Experiência da atenção integral à saúde individual e familiar com enfoque na responsabilização, vínculo médico-paciente, ética e profissionalismo no Currículo Médico Integrado / The experience with comprehensive individual and family healthcare with a focus on accountability, the physician-patient relationship, ethics, and professionalism in the Integrated Medical Curriculum

INTRODUÇÃO: Visando atualizar suas práticas pedagógicas, atender as exigências da comunidade, da reestruturação do sistema de saúde e os avanços tecnológicos, a Faculdade de Ciências Médicas da Universidade Estadual de Campinas implementou uma grande reforma curricular para alunos ingressantes de 2001. OBJETIVO: Descrever uma experiência de ensino voltada à integração dos conhecimentos para atenção aos indivíduos nas diversas fases da vida, dentro da realidade de assistência primária à saúde, com ênfase no conhecimento, nas habilidades clínicas, na responsabilização e nas atitudes humanísticas e éticas. MÉTODOS: No novo currículo, a integração intra, inter e transdisciplinar foi estruturada em módulos interdepartamentais, inserção progressiva das disciplinas clínicas, contato mais cedo e progressivo do aluno com a sistema de saúde, preservando módulos integradores horizontais e verticais. A iniciação da prática clínica em Centros de Saúde tem, no quarto ano, 432 horas destinada a atendimentos clínico-ambulatoriais de assistência à criança, à mulher, ao adulto e ao idoso num contexto de saúde da família. A supervisão é realizada por professores, médicos assistentes da Faculdade e tutores selecionados entre os profissionais da rede primária de saúde. O Programa Nacional de Reorientação da Formação Profissional em Saúde Pró-Saúde facilitou a inserção e a parceria do curso de medicina com as UBS. O conteúdo teórico é integrado em seminários ministrados em dois períodos semanais e avaliado por meio de provas teóricas (conhecimento cognitivo). As habilidades e competências nas atividades clínicas são avaliadas por meio de discussões teórico-práticas quinzenais ao longo do estágio, avaliações clínicas estruturadas de atendimentos à criança, mulher e adulto, além da composição de portfólio com planilha de atendimentos totais, casos selecionados para revisão e auto-crítica de aprendizado. RESULTADOS: O módulo foi avaliado na forma de fóruns semestrais de discussão, com participação de discentes, docentes, tutores e gestores. Os grupos foram unânimes em considerar plenamente atingidos os objetivos de responsabilização, vínculo e ética, e parcialmente atingida a integração dos conteúdos teórico-práticos e trabalho em equipe. CONCLUSÃO: O currículo integrado propiciou uma visão clínica abrangente da família. Permitiu que o estudante se responsabilizasse e criasse vínculo com o paciente, entendendo a resolutividade e demandas da atenção básica à saúde por meio de sua vivência.

INTRODUCTION: In order to update its teaching practices and meet the community's needs and restructuring of the health system and technological advancements, the School of Medical Sciences at the State University in Campinas implemented a major curricular reform for incoming students in 2001. OBJECTIVE: Describe a teaching experience focused on the integration of knowledge for individual care in the various life phases, within the reality of primary healthcare, with an emphasis on knowledge, clinical skills, accountability, and humanistic and ethical attitudes. METHODS: In the new curriculum, intra-, inter-, and cross-disciplinary integration was organized in inter-departmental modules, progressive participation in clinical disciplines, students' earlier and progressive contact with the health system, maintaining horizontally and vertically integrated modules. Initiation in clinical practice in Health Centers in the fourth year of school, with 432 hours dedicated to outpatient clinical care for children, women, adults, and the elderly in the context of family health. Supervision is provided by faculty, clinical staff from the medical school, and tutors selected from among the primary healthcare system staff. The National Program for Reorientation of Professional Training in Health (Pró-Saúde) facilitated participation and partnership between the medical school and the primary care units. Theoretical content is provided in seminars during two weekly periods, with grading based on written tests (cognitive knowledge). Skills and competencies in clinical activities are evaluated by means of theoretical and practical discussions every other week throughout the internship, structured clinical evaluations of care provided to children, women, and adults, in addition to the portfolio composition with the total number of consultations, selected cases for review, and self-criticism of the learning process. RESULTS: The module was evaluated through discussion forums held once a semester with students, professors, tutors, and administrators. The groups agreed unanimously that the project had fully achieved the goals of accountability, bonds, and ethics, having partially achieved the integration between theoretical and practical course content and teamwork. CONCLUSION: The integrated curriculum fostered a comprehensive view of the family. It allowed students to take responsibility and create ties with patients, understanding the service's case-resolution capacity and demands of primary care through their direct experience.

Student perceptions’ of the educational environment in the midst of curriculum change.

The Faculty of Medicine University of Indonesia underwent a major curriculum reform in 2005. There is a necessity to evaluate the new curriculum’s educational environment, as a part of the curriculum evaluation. In June 2007, the DREEM (Dundee Ready Education Environment Measure) was administered to 210 second year students with an innovative curriculum and 259 third year students with the more traditional curriculum, to measure the students’ perceptions of the educational environment. One of the most significant differences between the perceptions of the two groups is that there are less cheating problems in the second year, but the third year is better timetabled. The almost similar profiles indicate that the new curriculum’s educational environment has not improved significantly. It is related with problems in managing and organizing the new curriculum’s detail aspects. The institution needs to re-evaluate the perceptions of the educational environment when the curriculum is more internalised.

Study on the Medical Humanities and Social Sciences Curriculum in Korean Medical School: Current Teaching Status and Learning Subjects / 한국의학교육

PURPOSE: We did this study to find out the current teaching status of the medical humanities and social sciences curriculum in Korean medical schools. Further, we discuss the tasks at hand to improve the curriculum in medical education. METHODS: The curricula of 41 medical schools and the syllabi of 10 schools were examined. We analyzed the tables of course organization and contents of integrated medical humanities. After analysis of the contents, they were grouped into 6 categories of medical humanities and social sciences domain. RESULTS: Our results are as follow: 1) there are 3 types of medical humanities and social sciences subject forms: inter-disciplinary (integrated, for example, PDS), multi-disciplinary (separated subject form), and mixed (integrated+separated); 2) most schools offer medical humanities and social sciences in a required class; 3) medical humanities and social sciences are taught through all school years and all 8 graduate medical schools offer a medical humanities and social sciences course from year 1; and 4) the average academic credits for medical humanities are 10 or 11. With respect to the curriculum content, there is some commonality in 10 schools: disease prevention, health improvement, medical ethics, medical regulation, professionalism, and community medicine. Differences were seen in content selection and organization. CONCLUSION: After brief reviews of the medical humanities and social science curriculums, we discovered that all Korean medical schools meet the need of medical humanities and social sciences education. However, curriculum implementation differed in various ways. We suggest the following tasks: 1) clarification of educational goals in order to develop a core curriculum of medical humanities and social sciences in Korea; 2) sharing experiences of developing a well-designed curriculum with other medical schools for effective teaching of this subject area.

Efeitos da mudança curricular: características do aprendiz e desfechos da aprendizagem

Resumo: Um estudo comparativo foi realizado envolvendo a grande maioria dos estudantes de currículo em desativação e de novo currículo em implantação, no curso de Medicina da Universidade de Brasília. Foram comparadas as características motivacionais dos alunados e os desfechos da aprendizagem no pré-clínico. Três diferenças significantes foram observadas: estudantes do currículo em desativação apresentavam maior nível de autoconfiança, enquanto a motivação para aprender era maior nos alunos do novo currículo; ademais, os escores da significação percebida do aprendizado (durante o pré-clínico) eram mais elevados no alunado do novo currículo. Não houve diferenças significante de rendimento acadêmico (média geral) entre os dois grupos na iniciação clínica, nem nas preferências por carreira dos estudantes. Os achados indicam que a reestruturação curricular no pré-clínico não afetou o nível de conhecimento aplicado, embora as percepções iniciais da significação do aprendizado tenham sido mais positivas entre os alunos do novo currículo. Essas percepções são influenciadas por várias características motivacionais individuais.

Summary: An evaluation study was undertaken to compare data of students in two medical curriculum tracks at the Universily of Brasilia. Pre-clinical motivacional characterislics and learning outcomes were compared. Some significant differences were observed: students in the standing curriculum showed higher level of self confidence while motivation to learn was higher among students in the new curriculum. Also, the scores of perceived meaningfulness of learning were higher in the new curriculum. There were no significant differences between student groups in grade point averages of clinical clerkships or in career preferences. The finings suggest that the change in curriculum structure has not affected students applied knowledge as they started the clinical phase, although they showed more positive perceptions of their pre-clinical experience. Such perceptions were influenced by many motivational characteristics.

Innovative Approaches to Curriculum Changes in Medical Schools in Japan / 医学教育

I briefly summarized major innovative movements and events in medical education in Japan during the last 25 years. We recognized that constant efforts have been exerted and resulted in changes in manyaspects of medical education in our country.<BR>Traditional medicine is rapidly changing, developing and expanding to more sophistication and integration. The world is changing, thus the needs for medicine and medical care are different from even those several years ago. To update medical education in order to meet social needs and demands, we have to install a device which constantly renews ourselves in each school and in the government. Both governmental and non-governmental approaches in cooperation seem to be necessary in our country. I have shown our non-governmental efforts from various sources. We recognize that our thinking and discussions in an environment of freedom have contributed a great deal to national decision making.

Meaning of Curriculum Change / 한국의학교육

There have been quite active discussions on the revision or improvement of medical education curriculum recently more than ever before in Korea influenced by the results of the National Medical Licens ing Examination for the last 2 years and consequently attempts to revise medical education curriculum became in vogue. Efforts to improve curriculum further became imperative with the introduction of university grade evaluation scheme. But, there appears quite a big discord or confusion in the real broad meaning of curriculum improvememt since curriculum changes mainly aim at raising the passing rate of the medical school graduates in the National Medical Licensing Examination in most cases. It is quite obvious that the main purpose of the National Medical Licensing Examination and the national university grade evaluation scheme is to produce medical doctors who are capable of performing primary health care and this purpose also meets the policy guidelines of the WHO. It, therefore, is very clear that the curriculum revision or improvement should not be focused on or aimed at only raising the passing rate of the medical school graduates in the National Medical Licewnsing Examination as it only has a very narrow sense of meaning.