ABSTRACT
A formação do aluno no curso de Medicina precisa se aproximar dos campos de prática vivenciados pelo médico atualmente. Este estudo objetivou caracterizar as experiências educacionais dos internos dentro de atividades em Atenção Primária, Secundária e Terciária à saúde, com vistas a otimizá-las. Inicialmente, foi descrita a criação de um estágio em atendimento secundário, antes inexistente na instituição, e avaliada a percepção dos alunos envolvidos. Posteriormente, foram caracterizados os atendimentos prestados pelos alunos em três cenários (primário, secundário e terciário) durante 30 dias. A criação do estágio na Unidade de Pronto Atendimento foi bem recebida pelos alunos, que sentiram necessidade de investir mais carga horária neste cenário. Foram avaliadas 201 consultas realizadas por internos, sendo a maioria na Atenção Primária. Houve grande diversificação dos motivos das consultas conforme o cenário de prática, e a preceptoria do interno ocorreu em todos os atendimentos. Concluímos que os diferentes cenários realmente oferecem oportunidades de aprendizado complementares que devem ser valorizadas institucionalmente.
There is a need for undergraduate medical training to bring students closer to the real clinical settings they will face early in their professional lives. This study aims to review and improve student interns’ experience in different clinical scenarios: primary health care; secondary outpatient clinic (a new rotation) and the emergency room of a tertiary hospital. This new rotation is an opportunity for students to see acutely ill patients before they are referred to the hospital. Following a 30-day period, the students’ perceptions were surveyed and, based on student records, a list of all the patients (and diagnoses) which they saw was composed. The final result was a list of clinical conditions from these three different scenarios. Students acknowledge that the new rotation added to their clinical learning, especially because it was based on non-referred patients. They also felt that 4 hours/week is not enough and asked for more time in this rotation. During their 30 days, 7 students performed 201 consultations, most of them in the primary health care setting. There was a wide variety of clinical cases, which was possible because the students rotate among those three settings. Some experiences were only possible due to the new outpatient clinic rotation, indicating how this approach offer complementary learning opportunities which should be institutionally valued.
ABSTRACT
Posiblemente la enseñanza al lado de la cama del paciente sea tan antigua como la medicina misma. Grandes maestros de la medicina como F. Silvio o Sir W. Osler abogaron por un uso intenso de la misma destacando sus virtudes. En la era moderna, se le reconoce a la enseñanza en las recorridas múltiples aspectos que no pueden ser enseñados en el aula, como el aprendizaje de las habilidades de la comunicación, de la exploración física, la enseñanza de los aspectos humanísticos, etc., pero también múltiples barreras que dificultan una exitosa implementación. En este artículo, se detallan las barreras que con mayor frecuencia impiden que el docente promueva un aprendizaje significativo y profundo, y una serie de propuestas prácticas que favorecen su adecuada implementación. (AU)
Possibly, bedside teaching in medicine is as old as medicine itself. Through history, well-known professors like F. Silvio and Sir W. Osler considered the strength of this teaching strategy and promoted it extensively. In the modern age, it is recognized that bedside teaching covers a variety of aspects that can not be taught in the classroom, such as learning of communication skills, physical examination, etc.; but at the same time, multiple barriers to its successful implementation have been identified. In this article, we describe the most common barriers that teachers should overcome to promote a meaningful and deep learning; as well as a series of practical proposals that are indicated to favour a proper implementation.(AU)
Subject(s)
Humans , Teaching , Clinical Medicine/methods , Clinical Competence , Education, MedicalABSTRACT
Clerkship has a vital role in undergraduated medical education. Despite potential benefits, clinical teaching has been much criticised for its variability due to its complex clinical environment. This article describes several problems and educational theories related to learning in clinical settings. Effective strategies were developed after these problems arised and learning theories were created, in terms of students, clinical teachers and teaching institution: first, the student should prepare medical knowledge and survival skills for self-directed learning in the clinical setting; second, the clinical teachers provide opportunities for active participation-effective feedback-reflection to students; and lastly, the teaching institution has to design a clerkship curriculum effectively. A clinical environment for students allowing them to participate actively is essential.
Subject(s)
Humans , Clinical Clerkship , Curriculum , Education, Medical , Learning , Test Taking SkillsABSTRACT
There is not much published literature on the use of rivastigmine patch in a "routine" clinical setting. Objectives: In this naturalistic longitudinal observational study we sought to evaluate the safety, tolerability and efficacy of the rivastigmine patch in patients with early and late onset moderate Alzheimer's disease in a routine clinical setting. Methods: Out of all routine clinical referrals, the first 30 patients with diagnosis of moderate Alzheimer's dementia who were started on rivastigmine patch were included in the study. Rivastigmine patch dose was titrated from 4.6 to 9.5 mg/ 24 hours as appropriate. The primary outcome measure was safety and tolerability, measured by the incidence of adverse events and discontinuation due to any reason. The secondary outcome measure was to examine improvement on global, functional and behavioral domains as demonstrated by the MMSE (Mini Mental State Examination) score, BADLS (Bristol Activities of Daily Living Skills) score, patient and carer feedback and clinical judgment. Results: Adverse events were reported in 20% of patients and 10% of total patients needed discontinuation of treatment. Improvement on global, functional and behavioral domains was observed in two thirds of patients whereas one third showed a relative decline. The most common side effect was skin irritation or erythema. Conclusions: The rivastigmine transdermal patch may provide a treatment option for those patients who require a change in their current oral cholinesterase inhibitor therapy due to safety or tolerability concerns.
Não há muita publicação na literatura sobre o uso do adesivo de rivastigmina na prática clínica. Objetivos: Em um estudo observacional longitudinal naturalístico nós tentamos avaliar a segurança, tolerabilidade e eficácia do adesivo transdérmico de rivastigmina em pacientes com doença de Alzheimer moderada de início precoce e tardio. Métodos: Os primeiros 30 pacientes ambulatoriais com DA moderada de clínicas de referência que iniciaram o uso de adesivo de rivastigmina foram incluídos no estudo. A dose foi escalonada de 4,6 a 9,5 mg/24 hs quando apropriado. As medidas de desfecho primário foram a segurança e tolerabilidade medidas pela incidência de eventos adversos e descontinuação por alguma razão. A medida de desfecho secundário foi a melhora global, funcional e comportamental, demonstrada pelos escores do Mini-Exame do Estado Mental (MEEM), escores na escala de Atividade de Vida Diária de Bristol, retorno do paciente e cuidador e julgamento clínico. Resultados: Eventos adversos foram reportados em 20% dos pacientes e 10% deles descontinuaram o tratamento. Melhora em domínios global, funcional e comportamental foi observada em dois terços dos pacientes, enquanto que, no terço restante um declínio relativo foi observado. O efeito colateral mais comum foi irritação ou eritema de pele. Conclusões: O adesivo transdérmico de rivastigmina pode ser uma opção terapêutica para aqueles pacientes que requeiram mudança na sua terapia oral com inibidor da colinesterase devido à sua segurança e tolerabilidade.