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1.
Cien Saude Colet ; 26(6): 2013-2022, 2021 Jun.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34231715

RESUMO

This article aims to present the experience of 15 years of the Family Health Residency Program of the Sérgio Arouca National School of Public Health (ENSP/Fiocruz) in the city of Rio de Janeiro-RJ, and seeks to identify the challenges and potentialities of the training process of preceptors facing the development of resident training programs. Presents one of its effects that resulted in the contribution with the development of a multiprofessional residency program in partnership with the Municipal Health Department of Campo Grande-MS. Seeks to identify the challenges and potentialities of preceptors training process in the face of the development of training programs for residents. From a theoretical point of view, it presents as cross-cutting questions, multiprofessionality, interprofessionality and the relationship between field and nucleus in the formation of residences in the health professional area. Concludes by pointing out the challenges contained in the practice of the preceptorship of the ENSP program and how they can be implemented in the project of Campo Grande, as well as a new trend for cooperative education institutions for the current model of expansion of residences with the unit offeror to the municipal health departments.


Assuntos
Internato e Residência , Brasil , Saúde da Família , Humanos , Preceptoria , Atenção Primária à Saúde
2.
Cien Saude Colet ; 26(6): 2119-2130, 2021 Jun.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34231724

RESUMO

The training, recruitment and retention of primary care professionals is a constant challenge in Brazil. The recent expansion of family and community medicine residency programs in the country coexists with gaps in the literature on the effects of this process. This article explores municipal health managers' understanding of these programs and the role they play in professional training and improving the quality of health care. We conducted a quantitative and qualitative analysis of the responses to questionnaires answered by 48 health managers working in municipal health services affiliated to residency programs. A descriptive statistical analysis of the quantitative data was performed and the qualitative data were analyzed using thematic analysis. The findings show that efforts were made to incorporate family and community doctors into the health care network and that managers recognized the potential residency program have to improve the quality of care and enhance professional training. Weaknesses were found in actions to improve infrastructure and facilities and the organization of the services affiliated to the programs. This study highlights the potential of residency programs for addressing longstanding problems in primary health care in Brazil when combined with actions to strengthen services, human resources and the programs.


Assuntos
Medicina Comunitária , Internato e Residência , Brasil , Medicina Comunitária/educação , Mão de Obra em Saúde , Humanos , Atenção Primária à Saúde
3.
BMC Med Educ ; 21(1): 366, 2021 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217282

RESUMO

BACKGROUND: Despite multi-professional collaboration via consultation being increasingly important given the variety of disease diagnoses and treatment, the key elements as consultants remain unclear. The study aimed to identify the skills and attitudes that are important for consultants from the residents' perspective so that they can be targeted as priority goals in subsequent educational interventions. METHODS: We conducted our research in two phases: a preliminary survey (May 1 to 14, 2020) and a main survey (June 1 to 14, 2020). As a preliminary survey, first-year postgraduate residents at St. Luke's International Hospital in Tokyo, Japan, were first asked an open-ended question about the types of skills and attitudes that are important for consultants. After eliminating duplicate answers, there were 19 skills and attitudes in total. In the main survey with residents who completed their residency training at our institute, from 2014 to 2018 and current residents (2019-2020), we first asked them about their demographic characteristics (gender, years of postgraduate education, and type of specialty). Then, they answered how important each skill and attitude are for consultants. All 19 items were scored on a seven-point Likert scale that ranged from 0 (completely disagree) to 6 (totally agree). Cronbach's alpha confirmed the internal consistency of the questionnaire items. Principal component analysis and exploratory factor analysis were performed. RESULTS: The survey included 107 individuals (61.1 %, 175 potential participants). The median postgraduate years of education was four (interquartile range: 2-5), and 64.5 % were men (n = 69). Seven key elements for consultants were identified and termed Willing CONSULT. These included (1) willingness (willingness to accept consultation requests), (2) contact (easy access to consultants), (3) needs (consideration of consulters' needs), (4) suggestions and support (providing clear recommendations and suggestions, following up on the patients, and supporting the consulters continuously), (5) urgency (considering the situation's urgency and responding appropriately), (6) learning opportunities (providing teaching points), and (7) text (writing medical records). CONCLUSIONS: We propose Willing CONSULT, which are important skills and attitudes for consultants.


Assuntos
Consultores , Internato e Residência , Atitude do Pessoal de Saúde , Estudos Transversais , Humanos , Japão , Masculino , Encaminhamento e Consulta , Inquéritos e Questionários , Tóquio
4.
Rev Lat Am Enfermagem ; 29: e3406, 2021.
Artigo em Inglês, Espanhol, Português | MEDLINE | ID: mdl-34231784

RESUMO

OBJECTIVE: to evaluate the acquisition of cognitive knowledge in cardiorespiratory resuscitation through training mediated by health simulation and to verify satisfaction with the teaching methodology design. METHOD: a study of quasi-experimental intervention, of the before and after type, with only one group. Population composed of medical students in the internship phase, nurses and resident physicians, nursing technicians and nurses of the institution's effective staff. Convenience sampling consisting of 91 participants. Data collected through the Sociodemographic and Educational Questionnaire, Knowledge Test and Simulation Design Scale. Data was organized in tables and analyzed based on absolute frequencies, measures of central tendency and dispersion, Cronbach's alpha reliability test, Wilcoxon's test. RESULTS: the increase in cognitive learning was 81.9%, being that for nursing technicians it was 117.8 %. Wilcoxon's test showed a significant increase (p<0.0001) in knowledge. The Simulation Design Scale, displayed 4.55 of global mean. Cronbach's alpha pointed good internal consistency (0.898). CONCLUSION: the health simulation was effective as a learning-teaching method in cardiorespiratory resuscitation, being effective in increasing knowledge in cardiorespiratory arrest, with a great level of design satisfaction.


Assuntos
Parada Cardíaca , Internato e Residência , Treinamento por Simulação , Competência Clínica , Simulação por Computador , Humanos , Reprodutibilidade dos Testes , Ressuscitação
5.
Front Public Health ; 9: 697515, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34235134

RESUMO

This report arises from the intersection of service learning and population health at an academic medical center. At the University of California, San Francisco (UCSF), the Office of Population Health and Accountable Care (OPHAC) employs health care navigators to help patients access and benefit from high-value care. In early 2020, facing COVID-19, UCSF leaders asked OPHAC to help patients and employees navigate testing, treatment, tracing, and returning to work protocols. OPHAC established a COVID hotline to route callers to the appropriate resources, but needed to increase the capacity of the navigator workforce. To address this need, OPHAC turned to UCSF's service learning program for undergraduates, the Patient Support Corps (PSC). In this program, UC Berkeley undergraduates earn academic credit in exchange for serving as unpaid patient navigators. In July 2020, OPHAC provided administrative funding for the PSC to recruit and deploy students as COVID hotline navigators. In September 2020, the PSC deployed 20 students collectively representing 2.0 full-time equivalent navigators. After training and observation, and with supervision and escalation pathways, students were able to fill half-day shifts and perform near the level of staff navigators. Key facilitators relevant to success reflected both PSC and OPHAC strengths. The PSC onboards student interns as institutional affiliates, giving them access to key information technology systems, and trains them in privacy and other regulatory requirements so they can work directly with patients. OPHAC strengths included a learning health systems culture that fosters peer mentoring and collaboration. A key challenge was that, even after training, students required around 10 h of supervised practice before being able to take calls independently. As a result, students rolled on to the hotline in waves rather than all at once. Post-COVID, OPHAC is planning to use student navigators for outreach. Meanwhile, the PSC is collaborating with pipeline programs in hopes of offering this internship experience to more students from backgrounds that are under-represented in healthcare. Other campuses in the University of California system are interested in replicating this program. Adopters see the opportunity to increase capacity and diversity while developing the next generation of health and allied health professionals.


Assuntos
COVID-19 , Internato e Residência , Saúde da População , Humanos , SARS-CoV-2 , São Francisco , Recursos Humanos
6.
Surg Clin North Am ; 101(4): 555-563, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242599

RESUMO

Bedside teaching plays a vital role the training future physicians, allowing for instruction in history taking, physical examination skills, differential diagnosis development, professionalism, teamwork integration, effective communication, and discussions of medical ethics. Due to changes in the health care system, accreditation bodies, and shortened admittance of patients, rates of bedside teaching have declined. Attending surgeons feel increased external pressures to meet performance metrics while resident physicians adhere to duty hour restrictions. This article highlights popular methods, including bedside rounds, near-peer teaching, and resident versus attending preceptors, and discusses how teaching on rounds has an impact on patients.


Assuntos
Internato e Residência/métodos , Modelos Educacionais , Visitas com Preceptor/métodos , Ensino , Humanos , Personalidade , Estudantes de Medicina/psicologia , Estados Unidos
7.
Surg Clin North Am ; 101(4): 587-595, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242602

RESUMO

The operating room continues to be the location where surgical residents develop both technical and nontechnical skills, ultimately culminating with them being capable of safe and independent practice. The process of intraoperative instruction is, by necessity, moving from an apprentice-based model where skills are acquired somewhat randomly through repeated exposure and evaluation is done in a global gestalt fashion. Modern surgical education demands that intraoperative instruction be intentional and that evaluation provides formative and summative feedback. This chapter describes some best practice approaches to intraoperative teaching and evaluation.


Assuntos
Competência Clínica , Feedback Formativo , Cirurgia Geral/educação , Internato e Residência/métodos , Procedimentos Cirúrgicos Operatórios/educação , Ensino , Humanos , Estados Unidos
8.
Surg Clin North Am ; 101(4): 597-609, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242603

RESUMO

Within general surgery education circles, the state of autonomy for residents in surgery training programs has been of growing concern. Although there is no direct evidence showing less autonomy in modern surgical training, multiple surrogates have been cited as reasons for concern. Many reasons have been given for lost autonomy including the 80-hour work week, financial constraints, concerns over quality of patient care, patient expectations, new and innovative technologies, legal limitations, and public opinion. This article discusses the current state of general surgery resident autonomy, why autonomy is important, barriers to autonomy, and ways to support autonomy.


Assuntos
Cirurgia Geral/educação , Internato e Residência/métodos , Autonomia Profissional , Competência Clínica , Humanos , Internato e Residência/organização & administração , Segurança do Paciente , Autoimagem , Responsabilidade Social , Estados Unidos
9.
Surg Clin North Am ; 101(4): 611-624, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242604

RESUMO

There are myriad types of problem learners in surgical residency and most have difficulty in more than 1 competency. Programs that use a standard curriculum of study and assessment are most successful in identifying struggling learners early. Many problem learners lack appropriate systems for study; a multidisciplinary educational team that is separate from the team that evaluates the success of remediation is critical. Struggling residents who require formal remediation benefit from performance improvement plans that clearly outline the issues of concern, describe the steps required for remediation, define success of remediation, and outline consequences for failure to remediate appropriately.


Assuntos
Competência Clínica/normas , Currículo/normas , Cirurgia Geral/educação , Internato e Residência/métodos , Aprendizagem , Ensino de Recuperação/métodos , Cirurgia Geral/normas , Humanos , Internato e Residência/normas , Ensino de Recuperação/normas , Estados Unidos
10.
Surg Clin North Am ; 101(4): 653-665, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242607

RESUMO

The predicted shortage of surgeons in the future workforce is already occurring in rural areas and is expected to worsen. US allopathic medical school graduates have been losing interest in surgery for the past 40 years. The residency match remains unaffected because of foreign and osteopathic applicants. Negative myths regarding surgeon training, lifestyle, and personality persist among medical students, proving to be a powerful deterrent to students who might consider a surgical career. Proven strategies for making surgery more attractive to students are not always used and can be as simple as getting early exposure to students before clinical rotations.


Assuntos
Escolha da Profissão , Cirurgia Geral/educação , Internato e Residência , Estudantes de Medicina/psicologia , Canadá , Estágio Clínico/métodos , Estágio Clínico/tendências , Educação de Graduação em Medicina/métodos , Educação de Graduação em Medicina/tendências , Cirurgia Geral/tendências , Humanos , Internato e Residência/métodos , Internato e Residência/organização & administração , Internato e Residência/tendências , Estilo de Vida , Área Carente de Assistência Médica , Mentores , Personalidade , Sexismo , Estudantes de Medicina/estatística & dados numéricos , Cirurgiões/educação , Cirurgiões/psicologia , Cirurgiões/provisão & distribuição , Estados Unidos , Equilíbrio Trabalho-Vida
11.
Surg Clin North Am ; 101(4): 667-677, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242608

RESUMO

Residency programs should use a systematic method of recruitment that begins with defining unique desired candidate attributes. Commonly sought-after characteristics may be delineated via the residency application. Scores from standardized examinations taken in medical school predict academic success, and may correlate to overall performance. Strong letters of recommendation and a personal history of prior success outside the medical field both forecast success in residency. Interviews are crucial to determining fit within a program, and remain a valid measure of an applicant's ability to prosper in a particular program, even with many interviews being completed in the virtual realm.


Assuntos
Cirurgia Geral/educação , Internato e Residência/organização & administração , Critérios de Admissão Escolar , Prática Clínica Baseada em Evidências , Humanos , Entrevistas como Assunto , Personalidade , Habilidades Sociais , Estudantes de Medicina/psicologia , Estados Unidos
12.
BMC Med Educ ; 21(1): 384, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34266446

RESUMO

BACKGROUND: An increasing number of medical trainees across specialties desire and expect Global Health (GH) experiences during training. It is useful for residency programs to know the impact that offering GH opportunities has on resident recruitment. The study objectives were to explore the importance of GH opportunities in residency selection among fourth-year medical students, examine the relationship between interest in GH and career plans, and describe students' perspectives on prior GH experiences. METHODS: The authors administered an electronic survey to all fourth-year medical students attending 12 different US institutions in February 2020. Data from the ten schools who were able to comply with the survey distribution methodology and with response rates above 25% were analyzed using descriptive statistics and Pearson's correlation. RESULTS: A total of 707 fourth-year medical students from the included schools completed the survey out of 1554 possible students (46% response rate). One third of respondents ranked the presence of GH experiences in residency as moderately or very important and 26% felt that the presence of a formal GH curriculum was at least moderately important, with variation noted among specialties. After training, 65% of students envision practicing internationally in some capacity. A desire to care for underserved patients in their careers was significantly correlated with an interest in GH experiences during residency. CONCLUSIONS: The opportunity to be involved in GH experiences during training can be an important factor for many medical students when considering residency choice, and the availability of these opportunities may be a valuable recruitment tool. Students valuing GH opportunities during residency are more interested in working with underserved populations in their future careers.


Assuntos
Internato e Residência , Estudantes de Medicina , Escolha da Profissão , Currículo , Saúde Global , Humanos , Inquéritos e Questionários
13.
Med Educ Online ; 26(1): 1950107, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34252014

RESUMO

Background: Physician well-being remains a critical topic with limited information concerning the impact of the progression of training and duty hours. To date, our knowledge and interventions have not adequately addressed these issues. We assessed differences in well-being across the USA: (1) between all post-graduate trainees and their academic core faculty; (2) between all obstetrics and gynecology trainees and their academic core faculty and (3) during the progression of training within obstetrics and gynecology (OB/GYN).Methods: A cross-sectional study analyzing responses to well-being questions included in the 2017-2018 Accreditation Council for Graduate Medical Education (ACGME) surveys given to all U.S. trainees and core faculty. Results: More than 85% of all U.S. physician-trainees and faculty surveyed responded. Respondents included 128,443 trainees from all specialties combined, 5,206 OB/GYN residents and 799 OB/GYN subspecialty fellows. A total of 94,557 faculty from all specialties combined, 4,082 general OB/GYN faculty and 1,432 sub-specialty OB/GYN faculty responded. Trainees were more negative than faculty for the majority of questions for both all trainees combined and within OB/GYN when progressing from resident to subspecialty fellow to subspecialty faculty (p ≤ 0.05). Questions focusing on work satisfaction (e.g., pride in work) were more negative for residents compared to fellows and for fellows compared to faculty. In contrast to work satisfaction, responses to the question 'Felt the amount of work you were expected to complete in a day was reasonable' showed either no difference or higher scores for trainees compared to their faculty. Conclusions: Although an issue for all physicians, well-being impacts trainees more, and differently, than faculty and well-being improves during training from resident to fellow to faculty. Survey responses suggest that interventions should focus on workplace satisfaction over workplace environment areas and further limitations in duty hours are unlikely to improve physician well-being.


Assuntos
Ginecologia/educação , Internato e Residência/organização & administração , Obstetrícia/educação , Apoio ao Desenvolvimento de Recursos Humanos/organização & administração , Acreditação , Estudos Transversais , Educação de Pós-Graduação em Medicina/organização & administração , Feminino , Humanos , Satisfação no Emprego , Inquéritos e Questionários , Estados Unidos , Local de Trabalho
15.
Medicine (Baltimore) ; 100(19): e25723, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106596

RESUMO

ABSTRACT: Tracheal intubation is an essential technique for many healthcare professionals and one of the mega code simulations in advanced cardiac life support. In recent years, video laryngoscopy (VL) has provided a rescue for difficult airways during intubation and has proven to have higher success rates. Moreover, VL facilitates a more rapid learning curve for inexperienced doctors.In this article, we report 16 cases intubated with VL by a novice doctor of postgraduate year 1, who shared the learning experience and the difficulties encountered in this case series. We also conducted a statistical analysis to evaluate the learning outcomes of the trainee after 1 month.Our results showed that the overall first-shot success rate was 81.3% for the 16 objectives. Over time, improvements in intubation performance measures, including shortened duration and lower Intubation Difficulty Scale score, have been observed. In this learning project, we found that limitation of mouth opening (<2.5 fingers wide) is an important risk factor for predicting the initial difficulty of tracheal intubation on the novice trainee.For inexperienced doctors, VL produces high first-shot success rates for tracheal intubation and may be useful for training their performance in a short period of time. In addition, mouth opening <3 fingers wide may result in difficult intubation by novice doctors.


Assuntos
Internato e Residência , Intubação Intratraqueal , Laringoscopia/educação , Aprendizagem Baseada em Problemas , Adulto , Idoso , Competência Clínica , Feminino , Humanos , Laringoscópios , Masculino , Pessoa de Meia-Idade , Gravação em Vídeo , Adulto Jovem
18.
BMC Med Educ ; 21(1): 342, 2021 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-34120607

RESUMO

BACKGROUND: Assessment is a necessary part of training postgraduate medical residents. The implementation of methods located at the "shows how" level of Miller's pyramid is believed to be more effective than previous conventional tools. In this study, we quantitatively compared electronic and conventional methods in assessing ophthalmology residents. METHODS: In this retrospective study, eight different conventional methods of assessment including residents' attendance, logbook, scholarship and research skills, journal club, outpatient department participation, Multiple Choice Question (MCQ), Objective Structured Clinical Examination (OSCE), and professionalism/360-degree (as one complex) were used to assess 24 ophthalmology residents of all grades. Electronic media consisting of an online Patient Management Problem (e-PMP), and modified electronic OSCE (me-OSCE) tests performed 3 weeks later were also evaluated for each of the 24 residents. Quantitative analysis was then performed comparing the conventional and electronic assessment tools, statistically assessing the correlation between the two approaches. RESULTS: Twenty-four ophthalmology residents of different grades were included in this study. In the electronic assessment, average e-PMP scores (48.01 ± 12.40) were much lower than me-OSCE (65.34 ± 17.11). The total average electronic score was 56.67 ± 11.28, while the total average conventional score was 80.74 ± 5.99. Female and male residents' average scores in the electronic and conventional method were (59.15 ± 12.32 versus 83.01 ± 4.95) and (55.19 ± 10.77 versus 79.38 ± 6.29), respectively. The correlation between modified electronic OSCE and all conventional methods was not statistically significant (P-value >0.05). Correlation between e-PMP and six conventional methods, consisting of professionalism/360-degree assessment tool, logbook, research skills, Multiple Choice Questions, Outpatient department participation, and Journal club active participation was statistically significant (P-value < 0.05). The overall correlation between conventional and electronic methods was significant (P-value = 0.017). CONCLUSION: In this study, we conclude that electronic PMP can be used alongside all conventional tools, and overall, e-assessment methods could replace currently used conventional methods. Combined electronic PMP and me-OSCE can be used as a replacement for currently used gold-standard assessment methods, including 360-degree assessment.


Assuntos
Internato e Residência , Oftalmologia , Competência Clínica , Avaliação Educacional , Eletrônica , Bolsas de Estudo , Feminino , Humanos , Masculino , Estudos Retrospectivos
20.
Medicine (Baltimore) ; 100(24): e26328, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128876

RESUMO

ABSTRACT: In-training examinations (ITEs), arranged during residency training, evaluate the residents' performances periodically. There is limited literature focusing on the effectiveness of resident ITEs in the format of simulation-based examinations, as compared to traditional oral or written tests. Our primary objective is to investigate the effectiveness and discriminative ability of high-fidelity simulation compared with other measurement formats in emergency medicine (EM) residency training program.This is a retrospective cohort study. During the 5-year study period, 8 ITEs were administered to 68 EM residents, and 253 ITE measurements were collected. Different ITE scores were calculated and presented as mean and standard deviation. The ITEs were categorized into written, oral, or high-fidelity simulation test forms. Discrimination of ITE scores between different training years of residency was examined using a one-way analysis of variance test.The high-fidelity simulation scores correlated to the progression of EM training, and residents in their fourth training year (R4) had the highest scores consistently, followed by R3, R2, and then R1. The oral test scores had similar results but not as consistent as the high-fidelity simulation tests. The written test scores distribution failed to discriminate the residents' seniority. The high-fidelity simulation test had the best discriminative ability and better correlation between different EM residency training years comparing to other forms.High-fidelity simulation tests had the good discriminative ability and were well correlated to the EM training year. We suggest high-fidelity simulation should be a part of ITE in training programs associated with critical or emergency patient cares.


Assuntos
Competência Clínica/estatística & dados numéricos , Avaliação Educacional/estatística & dados numéricos , Medicina de Emergência/educação , Treinamento com Simulação de Alta Fidelidade/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Adulto , Análise Discriminante , Feminino , Humanos , Masculino , Estudos Retrospectivos
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