Medical Education In Brazil Research Articles

Medical schools in Brasil: population, economic and historical analysis.

To describe the current distribution and historical evolution of undergraduate courses in medicine in Brasil. Analytical cross-sectional study of secondary data. Through the Ministry of Education, the data of the medical courses were obtained, and through the Brazilian Institute of Geography and Statistics, the population and economic data of the Brazilian states were obtained. In Brasil, there were 298 medical courses (1,42 courses / million inhabitants) in January 2018, totaling 31,126 vacancies per year, with 9,217 gratuitous vacancies (29.6%) and 17,963 vacancies in the hinterland (57, 7%). In Brazilian states, there are positive and statistically significant (p <0.001) correlations of the variables: "vacancies" and "population" (R 0.92); "vacancies" and "gross domestic product" ("GDP") (R 0.83); "percentage of vacancies in the hinterland" and "population in the hinterland" (R 0.71) and "percentage of vacancies in the hinterland" and "GDP" (R 0.64). There was a negative and statistically significant correlation between "gratuitous vacancy percentage" and "GDP" (R -0.54, p = 0.003). More paid courses than gratuitous courses and more courses in the hinterland than in the capitals have been created since 1964, in proportions that have remained similar since then, but in higher numbers since 2002. The distribution of medical courses in Brasil correlates with the population and economical production of each state. The expansion of Brazilian medical education, which has been accelerated since 2002, is based mainly on paid courses in the hinterland, in the same pattern since 1964.

Esp teaching in contemporary medical education in Brazil

The early 2000s have witnessed significant changes in medical education in Brazil, especially because of the creation of the More Doctors (Mais Médicos) program in 2013 and the publication of the resolution that establishes the National Curricular Guidelines for Medicine undergraduate courses in 2014. The latter focuses on a human, critical and socially responsible education, which comprehends the development of the proficiency in a foreign language, preferably a lingua franca. The objective of this paper is to map the inclusion of foreign languages, particularly English, in Political Pedagogical Projects (PPPs) from public medical schools between the years 2013-2019. Online bibliographical research was carried out and data were collected from the e-MEC system and the PPPs. Descriptive statistics have shown that 65.1% of Medicine undergraduate courses (n=28) include the proficiency of a foreign language in their PPPs, being that language English in 35.7% and any other language in 64.3%; 34.9% of the institutions do not incorporate any foreign language at all. Although the majority of medical schools seem to be conforming with the National Curricular Guidelines, there might be still a gap between targeted English language practices and their association to health education and the promotion of healthcare actions.

The Visual Practice: the Infographic as a Facilitating Tool for Learning in Medical School

Abstract: Introduction: In the context of medical school, the development of methodologies that stimulate the students’ search for learning, autonomy and creativity are essential for medical education in Brazil. The study aims to describe the construction of infographics as a pedagogical proposal for the learning of organic human aging processes by medical students. Method: Medical students attending the 4th period at a Higher Education Institution built infographics, as a requirement for the practical content of the Aging Process module. The static-type infographic was adopted, following criteria such as the definition of the target audience; definition of the objective; choice of topic; selection of the most relevant information (focus); direct and accessible language; organized information; choices of color palettes and style and; infographic sketch. The entire creation process was supervised by the teacher in charge of the project, and evaluation criteria were previously established. Results: The class was divided into seven groups, resulting in the production of an infographic with a specific topic per group. The human aging topics were: Degenerative Joint Diseases, Bone Weakness, Pneumonia in the Elderly, Acute Myocardial Infarction, Vascular Dementia, Atherosclerosis and Herpes Zoster. It is worth noting that in addition to the creation, each group presented the final product to the other colleagues, explaining each item included in the static infographic. Conclusions: We observed that the students satisfactorily met the proposed evaluation requirements, demonstrating their involvement in the construction of infographics and, above all, in simple, creative and objective learning, using a powerful visual tool. We also add that the printed material will be used as aid in the histology laboratory and in extramural activities.

The Visual Practice: the Infographic as a Facilitating Tool for Learning in Medical School

Abstract: Introduction: In the context of medical school, the development of methodologies that stimulate the students’ search for learning, autonomy and creativity are essential for medical education in Brazil. The study aims to describe the construction of infographics as a pedagogical proposal for the learning of organic human aging processes by medical students. Method: Medical students attending the 4th period at a Higher Education Institution built infographics, as a requirement for the practical content of the Aging Process module. The static-type infographic was adopted, following criteria such as the definition of the target audience; definition of the objective; choice of topic; selection of the most relevant information (focus); direct and accessible language; organized information; choices of color palettes and style and; infographic sketch. The entire creation process was supervised by the teacher in charge of the project, and evaluation criteria were previously established. Results: The class was divided into seven groups, resulting in the production of an infographic with a specific topic per group. The human aging topics were: Degenerative Joint Diseases, Bone Weakness, Pneumonia in the Elderly, Acute Myocardial Infarction, Vascular Dementia, Atherosclerosis and Herpes Zoster. It is worth noting that in addition to the creation, each group presented the final product to the other colleagues, explaining each item included in the static infographic. Conclusions: We observed that the students satisfactorily met the proposed evaluation requirements, demonstrating their involvement in the construction of infographics and, above all, in simple, creative and objective learning, using a powerful visual tool. We also add that the printed material will be used as aid in the histology laboratory and in extramural activities.

Medical school expansion policies: educational access and physician distribution.

Many countries are employing strategies intended to reduce maldistribution of health workers and inequities. The purpose of this study was to analyse the impact of expansion policies of medical schools on regional inequalities in the distribution of undergraduate class sizes, and the capacity to attract and retain doctors and to expand health facilities. We conducted a descriptive analysis to compare the distribution of undergraduate places in 2007 and 2016 to determine the impact of targeted expansion policies on inequalities in access to medical education in Brazil. A group of municipalities with new medical schools (n=54) and a control group without medical schools (n=408) were compared to analyse impacts of expansion in the health sector. We compared the increase in the number of physicians per 1000 inhabitants and health establishments per inhabitants between 2007 and 2016 based on these two groups. We also analysed the relationship between geographic distance from the state capital and capacity to attract physicians. There was a decrease in the regional inequalities of undergraduate places in medical schools; the greatest increase in the places per 1000 inhabitants was in municipalities of between 50000 and 100000 inhabitants. Municipalities with new medical schools showed an increase in physicians per 1000 inhabitants and in health establishments per inhabitant ratio, demonstrating the potential to attract and retain doctors, as well as strengthening the health infrastructure. Municipalities more distant from state capitals showed a greater increase in physician:inhabitant ratio. Countries with health workforce shortages and inequalities in their distribution might consider public financing and regulation policies for expansion of medical schools as a strategy to attract and retain professionals. Early results in Brazil showed that such strategies could strengthen service networks in deprived areas, supporting implementation of Universal Healthcare Coverage.

Medical education in Brazil

This paper aims to describe and analyze medical education in Brazil, a history of over 200 years. As in most European countries and influenced by the Flexner Report, an undergraduate medical course in Brazil takes 6 years. Recently, medical education research has been advocating a shift from a teacher-centered and hospital-based approach to student-centered and community-based education. Nevertheless, a huge variation exists among Brazilian medical schools. The physicians’ supply program known as “More Physicians” has strongly impacted the number of medical schools in Brazil, which is growing rapidly. Professors of medicine from several institutions and other stakeholders have alerted authorities to the risks of operating so many schools without adequate time to prepare teachers, clinician-educators, curricula, and sufficient pedagogical structure to ensure quality medical education. The possibility of an imminent catastrophe in medical education has united stakeholders in pursuit of a guarantee of quality maintenance. This effort has resulted in the creation of an independent accreditation system approved by the World Federation of Medical Education. The study of the unbalanced relationship between stakeholders in medical education in Brazil until now has provided valuable information concerning the importance of having their roles and limits clear. It is possible that these findings might be replicable around the world.

Desenvolvimento e expansão do ensino médico no Brasil

Desenvolvimento e expansão do ensino médico no Brasil

Evaluation of Residency Admission Exams

ABSTRACT Introduction: Residency admission exams, although not intended to evaluate medical training, do so in an indirect way. The evaluation of the quality of the medical residency tests allows, among other things, to re-evaluate the training process itself and the skills expected of the candidates. Objective: To evaluate first phase exam tests of different medical residency programs in the largest Brazilian urban centers. Method: We evaluated 500 questions of residency admission exams in the states of São Paulo, Rio de Janeiro and Minas Gerais. The items were evaluated in terms of their origin, geographical location, area of knowledge, contextualization, context scenarios and complexity by Bloom's taxonomy. Results: Most of the questions presented contextualization (64.4%, n = 322), with predominant scenarios of high complexity and in hospital environment. The predominant taxonomic category was identified as recognition (41.60%, n = 208), the second most frequent was judgment, in 26% of the questions (n = 130), followed by synthesis (15%, n = 75), analysis (7.60%, n = 38), comprehension (6%, n = 30) and application (3.8%, n = 19). Considering the dichotomization between questions of theoretical and clinical reasoning, we found a balance between both (clinical reasoning: 48.9%, n = 243; theoretical reasoning: 51.4%, n = 257). The association of contextualization with clinical reasoning was high, with the relative risk of an item requiring clinical reasoning in the presence of contextualization of 26.31 (CI 11.06 – 62.59). Final considerations: The scenario outlined by the present research demonstrates that the different selective processes for medical residency in Brazil differ greatly in relation to the selection profile, with hospital-centered focus, favoring scenarios of high complexity in a hospital environment. Although much has been done and discussed in order to promote changes in medical education in Brazil, the selection process for Medical Residency still fails to reflect the changes advocated since the end of the last century and consolidated in the public policies of the beginning of this century. If we consider that the selected professionals are likely to remain at that institution after the end of their undergraduate studies, then we can have some understanding of the feedback cycle that is created in the programs.

Espiritualidade/religiosidade e o humanizaSUS em Unidades de Saúde da Família

Objective: To describe and compare the influence of spirituality/religiosity and HumanizaSUS on the clinical practice of health professionals working in Family Health Units. Methods: A descriptive, cross-sectional study, in which all 10 graduate health professionals of the Family Health Units of Jiquirica, Bahia, were interviewed. The interviews were carried out by means of a questionnaire adapted from the multicenter study SEBRAME (Spirituality and Brazilian Medical Education), in addition to a questionnaire specifically developed to approach HumanizaSUS. Results: Of the interviewees, 40% (n=4) said they do not have any religion but believe in God; 30% (n=3) are Evangelical/Protestant, 20% (n=2) are Catholic, and 10% (n=1) say they have no religion and do not believe in God. Most professionals (n=6; 60%) reported moderate intensity of influence of religiosity/spirituality on the clinical practice. Most (n=9; 90%) of the professionals know HumanizaSUS, and 50% (n=5) declared they apply the orientations and guidelines of the program. Conclusion: The spirituality/religiosity was more influential in the clinical behavior of the professionals interviewed than HumanizaSUS.

Mobilidade internacional na graduação em medicina: relato de experiência

Introdução: A mobilidade acadêmica nas universidades apresenta-se como uma ferramenta para a internacionalização do ensino superior brasileiro, promovendo a inserção dos estudantes universitários em diferentes contextos culturais e educacionais, agregando tanto novos conhecimentos teóricos como habilidades sociais e linguísticas. Relato de experiência: Este artigo trata‑se de um relato de experiência de um estudante de medicina viabilizado pelo programa de mobilidade internacional Ciência Sem Fronteiras, realizado no curso de Promoção da Saúde do Waterford Institute of Technology, na cidade de Waterford, Irlanda, no período de setembro de 2014 a julho de 2015. O relato apresenta as atividades acadêmicas desenvolvidas na instituição, bem como analisa a contribuição dos programas de intercâmbio para a graduação médica. Conclusão: A mobilidade internacional pode representar um importante instrumento para a formação médica, pois estimula o amadurecimento profissional e pessoal dos estudantes, ao expô‑los a um cenário diferenciado, no qual são incitados a refletir sobre suas práticas e seu conhecimento, ao se deparar com o novo e o diferente. Tais contribuições podem representar o aprimoramento das habilidades médicas e humanísticas dos graduandos, configurando-se como um avanço para o ensino médico no Brasi.

The legacy of Cabanis: a hypothesis on the roots of medical education in Brazil

Georges Cabanis was a reformer of clinical practice and medical education who laid the conceptual foundations during the French Revolution for the development of education in France over the course of the 19th century. The model, in turn, marked the organization of educational systems in many Latin American countries. The objective of this article is to present and justify a hypothesis: the model of medical education still hegemonic in Brazil is still based upon the Cabanisian reform, holding a linear and Cartesian conceptual perspective, with a discipline-based curriculum, traditional teaching formats, and submission to corporate professional logic. In order to better understand the social and political context of the historical processes that generated this anachronism, I begin with a summary of the biography and thinking of Georges Cabanis, introducing him as a central character in his historical context. Next, I highlight the main structural elements in the Cabanis model, with a special focus on medical teaching, drawing on some of his writings as the documental source. Finally, in broad strokes, I present the project for reform of medical teaching elaborated by Cabanis and his collaborators as backing for a preliminary evaluation of the proposed hypothesis.

Development of a Brazilian Portuguese adapted version of the Gap-Kalamazoo communication skills assessment form Development of a Brazilian Portuguese adapted version of the Gap-Kalamazoo communication skills assessment form

ObjectiveThe goal of this study was to translate, adapt and validate the items of the Gap-Kalamazoo Communication Skills Assessment Form for use in the Brazilian cultural setting. MethodsThe Gap-Kalamazoo Communication Skills Assessment Form was translated into Portuguese by two independent bilingual Brazilian translators and was reconciled by a third bilingual healthcare professional. The translated text was then assessed for content using a modified Delphi technique and adjusted as needed to assure content validity. A total of nine phrases in the completed tool were adjusted. The final tool was then used to assess videotaped simulations as a means of validation. Response process was assessed using exploratory factor analysis and internal structure was assessed via Cronbach’s Alpha (internal consistency) and Intraclass Correlation (test-retest reliability and inter-rater reliability). ResultsOne hundred and four (104) videotaped communication skills simulations were assessed by 38 subjects (6 staff physicians, 4 faculty physicians, 8 resident physicians, 4 professional actors with experience in simulation, and 16 other allied healthcare professionals). Measures of Internal consistency (Cronbach’s alpha = 0.818) and test-retest reliability (intra-class correlation coefficient = 0.942) were high. Exploratory factor analysis confirmed the uni-dimensionality of the instrument. ConclusionsOur results support the validity and reliability of the Brazilian Gap-Kalamazoo Communication Skills Assessment Form when used among Brazilian medical residents. The Brazilian version of Gap-Kalamazoo Communication Skills Assessment Form was found to be adequate both in the linguistic and technical aspects. The use of this instrument in Brazilian medical education can enhance the assessment of physician-patient-team relationships on an ongoing basis.

Validating competencies for an undergraduate training program in rural medicine using the Delphi technique

Worldwide, half the population lives in rural or remote areas; however, less than 25% of doctors work in such regions. Despite the continental dimensions of Brazil and its enormous cultural diversity, only some medical schools in this country offer students the opportunity to acquire work experience focused on medicine in rural or remote areas. The objective of the present study was to develop a framework of competencies for a longitudinal medical training program in rural medicine as an integrated part of medical training in Brazil. Two rounds of a modified version of the Delphi technique were conducted. Initially, a structured questionnaire was elaborated, based on a literature review. This questionnaire was submitted to the opinion of 20 panelists affiliated with the Rural Medicine Working Party of the Brazilian Society of Family and Community Medicine. The panelists were asked to evaluate the relevance of the competencies using a five-point Likert-type scale. In this study, the consensus criterion for a competency to be included in the framework was it being deemed 'very important' or 'indispensable' by a simple majority of the participants, while the criterion for excluding a competency was that a simple majority of the panel members considered that it 'should not be included' or was 'of little importance'. When a consensus was not reached regarding a given competency, it was submitted to a second round to enable the panelists to re-evaluate the now dichotomized questions. Compliance in responding to the questionnaire was better among the panelists predominantly involved in teaching activities (85%; n=12) compared to those working principally in patient care (45%; n=8). The questionnaire consisted of 26 core competencies and 165 secondary competencies. After evaluation by the specialists, all the 26 core competencies were classified as relevant, with none being excluded and only eight secondary competencies failing to achieve a consensus. No new competencies were suggested. Of the competencies that failed to reach a consensus in the first round, seven were excluded from the framework in the second round, with most of these being associated with hospital procedures. A framework of competencies for a program in rural medicine was developed and validated. It consists of 26 core competencies and 158 secondary competencies that should be useful when constructing competency-based curricula in rural medicine for medical education in Brazil.

Medical education – historic perspective and future challenges

The history of medical education is binded to the history of medicine itself once teach, learn and practice happens together. Since ancient times the role of the mentor / tutor is the key to practical learning. Over time, and particularly in the last 300 years, the medical knowledge expansion and new technologies incorporation brought drastic changes in medicine and, therefore, in medical education but yet, the presence of one or many reference doctors in medical learning is still an important part of thousands of undergraduate students every year. In this period new concepts, new teaching techniques and use of multiple technologies including distance learning and simulation were included in several medical curricula. In this article we seek to briefly present the key events of the evolution of medical education including some particularities of medical education in Brazil and at USP School of Medicine, as well as point out the challenges for the ongoing century.

José Lima Pedreira de Freitas and the redefinition and control of Chagas disease

A brief overview of the evolution of knowledge about Chagas disease since its discovery by Carlos Chagas in 1909 until the mid-1940s is presented. The trajectory of physician Pedreira de Freitas and his growing involvement in research in the area led to his contributions to laboratory diagnosis - which lent consistency and security to epidemiological surveys of Chagas disease - and the redefinition of the scale of the disease in Brazil and the Americas with its terrible social and economic impact. His proposal for the disease prevention model - based on selective purging in the application of insecticide - was adopted nationally and internationally and made it possible to bring the disease under control in Brazil and other countries. He devoted himself with equal intensity to enhancing the teaching of medical practices in the community and was a pioneer in the implementation of preventive medicine in medical education in Brazil.

PROJETO MAIS MÉDICOS PARA O BRASIL: A EXPERIÊNCIA PIONEIRA DO APOIO INSTITUCIONAL NO MINISTÉRIO DA EDUCAÇÃO

RESUMO: O Projeto Mais Médicos para o Brasil (PMMB) foi criado em 2013, em virtude da necessidade de fixar profissionais médicos na Atenção Primária à Saúde e reorientar a formação médica no Brasil. No intuito de fortalecer as ações do PMMB nos Estados, especialmente aquelas relacionadas ao processo de Supervisão Acadêmica dos médicos do PMMB, o Ministério da Educação estruturou uma proposta de apoio institucional (AIMEC), pioneira no âmbito desta Instituição. Os primeiros apoiadores foram contratados em março de 2014, para os estados de Minas Gerais, Bahia, Ceará e Rio Grande do Sul. Este trabalho vem relatar essa experiência, com a discussão sobre os pontos fortes e frágeis desta iniciativa pioneira, na perspectiva de apontar oportunidades de seu fortalecimento e consolidação. O AIMEC tem se apresentado como um novo e interessante modo de gestão e tem sido uma ferramenta valorizada entre os diversos atores do PMMB. Por meio do diálogo e trabalho colaborativo, resultados positivos têm sido observados, o que tem impactado diretamente no aperfeiçoamento do PMMB.

The privatization of medical education in Brazil: trends and challenges.

BackgroundLike other countries, Brazil is struggling with issues related to public policies designed to influence the distribution, establishment, supply and education of doctors.While the number of undergraduate medical schools and places available on medical schools has risen, the increase in the number of doctors in Brazil in recent decades has not benefitted the population homogeneously.The government has expanded the medical schools at the country’s federal universities, while providing incentives for the creation of new undergraduate courses at private establishments. This article examines the trends and challenges of the privatization of medical education in Brazil.MethodsThis is a descriptive, cross-sectional study based on secondary data from official government databases on medical schools and courses and institutions offering such courses in Brazil. It takes into account the year when the medical schools received authorization to initiatte the activities, where they are situated, whether they are run by a public or private entity, how many places they offer, how many students they have enrolled, and their performance according to Ministry ofEducation evaluations.ResultsBrazil had 241 medical schools in 2014, offering a total of 20,340 places. The private higher education institutions are responsible for most of the enrolment of medical students nationally (54 %), especially in the southeast. However, enrolment in public institutions predominate more in the capitals than in other cities. Overal, the public medical schools performed better than the private schools in the last two National Exam of Students’ (ENADE) .ConclusionThe privatization of the teaching of medicine at undergraduate level in Brazil represents a great challenge: how to expand the number of places while assuring quality and democratic access to this form of education. Upon seeking to understand the configuration and trends in medical education in Brazil, it is hoped that this analysis may contribute to a broader research agenda in the future.

Empreendedorismo em saúde: relato de um modelo de Empresa Júnior em Medicina

O ensino da medicina Brasil afora é marcado pelo pouco interesse dos acadêmicos pelo tema de gestão em saúde no ensino superior. O reflexo disso são as inúmeras afrontas feitas diariamente à saúde nacional, devido ao mau gerenciamento de recursos públicos e privados, como tanto se vê em clínicas e hospitais atualmente. Tais problemas apresentam como uma de suas causas, entre tantas outras, a falta de conhecimento técnico por parte daqueles que assumem o poder administrativo na área da saúde, muitas vezes escolhidos por suas habilidades assistenciais e conhecimentos médicos, ao invés de por verdadeiro conhecimento e mérito gerencial. Nesse contexto, a Medicina Jr. surgiu como uma iniciativa estudantil a fim de aproximar os universitários da Faculdade de Medicina da Universidade de São Paulo do universo da gestão, apresentando-lhes a área e despertando o interesse para tal assunto tão pouco comentado nos currículos formais. Nasceu assim a ideia de unir os impactos positivos trazidos pela prática de atividades extra-curriculares ao ensino de gestão no ambiente universitário, na expectativa de contribuir para a formação de novos profissionais mais abertos ao tema e com maior conhecimento na área.

A Pedagogia de Paulo Freire e o Processo Ensino-Aprendizagem na Educação Médica

RESUMO A educação médica brasileira apresenta desafios com o intuito de contribuir com a formação de recursos humanos para o Sistema Único de Saúde, em consonância com as principais políticas de saúde do País. A pedagogia de Paulo Freire apresenta uma visão crítica do processo ensino-aprendizagem enquanto processo de emancipação política e de ação transformadora da realidade. Tais valores são desejados na formação profissional dos médicos. O presente estudo visa avaliar a concepção de docentes de Faculdade de Medicina paulistana sobre o processo ensino-aprendizagem segundo os princípios da pedagogia problematizadora de Paulo Freire.

Use of Psychodrama in medicine in Brazil: a review of the literature

Objective To review the literature on experiences of the use of psychodrama in medical education in Brazil. Methods Papers published between 2003 and 2013 were identified in the main databases. Results Seven papers were identified. Role playing and sociodrama were the psychodrama techniques reported. They were used to address aspects of relationships such as emotions and behavior and to improve some communication and clinical skills. Psychodrama provided the students with opportunities for critical reflection, questioning of professional practices and sharing of experiences, and also decreased their anxiety and fear. Role playing was used among students and among teachers undergoing academic development, while sociodrama was only used among students. Conclusions There are still few papers reporting on experiences from the use of psychodrama in Brazilian medical schools.