A pratica anatomica e a formacao medica / Anatomy practice and medical education

Medical education is committed to a distant and impersonal model of medical care that does not take into consideration the complexity of the encounter between physician and patient. Some authors believe that the "dehumanizing posture" of physicians is encouraged by the pedagogical practice of dissecting cadavers. In this sense the relationship between student and cadaver would be a model preceding and shaping the relationship between physician and patient. This article describes a study on the impact of anatomy practice on first-semester medical students enrolled in the anatomy course at the Federal University of Rio de Janeiro, Brazil. Groups of 16 students attended four 1-hour meetings over the semester. Thirty-two groups were assessed over four semesters, with a total of 384 students. The activity was coordinated by medical psychology and anatomy professors, who took notes during the sessions. At the end of each semester the students filled out a questionnaire to help evaluate this teaching activity. In the groups, the most frequent themes were the first encounter with the cadaver, respect for the cadaver, and the presence or absence of humanity in the cadaver. In general the questionnaire showed that the students found the experience to be positive. We believe that the pedagogical activity described here provides an opportunity to reverse the gloomy state of affairs of dehumanized medical care. Group discussions help decrease students' anxiety with the cadaver. This in turn results in a more humane model for the physician-patient relationship and promotes change in the ideology of coldness and distance on the part of the physician. The paradox of medical education - being technical and also having to take into account the complexity of human relationships - can be resolved through activities such as this one

Psicossomática na infância: enfoque psicodinâmico / Psychosomatics in childhood: a psychoanalytical approach

As autoras apresentam inicialmente alguns conceitos e as principais abordagens psicodinâmicas da psicossomática. Dentre os diferentes pontos de vista, identificam-se com as idéias da Escola Psicossomática de Paris, dos trabalhos atuais da psicanalista Joyce Mc Dougall e com a concepçäo da "Medicina da Pessoa" desenvolvida por Danilo Perestello, Abram Eksterman e outros. A partir dessas idéias, passam a entender as desordens psicossomáticas como criaçöes do indivíduo para reduzir a intensidade da dor psíquica, no momento em que há uma incapacidade para elaborar e integrar psiquicamente os conflitos ou traumatismos. Desta forma, o corpo age no lugar da mente. Quanto à psicossomática na infância, essa incapacidade de integraçäo e elaboraçäo psíquicas deve-se à imaturidade (especialmente nos bebês) ou a uma crise natural do desenvolvimento. Na medida em que essa capacidade de eleboraçäo se desenvolve, progressivamente as crianças deixam de utilizar o corpo como meio previlegiado de expressäo da tensäo e da angústia. A cristalizaçäo desta forma de expressäo é que caracterizaria o distúrbio psicossomático. Após desenvolvimento dessas colocaçöes teóricas, as autoras tecem algumas consideraçöes sobre a psicoterapia de crianças que apresentam desordens psicossomáticas. Apresentam um caso clínico de uma criança gêmea, näo univitelina, do sexo feminino, com alopecia. A apresentaçäo desse caso pretende ilustrar as consideraçöes teóricas apresentadas assim como contribuir para conhecimento empírico no