Black men in white coats - Barriers black men face in medicine, implications to decreased representation, and potential interventions at the uniformed services university of the health sciences.

The number of black male applicants to US medical schools has remained stagnant over the last 30 years. The etiology behind the lack of applicants is multifaceted and involves greater systemic barriers, specifically, educational and social barriers. The lack of representation of black males in medicine also has downstream implications for the health of the African American/black community. African Americans exhibit some of the lowest levels of trust in the healthcare system, have less access to care than their non-minority peers, and have, comparatively, poorer healthcare outcomes than other populations in the US. Research has demonstrated that patient-provider race concordance improves communication, outcomes, culturally competent care, and satisfaction with care. The greater the gap between these two populations, the harder it becomes to improve healthcare outcomes, maintain a medically ready fighting force in the US military, and improve trust in the healthcare system. This article provides an analysis of the multifactorial barriers black male applicants face applying, matriculating, and graduating medical school and how decreased representation may affect healthcare delivery. Furthermore, this review explores next steps and potential implementations at the Uniformed Services University of the Health Sciences to address the above deficiencies.

Medical Student Selection.

Medical school admissions committees are tasked with fulfilling the values of their institutions through careful recruitment. Making accurate predictions regarding the enrollment behavior of admitted students is critical to intentionally formulating class composition and impacts long-term physician representation.

Evaluation of undergraduate medical students' preference to human anatomy practical assessment methodology: a comparison between online and traditional methods.

PURPOSE: COVID 19 pandemic has brought crucial changes in the field of medical education. Ad mist university examinations in India medical schools have switched to online assessment methods to avoid student gatherings. In this context, we conducted online anatomy practical evaluation and we have aimed at quantifying the students' experience on virtual assessment. METHODS: A total of 250 first year MBBS students appeared for online anatomy practical examinations. Immediately after the completion of exams electronic feedback about their experience, in questionnaire format was obtained after getting informed consent. Their feedback was analysed and quantified. RESULTS: Completed feedback forms were submitted by 228 students. More than 50% of students favoured online anatomy spotter examinations. Only 32.8% of students were comfortable with soft parts discussion using images. For image based viva voce 61.4%, 80% & 82% of students responded that the features and orientation of osteology, radiology and embryology images, respectively, were good. For surface marking 55% of the participants preferred online verbal evaluation. Finally, more than 60% of the students preferred the conventional over online assessment methods. CONCLUSIONS: The inclination of students' preference for traditional anatomy examination methods mandates adequate training of both students and teachers for virtual examination. The superiority of conventional anatomy practical examination methods is unbiased but pandemic situations warrant adequate preparedness. In the future the anatomy teaching and evaluation methodology in Indian medical schools have to be drastically reviewed in equivalence with global digitalization.

Demographics and Career Intentions of Graduates of Combined Baccalaureate-MD Programs, 2010-2017: An Analysis of AAMC Graduation Questionnaire Data.

PURPOSE: Combined baccalaureate-MD programs exist to fulfill a variety of educational missions, including to promote the development of physician-scientists, increase workforce diversity, promote primary care careers, and meet the needs of underserved patients. The authors sought to determine the demographics of combined program graduates, as well as their intention to practice in primary care (IPPC) and intention to work with the medically underserved (IWMU), as compared with graduates of traditional MD programs. METHOD: Data from the 2010-2017 Association of American Medical Colleges Graduation Questionnaire, a national survey of graduating medical students, were recategorized (e.g., as combined program or traditional program) before analysis. Logistic regression models on the 2 primary outcomes (IPPC and IWMU) were conducted to estimate odds ratios for the effects of covariates and predictors (e.g., gender, underrepresented in medicine [URM] group member, type of medical degree program). RESULTS: Data from a total of 109,028 respondents were included (3,182 from combined and 105,846 from traditional programs). Compared with students in traditional programs, those in combined programs were more likely to be younger (age at graduation ≤ 29: 3,143, 98.8% vs 89,688, 84.7%) and female (1,813, 57.0% vs 52,013, 49.1%) but less likely to identify as a URM group member (276, 8.7% vs 14,757, 13.9%). In an adjusted logistic regression model, graduating from a combined program, identifying as female, and IWMU predicted significantly greater odds of IPPC, while identifying as a URM, identifying as female, and having debt predicted significantly greater odds of IWMU. Graduating medical students who indicated family medicine as a career specialty were more likely to indicate an IWMU. CONCLUSIONS: Medical students graduating from combined programs were more likely to indicate an IPPC but were no more likely to indicate an IWMU than traditional program graduates.

Women in Thoracic Surgery Scholarship: Impact on Career Path and Interest in Cardiothoracic Surgery.

BACKGROUND: Women remain underrepresented in cardiothoracic surgery (CTS). In 2005, Women in Thoracic Surgery (WTS) began offering scholarships to promote engagement of women in CTS careers. This study explores the effect of WTS scholarships on CTS career milestones. METHODS: We assessed career development using the number of awardees matching into CTS residency/fellowship, American Board of Thoracic Surgery (ABTS) certification, and academic CTS appointment. Scholarship awardee data were obtained from our WTS database. Comparison data were gathered from the National Residency Match Program and ABTS. Details of the current roles of ABTS-certified women were determined from public resources. Qualitative results were gathered from post-scholarship surveys. RESULTS: A total of 106 WTS scholarships have been awarded to 38 medical students (36%), 41 general surgery residents (39%), and 27 CTS residents/fellows (25%). Among medical students, 26% of awardees entered integrated CTS residency (vs <0.1% for medical students, P < .001), and 37% entered general surgery residency (vs 4.8% for medical students, P < .001). Of general surgery awardees, 59% entered CTS fellowships (vs 7.7% for general surgery residents, P < .001), and of CTS resident/fellow awardees, 100% earned ABTS certification (vs 73% ABTS pass rate, P = .01). Of ABTS-certified awardees, 44% are practicing cardiothoracic surgeons at US academic training institutions (vs 33% of non-awardee ABTS-certified women, P = .419). All awardees reported that their scholarship was valuable in their development. CONCLUSIONS: Receipt of a WTS scholarship is associated with successful pursuit of CTS career milestones at significantly higher rates than contemporaries. These scholarships foster a supportive community for women trainees in CTS.

Preparing for the MD: How Long, at What Cost, and With What Outcomes?

PURPOSE: To assess educational and professional outcomes of an accelerated combined bachelor of science-doctor of medicine (BS-MD) program using data collected from 1968 through 2018. METHOD: Participants of this longitudinal study included 2,235 students who entered medical school between 1968 and 2014: 1,134 in the accelerated program and 1,101 in the regular curriculum (control group)-matched by year of entrance to medical school, gender, and Medical College Admission Test (MCAT) scores. Outcome measures included performance on medical licensing examinations, academic progress, satisfaction with medical school, educational debt, first-year residency program directors' ratings on clinical competence, specialty choice, board certification, and faculty appointments. RESULTS: The authors found no practically important differences between students in the accelerated program and those in the control group on licensing examination performance, academic progress, specialty choice, board certification, and faculty appointments. Accelerated students had lower mean educational debt (P < .01, effect sizes = 0.81 and 0.45 for, respectively, their baccalaureate debt and medical school debt), lower satisfaction with their second year of medical school (P < .01, effect size = 0.21), and lower global satisfaction with their medical school education (P < .01, effect size = 0.35). Residency program directors' ratings in 6 postgraduate competency areas showed no practically important differences between the students in the accelerated program and those in the control group. The proportion of Asian students was higher among program participants (P < .01, effect size = 0.43). CONCLUSIONS: Students in the accelerated program earned BS and MD degrees at a faster pace and pursued careers that were comparable to students in a matched control who were in a regular MD program. Findings indicate that shortening the length of medical education does not compromise educational and professional outcomes.

Assessment of Medical Laboratory Undergraduates Training in Different School Year Systems.

OBJECTIVE: To assess the effect of the change from the 5-year system of coursework to a 4-year system on the achievements of medical laboratory undergraduates. METHODS: We analyzed and then compared the topics of training and the test scores among all subject individuals in the 5-year vs the 4-year undergraduate program. RESULTS: Five-year-program undergraduates and 4-year-program undergraduates were required to complete 50 courses. The average weekly education time in the 4-year program (27.05 lesson-hours/week) was greater than that in the 5-year program (22.99 lesson-hours/week). The proportion of clinical practice in the hospital setting in the 4-year program (26.8%) was higher than that in the 5-year program (24.5%). The average, excellent, and good scores among 4-year-program undergraduates in general education courses, professional basic courses, professional courses, all courses, and common courses were lower than those scores among the 5-year-program undergraduates. CONCLUSIONS: The 5-year undergraduate program should be adapted to help boost the achievements and practical skills among its students, in helping them adapt quickly to the new, 4-year training plan (which presented a serious challenge in our cohort).

Inclusion of health care for people with disabilities in Brazilian undergraduate medical education / Inclusão do cuidado com a saúde das pessoas com deficiência nos currículos de medicina do Brasil

Abstract: Introduction: In Brazil, official data estimate there are 45.6 million people with some type of disability and legislation establishes that medical schools should prepare future professionals for the essential care for people with disabilities (PWD). Health disparities faced by PWD are due, among other factors, to inadequate access to healthcare and poor training of professionals to deal with these situations. Objective: To identify the presence of aspects related to PWD healthcare in the curricula of medical courses in Brazil. Method: A documentary analysis of curricula and syllabuses was performed and included research in websites of 328 medical courses (42% public and 58% private) authorized by the Brazilian Ministry of Education. The Brazilian National Curricular Guidelines (NCG) were adopted as a theoretical framework (Brazil, 2014). The classification considered was: Class I - minimum attendance of the pedagogical project to the recommendations on care for PWD, due to the strict transcription of the NCG text and Class II - inclusion in the syllabus and programmatic content of the reference curricular components to the development of specifically related clinical skills to the health care of the PWD, including communication, clinical examination skills and ethical aspects. Results: Documents from 171 courses were available for analysis and the inclusion of aspects related to PWD healthcare was identified in 89 courses (52%). This inclusion was more prevalent in public courses (n=56; 62,9%) than in private ones. The inclusion of the teaching of the Brazilian Sign Language (Libras) was observed In 50 courses (29.2%). The curricular contents were predominantly focused on the Class I (n=80;89,9%) with an absolute lack of description of the procedural strategies to promote the development of clinical competencies related to PWD care. Conclusion: Our study reinforces the need to improve this approach in medical school curricula since providers can play an essential role in mitigating health disparities faced by PWD through competent care. In the Brazilian context, our data point out to a dramatic situation consistent with the invisibility of PWD issues; a need for the development and implementation of PWD-specific educational curricula.

Resumo: Introdução: No Brasil, estima-se que haja 45,6 milhões de pessoas com alguma deficiência. As disparidades de saúde enfrentadas pelas pessoas com deficiência (PCD) decorrem, entre outros fatores, do acesso inadequado aos cuidados de saúde e da formação deficiente dos profissionais para lidar com essas situações. Objetivo: Este estudo teve como objetivo identificar a presença de aspectos relacionados com a atenção à saúde das PCD nos currículos dos cursos de Medicina do Brasil. Método: Foi realizada análise documental dos projetos pedagógicos dos cursos, dos currículos, das ementas de componentes curriculares e dos conteúdos programáticos, incluindo pesquisas em sites de 328 cursos de Medicina (42% públicos e 58% privados) autorizados pelo Ministério da Educação. As Diretrizes Curriculares Nacionais (DCN) do Curso de Graduação em Medicina foram adotadas como referencial teórico. A classificação considerada foi: classe I - atendimento mínimo do projeto pedagógico às recomendações sobre o cuidado para PCD, pela estrita transcrição do texto das DCN, e classe II - inclusão nas ementas e nos conteúdos programáticos dos componentes curriculares de atividades voltadas ao desenvolvimento de competências clínicas especificamente relacionadas ao cuidado destinado à saúde das PCD, incluindo comunicação, exame clínico e aspectos éticos. Resultado: Documentos de 171 cursos estavam disponíveis para análise adequada. Desse total, em 89 cursos (52%) foi identificada a inclusão de aspectos relacionados ao cuidado com PCD, sendo mais prevalente nos cursos públicos (n = 56; 62,9%). Em 50 (29,2%) cursos, observou-se a inclusão do ensino da Língua Brasileira de Sinais (Libras). Os conteúdos curriculares identificados foram predominantemente focados na classe I (n = 80; 89,9%), com absoluta falta de descrição das estratégias processuais para promover o desenvolvimento de competências clínicas relacionadas ao cuidado para PCD. Conclusão: No contexto brasileiro, os dados apontam para uma situação dramática no que se refere à invisibilidade das questões relativas às PCD na formação médica e para a necessidade de desenvolvimento e implementação de estratégias educacionais especificamente voltadas para o cuidado com as PCD nos currículos médicos. O estudo reforça o papel essencial do cuidado competente destinado à saúde das PCD como estratégia que visa à mitigação das iniquidades de saúde enfrentadas por essas pessoas.

A Narrative Study of Equity in Clinical Assessment Through the Antideficit Lens.

PURPOSE: Efforts to address inequities in medical education are centered on a dialogue of deficits that highlight negative underrepresented in medicine (UIM) learner experiences and lower performance outcomes. An alternative narrative explores perspectives on achievement and equity in assessment. This study sought to understand UIM learner perceptions of successes and equitable assessment practices. METHOD: Using narrative research, investigators selected a purposeful sample of self-identified UIM fourth-year medical students and senior-level residents and conducted semistructured interviews. Questions elicited personal stories of achievement during clinical training, clinical assessment practices that captured achievement, and equity in clinical assessment. Using re-storying and thematic analysis, investigators coded transcripts and synthesized data into themes and representative stories. RESULTS: Twenty UIM learners (6 medical students and 14 residents) were interviewed. Learners often thought about equity during clinical training and provided personal definitions of equity in assessment. Learners shared stories that reflected their achievements in patient care, favorable assessment outcomes, and growth throughout clinical training. Sound assessments that captured achievements included frequent observations with real-time feedback on predefined expectations by supportive, longitudinal clinical supervisors. Finally, equitable assessment systems were characterized as sound assessment systems that also avoided comparison to peers, used narrative assessment, assessed patient care and growth, trained supervisors to avoid bias, and acknowledged learner identity. CONCLUSIONS: UIM learners characterized equitable and sound assessment systems that captured achievements during clinical training. These findings guide future efforts to create an inclusive, fair, and equitable clinical assessment experience.

Medical schools in Brasil: population, economic and historical analysis.

OBJECTIVE: To describe the current distribution and historical evolution of undergraduate courses in medicine in Brasil. METHODS: Analytical cross-sectional study of secondary data. Through the Ministry of Education, the data of the medical courses were obtained, and through the Brazilian Institute of Geography and Statistics, the population and economic data of the Brazilian states were obtained. RESULTS: In Brasil, there were 298 medical courses (1,42 courses / million inhabitants) in January 2018, totaling 31,126 vacancies per year, with 9,217 gratuitous vacancies (29.6%) and 17,963 vacancies in the hinterland (57, 7%). In Brazilian states, there are positive and statistically significant (p <0.001) correlations of the variables: "vacancies" and "population" (R 0.92); "vacancies" and "gross domestic product" ("GDP") (R 0.83); "percentage of vacancies in the hinterland" and "population in the hinterland" (R 0.71) and "percentage of vacancies in the hinterland" and "GDP" (R 0.64). There was a negative and statistically significant correlation between "gratuitous vacancy percentage" and "GDP" (R -0.54, p = 0.003). More paid courses than gratuitous courses and more courses in the hinterland than in the capitals have been created since 1964, in proportions that have remained similar since then, but in higher numbers since 2002. CONCLUSIONS: The distribution of medical courses in Brasil correlates with the population and economical production of each state. The expansion of Brazilian medical education, which has been accelerated since 2002, is based mainly on paid courses in the hinterland, in the same pattern since 1964.

Medical schools in Brasil: population, economic and historical analysis

SUMMARY BACKGROUND To describe the current distribution and historical evolution of undergraduate courses in medicine in Brasil. METHODS Analytical cross-sectional study of secondary data. Through the Ministry of Education, the data of the medical courses were obtained, and through the Brazilian Institute of Geography and Statistics, the population and economic data of the Brazilian states were obtained. RESULTS In Brasil, there were 298 medical courses (1,42 courses / million inhabitants) in January 2018, totaling 31,126 vacancies per year, with 9,217 gratuitous vacancies (29.6%) and 17,963 vacancies in the hinterland (57, 7%). In Brazilian states, there are positive and statistically significant (p <0.001) correlations of the variables: "vacancies" and "population" (R 0.92); "vacancies" and "gross domestic product" ("GDP") (R 0.83); "percentage of vacancies in the hinterland" and "population in the hinterland" (R 0.71) and "percentage of vacancies in the hinterland" and "GDP" (R 0.64). There was a negative and statistically significant correlation between "gratuitous vacancy percentage" and "GDP" (R -0.54, p = 0.003). More paid courses than gratuitous courses and more courses in the hinterland than in the capitals have been created since 1964, in proportions that have remained similar since then, but in higher numbers since 2002. CONCLUSIONS The distribution of medical courses in Brasil correlates with the population and economical production of each state. The expansion of Brazilian medical education, which has been accelerated since 2002, is based mainly on paid courses in the hinterland, in the same pattern since 1964.

RESUMO OBJETIVO Descrever a distribuição e evolução histórica das vagas em cursos de graduação em medicina no Brasil. MÉTODOS Estudo transversal analítico de dados secundários. No Ministério da Educação obtiveram-se dados dos cursos de medicina e no Instituto Brasileiro de Geografia e Estatística foram obtidos dados populacionais e econômicos dos estados. RESULTADOS Havia no Brasil, até janeiro de 2018, 298 cursos de medicina (1,42 curso/milhão de habitantes), totalizando 31.126 vagas anuais, com 9.217 vagas gratuitas (29,6%) e 17.963 vagas no interior do País (57,7%). Nos estados há correlações positivas e significativas (p<0,001) das variáveis: "vagas em medicina" e "população" (R 0,92); "vagas em medicina" e "produto interno bruto" ("PIB") (R 0,83); "percentual de vagas em medicina no interior" e "população no interior" (R 0,71) e "percentual de vagas em medicina no interior" e "PIB" (R 0,64). Há correlação negativa e significativa entre "percentual de vagas gratuitas" e "PIB" (R -0,54, p=0,003). Passaram a ser criados mais cursos pagos do que gratuitos e mais cursos no interior do que nas capitais a partir de 1964 (p <0,001), e a relação curso/milhão de habitantes aumentou a partir de 2002 (p<0,001). CONCLUSÕES A distribuição de vagas em cursos de medicina no Brasil correlaciona-se à população e à produção econômica de cada estado. A expansão do ensino médico brasileiro, acelerada além do crescimento populacional a partir de 2002, é baseada principalmente em cursos pagos no interior dos estados brasileiros, característica inalterada desde 1964.

Are battlefield and prehospital trauma scenarios an effective educational tool to teach leadership and crisis resource management skills to undergraduate medical students?

INTRODUCTION: Leadership and crisis resource management (CRM) skills are important skills for doctors, however there is a recognised lack of undergraduate leadership education. There remains debate over how best to teach leadership and CRM skills, and poor leadership skills among clinicians are associated with adverse patient outcomes. We examined whether high-fidelity battlefield and prehospital scenarios can improve leadership and CRM skills. METHOD: This was a prospective observational study with students self-reporting their leadership and CRM skills using the Ottawa Crisis Resource Management Global Ranking Scale (OCRMGRS) before and after completing the Cambridge University Emergency Medicine Society Battlefield and Pre-Hospital Trauma course. The course involves a mixture of small group tutorials and practical high-fidelity battlefield and prehospital trauma scenarios. Faculty also completed the OCRMGRS for the first and last candidates at the scenarios. The mean precourse versus mean postcourse score of the OCRMGRS was analysed using a two-tailed t-test. RESULTS: 46 students completed paired OCRMGRS before and after the course. The mean precourse scores for each of the domains (leadership, communication skills, resource utilisation, problem solving skills and situational awareness) were calculated. There was a statistically significant (p<0.05) increase in both self-reported and faculty-reported scores across all domains, and the increase remained at 1-year follow-up. CONCLUSIONS: Leadership and CRM skills are important non-clinical skills for doctors, however there is debate over how best to teach them. High-fidelity battlefield and prehospital trauma scenarios are an effective means of teaching leadership and CRM skills to civilian medical students.

Quantitative Assessment of a Case Based Digital Learning Curriculum for Testicular Cancer.

OBJECTIVE: To address information overload for trainees, a concise electronic case-based urology learning program (CBULP) was developed. Previous qualitative assessments suggested CBULP's potential efficacy/utility. Herein we assess CBULP more stringently by evaluating test performance before/after reviewing a CBULP curriculum covering core concepts in testicular cancer. METHODS: Eleven of 33 CBULP testicular cancer cases were strategically selected for this curriculum. A 26 question multiple-choice test was developed to assess fundamental knowledge about testis cancer tumor biology and evaluation/management. Pretest was administered to PGY4/PGY1 residents at 2 pilot urology-training programs, and medical students interested in Urology. Participants were given 4 weeks to review the curriculum and the test was then repeated. A control group (4 PGY1s) was administered the pretest and repeat test in an analogous manner without provision of the CBULP curriculum. RESULTS: Twenty individuals took the pretest (7 medical students, 8 PGY1s, and 5 PGY4s), and 17 (85%) took the post-test (5 medical students, 8 PGY1s, and 4 PGY4s,). As expected, PGY4s performed significantly better than the other 2 groups on the pre- and post-test. However, significant improvement in test performance was seen across all groups that utilized the CBULP curriculum (P <.02), with highest increase demonstrated by PGY1 residents (4.75 more questions correct, P = .002). The control arm did not demonstrate significant improvement (P = .20). CONCLUSION: Significant improvement in test performance was observed after completion of the CBULP testicular series. This study suggests that CBULP can be an efficacious and clinically useful educational resource for urologic residents and students interested in the field.

[Undergraduate studies in health: supply and institutional strategies in the context of the Brazilian Unified National Health System regionalization]. / Graduação em saúde: oferta e estratégias para o fortalecimento da regionalização do Sistema Único de Saúde.

This article aims to provide an overview of the territorial distribution of health training supply and to identify the strategies for strengthening regionalization adopted by teaching institutions that offer health courses and the changes in the regional surroundings as a function of these institutions. This is a descriptive-exploratory multiple-case study conducted at the national level in Brazil from December 2015 to September 2016. The study analyzed secondary data on health training supply and interviewed 68 administrators of undergraduate health courses, whose commentary was submitted to content analysis. There was an increase in health training institutions in smaller regions and municipalities (counties), although such institutions were still concentrated mainly in more socioeconomically developed regions. Policies have been implemented for access and enrollment in higher education from the perspective of promoting provision and professional retention in the region where the health course is located. The university's presence promotes regional development and has the potential to strengthen health regionalization.

Este artigo objetiva descrever o panorama de distribuição territorial da oferta de formação em saúde, bem como identificar as estratégias para o fortalecimento da regionalização adotadas pelas instituições de ensino que ofertam cursos de saúde e as mudanças verificadas no entorno regional em função dessas instituições. Trata-se de estudo descritivo-exploratório, do tipo estudo de casos múltiplos, desenvolvido em âmbito nacional no período de dezembro de 2015 a setembro de 2016. Foram analisados dados secundários de oferta de formação em saúde e foram entrevistados 68 gestores de ensino de cursos de graduação em saúde, cujos depoimentos foram submetidos a análise de conteúdo. Percebe-se um aumento de equipamentos para formação em saúde em regiões e municípios de menor porte, não obstante a concentração em locais com maior desenvolvimento socioeconômico. Políticas de acesso ao ensino superior de estudantes vêm sendo empreendidas, na perspectiva de promover a provisão e fixação profissional do entorno onde se localizam os cursos da saúde. Constata-se que a presença da universidade promove desenvolvimento regional e tem potencial para o fortalecimento da regionalização da saúde.

El objetivo de este artículo es describir el panorama de la distribución territorial, en cuanto a la oferta de formación en salud, e identificar estrategias para el fortalecimiento de la regionalización, adoptadas por las instituciones de enseñanza que ofrecen cursos de salud, además de analizar los cambios verificados en el entorno regional, en función de estas instituciones. Se trata de un estudio descriptivo-exploratorio, de casos múltiples, desarrollado en el ámbito nacional de Brasil durante el período de diciembre de 2015 a septiembre de 2016. Se analizaron datos secundarios de oferta de formación en salud, y se entrevistaron a 68 gestores de enseñanza de cursos de grado en salud, cuyas declaraciones fueron sometidas a análisis de contenido. Se percibe un aumento de equipamientos para la formación en salud en regiones y municipios de menor porte, pese a la concentración en lugares con mayor desarrollo socioeconómico. Se están emprendiendo políticas de acceso e ingreso en la enseñanza superior de estudiantes, desde la perspectiva de promover la provisión y emplazamiento del profesional en el entorno donde se localizan los cursos de salud. Se constata que la presencia de la universidad promueve el desarrollo regional y tiene potencial para el fortalecimiento de la regionalización de la salud.

Quality of life of medical students in Brazil. A comparative study.

BACKGROUND: VERAS survey multicenter project, carried out in 2011-2012, evaluated the quality of life (QoL) of students from 22 Brazilian medical schools. AIM: To evaluate QoL of undergraduate medical students, taking Veras-q national data as comparison. MATERIAL AND METHODS: We evaluated the QoL of 197 medical students in a Brazilian private medical school at Salvador, Bahia, Brazil in 2014. Students in the first two years were grouped in Phase I; those in years three and four were grouped in Phase II. Those in the internship (fifth and sixth years) were grouped in Phase III. RESULTS: Students from Phase I group had better QoL averages than those from Phase II. Phase I students presented significantly (p < 0.05) better scores in the Psychological and Use of Time domains. Compared to Phase II students, those in Phase III obtained better scores in the Physical and Environmental domains. Female students had significantly lower (p < 0.01) scores than male students in Physical, Psychological and Use of Time domains. Compared to the national sample survey, these students had higher (p < 0.01) scores in all domains, except for the Physical domain in Phase II (p < 0.4352). CONCLUSIONS: These students had a better quality of life than those surveyed in the national Veras-q study. Female students had lower scores. Adjusted schedules and lower work overload, as consequences of effective interdisciplinarity in curricular components, may have contributed to higher students' QoL.

Early identification of first-year students at risk of dropping out of high-school entry medical school: the usefulness of teachers' ratings of class participation.

Dropping out from undergraduate medical education is costly for students, medical schools, and society in general. Therefore, the early identification of potential dropout students is important. The contribution of personal features to dropout rates has merited exploration. However, there is a paucity of research on aspects of student experience that may lead to dropping out. In this study, underpinned by theoretical models of student commitment, involvement, and engagement, we explored the hypothesis of using inferior participation as an indicator of a higher probability of dropping out in year 1. Class participation was calculated as an aggregate score based on teachers' daily observations in class. The study used a longitudinal dataset of six cohorts of high-school entry students (N = 709, 67% females) in one medical school with an annual intake of 120 students. The findings confirmed the initial hypothesis and showed that lower scores of class participation in year 1 added predictive ability to pre-entry characteristics (Pseudo-R2 raised from 0.22 to 0.28). Even though the inclusion of course failure in year 1 resulted in higher explanatory power than participation in class (Pseudo-R2 raised from 0.28 to 0.63), ratings of class participation may be advantageous to anticipate dropout identification, as those can be collected prior to course failure. The implications for practice are that teachers' ratings of class participation can play a role in indicating medical students who may eventually drop out. We conclude that the scores of class participation can contribute to flagging systems for the early detection of student dropouts.

Assessment of Middle Ear Anatomy Teaching Methodologies Using Microscopy versus Endoscopy: A Randomized Comparative Study.

Teaching methodologies for the anatomy of the middle ear have not been investigated greatly due to the middle ear's highly complex structure and hidden location inside of the temporal bone. The aim of this randomized study was to quantitatively compare the suitability of using microscope- and endoscope-based methods for teaching the anatomy of the middle ear. We hypothesize that the endoscopic approach will be more efficient compared to the microscopic approach. To answer the study questions, 33 sixth-year medical students, residents and otorhinolaryngology specialists were randomized either into the endoscopy or the microscopy group. Their anatomical knowledge was assessed using a structured anatomical knowledge test before and after each session. Each participant received tutoring on a human cadaveric specimen using one of the two methods. They then performed a hands-on dissection. After 2-4 weeks, the same educational curriculum was repeated using the other technique. The mean gains in anatomical knowledge for the specialists, residents, and medical students were +19.0%, +34.6%, and +23.4%, respectively. Multivariate analyses identified a statistically significant increase in performance for the endoscopic method compared to the microscopic technique (P < 0.001). For the recall of anatomical structures during dissection, the endoscopic method outperformed the microscopic technique independently of the randomization or the prior training level of the attendees (P < 0.001). In conclusion, the endoscopic approach to middle ear anatomy education is associated to an improved gain in knowledge as compared to the microscopic approach. The participants subjectively preferred the endoscope for educational purposes.

Quality of life of medical students in Brazil: a comparative study / Calidad de vida de estudiantes de medicina en Brasil: un estudio comparativo

ABSTRACT Background: VERAS survey multicenter project, carried out in 2011-2012, evaluated the quality of life (QoL) of students from 22 Brazilian medical schools. Aim: To evaluate QoL of undergraduate medical students, taking Veras-q national data as comparison. Material and Methods: We evaluated the QoL of 197 medical students in a Brazilian private medical school at Salvador, Bahia, Brazil in 2014. Students in the first two years were grouped in Phase I; those in years three and four were grouped in Phase II. Those in the internship (fifth and sixth years) were grouped in Phase III. Results: Students from Phase I group had better QoL averages than those from Phase II. Phase I students presented significantly (p < 0.05) better scores in the Psychological and Use of Time domains. Compared to Phase II students, those in Phase III obtained better scores in the Physical and Environmental domains. Female students had significantly lower (p < 0.01) scores than male students in Physical, Psychological and Use of Time domains. Compared to the national sample survey, these students had higher (p < 0.01) scores in all domains, except for the Physical domain in Phase II (p < 0.4352). Conclusions: These students had a better quality of life than those surveyed in the national Veras-q study. Female students had lower scores. Adjusted schedules and lower work overload, as consequences of effective interdisciplinarity in curricular components, may have contributed to higher students' QoL.

Antecedentes: El proyecto multicéntrico VERAS evaluó la calidad de vida de estudiantes de medicina en los años 2011-2012. Objetivo: Evaluar la calidad de vida de un grupo de estudiantes de medicina y compararla con los datos del proyecto VERAS. Material y Métodos: Se evaluó calidad de vida en 197 estudiantes de medicina de universidades privadas de Salvador, Bahía, Brasil en 2014. Los estudiantes de los dos primeros años fueron agrupados en la fase I, aquellos de tercer y cuarto año en fase II y los del internado en fase III. Resultados: Los estudiantes en fase I tuvieron mejor calidad de vida que aquellos en fase II. Los estudiantes en fase I tuvieron mejores puntajes en los dominios psicológico y uso del tiempo. Los estudiantes en fase III tuvieron mejores puntajes en los dominios físico y ambiental que los estudiantes en fase II. Las mujeres obtuvieron menores puntajes en los dominios físico, psicológico y uso del tiempo, que los hombres. Al comparar con el estudio nacional, estos estudiantes tuvieron mejores puntajes en todos los dominios, excepto el físico en estudiantes en fase II. Conclusiones: Estos estudiantes tuvieron mejor calidad de vida que sus pares estudiados previamente. Las mujeres tuvieron puntajes más bajos que los hombres. Una menor carga de trabajo, como consecuencia de un currículo multidisciplinario, puede haber influido en esta mejor calidad de vida.

Graduação em saúde: oferta e estratégias para o fortalecimento da regionalização do Sistema Único de Saúde / Undergraduate studies in health: supply and institutional strategies in the context of the Brazilian Unified National Health System regionalization / Grado en salud: oferta y estrategias institucionales contextualizadas respecto a la regionalización del Sistema Único de Salud brasileño

Resumo: Este artigo objetiva descrever o panorama de distribuição territorial da oferta de formação em saúde, bem como identificar as estratégias para o fortalecimento da regionalização adotadas pelas instituições de ensino que ofertam cursos de saúde e as mudanças verificadas no entorno regional em função dessas instituições. Trata-se de estudo descritivo-exploratório, do tipo estudo de casos múltiplos, desenvolvido em âmbito nacional no período de dezembro de 2015 a setembro de 2016. Foram analisados dados secundários de oferta de formação em saúde e foram entrevistados 68 gestores de ensino de cursos de graduação em saúde, cujos depoimentos foram submetidos a análise de conteúdo. Percebe-se um aumento de equipamentos para formação em saúde em regiões e municípios de menor porte, não obstante a concentração em locais com maior desenvolvimento socioeconômico. Políticas de acesso ao ensino superior de estudantes vêm sendo empreendidas, na perspectiva de promover a provisão e fixação profissional do entorno onde se localizam os cursos da saúde. Constata-se que a presença da universidade promove desenvolvimento regional e tem potencial para o fortalecimento da regionalização da saúde.

Abstract: This article aims to provide an overview of the territorial distribution of health training supply and to identify the strategies for strengthening regionalization adopted by teaching institutions that offer health courses and the changes in the regional surroundings as a function of these institutions. This is a descriptive-exploratory multiple-case study conducted at the national level in Brazil from December 2015 to September 2016. The study analyzed secondary data on health training supply and interviewed 68 administrators of undergraduate health courses, whose commentary was submitted to content analysis. There was an increase in health training institutions in smaller regions and municipalities (counties), although such institutions were still concentrated mainly in more socioeconomically developed regions. Policies have been implemented for access and enrollment in higher education from the perspective of promoting provision and professional retention in the region where the health course is located. The university's presence promotes regional development and has the potential to strengthen health regionalization.

Resumen: El objetivo de este artículo es describir el panorama de la distribución territorial, en cuanto a la oferta de formación en salud, e identificar estrategias para el fortalecimiento de la regionalización, adoptadas por las instituciones de enseñanza que ofrecen cursos de salud, además de analizar los cambios verificados en el entorno regional, en función de estas instituciones. Se trata de un estudio descriptivo-exploratorio, de casos múltiples, desarrollado en el ámbito nacional de Brasil durante el período de diciembre de 2015 a septiembre de 2016. Se analizaron datos secundarios de oferta de formación en salud, y se entrevistaron a 68 gestores de enseñanza de cursos de grado en salud, cuyas declaraciones fueron sometidas a análisis de contenido. Se percibe un aumento de equipamientos para la formación en salud en regiones y municipios de menor porte, pese a la concentración en lugares con mayor desarrollo socioeconómico. Se están emprendiendo políticas de acceso e ingreso en la enseñanza superior de estudiantes, desde la perspectiva de promover la provisión y emplazamiento del profesional en el entorno donde se localizan los cursos de salud. Se constata que la presencia de la universidad promueve el desarrollo regional y tiene potencial para el fortalecimiento de la regionalización de la salud.

Pilot evaluation of an objective structured assessment of technical skills tool for chest tube insertion.

Background: Chest tube insertion is a standard intervention for management of various injuries of the thorax. Efficient clinical training of this and similar bed-side procedures is equally demanded and improvable. Here, we propose a nouveau means of assessment and feedback using an Objective Structured Assessment of Technical Skills (OSATS) tool. The modified OSATS for chest drain insertion is evaluated in a pilot trial focusing on chest drain insertion. Methods: Participants in the pilot trial were medical students (3rd-6th year of studies, n=9), junior residents (1st-3rd post-graduate year, n=12), senior residents (4th-6th post-graduate year, n=14), and attending surgeons (n=6) from Heidelberg University. Chest drain insertions on a cadaveric porcine model were rated by experts with the modified OSATS score. Participants' performances were videotaped and subsequently rated by two remote experts (video rating). Primary aim was to assess criterion validity of the OSATS to distinguish experience levels. Results: Kruskal-Wallis test showed significant differences between means of scores between four groups stratified by previous experience in chest tube insertion (level 0: 22.1±3.2 vs. level 1: 26.8±2.8 vs. level 2: 35.4±2.2 vs. level 3: 41.0±2.0; p=0.002; p1,3=0.049, p0,3=0.005). However, if groups were stratified by formal professional level, no statistically significant distinction could be made using OSATS. Hence, the OSATS tool showed criterion validity for differentiation between experience levels. Conclusion: In the pilot study, the modified OSATS for chest tube insertion was apt to standardize expert rating and could be used to measure skill and to depict different experience levels. The OSATS will help facilitate training and assessment of chest drain insertion and could therefore improve surgical training for trauma situations. According to our data, the OSATS might be integrated into modern curricula.