[Mapping the implementation characteristics of new Medicine programs in Brazilian federal universitiesMapeo de las características de implementación de los nuevos programas de medicina en universidades federales brasileñas]. / Mapeamento das características da implantação de novos cursos de Medicina em universidades federais brasileiras.

OBJECTIVE: To map the implementation characteristics of Medicine programs established in Brazilian federal universities from 2013 onwards. METHODS: A qualitative and quantitative exploratory study was performed. Newly created Medicine programs were identified in federal universities, with analysis of pedagogical frameworks and interviews with students, faculty, and health care professionals from associated health care services. Data were analyzed using qualitative and quantitative methods. RESULTS: Thirty new Medicine programs were identified, of which 24 were visited. All the new programs were located outside large urban centers and capitals, across the five Brazilian macro-regions, and adopted various formative configurations in an attempt to overcome fragmentation of content with active methodologies and formative evaluations. The healthcare network is used for training as a means to meet the challenge of academic-health service-community integration, with the aim of providing critical education focused on public health. The establishment of the Medicine programs facilitated to a limited extent the retention of faculty in remote areas and promoted the access of local students and the creation of residency programs, which are powerful strategies to enhance the retention of medical professionals. CONCLUSIONS: Variations were observed among the programs in the manner of implementation and adherence to the National Curriculum Guidelines for Medicine, published in 2014. The construction of medical training models that appropriately address local specificities and the requirements of the Unified Health System in its formative role for health care may contribute to reduce health inequalities.

OBJETIVO: Mapear las características de implementación de los programas de Medicina establecidos en las universidades federales brasileñas a partir de 2013. MÉTODOS: Se realizó un estudio exploratorio cualitativo y cuantitativo. Se identificaron los programas de medicina recién creados en las universidades federales, se anlizaron los marcos pedagógicos y se entrevistaron estudiantes, profesores y profesionales de la salud de los servicios de salud asociados. Los datos fueron analizados usando métodos cualitativos y cuantitativos. RESULTADOS: Se identificaron 30 nuevos programas de medicina, de los cuales se visitaron 24. Todos los nuevos programas se ubicaron fuera de los grandes centros urbanos y capitales en las cinco macrorregiones brasileñas y adoptaron diversas configuraciones formativas en un intento de superar la fragmentación de contenido con metodologías activas y evaluaciones formativas. La red de salud se empleó para la formación como un medio para facilitar la integración entre los ámbitos académico, de servicios de salud y la comunidad, con el objetivo de proporcionar una educación crítica centrada en la salud pública. El establecimiento de los programas de medicina facilitó en cierta medida la retención del profesorado en zonas remotas y promovió el acceso de los estudiantes locales y la creación de programas de residencia, que son estrategias importantes para mejorar la retención de los profesionales médicos. CONCLUSIONES: Se observaron variaciones entre los programas en cuanto a la manera de aplicar y cumplir las Directrices Curriculares Nacionales de Medicina, publicadas en 2014. La construcción de modelos de formación médica que aborden adecuadamente las especificidades locales y los requisitos del Sistema Único de Salud en su función formativa para la atención de la salud puede contribuir a reducir las desigualdades en materia de salud.

Mapeamento das características da implantação de novos cursos de Medicina em universidades federais brasileiras

[RESUMO]. Objetivo. Mapear as características de implantação de novos cursos de Medicina nas universidades federais brasileiras, a partir de 2013. Métodos. Estudo exploratório com metodologia quantitativa e qualitativa. Foi realizado um levantamento das novas escolas de Medicina em universidades federais, com análise dos projetos pedagógicos dos cursos e entrevistas a estudantes, professores e profissionais de serviços de saúde vinculados às escolas de Medicina. Os dados coletados foram analisados quantitativa e qualitativamente. Resultados. Foram identificados 30 novos cursos de Medicina, dos quais 24 foram visitados. Todos os novos cursos se localizam fora dos grandes centros urbanos e capitais, nas cinco macrorregiões brasileiras; são organizados em arranjos formativos diversos, que buscam superar a fragmentação disciplinar com metodologias ativas e avaliação formativa. A rede de saúde é utilizada na formação para enfrentamento dos desafios da integração ensino-serviço-comunidade, com vistas a uma formação crítica e voltada à saúde pública. A criação dos cursos promoveu a interiorização de docentes, embora de forma limitada, e contribuiu para o ingresso de estudantes locais e a criação de residências médicas, expedientes potentes na fixação médica. Conclusões. Observou-se diversidade nas formas da materialidade e aderência ao disposto pelas Diretrizes Curriculares Nacionais de Medicina publicadas em 2014. A construção de modelos de formação médica condizentes com as particularidades locais e com as exigências do Sistema Único de Saúde (SUS) em seu papel de ordenador da formação dos profissionais da saúde pode contribuir para reduzir as desigualdades em saúde.

[ABSTRACT]. Objective. To map the implementation characteristics of Medicine programs established in Brazilian federal universities from 2013 onwards. Methods. A qualitative and quantitative exploratory study was performed. Newly created Medicine programs were identified in federal universities, with analysis of pedagogical frameworks and interviews with students, faculty, and health care professionals from associated health care services. Data were analyzed using qualitative and quantitative methods. Results. Thirty new Medicine programs were identified, of which 24 were visited. All the new programs were located outside large urban centers and capitals, across the five Brazilian macro-regions, and adopted various formative configurations in an attempt to overcome fragmentation of content with active methodologies and formative evaluations. The healthcare network is used for training as a means to meet the challenge of academic-health service-community integration, with the aim of providing critical education focused on public health. The establishment of the Medicine programs facilitated to a limited extent the retention of faculty in remote areas and promoted the access of local students and the creation of residency programs, which are powerful strategies to enhance the retention of medical professionals. Conclusions. Variations were observed among the programs in the manner of implementation and adherence to the National Curriculum Guidelines for Medicine, published in 2014. The construction of medical training models that appropriately address local specificities and the requirements of the Unified Health System in its formative role for health care may contribute to reduce health inequalities.

[RESUMEN]. Objetivo. Mapear las características de implementación de los programas de Medicina establecidos en las universidades federales brasileñas a partir de 2013. Métodos. Se realizó un estudio exploratorio cualitativo y cuantitativo. Se identificaron los programas de medicina recién creados en las universidades federales, se anlizaron los marcos pedagógicos y se entrevistaron estudiantes, profesores y profesionales de la salud de los servicios de salud asociados. Los datos fueron analizados usando métodos cualitativos y cuantitativos. Resultados. Se identificaron 30 nuevos programas de medicina, de los cuales se visitaron 24. Todos los nuevos programas se ubicaron fuera de los grandes centros urbanos y capitales en las cinco macrorregiones brasileñas y adoptaron diversas configuraciones formativas en un intento de superar la fragmentación de contenido con metodologías activas y evaluaciones formativas. La red de salud se empleó para la formación como un medio para facilitar la integración entre los ámbitos académico, de servicios de salud y la comunidad, con el objetivo de proporcionar una educación crítica centrada en la salud pública. El establecimiento de los programas de medicina facilitó en cierta medida la retención del profesorado en zonas remotas y promovió el acceso de los estudiantes locales y la creación de programas de residencia, que son estrategias importantes para mejorar la retención de los profesionales médicos. Conclusiones. Se observaron variaciones entre los programas en cuanto a la manera de aplicar y cumplir las Directrices Curriculares Nacionales de Medicina, publicadas en 2014. La construcción de modelos de formación médica que aborden adecuadamente las especificidades locales y los requisitos del Sistema Único de Salud en su función formativa para la atención de la salud puede contribuir a reducir las desigualdades en materia de salud.

Smoking cessation program as a tool for the early diagnosis of chronic obstructive pulmonary disease.

OBJECTIVE: The impact of chronic obstructive pulmonary disease (COPD) is underestimation as a result of underdiagnosis and undertreatment. The objective of this study was to determine whether using spirometry to evaluate smokers enrolled in smoking cessation programs facilitates early diagnosis of COPD. METHODS: The medical records of 158 smokers enrolled in the smoking cessation program at the Botucatu School of Medicine (Botucatu, Brazil) between January of 2003 and November of 2005 were evaluated retrospectively. All were over 40 years old (mean age: 55 +/- 8.5 years), and 99 (62.6%) were female. We analyzed the clinical data, the previous medical diagnosis, and the spirometry results. RESULTS: The diagnostic criteria for COPD were met by 57 (36.1%) of the 158 individuals evaluated, and 14 individuals (8.9%) were considered to be at risk for the development of the disease. Of those 57 individuals meeting the criteria for a diagnosis of COPD, 39 (68.4%) were receiving their first diagnosis of COPD, whereas 18 (31.6%) were receiving confirmation of a prior diagnosis. Of the 18 individuals previously diagnosed, 10 (56%) presented the mild/moderate form of the disease, and 8 (44%) presented the severe form. Of the 39 newly diagnosed individuals, 38 (97,4%) presented the mild/moderate for of the disease, and only 1 (2,6%) had severe COPD. Seven patients previously diagnosed with COPD presented pulmonary function test results inconsistent with the diagnostic criteria. CONCLUSION: Using spirometry in the initial evaluation of smokers enrolling in smoking cessation program might be a useful tool for early diagnosis of COPD.

Programa de cessação de tabagismo como ferramenta para o diagnóstico precoce de doença pulmonar obstrutiva crônica / Smoking cessation program as a tool for the early diagnosis of chronic obstructive pulmonary disease

OBJETIVO: A doença pulmonar obstrutiva crônica (DPOC) é subdiagnosticada e subtratada, o que resulta em subestimação do impacto da doença. O objetivo deste estudo foi avaliar se a inclusão da espirometria na avaliação dos fumantes que ingressam em programas de cessação do tabagismo contribui para o diagnóstico precoce da DPOC. MÉTODOS: Análise retrospectiva de dados médicos de 158 fumantes atendidos no programa cessação de tabagismo (Faculdade de Medicina de Botucatu, São Paulo, Brasil), de janeiro 2003 a novembro 2005. Todos os indivíduos tinham mais de 40 anos (idade média: 55 ± 8,5 anos), sendo 99 (62,6 por cento) do sexo feminino. Foram analisados os dados clínicos, os diagnósticos médicos prévios e os resultados da espirometria. RESULTADOS: Dos 158 fumantes avaliados, 57 (36,1 por cento) indivíduos preenchiam os critérios diagnósticos para DPOC e 14 (8,9 por cento) foram considerados em risco para o desenvolvimento da doença. Dos 57 que preenchiam os critérios diagnósticos para DPOC, 39 (68,4 por cento) foram diagnósticos novos e 18 (31,6 por cento) foram confirmação de diagnóstico prévio da doença. Entre os 18 com diagnóstico anterior, 10 (56 por cento) tinham doença leve/moderada e 8 (44 por cento) doença grave. Sete pacientes com diagnóstico anterior de DPOC apresentaram resultados de função de pulmonar não compatíveis com os critérios diagnósticos da doença. Entre os 39 novos diagnósticos, 38 (97,4 por cento) eram de doença leve/moderada e apenas 1 (2,6 por cento) tinha DPOC grave CONCLUSÃO: A inclusão da espirometria na avaliação inicial dos fumantes admitidos em programa de cessação de tabagismo pode ser uma ferramenta útil para o diagnóstico precoce da DPOC.

OBJECTIVE: The impact of chronic obstructive pulmonary disease (COPD) is underestimation as a result of underdiagnosis and undertreatment. The objective of this study was to determine whether using spirometry to evaluate smokers enrolled in smoking cessation programs facilitates early diagnosis of COPD. METHODS: The medical records of 158 smokers enrolled in the smoking cessation program at the Botucatu School of Medicine (Botucatu, Brazil) between January of 2003 and November of 2005 were evaluated retrospectively. All were over 40 years old (mean age: 55 ± 8.5 years), and 99 (62.6 percent) were female. We analyzed the clinical data, the previous medical diagnosis, and the spirometry results. RESULTS: The diagnostic criteria for COPD were met by 57 (36.1 percent) of the 158 individuals evaluated, and 14 individuals (8.9 percent) were considered to be at risk for the development of the disease. Of those 57 individuals meeting the criteria for a diagnosis of COPD, 39 (68.4 percent) were receiving their first diagnosis of COPD, whereas 18 (31.6 percent) were receiving confirmation of a prior diagnosis. Of the 18 individuals previously diagnosed, 10 (56 percent) presented the mild/moderate form of the disease, and 8 (44 percent) presented the severe form. Of the 39 newly diagnosed individuals, 38 (97,4 percent) presented the mild/moderate for of the disease, and only 1 (2,6 percent) had severe COPD. Seven patients previously diagnosed with COPD presented pulmonary function test results inconsistent with the diagnostic criteria. CONCLUSION: Using spirometry in the initial evaluation of smokers enrolling in smoking cessation program might be a useful tool for early diagnosis of COPD.