Physiology and Execution of Swallowing Maneuvers in 3D Videos: Integrating the Technology into Patient Care.

Educational technologies have proven to be an effective way to guide and educate patients, allowing them to increase awareness of their dysphagia condition and how treatment will help them. In this sense, this study aimed to develop and validate the content and appearance of 3D iconographic videos, which addressed the physiological demonstration and execution of protective and facilitating swallowing maneuvers, as well as verifying the feasibility of its use in teleconsultation, having adults and elderly people with oropharyngeal dysphagia as the main target audience. The development of the 3D videos was elaborated based on a guiding scientific script, constructed from an integrative literature review. After the development of the 3D videos by the digital designer, a committee of 12 expert judges evaluated the material produced to validate the content and appearance where a minimum agreement index of 0.8 among the judges was considered satisfactory. Subsequently with the validated material, the proof of concept was conducted together with the target population of 10 dysphagic patients through individual teleconsultation via Google Meet platform. After the teleconsultation, patients responded to a Google Forms questionnaire, analyzing the videos presented. From the integrative literature review, 29 studies that contained relevant information about the physiological effects caused by swallowing maneuvers were selected. Based on this information, the scientific script was created, allowing a detailed description of the physiological events that occurred during swallowing while executing the maneuvers. With the finished script, 3D videos of swallowing maneuvers were produced. After developing the material, the committee of expert judges validated the content and appearance. The twelve items that had an agreement index below 0.8 were adjusted. Once the adjustments were completed, the videos were analyzed again, obtaining approval from the judges, and ensuring the validation of content and appearance of the material developed. A proof of concept was conducted on ten dysphagic patients. The maneuver applied was chosen according to the patient's physiological changes, causing only 4 of the 9 maneuvers to be tested, as the patients did not demonstrate changes in swallowing that would justify the use of the other maneuvers. After this, patients answered a form in which all items covered received positive evaluations, related to both ease of understanding and learning. This study allowed the development of the 3D videos with a didactic demonstration of the physiology and execution of protective and facilitating swallowing maneuvers, in addition to having its content and appearance validity assured through analysis by the committee of expert judges.

A randomised controlled trial of a web-based educational program in child mental health for schoolteachers.

Children affected by mental disorders are largely unrecognised and untreated across the world. Community resources, including the school system and teachers, are important elements in actions directed to promoting child mental health and preventing and treating mental disorders, especially in low- and middle-income countries. We developed a web-based program to educate primary school teachers on mental disorders in childhood and conducted a cluster-randomised controlled trial to test the effectiveness of the web-based program intervention in comparison with the same program based on text and video materials only and to a waiting-list control group. All nine schools of a single city in the state of São Paulo, Brazil, were randomised to the three groups, and teachers completed the educational programs during 3 weeks. Data were analysed according to complete cases and intention-to-treat approaches. In terms of gains of knowledge about mental disorders, the web-based program intervention was superior to the intervention with text and video materials, and to the waiting-list control group. In terms of beliefs and attitudes about mental disorders, the web-based program intervention group presented less stigmatised concepts than the text and video group and more non-stigmatised concepts than the waiting-list group. No differences were detected in terms of teachers' attitudes. This study demonstrated initial data on the effectiveness of a web-based program in educating schoolteachers on child mental disorders. Future studies are necessary to replicate and extend the findings.

Training of beauty salon professionals in disease prevention using interactive tele-education.

BACKGROUND: Infectious diseases can be acquired in places where invasive procedures are often performed without the proper care of hand washing and material sterilization. There are approximately 500,000 beauty and esthetics centers in Brazil, which are visited by thousands of people every day. Many diseases, including sexually transmitted infections, are still highly prevalent in Brazil, such as warts caused by human papillomavirus, hepatitis B and C, and human immunodeficiency virus infection, and can be transmitted in beauty salons. MATERIALS AND METHODS: We have developed a tele-education course divided into four main themes: sexually transmitted infections, indoor health in beauty salon workplaces, hand washing, and material sterilization. The course was made available through a Web site, which included a face-to-face meeting, Web synchronous meetings (chats and Web conferences), and asynchronous resources (reading material, discussion lists, situations simulator, educational videos, and three-dimensional virtual human video animation on sexually transmitted infections and hand washing), mediated by professors and coordinators. RESULTS: Fifty-two beauty professionals and 33 other professionals were enrolled from different regions. Of the 61 who completed the course and received a certificate at the course's end, 100% considered good to excellent the course's applicability to everyday life and would recommend it to a fellow professional. CONCLUSIONS: The results demonstrate the feasibility of an interactive, tele-education model using low-cost tools as an educational resource to teach beauty professionals. In the future, this may become a branch of nationwide telehealth action.

Alcohol abuse management in primary care: an e-learning course.

BACKGROUND: The mental health knowledge gap challenges public health. The Alcohol Abuse Management in Primary Care (AAMPC) is an e-learning course designed to cover alcohol-related problems from the primary care perspective. The goal of this study was to verify if the AAMPC was able to enhance healthcare professionals' alcohol-related problems knowledge. MATERIALS AND METHODS: One hundred subscriptions for the AAMPC were offered through the federal telehealth program. The course was instructor-led and had nine weekly classes, delivered synchronously or asynchronously, at the students' convenience, using a varied array of learning tools. At the beginning, students took a test that provided a positive score, related to critical knowledge for clinical management, and a negative score, related to misconceptions about alcohol-related problems. The test was repeated 2 months after course completion. RESULTS: Thirty-three students completed the course. The positive score improved significantly (p<0.001), but not the negative score. Students with previous experience with e-courses presented greater improvement on the positive score (p<0.036). Eighty-percent of the students thought the course excelled in meeting its objectives. Web conferences and video and audio recordings were the most appreciated learning tools. Course satisfaction was negatively related to frequency of Internet access (Spearman's rho=-0.455, p=0.022). CONCLUSIONS: E-learning was highly appreciated as a learning tool, especially by students with the least frequency of Internet use. Nonetheless, it worked better for those previously familiar with e-courses. The AAMPC e-course provided effective knowledge transmission and retention. Complementary strategies to reduce misconceptions about alcohol-related problems must be developed for the training of primary care staff.

Community health worker training for infant hearing health: effectiveness of distance learning.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of a distance training program in infant hearing health to community health workers (CHWs). DESIGN: Pre- and post- tests were administered to two groups of subjects following the use of an interactive CD-ROM for tele-educational training. STUDY SAMPLE: Two groups of subjects were used: Group I (GI) consisted of 43 CHWs who had previously participated in at least one training activity involving hearing health, and Group II (GII) were 47 CHWs who had received no prior training in hearing health. RESULTS: CHWs retained a significant amount of training content. There was not significant correlation between the global post-training questionnaire score and performance on the simulation activity (GI: r = 0.11, p = 0.698 and GII: r = 0.29, p = 0.074), and the simulation activity performance was significantly better among GI CHWs (p = 0.05). CONCLUSION: The CHWs' training in infant hearing health using an interactive tele-educational tool was effective, as the CHW demonstrated significant short-term information retention and applied such data in hypothetical situations representative of their daily activities.

[Nursing contributions to the development of the Brazilian Telehealth Lactation Support Program]. / Teleamamentação no Programa Nacional de Telessaúde no Brasil: a experiência da Telenfermagem.

The National Telehealth Program was founded by the Ministry of Health, in partnership with the Ministry of Education (Ministério da Educação - MEC) and the Ministry of Science and Technology (Ministério da Ciência e Tecnologia - MCT), to support the development of family healthcare teams throughout the country. The São Paulo Telehealth Center has developed the Telehealth Lactation Support program, which provides primary healthcare professionals with information on diverse aspects of breastfeeding. This paper reports the development of the Lactation Support program and the nursing contributions. Project methodology included the formation of a multidisciplinary group of pediatricians, nurses, speech and language therapists, nutritionists, and dentists. Multimedia teaching resources were prepared for inclusion in the Cybertutor platform. Telehealth Lactation Support is an innovative and promising addition to continuing education for healthcare professionals and provides a framework for the development of other programs.

Building an outpatient telemedicine care pilot using Scrum-like framework within a medical residency program.

OBJECTIVES: A good health care does not only depend on good medical practice, but also needs great management of its resources, which are generally short. In this sense, PROAHSA has been training new health managers since 1972. With the arrival of the COVID-19 pandemic, it was clear that medicine will go through a new phase, where telehealth will be present in this "Improved Normal". This report is about how a pilot teleconsultation study was carried out for HCFMUSP patients through the Scrum-like framework. It is to deploy a pilot of remote assistance involving a doctor and a patient in the Ambulatory of Hepatology and Liver Transplantation of HCFMUSP. METHODS: We applied the Scrum-like framework to carry out this work with an interdisciplinary multifunctionality team. RESULTS: A full telemedicine service flow was implemented within eight weeks using existing infrastructure and resources implementing the Scrum methodology. Twenty-three teleconsultations were scheduled and eight guides built. CONCLUSION: Scrum framework has a great potential to improve the training of students and to conclude pilot projects.

A Virtual 3D Dynamic Model of Caries Lesion Progression as a Learning Object for Caries Detection Training and Teaching: Video Development Study.

BACKGROUND: In the last decade, 3D virtual models have been used for educational purposes in the health sciences, specifically for teaching human anatomy and pathology. These models provide an opportunity to didactically visualize key spatial relations that can be poorly understood when taught by traditional educational approaches. Caries lesion detection is a crucial process in dentistry that has been reported to be difficult to learn. One especially difficult aspect is linking clinical characteristics of the different severity stages with their histological features, which is fundamental for treatment decision-making. OBJECTIVE: This project was designed to develop a virtual 3D digital model of caries lesion formation and progression to aid the detection of lesions at different severity stages as a potential complement to traditional lectures. METHODS: Pedagogical planning, including identification of objectives, exploration of the degree of difficulty of caries diagnosis-associated topics perceived by dental students and lecturers, review of the literature regarding key concepts, and consultation of experts, was performed prior to constructing the model. An educational script strategy was created based on the topics to be addressed (dental tissues, biofilm stagnation areas, the demineralization process, caries lesion progression on occlusal surfaces, clinical characteristics related to different stages of caries progression, and histological correlations). Virtual 3D models were developed using the Virtual Man Project and refined using multiple 3D software applications. In the next phase, computer graphic modelling and previsualization were executed. After that, the video was revised and edited based on suggestions. Finally, explanatory subtitles were generated, the models were textured and rendered, and voiceovers in 3 languages were implemented. RESULTS: We developed a 6-minute virtual 3D dynamic video in 3 languages (English, Spanish, and Brazilian Portuguese) intended for dentists and dental students to support teaching and learning of caries lesion detection. The videos were made available on YouTube; to date, they have received more than 100,000 views. CONCLUSIONS: Complementary pedagogical tools are valuable to support cariology education. This tool will be further tested in terms of utility and usability as well as user satisfaction in achieving the proposed objectives in specific contexts.

Tele-education on leprosy: evaluation of an educational strategy.

The purpose of this research was to evaluate educational strategies applied to a tele-education leprosy course. The curriculum was for members of the Brazilian Family Health Team and was made available through the Sao Paulo Telehealth Portal. The course educational strategy was based on a constructivist learning model where interactivity was emphasized. Authors assessed motivational aspects of the course using the WebMAC Professional tool. Forty-eight healthcare professionals answered the evaluation questionnaire. Adequate internal consistency was achieved (Cronbach's alpha = 0.79). More than 95% of queried items received good evaluations. Multidimensional analysis according to motivational groups of questions (STIMULATING, MEANINGFUL, ORGANIZED, EASY-TO-USE) showed high agreement. According to WebMAC's criteria, it was considered an "awesome course." The tele-educational strategies implemented for leprosy disclosed high motivational scores.

Accuracy of store-and-forward diagnosis in leprosy.

Telemedicine might increase the speed of diagnosis for leprosy and reduce the development of disabilities. We compared the accuracy of diagnosis made by telemedicine with that made by in-person examination. The cases were patients with suspected leprosy at eight public health clinics in outlying areas of the city of São Paulo. The case history and clinical examination data, and at least two clinical images for each patient, were stored in a web-based system developed for teledermatology. After the examination in the public clinic, patients then attended a teaching hospital for an in-person examination. The benchmark was the clinical examination of two dermatologists at the university hospital. From August 2005 to April 2006, 142 suspected cases of leprosy were forwarded to the website by the doctors at the clinics. Of these, 36 cases were excluded. There was overall agreement in the diagnosis of leprosy in 74% of the 106 remaining cases. The sensitivity was 78% and the specificity was 31%. Although the specificity was low, the study suggests that telemedicine may be a useful low-cost method for obtaining second opinions in programmes to control leprosy.

Educação tecnológica hibrida blended learning adesão ao paciente hipertenso: ensaio clinico randomizado / Hybrid technology education blended learning hypertension patient support: randomized clinical trial

Avaliar a influência do uso da tecnologia educacional híbrida blended learning (ensino presencial associado por meio do ambiente virtual de aprendizado "E-Care da Hipertensão") na melhoria do controle da pressão arterial. Métodos: Ensaio Clinico Randomizado Controlado, realizado no período de novembro de 2015 a março de 2016,dividido em dois grupos: a) Grupo Hibrido com 14 pacientes submetidos a orientação individual por meio da consulta de Enfermagem a cada 20 dias com a utilização do recurso tecnológico educacional digital "E-Care da Hipertensão" ; b) Grupo Controle com 16 pacientes em que se utilizou da consulta com orientação individual por meio da consulta de Enfermagem a cada 20 dias sem o uso da tecnologia educacional. Os grupos foram acompanhados por 120 dias, utilizando o Teste de Morisk-Green, e exame da MAPA e WHOQOL-bref na randomização e aos 120 dias. Resultados: Para o Grupo Hibrido quando realizadas as comparações no início do estudo (momento da randomização) ao final 120 dias observou-se diferenças estatísticas em relação a diversas variáveis, a saber: a) circunferência abdominal, na randomização 99,61±10 vs. 96,69±8 (p=0,006); b) em relação a MAPA na pressão arterial sistólica PAS de vigília (PAS) 159,61±15mmHg vs. 143,30±19mmHg (p=< 0,001); c) pressão arterial diastólica na vigília (PAD) 106,61±12mmHg vs. 95,92±15mmHg (p= < 0,001); d) quanto a carga pressórica da MAPA na randomização para PAS na vigília obteve-se 93,28±7mmHg vs. 66,38±31mmHg (p=0,003); e) quanto aos valores da PAD 92,63±11mmHg vs. 70,96±28mmHg (p=0,002). Conclusão: Não foram observadas diferenças significativas nos resultados analisados em 120 dias com o uso da tecnologia educacional na modalidade hibrida quando comparada com o grupo controle que realizou apenas consulta individual pelo enfermeiro

The Hypertension is a chronic manageable, however, in clinical practice several difficulties in joining the therapeutic plan. In this regard, several studies analyze the influence of different educational technologies in therapeutic adhesion, but little is known about educational technology hybrid. Objective: Evaluate the influence of the use of educational technology hybrid (face-to-face education associated through the virtual environment of learning "E-Care of hypertension") in improving blood pressure control. Method: Clinical Randomized Controlled Study divided into two groups: the Hybrid Group with 14) patients undergoing individual guidance through the nursing consultation every 20 days with the use of educational technology digital feature "E-Care of hypertension"; In hybrid mode b) control group with 16 patients in which the query was used with individual guidance through the nursing consultation every 20 days without the use of educational technology. All patients in both groups were followed for 120 days and 7 queries. The research took place in the period of December 2014 to March 2017. Approved by the CEP under CAAE 08625112.7.0000.0068. Results: There were no differences with statistical significance between the groups on randomization and at the end of 120 days as socio demographic and hemodynamic variables. However when held Control Group comparison in 120 days and randomization in relation to your perception about the WHOQOL quality of lifestatistical difference was observed between the beginning of the study (randomization) 2,73±0,9 vs. 3,80±0,94 to 120 days (p=0,012). For the Hybrid Group when performed comparisons at the beginning of the study (time of randomization) the end 120 days statistics differences were observed in relation to several variables, namely: a) abdominal circumference the randomization 99,61±10 vs. 96,69±8 (p=0,006); b) for Ambulatory Blood Pressure Monitoring (ABPM) in systolic blood pressure, SBP in awake 159.61± 15mmHg vs. 143.30 ± 19mmHg (p = < 0.001); c) diastolic blood pressure (DBP) on the eve 106,61±12mmHg vs. 95,92±15mmHg (p = < 0,001);d) as the pressure load of the (ABPM) on randomization to SBP on vigiía was obtained 93,28±7mmHg vs. 66,38±31mmHg (p=0,003); e) as for the values of the SBP 92,63±11mmHg vs. 70,96±28mmHg (p=0,002); f) for the period of sleep SBP obtained value of 140,61± 15mmHg vs. 131,38± 21mmHg (p = 0,044); g) with respect to DBP the values were 86,37± 24mmHg vs. 71,06±31mmHg (p=0,039). As for the test of Morisky-Gren, was not with statistical significance differences between the Hybrid Group and the Control Group. Conclusion: There were no significant differences in the results analyzed in 120 days with the use of educational technology in hybrid mode when compared with the control group which held only individual consultation by a nurse. On the other hand, the comparison between the study group itself, proved to be effective with satisfactory results and may be an alternative to be perfected as an educational tool

Building an outpatient telemedicine care pilot using Scrum-like framework within a medical residency program

OBJECTIVES: A good health care does not only depend on good medical practice, but also needs great management of its resources, which are generally short. In this sense, PROAHSA has been training new health managers since 1972. With the arrival of the COVID-19 pandemic, it was clear that medicine will go through a new phase, where telehealth will be present in this "Improved Normal". This report is about how a pilot teleconsultation study was carried out for HCFMUSP patients through the Scrum-like framework. It is to deploy a pilot of remote assistance involving a doctor and a patient in the Ambulatory of Hepatology and Liver Transplantation of HCFMUSP. METHODS: We applied the Scrum-like framework to carry out this work with an interdisciplinary multifunctionality team. RESULTS: A full telemedicine service flow was implemented within eight weeks using existing infrastructure and resources implementing the Scrum methodology. Twenty-three teleconsultations were scheduled and eight guides built. CONCLUSION: Scrum framework has a great potential to improve the training of students and to conclude pilot projects.

The efficacy of telemedicine for ophthalmology triage by a general practitioner.

Although there are enough ophthalmologists for the Brazilian population, they are not evenly distributed throughout the country. Tele-ophthalmology may therefore be a useful tool. We have examined the feasibility of ophthalmology triage, performed by a general practitioner (GP) with remote support from an ophthalmologist. Forty patients with a variety of external and internal eye disorders were examined by the GP and also reassessed by an ophthalmologist, face to face, and then remotely by another ophthalmologist. There was agreement in 95% of the diagnoses between face-to-face and distant evaluation. The use of a digital camera and slit-lamp allowed greater accuracy of telediagnosis than the use of a digital camera alone. The GP would have referred 36 patients to an ophthalmologist, while both the local and the remote ophthalmologist saw the need for referral in 31 cases, i.e. assessment by tele-ophthalmology resulted in a 14% decrease in referrals. GP triage therefore appears to be feasible after appropriate training.

A Brazilian model of distance education in physical medicine and rehabilitation based on videoconferencing and Internet learning.

We have developed an integrated educational model in rehabilitation mediated by technology. Three teams of professionals worked to implement the interactive model based on videoconferencing, use of the Internet and three-dimensional (3-D) animated models. Two courses were created: amputee rehabilitation and back pain. Each course was divided into four phases: (1) a first videoconference; (2) Internet-based learning; (3) a second videoconference (workshop); (4) an Internet discussion list. The Internet-based learning modules were divided into topics by multiple-choice questions. Multisite videoconferences were used to connect the remote sites. Eleven animated 3-D models were created to help the teaching process. Each course had 11 modules, and each module required up to 2 h to be completed. There were 136 participants on the two courses. None of the participants, including the teachers, had had any previous experience with Internet-based learning and videoconferencing. The integrated educational model has great potential in a country the size of Brazil, where there may be difficulties in travel for patients with disabilities and for health-care professionals.

Dental students' and lecturers' perception of the degree of difficulty of caries detection associated learning topics in Brazil.

PURPOSE: It aimed to explore the degree of difficulty of caries-detection-associated-topics perceived by dental students and lecturers as pedagogical step in the development of learning objects for e-learning. METHODS: A convenience sample comprising ninety-eight subjects from different academic levels (undergraduate/graduate students and pediatric dentistry lecturers) participated. Two spreadsheets (isolated/relative) were created considering key topics in the caries detection process. The isolated evaluation intended to explore each topic in an isolated way, while the relative intended to classify, comparatively, the participants' perceived difficulty per topic. Afterwards, data were analyzed. All values on spreadsheets were combined obtaining the subject's final perception. Associations between the subjects' degree of the perceived difficulty and academic level were estimated. ANOVA was used to determine differences regarding the perception among evaluated topics in distinct groups. RESULTS: Caries histopathology and detection of proximal carious lesions were the topics perceived as the most difficult in the process of caries detection by both students and lecturers. Differentiation between an extrinsic pigmentation and a brown-spot (caries lesion) as well as differential diagnosis between caries and enamel developmental defects or non-carious lesions were considered as more difficult by undergraduates in comparison to graduates/lecturers (regression-coefficient=14.54; Standard Error=3.34; P<0.001 and 8.40, 3.31, and 0.01 respectively). CONCLUSION: Topics as histopathology and detection of proximal caries lesions were identified as the most difficult despite the academic level. However, some topics are differently perceived according to the group. These results are useful for developing pedagogical material, based on the students real learning needs/expectations.

Proposal of e-learning strategy to teach Atraumatic Restorative Treatment (ART) to undergraduate and graduate students.

BACKGROUND: The aim of this study was to evaluate e-learning strategy in teaching Atraumatic Restorative Treatment (ART) to undergraduate and graduate students. The sample comprised 76 participants-38 dental students and 38 pediatric dentistry students-in a specialization course. To evaluate knowledge improvement, participants were subjected to a test performed before and after the course. RESULTS: A single researcher corrected the tests and intraexaminer reproducibility was calculated (CCI = 0.991; 95% IC = 0.975-0.996). All students improved their performances after the e-learning course (Paired t-tests p < 0.001). The means of undergraduate students were 4.7 (initial) and 6.4 (final) and those of graduate students were 6.8 (initial) and 8.2 (final). The comparison of the final evaluation means showed a statistically significant difference (t-tests p < 0.0001). CONCLUSIONS: The e-learning strategy has the potential of improving students' knowledge in ART. Mature students perform better in this teaching modality when it is applied exclusively via distance learning.

Impact of a cybertutor in dermatological teaching.

BACKGROUND: The potential value of multimedia programs as an accessory instrument for medical education has already been demonstrated in several areas. However, most of them lack adequate validation. The authors proposed this study in order to develop and evaluate a computer multimedia program, aiming at providing a more attractive and state of the art learning tool in dermatology. METHODS: The cybertutor was developed containing clinical cases, self-education classes, and short video presentations. In order to evaluate its impact, 50 undergraduate students attending the third year of Medical School at UFRGS were randomized into two groups: group 1 was submitted to a multimedia program on a specific dermatological subject - parasite infestations, and group 2 to standard classes on the same subject. Both classes were taught by an experienced teacher, on the same subject and at the same time. In the end, the level of knowledge acquisition for the two groups was evaluated by a multiple choice test. RESULTS: The average of correct answers was 11.16 (SD = 1.625) in group 1 and 11.96 (SD = 1.645) in group 2. There were no statistically significant differences between the two groups (P = 0.09). The majority (80%) of the students who attended the cybertutor group showed interest in taking part in similar activities. CONCLUSIONS: According to this study, multimedia programs may be used for undergraduate education in Dermatology as a complementary educational tool. Contact with an instructor is still considered to be important and should be offered simultaneously.

Projeto Jovem Doutor: o aprendizado prático de estudantes de medicina por meio de atividade socioeducativa / Young Doctor Project-Health in Schools: potential learning of medical students through taking part in socio-educational activity

O trabalho mostra a potencialização no aprendizado de estudantes de medicina (graduandos) através de participação em atividade sócio-educacional (Projeto Jovem Doutor-Saúde nas Escolas - PJD) usando recursos de educação interativa, vídeos, computação gráfica 3D e estruturas produzidas por impressora 3D (Homem Virtual). O PJD usou educação híbrida, reunindo plataforma educacional, ferramentas de mídias sociais, webconferências e objetos educacionais de aprendizagem com dinâmicas presenciais na estruturação de sistemática que proporcionou aprendizado flexível e em serviço, agregando experiências e conhecimentos complementares aos graduandos participantes do projeto. Baseado em conteúdos que seguiam as prioridades do Ministério da Saúde do Brasil, os graduandos puderam conhecer aspectos da Atenção Primária, desenvolver várias atitudes e aprender conhecimentos não previstos na grade curricular médica normal. Por meio de responsabilidades atribuídas a cada um, os graduandos desenvolveram postura ativa para aprender os assuntos de forma contextualizada (pesquisa de temas, debate com professores e profissionais especialistas). Ao final do projeto, 81,9% (8 de 11) graduandos do PJD responderam que tiveram uma formação crítica, reflexiva e maior habilidade em comunicação. Todos (100%), consideraram ter ampliado a capacidade de trabalho em equipe e conhecimentos em novas tecnologias. A interação dos graduandos com professores das escolas onde foram implantados o PJD levou-os a se tornarem "símbolos" para alunos do ensino fundamental II, promoveu a percepção dos futuros médicos sobre o seu papel no contexto social da saúde e estimulou a formação de vínculo social com alunos do ensino fundamental II. O aprendizado em serviço, através de uma ação sócio-educacional, sob orientação de professores e profissionais especialistas, é uma boa forma de estimular o aprendizado dos alunos de medicina e está em conformidade com as diretrizes de 2014 do CNE/MEC para graduação em Medicina.

This article presents the learning potentiation of medical students (undergraduates) through participation in socio-educational activity (Young Doctor Project-Health in Schools -YDP), using interactive educational resources, videos, 3D computer graphics and by 3D printer produced structures (Virtual Man). The YDP used hybrid education, bringing together educational platform, social media tools, web conferencing and educational learning objects with dynamic presence in the system structuring that provided flexible learning and in service, gathering experience and complementary expertise to the participants. Based on content that followed the priorities of the Ministry of Health of Brazil, the graduate students were able to learn aspects of primary care, develop various attitudes and acquire knowledge not covered by conventional medical curriculum. By being assigned to specific responsibilities, students developed active approach to learning the subjects in context (subjects research, discussion with teachers and professional experts). At the end of the project, 81.9% (8 of 11) of the YDP academics said that they had a critical training, reflective and greater communication skills. All (100%), considered to have expanded the ability to work in teams and knowledge in new technologies. The interaction of the undergraduate with teachers from cities where the YDP were implemented led them to become "symbols" for middle school, promoted the perception of future doctors about their role in the social context of health and stimulated the formation of social bond with middle school. Learning in service, through a socio-educational action, under the guidance of teachers and professional experts is a good way to encourage the learning of medical students and complies with the guidelines of 2014 CNE / MEC for undergraduates in medicine.