Dissertations / Theses on the topic 'Medical Residency (Medical Internship)'

In November 1999, financial losses led the University of California at San Francisco Medical Center (UCSF) to close all inpatient services at Mount Zion Hospital, a community teaching hospital affiliated with UCSF since 1990. As a result of the closure, Mount Zions primary care residency program (MZPC) was merged with UCSFs university-based primary care program. We examined these events in the context of three major currents in U.S. health care: containment of rising health care costs, financial pressures on teaching hospitals, and the shifting priorities in graduate medical education with respect to subspecialty medicine and primary care. As part of this descriptive study, we investigated the impact of the Mount Zion closure on all UCSF internal medicine residents who were in training at the time. Using a cross-sectional survey, we found that a majority of residents felt the closure was harmful to their training, but that reasons varied by program affiliation. Many specific areas of training remained unaffected. Low morale correlated with abandonment of generalist career plans among some primary care residents (p=0.02). We concluded that the perception of harm reflected a temporary reaction to change rather than actual harm to the quality of the programs, and that while attrition from generalism may have resulted from disillusionment by some residents, it more likely reflected a national decline in interest in primary care since 1997. We also concluded that the closure of Mount Zion and its residency program was a consequence of the shifting emphasis toward subspecialization in the U.S. and is a harbinger of further changes in that direction.

Information is a powerful tool for enabling physicians to provide quality healthcare for their patients. Information use in the clinic is a skill that must be learned. If medical residency programs fail to impart this skill, then patients will suffer. The residents of the ETSU Quillen College of Medicine were surveyed as to their use of clinical information. Of the 217 residents of the 2005-2006 class who were surveyed, 105 returned the survey for a return rate of 48%. The clinical faculty was also surveyed in order to measure the responses of the residents against that of their instructors. ETSU residents frequently had a new information need in the clinic. The majority of the time they did not seek an answer, but when they did they were often successful in finding an answer. Therapy information was the most frequently sought after type of information. Most residents used the Quillen College of Medicine Library, but not at a desirable rate. Residents stated that information obtained from the library was helpful in caring for their patients. The most frequent source of information used by residents was electronic resources and the greatest barrier to the use of information was time. The majority of residents were PDA users, with Palm devices being the primary platform. The residents rated their PDA skills and evidence-based medicine skills as above average. Few were LoansomeDoc users. The majority of residents received information training from clinical faculty and from librarians and rated it highly. Residents indicated a desire for more training and the majority indicated that they would like a clinical medical librarian for their program. They rated the library service of the Quillen College of Medicine and the area teaching hospitals highly. Residents used Google and the Web frequently. PubMed was rated as a valuable resource. Online journals and the UpToDate database were important electronic resources for the residents. ETSU residents have many excellent resources and training opportunities in place. However, for ETSU residents to go out into community practice as true "Infomasters" an upgrading of their information training should be undertaken.

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The lack of a skills-based curriculum to guide and qualify the residents` education is a reality in several Residency programs in the country. This vulnerability has been discussed by residents, preceptors and coordination of the residency program of family and community medicine (PRMFC), which generated the need of the development of this research. This fact brings the following vulnerabilities: lack of clarity of the learning objectives, educational strategies and the evaluation to be addressed to the residents. Initially, a literature review of the competency-based curricula and a review of documents prepared by associations, societies and professional bodies were conducted. Then we conducted a teacher training course for the preceptors of the PRMFC, with discussions on the theoretical bases of the competency-based curriculum; active learning methodologies; planning and conducting educational activities and strategies; and learning evaluation. After this training, workshops were held for the development of an array of macro competencies. This work trained 12 preceptors of PRMFC and allowed the construction of an array of macro competencies. It will surely facilitate the teaching-learning process in a two-year Residency Program, evaluating the skills of the residents at the end of the course, which guarantees to society a professional able to develop its actions. With a competency-based curriculum specific designed for Family Medicine and for Primary Health Care, we wish to reorient the teaching-learning processes of residents and preceptors to qualify clinical practice.
A falta de um currÃculo baseado em competÃncias para nortear e qualificar o ensino dos residentes à uma realidade em vÃrios os Programas de ResidÃncia no paÃs. Esta vulnerabilidade foi problematizada por residentes, preceptores e coordenaÃÃo do Programa de ResidÃncia de Medicina de FamÃlia e Comunidade (PRMFC), o que gerou a necessidade do desenvolvimento deste estudo. Este fato traz as seguintes vulnerabilidades: falta de clareza dos objetivos de aprendizado, das estratÃgias educacionais e de avaliaÃÃo a serem abordadas. Inicialmente foi realizada uma revisÃo da literatura sobre os currÃculos baseados em competÃncia e uma anÃlise dos documentos elaborados por associaÃÃes, sociedades e entidades profissionais. Em seguida foi realizado um curso de formaÃÃo docente para os preceptores do PRMFC, com discussÃes sobre as bases teÃricas do currÃculo baseado em competÃncia; metodologias ativas de aprendizagem; planejamento e conduÃÃo de estratÃgias e atividades educacionais; e avaliaÃÃo da aprendizagem. ApÃs a capacitaÃÃo foram realizadas oficinas de desenvolvimento de uma matriz de macrocompetÃncias. Esta trabalho traz como produtos a capacitaÃÃo de 12 preceptores do PRMFC e a construÃÃo de uma matriz de macrocompetÃncias. Certamente irà para favorecer o processo de ensino-aprendizagem nos dois anos de programa, avaliando as competÃncias dos residentes no final do curso, o que garante para a sociedade um profissional apto para desenvolver as suas aÃÃes. Com um currÃculo baseado em competÃncias necessÃrias para MFC e APS desejamos reorientar os processos de ensino-aprendizagem dos residentes e preceptores para qualificar a prÃtica.

The purpose of this qualitative study was to explore intern's perspectives on how the professional environment impacts their well-being. In-depth, semi-structured interviews were conducted in March and April of 2009 with seventeen interns from residency programs in a variety of specialties at an urban teaching hospital. Investigators coded interview transcripts line-by-line, and identified recurrent themes through an iterative process of analyzing tagged quotations. Three themes (each with three sub-themes) characterized aspects of the professional environment that interns perceived as impacting their well-being: 1) high-quality education (workload, work hours, and quality and quantity of teaching), 2) professional development and satisfaction (making a meaningful contribution to patient care, positive feedback and extrinsic reward, and balance of autonomy and supervision), and 3) social and emotional support from colleagues (feeling supported by the residency program, cooperative team environment, and intern community). These aspects of the professional environment have the potential to significantly impact intern well-being, and should be taken into consideration when developing new systems, interventions and policies to improve the well-being of interns.

Anualmente, a Secretaria de Estado da Saúde de São Paulo (SES/SP) realiza o Concurso SUS-SES/SP para o preenchimento de vagas de RM oferecidas pelas instituições participantes, nas diferentes especialidades médicas. Partindo da compreensão que a decisão pela especialidade é um momento singular na trajetória da profissão médica, e que, a RM desempenha um importante papel para o sistema de saúde; este trabalho objetivou conhecer a tendência da demanda por especialidades médicas tomando como referência, o universo dos candidatos que se inscreveram no Concurso SUS, no período entre 1999 e 2004. Dentre as especialidades que contaram com aumento na procura estão a Anestesiologia, Cirurgia Cardiovascular, Cirurgia Oncológica, Cirurgia Plástica, Clínica Médica, Dermatologia, Endocrinologia e Psiquiatria. As especialidades que apresentaram queda na procura foram Cirurgia de Cabeça e Pescoço, Gastroenterologia, Oftalmologia, Pediatria e Pneumologia
Annually, the Secretaria de Estado da Saúde de São Paulo (SES/SP) opens Single Health System SES/SP Medical Residency Contest offered by participant institutions in different medical specialties. The public selection process has been held in partnership with Fundação Carlos Chagas for more than fifteen years. Currently, this process counts with almost six thousand candidates enrolled from several regions of Brazil. Assuming that making decision for specialty is a very singular moment for medical career, and that, Medical Residency conducts an important function for Health System; this research aims to point out tendencies for medical specialties, using the amount of enrolled candidates for SUS Contest, between 1999 and 2004, as reference. Therefore, the number of inscriptions raised 18% in this period, distinguishing male predominance. Considering candidates hometown, 52% lived outside Sao Paulo State in the moment of contest inscription, making evident the attractive potential for doctors from different regions of Brazil. In terms of numbers, basic specialties took part in half inscriptions in this period. In terms of numbers, basic specialties took part in half inscriptions in this period. The specialties with raised number of searching were Anesthesiology, Surgery Cardiovascular, Oncology Surgery, Plastic Surgery, General Internal Medicine, Dermatology, Endocrinology and Psychiatry. The specialties with decreased number of searching were Head and Neck Surgery, Gastroenterology, Ophthalmology, Pediatrics and Pneumology

Orientador: Eliana Martorano Amaral
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: A escolha da especialidade para a Residência Médica (RM) tem sido alvo de estudos na maior parte do mundo. Há uma percepção da carência de profissionais, novas demandas com as mudanças epidemiológicas e nos sistemas de saúde, crescente necessidade de profissionais que atuem na Atenção Primária, ao mesmo tempo em que se observa redução da opção pela formação clínica geral dos graduandos em Medicina e frequente opção pelas especialidades. De acordo com esta tendência, a falta de profissionais atuantes na Atenção Primária é observada em todo o mundo. O conhecimento dos fatores influenciadores desta escolha é importante para que sejam pensadas possíveis soluções para atender às necessidades da população em determinadas especialidades ¿ especialmente as de perfil mais generalista, para que sejam atrativas para os médicos. No Brasil, para atender a esta demanda, houve um recente aumento da oferta de vagas de Residência Médica em Medicina de Família e Comunidade e o governo federal criou programas de incentivo para o médico trabalhar na Atenção Primária, como o PROVAB e o `Mais Médicos¿. Os objetivos deste estudo foram: avaliar possíveis fatores influenciadores da escolha da especialidade médica por recém-ingressos na Residência Médica ('R1') e avaliar os motivos destes não escolherem Medicina de Família e Comunidade como carreira. Métodos: Trata-se de um estudo transversal, em que médicos recém-ingressos na Residência Médica (RM), em quaisquer das especialidades de acesso direto (R1) das quatro maiores universidades públicas federais do estado de Minas Gerais pré-selecionadas, responderam um questionário semi-estruturado, com questões abertas e fechadas, no início da RM. Foram estudados fatores pessoais, familiares e socioeconômicos que pudessem interferir com a escolha da especialidade, em diferentes momentos do curso médico. As especialidades foram estratificadas em quatro grupos, a saber: 1) APS = profissionais que compõem a equipe de Atenção Primária à Saúde, incluindo Medicina de Família e Comunidade, Pediatria e Ginecologia & Obstetrícia, 2) CM ¿ Clínica Médica, 3) CR ¿ Cirurgia, 4)Outros ¿ Ortopedia, Anestesiologia, Patologia e Radiologia. Foi realizada análise exploratóriados dados e os fatorespotencialmente associadosà escolha das especialidades de APS foram avaliados com OR e IC 95%, em análise bivariada e multivariada. O estudo da associação entre o tempo transcorrido desde a conclusão da graduação até o ingresso na RM e a escolha da carreira na APS foi realizado através do teste de Kruskal-Wallis. A amostra total de residentes entrevistados foi, ainda, dividida em 2 grupos (com e sem experiência profissional no PSF prévia ao ingresso na RM) e o grupo dos que trabalharam previamente no PSF foi subdividido em residentes que trabalharam através de um programa do governo federal e em residentes que não atuaram por nenhum programa. Foi realizada uma análise de conteúdo das respostas abertas, comparando-se estes grupos, com foco na experiência profissional no PSF prévia ao ínicio da RM. Resultados: De um universo de 277 residentes admitidos por acesso direto nestes instituições, 188 (67,9%) responderam ao questionário e 23 (12,2%) responderam às questões abertas.A maioria era composta de indivíduos do sexo feminino, com idade maior ou igual a 26 anos, que estudaram em instituições públicas da região Sudeste brasileira, graduados em Medicina há pelo menos 12 meses. Cento e oito (57,5%) tiveram experiência profissional no PSF prévia à Residência e 34 (18,0%) trabalharam através de programas de incentivo do governo federal (33 PROVAB e1 'Mais Médicos'). Os principais fatores motivadores considerados para escolha de qualquer especialidade foram: desejo de trabalhar em consultório ou em hospital, realizar procedimentos e ter mais contato com os pacientes. Os principais fatores desmotivadores foram: experiência negativa durante o contato com os pacientes da especialidade durante a graduação e carga horária elevada de trabalho. Em relação às especialidades de APS, a despreocupação com o nível salarial e o interesse neste grupo de especialidades durante a graduação foram importantes fatores motivadores para a escolha. Contudo, a experiência profissional no PSF esteve associada com escolha de outros grupos de especialidades. Em relação às questões abertas (O que motivou a escolha de sua carreira? Por que trabalhou como médico de família antes da Residência e como esta experiência influenciou sua escolha?), as respostas foram agrupadas em categorias comuns, tais como: "Preenchendo o tempo", "Razões pessoais", "Sentimento de decepção após a experiência profissional" e "chance para maior tempo de treinamento". Conclusão: Os fatores influenciadores da escolha da especialidade evidenciaram diferentes perfis para cada grupo de especialidades. O principal fator de influência geral foi o estilo de vida "controlável". Não se observou influência da exposição prévia a programas de incentivo à APS (PROVAB e Mais Médicos) após o término da graduação na escolha de especialidades de APS, tampouco do tempo transcorrido desde a conclusão da graduação. O interesse pela APS durante a graduação foi o fator de maior importância, representando uma chance 7,3 vezes maior de escolha de uma especialidade relacionada à APS na análise ajustada (multivariada), o que reforça o importante papel das escolas médicas em despertar o interesse por esta carreira. O interesse pela carreira na APS foi baixo em nosso estudo por diversos fatores, como más condições de trabalho, elevada carga de trabalho, falta de plano de carreira e falta de infra-estrutura dos cuidados de saúde e falta de boas condições de vida nas áreas periféricas e distantes
Abstract: Introduction: The specialty choice to the medical residency has been investigated worldwide. There is a perceived lack of professionals and new demands caused by changes in epidemiologic characteristics and health systems, what increase the need of professionals working in Primary Care. At the same time, the options to General Practice by the medical students are decreasing and there is a frequent choice for the specialties.In this setting, the shortage of professionals to work in Primary Care is reported all around the world. The knowledge of the factors that influence this choice is important to think in possible solutions to the population needs in some specialties - specially the specialties of general profile - and could be more attractive to the physicians. In Brazil, there was a recent expansion of vacancies at Family and Community Medicine Residency training and the federal government created incentive programs to improve the interest in Primary Care, as PROVAB and 'Mais Médicos' ('More Physicians'). This study aimed to assess potential factors that could influence the specialty choice by the fresh residents admitted in the first year of the medical residency ('Y1') and to assess the reasons for non choice the Family Medicine as the medical career. Methods: We have studied a population of fresh admitted residents on the specialties of direct access in the four higher public universities of Minas Gerais State, in Brazil. They were interviewed through a semi-structured and self-answered questionnaire, with open and closed questions, applied on the day of the admission at the residency. There were studied personal, familial and socioeconomic factors that could influence the specialty choice in different times in the graduation. The medical specialties were stratified in four groups, as the following: 1) Primary Care= composed by Family Medicine, Pediatrics and Gynecology & Obstetrics, 2) Internal Medicine, 3) Surgery, 4) Others = composed by Orthopedics, Anesthesiology, Pathology and Radiology. It was performed an exploratory data analysis and the factors associated on the choice of the specialties of the Primary Care group were assessed with OR and confidence interval of 95%, in a bivariated and multivariated analysis. A possible association between the time from the end of the graduation to the residency beginning and the choice of Primary Care career was studied through the Kruskal-Wallis test.The residents were also divided in two groups (with and without professional work experience in Primary Care, previous the beginning of the residency). The group of the physicians that worked in Primary Care was subdivided in physicians that worked and that not worked through a government program incentive. It was performed a content analyze of the open answers, comparing these two groups, focusing on the previous professional experience in the Family Health Program before beginning the residency training. Results: One hundred and eighty eight residents of 277 (67.9%) have answered the questionnaire and 23 (12.2%) have answered the open questions. The majority of them was of female gender, equal or older than 26 years old, was graduated in public medical schools of the southeast region of Braziland finishedthe graduation for at least 12 months ago. One hundred and eight of these residents (57.5%) had worked professionally in Primary Care previous the admission to the residency and 34 (18.0%) of them worked through a Brazilian federal government program (33 PROVAB and 1 "More Physicians"). The main factors that motivated the specialty choice in this study were: desire to work at the own office or at the hospital, do procedures and to have more contact to the patients. The main factors that demotivated the choice of the career were: negative experience on the contact to the patients during the graduation and high workload. Concerning on the Primary Care group, the income unconcern and the interest to the Primary Care during the graduation were important motivating factors for this choice for the residency. However, the previous professional experience working in Primary Care was more associated to a choice of a specialty not related to Primary Care. Concerning the open questions (What motivated you about the choice of your career? Why did you work as a Family Physician in Primary Care before the beginning of the medical residence and how did this experience influence your choice?), the answers were grouped in identified common categories as: "Filling the time", "Personal reasons", "Feeling of disappointment after experiencing" and "Chance for more time to training". Conclusion: The factors related to the specialty choice have established distinct profiles for the each studied group of specialties. The main general motivate factor of the specialty choicewas the"controllable" lifestyle. It was not observed any influence of previous exposition to stimulating government programs, as PROVAB and "More Physicians". It was not also observed an association with the time from the end of the graduation on the choice of the Primary Care specialties. The interest in Primary Care during the graduation was the most important factor to this choice, increasing this chance in 7.3 timesin the adjusted analysis, reinforcing the important role of the medical schools on awaking the interest on this career.The interest of a career in Primary Care was low in this study because of several factors, suchpoor work conditions, high workload, lack of career plan, poor health care infrastructure and poor living conditions in remote and periurban areas
Mestrado
Ensino em Saúde
Mestra em Clínica Médica

Introdução: A simulação médica está se tornando um padrão no treinamento da área da saúde, seja na graduação, pós-graduação ou educação continuada. Embora existam significativos estudos avaliando os efeitos do estresse crônico na saúde física e mental de médicos, poucas são as pesquisas sobre os efeitos do estresse agudo na performance. A relação entre performance e estresse agudo é controversa. O objetivo primário desta pesquisa foi avaliar se cenários simulados podem induzir níveis de estresse equivalentes a emergências reais. Métodos: Vinte e oito residentes de clínica médica participaram de 32 atendimentos de emergência (16 reais e 16 simulados). Eles tiveram o nível de estresse medido no período basal (T1) e imediatamente após os atendimentos (T2). Parâmetros medindo estresse agudo foram: frequência cardíaca (FC), pressão arterial sistólica (PAS) e diastólica (PAD), alfa-amilase salivar (AA), interleucina-1 beta salivar (IL-1beta) e o Inventário de Ansiedade Estado (IDA-E). Resultados: No grupo realidade, todos os parâmetros aumentaram significativamente entre T1 e T2. No grupo simulação, apenas a FC e IL-1beta aumentaram. A comparação entre os grupos (real versus simulação) demonstrou que a resposta de estresse agudo (T2-T1) e o IDA-E (T2) não diferiu entre os grupos. A correlação entre os diferentes parâmetros medindo estresse foi ruim. Discussão/Conclusão: Parâmetros medindo estresse aumentaram entre o T1 e T2 na realidade (FC, SBP, DBP, AA e IL-1beta) e no ambiente simulado (FC e IL-1beta). Resposta de estresse agudo, medida pelos valores T2-T1 e a pontuação no IDA-E não diferiram entre os grupos. Nossos resultados indicam que a simulação em medicina de emergência pode criar um ambiente de alta fidelidade psicológica equivalente à uma sala de emergência real. A simulação médica pode ser usada de maneira efetiva em medicina de emergência, especialmente quando treinamos elementos de fatores humanos, como o estresse
Introduction: Medical simulation is fast becoming a standard of health care training throughout undergraduate, postgraduate and continuing medical education. Although there has been significant research into the effects of chronic stress on both physical and mental health of physicians, there has been little research into the effects of acute stress on performance. The relation between performance and acute stress is highly controversial. Our aim in this research was to evaluate if simulated scenarios may induce stress levels equivalent to real emergency medical situations. Method: Twenty-eight internal medicine residents participated in 32 emergency situations (16 real-life emergencies and 16 simulated emergencies). They had their stress levels measured in baseline (T1) and immediately post-emergencies (T2). Parameters measuring acute stress were: heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP), salivary alpha amylase (AA), interleukine-1 beta (IL-b) and State Anxiety Inventory (STAI-s). Results: In the real-life group, all parameters increased significantly between T1 and T2. In the simulation group, only HR and IL-1b increased after emergencies. The comparison between groups (real-life versus simulation) demonstrates that acute stress response (T2-T1) and STAI-s (T2) did not differ between both groups. The correlation between the different parameters measuring stress was poor. Discussion/Conclusion: Stress measuring parameters increased between T1 and T2 in real-life situations (HR, SBP, DBP, AA and IL-1b) and in the simulated setting (HR and IL-1b). Acute stress response, measured by T2 - T1 values and STAI-s scale, did not differ between both groups. Our results indicate that emergency medicine simulation may create a high psychological fidelity environment, similarly to what is observed in an actual emergency room. Medical simulation may be effectively used in emergency medicine, especially when training human factor elements

Orientador: Keila Miriam Monteiro de Carvalho
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: Os programas de residência médica em oftalmologia credenciados pelo Ministério de Educação são avaliados baseados em critérios objetivos e podem não refletir as percepções que os egressos desses programas têm sobre sua formação. Há poucos estudos no Brasil que avaliaram se as habilidades necessárias para a prática estão sendo adequadamente adquiridas ou como os egressos dos programas de residência percebem a aquisição dessas habilidades. Objetivos: Verificar as percepções de médicos oftalmologistas egressos de programas de residência médica em oftalmologia do estado de São Paulo nos últimos 5 (cinco) anos sobre como sua residência médica os preparou para a prática, verificando o nível de satisfação dos egressos quanto à aquisição de conhecimentos clínicos, à aquisição de habilidades cirúrgicas e ao desenvolvimento da relação médico-paciente e identificando possíveis deficiências no ensino da oftalmologia nas diversas áreas clínicas e cirúrgicas. Material e Métodos: O instrumento de pesquisa utilizado foi um questionário, elaborado com base nos critérios exigidos para credenciar os programas de residência em oftalmologia pelo Conselho Brasileiro de Oftalmologia, com perguntas estruturadas e uma escala do tipo Likert para avaliar o nível de satisfação dos egressos quanto ao seu curso de residência. A amostra calculada foi de 206 sujeitos para um nível de significância de 5%. O questionário foi aplicado através de correio eletrônico de janeiro a dezembro de 2010. Resultados: Duzentos e onze egressos de programas de residência em oftalmologia do estado de São Paulo responderam ao questionário, sendo 95 do sexo feminino e 116 do sexo masculino. Os níveis de satisfação encontrados foram: 89,1% estavam extremamente ou muito satisfeitos com a aquisição de conhecimento clínico, 93,4% estavam extremamente ou muito satisfeitos com a aquisição de habilidades cirúrgicas e 74,9% estavam extremamente ou muito satisfeitos com o desenvolvimento da relação médico-paciente. Em cada uma das áreas clínicas e cirúrgicas foi avaliada a percepção ou não de deficiência no ensino. As áreas clínicas em que eles perceberam mais deficiência foram órbita (48,3%) e patologia ocular (47,9%) e as áreas cirúrgicas foram cirurgia refrativa (65,9%) e cirurgia orbitária (59,2%). Análise estatística mostrou que quanto maior o tempo que haviam terminado a residência, maior era a satisfação dos egressos com a aquisição de conhecimento clínico (Coeficiente de Correlação de Pearson r=0,292, p<0,001) e menor era a percepção de deficiência nas áreas de uveíte (p=0,017), emergência (p=0,012) e órbita clínica (p=0,048) e cirúrgica (p=0,044). Na cirurgia refrativa, porém, quanto mais tempo de prática de oftalmologia, mais frequente foi à percepção de deficiência (p<0,001). A Razão de Chances (Odds Ratio) de perceber deficiência na área cirúrgica quando havia deficiência na área clínica correlacionada era estatisticamente significativa para todas as áreas exceto para as áreas correlacionadas refração e cirurgia refrativa. Conclusões: As percepções de egressos de programas de residência médica em oftalmologia do estado de São Paulo mostraram um bom nível de satisfação dos mesmos com sua residência na aquisição de conhecimento clínico, aquisição de habilidades cirúrgicas e desenvolvimento da relação médico-paciente, tendo sido identificadas deficiências no ensino de áreas específicas
Abstract: Introduction: The ophthalmology residency training programs accredited by the Ministry of Education are evaluated based on objective criteria and may not reflect the perceptions of graduates about their training. There are few studies in Brazil that evaluated whether the skills needed to practice are being properly acquired or how the graduates of residency programs perceive the acquisition of these skills. Objectives: To verify the perceptions of ophthalmologists graduates of residency programs in ophthalmology in the state of São Paulo in the last five (5) years regarding on how their residency prepared them for practice, checking the level of satisfaction of graduates with the acquisition of knowledge clinical, acquisition of surgical skills and development of doctor-patient relationship and identifying possible deficiencies in the teaching of ophthalmology in several clinical and surgical areas. Material and Methods: The survey instrument used was a questionnaire developed based on the criteria for accrediting of ophthalmology residency training programs by the Brazilian Council of Ophthalmology, with structured questions and a Likert scale to assess the level of satisfaction of the graduates with their residency training program. The calculated sample was of 206 subjects for a significance level of 5%. The questionnaire was administered by electronic mail from January to December 2010. Results: Two hundred and eleven graduates of residency programs in ophthalmology in the state of São Paulo answered the questionnaire, 95 females and 116 males. Satisfaction levels were: 89.1% were extremely or very satisfied with the acquisition of clinical knowledge, 93.4% were extremely or very satisfied with the acquisition of surgical skills and 74.9% were extremely or very satisfied with the development of the doctor-patient relationship. The perceptions of deficiency in the teaching of each of the clinical and surgical areas were assessed. The clinical areas that they had perceived more deficiency were orbit (48.3%) and ocular pathology (47.9%) and the surgical areas were refractive surgery (65.9%) and orbital surgery (59.2%). Statistical analysis showed that the longer the time they had finished the residence, the greater the satisfaction of graduates with the acquisition of clinical knowledge (Pearson Correlation r = 0292, p <0.001) and the smaller the perception of deficiency in uveitis (p = 0.017), emergency (p = 0.012) and clinical orbit (p = 0.048) and surgical orbit (p = 0.044). In refractive surgery, however, the longer the practice of ophthalmology, the more common the perception of deficiency (p <0.001). The odds ratio (odds ratio) for perceiving a surgical area deficiency when there was deficiency in the correlated clinical area was statistically significant for all areas except for the areas of refraction and refractive surgery. Conclusions: Perceptions of graduates from ophthalmology residency training programs in the state of São Paulo showed a good level of satisfaction with their residency training program in the acquisition of clinical knowledge, acquisition of surgical skills and development of surgical doctor-patient relationship and identified deficiency in the teaching of specific areas
Doutorado
Oftalmologia
Doutora em Ciências Médicas

O objetivo deste estudo foi caracterizar o perfil dos candidatos ao Concurso de Residência Médica do Sistema Único de Saúde a partir do Concurso 1999, comparando-o com o concurso realizado 5 anos depois, Concurso SUS 2004. Trata-se de um estudo descritivo a partir da utilização de dados secundários contidos num banco organizado pela Fundação Carlos Chagas e disponibilizado para a Secretaria de Estado da Saúde de São Paulo. As variáveis dos candidatos analisadas foram: sexo, idade, opção de escolha, local de graduação, natureza jurídica da faculdade de graduação, bem como seu desempenho no Exame Nacional de Cursos - Provão, presença e situação de habilitação no concurso. O número de candidatos aumentou 18% no período, sendo a maioria dos inscritos do sexo masculino, embora as mulheres tenham aumentado seu percentual de participação. A maior parte dos candidatos encontra-se na faixa entre 22 e 24 anos, seguida por candidatos na faixa entre 25 e 27 anos, tendo havido um envelhecimento do perfil dos candidatos no período. A maioria dos inscritos origina-se da Região Sudeste, sobretudo do Estado de São Paulo, e as Regiões Norte e Centro-Oeste contribuem com o menor percentual de candidatos. De forma geral predominam candidatos graduados em faculdades públicas, principalmente federais e, no caso dos candidatos graduados no Estado de São Paulo, a maior parte graduou-se em faculdades privadas. As especialidades com maior número de candidatos são as das Áreas Básicas, sobretudo a Clínica Médica, seguida pelas especialidades com acesso direto, enquanto as especialidades que exigem cumprimento de pré-requisito anterior contam com o menor número de candidatos, apesar de ser o único grupo que apresentou incremento no percentual de candidatos no período. A maior parte dos inscritos graduou-se em faculdades com conceito C na avaliação do provão, sendo o percentual de candidatos oriundos de escolas com ótima avaliação no provão (conceitos A ou B) é um pouco superior ao de candidatos oriundos de escolas com avaliação ruim (conceitos D ou E). A relação entre o número de candidatos habilitados e o de presentes (índice de habilitação) é maior para a Região Sul, enquanto a Região Norte apresenta o menor índice entre as regiões. Este índice ainda é superior para candidatos oriundos de faculdades públicas assim como para os candidatos oriundos de escolas com melhor avaliação no provão. O índice de ausência sofreu redução de 50% no período, sendo maior para candidatos graduados em escolas públicas, assim como para os originários da Região Sul do país.
The objective of the study was to describe the applicants profile to Single Health System Medical Residency Contest in 1999, comparing to applicants profile to the contest placed five years later. This is a descriptive study, based on secondary data organized by Fundação Carlos Chagas and put available to Secretaria de Estado da Saúde de São Paulo. The applicants\' variables analyzed were: gender, age, medical specialty, place of graduation, legal nature of university\'s graduation course, performance at the Courses National Examination, attendance frequency and contest habilitation condition. The number of applicants increased 18% in the period and most of the applicants were men, although women had increased their relative participation. In 1999 and 2004, most of the applicants were between 22 and 24 years, followed by applicants between 25 and 27. However, the relative participation of this last group has increased in 2004, pointing to an ageing of the applicants profile in the period. Most of the applicants were from Brazil Southwest region, especially from São Paulo state; Brazilian North and Center regions contributed with the smallest number of applicants. In general terms, applicants that graduated from public universities (mainly federal universities) predominate and applicants from São Paulo state were, in most cases, graduated from private universities. The specialties that had the highest number of applicants were Basics Areas (mainly Medical Clinic), followed by direct access specialties, while specialties that requires a concluded program had the smallest number of applicants; however, this were the only group which relative number of applicants had increased during the period. Most of the applicants were from universities with grade C in the national examination, and the number of applicants from universities with a good performance (grade A or B) was a little higher than the applicants from universities with a bad performance (grade D ou E). The relationship between the number of applicants habilitated and the number of applicants that were present (index of habilitation) is higher in South Region, while the North Region presents the smallest index; this index is higher when considering applicants from public universities and universities with good performance in the Courses National Examination. The absence index had decreased 50% in the period, being higher in applicants from public universities than from private ones, as in applicants from the South of the country.

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In Brazil, a lot of health professionals search insertion in graduate degree programs such as professional residency/improvement. To finish such training process, they can pass through great difficulties with high levels of health problems that interfere in their life quality. Objective: To evaluate the quality of life of resident physicians and non-medical resident professionals of a school hospital. Casuistic and Method: The population of this study comprised 269 resident physicians, 89 non-medical resident professionals (55 aprimorandos and 34 aperfeiçoandos). To collect data WHOQOL-100 was used an instrument of World Health Organization to evaluate the life quality. Data was collected in the period from November 2008 to January 2009. The intern consistence of the WHOQOL-100 was evaluated by the Cronbach Coefficient Alpha, in which the values equal or superior to 0.70 are considered satisfactory. Results: There were 358 enrolled in vocational programs, of which 196 participated in the study, and 120 (44.61%) resident physicians, and 76 non-medical resident physicians (52 (96.30%) aprimorandos and 24 (70.59%) aperfeiçoandos) participated in the study. There was a low intern consistence in the domain level of independence (α = 0.54 / 0.48 and 0.54 for residence, non-medical resident professionals (aprimorandos and aperfeiçoandos), respectively and in the social relationship domain for the nonmedical resident professionals (α = 0.68). Considering respectively residents and nonmedical resident professionals (aprimorandos and aperfeiçoandos), presented higher average scores were: independence level (77.18 / 75.03 / 82.29); spiritual/religion aspects (74.01 / 77.76 / 83.59) and social relationship (68.80 / 69.79 / 71.18) domains; the lower scores were for the psychological (63.38 / 61.37 / 66.87), environmental (62.46 / 59.15 / 58.93) and physical (57.36 / 55.73 / 61.72) domains. The characteristics with higher scores were: dependence on medication or treatments (88.54 / 82.57 / 93.94), personal relationship (70.31 /74.27 / 76.30) and sleep and rest (63.59 / 64.40 / 68.23) for all professionals; self (67.65 / 65.38) for residents and non-medical resident professionals (aprimorandos), body image and appearance (73.17) for non-medical resident professionals (aperfeiçoandos); transportation (80.26) for residents, home environment for non-medical resident professionals (aprimorandos) and physical environment (69.19) for non-medical resident professionals (aperfeiçoandos). The professionals presented great scores in the spirituality, religion and personal beliefs characteristic. The characteristics with lower scores were: daily life activities (67.13 / 67.30 / 76.30) and negative feelings (57.60 / 51.80 / 59.11) for all the professionals; sexual activity (66.77 / 63.10) and energy and fatigue (50.20 / 51.32) for residents and non-medical resident professionals (aprimorandos); social support (67.70) and pain and discomfort (54.17) for non-medical resident professionals (aperfeiçoandos); participation in recreation/leisure opportunities (49.21) for residents and financial resources (45.55 / 50.52) for non-medical resident professionals (aprimorandos and aperfeiçoandos respectively). Conclusions: The evaluation of life quality showed that the studied professionals are satisfied with their life quality; life and health; presented an adequate level of independence and good spiritual/religious structure. There is a commitment of sexual life and daily life activities, furthermore on coping with difficulties of stressful situations.
No Brasil, muitos profissionais de saúde buscam inserção em programas e pós-graduação como residência/aprimoramento profissional. Para concluírem tal processo de formação, passam por grandes dificuldades com elevados índices de problemas de saúde que interferem na sua qualidade de vida. Objetivo: Avaliar a qualidade de vida dos médicos residentes, aprimorandos e aperfeiçoandos de um hospital escola. Casuística e Método: A população deste estudo foi composta por 269 médicos residentes, 55 aprimorandos e 34 aperfeiçoandos. Para a coleta dos dados utilizou-se o WHOQOL-100, instrumento da Organização Mundial de Saúde para avaliar qualidade de vida. Os dados foram coletados no período de novembro de 2008 a janeiro de 2009. A consistência interna do WHOQOL-100 foi avaliada pelo Coeficiente Alfa de Cronbach, cujos valores iguais ou maiores a 0,70 são considerados satisfatórios. Resultados: Havia 358 profissionais matriculados nos programas, dos quais 196 participaram do estudo, sendo 120 (44,61%) médicos residentes, 52 (96,30%) aprimorandos e 24 (70,59%) aperfeiçoandos. Houve baixa consistência interna no domínio nível de independência (α = 0,54 / 0,48 e 0,54 para residência, aprimoramento e aperfeiçoamento, respectivamente) e no domínio relações sociais para os aprimorandos (α = 0,68). Considerando respectivamente residentes, aprimorandos e aperfeiçoandos, os domínios que apresentaram maiores escores médios foram: nível de independência (77,18 / 75,03 / 82,29); aspectos espirituais/religiosos (74,01 / 77,76 / 83,59) e relações sociais (68,80 / 69,79 / 71,18); os menores escores foram para os domínios psicológico (63,38 / 61,37 / 66,87), ambiente (62,46 / 59,15 / 58,93) e físico (57,36 / 55,73 / 61,72). As facetas com maiores escores foram: dependência de medicação ou de tratamentos (88,54 / 82,57 / 93,94), relações pessoais (70,31 / 74,27 / 76,30) e sono e repouso (63,59 / 64,40 / 68,23) para todos os profissionais; autoestima (67,65 / 65,38) para residentes e aprimorandos; imagem corporal e aparência (73,17) para aperfeiçoandos; transporte (80,26) para residentes; ambiente no lar para aprimorandos e ambiente físico: poluição, ruído, trânsito, clima (69,19) para aperfeiçoandos. Os profissionais apresentaram ótimos escores na faceta de espiritualidade, religião e crenças pessoais. As facetas com menores escores foram: atividade da vida cotidiana (67,13 / 67,30 / 76,30) e sentimentos negativos (57,60 / 51,80 / 59,11) para todos os profissionais; atividade sexual (66,77 / 63,10) e energia e fadiga (50,20 / 51,32) para residentes e aprimorandos; suporte social (67,70) e dor e desconforto (54,17) para aperfeiçoandos; participação em/e oportunidades de recreação/lazer (49,21) para residentes e recursos financeiros (45,55 / 50,52) para aprimorandos e aperfeiçoandos. Conclusões: A avaliação da qualidade de vida mostrou que os profissionais estudados apresentam-se satisfeitos com a qualidade de vida, a vida e a saúde; apresentam bom nível de independência e boa estrutura espiritual/religiosa. Há um comprometimento da vida sexual e das atividades da vida cotidiana, além de dificuldades de enfrentamento das situações estressantes.

Introdução: A comunicação de más notícias é uma prática difícil, porém frequente, tornando-se praticamente rotineira no dia-a-dia de médicos. No departamento de emergência, esta categoria de comunicação adquire aspectos bastante particulares. Objetivos: O principal objetivo deste estudo é avaliar a percepção de pacientes e familiares acerca da comunicação de más notícias no departamento de emergência, comparando-as à percepção de médicos residentes. Método: Trata-se de um estudo observacional transversal realizado no departamento de emergência de um hospital universitário terciário. Com o intuito de comparar as percepções de médicos residentes e receptores (pacientes e familiares), foi criado um questionário baseado nas seis recomendações provenientes do protocolo SPIKES (Setting [Ambientação]: questões 1-5; Perception [Percepção]: questão 6; Invitation [Convite]: questão 7; Knowledge [Conhecimento]: questões 8-12; Emotions [Emoções]: questões 13-15; Strategy and Summary [Estratégia e Resumo]: questão 16). Os questionários foram aplicados aos participantes imediatamente após a comunicação de uma má notícia no departamento de emergência. A concordância entre médicos residentes e receptores foi analisada utilizando os testes estatísticos de Kappa e Qui-quadrado. Resultados: Um total de 73 comunicações de más notícias foram analisadas. Os participantes foram 73 médicos residentes, 69 familiares e 4 pacientes. Em geral, houve um baixo nível de concordância entre médicos residentes e receptores acerca de como se deu a comunicação da má notícia no departamento de emergência. O nível de satisfação de pacientes e familiares sobre como os médicos residentes comunicaram estas notícias apresentou média de 3,7 + 0,6 pontos. Em contraste, os médicos residentes demonstraram uma pior percepção do mesmo encontro (2,9 + 0,6 pontos), sendo p < 0.001. Conclusão: Médicos residentes e receptores tendem a discordar em relação a diversos aspectos da comunicação de uma má notícia. As discrepâncias foram mais evidentes em questões envolvendo emoções, convite e privacidade. No entanto, uma importante concordância entre as percepções foi encontrada nas questões técnicas e de conhecimento que surgiram durante a comunicação
Introduction: Breaking bad news is a common and routine practice, performed practically every day by physicians. In the Emergency Department, communication acquires unique aspects. Objective: Our main objective was to assess patient and family member\'s perception about bad news communication in the Emergency Department and compare these with physicians\' perceptions. Method: This is a cross-sectional study performed at the Emergency Department of a tertiary teaching hospital. To compare physicians\' and receivers\' (patient and/or family member) perceptions, we created a survey based on the six attributes derived from the SPIKES protocol (Setting: questions 1-5; Perception: question 6; Invitation: question 7; Knowledge: questions 8-12; Emotions: questions 13-15; Strategy and Summary: question 16). The surveys were applied immediately after bad news communication happened in the Emergency Department. We analyzed agreement amongst participants using Kappa statistics and Qui-squared test to compare proportions. Results: A total of 73 bad news communication encounters were analyzed. The survey respondents were 73 physicians, 69 family members and 4 patients. In general, there is a low level of concordance between physicians\' and receivers\' perceptions of how breaking bad news transpired. The satisfaction level of receivers in regards to breaking bad news by doctors presented a mean of 3.7 + 0.6 points. In contrast, the physicians\' perception of the communication was worse (2.9 + 0.6 points), with p < 0.001. Conclusions: Doctors and receivers disagree in relation to what transpired throughout the bad news communication. Discrepancies were more evident in issues involving emotion, invitation and privacy. However, an important agreement between perceptions was found in technical and knowledge related aspects of the communication

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Introduction: The medical residency is a teaching mode characterized by in-service training under supervision at all times. Comprises an intense and thorough work experience, makes professionals a group at risk for developing emotional disorders and dysfunctions, professionals with high incidence of anxiety and depression. Despite causing harmful effects on sensitivity of doctors in relation to patients, in the academic and professional performance, health, well-being and quality of life, contributes to enhancing skills, self-confidence and security professionals. Objectives: To evaluate the levels of anxiety, depression and work engagement in professionals enrolled in a Residency Program in Pediatrics of an educational institution in the State of São Paulo in Brazil. Methods: Cross-sectional study of population base, among the professionals enrolled in the medical residency program in Pediatrics. The data were collected between the months of november, 2013 to february, 2014, using instruments: an elaborate by the authors, for Demographic data collection, the Beck Anxiety Scale (BAI), the Beck Depression Scale (BDI-II) and the Utrecht Work Engagement Scale (UWES). Results: 36 residents participated in the study. There was a predominance of females (91.4%), median age 28 years (minimum: 25; maximum: 34), singles (86.11%), family income from 10 or more wages (47.1%), workday of 12 hours or more (55.6%), without physical activity (55.5%) and leisure (44.2%), with another employment (71.4%) satisfied with the job (88.9%) and thought about quitting the programme (52.8%). The engagement ranged from 3.56 to 4.28. The dimension Dedication obtained high index (4.28 ± 1.12) and dimensions, Force Absorption and Engagement, (3.58 ± 3.56 ± 0.98 1.00; and 3.78 ± 0.96). Anxiety was present in 50.0% and depression in 44.4%. There was no statistical association of anxiety with the age group (p<0.005) and with the desire to give up the program (p=0.038); and depression with age group (p=0.001), practice of physical activity (p=0.016), leisure activities (p=0.012) and with the desire to give up the program (p=0.008). Conclusions: The residents showed good levels of engagement, especially in the field Dedication. There is a low percentage of people with low level of engagement in all areas of the UWES. Anxiety and depression levels were higher than those observed in other programs, with Association of these disorders with age, lack of physical activity and leisure, highlighting the need for greater attention and professional support, and implementation of control of stressors factors among residents in Pediatrics, and of strategies to promote physical and mental well-being of these professionals.
Introdução: A residência médica é uma modalidade de ensino caracterizada por treinamento em serviço sob supervisão, em tempo integral. Compreende uma experiência de trabalho intenso e exaustivo, faz dos profissionais um grupo de risco para o desenvolvimento de distúrbios emocionais e disfunções profissionais, com alta incidência de ansiedade e depressão. Apesar de causar efeitos prejudiciais na sensibilidade dos médicos em relação aos pacientes, no desempenho acadêmico e profissional, na saúde, no bem-estar e na qualidade de vida pessoal, contribui com o incremento de competências, autoconfiança e segurança profissionais. Objetivos: Avaliar os níveis de ansiedade, depressão e engagement no trabalho dos profissionais matriculados em um Programa de Residência Médica em Pediatria de uma instituição de ensino do interior do estado de São Paulo. Métodos: Estudo transversal descritivo, de base populacional, entre os profissionais matriculados no Programa de Residência Médica em Pediatria. Os dados foram coletados entre os meses de novembro de 2013 a fevereiro de 2014, utilizando-se instrumentos: um elaborado pelos autores, para coleta dos dados Sociodemográficos, a Escala de Ansiedade de Beck (BAI), a Escala de Depressão de Beck (BDI-II) e a Utrecht Work Engagement Scale (UWES). Resultados: Participaram do estudo 36 médicos residentes. Houve predominância do sexo feminino (91,4%), idade mediana de 28 anos (mínimo: 25; máximo: 34), solteiros (86,11%), renda familiar de dez ou mais salários (47,1%), jornada de trabalho de 12 horas ou mais (55,6%), sem atividade física (55,5%) e de lazer (44,2%), com outro vínculo laboral (71,4%), satisfeitos com o trabalho (88,9%) e pensaram em desistir do programa (52,8%). Os índices de engagement variaram de 3,56 a 4,28. A dimensão Dedicação obteve índice alto (4,28±1,12) e as dimensões Absorção, Vigor e Engagement, médios (3,58±1,00; 3,56±0,98 e 3,78±0,96). Ansiedade esteve presente em 50,0% dos profissionais e depressão em 44,4%. Houve associação estatística da ansiedade com a faixa etária (p<0,005) e com o desejo de desistir do programa (p=0,038); e da depressão com a faixa etária (p=0,001), prática de atividade física (p=0,016), atividades de lazer (p=0,012) e com o desejo de desistir do programa (p=0,008). Conclusões: Os residentes apresentaram bons índices de engagement, principalmente no domínio Dedicação. Há um baixo percentual de profissionais com baixo índice de engagement em todos os domínios do UWES. Os níveis de ansiedade e depressão foram superiores aos observados em outros programas, havendo associação destes transtornos com a faixa etária, ausência de atividade física e de lazer, evidenciando a necessidade de maior atenção e suporte aos profissionais, de implementação de ações de controle dos fatores estressores entre os residentes de pediatria, e de estratégias de promoção do bem-estar físico e mental destes profissionais.

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Clinical skills assessment is an essential step in the medicine students´ graduation and must be done by the teacher through direct performance observation in a real situation. The usage of Mini-Cex is an additional formative and summative evaluation option that assesses pre or post graduates students´ medical expertise. Objectives: Evaluate clinical residents competence on performing urodynamic exames; quantify performance development after feedback attainment, quantify technical improvement quality of urodynamic examination by the resident doctor ; quantify the time spent in applying the Mini-Cex by the observer; detect and quantify medical disabilities during urodynamic examination, evaluate the reliability and internal consistency of the Mini exercise Clinical Evaluative ( Mini-Cex ) for the urodynamic examination. Methods: A quantitative and qualitative study conducted with graduated students in urology during the performance of urodynamic examination, through the Mini-Cex instrument application, which is based on a Likert Scale of 9 categories, which grades 1 to 3 refer to unsatisfactory performance ; 4 to 6 to satisfactory performance and 7 to 9 the exemplary performance . This instrument allowed residents' performance assessment in achieving the urodynamic examination by the researcher on the following questions: on interviewing, physical examination, clinical reasoning skills, humanistic and professional qualities, orientation, organization/efficiency and overall, clinical competence. At the end of the consultancy the researcher conducted a feedback to each student pointing their failures and successes in achieving the urodynamic testing, setting up formative assessment. Results: The findings recommend the usage of the Mini-Cex in performing urodynamic studies (Cronbach's alpha between 0.8 and 0.9) and performing feedback advantages on development of residents´ learning
A avaliação de competências clínicas constitui etapa essencial na formação do estudante de Medicina e deve ser feita pelo professor, por meio da observação direta do desempenho em situação real. O uso do Miniexercício Clínico Avaliativo (Mini-Cex) é uma opção complementar de avaliação formativa e somativa, que avalia as competências clínicas do estudantes pré ou pós-graduados. Objetivos: Avaliar a competência clínica, de médicos residentes, na realização do exame urodinâmico; quantificar a evolução do seu desempenho após a realização do feedback; quantificar a melhora da qualidade técnica do exame urodinâmico pelo médico residente; quantificar o tempo gasto na aplicação do Mini-Cex pelo observador; detectar e quantificar as deficiências médicas durante o exame urodinâmico; avaliar a confiabilidade e a consistência interna do Mini-Cex para o exame urodinâmico. Material e Método: Estudo quanti-qualitativo realizado com estudantes de pós-graduação em Urologia durante a realização do exame urodinâmico, por meio da aplicação do instrumento Mini-Cex, que é baseado em uma Escala de Likert de 9 categorias, em que as notas de 1 a 3 referem-se a um desempenho insatisfatório; de 4 a 6 a um desempenho satisfatório e de 7 a 9 a um desempenho exemplar. Este instrumento possibilitou a avaliação do desempenho dos residentes na realização do exame urodinâmico por parte do pesquisador nos seguintes quesitos: habilidades na entrevista, habilidades no exame físico, qualidades humanísticas/profissionalismo, raciocínio clínico, habilidades de orientação, organização/eficiência e competência clínica geral. Ao final da consulta, o pesquisador realizou um feedback com cada estudante, apontando suas falhas e acertos na realização do exame urodinâmico, configurando a avaliação formativa. Resultados: Os achados recomendam o uso do Mini-Cex na realização de exames urodinâmicos (Alpha de Cronbach entre 0,8 e 0,9) e vantagens da realização do feedback na evolução do aprendizado de médicos residentes

INTRODUÇÃO: Na residência médica, inúmeros fatores favorecem o desgaste emocional, colocando em risco atitudes relevantes, como empatia, resiliência e percepção da qualidade de vida, o que pode comprometer o desempenho profissional. OBJETIVO: Avaliar o impacto do treinamento em Clínica Médica na percepção da qualidade de vida, empatia, resiliência e sonolência diurna, e suas correlações com o desempenho médico na avaliação de competências clínicas pelo método OSCE. A influência do gênero nesses construtos também foi investigada. METODOLOGIA: Estudo transversal com médicos residentes do primeiro ano de Clínica Médica, com questionários de autorrelato para avaliar a percepção de qualidade de vida específica para residência médica (Veras-Q), dados sociodemográficos, empatia (escala Jefferson), resiliência (escala Wagnild& Young RS-14) e sonolência diurna (escala de Epwoth). O desempenho acadêmico foi avaliado pelo método OSCE no final do primeiro ano da residência em Clínica Médica. Análise de grupos focais com residentes do sexo feminino foi feita para compreender as diferenças entre os gêneros nos construtos investigados. RESULTADOS: Cento e nove médicos residentes participaram do estudo: 31 (28,4%) do sexo feminino e 78 (71,6%) masculinos. As residentes do sexo feminino apresentaram escores de qualidade de vida significativamente menores do que os residentes masculinos nos domínios de uso do tempo (30,3, feminino vs 41,1, masculino p < 0,001), psicológico (48,1, feminino vs 56,7, masculino p < 0,01) e saúde física (42,8, feminino vs 53,6, masculino p < 0,05). Os escores de sonolência diurna foram significativamente maiores para as residentes do sexo feminino (13,0, feminino vs 9,0, masculino p < 0,001), com valores considerados patológicos (p < 0,001). Houve moderada correlação negativa entre sonolência diurna e o domínio manejo do tempo da qualidade de vida (p < 0,01). Houve forte correlação positiva entre resiliência e os domínios psicológico e saúde física da qualidade de vida (respectivamente, 0,48 e 0,50; p < 0,01). Os escores do desempenho acadêmico pelo método OSCE não diferiram entre os gêneros e não apresentaram correlação com os construtos investigados. A análise dos grupos focais destacou dificuldade de manejo do tempo, insegurança, sensação de perda, autocobrança, dificuldade de estabelecer laços afetivos, dificuldade de concentração e de aquisição do conhecimento como fatores relacionados à pior percepção da qualidade de vida para as residentes do sexo feminino. CONCLUSÃO: Ao final do primeiro ano da residência em Clínica Médica, os residentes apresentaram baixos escores na percepção da qualidade de vida e maior sonolência diurna. Houve diferenças significativas entre os gêneros na percepção da qualidade de vida e na sonolência diurna, com escores menores de qualidade de vida e escores maiores de sonolência diurna nas residentes do sexo feminino. Não foram identificadas correlações entre qualidade de vida, empatia, resiliência, sonolência diurna e o desempenho acadêmico pelo método OSCE em residentes do primeiro ano de Clínica Médica
INTRODUCTION: During medical residency, many factors may lead to emotional distress, putting at risk relevant attitudes such as empathy, resilience and perception of quality of life, which can compromise professional performance. OBJECTIVE: To evaluate the impact of training in internal medicine on quality of life, empathy, resilience, daytime sleepiness and their correlation with academic performance using the OSCE method. The influence of gender in these constructs was also investigated. METHODOLOGY: A cross-sectional study with first-year internal medicine residents was performed to evaluate self-reported quality of life specific for medical residency (Veras-Q), socio demographic data, empathy (Jefferson scale), resilience (Brief Resilience Scale from Wagnild and Young) and daytime sleepiness (Epwoth scale). Academic performance was assessed by the OSCE method at the end of the first year of internal medicine residency. Differencesbetween genders were investigated using focus groups analysis with female residents. RESULTS: One hundred and nine resident physicians participated in the study: 31 (28.4%) were female and 78 (71.6%) were male. Female residents presented significantly lower scores than those of male residents for quality of life in the domains of time management (30.3, females vs 41.1, males p < 0.001), psychological (48.1 females vs 56, 7, males p < 0.01) and physical health (42.8, females vs 53.6, males p < 0.05). They also scored higher in daytime sleepiness (13.0, females vs 9.0, males p < 0.001) with pathological scores for daytime sleepiness. A moderate negative correlation between daytime sleepiness and time management domain of quality of life (p < 0.01) was observed. There was a strong positive correlation among resilience, psychological and physical health domains of quality of life (respectively 0.48 and 0.50, p < 0.01). Academic performance scores by the OSCE method did not differ between genders and did not correlate with empathy, resilience and daytime sleepiness scores. The focus group assessment revealed difficulty in concentration and knowledge acquisition, insecurity, feeling of loss, greater critical perception, self-doubt and difficulty in creating affective bonds to support the training period as the main factors involved in the lower perception of quality of life among the women. CONCLUSION: Female residents had lower scores of quality of life and higher scores on daytime sleepiness. No significant differences between genders were detected for academic performance scores and no relationship among quality of life, empathy, resilience, daytime sleepiness and academic performance by the OSCE method was observed in first-year internal medicine residents. Measures to improve quality of life among female residents during this critical period of medical training might include investing in mentoring to help them better manage their time and encouraging activities that facilitate relationship development

Up to the middle of the 1970's most government policies dealing with physician manpower dealt with the problems of increasing the supply of physicians, rather than changing the geographic disparity of physicians between urban and rural areas. In 1983 the British Columbia government introduced legislation (passed in a modified form in 1985) that would restrict certain groups of physicians from obtaining Medical Service Plan billing numbers in certain areas of the province, in an attempt to change the geographic distribution of physicians in this province. Regulation is only one of a number of approaches to altering the distribution of physicians. The purpose of this study is to attempt to recommend other approaches that could be used to alter the geographic distribution of physicians, based on the factors which the residents and interns of British Columbia would consider necessary before they will establish practices in the rural areas of the province. The literature was examined to determine the present supply and distribution of physicians in the province of British Columbia. It was shown that the metropolitan areas had much higher concentrations of physicians than did the non-metropolitan regions. The literature was then searched to determine what types of policies had been used in an effort to change this geographic disparity and also to determine what factors influence physicians to locate their practices where they do. From this research a questionnaire was developed and mailed to all residents and interns registered in the University of British Columbia medical program in the academic year 1984-85. A response rate of 31.8% was obtained in this survey. It was found that many physicians were raised in large communities and planned to locate their practices in similar geographic areas to where they were raised. It was also found that the factors which the residents and interns considered to be the most important fell into the "Fixed Determinant" category, that is factors that are personal preferences of the physician. This makes it very difficult to formulate any type of non-regulatory policy to affect the geographic distribution of physicians in British Columbia
Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate

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Introdução: Vivencia-se no Brasil, a transição demográfica em paralelo à transição epidemiológica, caracterizada por tripla carga de doença. De acordo com a Organização Mundial de Saúde, devido ao envelhecimento populacional e a cronicidade das doenças, existe uma elevada demanda de Cuidados Paliativos (CP) e para resolver essa questão, existe a proposta para implantar os CP na atenção primária em saúde (APS) que é o pilar do Sistema Único de Saúde no Brasil e um dos locais de atuação do Médico de Família e Comunidade (MFC). Objetivo geral: Analisar o ensino de Cuidados Paliativos nas residências em Medicina da Família e Comunidade de Curitiba e Região Metropolitana. Objetivos específicos: Caracterizar a inserção do ensino de Cuidados Paliativos nas residências de MFC de Curitiba e região metropolitana; Identificar as estratégias pedagógicas utilizadas para esse ensino; Identificar, na visão dos preceptores dos programas, as competências que têm sido desenvolvidas durante a residência, no tocante aos Cuidados Paliativos; Apreender as percepções dos residentes acerca das competências em Cuidados Paliativos, desenvolvidas no decorrer da residência médica em MFC. Metodologia: Estudo transversal, exploratório, descritivo, qualitativo/quantitativo pela triangulação de métodos. Participaram do estudo quatro Programas de Residência de Medicina de Família e Comunidade, dos quais dois de Curitiba e dois da região metropolitana. Foram entrevistados seis preceptores e aplicado questionário a 43 residentes (89,53% dos residentes). Foi realizada a entrevista semiestruturada com preceptores para identificar a existência de ensino de CP, as competências em CP desenvolvidas, as estratégias e os espaços de ensino e aprendizagem utilizados. Aos residentes foi aplicado um questionário, constituído por questões fechadas (para caracterizar os sujeitos da pesquisa e identificar os temas em CP sugeridos pelos os residentes), uma questão aberta (para identificar se existe ensino de CP) e um instrumento tipo Likert de autopercepção de desenvolvimento de competências em CP, desenvolvido pelos autores e validado estatisticamente. A análise das entrevistas / questão aberta foi realizada pela análise de conteúdo modalidade temática e a escala tipo likert por análise estatística descritiva, Teste da Correlação Linear (r), Gráfico de Barras e teste de Mann-Whitney. Resultados: Identificou-se que ao ensino de CP ocorre de maneira não estruturada no currículo oculto e por meio da inserção pontual da temática. Na percepção de um preceptor, o ensino é ausente e se justifica pela falta de capacitação do preceptor, pelo pouco tempo de contato com o paciente terminal na APS e pela ausência de protocolo institucional. Os espaços de ensino e aprendizagem citados foram: a unidade de saúde, o atendimento em domicílio e a sala de aula. As estratégias pedagógicas citadas foram: a aula teórica, a discussão de caso clínico, o estudo dirigido e o caso clínico simulado. Quanto às competências desenvolvidas, os residentes se consideraram em zona de alerta (necessidade de intervenção a médio prazo) para: “demonstrar habilidade de comunicação com o paciente, com os seus cuidadores e sua família, com ênfase na comunicação de más notícias” (média 2,77), preparar e orientar familiares e paciente quanto às providências “relacionadas à morte” (média 2,72), “manejo de Intercorrências comuns no paciente em cuidado paliativo e de situações terminais de doenças crônicas” (média 2,47), “manejo de úlcera por pressão / decúbito” (média 2,4), manejo da dor oncológica e não oncológica no paciente terminal (média 2,36), “manejo da nutrição no paciente terminal” (média 2,47), saber fazer abordagem do luto (média 2,92) e saber fornecer atestado de óbito (2,74). A única competência na qual os residentes se consideram em zona de perigo é “reconhecer situações urgentes em CP”, com a média de 1,65. Conclusão: No decurso da residência de Medicina de Família e Comunidade, o ensino de CP ocorre no currículo oculto e de maneira não planejada e é, provavelmente, a consequência das similaridades entre os princípios dos CP e da MFC. Por meio de instrumento aplicado aos residentes, identificou-se a autopercepção de desenvolvimento de 10 competências, propostas pela SBMFC. Os residentes se consideram em zona de alerta para nove dessas competências e se consideram em zona de perigo, para uma delas. Com base na pesquisa realizada, sugere-se a estruturação do ensino de CP na residência de MFC, para que se possa formar profissionais com capacitação plena para conduzir os pacientes com necessidades de CP.
Introduction: Currently, Brazil lives a demographic transition in parallel to the epidemiological transition characterized by triple burden of disease. According to the World Health Organization, due to population aging and chronicity of diseases, there is a high demand for Palliative Care (PC) and to solve this, there is a proposal to implement PC in Primary Health Care (PHC) which is the pillar of Unified Health System in Brazil and one of the places of work of the Family Physician (FP). General objective: analyze the teaching of Palliative Care in residences in Family Medicine (FM) of Curitiba and the metropolitan region. Specific objectives: characterize the insertion of the Palliative Care teaching in the FM residences of Curitiba and metropolitan region; identify the pedagogical strategies used for this teaching; identify, in the view of program preceptors, the skills that have been developed during the residency in Palliative Care; assimilate the residents’ perceptions of Palliative Care competencies, developed throughout medical residency in FM. Methodology: a cross-sectional, exploratory, descriptive, qualitative / quantitative study by the triangulation of methods. The study included 04 Residency Programs in Family Medicine, two of Curitiba and two in the metropolitan region. We interviewed 06 preceptors and applied a questionnaire to 43 residents (89.53% of residents). A semi-structured interview with preceptors was carried out in order to identify if there is PC teaching, PC competencies developed, strategies, teaching and learning spaces used. Residents were given a questionnaire consisting of closed-ended questions (to characterize the subjects of the research and identify PC themes suggested by the residents) an open-ended question (to identify if there is PC teaching) and a kind of Likert-type scale of self-perception of competences development created by the authors and statistically validated. The analysis of the interviews / open-ended question was performed by the thematic modality content analysis, a Likert-type scale and by descriptive statistical analysis, Linear Correlation Test (r), Bar Graph and Mann-Whitney test. Results: We identified that the teaching of PC occurs in an unstructured way in the hidden curriculum and through the punctual insertion of the thematic. According to a preceptor’s perception, there is an absence of teaching and is justified by the lack of training of the preceptor, by the short time of contact with the terminal patient in the PHC and by the absence of institutional protocol. The teaching and learning spaces cited were health unit, home care and the classroom. The pedagogical strategies cited were theoretical class, clinical case discussion, directed study and simulated clinical case. Regarding the competencies developed, residents considered themselves to be in alert zones (need for medium-term intervention) “to demonstrate communication skills with the patient, with their caregivers and with their family, especially when communicating bad news” (mean 2,77), “to prepare and orient family members and patients concerning death-related providences” (mean 2.72), "management of common intercurrences in patients in palliative care and in terminal situations of chronic diseases" (mean 2.47) , "management of pressure and decubitus ulcer" (mean 2.4), “management of oncological and non-oncological pain in terminal patient (mean 2.36), "management of nutrition in the terminal patient" (mean 2.47), to know how to make an approach to grief (mean 2.92) and to know how to provide a death certificate (2.74). The only competence in which residents consider themselves to be in danger zones is to "recognize urgent situations in PC" (mean 1.65).Conclusion: PC teaching occurs throughout the Family Medicine residency in the hidden curriculum and in an unplanned way and is probably the consequence of similarities between the principles of PC and FM. Through an instrument applied to the residents, we identified the self-perception of the development of 10 competences, proposed by SBMFC. Residents consider themselves in an alert zone for nine of these competences and consider themselves in danger zone for one of them. Based on the research carried out, we suggest structuring the teaching of PC in the FM residency so that we can train professionals with full capacity to lead patients with PC needs.

A avaliação de programas de residência medica é parte integrante de um sistema maior de acreditação em diversos países. A acreditação é um produto simbólico. Não \"vende\" um bem concreto, mas um símbolo de confiança na existência de critérios elevados de qualidade em determinado programa que é objeto de sua análise. A acreditação na residência médica é bastante complexa, posto que, além dos conhecimentos em educação médica, são necessários conhecimentos em estrutura, processo e resultados esperados para programas de pós-graduação no ensino superior e também na saúde e no trabalho médico. O resultado final esperado de todo esse sistema deve ser o médico competente. Lições aprendidas com as experiências internacionais podem contribuir com a construção de modelos locais e evitar que erros históricos sejam cometidos. Muitos países direcionam investimentos no campo da educação médica em busca da qualidade de seus profissionais, visando impactar positivamente o sistema de saúde. Ao investigarmos mais profundamente o sistema canadense de acreditação do Royal College of Physicians and Surgeons of Canada, por meio de métodos etnográficos, descrição qualitativa e estudo de caso, observamos que seus processos internos não diferem muito do praticado no Brasil. No entanto, a formação dos médicos especialistas segue de maneira desagregada neste país; Comissão Nacional de Residência Médica, CNRM; avaliações das Sociedades de Especialidades Médicas continuam desintegradas, em um ambiente político desfavorável, de afastamento dos principais interessados e especialistas nesse processo (governo, universidades, entidades médicas etc.). Um projeto piloto realizado neste estudo, conjuntamente, entre a Sociedade Brasileira de Neurocirurgia e a CNRM unificou critérios, realizou avaliações conjuntas e somou saberes com resultados exemplares para o país. O sistema brasileiro, por não ser unificado e não possuir independência institucional,funciona de maneira errática, impossibilitando estabilidade e garantia de qualidade em conformidade com elevados padrões internacionais. O foco na quantidade de médicos, que toma conta da pauta da saúde de boa parte do planeta, não pode impedir o avanço e as garantias de busca pela qualidade. Propiciar desequilíbrio entre qualidade e quantidade na educação médica pode ser catastrófico para o futuro dos profissionais e colocar em risco a população geral. Os resultados desta tese vêm da concepção internacional para a proposta do modelo nacional de acreditação e avaliação de programas de residência. Visa à construção democrática e unida dos principais partícipes do sistema, em que qualidade e quantidade se encontram de maneira harmônica e equilibrada
Residency program evaluation is part of the accreditation system in several countries. Accreditation is a symbolic good. It does not sell a product to take over, but a symbol of trustiness on the high level standards at a specific program. Residency accreditation is away complex. Beyond the knowledge on medical education we have to have skills and knowledge of structure, process and outcomes on post-graduation, health sector and medical work. The final outcome of this system must be a competent physician. Lessons learned from the international experiences might contribute to local models and avoid historical mistakes. Searching for quality of the physicians in order to have positive impact on the health system, several countries have been amplifying the investments on medical education. Further researches about the Royal College of Physicians and Surgeons of Canada residency accreditation system through ethnography, qualitative description and case study methodologies reveal similarities with what would be a Brazilian system. The evaluations of the physician\'s post-graduation performed by the National Medical Residency Committee, CNRM, and the medical specialty societies have been kept apart. The political environmental and relationship among the stakeholders (government, physicians\' institutions, university, etc.) does not help consensus. A pilot project unified standards, made joint evaluations and add knowledge between the Brazilian Neurosurgery Society and CNRM providing exemplary results. The Brazilian system is not unified or independent. It jeopardizes the stability of the system\'s performance and turns the comparison within the international high level standards impossible. There have been a lot of efforts on the health sector to plan the quantity of physicians. However, it can\'t build a barrier to meet and improve the quality of the physicians. The lack of balance between quantity and quality in medical education might be destructive to the professional and put on risk the general population. From international experiences and studies, the results of this thesis propose a national model for residency program evaluation and accreditation. Bringing balance and harmony between quantity and quality through democratic and unify bounding of the stakeholders

Para determinar o desempenho cognitivo de médicos residentes de Anestesiologia relacionado a características afetivo-motivacionais, 60 residentes completaram, com intervalos de 6 meses, questionários sobre Qualidade de Vida, Ambiente Educacional, Estratégias de Ensino e Aprendizado e um teste de progresso. Análises de conglomerados classificaram os residentes de acordo com as variáveis afetivo-motivacionais e cognitivas. Grupos resultando de combinações dos conglomerados foram obtidos. Gráficos de progresso cognitivo foram obtidos pelo cálculo de médias móveis exponencialmente ponderadas. Somente os grupos com perfil afetivo-motivacional mais positivo demonstraram ganho significativo de conhecimento
To determine residents' cognitive achievements related to differential characteristics in affective-motivational variables, 60 anesthesia residents completed at four 6-month intervals World Health Organization Quality of Life Inventory, the Dundee Ready Educational Environment Measure, the Learning and Study Strategies Inventory, and a Rasch modeled progress test. Cluster analyses classified residents according to affective-motivational and cognitive measures. Groups resulting from combinations of clusters were obtained. Exponentially weighted moving average charts assessed cognitive progress. Only groups exhibiting more positive affective-motivational profiles demonstrated significant knowledge-gain

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Neste trabalho analisa-se o papel do preceptor na residência médica e sua visão sobre o processo de ensino-aprendizagem. Apresenta-se uma revisão bibliográfica sobre a evolução histórica da residência, o conceito de preceptor, as questões pedagógicas e os fundamentos da formação moral relacionados. Analisam-se as percepções dos preceptores dos programas de residência em especialidades clínicas de um hospital deensino. Através de uma pesquisa descritiva, utiliza-se a técnica de entrevista não diretiva, com o intuito de estudar o fenômeno a partir da fala de 16 desses preceptores. Utiliza-se a análise de conteúdo, tecendo uma relação com as referências da literatura. O envolvimento nas atividades diárias mostrou-se a base do processo de ensino aprendizagem, desenvolvendo-se atributos técnicos e relacionais. O estudo teórico, as discussões de casos e as reuniões científicas estimulam a capacidade de raciocínio. Apesar da força tradicional da transmissão de conhecimentos, valorizam-se a atitude ativa e a participação do residente. O preceptor assume vários papéis. Encontram-se referências a orientador, tutor, supervisor e mentor. Ele planeja, controla, guia; estimula o raciocínio e a postura ativa; analisa o desempenho; aconselha e cuida do crescimento profissional e pessoal; observa e avalia o residente executando suas atividades; atua na formação moral. Grande é a importância do preceptor como educador, oferecendo, ao aprendiz, ambientes que lhe permitam construir e reconstruir conhecimentos. O preceptor ensina, realizando procedimentos técnicos e moderando a discussão de casos. Assume papel do docente-clínico, um profissional que domina a prática clínica e os aspectos educacionais relacionados a ela, transformando-a em ambiente e momento educacionais propícios. O residente aprende de diversas formas e a residência, além do ensino de um corpo de conhecimentos e de habilidades, compreende também aaquisição de atributos relacionais, posturas e atitudes que definem o profissionalismo médico. A residência deve ser um momento da formação que abarca o desenvolvimento de atributos técnicos e relacionais, no qual preceptor e residente façam, de sua ação diária como médicos, educador e aprendiz, um processo educacional. Nesse sentido,tanto residente como preceptor devem, no relacionamento diário com os pacientes, preocupar-se com a formação técnica e ética para atingirem a qualidade profissional em plenitude.
This study tries to comprehend the preceptor’s view upon medical residence and upon their role in the teaching-learning process. It starts from a panorama covering the historical evolution of medical residence, the building of the concept of a preceptor, the pedagogical issues and the related basis of moral construction. Based on these matters, the preceptor’s perceptions of the residence program on medical specialties in a teaching hospital have been analyzed. A descriptive research was carried out, using the nondirected interviews technique in order to study the phenomenon from the saying of 16 of these preceptors. By using content analysis, a connection between literary references and data has been made. The involvement in daily practical activities proved to be the basis of the learning-teaching process, looking up the development of technical and relational features. The theoretical study, the discussion of cases and scientific meetings are stimuli to the ability of reasoning. Despite the traditional strength of knowledge transmissions, the active attitude and the truly participation of the resident are of great value. The preceptor plays different roles. References to guide, mentor, supervisor and tutor were found. He plans, controls, guides; stimulates active thinking and attitude; analyzes performance; advise and takes care of the professional and personal improvement; observes and assess the resident while doing their duties; takes part in their moral construction.. It is noticeable the importance of the preceptor as an educator who creates the atmosphere where the learner is allowed to build and re-build knowledge. The preceptor teaches by performing technical procedures and moderating discussions of cases. They take the role of a clinical teacher, a professional who dominates the clinical practice and also the educational aspects related to it, transforming this moment into a propitious one of learning. The resident learns from various forms and the residence, beyond the teaching of a body of knowledge and skills must also enhance the acquisition of relational attributes, postures and attitudes which define the medical professionalism. The residence may and must be the medical teaching moment that the development of technical and relational features are covered and in which preceptor and resident make their daily duties as doctors an educational process as teacher and pupil. Accordingly, in their daily relationship with patients, both resident and preceptor have to be concerned about technical and ethics training to achieve professional quality in full.

Introduction: In Peru there are different hospitals and university programs for training of specialists in nephrology. Objective: To assess the perception of physicians who attend such programs. Methods: We carried out a descriptive cross-sectional national-level study in physicians who were in the last two years of nephrology training during February 2012 and who had graduated from it in 2010 and 2011. A self-applied questionnaire was developed along with the Peruvian Society of Nephrology based on international standards. The questionnaire evaluated: mentoring, clinical training, procedures, external rotations, research and global perception. Results: Forty doctors were surveyed nationwide. 82.5% had tutors, 22.5% of them said their support was poor. A 27.5% described their theoretical formation as deficient. The practical training was perceived as acceptable globally; however, improvements in training on peritoneal dialysis and reading kidney transplant biopsies are necessary. A 90% have national external rotations and 65% reported to have an international rotation. In the assessment of research, 77.5% thought this is deficient. In addition, 82.5% believed that residency should last four years. However, 60% reported that their residency training was good. There is a decrease in the positive perception of the aspects studied among residents regarding graduates. Conclusion: The overall perception of nephrology residency training was considered good; however, areas of tutoring, and academic and research activities on average were deficient.

The purpose of this study was to examine the effects of utilizing high-fidelity simulation on the team performance, perceived level of learning, and satisfaction of resident physicians in a simulated cardiac resuscitation scenario. This study was significant because it filled a gap in the literature about how methods of education impact healthcare practitioners. While a body of research exists in education on adult learning principles, there are few studies on how applying adult learning principles to professional development is an effective method of instruction in healthcare.

A convenience sample of resident physicians from two hospitals that are part of a large health system was utilized for this study. Resident physicians participated in a simulated mock cardiac resuscitation scenario monthly. The Simulated Cardiac Resuscitation Team Performance Evaluation instrument was utilized to assess the team performance of the residents in the scenarios. A program evaluation form was administered to measure perceived level of learning and satisfaction with the simulation experience.

One-way multivariate analyses of variance were conducted to evaluate the relationships between year of residency and gender and the team performance score on the Simulated Cardiac Resuscitation Team Performance Evaluation. Significant differences were not found among the years of residency on the dependent measures. Significant differences were not found between the genders on the dependent measures. A one-way multivariate analysis of variance was conducted to evaluate the relationship between year of residency and the level of satisfaction and perceived level of learning of the resident physicians. Significant differences were not found among the three years of residency on the dependent measures. A one-way multivariate analysis of variance was conducted to evaluate the relationship between gender and the level of satisfaction and perceived level of learning of the resident physicians. Significant differences were not found between genders on the dependent measures. A one-way multivariate analysis of variance was conducted to evaluate the relationship between prior use of simulation and the level of satisfaction and perceived level of learning of the resident physicians. Significant differences were not found between prior use of simulation on the dependent measures.

This record of study describes work done in the capacity of Research and Development (R&D) Engineer at Byrne Medical Incorporated, Conroe, TX. The company manufactures accessories used for endoscopic irrigation. The endoscopy system requires a supply of pressurized distilled water that is used by the physician for certain procedures. It becomes the responsibility of the irrigation subsystem to fulfill this need. It consists of a pressurization system, distilled water holder, tubing to convey this to the endoscope and fittings to interface the tubing to the endoscope body. Byrne Medical Inc. manufactures products from every stage of the system for many of the larger endoscope manufacturers. As an R&D Engineer, I was placed in the operations facility to aid the engineering team in its role to develop, test, prototype and refine products. In performing this role, I had to work with managers and staff from different functional areas of the company. Projects did not stop with technical design; they called for effective communication, planning and decision making. This document covers salient projects completed during the course of the internship. Designing an endoscopic irrigation pump to be sold in conjunction with an instrument cart was one. An automated measurement system comprising of instrumentation interfaced with a personal computer and LabVIEW software is another. To facilitate assembly, tools to insert plastic components into extruded tubes were designed in SolidWorks. Another project that involved mechanical design and elements of project management was designing a tubeset to be used with an Endoscopic Retrograde Cholangiopancreatography (ERCP) system. This was done by Byrne Medical Inc. for Boston Scientific Corporation, the manufacturers of the core ERCP system. These projects not only called for engineering skills but inputs from other departments and personnel also. Inputs from regulatory affairs, technicians and clean room staff were critical to the success of all these projects.

Mestrado em Biomedicina Farmacêutica
The contents of this report are a summary of the activities carried out during the 8-month internship as an Associate Medical Writer at Blueclinical Ltd, Matosinhos, Portugal. Mainly my activities were related to medical writing, particularly writing the clinical research protocols, clinical study reports, writing manuscript and preparing poster presentations. In addition to these activities, I also participated in performance of a clinical trial from beginning to end. During the period of its realization, I was able to familiarize myself with all the steps of the Phase I clinical trial.
O conteúdo deste relatório é um resumo das actividades realizadas durante o estágio de 8 meses, como escritor Médico Associado na Blueclinical, Ltd, em Matosinhos, Portugal. As atividades desenvolvidas foram essencialmente relacionadas com a escrita médica, nomeadamente a escrita dos protocolos de investigação clínica, dos relatórios de ensaios clínicos, redação e preparação de apresentações de pósteres. Além destas atividades, também tive a oportunidade de acompanhar um ensaio clínico de fase I desde o seu início até ao fim. Durante este estudo, foi possível conhecer de perto todas as etapas de realização de ensaios clínicos de fase I.

Mestrado em Biomedicina Farmacêutica
This report aims at describing my experience uring the 9 months of curricular internship at Eurotrials, Scientific Consultants, as part of the 2nd year of the Master’s in Pharmaceutical Medicine. The internship was mainly focused on the development of skills and acquiring experience in Medical Writing activities, trought actively participating in activities usually developed by medical writers: writing, preparation and submission of scientific articles, preparation of scientific posters, compilation of appendices for Clinical Study Reports, and writing of educational material. Throughout the internship, I had the opportunity to acquire valuable knowledge related to Medical Writing, as well as to clearly understand its role in clinical research, as an essential tool to interpret, describe and publish the data obtained.
Este relatório tem como objetivo descrever a minha experiência durante os 9 meses de estágio curricular na Eurotrials, Consultores Científicos, como parte do 2º ano do Mestrado de Biomedicina Farmacêutica. O estágio focou-se maioritariamente no desenvolvimento de competências e obtenção de experiência em atividades de Medical Writing, através da participação ativa em atividades usualmente desenvolvidas por medical writers: escrita, preparação e submissão de artigos científicos, preparação de pósters científicos, complilação de apêndices para Clinical Study Reports, e escrita de material educativo. Durante o estágio, tive a oportunidade de adquirir conhecimentos essenciais relacionados com a atividade de Medical Writing, e de perceber de forma clara o seu papel na investigação clínica, como ferramenta essencial na interpretação, descrição e divulgação dos dados obtidos.

Mestrado em Biomedicina Farmacêutica
This document describes an internship carried out in the healthcare unit Lenitudes Medical Center & Research, located in Santa Maria da Feira, held from 1st September 2015 until 31st May 2016. This internship was performed as part of the second year of the Master in Pharmaceutical Biomedicine at the University of Aveiro, aiming to acquire technical skills and experience in Risk Management and Pharmacovigilance, as well as to consolidate previous knowledge. Besides the acquisition of theoretical knowledge, this training period was paramount for the development of a number of social and personal skills that contributed for my profissional growth within the host institution. The training mainly focused in topics related to Risk Management, involving the preparation of the Risk Management Manual of the unit and adverse events monitoring periodic reports associated with radiotherapy. Additionally, during the internship were conducted multidisciplinary activities related to initial processes regarding research and medical writing. This internship was a very enriching experience with great value on a professional, personal and social level, that allowed me to achieve the main objectives established.
O presente documento descreve o estágio curricular realizado na clínica Lenitudes Medical Center & Research, localizada em Santa Maria da Feira, que decorreu desde 1 de setembro de 2015 até 31 de maio de 2016. Este estágio foi realizado no âmbito do segundo ano do Mestrado em Biomedicina Farmacêutica da Universidade de Aveiro e teve como objetivos a aquisição de competências técnicas, experiência e consolidação de conhecimentos nas áreas de Gestão de Risco e Farmacovigilância. Para além da aquisição de conhecimentos teóricos, este período de estágio foi fundamental para o desenvolvimento de um conjunto de aptidões sociais e pessoais que contribuíram para o meu crescimento profissional dentro da instituição de acolhimento. O estágio focou essencialmente tópicos relacionados com a Gestão de Risco, envolvendo a elaboração do Manual de Gestão de Risco da unidade, bem como relatórios periódicos de monitorização de eventos adversos associados à radioterapia. Adicionalmente, durante o estágio foram realizadas atividades de carácter multidisciplinar relacionadas com processos iniciais de investigação e medical writing. Esta foi uma experiência bastante enriquecedora, de grande valor a nível profissional, pessoal e social, que me permitiu atingir os principais objetivos estabelecidos.

The implementation of Electronic Health Records (EHR) has improved medical documentation in terms of accuracy, team communication, and ease of ordering tests and prescriptions; however, charting in an EHR strains the provider/patient relationship and contributes to physician burnout. Medical scribes are a promising potential solution to these problems. Our study aims to demonstrate that implementation of scribes into a medical residency program positively affects provider/patient satisfaction and improves quality and efficiency of EHR documentation. Our study evaluated the effectiveness and utility of scribes in a residency training program utilizing the established implementation framework “RE-AIM,” or Reach, Effectiveness, Adoption, Implementation (quality), and Maintenance. During the study’s initial “Training Phase,” 11 first and second-year Family Medicine residents conducted scribe-facilitated patient visits. Patient and provider satisfaction ratings were collected, note quality was evaluated, and time to note closure was measured. During the subsequent “Choice Phase,” residents were given the option of whether to utilize scribes, and the same data measures were collected. Resident satisfaction ratings during the Training Phase showed an average score of 6.03 (on a 1-7 scale where “7” = “strongly agree” with positive statements), and a pilot sample of 9 patients showed an average patient satisfaction rating of 4.77 (on a 1-5 scale where “5” = “strongly agree” with positive statements). Scribe-facilitated notes coded for quality had an average score of 3.375 (on a 1-5 scale where 5 is “extremely” high quality). Finally, residents’ average time to note closure was decreased by more than 8 hours in scribe-facilitated visits. During the Choice Phase, all 11 participating residents requested scribe-facilitated visits, again with very high patient satisfaction scores (4.67 on a 1-5 scale) as well as high clinician satisfaction scores (6.06 on a 1-7 scale). Choice Phase note quality and note-closure time are currently being assessed. These results demonstrate that scribes improve clinician and patient satisfaction, as well as quality and efficiency of EHR documentation. Limitations include a small sample size of clinicians and patients. Further research is needed with larger sample sizes to determine whether scribes in a medical residency program represent a sustainable and effective intervention.

Securing and Excelling in a Pharmacy Residency is a practical guide and handbook for pharmacy students seeking a residency, residents currently enrolled in a program, and residency program leadership. This user-friendly text encourages high-quality pharmacy residency training, which elevates the individual, the profession, and ultimately patient care. Answering the need for residency training and improvement raised by the ASHP/ACCP joint 2020 initiative, Securing and Excelling in a Pharmacy Residency uniquely prepares students for the increasingly competitive pharmacy residency market. This one-of-a-kind resource is also helpful to guide individuals currently enrolled in a residency and their mentors. This valuable resource also addresses options after residency training, priceless guidance for both current residents and faculty advisers.

Appropriate coding is a daunting task for new physicians just entering the world of medical practice. This is mostly due to the ever-changing standards for reimbursement, and the constant demand on provider time from an ever-growing number of patients to serve from a primary care perspective. It has been shown that family physicians lose up to 10- 20 percent of reimbursement each year because of incorrect coding. Physicians are the ones responsible for appropriately coding their work and documentation so that the clinic can be fairly reimbursed. In the East Tennessee State University Family Physicians of Bristol residency program, there is a strong tendency for most physicians to under-code the majority of office visits to a 99213, despite the fact that their documentation of these visits reflects coding at much higher levels. The goal of this project is to provide more intensive education to resident physicians on the requirements for coding, and thus change behaviors that led to continued under-coding. Researchers in this project utilized aggregate data collected in the course of the usual practice of business to show the present state of coding behaviors as broken down by resident, and then re-assessed these numbers after the presentation of more intensive education regarding appropriate coding. Education was provided in a variety of formats, including 4 short lectures at didactic sessions over the course of several months, as well as handouts for residents to keep with them at nurses’ stations containing guidelines for coding. Data analysis is currently underway. It is expected that the implementation of the educational program will have led to a statistically significant increase in appropriate coding within the clinic. This result has important implications regarding education to improve appropriate coding and reimbursement, particularly for small clinics operating in rural regions that are at the highest risk of harm from under-reimbursement due to inaccurate coding.

Osteopathic physician (D.O.) residency programs that do not achieve accreditation under the new Single Accreditation System (SAS) standards by June 30, 2020 will lose access to their share of more than $9,000,000,000 of public tax dollars. This U.S. Centers for Medicare & Medicaid Services (CMS) funding helps sponsoring institutions cover direct and indirect resident physician training expenses. A significant financial burden would then be shifted to marginal costs of the residency program’s sponsoring institution in the absence of CMS funding. The sponsoring institution’s ability or willingness to bare these costs occurs during a time when hospital operating margins are at historic lows (Advisory.com /Daily Briefing /May 18, 2017 | The Daily Briefing / Hospital profit margins declined from 2015 to 2016, Moody's finds). Loss of access to CMS funding may result in potentially cataclysmic reductions in the production and availability of primary care physicians for rural and urban underserved populations. Which osteopathic residency programs will be able to survive the new accreditation requirement changes by the 2020 deadline? What are some of the defining attributes of those programs that already have achieved “initial accreditation” under the new SAS requirements? How can the osteopathic programs in the process of seeking the new accreditation more effectively “pivot” by learning from those programs that have succeeded? What are the potential implications of SAS to both access and quality of health care to millions of Americans? This report is based upon a study that examined and measured how osteopathic physician residency programs in the U.S. are accommodating the substantive structural, financial, political and clinical requirements approximately half way through a five-year adaptation period. In 2014, US Graduate Medical Education (GME) physician program accreditation systems formally agreed to operate under a single accreditation system for all osteopathic (D.O) and allopathic (M.D.) programs in the U.S. Since July 1, 2015, the American Osteopathic Association (AOA) accredited training programs have been eligible to apply for Accreditation Council for Graduate Medical Education (ACGME) accreditation. This agreement to create a Single Accreditation System (SAS) was consummated among the AOA, the American Association of Colleges of Osteopathic Medicine (AACOM) and ACGME with a memorandum of understanding. As this research is published, the ACGME is transitioning to be the single accreditor for all US GME programs by June 30, 2020. At that time, the AOA would fully relinquish all its GME program accreditation responsibilities. The new SAS operates under published ACGME guidelines and governance. Business policy and health care resource allocation question motivated this research. Failure of osteopathic programs to “pivot” to the new standards could result in fewer licensed physicians being produced in the high demand primary care field. Potential workforce shortage areas include urban and especially rural populations (CRS Report 7-5700 R44376 Feb 12, 2016). Large physician shortages already have been projected to care for a rapidly aging US population without considering the impact of the GME accreditation changes currently underway (Association of American Medical Colleges 2017 Key Findings report www.aamc.org/2017projections). The goal of this research is to provide osteopathic GME programs practical insights into characteristics of a sample of osteopathic GME programs that have successfully made the “pivot” into SAS requirements and been accredited by ACGME and those that have not. The study seeks to better understand the experiences, decisions, challenges and expectations directly from osteopathic programs directors as they strive to meet the realities of the new SAS requirements. Do programs that are already accredited differ significantly from those that have not? How do characteristics such as program size, geographic locations, clinical program components, program sponsor structure, number and experience of faculty and administration, cost planning and perceived benefits of the movement to SAS factor into successfully meeting the new requirements before the 2020 closing date? A cross-sectional research survey was designed, tested and deployed to a national sample of currently serving osteopathic GME program directors. The survey elicited data about each program’s “pivot” from AOA GME accreditation practices and guidelines to the new Single Accreditation System (SAS). The survey instrument was designed to obtain information about patterns in osteopathic GME program curricula, administrative support functions, faculty training, compliance requirements and program director characteristics shared by those programs that have been granted “initial accreditation” by the Accreditation Council for Graduate Medical Education (ACGME) who administer SAS. Thirty five (35) osteopathic GME program directors responded to the 26 question survey in June 2017. Descriptive statistics were applied and central tendency measures determined. The majority of survey respondents were Doctors of Osteopathic Medicine (D.O.s) from specialty residency programs sponsoring an average of 16 residents. (Abstract shortened by ProQuest.)

The context of this thesis is learning in internship in New Zealand (NZ). Internship is a period of apprenticeship in medicine which bridges the transition from medical school to practise as a registered doctor. It is a formal apprenticeship leading to the professional practise of medicine, and is central to the identity construction of the junior doctor. However, because the workplace is changing the traditional model of apprenticeship is described in the literature as failing. As a consequence, internship has been subject to cycles of review and reform since the turn of the century, first in the United Kingdom (UK) and more recently in Australia and NZ. Despite the reforms current literature and professional commentary indicate that the problems are not all solved by what are essentially structural reforms. A review of the literature on clinical learning and supervision identifies a gap in the research that is contributing to the wider problem. While it is recognised that supervision is a key component of internship there is no conceptual model or framework to guide supervisory practice or to inform the training of supervisors. This is the problem addressed in this thesis. This thesis proposes a solution using socio-cultural learning theory to understand learning in internship in order to offer an explanation of learning that can inform the supervisory practice; and then for the development of a model of learning and a supervision framework to guide and inform the practice of interns, supervisors and managers in health provider organisations. A review of the literature since 1990 (Chapter 2) shows that there has been very little research on postgraduate supervision but there has been considerable work investigating the learning environment (or the immediate context of learning), drawing on experiential learning theory, describing the attributes of supervisors, devising models for giving feedback, and more recently seeking to understand and explain learning at work and the development of expertise. However, the transference of research findings into a conceptual and structural model of supervision has not occurred. In addition, recent research (2002-2010) has demonstrated that social learning approaches exploring clinical/workplace learning can be useful in bridging this gap. While there is an emerging body of work exploring the immediate (ward or clinic) learning climate there remains an absence of research on supervision and little consideration of the wider organisational and professional context in which internship is conducted. Before proposing a solution, literature describing the learning demands placed on interns and the expectations placed on supervisors is used to develop criteria for a specification to guide the development of a model of supervision that will meet the needs of the sector. The specification recognises the importance of an underlying educational framework that: addresses how learning occurs, how competence is developed, the supervisee and supervisor relationship, relationships with the team, the structure and context of supervision in internship at both the micro-level (learner environment) and the macro-level (organisational and national). The specification also recognizes that within the NZ context a model of practicebased teaching and supervision must be flexible enough to be translated into varied health contexts, including Maori health environments. Certainly in a Maori world view, learning (ako) and health practice is seen as part of the community and knowledge is a treasure (taonga) owned by the community not by individuals. Practice must support the articles of the Treaty of Waitangi and therefore seek to encourage participation, partnership and self determination. (This is a legislative requirement in NZ.) The thesis is reported in three parts looking at the micro-level (learner - supervisor), and macro-level (organizational) levels of the problem, and then bringing these together to inform a framework for supervision. In Part I a series of studies explore interns’ perceptions of learning in clinical areas and support the proposition that a social learning perspective can be applied to internship. The initial exploratory qualitative study shows that interns recognise and value a participatory learning environment with supervision strategies that promote participation and engagement and which are linked to knowledge sharing and identity formation. From these outcomes a model is presented that sets out the critical components that ensure clinical settings are positive learning environments which encourage social interaction. The model also provides an evaluation tool to assess placements as learning environments. Finally, strategies are offered that both supervisors and learners can use to promote and support learning in clinical workplaces. Part II uses document analysis to describe the organisational and professional context of learning in internship in order to lay out clearly the wider environment in which internship is enacted, and to uncover the rich formal, and often tacit, informal learning opportunities available. Critical analysis of Wenger’s (1998) model of communities of practice (CoPs) shows that this conceptual model of learning can provide a framework to organize and consider the learning environment of internship in a way that is more compatible with a teambased approach to the delivery of healthcare than previous perspectives. Importantly, the CoP framework also appears to be compatible with a Maori world view and this offers a platform for future research by, or with, Maori practitioners to develop a blended model of supervision for Maori health contexts. The CoP framework and its potential as a conceptual model in the context on internship was shared and discussed within workshops at conferences and learning events with over 100 practitioners who identify and described three sites where CoPs naturally occur these are: the clinical team who provide patient care, the interprofessional ward or unit and the medical team. In Part III, descriptions of these three sites as CoPs, the data on support structures, formal and informal learning opportunities within health provider organizations and the outcomes from Part I are combined to develop a framework of supervision and to describe the roles and responsibilities of a supervisor. The result of combining these two streams of work is: 1. A model of learning by participation and engagement in clinical practice to guide supervisory practice and assist interns as they develop the skills needed to be active lifelong learners throughout their medical careers. 2. An alternative framework from which interns, supervisors and organisations can view, and therefore plan and coordinate internship. The thesis is upheld that social learning theory is useful as a framework for understanding learning in internship and for developing a framework to guide supervision. The potential to utilise socio-cultural models either as supplementary, or an alternative to individualistic models, and to utilise team and organisational learning is a strategy that fits with discourses about healthcare teams, patient safety, inter-professional learning and the emergent properties and facets of work within current post-reform health services. This thesis offers an alternative way to conceptualise and define the role of the supervisor and the supervisee and transform supervisory practice in a way that aligns it to modern healthcare systems of delivery and accountability with, and to, other health professionals and other stakeholders. This study concludes with recommendations for a framework and overarching structure that is neither implemented nor tested, and this is clearly a necessary direction for future research. It is hoped that publication of this framework will lead to further testing and refinement, including its applicability to Maori, and the exploration by Maori medical educators of the recommendation for a blended model of supervision. Internship as a period of identity formation is introduced within the framework, but is less well explained than was possible within this study and warrants further investigation. More work is also needed to explore the impact on learning of the hierarchical structures in health and the possibility that not all healthcare environments are friendly and supportive.

Mestrado em Biomedicina Farmacêutica
Este trabalho apresenta uma experiência de estágio curricular com a duração de 9 meses, desenvolvido na ARC Publishing, uma empresa que opera nos ramos da comunicação e publicação científica. O estágio curricular foi orientado para a área da redação científica, no entanto, atividades em outras áreas, aqui designadas de atividade multidisciplinar, também foram executadas. A atividade multidisciplinar variou desde atividades relacionadas com o desenvolvimento de negócio e marketing até atividades relacionadas com a gestão editorial de revistas científicas. Já as atividades de redação científica incluíram a redação de artigos de investigação original, traduções de documentação relacionada com a investigação clínica, edição de livros e controlo de qualidade de outros tipos de documentação científica. Globalmente, este estágio curricular representou um ótimo complemento à minha formação académica. Tive a oportunidade de aprofundar o meu entendimento acerca dos processos envolvidos na produção e na comunicação de conhecimento médico/científico. Descobri novos tópicos de interesse. E, fiquei com uma visão mais ajustada daquilo que é a realidade do mercado de trabalho e das oportunidades disponíveis. Por fim, a junção destes fatores permitiu-me maturar as minhas perspetivas de desenvolvimento de carreia.
The present work reports a 9-month curricular training experience developed at ARC Publishing, a company operating in the fields of medical communication and medical publishing. The training experience was oriented towards the medical writing field, but activities in other fields, here designated as multidisciplinary activity, were also conducted. Multidisciplinary activity ranged from business development and marketing, to editorial management. Whereas medical writing activities included preparation of original research reports, translation of clinical documents, book editing, and quality control of scientific documentation. Overall, this training period was an excellent complement to my academic education. I advanced my understanding of the processes involved in medical knowledge generation and communication. I discovered new topics of interest. And, I also improved my vision of the real marketplace and the opportunities it poses. Lastly, the combination of all these factors, allowed me to mature my perspectives for future career development.

Recruitment and retention of professional nurses are crucial issues for hospital departments of nursing. Recognizing the necessity to bridge the gap that persists between nursing education and nursing services, hospitals have designed programs to assist new nurses make the transition to current nursing practice. By helping individuals make the transition to current nursing practice it is hoped that staff nurses will be retained.

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.

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Este trabalho tem por objetivo analisar a preceptoria desenvolvida no internato do curso médico da Universidade do Estado do Amazonas (UEA). O desenho da pesquisa foi um estudo descritivo com 28 preceptores da UEA. A coleta de dados deu-se por meio de um questionário com questões fechadas e uma entrevista semiestruturada. A intenção era fazer um levantamento das atividades desenvolvidas na preceptoria; conhecer o preparo dos preceptores, os pontos fortes e os nós críticos da preceptoria na UEA, as sugestões para o aprimoramento da preceptoria, e as qualidades de um bom preceptor. A análise dos dados foi feita por tema. Os resultados quanto às motivações para atuar como preceptor apontados foram o gosto pela docência e a possibilidade de aprimorar a formação médica. Os preceptores percebem sua atuação como uma oportunidade de compartilhar o seu conhecimento com os estudantes. Referem-se à pós-graduação e à prática clínica como espaços importantes de formação. Gostariam, entretanto, de ter um melhor preparo pedagógico para a sua atuação, assim como a possibilidade de aprimorar sua titulação acadêmica. No que se refere às atividades que desenvolvem, foram apontadas as práticas nos diferentes cenários, as discussões teóricas e o estudo de caso. Como nós críticos, destacam a necessidade de melhores cenários de prática, a restrita integração com a equipe de saúde, o desafio de despertar o interesse discente, e a necessidade de maior número de preceptores. Os pontos fortes da preceptoria citados indicam a relação médico paciente e a interação com os alunos. Como sugestões para aperfeiçoar a preceptoria, destacam a adequação dos cenários de prática, a contratação de preceptores, a melhora da qualidade dos estudantes ingressantes, e o oferecimento de possibilidade de atualização. Valorizam como principais competências de um bom preceptor as relativas aos domínios afetivo-moral, relacionais e de aquisição e uso do conhecimento. Os dados possibilitaram a laboração de um relatório técnico, a ser apresentado na instituição no intuito de colaborar para o aperfeiçoamento do curso médico.
The medical internship is the last cycle of medical education and preparation for your preceptor has been much discussed pedagogical practice, although there is scarcity of papers on this activity in undergraduate teaching. The objective of this research is to analyze the preceptorship developed during internship medical students at the University of the State of Amazonas (UEA). The research design was a descriptive study with 28 preceptors at UEA. To collect data, a questionnaire with closed questions and a semi - structured interview seeking to characterize the activities in the preceptorship, the meaning and the preparation of preceptors, strengths and critical nodes of preceptorship in UEA, suggestions for improving the same and were used qualities of a good teacher. Data were analyzed using thematic analysis. The main motivations to act as preceptor were a taste for teaching and the opportunity to enhance medical training. Preceptors perceive their work as an opportunity to share their knowledge with students. Refer to graduate and clinical practice as important areas of training, however would like a better educational preparation for their performance, and enhance possibility of their academic titles. The main activities are the practices in different scenarios, in addition to theoretical discussions and case study. As critics we need to highlight the best practice scenarios, the limited integration with the healthcare team, the challenge pique student interest and need for greater numbers of preceptors. Refer to as strengths preceptorship mainly doctor patient relationship and interaction with students. Present as main suggestions to improve the adequacy of preceptorship practice scenarios, hiring tutors, improve the quality of incoming students and offering upgradeability. Value as key skills of a good preceptor those relating to affective- moral domain , in addition to relational and acquisition and use of knowledge . The data allowed the preparation of a technical report to be submitted by the institution, as to collaborate in the improvement of the medical course.

Mestrado em Biomedicina Farmacêutica
The present internship report is a detailed description of my experience in the curricular internship performed at the Clinical Pharmacology Unit of the Instituto de Medicina Molecular, from October 13th 2014 to June 5th 2015. This internship was performed as part of the second and final year of the Master’s Degree in Pharmaceutical Biomedicine of the University of Aveiro. During the course of the experience I had the opportunity to participate in several projects in collaboration with different teams, most relevantly the activities related to the regulatory submission of a clinical trial in Portugal and related to the training in Pharmacovigilance. This internship has allowed me to put into practice the knowledge acquired during my academic training and deepen my knowledge on Clinical Research in a practical perspective. Additionally, it has also allowed me to improve many of skills and to understand my interests, capacities, weaknesses and strengths. In conclusion, I can affirm that this internship was an outstanding training and a very valuable professional and personal experience, for the main established objectives were achieved and exceeded.
O presente relatório de estágio descreve detalhadamente a minha experiência no estágio curricular realizado na Unidade de Farmacologia Clínica do Instituto de Medicina Molecular, desde 13 de Outubro de 2014 até 5 de Junho de 2015. Este estágio foi realizado como parte do segundo ano do Mestrado em Biomedicina Farmacêutica da Universidade de Aveiro. Durante o decorrer desta experiência, tive a oportunidade de participar em diversos projetos em colaboração com diferentes equipas, destacando-se as atividades relacionadas com a submissão de um ensaio clínico em Portugal e as atividades no âmbito da formação em Farmacovigilância. Este estágio possibilitou-me pôr em prática os conhecimentos obtidos durante a minha formação académica e aprofundar o meu conhecimento sobre investigação clínica, numa perspetiva prática. Para além disso, permitiu-me melhorar as minhas competências e perceber os meus interesses, capacidades, pontos fracos e fortes. Concluindo, posso afirmar que este estágio foi uma aprendizagem excelente e uma experiência de grande valor a nível profissional e pessoal, tendo conseguido atingir e ultrapassar os principais objetivos estabelecidos.

Adult immunizations effectively reduce morbidity, mortality, and transmission rates of multiple diseases; however, outpatient providers often a struggle to convince patients to accept vaccinations. This project’s aim is to address vaccination rates in our adult population, focusing first on the influenza vaccine in year one (2016), and then on pneumococcal vaccine in year two (2017), by 1) using a strong quality improvement strategy (known as a Champion Team) and 2) implementing a clinic program consisting of provider training, improved documentation, and informative posters targeted at patients. A quality improvement strategy known as a “Champion Team” provided a strong mechanism through which we developed and implemented the interventions across both years. Specifically, the Champion Team consisted of key stakeholders (nurses, residents, physician faculty, and informatics expert) who identified, developed, and evaluated the program. Programming included an annual health care professional training session for each vaccine (early fall of 2016 and 2017 for flu, spring 2017 for pneumococcal), improved documentation strategies and nursing uptake, and informative posters in the clinic. We assayed data from our patient electronic health record to evaluate: the percentage of our patient population for whom an immunization was documented relative to the number of unique patients seen in our clinic during that time frame. This approach in year one showed a marked increase in influenza vaccination rates in our clinic. During the 2014/2015 and 2015/2016 flu seasons our clinic vaccination rates were 39.98% and 42.05% respectively. After implementation of our champion team and clinic wide program to increase rates in 2016 our vaccination rates for the 2016/2017 flu seasons was 50.88%. Pneumonia data for a full year are under analyses and will be included in this presentation. We anticipate a similar increase in rates for our pneumococcal vaccinations. Our Champion Team and clinic wide program were perceived as relatively low-effort interventions yet appeared to increase vaccinations over the course of this study. The replication of these findings across pneumonia data (pending) and, in future work, with the herpes zoster vaccine (planned for Year 3), will increase our confidence that increases in rates were attributable to these very accessible interventions.

Darbo tikslas: įvertinti Kauno medicinos universiteto gydytojų rezidentų pasirengimą praktiniam darbui sveikatos priežiūros įstaigose. Uždaviniai: 1. Įvertinti KMU rezidentūros studijų programų aprašą; 2. Įvertinti Lietuvos medicinos normų struktūros atitikimą reikalavimams; 3. Įvertinti KMU gydytojų rezidentų nuomonę apie savo pasirengimą praktinei veiklai. Tyrimo metodika: Tyrimo objektas: KMU rezidentūros studijų programos; medicinos normos; 2006 m. KMU rezidentūros studijas baigę gydytojai rezidentai. Tyrimo metodai: mokslinės literatūros analizė; dokumentų analizė; anketinė apklausa; statistinė duomenų analizė programa SPSS 12. Rezultatai: 1. Įvertintos 28 rezidentūros studijų programos turi aiškią ir vienodą visoms programoms struktūrą. Daugelyje programų išsamiai aprašyta jų sudėtis ir turinys, nėra bendros vidinio studijų kokybės užtikrinimo politikos. Šešiolikoje studijų programų rasta netikslumų šioje dalyje. 2. Septynios profesinės kvalifikacijos neturi patvirtintų medicinos normų. Visos medicinos normos turi vienodą ir aiškią struktūrą. Rezidentūros studijų programos parengtos remiantis šių normų reikalavimais. 3. Su medicinos norma yra susipažinę 53,8 proc. rezidentų, kurie taip pat geriau žinojo savo specialybės ligų sąrašą (p=0,029). Specialybės ligų simptomus, geriau žinojo konservatyviojo profilio rezidentai (Fišerio tiksliojo testo p=0,027). Pakankamai bendravimo su ligoniais patirties mano turintys 36,5 proc. rezidentų. Diagnozuoti ir gydyti navikus mano... [toliau žr. visą tekstą]
Aim of the study: to evaluate Kaunas University of Medicine residents preparation for a practical activity and work in health care institutions. Objectives: 1. the evaluation of description of residential studies programs; 2. the evaluation of structure of medical standards; 3. the evaluation of resident’s opinion of their preparation for practical activity. Methods: The object of analysis: KMU programs of residency studies; medical standards; KMU doctors graduated in 2006. Methods of analysis: the analysis of scientific literature; the analysis of documents; questionnaire; the analysis of statistical data using the program SPSS 12. Results: 1. There was 28 residency studies programs evaluated, that had clear and equal for all programs structure. The constitution and content of programs were clearly described. There was no security of common internal residency programs quality politics and procedures. Some inaccuracy was found in sixteen residency programs. 2. Seven professional qualifications did not have certified medical standards. The standards had equal and clear structure. The residency programs were organized according to these standards. 3. 53, 8 % of residents got to know the medical standards, they also better knew their specialty diseases (p=0,029). Medical residents of traditional profile better knew the symptoms of their specialty diseases (Fisher exact test p=0,027). 36, 5 % of residents assumed that they had enough experience in communication with patients... [to full text]

Mestrado em Biomedicina Farmacêutica
This report presents my internship experience at the Clinical Pharmacology Unit where I could participate in research projects, mainly as a medical writer, data manager, project manager and monitor of observational studies and at the Neurological Clinical Research Unit, where I could work in coordination of clinical trials. The internship is part of the curricular activities of the second year of the Masters in Pharmaceutical Biomedicine, University of Aveiro. The internship took place from 15th September 2015 to June 30th, 2016. This report will address the activities that I performed, namely the coordinating activities of clinical trials and observational studies, or activities related to medical writing. Throughout the internship, I had the opportunity to put into practice the knowledge acquired during the master's degree, and deepen my knowledge of the coordination activities of clinical and observational trials. In scientific writing component, I was able to improve my scientific writing skills, to know how to develop a systematic review and understand some of the concepts of meta-analyses. In conclusion, the internship allowed me to put into practice the knowledge acquired in the University, and served as an extremely valuable learning source and for professional and personal growth.
Este relatório apresenta a minha experiência de estágio na Unidade de Farmacologia Clínica onde pude participar em projetos de investigação, essencialmente como “medical writer”, “data manager”, gestor de projeto e monitor de estudos observacionais e na Unidade Neurológica de Investigação Clínica, onde pude desenvolver atividades de coordenação de ensaios clínicos. O estágio realizou-se entre 15 de setembro de 2015 a 30 de Junho de 2016. O estágio insere-se nas atividades curriculares do segundo ano do Mestrado em Biomedicina Farmacêutica da Universidade de Aveiro. Serve o presente relatório para relatar as atividades que tive a oportunidade de desenvolver, nomeadamente de coordenação de ensaios clínicos e estudos observacionais, bem como as atividades de “medical writer”, farmacovigilância, entre outras. No decurso do estágio, tive a possibilidade de pôr em prática os conhecimentos adquiridos ao longo do Mestrado, e aprofundar o meu conhecimento sobre as atividades de coordenação de ensaios clínicos e observacionais. Na componente de escrita científica, tive a possibilidade de melhorar as minhas capacidades de escrita científica, perceber os processos necessários para a publicação de uma revisão sistemática e compreender algumas noções de meta-análises. Em conclusão, o estágio permitiu-me pôr em prática o conhecimento adquirido no Mestrado em Biomedicina Farmacêutica da Universidade de Aveiro e serviu como nova fonte de aprendizagem e crescimento profissional e pessoal.

To achieve Sustainable Development Goal 3 in developing countries, Good health and wellbeing for all, the health workforce is vital however the unpopularity of rural medical practice results in widening healthcare inequalities between urban and rural areas. This study determined the heterogeneity in valuations for rural facility attributes by final year medical students at one South African public university to inform cost-effective recruitment policy recommendations. Focus groups conducted identified facility attributes, a D-efficient design was generated with 15 choice sets, each with two rural hospital alternatives and no opt-out option. An online, unlabelled discrete choice experiment (DCE) was conducted, the results effects coded, and mixed logit models applied. The final sample size was 193 (86,16% of the class), majority female 130 (66.33%), with urban origins 176 (89.80%), unmarried 183 (93.37%) and without children 193 (98.47%). Most had undergraduate rural medicine exposure 110 (56.12%) and intended to specialise 109 (55.61%). The main-effects mixed logit found advanced practical experience, hospital safety, correctly fitted personal protective equipment (PPE) and availability of basic resources the highest weighted attributes with their mean utilities increasing by 0.82, 0.64, 0.62 and 0.52 respectively (p=0.000). In contrast, increases in rural allowance and the provision of housing provided smaller mean utility increases of 0.001 (p<0.01) and 0.09 (p<0.05) respectively. The interaction terms; female, general practise and prior rural medicine exposure, were associated with higher weighting for hospital safety, mean utility increases 1.59, 1.82, 1.42 respectively (p=0.000). Participants were willing to pay ZAR 2636.45 monthly (95%CI: 1398.55;3874.355) to gain advanced practical experience (equivalent to 65.91% of current rural allowance). Medical students’ facility preferences have been found to be influenced by their gender, career aspirations and prior experienced with rural medicine. The policy recommendations derived from this research include publicising rural health facility “draw-cards” among medical graduates, such as the opportunity to gain practical experience, improving the physical and occupational safety at rural health facilities and providing greater transparency about rural facility attributes to medical graduates.

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JUSTIFICATION: The teaching-learning process during the Medical Residency needs more studies in our country. And in the program of Medical Residency in Anesthesiology, due to the characteristics of the procedures performed, the growing advances in technology, the surgical environment as a learning scenario and the medical practice directed towards the extreme technicality, the teaching-learning process becomes a challenge for the educator and preceptor. OBJECTIVES: To describe the professional training profile of the preceptors of the Medical Residency Program in Anesthesiology. Specific Objectives: to characterize the preceptors who work in the Program of Medical Residency in Anesthesiology, to verify the perception of the preceptors about their educational practice, to identify the pedagogical models used by the preceptors. METHODS: This is a quantitative research, of descriptiveexploratory character. The study was carried out, from January 2017 to January 2018, in three educational institutions that offer the Program of Medical Residency in Anesthesiology in the city of Manaus - AM. Data were collected through an instrument containing sociodemographic information; a validated questionnaire, focused on the perception of preceptors about preceptory and their role in educational processes in practice scenarios; plus a question about the pedagogical model adopted by the preceptors participating in the research. RESULTS: The study sample consisted of a greater percentage of female preceptors (60%), caregivers (90%) and higher degree of medical residency (96.6%). An expressive percentage of preceptors (80%) reported not having received pedagogical training to develop the preceptory and did not participate in spaces for discussion of teaching-service integration. The lack of support from the leadership, recognition and remuneration for the role of preceptor were also highlighted as points of greater negative perception. The participants of the study related the presence of the student in the service to the improvement of the quality of care, because they realized the need for constant search for knowledge and updates, in order to better contribute to the resident's education. The traditional pedagogical model was the most related to the teaching practice of preceptors. CONCLUSIONS: Therefore, it is demonstrated the importance of the situational diagnosis of the preceptor in the Medical Residency in Anesthesiology, pointing out the need for teacher training for the development of the preceptor's activity, as well as its adequate valorization and compensation, aiming at the best medical training and quality assistance.
JUSTIFICATIVA: O processo ensino-aprendizagem durante a Residência Médica necessita de mais estudos em nosso meio. E no programa de Residência Médica em Anestesiologia, devido às características dos procedimentos executados, aos crescentes avanços na tecnologia, ao ambiente cirúrgico como cenário de aprendizagem e à prática médica direcionada para o extremo tecnicismo, o processo ensino-aprendizagem se torna um desafio para o educador e preceptor. OBJETIVOS: Descrever o perfil de formação profissional dos preceptores do Programa de Residência Médica em Anestesiologia. Objetivos Específicos: caracterizar os preceptores que atuam no Programa de Residência Médica em Anestesiologia, verificar a percepção dos preceptores sobre a sua prática educativa, identificar os modelos pedagógicos utilizados pelos preceptores. METODOLOGIA: Trata-se de uma pesquisa quantitativa, de caráter descritivo-exploratório. O estudo foi realizado, no período de janeiro de 2017 a janeiro de 2018, em três instituições de ensino que oferecem o Programa de Residência Médica em Anestesiologia na cidade de Manaus – AM. Os dados foram coletados por meio de um instrumento contendo informações sociodemográficas; um questionário validado, com foco na percepção dos preceptores acerca da preceptoria e do seu papel nos processos educacionais em cenários de prática; acrescido de uma questão versando sobre o modelo pedagógico adotado pelos preceptores participantes da pesquisa. RESULTADOS: A amostra do estudo foi composta por um maior percentual de preceptores do sexo feminino (60%), assistenciais (90%) e com maior titulação em residência médica (96,6%). Um percentual expressivo dos preceptores (80%) informou não ter recebido formação pedagógica para desenvolver a preceptoria e não ter participado de espaços de discussão da integração ensino-serviço. A falta de apoio da chefia, reconhecimento e remuneração para função de preceptor também foram destacados como pontos de maior percepção negativa. Os participantes do estudo relacionaram a presença do estudante no serviço à melhoria da qualidade da assistência, por perceberem a necessidade de busca constante de conhecimentos e atualizações, a fim de melhor contribuir para a formação do residente. O modelo pedagógico tradicional foi o mais relacionado com a prática docente dos preceptores. CONCLUSÕES: Demonstra-se, portanto, a importância do diagnóstico situacional da preceptoria na Residência Médica em Anestesiologia, apontando a necessidade de formação docente para o desenvolvimento da atividade do preceptor, bem como, sua valorização e remuneração adequadas, tendo como finalidade, a melhor formação médica e uma assistência de qualidade.