Brazilian Medical Schools Research Articles

Inclusion of palliative care teaching in medical schools in Brazil

Abstract: Introduction: The palliative care (PC) approach is a care modality recommended by the World Health Organization. Suffering and the process of dying are present in everyday clinical practice, affecting people with life-threatening diseases. However, the predominant model of teaching in Brazilian medical schools does not include palliative care. Objectives: The aim of the study was to get to know the Brazilian medical schools that include PC in their curriculum, and how it has been taught. Methods: Descriptive and exploratory study, carried out by searching for medical schools with disciplines in PC, through the analysis of the course syllabi available in the curricular matrices on the official websites of higher education institutions from August to December 2018. They were analyzed considering the offered period of the PC content, workload, scenario, and type of discipline (elective or mandatory). Results: 315 schools registered with the Ministry of Education were found, and only 44 of them (14%) offer courses in PC. These schools are distributed throughout 11 Brazilian states, of which 52% are located in the Southeast region, 25% in the Northeast, 18% in the South, 5% in the Midwest, and none in the North region. The predominant modality of the type of discipline in PC was mandatory in 61% of schools. Most Brazilian medical schools are private entities (57%), a similar percentage to the total number of medical schools identified with the teaching of PC. This course takes place in the 3rd and 4th years of the course; in most schools, the workload was 46,9 hours. The predominant scenario is the classroom, while some institutions provide integration between teaching community service and medical practice. The program contents are diverse, including thanatology, geriatrics and finitude, humanization, bioethics, pain, oncology and chronic diseases. Conclusion: PC education in Brazil is insufficient, which represents a barrier to the training of doctors in line with the recommendations of international entities, the National Curriculum Guidelines and legal frameworks within the scope of SUS. Investments by medical entities and government agencies are necessary to increase teaching in PC and the consequent qualification of medical training.

Surgery course load in Brazilian medical schools

Abstract: Introduction: Surgery is an important curricular component of undergraduate medical courses. This study was conducted because the surgery course load in Brazilian medical has not been systematically explored at the national level. Objective: To analyze the surgery course load in Brazilian medical schools. Method: A cross-sectional, descriptive study was carried out with Brazilian medical schools acknowledged by the Ministry of Education, which had begun their activities prior to December 31, 2017 and, as of September 2018, had their curriculum matrix and/or political-pedagogical project with the surgery course load available on the internet. The variables studied were total medical curriculum course load and surgery course load before and during clerkship, as well as the schools’ geographic region and fee status. Data analysis was performed using descriptive statistic Student t-test, analysis of variance, and Mann-Whitney U and Kruskal-Wallis tests, with the null hypothesis rejected for p < .05. Results: The study included 205 of the country’s 323 existing medical schools, of which 175 had available information on the surgery course load during the clerkship, 157 before the clerkship, and 129 had information on course load before and after the clerkship. The median total surgery course load in hours was 815.0 (P25 - 75 = 677.5 - 992.0; minimum = 340.0 h; maximum =1,665.0), while the mean surgery course load before clerkship in hours was 268.7 (SD = 140.3; minimum = 32.0; maximum = 780.0), with no difference between geographic regions or fee status. During the clerkship, the median course load was 540.0 hours (P25 - 75 = 400.0 - 712.0; minimum = 170.0 h; maximum = 1,410.0), with no difference between geographic regions, but with higher values in medical schools with no tuition fees. Regarding the total curriculum course load, the mean percentage of the surgery course load before clerkship was 3.2% (SD = 1.7), the median percentage during the clerkship was 6.4% (P25 - 75 = 5.0 - 8.2), the median percentage of the total surgery course load was 6.4% (P25 - 75 = 5.0 - 8.2%, and the median percentage of surgery course load (both periods) was 9.7% (P25 - 75 = 8.3 - 11.8%). Conclusions: Despite the considerable variation in the surgery course load limits, the median of total surgery and the mean of surgery course load before clerkship were similar across geographic regions and fee statuses. The median surgery course load during clerkship was also similar across regions but higher in tuition-free medical schools. The values found in this study can help schools’ administrators to assess and plan the surgery course load in their institutions.

Community Health course load before clerkship in Brazilian medical schools

Abstract: Introduction: The limits of the Community Health (CH) course load (CL) before medical clerkship (MC) in undergraduate medical courses are not defined neither in the National Curriculum Guidelines nor in other documents, and have not been investigated in a comprehensive way in national studies. Objective: To analyze the community health course load before clerkship in Brazilian medical schools. Method: Cross-sectional study of schools acknowledged by the Ministry of Education, which started activities until December 31, 2017. The sites of the 323 existing schools were accessed and the schools that had their curricula available in the internet with details of the CH CL before MC were included. The variables were school geographic region and administration type, medical course CL and CH CL before MC, also including epidemiology, biostatistics and occupational health course loads. Data were analyzed using descriptive statistics, Pearson chi-square (Ӽ2) for categorical variables and Mann-Whitney-U (U) and Kruskal Wallis Ӽ2 tests for continuous variables. Results: Out of 323 existing medical schools, 222 were included (68.7%). Among the included schools, 83 were tuition-free (37.4%) and 139 were not (62.6%). The median of the CH CL before MC was 440.0 hours (P25-75 = 300.0 - 640.0), equivalent to 5.4% (P25-75 = 3.5 - 7.8) of the medical course CL. The median of the CH CL before MC in hours in private and municipal schools was, respectively, 480.0 (P25-75 = 330.7 - 679.2) and 576.0 (P25-75 = 360.0 - 766.0), and of state and federal schools, respectively, 337.0 (P25-75 = 281.2 - 524.2) and 370.0 (P25-75 = 300.0 - 480.0), Ӽ2(3) = 11.48, p = .009. The median of the total CH CL in non-tuition-free schools was 500.0 hours (P25-75 = 336.0 - 690.0) and in the tuition-free schools, it was 364.0 hours (P25-75 = 285.0 - 504.0), U = 4.259.0, z = -3.26, p = .001. The median of epidemiology and biostatistics CL in hours before MC in the 124 schools was 88.0 (P25-75 = 60.0 - 120.0), whereas the occupational health CL in 63 schools was 40.0 (P25-75 = 33.0 - 60.0). Conclusions: The CH CL before clerkship varies widely, being higher in non-tuition-free medical schools.

Community Health course load before clerkship in Brazilian medical schools

Abstract: Introduction: The limits of the Community Health (CH) course load (CL) before medical clerkship (MC) in undergraduate medical courses are not defined neither in the National Curriculum Guidelines nor in other documents, and have not been investigated in a comprehensive way in national studies. Objective: To analyze the community health course load before clerkship in Brazilian medical schools. Method: Cross-sectional study of schools acknowledged by the Ministry of Education, which started activities until December 31, 2017. The sites of the 323 existing schools were accessed and the schools that had their curricula available in the internet with details of the CH CL before MC were included. The variables were school geographic region and administration type, medical course CL and CH CL before MC, also including epidemiology, biostatistics and occupational health course loads. Data were analyzed using descriptive statistics, Pearson chi-square (Ӽ2) for categorical variables and Mann-Whitney-U (U) and Kruskal Wallis Ӽ2 tests for continuous variables. Results: Out of 323 existing medical schools, 222 were included (68.7%). Among the included schools, 83 were tuition-free (37.4%) and 139 were not (62.6%). The median of the CH CL before MC was 440.0 hours (P25-75 = 300.0 - 640.0), equivalent to 5.4% (P25-75 = 3.5 - 7.8) of the medical course CL. The median of the CH CL before MC in hours in private and municipal schools was, respectively, 480.0 (P25-75 = 330.7 - 679.2) and 576.0 (P25-75 = 360.0 - 766.0), and of state and federal schools, respectively, 337.0 (P25-75 = 281.2 - 524.2) and 370.0 (P25-75 = 300.0 - 480.0), Ӽ2(3) = 11.48, p = .009. The median of the total CH CL in non-tuition-free schools was 500.0 hours (P25-75 = 336.0 - 690.0) and in the tuition-free schools, it was 364.0 hours (P25-75 = 285.0 - 504.0), U = 4.259.0, z = -3.26, p = .001. The median of epidemiology and biostatistics CL in hours before MC in the 124 schools was 88.0 (P25-75 = 60.0 - 120.0), whereas the occupational health CL in 63 schools was 40.0 (P25-75 = 33.0 - 60.0). Conclusions: The CH CL before clerkship varies widely, being higher in non-tuition-free medical schools.

Surgery course load in Brazilian medical schools

Abstract: Introduction: Surgery is an important curricular component of undergraduate medical courses. This study was conducted because the surgery course load in Brazilian medical has not been systematically explored at the national level. Objective: To analyze the surgery course load in Brazilian medical schools. Method: A cross-sectional, descriptive study was carried out with Brazilian medical schools acknowledged by the Ministry of Education, which had begun their activities prior to December 31, 2017 and, as of September 2018, had their curriculum matrix and/or political-pedagogical project with the surgery course load available on the internet. The variables studied were total medical curriculum course load and surgery course load before and during clerkship, as well as the schools’ geographic region and fee status. Data analysis was performed using descriptive statistic Student t-test, analysis of variance, and Mann-Whitney U and Kruskal-Wallis tests, with the null hypothesis rejected for p < .05. Results: The study included 205 of the country’s 323 existing medical schools, of which 175 had available information on the surgery course load during the clerkship, 157 before the clerkship, and 129 had information on course load before and after the clerkship. The median total surgery course load in hours was 815.0 (P25 - 75 = 677.5 - 992.0; minimum = 340.0 h; maximum =1,665.0), while the mean surgery course load before clerkship in hours was 268.7 (SD = 140.3; minimum = 32.0; maximum = 780.0), with no difference between geographic regions or fee status. During the clerkship, the median course load was 540.0 hours (P25 - 75 = 400.0 - 712.0; minimum = 170.0 h; maximum = 1,410.0), with no difference between geographic regions, but with higher values in medical schools with no tuition fees. Regarding the total curriculum course load, the mean percentage of the surgery course load before clerkship was 3.2% (SD = 1.7), the median percentage during the clerkship was 6.4% (P25 - 75 = 5.0 - 8.2), the median percentage of the total surgery course load was 6.4% (P25 - 75 = 5.0 - 8.2%, and the median percentage of surgery course load (both periods) was 9.7% (P25 - 75 = 8.3 - 11.8%). Conclusions: Despite the considerable variation in the surgery course load limits, the median of total surgery and the mean of surgery course load before clerkship were similar across geographic regions and fee statuses. The median surgery course load during clerkship was also similar across regions but higher in tuition-free medical schools. The values found in this study can help schools’ administrators to assess and plan the surgery course load in their institutions.

Mapping of medical schools: the distribution of undergraduate courses and annual vacancies in Brazilian cities in 2020

Abstract: Introduction: The number of medical schools in Brazil, as well as the number of vacancies offered at these schools, has grown considerably in the last few years. Since 2013, this increasehas aimedat reaching especially the rural and underserved areas of the country. Objective: Considering that there are many different interests concerning this debate and that this reality directly influences the education and health policies of the country, the aim of this study was to evaluate the number and the distribution of the medical courses,as well as vacancies in these schools in 2020, presenting an updated overview of the Brazilian medical schools. Methods: This was a cross-sectional study, based on data gathered from the Brazilian Ministry ofEducation and Institute of Geography and Statistics (IBGE) website. The utilized variables were the number of courses, number of vacancies offered in each course, characteristics of the cities where the medical schools are located, such as population size, Human Development Index (HDI) and distance to the capital city of each state. Results: Among the institutions that have already initiated their activities, there are 328 active courses, offering 35.480 vacancies for Medical School applicants. There is a difference when analyzing public or private institutions and paid or tuition-free institutions. There is a greater offer of paid courses (74,1%) and of courses located in the countryside (69,8%). Among the courses in the countryside, 27,8% of the vacancies are offered within 100 km of the capital city. Only 7,9% of the annual vacancies are offered in cities with a medium HDI, and the remainder are offered in cities with high or very high HDI. The increase in HDI is related to the higher proportion of private courses offering medical vacancies. It was observed that there is no correspondence between the absolute number of vacancies and the population of the North region, differentfrom what occurs in the other regions of the country. Conclusions: Medical training is under many influences, such as economic and political trends. This discussion needs to consider the regionalization and democratization of access. It was observed that public institutions tend to be located in municipalities that are farther away from the capitals. Even though there is now greater homogeneity between the regions, the Southeast still concentrates almost half of the vacancies in medical courses. Also, the increase in the number of vacancies in private courses brings up the reflection about the socioeconomic profile of medical students who have the opportunity to gain access to this level of education.

Volunteering among medical students during the COVID-19 pandemic: what should be taken into account?

Abstract: Introduction: during the COVID-19 pandemic, the universities suspended in-person activities and medical education adapted from the traditional format to virtual scenarios. Thus, the volunteering activities might improve the apprenticeship in critical situations and constitute a way to obtain competences and clinical skills. Objective: to identify the frequency of student volunteering during the COVID-19 pandemic and the associated factors. Methods: a cross-sectional study was performed targeting medical students in their last 3 years at a medical school in Brazil. Three hundred and fifty invitations were sent by email to ask students to participate in a self-administered, anonymous electronic survey during the pandemic. The primary outcome was the frequency of volunteer activities. Sociodemographic variables and characteristics of the medical students’ activities were the dependent variables for the multivariate analysis that calculated the factors associated with volunteering. Results: One hundred and twenty-five respondents (35.8% response rate) were included in the analysis (no missing data). The frequency of volunteering was 52% and most of the participants were females (63.2%) and all had access to online activities. Telemedicine was the most frequent activity (56/65). After the multivariate analysis, it was found that a family income of 5.1-10 minimal wages (OR=2.32[0.94-6.42]), expressing the ability and confidence in a pandemic situation (OR=4.91[1.49-16.2]) and considering e-learning important before the pandemic (OR=16.46[1.35-200.32]) and exposure of more than 120 minutes to social media platforms were less motivating for volunteering. Conclusion: About half of the medical students volunteered during the COVID-19 pandemic. The presence of self-confidence, with previous training in a pandemic situation motivated the students to volunteer.

Mapping of medical schools: the distribution of undergraduate courses and annual vacancies in Brazilian cities in 2020

Abstract: Introduction: The number of medical schools in Brazil, as well as the number of vacancies offered at these schools, has grown considerably in the last few years. Since 2013, this increasehas aimedat reaching especially the rural and underserved areas of the country. Objective: Considering that there are many different interests concerning this debate and that this reality directly influences the education and health policies of the country, the aim of this study was to evaluate the number and the distribution of the medical courses,as well as vacancies in these schools in 2020, presenting an updated overview of the Brazilian medical schools. Methods: This was a cross-sectional study, based on data gathered from the Brazilian Ministry ofEducation and Institute of Geography and Statistics (IBGE) website. The utilized variables were the number of courses, number of vacancies offered in each course, characteristics of the cities where the medical schools are located, such as population size, Human Development Index (HDI) and distance to the capital city of each state. Results: Among the institutions that have already initiated their activities, there are 328 active courses, offering 35.480 vacancies for Medical School applicants. There is a difference when analyzing public or private institutions and paid or tuition-free institutions. There is a greater offer of paid courses (74,1%) and of courses located in the countryside (69,8%). Among the courses in the countryside, 27,8% of the vacancies are offered within 100 km of the capital city. Only 7,9% of the annual vacancies are offered in cities with a medium HDI, and the remainder are offered in cities with high or very high HDI. The increase in HDI is related to the higher proportion of private courses offering medical vacancies. It was observed that there is no correspondence between the absolute number of vacancies and the population of the North region, differentfrom what occurs in the other regions of the country. Conclusions: Medical training is under many influences, such as economic and political trends. This discussion needs to consider the regionalization and democratization of access. It was observed that public institutions tend to be located in municipalities that are farther away from the capitals. Even though there is now greater homogeneity between the regions, the Southeast still concentrates almost half of the vacancies in medical courses. Also, the increase in the number of vacancies in private courses brings up the reflection about the socioeconomic profile of medical students who have the opportunity to gain access to this level of education.

Medical students with performance difficulties need wide support: Initial results of an academic tutoring program

BACKGROUND:Even students with previous academic success may face challenges that affect their academic performance. Many medical schools offer programs to students at the risk of academic failure, to ensure that they succeed in the course.OBJECTIVE AND METHODS:In this report we describe a pioneering academic tutoring program developed at a Brazilian medical school and discuss the initial results of the program based on the feedback from tutors and data regarding the progression of students in the medical course.RESULTS:In 2018, 33 students enrolled into the program. Students' performance difficulties were mainly associated with mental health problems and socioeconomic vulnerability. Of the 33 students, 27 (81.8%) were assisted by the Mental Health Support Service and 16 (48.5%) were assisted by the Social Assistance Service. In addition to the planning academic activity class load, tutors were able to assist students in solving socioeconomic issues, carrying out personal support interventions with the promotion of self-esteem, and presenting suggestions for behavioral changes in their routine. For most students (72%), the action plan proposed by the tutors was successful. Eight of the 14 (57%) students in the fourth year progressed to the final two years of in-hospital practical training (internship).CONCLUSIONS:The Academic Tutoring Program showed positive results for most of the students. Close monitoring and tutor intervention allowed students with poor academic performance to overcome the low performance cycle. These important tasks demand time and energy from tutors, and institutional recognition of these professionals is essential for the successful maintenance of the program.

Medical students’ and teachers’ attitude: physician or patient-centered?

Abstract: Introduction: Patient-centered care has been associated with positive results in medical practice. Objective: The aim of this study was to evaluate the attitudes of students and teachers from a Brazilian medical school regarding the physician-patient relationship and verify associated factors. Methods: This was an analytical cross-sectional study carried out in a public university, using the PPOS “Patient-Practitioner Orientation Scale” as well as a sociodemographic questionnaire. The subjects were regularly enrolled students attending the second semester of 2015 and their teachers. Mann-Whitney and Kruskal-Wallis tests were used to examine the effect of sociodemographic variables and the interaction with the scores found for students and teachers. Results: A total of 212 students were surveyed, corresponding to 57.1% of the enrolled students in the medical course. The value of the total PPOS score found for the students was 4.35 (± 0.5 SD), and the mean total score of PPOS among female students (4.43) was significantly higher than that in males (4.23) (p < 0.001), indicating more patient-centered attitudes in that group. Regarding medical teachers, 77 (56%) participated. The total score of PPOS was 4.52 (± 0.5 SD), with a more patient-centered attitude among teachers in comparison to students (4.35) (p = 0.001). However, there is a clear need for progress in both groups. Conclusion: The analysis of the students’ and teachers’ attitudes about the physician-patient relationship disclosed an unknown scenario, with more patient-centered attitudes verified among teachers despite the need for improvements by both. Further research is needed to evaluate not only the attitude but the behavior of these subjects.

Medical students’ and teachers’ attitude: physician or patient-centered?

Abstract: Introduction: Patient-centered care has been associated with positive results in medical practice. Objective: The aim of this study was to evaluate the attitudes of students and teachers from a Brazilian medical school regarding the physician-patient relationship and verify associated factors. Methods: This was an analytical cross-sectional study carried out in a public university, using the PPOS “Patient-Practitioner Orientation Scale” as well as a sociodemographic questionnaire. The subjects were regularly enrolled students attending the second semester of 2015 and their teachers. Mann-Whitney and Kruskal-Wallis tests were used to examine the effect of sociodemographic variables and the interaction with the scores found for students and teachers. Results: A total of 212 students were surveyed, corresponding to 57.1% of the enrolled students in the medical course. The value of the total PPOS score found for the students was 4.35 (± 0.5 SD), and the mean total score of PPOS among female students (4.43) was significantly higher than that in males (4.23) (p < 0.001), indicating more patient-centered attitudes in that group. Regarding medical teachers, 77 (56%) participated. The total score of PPOS was 4.52 (± 0.5 SD), with a more patient-centered attitude among teachers in comparison to students (4.35) (p = 0.001). However, there is a clear need for progress in both groups. Conclusion: The analysis of the students’ and teachers’ attitudes about the physician-patient relationship disclosed an unknown scenario, with more patient-centered attitudes verified among teachers despite the need for improvements by both. Further research is needed to evaluate not only the attitude but the behavior of these subjects.

Empathy, well-being, and mental health: do gender differences diminish by the end of medical school?

ABSTRACT This study aims to investigate if medical students demonstrate differences related to gender in terms of empathy, burnout, tolerance, openness to spirituality, well-being, and mental health, and to examine whether these differences vary across levels of medical training. A cross-sectional study was conducted in the first semester of 2015 in a Brazilian medical school. The following were evaluated: quality of life (WHOQOL-Bref), burnout (Oldenburg), mental health (DASS-21), empathy (Empathy Inventory and ESWIM), and tolerance, well-being, and openness to spirituality (ESWIM). We investigated how these outcomes varied in terms of gender, stage of medical training, and its interaction using a two-way MANOVA. A total of 776 students were included and important differences were observed. As medical training advanced, the differences between genders that were present during students’ initial years (greater empathy, worse quality of life, and worse mental health among women) tended to become nonsignificant during the clerkship years. In addition, a significant interaction between stage and gender was found for ESWIM Wellness; WHOQOL; DASS Anxiety and DASS Stress. These results may denote a shortcoming in the way medical schools approach gender differences. Educators should consider these findings when restructuring curricula to respect gender differences, thus fostering their respective potentials.

Tauopathies: Need for education and advocacy — Que Tau? A pilot study

AbstractIntroductionWhen we ask a medical student or a medical resident about tauopathies our perception of the level of knowledge is in average low. It reinforces the need for education and advocacy of tauopathies involving health care professionals and general population in our country, and probably worldwide.ObjectiveTo disseminate information about tauopathies using social media campaign.MethodsWe planned an educational program for medical students and medical residents named Que Tau? (in Portuguese Que Tal, means: What about?). We will use social media, sending information by messaging app (WhatsApp and/or Telegram) using images (jpg), short videos, texts or articles (PDF). A pilot study will involve a sample of 60 undergraduate and 60 postgraduate students of a medical school in Brazil, and the same number of controls. Both groups will be asked about tauopathies key concepts three months later the messages.ResultsThis strategy to use smartphones to disseminate information about tauopathies can result in a good initiative to take attention of medical residents and medical students for tauopathies and to stimulate future actions to fight these diseases.ConclusionWe expect that he level of knowledge about tauopathies can increase between medical students and residents according to dissemination of information using social media campaign.

Awareness related to value-based health care among Brazilian Medical Students

Introduction: The steep global increase in healthcare costs demands a transition from the current fee-for-service to a Value-Based Health Care (VBHC) Model. According to Porter, value is defined as the outcomes that matter to patients over the costs for a full cycle of care. In order to build a solid basis for this change, it is imperative that the core concepts of VBHC are taught and discussed during and after medical school. The survey aimed at evaluating the degree of awareness related to VBHC among brazilian medical students and how that awareness would impact their professional future (primary objective). The secondary objective was to correlate intrinsic and extrinsic factors associated with the degree of awareness and exposure to VBHC. Methodology: This was a cross-sectional, prospective study, conducted through online surveys and applied to students from Brazilian medical schools who agreed to participate. Categorical variables were presented as integers and percentages. For univariate analysis, we performed chi-square tests with a 5% significance level. All analyses were performed using software R version 3.6.0. Results and Discussion: A total of 3,001 medical students from all Brazilian states completed the survey. Students were compared in 2 groups according to their awareness of VBHC, with 14% (426 respondents) declaring themselves familiar with VBHC concepts. An univariate analysis showed that medical students had contact with VBHC through classes, extracurricular activities, lectures and electronic sources. Students with a higher awareness of VBHC were more willing to share data on outcomes and costs related to their clinical practice for the benefit of cost reduction and quality improvement, if data were anonymous (57.04%) compared to those with no contact with VBHC (48.12%). Similarly, those with higher awareness of VBHC were more open to be evaluated and ranked by patients (32.86%), as long as data were anonymized, against 25.36% of those not familiar with the topic. VBHC enthusiasts were more inclined to pursue an MBA (19.95%), a career in management (11.74%) or research (17.14%) when compared to those with lower awareness (8.47%, 6.06% and 13.55%, respectively). Overall, students with higher awareness related to VBHC showed greater interest in areas beyond clinical practice, such as research, innovation, patient safety, quality, health economics, artificial intelligence and health policies. Conclusion: Awareness related to VBHC is still low among medical students. In a transforming Healthcare system this is an essential topic to be discussed in medical schools in order to prepare future professionals for the new scenario they will face when entering this new healthcare market. Although some students showed higher awareness related to VBHC, such awareness was mostly due to self-education efforts. It should be part of medical schools ́ responsibilities to provide education beyond clinical practice and research and include a deeper understanding of the healthcare system and strategies proposed to improve outcomes and costs and create value to patients, such as the proposed VBHC strategy.

Examining the effect of non-specialised clinical rotations upon medical students’ Thanatophobia and Self-efficacy in Palliative Care: a prospective observational study in two medical schools

IntroductionIncluding palliative care (PC) in overloaded medical curricula is a challenge, especially where there is a lack of PC specialists. We hypothesised that non-specialised rotations could provide meaningful PC learning...

Education is an important factor in end-of-life care: results from a survey of Brazilian physicians\u2019 attitudes and knowledge in end-of-life medicine

BackgroundAccording to the Latin America Association for palliative care, Brazil offers only 0.48 palliative care services per 1 million inhabitants. In 2012, no accredited physicians were working in palliative care, while only 1.1% of medical schools included palliative care education in their undergraduate curricula. As a reflection of the current scenario, little research about end-of-life care has been published so that studies addressing this subject in the Brazilian setting are crucial.MethodsA cross-sectional study study conducted with students applying for the medical residency of the Federal University of São Paulo were invited to voluntarily participate in an anonymous and self-administered questionnaire survey. The latter included demographic information, attitudes, prior training in end-of-life care, prior end-of-life care experience, the 20-item Palliative Care Knowledge Test (PCKT) and a consent term.ResultsOf the 3086 subjects applying for residency, 2349 (76%) answered the survey, 2225 were eligible for analysis while 124 were excluded due to incomplete data. Although the majority (99,2%) thought it was important to have palliative care education in the medical curriculum, less than half of them (46,2%) reported having received no education on palliative care. The overall performance in the PCKT was poor, with a mean score of 10,79 (± 3). While philosophical questions were correctly answered (81,8% of correct answers), most participants lacked knowledge in symptom control (50,7% for pain, 57,3% for dyspnea, 52,2% for psychiatric problems and 43,4% for gastrointestinal problems). Doctors that had already concluded a prior residency program and the ones that had prior experience with terminal patients performed better in the PCKT (p < 0,001). The high-performance group (more than 50% of correct answers) had received more training in end-of-life care, showed more interest in learning more about the subject, had a better sense of preparedness, as well as a higher percentage of experience in caring for terminal patients (p < 0,001).ConclusionsOur study showed that Brazilian physicians lack not only the knowledge, but also training in end-of-life medicine. Important factors to better knowledge in end-of-life care were prior training, previous contact with dying patients and prior medical residency. Corroborating the literature, for this group, training showed to be a key factor in overall in this area of knowledge. Therefore, Brazilian medical schools and residency programs should focus on improving palliative training, especially those involving contact with dying patients.

Differences in clerkship development between public and private Brazilian medical schools: an overview

BackgroundAround the world, it is very expensive to become a physician. Although public medical schools are less expensive than private medical schools, tuition fees are charged at public medical schools in the majority of countries. In Brazil, public medical schools, with the exception of municipal schools, are free. There has been little investigation of any differences in conditions offered by paid or free medical schools or what occurs in public and private clerkships in Brazil. We investigated the clerkship conditions offered to the students in both public and private Brazilian medical schools by gathering the opinions of clerkship coordinators and others responsible for clerkships.MethodsA cross-sectional, descriptive, analytical study using an electronic questionnaire was answered by clerkship coordinators to compare the clerkships of 30 public and 38 private Brazilian medical schools from all regions of the country. The questionnaires covered various aspects of the clinical environments, student supervision, faculty development, student assessments, rotation evaluations and extracurricular activities developed by students.ResultsWe observed significant differences between public and private medical schools in several aspects investigated. Based on the opinions of the clerkship coordinators, with the exception of access to university hospitals, which was predominantly offered by public medical schools, private medical schools offer better clerkship conditions. The main differences were related to the number of positions, infrastructure, clinical learning environments, faculty development, student assessments, rotation evaluations and students’ extracurricular activities.ConclusionThis is the first study comparing Brazilian medical clerkships in private and public medical schools and provides a general vision of these programmes. It is necessary to further investigate clerkship development in the Brazilian medical school system and to study the differences between private and public medical schools globally.

COVID-19 and medical education in a Brazilian medical school: how to deal with the current complex problems happening in the world? “When life gives you lemons, make lemonade”

This article was migrated. The article was not marked as recommended. The COVID global pandemia affected all the medical educational system. In Brazil, less than one month after the first case detected, the government confirmed the existence of sustained community transmission of the virus in the country and social distance was imposed, closing all Universities. Virtual learning, through technological advancements and its multiple resources, has been considered as an alternative to mitigate such impact, but it is also possible to develop other skills and medical competencies such as empathy, finitude, ethics and other questions related to the moment in the future doctor. Finally, is important to take care of mental health of those who work in the medical profession, reinforcing the care and the need to teach academics coping strategies to face stressful situations.

Assessing palliative care education in undergraduate medical students: translation and validation of the Self-Efficacy in Palliative Care and Thanatophobia Scales for Brazilian Portuguese

BackgroundAs the global population ages, palliative care is ever more essential to provide care for patients with incurable chronic conditions. However, in many countries, doctors are not prepared to care...

Sequence FEDATHI and TBL (Team Based Learning) improve the learning of human anatomy

The FEDATHI Sequence is a new teaching methodology designed by researchers from the faculty of Brazilian Education with the aim of improving the teaching and learning process in several areas of knowledge, and its application in the teaching of anatomy requires understanding the educational phenomenon known as mediation. The FEDATHI Sequence is a methodology aimed at improving the pedagogical practice aiming at the proper posture of the teacher in the classroom, whose essence is to contribute for the student to overcome the epistemological and didactic obstacles that occur in the approach of anatomical concepts in the classroom. The main phases of the FEDATHI sequence are: positioning, maturation, solution and proof. Team Basead Learning (TBL) is an active teaching and learning methodology widely used by medical schools in Brazil, which consists of an educational strategy that offers students active learning and can be used with large classes of students divided into small groups. Thus, the objective of this work was to compare learning using two different methodologies: sequence FEDATHI and TBL. A descriptive, cross‐sectional study with a quantitative approach was carried out with 90 students in the discipline of human anatomy. The didactic methodologies sequence Fedathi and TBL were used in the anatomy class of the endocrine and sensory systems. For data collection, a semi‐structured questionnaire with 10 questions was used. For statistical analysis, the Mann‐Whitney test was performed, being considered significant when they presented p &lt;0.05. It was observed that there was no statistically significant difference between learning using FEDATHI and TBL sequences, however when the two methodologies were compared with traditional teaching, both showed statistically significant differences p &lt;0.05. It was found that there were no statistically significant differences between the age of the participants. With regard to methodological preferences, 60% of students stated that the FEDATHI sequence was better for learning, 20% prefer TBL and 20% prefer traditional teaching. It was found that hybrid teaching with diversity of methodologies improves anatomy learning, being an important tool for consolidating anatomical knowledge.