Estudos sobre a formação em pesquisa na educação médica: um estado da questão / Studies on research training in medical education: a state of the question

Resumo: Introdução: É notória a crescente importância dada à formação em pesquisa na educação médica por todo o mundo, o que é refletido na crescente produção científica com essa temática. Nesse cenário, o estado da questão (EQ) surge como uma ferramenta de produção bibliográfica que promove um panorama das pesquisas produzidas sobre um determinado tema, sendo capaz de proporcionar uma maior aproximação ao objeto de pesquisa e uma estimativa dos avanços que a pesquisa naquele campo pode alcançar. Objetivo: Este estudo teve como objetivos identificar as investigações feitas sobre a formação em pesquisa na educação médica e classificá-las considerando o local, o tipo e as intencionalidades delas. Método: Trata-se de um EQ cujo objeto de estudo é a formação em pesquisa na educação médica. Utilizaram-se descritores relacionados à formação em pesquisa e à educação médica nos idiomas português, espanhol e inglês. Foram pesquisadas duas bases de dados para dissertações e teses nacionais (Biblioteca Digital de Teses e Dissertações e Catálogos de Teses e Dissertações da Capes) e duas bases de dados para periódicos científicos internacionais (Portal de Periódicos da Capes e PubMed). Resultado: Identificaram-se 33 artigos científicos de 17 países de cinco continentes. Quatro trabalhos (12%) apresentavam-se como artigos de opinião em que os autores teorizavam sobre a importância da inserção de elementos da pesquisa nos níveis curricular e disciplinar. Sete artigos (21%) retrataram, por meio de relatos de casos, as modificações estruturais e os percursos traçados em suas instituições, assim como as implicações dessas ações na educação médica e no processo educativo. Os demais 22 artigos (67%) documentavam pesquisas empíricas com diversas intencionalidades, sendo a temática mais recorrente a identificação dos fatores que influenciam a busca do corpo discente pela participação em pesquisa. Conclusão: A formação em pesquisa na educação médica conta com um corpo de pesquisadores qualificados e periódicos especializados para sua veiculação em nível global. Ressaltamos que, a partir das buscas realizadas, não foram encontrados estudos no contexto de teses e dissertações, tornando este um campo aberto para pesquisadores aprofundarem e acumularem conhecimento.

Abstract: Introduction: The growing importance given to research training in medical education globally is notorious and reflects the growing scientific production on this topic. In this scenario, the state of the question (EQ) emerges as a bibliographic production tool that promotes an overview of the re-search produced on a given topic, being able to provide a closer approach to the research object and to estimate the possible advances that research in that field can reach. Objective: This study aimed to identify what has been studied about research training in medical education and classify them considering the location, type, and intentions of the research. Method: This is a EQ whose object of study is research training in medical education. Descriptors related to research training and medical education in Portuguese, Spanish, and English were used. Two databases for national dissertations and theses (Biblioteca Digital de Teses e Dissertações and Catálogos de Teses e Dissertações da Capes) and two databases for international scientific journals (Portal de Periódicos da Capes and PubMed) were searched. Result: We identified 33 scientific articles from 18 countries on all continents. Four articles (12%) were presented as opinion articles where the authors theorized about the importance of inserting research elements at the curricular and disciplinary level. Seven articles (21%) portrayed, through case reports, the structural changes and the paths traced in their institutions, as well as the implications of these actions in medical education and the educational process. The remaining 22 articles (67%) documented empirical research with different intentions, with the most recurrent theme being the identification of factors that influence the student body's search for participation in research. Conclusion: Research training in medical education has a body of qualified researchers and spe-cialized periodicals for its dissemination on a global level. We emphasize that no studies were found in the context of theses and dissertations, making this an open field for researchers to deepen and accumulate knowledge.

"Bread and butter" fibrinous pericarditis

Pericarditis is the inflammatory process involving the pericardium as a result of a systemic disease or a primary pericardium disorder.1 The actual incidence of pericarditis is difficult to ascertain,2 most probably because of under-reported or misdiagnosed cases. In the 19th century, Sir William Osler stated that pericarditis was one of the most serious diseases overlooked by practitioners.3 Even so, the rate of hospitalization by this diagnosis is estimated in 3.32 cases per 100,000 person-years, which corresponds to 0.2% of all causes of hospitalization in cardiology centers,4 with an incidence of 1.06% found in autopsy case series.5 Didactically, pericarditis can be morphologically classified in five types: (i) fibrinous; (ii) serous; (iii) purulent; (iv) hemorrhagic; or (v) caseous.6 The image presented herein refers to a typical fibrinous pericarditis, also known as "bread and butter" pericarditis.7 In such an entity, the pericardium, which is regularly smooth and bright, becomes opaque and granular, and macroscopically resembles two pieces of buttered bread pressed together then pulled apart. The histology shows the deposition of fibrin and leukocytic exudate involving the pericardial leaflets.8 Antonio Benivieni (1443-1502), a Florentine physician and a contemporary of Leonardo da Vinci, was assigned the first description of fibrinous pericarditis. However, René Laennec (1781-1826), also known for creating the stethoscope, was the first to register the analogy of this type of pericarditis with "buttered bread"9 in his book, A Treatise on the Diseases of the Chest and on Mediate Auscultation.10 The image presented in Figure 1 was obtained during the autopsy of a 25-year-old man who presented a 5-day history of high-grade fever, odynophagia, chest pain, and bloody sputum. He was hospitalized presenting marked leukocytosis with blasts in the peripheral blood smear and died 14 days later due to multiple organ failure. The autopsy revealed fibrinous pericarditis with a brighter yellow exudate than usual (probably due to hyperbilirubinemia, with direct and indirect bilirubin levels of 4.61 mg/dL and 2.07 mg/dL, respectively), lungs with "beefy red consolidation" due to alveolar edema, hemorrhage, hyaline membrane, and diffuse neutrophilic infiltrate. The patient's bone marrow was hypercellular at the expense of immature myeloid cells with areas of necrosis. The immunohistochemical study evidenced diffuse positivity for myeloperoxidase; CD117-positivity for 30% of the viable cells; CD34-positivity for 1% of the viable cells; and negativity for the terminal deoxynucleotidyl transferase­all of which were consistent with the diagnosis of M3 acute myeloid leukemia (French-American-British classification).11 Acute myocardial infarction, trauma/surgery, infection, uremia, systemic diseases, and neoplasia are among the most common causes of fibrinous pericarditis. Among the neoplasia, lung and breast malignancies stand out, followed by lymphomas and leukemia,12 although pericardial infiltration by nonlymphocytic leukemia is rarer.13 In a large case series of 420 postmortem examinations of the heart in acute leukemia,14 only 20 patients had symptoms of heart disease in life, and 9 of them had pericarditis at autopsy. In only 2 of the 9 patients, the pericarditis was the result of leukemic cell infiltrates into the pericardium; in 4 patients it was hemorrhagic; and in 2 it was pyogenic. Only 1 case remained with uncertain etiology, being fibrinous and unassociated with pericardial leukemic infiltrates, hemorrhages, or organisms, which also occurred in our case. The histopathologic study of the pericardium failed to reveal neoplastic cells, microorganisms, and viral inclusion; therefore, the precise etiology of the pericardial disease was not disclosed.

Formação para a Estratégia Saúde da Família na Graduação em Medicina / The Family Health Strategy in Undergraduate Medical Training

A adoção da Estratégia Saúde da Família (ESF) como modelo de reorientação da Atenção Básica tornou necessário um novo tipo de profissional médico. Este estudo objetiva analisar a formação médica adquirida na graduação em Medicina para o desenvolvimento das ações exigidas pela ESF e identificar lacunas dessa formação.Foram conduzidas entrevistas semiestruturadas com 37 médicos residentes de Medicina de Família e Comunidade de unidades de saúde de Fortaleza (CE)de setembro a dezembro de 2007. Os depoimentos foram categorizados e apreciados mediante a técnica de Análise de Conteúdo. Observou-se que já ocorrem mudanças na formação médica, embora ainda haja muitas lacunas a preencher. Novos currículos,mais voltados para a Atenção Básica, permitiram que os médicos recém-formados se sentissem mais preparados para atuar na ESF, ao contrário dos profissionais formados em currículos antigos.

The adoption of the Family Health Strategy (FHS) as a model for reorientation of primary care has demanded a new kind of medical professional. Our study aims to analyze undergraduate medical training in terms of developing the actions required by the FHS, and to identify gaps in undergraduate training. We conducted semi-structured interviews with 37 resident-doctors of Family and Community Medicine at health centers in Fortaleza-CE between September and December 2007, and their statements were categorized and assessed using the content analysis method. We observed that changes are already occurring in medical training, with many gaps still to be filled, and that new curricula more focused on primary care have allowed doctors to feel more prepared to act in the FHS, in contrast to the graduates in former curricula.

Integração ensino-pesquisa na educação médica: perfil docente de um colegiado / Teaching-research integration in medical education: teaching staff profile of a college

A formação em pesquisa é um elemento importante para o preparo de médicos com perfil crítico-reflexivo. Tendo o docente como pesquisador-orientador, o aluno une teoria e prática, ensino e pesquisa, adquirindo preparação adequada para sua futura ação profissional. Foi realizado um estudo de caso, descritivo, de abordagem quantitativa, onde buscamos identificar, no curso de graduação em Medicina da Universidade Estadual do Ceará, o perfil dos docentes que desenvolvem atividades de pesquisa integradas às didáticas. Para caracterizar esses profissionais foram utilizadas as variáveis: formação na graduação, ciclo em que lecionam as disciplinas e regimes de contratação. Concluímos que a participação em pesquisa é maior entre os docentes não médicos, que lecionam no ciclo básico e que possuem dedicação exclusiva. Acreditamos que a menor participação em pesquisa entre docentes médicos e que atuam no ciclo profissional decorra principalmente da alta proporção desses docentes com vinculação de apenas 20 horas à universidade. A contratação de professores com maiores vínculos e a inserção da pesquisa no currículo principal podem contribuir na formação em pesquisa e, portanto, aprimorar a formação de médicos críticos e reflexivos.

Research training is important for the preparation of physicians with a critical and reflective profile. Having the teacher as researcher-mentor, the student combines theory and practice, teaching and research, acquiring adequate preparation for their future professional activity. We conducted a descriptive case study, using a quantitative approach, in which we sought to identify the profile of teachers who combine research and learning activities at the Ceará State University School of Medicine. To characterize these professional the following variables were used: undergraduate education; cycle in which their disciplines are taught, and time dedication regime of employment. We concluded that research participation is higher among teachers: with non-medical degrees; who lecture in the basic cycle; and with exclusive dedication. We believe that the lower participation in research among medical and professional cycle teachers results mainly from the high proportion of these teachers with only 20 class hours at the university. Hiring teachers with greater time commitment and integrating research into the core curriculum are factors that could contribute toward improving research training and, therefore, the qualification of critical and analytically minded physicians.