Theater for Healthcare Equity; A Model for Inclusion and Anti-Bias Training in Academic Medicine.

There are no standardized methods for training medical personnel in antiracist action, such as how to be an upstander or how to use micro-resistance. Roleplay and drama-based pedagogy can empower and educate healthcare professionals by providing experiential training and a safe space for antiracist practice and discussion. The Theater for Healthcare Equity (THE) is an innovative methodology that explores upstander techniques in real time with facilitated instruction. We implemented eight THE sessions at our institution and assessed participant responses via a voluntary survey. Forty-one participants completed a REDCap survey, and 32 participants completed the Continuing Medical Education survey. Participants appreciated the creation of safe spaces, the practice format, and the learning experience, which provided an honest and open environment for the sharing of experiences, addressing race-based bias, and practicing responses to real-life scenarios. Constructive feedback included changes to session duration, participant discomfort with improvisation, and lack of printed tools.

Mid-level healthcare workers knowledge on non-communicable diseases in Tanzania: a district-level pre-and post-training assessment.

INTRODUCTION: Over the past two decades, Tanzania's burden of non-communicable diseases has grown disproportionately, but limited resources are still prioritized. A trained human resource for health is urgently needed to combat these diseases. However, continuous medical education for NCDs is scarce. This paper reports on the mid-level healthcare workers knowledge on NCDs. We assessed the knowledge to measure the effectiveness of the training conducted during the initiation of a Package for Essential Management of Severe NCDs (PEN Plus) in rural district hospitals in Tanzania. METHODS: The training was given to 48 healthcare employees from Dodoma Region's Kondoa Town Council District Hospital. For a total of five (5) days, a fundamental course on NCDs featured in-depth interactive lectures and practical workshops. Physicians from Tanzania's higher education institutions, tertiary university hospitals, research institutes, and medical organizations served as trainers. Before and after the training, a knowledge assessment comprising 28 questions was administered. Descriptive data analysis to describe the characteristics of the specific knowledge on physiology, diagnosis and therapy of diabetes mellitus, rheumatic fever, heart disease, and sickle cell disease was done using Stata version 17 (STATA Corp Inc., TX, USA). RESULTS: Complete assessment data for 42 out of the 48 participants was available. Six participants did not complete the training and the assessment. The mean age of participants was 36.9 years, and slightly above half (52%) were above 35 years. Two-thirds (61.9%) were female, and about half (45%) were nurses. The majority had the experience of working for more than 5 years, and the average was 9.4 years (+/- 8.4 years). Overall, the trainees' average scores improved after the training (12.79 vs. 16.05, p < 0.0001) out of 28 possible scores. Specifically, trainees' average scores were better in treatment than in diagnosis, except for sickle cell disease (1.26 vs. 1.83). Most were not able to diagnose rheumatic heart disease (47.6% able) compared to diabetes mellitus (54.8% able) or sickle cell disease (64.3% able) at baseline. The proportion of trainees with adequate knowledge of the treatment of sickle cell disease and diabetes mellitus was 35% and 38.1%, respectively, and there was a non-statistical difference after training. Those working for less than 5 years had a higher proportion of adequate knowledge (30.8%) compared to their more experienced colleagues (6.9%). After the training, participants' knowledge of NCDs increased by three times (i.e., aPR 3, 95% CI = 1.1, 1.5, and 6.0). CONCLUSION AND RECOMMENDATIONS: PEN Plus training improved the knowledge of healthcare workers at Kondoa Town Council District Hospital. Training is especially needed among nurses and those with a longer duration of work. Continuing education for human resources for health on the management of NCDs is highly recommended in this setting.

Redefining the Role of Medical Affairs Professionals as Innovators and Leaders in Industry-Led Medical Education.

Medical affairs professionals are pivotal players at the intersection of medical innovation and practice in the pharmaceutical industry. They are uniquely positioned to translate complex medical knowledge into actionable insights for internal and external stakeholders. Industry-led continuing medical education (CME) programs, guided by these professionals, hold the potential to markedly improve clinicians' application of evidence-based medicine (EBM) in clinical settings, thereby elevating patient care outcomes. However, current CME techniques often overlook the integration of diverse disciplines such as educational theories, cognitive psychology, information mastery, and implementation science, which are important for effective real-time decision-making in patient care. This gap in integrating implementation science is vital, as it is key in ensuring that medical innovations are not just developed but also effectively implemented and efficiently utilized in clinical settings. In this opinion article, we aim to highlight the crucial yet often underrecognized role of medical affairs professionals in shaping robust and practical CME programs within the industry. We explore emerging trends and approaches in medical education and CME based on the principles of adult education. Additionally, we explore how medical affairs professionals can effectively drive the adoption of EBM in clinical practice. This exploration aims to provide insights into enhancing CME programs, with medical affairs professionals at the forefront of innovation and leadership in bridging gaps in clinical practice.

Measuring continuing medical education conference impact and attendee experience: a scoping review.

Objectives: The aim was to comprehensively identify published research evaluating continuing medical education conferences, to search for validated tools and perform a content analysis to identify the relevant domains for conference evaluation. Methods: We used scoping review methodology and searched MEDLINE® for relevant English or French literature published between 2008 and 2022 (last search June 3, 2022). Original research (including randomized controlled trials, non-randomized studies, cohort, mixed-methods, qualitative studies, and editorial pieces) where investigators described impact, experience, or motivations related to conference attendance were eligible. Citations were assessed in triplicate, and data extracted in duplicate. Results: Eighty-three studies were included, 69 (83%) of which were surveys or interview based, with the majority conducted at the end of or following conference conclusion. Of the 74 tools identified, only one was validated and was narrowly focused on a specific conference component. A total of 620 items were extracted and categorized into 4 a priori suggested domains (engagement-networking, education-learning, impact, scholarship), and an additional 4 identified through content analysis (value-satisfaction, logistics, equity-diversity-inclusivity, career influences). Time trends were evident, including the absence of items related to equity-diversity-inclusivity prior to 2019, and a focus on logistics, particularly technology and virtual conferences, since 2020. Conclusions: This study identified 8 major domains relevant for continuing medical education conference evaluation. This work is of immediate value to individuals and organizations seeking to either design or evaluate a conference and represents a critical step in the development of a standardized tool for conference evaluation.

[Continuing medical education (Cme/Ecm) on medical devices in Italy: a review for the 2019-2021 period.] / Offerta formativa Ecm in materia di dispositivi medici: una ricognizione nazionale per il triennio 2019-2021.

INTRODUCTION: Health technology assessment (Hta) is a multidisciplinary process that uses explicit methods to determine the value of a health technology across various domains. It aims at supporting decision-makers in promoting an equitable, efficient, and high-quality healthcare system. During 2023, the Italian Minister of Health officially endorsed the National program for Hta on medical devices 2023-2025 (Pnhta), aligning with EU Regulation 2017/745 and EU Regulation 2017/746. A key objective of Pnhta is to launch a continuous training initiative targeting all professionals within the Italian Health Service to enhance their knowledge and usability of Hta. To support this effort, a national analysis of educational offerings on medical devices (MD) during the 2019-2021 triennium was undertaken. METHODS: The Italian database of accredited Continuing medical education (Cme/Ecm) events was queried using relevant keywords. A descriptive analysis of the educational offerings was conducted based on variables already provided by the database. The analysis was structured according to pre-identified categories related to the courses' objectives ("correct use", "appropriate use", "procurement", "expert patient") and clinical-care areas of interest. RESULTS: Overall, 1,450 training events were included in the analysis. Courses specifically focused on MD were less than 2% of all Cme/Ecm events. The number of participants trained in MD-related topics decreased in 2020 compared to 2019 (14,787 vs 32,784). However, the average number of credits per course and per participant increased in both 2020 and 2021. Distance learning showed an upward trajectory, rising from 16 events in 2019 to 132 in 2021. Regarding the courses' objectives, 73.2% of events concerned the "proper use" of MD, 31.9% focused on their "appropriateness", 14.7% on "updates", 1.2% on "procurement", while no course was specifically dedicated to the "expert patient". Most of the events were related to dentistry/orthodontics (50.4%), followed by orthopedics (8.1%), laparoscopic, general, and plastic surgery (7%). The telemedicine sector has grown, almost quadrupling the number of educational events offered in 2021 compared to 2019 (12 vs 46). CONCLUSIONS: Future Hta training should encompass a diverse range of thematic areas and should place particular emphasis on procurement issues, as well as the involvement of adequately trained patients and caregivers. Finally, the increase in telemedicine-focused courses during the triennium suggests the need for further reflection on this topic. KEY WORDS: Continuing medical education, Hta, medical devices, telemedicine.

Low-cost versus high-fidelity pediatric simulators for difficult airway management training: a randomized study in continuing medical education

Abstract Background: High-fidelity (HF) pediatric patient simulators are expensive. This randomized study aimed to compare the quality and educational impact of a full-scale simulation workshop with an HF infant simulator (SimBaby™, Laerdal) or with a low-cost (LC) simulator composed of an inert infant manikin with SimBaby™ software that displays respiratory/hemodynamic parameters on a monitor for medical education in pediatric difficult airway management. Methods: After written informed consent, anesthetists and emergency or ICU physicians participated in teams (4 to 6 participants) in a training session that included direct participation and observation of two difficult intubation scenarios. They were randomized into two groups (HF group, n = 65 and LC group, n = 63). They filled out a simulation quality score (SQS, 0 to 50), self-evaluated their anesthetists' non-technical skills (ANTS) score (15 to 60), and an educational quality score (EQS, 0 to 60) immediately (T0, main criteria), as well as 3 (T3) and 6 (T6) months after the training session. Results: We enrolled 128 physicians. Direct participation SQS (39 ± 5 HF group versus 38 ± 5 LC group), observation SQS (41 ± 4 H F group versus 39 ± 5 LC group), ANTS scores (38 ± 4 HF group versus 39 ± 6 LC group), T0 SQS (44 ± 5 HF group versus 43 ± 6 LC group), T3 and T6 SQS were not different between groups. Conclusion: Our low-cost simulator should be suggested as a less expensive alternative to an HF simulator for continuing medical education in pediatric difficult airway management.

A clínica psicanalítica das urgências subjetivas no hospital universitário: construção de um caso clínico / Psychoanalysis of subjective urgencies at a university hospital: construing a clinical case / La clínica psicoanalítica de urgencias subjetivas en el hospital universitario: construcción de un caso clínico

O hospital constitui-se como um contexto em que a urgência subjetiva pode vir a se apresentar de forma frequente, instaurando, para cada sujeito, uma vivência de angústia. O objetivo desta pesquisa foi investigar as possibilidades para uma clínica das urgências subjetivas no contexto de um hospital universitário em Salvador, considerando as vivências em uma residência multiprofissional. Trata-se de uma pesquisa qualitativa de caráter exploratório, em que se realizou revisão teórica sobre o tema e se construiu um caso clínico, sob orientação psicanalítica. A escolha do caso baseou-se na escuta clínica ao longo dos atendimentos e da atuação em equipe multiprofissional, considerando os impasses ao longo do tratamento. Foram utilizados registros documentais produzidos pela psicóloga residente ao longo dos atendimentos, que ocorreram durante três meses. Os resultados apontam para as contribuições da escuta psicanalítica no tratamento das urgências e na atuação em equipe multiprofissional no contexto hospitalar. A subjetivação da urgência permitiu, no caso em questão, um tratamento pela palavra do que havia incidido diretamente no corpo como fenômeno. Conclui-se pela relevância em discutir o tema da urgência e suscitar novas pesquisas, reintroduzindo no contexto hospitalar a questão sobre a subjetividade.(AU)

Hospitals are contexts in which subjective urgency can frequently materialize, triggering an experience of anguish for each subject. Hence, this research investigates the possibilities of establishing a subjective urgency clinic at a university hospital in Salvador, considering the experiences in a multidisciplinary residence. A qualitative, exploratory research was conducted by means of a theoretical review on the topic and construction of a clinical case, under psychoanalytical advisement. The case was chosen based on clinical listening during the sessions and performance in a multidisciplinary team, considering the obstacles for long-term treatment. Data were collected from documentary records produced by the resident psychologist during three months. Results point to the contributions of psychoanalytic listening to treating subjective urgencies and to the performance of a multidisciplinary team in the hospital context. In the case in question, subjectivation of urgency allowed a treatment through the word of affecting phenomenon. In conclusion, discussing urgency and conducting further research, are fundamental to reintroduce subjectivity in the hospital context.(AU)

El hospital es un contexto en el que frecuentemente se puede percibir una urgencia subjetiva, estableciendo una experiencia de angustia para cada sujeto. El objetivo de esta investigación fue investigar las posibilidades de una clínica de urgencia subjetiva en el contexto de un hospital universitario en Salvador (Brasil), considerando las experiencias en una Residencia Multiprofesional. Se trata de una investigación cualitativa, de carácter exploratorio, en la que se realizó una revisión teórica sobre el tema y construcción de un caso clínico, con orientación psicoanalítica. La elección del caso se basó en la escucha clínica a lo largo de las sesiones y actuación en un equipo multidisciplinar, considerando los impasses para el tratamiento a largo plazo. Se utilizaron registros documentales elaborados por el psicólogo residente, durante las atenciones, que se realizaron durante tres meses. Los resultados apuntan a las contribuciones de la escucha psicoanalítica en el tratamiento de urgencias y en la actuación de un equipo multidisciplinario en el contexto hospitalario. La subjetivación de la urgencia permitió, en el caso en cuestión, un tratamiento a través de la palabra de lo que había afectado directamente al cuerpo como fenómeno. Se concluye que es relevante discutir el tema de la urgencia y plantear nuevas investigaciones, reintroduciendo el tema de la subjetividad en el contexto hospitalario.(AU)

Educação permanente no sistema único de saúde: concepções de profissionais da gestão e dos serviços / Continuing permanent education in the brazilian national health system: conceptions from management and care professionals / Educación continua en el sistema único de salud brasileño: concepciones de los profesionales de gestión y servicios

Este artigo pretende compreender as concepções de profissionais da gestão e dos serviços do Sistema Único de Saúde (SUS) sobre Educação Permanente em Saúde (EPS), bem como seus desafios e potencialidades. Utilizou-se de grupo focal para coleta, seguido de análise lexical do tipo classificação hierárquica descendente com auxílio do software Iramuteq. Os resultados delinearam quatro classes: a) EPS - entendimentos e expectativas; b) entraves à EPS; c) ETSUS e EPS por meio de cursos e capacitações; e d) dispositivos de EPS: potencialidades e desafios. Os participantes apontaram equívocos de entendimentos acerca da EPS ao equipará-la à Educação Continuada (EC) voltada à transferência de conteúdo, com repercussões negativas na prática de EPS. Discute-se o risco em centralizar o responsável pela concretização dessa proposta, que deveria ser coletiva e compartilhada entre diferentes atores. Reivindica-se, portanto, uma produção colaborativa, que possa circular entre os envolvidos, de modo que cada um experimente esse lugar e se aproprie da complexidade de interações propiciadas pela Educação Permanente em Saúde.(AU)

This article aims to understand the conceptions of professionals from the management and services of the Unified Health System (SUS) on Permanent Education in Health (EPS), as well as its challenges and potential. A focus group was used for data collection, followed by a lexical analysis of the descending hierarchical classification type using the Iramuteq software. The results delineated four classes: a) EPS - understandings and expectations; b) obstacles to EPS; c) ETSUS and EPS by courses and training; and d) EPS devices: potentialities and challenges. Participants pointed out misunderstandings about EPS, when equating it with Continuing Education (CE) focused on content transfer, with negative repercussions on EPS practice. The risk of centralizing the person responsible for implementing this proposal, which should be collective and shared among different actors, is discussed. Therefore, a collaborative production is claimed for, which can circulate among those involved, so that each one experiences this place and appropriates the complexity of interactions provided by Permanent Education in Health.(AU)

Este artículo tiene por objetivo comprender las concepciones de los profesionales de la gestión y servicios del Sistema Único de Salud (SUS) sobre Educación Continua en Salud (EPS), así como sus desafíos y potencialidades. Se utilizó un grupo focal para la recolección de datos, seguido por un análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Iramuteq. Los resultados delinearon cuatro clases: a) EPS: entendimientos y expectativas, b) Barreras para EPS, c) ETSUS y EPS a través de cursos y capacitación, y d) Dispositivos EPS: potencialidades y desafíos. Los participantes informaron que existen malentendidos sobre EPS al equipararla a Educación Continua, con repercusiones negativas en la práctica de EPS, orientada a la transferencia de contenidos. Se discute el riesgo de elegir a un solo organismo como responsable de implementar esta propuesta colectiva, que debería ser colectiva y compartida entre los diferentes actores. Se aboga por un liderazgo colaborativo, que pueda circular entre los involucrados, para que cada uno experimente este lugar y se apropie de la complejidad de interacciones que brinda la Educación Continua en Salud.(AU)

Potencialidades e fragilidades da supervisão acadêmica no cenário da pandemia do covid-19: relato de experiência / Potentials and weaknesses of academic supervision during the covid-19 pandemic: an experience report / Potencialidades y fragilidades de la supervisión académica en el escenario de la pandemia del covid-19: reporte de experiencia

A pandemia pelo Covid-19¹ levou o Brasil ao maior colapso sanitário-hospitalar de sua história. O Programa Mais Médicos (PMM) prevê a qualificação profissional dos médicos, além de contar com as instituições públicas de educação superior por meio da supervisão acadêmica2. Contudo, a situação pandêmica restringiu as visitas de supervisão, as quais passaram a ser realizadas virtualmente. Com isto, este artigo busca conhecer o olhar dos supervisores acadêmicos na atuação dentro do PMMB, no contexto da pandemia do Covid-19, a luz das fragilidades e potencialidades no que tange à atuação na atenção básica. Trata-se de um relato de experiência realizado com base nos relatórios de acompanhamento do processo de supervisão acadêmica. Foram realizados nos momentos de avaliação das supervisões, elaborado pela tutoria, com os 16 supervisores, entre 2020 e 2021. Como resultado, notamos a indisponibilidade de internet estável nas Unidades Básicas de Saúde (UBS), perda da vinculação, devido a distância física não propiciar o fortalecimento do vínculo com os gestores das secretarias de saúde, dificuldades no manejo clínico das infecções respiratórias, a realização de diagnósticos diferenciais, a gestão da demanda reprimida e prejuízos frente à saúde mental dos profissionais. Portanto, o uso de ferramentas virtuais para manter o vínculo com seus supervisionados foi a estratégia mais efetiva nesse período de distanciamento social. A pandemia pelo Covid-19 trouxe desafios para os profissionais médicos, porém mesmo diante das fragilidades apontadas, à presença do supervisor acadêmico, se possibilitou a educação permanente, diante de uma doença nova e com atualizações de propedêutica recorrentes, bem como o apoio organizacional e ético.

The Covid-19 pandemic resulted in the biggest health system collapse in Brazil's history. Within the Mais Médicos Program (PMM), professional qualification by academic supervision relied on public higher education institutions, activity that became restricted to virtual meetings due to the pandemic situation. Given this context, this experience report investigates how academic supervisors evaluate their performance within the PMM during the Covid-19 pandemic, focusing on the weaknesses and potentialities in primary health care. Data were collected from the academic supervision monitoring reports on tutoring evaluation carried out by 16 supervisors, between 2020 and 2021. Poor internet connection (instability, loss of connection) in the UBS hinders strengthening the bond between physicians and health management. Results point to difficulties in the clinical management of respiratory infections, in performing differential diagnoses, in managing pent-up demand and mental health issues. During social distancing, the use of virtual tools was the most effective strategy to maintain the academic bonds. Notwithstanding the challenges brought and weaknesses revealed by the pandemic, the academic supervision enabled permanent education in the face of a new disease and recurrent propaedeutic updates, as well as organizational and ethical support.

La pandemia del COVID-19¹ llevó a Brasil al mayor colapso sanitario hospitalario de su historia. El Programa Más Médicos (PMM) prevé la calificación profesional de los médicos y de las instituciones  de educación superior públicas, a través de la supervisión académica. Sin embargo, la situación pandémica ha restringido las visitas de supervisión, que ahora se han realizado de manera virtual. Ante lo anterior, este artículo tiene como objetivo conocer la perspectiva de los supervisores académicos en el desempeño del PMM en el contexto de la pandemia del COVID-19, a la luz de las debilidades  y potencialidades en cuanto al desempeño en la atención primaria. Este es un informe de experiencia basado en los informes de seguimiento del proceso de supervisión académica, realizado por la tutoría en los momentos de evaluación de las supervisiones, en la que participaron 16 supervisores en el período entre 2020 y 2021. La indisponibilidad de internet estable en la Unidad Básica de Salud (UBS) y la pérdida de conexión por distanciamiento físico no brindan el fortalecimiento del vínculo con los directivos de los departamentos de salud. Se observaron dificultades en el manejo clínico de las infecciones respiratorias, realización de diagnósticos diferenciales, manejo de la demanda acumulada y problemas de salud mental entre los profesionales. Se concluye que el uso de herramientas virtuales para mantener el vínculo con sus supervisados fue la estrategia más efectiva en este período de distanciamiento social. La pandemia del COVID-19 ha generado desafíos para los profesionales médicos. Sin embargo, en estas debilidades, la presencia del supervisor académico posibilitó  la educación permanente frente a una nueva enfermedad y con actualizaciones propedéuticas recurrentes, además de apoyo organizacional y ético.

Simulación de intubación pediátrica con videolaringoscopio de bajo costo en contexto de pandemia por COVID-19 / Simulation of pediatric intubation using a low-cost videolaryngoscope in the setting of the COVID-19 pandemic

En pacientes con infección por SARS-CoV-2 la intubación endotraqueal es un procedimiento con riesgo elevado de contagio. La videolaringoscopia complementa la protección del profesional, pero los videolaringoscopios comerciales son caros y no siempre están disponibles en las terapias intensivas pediátricas argentinas. El objetivo fue describir la práctica de intubación en un modelo de cabeza de simulación de lactante con un videolaringoscopio artesanal de bajo costo.Quince pediatras sin experiencia previa con el dispositivo participaron de una práctica de intubación en una cabeza de simulación con un videolaringoscopio artesanal. El tiempo promedio del primer intento fue de 116,4 segundos (intervalo de confianza del 95 % [IC95 %]: 84,8-148,0) y, el del siguiente fue de 44,2 segundos (IC95 %: 27,7­60,6). El tiempo disminuyó de forma significativa en el segundo intento (p : 0,0001). El dispositivo permitió la intubación exitosa en todos los intentos acortando la duración del procedimiento en la segunda práctica

In patients with SARS-CoV-2 infection, endotracheal intubation is a procedure with a high risk for transmission. A videolaryngoscopy is a supplementary level of health care provider protection, but commercial videolaryngoscopes are expensive and not always available in pediatric intensive care units in Argentina. Our objective was to describe intubation practice using an infant head mannequin with a low-cost, handcrafted videolaryngoscope.Fifteen pediatricians with no prior experience using the device participated in an intubation practice in a head mannequin with a handcrafted videolaryngoscope. The average time for the first attempt was 116.4 seconds (95 % confidence interval [CI]: 84.8-148.0) and, for the second one, 44.2 seconds (95 % CI: 27.7-60.6). Time decreased significantly for the second attempt (p: 0.0001).A successful intubation was achieved with the device in all attempts, and the procedure duration decreased with the second practice

Percepções da integração ensino-serviço-comunidade: contribuições para a formação e o cuidado integral em saúde / Perceptions of teaching-service-community integration: contributions to health education and to comprehensive healthcare / Percepciones de la integración enseñanza-servicio-comunidad: contribuciones para la formación y el cuidado integral en salud

O presente estudo objetiva conhecer a percepção dos sujeitos no processo de ensino-aprendizagem-cuidado no Sistema Único de Saúde (SUS), com base no perfil profissional e nas competências e habilidades recomendadas nas Diretrizes Curriculares Nacionais (DCNs) dos cursos de graduação da saúde. Trata-se de pesquisa qualitativa realizada por meio de técnicas de entrevista não diretiva e grupos focais, envolvendo 42 participantes, sendo: professores, estudantes e gestores das instituições de ensino além de usuários, profissionais e gestores da Secretaria Municipal de Promoção de Saúde (SEMUS). A percepção dos diferentes sujeitos que produzem e vivenciam a integração ensino-serviço-comunidade (IESC) revela afinidade com o perfil profissional e com as competências e habilidades comuns recomendadas nas DCNs dos cursos de graduação da área da saúde. A IESC é compreendida como espaço necessário para a efetivação das DCNs e para se alcançar o perfil profissional proposto.(AU)

The study aims to investigate the perception of subjects in the teaching-learning-care process within the Brazilian National Health System (SUS), based on the professional profile and on the skills and competencies recommended by the National Curricular Guidelines (DCNs) for undergraduate programs in the area of health. It is a qualitative research carried out through non-directive interviews and focus groups, involving 42 participants: teachers, students and managers of education institutions, as well as users, professionals and managers of the Municipal Health Promotion Department (SEMUS). The perception of different subjects who produce and experience teaching-service-community integration (TSCI) reveals affinity with the professional profile and with the common skills and competencies recommended by the DCNs. TSCI is understood as a necessary space for the fulfilment of the DCNs and of the proposed professional profile.(AU)

El presente estudio tiene el objetivo de conocer la percepción de los sujetos en el proceso de enseñanza-aprendizaje-cuidado en el Sistema Brasileño de Salud (SUS), con base en el perfil profesional y en las competencias y habilidades recomendadas en las Directrices Curriculares Nacionales (DCNs) de los cursos de graduación de la salud. Se trata de una encuesta cualitativa por medio de técnicas de entrevista no-directiva y grupos focales, envolviendo a 42 participantes, siendo ellos: profesores, estudiantes y gestores de las instituciones de enseñanza, además de usuarios, profesionales y gestores de la Secretaría Municipal de Promoción de Salud (SEMUS). La percepción de los diferentes sujetos que producen y experimentan la integración enseñanza-servicio-comunidad (IESC) revela afinidad con el perfil profesional y con las competencias y habilidades comunes recomendadas en las Directrices Curriculares Nacionales (DCNs) de los cursos de graduación del área de la salud. La IESC se entiende como un espacio necesario para hacer efectivas las DCNs y para alcanzar el perfil profesional propuesto.(AU)

Relación médico-industria y los conflictos de interés: aspectos históricos y normativos, impactos negativos y propuestas / Physician-industry relationship and conflicts of interest: Historical, normative aspects, negative impact and proposals

RESUMEN El presente artículo revisa de manera narrativa y general la relación entre los médicos y la industria (RMI); se incluye a la industria farmacéutica, de dispositivos, de suplementos y los conflictos de intereses que surgen de dicha relación. Se aborda el tema mediante algunas definiciones y un breve recuento histórico de cómo la RMI se ha convertido en un problema importante en el ejercicio médico y los sistemas de salud. El artículo expone los diversos roles dentro de los escenarios más comunes en los que ocurre la RMI: en la investigación biomédica, las guías de práctica clínica, la educación médica continua, la visita médica, los líderes de opinión, así como en la interacción directa, la exposición indirecta y la que denominamos exposición temprana. Se mencionan, posteriormente, algunas técnicas que utiliza la industria para modificar los hábitos de prescripción basadas en elementos de psicología social, así como el papel que ejercen los obsequios y otras estrategias de mercadeo. Se revisó la literatura que muestra el impacto y el efecto que estas técnicas tienen en el ejercicio médico. Finalmente, se plantean algunas propuestas que se han desarrollado desde la normatividad y recomendaciones para afrontar el problema que podrían contribuir a mitigar los efectos negativos de una RMI muy estrecha. Estas propuestas son prohibir el contacto de los. estudiantes con la industria, la inclusión del tema de conflictos de intereses (CI) en los currículos de medicina, financiación alternativa de la educación continua, declaración de conflictos como norma, campañas de concientización, uso de evidencia sintetizada y analizada transparente e independientemente, entre otras.

SUMMARY This article presents a narrative review of the relationship between physicians and industry (RPI), which includes pharmaceutical, devices and supplements' industries and the conflicts of interest that arise from this relationship. It introduces the problem through some definitions and a brief history review of how RPI has become a major problem in medical practice and health systems. The article discusses the different roles within the most common scenarios in which RPI occurs: biomedical research, clinical practice guidelines, continuing medical education, medical visits, opinion leaders, as well as in direct interaction, indirect exposure, and what we call, an early exposure. Some techniques used by industry to modify prescription habits based on elements of social psychology, are described, as well as the role of gifts and other marketing techniques on prescriptions. We review literature that shows the impact and effect these techniques have on medical practice. Finally, some initiatives, codes and recommendations that have been developed to address the problem and which could contribute to mitigate the negative effects of a very close RPI. The possible actions are: banning any contact between industry and students, inclusion of conflict of interests into the medical curricula, alternative financial support to continuous education, making the disclosure of conflicts of interests mandatory, launching awareness campaings among physicians, and the use of synthesized evidence that have been transparently and independently assessed, among others.

Implementation of an Acute Coronary Syndrome Simulation Training Strategy for Emergency Healthcare Professionals

The knowledge on the management of patients with acute coronary syndrome (ACS) is essential to reduce the gap between evidence and practice. Objective: To describe a simulation training strategy for emergency healthcare professionals and provide preliminary data on knowledge acquisition, learners' confidence and prescription of medications after training. Methods: The training was part of the implementation of two myocardial infarction systems of care. It comprehended lectures and simulation-based learning using high and low-fidelity mannequins and actors. It was tested in two phases: the first one in Belo Horizonte and the second one in Montes Claros, both in the state of Minas Gerais. A test was applied before and after training to assess knowledge acquisition. Confidence to perform thrombolysis in ST-elevation myocardial infarction (STEMI) patients was assessed using a questionnaire, and the impact on medication prescription analyzed STEMI patients admitted to hospitals in Montes Claros. Results: In the first phase, 156 professionals answered both tests: 70% of them improved their results and the median number of right answers increased (6, interquartile range [IQR] 5-7; vs 7 ([IQR] 6-9; p < 0.05). In the second phase, 242 professionals answered both tests: 58% of the physicians and 83% of the nurses obtained better test scores. Participants referred a positive impact on their clinical practice, 95% reported feeling very secure when perform fibrinolysis after the training, and there was also an impact on medication prescription. Conclusions: There was an impact on the learners' knowledge acquisition and confidence using our two-phase training model, with evidence of impact on performance

A experiência do Programa de Educação Permanente para médicos em Belo Horizonte na visão dos seus participantes / The Experience of physicians' Permanent Education Program in Belo Horizonte. The participant point of view

O cenário da Atenção Primária à Saúde (APS) é bastante heterogêneo e dinâmico, tanto no que tange às populações adscritas, como aos profissionais atuantes. Considerada a principal porta de entrada do usuário na rede pública de saúde, a APS exerce importante função ordenadora dos fluxos assistenciais. Através da Estratégia Saúde da Família (ESF), a APS pode alcançar elevados índices de resolutividade para sua demanda. Nesse panorama, a Educação Permanente em Saúde surge como uma ferramenta importante para diminuir as desigualdades de ações e condutas e aprimorar os conhecimentos e habilidades dos profissionais médicos em seus processos cotidianos de trabalho, impactando diretamente na efetividade da ESF. Em 2005, no estado de Minas Gerais, a Secretaria de Estado de Saúde (SES) criou o Programa de Educação Permanente (PEP) para promover a educação continuada entre os profissionais médicos atuantes na ESF, através da parceria com instituições de ensino superior. A Prefeitura de Belo Horizonte (PBH), em 2010, através do seu Centro de Educação em Saúde (CES), Gerência de Assistência (GEAS) e suas coordenadorias distritais, assumiu a própria gestão do seu PEP, capacitando servidores da rede e fomentando toda infraestrutura necessária para sua implementação. Desde 2015, na rede municipal de saúde de Belo Horizonte, o PEP médico encontra-se extinto. O presente estudo visa analisar a percepção dos médicos participantes do PEP dessa rede, durante a sua vigência, em relação a sua importância, potencialidades, fragilidades. Para tanto, realizou-se uma revisão da literatura sobre o assunto e a elaboração de um questionário, que passou por um teste piloto com médicos participantes do PEP de outros municípios, para coletar as informações necessárias do público alvo. Os resultados foram analisados utilizando os testes T de Student, Exato de Fisher e o Qui-quadrado, de acordo com as variáveis analisadas. Houve, entre os entrevistados, unanimidade em reconhecer o PEP como uma estratégia relevante para médicos atuantes da APS e expressivo reconhecimento dos entrevistados quanto a relevância da sua retomada

The Primary Health Care set is very heterogeneous and dynamic in relation to the population attached to them, as well to the professionals working there. Considered the main entrance of the users in the public health system, it has an important function in the organization of the assistance flows. Through the Family Health Strategy, the Primary Health Care could achieve high levels of cases resolution. In this way, the Health Continuing Education shows up as an important instrument to decrease the differences of actions and conducts and develop the knowledge and skills of the physician professionals in their daily process of work, affecting directly in the effectiveness of the Family Health Strategy. In 2005, the state of Minas Gerais, the Health State Secretary developed the Continuing Education Program to promote continued education for the physicians working at Family Health Strategy. It was performed in partnership with higher education institutions. In 2010, the municipality of Belo Horizonte through its Health Education Center, Assistance Management and its district coordinating's took on her own management of Continuing Education Program, training employees and giving all the structure needed to develop it. In 2015, the Continuing Education Program for physicians was closed in Belo Horizonte. This study analyzed the perception of the physicians that participated in the Program when it occurred in relation to its importance, potentialities and fragilities. A revision of literature about the topic was done and elaborated a questionary, that was submitted to a previous test applied to physicians who participated in the Continuing Education Program in other municipalities. It was realized to collect the necessary information of the target audience. The results were analyzed using the t-Student and chi square tests, according to the variables analyzed. Among the participants it was unanimous that the Continuing Education Program is a relevant strategy for physicians that work at the Primary Health Care and an expressive number of participants considered important its reactivation

O perfil das ligas acadêmicas de angiologia e cirurgia vascular e sua eficácia no ensino da especialidade / The profiles of angiology and vascular surgery academic leagues and their effectiveness in specialty education

As ligas acadêmicas são organizações estudantis extracurriculares que contam com a supervisão de um docente vinculado à instituição de ensino e visam aprimorar o conhecimento em determinadas áreas. Verificou-se, nos últimos anos, um crescimento do número de novas ligas, nas quais os graduandos têm acesso a informações complementares através de aulas, estágios e congressos. A especialidade de angiologia e cirurgia vascular encontra-se entre aquelas que dispõem dessas organizações. Objetivos Determinar o perfil acadêmico das ligas de angiologia e cirurgia vascular das faculdades de Medicina do estado de São Paulo e verificar o desempenho dos membros dessas ligas no ensino. Métodos Este estudo transversal, descritivo e analítico incluiu graduandos de Medicina membros de ligas acadêmicas de angiologia e cirurgia vascular do estado de São Paulo. Foram utilizados questionários on-line para determinação dos dados de cada liga e foram aplicadas provas para verificação do desempenho. Resultados O ingresso ocorreu prioritariamente por prova, com curso introdutório obrigatório. Realizaram-se aulas teóricas mensalmente em 42,9% das ligas. Quanto a atividades práticas, 85,7% das ligas as realizaram. A maioria das ligas (71,4%) relataram realizar atividades científicas. A comparação pareada do desempenho dos alunos nas provas demonstrou um aumento significativo na média, de 61,1 para 72,6 (p < 0,05). Conclusões As ligas acadêmicas de angiologia e cirurgia vascular do estado de São Paulo apresentam modos de funcionamento semelhantes e um perfil heterogêneo quanto a atividades teóricas, práticas e científicas. A partir da presente amostra, as ligas acadêmicas aparentam ser efetivas no ensino de angiologia e cirurgia vascular durante a graduação

Academic leagues are extracurricular student organizations that are supervised by professors on the faculty of a higher education institution and are dedicated to improving knowledge in certain areas. There has recently been a marked growth in the number of new leagues, giving undergraduate students access to additional information, lectures, internships, and conferences. Angiology and vascular surgery is one of the specialties that have such organizations. Objectives To determine the academic profile of the angiology and vascular surgery academic leagues at medical schools in the state of São Paulo, Brazil, and investigate the academic performance of their members. Methods This is a cross-sectional, descriptive, and analytical study that recruited undergraduate medical students who had joined angiology and vascular surgery academic leagues in the state of São Paulo. On-line questionnaires were used to collect data on each league and the students took examinations to determine their performance. Results Most leagues had an entrance exam for enrollment, with an obligatory introductory course. Monthly theoretical lectures were held by 42.9% of the leagues. Practical activities were provided by 85.7% of the leagues. The majority of the leagues (71.4%) were involved in scientific research. Paired-sample comparison of students' performance in the exams revealed a significant increase in mean scores, from 61.1 to 72.6 (p < 0.05). Conclusions The angiology and vascular surgery academic leagues in the state of São Paulo all function in a similar manner, but the range of theoretical, practical and scientific activities they offer are not uniform. For the sample investigated, the academic leagues appear to be effective at teaching angiology and vascular surgery during undergraduate courses