Brazilian Medical Schools Research Articles

Evaluating Undergraduate Learning in an Ophthalmology Rotation: A Study Using Virtual Questionnaires.

Background Medical school ophthalmology education is often insufficient for non-ophthalmologist physicians to achieve proficiency in managing ophthalmic cases. Objective This study evaluates learning during a clinical rotation in a Brazilian medical school that implemented a two-week ophthalmology rotation. Methods This quantitativeand qualitative study involved all eligible students for the rotation. Two different questionnaires were administered before and after to assess knowledge, understanding, and problem-solving abilities in ophthalmology. Each questionnaire contained 11 theme-paired questions developed according to the International Council of Ophthalmology curriculum and guidelines for medical student education. The primary qualitative outcome was a 30% improvement in scores between the pre- and post-rotation tests, as defined by two ophthalmology professors who developed the questionnaire. Data was analyzed anonymously using STATA BE 18 software, and questionnaire reliability was measured using Kuder-Richardson Formula. Results Of the 69 eligible students, 36 (52.17%) completed both tests. The internal consistency of the pre-and post-rotation questionnaires was acceptable, with Kuder-Richardson Formula scores of 0.66 and 0.64, respectively. Although scoressignificantly improved from 6.97 pre-rotation to 7.72 post-rotation (p=0.01), the mean score only improved by 10.76%, falling short of the 30% target. Scores improved significantly in the Red Eye and Primary Care Attention from 0.49 to 0.78 (p<0.01), but decreased in Anatomy and Physiology of the Posterior Segment (from 0.80 to 0.67, p<0.01) and the Anatomy and Physiology of Extraocular Muscles (from 0.92 to 0.79, p=0.04). No statistically significant difference was observed in the Anatomy and Physiology of the Anterior Chamber. Conclusions This study concludes that undergraduate students learning during an ophthalmology rotation was unsatisfactory. However, this is an exploratory study; further research with a larger sample size is necessary.

Implementation of Choosing Wisely in gynecology and obstetrics internship

INTRODUCTION: Throughout undergraduate school, it is important to instill a continuous emphasis on cost-conscious thinking across all specialties, including obstetrics and gynecology (OB/GYN). One potential strategy is the implementation of the Choosing Wisely (CW) Campaign. OBJECTIVE: To describe and assess the implementation strategies of the Choosing Wisely (CW) campaign within a medical internship in Obstetrics and Gynecology (OB/GYN). METHODS: This intervention study involved medical teachers and undergraduate medical students at a Brazilian medical school. Initially, teachers identified three common unnecessary clinical scenarios, which were then grouped and adapted to fit the CW recommendation format. Based on the five most frequently occurring recommendations, educational activities were developed, including workshops, banners, and discussions on cost-consciousness in healthcare with undergraduate students and medical doctors. RESULTS: The top five recommendations were as follows: 1. Don’t routinely order hormone levels for menopause diagnosis; 2. Don’t recommend ovarian removal during hysterectomy for premenopausal women without ovarian câncer risk; 3. Don’t prescribe broad-spectrum antibiotics for uncomplicated acute cystitis treatment; 4. Don’t request preventive examinations for colpitis diagnosis; and 5. Don’t request unnecessary exams during low-risk prenatal care, such as kidney and liver function tests. The theoretical and practical components of these educational activities led to increased awareness and subsequent discussions among internship faculty and undergraduate students. CONCLUSION: Implementation of the CW campaign within the medical internship in OB/GYN resulted in a positive impact, fostering reflection among participants and aiding in the avoidance of unnecessary treatments or prescriptions.

Progress test as an assessment for learning approach in an Infectious Diseases Residency Program: a case study

Assessment is an essential component for all educational programs and must check competence acquirement while foster and promote learning. Progress Test (PT) is well recognized to assess cognitive knowledge, clinical reasoning and decision making in the clinical context, offering important information about the individual performance and program quality. It is widely used in Brazilian and international medical schools; however, it still has little role in assessing medical residents in Brazil. We present the experience of a PT pilot implementation in an Infectious Diseases residency program over two years. The first, second and third-year residents did four serial exams with 40 multiple choice questions (item)/each. Preceptors were trained on best practices on item writing. All the items were reviewed by a panel of experts and, after approval, included in the item bank. All participants answered a survey on their perceptions about the experience. The final score was higher for the third-year residents in all exam applications. The level of satisfaction was high among the participants, who mentioned the learning opportunity with the exam and the feedback. PT can improve residents’ assessment along the training period and residents’ performance should guide review and improvement of the programs.

Lung ultrasound teaching in medical education: a pilot study at a Brazilian medical school.

To evaluate cognitive learning, ability to perform and interpret lung ultrasound exams, and self-perception of learning among medical students after a short pedagogical intervention at a medical school in Brazil. An experimental pilot study was conducted with medical students at different stages of their education (basic cycle, clinical cycle, and medical internship). The participants underwent a cognitive test before and after the intervention, a practical test, a test to recognize lung ultrasound pathologies, and a qualitative evaluation test at the end of the intervention. Statistical analysis was performed using a significance level of p < 0.05. A total of 42 students were included in the study, with a median age of 23 years and a predominance of males. The mean score of the pre-intervention cognitive test was 2.97 ± 0.87, and that of the post-intervention test was 6.57 ± 1.41, showing significant improvement (p < 0.001). The score of the practical test and that of the recognition of pathologies test also showed significant improvement after the intervention. There was no significant difference in execution time between the groups. Students in the clinical cycle had a better self-perception of learning. Theoretical teaching and practical training of lung ultrasound in a short pedagogical intervention can improve cognitive performance, practical skills, and interpretation of the exam. The level of learning achievement was higher among more advanced students in medical education. Additionally, the students in the clinical cycle had a better perception of their learning.

Association of performance in medical residency selection with a psychiatric diagnosis, and depressive and anxiety symptoms

Objective Few studies have focused on medical students and residents’ mental health impact on medical residency selection (MRS) performance. The authors evaluated the association of performance in MRS with depressive and anxiety symptoms and with a reported psychiatric diagnosis (rPD). Methods The authors enrolled candidates after the second round of MRS examinations at a Brazilian Medical School. Performance was assessed by final grade. Depressive and anxiety symptoms were assessed by the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) and the State-Trait Anxiety Inventory (STAI). The authors performed mediation analysis and multiple linear regression analysis to investigate the impact of rPD, state and trait anxiety, and depressive symptom severity on performance. Results 515 of the 643 MRS candidates (80.1%) participated in the study. Higher age, attending a preparatory course for MRS, rPD, and the number of MRS applications that year were associated with poorer performance. In mediation analysis, trait anxiety was associated with a direct effect on performance and an indirect effect mediated by rPD. Conclusion The data suggest that psychiatric diagnosis is associated with poorer performance on MRS, regardless of current symptoms of anxiety and depression. Additionally, increased levels of trait anxiety may negatively impact performance, directly and indirectly.

Analysis of the implementation of the medical boarding school in a medical course derived from the mais médicos program

The mandatory curriculum internship corresponds to an essential period for medical education in which the apprentice, through supervised training in the health service, develops and improves competencies and knowledge of medical practice. In 2014, the new National Curriculum Guidelines (DCN) were instituted that guide medical education activities according to the scenario observed in the Unified Health System (SUS), aiming to qualify professionals so that the demands of citizens, families and communities are served. In this context, through the Mais Médicos Program (PMM) and the initiatives for the expansion of medical schools in Brazil, the medical course analyzed in this study, started its activities in 2015, starting to compose the set of courses guided by the new DCN. This article proposed to analyze the process of implementing the medical boarding school of the course, from the perspective of the students. This is a qualitative study, in which the data were collected through a questionnaire sent to the students of the course, with a total of 29 participants. The analysis of the data produced was performed by the dialectical hermeneutic technique. The categories of analysis were health care, health management and health education, which addressed topics about a) operational techniques, such as the correct filling of medical records, learning maneuvers and physical examination techniques and the communication of established hypotheses and sharing the therapeutic process with the patient; b) Integration between service, teaching and community, discussing the adaptation of the structure of health services to receive academics, perceptions about the number and quality of practice scenarios, students' performance in the health service and incentive to contribute actions in the context SUS; c) Structuring the boarding school, discussing the total workload of the stages, pointing out which casters demonstrated the largest and lower organization and what their evaluative methods were; d) Preceptoria, deepening about the performance of preceptors in the practical scenarios, the quality of preceptoria and communication between preceptors and students. It was concluded that the process of implementation of the medical boarding school analyzed is in line with the new DCN, but it demands improvements to fully achieve the learning objectives specified in the course regulation.

Assessment of medical students' knowledge of primary limb sarcomas

IntroductionTypically, oncology is not a structured part of the curriculum in Brazilian medical schools. Furthermore, sarcomas, which are uncommon tumors, are seldom covered in depth. A lack of comprehensive education on sarcomas might result in medical professionals being ill-equipped to care for patients with this condition.ObjectivesTo assess medical students' understanding and awareness of sarcomas and the specific principles related to these tumors.Materials and methodsA quantitative, cross-sectional study was conducted using a questionnaire, applied to medical students, focusing on the epidemiology, pathophysiology, and treatments of bone and soft tissue sarcomas. In all tests, the significance level adopted was 5%. The SPSS version 25.0 software was used.ResultsOf the 825 questionnaires distributed, 325 were returned. Educational sessions on sarcomas did not appear to significantly improve the student's knowledge. Only 29.5% of students identified the lack of pain as an indicator of potential malignancy in soft tissue sarcomas, while 73.8% correctly recognized pain as a symptom of bone sarcomas. Limb amputation as the optimal surgical method for patient recovery was incorrectly reported by 39.1% of the sample.ConclusionA great part of the surveyed population does not have adequate knowledge about the basic concepts associated with limb sarcomas. The minority of them are satisfied with the knowledge gained during their medical education about these tumors. Inadequate medical academic training may initially lead to the wrong clinical management of patients with bone and soft tissue tumor lesions. An educational effort is needed to enhance oncology education for medical students, especially concerning sarcomas.

Mapping the learning styles of medical students in Brazil

BackgroundMedical education has evolved based on the application of pedagogical actions that place the student as the protagonist of the learning process through the use of active teaching methodologies. Within this context, higher education teachers should use strategies that focus on the student and his/her context and avoid traditional teaching methods. Specifically in medical schools, there is an even greater challenge since the teaching methods of medical curricula differ from those used in previous schooling. Consequently, students acquire their own style of processing information that is often incompatible with the profile of medical schools. This may be one of the factors responsible for the lack of motivation among undergraduates.ObjectiveThe aim of this study was to characterize the learning styles of students enrolled in a Brazilian medical school using the Felder-Soloman Index of Learning Styles (ILS).MethodsThis was a cross-sectional, descriptive, quantitative study that included students from the 1st to the 6th year of a Brazilian medical school. The students participating in this study voluntarily answered 44 questions about learning styles of the Felder-Silverman instrument validated in Brazil. The instrument was divided so that each domain consisted of 11 questions with two response options in which only one could be selected. For each domain, a score (1 point) was assigned to the selected option (a, b) of the question and the learning style category was determined as the difference between these values. For data collection and tabulation, we used the Learning Syle Platform (EdA Platform) developed based on Felder’s studies since this system processes information about the dimension analyzed, the preferred style, and the most striking characteristics of each style.ResultsThe results showed that sensing was the preferred learning style of the students, followed by the sequential and visual styles. It was not possible to determine whether gender or age influences the choice of learning methods because of the homogeneity of the results.ConclusionsThe present data will enable teachers of the institution involved in this study to plan pedagogical actions that improve the students’ self-awareness, as well as their teaching-learning skills, by choosing the most adequate active methodologies for the medical education programs considering the individuality of each student and class.

Situation of ophthalmology education in Brazil: supply versus demand.

The number of medical schools in Brazil has increased in recent years; however, vacancies for specialization in ophthalmology probably have not kept up with the growing demand. This study wants to estimate the increase in medical schools, the demand for ophthalmology specialization, and evaluate learning opportunities in ophthalmology. This was a retrospective study with research from the Ministry of Education and Brazilian Council of Ophthalmology database from 2002 to 2021. These data were checked through 120 notices published by the institutions in 2021. The number of medical school vacancies increased by 370%, whereas the number of certified ophthalmology vacancies increased by 64%. There was an 11.4% misalignment between the Brazilian Council of Ophthalmology data in the Ministry of Education. The proportion of medical graduates has increased much more than opportunities for ophthalmology specialization. The effect on the search for unaccredited specialization positions is unknown, and policies for monitoring the specialization of ophthalmology vacancies should be established.

Reliability across content areas in progress tests assessing medical knowledge: a Brazilian cross-sectional study with implications for medical education assessments.

Brazilian medical schools equitably divide their medical education assessments into five content areas: internal medicine, surgery, pediatrics, obstetrics and gynecology, and public health. However, this division does not follow international patterns and may threaten the examinations' reliability and validity. To assess the reliability indices of the content areas of serial, cross-institutional progress test examinations. This was an analytical, observational, and cross-sectional study conducted at nine public medical schools (mainly from the state of São Paulo) with progress test examinations conducted between 2017 and 2023. The examinations covered the areas of basic sciences, internal medicine, surgery, pediatrics, obstetrics and gynecology, and public health. We calculated reliability indices using Cronbach's α, which indicates the internal consistency of a test. We used simple linear regressions to analyze temporal trends. The results showed that the Cronbach's α for basic sciences and internal medicine presented lower values, whereas gynecology, obstetrics, and public health presented higher values. After changes in the number of items and the exclusion of basic sciences as a separate content area, internal medicine ranked highest in 2023. Individually, all content areas except pediatrics remained stable over time. Maintaining an equitable division in assessment content may lead to suboptimal results in terms of assessment reliability, especially for internal medicine. Therefore, content sampling of medical knowledge for general assessments should be reappraised.

The impact and the challenges of implementing a faculty development program on health professions education in a Brazilian Medical School: a case study with mixed methods

PurposeFaculty development in health professions education is still challenging in developing countries like Brazil. Work overload and the lack of financial support hinder faculty members' participation. Ribeirão Preto Medical School founded its Center for Faculty Development in 2016. Since then, an essential skills module (ESMo) on health professions education (HPE) has been offered regularly to faculty members and preceptors of seven undergraduate programs. This case study aims to evaluate the impact of this Essential Skills Module on the educational practices of participants two years after attending the module and the challenges faced during the process.MethodThe study used a mixed-method approach with a description of the demographic and professional profile data of the ESMo participants. Immediate post-ESMo perceptions (satisfaction and learning) of the participants were determined with structured instruments. Two years later, a semi-structured interview was conducted and recorded to determine the long-term effects (application of learning and behavior changing as an educator). NVIVO® software was used to store and systematize the thematic discourse analysis with a socio-constructivist theoretical framework interpretation.ResultsOne hundred forty-six participants were included: 86 (59%) tenured faculty members, 49 (33,5%) clinical preceptors, and 11 (7,5%) invited teachers. Most were female (66%), and 56% had teaching experience shorter than ten years. 52 (69%) out of 75 eligible participants were interviewed. The immediate reaction to participating in the module was quite positive and 80% have already implemented an educational intervention in their daily activities. Discourses thematic analysis showed five emerging themes appearing in different frequencies: Changes in teaching activities (98%); Lack of previous pedagogical training (92.3%); Commitment and enthusiasm towards teaching (46.15%); Overlapping functions inside the institution (34.6%) and Challenges for student assessment (23%).ConclusionThis first in-depth evaluation of the long-term effects of a faculty development intervention in a Brazilian Health Profession Education school showed that participation positively changed participants' teaching & learning practices. These interventions consistently fostered a community of practice and valued faculty development processes in local and national scenarios.

Mental health and quality of life across 6 years of medical training: A year-by-year analysis.

Despite growing evidence on medical students' mental health deterioration, studies have primarily used short follow-up periods and not followed the students throughout their medical training. To assess mental health (stress, anxiety, and depression) and quality of life changes throughout their medical program, we followed up with the same cohort of students for 6 years. This longitudinal prospective study followed up with the same group of medical students at a Brazilian public medical school from 2014 to 2020. The study analyzed sociodemographic data, mental health (including depression, anxiety, and stress [DASS-21]), quality of life (WHOQOL-BREF), satisfaction from studying to be a physician, and happiness with life. General linear mixed models were used for the analyses. The cohort included 80 Brazilian medical students (63.7% women; mean age = 19.6 years [SD = 2.21]). A high prevalence of depressive symptoms, anxiety, and stress was found throughout medical training, with more than 50% of students having significant symptoms. Mental health, happiness, and quality of life levels tended to be better in the first and last semesters, being worse in the middle of the program. However, satisfaction from studying to become a doctor decreased in the second semester, remained low throughout the program, and never returned to baseline levels. Mental health and quality of life levels remained high throughout the medical program, with better levels in the first and last semesters and falling in the middle of the program. These data can help managers and educators understand how psychological distress affects medical students.

Prevalence of Persons with Disability Enrolled in Undergraduate Medical Schools in Brazil, 2019.

The affirmative policies in Brazil guarantee the provision of undergraduate medical education to People with Disability (PWD). The objective was to estimate the prevalence of PWD undergraduate medical students in Brazil in 2019. This is an exploratory, descriptive study that used census data from the total population of the undergraduate medical students (N=183,646) who were enrolled at the Brazilian medical schools, in 2019. The data are secondary, unidentified and accessed online, and were originally collected by the Higher Education Census conducted by Anísio Teixeira National Institute of Educational Studies and Research (INEP), which used a questionnaire designed to capture information from students and medical courses. The descriptive analysis was based on absolute and relative frequencies. The prevalence of medical students that were PWD was 0.80% (1,460/183,646), and this includes both Brazilian and foreign students. The latter includes people from 76 different countries. Foreign students who are PWD came from eight different countries: Bolivia, Burundi, Cabo Verde, Republic of Congo, Paraguay, Philippines, Singapore and Spain. Most of the PWD were male (51.37%), aged 20 to 24 years (46.78%) and of non-white ethnicity (52.26%). Most students were enrolled in public medical schools (73.97%). A fraction of PWD students (6.51%) was enrolled in medical schools with no specific resource or assistance for PWD. The highest prevalence was the physical disability (39.11%), followed by low vision accuracy (24.45%), intellectual (15.41%), low hearing (14.11%), blindness (3.97%), multiple disabilities (2.47%) and deafness (1.51%). The prevalence of PWD medical students in Brazil is low, and is dominated by students with physical and sensory disabilities but lacks the deaf-blind. Despite the existence of legal regulations favoring PWD to study medicine, some medical schools have not done adequate adjustments to accommodate them. This suggests that affirmative policies for the inclusion of PWD in higher education, particularly in medicine, still need improvement.

PALLIATIVE CARE IN HIGHER EDUCATION INSTITUTIONS: A PROMISING CHALLENGE

The new epidemiological profile of the Brazilian population requires changes in the curriculum of Higher Education Institutions concerning the process of training medical professionals. The study aimed to investigate palliative care teaching in Brazilian medical schools. It was guided by the research question: What is the current status of palliative care education in medical schools across Brazil? Searches were carried out in the electronic databases of the Virtual Health Library, using the Descriptors in Health Sciences and Medical Subject Headings: Palliative care; Medical Education and Diseases. As inclusion criteria, English, Portuguese, and Spanish publications were chosen in articles with full-text availability and free access to the searched databases. Results: 55 publications were identified from 2016-2021, of which only 25 documents met the inclusion criteria. The topic of palliative care emerges as an educational incentive capable of promoting essential and surprising discussions throughout graduation and providing educational strategies that can provide opportunities for improving skills and competencies based on integral models centered on the person. This requires a demand for training in this subject as a multidisciplinary approach that prepares the team to deal with patients with life-threatening incurable chronic diseases and infinitude.

Education Research: Monitoring and Tracking Neurophobia: Evidence From a Temporal Analysis of Brazilian Medical Schools.

Neurologic disorders are common medical conditions. However, even with a higher demand for neurologic care, the capacity to train neurologists is impaired. The fear of neurosciences/neurology by medical students, known as neurophobia, may cause multiple adverse effects in neurologic assistance. The objectives of this study were to estimate the current prevalence and characteristics of neurophobia in medical students in Brazil and to compare neurophobic symptoms at 2 time points. This is a cross-sectional study conducted with students from 4 medical schools in Pará, Brazil, who matriculated into the preclinical stage, clinical stage, and internship were submitted to a questionnaire to assess the perception of clinical specialties, including neurology. Reasons for neurophobia, probable strategies to improve neurologic education, and a specific scale to detect neurophobia were also evaluated. Furthermore, we performed a temporal comparison of current results with those from a previous study from 2015. Neurophobia was detected in 63.3% of medical students. The perception of the difficulty in neurology/neurosciences was very high in all stages, and the perception of interest and quality of teaching worsened during the internship. The need to understand neuroanatomy and neurophysiology was cited as the most important reason for neurophobia. More and better bedside tutorials were the most mentioned suggestion to improve neurologic education. The temporal comparison between 2015 and 2022 showed that the level of knowledge, quality of teaching, and likelihood of pursuing a career in neurology has become more favorable in 2022. The prevalence of neurophobia in Brazil was higher than that in high-income countries. Unfavorable opinions about neurology tended to increase throughout the medical course, but the temporal comparison showed that the impact of neurophobia has decreased. Surveillance systems for monitoring and tracking neurophobia should be implemented in medical schools.

Depression among Brazilian medical students exposed to remote learning and the role of scopophobia

Medical education was greatly affected by the COVID-19 pandemic, and remote teaching through lectures and classes through videoconferencing was heavily used. However, the need to use cameras led to scopophobia, which is the fear of being watched, which can lead to psychological symptoms. Despite the relevance and prevalence of depression and the increase in the use of cameras for learning, research evaluating the impact of scopophobia on students’ mental health is surprisingly scarce. Hence, to fill up this gap, a cross-sectional study was carried out in medical schools in Brazil. To assess the presence of depressed mood, the Patient Health Questionnaire-9 (PHQ-9) was applied. We used logistic regression models to verify the associations. The overall prevalence of positive PHQ9 found in our study was 62%. By studying the factors associated with a high risk of scopophobia, we could identify that the PHQ was statistically associated with scopophobia (odds ratio 2.43 (confidence interval 1.11–5.26), adjusted p value = .0269). Also, a lower family income, a higher number of household inhabitants, and female gender were associated. These results suggest that scopophobia is associated with depression, leading us to believe that interventions to mitigate this risk in students are opportune, especially if targeted at lower-income students.

The current status of “spirituality and health” teaching in Brazilian medical schools: a nationwide survey

BackgroundRecent data on the teaching of “spirituality and health” (S/H) in medical schools are needed. In this study, we aimed to investigate the current status of S/H teaching in Brazilian medical schools, the opinions of medical directors/deans on this topic and the factors associated with its incorporation into the curriculum.MethodsA nationwide cross-sectional survey was carried out in 2021. Information concerning the S/H content in the curricula of medical schools was obtained through medical school representatives and other sources. Medical school representatives were asked about their opinions of and barriers to S/H teaching. Regression models were used to evaluate the factors associated with the incorporation of such content into the curriculum.ResultsInformation on the incorporation of S/H content in medical curricula was retrieved from different sources for all 342 (100%) Brazilian medical schools. Among the representatives, 150 (43.9%) completed the online form. An increase in the S/H content in Brazilian medical schools was observed (from 40% to 2011 to 65.5% in 2021). Most medical school representatives agreed that this issue is important in medical training and that more space in the curriculum is needed. However, they also observed several barriers, such as a lack of knowledge of medical teachers/faculty, a lack of time, and the topic not being included in teaching plans. The most important factors that influenced the incorporation of S/H teaching in medical schools and representatives’ opinions were a lack of time and knowledge, professor preparedness and standardized national competency requirements.ConclusionThese results could help medical educators rethink the incorporation of S/H content into their curricula.

Internato rural nos cursos de Medicina no Brasil

Abstract: Introduction: The consolidation of rural internship programs is not a simple phenomenon, although its importance is currently recognized by students and teachers as a differentiated activity in their training itineraries. Medical schools still face considerable challenges in carrying out this type of activity. The existence of evidence that recruiting students to rural internships, offering meaningful experiences during undergraduate school and implementing a specific training program for rural areas after graduation, are the most effective interventions for recruitment and retention. Objective: Identify the rural internship programs in operation in Brazil, through the evaluation of Curricular Pedagogical Projects (PPCs,) of medical courses, fostering the debate on medical training for rural and remote areas, as well as emphasizing the importance of this type of training. Method: Cross-sectional, descriptive and documentary analysis study, with a quantitative characteristic, with a sampling of the access to the Curricular Pedagogical Projects (PPCs) of medical schools in Brazil with rural internships in the curriculum. Result: Of the 357 Medical Schools in Brazil, the authors found 18 programs with rural internships, corresponding to 5% of the institutions. The Southeast Region, when compared to the North region, concentrates the largest number of medical schools in Brazil (148), but the largest number of PPCs with rural internship is in the North Region of Brazil, totaling 6 (16%) in relation to medical schools in the region. Furthermore, of the 47 medical schools in the Southeast Region, in Minas Gerais, 2 rural internship programs were identified by the authors, in relation to other states in the same region. Conclusion: There are few rural internship programs identified in the PPCs in Brazilian medical schools. Changes are needed in the PPCs, with the inclusion of rural internships, with the inclusion of well-defined competencies and based on people’s health needs; construction of knowledge and development of skills and attitudes to solve problems, consistent with the reality of Brazil.

Estratégias de ensino do raciocínio clínico nos cursos de Medicina do Brasil - revisão integrativa

Abstract: Introduction: Clinical reasoning is considered one of the main skills that must be developed by medical students, as it allows the establishment of diagnostic hypotheses and directs investigative and diagnostic strategies using a rational approach. Although educators have traditionally focused the teaching method on the analytical model, many medical professors face the challenge in their daily lives of finding new strategies to help their students develop clinical reasoning. Objective: To carry out an integrative literature review to identify the strategies used in the teaching-learning process of clinical reasoning in Brazilian medical schools. Method: The methodology used consists of six steps: 1. creation of the research question; 2. definition of inclusion and exclusion criteria; 3. list of information to be extracted; 4. evaluation of included studies; 5. interpretation of results and 6. presentation of the review. Results: Most studies indicate that the teaching of clinical reasoning is carried out through discussions of clinical cases, incidentally, in different disciplines or through the use of active methodologies such as PBL, TBL and CBL. Only three studies presented at conferences disclosed experiences related to the implementation of a mandatory curricular discipline specifically aimed at teaching clinical reasoning. The teaching of clinical reasoning is prioritized in internships in relation to the clinical and pre-clinical phases. Final considerations: There are few studies that analyze how clinical reasoning is taught to medical students in Brazilian medical schools. Although more studies are needed, we can observe the lack of theoretical knowledge about clinical reasoning as one of the main causes of the students’ difficulty in developing clinical reasoning.

Teaching strategies for clinical reasoning in Brazilian medical schools - an integrative review

Resumo: Introdução: O raciocínio clínico é considerado uma das principais habilidades que devem ser desenvolvidas pelos estudantes de Medicina, porque permite a elaboração de hipóteses diagnósticas e orienta estratégias investigativas e diagnósticas de forma racional. Embora os educadores tradicionalmente foquem o ensino no modelo hipotético-dedutivo ou analítico, muitos professores de medicina enfrentam no seu dia a dia o desafio de encontrar novas estratégias para ajudar seus estudantes a desenvolver o raciocínio clínico. Objetivo: Este estudo realizou uma revisão integrativa da literatura para identificar as estratégias utilizadas no processo ensino-aprendizagem do raciocínio clínico, nas escolas médicas brasileiras. Método: A metodologia utilizada consistiu em seis etapas: 1. elaboração da pergunta da pesquisa; 2. definição dos critérios de inclusão e exclusão; 3. elenco das informações a serem extraídas; 4. avaliação dos estudos incluídos; 5. interpretação dos resultados; e 6. apresentação da revisão. Resultado: A maioria dos trabalhos apontam que o ensino do raciocínio clínico é realizado por meio de discussões de casos clínicos, de maneira incidental, em diversas disciplinas ou por meio do uso de metodologias ativas, como PBL, TBL e CBL. Apenas três trabalhos apresentados em congressos demonstraram experiências relacionadas à implantação de uma disciplina curricular obrigatória voltada especificamente ao ensino do raciocínio clínico. O ensino do raciocínio clínico é priorizado no internato em relação às fases clínicas e pré-clínicas. Conclusão: Poucos são os estudos que analisam a maneira como se dá o processo ensino-aprendizagem do raciocínio clínico nas escolas médicas brasileiras. Embora mais estudos sejam necessários, podemos verificar a falta de conhecimento teórico sobre raciocínio clínico como uma das principais causas de dificuldade para o desenvolvimento dessa competência pelos estudantes.