Our purpose is to examine the possibilities of Bakhtinian dialogical analysis for understanding students' experiences of medical training. Twenty-three interviews were conducted with eleven British medical students intercalating in psychology. Forty emotionally resonant key moments were identified for analysis. Our analysis illustrates students' use of the professional genre to present their training as emotionally neutral. However, we show how medical training can be framed in more unofficial and affective-laden ways in which threshold moments of crisis are presented as space-time breaches characteristic of the genres of adventure-wonder and adventure-ordeal. This affect was often depotentiated in the narratives through brief allusion to the professional genre. This cycling between genres suggests that the students were searching for an appropriate way in which to frame their experiences, a central dilemma being the extent to which medical training makes sense within an immediate and affect-laden, or future-orientated and affect-neutral, pedagogy. Finally, we identify how consultants are an important aspect of the affective experience of medical training who, at their best, offer inspiring exemplars of flexible movement between official and unofficial ways of being a doctor. In conclusion, we demonstrate the potential of genres to make sense, and to organize the experience, of medical training spatially in terms of moving between personal and impersonal contact, temporally in terms of moving between the extraordinary and routine, and affectively in terms of moving between potent and neutral affect. Learning to use the professional genre is part of enculturation as a doctor and can be helpful in providing a framework restoring coherence and composure through engaging with, and reformulating, difficult experiences. However, it is important to take seriously the resistance many of the students demonstrated to the professional genre as a possible barometer of its acceptability to the general public.

This dissertation reports five experiments exploring the use of AI-based smart agents to support physician-patient interactions. In each experiment, a sample of female participants evaluates video tapes of simulated physician-patient interactions in a setting involving early stage breast cancer diagnosis. Experiment 1 manipulates communication style (empathetic/impassive) for both a human physician (played by an actor) and an avatar that mimics the human. Empathetic styles elicit more liking and trust from patients and are also more persuasive. The avatar loses less than the human physician on desirable patient outcomes when communication style changes from empathetic to impassive. A mediation analysis shows that the communication style and physician type effects flow serially through liking and trust to persuasion. Experiment 2 reports an extended replication, adding a new avatar with less resemblance to the human physician. The findings match those of Experiment 1: both avatars have similar effects on liking, trust, and persuasion and are similarly anthropomorphized. Experiment 3 examines whether the patient's mindset (hope/fear about the cancer prognosis) influences likely patient outcomes. The mindset manipulation does not influence patient outcomes, but we find support for the core serial mediation model (from liking to trust to persuasion). Experiment 4 explores whether it matters how the avatar is deployed. Introducing the avatar as the physician's assistant lowers its evaluations perhaps because the patients feel deprioritized. The human physician is evaluated significantly higher on all outcome dimensions. Experiments 1-4 focused on the first phase of a standard three-phased physician-patient interaction protocol. Experiment 5 examines communication style (empathetic/ impassive) and physician type (human/avatar) effects across the three sequential phases. Patient outcomes improve monotonically over the three interaction phases across all study conditions. Overall, our studies show that an empathetic communication style is more effective in eliciting higher levels of liking, trust, and persuasion. The human physician and the avatar elicit similar levels of these desirable patient interaction outcomes. The avatar loses less when communication style changes from empathetic to impassive, suggesting that patients may have lower expectations of empathy from avatars. Thus, if carefully deployed, smart agents acting as physicians' avatars may effectively support physician-patient interactions. / Doctor of Philosophy / Healthcare professionals often have the difficult task of breaking bad news to patients. Research has shown that physician's communication style influences patient outcomes (liking, trust, persuasion, and compliance). Some physicians may adopt an impassive communication style to avoid emotional involvement with patients and some others may be overly empathetic and are prone to be perceived as inauthentic. These deficiencies persist despite an emphasis on developing physician communication skills. As in other service domains, a new generation of humanoid service robots (HSRs) offers potential for supporting physician-patient interactions. The effectiveness of such Artificial Intelligence (AI)/smart agent supported physician-patient interactions will rest, in part, on the communication style designed into the smart agents. A patient interacting with a smart agent emulating a human physician may assess different cognitive capabilities (knowledge and expertise), attribute different motivations, and make different socio-cultural appraisals than when they interact with the physician in-person. This research examines whether communication style (empathetic versus impassive) implemented via facial expression and vocal delivery elicits different patient responses when interacting with a smart agent (a physician' avatar) versus the physician in person. Findings suggest that, an empathetic (vs impassive) communication style elicits more positive patient responses, avatar physicians fare at par or better than the human physician and lose less on the patient outcomes when the communication style changes from empathetic to impassive. The avatars' appearance does not play a role in persuasion. Avatars were similarly anthropomorphized and participants' mindset (Hope/Fear) did not influence the outcomes. However, if the avatars are introduced as assistants (versus standalone physicians) there is a possibility that patients may feel downgraded/deprioritized, leading to lower evaluations for the avatars than the human physician. The contrast created when the human physician introduces the avatar may have unintended consequences that lower the avatar's evaluation. Without a direct contrast, patients may be more receptive to avatar interactions, particularly as they become more familiar in service environments. Our findings suggest that, if carefully deployed, smart agents acting as physicians' avatars may effectively support physician-patient interactions. Indeed, patients may have lower expectations of empathy from an avatar versus a human physician. This can facilitate more effective physician-patient interactions and elicit positive downstream effects on patient liking, trust and compliance.

No / Prognosis in COPD is poor and many patients perceive shortcomings in the education they receive about aspects of their condition. This study explores the experiences of patients with COPD, particularly fears surrounding death and dying. Semi-structured interviews were conducted with 21 patients with moderate or severe COPD. Findings revealed that patient understanding of COPD was poor, most patients were unaware of the progressive nature of the condition, and few were aware they could die of COPD. Despite this, patients often expressed concerns that their condition might deteriorate. Patients had particular concerns regarding the manner of their death; the overriding fear was dying of breathlessness or suffocation. None of the patients' had discussed these fears with a health care professional. Improved patient education is needed in order to improve patients understanding of their condition and prognosis. Open communication regarding death, as advocated in a palliative care approach, is also appropriate to alleviate patients fears and to allow them to make decisions regarding the management of their care at the end of life.

Nous cherchions à explorer les compétences que les intervenants du service des urgences (SU), des médecins et des infirmières travaillant en équipe dans des rôles complémentaires, ont développées dans la divulgation d‘un décès, pour éclairer l‘apprentissage de cette compétence de « Communicateur ». Nous avons utilisé des entrevues semi-dirigées et un échantillonnage non probabiliste de 8 intervenants. Nous avons analysé les entrevues à l‘aide de méthodes qualitatives reconnues. Le nombre total de présences de nos intervenants à une divulgation est estimé supérieur à 2000. Notre analyse a démontré qu‘ils utilisent une structure de divulgation uniforme. Néanmoins, ils repoussaient l‘utilisation d‘un protocole, parce que jugé trop rigide. La flexibilité et l‘empathie se sont révélées des qualités essentielles pour les intervenants. Nous représentons la visite de la famille comme un épisode de désorganisation/dysfonction qui se résorbe partiellement durant le séjour au SU. Nous proposons un modèle pédagogique qui est basé sur nos résultats. / We explored the competencies that Emergency Department (ED) healthcare providers (HPs), physicians and nurses working as team members with complementary roles, have developed through notifications of death, to inform the teaching of this ‘Communicator‘ competency. We used semi-structured interviews on a non-probabilistic sample of 8 HPs. We analyzed the interviews using recognized qualitative methods. The total self-estimated number of death notifications attended by our HPs is superior to 2000. Analysis showed that experienced HPs use a uniform structure to death notification in ED. In spite of this, the use of a protocol for notification was considered inappropriate because it was deemed too rigid. Flexibility and empathy emerged as essential qualities for HPs. We submit that the family‘s ED visit is an episode of disorganization/dysfunction that gets partially resolved during their stay. Based on our results, we propose an educational model for teaching delivery of news of death in the ED.

<p>Uvod: U svakodnevnom kliničkom radu anesteziologa, postoperativna vizita anesteziologa na odelјenjima rutinski se ne izvodi, niti su ustanovlјeni jasni kriterijumi i stavovi o njenom značaju na zadovolјstvo bolesnika anestezijom. Cilј ovog istraživanja je bio konstrukcija i psihometrijska provera instrumenta koji može rutinski da se koristi za procenu zadovolјstva bolesnika anestezijom u svakodnevnom kliničkom radu anesteziologa na na&scaron;im prostorima, kao i da se ispita uticaj postoperativne vizite anesteziolioga na zadovolјstvo bolesnika anestezijom podvrgnutih rekonstrukciji prednjeg ukr&scaron;tenog ligamenta kolena. Materil i metode rada: U istraživanje je bilo uklјučeno 218 ispitanika, starijih od 18 godina, koji dobro govore i pi&scaron;u srpski jezik, koji su ASA I i ASA II statusa i koji su bili operisani u op&scaron;toj anesteziji. Ispitanici su podelјeni u tri grupe: prvu grupu čini 74 bolesnika, koje je postoperativno na odelјenju obi&scaron;ao anesteziolog koji je davao anesteziju, drugu grupu čini 70 bolesnika, koje je posle operacije obi&scaron;ao medicinski tehničar na anesteziji, koji nije učestvovao u anesteziji i treću grupu čini 74 bolesnika, koji nisu imali postoperativnu vizitu. U prvoj fazi iztraživanja prikuplјali su se osnovni sociodemografski podaci i bolesnicima su usmeno postavlјena pitanja. U drugoj fazi istraživanja svim bolesnicima je data op&scaron;ta balansirana anestezija. U trećoj fazi istraživanja, sprovedena je prva postoperativna vizita anesteziologa za bolesnike prve grupe i prva postoperativna poseta medicinskog tehničara na anesteziji za bolesnike druge grupe. Treća, kontrolna grupa bolesnika nije imala postoperativnu vizitu. U okviru ove vizite procenjivalo se objektivno (PAS skor) i subjektivno stanje bolesnika. Druga postoperativna vizita sprovedena je prvog postoperativnog dana. Drugog postoperativnog dana bolesnicima je odelјenska medicinska sestra, koja nije učestvovala u perioperativnom periodu bolesnika, davala upitnik za merenje zadovolјstva bolesnika anestezijom. Rezultati: Upitnik zadovolјstva bolesnika anestezijom je konstruisan za potrebe istraživanja. Prve metrijske provere upitnika su utvrđene u pilot studiji na 100 ispitanika, na osnovu kojih je neizmenjen upitnik primenjen na celom uzorku. Na osnovu teorijskih okvira formulisana je 21 stavka. Upitnik se sastoji od četiri faktora: prvi faktor je Zadovolјstvo odnosom anesteziologa prema bolesniku, drugi faktor Perianestezijski komfor, treći faktor Nezadovolјstvo postoperativnom brigom i četvrti faktor Strah od anestezije Mera pouzdanosti upitnika na ovom uzorku izražena Kronbahovom alfom iznosi 0.889. Kada se uzmu u obzir sve stavke mera pouzdanosti izražena Kronbahovom alfom celog upitnika iznosi 0.845, &scaron;to ukazuje na visoku pouzdanost skale u celini. Kako bi se proverila konstruktna validnost upitnika, sprovedena je faktorska analiza na uzorku od 218 pacijenata. Bartletov test (p&lt;.01) i KMO vrednosti (KMO=0.880) ukazuju da je sprovođenje faktorske analize na ovom upitniku statistički opravdano. Srednje vrednosti interkorelacija faktora pokazuju da &scaron;to je odnos između anesteziologa i bolesnika bolјi, da će bolesnik imati manji strah od anestezije, biti zadovolјniji postoperativnom brigom i imati veći nivo komfora. Rezultati jednosmerne analize varijanse pokazuju da postoji statistički značajna razlika između grupa kada su u pitanju Zadovolјstvo odnosom anesteziologa prema bolesniku, Strah od anestezije i Nezadovolјstvo postoperativnom brigom. Grupe se statistički značajno ne razlikuju u Perianestezijskom komforu Kada je u pitanju faktor Zadovolјstvo odnosom anesteziologa prema bolesniku, eksperimentalna grupa koja je imala postoperativnu vizitu od strane anesteziologa je bila zadovolјnija ovim aspektom i od eksperimentalne grupe koja je imala postoperativnu vizitu od strane medicinskog tehničara koji nije učestvovao u davanju anestezije i od kontrolne grupe. Grupe se međusobno nisu statistički značajno razlikovale u proceni Perianestezijskog komfora. Kada je u pitanju Nezadovolјstvo postoperativnom brigom, kontrolna grupa se statistički značajno razlikuje u odnosu na obe eksperimentalne grupe. Bolesnici u kontrolnoj grupi su imali izraženiji Strah od anestezije u odnosu na eksperimentalnu grupu gde je postoperativnu posetu obavio anesteziolog. Zaklјučak: U ovom istraživanju konstruisan je visoko pouzdan upitnik koji može rutinski da se koristi za procenu zadovolјstva bolesnika anestezijom u svakodnevnom kliničkom radu anesteziologa na na&scaron;im prostorima. Postoji statistički značajna razlika u zadovolјstvu bolesnika anestezijom podvrgnutih rekonstrukciji prednjeg ukr&scaron;tenog ligamenta kolena između bolesnika koji su imali postoperativnu vizitu anesteziologa i onih koji je nisu imali u korist bolesnika koji su imali postoperativnu vizitu anesteziologa. Postoji statistički značajna razlika u zadovolјstvu bolesnika anestezijom podvrgnutih rekonstrukciji prednjeg ukr&scaron;tenog ligamenta kolena između onih koje je postoperativno obi&scaron;ao anesteziolog i onih koje je postoperativno obi&scaron;ao medicinski tehničar na anesteziji koji nije učestvovao u anesteziji.</p> / <p>Uvod: U svakodnevnom kliničkom radu anesteziologa, postoperativna vizita anesteziologa na odeljenjima rutinski se ne izvodi, niti su ustanovljeni jasni kriterijumi i stavovi o njenom značaju na zadovoljstvo bolesnika anestezijom. Cilj ovog istraživanja je bio konstrukcija i psihometrijska provera instrumenta koji može rutinski da se koristi za procenu zadovoljstva bolesnika anestezijom u svakodnevnom kliničkom radu anesteziologa na na&scaron;im prostorima, kao i da se ispita uticaj postoperativne vizite anesteziolioga na zadovoljstvo bolesnika anestezijom podvrgnutih rekonstrukciji prednjeg ukr&scaron;tenog ligamenta kolena. Materil i metode rada: U istraživanje je bilo uključeno 218 ispitanika, starijih od 18 godina, koji dobro govore i pi&scaron;u srpski jezik, koji su ASA I i ASA II statusa i koji su bili operisani u op&scaron;toj anesteziji. Ispitanici su podeljeni u tri grupe: prvu grupu čini 74 bolesnika, koje je postoperativno na odeljenju obi&scaron;ao anesteziolog koji je davao anesteziju, drugu grupu čini 70 bolesnika, koje je posle operacije obi&scaron;ao medicinski tehničar na anesteziji, koji nije učestvovao u anesteziji i treću grupu čini 74 bolesnika, koji nisu imali postoperativnu vizitu. U prvoj fazi iztraživanja prikupljali su se osnovni sociodemografski podaci i bolesnicima su usmeno postavljena pitanja. U drugoj fazi istraživanja svim bolesnicima je data op&scaron;ta balansirana anestezija. U trećoj fazi istraživanja, sprovedena je prva postoperativna vizita anesteziologa za bolesnike prve grupe i prva postoperativna poseta medicinskog tehničara na anesteziji za bolesnike druge grupe. Treća, kontrolna grupa bolesnika nije imala postoperativnu vizitu. U okviru ove vizite procenjivalo se objektivno (PAS skor) i subjektivno stanje bolesnika. Druga postoperativna vizita sprovedena je prvog postoperativnog dana. Drugog postoperativnog dana bolesnicima je odeljenska medicinska sestra, koja nije učestvovala u perioperativnom periodu bolesnika, davala upitnik za merenje zadovoljstva bolesnika anestezijom. Rezultati: Upitnik zadovoljstva bolesnika anestezijom je konstruisan za potrebe istraživanja. Prve metrijske provere upitnika su utvrđene u pilot studiji na 100 ispitanika, na osnovu kojih je neizmenjen upitnik primenjen na celom uzorku. Na osnovu teorijskih okvira formulisana je 21 stavka. Upitnik se sastoji od četiri faktora: prvi faktor je Zadovoljstvo odnosom anesteziologa prema bolesniku, drugi faktor Perianestezijski komfor, treći faktor Nezadovoljstvo postoperativnom brigom i četvrti faktor Strah od anestezije Mera pouzdanosti upitnika na ovom uzorku izražena Kronbahovom alfom iznosi 0.889. Kada se uzmu u obzir sve stavke mera pouzdanosti izražena Kronbahovom alfom celog upitnika iznosi 0.845, &scaron;to ukazuje na visoku pouzdanost skale u celini. Kako bi se proverila konstruktna validnost upitnika, sprovedena je faktorska analiza na uzorku od 218 pacijenata. Bartletov test (p&lt;.01) i KMO vrednosti (KMO=0.880) ukazuju da je sprovođenje faktorske analize na ovom upitniku statistički opravdano. Srednje vrednosti interkorelacija faktora pokazuju da &scaron;to je odnos između anesteziologa i bolesnika bolji, da će bolesnik imati manji strah od anestezije, biti zadovoljniji postoperativnom brigom i imati veći nivo komfora. Rezultati jednosmerne analize varijanse pokazuju da postoji statistički značajna razlika između grupa kada su u pitanju Zadovoljstvo odnosom anesteziologa prema bolesniku, Strah od anestezije i Nezadovoljstvo postoperativnom brigom. Grupe se statistički značajno ne razlikuju u Perianestezijskom komforu Kada je u pitanju faktor Zadovoljstvo odnosom anesteziologa prema bolesniku, eksperimentalna grupa koja je imala postoperativnu vizitu od strane anesteziologa je bila zadovoljnija ovim aspektom i od eksperimentalne grupe koja je imala postoperativnu vizitu od strane medicinskog tehničara koji nije učestvovao u davanju anestezije i od kontrolne grupe. Grupe se međusobno nisu statistički značajno razlikovale u proceni Perianestezijskog komfora. Kada je u pitanju Nezadovoljstvo postoperativnom brigom, kontrolna grupa se statistički značajno razlikuje u odnosu na obe eksperimentalne grupe. Bolesnici u kontrolnoj grupi su imali izraženiji Strah od anestezije u odnosu na eksperimentalnu grupu gde je postoperativnu posetu obavio anesteziolog. Zaključak: U ovom istraživanju konstruisan je visoko pouzdan upitnik koji može rutinski da se koristi za procenu zadovoljstva bolesnika anestezijom u svakodnevnom kliničkom radu anesteziologa na na&scaron;im prostorima. Postoji statistički značajna razlika u zadovoljstvu bolesnika anestezijom podvrgnutih rekonstrukciji prednjeg ukr&scaron;tenog ligamenta kolena između bolesnika koji su imali postoperativnu vizitu anesteziologa i onih koji je nisu imali u korist bolesnika koji su imali postoperativnu vizitu anesteziologa. Postoji statistički značajna razlika u zadovoljstvu bolesnika anestezijom podvrgnutih rekonstrukciji prednjeg ukr&scaron;tenog ligamenta kolena između onih koje je postoperativno obi&scaron;ao anesteziolog i onih koje je postoperativno obi&scaron;ao medicinski tehničar na anesteziji koji nije učestvovao u anesteziji.</p> / <p>Introduction: In daily clinical practice the anesthesiologist, anesthesiologist postoperative rounds on the wards routine is not performed, not have established clear criteria and attitudes about its importance to the satisfaction of patients anesthesia. The aim of this study was to design and psychometric instrument checks that can routinely be used to assess patient satisfaction with anesthesia in everyday clinical practice anesthesiologist in our region, as well as to investigate the influence of post-operative rounds of anesthesiologisr to the satisfaction of patients undergoing anesthesia reconstruction of the anterior cruciate ligament. Matera and methods: The study included 218 patients, aged 18 years, who speak and write the Serbian language, which are ASA I and ASA II status and who were operated under general anesthesia. Subjects were divided into three groups: the first group consists of 74 patients, which is postoperatively in the department visited the anesthesiologist who gave the anesthesia, the second group consists of 70 patients, which is postoperatively visited the medical technician to anesthesia, who was not involved in the anesthesia and the third group makes 74 patients who had postoperative rounds. In the first phase Researches were collected basic socio-demographic data and patients are oral questions. In the second phase of the study all patients received general balanced anesthesia. In the third phase of the study, conducted the first post-operative rounds anesthesiologist for patients of the first group and the first post-operative visit a medical technician in anesthesia for patients other groups. The third, control group patients had postoperative rounds. Within these rounds judged objectively (PAS score) and subjective state of patients. The second post-operative rounds conducted the first postoperative day. On the second postoperative day, the patients underwent Classroom nurse, who did not participate in the perioperative period, patients given a questionnaire to measure satisfaction with anesthesia. Results: The questionnaire satisfaction with anesthesia was designed for research purposes. The first metric verification of the questionnaire were determined in a pilot study on 100 subjects, on which it is unchanged from the questionnaire applied to the whole sample. Based on the theoretical framework formulated in paragraph 21. The questionnaire consists of four factors: the first factor is the ratio of pleasure anesthesiologist to the patient, another factor perianesthesian comfort, the third factor Dissatisfaction postoperative care and the fourth factor, fear of anesthesia questionnaire to measure the reliability of the sample expressed Cronbach alpha is 0.889. When taking into account all items measure expressed by Cronbach alpha reliability of the whole questionnaire is 0.845, which indicates the high reliability of the scale as a whole. In order to test the construct validity of the questionnaire, factor analysis was conducted on a sample of 218 patients. Bartlett&#39;s test (p &lt;.01) and the KMO value (KMO = 0.880) indicate that the implementation of factor analysis on the questionnaire statistically significant. Mean values Intercorrelation factors show that the relationship between the anesthesiologist and patient better, the patient will have less fear of anesthesia, be satisfied with the postoperative care and have a higher level of comfort. Results-way analysis of variance show that there is a statistically significant difference between the groups in terms of their satisfaction with the anesthesiologist to the patient, and the fear of anesthesia and postoperative care Dissatisfaction. The groups do not differ significantly in perianesthesia comfort when it comes to sexual satisfaction factor anesthesiologist to the patient, the experimental group had post-operative rounds by the anesthesiologist was pleased with this aspect of the experimental group had post-operative rounds by medical technicians who did not participated in giving anesthesia and the control group. Groups each other not statistically significant in assessing perianesthesia comfort. When it comes to the dissatisfaction of postoperative care, the control group was significantly different from both experimental groups. Patients in the control group had a pronounced fear of anesthesia compared to the experimental group in which the postoperative visit carried anesthesiologist. Conclusion: In this study constructed a highly reliable questionnaire that can be routinely used to assess patient satisfaction with anesthesia in everyday clinical practice anesthesiologist in our region. There was a statistically significant difference in the satisfaction of patients undergoing anesthesia reconstruction of the anterior cruciate ligament between the patients who had postoperative rounds anesthesiologist and those who did not have the benefit of patients who had postoperative rounds anesthesiologist. There was a statistically significant difference in the satisfaction of patients undergoing anesthesia reconstruction of the anterior cruciate ligament between those postoperatively visited the anesthesiologist and those he visited postoperative medical technician in anesthesia who was not involved in anesthesia.</p>

INTRODUÇÃO: O modelo epistemológico humanista na Medicina redefine o bom médico como um profissional que detém tanto excelência técnica quanto traços humanísticos. Os currículos médicos tiveram que se adaptar e se preocupar com projetos pedagógicos que dessem conta de promover o ensino/aprendizagem desses traços humanísticos. Esses projetos têm tentado resgatar a Educação Liberal nos currículos de Medicina através da introdução das Humanidades Médicas. Essa introdução tem sido tentada ao redor do mundo nos últimos 40 anos e requer cada vez mais novos projetos pedagógicos. Essa tese propõe o uso de uma atividade instrucional específica no campo das Artes Cinemáticas (enquanto Humanidade Médica) com a finalidade de mediar junto aos alunos a consecução de objetivos humanísticos pertinentes à Educação Médica. OBJETIVOS: Pretendeu-se analisar o filme And the band played on, produzindo possibilidades interpretativas sobre ele, justificando-as e comunicando-as através de uma síntese elucidativa; identificar aspectos de relevância médica cujo ensino/aprendizagem pode ser mediado pela discussão estruturada do filme como atividade instrucional; compilar esses aspectos em termos de objetivos educacionais humanísticos e de sua alocação a uma das taxonomias de objetivos educacionais nas Humanidades Médicas e prover exemplos concretos de possibilidades de ensino/aprendizagem relacionadas a essa atividade instrucional. METODOLOGIA: A análise fílmica abordou a obra nos seus aspectos narratológicos (como personagens e convenções de ponto de vista e narração) e estilísticos específicos do cinema. Observou os vários eixos que geram significação no cinema (linguagem verbal, linguagem escrita, visualidade, ruídos e música). Foi macro-analítica (analisando a obra como um todo), mas necessitou de momentos de micro-análise (seqüências e planos específicos). Envolveu a análise descritiva e formal da obra e sua interpretação através da análise interna (aspectos inerentes como iconografia e simbolismo) e externa (sistemas referenciais externos como teorias psicológicas) de sentido. Os aspectos de relevância médica passíveis de ensino/aprendizagem através dessa atividade instrucional foram procurados e alocados nos campos das grandes taxonomias que organizam os objetivos educacionais (Taxonomia de Objetivos Educacionais, Campos de Significado e Competências). RESULTADOS: Descreveram-se possibilidades de uso do filme de duas maneiras instrucionais: assistência do filme inteiro e assistência de excertos, em ambos os casos com posterior discussão. Em relação ao filme como um todo, duas propostas interpretativas diferentes foram geradas com base no seu potencial uso no ensino/aprendizagem em Medicina. A primeira baseia-se na narrativa romanesca da crise vocacional vivenciada pelo protagonista e a segunda centra-se na análise da instância narrativa e seus dispositivos. Em relação aos excertos, pinçaram-se algumas seqüências para ilustrar alguns de seus possíveis usos instrucionais. CONCLUSÕES: O filme pode ser usado instrucionalmente com vistas à abordagem educacional de objetivos humanísticos. Esses objetivos são pertinentes a diversas áreas do conhecimento, entre as quais citam-se os Domínio Afetivo e Emocional, os Campos Ético e Sinoético, e as Competências Adaptativa, Contextual, de Identidade Profissional e Motivação para Aprendizagem Continuada. Esses objetivos abordam áreas de conteúdo relevantes, como a relação médico-paciente, a vocação médica, o contar notícias ruins, a persona médica, o arquétipo do médico ferido, a comunicação humana e a identidade profissional médica, entre outras. / INTRODUCTION: The humanist epistemological model in Medicine redefines the good physician as a professional that has technical excellence, but also wields humanistic traits. Medical curricula have had to adapt themselves and make efforts to generate pedagogical projects that could foster the teaching/learning of these traits. These projects have attempted to address a Liberal Education in medical curricula by means of the introduction of the Medical Humanities. This introduction has been attempted worldwide in the latest 40 years and is still in need of new pedagogical projects. This thesis proposes the use of a specific instructional activity in the Cinematic Arts (as Medical Humanity) so as to provide mediation to the accomplishment by students of humanistic objectives. OBJECTIVES: The objectives of this thesis were to analyze the film And the band played on, producing interpretative possibilities about it, justifying them and communicating them by means of an elucidative work of synthesis; to identify aspects of medical relevance, whose teaching/learning could be mediated by the structured discussion of the film as an instructional activity; to compile these aspects in terms of humanistic educational objectives and their allocation to one of the taxonomies for educational objectives in Medical Humanities; and to provide concrete examples of teaching/learning possibilities related to this instructional activity. METHODS: Film analysis approached the movie through narratological (characters and conventions of narration and point of view) and cinema-specific stylistic aspects. The several axes that generate meaning in cinema have been considered (verbal language, written word, visuality, sounds and music). The analysis was macro-analytic (approaching the film as a whole), but contemplated micro-analysis (specific sequences). It involved the descriptive and formal analysis of the film and its interpretation in the light of internal (inherent aspects such as iconography and symbolism) and external (external referential systems such as psychological theories) analysis of meaning. The aspects of medical relevance were allocated to and searched for in the fields of the great taxonomies that organize educational objectives (Taxonomy of Educational Objectives, Realms of Meaning and Competences). RESULTS: Two instructional uses of the film were described: projection of the whole film, as opposed to the projection of excerpts. In both cases, a discussion should follow. In the first case, two different interpretative proposals were generated, based on their potential use in teaching/learning in Medicine. The first is based on a romanesque narrative about the vocational crisis experienced by the protagonist, whereas the second one focuses on the narrating instance and its dispositions. In terms of the excerpts, some sequences were pinpointed to illustrate some of their possible instructional uses. CONCLUSIONS: The film may be used instructionally within the educational approach to humanistic objectives. These objectives pertain to several areas of knowledge, among which, the Affective and Emotional Domains; Ethics and Synnoetics (Realms of Meaning); and Lifelong Learning, Professional Identity, Adaptative and Contextual Competences. These objectives comprehend relevant contents, such as the physician-patient relationship, medical vocation, breaking bad news, the medical persona, human communication and medical professional identity, among others.

O profissional de saúde ao visualizar a gravidez na adolescência como um problema de saúde a ser corrigido, torna invisível o paciente como sujeito de direitos e necessidades de cuidado. Há percepções de que as práticas no campo da Medicina estão descoladas da realidade e não atendem, ao que parece, às demandas dos usuários como sujeitos de direitos das ações em saúde. Os conhecimentos adquiridos, construídos e compartilhados foram incorporados à realidade da prática médica, porém a grande questão é saber e entender em que medida e de que forma acontece esse processo e como se relaciona com os demais envolvidos, ou seja, qual a percepção e o que prevalece ou torna-se invisível o sujeito paciente na abordagem médica às questões complexas da saúde dos indivíduos. Os objetivos desse trabalho foram desvelar as invisibilidades do sujeito paciente na questão da gravidez na adolescência sob os olhares do profissional da saúde e, consequentemente, caracterizar especificidades dos olhares do profissional da saúde na prática da assistência aos adolescentes com experiência de gravidez que os tornam invisíveis ao profissional. Para esse fim, foi adotado como procedimento metodológico a investigação cientifica da pesquisa descritiva de abordagem qualitativa, por meio da análise de conteúdo des entrevistas semi estruturadas, de aspecto geral sobre assuntos relacionados ao tema central gravidez na adolescência e a assistência médica, com perguntas comuns e consensuais que envolviam significados, ensino, a prática cotidiana e saúde pública com profissionais de saúde médicos, que trabalham com adolescentes grávidas, nos serviços da rede de saúde pública em município da Grande São Paulo, com vinculação acadêmica a Instituição de Ensino Superior. Desvelaram-se que as invisibilidades do sujeito paciente na questão da gravidez na adolescência são resultados da produção médica no cuidado ao paciente, nos valores e representações da lógica médica. Caracterizaram-se como especificidades dos olhares do profissional de saúde que invisibiliza o sujeito adolescente na prática assistencial a produção da ciência médica fundamentada na percepção de mundo para esses profissionais que conflitam com as percepções de mundo do adolescente na experiência da gravidez. A ciência médica voltada ao modelo biomédico e organicista, baseada numa tradição positivista, torna a arte médica um lugar de pouca reflexão estrutural e privilegia-se o saber instituído em detrimento de novas possibilidades do cuidado médico, onde as questões que envolvem dimensões humanas têm difícil inserção. O outro eixo está fundamentado nas percepções de modelo social de estrutura familiar tradicional e no poder em manter a ordem que a sociedade atribui ao médico. / The health professional to show teenage pregnancy as a health problem to be corrected, makes invisible the patient as a subject of rights and care needs. There are perceptions that the practices in the medical field are detached from reality and does not meet, it seems, the demands of the users as subjects of rights of health actions. The knowledge acquired, built and shared were incorporated to the reality of medical practice, but the big question is to know and understand to what extent and in what way does this process and how it relates to others involved, therefore, what the perception and what prevails or becomes invisible subject patient in medical approach to the complex issues of the health of individuals. Among the most common health guidelines, some are eligible to potentially reach a greater degree of complexity to the care and become provocative assistance gaps, which in this study called the invisibility of the subject, and one of the staves, we work with teenage pregnancy, and the invisibility of this teenager in this important moment of your life that need care and support of the health professional. The objectives of this study were to reveal the invisibilities of fellow patient on the issue of teen pregnancy in the looks of the healthcare professional and, consequently, characterize specificities of the looks of the health professionals in the practice of assistance to adolescents with pregnancy experience that makes them invisible to the professional. For this purpose, was adopted as methodological procedure scientific research of qualitative research, through the analysis of semi structured interviews, General aspect on subjects related to the central theme teen pregnancy and medical assistance, with common questions and consensual involving meanings, teaching, daily practice and public health with medical health professionals, who work with pregnant adolescents services public health network in municipality of greater São Paulo, academic affiliation with the Medical Education Institution. Was unveiled that the invisibility of the subject patient issue of teenage pregnancy are the result of medical production in patient care, values and representations of medical logic. Were characterized as specific looks of the health professional that the adolescent subject rather invisible in healthcare practice the production of medical science based on the perception of the world for these professionals that conflict with the perceptions of the world of the adolescent experience of pregnancy. The focused on biomedical and medical science organicist model, based on a positivist tradition, makes the medical art a place of reflection and little structural knowledge is privileged at the expense of established new possibilities of medical care, where issues involving human dimensions are difficult insertion. The other axis is based on the perceptions of the social model of traditional family structure and power \"in maintaining order\" that society attaches to the doctor.

O profissional de saúde ao visualizar a gravidez na adolescência como um problema de saúde a ser corrigido, torna invisível o paciente como sujeito de direitos e necessidades de cuidado. Há percepções de que as práticas no campo da Medicina estão descoladas da realidade e não atendem, ao que parece, às demandas dos usuários como sujeitos de direitos das ações em saúde. Os conhecimentos adquiridos, construídos e compartilhados foram incorporados à realidade da prática médica, porém a grande questão é saber e entender em que medida e de que forma acontece esse processo e como se relaciona com os demais envolvidos, ou seja, qual a percepção e o que prevalece ou torna-se invisível o sujeito paciente na abordagem médica às questões complexas da saúde dos indivíduos. Os objetivos desse trabalho foram desvelar as invisibilidades do sujeito paciente na questão da gravidez na adolescência sob os olhares do profissional da saúde e, consequentemente, caracterizar especificidades dos olhares do profissional da saúde na prática da assistência aos adolescentes com experiência de gravidez que os tornam invisíveis ao profissional. Para esse fim, foi adotado como procedimento metodológico a investigação cientifica da pesquisa descritiva de abordagem qualitativa, por meio da análise de conteúdo des entrevistas semi estruturadas, de aspecto geral sobre assuntos relacionados ao tema central gravidez na adolescência e a assistência médica, com perguntas comuns e consensuais que envolviam significados, ensino, a prática cotidiana e saúde pública com profissionais de saúde médicos, que trabalham com adolescentes grávidas, nos serviços da rede de saúde pública em município da Grande São Paulo, com vinculação acadêmica a Instituição de Ensino Superior. Desvelaram-se que as invisibilidades do sujeito paciente na questão da gravidez na adolescência são resultados da produção médica no cuidado ao paciente, nos valores e representações da lógica médica. Caracterizaram-se como especificidades dos olhares do profissional de saúde que invisibiliza o sujeito adolescente na prática assistencial a produção da ciência médica fundamentada na percepção de mundo para esses profissionais que conflitam com as percepções de mundo do adolescente na experiência da gravidez. A ciência médica voltada ao modelo biomédico e organicista, baseada numa tradição positivista, torna a arte médica um lugar de pouca reflexão estrutural e privilegia-se o saber instituído em detrimento de novas possibilidades do cuidado médico, onde as questões que envolvem dimensões humanas têm difícil inserção. O outro eixo está fundamentado nas percepções de modelo social de estrutura familiar tradicional e no poder em manter a ordem que a sociedade atribui ao médico. / The health professional to show teenage pregnancy as a health problem to be corrected, makes invisible the patient as a subject of rights and care needs. There are perceptions that the practices in the medical field are detached from reality and does not meet, it seems, the demands of the users as subjects of rights of health actions. The knowledge acquired, built and shared were incorporated to the reality of medical practice, but the big question is to know and understand to what extent and in what way does this process and how it relates to others involved, therefore, what the perception and what prevails or becomes invisible subject patient in medical approach to the complex issues of the health of individuals. Among the most common health guidelines, some are eligible to potentially reach a greater degree of complexity to the care and become provocative assistance gaps, which in this study called the invisibility of the subject, and one of the staves, we work with teenage pregnancy, and the invisibility of this teenager in this important moment of your life that need care and support of the health professional. The objectives of this study were to reveal the invisibilities of fellow patient on the issue of teen pregnancy in the looks of the healthcare professional and, consequently, characterize specificities of the looks of the health professionals in the practice of assistance to adolescents with pregnancy experience that makes them invisible to the professional. For this purpose, was adopted as methodological procedure scientific research of qualitative research, through the analysis of semi structured interviews, General aspect on subjects related to the central theme teen pregnancy and medical assistance, with common questions and consensual involving meanings, teaching, daily practice and public health with medical health professionals, who work with pregnant adolescents services public health network in municipality of greater São Paulo, academic affiliation with the Medical Education Institution. Was unveiled that the invisibility of the subject patient issue of teenage pregnancy are the result of medical production in patient care, values and representations of medical logic. Were characterized as specific looks of the health professional that the adolescent subject rather invisible in healthcare practice the production of medical science based on the perception of the world for these professionals that conflict with the perceptions of the world of the adolescent experience of pregnancy. The focused on biomedical and medical science organicist model, based on a positivist tradition, makes the medical art a place of reflection and little structural knowledge is privileged at the expense of established new possibilities of medical care, where issues involving human dimensions are difficult insertion. The other axis is based on the perceptions of the social model of traditional family structure and power \"in maintaining order\" that society attaches to the doctor.

Introdução: Em Reprodução Assistida toda a equipe compartilha com o casal o árduo caminho composto pelas fases do tratamento, porém, o presente estudo deteve-se a experiência do médico. Objetivos: Investigar o Imaginário Coletivo de médicos que atuam em Reprodução Assistida sobre as situações de difícil manejo em sua prática profissional. Métodos: Foram feitas entrevistas únicas individuais, utilizando o Procedimento de Desenho-Estória com Tema como instrumento dialógico. A partir das entrevistas foi criada uma narrativa transferencial ficcional preservando elementos essenciais da dramática humana estudada. Os registros foram interpretados à luz do método psicanalítico buscando a criação/encontro de campos de sentido afetivo-emocional. Resultados: Foram encontrados os seguintes campos: \"Não deu certo!?\", que organiza-se ao redor da ideia de que não alcançar o objetivo pretendido seria o equivalente a fracassar, mesmo diante de situações incertas; \"Engole o choro!\", que organiza-se mediante a crença de que é preciso conter os sentimentos diante de determinadas situações, não deixar-se emocionar; \"Fora do comum\", que organiza-se por meio da crença de que quem está em posição de cuidador é e/ou precisa ser excepcional. Conclusões: Para a formação e à prática médica é preciso incluir, além da visão científica-tecnológica, a abordagem da subjetividade. É necessária a criação de enquadres diferenciados que auxiliem o médico a aproximar-se emocionalmente de seu trabalho, facilitem a superação de dissociações, promovam a saúde mental, contribuindo para que o exercício da profissão seja gratificante e dotado de um sentido genuíno / In Assisted Reproduction the whole team shares with the couple the hard journey through the phases of the treatment, however, this study is about the doctor\'s experience. Objectives: To investigate the Collective Imaginary of doctors working in Assisted Reproduction on some difficult situations in their professional practice. Methods: Individual interviews were conducted using the Thematic Story-Drawing Procedure as dialogical instrument. From the interviews a fictional narrative transference were created preserving essential elements of the human drama studied. The records were interpreted in light of the psychoanalytic method seeking the creation / gathering of affective-emotional sense fields. Results: The following fields were found: \"It did not work!?\", which is organized around the idea that not reaching the target would be equivalent to failing, even due to uncertain situations; \"Swallow your crying!\", Which is organized by the belief that one must contain the feelings before certain situations, not allowing themselves to get emotional; \"Out of the ordinary\", which is organized by the belief that who is in the position caregiver is and / or needs to be exceptional. Conclusions: For the training and medical practice is necessary to include, beyond the scientific-technological view, the approach of subjectivity. It is necessary to create different framings that help the doctor to approach their work emotionally, facilitate the overcoming of dissociations, promote mental health, this way contributing to the exercise of the profession so it can be rewarding and endowed with a genuine sense

Submitted by JOSIANE SANTOS DE OLIVEIRA (josianeso) on 2018-08-14T13:53:07Z No. of bitstreams: 1 Daiane Baldasso Böhm_.pdf: 1286054 bytes, checksum: 502a9d545ea8a3ec5b352f21f9ebe9b7 (MD5) / Made available in DSpace on 2018-08-14T13:53:07Z (GMT). No. of bitstreams: 1 Daiane Baldasso Böhm_.pdf: 1286054 bytes, checksum: 502a9d545ea8a3ec5b352f21f9ebe9b7 (MD5) Previous issue date: 2018-03-23 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / PROSUP - Programa de Suporte à Pós-Gradução de Instituições de Ensino Particulares / Os/As pacientes têm o direito de escolher a alternativa mais apropriada dentre os tratamentos de saúde disponíveis (TOERIEN et al., 2011), e precisam ser informados/as sobre as opções de possíveis tratamentos e exames diagnósticos especializados para que possam alcançar a autonomia necessária para tomar sua decisão. (LANDMARK; GULBRADSEN; SVENNEVIG, 2015; WESSELS; KOOLE; PENN, 2014). Para tanto, almeja-se o provimento de todas as informações necessárias e existentes sobre essa possível próxima etapa com certo grau de neutralidade, a fim de reconhecer a autonomia e o conhecimento do/a paciente. (LANDMARK; GULBRANDSEN; SVENNEVIG, 2014; DREW; HERITAGE, 1992). Recomendações realizadas de forma a priorizar uma opção em particular representam a autoridade deôntica do/a profissional. (STEVANOVIC; PERÄKYLÄ, 2012). Há uma lacuna em estudos interacionais na área da saúde com interações naturalísticas, i.e., “[...] dados advindos de situações cotidianas e que acontecem (e aconteceriam) com ou sem a presença de um pesquisador” (OSTERMANN; MENEGHEL, 2012, p. 14) em língua portuguesa que observem as recomendações médico/a-paciente e o processo de tomada de decisão. Ressaltamos, contudo, que ao se desenvolver uma pesquisa sob essa temática, toda uma classe profissional pode se beneficiar dos resultados. Esse tipo de análise pode contribuir para a formação de profissionais que atuam em áreas em que recomendar/tomar decisões é prática recorrente. Esta dissertação visa a analisar de que forma é realizada a sequência de recomendações médicas a pacientes grávidas (gestações de médio e alto risco) em consultas de Aconselhamento Genético (AG). Nas consultas, um médico geneticista recomenda a realização de testagem genético-fetal envolvendo procedimentos (i.e., amniocentese ou cordocentese) para posterior análise do cariótipo fetal. Ambos são procedimentos invasivos e não são livres de risco. O estudo objetiva (1) identificar a Organização Estrutural Geral (OEG) dos segmentos em que há recomendações (nível macro estrutural de análise das interações); (2) descrever as fases das recomendações nas consultas analisadas; (3) analisar as características linguístico-interacionais das sequências de recomendações (nível microinteracional de análise); (4) investigar, de uma perspectiva analítica interacional (SACKS, 1992), como (e se) a autoridade deôntica do profissional emerge nessas sequências, e sua relação com o domínio epistêmico dos/as participantes. Para tanto, a análise dos dados foi realizada sob a perspectiva teórico-metodológica da Análise da Conversa (SACKS; SCHEGLOFF; JEFFERSON, 1974; CLIFT, 2016), que permite uma análise minuciosa e retrospectiva dos turnos de fala que compõem sequências interacionais. O contexto de pesquisa é um hospital do Sistema Único de Saúde (SUS), localizado no sul do Brasil, que oferece consultas de AG a pacientes grávidas com gestações de médio e alto risco. Este estudo insere-se em um projeto maior coordenado pela Profa. Dra. Ana Cristina Ostermann, chamado A mobilização do saber e do fazer: episteme e deonticidade na fala-em-interação institucional e na conversa cotidiana, bem como as interações aqui analisadas advêm desse mesmo projeto. / Patients have the right to choose the most suitable among the different alternatives of health treatment (TOERIN et al., 2011), and thus need to be informed about the choices of possible treatments as well as of more specialized diagnostic exams so that they can reach the necessary autonomy to make a decision. (LANDMARK; GULBRANDSEN; SVENNEVIG, 2015; WESSELS; KOOLE; PENN, 2014). For this reason, professionals are supposed to provide patients with the necessary and existing information about the possible next step with some degree of neutrality, recognizing patients’ autonomy and knowledge. (LANDMARK; GULBRANDSEN; SVENNEVIG, 2014; DREW; HERITAGE, 1992). Non-neutral (biased) recommendations for a specific treatment or medical exam might represent an explicit stance of the professional’s deontic authority. (STEVANOVIC; PERÄKYLA, 2012). There is a lack of health interactional studies with naturalistic interactions i.e., “[…] data from daily situations which happen (and would happen) with or without the researcher presence” (OSTERMANN; MENEGHEL, 2012, p. 14, our translation) in Brazilian Portuguese language that observe physician-patient recommendations and the decision-making process. We highlight, however, that developing a research concerning this theme, a whole professional class must be beneficiated from the results. This kind of analysis may contribute for the formation of professionals who work in areas in which recommending/making decisions is current practise. The present master’s dissertation analyzes how the medical-pregnant patients’s (medium and high risk pregnancies) recommendation sequence is done in Genetic Counselling (GC) consultations. Along the consultations, a geneticist recommends the foetal-genetic test involving procedures (i.e. amniocentesis or cordocentesis) for further foetal karyotype analysis. Both procedures are invasive and not free risk. This study consists of (1) identifying the Overall Structural Organization (OSO) of the segments in which there are recommendations (macro structural level of interactional analysis); (2) describing the recommendation phases in the analysed consultations; (3) analysing the linguistic-interactional features of recommendation sequences (micro structural level of analysis); (4) investigating, from a conversation analytical perspective (SACKS, 1992), how (and if) the professional deontic authority takes shape in these sequences, and its relation with the participants epistemic domain. In order to do so, the data analysis was done under Conversation Analysis (CA) theoretical-methodological approach (SACKS; SCHEGLOFF; JEFFERSON, 1974; CLIFT, 2016), which enables a meticulous analysis and turns of talk retrospective that make interactional sequences. The research context is a public hospital in the south of Brazil, which offers GC consultations for pregnant patients with medium and high risk pregnancies. This study consists of a subproject of a larger project coordinated by Profa. Ana Cristina Ostermann, named A mobilização do saber e do fazer: episteme e deonticidade na fala-em-interação institucional e na conversa cotidiana, as the analysed interactions also come from the same project.