training. However, some students had learned distancing behaviours to hide their empathetic feelings. In the light of this research, it is hoped that medical educators will develop ways of supporting students to deal appropriately with their own emotions and those of patients.

No description available.

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.

Introdução: A formação médica tem sido muito discutida recentemente em virtude do crescimento do número de instituições e da crescente percepção de necessidade de um controle social para a qualidade do egresso. A exemplo da avaliação desencadeada por crise similar de crescimento desordenado das faculdades de medicina na década de 70, é oportuna a avaliação abrangente do perfil dos egressos dessas instituições. A medicina vem sofrendo diversas transformações impostas pelas modificações sociais da globalização, o que sem dúvida apresentou impacto sobre o perfil dos alunos egressos. Objetivos: 1. Avaliar o perfil do profissional médico egresso da FMRP-USP de acordo com a década de formação; 2. Avaliar a distribuição geo-espacial dos egressos da FMRP-USP; 3. Avaliar o envolvimento com o currículo informal e o currículo oculto ao longo das décadas de formação; 4. Avaliar o envolvimento com educação continuada dos egressos da FMRP-USP; 5. Avaliar a aderência à profissão e o envolvimento com outros tipos de atuação profissional ao longo das décadas de formação; 6. Avaliar aspectos relacionados à remuneração dos egressos; 7. Constituir um banco de dados atualizado dos egressos da FMRP-USP que favoreça contatos futuros e projetos para o resgate da história da instituição. Metodologia: Foram realizadas entrevistas sistematizadas através de instrumento dedicado desenvolvido para o presente trabalho e testado em estudo piloto. A identificação dos egressos envolveu diversas estratégias, incluindo a rede mundial de computadores, comissões de formatura para encontro de turmas, bancos de endereços disponíveis, anúncio em páginas da rede mundial de computadores da FMRP-USP e de seu hospital universitário e dados do CREMESP e CFM. O projeto foi aprovado no Comitê de Ética em Pesquisa do HC-FMRP-USP. Resultados: Foram incluídos 1064 egressos (24.9% do total) distribuídos, estratificados em 5 grupos de acordo com a década de formação. Esse trabalho documentou o perfil dos egressos da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRPUSP) de modo pioneiro, sendo extremamente representativo ao se considerar o número de egressos incluídos de acordo com parâmetros com que tais estudos de levantamento (\"survey\") são analisados. Demonstrou a distribuição geográfica dos alunos, que embora mais concentrados no Estado de São Paulo, possuem distribuição nacional, tanto no que se refere aos profissionais médicos, quanto aos profissionais com pós-graduação stricto sensu que se inserem nas mais conceituadas universidades do país, estes últimos com 50% do inserção fora do Estado de São Paulo Ao longo do tempo, o perfil dos egressos demonstrou modificações significativas do ponto de vista demográfico (maior representação do gênero feminino - de 6,5% nas turmas mais antigas para 36% nas mais novas), do envolvimento com atividades extracurriculares em atividades mais relacionadas à prática clínica em detrimento de atividades mais sociais (pouco mais de 40% nas turmas mais antigas versus mais de 70% nas mais novas ) e da busca por especialidades médicas que representem maior poder aquisitivo e qualidade de vida, por exemplo oftalmologia/otorrinolaringologia (15,2% nas turmas mais jovens versus 6,6% nas mais antigas). A busca por educação continuada teve alta porcentagem entre os egressos, com até 42,2% de pós-graduação stricto sensu e 98,5% de especialistas entre os egressos com 20 a 29 anos de formado. A inserção profissional foi caracterizada por atividade médica continuada, tanto em ambiente privado como público (SUS), com uma percentagem relativamente significativa ainda realizando plantões para complementação de renda, principalmente nos mais jovens (54,5% versus 14,0 nos mais antigos). Finalmente, detecta-se o desejo de se reaproximar da instituição formadora, mantendo contato de diversas formas, como o desejo de receber malas diretas da FMRPUSP mais de 80 % do total dos egressos, chegando a 96,6% nos mais jovens, mas que ainda requer uma liderança mais efetiva. Conclusões: A amostra de 1064 egressos constituída demonstrou que há grande valorização pela busca contínua de atualização profissional, representada tanto pela busca de programas de residência, pós-graduação e títulos de especialista. Apesar de ser um fator influente, o tempo de formado não prejudicou esse interesse. A influência do perfil docente pode ser refletida na proporção razoável de profissionais que buscam a docência como forma de inserção inicial ou quando se desvinculam da atividade médica. / Introduction: Medical education has been much discussed recently due to the growing number of institutions and the growing realization of the need for a social control to the quality of graduates. Like the assessment triggered by similar crisis of uncontrolled growth of medical schools in the 70s, is timely comprehensive the evaluation of the profile of the graduates of these institutions. The medicine has undergone several transformations imposed by the social changes of globalization, which undoubtedly had an impact on the profile of students graduating. Objectives: 1. Assess the profile of the professional of medicine graduate in the FMRP-USP according to the decade of formed; 2. Assess the geo-spatial distribution of graduates of the FMRP-USP; 3. Assess engagement with the informal curriculum and with the hidden curriculum throughout the decades of formed; 4. Assess involvement of graduates of the FMRP-USP in continuing education; 5. Assess adherence to the medical profession and involvement in other types of professional performance throughout the decades of formed; 6. Assess aspects related to the remuneration of graduates; 7. Establish a updated database of the FMRP-USP graduates that encourages future contacts and projects to rescue the history of the institution. Methodology: Interviews were systematically conducted through a dedicated questionary tool developed for this study and tested in a pilot study. The identification of the graduates involved several strategies, including the World Wide Web, graduation commissions for meeting groups, databases of addresses, ad pages of the World Wide Web of the FMRP-USP and its university hospital and CREMESP data and CFM. The project was approved by the Research Ethics Committee of the HC-FMRP-USP. Results: Were included 1064 graduates (24.9% of total) distributed in 5 groups according to the decade of formed. This work documented the profile of graduates of Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP) in a pioneering way, being extremely representative when considering the number of graduates included according to parameters such survey studies (\"survey\") are analyzed. It demonstrated the geographic distribution of students, who although more concentrated in São Paulo, have national distribution, both with regard to medical professionals, as professionals with stricto sensu pos-graduate working into the most prestigious universities in the country. Over time, the profile of graduates showed significant changes from the demographic point of view (greater representation of females), involvement with extra-curricular activities with more activities related to clinical practice at the expense of more social activities and the search for medical specialties representing higher income and quality of life. Some values of the FMRP-USP have proved perennial over time, as the fact of being imbued in the formation of their students the continued search for specialization in various levels. The professional insertion was characterized by continuing medical activity, both in private and public (SUS), with a relatively significant percentage still performing shifts for supplementary revenue. Finally, it detects the desire to reconnect to the educational institution, maintaining contact in many ways, but still requires more effective leadership. Conclusions: The sample composed of 1064 graduates showed that there is great appreciation for the continuous pursuit of professional development, represented both by seeking residency programs, postgraduate and specialist titles. Despite being an influential factor, the time since graduation did not harm that interest. The influence of the teacher profile can be reflected in reasonable proportion of professionals seeking teaching as initial insertion or at the end of your medical activity.

Submitted by JÚLIO HEBER SILVA (julioheber@yahoo.com.br) on 2017-03-16T17:49:57Z No. of bitstreams: 2 Tese - Fabiana Aparecida da Silva - 2017.pdf: 3401004 bytes, checksum: d644b3d267baeb6dcd4faf364e1c050e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-03-20T13:22:32Z (GMT) No. of bitstreams: 2 Tese - Fabiana Aparecida da Silva - 2017.pdf: 3401004 bytes, checksum: d644b3d267baeb6dcd4faf364e1c050e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-03-20T13:22:33Z (GMT). No. of bitstreams: 2 Tese - Fabiana Aparecida da Silva - 2017.pdf: 3401004 bytes, checksum: d644b3d267baeb6dcd4faf364e1c050e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-07-20 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The facult development in medical schools has become one of the focus for consolidation and re-elaboration of medical courses to meet the current National Curricular Guidelines. The objective of this thesis was to analyze the perception of teachers, students and administrative technicians, called institutional actors, on the facult development in Brazilian medical schools from a self - assessment process. This is a descriptive and exploratory study with a qualitative approach. The data were obtained from a national evaluation of the trends of changes in medical schools conducted in 2013 by the Commission for Evaluation of Schools of the Health area of the Brazilian Association of Medical Education and interpreted according to content analysis. Forty-one medical courses were evaluated, using the method of evaluation of medical schools "Method da Roda", which has five thematic axes: World of Work, Pedagogical Project, Pedagogical Approach, Scenarios of Practice and Teaching Development. Each axis has corresponding vectors. In this thesis, the institutional actors' responses to the Teaching Development Axis and its four vectors were analyzed: (1) didacticpedagogical training, (2) technical-scientific updating, (3) participation in care services and ) Managerial capacity. The analysis of all the categories that emerged from the data revealed that recognized and institutionalized training processes are still scarce. Medical schools have limitations to recognize the importance of the institutionalization of teacher training programs, and when these processes are offered, the adherence of teachers is low, indicating the distance between the training proposals and the actual needs of the teacher. The integration of the school and the teaching participation in the local health system are still incipient, with some actions showing a discrete integration, however decontextualized of its political and social importance. Most medical schools do not promote managerial training, but recognize their importance, indicating the need to institutionalize teacher development programs that address competency-based management and its attributes: knowledge, skills, and attitudes. The process of self-evaluation was participatory and collaborative, providing a moment in which those involved could visualize and analyze the reflexes of their actions. The CAES assessment can be compared to an "institutional mirror" that reflects the actions of actors who (re) build medical schools. It is concluded that the training processes for health professionals need to be institutionalized and that their elaboration and planning should involve the teachers to awaken the group's sense of belonging, considering their individuality and historicity. / O desenvolvimento docente em escolas médicas tem se tornado um dos focos para a consolidação e reelaboração dos cursos de medicina para atender as Diretrizes Curriculares Nacionais vigentes. O objetivo desta tese foi analisar a percepção de docentes, estudantes e técnicos administrativos, denominados atores institucionais, sobre o desenvolvimento docente em escolas médicas brasileiras a partir de um processo autoavaliativo. Trata-se de um estudo descritivo e exploratório de abordagem qualitativa. Os dados foram obtidos de uma avaliação nacional sobre as tendências de mudanças das escolas médicas realizada no ano de 2013 pela Comissão de Avaliação das Escolas da área da Saúde da Associação Brasileira de Educação Médica e interpretados segundo análise do conteúdo. Foram avaliados quarenta e um cursos de medicina, utilizando-se o instrumento de avaliação de escolas médicas “Método da Roda”, o qual possui cinco eixos temáticos: Mundo do Trabalho, Projeto Pedagógico, Abordagem Pedagógica, Cenários de Prática e Desenvolvimento Docente. Cada eixo possui vetores correspondentes. Nesta tese, foram analisadas as respostas dos atores institucionais para o Eixo “Desenvolvimento docente”, e seus quatro vetores: (1) formação didático-pedagógica, (2) atualização técnico-científica, (3) participação nos serviços de assistência e (4) capacidade gerencial. A análise de todas as categorias que emergiram dos dados, revelou que os processos formativos reconhecidos e institucionalizados, ainda são escassos. As escolas médicas apresentam limitações para reconhecer a importância da institucionalização de programas de formação docente e, quando esses processos são ofertados, a adesão dos professores é baixa, indicando o distanciamento entre as propostas de formação e as reais necessidades do docente. A integração da escola e a participação docente no sistema de saúde local, ainda são incipientes, com algumas ações que evidenciam discreta integração, porém descontextualizada de sua importância política e social. A maioria das escolas médicas não promove a capacitação gerencial, mas reconhece sua importância, indicando a necessidade de institucionalizar programas de desenvolvimento docente que aborde a gestão baseada em competências e seus atributos: conhecimento, habilidades e atitudes. O processo de autoavaliação teve caráter participativo e colaborativo proporcionando um momento em que os envolvidos pudessem visualizar e analisar os reflexos de suas ações. A avaliação da CAES pode ser comparada a um “espelho institucional” que reflete as ações dos atores que (re)constroem as escolas médicas. Concluise que os processos formativos para profissionais da área da saúde necessitam ser institucionalizados e que sua elaboração e planejamento devem envolver os professores para despertar o sentimento de pertencimento de grupo, considerando sua individualidade e historicidade.