Effectiveness of an Active Methodology for Learning ECG during the Internal Medicine Internship. / Eficácia de Metodologia Ativa de Aprendizagem do ECG no Internato em Clínica Médica.

BACKGROUND: Studies have shown a low accuracy of urgent care physicians in interpreting electrocardiogram (ECG) in severe cardiovascular conditions. OBJECTIVE: To evaluate the effectiveness of an ECG learning method in internal medicine internships and to know the perception of interns regarding learning before and after the methodology. METHODS: This study used a database with the results of an ECG pre- and post-test of the classes in the internal medicine internship from 2017 to 2022. A qualitative questionnaire was sent with questions for self-assessment of perception of learning. RESULTS: The study included a total of 227 students, 161 of whom (70.9%) were female. The mean age was 26.4 ± 4.2 years old. The pre-test mean was 3.75 ± 2.0 points, and the post-test mean was 8.48 ± 1.5 points, showing a statistically significant difference, even after stratification by sex, age, and course period (p < 0.001 for all comparisons). Sixty-nine (30%) of the students responded to the qualitative questionnaire. The three predominant feelings prior to learning were despair, fear, and insecurity. After the Club, the predominant feelings were security, tranquility, and confidence. CONCLUSION: The level of prior knowledge regarding ECG was low among students in the medical internship, and the proposed methodology was effective for learning ECG, regardless of age, sex, or course period. It was possible to transform negative beliefs regarding ECG learning and make learning meaningful and enjoyable. A more incisive look at medical courses for learning the ECG in a more practical and contextualized way can improve this scenario.

FUNDAMENTO: Estudos têm mostrado uma baixa acurácia de médicos urgentistas em interpretar o eletrocardiograma (ECG) em quadros cardiológicos graves. OBJETIVO: Avaliar a eficácia de um método de aprendizagem do ECG no internato de clínica médica e conhecer a percepção dos internos quanto ao aprendizado antes e após a metodologia. MÉTODOS: Foi utilizado um banco de dados com os resultados do pré e pós-teste de ECG das turmas de internato em clínica médica de 2017 a 2022. Foi enviado um questionário qualitativo com perguntas para autoavaliação da percepção do aprendizado. RESULTADOS: Foram incluídos 227 estudantes, 161 (70,9%) do sexo feminino, com idade de 26,4 ± 4,2 anos. A média do pré-teste foi 3,75 ± 2,0 pontos e do pós-teste 8,48 ± 1,5 pontos, diferença estatisticamente significativa, mesmo após estratificação por sexo, idade e período do curso (p < 0,001 para todas as comparações). Sessenta e nove (30%) dos alunos responderam ao questionário qualitativo. Os três sentimentos predominantes anteriores ao aprendizado foram desespero, medo e insegurança. Após o Clube, os sentimentos predominantes foram segurança, tranquilidade e confiança. CONCLUSÃO: Foi baixo o nível de conhecimento prévio do ECG entre os egressos do internato médico e a metodologia proposta foi eficaz em melhorar o grau de conhecimento do ECG, independente da idade, sexo ou período do curso. E foi possível transformar as crenças negativas quanto à aprendizagem do ECG e torná-la significativa e leve. Um olhar mais incisivo nos cursos de medicina para o aprendizado do ECG de forma mais prática e contextualizada, pode melhorar este cenário.

Eficácia de Metodologia Ativa de Aprendizagem do ECG no Internato em Clínica Médica / Effectiveness of an Active Methodology for Learning ECG during the Internal Medicine Internship

Resumo Fundamento Estudos têm mostrado uma baixa acurácia de médicos urgentistas em interpretar o eletrocardiograma (ECG) em quadros cardiológicos graves. Objetivo Avaliar a eficácia de um método de aprendizagem do ECG no internato de clínica médica e conhecer a percepção dos internos quanto ao aprendizado antes e após a metodologia. Métodos Foi utilizado um banco de dados com os resultados do pré e pós-teste de ECG das turmas de internato em clínica médica de 2017 a 2022. Foi enviado um questionário qualitativo com perguntas para autoavaliação da percepção do aprendizado. Resultados Foram incluídos 227 estudantes, 161 (70,9%) do sexo feminino, com idade de 26,4 ± 4,2 anos. A média do pré-teste foi 3,75 ± 2,0 pontos e do pós-teste 8,48 ± 1,5 pontos, diferença estatisticamente significativa, mesmo após estratificação por sexo, idade e período do curso (p < 0,001 para todas as comparações). Sessenta e nove (30%) dos alunos responderam ao questionário qualitativo. Os três sentimentos predominantes anteriores ao aprendizado foram desespero, medo e insegurança. Após o Clube, os sentimentos predominantes foram segurança, tranquilidade e confiança. Conclusão Foi baixo o nível de conhecimento prévio do ECG entre os egressos do internato médico e a metodologia proposta foi eficaz em melhorar o grau de conhecimento do ECG, independente da idade, sexo ou período do curso. E foi possível transformar as crenças negativas quanto à aprendizagem do ECG e torná-la significativa e leve. Um olhar mais incisivo nos cursos de medicina para o aprendizado do ECG de forma mais prática e contextualizada, pode melhorar este cenário.

Abstract Background Studies have shown a low accuracy of urgent care physicians in interpreting electrocardiogram (ECG) in severe cardiovascular conditions. Objective To evaluate the effectiveness of an ECG learning method in internal medicine internships and to know the perception of interns regarding learning before and after the methodology. Methods This study used a database with the results of an ECG pre- and post-test of the classes in the internal medicine internship from 2017 to 2022. A qualitative questionnaire was sent with questions for self-assessment of perception of learning. Results The study included a total of 227 students, 161 of whom (70.9%) were female. The mean age was 26.4 ± 4.2 years old. The pre-test mean was 3.75 ± 2.0 points, and the post-test mean was 8.48 ± 1.5 points, showing a statistically significant difference, even after stratification by sex, age, and course period (p < 0.001 for all comparisons). Sixty-nine (30%) of the students responded to the qualitative questionnaire. The three predominant feelings prior to learning were despair, fear, and insecurity. After the Club, the predominant feelings were security, tranquility, and confidence. Conclusion The level of prior knowledge regarding ECG was low among students in the medical internship, and the proposed methodology was effective for learning ECG, regardless of age, sex, or course period. It was possible to transform negative beliefs regarding ECG learning and make learning meaningful and enjoyable. A more incisive look at medical courses for learning the ECG in a more practical and contextualized way can improve this scenario.

Orthostatic changes in blood pressure and survival in elderly cardiopaths.

OBJECTIVE: The objective of this study was to analyze the association between orthostatic changes in blood pressure and mortality in elderly cardiopath patients. METHODS: A cohort of 455 elderly cardiopath patients, monitored at a referral outpatient cardiology clinic in Pernambuco, Brazil, from October 2015 to July 2018. The exposure groups were formed according to their orthostatic changes in blood pressure following the requirements of the Brazilian Guidelines for Hypertension. RESULTS: Orthostatic hypotension was present in 46 patients (10.1%), 91 had orthostatic hypertension (20%), and 318 had no orthostatic alterations (69.9%). There were 52 deaths during follow-up. The results demonstrated that there was no statistically significant association between orthostatic hypotension and overall mortality (HR 1.30; 95%CI 0.53-3.14; p=0.567) nor between orthostatic hypertension and overall mortality (HR 0.95; 95%CI 0.65-1.39; p=0.34). Survival in relation to the exposure groups presented no statistically significant difference (p=0.504). CONCLUSION: There was a low frequency of orthostatic hypotension and a mild high frequency of orthostatic hypertension when compared with previous studies, and no association was observed with overall mortality or with the survival time of elderly patients with heart disease.

Orthostatic changes in blood pressure and survival in elderly cardiopaths

SUMMARY OBJECTIVE: The objective of this study was to analyze the association between orthostatic changes in blood pressure and mortality in elderly cardiopath patients. METHODS: A cohort of 455 elderly cardiopath patients, monitored at a referral outpatient cardiology clinic in Pernambuco, Brazil, from October 2015 to July 2018. The exposure groups were formed according to their orthostatic changes in blood pressure following the requirements of the Brazilian Guidelines for Hypertension. RESULTS: Orthostatic hypotension was present in 46 patients (10.1%), 91 had orthostatic hypertension (20%), and 318 had no orthostatic alterations (69.9%). There were 52 deaths during follow-up. The results demonstrated that there was no statistically significant association between orthostatic hypotension and overall mortality (HR 1.30; 95%CI 0.53-3.14; p=0.567) nor between orthostatic hypertension and overall mortality (HR 0.95; 95%CI 0.65-1.39; p=0.34). Survival in relation to the exposure groups presented no statistically significant difference (p=0.504). CONCLUSION: There was a low frequency of orthostatic hypotension and a mild high frequency of orthostatic hypertension when compared with previous studies, and no association was observed with overall mortality or with the survival time of elderly patients with heart disease.

Updated geriatric cardiology guidelines of the brazilian society of cardiology ­ 2019 / Atualização das diretrizes em cardiogeriatria da sociedade brasileira de cardiologia ­ 2019

Development: The Department of Geriatric Cardiology of the Brazilian Society of Cardiology (Departamento de Cardiogeriatria da Sociedade Brasileira da Cardiologia) and the Brazilian Geriatrics and Gerontology Society (Sociedade Brasileira de Geriatria e Gerontologia). (AU)

Nova Metodologia de Ensino do ECG: Desmistificando a Teoria na Prática – Ensino Prático do ECG / New ECG Training Methodology: Demystifying Theory in Practice – Practical Teaching of ECG

RESUMO O eletrocardiograma é um método diagnóstico de simples execução, de grande utilidade nos diagnósticos das doenças cardiovasculares, sobretudo as agudas, como as arritmias e o infarto agudo do miocárdio. O seu entendimento não é claro, provavelmente porque a base da explicação é voltada para conceitos básicos da física, atrelado ao ensinamento mais teórico que prático aos estudantes de medicina. A presente experiência mostra o modelo criado e adotado para explicar um método de ensino desenvolvido com os devidos materiais fornecidos à população alvo do ensino: estudantes de medicina e médicos residentes de cardiologia e outras especialidades clínicas, que fazem prática de estágio obrigatório dos seus respectivos programas de aprendizagem em uma emergência cardiológica de um hospital universitário em Recife/PE.

ABSTRACT The electrocardiogram is a straightforward diagnostic method, which is very useful to diagnose cardiovascular diseases, particularly acute ones, such as arrhythmias and acute myocardial infarction. Its understanding is unclear, probably because the basis of the explanation is focused on basic concepts of physics, bound to a more theoretical than practical teaching approach for the medical students. This experience shows the model created and adopted to explain a teaching method developed with the proper materials provided to the target group: medical students and medical residents in cardiology and other clinical specialties that require the student to undertake practical training in a cardiac emergency unit of a teaching hospital in Recife / PE.