Medical students' reflections on surgical educators' professionalism: Contextual nuances in the hidden curriculum.

INTRODUCTION: Surgical educators' professional behavior constitutes a hidden curriculum and impacts trainee's professional identity formation. This study explores the nuances of professional behaviors as observed in varying surgical settings. METHODS: 411 Transcripts originated from essays written by MS3 students during their surgical clerkship from 2010 to 2016 were collated. Employing a qualitative research methodology, we conducted a thematic analysis to uncover specific meaning emerging from medical student reflections' on surgical professionalism. RESULTS: In clinics, taking time and protecting patient privacy; in the OR, control over emotion during difficult situations and attention to learners; and in the inpatient setting, showing accountability above normal expected behavior were noted as professional. Similarly, unprofessional behaviors in these contexts paralleled lack of these attributes. CONCLUSIONS: Behaviors observed and the attributes of professionalism in the surgical learning environment have contextual nuances. These variations in professionalism can be utilized in deliberate development of professionalism in surgery.

Overcoming a Hostile Work and Learning Environment in Academic Surgery-Tools for Change at Every Level.

Mistreatment has been documented as a negative factor in the learning environment for the past 30 y but little progress has been made to determine an effective way to significantly improve these interactions. Faculty may also be victims of a hostile work environment as well, although frequency has not been well-measured or reported. In fact, it may be difficult to identify and address mistreatment and hostility in the work place within the commonly established surgical culture. Thus, efforts to define, identify, and address workplace mistreatment or hostility are crucial to the success of the academic surgical environment. This article summarizes presentations and panel discussion that took place at the 2019 Academic Surgical Congress organized by the Association for Academic Surgery and the Society of University Surgeons. Definitions of mistreatment and hostility were provided, as well as information regarding occurrence. Tools for addressing mistreatment in the work environment and tips for creating a positive environment were presented and discussed.

Revolución flexneriana y su influencia en la educación médica / Flexnerian revolution and its influence on medical education

La evolución de la educación médica en América tiene un momento clave en la historia, definido con el estudio de las escuelas de medicina de Estados Unidos y Canadá realizado por Abraham Flexner en 1910, el cual dividió en su momento a la educación médica en una etapa pre-flexneriana y post-flexneriana. Este estudio caracterizó al sistema educativo médico en Estados Unidos como un sistema deficiente, carente de regulación y sin estándares establecidos. La medicina, enseñada y ejercida con pocos principios científicos representaba un importante problema de salud y seguridad poblacional. Ante este panorama, la Asociación Americana de Medicina decide promover una evaluación de la mayoría de las escuelas de medicina con el fin de proponer cambios en el sistema educativo médico. Flexner, un teórico educativo, realiza el análisis curricular, de evaluación y prácticas ejercidas en 155 centros educativos. De su reporte se desprende la propuesta conocida como Revolución Flexneriana la cual hace tambalear el sistema educativo médico en Norteamérica en 1910. Enfatizando falta de estandarización, integración, investigación y deficiencia de la formación de médicos con identidad profesional, Flexner propuso cambios que en su momento llegaron a regir la enseñanza de los médicos en Norteamérica. Se realizó una revisión bibliográfica utilizando búsqueda manual en PubMed y Google Scholar para hacer descripcion de los aspectos históricos de la educación médica en Norteamérica, su influencia en Latinoamérica y la prevalencia actual de la integración curricular en muchas escuelas de medicina...(AU)

Have We Come as Far as We Had Hoped? Discrimination in the Residency Interview.

OBJECTIVE: The primary objective was to use a pilot survey of fourth-year medical students at our institution to determine if female residency applicants were asked potentially illegal questions regarding family status and childbearing more frequently than male applicants. Secondary objectives included comparing the use of potentially illegal questions in surgical versus nonsurgical specialties and between community and academic residency programs. DESIGN: A 20-item questionnaire was distributed to all fourth-year medical students at the University of Kansas School of Medicine. Data were analyzed in SPSS using descriptive statistics, bivariate analysis, and multivariate analysis. SETTING: University of Kansas Health System, Tertiary Care Center. PARTICIPANTS: Fourth-year medical students from the University of Kansas School of Medicine. RESULTS: There were 57 survey respondents (51% male and 49% female). Female applicants were more likely to report being asked about their desire to have a family than male applicants (32% vs. 3%, respectively, p = 0.041). However, male and female students were equally likely to report being asked specifically if they had or intended to have children (p = 0.194). No significant differences were found in potentially illegal question-asking between surgical and nonsurgical specialties or between community-based and academic programs. CONCLUSIONS: Although women now represent 47% of the applicant pool, gender discrimination in the residency interview has not been eradicated. Women are more likely to report potentially illegal questions regarding their desire to have a family on residency interviews than men. Community and academic programs appear to ask similar numbers and types of potentially illegal questions. Further study is warranted to determine if these findings apply to the entire applicant pool. Further education of interviewers is necessary regarding potentially illegal questions during the residency interview process.

The 1951 Harvard student uprising against the intern match.

In the fall of 1951, a group of Harvard medical students led by W. Hardy Hendren, III organized a national movement against the newly instituted match that would assign graduating seniors to hospital internship programs. Before then, hospitals with intern positions to fill rushed to secure commitments from students, who in turn accepted the first decent offer that came their way. Knowing that students could not risk waiting for a better offer, hospitals pushed them into making early commitments. When some students began getting offers in their junior and sophomore years, medical schools, professional groups, and hospitals organized the National Inter-association Committee on Internships to deal with the issue. The intern match was thus organized and scheduled to take place in 1952. When the plan was announced in mid-October 1951, Hendren recognized that the proposed algorithm placed students at a disadvantage if they did not get their first choice of hospitals. Facing resistance at every step from the National Inter-association Committee on Internships and putting his standing at Harvard Medical School at risk, Hendren led a nationwide movement of medical students to change the procedure to one that favored students' choices. Their success <1 month later established in the inaugural match the fundamental ethic of today's National Resident Matching Program to favor students' preferences at every step of the process.

Medical Education Capacity-Building Partnerships for Health Care Systems Development.

Health care workforce development is a key pillar of global health systems strengthening that requires investment in health care worker training institutions. This can be achieved by developing partnerships between training institutions in resource-limited and resource-rich areas and leveraging the unique expertise and opportunities both have to offer. To realize their full potential, however, these relationships must be equitable. In this article, we use a previously described global health ethics framework and our ten-year experience with the Makerere University-Yale University (MUYU) Collaboration to provide an example of an equity-focused global health education partnership.

Power Day: Addressing the Use and Abuse of Power in Medical Training.

PROBLEM: Medical student mistreatment, as well as patient and staff mistreatment by all levels of medical trainees and faculty, is still prevalent in U.S. clinical training. Largely missing in interventions to reduce mistreatment is acknowledgement of the abuse of power produced by the hierarchical structure in which medicine is practiced. APPROACH: Beginning in 2001, Yale School of Medicine has held annual "Power Day" workshops for third year medical students and advanced practice nursing students, to define and analyse power dynamics within the medical hierarchy and hidden curriculum using literature, guest speakers, and small groups. During rotations, medical students write narratives about the use of power witnessed in the wards. In response to student and small group leader feedback, workshop organizers have developed additional activities related to examining and changing the use of power in clinical teams. OUTCOME: Emerging narrative themes included the potential impact of small acts and students feeling "mute" and "complicit" in morally distressing situations. Small groups provided safe spaces for advice, support, and professional identity formation. By 2005, students recognized residents that used power positively with Power Day awards and alumni served as keynote speakers on the use of power in medicine. By 2010, departments including OB/GYN, surgery, psychiatry, and paediatrics, had added weekly team Power Hour discussions. NEXT STEPS: The authors highlight barriers, benefits, and lessons learned. Barriers include the notion of clinical irrelevance and resistance to the word "power" due to perceived accusation of abuse. Benefits include promoting open dialogue about power, fostering inter-professional collaboration, rewarding positive role modelling by residents and faculty, and creating a network of trainee empowerment and leadership. Furthermore, faculty have started to ask that issues of power be addressed in a more transparent way at their level of the hierarchy as well.

A educação em valores e as práticas morais nas disciplinasde bioética de faculdades de medicina no Estado de São Paulo / Education in values and moral practices in bioethics courses in medical colleges in the state of São Paulo

Apresente pesquisa analisou as práticas morais e os valores trabalhados como parte do processo de ensino-aprendizagem nas disciplinas de Bioética. Buscou-se ainda compreender qual a contribuição de tais práticas morais e de valores para auxiliar na formação moral na visão de alunos e professores dos cursos de graduação em Medicina. Para isso, foram investigadas cinco faculdades de Medicina no Estado de São Paulo, e na pesquisa de campo foram aplicados: aos estudantes, um total de 206 questionários fechados, e cinco grupos focais com a participação de 56 alunos; e foi realizado um total de nove entrevistas com os professores responsáveis pelas disciplinas de Bioética das faculdades que participam da pesquisa. Posteriormente, os questionários foram analisados quantitativamente, e as falas dos grupos focais e entrevistas, analisadas qualitativamente, utilizando o método da análise categorial de Bardin, sendo transcritas, analisadas e classificadas de acordo com as categorias encontradas. Através das respostas dos alunos, comprovou-se que as práticas morais podem influenciar para gerar boas discussões em sala de aula e estimular os estudantes: a aprender a respeitar, a ouvir o outro, a expor suas ideias, a dialogar, a tomar decisões e a ser crítico também no seu desenvolvimento moral. E que as práticas morais que mais mobilizaram e possibilitaram esse aprendizado moral foram: as práticas deliberativas, como discussão de filmes e/ou séries de TV, discussões de casos, roleplaying – dramatização, discussões de debate e palestras, e, em uma menor proporção, a prática normativa, neste caso, aula expositiva, porém aula dialógica, em que tenham participação de sujeitos ativos. Verificou-se a importância em se discutir os valores em sala de aula, sendo considerados os mais importantes, segundo os alunos e professores: respeito, tolerância, empatia, liberdade e autonomia. Deste modo, a disciplina de Bioética e as práticas morais, enquanto metodologia para a educação em valores, podem incrementar a maturidade moral dos estudantes de Medicina após um planejamento adequado à sua prática e vivência, através de uso estruturado e o devido conhecimento das finalidades dos métodos de suas técnicas, para que sejam alcançadas e desenvolvidas as capacidades de inteligência moral e a construção da personalidade moral dos alunos. Porém, são necessários mais estudos para o desenvolvimento de métodos de avaliação dessas práticas morais, além de evidenciar a validade de que estas podem mobilizar as capacidades e estruturas do raciocínio moral e formar agentes morais mais competentes.

This research analyzed the teaching-learning process between moral practices and the values used in the disciplines of Bioethics and how they can contribute to the moral education of students of undergraduate courses at Medical schools. For this, five medical schools were investigated in the State of São Paulo, and field research were applied: students, a total of 206 closed questionnaires and five focus groups with the participation of 56 students; and it was performed a total of nine interviews with teachers responsible for the disciplines of Bioethics of the colleges participating in the survey. Subsequently, the questionnaires were analyzed quantitatively, and the speeches of the focus groups and interviews, analyzed qualitatively using the method of categorical analysis of Bardin, being transcribed, analyzed and classified according to the categories found. Through the students’ responses it was proved that moral practices can influence to generate good discussions in the classroom and encourage students to learn to respect, listen to each other, share ideas, discuss, make decisions, and be critical in their moral development. And the moral practices that mobilized more and enabled this moral learning were deliberative practices, such as discussion of movies and/or TV series, case discussions, roleplaying, discussion on debates and lectures, and a smaller proportion was the legislative practice, in this case we can mention the lecture, but the dialogical class that have active participation and subjects. The importance of discussing the values in the classroom, and that the most important was found, according to the students and professors were: respect, tolerance, empathy, freedom and autonomy. Therefore, the discipline of Bioethics and moral practices as a methodology for education in values can increase the moral maturity of Medical students after appropriate practice and experience of planning through structured use and proper knowledge of the purposes of the methods of their techniques, to be achieved and developed the capabilities of moral intelligence and the construction of the moral character of students. However, it is necessary more studies to the development of the methods of assessment of these moral practices and which highlights the validity of these, mobilizing the capacities and structures of moral reasoning and constitute more competent moral agents.

Why medical schools are tolerant of unethical behavior.

The exposure to unethical and unprofessional behavior is thought to play a major role in the declining empathy experienced by medical students during their training. We reflect on the reasons why medical schools are tolerant of unethical behavior of faculty. First, there are barriers to reporting unprofessional behavior within medical schools including fear of retaliation and lack of mechanisms to ensure anonymity. Second, deans and directors do not want to look for unethical behavior in their colleagues. Third, most of us have learned to take disrespectful circumstances in health care institutions for granted. Fourth, the accreditation of medical schools around the world does not usually cover the processes or outcomes associated with fostering ethical behavior in students. Several initiatives promise to change that picture.

Vinte e dois anos de um Curso Informativo de Cirurgia Plástica / 22 years of an Informational Overview Course on Plastic Surgery

Há 22 anos, um curso informativo de cirurgia plástica para acadêmicos de medicina, promovido pela integração de quatro escolas médicas, três universidades e pela regional da Sociedade Brasileira de Cirurgia Plástica vem sendo ministrado, contribuindo para a educação médica em Curitiba, uma cidade de dois milhões de habitantes, em uma área metropolitana de aproximadamente três milhões de pessoas. Este curso informativo proporciona uma visão abrangente da especialidade, para que acadêmicos de medicina possam avaliar sua vocação pessoal para o exercício da cirurgia plástica, além de fornecer conhecimentos básicos indispensáveis à formação de qualquer médico. Anualmente o curso é ministrado em 47 horas e ofertado para 120 alunos. O programa inclui 70% de "cirurgia reconstrutiva" e 30% de "cirurgia estética", sendo a maioria dos professores membros titulares da Sociedade Brasileira de Cirurgia Plástica. Nos primeiros 19 anos de atividade (1992 a 2010), 4,6% dos alunos que concluíram o curso cursaram residência em cirurgia geral, foram admitidos na residência em cirurgia plástica e hoje fazem parte da Sociedade Brasileira de Cirurgia Plástica. O curso tornou-se um importante instrumento de educação médica, complementando o currículo de quatro escolas médicas e promovendo a cirurgia plástica como especialidade única e indivisível, enfatizando a importância da prova de especialista em cirurgia plástica e a conveniência da escolha e da indicação destes especialistas para a realização de qualquer procedimento no âmbito da cirurgia plástica.

For 22 years, a reproducible introductory overview course on plastic surgery for medical students, cosponsored by four medical schools, three universities and the regional chapter of the Brazilian Society of Plastic Surgery (SBCP), has contributed to medical education in Curitiba, a city of 2 million, and serving a metropolitan population of nearly 3 million people. This course helps medical students determine if plastic surgery is the right choice for them and provides valuable information about the specialty itself that will serve all participants as they go forward into their chosen fields, as plastic surgeons or not. This broad-ranging 47 hour course, limited to 120 students, is fully enrolled every year. Its content is weighted approximately 70% toward reconstructive plastic surgery and 30% toward aesthetic plastic surgery. Most lectures are presented by plastic surgeons who are full members of the SBCP. During its first 19 years of operation, 4.6% of the students completing the course have gone on to a general surgery residency followed by a plastic surgery residency, and are current SBCP members. The course has become a valuable educational and marketing tool for the regional chapter of the SBCP. It promotes the unique scope of the specialty and increases awareness among participants, as well as among their many personal and professional contacts (currently and in the future) about the benefits of becoming fully qualified, board-certified plastic surgeons.

Accounting for social accountability: developing critiques of social accountability within medical education.

BACKGROUND: The concept of the social accountability of medical schools has garnered many followers, in response to a broad desire for greater social justice in health care. As its use has spread, the term 'social accountability' has become a meta-narrative for social justice and an inevitable and unquestionable good, while at the same time becoming increasingly ambiguous in its meaning and intent. In this article, we use the lenses of postmodernism and critical reflexivity to unpack the multiple meanings of social accountability. In our view, subjecting the concept of 'social accountability' to critique will enhance the ability to appraise the ways in which it is understood and enacted. DISCUSSION: We contend that critical reflexivity is necessary for social accountability to achieve its aspirations, and hence we must be prepared to become accountable not only for our actions, but also for the ideologies and discourses underlying them.

Aprender a observar desde el inicio de los estudios médicos es una necesidad formativa / to observe from the beginning of medical studies is a training need

Fundamento: la habilidad observar tiene importancia en la educación y práctica médicas, se aplica ante situaciones que van desde los estudios anatómicos, hasta el trabajo sistemático con distintos métodos y procedimientos propios de la profesión; no obstante los resultados actuales en el ciclo básico biomédico son aún insuficientes. Objetivo: profundizar en las dimensiones conceptuales, microcurriculares y didácticas de la habilidad observar en los estudios básicos biomédicos. Metodología: se realizó revisión documental, observaciones científicas a actividades docentes durante el curso 2012/2013 y se aplicó cuestionario a profesores. Resultados: no se constató claridad conceptual en los profesores con respecto a la habilidad observar en los estudios médicos. En la dimensión microcurricular se comprobó falta de sistematicidad en la inclusión de la habilidad observar en los sistemas de objetivos y habilidades. En las observaciones realizadas se constató un pobre accionar de profesores y estudiantes en la formación y el desarrollo de la habilidad observar; menos aún para evaluar el dominio alcanzado. Conclusiones: el conocimiento conceptual constatado, las condiciones de diseño microcurricular actual y las características del proceso de enseñanza aprendizaje de las ciencias básicas biomédicas, no favorecen una adecuada formación y desarrollo de la habilidad observar en los estudios básicos biomédicos.

Background: the observation ability is important in medical education and practice, it is applied to situations, ranging from anatomical studies to the systematic work with different methods and procedures of the profession; however actual results in the biomedical basic cycle are still insufficient. Objective: to deepen into the conceptual, microcurricular and didactical dimensions of the observation ability in basic biomedical studies. Methodology: a literature review was made as well as scientific observations on teaching activities during the 2012/2013 academic course and a questionnaire to teachers was applied. Results: no conceptual clarity was found in the teachers regarding the observation ability in medical studies. In the microcurricular dimension lack of systematic inclusion of the observation ability in the systems of objectives and skills was found. In the performed observations poor acting by the teachers and students in the training and development of the observation ability was found; still less to assess the achieved mastery. Conclusions: the conceptual knowledge found, the current microcurricular design conditions and the characteristics of the teaching-learning process of the basic biomedical sciences, do not favor the proper training and development of the observation ability in basic biomedical studies.

Perfiles de calificaciones obtenidas por estudiantes de medicina en la asignatura Salud Pública durante los cursos académicos desde 2005 hasta 2008 / Profiles of grades obtained by medical students in the subject Public Health during the academic years from 2005 to 2008

Introducción: En el sistema de educación médica superior cubano, la evaluación del aprendizaje implica el control y la valoración de los conocimientos, las habilidades y los hábitos, además de los modos de actuación que los estudiantes van adquiriendo a través del proceso docente-educativo. Objetivo: Comparar los resultados de las evaluaciones finales de la asignatura Salud Pública durante los cursos académicos 2005-2006, 2006-2007 y 2007-2008, con las restantes asignaturas que se impartieron en el quinto año de la carrera de medicina durante esos períodos. Métodos: Se realizó un estudio descriptivo y retrospectivo de los 790 estudiantes que cursaron quinto año en la Facultad de Ciencias Médicas No. 2 de Santiago de Cuba durante los 3 cursos académicos (del 2005 al 2008). Resultados: En la serie se evaluaron las calificaciones de todos los alumnos en las 11 asignaturas del plan de estudios y se obtuvo que en la materia Salud Pública en los 3 cursos de referencia, 8 estudiantes obtuvieron 2 puntos, 57 aprobaron con 3 puntos, 255 tuvieron 4 puntos y 470 calificaron con 5. Solo en la asignatura Urología el porcentaje de estudiantes (34,2) con puntuación de 5 estuvo en un perfil esperado, en tanto Salud Pública estuvo por encima de esa cifra (59,5 por ciento). Respecto a las calificaciones de 4, hubo 32,3 por ciento de educandos en Salud Pública, 55,1 por ciento en Urología y de 20 a 23 por ciento en el resto de las asignaturas comparadas. Igualmente, al analizar la notas de 3 y 2, la asignatura Salud Pública tuvo el mayor índice de alumnos (7,2 por ciento), seguida de Urología (6,8 por ciento) para la primera, contrariamente a la segunda, que mostró primacía en la materia Urología (3,9 por ciento), seguida de Salud Pública (1,0 por ciento); el resto de las asignaturas se mantuvieron con cifras más bajas.Conclusiones: El análisis de la casuística mostró un patrón de excesivas calificaciones de 4 y 5, por lo que es...

Introduction: In the Cuban higher medical education system learning evaluation involves control and assessment of knowledge, skills and habits, as well as the performance that students are acquiring through the educational process. Objective: To compare the results of the final evaluations of the subject Public Health during the academic years 2005-2006, 2006-2007 and 2007-2008 with the other subjects that were taught in the fifth year of the medical career during those periods. Methods: A descriptive and retrospective study was carried out in 790 students who completed the fifth year in the Medical College 2 of Santiago de Cuba for three academic years (2005-2008). Results: In the series grades of all students were evaluated in the 11 subjects of the curriculum and it was found that in the Public Health subject during these 3 reference years, 8 students scored 2, 57 passed with grades 3, 255 with 4 and 470 students with 5. Only in Urology subject the percentage of students (34.2) with grades 5 was in an expected profile, while Public Health was above that rate (59.5 percent). For grades 4 there were 32.3 percent of students in Public Health, 55.1 percent in Urology and 20 to 23 percent in other subjects. Similarly, when analyzing grades of 3 and 2, Public Health subject had the highest rate of students (7.2 percent), followed by Urology (6.8 percent) for the former, unlike the latter, which predominated in the Urology subject (3.9 percent), followed by Public Health (1.0 percent); the remaining subjects were maintained with lower rates. Conclusions: The analysis of cases showed a pattern of excessive grades of 4 and 5, so that it is necessary to deepen the study of factors that influence the evaluation process of these subjects. Also, it was felt that it would be interesting to compare the grade profiles with those of other colleges in the country

Evaluation of academic scientists' responses to situations that pose a conflict of interest.

The industry-academy relationship has many benefits, but it also has potential drawbacks, including potential conflicts of interest (e.g., when the profit motives of a private company unduly influence academic responsibilities). To date, policies intended to regulate or manage financial conflicts of interest appear to be unsatisfying and inadequate. The present study examined predictors of the responses of academic scientists and clinicians to hypothetical situations in which financial and other conflicts of interest may arise. Academic scientists and clinicians at five medical schools completed an anonymous survey that included vignettes that posed a potential conflict of interest. Participants indicated the likelihood that they would engage in specific actions to avoid conflicts of interest. Findings indicated that junior faculty and those whose departments received more federal grant money were more likely to respond in ways that could create conflicts of interest (ps < .05). These results suggest that various sub-groups of faculty may require different approaches to appropriately avoid or manage financial conflicts of interest. These findings may contribute to the development of new policies that deal more effectively with conflicts of interest.

Novas tendências, velhas atitudes: as distâncias entre valores humanísticos e inter-relações observadas em um espaço docente e assistencial / New trends, old attitudes: the gaps between humanist values and observed interrelations in a teaching and patient care setting

Historicamente, a medicina, enquanto arte e ciência, esteve ligada a bases humanísticas. Após se distanciar destes valores no século 19, tende, atualmente, a recuperar estas origens. Às escolas médicas cabe formar profissionais comprometidos com todos os determinantes do processo saúde-doença. Analisaram-se qualitativamente dados de observações realizadas nos cenários coletivos de um ambiente docente e assistencial de uma escola médicado Sul do Brasil.Os objetos de estudo foram os espaços físicos, em suas possibilidades e limitações, e as ações e atitudes de usuários, docentes, funcionários e, especialmente, de alunos em atividades práticas nos ambientes da unidade, ao se detalharem aspectos de comunicação entre os grupos, instrumentos de empoderamento e diferenças na estruturação de cinco ambulatórios de especialidades médicas. Em 40 horas de observações, vínculos superficiais, raras atitudes de acolhimento e de respeito como outro, distanciamento na produção de cuidado em saúde e comportamentos inoportunos entre colegas marcaram vivências cotidianas ainda distantes dos ideais de humanização. Pretende-se contribuir para revalorizar a dimensão humana dos processos de ensino e aprendizagem desta escola médica, no sentido de preparar egressos instrumentalizados para conhecer, entender e atuar de maneira comprometida, afetiva e efetiva nas novas tendências e demandas do setor saúde.

Historically, as an art and science, medicine was associated with humanist values. After distancing it self from such values in the 19th century, medicine is currently tending to reclaim its origins. Medical schools bear the responsibility for training professionals committed to dealing with all the determinants of the health-disease process. This study features a qualitative analysis of data from observations performed in collective scenarios within a teaching and patient care setting in amedical school in southern Brazil. The objects of the study were the physical settings and their possibilities and limitations, and the actions and attitudes of users, faculty, employees, and especially students involved in practical activities in the department, describing communications aspects among the groups, instruments for empowerment, and differences in the structuring of outpatient clinics in fivemedical specialties. Forty hours of observation revealed daily experiences that were still far fromthe ideals of humanization, displaying superficial relations, rare attitudes of care andrespect for others, aloofness in patient care, and inopportune behaviors among colleagues. The article aims to contribute to a revaluation of the human dimension in the teaching and learning processes in medical school, in the sense of preparing graduates to know, understand, and act in a committed, affective, and effective way in accordance with the health sector's new trends and demands.

Avaliação do ensino de Bioética nas faculdades de medicinado estado de São Paulo / Evaluation of the Bioethics teaching at medical colleges of São Paulo state

Introdução: Durante muito tempo focada apenas no ensino de questões pertinentes à Deontologia e Medicina Legal, a educação ética nas escolas Médicas brasileiras passa por um momento de grandes mudanças. Devido ao descompasso entre o enorme progresso da tecnologia e a maturidade das reflexões morais sobre suas conseqüências, surge uma crescente necessidade da inserção da Bioética nos cursos médicos, a fim de despertar no graduando um maior conteúdo humanístico. Objetivo: Caracterizar como é realizado o ensino da Bioética no Estado de São Paulo, avaliar como os alunos atuam tendo esta disciplina no currículo e se houve alguma mudança no comportamento dos acadêmicos em relação ao seu ingresso no curso. Materiais e Métodos: Foi realizado com 179 alunos, segregados em 23 Faculdades de Medicina do Estado de São Paulo. Os alunos responderam um questionário contendo treze perguntas fechadas e sete questões sob modelo de um caso clínico. Resultados: Este trabalho constou com 70,7% de participação dos alunos no estudo. Cento e sessenta e seis alunos (92,7%) responderam que a disciplina de Bioética estava presente na sua grade curricular. A forma com que tal disciplina é ensinada aos alunos predominou-se nas aulas teóricas em 72,3% dos casos. O tema das questões que apresentaram maior porcentagem de erros foi transfusão sanguínea em Testemunha de Jeová e portador de Vírus da Imunodeficiência Adquirida que não aceita contar tal fato à companheira. O último ano da graduação foi o que mais acertou as questões. Conclusões: As atividades relacionadas à Bioética se dão na grande maioria das vezes sob a forma de aulas teóricas, podendo ser uma das responsáveis pelo grande desinteresse que os alunos da graduação de medicina têm pela referida disciplina. Este desinteresse dos alunos contribui para a formação de médicos menos humanizados no futuro, com substancial distanciamento médico-paciente.

Introduction: For a long time focused only on teaching pertinent questions to Deontology and Medical jurisprudence, the ethical education in Brazilian Medical Schools has been through a dramatic breakthrough.Due to the unbalance between the out standing development of technology and the maturity of moral reflections upon its consequences, the insertion of Bioethics in medical courses appears to be an increasing requirement in order to arouse a higher humanistic interest in undergraduate students. Objective: To characterize how Bioethics has been taught in the State of São Paulo; to evaluate the students behavior regarding the insertion of this subject as part of the curriculum; and to evaluate if there has been changes, if any, in students behavior in relation to their admission in the course. Materials and Methods: The study was carried out with 179 students, gathered in 23 Medical Colleges of São Paulo State. A questionnaire with 13 closed questions and seven questions concerning a clinical case as a model were answered by the students. Results: The study comprised 70.7% of the student population. The answers obtained were as follows: 166 (92.7%) students reported that Bioethics was present as a component of the formal curriculum. The predominant modality of teaching Bioethics is theoretical in 72.3% of the courses. The questions which presented greater percentage of errors were Jehovah’s Witness blood transfusion and AIDS patients who do not accept sharing the burden of the disease with his/her partner. The seniors have given the most accurate answers. Conclusions: Most of the times, the activities related to Bioethics are only performed theoretically. This modality of teaching is hold responsible for the great indifference showed by the undergraduate medicalstudents. This indifference showed by the students contributes for the education of less humanized physicians, substantially jeopardizing the doctor/patient relationship.