Inadequacies of musculoskeletal medicine curriculum for undergraduate medical students: a cross-sectional study

ABSTRACT BACKGROUND: Musculoskeletal disorders account for up to one in four of general-practice consultations and almost one third of complaints in primary-care clinical practice. However, an insufficient amount of time and importance is given to their teaching in most medical schools. OBJECTIVE: To evaluate the acquisition of musculoskeletal competences in our institution, in order to identify flaws and propose changes to correct and improve the musculoskeletal curriculum. DESIGN AND SETTING: Cross-sectional study conducted in São Paulo, Brazil. METHODS: First to fifth-year medical students were enrolled in a survey using the Freedman and Bernstein musculoskeletal examination, in order to evaluate the acquisition of musculoskeletal competencies. Categorical data were analyzed using the chi-square test. Continuous data were analyzed using one-way analysis of variance (ANOVA). The level of significance was set as P < 0.05. RESULTS: A total of 545 students completed the questionnaire: from year 2, 115/167 (29.6%); from year 3, 118/138 (30.4%); from year 4, 98/130 (25.3%); and from year 5, 57/110 (14.7%). None of the students achieved the pass mark (established as 70%). The level of confidence in performing musculoskeletal examination was very low (3.7 ± 2.2; n = 386) and bore no relationship to the percentage of correct answers in the questionnaire (r = 0.331; 95% confidence interval, CI: 0.239-0.417; P < 0.001). CONCLUSION: Undergraduate teaching is the only exposure most general practitioners have to orthopedic problems. Universities are concerned about the adequacy of the musculoskeletal programs taught in their institutions. Student scores were found to be unsatisfactory in all the topics evaluated.

Revascularizacao do miocardio atraves de tecnicas minimamente invasivas / Myocardial revascularization through minimally invasive surgical techniques

A coronariopatia e uma doenca altamente prevalente em todo o mundo, tendo assim grande importancia para a comunidade medica. O tratamento considerado mais eficaz tem sido a revascularizacao do miocardio, que pode ser feita tanto por cirurgia do tipo ponte quanto por angioplastia. No entanto, devido ao grau significativo de reestenose deste ultimo procedimento, a tecnica padrao principalmente para revascularizacao de varias coronarias ainda e a cirurgia do tipo ponte (tanto venosa quanto arterial). Ultimamente grandes esforcos tem sido realizados no sentido de tornar a cirurgia o menos traumatica possivel atraves de tecnicas minimamente invasivas. A revascularizacao do miocardio minimamente invasiva tem por objetivo oferecer os mesmos beneficios da cirurgia convencional, apresentando porem, uma menor morbidade, uma vez que evita a circulacao extra-corporea, a esternotomia mediana classica e a manipulacao aortica (fatores que estao associados a maiores complicacoes no pos-operatorio)...