University Pharmacy: from the foundation to the Pandemic times of Covid-19

Abstract The University Pharmacy Program (FU), from the Federal University of Rio de Janeiro (UFRJ), was created based on the need to offer a curricular internship to students of the Undergraduate Course at the Faculty of Pharmacy. Currently, it is responsible for the care of about 200 patients/day, offering vacancies for curricular internships for students in the Pharmacy course, it has become a reference in the manipulation of many drugs neglected by the pharmaceutical industry and provides access to medicines for low-income users playing an important social function. Research is one of the pillars of FU-UFRJ and several master and doctoral students use the FU research laboratory in the development of dissertations and theses. As of 2002, the Pharmaceutical Care extension projects started to guarantee a rational and safe pharmacotherapy for the medicine users. From its beginning in 1982 until the current quarantine due to the COVID-19 pandemic, FU-UFRJ has been adapting to the new reality and continued to provide patient care services, maintaining its teaching, research, and extension activities. The FU plays a relevant social role in guaranteeing the low-income population access to special and neglected medicines, and to pharmaceutical and education services in health promotion.

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

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

Bronchoscopy Teaching Without a Gold Standard: Attending Pulmonologists' Assessment of Learners, Supervisory Styles, and Variation in Practice.

BACKGROUND: Despite the growing role of simulation in procedural teaching, bronchoscopy training largely is experiential and occurs during patient care. The Accreditation Council for Graduate Medical Education sets a target of 100 bronchoscopies to be performed during pulmonary fellowship. Attending physicians must balance fellow autonomy with patient safety during these clinical teaching experiences. Few data on best practices for bronchoscopy teaching exist, and a better understanding of how bronchoscopy currently is supervised could allow for improvement in bronchoscopy teaching. RESEARCH QUESTION: How do attending bronchoscopists supervise bronchoscopy, and in particular, how do attendings balance fellow autonomy with patient safety? STUDY DESIGN AND METHODS: This was a focused ethnography conducted at a single center using audio recording of dialog between attendings and fellows during bronchoscopies, supplemented by observation of nonverbal teaching. Interviews with attending bronchoscopists and limited interviews of fellows also were recorded. Interviews were transcribed verbatim before analysis. We used constant comparative analysis to analyze data and qualitative research software to support data organization and thematic analysis. Education researchers from outside of pulmonary critical care joined the team to minimize bias. RESULTS: We observed seven attending bronchoscopists supervising eight bronchoscopies. We noted distinct teaching behaviors, classified into themes, which then were grouped into four supervisory styles of modelling, coaching, scaffolding, and fading. Observation and interviews illuminated that assessing fellow skill was one tool used to choose a style, and attendings moved between styles. Attendings accepted some, but not all, variation in both performing and supervising bronchoscopy. INTERPRETATION: Attending pulmonologists used a range of teaching microskills as they moved between different supervisory styles and selectively accepted variation in practice. These distinct approaches may create well-rounded bronchoscopists by the end of fellowship training and should be studied further.

Surgical autonomy: A resident perspective and the balance of teacher development with operative independence.

BACKGROUND: This study aims to understand the perspectives of operative autonomy of surgical residents at various postgraduate levels. METHODS: Categorical general surgery residents at a single academic residency were invited to participate in focus groups to discuss their opinions and definitions of operative autonomy. Employing constructivist thematic analysis, focus groups were audio recorded, transcribed, and inductively analyzed using a constant comparative technique. RESULTS: Twenty clinical surgical residents participated in 6 focus groups. Overarching themes identified include autonomy as a dynamic, progressive path to operative independence and the complex interaction of resident-as-teacher development and operative autonomy. Four within operative case themes were intrinsic factors, extrinsic factors, autonomy promoting or inhibiting behaviors, and the relationship between residents and attendings. CONCLUSION: Residents define operative autonomy as a progressive and dynamic pathway to operative independence. Teacher development is viewed as both an extension beyond operative independence and potentially in conflict with their colleagues' development.

[Teaching at hospitals: Between educational and nursing care activities]. / L'enseignement en milieu hospitalier : entre éducation et soins infirmiers.

This article aims to reveal the ethical framework surrounding hospitalized school students, showing that, in the context of disease, traditional ethics do not work. From a philosophical perspective, the target audience are teachers and volunteers who teach at hospitals, but also nurses and other professionals who work with sick children. The development of an ethical framework based on the ethics of care (EoC) will enable teachers to guide their activity in hospitals, highlighting the need for another ethical framework in order to achieve a teaching practice that is fully responsible and compassionate. In an ethical framework centered on the sick child, concepts such as "care" and "well-being" are mobilized by understanding how they relate to the psychological well-being of hospitalized students. I propose that an educational attitude rooted in admiration, respect and love can be a good guide for teaching practices in hospitals, offering an alternative to the ethical limitations of codes based on a universal conception of justice.

Testing Boundaries COVID-19 made the USMLE, Clerkships a Moving Target for Med Students.

Medical schools typically have predictable schedules. The timing of lectures, clerkships, exams, and even extracurricular activities tend to follow in the same grooves year after year. Students can reliably block out even minor events months ahead of time and be confident they'll take place. All that changed with COVID-19. Since March, when the pandemic began closing down schools, businesses, and other institutions across the state, figuring out what comes next in medical school has been anything but predictable.

Patients and carers as teachers in psychiatric education: a literature review and discussion.

INTRODUCTION: The direct involvement of patients and carers in psychiatric education is driven by policy in the United Kingdom and Ireland. The benefits of this involvement are well known, however, it is important to consider the ethical aspects. This paper suggests how further research could explore and potentially mitigate adverse outcomes. METHOD: A literature search evaluating the role of patients and carer involvement in psychiatric education was undertaken to summarise existing evidence relating to the following: methods of involvement, evidence of usefulness, patient's/carer's views and learners' views. RESULTS: The Medline search produced 231 articles of which 31 were included in the literature review based on the key themes addressed in the paper. DISCUSSION/CONCLUSION: The available evidence is generally positive regarding the use of patients and carers in psychiatric education. However, available research is varied in approach and outcome with little information on the ethical consequences. More research is required to inform policies on teaching regarding potential adverse effects of service user involvement.

Health and social care educators' ethical competence.

BACKGROUND AND PURPOSE: Educators' ethical competence is of crucial importance for developing students' ethical thinking. Previous studies describe educators' ethical codes and principles. This article aims to widen the understanding of health- and social care educators' ethical competence in relation to core values and ethos. THEORETICAL BACKGROUND AND KEY CONCEPTS: The study is based on the didactics of caring science and theoretically links the concepts ethos and competence. METHODS: Data material was collected from nine educational units for healthcare and social service in Finland. In total 16 semi-structured focus group interviews with 48 participants were conducted. The interviews were analysed with a thematic analysis according to Braun and Clarke. ETHICAL CONSIDERATIONS: The study is approved by the Declaration of Helsinki, the legislation regarding personal data and the General Data Protection Regulation. The study received ethical permission from the University of Jyväskylä. Informed consent was obtained from all the educational units and participants in the study. FINDINGS: The findings are presented based on three general patterns, an ethical basic motive, an ethical bearing and ethical actions. Subthemes are Humane view of students as unique individuals with individual learning, Bearing of tactfulness and firmness, Bearing of perceptiveness and accessibility, Bearing of satisfaction and joy over student learning, Valuing bearing towards each oneself and colleagues, Ability to interact and flexibility, Collegiality and a supportive work community and Educators as role models and inspirators. CONCLUSION: Educators' personal and professional ethos is crucial to student learning, personal growth and ethical reasoning. Therefore, it is important to further develop educators' training regarding ethical competence.

Perceived leader integrity as a mediator between ethical leadership and ethical climate in a teaching context.

BACKGROUND: Scandalous incidents occurring in prominent organisations in the world have brought to limelight the role of leaders in shaping the ethical climate of their organisations. As a result, several studies across different organisational/occupational contexts and climes have examined and unanimously proven that ethical leadership was positively related to ethical climate. However, there is rarely any of these studies that was conducted in teaching context. Besides, the mechanisms involved between ethical leadership and ethical climate seems not to have been addressed in literature. Thus, this paper reports the findings of a study that investigated the mediating role of perceived leader integrity in the ethical leadership-ethical climate relationship among teachers. METHODS: Data were collected from 336 teachers (105 male and 231 female) in three-time periods using measures of ethical leadership, perceived leader integrity, ethical climate, and demographics. RESULTS: The results from OLS regression-based path analysis showed that: 1) ethical leadership was positively related to perceived leader integrity, 2) perceived leader integrity was positively related to ethical climate, 3) ethical leadership was positively related to ethical climate, and 4) the positive relationship between ethical leadership and ethical climate was mediated by perceived leader integrity. CONCLUSIONS: The current study extends the social learning theory by identifying perceived leader integrity as a mechanism underlying the relationship between ethical leadership and ethical climate. The findings have some implications for personnel selection especially in relation to selection of ethical leaders.

Docencia de la Medicina Intensiva. Aspectos bioéticos / Teaching Intensive Care Medicine. Bioethical aspects / La docència de la Medicina Intensiva. Aspectes bioètic

Cualquier acto médico presenta siempre una doble vertiente, técnica y moral. La bioética, surge como herramienta clave para poder conjugar ambos aspectos en la toma diaria de decisiones médicas. Además, docencia y aprendizaje estarán presentes de forma patente durante toda la vida profesional de la mayoría de los médicos. En la actualidad, los avances obtenidos por la comunidad universitaria en cuanto a la docencia de la bioética son notables. No han sido tan claro, sin embargo, para la formación durante la residencia ni tras la especialidad. El contexto de la Medicina Intensiva, dedicada a pacientes con enfermedades críticas, ofrece una serie de particularidades que pueden ser beneficiosas para el aprendizaje de muchos aspectos bioéticos. Estos incluyen, entre otros, el respeto a la autonomía del paciente, la búsqueda de la beneficencia, incluso durante los cuidados al final de la vida, o la toma de decisiones en equipo o en situaciones de extrema urgencia. En cuanto al modo de enseñanza de la bioética existen diferentes aproximaciones, desde la clásica clase magistral a la clase invertida o el método del caso, que tiene su mayor exponente en la simulación. Nuestra propuesta particular consiste en la integración de la práctica y la discusión en grupo como elemento fundamental de la enseñanza de la bioética, ayudada de las metodologías más recientes, fundamentalmente, de la simulación. Cualquier acto médico presenta siempre una doble vertiente, técnica y moral. La bioética, surge como herramienta clave para poder conjugar ambos aspectos en la toma diaria de decisiones médicas. Además, docencia y aprendizaje estarán presentes de forma patente durante toda la vida profesional de la mayoría de los médicos. En la actualidad, los avances obtenidos por la comunidad universitaria en cuanto a la docencia de la bioética son notables. No han sido tan claro, sin embargo, para la formación durante la residencia ni tras la especialidad. El contexto de la Medicina Intensiva, dedicada a pacientes con enfermedades críticas, ofrece una serie de particularidades que pueden ser beneficiosas para el aprendizaje de muchos aspectos bioéticos. Estos incluyen, entre otros, el respeto a la autonomía del paciente, la búsqueda de la beneficencia, incluso durante los cuidados al final de la vida, o la toma de decisiones en equipo o en situaciones de extrema urgencia. En cuanto al modo de enseñanza de la bioética existen diferentes aproximaciones, desde la clásica clase magistral a la clase invertida o el método del caso, que tiene su mayor exponente en la simulación. Nuestra propuesta particular consiste en la integración de la práctica y la discusión en grupo como elemento fundamental de la enseñanza de la bioética, ayudada de las metodologías más recientes, fundamentalmente, de la simulación

All medical action always includes a double perspective: technical and moral. Bioethics emerges as a key tool to combine both aspects when medical decisions are taken in the daily work of a physician. In addition, teaching and learning are always clearly present in the working life of the majority of the practitioners. Currently, the advances of teaching Bioethics reached by the university community are remarkable. However, it was not so clear the level to the training during the medical residency and after the specialty. The context of Intensive Care Medicine dedicated to patients with critical diseases offers some characteristics which might be beneficial to the learning of a wide variety of bioethical aspects. These include, among others, the respect of the patient’s autonomy, the search of beneficence, also during end-oflife care, decision making in groups or in extreme emergency cases. Related to the way of teaching Bioethics, there are different approaches, from the master class to the flipped class or the case method whose greatest exponent is simulation. Our particular proposal consists in the integration of practice and discussion in groups as essential element in teaching Bioethics, helped by some recent methodologies like simulation

Qualsevol acte mèdic presenta sempre un doble vessant, a la vegada tècnic i moral. La bioètica sorgeix com a eina clau per poder conjugar tots dos aspectes en la presa diària de decisions mèdiques. A més, docència i aprenentatge estaran presents de forma palesa durant tota la vida professional de la majoria dels metges. En l'actualitat, els avanços obtinguts per la comunitat universitària quant a la docència de la bioètica són notables. No ha estat tan clar, no obstant això, per a la formació durant la residència ni després de l'especialitat. El context de la Medicina Intensiva, dedicada a pacients amb malalties crítiques, ofereix una sèrie de particularitats que poden ser beneficioses per a l'aprenentatge de molts aspectes bioètics, que inclouen, entre altres, el respecte a l'autonomia del pacient, la recerca de la beneficència, fins i tot durant les cures al final de la vida, o la presa de decisions en equip o en situacions d'extrema urgència. Quant a la manera d'ensenyar la bioètica, existeixen diferents aproximacions, des de la clàssica classe magistral a la classe invertida o el mètode del cas, que té el seu major exponent en la simulació. La nostra proposta particular consisteix en la integració de la pràctica i la discussió en grup com a element fonamental de l'ensenyament de la bioètica, ajudada per les metodologies més recents, i fonamentalment de la simulació

Ethics in Child and Adolescent Psychiatry Training: What and How Are We Teaching?

OBJECTIVE: This article describes survey results describing ethics/professionalism curricula of US child and adolescent psychiatry (CAP) residency programs. This project repeated and expanded upon an earlier survey. METHODS: CAP program directors were sent an e-mail with a link to an anonymous electronic survey. RESULTS: Ninety-nine programs responded with 92 completing the majority of the survey. All had instruction during both training years; reading seminars and lectures were the most common teaching formats. The median number of teaching hours was 10. Teaching was considered inadequate by 22%. Confidentiality, child advocacy, and informed consent were the most frequent ethics topics. Communication, patient care during working hours, and conduct at work were the most common professionalism topics. Faculty and resident opinion differed on certain topics. CAPs were preferred educators in 56.5%. External program resources were available to 87% but over 30% used them rarely or never. Faculty evaluations, 360-degree evaluations, and faculty observations were the most common assessment methods; 38% thought trainee assessments need improvement. Programs were classified into more confident and less confident. More confident programs used available ethics resources more frequently (25% vs 8%, p = 0.30) and had more than the median teaching hours (58% vs 35%, p = 0.035). CONCLUSIONS: Compared to the previous study, CAP programs had increased use of interactive methods with more programs reporting having adequate hours. These results are consistent with existing literature confirming the importance of this curriculum but significant issues with adequately educating and evaluating trainees remain.

Profile of activities developed by community pharmacists: do they corroborate the precepts of the pharmaceutical profession?

Studies that addressed the profile of pharmaceutical activities and behaviors in community pharmacies in the last decades pointed to a gap between community pharmacy practice and the precepts of the profession. Facing the need to analyze whether the new legislation has impacted this scenario, the objective of this study was to describe the general profile and academic profile of community pharmacists, and the profile of the activities they develop, as well as to know their place of work. This is a descriptive study, to which all pharmacists in charge of community pharmacies in the metropolitan area of ​​Belo Horizonte-MG (n = 1624) were invited. Data collection was performed through a questionnaire validated online, from October to December 2017, via Google Docs®. Responses were obtained from 109 pharmacists, most of them female, aged 31-40 years, being general graduates, and in private institutions. Pharmacotherapeutic follow-up, an activity linked to clinical management, is performed by only 37.60% of pharmacists, evidencing that there is still a lag in relation to the provision of clinical services by community pharmacists. Thus, we emphasize the importance of implementing the precepts established by Brazilian curricular guidelines for undergraduate pharmacy courses which focus on the development of clinical skills, since the insertion of the pharmacist into the health team and the provision of clinical services to the community can add new value to the use of medications, and contribute effectively to their rational use in Brazil.

Projeto social e Educação Física: fundamentos e produção de sentidos em uma proposta de educação em valores / Social project and Physical Education: background and directions of production on a proposal of education in values

Este estudo analisa os sentidos que os professores de Educação Física, educadores sociais e jovens atribuem à educação em valores desenvolvida e ministrada em um projeto social do Estado do Espírito Santo. Caracteriza-se como um estudo de caso etnográfico, utilizando os instrumentos: análise documental, observação não participante, registro no diário de campo, entrevista semiestruturada e grupo focal. Participaram da pesquisa um professor de Educação Física, quatro educadores sociais e 28 jovens. O estudo identifica que os sujeitos partem a priori de suas experiências formativas e desenvolvem uma atividade que lhes é própria. A mediação do conteúdo valores acontece de forma incidental, não sistematizada, de acordo com as demandas que ocorrem na prática. Dentro do projeto social, a prática e a especificidade das oficinas demonstraram fazer sentido para a intervenção dos sujeitos.

This study analyzes the meanings that Physical Education teachers, social educators and young people attribute to values education developed and taught in a social project in the state of Espírito Santo. It is characterized as an ethnographic case study, using the following instruments: document analysis, non-participant observation, field diary recording, semi-structured interview and focus group. One physical education teacher, four social educators and 28 youngsters participated in the research. The study identifies that the subjects start a priori from their formative experiences and develop their own activity. The mediation of content values happens incidentally, not systematized, according to the demands that occur in practice. Within the social project, the practice and specificity of the workshops demonstrated to make sense for the intervention of the subjects.

Pimping: a tradition of gendered disempowerment.

The use of pimping as a method of teaching is widespread in the clinical phase of medical education. In this paper we consider pimping's colloquial meanings and discuss how it was introduced into the language of medical education. We posit that such language reflects persistent gendered hierarchies in medicine, and we evaluate pimping's pedagogical value. Finally, we call for an end to the term and the practice, and for a renewed emphasis on pedagogy in medical education.

[Proposal of a deontological framework for spanish biologists]. / Propuesta de un marco deontológico para los biólogos españoles.

Deontology is the set of duties and obligations in which the correct act is specified in the exercise of a profession. The Deontological Codes (CD), in addition to respecting the legal framework in which they are inserted, must go beyond the laws insofar as they are a reflection of the ethical commitment of each profession; commitment to deontological principles, which also helps to shape your identity. The aim of this project is to provide, based on the bibliography and current legal and deontological regulations, a proposal to serve as a guide for the accomplishment of Ethic Codes for Biologists (CDB), which currently does not exist in Spain, taking as a basis the revision of the ethics codes of other professions related to Biology. Under this purpose, a systematic and comparative review has been carried out of other health professions ethics codes, of the ethical guidelines emanating from scientific societies (above all, from the Anglo-Saxon area) and of the regulations applicable to those professions. The result is the proposal of the most important sections that we believe this Code should contain.