Nos últimos anos, o ensino de fisiologia tem sido fortemente beneficiado pelo desenvolvimento de modelos matemáticos e simuladores de paciente capazes de reproduzir com segurança partes específicas ou sistemas fisiológicos completos. Estudos mostram que aulas teóricas aliadas a simulações conseguem potencializar o nível de compreensão dos conceitos envolvidos. O principal objetivo deste trabalho consiste no desenvolvimento de um simulador do sistema cardiovascular, capaz de representar de forma didática a dinâmica do ciclo cardíaco. A disponibilidade de simuladores deste tipo é reduzida, e limitada a modelos simplificados ou interfaces pouco amigáveis. De modo a conseguir maior flexibilidade nas situações simuladas e um adequado grau de proximidade com o sistema real, decidiu-se pela utilização de um modelo matemático da fisiologia cardiovascular para o cálculo das variáveis e parâmetros atuantes no plano de fundo do simulador. O desenvolvimento deste modelo constitui o segundo objetivo deste trabalho. Devido ao grau de complexidade desejado, optou-se pela utilização de um modelo existente na literatura, acrescido dos parâmetros que fossem considerados ausentes. O resultado foi um modelo com oito compartimentos vasculares e quatro compartimentos representando as câmaras do coração, todas com atividade pulsátil, controlados pelo mecanismo reflexo baroceptor, controle de curto prazo que atua na regulação da pressão arterial. O simulador (desenvolvido em Visual C# com interface em Macromedia Flash) permite a alteração individual dos parâmetros vasculares e a simulação de hemorragias, bem como a visualização de gráficos de pressão, fluxo e volume em qualquer compartimento, e a construção de alças pressão-volume para os átrios e ventrículos. Além disso, o aplicativo resultante possibilita a inclusão futura de novos recursos e ferramentas, como tutoriais e simulação de patologias. / During the last years, physiology learning has been strongly favored by the development of mathematical models and patient simulators capable of safely reproduce specific parts or complete physiological systems. Studies show that traditional classes together with simulations are able to in-crease the comprehension of concepts involved. The main objective of this work is to develop a simu-lator of the cardiovascular system capable of representing the cardiac cycle dynamics in a didactic fashion. There are just a few available simulators of this kind, and the existing ones are based on simplified models or unfriendly interfaces. In order to achieve high flexibility in simulated scenarios and an adequate level of realism, we decided to use a mathematical model of the cardiovascular physiology to calculate variables and parameters acting in the background of the application. The development of this model constitutes the second objective of the present work. Due to the desired level of complexity, we decided to use an existing model found in the literature, improved with addi-tional parameters we found necessary. The result is a model with eight vascular compartments and all four cardiac chambers, with pulsatile behavior, controlled by the baroreflex mechanism, a short term control that regulates arterial pressure. The simulator (developed in Visual C# with an interface built in Macromedia Flash) allows the user to change individual parameters and simulate blood losses, as well as visualize press, flow and volume graphs from any compartment and also pressure-volume loops from the cardiac chambers. Moreover, the resulting application is open to future inclusion of new resources and tools, such as tutorials and pathology simulation.

Reflective practice, though ill-defined, has become an accepted educational concept within many health care disciplines particularly in nursing. Subsequently it has become benchmarked within Paramedic Sciences as a professional requirement for continuing education and clinical practice. However, despite the vast literature in nursing and the increasing growth of reflective practice in paramedic curricula it is unclear how it influences the students’ learning in preparation for graduate practice as future reflective practitioners. This research explored ‘to what extent does reflective practice in the paramedic curriculum influence the students’ academic and clinical learning leading to graduate practice’? A mixed methods approach with cohort samples of undergraduate health care students comprised four studies including surveys and non-participant observations of clinical simulation that were conducted in a university learning environment. The results showed overall that Paramedic students believed that they understood reflective practice and perceived it to be useful for their academic studies and clinical practice; although this is probably influenced more by formal teaching rather than the result of their own views. Students were able to describe reflective practice in ideal theoretical terms and were positive towards it regardless of their individual learning styles. However, in a clinical context, they applied it differently with significant emphasis on technical reflection. Evidence of the nature of reflective practice as it occurred during and after clinical simulation scenarios highlights a need for revised approaches to existing learning/teaching strategies with paramedic students. An extended understanding and refinement of reflective practice concepts including a new pedagogic framework to promote enhanced reflectivity are proposed. This theoretical framework is designed to accommodate reflective learning for both personal and collaborative learning related to curriculum outcomes. The use of clinical simulation for the development of reflective practice in the paramedic curriculum is supported with recommendations for further studies in academic and clinical settings.