Orientador: Maria Helena Salgado Bagnato / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Educação / Made available in DSpace on 2018-08-21T11:24:17Z (GMT). No. of bitstreams: 1 Andrade_MarciaReginaSelpade_D.pdf: 3594605 bytes, checksum: 56c04b5f9b5a7471551d9b58c08251d5 (MD5) Previous issue date: 2012 / Resumo: Essa pesquisa aborda as propostas de currículo integrado de duas escolas médicas de Santa Catarina, a Universidade Federal de Santa Catarina - UFSC e a Universidade Comunitária da Região de Chapecó - UNOCHAPECÓ. A investigação teve como finalidade compreender o processo de construção e recontextualização do currículo integrado a partir da análise dos Projetos Pedagógicos e por meio de entrevistas semiestruturadas com professores e coordenadores dos respectivos cursos de medicina. Buscou problematizar como a integralidade curricular é recontextualizada nos dois cursos de medicina? quais as principais características dos currículos integrados? quais os caminhos pelos quais se expressam a mudança curricular? A partir das questões norteadoras que envolveram a pesquisa foi possível nessa trajetória identificar: a) no Campo de Recontextualização Oficial as principais influências das políticas e programas de incentivo a mudança curricular. Nesse contexto compreendemos que as políticas mobilizam os sujeitos e grupos sociais, os discursos e as práticas curriculares, porém, em processos contínuos de interpretações e ressignificações; b) no Campo de Recontextualização Pedagógica foi situado as características de currículos integrados. Nesse campo identificamos que os currículos das duas escolas médicas foram organizados numa perspectiva modular e espiral. Os projetos também revelam a dinâmica e a complexidade de sua operacionalização. Na análise das entrevistas foi possível perceber os principais atores sociais envolvidos no processo de mudanças, as dificuldades, os avanços, e os desafios tanto na elaboração como na implementação das propostas curriculares integradas. Assim, essa pesquisa mostra as ambivalências das motivações e as influências das políticas no contexto das mudanças e construção da proposta curricular. Porém, consideramos que tais influências e motivações são recontextualizadas e reinterpretadas nos diferentes contextos a partir da história de vida pessoal e profissional de cada ator social e das complexas conexões com a coletividade, a cultura e as relações de poder. Portanto, não se buscou apenas apontar resistências, ou a aceitação de uma mudança curricular, mas compreender que as propostas curriculares, entendidas como artefato social e histórico buscam além da integração do conhecimento, a visão integrada do ser humano. Nesse sentido uma recontextualização da formação médica está em percurso. / Abstract: This research discusses the proposed integration of the curriculum of two medical schools of Santa Catarina, The Federal University of Santa Catarina (UFSC) and the Community University for the Region of Chapecó - (UNOCHAPECÓ). The aim of the research is to understand the process of development and re-contextualization of an integrated curriculum from the analysis of pedagogical projects and through semi-structured interviews with teachers and coordinators of the respective medical courses. We sought to consider the problem of; How to integrate the curriculum and re-contextualize the two courses of medicine? What are the main characteristics of the integrated curricula? What are the ways through which we express the curricular change? Using these questions to direct the research it was possible in this way to identify: (a) in the area of official re-contextualization, the primary influences of policies and programs to encourage curricular change. In this context we understand that the policies mobilize individuals and social groups, in the communication and curriculum practices, providing that there is a continuous processes of interpretation and re-interpretation. (b) the attributes of integrated curricula were placed within the area of pedagogical re-contextualization. In this area we have identified that the curricula of the two medical schools were organized in a modular and spiral approach. The projects also revealed the dynamics and complexity of its operation. In the analysis of the interviews it was possible to realize the principle social players involved in the process of change, the difficulties, the advances and challenges both in the preparation and the implementation of integrated curricular proposals. Thus, this study shows the ambivalence of the motivations and influences of the policies in the context of the changes and development of the proposed curriculum. However, we believe that such influences and motivations are re-contextualized and re-interpreted in different ways due to the personal and professional history of each participant and the complex connections with the collectivity, the culture and power relationships. Therefore, we not only sought to identify resistance or acceptance of a curriculum change, but to understand that the proposed curriculum, understood as a social and historical tool, aims to look beyond the integration of knowledge and also as an integrated vision of humanity. In this sense a re-contextualization of medical training is being formed. / Doutorado / Ensino e Práticas Culturais / Doutor em Educação

Background Latin America is undergoing a human resource crisis in health care in terms of labor shortage, misdistribution and poor orientation to primary care. Workforce data are needed to inform the planning of long-term strategies to address this problem. This study aimed to evaluate the academic and motivational profile, as well as the professional expectations, of Latin American medical students. Results We conducted an observational, cross-sectional, multi-country study evaluating medical students from 11 Spanish-speaking countries in 2011–2012. Motivations to study medicine, migration intentions, intent to enter postgraduate programs, and perceptions regarding primary care were evaluated via a self-administered questionnaire. Outcomes were measured with pilot-tested questions and previously validated scales. A total of 11,072 valid surveys from 63 medical schools were gathered and analyzed. Conclusions This study describes the profile and expectations of the future workforce being trained in Latin America. The obtained information will be useful for governments and universities in planning strategies to improve their current state of affairs regarding human resources for health care professions.

Objectives: This study aimed to assess residents' and fellows' knowledge of finance principles that may affect their personal financial health. Methods: A cross-sectional, anonymous, web-based survey was administered to a convenience sample of residents and fellows at two academic medical centers. Respondents answered 20 questions on personal finance and 28 questions about their own financial planning, attitudes, and debt. Questions regarding satisfaction with one's financial condition and investment-risk tolerance used a 10-point Likert scale (1=lowest, 10=highest). Of 2,010 trainees, 422 (21%) responded (median age 30 years; interquartile range, 28-33). Results: The mean quiz score was 52.0% (SD = 19.1). Of 299 (71%) respondents with student loan debt, 144 (48%) owed over $200,000. Many respondents had other debt, including 86 (21%) with credit card debt. Of 262 respondents with retirement savings, 142 (52%) had saved less than $25,000. Respondents' mean satisfaction with their current personal financial condition was 4.8 (SD = 2.5) and investment-risk tolerance was 5.3 (SD = 2.3). Indebted trainees reported lower satisfaction than trainees without debt (4.4 vs. 6.2, F (1,419) = 41.57, p < .001). Knowledge was moderately correlated with investment-risk tolerance (r=0.41, p < .001), and weakly correlated with satisfaction with financial status (r=0.23, p < .001). Conclusions: Residents and fellows had low financial literacy and investment-risk tolerance, high debt, and deficits in their financial preparedness. Adding personal financial education to the medical education curriculum would benefit trainees. Providing education in areas such as budgeting, estate planning, investment strategies, and retirement planning early in training can offer significant long-term benefits.

Lung cancer is the second most prevalent cancer in men and women in the United States and the overall leading cause of cancer-related deaths. Due to this high prevalence, lung cancer screening is a critical procedure in all Family Medicine practices. However, screening is particularly important in rural Appalachian clinics, as this area experiences especially high rates of mortality due to lung cancer. The United States Preventive Services Task Force recommends annual low-dose computed tomography (LDCT) lung cancer screening in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. The goal of this project is assess readiness of clinical providers of the risks and benefits of lung cancer screening, to encourage screening when appropriate, and ultimately increase then number of LDCT annual screenings. Provider knowledge was assessing using a lung cancer screening knowledge and practice survey. Participants then attended an educational sessions that provided information on the importance of screening and when it is appropriate to administer LDCT. Finally, a second survey was administered, again to assess knowledge and practice. Data analysis is currently in process. A t-test will be executed to determine if there is a statistically significant difference between survey scores before and after the educational session. It is expected that the educational program will lead to increases in provider knowledge and more appropriate screenings. The results of this study have important ramifications for this area; because Appalachia has disproportionately high mortality due to lung cancer, it is imperative that the disease be identified as early as possible to ensure the most effective treatment. This project illustrates a method to increase screenings.

Objective: To evaluate the differences among Primary Care (PC) labor perceptions of medical students from Latin America according to their country. Methods: Observational, analytic and cross-sectional multicountry study that evaluated 9 561 first and fifth-year medical students from 63 medical schools of 11 Latin American countries through a survey. To evaluate the perceptions on the PC work, a previously validated scale was used. Tertiles of the scores were created in order to compare the different countries. Crude and adjusted prevalence ratios were calculated using simple and multiple Poisson regression. A p-value<0.05 was considered statistically significant. Findings: 52.9% of the subjects were female and the mean age was 20.4±2.9 years. 35.5% were fifth-year students. Statistically significant differences were found between the study subjects’ country, using Peru as reference. Students from Chile, Colombia, Mexico and Paraguay perceived PC work more positively compared with Peruvian students, while those from Ecuador showed less favorable opinions. No differences were found among the perceptions of Bolivian, Salvadoran, Honduran and Venezuelan students when compared to their Peruvian peers. Conclusions: Perceptions of PC among medical students from Latin America vary according to the country. Considering such differences can be of major importance for potential local specific interventions for the improvement of PC in these. / Tesis

LGBT+ patients, medical students, and healthcare providers have been shown to experience significant health disparities and poor health outcomes, to less frequently seek out healthcare, and to often face discrimination in healthcare settings. Researchers suggest the lack of high quality and in-depth training on LGBT+ health and communication skills may contribute to hostile clinic cultures and reinforce implicit and explicit biases towards LGBT+ patients. Despite the growing body of research and interest in curriculum reforms, there has not been an up to date, comprehensive review of LGBT+ health trainings and resources at U.S. medical schools since 2015. We conducted a systematic review of available information on the presence of LGBT+ trainings, support groups, and resources for medical students, residents, and faculty at all M.D.-granting institutions who are part of the Association of American Medical Colleges (AAMC). The systematic review was conducted between May and September 2020 through Google using pre-determined keyword search strategies. Collected information included type of programming, targeted audience, and length of training among others that was built into an easily accessible online database of LGBT+ health curriculums and resources. Similar to 2015, most U.S. medical schools (52%) do not have or do not provide easily accessible information about LGBT+ trainings for their students. Even fewer medical schools (39%) report that they require their students to take some form of LGBT+ health training, and almost no information is easily available on LGBT+ trainings for residents and medical school faculty. Our findings suggest that medical schools have made some progress in creating more inclusive curricula and training environments compared to 2015. However, there has not been a consensus in how medical students should be trained to be more aware of and to address biases, discrimination, and poor health outcomes affecting their LGBTQ+ patients and colleagues.

Most medical students across the U.S. currently receive intubation skills training on low fidelity simulation (LFS) plastic mannequins. A limitation of these LFS models is that they do not allow students to attain complete familiarity and proficiency with intubation in a real-world clinical setting. For several years now, ETSU has been utilizing the Thiel embalming technique, which allows for greater joint flexibility and preservation of soft tissues compared to traditional embalming techniques. Our study set out to evaluate the efficacy of Thiel cadavers versus LFS plastic mannequins in assessing whether one model was more suitable in teaching intubation skills. After IRB approval, we exposed thirty-two first-and second-year medical students to both LFS models and Thiel embalmed cadavers in order to assess preparedness and confidence for performing intubations, and overall transference to patient care. Participants were shown an instructional video and given a brief lecture on the steps of a successful intubation by the primary investigators of the project before they were asked to practice intubation on both a Thiel cadaver as well as a LFS plastic mannequin. Participants were randomly assigned to note which teaching method to practice on first (Thiel cadaver or LFS model). Students were given written instructions during the procedure, and they completed a pre and post survey assessing preparedness, confidence, transference to patient care, and overall preference between the Thiel cadaver and LFS model for education. Our study significantly concluded that students felt better prepared and more confident by practicing on the Thiel cadaver and unanimously thought that it had better transference to clinical care. Overall, students also felt that the Thiel cadaver provided more knowledge, and close to two thirds of subjects preferred the Thiel cadaver over the LFS mannequin for learning intubation skills while a third of subjects said that both models should be used in training.

Barriers to competent and safe healthcare disproportionately impact people who are marginalized because of their race, ethnicity, gender, or socioeconomic status. It is well documented that transgender patients in particular experience barriers to both accessing care and receiving high quality, non-discriminatory care (Hatzenbuehler & Pachankis, 2016; James et al., 2016; Rahman et al., 2019; Safer et al., 2016). This lack of access to culturally competent healthcare services contributes to health disparities that disproportionately impact the trans community. Literature on barriers to competent care for trans patients indicates that providers experience discomfort related to their ability to provide competent care (Safer et al., 2016). Many providers endorse a median of only five hours of trans healthcare training across their entire medical school curriculum (Hughto et al., 2015), and in some cases, as little as 45 minutes per year (Sawning et al., 2017). Primary care clinics should be the place in which general health and wellbeing are addressed for trans patients, as has been true for cisgender people. Primary care providers should be competent in assessing eligibility for Hormone Replacement Therapy (HRT) and surgery (Wylie et al., 2016), as well as providing necessary preventative care. Thus, this makes primary care the ideal setting for the proposed medical education implementation project. The current study aimed to develop and implement a training program for medical residents in primary care in rural South Central Appalachia. A six-stage development and implementation study is described. The intervention was evaluated for pedagogical outcomes including sustainability for future use, usefulness to residents, and accessibility. Evaluation of effectiveness included analyses of changes in providers’ self-reported competency, awareness of discriminatory experiences, and attitudes towards treating trans patients. There were no significant differences in pre-post competency scores (r=22, M=33.29[SD=5.96]; r=31, M=37.33[SD=1.02], SD=8.00) or in pre-post attitudes scores (r=15, M=32.76[SE=0.8], SD=4.69; r=13, M=34.7273[SE=1.00], SD=4.692). Accessibility and sustainability were measured qualitatively and included data such as resident attendance and ease of use of material for future behavioral health provider trainers. These outcomes were found to be satisfactory based on stakeholder feedback. Usefulness included three data points (satisfaction, helpfulness, value of training).

This article outlines a process for developing standardized patient cases. The initial step in the process is to define the educational goals of the exercise. Following this step the patient characteristics, setting for the interaction and clinical information are developed. Clinical information, in addition to history, may include elements of nonverbal communication, actual or simulated abnormal physical findings, and laboratory results. Guidelines for the standardized patient regarding disclosure of information to the student and providing feedback to the student enhance the value of the case. If the case is to be used as part of an examination, a grading system must be developed. Issues of cost, validity, and reliability are briefly addressed. .

PURPOSE OF REVIEW: To assess the current use of simulation in medical education, specifically, the teaching of the basic sciences to accomplish the goal of improved integration. RECENT FINDINGS: Simulation is increasingly being used by the institutions to teach the basic sciences. Preliminary data suggest that it is an effective tool with increased retention and learner satisfaction. SUMMARY: Medical education is undergoing tremendous change. One of the directions of that change is increasing integration of the basic and clinical sciences to improve the efficiency and quality of medical education, and ultimately to improve the patient care. Integration is thought to improve the understanding of basic science conceptual knowledge and to better prepare the learners for clinical practice. Simulation because of its unique effects on learning is currently being successfully used by many institutions as a means to produce that integration through its use in the teaching of the basic sciences. Preliminary data indicate that simulation is an effective tool for basic science education and garners high learner satisfaction.