Competencies of Indian Medical Graduates in Delivering Effective Tuberculosis care: A Mixed Method Study among Doctors at Chennai, India

Introduction: In spite of the various advances in the Tuberculosis (TB) management system in our country, we are still struggling to achieve the End TB strategy. Addressing the health provider difficulties in TB care will definitely be potential tool to control TB. Objective: To assess the competency, challenges and solutions of Indian medical graduates to provide effective Tuberculosis care. Method: It is a mixed methodological study conducted among the Bachelor of Medicine and Bachelor of Surgery (MBBS) graduates practising in various parts of Chennai, Tamil Nadu, India. The competency of the Indian medical graduates in delivering TB care was assessed using a content validated e-survey questionnaire disseminated through social media affinity groups and free listing;pile sorting and in-depth interview was done in the qualitative part. Results:The proportion of participants having good, fair and poor competency in providing effective TB care was 35%,19% and 46%, respectively. Various challenges in attaining good competency were enlisted by the participants through free listing, a smaller number of TB patients in private medical college has attained the highest Smith S value followed by other eleven challenges. Based on the pile sorting and in- depth interview various solutions have been suggested, with most of them emphasizing on compulsory TB chest clinic posting followed by others measures. Conclusion: The major reason identified in difficulties in delivering TB care was inadequate exposure in managing TB patients, incomplete knowledge on notification,referral and followup system. These lacunae can be overturned by compulsory posting in TB clinics during internship period, provision of required personal protective equipment (PPE) for doctors and patients in TB wards and outpatient department, mandatory teaching on updates of TB management

Merits and demerits of technical shift of biochemistry classes of medical undergraduates from classroom to online teaching in COVID-19 pandemic: A cross-sectional survey

Background: The ongoing global pandemic due to novel corona virus (SARS-CoV2) has jeopardized our lives from all corners. With the exponential growth of cases, even Medical institutes have curtailed physical classes and shifted to virtual classrooms. The medical graduates have exposure to online education due to vanguard of technology. However, in dwindling of COVID-19 struck economy in a developing country like India, all the medical graduates may not be privileged to have access the android phone or fast-streaming internet. Aims and Objectives: The purpose of this survey was to evaluate the impact and impression of online classes among facilitators and students. Materials and Methods: This cross-sectional study was conducted in the Department of biochemistry of Nil Ratan Sircar Medical College after obtaining Institutional Ethical Clearance. The students and faculties who voluntarily agreed to participate in the study were given a questionnaire. The responses were recorded in five-point Likert Scale. Results: Both the medical undergraduates and facilitators had a consensus opinion (0.61 and 0.71, respectively) that simultaneous access to multiple website is merit of e-learning. About 81.5% had a strong consensus opinion that there less chances of interaction with the facilitators. About 66.7% of facilitators either agreed or strongly agreed that there are hurdles to motivate the students in virtual platform. The ordinal logistic regression analysis revealed interaction with facilitators and easy of assessment is important predictors for successful outcome of online education. Conclusion: The study concluded that scope of interaction and self-motivation of the students remains to be cornerstone for the successful outcome of virtual teaching sessions. The outcome of this study may guide to identify lacunae and advantages of online methodologies in comparison to the physical classrooms.

Perceptions of undergraduate medical students regarding online classes during COVID-19 pandemic: A questionnaire survey

Background: The nationwide lockdown due to coronavirus disease pandemic lead to shutdown of medical colleges. Due to which, it was not possible to teach students in classrooms anymore. To continue with their teaching, the option of online classes was recommended. Aims and Objectives: This study was conducted with an aim to evaluate students’ perceptions regarding online lectures. Materials and Methods: This was a cross-sectional, and questionnaire survey conducted among medical college students in Uttar Pradesh, India. Online lectures were delivered routinely using online applications for 8 weeks which was followed by offline regular classes. A pre-approved, pre-validated semi-structured questionnaire containing 13 close-ended multiple-choice questions was distributed through Google forms as well as in person among all the medical students using a non-probability sampling approach after taking their informed consent. The collected data were organized and tabulated using Google spreadsheet and descriptive statistics was used to depict the results. Results: A total of 193 responses were obtained from MBBS students of first and second phase. The mean age of students was 18.73 ± 1.87 years. Mobile phones (63.21%) were the most popular device used by the students to attend classes. More than half of the students (57%) were self-motivated to attend online classes. The major barrier to online learning as reported by 76.68% students was network issues. About 44% students reported lower understanding of subject compared to offline classes. About 70.47% felt online classes to be more comfortable to attend. More number of students either preferred offline method (37.82%) or a mix of both the methods (34.20%). Conclusion: Online lectures are effective teaching method, but they cannot replace classroom teaching. Thus, online teaching serves as add-on to the offline learning.

Impact of war on foreign students' satisfaction with quality of dental and medical education in Ukraine

Abstract The objective of this study was to evaluate the changes in foreign students' satisfaction with the quality of dental and medical education considering the impact of the war in Ukraine. The present study was organized in the form of a questionnaire-based survey among 300 foreign students of Medical Faculty and Faculty of Dentistry in Ukraine. The questionnaire was ad mistered via Google form in a multiple-choice, closed-ended format. Students' satisfaction with environment safety and comfort (p < 0.05) and with the collaborative learning offered (p < 0.05) statistically decreased during the war. Sixty percent of the variability in the mean of students' satisfaction with the quality of education during the war could be explained by the satisfaction rate before the war. The need of migration from Ukraine had a stronger inverse correlation with education quality (r = -0.58) than the fact of the war itself (r = -0.32). The war in Ukraine has had a negative impact on the educational process of foreign medical and dental students, even though the quality of education was considered by students to be as high as before and during the war. The personal effort of professors, the quality of study materials, and adequate technical support could potentially overcome the negative impact of the war on student satisfaction with the quality of medical and dental education by the online mode, if the academic medium could be protected from the direct impact of the war or if the influence of the war within the university community could be minimized.

Effectiveness of healthcare ethics training in the undergraduate medical curriculum: A quasi-experimental study from rural India

Conventional medical education does not provide adequate training to undergraduates to resolve healthcare-related ethical dilemmas. This quasi-experimental study using a pre-post design was conducted to assess knowledge, attitudes and practices in healthcare ethics (HCE) and evaluate the effectiveness of the introduction of HCE in ethical behaviour among medical undergraduates at the Mahatma Gandhi Institute of Medical Sciences in Sevagram, India. All the participants thought that knowledge of HCE is important. There was an improvement in the knowledge of HCE after the intervention, as both weighted mean and percentage consensus improved. In Phase I, absolute learning gain, relative learning gain, and normalised gain “g” were significantly higher after the intervention. In Phase II, the intervention showed low and moderate effectiveness in improvements in the affective and psychomotor domain, and in the ability to handle ethical issues, respectively; but no significant improvement in communication skills. During the feedback session, it was seen that a majority of the participants thought that it is the need of the hour to introduce skill-based HCE into their curriculum from the first year. It can be concluded that it is possible to improve knowledge, and affective, psychomotor ability to handle ethical issues among undergraduate medical students with formal training

Ophthalmology as a career choice among medical students in Eastern India – A cross-sectional study

Purpose: Several factors influence medical students to choose a specialty branch for post?graduate training, and it is important to understand them so that strategies can be made to make it more attractive and hence the shortage in the workforce can be addressed. This study aimed to identify the factors that influenced under?graduate medical students to choose ophthalmology as their specialty for post?graduate training. Methods: It was a descriptive, cross?sectional, questionnaire?based study, carried out among medical students at a tertiary academic institute in eastern India. In this survey tool, 25 questions were divided into different sections: demographic data, factors influencing the choice and perceptions about ophthalmology as a career option, and the impact of rotatory internship posting on the choice of subject. The various factors were then scored and indexed appropriately. Results: There were 515 participants. The median age was 23 years. The major influencing factor for choosing ophthalmology was “adequate time” (52.04%), and the discouraging factor was “steep learning curve” (58.64%). Age had an odds ratio of 0.781, showing that the lower the age, the higher the chances of being positively inclined toward ophthalmology as a career choice. Similarly, major deciding factors, perceptions, and experiences in ophthalmology had odds ratios of 1.841, 1.725, and 2.057, respectively, showing a positive inclination. Conclusion: The study states that a steep learning curve, personal attitudes, and misconceptions may dissuade the students from taking this subject, but adequate clinical exposure and experience, as well as role models during the internship, can create a positive impact on career choice

Alternate careers for medical graduates and house officers in Malaysia

@#Introduction: In recent years, many unresolved issues pertaining to house officers in Malaysia have led to a longer waiting time and a ‘glut’ of medical graduates with a surprising 20% dropout amongst those who join the housemanship programme. This appears to reflect the changing times, mindsets and work expectations of millennials who comprise this cohort reflecting a need to consider possibilities of career shifts especially so in these uncertain times. This study explores the perceptions, awareness and interest in alternative career options amongst recent graduates and house officers. Materials and Methods: This was a study done between 2018 and 2019 using a questionnaire which was shared on various social platforms. Data analysis was done using Excel spreadsheet. Results: A total of 450 house officers and 657 medical graduates responded. Expectedly 66.8% claimed lifelong passion whilst another 12.1% claimed family influence as their reason to do medicine. Most were aware of their career challenges and 40% of them were keen to consider career change and reskilling indicating a possible shift from traditional expectations of a medical career. Conclusion: Whilst medicine is often considered a true calling, current challenges will require mental and emotional flexibility to explore other career opportunities. Thus, engagement programmes should be directed at medical graduates and house officers to identify and support those open to career transitions. This will help address current issues of internship bottleneck and rising dropout rates amongst internees. Early career change engagements will give them insight into their true career goals whilst opening up opportunities for those who wish to change.

Financial impact of the change in the vulnerability profile of More Doctors Program / Impacto financeiro da alteração do perfil de vulnerabilidade no Programa Mais Médicos

ABSTRACT OBJECTIVE To estimate the flow of professionals and the financial impact of the Programa Mais Médicos para o Brasil (PMMB - More Doctors for Brazil Program) within the More Doctors Program (MDP) for the Brazilian Ministry of Health and the participating municipalities of the state of São Paulo, from January 2019 to March 2022. METHODS A financial impact study was conducted in the state of São Paulo based on public secondary databases. The number of PMMB vacancies per municipality, of physicians and vulnerability profiles were described to measure the loss of replacement of professionals in the period. RESULTS In the specified period, the number of PMMB physicians in participating cities will decrease from 2,533 to 320, and the number of participating municipalities from 373 to 86. The municipalities that will need to replace the physicians will have a financial impact of R$ 929,487,904.77 (with sensitivity analysis, ranging from R$ 650,641,533.34 to R$ 1,208,334,276.20). CONCLUSION The change of vulnerability methodology adopted for the PMMB will represent serious consequences, that is, less population assistance and high financial impact for the municipalities of the state of São Paulo in a scenario of budget limitations.

RESUMO OBJETIVO Calcular o fluxo de profissionais e o impacto financeiro do Projeto Mais Médicos para o Brasil (PMMB), dentro do Programa Mais Médicos (PMM), para o Ministério da Saúde e os municípios do estado de São Paulo aderentes, no período de janeiro de 2019 a março de 2022. MÉTODOS Realizou-se estudo de impacto financeiro a partir de bases de dados secundários públicos do estado de São Paulo. O número de vagas do PMMB por município, de médicos do projeto e os perfis de vulnerabilidade foram descritos para dimensionar a perda de reposição de profissionais no período. RESULTADOS No intervalo de tempo especificado, o número de médicos do PMMB em cidades a ele aderentes passará de 2.533 para 320, e o número de municípios participantes de 373 para 86. O impacto orçamentário para os municípios que necessitarão repor médicos será de R$ 929.487.904,77 (com análise de sensibilidade variando de R$ 650.641.533,34 a R$ 1.208.334.276,20). CONCLUSÃO A mudança de metodologia da vulnerabilidade adotada para o PMMB trará sérias consequências, ou seja, desassistência da população e alto impacto financeiro para os municípios do estado de São Paulo em um cenário de limitações orçamentárias.

Tracking Medical Graduates in Jamaica and The Bahamas / Tras los graduados de medicina en Jamaica y las Bahamas

ABSTRACT Objective: To determine the availability of employment and retention for the increased number of medical graduates in Jamaica and The Bahamas. Methods: The availability of internships and junior medical posts for graduates of The University of the West Indies in Jamaica and The Bahamas over the five-year period of 2012 to 2016 was reviewed. Results: There were 947 medical graduates between 2012 and 2016 in Jamaica; 69.4% of them were female. The number of graduates increased annually. The majority of graduates were Jamaicans; non-Jamaicans comprised 18.2%. All Jamaican graduates obtained internship posts in the public hospitals and at the University Hospital of the West Indies, Jamaica, with a phased increase of approximately 20% in the posts available over the period. The public hospitals employed 75% of the graduates. There were 172 non-Jamaican graduates, the majority of whom were from Trinidad and Tobago, who did not seek employment in Jamaica. In The Bahamas, there were 132 graduates, all of whom obtained internship posts in public hospitals. Of the 2259 applicants, 664 were accepted to postgraduate programmes in Jamaica and The Bahamas between 2012 and 2016. Seventy per cent of all graduates were working in the English-speaking Caribbean, with the majority in Jamaica. Conclusion: The number of medical graduates trained increased, with a predominance of females. All graduates obtained employment in Jamaica and The Bahamas, mainly in public institutions. Although there was 70% retention of graduates, there is an urgent need to increase the number of postgraduate posts and accredited training institutions in the Caribbean.

RESUMEN Objetivo: Determinar la disponibilidad de empleo y la retención para el número creciente de graduados de medicina en Jamaica y las Bahamas. Métodos: Se revisó la disponibilidad de pasantías y puestos médicos para recién graduados de la Universidad de West Indies en Jamaica y las Bahamas durante el período de cinco años de 2012 a 2016. Resultados: Hubo 947 graduados de medicina entre 2012 y 2016 en Jamaica, de los cuales el 69.4% eran mujeres. El número de graduados aumentó anualmente. La mayoría de los graduados eran jamaicanos; los no jamaicanos comprendían el 18.2%. Todos los graduados jamaicanos obtuvieron puestos de pasantía en los hospitales públicos y en el Hospital Universitario de UWI, Jamaica, con un aumento gradual de aproximadamente 20% de los puestos disponibles durante el período. Los hospitales públicos emplearon el 75% de los graduados. Hubo 172 graduados no jamaicanos, la mayoría de los cuales eran de Trinidad y Tobago, y no buscaban empleo en Jamaica. En las Bahamas, hubo 132 graduados, todos los cuales obtuvieron puestos de pasantía en hospitales públicos. De los 2259 solicitantes, 664 fueron aceptados en los programas de postgrado en Jamaica y las Bahamas entre 2012 y 2016. El setenta por ciento de todos los graduados trabajaban en el Caribe de habla inglesa, mayormente en Jamaica. Conclusión: El número de graduados médicos entrenados aumentó, con predominio de las mujeres. Todos los graduados obtuvieron empleo en Jamaica y las Bahamas, principalmente en instituciones públicas. Aunque hubo 70% de retención de graduados, hay una necesidad urgente de aumentar el número de puestos de posgrado y formación acreditada en las instituciones del Caribe.

Influence Factors and Countermeasures on the Ability of Kunming Medical University Graduates'Social Adaptation / 昆明医科大学学报

Objective to understand the current situation of the social adaptation ability of Kunming Medical University graduates and to explore the possible influence factors, so as to provide some references for the school to formulate effective countermeasures to improve college students'social adaptability.Methods The method of census was adopted in 1 228 graduates of Kunming Medical University with a self-administered questionnaire.Results The social adaptation ability of graduates is poor, accounting for 63.43%, while for students'financial situation, parents educational level, the number of joining college clubs, the quantity of the awards and qualification certificates, awareness of employment policy, the time to focusing on employment, and job prospects were statistically significant with social adaptation ability (P＜0.05) .Conclusion The social adaptability of the graduates in our school is poor, and the reasonable countermeasures should be formulated in view of the key factors.

Análise das emendas parlamentares ao Programa Mais Médicos: o modelo de formação médica em disputa / Analysis of the parliamentary amendments to the Mais Médicos Program: the medical training model in dispute

RESUMO Pesquisa documental qualiquantitativa que analisa o processo legislativo e atos normativos do Programa Mais Médicos. O estudo categoriza 575 emendas apresentadas e as alterações na Medida Provisória. Evidencia o conjunto dos interesses e disputas envolvidos no processo, seja aperfeiçoando ou desvirtuando. Ressalta os confrontos nas emendas que atendem a interesses corporativos e aquelas aliadas ao princípio constitucional da universalidade, resultando em mudanças principalmente no Capítulo da Formação Médica. Conclui que a polêmica e o acirramento entre posições ideológicas não comprometeram a iniciativa governamental de diminuir a carência de médicos e fixá-los em áreas prioritárias do Sistema Único de Saúde (SUS).

ABSTRACT Qualitative-quantitative documentary research, which aimed to analyze the Mais Médicos (More Doctors) Program legislative process and normative acts. The study categorizes the 575 amendments submitted and the changes in the Provisional Measure. It shows the set of interests and disputes involved in the process, resulting in changes mainly in the Medical Education Chapter. It highlights the clashes in the amendments that serve corporate interests and those allied to the constitutional principle of universal health. It concludes that the controversy, interests and dispute among ideological positions did not compromise the governmental initiative to reduce the shortage of doctors for the Public Health System (SUS).

Evaluation of research quality for medical graduates / 中华医学教育探索杂志

Objective To investigate the research quality of present medical graduates and propose suggestions for improvement.Method A self-designed questionnaire entitled Investigating Questionnaire for Research Quality Analysis of Medical Graduates in Peking Union Medical College Hospital was distributed to the clinical and academic medical graduates in the hospital from July to August 2015.Among 276 collected questionnaires,270 were validated as effective.SPSS 18.0 software was used to statistically describe the result and to perform t test on different subgroups.Results The research quality average of the surveyed hospital was 10.28.Results revealed that in regard of the three aspects of research quality,research consciousness ranked first,followed by the research ability,while scientific spirit was the weakest.Academic medical graduates showed significantly higher scores than clinical graduates in terms of total research quality and every single aspect (P values less than 0.05).Conclusions To better cultivate the academic leaders in medical research,it is necessary to strengthen the research training for the graduates,practice their scientific thinking especially the clinical graduates,reinforce tutors' guidance,and promote communication and collaboration.

Evaluation of a course to prepare international students for the United States Medical Licensing Examination step 2 clinical skills exam / 보건의료교육평가

PURPOSE: United States (US) and Canadian citizens attending medical school abroad often desire to return to the US for residency, and therefore must pass US licensing exams. We describe a 2-day United States Medical Licensing Examination (USMLE) step 2 clinical skills (CS) preparation course for students in the Technion American Medical School program (Haifa, Israel) between 2012 and 2016. METHODS: Students completed pre- and post-course questionnaires. The paired t-test was used to measure students' perceptions of knowledge, preparation, confidence, and competence in CS pre- and post-course. To test for differences by gender or country of birth, analysis of variance was used. We compared USMLE step 2 CS pass rates between the 5 years prior to the course and the 5 years during which the course was offered. RESULTS: Ninety students took the course between 2012 and 2016. Course evaluations began in 2013. Seventy-three students agreed to participate in the evaluation, and 64 completed the pre- and post-course surveys. Of the 64 students, 58% were US-born and 53% were male. Students reported statistically significant improvements in confidence and competence in all areas. No differences were found by gender or country of origin. The average pass rate for the 5 years prior to the course was 82%, and the average pass rate for the 5 years of the course was 89%. CONCLUSION: A CS course delivered at an international medical school may help to close the gap between the pass rates of US and international medical graduates on a high-stakes licensing exam. More experience is needed to determine if this model is replicable.

Análise comparativa sobre a implantação do Programa Mais Médicos em agregados de municípios do Rio Grande do Sul, Brasil / A comparative analysis of the implementation of the Mais Médicos (More Doctors) Program in municipalities in the State of Rio Grande do Sul, Brazil

Resumo A partir da implantação de uma estratégia programática governamental, o Programa Mais Médicos (PMM), tem ocorrido a inserção e o incremento da ocupação e atividade profissional médica em serviços de Atenção Primária à Saúde (APS) em todo o país. Considerada tal iniciativa, que resultados de curto prazo podem ser identificados e comparados entre agregados de municípios do Rio Grande do Sul? O artigo apresenta um estudo de caso-controle de agregados municipais, a partir de dados de fontes secundárias, com propósito exploratório e análise descritiva de um conjunto selecionado de indicadores correlatos aos serviços de APS. Observou-se o incremento de indicadores estruturais nos agregados de municípios com implantação do PMM. Para os indicadores de resultados selecionados, observou-se discreto incremento na produção de serviços nos agregados com PMM, contudo, não foram identificadas diferenças de impactos entre os agregados casos e controles. Estes resultados podem ter sido influenciados pelo exíguo tempo decorrido desde a implantação do PMM, por subnotificações de registro médicos no cadastro de estabelecimentos de saúde (CNES), além da predominância de caráter substitutivo de ocupações médicas nos municípios selecionados para o estudo e com PMM implantado.

Abstract The Mais Médicos (More Doctors) Program has led to an increase in the number of doctors and medical treatment in primary health care services across Brazil. This article presents the results of a case-control study of groups of municipalities based on secondary data sources. It aims to explore and discuss a set of indicators of primary health care service delivery. An improvement in performance against structural indicators was observed in municipalities where the program was implemented. With respect to the outcome indicators, a slight improvement in service delivery was observed in municipalities where the program was implemented. However, no difference was observed in impacts between the case and control municipalities. These results may have been influenced by the fact that the program has only been underway for a limited time, by underreporting of doctors by the National Health Facilities Register (CNES, acronym in Portuguese), and the predominantly substitutive nature of the allocation of medical professionals under the program in the selected municipalities.

Apontamentos sobre o Módulo de Acolhimento e Avaliação do Programa Mais Médicos / Notes on the Welcome and Evaluation Module of the Mais Médicos Program

RESUMO Este artigo se originou da experiência de participação em um Módulo de Acolhimento e Avaliação de Médicos Intercambistas do Programa Mais Médicos, no Brasil. Tem como objetivo apresentar e discutir aspectos relativos aos conteúdos e práticas pedagógicas utilizadas em sala de aula, para, em um sentido mais amplo, fomentar as discussões acerca da formação médica brasileira, seja com profissionais brasileiros ou não. Ao final do processo de formação, percebeu-se um descompasso entre as ações pedagógicas realizadas nesse módulo e o que é preconizado pelas políticas públicas brasileiras no campo da formação profissional em saúde.

ABSTRACT This article is based on the authors’ participation in the organization of the Foreign Doctors’ Welcome and Evaluation Module as part of the Programa Mais Médicos [More Doctors Program] in Brazil. The aim is to present and discuss several aspects of contents and pedagogical practices used in the classroom in order to foster wider debate on Brazilian medical education (whether with Brazilian professionals or not). At the end of the degree process, a discrepancy was noted between the pedagogical initiatives undertaken as part of the module and that which is recommended by Brazilian public policies for professional healthcare training.

North Korean refugee doctors' preliminary examination scores / 한국의학교육

PURPOSE: Although there have been studies emphasizing the re-education of North Korean (NK) doctors for post-unification of the Korean Peninsula, study on the content and scope of such re-education has yet to be conducted. Researchers intended to set the content and scope of re-education by a comparative analysis for the scores of the preliminary examination, which is comparable to the Korean Medical Licensing Examination (KMLE). METHODS: The scores of the first and second preliminary exams were analyzed by subject using the Wilcoxon signed rank test. The passing status of the group of NK doctors for KMLE in recent 3 years were investigated. The multiple-choice-question (MCQ) items of which difficulty indexes of NK doctors were lower than those of South Korean (SK) medical students by two times of the standard deviation of the scores of SK medical students were selected to investigate the relevant reasons. RESULTS: The average scores of nearly all subjects were improved in the second exam compared with the first exam. The passing rate of the group of NK doctors was 75%. The number of MCQ items of which difficulty indexes of NK doctors were lower than those of SK medical students was 51 (6.38%). NK doctors' lack of understandings for Diagnostic Techniques and Procedures, Therapeutics, Prenatal Care, and Managed Care Programs was suggested as the possible reason CONCLUSION: The education of integrated courses focusing on Diagnostic Techniques and Procedures and Therapeutics, and apprenticeship-style training for clinical practice of core subjects are needed. Special lectures on the Preventive Medicine are likely to be required also.

Análise do processo de implantação do “Projeto Mais Médicos para o Brasil” no estado do Rio Grande do Sul / Analysis of the implementation process of the \"Project More Doctors to Brazil\" in Rio Grande do Sul state

Quais os impactos de curto prazo ocorridos a partir dos ciclos iniciais de implantação do “Programa Mais Médicos” (PMM) em municípios do Rio Grande do Sul? Essa dissertação versa um sobre subtipo de ensaio comunitário acerca da problemática em questão, com estudo agregado com múltiplos grupos, longitudinal em série temporal retrospectiva, a partir de dados de fontes secundárias, com análise descritiva de propósito exploratório. Trata-se de 10 grupos conformados por agregados de municípios do Rio Grande do Sul, selecionados e estratificados em 5 faixas populacionais, estando pareados pela condição de implantação e não implantação do PMM. Realizou-se análise comparativa e descritiva de um conjunto selecionado de indicadores correlatos aos serviços de Atenção Primária à Saúde (APS). De um modo geral, observou-se o incremento de indicadores de estrutura nos agregados de municípios com implantação do PMM, notadamente nos agregados com faixas de menores populações. Em termos de indicadores de resultados observou-se discreto incremento na produção de serviços nos agregados com implantação do PMM, contudo, não foram identificadas diferenças significativas de internações por causas sensíveis e de outros indicadores de impacto próprios da APS. As hipóteses mais plausíveis para explicar os achados estão referidas ao exíguo tempo decorrido entre a implantação do PMM e a realização do estudo, além da constatação de que nos ciclos iniciais de implantação do programa houve predominância de caráter substitutivo de trabalho profissional médico nos municípios selecionados para o estudo.

What are the short-term impacts occurred in the early cycles implementation of the "More Doctors Program" (PMM) in municipalities of Rio Grande do Sul? This research focuses on one community trial subtype, added to multiple groups, in longitudinal retrospective time series, based on data from secondary sources, with descriptive analysis of exploratory purpose. It is conformed by 10 groups clusters of municipalities of Rio Grande do Sul, selected and stratified into five population groups, being matched by the deployment condition and not implementation of PMM. We carried out comparative and descriptive analysis of a selected set of indicators related to the services of Primary Health Care (PHC).In general, there was the structure of indicators of growth in clusters of municipalities with implementation of PMM, especially in conglomerates with smaller populations tracks. In terms of outcome indicators showed a slight increase in the production of services in conglomerates with implementation of PMM, however, significant differences in hospital admissions were identified by sensitive causes and other APS's own impact indicators. The most plausible hypotheses to explain the findings are referred to the narrow time between the implementation of the PMM and the study, besides the fact that in the early cycles of program implementation was substitute character predominance of medical professional working in selected municipalities to the study.

Basic experimental teaching content improvement for biological and medical graduates / 中华医学教育探索杂志

Life science is based on an experimental basis, so the basic experimental teaching for biological and medical graduates is very important. Targeted basic experimental teaching content can help biological and medical graduates lay a solid experiment foundation and promote them to fol-low the development of cutting-edge bioscience.The basic experimental teaching content for biological graduate is set up into four experimental categories uniformly: molecular biology, proteomics experi-ments, bioinformatics experiments and large equipment use. Each category is further set into three experimental projects: validation experiments, comprehensive experiments and independent research experiment. By increasing the degree of openness of large instruments and equipment, improving teaching methods and perfecting appraisal methods, ggraduates' experimental skills, research ability and innovation ability are trained, and the quality of experimental teaching has been improved.

The exploration on cultivation of medical graduates' creativity / 中华医学教育探索杂志

Creativity is the demand of the time.The cultivation of creativity is what we should put first in the education of graduates.The Fourth Military Medical University attempts to consummate the selection,training and evaluating system of supervisors by strictly checking the qualification of supervisors and examining the enrollment qualification,sending supervisors abroad for further education and making them attending academic conferences for academic communication.The university also modularizes English teaching and giving lectures on political theory courses in order to establish a curriculum system which integrates the education of theory,practicing and the cultivation of comprehensive quality.Moreover,by creating funds for graduates' searching and international academic communication of academy,the university tries to complete stipend and scholarship systems to encourage innovation and exploration.By doing these,the cultivation of graduates' innovation ability has been improved.

An Alternative Certification Examination ‘ACE’: Can Post Graduate Methods Be Used to Assess Clinical Skills in Medical Under Graduates.

Background: Progressing from undergraduate education to post graduate training has been punctuated by a clinical examination which has not changed significantly in decades. This study investigated the feasibility of using a validated postgraduate assessment methodology in an undergraduate setting; The Toronto Patient Assessment & Management Exam (PAME). Methods: A standardised patient-centred multifaceted healthcare pathway examination consisting of 4 separate consecutive encounters was piloted in the final year of undergraduate training. The entire final year medical class was invited to participate. The final sample of 25 was selected on a consecutive, volunteer basis. Student’s experienced 2 standardised simulated cases; 1 medical, 1 surgical. Candidates were examined by 2 independent examiners (subject experts) and were ranked on a Global Rating Scale. Passing standard was set at 3/5 - ‘barely adequate for Intern/PGY1’ but with the addition of second pass criteria of avoidance of an egregious error. Results: 23 students completed the examination. Two arrived late and were excluded. 21/23 demonstrated knowledge and skills at least at minimum expected standard. 18/23 avoided an egregious error. Subgroup analysis identified better performance in the assessment and management of the medical case and the review encounter (encounter 4) was the lowest scoring in both cases. The format was well received by students and examiners. Conclusion: The use of an alternative certification examination ‘ACE’ based on a postgraduate format ‘PAME’ in undergraduate setting appears feasible and discriminatory. Inclusion in the pass criteria of avoidance of egregious error appears to improve the specificity of the examination. The ACE format reveals potential to replace elements of prepractice (PGY1) clinical barrier assessment.