Influência de Políticas de Ação Afirmativa no Perfil Sociodemográfico de Estudantes de Medicina de Universidade Brasileira / Influence of Affirmative Action Policies on Socio Demographic Profile of Medical Students from a Brazilian University

RESUMO A adoção de políticas públicas de inclusão pela Universidade Estadual de Campinas (Unicamp) desde o processo seletivo de 2005, atrelada às modificações nos vestibulares de 2014 e, mais recentemente, no de 2016, possivelmente trouxe grandes mudanças no perfil do estudante de Medicina dessa universidade. Desse modo, o objetivo do presente estudo é avaliar o perfil sociodemográfico desses acadêmicos, bem como suas pretensões na escolha da carreira médica e da futura especialidade. O estudo de corte transversal foi realizado com 290 acadêmicos do primeiro, terceiro e sexto ano da graduação médica da Unicamp por meio de um questionário anônimo aplicado após aprovação do Comitê de Ética em Pesquisa. Houve coleta de dados sociodemográficos, além dos fatores de influência para a escolha da profissão e da especialidade médica. A análise dos dados revelou uma amostra com idade média de 20-24 anos, predominantemente composta por mulheres (63,2%), da etnia branca (77,5%), procedentes do Estado de São Paulo (84,8%) e de regiões interioranas (62,3%). Para o primeiro ano, houve presença de negros (6,6%) e diferença estatística para pardos (22,6%), comparativa com o terceiro e sexto ano, egressos de ensino fundamental (42,5%) e médio (73,6%) públicos, com menor escolaridade materna (ensino médio) e renda familiar inferior (p < 0,001). Por sua vez, o terceiro e sexto ano eram compostos majoritariamente por alunos brancos (76,7% e 90,3%, respectivamente), oriundos de escola privada no ensino fundamental e médio, com maior escolaridade materna (ensino superior ou pós-graduação) e renda familiar mais elevada. Ainda, verificou-se variação das opções de especialidade ao longo do curso (p < 0,001). No primeiro ano, as especialidades mais pretendidas foram Cirurgia/Ortopedia (37,7%), Clínica Médica/Neurologia (23,6%) e Psiquiatria (11,3%). Para o terceiro ano, as especialidades mais desejadas foram Clínica Médica/Neurologia (40%), Cirurgia/Ortopedia (13,4%) e Ginecologia/Obstetrícia (13,3%). Entre os alunos do sexto ano, as especialidades mais escolhidas foram Clínica Médica/Neurologia (24,5%), Ginecologia/Obstetrícia (20,2%) e Cirurgia/Ortopedia (17%). Acadêmicos do primeiro ano também apresentaram diferentes aspirações abrangendo o local de trabalho futuro, com mais desejo de atuar somente no SUS ou em programas internacionais. Nesse contexto, os resultados apontam que a política de bonificação da Unicamp e suas alterações ao longo do tempo, em especial no vestibular de 2016, mostraram-se efetivas em democratizar o acesso à graduação médica, com maior pluralidade demográfica, social, econômica e étnica atreladas a variações na escolha da carreira e da especialidade médica ao longo das turmas analisadas.

ABSTRACT Affirmative action policies adopted by University of Campinas (Unicamp) in 2005 entrance exams, added to 2014 modifications, and more recently in 2016, lead to a big profile change of University of Campinas medical students. Therefore, this paper aims to describe academics' sociodemographic profile, as well as their aspirations in choice of medical career and future specialty. The cross-sectional study included 290 undergraduate years 1, 3 and 6 (Y1, Y3 and Y6) medical students from Unicamp who answered an anonymous questionnaire applied after approval by the Institutional Review Board. Socio demographic data and factors potentially influencing decisions on medical career and specialty choices were analyzed. Data analysis showed a sample composed mostly of white (77.5%), female (63.2%), 20-24 years population, from the State of São Paulo (84.8%) and interior (62.3%). For Y1, there was statistically significant difference for 'pardo' (22.6%) - it can be translated as brown - and black (6.6%) - there wasn't black in Y3 and Y6 - ethnic groups, public school provenience - both elementary school (42.5%) and high school (73.6%) -, lower maternal schooling (high school, p < 0.001) and lower family income (p < 0.001). Years 3 and 6 majority was composed of white academics (76.7% and 90.3%, respectively), coming from private schools (basic education and high school), with further maternal education (higher education/post-graduation) and bigger average income. The influence factors leading to choice for medical specialty modified (p < 0,001) among graduation years. Y1 students opted more frequently for 'surgery/orthopedics' (37.7%), 'medical clinic/neurology' (23.6%) and 'psychiatry' (11.3%). To Y3, the most desired specialties were 'medical clinic/neurology' (40%), 'surgery/orthopedics' (13.4%) and 'obstetrician-gynecologist' (13.3%). Amongst Y6 undergraduates, the most chosen specialties were 'medical clinic/neurology' (24.5%), 'obstetrician-gynecologist' (20.2%) and 'surgery/orthopedics' (17%). Y1 academics also revealed different aspirations regarding intended future workplace, with larger desire to practice only on SUS or on international programs. In this context, results indicate that Unicamp inclusion policy and its modifications over the years, particularly in 2016 entrance exams, have been effective in broadening access to medical education, such as greater socio demographic, economic and ethnic plurality coupled with variations in reasons for choice of medical career and specialty among graduation years analyzed.

Evaluación de docentes clínicos de Postgrado: desarrollo y propiedades psicométricas del instrumento MEDUC-PG14 / Development of MEDUC-PG14 survey to assess postgraduate teaching in medical specialties

Background: Feedback is one of the most important tools to improve teaching in medical education. Aim: To develop an instrument to assess the performance of clinical postgraduate teachers in medical specialties. Material and Methods: A qualitative methodology consisting in interviews and focus-groups followed by a quantitative methodology to generate consensus, was employed. After generating the instrument, psychometric tests were performed to assess the construct validity (factor analysis) and reliability (Cronbach’s alpha). Results: Experts in medical education, teachers and residents of a medical school participated in interviews and focus groups. With this information, 26 categories (79 items) were proposed and reduced to 14 items (Likert scale 1-5) by an expert’s Delphi panel, generating the MEDUC-PG14 survey, which was answered by 123 residents from different programs of medical specialties. Construct validity was carried out. Factor analysis showed three domains: Teaching and evaluation, respectful behavior towards patients and health care team, and providing feedback. The global score was 4.46 ± 0.94 (89% of the maximum). One teachers’ strength, as evaluated by their residents was “respectful behavior” with 4.85 ± 0.42 (97% of the maximum). “Providing feedback” obtained 4.09 ± 1.0 points (81.8% of the maximum). MEDUC-PG14 survey had a Cronbach’s alpha coefficient of 0.947. Conclusions: MEDUC-PG14 survey is a useful and reliable guide for teacher evaluation in medical specialty programs. Also provides feedback to improve educational skills of postgraduate clinical teachers.

Tendencia en el estudiante de medicina a ejercer como médico general o especialista / Trends among medical students towards general practice or specialization

Background: A 60/40 ratio has been estimated as a country's ideal proportion between general practitioners and specialists. In Chile this proportion was 36/ 64 in 2004, exactly the opposite of the ideal. Trends towards specialization or general practice among medical students have not been thoughtfully studied. Aim: To assess trends among medical students towards becoming general practitioners or specialists, exploring associated factors. Material and methods: Descriptive survey of 822 first to seventh year medical students at the University of Chile, School of Medicine. Desired activity to pursue (general practice or specialization) after graduation and general orientations within clinical practice were explored. Results: Fifty three percent of students desired to enter a specialization program. Only 20 percent would work as a general practitioner (27 percent were still indecisive). Furthermore, a trend in early years of medical training towards an integral medicine is gradually reversed within later years. Seventh year students give significantly more importance to specialization than to integral medicine (p <0.01). Ten percent of this opinion change is related to the emphasis given to specialized medicine in the teaching environment. Conclusions: Most students prefer to enter a specialization program immediately after finishing medical school. Moreover, there is a social trend, at least within the teacher-attending environment, promoting not only the desire to specialize, but a pro-specialist culture.

Motivos relacionados à escolha da medicina intensiva como especialidade por médicos residentes / Reasons related to the choice of critical care medicine as a specialty by medical residents

OBJETIVOS: A medicina intensiva é especialidade relativamente nova que apresentou grande desenvolvimento no Brasil nos últimos anos. No entanto, existe pouca procura por parte dos médicos em realizar este tipo de especialização. O objetivo deste estudo foi descrever os motivos pelos quais os médicos residentes de Salvador-BA pretendem ou não realizar residência médica em medicina intensiva. MÉTODOS: Trata-se de um estudo transversal e descritivo, em que foi aplicado um questionário, durante o período de outubro a dezembro de 2007, a todos os médicos residentes das especialidades pré-requisito para medicina intensiva (clínica médica, cirurgia geral e anestesiologia). RESULTADOS: Foram incluídos no estudo 165 médicos residentes (89,7 por cento do total), sendo 51,5 por cento residentes de clínica médica, 25,5 por cento de cirurgia geral e 23 por cento de anestesiologia. Dos entrevistados, 14 (9,1 por cento) pretendem fazer residência de medicina intensiva, embora 90 (54,5 por cento) pretendam ser plantonistas de unidades de terapia intensiva após a residência. O principal motivo destacado para se especializar em medicina intensiva foi gostar de trabalhar com pacientes graves (92,9 por cento). Já os principais motivos para não se especializar em medicina intensiva estão relacionados à pior qualidade de vida ou de trabalho. Os médicos residentes que fizeram algum estágio em unidade de terapia intensiva durante a graduação são mais propensos a serem plantonistas de unidades de terapia intensiva após a residência. CONCLUSÕES: A população avaliada demonstrou baixo interesse em se especializar em medicina intensiva. Os principais motivos apontados foram os fatores relacionados à qualidade de vida dos intensivistas e ao ambiente de trabalho. Um levantamento nacional se faz necessário para identificar quais as intervenções são adequadas para incentivar esta especialização.

OBJECTIVES: Critical Care Medicine is a relatively new specialty, which in recent years has made significant progress in Brazil. However, few physicians are willing to acquire this specialization. The main objective of this study was to describe the factors associated with choice of Critical Care Medicine as a specialty by medical residents of Salvador-BA. METHODS: A cross-sectional and descriptive study, in which a questionnaire was submitted to all residents of the specialties that are a prerequisite for Critical Care Medicine (Clinical Medicine, General Surgery and Anesthesiology), between October and December 2007. RESULTS: The study included 165 residents (89.7 percent of the total), in which 51.5 percent were clinical medicine residents, 25.5 percent were general surgery residents, and 23.0 percent were anesthesiology residents. Of the respondents, 14 (9.1 percent) intended to enter Critical Care Medicine residency, although 90 (54.5 percent) were willing to become intensive care unit physicians after their regular residency. The main reason stated to specialize in critical care medicine was to like work with critically ill patients (92.9 percent). The main reasons stated not to specialize in critical care medicine, however were related with the poorer quality of life and work. Residents who did intensive care unit initernship during medical studies were more likely to work in an intensive care units after residency. CONCLUSIONS: This population showed little interest to specialize in critical care medicine. The main reasons given for this limited interest were factors related to quality of life and intensive care unit environment. A national survey is required to identify the interventions needed to favor this specialization.

Os diferentes olhares na avaliação de alunos em estágio clínico supervisionado / The different perspectives in the assessment of learners during supervised clinical clerkship

OBJETIVO: Comparar notas do Conceito Global Itemizado (CGI) e da Avaliação Estruturada (AE), atribuídas por três especialidades - Ginecologia e Obstetrícia (GO), Clínica Médica (CM) e Pediatria (Ped) - a alunos em final de estágio clínico nas unidades básicas de saúde. MÉTODOS: Cento e seis alunos do 4º ano médico foram avaliados por um docente de cada especialidade, utilizando CGI contendo seis domínios de habilidades técnicas (CGIt) e sete domínios humanísticos (CGIh), em escala 0-10, e pela AE resultante de observação de atendimento. Para análise estatística, utilizaram-se coeficientes de Cronbach, testes de Friedman e pareados de Wilcoxon, coeficientes de correlação de Spearman e Pearson e distâncias Euclidianas (p< 0,05). RESULTADOS: Houve alta consistência interna do CGI nas especialidades (>0,92). As distribuições das notas concentraram-se no extremo superior da escala. As notas de Ped foram significativamente inferiores às de GO e CM (diferenças de medianas entre 0,50 e 0,67), com correlações baixas entre elas (-0,02

OBJECTIVE: To compare medical students' global itemized ratings (GIR) and real-case structured clinical assessment (RC-SCA), generated by faculty members from three different specialties (Gynecology-O&G, Internal Medicine-IM, Pediatrics-Ped). METHOD: 106 Y4 learners were assessed by one faculty member from each specialty, who filled in GIR, consisting of 6 technicaldomains (mean score GIRt) and 7 humanistic domains (mean score GIRh), on a 0-10 scale, and resultant RC-SCA, from direct attendance observation. Statistical analyses used Cronbach coefficient, Friedman and Wilcoxon paired tests, Pearson and Spearman correlation coefficients, Euclidean distances. Significance level=5 percent. RESULTS: High internal consistency was observed in the three GIR (> 0.92). Ratings were negatively skewed. Ped scores were significantly lower than O&G and IM (median differences between 0.50 and 0.67), with low correlations between them (-0.02

Perfil do médico residente atendido no Grupo de Assistência Psicológica ao Aluno (GRAPAL) da Faculdade de Medicina da Universidade de São Paulo / Profile of the resident physician attended by the Group of Psychological Assistance for Students at the São Paulo University School of Medicine

OBJETIVOS: Definir o perfil do médico residente atendido em um serviço de assistência à saúde mental a fim de contribuir para o conhecimento das necessidades deste grupo. MÉTODOS: Estudo observacional do tipo coorte retrospectivo. Os dados foram obtidos por meio de revisão de prontuários de uma série de residentes atendidos pelo Grupo de Assistência Psicológica ao Aluno (Grapal) no período de 1998 a 2002 e pelo acesso ao registro geral de matrícula de residentes. Inclui a descrição da proporção de residentes atendidos segundo ano [cronológico], ano de residência, sexo, idade, especialidade, faculdade de origem e distância do núcleo familiar; e a análise das diferenças de proporções entre as categorias das variáveis investigadas. RESULTADOS: Durante o período estudado temos o registro de 2.131 residentes matriculados, totalizando 4.727 residentes-ano de seguimento. Neste conjunto, computando-se somente o primeiro atendimento, temos 104 residentes atendidos pelo Grapal (4,9 por cento residentes atendidos, ou 2,2 atendidos para cada 100 residentes-ano de seguimento). Os dados revelam maior proporção de residentes atendidos com as seguintes características: primeiro ano de residência (4,5 por cento), idade inferior a 26 anos (6,1 por cento), sexo feminino (6,9 por cento), egresso de outras escolas médicas (5,9 por cento) e residentes de especialidades cognitivas (6,7 por cento). CONCLUSÃO: A assistência psiquiátrica mostrou-se associada ao gênero, a fatores ligados a crises adaptativas e a especialidades cognitivas. Não houve crescimento da proporção de residentes atendida pelo serviço durante o período analisado.

OBJECTIVES: To define the profile of medical residents assisted by a mental health care service, aiming to contribute to the understanding of this group's needs. Methods: Observational study, retrospective cohort design. Data were collected from the medical records of a series of residents assisted by the group of psychological care for students of the Sao Paulo University School of Medicine , during the period 1998-2002; and from the institution's general register of residents. Proportions of residents assisted according to time, year of residency, gender , age, specialty, graduation school and distance from family home are described and differences between proportions of these variables categories are analyzed. RESULTS: The total of residents included was 2,131 with a follow-up time of 4,727 resident-years. Among them, computing first episode of care only, there were 104 residents assisted (4.9 percent residents assisted, or 2.2 residents assisted per 100 resident-years of follow-up). Their most frequent characteristics were: first year of residency (4.5 percent), age under 26 years (6.1 percent), female (6.9 percent), graduates from other schools (5.9 percent), and residents of cognitive specialties (6.7 percent).Psychiatric assistance in this sample shows an association with gender and factors related to a crisis of adaptation. The proportion of residents assisted has not increased during the period analyzed.

Estado actual de las especialidades médicas en Chile: realidad en el sistema público no municipalizado / Present status of medical specialties in the Chilean public health system

To adequately plan the post graduate training of physicians, we need to know the needs for specialists in the country and the most prevalent diseases and causes of consultations. In 2004, the National System of Health Services assessed the number of hours and types of specialities available, their regional distribution and calculated an approximate number of physicians in charge of those specialities, determining an equivalent per 44 weekly hours of physician. This number of hours is the maximum that a physician is allowed to work per week. Fifty six percent of specialists correspond to basic specialities (3,688 physicians equivalent to 44 hours, 33 percent to primary specialities (2,205 physicians) and 10 percent to subspecialties (666 physicians). The regional distribution of basic specialties is proportional to the population of each region. However, there are gaps in the distribution of primary specialties and subspecialties. The demand for specialists, assessed measuring the yield in minutes of each hired hour, determined that 54 percent of specialist hours are delicated to the new health program that guaranties the access to certain specialties in a predefined lapse, to all beneficiaries (AUGE). Moreover the demand for attentions to cover this health system has a gap of 30 percent in hours or 800 specialists. This motivated the creation of new posts for specialties during 2005 and 2006, equivalent to 250 physicians hired for 44 hours per week.

Recuento histórico de los programas de especialización médica en Colombia / Reminiscences of graduate medical training in Colombia

Se hace un relato histórico de cómo fue el desarrollo en los sistemas de formación del médico para alcanzar la meta de ser un especialista en el campo de su elección, en las décadas de 1940 hasta 1992, año en el cual se organiza por el Gobierno Nacional el servicio público de la Educación Superior, Ley 30 de 28 de diciembre de 1992.

Historical portrayal of how the formation of higher medical education, post-graduated specialties, developed in Colombia, dating from 1940 until 1992. In 1992 the Colombian government organizes Higher Medical Education by Law N° 30 passed on the 28 of December of 1992. In the article the author expresses how more organized this education may have become it may have lost some of its mystic and ethical vitality.

Características de la violencia en residentes de dos instituciones formadoras de pediatras en el estado de Sonora / Violence epidemiological profile inside two pediatricians schools in Sonora state

Introducción. El fenómeno de la violencia en la educación médica se manifiesta con patrones consistentes, afectando el desarrollo de los cursos de especialización. Material y métodos. Mediante un censo, se aplicó un instrumento validado a residentes de pediatría de 2 hospitales-escuela, indagando la posibilidad de haber sido víctima de violencia física, psicológica, verbal o sexual, por 4 fuentes potenciales, en circunstancias o situaciones académico-laborales y por su apariencia personal, ser o pensar. Para el análisis de los datos utilizamos estadística no paramétrica. Resultados. Participaron 45 residentes, 11 (25%) de la sede A y 34 (75%) de la sede B; 93% refirió haber sido víctima de alguna forma de violencia, 9 (20%) en niveles de máxima a extrema. Predominó la violencia física, la fuente más común fueron los propios residentes durante las guardias. Existió diferencia significativa (P =0.0001) entre ambas sedes, determinada por una mayor violencia en la sede A. Conclusiones. La violencia en los cursos de pediatría que se imparten en estas instituciones, tiene un perfil predominantemente físico, durante las guardias y entre compañeros, contemplando características específicas dependientes de cada contexto.

Introduction. The phenomenon of the violence in the medical education programs ranging from verbal, psychological, physical, and sexual follows different patterns and has a negative influence on training. Material and methods. A validated questionnaire was applied to a 2 pediatrics residency training programs, to investigate whether during the course training a resident had been a victim of physical, psychological, verbal or sexual harassment. In academic-work situations due to their personal appearance, how they behaved or the expression of their personal views. For the analysis of the data we used nonparametric statistics. Results. Forty five residents, 11 in hospital A and 34 in hospital B participated. The 93% referred to have been victim of some form of harassment, 9 in levels of maximal to extreme. The physical harassment predominated, the commonest setting was while being on call. Significant difference (P =0.0001) was found between both hospitals, as determined by a greater harassment in hospital A. Conclusions. Harassment between fellow residents during the course of pediatric residency training is not uncommon and in this study had a predominantly physical profile.

Los planes de estudio y programas de las especialidades médicas

Las especialidades médicas y estomatológicas constituyen una parte importante del sistema de educación posgraduado, que está organizado y dirigido por el Área de Docencia del MINSAP y asesorado por la Dirección de Posgrado del MES. Estas especialidades se han desarrollado a lo largo de estos años y han perfeccionado sus formas de organización y planificación. Este trabajo explica los fundamentos metodológicos que dan origen a los planes de estudios de las 56 especialidades que se realizan actualmente en el país.

Medicine and dental specialties are an important part of the graduate education system that is organized and managed by the Teaching Division of MINSAP with the advise of the Graduate Education Division of the Ministry of Higher Education. These specialties have developed throughout the years and their organization and planning have improved. This paper explains the methodological foundations that give rise to the curricula of the 56 specialties in the country.

Um Novo Paradigma de Ensino Médico / A new Paradigm for Medical Education

Resumo: O atual Sistema de ensino médico no Brasil necessita de uma reformulação. A Cinaem tem nos indicado o caminho a ser trilhado. O Programa de Saúde da Família exige um profissional com perfil diferente do atual. Estamos propondo um tipo de ensino baseado 70% no ambulatório e só 30% no hospital, ao contrário dos dias de hoje. O modelo deve integrar, simultaneamente, a Clínica Médica da criança, do adolescente, do adulto e do idoso. Estamos tentando evitar a fragmentação artificial da Clínica Médica em disciplinas estanques e ensiná-la integrada em módulos. Estabelecemos um limite ao conjunto de conhecimentos que deve ser transmitido ao aluno. O graduado em Medicina deve ser um profissional preparado para diagnosticar e tratar bem 80% das doenças de uma comunidade. Cada uma das turmas de 50 alunos é dividida em seis pequenos grupos de oito estudantes para efeito de seminários e prática ambulatorial, sempre com a orientação de um preceptor. As aulas teóricas de Clínica Médica são ministradas só uma vez por semana. O exame dos docentes é a atividade mais freqüente e soma 15 horas no mesmo período. A promoção da saúde em todos os seus aspectos tem prioridade no curso da Unigranrio. A profissionalização dos preceptores é um dos nossos objetivos.

Abstract: The current medical teaching system in Brazil needs reformulation. CINAEM has shown us the road to follow. The family Health Program requires health care professionals with a different kind of background than the current norm. We propose a kind of teaching in which 70% is based on out-patient care, with the remaining 30% in-hospital, contrary to the prevailing model. The model should simultaneously include Clinical Medicine for children, adolescents, adults, and the elderly. We are attempting to avoid artificial fragmentation of Clinical Medicine in isolated disciplines and to teach trough integrated modules. We establish a limit on the set of knowledge that should be transmitted to students. Graduates in Medicine should be professionals prepared to diagnose and properly treat 80% of the disease in a community. Each class of 50 students is divided into six smaller groups of eight students each for seminars and out-patient practice, oriented by monitors. Theoretical lectures in Clinical Medicine are given only once a week. The most frequent activity is examining patients and takes up 15 hours during the same period. Health promotion with all is its aspects is a course priority at the Unigranrio Shool of Medicine. Professional training of monitors is one of our objectives.