Rastreamento da retinopatia diabética pelo médico generalista na Atenção Primária de Saúde do Brasil / Screening of diabetic retinopathy by the physician of Primary Health Care in Brazil

RESUMO Objetivo: Avaliar a acurácia de médicos generalistas em reconhecer a retinopatia diabética por meio da retinografia colorida, com um curso de capacitação com duração de 2 horas, comparando a capacidade de rastrear e classificar a retinopatia diabética em relação ao exame presencial com oftalmologista. Métodos: No primeiro braço do estudo, de 142 pacientes diabéticos incluídos, avaliaram-se 274 olhos, em que esses pacientes foram examinados com oftalmoscópio binocular indireto e classificados quanto ao grau da retinopatia diabética. No segundo braço do estudo, 14 médicos não especialistas em oftalmologia receberam um treinamento de 2 horas para o diagnóstico de retinopatia diabética com a retinografia colorida e se aferiu a acurácia desses profissionais em rastrear a retinopatia diabética antes e depois do curso de capacitação, utilizando as retinografias obtidas na primeira frente do estudo. Resultados: Verificou-se aumento significativo da sensibilidade (82% para 99%) e da especificidade (44% para 83%) na detecção da retinopatia diabética pelos médicos generalistas, com o curso de capacitação. Conclusão: O médico generalista capacitado pode avaliar a retinopatia diabética por meio da retinografia colorida, sendo o programa de rastreamento dessa complicação do diabetes uma proposta viável e benéfica ao país.

ABSTRACT Objective: To assess the accuracy of general practitioners in recognizing diabetic retinopathy through color retinal retinography, with a two-hour training course, by comparing the capacity of screening and classifying diabetic retinopathy. Methods: In the first arm of the study, of 142 diabetic patients included, 274 eyes were evaluated, and these patients were examined with an indirect binocular ophthalmoscope and classified according to the degree of diabetic retinopathy. In the second arm of the study, 14 physicians who are not specialists in ophthalmology received two-hour training to diagnose diabetic retinopathy with color retinography, and the accuracy of these professionals in screening for diabetic retinopathy before and after the training course was measured using the photographic images obtained on the first front of the study. Results: There was a significant increase in sensitivity (82% to 99%) and specificity (44% to 83%) in detecting diabetic retinopathy by general practitioners, after attending the training. Conclusion: Qualified general practitioners can assess diabetic retinopathy through color retinography, and the screening program for this diabetes complication is a viable and beneficial proposal for the country.

Análisis crítico del programa de la asignatura Genética Médica de la disciplina Investigaciones Diagnósticas / A Critical Analysis of the Syllabus for the Subject Medical Genetics of the Discipline Diagnostic Research

Introducción: El programa de estudio es una formulación hipotética de los aprendizajes que se pretenden lograr en el educando. Constituye una herramienta fundamental de trabajo docente. Objetivo: Exponer un análisis crítico del programa de estudio de la asignatura Genética Médica en la carrera de medicina, a partir de lo normado en el reglamento vigente para el trabajo docente-metodológico. Métodos: Se realizó una revisión bibliográfica para desarrollar un análisis crítico del programa de la asignatura genética médica, en la que se consideraron artículos publicados entre 2012 y 2022. La búsqueda fue realizada en Google académico, Dialnet, SciELO y Redalyc en septiembre de 2022. Las palabras clave utilizadas fueron: programas, genética, asignatura, disciplina y proceso docente-educativo. Dentro de este marco se incluyeron todos los artículos cubanos publicados; no hubo restricción en cuanto al idioma. Se consultaron 50 artículos, de estos 11 fueron seleccionados. Se excluyeron aquellos no relacionados con la educación médica superior. Resultados: Se orientó metodológicamente la inclusión de aspectos encaminados a la promoción de salud; fomentar las habilidades comunicativas; reformular los objetivos, incluyendo en su estructura los elementos esenciales; realizar un cambio en el orden de impartir el contenido, con modificaciones, además, en el nivel de profundidad y con aporte de un enfoque preventive; y declarar adecuadamente los valores, la rectificación de la cantidad de horas del fondo de tiempo y la actualización de la bibliografía. Conclusiones: Las insuficiencias encontradas en el análisis efectuado identificaron las áreas vulnerables hacia donde deben dirigirse las principales acciones encaminadas a aumentar la calidad del proceso docente educativo y reflejaron la necesidad de su reevaluación(AU)

Introduction: The syllabus is a hypothetical formulation of the learning aspects intended to be achieved in the student. It is a fundamental tool for teaching. Objective: To present a critical analysis of the syllabus for subject Medical Genetics in the medical major, based on the current regulations for the teaching-methodological work. Methods: A literature review was carried out to develop a critical analysis of the syllabus of the subject Medical Genetics, considering articles published between 2012 and 2022. The search was performed in Google Scholar, Dialnet, SciELO and Redalyc in September 2022. The keywords used were programas [syllabuses], genética [genetics], asignatura [subject], disciplina [discipline] and proceso docente-educativo [teaching-educational process]. This framework included all published Cuban articles; there were not any language-related restrictions. Fifty articles were consulted, 11 of which were selected. Those not related to higher medical education were excluded. Results: The methodological orientation was to include aspects aimed at health promotion, to encourage communicative skills, to reformulate the objectives (including the essential elements in their structure), to make a change in the order of teaching (with modifications also in the level of depth and contributing with a preventive approach), as well as to state the values adequately, to rectify the number of hours within the available time fund, to update the bibliography. Conclusions: The insufficiencies found through the performed analysis permitted to identify the vulnerable areas towards the main actions should be directed if aimed at increasing the quality of the educational teaching process, apart from reflecting their need to be reassessed(AU)

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)

Caracterización del tutor como figura central en la formación del médico general integral / Characterization of the tutor as a key actor in the training of the family medicine physician

Introducción: La educación y la práctica médica constituyen un par dialéctico, del cual emerge el tutor como figura protagónica de los procesos formativos, con conocimientos, habilidades y experiencia para guiar al educando hacia su desarrollo integral. Objetivo: Caracterizar la preparación del tutor en el proceso de formación del residente de Medicina General Integral en el municipio Habana Vieja durante enero-junio de 2019. Métodos: Se realizó una investigación pedagógica en el área del posgrado, de tipo descriptivo. El universo y la muestra estuvieron constituidos por 75 médicos que ejercían la tutoría de formación en residentes de la especialidad de Medicina General Integral. Se aplicaron métodos teóricos y empíricos. Para obtener la información, se efectuó un análisis documental y se aplicó una encuesta, previo consentimiento informado. Resultados: El 42,7 por ciento de los tutores poseía experiencia como tutor y se encontraba en la agrupación entre 1-3 años; el 54,7 por ciento tenía entre 5-10 años como especialistas. La mayor representación (65,3 por ciento) no ostentaba categoría docente ni científica. La maestría de educación médica superior fue la actividad formativa de mayor representación (15,9 por ciento). El 86,6 por ciento refirió no formar parte de investigaciones; y el 53,3 por ciento, no haber participado en eventos científicos. Solo el 24 por ciento de tutores puntualizó haber realizado publicaciones en revistas de alto impacto. Conclusiones: Existen insuficiencias en la preparación del tutor, por lo que se hace necesario implementar estrategias, como la creación de la comisión de trabajo tutorial a nivel del departamento docente(AU)

Introduction: Medical education and practice make up a dialectical pair, from which tutors emerge as leading actors of training processes, with knowledge, skills and experience to guide learners towards their comprehensive development. Objective: To characterize tutor training in the process of formation of the Family Medicine resident in La Habana Vieja Municipality in the period from January to June 2019. Methods: A descriptive pedagogical research was carried out in the postgraduate area. The universe and the sample consisted of 75 physicians who provided tutorship for training Family Medicine residents. Theoretical and empirical methods were applied. To obtain the information, a documental analysis was carried out and a survey was applied, with prior informed consent. Results: 42.7 percent of the participants had experience as tutors and were in the group between one and three years, while 54.7 percent had been specialists for five to ten years. The highest representation group (65.3 percent) did not hold a teaching or scientific rank. The master's degree in higher medical education was the training activity with the highest representation (15.9 percent). 86.6 percent expressed that they were not carrying out any research, while 53.3 percent have not participated in scientific events. Only 24 percent of the tutors specified that they have published in high-impact journals. Conclusions: There are shortcomings in tutor training, a reason why it is necessary to implement strategies, such as the creation of a tutorial work commission at the level of the teaching department(AU)

Discernimento e realidade são necessários / Discerniment and reality are required

Temos vivido uma situação extremamente delicada e alarmante diante do cenário da pandemia da doença pelo coronavírus 2019 (Covid-19). Como se não bas-tassem as perdas de milhares de vidas, incluindo as de colegas médicos, presenciamos algumas ações errôneas que, infelizmente, têm o intuito mercadológico. Evi-dentemente, esse tipo de postura denota uma falta de formação e cultura médica, abstendo-se do compro-misso real com a população. Vale ressaltar que a Sociedade Brasileira de Clínica Médica (SBCM) prima pela honestidade, pela valo-rização do médico e pela proteção da comunidade. Condenamos veementemente o uso das mídias como veículos contra a vacina. Diante dessa postura, man-temo-nos firmes e fortes, para salientar a importância da boa formação do médico clínico, da conduta e ética médica e, sobretudo, do atendimento humanístico ao paciente. Faz-se necessário sempre lembrar que "o im-portante não é tratar a doença que o homem tem, mas o homem que possui a doença". Desde a sua fundação, em 1989, a SBCM, que com-pletou 33 anos no último dia 16 de março, vê-se diante de muitas transformações no cenário da saúde. No entanto, ela manteve-se firme em relação às questões que envolvem a qualidade e a valorização do médico clínico em sua essência profissional e humanística. Um bom médico é norteado por bases científicas e dados epidemiológicos de fontes fidedignas, com reco-nhecimento notório de entidades que validam os reais cenários globais. Também, fazemos zelo ao médico que procura sempre melhorar sua bagagem teórica e práti-ca para se inspirar em resultados conquistados por seus colegas, vistos nos congressos, nos cursos de reciclagem, em webnários e, principalmente, no dia a dia, tendo como exemplo a beira do leito e a atenção ao enfermo. Para valorizar e enaltecer essa conduta, o médico clínico é um dos especialistas mais capacitados para acompanhar e deliberar quadros clínicos com êxito, sem a necessidade de explorar campos supérfluos para a cura. Portanto, nossa luta em valorizar o médico clínico será contínua e firme pelos nossos princípios e valores.Parabéns aos colegas clínicos pelo seu empenho diário e por se manterem firmes em sua especialidade, mesmo diante de tantos desafios! A SBCM faz parte da sua história e sempre estará ao seu lado.

Consideraciones sobre el programa de Farmacología General en el plan de estudio D para la carrera de medicina / Considerations on the program of the General Pharmacology subject in the syllabus D for the medicine career

El plan de estudio, documento fundamental que establece la dirección general y el contenido principal de la preparación de los profesionales, se ha ido perfeccionamiento continuamente, en correspondencia con el desarrollo cientificotécnico alcanzado. El programa de la asignatura es el que refleja las características más importantes de esta, tiene validez científica y pedagógica y contribuye a la formación del médico general, según las demandas de la sociedad cubana actual. Teniendo en cuenta las consideraciones anteriores se realizó el presente estudio con el objetivo de analizar los elementos teóricos y metodológicos del programa de la asignatura Farmacología General en el plan de estudio D para la carrera de medicina.

The syllabus, fundamental document that establishes the general direction and the main content of the professionals training, has been continually improving, in correspondence with the scientific technical development achieved. The subject program is the one that reflects its most important characteristics; it has scientific and pedagogic validity and contributes to the general doctor training, according to the demands of the present Cuban society. Taking into account the previous considerations this study was carried out aimed at analyzing the theoretical and methodological elements of the General Pharmacology subject program in the syllabus D for the medicine career.

Diseño curricular del Análisis de la Situación de la Salud para la carrera de medicina / Curricular design of the Analysis of Health Situation in medical studies

Introducción: Las reformas curriculares al Análisis de la Situación de Salud se orientan hacia la formación de un médico general con capacidades transformadoras para la intervención en la salud comunitaria. Objetivo: Identificar el tratamiento dado al contenido del Análisis de la Situación de Salud en elementos curriculares seleccionados del plan de estudio C de medicina, perfeccionado en 2010. Métodos: Se realizó una investigación pedagógica exploratoria al plan de estudio C de la carrera de medicina. Se aplicaron los métodos analítico-sintético e histórico-lógico y se hizo un análisis de contenido del Análisis de la Situación de Salud en 3 elementos curriculares: trascendencia en funciones profesionales y habilidades, tratamiento en estrategias curriculares y manifestación en la asignatura Salud Pública, con su representación en el plan de estudio. Resultados: En los 21 elementos analizados, de las cinco funciones profesionales, el Análisis de la Situación de Salud estuvo explícito en 5 e implícito en 12; en las 40 habilidades de aplicación, explícito en 3 e implícito en 18, y incluido en las 2 estrategias curriculares. En la asignatura Salud Pública ocupó el 25,62 por ciento del fondo de tiempo, y fue explícito en 3 de sus objetivos generales e implícito en los demás. En el currículo: la asignatura representó el 5,42 por ciento; y el contenido del Análisis de la Situación de Salud, el 1,39 por ciento. Conclusiones: Los elementos curriculares analizados revelaron la acertada reforma realizada al contenido del Análisis de la Situación de Salud cuando fue perfeccionado el plan de estudio C de la carrera de medicina(AU)

Introduction: The curricular reforms to the analysis of the health situation are oriented towards the formation of a general practitioner with transformative capacities for intervention in community health. Objective: To identify the management given to the content of the analysis of the health situation in selected curricular elements of the study plan C of medicine, perfected in 2010. Methods: An exploratory pedagogical investigation was carried out to study plan C of the medical studies. Analytical-synthetic and historical-logical methods were used and content analysis of the Health Situation Analysis was made in 3 curricular elements: transcendence in professional functions and skills, treatment in curricular strategies and meters in the Public Health subject, with its representation in the study plan. Results: In the twenty-one elements analyzed, out of the five professional functions, the Health Situation Analysis was explicit in 5 and implicit in 12. Concerning the forty application skills, it was explicit in 3 and implicit in 18, and it was included in the two curricular strategies. Regarding the Public Health subject, it employed 25.62 percent of the hours, and was explicit in 3 of its general objectives and implicit in the others. In the curriculum, the subject represented 5.42 percent; and the content of the Analysis of the Health Situation represented 1.39 percent. Conclusions: The curricular elements analyzed revealed the reform to the content of the Analysis of the Health Situation was successful in reference to study plan C of the medical studies(AU)

Propuesta de perfeccionamiento de tarjeta de habilidades específicas para la especialización en Medicina General Integral / A Proposal for the Improvement of the Card of Specific Skills for the Family Medicine Specialization

Introducción: El sistema de habilidades específicas diseñado para la residencia de Medicina General Integral debe brindar al proceso formativo del profesional un actualizado instrumento en su especialización y actividad científica a partir de las exigencias sanitarias. Objetivo: Elaborar una propuesta de perfeccionamiento de tarjeta de habilidades específicas para la especialización en Medicina General Integral. Métodos: Se realizó estudio de corte pedagógico rectorado por el método materialista dialéctico en el Policlínico Universitario Pedro Borrás Astorga de la ciudad Pinar del Río durante el año 2018. Se utilizaron métodos de los niveles teórico y empírico. Conclusiones: El perfeccionamiento de habilidades específicas en residentes de Medicina General Integral representa un reto a asumir dentro de su programa formativo(AU)

Introduction: The system of specific skills that has been designed for the family medicine residency must provide the professional training process with an updated instrument in its specialization and scientific activity based on health requirements. Objective: To prepare a proposal for the improvement of the card of specific skills for the family medicine specialization. Methods: A pedagogical study guided by the dialectical-materialist method was carried out at Pedro Borrás Astorga University Polyclinic in Pinar del Río City, during the year 2018. Methods of the theoretical and empirical levels were used. Conclusions: The improvement of specific skills in family medicine residents represents a challenge to be taken within their training program(AU)

Atualização do atendimento do paciente em parada cardiorrespiratória: O que todo clínico deve saber? / Update of medical care in cardiorespiratory arrest: What should every clinician know?

O objetivo deste estudo foi apresentar uma revisão narrativa do atendimento à parada cardiorrespiratória, baseada nas diretrizes mais atuais e, também, uma análise crítica de informações de literatura recente, que vão além das recomendações gerais das diretrizes vigentes. A parada cardiorrespiratória, quando ocorre de forma inesperada, abrupta, em indivíduo que se encontrava estável horas antes do evento, é chamada de morte súbita. Essa condição é a principal causa de óbito extra-hospitalar não traumático e, dentre suas diversas causas, a síndrome coronariana aguda é a mais comum em adultos. Uma vez que a frequência de síndrome coronariana aguda tende a aumentar com o aumento da expectativa de vida e de prevalência de outros fatores de risco na população, a ocorrência de morte súbita também tende a aumentar nesse cenário. No intuito de orientar o atendimento de pacientes em parada cardiorrespiratória, há mais de quatro décadas foram criadas diretrizes internacionais, que evoluíram com o surgimento de novas evidências, especialmente nos últimos 20 anos. Todo médico deve estar preparado para atender uma situação de parada cardiorrespiratória, pois ele pode ser chamado para atender tais casos em diferentes cenários (emergência, unidade de internação ou em ambiente extra-hospitalar). Entretanto, apesar da importância da incorporação de novas evidências nessas diretrizes, mudanças frequentes nas recomendações representam grande desafio para os clínicos se manterem atualizados. Além da dificuldade na atualização permanente, há recomendações feitas pelas diretrizes de sociedades médicas que divergem entre si e são questionadas por especialistas, o que gera dúvida na tomada de decisão do clínico. Conforme pormenorizado neste artigo de atualização, as etapas do algoritmo de Suportes Básico e Avançado de Vida são apresentadas como uma sequência, para facilitar para o socorrista que atua sozinho a oferecer intervenções com impacto na sobrevivência do paciente, devendo priorizar a reanimação cardiopulmonar de qualidade e a desfibrilação precoce, se indicada.

The objective of this study was to present a narrative review of cardiac arrest care based on the most current guidelines, and also a critical analysis of recent literature information that goes beyond the general recommendations of the current guidelines. Cardiac arrest, when occurring unexpectedly, abruptly, in an individual who was stable hours before the event, is called sudden death. This condition is the leading cause of non-traumatic out-of-hospital death and, among its many causes, acute coronary syndrome is the most common in adults. Since the frequency of acute coronary syndrome tends to increase with increasing life expectancy and the prevalence of other risk factors in the population, sudden death also tends to increase in this scenario. In order to guide the care of patients with cardiopulmonary arrest, for over 4 decades, international guidelines have been created and have evolved with the emergence of new evidence, especially in the last 20 years. Every physician should be prepared to deal with a cardiac arrest situation as he or she may be called upon to treat such cases in different scenarios (emergency, inpatient unit or out-of-hospital setting). However, despite the importance of incorporating new evidence into these guidelines, frequent changes to the recommendations pose a major challenge for clinicians to update their knowledge. In addition to the difficulty of constantly updating, there are recommendations made by the guidelines of medical societies that differ from each other and are questioned by specialists, which creates doubt in the process of decision making among clinicians. As detailed in this update article, the stages of the algorithm of Basic and Advanced Life Support are presented in a sequence to help the rescuer who works alone to provide interventions that impact the patient's survival, and prioritize quality cardiopulmonary resuscitation and early defibrillation, if required.

Twelve-month utilization rates and adequacy of treatment for mental health and substance use disorders in Argentina

Objective: To estimate the 12-month prevalence of mental health services utilization (overall and by type of service sector), the adequacy of treatment provided, and sociodemographic correlates in the Argentinean Study of Mental Health Epidemiology (ASMHE). Methods: The ASMHE is a multistage probability household sample representative of adults in urban areas of Argentina. The World Health Organization World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to evaluate psychiatric diagnosis and service utilization. Results: Among those with a disorder, 27.6% received any treatment in the prior 12 months. Of these, 78.3% received minimally adequate treatment using a broad definition and only 43.6% using a stringent definition. For individuals with a disorder, more services were provided by mental health professionals (17.7%) than by general medical professionals (11.5%) or non-healthcare sectors (2.6%). Younger individuals with low education and income were less likely to receive treatment; those never married and those with an anxiety or mood disorder were more likely to receive treatment. Among those in treatment, treatment was least adequate among younger individuals with low education and low income. Conclusions: Policies to increase access to services for mental health disorders in Argentina are needed, as is training for primary care practitioners in the early detection and treatment of psychiatric disorders.

Los internados verticales actuales en la Carrera de Medicina / Current vertical internship in the Medical Major

Introducción: La Comisión Nacional de la Carrera de Medicina ha estado confeccionando nuevas propuestas de programas perfeccionados. La creación de internados verticales en los últimos 2 años ha creado expectativas positivas y negativas en el claustro de profesores de más experiencia en la Educación Médica en distintas universidades del país. Objetivo: Invitar al análisis y reflexión sobre los nuevos internados verticales y cual considerar el más apropiado en la actualidad para las especialidades derivadas de la clínica o para la formación del médico general básico. Desarrollo: Se realizó un breve recorrido desde su creación inicial hasta nuestros tiempos. Se destacó el Internado Vertical en medicina en su programa como base para las demás especialidades derivadas de la clínica, así como los retos de los nuevos programas de internado de otras especialidades. Se enfatizó en la importancia del Internado Rotatorio para la formación del Médico General Básico. Conclusiones: Se expresa nuestra posición e invitamos al análisis y reflexiones de esos nuevos programas partiendo del diseño curricular actual de la carrera de medicina en lograr un médico capaz de brindar a la sociedad la asistencia de calidad esperada. Valoramos necesario retornar al año académico de Semiología y Propedéutica y al año académico de Medicina Clínica para una mejor preparación y desarrollo de habilidades del sistema de competencias del futuro egresado y la aplicación correcta del método clínico y el razonamiento diagnóstico(AU)

Introduction: The Medical Major National Board has been preparing new proposals for improved programs. The creation of vertical internships in the last two academic years has built positive and negative expectations among the most experience faculty in the field of medical education nationwide. Objective: To invite the analysis and reflection on the new vertical internships and which one is to be considered as the most appropriate at present for clinical specialties or for the training of the basic general physician. Development: A brief journey was made from its creation to our times. The Vertical Internship in Medicine was highlighted considering its program as a basis for the other clinical specialties, together with the challenges of the new internship programs for other specialties. Emphasis was placed on the importance of the Rotary Internship for the training of the basic general physician. Conclusions: Our position is expressed and we invite the analysis and reflections of these new programs based on the current curricular design of the medical major to train a physician capable of providing the society with the expected quality healthcare. We value the need to return to the academic year of Semiology and Propaedeutics and the academic year of Clinical Medicine for better preparation and development of skills of the future graduate competence system and the correct application of the clinical method and diagnostic reasoning(AU)

Autoavaliação de médicos sobre sua formação em Medicina do Adolescente / Physicians' self-assessment on their training in Adolescent Medicine

OBJETIVOS: Caraterizar como os especialistas e residentes de Pediatria e de Medicina Geral e Familiar consideram que abordam os adolescentes, identificar as suas habilitações em Medicina do Adolescente, averiguar que tópicos dessa área os médicos gostariam de ver abordados em futuros treinamentos e comparar as percepções dos médicos das duas especialidades em relação à sua experiência na prática em saúde do adolescente. MÉTODOS: Estudo transversal com base em inquérito enviado via correio eletrônico a 241 médicos da área de influência de um hospital de nível II, tendo-se incluído especialistas e residentes de Pediatria e de Medicina Geral e Familiar de centros de saúde do concelho de Viseu, Portugal. Utilizaram-se os testes Qui-quadrado ou teste Exacto de Fisher para testar associações entre variáveis, assumindo-se significado estatístico quando p<0,05. RESULTADOS: Um total de 113 médicos completou o inquérito, sendo 74% do gênero feminino, com uma mediana de anos de prática de 12 anos (intervalo interquartil 5-30, mínimo 2 anos, máximo 38 anos). O grupo de Pediatria tinha mais formação em Medicina do Adolescente (57%) do que o grupo de Medicina Geral e Familiar (25%) (p=0,007). Mais médicos com formação específica em Medicina do Adolescente consideravam-se preparados para a entrevista ao adolescente (51%, vs. 28% dos que não tinham formação específica, p=0,03). Os médicos Gerais e de Família orientavam mais os adolescentes sobre consumo de substâncias, contracepção e doenças sexualmente transmissíveis, enquanto os médicos de Pediatria identificavam mais adolescentes com depressão. A maioria dos médicos avaliou-se como tendo conhecimentos insuficientes em Medicina do Adolescente, sendo o treino insuficiente a barreira mais frequentemente referida. Cinquenta e sete por cento dos médicos de Pediatria, 78% dos médicos Gerais e de Família e 84% dos que não tinham formação específica em Medicina do Adolescente, considerando as duas especialidades, gostariam de aprofundar os seus conhecimentos nessa área. CONCLUSÕES: Este estudo permitiu identificar que áreas de conhecimento sobre Medicina do Adolescente estão deficitárias na formação dos pediatras e dos médicos gerais e de família. A maioria dos médicos, principalmente os que não tiveram formação em Medicina do Adolescente, mostraram-se interessados em preencher essa lacuna.

AIMS: To characterize the way in which General and Family physicians and Pediatricians consider approaching adolescents, identify their qualifications in Adolescent Medicine, ascertain which topics of this specialty these physicians would like to see addressed in future training, and to compare the perceptions of physicians of both specialties with respect to their experience in adolescent health practice. METHODS: Cross-sectional study based on a survey sent by e-mail to 241 physicians in the area of influence of a level II hospital, including specific training interns or experts in Pediatrics and General and Family Medicine from health centers of the municipality of Viseu, Portugal. Chi-square tests or Fisher's exact test were used to test associations between variables, assuming statistical significance when p<0.05. RESULTS: A total of 113 physicians completed the survey, of them 74% female, with a median of 12 years of practice (interquartile range 5-30, minimum 2 years, maximum 38 years). The Pediatrics group had more training in Adolescent Medicine (57%) than the General and Family Medicine group (25%) (p=0.007). More physicians with specific training in Adolescent Medicine considered themselves prepared for the adolescent interview (51%, vs. 28% of those who did not have specific training, p=0.03). Family and General practitioners guided adolescents more about substance use, contraception, and sexually transmitted diseases, while Pediatrics doctors identified more adolescents with depression. Most physicians rated themselves as having insufficient knowledge in Adolescent Medicine, with insufficient training being the most frequently referred barrier. Fifty-seven percent of Pediatrics doctors, 78% of General practitioners and 84% of those with no specific training in Adolescent Medicine, considering the two specialties, would like to deepen their knowledge in this area. CONCLUSIONS: This study allowed identifying which areas of knowledge on Adolescent Medicine are deficient in the training of Pediatricians and General practitioners. Most physicians, especially those with no training in Adolescent Medicine, showed interest in filling this gap.

El análisis de la situación de salud y la participación social en la formación médica / Health situation analysis and the social participation in medical formation

Se realizó una reflexión acerca del alcance social que ejercen las influencias contextuales en la impartición del análisis de la situación de salud (ASIS), como contenido en la formación médica. En consonancia con las potencialidades formativas que aporta la sistematización de la participación social en salud para lograr su efectividad, se realizó una revisión bibliográfica sobre el contexto político de la participación, la trascendencia del ASIS como herramienta científica y su alcance en la docencia, y las condiciones contextuales donde se realiza la formación. Se destaca que la participación social continúa siendo mundialmente proclamada y nacionalmente promulgada, como condición necesaria en la transformación del cuadro de salud; se reconoce que a pesar del perfeccionamiento del sistema sanitario ha sido compleja su aplicación en la práctica de sus sustentos teóricos y que subyacen insuficiencias en su aplicabilidad que repercuten en la formación, constituyendo un desafío en la contemporaneidade.

A reflection was made on the social scope of setting influences in teaching of the health situation analysis (HSA) as contents in the medical formation. In line with the formative potentialities of the systematization of social participation in health to attain effectiveness, a literature review was made about the political context of participation, the significance of HAS as a scientific tool and its scope in teaching as well as the setting conditions where formation takes place. It is stressed that social involvement remains a claimed aspect nationally and internationally since it is a must in health picture changes; it is also recognized that despite the improvement of the health system, the implementation of its theoretical fundamentals has been complex and there still are deficiencies in applicability that have an effect on formation and represents a contemporary challenge.

Perfiles de egreso de las carreras de Medicina en Chile / Professional profiles of graduates from Chilean Faculties of Medicine

Background: The professional profile of health care professionals should incorporate recommendations of international agencies and adapt to the local conditions of each country. Aim: To conduct a qualitative analysis of Medical Graduate Profiles of universities grouped in the Chilean Association of Medicine Faculties (ASOFAMECH), characterizing its Social Focus, Humanist Approach, Social and Communication Skills. Material and Methods: Documentary analysis of profiles published on the respective web pages, using Atlas Ti software, establishing emerging categories and subcategories. These profiles were compared with the recommendations of the Pan-American Health Organization. Results: Data in Social Focus suggests that although community issues are a common element, the work in primary health and health promotion are rarely included. The Humanist Approach is addressed more commonly than the Social Focus, emphasizing humanization of care, ethical and religious values. Although, social and communication skills are scarcely acknowledged, those mentioned are teamwork and leadership role. Conclusions: There is a marked heterogeneity in the information declared and universities have not fully incorporated the recommendations of international organizations.

Educación médica: ¿Qué tipo de médico necesita el país? / Medical education: What kind of doctor does the country need?

Esta pregunta plantea una serie de problemas que son muy trascendentes para nuestros servicios médicos y universidades. Cuadernos Médico-Sociales han querido recoger en un cuestionario las opiniones de diversos sectores en torno a algunos aspectos de esta materia. Hoy publicamos las opiniones del Dr. Benjamín Viel, Director de la Escuela de Medicina de la Universidad de Chile; del Dr. Mario Terreiro, quien ejerció dos años en Puerto Montt a continuación de su beca en Pediatría; del Dr. Luis Torres, Jefe de Inspectoría Médica del Servicio Nacional de Salud, y del Dr. José Steinberg, Director del Hospital Regional de Iquique.

Educación médica: ¿Qué tipo de médico necesita el país II? / Medical education: What kind of doctor does the country need II?

En su último número, Cuadernos Médico-Sociales recogió la opinión de distinguidos profesionales sobre esta materia. Nos complacemos hoy en presenciar la autorizada respuesta del Jefe del Departamento Técnico del S.N.S., Dr. Alfredo Leonardo Bravo. Dada la trascendencia y actualidad del problema, invitamos a los colegas a expresar su pensamiento, en la seguridad que su contribución será publicada en próximas ediciones.