Simulação realística como estratégia de ensino na graduação médica: uma revisão sistemática / Realistic simulation as a teaching strategy in medical undergraduation: a systematic review

Objetivo: avaliar a eficácia da simulação realística (SR) na graduação em medicina com base no conhecimento adquirido e na melhoria do desempenho clínico e analisar a percepção dos estudantes quanto à aplicabilidade do método como ferramenta de ensino. Métodos: foi realizada uma revisão sistemática de artigos científicos nas bases de dados PubMed, Lilacs e SciELO, em inglês e português, publicados no período de 2015 a 2020, utilizando a seguinte estratégia de busca: (simulation training OR simulation patient) AND (students medical AND education, medical, undergraduate). Resultados: dos 261 artigos identificados, apenas sete atenderam aos critérios de inclusão e exclusão estabelecidos, 57,2% deles com baixo ou moderado nível de evidência. Todos demonstraram que a SR promove modificações positivas no processo de construção acadêmica dos estudantes, contribuindo para o desenvolvimento de habilidades e competências essenciais para a formação médica. Além disso, houve majoritária percepção positiva dos estudantes quanto à utilização da SR como método de ensino durante a formação médica. Conclusão: houve evidências de eficácia da SR na aprendizagem e favorável percepção dos estudantes de medicina quanto à sua utilização. Todavia, os desafios relativos à sua implantação e execução, bem como o restrito número de artigos de alto rigor metodológico, limitam a inferência inequívoca de sua eficácia na educação médica.

Aims: to evaluate the effectiveness of realistic simulation (RS) in medical graduation based on the knowledge acquired and on the improvement of clinical performance, and to analyze the students' perception regarding the applicability of the method as a teaching tool. Methods: a systematic review of scientific articles was carried out in the PubMed, Lilacs and SciELO databases, in English and Portuguese, published from 2015 to 2020, using the following search strategy: (simulation training OR simulation patient) AND (students medical AND education, medical, undergraduate). Results: of 261 identified, only seven met the inclusion and exclusion criteria (57.2% with a low or moderate level of scientific quality). All of them demonstrated that RS promotes positive changes in the students' academic construction process, contributing to the development of essential skills and competences for medical education. In addition, there was a majority positive perception of students regarding the use of RS as a teaching method during medical training. Conclusion: there was evidence of the effectiveness of RS in learning and favorable perception of medical students regarding its use. However, the challenges related to its implementation and execution, as well as the limited number of articles of high methodological rigor, limit the unequivocal inference of its effectiveness in medical education.

Interspecies comparative morphological evaluation of the corneal epithelial stem cell niche:a pilot observational study

Background@#The corneal and limbal morphology relevant to corneal epithelial maintenance in ten different species was examined using histological methods. @*Objectives@#The presence of a Bowman’s layer, limbal epithelial cell, and superficial stromal morphology was examined in the following species to evaluate the differences in corneal thickness and epithelium: Java sparrows, frogs, macaws, spoonbills, red pandas, penguins, horses, Dobermans, orangutans, and humans. @*Methods@#Corneal sections (4 µm) were obtained from ten ocular globes from three different animal classes: Aves, Amphibia, and Mammalia. All sections were stained with hematoxylin and eosin and periodic acid-Schiff reaction. After microscopy, all stained slides were photographed and analyzed. @*Results@#Significant morphological differences in the corneal and limbal epithelia and their underlying stroma between species were observed. The number of corneal epithelial cell layers and the overall corneal epithelial thickness varied significantly among the species.The presence of a Bowman’s layer was only observed in primates (orangutans and humans).Presumed supranuclear melanin caps were noted in four species (orangutans, macaws, red pandas, and horses) in the limbal basal epithelial layer (putative site of corneal epithelial stem cells). The melanin granules covered the apex of the cell nucleus. @*Conclusions@#Supranuclear melanin capping has been described as a process within the epidermis to reduce the concentration of ultraviolet-induced DNA photoproducts. Similarly, there may be a relationship between limbal stem cell melanin capping as a protective mechanism against ultra-violet radiation.