Desenredando los nudos en cirugía: creando maestría con un simulador práctico en casa / Untangling the knots in surgery: Creating mastery with a practical at-home simulator

Introducción. Anudar es una de las habilidades quirúrgicas esenciales y de su correcta ejecución dependen procesos de vital importancia. La adquisición de estas competencias requiere trabajo motor, entornos amigables y realistas. Una estrategia para facilitar el aprendizaje de la técnica de anudado es generar instrumentos de simulación accesibles. Métodos. Se presenta un simulador de nudos quirúrgicos, construido con materiales de bajo costo y asequibles para la población en general, con un presupuesto de aproximadamente $5.000 COP (US$ 1,23). Resultados. Se desarrolló un simulador de nudos quirúrgicos que, al fijarse a la extremidad inferior desde una posición sentada, proporciona una superficie estable para llevar a cabo la práctica de anudado de manera efectiva. Conclusión. La cirugía moderna considera la seguridad del paciente como la principal prioridad, por lo que ya no es apropiado adoptar un método de formación de "ver uno, hacer uno, enseñar uno". Es la práctica constante mediante simuladores, el método más adecuado. Este trabajo presenta una alternativa de aprendizaje ininterrumpido de las técnicas quirúrgicas relacionadas con los nudos.

Introduction. Knotting is one of the essential surgical skills and vitally important processes that depends on its correct execution. The acquisition of these skills requires motor work, friendly and realistic environments. A strategy to facilitate learning the knotting technique is to generate accessible simulation instruments. Methods. A surgical knot simulator is presented, built with low-budget materials and affordable for the general population, with a budget of approximately $5,000 COP (US$ 1.23). Results. A surgical knot simulator has been developed in a way that, when attached to the thigh of a lower extremity from a seated position, provides a stable surface to effectively perform knot tying practice. Conclusion. Modern surgery considers patient safety as the top priority, so it is no longer appropriate to adopt a "see one, do one, teach one" training method. Constant practice using simulators is the most appropriate method. This work presents an alternative for uninterrupted learning of surgical techniques related to knots.

Factores asociados al riesgo e intentos suicidas en estudiantes de carreras de la salud: estudio transversal / Factors associated with suicide risk and attempts in healthcare students: A cross-sectional study

Introducción Las muertes por suicidio en jóvenes han ido en aumento en las últimas décadas y se considera un problema de salud pública prioritario a nivel mundial, siendo un evento parcialmente prevenible. La prevalencia de ideas suicidas es alta entre estudiantes universitarios, especialmente en carreras de la salud. El objetivo de este estudio fue medir la prevalencia de alto riesgo suicida en este grupo específico e identificar factores asociados, con la finalidad de aportar evidencia empírica para la construcción de estrategias efectivas de prevención del suicidio. Métodos Se realizó un estudio transversal basado en una encuesta en línea a estudiantes de carreras de la salud, casi al final del primer año de la pandemia de COVID-19, para conocer la frecuencia del riesgo suicida y sus factores asociados. La muestra fue de 477 estudiantes (70,8% mujeres, edad promedio 21,7 ± 2,5 años), de ocho carreras de la salud. Los datos se recogieron en enero de 2021. Resultados Un 22,6% de los jóvenes reportó un alto riesgo suicida en la escala de Okasha y 3,4% hizo un intento suicida en el año previo. Los factores asociados al alto riesgo suicida fueron: tener una orientación no-heterosexual, una trayectoria académica irregular, experiencias de violencia física y/o psicológica, mayores niveles de sintomatología depresiva y ansiosa, así como menores niveles de apoyo social de amigos y de la familia. Conclusiones Las cifras de riesgo e intentos suicidas son elevadas en este grupo de estudiantes y existe un perfil de factores que podrían orientar acciones más efectivas, tales como apoyo a grupos de mayor riesgo y hacer tamizaje para identificar y dar ayuda a jóvenes con alto riesgo suicida y con problemas de salud mental.

Introduction Suicide deaths in young people have been increasing in recent decades and are considered a major public health problem worldwide, being a partially preventable event. The prevalence of suicidal ideation is high among university students, especially in health careers. The objective of this study was to measure the prevalence of high suicidal risk in this specific group and to identify associated factors, aiming to provide empirical evidence for the construction of effective suicide prevention strategies. Methods A cross-sectional study was conducted based on an online survey directed to healthcare students near the end of the first year of the COVID-19 pandemic to learn about the frequency of suicidal risk and its associated factors. The sample consisted of 477 students (70.8% female, mean age 21.7 ± 2.5 years) from eight healthcare majors. The data were collected in January 2021. Results 22.6% of the young people reported a high suicide risk on the Okasha scale, and 3.4% made a suicide attempt in the previous year. Factors associated with high suicidal risk were having a non-heterosexual orientation, an irregular academic trajectory, experiences of physical and/or psychological violence, higher levels of depressive and anxious symptomatology, as well as lower levels of social support from friends and family. Conclusions Suicide risk and attempt levels are high in this group of students, and there is a group of factors that could guide more effective actions, such as support for higher-risk groups and screening to identify and provide support to young people at high suicidal risk and with mental health conditions.

Student performance in year 1 undergraduate medical education during traditional, emergency online, online and HyFlex teaching strategy: A single center study / Health Sciences Journal

Background@#The global pandemic caused by COVID-19, the subsequent improvement in health situation caused by anti- COVID-19 vaccination and the developments in digital technology prompted changes in undergraduate medical education as to content delivery and assessment. This study determined the difference in the performance of first year medical students in traditional face-to face, online and Hyflex teaching strategy.@*Methods@#A non-concurrent cohort study was done to determine the performance of students in three annual subjects in Year 1 undergraduate medical education for school years 2018 to 2023. One-way ANOVA at p=0.001 determined significance of differences of variables.@*Results@#There was no difference in the profile of students as to their sex, pre-medicine course and scores in the National Medical Admission Test (NMAT). The performance in the written examinations in Anatomy and Physiology showed significant difference (p=0.001) when the conduct of examinations was shifted online on an emergency basis. There was no difference (p=0.001) in performance in the laboratory conference sessions in Physiology, as compared to the focused group discussion sessions in Biochemistry and practical examinations in Anatomy.@*Conclusion@#Significant difference in the performance of first year medical students was observed only during the emergency shift to online examinations, otherwise the performance was similar in traditional face-to face, online and Hyflex teaching strategy.

Live Animal Training in Surgical Education for Undergraduate Medical Students / 医学教育

A live animal training program is offered to medical students seeking more advanced surgical education. This program requires active participation in all aspects, from planning to implementation.　The program provides medical students with a valuable opportunity to develop their interest in surgical care and to acquire advanced surgical techniques through a step-by-step approach. Additionally, they have the chance to develop various types of non-technical skills by assuming different roles within a team. Instructors offer support for their learning.　Peer learning allows medical students to learn from and discuss with each other, enabling them to acquire a broad range of knowledge and skills. Simultaneously, students are expected to understand the importance of a team approach by participating in this program from the perspectives of various medical professions. Moreover, the program contributes to the formation of their professional identity.

Medical ethics teaching in the new undergraduate physiology competency-based curriculum in medical institutions in Delhi: A pilot, feasibility study

Background: Medical ethics teaching has received little attention in India's undergraduate medical curriculum, so the National Medical Commission’s formal inclusion of medical ethics in the new competency-based curriculum (CBME) is creditable. However, the policymakers have left out the most crucial stakeholders — the teachers. This study was conducted to find out how physiology educators in Delhi felt about the implementation of ethics teaching in physiology in the CBME. Methods: This was a pilot, cross-sectional, observational, feasibility study conducted using a questionnaire, involving faculty and senior residents (post-MD) in the departments of Physiology at nine medical colleges in Delhi, conducted over the period from February to October 2020. Results: The response rate was 76% (60/79), of which 40% (24/60) were senior residents and 60 (36/60) were faculty. Around 55% (n=33) felt bioethics and clinical ethics are not synonymous; 53% (n=32) believed ethics education can be accomplished in a large group setting; 75% (n=45) believed it should be the responsibility of the physiology faculty, rather than the clinical faculty, and 61.7% (n=37) wanted it to be included in the formative assessment. The respondents shared ethical concerns that should be included in the physiology curriculum and the best candidates to teach them to achieve integration. Despite the challenges, the majority 65% (n=39) felt ethics in the physiology CBME should be an inseparable part of teaching in all instructional modalities. Conclusion: Early clinical exposure was considered preferable to the Attitude, Ethics, and Communication (AETCOM) programme. Using the five W’s and one H method, we talk about how our findings can be used as a road map to help physiologists teach ethics to medical students in the new CBME.

A Simple and Consistent Rule for Easy Learning of Neuroanatomy: Three Neurons of Afferent Nerves / Una Regla Simple y Consistente para Facilitar el Aprendizaje de la Neuroanatomía: Tres Neuronas de los Nervios Aferentes

SUMMARY: Many students regard neuroanatomy as a terrifying subject due to the complicated neuronal connections. Purpose of this research was to promote the easy and logical learning of neuroanatomy by systematizing a rule "three neurons of afferent nerves." The rule, in which the second neuron decussates and reaches the thalamus, was applied to as many structures as possible. The three neurons are drawn in a constant pattern to intuitively demonstrate the rule. The rule could be applied not only to the spinothalamic tract, medial lemniscus pathway, sensory cranial nerves (visual pathway, trigeminothalamic tract, taste pathway, and auditory pathway) and ascending reticular activating system, but also to the pontocerebellum (afferent to cerebrum), basal nuclei (direct pathway), and limbic system (medial limbic circuit). Exceptionally, some afferent nerves do not exactly follow the suggested rule. This simple rule, which corresponds to many pathways of the neuroanatomy, is expected to make the learning by novice students easier.

Muchos estudiantes consideran la neuroanatomía como un tema aterrador debido a las complicadas conexiones neuronales. El propósito de esta investigación fue promover el aprendizaje fácil y lógico de la neuroanatomía mediante la sistematización de una regla "tres neuronas de los nervios aferentes". La regla, en la que la segunda neurona se decusa y llega al tálamo, se aplicó a todas las estructuras cuando esto fue posible. Las tres neuronas se dibujan en un patrón constante para demostrar la regla intuitivamente. La regla podría aplicarse no solo al tracto espinotalámico, la vía del lemnisco medial, los nervios craneales sensoriales (vía visual, tracto trigeminotalámico, vía gustativa y vía auditiva) y el sistema de activación reticular ascendente, sino también al pontocerebelo (aferente al cerebro), núcleos basales (vía directa) y sistema límbico (circuito límbico medial). Excepcionalmente, algunos nervios aferentes no siguen exactamente la regla sugerida. Se espera que esta simple regla, que corresponde a muchas vías de la neuroanatomía, facilite el aprendizaje de los estudiantes principiantes.

Teaching-Learning Process of Medical Students with Real Anatomical Parts: A Practical Intervention Strategy / Proceso de Enseñanza-Aprendizaje de los Estudiantes de Medicina con Piezas Anatómicas Reales: Una Estrategia de Intervención Práctica

SUMMARY: The COVID-19 pandemic caused several changes in the teaching of human anatomy, among them the use of different teaching methodologies based on E-learning. However, studies evaluating electronic tools have not provided clear evidence of effective student learning. Thus, this was the first study to evaluate medical students after completing human anatomy courses in the E- learning modality. We recruited first term (Group A, n=25) and second term (Group B, n=13) medical students. We applied a practical assessment based on 50 human anatomy markingson real anatomical specimens and cadavers, to be completed in Questionnaire 01 (Phase I). After detecting low scores on Questionnaire 01 by both groups, we applied a practical and face-to-face tutoring system for 14 days (Phase II). Afterwards, we re-evaluated both groups by repeating the same scores (Questionnaire 02, Phase III). According to the paired analysis of questionnaires 01 and 02 by Student's T-test, both groups showed significant increase in the final scores obtained in questionnaire 02 (Phase III). The evidence showed that the remote format lecture system weakened the learning and retention process of basic anatomical knowledge by medical students. On the other hand, in-person practical teaching proved to be efficient in the formative process of the students, a fact proven by the significant increase in the scores of the students in the 02 questionnaire, for both groups.

La pandemia por COVID-19 provocó varios cambios en la enseñanza de la anatomía humana, entre ellos el uso de diferentes metodologías de enseñanza basadas en E-learning. Sin embargo, los estudios que evalúan las herramientas electrónicas no han proporcionado evidencia clara de un aprendizaje efectivo de los estudiantes. Este fue el primer estudio que evaluó a estudiantes de medicina luego de cursar cursos de anatomía humana en la modalidad E-learning. Reclutamos estudiantes de medicina de primer término (Grupo A, n=25) y segundo término (Grupo B, n=13). Se aplicó una evaluación práctica basada en 50 marcas de anatomía humana sobre especímenes anatómicos reales y cadáveres, para ser completado en el Cuestionario 01 (Fase I). Tras detectar puntuaciones bajas en el Cuestionario 01 por parte de ambos grupos, se aplicó un sistema de tutorías prácticas y presenciales durante 14 días (Fase II). Posteriormente, reevaluamos ambos grupos repitiendo las mismas puntuaciones (Cuestionario 02, Fase III). Según el análisis apareado de los cuestionarios 01 y 02 por la prueba T de Student, ambos grupos mostraron aumento significativo en los puntajes finales obtenidos en el cuestionario 02 (Fase III). La evidencia mostró que el sistema de conferencias en formato remoto debilitó el proceso de aprendizaje y retención de conocimientos anatómicos básicos por parte de los estudiantes de medicina. Por otro lado, la docencia práctica presencial demostró ser eficiente en el proceso formativo de los alumnos, hecho que demuestra el aumento significativo de las puntuaciones de los alumnos en el cuestionario 02, para ambos grupos.

Factores asociados a la publicación científica en estudiantes habaneros de medicina y estomatología

Introducción: Numerosas investigaciones se derivan del movimiento científico estudiantil cubano, pero son pocas las que se publican. Estudiar los factores que a ello se asocian puede contribuir sustancialmente a su resolución. Objetivo: Identificar factores asociados a la publicación científica en estudiantes de medicina y estomatología de la Universidad de Ciencias Médicas de La Habana. Métodos: Estudio observacional, descriptivo y transversal, mediante la aplicación de una encuesta en una muestra de 341 individuos. El análisis estadístico fue descriptivo. Se empleó la prueba exacta de Fisher para determinar la existencia de asociación entre la tenencia de publicaciones científicas y variables categóricas. Resultados: Predominaron los estudiantes del sexo femenino (74,8 %), de medicina (93 %), en el tercer año académico (21,4 %) y procedentes de la Facultad Victoria de Girón (50,1 %). El 19,6 % refirió poseer publicaciones científicas. La tenencia de estas se asoció de forma estadísticamente significativa (p< 0,05) con 10 variables, las cuales se consideraron factores con influencia sobre la publicación científica. Conclusiones: La pertenencia al Movimiento de Alumnos Ayudantes Frank País, la incorporación a un grupo científico estudiantil, la vinculación a proyectos de investigación, la participación y obtención de premios en eventos, la motivación por el enriquecimiento del currículo y del prestigio, así como la percepción de un insuficiente conocimiento de metodología de la investigación y de redacción científica, de un deficitario asesoramiento de los tutores, de una escasa disponibilidad de tiempo y de poca estimulación a quienes la practican, son factores asociados a la publicación científica estudiantil.

Introduction: Numerous investigations derive from the Cuban student scientific movement, but few are published. Studying the factors associated with it can contribute substantially to its resolution. Objective: To identify factors associated with the scientific publication in Medicine and Stomatology students of the University of Medical Sciences of Havana. Methods: Observational, descriptive and cross-sectional study, through the application of a survey in a sample of 341 individuals. Fisher's exact test was used to determine the existence of an association between holding scientific publications and categorical variables. Results: Female students (74.8%), enrolled in Medicine (93%), in the third academic year (21.4%) and from the Victoria de Girón Faculty (50.1%) predominated. 19.6% reported having scientific publications. The possession of those was associated in a statistically significant way (p< 0.05) with 10 variables, which were considered factors with influence on the scientific publication. Conclusions: Belonging to the Frank País Student Teacher Movement, incorporation into a student scientific group, involvement in research projects, participation and awarding of prizes in events, motivation for the enrichment of the curriculum and prestige, as well as the perception of an insufficient knowledge of research methodology and scientific writing, poor advice from tutors, limited availability of time, and little stimulation to those who practice it, are factors associated with student scientific publication.

Entrustable professional activities in undergraduate medical education in foreign medical colleges and universities: research advances and implications / 中华医学教育探索杂志

Objective:To review the process, contents, theoretical basis, and evaluation methods for constructing the framework of entrustable professional activities (EPAs) in the stage of undergraduate medical education (UME) in foreign medical colleges and universities.Methods:PubMed, Web of Science, Embase, and Scopus databases were searched to obtain the articles on EPAs in the stage of UME published up to May 2022, and then a systematic review was performed.Results:A total of 17 articles were included, and the analysis showed that the framework of EPAs in the UME stage was mainly constructed by referring to the existing framework of EPAs and conducting multiple rounds of consultation and revision. The contents of EPAs include core basic EPAs, core specific professional EPAs, and individual selective EPAs. The theoretical basis for developing the EPAs framework mainly include the Miller's Pyramid of Assessment model and Dreyfus and Dreyfus's Model of Skills Acquisition. The mainstream frameworks of EPAs competency include Canadian CanMEDS, six core competencies of American ACGME and their corresponding milestones. The confidence level of EPAs evaluated at the UME stage is highlighted as 9 levels of stratification, and the evaluation methods for confidence decision mainly include observation, communication, and review of results.Conclusion:Foreign EPAs-related research in the UME stage has become more mature, but there is a lack of related studies in China. Chinese medical education researchers can learn from the experience in the development of EPAs in foreign countries and combine it with China's actual situation to construct an integrated EPAs framework for medical education covering the UME stage and the evaluation criteria for confidence level, so as to promote competency-oriented evaluation and feedback and accelerate the construction of a medical talent training system that serves the whole life cycle and the whole health process.

Challenges and reflections on the final theoretical examination of Chinese undergraduate medical education in the context of organ-system based integrated curriculum / 中华医学教育探索杂志

In order to solve the problems faced by final theoretical examination in the context of organ-system based integrated curriculum, this article analyzes the challenges and demands placed on the final theoretical examination of organ-system based integrated curriculum in undergraduate medical education, and it is pointed out that traditional medical theoretical examinations cannot meet these new demands since they are mainly memorized questions with one knowledge point for each question, as well as a lack of multidisciplinary knowledge fusion. By analyzing the questions in the United States Medical Licensing Examination (USMLE) test, this article summarizes the features of final theoretical examination suitable for organ-system based integrated curriculum and proposes that the final theoretical examination of organ-system based integrated curriculum suitable for Chinese undergraduate medical education can be developed through the translation of USMLE test, item modeling technique, or writing new tests based on the classification of knowledge points. The reform of final theoretical examination in the context of organ-system based integrated curriculum may help to realize the aim and objective of integrated teaching.

2. Basic Knowledge about Sexual Orientation and Gender Identity, and the Status of Undergraduate Medical Education in Japan and Abroad / 医学教育

LGBTQ people are less visible in Japan and are exposed to minority stress and health disparities due to societal prejudice and discrimination. It is important for healthcare providers to learn about diverse sexual orientations and gender identities to achieve DE&I, in addition to providing equitable healthcare. In Japan, education on LGBTQ topics in medical schools is poor compared to the U.S. and Canada, and there is an urgent need to train faculty to teach this topic, create educational resources, and develop guidelines for medical education.

A Workshop on Supporting Students with Developmental Disabilities 2023 / 医学教育

With the enactment of the amended Anti-Discrimination Act, which mandates the provision of reasonable accommodations, the urgent task for all health professional education institutions is to establish a support system for students with developmental disabilities. On the other hand, they are also required to fulfill their social accountability through quality assurance in education, such as the implementation of outcome-based education curriculum. In order to consider how to balance reasonable accommodations for students with developmental disabilities, quality assurance in education, and social accountability in undergraduate medical education, Professionalism Subcommittee held a workshop on April 22, 2023. The participants engaged in active discussions during the workshop.　Through a post-workshop survey, educational needs and challenges in supporting students with developmental disabilities were clarified, providing insights for future Subcommittee activities.

Facilitating Early Departure from Examination Rooms to Alleviate Congestion Among Medical Students / 医学教育

Background: The management of medical student examinations has been affected by the COVID-19 pandemic, necessitating measures to prevent overcrowding at the entry/exit flow line of the examination room. Specifically, one method to mitigate congestion at the examination room exit is to allow students to leave early after completing their exams.Methods: This study utilized the regular final examination in emergency medicine for fourth-year medical students at Hirosaki University. Students were permitted to leave the room early, up until 20 minutes before the 60-minute examination period concluded. We included 130 participants in the study and conducted a multiple logistic regression analysis with the test score (higher (1) or lower (0) than the average score) as the dependent variable and the presence or absence of early withdrawal, gender, bachelor transfer status, and regional quota student status as independent variables.Results: Of the 130 fourth-year medical students included in the study, 14 (10.8%) left the exam room early. The multiple logistic regression analysis indicated that bachelor transfer students (odds ratio (OR) = 4.20, 95% confidence interval (95% CI) 1.24-14.18) and female students (OR = 2.56, 95%CI 1.24-5.25) tended to achieve statistically significantly higher scores. However, early leavers (OR = 1.78, 95%CI 0.53-5.95) and regional quota students (OR = 1.72, 95%CI 0.78-3.78) did not exhibit a significant association with the highest scores.Discussion: We found that there is no significant association between early exit of medical students and exam scores in our emergency medicine examinations. Therefore, implementing early dismissal can be justified as a measure to ensure a smooth flow of students when leaving the room.

Reflexões sobre a utilização do Teste de Progresso na avaliação programática do estudante / Reflections on the use of the Progress Test in the programmatic student assessment

Resumo: Introdução: O Teste de Progresso (TP) constitui modalidade estabelecida e bem-sucedida de avaliação de conhecimentos do estudante das profissões da saúde, principalmente os de Medicina, com potencial de contribuir substancialmente para as finalidades formativa e informativa (controle de qualidade e indicação de melhoria nos processos de ensino e aprendizagem). Adicionalmente, o TP apresenta características adequadas à sua inclusão em sistemas institucionais de avaliação que privilegiem a finalidade formativa, como a avaliação programática (AP), mas que cumprem também a somativa. Nas escolas que vêm definindo ações visando à introdução da AP em seus cursos de graduação, é necessária a reflexão sobre as fortalezas e limitações da utilização do TP no sistema de avaliação. Desenvolvimento: A partir das considerações de um grupo de trabalho representativo de toda a instituição, incumbido de propor meios de introdução da AP em um novo currículo para o curso de Medicina, contando com assessoria internacional com experiência tanto no TP como na AP, elaborou-se reflexão sobre esse tema, baseada na experiência dos autores e em dados da literatura. Propõe-se que, dentro da perspectiva longitudinal da AP, o TP constitua um dos pilares na avaliação de conhecimentos. O TP pode servir de base para acompanhamento do estudante, no contexto da sua turma (coorte), e seus resultados devem ser discutidos com o mentor que o acompanha e lhe dá suporte. O TP deve ter também papel central na gestão, como fonte de informações para eventual revisão e qualificação do currículo e das suas atividades de ensino e aprendizagem. É previsível que a utilização do TP na AP traga diferentes desafios e barreiras, que serão mais facilmente superados se houver na instituição experiências já consolidadas de aplicação de exames institucionais e de desenvolvimento docente para a elaboração de questões objetivas de boa qualidade. Conclusão: A efetividade do TP dentro do sistema institucional de AP vai depender de medidas que visem aumentar a sua efetividade na avaliação e que estimulem a participação ativa do estudante, refletindo sobre seu desempenho no TP, com o apoio do seu mentor, de modo a se engajar em ações que fomentem a autorregulação da aprendizagem.

Abstract: Introduction: The Progress Test (PT) is a well-established and mostly successful modality of student knowledge assessment in the health professions, mainly those in the medical area, with the potential to contribute substantially to the formative and informative purposes (quality control and indication of improvement in the teaching-learning processes). Additionally, the PT has characteristics that are adequate for its inclusion in institutional evaluation systems that facilitate the formative purpose, such as programmatic assessment (PA), but that also meet the summative purpose. In schools that have defined actions aimed at introducing PA in their undergraduate courses, it is necessary to reflect on the strengths and limitations of using PT in the evaluation system. Development: based on the considerations of a working group representative of the entire institution, tasked with proposing means of introducing PA in a new curriculum for the medical course, with international advice with experience in both PT and PA, we generated a reflection on this topic, based on the authors' experience and data from the literature. It is proposed that, within the longitudinal perspective of the PA, the PT constitutes one of the pillars in the assessment of knowledge. The PT can be used as a basis for monitoring the students, in the context of their class (cohort), and its results should be discussed with the mentors who accompanies and supports them. The PT must also play a central role in management, as a source of information for eventual review and qualification of the curriculum and its teaching-learning activities. It is predictable that the use of the PT in PA will bring different challenges and barriers, which will be more easily overcome if the institution has already consolidated experiences in the application of institutional exams and in faculty development for the production of good quality objective questions. Conclusion: the effectiveness of the PT within the institutional PA system will depend on measures aimed at increasing its effectiveness in the assessment and that encourage the student's active participation, reflecting on their performance in the PT, with the support of their mentor, aiming to engage in actions that encourage learning self-regulation.

Aplicabilidade da avaliação com consulta como estratégia de ensino em cursos de Medicina / Applicability of open book examination as a teaching strategy in medical schools

Resumo: Introdução: Nas últimas décadas, as práticas pedagógicas e as metodologias de ensino têm experimentado mudanças radicais, culminando hoje com o crescimento exponencial de metodologias de ensino ativas. Apesar da crescente utilização dessas metodologias ativas nos cursos de Medicina, as formas de avaliação teórica foram pouco, ou nada, alteradas nas últimas décadas, o que não deveria ocorrer, pois os sistemas de avaliação precisam evoluir concomitantemente para garantir um processo de ensino-aprendizagem coeso e de qualidade. Objetivo: Este estudo evidencia como está inserida a avaliação com consulta em cursos de Medicina. Método: Foi desenvolvida uma revisão integrativa por meio de consulta de publicações indexadas no período dos últimos dez anos nas bases de dados da Biblioteca Nacional de Medicina dos Estados Unidos (PubMed), Scientific Electronic Library Online (SciELO), ScienceDirect e Education Resources Information Center (ERIC), em formato de artigos completos nas línguas portuguesa ou inglesa. Utilizaram-se os descritores a seguir de forma combinada, respectivamente em inglês e português: "medicine", "assessment", "open book examination", "open book exam", "open book test" e "open book assessment"; "medicina", "avaliação", "prova com consulta", "avaliação com consulta" e "teste com consulta". Resultado: Para a composição deste estudo, selecionaram-se 11 publicações que atenderam aos critérios de elegibilidade traçados, e, após a imersão teórica e análise delas, emergiram duas categorias principais: "A avaliação com consulta como recurso educacional para o ensino médico" e "A avaliação com consulta como alternativa pedagógica no cenário pandêmico", as quais foram analisados à luz de uma revisão integrativa. Conclusão: Ainda que haja dúvidas e sejam necessários novos estudos, fica evidente que a avaliação com consulta é muito pertinente ao ensino médico, uma vez que contribui para a formação de profissionais com alta capacidade de questionamento e argumentação, preparados para rotinas de estudo e educação permanentes e que entendam que há constante evolução do conhecimento na área médica.

Abstract: Introduction: In the last decades, pedagogical practices and teaching methodologies have experienced radical changes, culminating today with the exponential growth of active teaching methodologies. Despite the growing use of these active methodologies in medical courses, the theoretical evaluation models changed little, if at all, in the last decades, which should not occur, as the evaluation systems need to evolve concomitantly to ensure a cohesive, quality teaching-learning process. Objective: To demonstrate how open-book examination is inserted in medical courses. Methods: An integrative review was developed by searching for publications indexed in the last 10 years in the databases of the U.S. National Library of Medicine (PubMed), "Scientific Electronic Library Online" (SciELO), Science Direct, and the "Education Resources Information Center" (ERIC), as full articles written in Portuguese or English. The following descriptors were used in combination, respectively in English and Portuguese: "medicine", "assessment", "open book examination", "open book exam", "open book test" and "open book assessment"; "medicina", "avaliação", "prova com consulta", "avaliação com consulta" and "teste com consulta". Results: For this review, a total of eleven publications that met the eligibility criteria were selected, and after their theoretical immersion and analysis, two main categories emerged: "Open-book examination as an educational resource for medical education" and "Open-book examination as a pedagogical alternative in the pandemic scenario", which were analyzed in the light of an integrative review. Conclusion: Although there are still doubts and further studies are required, it is evident that Open-Book examination is very pertinent to medical education, as it contributes to the training of professionals with high capacity for questioning and debating, who are prepared for permanent study and education routines, and who understand that there is constant evolution of knowledge in the medical field.

Aspectos demográficos e acesso aos projetos pedagógicos dos cursos de Medicina no Brasil / Demographic aspects and access to the pedagogical projects of medical courses in Brazil

Resumo: Introdução: A ampliação da educação superior no Brasil é recente. Na área médica, com o advento do Programa Mais Médicos, essa expansão tornou-se viável e culminou com a publicação de novas Diretrizes Curriculares Nacionais (DCN) para o curso de graduação em Medicina. O projeto pedagógico do curso (PPC) traduz o que se realiza no curso e funciona como instrumento de comunicação entre a instituição e a sociedade. A análise dos PPC das instituições de ensino superior propicia a identificação de elementos que apontam para convergência ou se afastam do preconizado nas mudanças pretendidas pelas DCN de 2014. Objetivo: Este estudo descreve demograficamente no Brasil o número de cursos de Medicina públicos e privados por estado e região da Federação, o número de vagas disponíveis e o acesso aos PPC dessas escolas por meio de metodologia sistematizada. Método: Realizou-se um levantamento de todas as faculdades com curso de Medicina no Brasil, no ano de 2021. A procura dos PPC foi realizada no site institucional. Em caso de ausência da informação, encaminhamos mensagem eletrônica à coordenação do curso de Medicina. Na indisponibilidade de contato direto com a coordenação pelo site institucional, encaminhamos mensagem ao coordenador por meio do acesso ao seu Currículo Lattes. Resultado: Foram identificadas 336 escolas médicas, 115 (34,2%) públicas e 226 (65,8%) privadas. Observamos a maior concentração de cursos na Região Sudeste (41,3%), seguida da Região Nordeste (24,6%). Das instituições públicas, o Nordeste é a região que mais concentra as escolas (35,6%), seguida da Região Sudeste (26%). Quanto às instituições privadas, ocorre o inverso. Obteve-se um total de 134 PPC (39,8%), sendo 111 (83%) das escolas públicas e 23 (17%) das privadas. Conclusão: Embora a disponibilização do documento de informação pedagógica no site da instituição seja obrigatória, isso não foi verificado em realidade, o que corrobora a necessidade de políticas de valorização e fiscalização da disponibilidade do PPC para facilitar o seu acesso pelos maiores interessados: alunos, comunidade acadêmica e pesquisadores da área da educação médica.

Abstract Introduction: The expansion of higher education in Brazil is recent. In the medical field, with the advent of the "Mais Médicos" Program, this expansion became feasible and culminated with the publication of new National Curricular Guidelines (DCN, Diretrizes Curriculares Nacionais) for undergraduate medical courses. The Pedagogical Course Project (PCP) translates what is accomplished in the course and works as an instrument of communication between the institution and society. The analysis of the PCPs of Higher Education Institutions provides the identification of elements that point to the convergence or move away from the changes proposed by the DCN 2014. Objective: To describe demographically in Brazil the number of public and private medical courses by state and region of the federation, the number of available vacancies, and access to the PCPs of these schools through a systematized methodology. Method: A study was carried out in all institutions with medical courses in Brazil by the year 2021. The search for the PCPs was carried out in the institutional website. In case of lack of information, an electronic message was sent to the medical course coordination. When it was not possible to contact the coordinator directly through the institutional website, a message was sent to the coordinator by accessing their curriculum lattes. Results: A total of 336 medical schools were identified, 115 (34.2%) of which were public and 226 (65.8%) private ones. A higher concentration of courses was observed in the southeast region (41.3%), followed by the northeast region (24.6%). Of the public institutions, the northeast region has the highest concentration of schools (35.6%), followed by the southeast region (26%). The opposite was observed regarding the private institutions. A total of 134 PCPs were obtained (39.8% of the total), 83% from public schools and 17% from private ones. Conclusion: Although the availability of the pedagogical information document on the institution's website is an obligation, this was not verified in reality, which makes it necessary to implement policies for valuing and monitoring PCP availability, thus facilitating its access by the most interested parties: students, the academic community and researchers in the field of medical education.

Por que e como reformar um currículo inovador? Um relato de experiência de Londrina / Why and how to reform an innovative curriculum? An experience report from Londrina

Resumo: Introdução: O curso de graduação em Medicina da Universidade Estadual de Londrina foi o segundo do Brasil a adotar currículo integrado e Aprendizagem Baseada em Problemas (PBL). Apesar de seu currículo inovador ter servido de referência a outras escolas, avaliações recentes mostraram a necessidade de reforma. Relato de experiência: As avaliações sistemáticas do curso indicaram os seguintes problemas: dificuldade de adaptação dos ingressantes à primeira série; desorganização da sequência de conteúdos ao longo do curso; falta de motivação docente para as atividades da primeira à quarta série; necessidade de incluir tópicos obrigatórios e novas tendências; e desgaste da metodologia (PBL) a partir da terceira série. Um amplo trabalho de reforma curricular foi iniciado, baseado na construção coletiva, culminando em mudanças, como: o desenho de uma primeira série mais acolhedora por meio da inclusão de nivelamento de ciências básicas e mentoria; a reorganização cronológica dos conteúdos; o redesenho dos módulos, agora organizados ao redor de grandes áreas ou especialidades afins; a adoção de metodologias ativas mais motivadoras; e a inclusão de novos conteúdos. Discussão: A adoção de novas metodologias ativas em substituição à PBL em alguns momentos apresenta vantagens estratégicas. A Aprendizagem Baseada em Equipes (TBL), mais estruturada que a PBL, pode ajudar na adaptação dos ingressantes à primeira série e facilitar a realização de metodologias ativas num contexto de escassez de docentes. A Aprendizagem Baseada em Casos (CBL) é mais motivadora e pode ser mais efetiva para desenvolver habilidades de raciocínio clínico nas séries pré-internato. Conclusão: O novo currículo, que incorpora as mudanças mencionadas, foi implantado em 2022. Novas avaliações mostrarão se as mudanças trarão melhorias ao curso em termos de adaptação, motivação e resultados de aprendizagem.

Abstract: Introduction: The undergraduate medical course of the State University of Londrina was the second in Brazil to adopt an integrated curriculum and Problem-Based Learning (PBL). Despite its innovative curriculum, which became a reference for other schools, new assessments showed the need to reform it. Experience Report: Systematic course evaluations showed some issues: difficulties in adaptation of new students attending the first year; disorganized sequence of contents throughout the course; teachers' lack of motivation for activities from first to the fourth years; need to include new contents; and deterioration of the methodology (PBL) in third and fourth years. A wide collective effort for curricular reform was initiated, which led to important changes, such as: a more welcoming first year, by including mentoring and activities for the leveling of basic knowledge; chronological reorganization of contents; redesign of modules around great areas of knowledge or related specialties; adoption of new and more motivating active learning and teaching methodologies, and the inclusion of new topics/trends. Discussion: The adoption of other active learning and teaching methodologies present strategic advantages in replacement for PBL. Team-Based Learning (TBL) is a more structured method than PBL, so it can help newcomers to adapt to the first year and make it easier to implement active methodologies in a context of teacher shortage. Case-Based Learning (CBL) generates higher motivation and can be more effective to foster the development of clinical reasoning skills in the preclinical years. Conclusion: The new curriculum, incorporating the changes described above, started in 2022. Further evaluations will show whether the changes will improve the course in terms of adaptability, motivation and learning outcomes.

Análisis de tesis médicas de pregrado en una universidad de Perú, 2011-2020: publicación en revistas indizadas y factores asociados / Analysis of undergraduate medical theses at a Peruvian university, 2011-2020: publication in indexed journals and associated factors

Los factores cuantitativos asociados a la publicación de tesis médicas en el pregrado no han sido lo suficientemente estudiados. Por ello, la investigación describió las tasas de publicación, así como la asociación con las características de las tesis, del asesor y del tesista. Se accedió, de manera virtual, a las tesis médicas de pregrado de la Universidad Nacional de San Agustín de Arequipa, Perú, durante el período 2011-2020. Mediante el análisis de regresión logística múltiple, se evaluó la asociación entre la publicación de la tesis en revistas indizadas (Scopus) y la experiencia previa en publicación en revistas indizadas en Scopus del asesor y del tesista, la unidad de análisis, el tamaño de muestra, diseño de estudio, número de páginas, aprobación por el comité de ética de investigación y el sexo del tesista. De 884 tesis solo 12 (1,5 por ciento) se publicaron; lo que constituye el 1,23 por ciento de las tesis publicadas anualmente, con tendencia constante. La experiencia previa en publicación del asesor se asoció con la colocación de las tesis en revistas indizadas (OR = 8,97 [1,70-42,98]; p = 0,005) y en revistas indizadas a Scopus (OR = 14,64 [1,24-336,11]; p = 0,037). Presentar la aprobación del comité de ética de la institución se asoció con publicar la tesis en revistas indizadas a Scopus (OR = 12,45 [1,06-285,94]; p = 0,050). La publicación de tesis médicas de pregrado en esta universidad es baja y constante. Se asoció con tener un asesor de tesis con experiencia previa en publicaciones en revistas indizadas a Scopus y a tener aprobación por comité de ética. Urge implementar estrategias para aumentar la publicación de tesis(AU)

Quantitative factors associated with the publication of undergraduate medical theses have not been sufficiently studied. Therefore, the research described publication rates, as well as the association with thesis, advisor, and thesis writer characteristics. Undergraduate medical theses from the Universidad Nacional de San Agustín de Arequipa, Peru, during the period 2011-2020 were accessed virtually. Multiple logistic regression analysis was used to evaluate the association between thesis publication in indexed journals (Scopus) and the previous publication experience in indexed journals in Scopus of the advisor and the thesis author, the unit of analysis, sample size, study design, number of pages, approval by the research ethics committee and the gender of the thesis author. Out of 884 theses only 12 (1.5percent) were published; this constitutes 1.23percent of the theses published annually, with a constant trend. The previous publication experience of the advisor was associated with the placement of theses in indexed journals (OR = 8.97 [1.70-42.98]; p = 0.005) and in journals indexed to Scopus (OR = 14.64 [1.24-336.11]; p = 0.037). Presenting the approval of the institution's ethics committee was associated with publishing the thesis in journals indexed to Scopus (OR = 12.45 [1.06-285.94]; p = 0.050). Publication of undergraduate medical theses at this university is low and consistent. It was associated with having a thesis advisor with previous experience in publishing in Scopus-indexed journals and having approval by an ethics committee. There is an urgent need to implement strategies to increase thesis publication(AU)

Publication rate and factors associated with the publication of papers submitted to the National Scientific Congresses held by the Peruvian Medical Student Scientific Society between 2010 and 2014

Introduction: The National Scientific Congress (NSC) is an annual event held in Peru in which medical students from all over the country present their research work. Objectives: To determine the publication rate in indexed scientific journals of research papers submitted to the NSCs held between 2010 and 2014, as well as the factors associated with their publication, and to describe the characteristics of the published papers. Materials and methods: Retrospective study in which 407 abstracts of research papers were reviewed. A publication time window of 6 years (from submission) was considered. A bivariate analysis was performed to assess differences between categorical and numerical variables using the chi-square and Mann-Whitney U tests, respectively. In addition, a multivariate analysis was performed using Poisson regression models (a crude and an adjusted model), calculating relative risk (RR) values with their respective 95% confidence intervals (95%CI) to determine the factors associated with the publication of papers. A significance level of p<0.05 was considered. Results: The publication rate and the median time until publication were 23.83% (95%CI: 19.93-28.23) and 14 months (IQR: 5-23), respectively. In the bivariate analysis, the year of submission and the number of advisors with experience in research that participated in the research paper were associated with the publication of the study (p=0.020 and p=0.007). In the multivariate analysis, it was found that papers with one advisor or those with two or more advisors were 2.19 and 2.61 times more likely to be published than those without advisors (RR=2.19, 95%IC: 1.10-4.36 and RR=2.61, 95%CI: 1.28-5.33, respectively). Conclusions: Nearly a quarter of the papers were published in a scientific journal and the participation of one or more advisors with research experience significantly increased the probability of publication.

Introducción. El Congreso Científico Nacional (CCN) es un evento anual realizado en Perú en el que estudiantes de medicina de todo el país presentan sus trabajos de investigación. Objetivos. Determinar la tasa de publicación de los trabajos de investigación presentados en las ediciones del CCN realizadas entre 2010 y 2014 en revistas científicas indexadas y los factores asociados a su publicación y describir las características de los trabajos publicados. Materiales y métodos. Estudio retrospectivo en el que se revisaron 407 resúmenes de trabajos de investigación. Se consideró una ventana de tiempo de publicación de 6 años (a partir de la presentación). Se realizó un análisis bivariado para evaluar las diferencias entre las variables categóricas y numéricas con las pruebas chi-cuadrado y U de Mann-Whitney, respectivamente. Además, se realizó un análisis multivariado mediante modelos de regresión de Poisson (uno crudo y uno ajustado), calculando valores de riesgo relativo (RR) con sus respectivos intervalos de confianza al 95% (IC95%) para determinar los factores asociados con la publicación de los trabajos. Se consideró un nivel de significancia de p<0.05. Resultados. La tasa y la mediana de tiempo de publicación fueron 23.83% (IC95%: 19.93-28.23) y 14 meses (RIC: 5-23), respectivamente. En el análisis bivariado, el año de presentación y el número de asesores con experiencia en investigación que participaron en el trabajo de investigación se asociaron con la publicación de los trabajos (p=0.020 y p=0.007). En el análisis multivariado, se encontró que los trabajos con un asesor o aquellos con dos o más asesores tuvieron una probabilidad de publicación 2.19 y 2.61 veces mayor que los que no tenían asesor (RR=2.19, IC95%: 1.10-4.36 y RR=2.61, IC95%: 1.28-5.33, respectivamente). Conclusiones. Casi una cuarta parte de los trabajos se publicaron en una revista científica y la participación de un o más asesores con experiencia en investigación incrementó significativamente la probabilidad de publicación.

Tendencias históricas del Análisis de la Situación de Salud en la formación médica en Cuba / Historical tendencies concerning the Health Situation Analysis within medical training in Cuba

Introducción: El Análisis de la Situación de Salud es un instrumento científico metodológico. Objetivo: Determinar las tendencias históricas del desarrollo de la enseñanza-aprendizaje del Análisis de la Situación de Salud en la formación médica. Métodos: Se realizó una investigación pedagógica en la universidad médica avileña en septiembre/2020-junio/2021. Los métodos teóricos histórico-lógico, analítico-sintético e inductivo-deductivo facilitaron el conocimiento de la evolución y el desarrollo del objeto investigado, revelar sus antecedentes, las etapas en su devenir y sus vínculos históricos esenciales. El análisis documental y la triangulación de fuentes, como empíricos, viabilizaron el análisis crítico de la información. Los tres indicadores construidos fueron: sistematización del contenido, relación interdisciplinar en el plan de estudio y nivel de interacción intercultural estudiante-actor social en la vinculación teórico-práctica del contenido. Se cumplieron los principios éticos. Resultados: El punto de inflexión tendencial fue 1970, cuando se introdujo la asignatura El Hombre y su Medio. Se identificaron cuatro etapas: aproximación (1970-1987), integración (1988-2004), consolidación en la intervención comunitaria (2005-2015) y concreción en el noveno semestre (2016-2021). Los cambios se evidenciaron en el salto cualitativo de cada indicador. Conclusiones: La sucesión de reformas ha proyectado al Análisis de la Situación de Salud como un eje curricular profesional, pero persisten insuficientes nexos interdisciplinares e interculturales para lograr la intervención comunitaria(AU)

Introduction: The health situation analysis is a methodological scientific instrument. Objective: To determine the historical tendencies concerning the development of the teaching-learning of the health situation analysis in medical training. Methods: A pedagogical research was carried out, between September 2020 and June 2021, in the medical university of Ciego de Ávila Province, Cuba. Theoretical methods (historical-logical, analytical-synthetic and inductive-deductive) facilitated to know the evolution and development of the investigated object, revealing its antecedents, the stages of its evolution, as well as its essential historical connections. Document analysis and the triangulation of sources, as empirical methods, facilitated the critical analysis of the information. The three indicators constructed were content systematization, interdisciplinary relationship in the study plan, and level of intercultural interaction between student and a social actor in the theoretical-practical connection of the content. Ethical principles were complied with. Results: As a tendency, the turning point was 1970, when a subject was introduced under the name The Man and His Environment. Four stages were identified: approximation (1970-1987), integration (1988-2004), consolidation in community intervention (2005-2015), and concretion in the ninth semester (2016-2021). The changes were evidenced through the qualitative leap in each indicator. Conclusions: The succession of reforms has projected the health situation analysis as a professional curricular axis, but insufficient interdisciplinary and intercultural connections persist, avoiding to achieve community intervention(AU)