In the past fifty years the medical profession in the United States has been transformed by federal and commercial forces. At teaching hospitals, clinical faculty were pressured to cut costs, treat more patients, and spend less time training students. Evidence emerged that medical students became increasingly cynical and detached throughout their training, and medical educators grew concerned that the for-profit priorities of clinical environments were damaging to the professional identities and values of trainees. Consequently, American medical schools reformed their curricula, adding coursework in bioethics and doctor-patient communication. These measures would not, however, counteract the stubborn effects of the so-called hidden curriculum in medical school. Associated with the unintended and implicit lessons that undermine espoused institutional principles, this “curriculum” was thought to be exacerbated by the challenges of contemporary clinical settings. In the late 1990s the “professionalism movement” arose to further the cause of medical ethics education and to promote more accountability in practice; by 2003 the accrediting body of North American medical schools mandated the explicit teaching of professionalism. Professionalism curricula differed from ethics in that it emphasized observable virtuous attitudes and behaviors rather than cognitive reasoning. The reforms at Tufts University School of Medicine (TUSM) in Boston illustrate one approach to the teaching and assessment of professionalism. Archival materials show that TUSM responded to the accreditation mandates by implementing coursework, special programs, performance-based assessment, and the medical school induction rite, the White Coat Ceremony. Professionalism education was complicated for medical schools like TUSM by a lack of clear curricular and institutional goals. Furthermore, the practice of medicine did not necessarily coincide with the ideals of the profession, and senior physicians were inconsistent role models of such ideals – contradictions not lost on students. In 2013 the medical school accreditation agency revised its standards regarding professionalism, shifting its focus to the context for developing professionalism, the learning environment. Recommendations to medical schools for advancing professionalism education include faculty development programming and preparing students to face the ideological conflicts inherent in the current healthcare system.

Made available in DSpace on 2016-04-28T20:56:54Z (GMT). No. of bitstreams: 1 Ieda Maria Brock.pdf: 1041672 bytes, checksum: fe8257c5b98f02d8da4ccb9d2e8f7f74 (MD5) Previous issue date: 2015-05-08 / This dissertation seeks to understand the teacher's constitution process that acts the medical courses in the work as a professor. Taking as concern the difficulties and resistance to change in the Medical Education, the research brings a discussion about education and more specifically, about the pedagogical knowledge necessary for the exercise of teaching these courses. The subjects of research were three professors of medicine courses who work in private Higher Education Institutions, two of them are located in São Paulo City and one of them in the state of São Paulo. The goals that permeated the context of the research were: analyze the meaning that the Professor of Medicine assigns to carry out teaching and construction of teaching knowledge; identify the teachers perception about the existence of specific knowledge of the teaching exercise and identify the influences that emerge for the construction of this knowledge. The work was constructed from a discussion of teacher education in higher education and then designed for training of the higher education teachers in the medicine area. The theoretical and methodological framework in the field of knowledge were used contributions from Tardif et al (1991) and Tardif (2000) and in medicine field and training of their teachers, the study used as reference Marcondes and Gonçalves (1998) and Silva and Batista (2001). The results revealed that these professors recognize the lack of pedagogical education and, in the process of teaching, were identifying with the instruction and constituting themselves, as teaching professionals. Also indicated the need of constantly update not only of scientific content, but also of educational content and, consequently, a further approximation educational centers of Higher Education institutions / Este trabalho busca compreender o processo de constituição do professor que atua nos cursos de Medicina em seu trabalho como docente. Tomando como preocupação as dificuldades e as resistências às mudanças na Educação Médica, a pesquisa traz uma discussão sobre o ensino e, de forma mais específica, sobre os saberes pedagógicos necessários para o exercício da docência nesses cursos. Foram sujeitos da pesquisa três professores do curso de medicina e que atuam em Instituições do Ensino Superior privadas, sendo que duas estão localizadas na cidade de São Paulo e uma no interior do Estado. Os objetivos que permearam o contexto da pesquisa foram: analisar o significado que o professor de Medicina atribui ao exercício da docência e à construção dos saberes docentes; identificar a percepção dos professores sobre a existência dos saberes específicos do exercício da docência e identificar as influências que emergem para a construção desses saberes. O trabalho foi construído a partir de uma discussão sobre a formação do professor no ensino superior e então delineado para a formação do professor do ensino superior na área da Medicina. Como referencial teórico-metodológico, no campo dos saberes foram utilizadas as contribuições de Tardif et al (1991) e Tardif (2000) e no campo da Medicina e da formação dos seus professores, o estudo se apoiou em Marcondes e Gonçalves (1998) e Silva e Batista (2001). Os resultados revelaram que estes professores percebem a ausência de formação pedagógica e que, no processo de ensinar, foram se identificando com a docência e se constituindo, também, como profissionais do ensino. Indicaram, ainda, a necessidade de atualização constante não só de conteúdos científicos, mas também de conteúdos pedagógicos e, consequentemente, de uma maior aproximação com os núcleos pedagógicos das instituições de Ensino Superior

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The Minnesota Multiphasic Personality Inventory (MMPI) is often used for evaluating candidates for gastric bypass surgery, chronic pain patients, head trauma victims, and medical school applicants. However, due to the considerable time involved in completing and scoring the standard MMPI, researchers have attempted to devise short versions of this instrument to reduce the time required while providing similar results. In recent years, the Faschingbauer Abbreviated MMPI (FAM) and the MMPI-16 8 have been proposed as viable MMPI substitutes. The present study examined the comparability between profiles using these short versions of the MMPI with the patterns obtained using the entire measure. Participants consisted of equal numbers of gastric bypass candidates, chronic pain patients, head trauma victims, and medical school applicants. Scores on the FAM tended to be similar to scores on the complete MMPI for gastric bypass, chronic pain and head trauma patients. In contrast, the MMPI-16 8 yielded profiles which were similar to complete MMPI profiles with chronic pain and head trauma patients.

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Students and graduates at Faculty of Medicine of Charles University in the First Half of the Twentieth Century: Social Structure, Curriculum, Student Life, and Professional Careers Tereza Kopecká Institute for History of Medicine and Foreign Languages, First Faculty of Medicine, Charles University The topic of medical studies in the first half of the twentieth century offers an interesting insight into the community of first-republic youth, developing modern medicine and universities. A prosopographical study brings the possibility to perceive the topic from multiple points of view: demographical, social, political, in terms of gender etc. The students who act as the subject of this study, have lived through a major part of the twentieth century; their common forming experience was the World War One but later, they differentiated enough to let us look inside the world of science, hospital and community medicine, underground movements, active politics and even art. Their medical carrers were influenced by the changes in organization of the public health care system that led to the loss of professional freedom. These difficulties could have been overcome by the social capital they had created yet during the school years. The main issue of the scientific life was the discontinuity caused by the World War Two...

The aim of this study was to describe the frequency of migration to study medicine in Peru. We conducted a secondary data analysis of the Red-LIRHUS study (2011-2012). We included 3 680 Peruvian students. Approximately, 23.2% migrated for medical school. Less than 1% were international migrants. We found a higher proportion of migrant students in Universities outside of Lima than in Universities in Lima (27.1% vs. 15.8%). There was also a higher proportion of migrants in private universities (28.3% vs. 16.0%) Migrant students were more likely to live alone (27.4% vs. 6.4%) and to report having failed a module/course (51.0% vs. 38.6%) compared to non-migrant students. It is necessary to evaluate potential interventions for the preservation of the well-being of people who migrate for their medical training. / Revisión por pares

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This study used qualitative research, particularly life history analysis, to determine the personal pathways of success for Latino students who chose to enter a health science center for graduate study and who graduated. By giving voice to individual success stories of Latino students, some of the influences on the life pathways of these graduates were determined. For the purposes of this study, success was defined as graduation from a health science center with either a doctor of philosophy, doctor of public health or doctor of osteopathic medicine degree. Four research subjects agreed to participate in this study from a possible 11 students from the graduating class of 2004-2005 at this health science center. Data were gathered through multiple in-depth interviews of the students themselves over a period of no more than one month for each participant. Data were analyzed using the mind mapping technique and Padilla's unfolding matrix. Findings indicate that each participant traveled a different pathway to achieve educational success although similarities did exist across participants. The influences of family background, cultural background, educational background and personal perceptions and goals did affect the pathways of these four Latino graduates. While three of four participants indicated that family was the most important influence on their academic success, all participants related the importance of family to their success, although their definitions of family seemed to vary and included the concepts of education, culture, and personal perceptions and goals. The concepts of family support of education and a culture of education within the family unit emerged as similar themes among study participants. Other similarities among participants were a high academic self-concept, a strong internal locus of control, the ability to create academic community, and a positive view of potentially negative situations. Individual themes emerged from the narratives within each category for each participant. The impact of previous studies on student success, using undergraduate models, was reviewed, and one influence was found among the study participants that had not been used in previous models - health. Implications of findings from this study for educational policy, programs, and practice are discussed.

Introdução: A episiotomia é intervenção instituída rotineiramente no Brasil, a partir da hospitalização do parto, em meados do século XX. Tida como facilitadora do parto no período expulsivo, vem sendo questionada pelas evidências científicas. Comprovou-se que a intervenção não impede lacerações importantes, incontinência urinária, dispareunia ou disfunções sexuais, e é associada a mais dor pós-parto e a complicações da episiorrafia. No Brasil, há médicos que fazem o procedimento rotineiramente, enquanto outros a praticam de modo seletivo ou, mais raramente, nunca o fazem. Este estudo buscou compreender o processo por meio do qual tais profissionais aprenderam e iniciaram sua prática, se esta foi revista, e as razões do posicionamento técnico e ético quanto ao procedimento, na atualidade. Objetivos: descrever e analisar o processo vivenciado pelos médicos obstetras, e que os levou ao posicionamento com relação à prática da episiotomia, tendo em vista sua formação, sua prática, o posicionamento de seus pares e o ambiente institucional. Método: Trata-se de estudo qualitativo, com análise temática a partir do referencial de gênero. A população de estudo foi composta por 12 médicos(as) obstetras que atendiam partos pela via vaginal, obedecendo ao método snowball. Os dados foram obtidos por meio de entrevistas norteadas por questões semiestruturadas. Resultados: A educação médica, no recorte da episiotomia, dá-se em escalonamento hierárquico, sem que o aluno aprenda por meio de professor, mas entre alunos, do mais graduado para o menos graduado. Transmite-se a insegurança técnica e o impedimento de questionar as indicações, a segurança do procedimento ou lesões decorrentes. Não se discute a autonomia da paciente, os direitos reprodutivos, o direito à integridade corporal ou a real informação para o consentimento. Vários entrevistados relatam dificuldades para deixar de praticar a episiotomia, o que resulta de pressão exercida pelos pares, pela corporação e pela instituição em que atende. Conclusões: É imprescindível a reforma na educação médica, para que professores, atualizados com as evidências científicas, transmitam as técnicas de modo adequado às taxas preconizadas internacionalmente. Sugerese alterar a didática e conteúdo de disciplina que discuta bioética, tornando-a mais conectada com a prática e a ética médica, além de contextualizar a lei vigente. Conclui-se, enfim, pela necessidade de exigir a justificativa em prontuário para a intervenção, a anotação de toda episiotomia realizada e de toda lesão espontânea, além da aplicação de ferramentas de segurança da paciente, adotando uma assistência que promova a integridade genital no parto. / Introduction: Episiotomy is an intervention routinely established in Brazil, from birth hospitalization, in mid-twentieth. Considered as a facilitative intervention in the expulsive stage of birth, it has been questioned by scientific evidences. It was concluded that the intervention does not prevent main lacerations, urinary incontinence, either dyspareunia or sexual dysfunction, and is related to after-birth pain and complications developed from episiorrhaphy. In Brazil, there are physicians that perform it routinely, while some perform it selectively or never use it. This ressearch aimed to understand the way those professionals learned and started their practice, if it has been reviewed, and the reasons for their technical and ethic positioning about the intervention, nowadays. Objective: Describe and analyze the process experienced by obstetricians, and what took them to their positioning regarding to episiotomy practice, in terms of their professional education, their practice, their peers positioning and institutional environment. Method: This is a qualitative study, with thematic analysis, based on gender references. The study population was composed by 12 obstetricians, who attended vaginal births, following snowball method. Data were obtained by interviews guided by semi-structured questions. Results: The medical education, on episiotomy, occurs in a hierarchical scheduling, and the student doesnt learn through a teacher, but through a more graduate student, resulting on technical uncertainty and the impossibility to question indications, the procedure safety or resulting injuries. Patient autonomy, reproductive rights, body integrity or information to the consent are not questioned. Many physician finds it difficult to stop practicing episiotomy, because of intense pressure from peers, corporative and institution. Conclusions: Some changes are essential in medical education, so that teachers, updated on scientific evidences, transmit the techniques adequately to the internationally recommended rates. It is suggested to change teaching and disciplines that discuss bioethics, making it more connected with the practice and medical ethics, and contextualize it to the current law. It follows, finally, the need to require physicians to justify interventions in medical charts, the annotation of all performed episiotomy and all spontaneous lacerations, as well as applying patient safety tools, adopting an assistance that promotes genital integrity at birth.