Teaching in the community: Changing and implementing a new curriculum

The Faculdade de Medicina de Botucatu is changing to, and implementing a new curriculum aimed at integrating teaching and learning in the community. Emphasis is on preparing the community settings for teaching, learning and providing health care. A particular task is staff development with emphasis on problem-based learning (PBL) and training medical and nursing students in the leadership to participate in this process. The new curriculum includes the gradual introduction of clinical practice during First Year, integration of the basic sciences with clinical sciences, through integrated modules studied in small groups, and maintenance of the two year clerkship. The undergraduates are introduced gradually to the community: 8% of the total curriculum during First Year, 10% during Second Year, 10% during Third Year, 20% during Fourth Year, 30% during Fifth and Sixth Years. The basic health units at primary care level, and the regional specialty outpatients and hospitals at the second level, are the main teaching sites. An Education Development Committee was established to discuss the strategies for supporting the changes and to structure the planning for promoting the gradual transformation of staff development. After 18 months of implementation of the curriculum, there followed discussions and monitoring of the objectives of changes in medical education at our school. Successful implementation of the new curriculum would fail, if the objectives were not absorbed by every member of the implementation Committee.

Trabalhando com estratégias de ensino-aprendizado por descoberta na área da saúde: a problematização e a aprendizagem baseada em problemas.

Considering the changes in teaching in the health field and the demand for new ways of dealing with knowledge in higher learning, the article discusses two innovative methodological approaches: problem-based learning (PBL) and problematization. Describing the two methods' theoretical roots, the article attempts to identify their main foundations. As distinct proposals, both contribute to a review of the teaching and learning process: problematization, focused on knowledge construction in the context of the formation of a critical awareness; PBL, focused on cognitive aspects in the construction of concepts and appropriation of basic mechanisms in science. Both problematization and PBL lead to breaks with the traditional way of teaching and learning, stimulating participatory management by actors in the experience and reorganization of the relationship between theory and practice. The critique of each proposal's possibilities and limits using the analysis of their theoretical and methodological foundations leads us to conclude that pedagogical experiences based on PBL and/or problematization can represent an innovative trend in the context of health education, fostering breaks and more sweeping changes.

Pediatras e os distúrbios respiratórios do sono na criança

OBJECTIVES. assessment of opinions and practices of pediatricians concerning sleep-disordered breathing (SDB) in children. Methods. randomly 516 pediatricians were selected in the state of São Paulo, Brazil. A survey mailed to them included questions regarding: their professional profile, knowledge about SDB in childhood, opinions and practices for diagnosis and treatment of these diseases. RESULTS. 112 anonymous completed surveys were returned (21.7%). The teaching of SDB during medical school and pediatric residency training was considered unsatisfactory respectively by 65.2% and 34.8% of the pediatricians. Forty-nine respondents (43.8%) rated their knowledge about SDB in children as regular, 39 (34.8%) as good and 17 (15.2%) as unsatisfactory. The most important sleep-related questions were: mouth breathing, breathing pauses, sleep amount, excessive daytime sleepiness and nocturnal wheezing. Clinical aspects regarded as the most significant for suspecting obstructive sleep apnea syndrome (OSAS) were: breathing pauses, adenoid hypertrophy, mouth breathing, craniofacial anomaly and snoring. The most frequent practices for evaluation of OSAS in children were: cavum radiography with referral to an otorhinolarnygologist (25%) and nocturnal pulse oximetry (14.2%). Only 11.6% of pediatricians recommended overnight polysomnography and 4.5%, nap polysomnography. The most effective practices for SDB were considered to be: adenoidectomy and adenotonsillectomy, parents counseling, weight loss and sleep hygiene. CONCLUSIONS. there is a gap between research on SDB in childhood and pediatric practice. © 2006 Associação Médica Brasileira.

Teledermatologia - Passado, presente e futuro

Teledermatology is the area of Telemedicine that studies the application of telecommunication and information technology to dermatology practice without the presence of a specialist. It is a potential manner to deliver health planning, research, education, clinical meetings, second medical opinions and dermatological care to populations who cannot easily travel. The evolution, cost reduction and dissemination of telecommunication and information technology have enabled the implementation of low cost and comprehensive teledermatology systems to support clinical practice all over the world. © 2005 by Anais Brasileiros de Dermatologia.

Multiplicadores reflexivos: Uma experiância do Instituto Familiae junto ao Grupo de Assistância em Transtornos Alimentares (GRATA) do HC-FMRP-USP

This article describes the Reflecting Practitioners Program developed by Instituto Familiae at GRATA (Grupo de Assistência em Transtornos Alimentares) placed at the Clinical Hospital of the Faculty of Medicine of Ribeirão Preto - University of Sao Paulo (HC-FMRP-USP). The aim of this program was to take care of the caretakers - the GRATA interdisciplinary team - through the development of their reflecting ability, the appropriation of their own resources and the support on constructing alternative histories and on solving situations defined by them as problematic. Thirteen monthly meeting had been carried out among Familiae members and GRATA interdisciplinary team. The changes described by the participants had occurred through sessions developed with interdisciplinary pairs and through the development of their capacity to construct more comfortable positions - as members of the team and in the relationship among professional/client/ family. This triad became to be seen by the team through its resources and abilities, instead of its flaws and lacks. As a result, horizontal relationships could be privileged instead of hierarchical ones.

Botucatu, Brazil: A Regional Community Palliative Care Model

The Pain Management and Palliative Care Service in the Department of Anesthesia at Botucatu Medical School, UNESP is a pioneer in Brazil. Based on an interdisciplinary team that provides specialized inpatient, ambulatory outpatient, and home care to patients in Botucatu and the surrounding region, the service is also able to provide extensive educational opportunities in pain management and palliative care for medical students, anesthesia residents, practicing anesthetists, and nurses. © 2007 U.S. Cancer Pain Relief Committee.

Students' preferred teaching techniques for biochemistry in biomedicine and medicine courses

The aim of this study was to investigate the students' preferred teaching techniques, such as traditional blackboard, power-point, or slide-projection, for biochemistry discipline in biomedicine and medicine courses from São Paulo State University, UNESP, Botucatu, São Paulo, Brazil. Preferences for specific topic and teaching techniques were determined from questionnaires on a Liquert scale from 1 to 5 (strongly disagree; disagree; neither agree, nor disagree; agree; strongly agree) distributed at the end of biochemistry discipline to 180 biomedical students (30 students/year) and 540 medical students (90 students/year), during the years 2000-2005. Despite of the different number of hours applied to the course topics for the two groups of students, the majority of undergraduates from biomedicine and medicine preferred metabolic topics. Although the perception of a medical student is expected to be different than that of a biomedical student, as the aims of the two programs are different, 92.4% of students from each course agreed or strongly agreed with the biochemistry topics, and 92.1% thought highly on this subject. The majority of students, a number of 139 undergraduates from biomedicine and 419 from medicine course, preferred traditional blackboard teaching than slide-projection, or power-point class. In conclusion, it is imperative that the health courses reflect on sophisticated technology and data presentation with high density of information in biochemistry discipline. The traditional classes with blackboard presentation were most favored by students from biomedicine and medicine courses. The use of students' preferred teaching techniques might turn biochemistry more easily understood for biomedical and medical students. © 2007 by The International Union of Biochemistry and Molecular Biology.

Produção científica na faculdade de filosofia, ciencias e letras de ribeirao preto-usp: Apliçãcao do índice de hirsch

In this work, an analysis of scientific bibliographic productivity was made using the Faculdade de Filosofia, Ciencias e Letras de Ribeirao Preto, Universidade de Sao Paulo (FFCLRP-USP) as example. It is a special Institution in the Brazilian University system which encompasses four important areas of knowledge (fields of concentration) in natural, biological, humanities, and social areas. It is composed by four departments which offer altogether eight undergraduate courses: 1) Psychology, 2) Pedagogy, 3) Chemistry, 4) Biology, 5) Medical Physics, 6) Biomedical Informatics, 7) Sciences of Information and Documentation and 8) Mathematics Applied to Business and six graduate programs leading to M.S. and Ph.D. degrees. Moreover, when analyzing the different courses of FFCLRP, they represent typical academic organization in Brazil and Latin America and could be taken as a model for analyzing other Brazilian research institutions. This analysis was made using: 1) the total number of papers (indexed in Curriculum Lattes database), 2) the number of papers indexed by Thomson ISI Web of Science database, and 3) the Hirsch (h-index). Bibliometric evaluations of undergraduate courses showed a better performance of the courses of Chemistry (P < 0.05), Biology (P < 0.05) and Medical Physics (P < 0.05) when compared to the Pedagogy, Sciences of Information and Documentation (P < 0.05) and Psychology (P < 0.05). We also analyzed the scientific output of the six graduate programs of FFCLRP-USP: 1) Chemistry, 2) Physics Applied to Medicine and Biology, 3) Entomology, 4) Compared Biology, 5) Psychology, 6) Psychobiology. The graduate programs in Psychobiology, Chemistry, Physics Applied to Medicine and Biology, Compared Biology, and Entomology presented very similar results, concerning the assessment of the three indexes. The graduate program in Psychology presented a lower h-index (P < 0.05) and had fewer papers indexed by the ISI (P < 0.05) when compared to the other graduate programs. The worse performance of the psychology program, pedagogy, sciences of information and documentation, psychology courses may be associated to the limited coverage of ISI database and some particular characteristics of this field of concentration.

Evaluación del impacto de una intervención educativa en atención farmacéutica y farmacia clínica

Introduction: The World Health Organization considers pharmaceutical care (PC) of fundamental importance for the patient and the community. Its exercise requires knowledge and skills, which can be acquired in academic and/or continuing educations, credited for effectiveness and impact evaluation. However, few manuscripts in the literature have showed the contribution of the educational interventions on the knowledge, skill and attitude of students and professionals who participate in scientifi c events related to PC. Objective: To evaluate the impact of an educational intervention (EI), and its degree of satisfaction, to pharmacists and pharmacy students. Method: A quasi-experimental study was performed, through an extension course with 40 hours of lectures approaching issues related to PC and clinical pharmacy (CP). Participants answered a survey which was handed out before and after the EI. The statistic tests of Sinais and Mann-Whitney were applied to evaluate the EI signifi cance. Results: Participants (n= 49) were mostly (n= 34) students and performing activities related to PC and CP (n= 20). Statistics differences, before and after the EI, were found in the scores of knowledge, skill and attitude (p <0.001). The evaluated item which showed the most improvement was the last one. Most (n= 30) had exceeded or met their expectations (n= 19). Conclusions: The analysis of the data led us to conclude that an EI of 40 h/week about knowledge, skill and attitude in PC using traditional methods, improves knowledge and problem-solving skills of participants. ©2012 Ediciones Mayo, S.A. All rights reserved.

An Educational international partnership responding to local needs: Process evaluation of the Brazil FAIMER Regional Institute

The Brazilian public health system requires competent professionals sensitive to the needs of the population. The Foundation for Advancement of International Medical Education and Research (FAIMER) provides a two-year faculty development programme for health professions educators, aiming to build leadership in education to improve health. A partnership with governmental initiatives and FAIMER was established for meeting these needs. This paper describes the initial process evaluation results of the Brazilian FAIMER Institute Fellowship (FAIMER BR). Methods: Data were analysed for the classes 2007-2010 regarding: application processes; innovation project themes; retrospective post-pre self-ratings of knowledge acquisition; and professional development portfolios. Results: Seventeen of 26 Brazilian states were represented among 98 Fellows, predominantly from public medical schools (75.5%) and schools awarded Ministry of Health grants to align education with public health services (89.8%). One-third (n = 32) of Fellows' innovation projects were related to these grants. Significant increases occurred in all topic subscales on self-report of knowledge acquisition (eff ect sizes, 1.21-2.77). In the follow up questionnaire, 63% of Fellows reported that their projects were incorporated into the curriculum or institutional policies. The majority reported that the programme deepened their knowledge (98%), provided new ideas about medical education (90%) and provided skills for conflict management (63%). One-half of the Fellows reported sustained benefits from the programme listserv and other communications, including breadth of expertise, establishment of research collaboration and receiving emotional support. Conclusion: Contributors to initial programme success included alignment of curriculum with governmental initiatives, curriculum design merging educational technology, leadership and management skills and central role of an innovation educational project responding to local needs.

Mnitoramento do desenvolvimento infantil realizado no Brasil

Objective: To review scientific literature in order to check how infant development surveillance is being carried out in Brazil. Data sources: Search on databases (PubMed, Medline, SciELO and CAPES Database Thesis) for studies on medical practices related to surveillance and monitoring of child development in Brazil from 2000 to 2011. The terms used for research were: child development surveillance, early intervention, developmental screening, and developmental screening tests. There were ten texts on the subject under study. Original articles, reviews, and thesis were analyzed, as well as the reference lists of publications on the topic. Data synthesis: Studies on monitoring of child development in Brazil showed major failures from pediatrician formation to clinical practice. Conclusions: It is urgent to offer continued medical education to pediatricians in order to update their knowledge about child development monitoring, especially due to the increasing numbers of preterm infants.