Lumbar puncture for neurosyphilis investigation in asymptomatic patients with HIV-syphilis coinfection: a cross-sectional study among infectious disease specialists

ABSTRACT BACKGROUND: Syphilis is a major public health issue worldwide. In people living with human immunodeficiency virus (PLHIV), there are higher incidences of both syphilis and neurosyphilis. The criteria for referring PLHIV with syphilis for lumbar puncture is controversial, and the diagnosis of neurosyphilis is challenging. OBJECTIVE: To describe the knowledge, attitudes, and practices of infectious disease specialists and residents in the context of care for asymptomatic HIV-syphilis coinfection using close-ended questions and case vignettes. DESIGN AND SETTING: Cross-sectional study conducted in three public health institutions in São Paulo (SP), Brazil. METHODS: In this cross-sectional study, we invited infectious disease specialists and residents at three academic healthcare institutions to answer a self-completion questionnaire available online or in paper form. RESULTS: Of 98 participants, only 23.5% provided answers that were in line with the current Brazilian recommendation. Most participants believed that the criteria for lumbar puncture should be extended for people living with HIV with low CD4+ cell counts (52.0%); in addition, participants also believed that late latent syphilis (29.6%) and Venereal Disease Research Laboratory (VDRL) titers ≥ 1:32 (22.4%) should be conditions for lumbar puncture in PLHIV with no neurologic symptoms. CONCLUSION: This study highlights heterogeneities in the clinical management of HIV-syphilis coinfection. Most infectious disease specialists still consider syphilis stage, VDRL titers and CD4+ cell counts as important parameters when deciding which patients need lumbar puncture for investigating neurosyphilis.

Four Corners: an educational strategy for learning infectious diseases in medical school / Four Corners: uma estratégia educacional para o ensino de infectologia para estudantes de Medicina

Abstract: Introduction: An extensive literature has demonstrated the benefits of active learning in medical education and has revealed the need for updating the teaching methodologies. Active learning strategies consolidate the theoretical knowledge, while simultaneously encouraging the student´s concrete abilities. Nonetheless, remodeling the pedagogical practice is challenging. Several active learning strategies are available and selecting the most suitable one is often a matter of format, not of content. In this article, we discuss the experience of the 'Four Corners' technique in the teaching of Infectious Diseases during the internship at our institution. Experience report: The four corners strategy can be adapted to different topics and should be implemented as follows: 1. pre-activity learning: students receive the supportive material for previous analysis; 2. Preparation of the room: each of the four corners is labeled with a different case vignette; 3. Dividing tasks: the specific assignments are divided among the students; 4. Activity: the students read the case vignette and discuss the questions, while the mediator has an observer's role, and 5. Debriefing: final discussion with all participants led by the mediator. The entire process takes from 2h30 to 3 hours. Discussion: The educational process emerges from the learner´s experience. Many instructors working in higher education believe they promote critical thinking and active teaching during their classes; however, the percentage of teachers who regularly use active teaching strategies is still low. A range of different active learning strategies have been described and many can be adapted to different scenarios; most approaches change the nature of the learning experience but do not always require a change in the given subject. The Four Corners technique is an active learning strategy that promotes debate and exchange of ideas among students. Conclusion: This experience report describes an active learning strategy for the teaching of Infectious Diseases to medical students. The medical education improvement goes through highlighting the teacher's role as a mediator of the learning process; proposing new teaching strategies is challenging and requires frequent adjustments. The Four Corners strategy improves student's engagement with the learning process, and it is an efficient strategy to comprise an extensive theoretical content in a relatively short discussion time.

Resumo: Introdução: Uma extensa literatura demonstra os benefícios do ensino ativo na educação médica e a necessidade de atualização das metodologias de ensino. As estratégias de aprendizagem ativa consolidam o conhecimento teórico e estimulam as habilidades conceituais do aluno. No entanto, reformar a prática pedagógica é desafiador. Existem diversas estratégias de aprendizagem ativa que sugerem uma adaptação do formato de entrega do conteúdo, de modo a adequá-las a diversos contextos. Neste artigo, discutimos a experiência da aplicação da técnica Four Corners no ensino de doenças infecciosas em nossa instituição. Relato de experiência: A estratégia Four Corners foi implementada da seguinte maneira: 1. preparação: os estudantes recebem material de estudo para análise prévia; 2. preparação da sala: cada um dos quatro cantos recebe cartelas com os casos clínicos escolhidos; 3. divisão de tarefas: as tarefas são divididas entre os estudantes; 4. atividade: os estudantes leem e discutem cada um dos casos propostos com mínima interferência do moderador; 5. finalização: discussão final com todos os participantes liderados pelo moderador. A duração de toda a tarefa varia de duas horas e meia a três horas. Discussão: O processo educacional emerge da experiência do aprendiz. Muitos professores do ensino superior acreditam que promovem o pensamento crítico por meio do ensino ativo em suas aulas, entretanto a porcentagem dos que aplicam essas técnicas ainda é baixa. Existe uma ampla variedade de técnicas ativas de ensino, e muitas delas se adaptam a diferentes cenários. A técnica Four Corners é uma estratégia de aprendizagem ativa que promove debate e troca de conceitos entre os estudantes. Conclusão: Este relato de experiência descreve uma estratégia de aprendizagem ativa para o ensino de doenças infecciosas para estudantes de Medicina. O aprimoramento da educação médica passa por entender o papel do professor como mediador do processo de aprendizagem. Propor novas estratégias de ensino é desafiador e requer ajustes frequentes. A estratégia Four Corners melhora o envolvimento do aluno com o processo de aprendizagem e é eficiente para compreender um conteúdo teórico extenso em um tempo de discussão relativamente curto.