Diversity Is Not Enough: Advancing a Framework for Antiracism in Medical Education.

Medical students, residents, and faculty have begun to examine and grapple with the legacy and persistence of structural racism in academic medicine in the United States. Until recently, the discourse and solutions have largely focused on augmenting diversity across the medical education continuum through increased numbers of learners from groups underrepresented in medicine (UIM). Despite deliberate measures implemented by medical schools, residency programs, academic institutions, and national organizations, meaningful growth in diversity has not been attained. To the contrary, the UIM representation among medical trainees has declined or remained below the representation in the general population. Inequities continue to be observed in multiple domains of medical education, including grading, admission to honor societies, and extracurricular obligations. These inequities, alongside learners' experiences and calls for action, led the authors to conclude that augmenting diversity is necessary but insufficient to achieve equity in the learning environment. In this article, the authors advance a 4-step framework, built on established principles and practices of antiracism, to dismantle structural racism in medical education. They ground each step of the framework in the concepts and skills familiar to medical educators. By drawing parallels with clinical reasoning, medical error, continuous quality improvement, the growth mindset, and adaptive expertise, the authors show how learners, faculty, and academic leaders can implement the framework's 4 steps-see, name, understand, and act-to shift the paradigm from a goal of diversity to a stance of antiracism in medical education.

Expansão de vagas e qualidade dos cursos de Medicina no Brasil: Em que pé estamos? / Expansion of vacancies and quality of medical courses in Brazil: Where do we stand?

Resumo: Introdução: A educação médica no Brasil vem enfrentando um importante processo de expansão. Essa realidade foi fortemente influenciada por programas e políticas educacionais implementados principalmente nas últimas décadas. Objetivo: O estudo teve como objetivo traçar um panorama da formação e da avaliação dos cursos de graduação em Medicina no contexto nacional. Método: Foi realizada uma pesquisa documental e descritiva, de abordagem quantitativa. O levantamento de dados ocorreu por meio de dados provenientes da Sistemática de Avaliação Nacional da Educação Superior do Ministério da Educação disponibilizado pelo Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira, órgão que coordena e gerencia dados relativos aos processos de regulação, avaliação e supervisão da educação superior no sistema federal de educação. Foram analisados 20 anos de oferta de cursos de Medicina no Brasil (2000-2019). Resultados: No período em estudo, o número de escolas médicas apresentou um crescimento de 214,9%. No total, analisaram-se 337 cursos de graduação em Medicina em atividade vinculados a instituições de ensino superior públicas (35%) e privadas (65%), perfazendo 34.585 vagas anuais ofertadas. Os cursos estão distribuídos nas 27 unidades federativas brasileiras, com maior e menor concentração de vagas e escolas médicas nas Regiões Sudeste e Norte, respectivamente. A média nacional do número de vagas/ano foi de 1.280,9 vagas/ano e da razão vagas/habitantes foi de 16,5 vagas/100 mil habitantes. A maioria dos cursos obteve conceito três nos indicadores de qualidade propostos pelo Ministério da Educação. Conclusão: O ensino da Medicina no Brasil vem passando por importante processo de expansão, e este é fundamentalmente privado e mal distribuído pelo país, e apresenta indicadores de qualidade mínimos para manutenção do seu funcionamento.

Abstract: Introduction: Medical education in Brazil is facing an important expansion process. This reality has been strongly influenced by educational programs and policies implemented mainly in the last few decades. Objective: The study aimed to provide an overview of the formation and evaluation of undergraduate medical courses in the national context. Method: A documentary and descriptive study was conducted, with a quantitative approach. Data was collected from the National Higher Education Assessment System of the Ministry of Education, made available by the Anísio Teixeira National Institute of Educational Studies and Research, the body that coordinates and manages data related to the regulation, evaluation and supervision processes of higher education in the federal education system. Twenty years of medical courses offered in Brazil (2000-2019) were analyzed. Results: In the period under study, the number of Medical Schools grew by 214.9%. In total, 337 active undergraduate medicine courses linked to public (35%) and private (65%) higher education institutions were analyzed, totaling 34,585 annual vacancies offered. The courses are distributed in the 27 Brazilian federative units, with a higher and lower concentration of places and Medical Schools in the Southeast and North regions, respectively. The national average number of vacancies/year was 1280.9 vacancies/year and the vacancy/inhabitants ratio was 16.5 vacancies/100 thousand inhabitants. Most of the courses obtained a grade three in the quality indicators proposed by the Ministry of Education. Conclusion: It was concluded that: i) the teaching of Medicine in Brazil has been going through an important expansion process, ii) that it is fundamentally private, iii) poorly distributed throughout the country, and iv) it presents minimum quality indicators for maintaining its operation.

Desenvolvimento docente pós-COVID-19: mudanças ou troca de cenário? / Teacher development after COVID-19: changes or just a change of scenario?

Resumo: Introdução: O mundo tem milhões de infectados pelo SARS-CoV-2, e o desfio permanece em 2021, com a vacinação e o aparecimento das novas cepas. Este é um texto sobre reflexões de como a pandemia está mobilizando as escolas médicas e se as mudanças induzidas pela emergência sanitária nos paradigmas pedagógicos serão revertidas em mudanças culturais. Desenvolvimento: A experiência de confinamento tem sido emocionalmente rica, entremeada por desafios, mergulhos pedagógicos reflexivos e muito trabalho. Analisamos o confronto entre a pandemia e as escolas médicas, com ênfase nos questionamentos a respeito das adaptações e se serão revertidas em mudanças culturais. O desenvolvimento docente não tem sido priorizado nas instituições de educação médica, e a troca do presencial para o remoto não garante mudanças. Conclusão: O docente tem papel nuclear na formação de médicos com competência, ética e humanidade. É necessário avançar, para além do brilho da hiperconectividade, com a instalação de um fórum permanente sobre desenvolvimento docente.

Abstract: Introduction: Millions of people around the world are infected with the SARS-CoV-2 virus, and the ongoing challenge in 2021 involves vaccination and the emergence of new strains. This text presents reflections on how the pandemic has mobilized medical schools, and whether the changes induced by the health emergency in our pedagogical paradigms will reverberate in cultural changes. Development: Self-isolation has proved to be an emotionally rich experience, pervaded by challenges, contemplative explorations in teaching, and a lot of work. We investigated how medical schools have tackled the pandemic, focusing on issues of the adaptations made and whether they will unfold into cultural changes. Teacher development has not been prioritized at medical schools, and the shift from the classroom to remote learning does not guarantee changes. Conclusion: The teacher plays a central role in the training of competent, ethical and humane physicians. It is necessary to move beyond the gloss of hyperconnectivity and install a permanent forum on teacher development.

Planificación de actividades de enseñanza en un currículo integrado: el riesgo de la "desintegración" / Planning activities within an integrated curriculum: the risk of "disintegration"

Introducción: en 2014, tras más de 10 años de comenzada la Carrera de Medicina en el Instituto Universitario Hospital Italiano de Buenos Aires (IUHIBA), en la comunidad educativa se comenzó a plantear la necesidad de realizar un cambio curricular con el objetivo de lograr la enseñanza de habilidades complejas en forma integrada para generar un aprendizaje significativo y un mayor desarrollo de competencias. El cambio curricular comenzó a implementarse en 2018. Propósitos: describir la experiencia de diseño de las actividades de enseñanza en un currículo integrado. Desarrollo: para el diseño de las actividades de cada módulo (de un cuatrimestre de duración) se conformaron grupos planificadores multidisciplinarios. El objetivo principal de la planificación fue que los estudiantes comenzaran a desarrollar las habilidades necesarias para poder llevar adelante las actividades profesionales (EPAs: Entrustable Professional Activities) al final de la carrera. Los escenarios donde transcurren las actividades del Ciclo Inicial son las sesiones de aprendizaje basado en problemas, los laboratorios para el desarrollo de habilidades, las charlas plenarias y la atención primaria orientada a la comunidad. Fueron definidas EPAs para desarrollarse en el Ciclo Inicial, que guiaron la planificación en diálogo con los contenidos seleccionados para el cuatrimestre. Para poder realizar un diseño integrado se estableció la relación de cada actividad con las de los módulos precedentes, retomando y complejizando los contenidos para que el diseño fuera espiralado. Conclusiones: el mayor desafío de esta experiencia radicó en que debimos sumergirnos en un nuevo paradigma. El principal logro como grupo planificador fue hacer propia esta nueva forma de enseñanza: basada en el alumno, en problemas, integrada, espiralada. Evaluaremos los resultados tras su implementación y rediseñaremos las actividades, de ser necesario. (AU)

Introduction: in 2014, after 10 years of the establishment of the School of Medicine at the Instituto Universitario Hospital Italiano de Buenos Aires (IUHIBA), the educational community identified the need to make a curricular change to teach complex skills in an integrated way to generate meaningful learning and further development of skills. The new curriculum was implemented in 2018. Purposes: to describe our experience in designing teaching activities for an integrated curriculum. Development: multidisciplinary planning groups were formed to design the activities of each four-month module. The main objective was for students to develop the skills necessary to carry out professional activities (EPAs: Entrustable Professional Activities) by the time of graduation. The "Initial Cycle" activities took place in four scenarios: (i) problem-based learning; (ii) skills lab (iii) forum discussions; and (iv) communityoriented education. The EPAs that would be acquired in the Initial Cycle were selected. Those EPAs, together with the contents selected for the semester guided the planning groups. To ensure an integrated design, the relationships of each module with the preceding one were established. We adopted a spiral design where we returned to the same topics at a deeper level and with more complexity. Conclusions: the greatest challenge was that this experience involved a paradigm change. Our main achievement was to adopt a new form of teaching that was student and problem based, within an integrated and spiral curriculum. We plan to evaluate the results after implementation and redesign the activities, if necessary. (AU)

A Report on the Representation of Women in Academic Plastic Surgery Leadership.

BACKGROUND: The year 2017 marked the first year women comprised a majority of U.S. medical school matriculants. While more women are pursuing surgical training, within plastic surgery, there is a steady attrition of women advancing in leadership roles. The authors report the current status of women in academic plastic surgery, from trainees to chairwomen and national leadership positions. METHODS: The Electronic Residency Applications Service, San Francisco Match, National Resident Matching Program, Association of American Medical Colleges, American Council of Academic Plastic Surgeons, Plastic Surgery Education Network, and professional websites for journals and national societies were accessed for demographic information from 2007 to 2017. RESULTS: The number of female integrated pathway applicants remained stable (30 percent), with an increased proportion of female residents from 30 percent to 40 percent. There was an increase in female faculty members from 14.6 percent to 22.0 percent, an increase of less than 1 percent per year. Twelve percent of program directors and 8.7 percent of department heads were women. Nationally, major professional societies and administrative boards demonstrated a proportion of female members ranging from 19 percent to 55 percent (average, 27.7 percent). The proportion of female committee leaders ranged from 0 percent to 50 percent (average, 21.5 percent). Only six societies have had female presidents. No major journal had had a female editor-in-chief. The proportion of female editorial board members ranged from 1 percent to 33 percent (average, 16.1 percent). CONCLUSIONS: The authors' study shows a leak in the pipeline at all levels, from trainees to faculty to leadership on the national stage. This report serves as a starting point for investigating reasons for the underrepresentation of talented women in plastic surgery leadership.

La docencia médica en ambientes de masividad: un desafío a la calidad / Medical teaching in environments of massiveness: a challenge to quality

RESUMEN La educación superior no cesa de estar en proceso de cambio en el contexto nacional e internacional, determinado por las necesidades de modernización estructural y curricular, así como por la necesidad de respuesta a los requerimientos de la sociedad. La masividad es una fortaleza que se fundamenta en la accesibilidad a la universidad y guarda relación con la equidad e igualdad de derechos para todos en el proceso formativo del profesional de la salud, pero, por otro lado, constituye un reto para el sistema que puede afectar directamente la calidad en el proceso de la docencia médica. En este trabajo se pretende abordar algunas pautas y puntos de vista acerca de la interacción entre la docencia médica en ambientes de masividad y su reto de acrecentar la calidad.

ABSTRACT Higher education continues to be in the process of change in the national and international context, determined by the needs of structural and curricular modernization, as well as by the need to respond to social requirements. Massiveness is a strength based on accessibility to the university and is related to equity and equality of rights for all in the training process of the health professional, but, on the other hand, it constitutes a challenge for the system which can directly affect quality in the process of medical teaching. This paper aims to address some guidelines and points of view about the interaction between medical teaching in mass environments and its challenge to increase quality.

Next Generation of Global Surgeons: Aligning Interest With Early Access to Global Surgery Education.

BACKGROUND: Although interest in global surgery is increasing among medical students,1 several questions remain unanswered such as: the association of demographics with said interest, the extent that global surgical burden education has been integrated into medical education, and the availability of global surgery electives. This study aimed to assess the current state of global surgery education in the United States (U.S.) to support recommendations for future curriculum development. MATERIALS AND METHODS: An anonymous online survey was distributed to medical students currently enrolled in the U.S. Descriptive data were compiled regarding interest in and access to global surgery programs; demographic data were analyzed using chi-squared testing for categorical variables. RESULTS: A total of 754 students from 18 medical schools throughout the U.S. responded to the survey. Only complete responses were included in final analysis (n = 658). Most of the respondents (66%) reported interest in global surgery, with a higher proportion of those interested being in their preclinical years. However, the majority (79%) reported that global surgery issues are rarely or never addressed in their required curriculum. Over half of respondents were unaware of whether their school even offers such programs. CONCLUSIONS: Although interest in global surgery is on the rise among medical students, results suggest that many currently lack exposure to global surgery concepts in their medical education. To that end, early exposure may be most effective during the preclinical years, so that the next generation may align global surgery participation with clinical aspirations, with the ultimate goal of addressing global disparities.

Diversity in Plastic Surgery: Trends in Minority Representation among Applicants and Residents.

BACKGROUND: Prior studies have shown a lack of diversity among plastic surgery trainees. The authors evaluate trends in minority representation among applicants to plastic surgery and the correlation with practicing residents, compared to other specialties. METHODS: The Association of American Medical Colleges Electronic Residency Application Service provided applicant data for integrated, independent plastic surgery, and other select specialties from 2010 to 2016. Journal of the American Medical Association Graduate Medical Education annual reports and Association of American Medical Colleges graduate student questionnaires provided resident and medical student data. Binomial distribution analysis was used to assess differences in Black, Hispanic, and female proportions of applicants and residents. Best-fit trend lines were compared among groups and specialties. RESULTS: Women have seen an increase in integrated and independent resident representation (+2.23 percent and +0.7 percent per year, respectively) over the past 7 years, despite a relative decrease in applicants. The proportion of female applicants and residents correlated yearly for all specialties (p > 0.05). Conversely, for all years and all specialties, the Black proportion of applicants was significantly higher than the resident representation of the same year (p < 0.05). Hispanic applicant and resident representation have seen a minimal change. CONCLUSIONS: Female representation among trainees has increased greatly, but there has been a decline in Black representation of integrated plastic surgery residents despite increases in medical school graduates and applicants. The data highlight a discrepancy between the population of applicants and residents suggesting that barriers starting from medical school may contribute to the lack of diversity in plastic surgery.

Educating Future Physicians in Nutritional Science and Practice: The Time Is Now.

The need to educate and train future physicians about nutrition and wellness has become increasingly apparent in the past decade. A rising incidence of chronic health conditions with a nutrition background (e.g., obesity, cardiovascular disease, type 2 diabetes) has led to an even greater need for nutrition educational content in medical school curricula so that physicians may counsel patients regarding their lifestyle factors. This review provides an overview of the successful development and integration of a nutrition thread in a 5-year medical school curriculum. Based on a survey conducted in our medical school program, students beginning medical school are lacking formal nutrition education, as only 8% arrived with some form of exposure. Despite this, nearly 85% of these medical students recognized that nutrition education is necessary in their training, and 70% state that the nutrition education they have received has influenced the way they care for patients. Key teaching points Physicians are faced with rising incidence of chronic health conditions that have a nutritional risk factor Physician self-care including optimal nutrition to support resilience is gaining importance. Nutrition education in medical schools is inadequate to address these rising needs. Implementing a comprehensive nutrition curricula that addresses personal wellness strategies, basic science concepts related to nutrition, and diagnosis and management of diseases that can be modified by or are related to nutrition as a topic thread that is woven throughout all years of the curriculum highlights the importance of nutrition in health and disease.

Bibliometrics of Tunisian publications on respiratory tract diseases from 2010 to 2014.

AIM: To describe the bibliometric characteristics of Tunisian publications on respiratory tract diseases, during the quinquennium 2010-2014. METHODS: This is a descriptive bibliometric study of respiratory medicine publications, indexed in "Medline", based on their MSDSs. All included articles were written by Tunisian researchers regardless of their position in the list of co-authors. The topics of the publications were explored through their "major" and "generic" keywords. RESULTS: A total of 340 publications was captured in Medline. These articles were co- authored by 218 authors in first position and 163 in last position. They were signed by pulmonologists, in first and last position respectively in 21.5% and 22.4% of articles. The A. Mami Hospital was the major affiliation of the first authors in 19.7% of the publications. These articles were published by 138 journals including "La Tunisie Medicale" in 11.8% of cases. They were "case reports" and written in English respectively in 44.4% and 54.1% of cases. Among 639 major keywords indexing, three were dominant: «Lung Neoplasms¼ (Tumeurs du poumon), «Chronic Obstructive Pulmonary Disease¼ (Broncho-pneumopathie chronique obstructive) and «Tuberculosis, Pulmonary¼ (Tuberculose pulmonaire), in 13.5%, 10.3% and 7.4% of articles respectively. CONCLUSION: Tunisian research on respiratory tract diseases has been thematically concordant with the public health needs. However, it has often been of low-level evidence and published in low-impact factor journals.

Reflections on the National Curricular Guidelines of undergraduate medical courses based on the National Health Promotion Policy / Reflexões em torno das Diretrizes Curriculares Nacionais do curso de graduação em Medicina a partir da Política Nacional de Promoção da Saúde / Reflexiones en torno a las Directrices Curriculares Nacionales del curso de Graduación en Medicina a partir de la Política Nacional de Promoción de la Salud

Abstract The objective of this article is to analyze the National Curricular Guidelines of medical courses based on Foucauldian discourse analysis. This analysis goes even deeper under the scope of health promotion presented by the National Health Promotion Policy (PNPS), since it is closely related to a comprehensive care proposal. The new National Curricular Guidelines are in accordance with PNPS, since it aims at a general, human, critical, reflective and ethical education that is able to prepare medical students to work with social responsibility and commitment to advocate for citizenship and human dignity in different levels of care in the health-disease process. On the other hand, the analysis reveals that, although there is an attempt to place graduates as active subjects in their educational process, there is no sign of inclusion of these social agents in the creation of their educational practices.(AU)

Resumo O objetivo deste artigo é realizar uma análise foucaultiana das Diretrizes Curriculares Nacionais (DCN) do curso de Medicina. Aprofunda-se essa análise no âmbito da promoção da saúde presente na Política Nacional de Promoção da Saúde (PNPS), por esta estar estreitamente relacionada à proposta de integralidade. As novas DCN estão em uníssono com o que se preconiza na PNPS, uma vez que se almeja uma formação geral, humanista, crítica, reflexiva, ética e capaz de atuar com responsabilidade social e compromisso com a defesa da cidadania e dignidade humana nos diferentes níveis da atenção do processo saúde-doença. Por outro lado, a análise revela que, embora exista a tentativa de situar o graduando como sujeito ativo no seu processo formativo, não há indicação de inclusão desse ator social na formulação de suas práticas formativas.(AU)

Resumen El objetivo de este artículo es realizar un análisis foucaultiano de las DCN para el curso de medicina. Se profundiza este análisis en el ámbito de la promoción de la salud presente en la Política Nacional de Promoción de la Salud (PNPS), por estar estrechamente relacionada a la propuesta de integralidad. Las DCN están en consenso con lo que se preconiza en la PNPS, una vez que se anhela una formación general, humanista, crítica, reflexiva y ética, capaz de actuar con responsabilidad social y compromiso con la defensa de la ciudadanía y la dignidad humana en los diferentes niveles de la atención. Por otro lado, el análisis revela que, aunque existe el intento de situar al graduado como sujeto activo en su proceso formativo, no hay indicación de inclusión de ese actor social en la formulación de sus prácticas formativas.(AU)

New National Curricular Guidelines of medical courses: opportunities to resignify education / Novas Diretrizes Curriculares Nacionais para os cursos de Medicina: oportunidades para ressignificar a formação / Nuevas Directrices Curriculares Nacionales para los cursos de Medicina: oportunidades para resignificar la formación

ABSTRACT The new National Curriculum Guidelines aim at restructuring and adapting medical curricula. The objective is to conduct a critical-reflective analysis of the restructure of a medical course's curricular matrix. This action research was conducted at a Brazilian federal university. The material was analyzed using the discourse analysis method. Among the results, the proposal of a curriculum that values life and transfers the biomedical paradigm to incorporate other dimensions in healthcare is highlighted. The need to strengthen a curricular matrix based on social demands and preferably focused on primary care is indicated. The establishment of longitudinal and transversal relationships among the competency areas of the 2014 National Curricular Guidelines and the curricular components is proposed. The intention is to foster the understanding of determinants and relationships between diseases and the communities' ways of living.

RESUMO As novas Diretrizes Curriculares Nacionais (DCN) visam à reestruturação e adequação dos currículos médicos. Objetiva-se realizar uma análise crítico-reflexiva da reestruturação da matriz curricular para um curso de Medicina. Trata-se de uma pesquisa-ação realizada em uma universidade federal brasileira. Para a análise do material, procedeu-se com Análise de Discurso. Como resultados, destacou-se uma proposição curricular que valorize a vida, capaz de transpor o paradigma biomédico para incorporar outras dimensões no cuidado em Saúde. Apontou-se para o fortalecimento de uma matriz curricular retroalimentada pelas demandas sociais, tendo a Atenção Primária como cenário preferencial para a formação. Propõe-se o estabelecimento de relações de longitudinalidade e transversalidade entre as áreas de competência das DCN de 2014 e os componentes curriculares ofertados. Intenciona-se fomentar a compreensão dos determinantes e relações das doenças com os modos de vida das comunidades.

RESUMEN Las nuevas Directrices Curriculares Nacionales (DCN) apuntan a la reestructuración y adecuación de los currículos médicos. Objetivo: Realizar un análisis crítico-reflexivo de la reestructuración de la matriz curricular para un curso de Medicina. Se trata de una investigación-acción participativa realizada en una universidad federal brasileña. Para el análisis del material se procedió con un Análisis de Discurso. Como resultado, se destacó una proposición curricular que valorice la vida, capaz de transponer el paradigma biomédico incorporando otras dimensiones al cuidado de la salud. El objetivo fue el fortalecimiento de una matriz curricular retroalimentada por las demandas sociales, con la atención primaria como escenario preferencial para la formación. Se propone establecer relaciones longitudinales y transversales entre las áreas de competencia de las DCN de 2014 y los componentes curriculares ofertados. Se intenta fomentar la comprensión de los factores determinantes y las relaciones de las enfermedades con la forma de vida de las comunidades.

Medical education in Primary Healthcare: a multiple-approach experience to teaching, service and community integration practices / Formação médica na Atenção Primária à Saúde: experiência com múltiplas abordagens nas práticas de integração ensino, serviço e comunidade / Formación médica en la Atención Primaria de la Salud: experiencia con múltiples abordajes en las prácticas de integración enseñanza, servicio y comunidad

ABSTRACT The Brazilian National Health System (SUS) is a public universal system and adopts primary healthcare as the main coordinator of care. SUS requires that Brazilian universities offer a new professional education model. This article aims at discussing the medical education provided in an institution in a city in the Brazilian state of Bahia, taking primary healthcare and the National Curricular Guidelines as guidance for the Medicine courses. The experience with teaching, service and community integration practices (Piesc) brings together students, teachers, health professionals and SUS users, integrating different perspectto the health-disease-care process under the Family Health Strategy context. Piesc includes Collective Health and General Family and Community Medicine knowledge, covering different territories and social agents in the process of care, helping to change medical education for SUS.

RESUMO O Sistema Único de Saúde (SUS), enquanto sistema público e universal que adota a Atenção Primária à Saúde (APS) como coordenadora do cuidado, demanda das universidades brasileiras um novo modelo de formação profissional. Este artigo busca discutir a formação médica em uma instituição do interior da Bahia, tomando como base orientadora a APS e as Diretrizes Curriculares Nacionais para os cursos de Medicina. A experiência das Práticas de Integração Ensino, Serviço e Comunidade (Piesc) reúne estudantes, professores, profissionais de saúde e usuários do SUS, integrando os diferentes olhares sobre o processo saúde-doença-cuidado, no contexto da Saúde da Família. As Piesc integram conhecimentos de Saúde Coletiva e Medicina Geral de Família e Comunidade, abrangendo diversos territórios e sujeitos sociais, no processo de cuidado, colaborando na mudança da formação médica para o SUS.

RESUMEN El Sistema Brasileño de Salud (SUS), como sistema público y universal, adopta la Atención Primaria de la Salud (APS), como coordinadora del cuidado, demanda de las universidades brasileñas un nuevo modelo de formación profesional. El objetivo de este artículo es discutir la formación médica en una institución del interior del Estado de Bahia, tomando como base orientadora la APS y las Directrices Curriculares Nacionales para los cursos de Medicina. La experiencia de las prácticas de integración enseñanza, servicio y comunidad (Piesc) reúne a estudiantes, profesores, profesionales de la salud y usuarios del SUS, integrando las diferentes miradas sobre el proceso salud-enfermedad-cuidado en el contexto de la Salud de la Familia. Las Piesc incluyen conocimientos de Salud Colectiva y Medicina General de Familia y Comunidad, comprendiendo diversos territorios y sujetos sociales en el proceso de cuidado, colaborando con el cambio de la formación médica para el SUS.

Documentary analysis of the pedagogical project of a Medicine course and teaching in Primary Care / Análise documental do projeto pedagógico de um curso de Medicina e o ensino na Atenção Primária à Saúde / Análisis documental del proyecto pedagógico de un curso de Medicina y la enseñanza en la Atención Primaria a la Salud

Abstract The 2014 National Curriculum Guidelines (DCN) for the medicine course provide for an education that focuses on primary care. The School of Medicine of Universidade Federal de Goiás, adapting itself to the new DCN, has developed a new Pedagogical Course Project (PCP). The objective of this study was to examine, through documentary analysis, the new PCP in the perspective of the 2014 DCN, based on the document "Guidelines for Primary Care Teaching in Undergraduate Medicine Courses". Although the PCP covers most of the aspects related to primary care teaching, there is no reference to the teaching of the person-centered clinical method, popular health education, respect for patient autonomy, and shared decision-making. We hope, therefore, to subsidize changes in the current PCP and to stimulate other universities to approach these issues.

Resumo As Diretrizes Curriculares Nacionais (DCN) do curso de Medicina de 2014 preveem uma formação com maior foco na Atenção Primária à Saúde (APS). A Faculdade de Medicina da Universidade Federal de Goiás, adaptando-se às novas DCN, elaborou um novo projeto pedagógico de curso (PPC). O objetivo deste estudo foi analisar e comparar, por meio de análise documental, o novo PPC nas perspectivas das DCN de 2014, tendo por base o documento "Diretrizes para o Ensino na Atenção Primária à Saúde na Graduação em Medicina". Embora o PPC contemple a maioria dos aspectos relacionados ao ensino da APS, observou-se a ausência de determinações para o ensino do método clínico centrado na pessoa, na educação popular, no respeito à autonomia do paciente e na tomada de decisão compartilhada. Espera-se, assim, subsidiar mudanças no PPC atual e estimular outras universidades a abordar esses temas.

RESUMEN Las Directrices Curriculares Nacionales (DCN) de 2014 prevén una formación con mayor foco en la Atención Primaria de la Salud (APS). La Facultad de Medicina de la Universidad Federal de Goiás, adaptándose a las nuevas DCN elaboró ​​un nuevo Proyecto Pedagógico de Curso (PPC). El objetivo de este estudio fue analizar y comparar, por medio de análisis documental, el nuevo PPC en las perspectivas de las DCN de 2014, teniendo como base el documento "Directrices para la Enseñanza en la Atención Primaria de la Salud en la Graduación en Medicina". Se observó la ausencia de determinaciones para la enseñanza del método clínico centrado en la persona, en la educación popular, en el respeto a la autonomía del paciente y en la toma de decisión compartida. Se espera, así, subsidiar cambios en el PPC actual e incentivar a otras universidades.

Declining racial and ethnic representation in clinical academic medicine: A longitudinal study of 16 US medical specialties.

OBJECTIVE: To evaluate trends in racial, ethnic, and sex representation at US medical schools across 16 specialties: internal medicine, pediatrics, surgery, psychiatry, radiology, anesthesiology, obstetrics and gynecology, neurology, family practice, pathology, emergency medicine, orthopedic surgery, ophthalmology, otolaryngology, physical medicine and rehabilitation, and dermatology. Using a novel, Census-derived statistical measure of diversity, the S-score, we quantified the degree of underrepresentation for racial minority groups and female faculty by rank for assistant, associate, and full professors from 1990-2016. METHODS: This longitudinal study of faculty diversity uses data obtained from the American Association of Medical Colleges (AAMC) Faculty Roster from US allopathic medical schools. The proportion of professors of racial minority groups and female faculty by rank was compared to the US population based on data from the US Census Bureau. The Roster includes data on 52,939 clinical medical faculty in 1990, and 129,545 in 2016, at the assistant professor level or higher. The primary measure used in this study was the S-score, a measure of representation based on the probability of the observed frequency of faculty from a racial/ethnic group and sex, given the racial and ethnic distribution of the US. Pearson correlations and 95% confidence intervals for S-score with time were used to measure trends. RESULTS: Blacks and Hispanics showed statistically significant trends (p<0.05) towards increasing underrepresentation in most specialties and are more underrepresented in 2016 than in 1990 across all ranks and specialties analyzed, except for Black females in obstetrics & gynecology. White females were also underrepresented in many specialties and in a subset of specialties trended toward greater underrepresentation. CONCLUSIONS: Current efforts to improve faculty diversity are inadequate in generating an academic physician workforce that represents the diversity of the US. More aggressive measures for faculty recruitment, retention, and promotion are necessary to reach equity in academia and healthcare.

Las transformaciones en el Sistema Nacional de Salud cubano, su incidencia en las Universidades de Ciencias Médicas / Transformations in the Cuban National Health System, its incidence in the Universities of Medical Sciences

El Sistema Nacional de Salud (SNS) cubano ha tenido la capacidad de transformarse, según el momento histórico, sin descuidar los preceptos que le dieron origen, así como los principios que lo sustentan. Todo ello ha permitido garantizar la universalidad y accesibilidad de los servicios que se prestan a la población, con calidad, equidad y solidaridad humana. En estos 60 años ha asegurado la formación de sus recursos humanos propios con elevados estándares de competencia y desempeño, lo que unido a los resultados en sus indicadores de salud, sitúan al país en una posición de vanguardia internacional en temas sanitarios...

The Cuban National Health System (SNS) has had the capacity to transform, according to the historical moment, without neglecting the precepts that gave rise to it, as well as the principles that sustain it. All this has ensured the universality and accessibility of the services provided to the population, with quality, equity and human solidarity. In these 60 years it has ensured the formation of its own human resources with high standards of competence and performance, which together with the results in its health indicators, place the country in an international vanguard position in health issues....

Mudança curricular e de métodos pedagógicos: impacto vivenciado por estudantes de medicina / Curricular change and pedagogical methods: impact experienced by students of medicine

As mudanças nas formas de ensinar e aprender com ênfase no papel ativo dos estudantes têm sido observadas no Ensino Superior em geral e, em particular, no Ensino Médico. Apesar de haver um número considerável de trabalhos em torno dessa temática, constata-se uma carência relativa a estudos que valorizem a percepção dos estudantes como os agentes ativos de sua própria formação. Logo, com a finalidade de conhecer e analisar a qualidade das experiências vivenciadas, foi realizado um grupo focal com 6 estudantes concluintes do curso de Medicina de uma Faculdade Privada em Minas Gerais - Brasil no qual foram trabalhadas as suas percepções sobre as mudanças a nível do currículo, do curso e dos métodos pedagógicos dos professores, nomeadamente as alterações ocorridas nas vivências acadêmicas e adaptação. Importante destacar que os estudantes da pesquisa tiveram meios de comparação pela convivência com os colegas do curriculo antigo durante toda a formação. Os resultados mostraram que os estudantes foram capazes de identificar as alterações ocorridas no currículo e nos métodos pedagógicos; que os métodos ativos favoreceram qualitativamente as vivências acadêmicas por estreitar e melhorar as relações interpessoais com colegas de turma e de outras áreas, no trabalho interprofissional, além prepara-los melhor para a relação com o paciente. Quanto às atitudes e comportamentos adaptativos, relataram imaturidade, ansiedade e medo inerentes às novidades implementadas e aos cenários reais de prática no início do curso, demonstrando que os mesmos necessitam de apoios vários no processo de transição e adaptação.

Modifications in the teaching and learning methods, focusing an active role of the students, have been experienced in Higher Education, in general, and especially, in Medical Education. Although there is a reasonable number of studies around this issue, it is recognised a lack of studies that highlight the attitude of students as active agents of their own education. Therefore, aiming to understand and analyse the quality of the experiences, it was carried out a focus group with six senior students of Medicine of a Private University in Minas Gerais – Brazil. Herewith, were worked up students’ perceptions about the modifications in the syllabus, the course and in the teaching methods of the professors, namely the changes occurred in the academic experience and adjustment. Also, important to point out is that the students taking part in the research have had comparison means by getting together with peers from former syllabus during their instruction. Results show that the students were able to identify the changes carried out in the syllabus and in the teaching methods; that the active methods have boosted qualitatively the academic experiences and straitened and enhanced the interpersonal relationships with their peers and from other fields, at interprofessional work, besides preparing them better in their relationship with the patient. Regarding attitudes and adjustment behaviours, they have described immaturity, anxiety and fear resulting from the new things implemented and the real practice sceneries of the instruction proving that they need different support during the adjustment and transition process.

¿Es tiempo de modificar la vinculación pregrado postgrado en la educación médica chilena? Reflexiones sobre una vía de doble titulación Médico cirujano/Doctor en ciencias médicas / Time to change the graduate-postgraduate liaison in Chilean medical education? Reflections about a double certification as Physician and Doctor in medical sciences

In the last 150 years, scientific research has produced extraordinary discoveries in Medicine and there is no doubt that research will continue contributing substantially in the future but there is no the same conviction regarding how to provision such capacities in medical graduates. In Chile, the Faculties of Medicine created several doctorate programs in Medical Sciences (Ph.D.) to strengthen medical research. However, the low number of physicians who apply to these programs is a caveat. These programs provide the advanced third-cycle competencies expected by students aspiring for an excellence research certification and their incorporation into academia. Universities stand out in their capacity to adapt themselves to educational needs, developing programs designed to fill specific gaps. Ph.D. programs intercalated to the medical career show that this is the correct approach. The development of specific doctorate programs for the small number of physicians interested in research and for medical students with a strong interest in research could be an innovative solution to motivate and encourage them to develop a career in clinical investigation. Using this approach, Medical Schools and Doctorate in Medical Sciences programs would jointly stimulate the training of medical scientists.