Orientadores: Eliana Martorano Amaral, Angelica Maria Bicudo Zeferino / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T11:06:13Z (GMT). No. of bitstreams: 1 Domingues_RosangelaCurvoLeite_D.pdf: 2568394 bytes, checksum: ef02de041cdb4116f477edbaf37a5267 (MD5) Previous issue date: 2008 / Resumo: Objetivo: Relacionar o Conceito Global Itemizado com o Conceito Geral dos alunos do 4º ano de Medicina, atribuídos por três tipos de avaliadores (docentes, colegas e próprio aluno) e compará-lo com os outros métodos de avaliação das competências esperadas no atendimento em unidade de atenção primária. Sujeitos e métodos: Foram estudadas as notas atribuídas a estudantes do 4º ano (n=106), por docentes (n=19), pelos próprios alunos e por colegas, ao final de um módulo de ensino que se desenvolve em 6 unidades básicas de saúde, sob supervisão de docentes e tutores de Ginecologia e Obstetrícia (GO), Clínica Médica (CM) e Pediatria (Ped). Os docentes forneceram uma nota (0 a 10) que resumia as competências do aluno no semestre, cuja média foi definida como Conceito Geral (CG). Depois de duas semanas, os mesmos docentes preencheram o formulário pré-testado do Conceito Global Itemizado (CGI) para os mesmos alunos, que continha 6 domínios de competências técnicas (CGIt) e 7 de competências humanísticas (CGIh). Os alunos preencheram formulários iguais (de CG e de CGI) para realizar sua auto-avaliação e apenas a parte das competências humanísticas (CGIh) para anonimamente avaliar 3-4 colegas que compunham o seu grupo. Por meio de um instrumento auto-respondido, também expressaram sua opinião sobre o exercício de se auto-avaliar e de avaliar seus colegas. As notas de CGI foram comparadas com notas provindas de outros métodos de avaliação: Provas Teóricas (Pt), Portfólio (Pf) e Avaliação Estruturada (AE). A análise estatística incluiu estatísticas descritivas, análise fatorial, coeficientes de Cronbach, testes de Friedman e de Wilcoxon para dados emparelhados, coeficientes de correlação de Pearson e de Spearman, modelos de análise de variância (ANOVA) e distâncias Euclidianas. Assumiu-se o nível de significância de 5%. Foi utilizado o programa SPSS Versão 10.0. O projeto foi aprovado pelo Comitê de Ética e Pesquisa da instituição. Resultados: Houve predominância de notas elevadas e discriminação reduzida entre os alunos. A consistência interna do questionário de CGI foi elevada para todos os avaliadores (alfa de Cronbach > 0,881). As notas de CG dos alunos foram significativamente inferiores às dos docentes (diferença de medianas = 0,41). As notas de CG foram significativamente inferiores às notas do CGI na avaliação docente (diferença de medianas = 0,13), mas não na auto avaliação e tiveram maior concordância e correlação com as notas de CGIt (r= 0,873 docente, r= 0,715 auto-avaliação) do que com as de CGIh (r= 0,614 docente, r= 0,481 auto-avaliação). As notas de CGIh foram significativamente mais elevadas do que as de CGIt, tanto na auto-avaliação (diferença de medianas = 0,17) quanto na avaliação docente (diferença de medianas = 0,19), com modestas correlações entre elas (r= 0,62 docentes, r= 0,61 auto-avaliação). Os alunos atribuíram notas significativamente mais baixas para os colegas do que para si mesmos (CGIh, diferença de medianas = 0,36). As correlações entre as notas dos três tipos de avaliadores para todos os domínios do CGI foram muito pobres e, em geral, não significativas. As notas dos docentes de Ped foram significativamente inferiores às dos docentes de GO e CM (diferenças de medianas entre 0,50 e 0,67), com correlações baixas entre elas (-0,02<r<0,48). A maior discordância ocorreu entre as notas de GO e Ped, em todos os métodos. Os domínios que tiveram maior impacto na confiabilidade do CGI foram: Exame físico, Solução de problemas, Capacidade de auto-reflexão e Julgamento clínico. Hábitos de trabalho poderia ser excluído do instrumento itemizado. 90,6% dos alunos/avaliadores avaliaram todos os seus colegas de grupo. Houve indicações de reciprocidade e constância no padrão das notas entre pares e situações sugestivas de conflitos interpessoais. Os alunos se sentiram mais confortáveis e preparados para a auto-avaliação do que para a avaliação dos colegas (diferença de 34,4% e 17,7%, respectivamente) e julgaram a auto-avaliação mais justa e valiosa do que a avaliação dos colegas (diferença de 4,2% e 34,7%, espectivamente). Houve diferenças significativas entre as distribuições das notas de todos os métodos, com notas mais elevadas na AE (mediana = 9,27). Houve correlação forte e significativa (r= 0,719) e maior concordância entre as notas da AE e as do CGI. Conclusão: Os alunos foram mais rigorosos consigo mesmo do que os docentes no CG e nos atributos técnicos do CGI e com seus pares nos atributos humanísticos do CGI. As notas do CG foram inferiores às do CGI para os docentes, mas não para os próprios alunos e enfocaram principalmente as competências técnicas dos estudantes. O CGI mostrou-se uma estratégia válida e confiável para compor o conjunto de métodos de avaliação dos estudantes do 4º ano de medicina, em estágio clínico. / Abstract: Purpose: To correlate the Global Itemized Rating with the Global Overall Rating attributed to Y4 medical students by three types of assessors (faculty, peers and self), and to compare it with other assessment methods used to evaluate learners in clinical clerkship, at the primary level of care. Subjects and Methods: The focus of the present study were ratings attributed to Y4 medical students (n= 106) by faculty members (n= 19), by own students and peers, at the end of a teaching module conducted at 6 primary care centers, and supervised by faculties and tutors from Obstetric and Gynecology (O&G), Internal Medicine (IM) and Pediatrics (Ped). Faculties provided a summative global numeric rating, ranging from 0 to 10, which summarized student's competencies during the clerkship. Faculty global scores across disciplines were averaged and defined as a Global Overall Rating (GOR). Two weeks after securing GOR ratings for all students, the same faculty members assessed the same students using in a pre-tested Global Itemized Rating, named GIR, which encompassed thirteen domains: six referred to technical skills (GIRt), and seven to humanistic skills (GIRh). Students completed similar GOR and GIR forms for self-assessment, and the humanistic scoring components of the GIR form to anonymously assess three to five working-group peers. Students answered a questionnaire on their perceptions to the experience as self and peer raters. GIR ratings were compared with ratings from other assessment methods: Multiple-choice questions (MCQs), Portfolio (Pf) and Real-case structured clinical assessment (RC-SCA). Statistical analyses included descriptive statistics, factor analysis, Cronbach's alpha, Friedman test, Wilcoxon signed rank test, Pearson and Spearman correlation coeffients, ANOVA models and Euclidean distances. Statistical significance was set at P<0.05. Statistical analyses were performed using SPSS program, version 10.0. Ethical approval was obtained. Results: Distributions were negatively skewed and reduced discrimination among students was observed. GIR internal consistency was high, across all types of raters (Cronbach's alpha > 0.881). Students' GOR ratings were significantly lower than faculties' (median difference = 0.41). GOR ratings were significantly lower than GIR ratings for faculty (median difference = 0.13), but not for self, and showed stronger agreement and correlation with GIRt (r= 0.873 for faculty and r= 0.715 for self) than with GIRh (r= 0.614 for faculty and r= 0.481 for self). GIRh ratings were significantly higher than GIRt (median difference = 0.17 for self and 0.19 for faculty), with modest correlations between them (r= 0.62 for faculty and r= 0.61 for self). Learners attributed lower mean ratings to their fellow students than to themselves (CGIh median difference = 0.36). Correlations between faculty, self and peer scores were very poor in all domains, and generally non significant. Ped scores were significantly lower than O&G and IM (median differences between 0.50 and 0.67), with low correlations between them (-0.02<r<0.48). O&G and Ped scores showed greater disagreement, in all methods. The domains that had greater impact on the reliability of the scale were: Physical examination, Problem-solving, Self- reflective skills and Clinical Judgment. Work habits could be excluded from the itemized form. 90.6% of the learners/raters assessed all their group-peers. Patterns of reciprocity and constancy in ratings, and some situations suggesting conflicts were noticed in working groups. Learners expressed to be more comfortable and prepared for self than for peer assessment (difference = 34.4% and 17.7%, respectively), and considered self-assessment more fair and valuable than peer assessment (difference = 4.2% and 34,7%, respectively). There were significant differences between score distributions in all assessment methods, with higher ratings in RC-SCA (median = 9.27). RC-SCA and GIR showed strong and significant correlations (r= 0.719) and greater agreement. Conclusion: Learners were sctricter with themselves than faculty in GOR and in GIR technical domains, and with their colleagues in GIR humanistic domains. GOR ratings were lower than GIR ratings for faculty, but not for self, and focused mainly on students' technical skills. GIR has shown to be a valid and reliable strategy, which can make up the set of assessment methods used to evaluate fouth-year students in clinical clerkship. / Doutorado / Ciencias Biomedicas / Doutor em Tocoginecologia

Thesis (M.Sc.)--Memorial University of Newfoundland, Faculty of Medicine, 1998. / Typescript. Bibliography: leaves 101-107.

Submitted by Erika Demachki (erikademachki@gmail.com) on 2015-01-29T17:19:33Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Arabela Maria Barbosa Sampaio - 2014.pdf: 5408735 bytes, checksum: 8ec17e6fa54be5d2ff85f5d0de698b1d (MD5) / Approved for entry into archive by Erika Demachki (erikademachki@gmail.com) on 2015-01-29T17:42:35Z (GMT) No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Arabela Maria Barbosa Sampaio - 2014.pdf: 5408735 bytes, checksum: 8ec17e6fa54be5d2ff85f5d0de698b1d (MD5) / Made available in DSpace on 2015-01-29T17:42:35Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Arabela Maria Barbosa Sampaio - 2014.pdf: 5408735 bytes, checksum: 8ec17e6fa54be5d2ff85f5d0de698b1d (MD5) Previous issue date: 2014-10-13 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / The Objective clinical Structural Examination (objective Structured Clinical Examination OSCE-) is a methodology for assessing clinical competence, which has been used worldwide since 1975 after being described by Harden while in Brazil, its use is more recent. However, studies evaluating the efficacy and acceptability among students are scarce. This research has the scope to collaborate in the production of data that can substantiate the efficiency of the model in question by describing and analyzing qualitative and quantitative aspects. To achieve such results, is outlined as a general goal, to investigate the perception of medical students over the course of the OSCE in the academic education pediatrics. With a quantitative and qualitative approach, assessing statistically describes and analyzes the data according to the method advocated by Bardin, bipolarizando subcategories under positive and negative aspects and sometimes neutral. We used an online semi-structured via Google Drive questionnaire to 330 students and gave a return of 123 respondents. Responses were categorized and frequenciada, so it came to the main results: 89.4% of students the OSCE assessed the clinical skills appropriately; 87.7% considered organized examination and 82.1% were satisfied with the scenery and staging. On the time available to perform the tasks 91.1% believed that was enough. When asked about the feedback given 87% agreed that learning opportunity offered, 88.6% agreed that feedback contributed to the academic and 75.6% thought that the evaluators were well prepared to give feedback. The qualitative categories of the OSCE environment was negative in 75.9%; 54.7% of the responses related to vocational training were positive; 60.4% recognized that feedback has positive aspects; OSCE model evaluation was positive in 90.6%; while the evaluation of the OSCE Pediatrics was negative for 52.2% of the respondents. We conclude that the OSCE is the accepted practice of evaluation, and that contributes to academic and learning, mainly because the feedback. / O Objective Structural clinical Examination (OSCE- Exame Clínico Objetivo Estruturado) é uma metodologia de avaliação de competências clínicas, que vem sendo utilizada mundialmente desde 1975 após ter sido descrita por Harden enquanto no Brasil o seu uso é mais recente. Porém, estudos avaliando a sua eficácia e aceitabilidade entre os estudantes ainda são escassos. Esta pesquisa tem por escopo colaborar na produção de dados que possam fundamentar a eficiência do modelo em pauta por meio da descrição e análise de aspectos qualitativos e quantitativos. Para alcançar tais resultados, traçou-se como objetivo geral, investigar a percepção do discente de medicina sobre o OSCE da disciplina de Pediatria na formação acadêmica. Com uma abordagem quanti-qualitativa, a avaliação descreve estatisticamente os dados e os analisa de acordo com método preconizado por Bardin, bipolarizando as subcategorias em aspectos positivos e negativos e às vezes neutros. Empregou-se um questionário semi-estruturado on-line via Google Drive a 330 estudantes e obteve-se um retorno de 123 respondentes. As respostas foram categorizadas e frequenciada, de tal forma que se chegou aos principais resultados: para 89,4% dos estudantes o OSCE avaliou as competências clinicas de forma adequada; 87,7% consideraram o exame organizado e 82,1% ficaram satisfeitos com o cenário e a encenação. Sobre o tempo disponibilizado para a realização das tarefas 91,1% acreditaram que foi suficiente. Quando questionado a respeito do feedback dado 87% concordaram que ofereceu oportunidade de aprendizagem, 88,6% concordaram que o feedback contribuiu na formação acadêmica e 75,6% consideraram que os avaliadores estavam bem preparados para dar o feedback. As categorias qualitativa relativas ao ambiente do OSCE foi negativa em 75,9%; 54,7% das respostas relativas a formação profissional foram positiva; 60,4% reconhecem que o feedback tem aspectos positivos; a avaliação do modelo OSCE foi positiva em 90,6%; enquanto que a avaliação do OSCE de Pediatria foi negativa para 52,2% dos respondentes. Conclui-se que o OSCE é a prática de avaliação aceita, e que contribui na formação acadêmica e aprendizado, devido essencialmente pelo feedback.

African Americans (AA) are more susceptible to end-stage renal disease (ESRD) for several reasons. Treatment options for patients with ESRD include dialysis therapy and transplantation, with the latter typically producing better outcomes. AA are less likely to complete the medical evaluation process, which requires patients to consult with doctors and undergo a series of tests and examinations. This study sought to determine the factors that predict completion of the medical evaluation for AA ESRD patients using a mixed methods design. Participants consisted of transplant professionals (N=23) recruited from nine transplant centers in the Mid-Atlantic, Mid-Western and Southeastern parts of the United States, and kidney patients (N=30 patients) recruited from one transplant center in the Mid-Atlantic region. Semi-structured interviews and nominal focus groups were conducted to gather qualitative data; quantitative survey data were also collected. The results revealed factors classified as impacting patients at the individual-level and systemic level, and others classified as health-related and informational/educational. Participants ranked insurances issues, limited income, lack of a personal means of transportation, lack of patient motivation, the number of procedures required to complete the evaluation, scheduling difficulties and time constraints as top barriers to completing the medical evaluation process. Top motivators consisted of informational support, social support, religious beliefs, patients’ desire to get off dialysis, support from the transplant staff, center-based education, patient’s knowledge of the benefits of transplantation and patient navigators. These findings provide valuable information on factors that impact AA renal patients’ completion of the medical evaluation.

No description available.

La nature des litiges relatifs à l'appréciation médicale de l'état du malade ou de la victime d'un accident du travail ou d'une maladie professionnelle, a conduit à l'organisation extra-judiciaire d'une expertise médicale dite "technique", les litiges relatifs aux états d'incapacité incombant directement à des juridictions spécialisées (contentieux technique).L'expert, désigné d'un commun accord entre le médecin-conseil et le médecin traitant, est saisi par la caisse en vue de l'examen clinique du malade ou de la victime, à l'aide d'un protocole. La procédure est assortie de brefs délais et l'avis de l'expert, qui s'impose aux parties, peut être contesté dans le cadre du contentieux général.La mise en œuvre de la procédure s'impose à la juridiction (qui fixe la mission et prend la décision), quand la difficulté d'ordre médical survient en cours d'instance. Cette obligation, née du caractère substantiel des formalités, dont a pu découler la force probante de l'avis de l'expert à l'égard du juge, est exceptionnelle en droit français.La question est bien celle des fonctions respectives de l'expert et du juge, quand la CEDH vise à étendre le principe du procès équitable à la phase expertale, de telle sorte que pourrait naître un droit général d'accès à l'expertise et d'y être assisté par un technicien, ce que l'on peut observer dans l'expertise médicale.La thèse vise à prôner l'extension du régime de l'expertise médicale à l'exception propre aux accidents du travail et maladies professionnelles dans le domaine agricole, dont le régime est inspiré du droit commun, le contentieux technique paraissant pouvoir lui-même être étendu à cette exception, alors que la Cour de cassation (rapports 2010 et 2011) recommande son intégration au contentieux général. / The nature of the disputes related to the medical appraisal of the state of the sick person, or of the victim of an accident at work or of a professional illness, led to manage an extra judicial medical evaluation, so called "technical", the disputes related to the states of incapacity being directly devolved to specialized courts (technical litigation). As appointed on the basis of a common agreement between the counseling doctor and the personal practitioner, the medical experts is refered to by the caisse in order to evaluate the medical state of the sick person or of the victim, in accordance to a protocol. The proceeding is concluded in a short delay, ant the opinion of the medical expert, as compulsory for the litigants, is opened to a dispute in the frame of the general litigation.The implementation of the procedure is imperative for the court when a medical difficulty occurs during the judicial proceeding. As rooted in the substantive nature of the formalities, grounding the value of evidence for the expert opinion, this is an exceptional obligation.So that, the point is the distinction between the functions of the medical expert and the court when is met the aim to extend the right to a fair trial to the evaluation stage, ant it could arise a general right to medical evaluation and to be assisted by a specialist, as for the extra judicial proceeding.An objective of the thesis is to propose an extension to the existing exception of the accidents at work or the professional illness in the agricultural area, as shaped by the general legal regime. So that the technical litigation could too receive an extension, completely in opposition to the solution wished by the Cour de cassation (reports 2010, 2011) of an integration to the general litigation