Cross-Cultural Adaptation of the Communication Assessment Tool for Use in a Simulated Clinical Setting.

Construct: The Communication Assessment Tool (CAT) is a 14-item instrument developed in English to assess medical trainees' interpersonal communication skills from the patient's perspective in clinical settings. Background: Using validated instruments and simulated patients constitutes good practice in assessing doctor-patient communication. The CAT was designed for use in real practice, but has not yet been applied to assessing OB-GYN residents' delivery of bad news in Objective Structured Clinical Examination (OSCE) stations. This study aims to provide validity evidence for using the CAT to assess residents' interpersonal communication skills under difficult circumstances in a simulated clinical setting in Brazil. Approach: Cross-cultural adaptation comprised translation into Portuguese, synthesis of translations, and back-translation. Next, a committee of 10 external and independent experts rated the items for linguistic equivalence and relevance to the overall scale. Researchers used the expert ratings to produce a preliminary Brazilian-Portuguese version. This version was applied by four simulated patients to assess 28 OB-GYN residents completing two, 10-minute OSCE stations focused on delivering bad news. Item and scale content validity indices and internal-consistency reliability were calculated. Simulated patients were interviewed to clarify any doubt regarding the content and usability of the tool and their response process. Findings: Thirteen of the 14 items in the Brazilian-Portuguese version were considered "equivalent" by at least 70% of the experts. All items were considered relevant by 100% of the experts. The Item Content Validity Index ranged from .9 to 1, and the Scale Content Validity Index was .99. The instrument showed good reliability for both scenarios (Cronbach's alpha > .90). Simulated patients considered the CAT easy to understand and complete. Conclusions: This study provides validity evidence for using the Brazilian-Portuguese CAT in a simulated clinical environment to assess OB-GYN residents' delivery of bad news. Based on this study's findings, the OB-GYN Department organized an annual formative assessment for residents to improve their interpersonal communication skills. This version of the CAT may also be applicable to other specialties.

Factors Related to Coital Frequency of Women in Their Thirties.

This cross-sectional study aimed to identify factors related to coital frequency (CF) among 254 women in their 30s using a semistructured interview to collect sociodemographic, anthropometric, reproductive, clinical, and relationship data. CF was characterized as (a) never, (b) rarely (≤1 times/month), (c) occasionally (≤1 times /week), (d) regularly (2-3 times/week), or (e) frequently (>3 times/week). The mean age was 34.38 ± 0.43 years, mean body mass index (BMI) was 27.86 ± 6.52 kg, mean family income was US$1,044.18 ± 796.19, mean number of children was 1.71 ± 0.89, and mean relationship duration was 8.87 ± 5.11 years. Eighty-seven women (35.2%) were taking hormonal contraceptives, 143 (98.0%) were employed, 239 (96.48%) had a secondary or higher education, and 9 (3.62%) had primary schooling. CF was classified as >3 times/week in 22 (8.66%), 2-3 times/week for 98 (38.58%), ≤1 times/week in 40 (15.75%), ≤1 times/month in 14 (5.51%), and never in 5 (1.97%). Women who reported having coitus >3 times/week a week had significantly higher body mass index (BMI; 32.72 ± 7.42 kg/m(2)) than those who had coitus 2-3 times/week (28.45 ± 6.76 kg/m(2)) and ≤1 times /week (26.81 ± 5.39 kg/m(2)) (p < 0.01 for both comparisons). Thus, coital frequency varies in women in their 30s. Obese women had a higher CF than normal-weight and overweight women.

Prevalence and factors associated with anxiety, depression and burnout in gynecology and obstetrics residents during the COVID-19 pandemic.

Objective: To determine the prevalence of anxiety, depression and burnout in residents of Gynecology and Obstetrics during COVID-19 pandemic in Brazil and its associated factors. Methods: Cross-sectional study involving all regions of Brazil, through the application of a sociodemographic questionnaire, the Hospital Anxiety and Depression Scale (HAD) and the Maslach Burnout Inventory (MBI-HSS) instrument. Multivariate analysis was performed after adjusting the Poisson model. Results: Among the 719 participating medical residents, screening was positive for anxiety in 75.7% and for depression in 49.8% of cases. Burnout syndrome was evidenced in 41.3% of the physicians studied. Those with depression are more likely to have anxiety (OR 0.797; 95%CI 0.687 - 0.925) and burnout syndrome (OR 0.847 95%CI 0.74 - 0.97). Residents with anxiety (OR 0.805; 95%CI 0.699 - 0.928) and burnout (OR 0.841; 95%CI 0.734 - 0.963) are more likely to have depression. Conclusion: High prevalence of anxiety, depression and burnout were found in residents of Gynecology and Obstetrics in Brazil, in addition to important correlations between anxiety-depression and depression-burnout.

Breaking Bad News in Obstetrics and Gynecology: We Must Talk About It.

Breaking bad news is common in obstetrics and gynecology (ob-gyn). However, it is difficult, and few doctors receive training on how to deal with this situation. This narrative review aims to gather, analyze, and synthesize part of the knowledge on the area, focused on Ob-Gyn. Among the 16 selected articles, two are randomized controlled intervention studies, and most studies refer to obstetrics. The results found by us pointed out that simulation, feedback/debriefing, lectures, and protocols could improve doctors' performance in communicating bad news. For patients, the context and how the information is transmitted seem to impact more than the content of the news. Ob-Gyn doctors could benefit from specific protocols and education, given the specialty's particularities. There is a lack of evidence about the most effective way to conduct such training. Finding validated ways to quantify and classify studies' results in the area, which would allow for the objective analysis of outcomes, is one of the biggest challenges concerning this topic.

Dar más notícias é comum em obstetrícia e ginecologia. Porém, é difícil e poucos médicos recebem treinamento sobre como lidar com essa situação. Esta revisão narrativa tem como objetivo reunir, analisar e sintetizar parte do conhecimento sobre a área, com foco na obstetrícia. Dentre os 16 artigos selecionados, dois são estudos de intervenção randomizados e controlados, e a maioria dos estudos refere-se à obstetrícia. Os resultados encontrados ressaltaram que simulação, feedback/entrevistas, palestras e protocolos podem melhorar o desempenho dos médicos na comunicação de más notícias. Para os pacientes, o contexto e como as informações são transmitidas parecem ter maior impacto do que o conteúdo das notícias. Os obstetras e ginecologistas poderiam se beneficiar de cursos e protocolos específicos, dadas as particularidades da especialidade. Faltam evidências sobre a forma mais eficaz de realizar esse treinamento. Encontrar formas validadas de quantificar e classificar os resultados dos estudos na área, permitindo uma análise objetiva dos resultados, é um dos maiores desafios neste tema.

Formative assessment scores in tutorial sessions correlates with OSCE and progress testing scores in a PBL medical curriculum.

BACKGROUND: Effective assessments programs are a challenge in problem-based learning (PBL). One of the main principles of this educational setting is the Formative Assessment (FA). We hypothesized that students' performance assessed by FA in tutorial sessions in a PBL curriculum is related to other summative assessments. OBJECTIVE: To investigate the correlation among FA in tutorial sessions with grades obtained in Objective Structured Clinical Evaluation (OSCE) and Progress Testing (PT) to better understand the assessment process in PBL medical teaching approach and to predict student's future performance. DESIGN: An observational cross-sectional study was conducted comparing FA, OSCE and PT scores from 4th to 8th semester medical students. Correlation analyses were performed using pooled and separate data from the 4th and 8th semesters. RESULTS: From the 5th to 8th semester, OSCE scores were smaller compared to the FA, while PT scores were lower in all stages. In the pooled data, the correlation analysis showed a significant positive relationship between grades on FA and OSCE, FA and PT and OSCE and PT. A significant correlation among the three assessments strategies was also detected in the 8th semester, but not in the 4th semester. CONCLUSIONS: Assessment strategies in PBL approach, including FA, OSCE and PT, have positive correlations, which increases as the medical course becomes more complex.

Prevalence and factors associated with anxiety, depression and burnout in gynecology and obstetrics residents during the COVID-19 pandemic

Abstract Objective: To determine the prevalence of anxiety, depression and burnout in residents of Gynecology and Obstetrics during COVID-19 pandemic in Brazil and its associated factors. Methods: Cross-sectional study involving all regions of Brazil, through the application of a sociodemographic questionnaire, the Hospital Anxiety and Depression Scale (HAD) and the Maslach Burnout Inventory (MBI-HSS) instrument. Multivariate analysis was performed after adjusting the Poisson model. Results: Among the 719 participating medical residents, screening was positive for anxiety in 75.7% and for depression in 49.8% of cases. Burnout syndrome was evidenced in 41.3% of the physicians studied. Those with depression are more likely to have anxiety (OR 0.797; 95%CI 0.687 - 0.925) and burnout syndrome (OR 0.847 95%CI 0.74 - 0.97). Residents with anxiety (OR 0.805; 95%CI 0.699 - 0.928) and burnout (OR 0.841; 95%CI 0.734 - 0.963) are more likely to have depression. Conclusion: High prevalence of anxiety, depression and burnout were found in residents of Gynecology and Obstetrics in Brazil, in addition to important correlations between anxiety-depression and depression-burnout.

Da formação por competências às EPAs / From competency-based training to EPAs

A Comissão Nacional de Residência Médica da Febrasgo trabalhou nos últimos anos para a criação da Matriz de Competências em Ginecologia e Obstetrícia, e orgulhosamente foi a primeira Matriz de Competências entre as diversas especialidades médicas, sendo a versão 2 publicada em 2019. Considerou-se a realidade local dos Programas de Residência Médica em Ginecologia e Obstetrícia e o nível profissional pretendido para servir à sociedade brasileira. Considera-se a Competência Médica como a capacidade médica verificável que integra os componentes de conhecimento, habilidades, atitudes e valores éticos. A Matriz de Competências é composta de 16 eixos e subdividida de acordo com os três anos de residência em Ginecologia e Obstetrícia. Uma forma interessante que contribui para a avaliação das competências de residentes são as atividades profissionais confiabilizadoras, conhecidas como EPAs.

Validação de escala de avaliação de profissionalismo traduzida e adaptada em cenário de simulação / Validation of a translated and adapted professionalism assessment scale in a virtual simulation scenario

Resumo: Introdução: O Professionalism Mini-Evaluation Exercise (P-MEX) é instrumento que avalia 21 habilidades de profissionalismo, distribuídas em quatro domínios. Objetivo: Este estudo teve como objetivos traduzir, adaptar e validar um instrumento de avaliação de profissionalismo médico. Método: Após a autorização do autor do P-MEX, realizaram-se a tradução do instrumento para a língua portuguesa, a análise de equivalência linguística e validade de conteúdo por especialistas em educação, e o exame de validade operacional em OSCE virtual entre estudantes do internato médico. Resultado: Houve elevada equivalência dos itens da versão em português do Brasil por especialistas em educação. O índice de validade de conteúdo da escala foi de 0,96. Seis professores validaram o P-MEX em ambiente de simulação para 27 estudantes do internato médico. Conclusão: A versão brasileira do P-MEX demonstrou ser adequada para avaliar o profissionalismo médico no contexto brasileiro, com boa validade operacional em cenário de simulação virtual.

Abstract: Introduction: "Professionalism Mini-Evaluation Exercise" (P-MEX) is an instrument that assesses 21 professionalism skills, distributed in four domains. Objective: To translate, adapt and analyze the validity of the medical professionalism evaluation exercise. Methods: After authorization from the author, the following tasks were performed: translation into Portuguese; linguistic equivalence and content validity analysis by education experts; operational validity analysis in virtual OSCE among medical clerkship students. Results: There was high equivalence of the items in the Brazilian Portuguese version by education specialists. The Scale Content Validity Index was 0.96. Six teachers validated the P-MEX in a simulation environment to 27 medical clerkship students. Conclusion: The Brazilian version of the P-MEX proved to be adequate to assess medical professionalism in the Brazilian context, and showed good operational validity in a virtual simulation scenario.

O Teste de Progresso na residência médica em ginecologia e obstetrícia: a experiência nacional / The Progress Test in gynecology and obstetrics medical residency: the national experience

Resumo: Introdução: O Teste de Progresso (TP) é uma avaliação cognitiva abrangente e longitudinal com vantagens para o aprendiz, os programas educacionais e a sociedade. No Brasil, embora seja amplamente utilizado na graduação, existe pouca experiência do seu uso na residência médica. Este estudo visa retratar a experiência da Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo) nos quatro primeiros anos de implementação do TP Individual do Residente em Ginecologia e Obstetrícia (TPI-GO). Relato da experiência: O TPI-GO foi implementado em 2018, sendo oferecido anualmente aos residentes brasileiros. Nos dois últimos anos, o TPI-GO passou a ser oferecido no formato on-line. Para incentivar a participação, estabeleceram-se critérios que possibilitam dispensa ou bonificação na prova teórica para a obtenção do Título de Especialista em Ginecologia e Obstetrícia (Tego) para os candidatos com melhor desempenho. Os resultados são fornecidos de maneira sigilosa a cada candidato. Os resultados do desempenho dos residentes de um mesmo serviço são fornecidos ao supervisor do programa sem a identificação dos seus residentes, de modo a oferecer subsídios para autoavaliação da qualidade e indicar pontos de melhoria. Discussão: Desde a implementação do TP, verificou-se um número crescente de candidatos inscritos com elevada taxa de aderência à prova. As medianas de desempenho do grupo de residentes evidenciaram evolução cognitiva entre os iniciantes (R1) e os concluintes (R3) dos programas. Conclusão: A implementação do TP na residência é factível e aceitável, apresentando vantagens e benefícios. No entanto, requer preparo e envolvimento da equipe organizadora, além de apoio logístico e financeiro. O sigilo na divulgação dos resultados é recomendável e preserva o candidato. A possibilidade de bonificação e dispensa na prova teórica do Tego é um grande atrativo para a adesão e aderência dos médicos residentes ao TP. A aplicação da prova em ambiente on-line amplia o acesso, com níveis aceitáveis de segurança.

Abstract: Introduction: The Progress Test (PT) is a comprehensive, longitudinal cognitive assessment with benefits for the learner, educational programs, and society. Although it is widely used in undergraduate courses in Brazil, there is little experience regarding its use in medical residency. This study aims to portray Febrasgo's experience in the first four years of implementing the Resident's Individual PT in ObGyn (TPI-GO). Experience report: The TPI-GO was implemented in 2018, being offered annually to Brazilian residents. In the last two years, the TPI-GO has been provided online. Febrasgo established criteria that allow for exemption or bonus in the theoretical test to encourage the trainees' participation in the TPI-GO to obtain the Specialist Certification in Gynecology and Obstetrics (TEGO). Results are provided confidentially to candidates and allow self-assessment. The results of the residents' performance from the same service are provided to the program supervisor, offering subsidies for self-assessment of quality and indicating points for improvement. Discussion: Since it was implemented, there has been an increasing number of candidates enrolled in the TPI-GO and a high adherence rate. The medians of performance of the two cohorts of residents studied showed cognitive evolution between beginners (R1) and graduates (R3), with differences attributed in part to the adverse effects of the Pandemic on training. Conclusion: The implementation of the PT in medical residency is feasible, acceptable, and shows advantages and benefits, but it requires the commitment of the organizing team, besides logistical and financial support. The results confidentiality is recommended and preserves the candidate. The possibility of granting bonuses and exemptions in the TEGO theoretical test is an excellent attraction aiming at the adhesion and adherence of residents to the PT. The TPI-GO online increases access with acceptable levels of security.

Breaking Bad News in Obstetrics and Gynecology: We Must Talk About It / Más notícias em obstetrícia e ginecologia: Devemos falar sobre isso

Abstract Breaking bad news is common in obstetrics and gynecology (ob-gyn). However, it is difficult, and few doctors receive training on how to deal with this situation. This narrative review aims to gather, analyze, and synthesize part of the knowledge on the area, focused on Ob-Gyn. Among the 16 selected articles, two are randomized controlled intervention studies, and most studies refer to obstetrics. The results found by us pointed out that simulation, feedback/debriefing, lectures, and protocols could improve doctors' performance in communicating bad news. For patients, the context and how the information is transmitted seem to impact more than the content of the news. Ob-Gyn doctors could benefit from specific protocols and education, given the specialty's particularities. There is a lack of evidence about the most effective way to conduct such training. Finding validated ways to quantify and classify studies' results in the area, which would allow for the objective analysis of outcomes, is one of the biggest challenges concerning this topic.

Resumo Dar más notícias é comum em obstetrícia e ginecologia. Porém, é difícil e poucos médicos recebem treinamento sobre como lidar com essa situação. Esta revisão narrativa tem como objetivo reunir, analisar e sintetizar parte do conhecimento sobre a área, com foco na obstetrícia. Dentre os 16 artigos selecionados, dois são estudos de intervenção randomizados e controlados, e a maioria dos estudos refere-se à obstetrícia. Os resultados encontrados ressaltaram que simulação, feedback/entrevistas, palestras e protocolos podem melhorar o desempenho dos médicos na comunicação de más notícias. Para os pacientes, o contexto e como as informações são transmitidas parecem ter maior impacto do que o conteúdo das notícias. Os obstetras e ginecologistas poderiam se beneficiar de cursos e protocolos específicos, dadas as particularidades da especialidade. Faltam evidências sobre a forma mais eficaz de realizar esse treinamento. Encontrar formas validadas de quantificar e classificar os resultados dos estudos na área, permitindo uma análise objetiva dos resultados, é um dos maiores desafios neste tema.

Como avaliar programas de residência a partir do Teste de Progresso? / How can residency programs be evaluated based on the Progress Test?

Resumo: Introdução: Embora o conhecimento especializado seja um elemento fundamental para a prática médica qualificada, não há, na maioria das especialidades, uma avaliação cognitiva unificada dos médicos residentes, e, consequentemente, não é possível verificar o conhecimento agregado durante o treinamento pelos programas de residência médica (PRM). O Teste de Progresso (TP) oferece uma oportunidade para avaliação dos PRM a partir do desempenho dos seus residentes. Em 2018, a Febrasgo implementou o Teste de Progresso Individual do Residente em Ginecologia e Obstetrícia (TPI-GO), que tem sido aplicado em todo o Brasil. Relato de experiência: Este estudo descritivo se refere ao acompanhamento longitudinal dos residentes que iniciaram a participação no TPI-GO em 2018 como R1 (n = 497) e concluíram a participação em 2020 como R3 (n = 314). O desempenho desses residentes no TPI-GO serviu de base para analisar o perfil de 32 PRM localizados nas Regiões Sul (28,1%), Sudeste (68,8%) e Centro-Oeste (3,1%), sendo identificados cinco diferentes perfis de PRM em relação ao desempenho dos residentes iniciantes, diferenças de desempenho entre R3 e R1 e desempenho dos concluintes. Discussão: No Brasil, não são oferecidas avaliações abrangentes e unificadas de conhecimento aos médicos residentes na maioria das especialidades, e consequentemente ainda não é possível incorporar essas informações na avaliação dos PRM. No modelo aqui apresentado, o desempenho dos residentes no TP possibilita inferir sobre o processo seletivo, o conhecimento agregado pelo PRM ao longo do treinamento e o nível de conhecimento dos concluintes, sendo reconhecidos PRM qualificados (tipo 1) e PRM que necessitam de melhorias (tipos 2, 3, 4 e 5). Conclusão: O TP oferece uma oportunidade para avaliação dos PRM a partir do desempenho dos seus residentes. Por meio do modelo aqui apresentado, é possível obter informações para subsidiar decisões institucionais que promovam melhorias dos PRM e do seu processo de formação na especialidade.

Abstract: Introduction: Although specialized knowledge is a fundamental element for qualified medical practice, in most specialties, there is no unified cognitive assessment of resident physicians, and it is impossible to verify the knowledge gained during training in Medical Residency Programs (MRPs). The Progress Test (PT) provides an opportunity to evaluate MRPs based on the performance of the residents. In 2018, Febrasgo applied the Resident Progress Test in Gynecology and Obstetrics (TPI-GO) throughout Brazil. Experience report: This descriptive study refers to the longitudinal follow-up of residents who started participating in the TPI-GO in 2018 as R1 (n=497) and completed their participation in 2020 as R3 (n = 314). The performance of these residents in the TPI-GO served as a basis for analyzing the profile of 32 MRPs located in the South (28.1%), Southeast (68.8%), and Central-West (3.1%) regions of Brazil, with five different identified PRM profiles in relation to the performance of beginner residents, differences in performance between R3 and R1 and the performance of residency graduates. Discussion: In Brazil, comprehensive and unified assessments of knowledge are not offered to resident physicians in most specialties, and consequently, it is not yet possible to incorporate this information into the assessment of MRPs. In the model presented here, the performance of residents in the PT enables one to make inferences about the selection process, the knowledge added by the MRP throughout the training, and the level of knowledge of the graduates, being recognized as qualified MRPs (type 1) and MRPs that need improvement (types 2, 3, 4 and 5). Conclusion: The PT offers an opportunity to evaluate MRPs based on the performance of their residents. Through the model presented here, it is possible to obtain information to support institutional decisions that promote improvements in MRPs and their training process in the specialty.

Insulin resistance in adolescents with menstrual irregularities.

PURPOSE: To assess the presence of insulin resistance as well as the incidence of polycystic ovary syndrome (PCOS) in adolescents with menstrual disorders. METHODS: A case-control study was conducted with 34 adolescents during the period of 2 to 4 years after menarche. The patients were divided into two groups: group I (G I) with 22 patients with menstrual irregularity, and group II (G II) with 12 patients with regular menstrual cycles. Body mass index and Ferriman-Gallway index were calculated for all patients, who also received a pelvic ultrasound. We measured DHEA-S, 17 hydroxyprogesterone, testosterone, TSH, LH, FSH, and prolactin in serum sample and conducted the glucose tolerance test with 75 mg dextrose with measurement of glucose and insulin. RESULTS: Mean +/- SD ovary volume was larger in G I (11.38 +/- 4.06 cm(3)) than in G II (7.72 +/- 5.59 cm(3)); P < 0.05. DHEA-S (G I = 47.23; G II = 38.38 microg/dl) and testosterone (G I = 54.19; G II = 32.53 ng/dl) levels were higher in patients with menstrual irregularity. In G I we detected two patients with diabetes mellitus and one patient with glucose intolerance. Sixteen patients in this group had clinical or hormonal characteristics of PCOS. The mean values of the area under the insulin curve (AUIC) were higher in patients with menstrual irregularities (8,556.52 muIU/mL/2 h) than in controls (5,743.38 microIU/mL/2 h); P < 0.05. CONCLUSIONS: The presence of PCOS was detected in 95% of the adolescents with menstrual irregularity. Patients with menstrual disorders presented higher AUIC values than controls.

Exame clínico objetivo estruturado como ferramenta de avaliação na residência médica em ginecologia e obstetrícia: relato de experiência e revisão da literatura / Structured objective clinical examination as an evaluation tool in medical residency in gynecology and obstetrics: experience report and literature review

A avaliação dos residentes é um grande desafio nos programas de residência médica em ginecologia e obstetrícia. Neste artigo descrevemos a experiência com a aplicação do exame clínico objetivo estruturado (objective structured clinical examination ­ OSCE) em residentes do terceiro ano nos programas de residência médica em ginecologia e obstetrícia de Porto Alegre no Rio Grande do Sul. O OSCE tem se mostrando uma ferramenta promissora na avaliação das competências clínicas dos residentes, como demonstra o nosso estudo.(AU)

Residents' assessment is a major challenge within medical residency programs in gynecology and obstetrics. In this article we will describe the experience with the application of the structured objective clinical examination (OSCE) in third year residents in the medical residency programs in gynecology and obstetrics in Porto Alegre in Rio Grande do Sul. OSCE has shown to be a promising tool in assessing the clinical competencies of residents, as shown in our study.(AU)

The Use of Clinical PBL in Primary Care in Undergraduate Medical Schools / Aplicação do PBL Clínico na Atenção Primária em Cursos de Medicina

Abstract: Introduction: Problem-based learning (PBL) is a collaborative student-centered learning method for small groups, based on the mobilization of previous knowledge and on critical reasoning for problem solving. Although it has been used predominantly in the classroom, when applied in clinical studies, PBL can increase the intrinsic motivation and long-term knowledge retention. In addition, Clinical PBL represents a more effective option to learn from practice considering the students' overload in clinical clerkships in the Unified Health System (UHS). This study aimed to assess the students' perception of a Clinical PBL model implemented in Primary Health Care (PHC) clerkships during the first four years of the Medical Course at the University of Ribeirão Preto (UNAERP) in 2017. Method: The primary outcome was assessed by the DREEM (Dundee Ready Educational Environment Measure) tool, which contains 50 items distributed in five dimensions. The questionnaire was applied to 374 medical students, corresponding to 78% of the total number of medical students from the first to the fourth year. Results: For most of the evaluated items, the students' perceptions were "positive", including the dimensions "Perception of Teachers", "Perception of Academic Results" and "Perception of the General Environment". For the dimensions "Perception of Learning" and "Perception of Social Relationships" the evaluation was "more positive than negative". The DREEM total score was 124.31, corresponding to 62.15% of the maximum score, which indicates a perception that is "more positive than negative" regarding the Clinical PBL. The internal consistency given by Cronbach's alpha was 0.92. Conclusion: The use of Clinical PBL in PHC qualifies learning from practice, is well accepted by medical students and offers a useful option to the students' overload in the clinical clerkship during the first four years of the Medical School.

Resumo: Introdução: A aprendizagem baseada em problemas (do inglês problem-based learning - PBL) é um método de aprendizagem colaborativa para pequenos grupos, centrado no estudante, fundamentado na mobilização de conhecimentos prévios e no raciocínio crítico para a solução de problemas. Embora tenha sido utilizado predominantemente em sala de aula, quando aplicado em estágios clínicos, o PBL pode aumentar a motivação intrínseca e a retenção de conhecimento em longo prazo pelos estudantes. Além disso, o PBL clínico pode representar uma opção mais efetiva de aprendizado a partir da prática ante a sobrecarga de alunos nos estágios clínicos no Sistema Único de Saúde. Este estudo teve por objetivo avaliar a percepção dos estudantes sobre um modelo de PBL clínico implementado em estágios de atenção primária à saúde (APS) no pré-internato do curso de Medicina da Universidade de Ribeirão Preto (Unaerp) em 2017. Método: O desfecho primário foi avaliado por meio do instrumento Dundee Ready Educational Environment Measure (DREEM), que contém 50 itens distribuídos em cinco dimensões. O questionário foi aplicado a 374 alunos de Medicina que correspondem a 78% do total de estudantes do pré-internato. Resultados: Para a maioria dos itens avaliados, a percepção dos foi "positiva", incluindo as dimensões "percepção dos professores", "percepção dos resultados acadêmicos" e "percepção do ambiente geral". Para as dimensões "percepção da aprendizagem" e "percepção das relações sociais", a avaliação foi "mais positiva do que negativa". O escore total das respostas foi de 124,31, correspondendo a 62,15% do escore máximo, o que indica uma percepção "mais positiva do que negativa" sobre a atividade. A consistência interna dada pelo alfa de Cronbach foi de 0,92. Conclusão: O uso do PBL clínico em APS qualifica o aprendizado a partir da prática, é bem-aceito pelos estudantes de Medicina e oferece uma opção viável à sobrecarga de alunos em estágios clínicos do pré-internato.

O uso do logbook e do portfólio nos programas de rtesidência / Use of logbook and portfolio in residency programs

O Logbook pode ser definido como um recurso por meio do qual os residentes documentam as experiências clínicas durante seus estágios.(1) O registro dos atendimentos e procedimentos pode ser efetuado tanto em papel quanto no formato eletrônico. Em muitos países onde foi implementado o Logbook eletrônico (e-logbook), os residentes recebem acesso individual ao sistema no qual devem registrar a sua experiência cirúrgica ao longo de todo o treinamento. Anual ou semestralmente, o Logbook é avaliado pelo supervisor, sendo esse um dos critérios para a progressão do residente no programa.