Made available in DSpace on 2015-12-06T23:05:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2005 / O modelo biomédico prevalente no ensino médico sofre sérios questionamentos a partir da metade do século XX, havendo uma transição paradigmática rumo ao atual, de atenção integral do indivíduo. Estas mudanças, que ocorreram em todo o mundo, tiveram reflexos tardios no Brasil, e somente na década de oitenta surgiram movimentos propondo uma reflexão mais profunda sobre a formação médica, no sentido de reduzir as falhas do ensino e qualificar o profissional para a nova realidade que se apresentava. O perfil contemporâneo de formação, preconizado pelas Diretrizes Curriculares Nacionais, é de um profissional capacitado em todas as dimensões da competência profissional, avançando para além das cognitivas e técnicas e incorporando as dimensões afetivas, relacionais, dentre outras. Hoje precisamos de um profissional humanizado e multicompetente, capaz de trabalhar em equipe e ciente de seu papel transformador da sociedade.Neste contexto situa-se essa pesquisa, voltada para a necessidade de estudar o ensino atual de uma especialidade médica – a oftalmologia – para compreender de que forma a inserção do ensino de uma especialidade (em geral isolada no currículo médico) ocorre, frente à necessidade da formação geral do médico. O objetivo deste trabalho é analisar a inserção da oftalmologia em cursos de medicina com currículo disciplinar e não-disiciplinar, a partir de análise documental e de entrevistas realizadas com coordenadores de graduação e com docentes responsáveis pela oftalmologia. Foram estudadas oito escolas de medicina, localizadas no Estado do Rio de Janeiro, São Paulo e Paraná. As entrevistas foram analisadas para apreender as concepções dos sujeitos sobre o ensino, identificando suas características principais. Todos os entrevistados, tanto coordenadores de curso como docentes da especialidade, consideraram que os cursos médicos devem formar um profissional com um perfil geral, em conformidade com as Diretrizes Curriculares Nacionais para os Cursos de Graduação em Medicina, sendo este o contexto no qual a oftalmologia deve ser inserida. Em que pese a oftalmologia, tanto como serviço hospitalar quanto componente curricular, ser relacionada dentre as especialidades cirúrgicas, foi possível depreender que o ensino da mesma no âmbito da formação geral do médico deve considerar essencialmente seus aspectos clínicos. Uma possibilidade de integração da oftalmologia diz respeito à “pulverização” dos conteúdos longitudinalmente no currículo, guardando relação com competências profissionais desenvolvidas por grandes áreas da medicina (clínica, pediatria e medicina comunitária, dentre outras). Os resultados demonstraram a necessidade de reavaliação do espaço da oftalmologia dentro do currículo médico, no sentido de adequar o ensino da especialidade à formação geral do médico. O trabalho finaliza propondo princípios norteadores para a inserção da oftalmologia na graduação médica, numa perspectiva de integração e de atenção integral à saúde. / The biomedical model widely adopted in medical education has been challenged since the second half of 20th.Century. There has been a paradigmatic shift towards a model that aims at integral care of the individual. Those worldwide changes reflected lately in Brazil, and only about 1980 it has been proposed a more deep reflection about medical undergraduation, in order to reduce educational failures and improve the training of professionals towards the new reality. Nowadays, National Curricular Guidelines demand that medical courses graduate doctors with all the dimensions of professional competence, from cognitive and technical to relational and affective, among others. Doctors must be able to work in teams, in a compassionate way, and must be conscious of their social transforming role. This research aims at studying the teaching of a medical specialty – ophthalmology – in order to understand how possible it is to insert a specialty in a generalist curriculum. The objective of the research is to analyze the insertion of ophthalmology in undergraduate medical courses with disciplinary and non-disciplinary curricula, by means of document analyses and interviews with deans and medical teachers responsible for ophthalmology courses. Eight schools in Rio de Janeiro, Sao Paulo and Parana States were investigated. The conceptions of the subject about teaching were apprehended in the interviews. All subjects stated that medical courses must graduate general physicians, according to Curricular Guidelines, and that is the context in which ophthalmology should be taught. Despite being a surgical specialty, emphasis should be put on clinical aspects. Integration with other areas could be attempted by “powdering” its contents longitudinally along the course. Competencies should be developed simultaneously with main fields of medical teaching, such as Internal Medicine, Pediatrics and Community Medicine, among others. The results showed the need of reevaluating the insertion of ophthalmology in medical undergraduate curriculum. Finally the work proposes several principles in order to achieve teaching of the specialty in an integrative perspective. / BV UNIFESP: Teses e dissertações

Background: The United States Preventive Services Task Force guidelines support screening and provision of intensive multi-component behavioral counseling for adults who have obesity. One barrier to providing such counseling is lack of training in medical school. Not much is known about factors associated with medical students’ perceived weight management counseling (WMC) skills or whether preceptors model or teach WMC during primary care clerkships. Methods: A mixed methods approach addressed factors affecting WMC training during primary care clerkships. A secondary analysis of 3rd year medical students (n=730) described students’ perceived WMC skills, attitudes and frequency of engagement in 5As educational experiences. Linear mixed models were used to determine associations between educational experiences and perceived skills. Semi-structured interviews (n=12) and a survey were administered to primary care preceptors (n=77). Interviews described individual, inter-personal and institutional factors associated with preceptors’ WMC. The survey described preceptors’ frequency of modeling WMC behaviors, perceived WMC skills, and attitudes. Results: Students perceived themselves to be moderately skilled (M=2.6, SD=0.05, range 1-4). Direct patient experiences and specific instruction were associated with higher perceived skill. Preceptors support WMC curricula but do not perceive themselves to be experts in WMC. Preceptors perceive themselves to be moderately skilled (M=2.8, SD=0.06, range 1-4) but only sometimes model WMC (M=3.3, SD=0.05, range 1-5) to students during clerkships. Conclusion: Preceptor modeling WMC may not be feasible or necessary during primary care clerkships. Providing specific WMC instruction and working with patients may provide more benefit as they were more strongly associated with students’ perceived skills.

Indiana University-Purdue University Indianapolis (IUPUI) / Background: Gross anatomy is a foundational medical school course upon which other courses and patient care is grounded; however, variability in student performance suggests potential in studying underlying non-academic factors to explain some of these inconsistencies. Thus, this study examined medical students’ implicit theories of intelligence (ITI) and grit in order to better understand student learning outcomes in gross anatomy. Methods: A mixed methods study was conducted using 2nd, 3rd, and 4th year medical students who successfully completed gross anatomy. Students (n=382) completed the ITI Scale and Short Grit Scale in order to identify individual’s ITI and grit scores. Subsequent interviews (n=25) were conducted to explore how medical students set goals, operated while reaching those goals, and monitored their progress in achieving those goals. Results: Entity and incremental theorists with high grit performed significantly better in gross anatomy when compared to those with low grit. Further, highly gritty incremental and entity theorists were hard workers and showed resilience in the face of challenges. Specifically, those with an entity ITI had the central goal of getting an honors grade, while those with an incremental ITI desired to understand and apply their anatomical knowledge. Conversely, low grit individuals became overwhelmed by challenges, were more likely to show an inconsistent work ethic, and questioned their ability to master the material. An individual’s ITI, more so than grit, drove the presence of negative emotions in a medical student, with entity theorists feeling anxious and vulnerable, and incremental theorists feeling fewer negative emotions. Finally, grit level moderated how a medical student would respond to negative emotions, with highly gritty individuals exhibiting more constructive coping mechanisms. Conclusions: These findings suggest that medical students who possess high grit and an incremental theory of intelligence have the most effective learning strategies, set achievable goals, and enlist effective coping mechanisms while learning gross anatomy. The findings and tools used in this study could be incorporated into the medical school admissions process. Finally, findings reinforce the value of examining the ITI and grit of medical students, as they can provide educators with insight regarding important non-academic factors driving learning in gross anatomy.

Training delivered to medical students and residents in behavioral health is widely acknowledged to be inadequate. While the use of standardized patients is common in medical training and education for physical health conditions via the adherence to clinical protocols for evaluation and treatment, this approach is infrequently used for behavioral health conditions. Used under specific circumstances, standardized patient encounters have long been considered a reliable method of training and assessing trainee performance on addressing physical health conditions, and are even comparable to ratings of directly observed encounters with real patients. This paper discusses common issues and challenges that arise in using standardized patients in behavioral health. Although current evidence of its value is modest and challenges in implementation exist, the use of standardized patients holds promise for medical training and education and as an evaluation tool in behavioral health.

Background In July 2014, the Institute of Medicine released a review of the governance of Graduate Medical Education (GME), concluding that changes to GME financing were needed to reward desired performance and to reshape the workforce to meet the nation's needs. In light of the rapid emergence of alternative payment systems, we evaluated the financial value of resident participation in operative surgical care. Methods The Department of Surgery provided Current Procedural Terminology (CPT) codes for procedures performed by the general surgical service at our institution for the 2011 academic year. For each code, the charge and total instances were provided. CPTs allowing an assistant fee were identified using the Searchable Medicare Physician Fee Schedule. This approach enabled calculation of the potential resident contribution to GME funding. Results A total of 515 unique CPTs were potentially billable for a total of 6,578 procedures, of which 2,552 (39%) were reimbursable. These CPTs would have generated $1,882,854 in assistant charges. The top 50 most frequent CPTs resulted in 4,247 procedures. Within the top 50, 1362 procedures (32% of the top 50, 21% of the total) were reimbursable. Of the total assistant charges, $963,227 (51%) occurred in the top 50 most frequent CPTs. Conclusions Credit for resident participation in operative care as co-surgeon would average $67,244 per resident, compared to our current funding of $142,635 per resident. This type of alternative funding could provide 47% of current educational support. The skew in distribution of procedures also suggests that such a system could provide guidance to a more balanced operative experience. Such performance-based credentialing could be used to ensure appropriate housestaff for a given case; these reimbursements could also be adjusted based on quality metrics to provide for transformational change in patient outcomes.

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Introduction: Competency-based medical education (CBME) is a learner-centered outcomes-based approach. Competence by Design (CBD) is a hybrid time-based and outcomes-based CBME model that was adopted by all Royal College of Physicians and Surgeons of Canada-based residency training programs, with the primary objective of enhancing postgraduate medical education quality. However, preliminary findings suggest that residents experience higher levels of stress, anxiety, and exhaustion in CBD than with previous curricula. This thesis aims to identify and understand the emotional effects of CBME on residents, faculty, and administrative staff. Methods: This study used a qualitative approach, specifically hermeneutic phenomenology. Seven residents, six faculty members (several with education leadership roles), and one administrative staff member from a postgraduate Psychiatry program were recruited. Participants underwent semi-structured, one-on-one interviews where they were probed on their emotions with CBME. Interviews were transcribed and analyzed using a line-by-line approach that generated individual meaning units and, subsequently, themes. Results: Five themes were identified: 1) Education is an emotional experience; 2) The emotional toll of CBD; 3) CBD is a failed educational promise—Expectations vs. realities; 4) Structural and administrative burdens of CBD; and 5) Survival of educational demands—The quest for coping. Participants initially struggled to articulate their emotions, but expressed surprise at realizing they did have strong, often negative, emotions related to CBD. There was also a dissonance identified between the anticipated benefits and the execution of CBD. Furthermore, participants highlighted administrative and structural challenges of CBD, specifically regarding Entrustable Professional Activities, which were a burden and lacked much educational value. Participants discussed using various coping strategies to manage CBD’s demands. Conclusion: The findings of this work suggest that CBD has a negative emotional impact on residents and faculty, specifically due to tension between CBD’s theoretical benefits and its practical challenges, including increased emotional burden and structural challenges. / Thesis / Master of Science (MSc) / Competency-based medical education (CBME) is a learner-centered outcomes-based approach. Competence by Design (CBD) is a hybrid time-based and outcomes-based CBME model that was adopted by all Royal College of Physicians and Surgeons of Canada-based residency training programs, with the primary objective of enhancing the quality of postgraduate medical education. However, preliminary findings suggest that residents experience higher levels of stress, anxiety, and exhaustion in a CBD model than with previous curricula. This thesis aims to understand the emotional effects of CBME on residents, faculty, and administrative staff in a postgraduate Psychiatry program. In this qualitative study, participants underwent semi-structured, one-on-one interviews where they were probed on their emotions and experiences with CBME. The findings suggest that CBD has a negative emotional impact on residents and faculty, specifically due to tension between CBD’s theoretical benefits and its practical challenges, including increased emotional burden and structural challenges associated with the assessment methods.

Thesis (MPhil)--Stellenbosch University, 2001. / ENGLISH ABSTRACT: The practice of medicine has always been a big area of interest as a profession. The focus ranges depending on issues at hand - it may be on the educational, training, humanistic, economic, professional ethics and legal aspects. One area of medicine that is under the spotlight around the world is that of the maintenance of clinical competency, followed very closely and almost linked to professional ethics. This study follows the introduction of a system of Continuing Professional Development (hereinafter also referred to as CPD), in South Africa and an overview of how it has been introduced in a few other countries. The main areas of focus being the extrication of inherent values of CPD, relating this aspect to quality improvement in medical health care. The medical profession as well as most of the interested parties, has different perspectives regarding the fact that the system is regulated through legislation. There is also the doubt whether the CPD system will be effective in achieving the goals that it has been set to achieve. Although a system of Continuing Medical Education has been a tradition in all countries, which implies that the CPD system is not totally new as far as the educational principles are concerned, the values accruable need to be exploited. It is the possible success of this kind of evaluations that may foster more understanding of the inherent values in this CPD system. / AFRIKAANSE OPSOMMING: Beroepsgewys het die praktyk van geneeskunde nog altyd groot belangstelling gelok. Die fokus verskuif na gelang van die onderwerpe ter sprake. Dit wissel van opvoedkunde, opleiding, humanisme, ekonomie, en professionele etiek tot regsaspekte. Dwarsoor die wêreld word daar gefokus op die handhawing van kliniese vaardighede, gevolg deur professionele etiek wat ook daarin verweef is. Hierdie studie bespreek die instelling van 'n stelsel van Voortgesette Professionele Ontwikkeling (hierna verwys na as VPO) in Suid-Afrika asook oorsig oor die wyse waarop dit in 'n paar ander lande ingestel is. Die klem lê op die inherente waardes met betrekking tot die verbetering gehalte in mediese gesondheidsorg. Die mediese beroep, asook meeste van die belangegroepe het verskillende opvattings oor die feit dat die stelsel deur wetgewing gereguleer word. Daar is ook twyfel of die VPO-stelsel in sy vooropgestelde doelwitte sal slaag. Wat die opvoedkundige beginsels betref, is die VPO-stelsel nie totaal en al nuut nie. Alhoewel VPO in ander lande tradisie is, is dit nodig om die totstandkoming van waardes te ontgin. Die moontlike sukses van hierdie tipe van evaluasies mag dalk beter begrip ten opsigte van die inherente waardes in die VPO-stelsel bevorder.

There is a severe shortage of rural physicians in America. One reason physicians choose not to practice, or persist in practice, in rural areas is due to a lack of professional community, i.e., community of practice (CoP). Online, "virtual" CoPs, enabled by now common Internet communication technology can help give rural physicians the CoP experience they traditionally have lacked, despite their remote practice locations. Therefore, it is important for rural medical education programs to provide technological experiences that give students the skills needed to create virtual CoPs in future rural practice contexts. The Oregon Rural Scholars Program (ORSP) provides such a technological experience in the form of the Student Clinical Round (SCR) activity. ORSP students located in remote, rural parts of Oregon "meet" in a synchronous online space (i.e., a virtual meeting room) with a faculty member, where they participate in the SCR activity via video chat, screen and document sharing, real-time collaborative note taking, and text chatting. The literature indicates that activities like the SCR may be precursors to virtual CoPs, and therefore it is important to better understand the ORSP SCR as it could be a strategy for creating virtual CoPs among rural practitioners. As the ORSP SCR is a novel educational approach among U.S. rural medical education programs, an intrinsic case study design was used to explore the impact of the SCR activity on one cohort of ORSP third-year medical students. Additionally, the study sought to better understand the nature of the ORSP students' experiences of having participated in the SCR. Recorded SCR sessions were coded using the Community of Inquiry (CoI) framework, a well validated methodology for analyzing higher education online learning. The CoI analysis revealed a movement of the group away from an individual, task focus towards a community, collaborative focus as the SCR sessions progressed. Additionally, student interview and field notes analyses revealed that the SCR experience reduced isolation, increased sense of community and positively influenced rural practice choice among the study participants. Conclusions drawn from this study are that the online ORSP SCR experience provides a strong social constructivist learning environment, thus creating the context for virtual CoP emergence. Additionally, the SCR activity is capable of generating an actual virtual CoP, an event directly observed during the study. Recommendations call for rural medical education programs as well as current rural practitioners to adopt similar online approaches to group learning, as such approaches may provide contexts for virtual CoP formation, thus contributing to the likelihood future physicians may become and current physicians may persist as rural practitioners.