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.

Caracterización del rendimiento académico de los estudiantes del plan de estudios "d" de medicina / Characterization of the academic performance of medical curriculum "d" students

Objetivo: Caracterizar el rendimiento académico de los estudiantes en el primer año del Plan de Estudios D de la carrera de Medicina en las Facultades 10 de Octubre y Salvador Allende de la Universidad de Ciencias Médicas de La Habana. Métodos: Se realizó un estudio correlacional de corte transversal a partir de las evaluaciones obtenidas por los estudiantes que cursaron las asignaturas del plan en ambas facultades durante el curso 2016-2017. Resultados: detectaron cuatro componentes principales en el conjunto de variables evaluativas del primer año de la carrera: Ciencias Básicas Biomédicas, Disciplinas Complementarias, Educación Física e Idioma Inglés. Los resultados obtenidos corroboran que las Ciencias Básicas Biomédicas constituyen para los estudiantes de Ciencias Médicas la principal dificultad docente en el logro de los objetivos planteados por el nuevo plan de estudios(AU)

Objective: To characterize the academic performance of first year medical curriculum D students at 10 de Octubre and Salvador Allende Medical Schools (Havana Medical University). Methods: A cross-sectional correlational study was carried out from the evaluations obtained by the students of the plan D in both faculties during the academic year 2016-2017. Results: Four main components were detected in the set of evaluative variables of the first year of the degree: Basic Biomedical Sciences, Complementary Disciplines, Physical Education and English Language. Conclusions: The obtained results corroborate that the Basic Biomedical Sciences constitute for the students of Medical Sciences the main teaching difficulty in the achievement of the objectives proposed by the new curriculum(AU)

An analysis of verbs used in the course outcomes of outcome-based integrated courses at a medical school based on the taxonomy of educational objectives / 한국의학교육

PURPOSE: The purposes of this study were to analyze the course outcomes of integrated courses of a medical school that introduced an outcome-based curriculum and to suggest ways to improve techniques in the description of outcomes. METHODS: In order to investigate the course outcomes of 39 courses in the first and second grades at Kyungpook National University School of Medicine in Korea, verbs for the course outcome were classified according to Bloom’s taxonomy and frequency analysis was completed. The appropriateness of use of verbs in description of the outcomes was also analyzed. RESULTS: The total number of course outcomes for both grades was 497. The number of course outcomes per credit ranged from a minimum of 0.9 to a maximum of 22.0. Most of the course outcomes were classified as the comprehension domain according to Bloom’s taxonomy. The most frequently used verb was “explain,” accounting for 61.0% (n=303) of the entire course outcome verbs. Some verbs in the outcomes, however, were unmeasurable. CONCLUSION: The major findings of this study include the followings. First, the number of course outcomes varied according to courses. Second, several course outcomes included unmeasurable verbs. Finally, most of the verbs used to describe course outcome belonged to the two lower levels of Bloom’s taxonomy—knowledge and comprehension. In order to improve the description of course outcomes, this study suggests that it is necessary to adjust the number of course outcomes, applicate overt behavior verbs, and elevate the level of course outcomes from the lower memorizing level to the higher application level.

Abordagem da Violência contra a Mulher no Ensino Médico: um Relato de Experiência / Addressing Violence against Women in Medical Education: an Experience Report

RESUMO Trata-se de um relato de experiência sobre a incorporação do tema da violência contra a mulher no ensino médico. O objetivo do estudo foi descrever as correntes teóricas explicativas da violência contra a mulher e as formas de intervenção apreendidas pelos estudantes. Foram realizados dez encontros semanais com um grupo de 12 estudantes e desenvolvidas as seguintes atividades: (a) leitura de um caso de uma mulher em situação de violência, busca na literatura científica; (b) visitas a serviços de atenção primária à saúde e ao Centro de Referência Especializado de Assistência Social; (c) sistematização dos dados teóricos e práticos para construção do planejamento estratégico; (d) apresentação das atividades realizadas aos demais grupos de alunos. Ao final do módulo, destacou-se o aprendizado de quatro aspectos importantes das implicações do tema para a saúde das mulheres: (a) influência dos fenômenos socioculturais e psicossociais no processo saúde-doença; (b) importância da integralidade no atendimento; (c) a estratégia de saúde da família como facilitadora na detecção e acompanhamento dos casos; (d) violência contra a mulher como um problema de saúde pública pertinente na formação médica.

ABSTRACT The following article is an experience report on the incorporation of the theme of violence against women in the medical curriculum. The objectives of this study were to describe the theoretical framework of the theme of violence against women and to identify the learning activities acquired by students. The module activities were developed throughout 10 weekly meetings with groups of 12 students, and are as follows: (a) read a study case of a woman in a violent situation and perform a literature review; (b) conduct visits to Primary Health Care Services and a Specialized Reference Center for Social Assistance; (c) systematize theoretical and practical data for strategic planning; and (d) present the activities developed to other student groups. At the end of the module, four relevant learning activities were identified in terms of women’s health: (a) the influence of socio-cultural and psychosocial phenomena in the health-disease process; (b) the importance of comprehensive care; (c) the Family Health Strategy as a facilitator in detecting and monitoring cases; and (d) violence against women as a relevant public health problem in the medical curriculum and training.

Violencia intrafamiliar y abuso sexual: ¿Cómo integrarlos al círculo de pregrado de medicina? / Domestic violence and sexual abuse: How to integrate them into undergraduate circle of medicine?

: Las cifras chilenas sobre abuso sexual (AS) y violencia al interior de las familias (VIF) son altísimas y transversales a todo estrato social. Un 25,9 por ciento de los niños ha sido víctima de violencia grave en sus hogares (patadas, puñetazos, mordeduras, quemaduras, agresiones con armas) y un 8,7 por ciento refiere haber experimentado AS. Un tercio de las chilenas ha sufrido VIF, cifra que se tradujo en 45 mujeres fallecidas el año 2015. Los médicos están en una posición única para identificar víctimas y romper el ciclo de violencia, sin embargo su formación al respecto es mínima. El Instituto de Medicina de Estados Unidos plantea que el medio más eficaz para mejorar la respuesta a VIF es la educación de los médicos, y ha llamado a que las facultades entreguen las competencias necesarias a sus estudiantes. Distintas Escuelas de Medicina de EEUU y Canadá ya lo están haciendo; en Chile esto aún no ocurre. Entre 2013 y 2014, mediante un Proyecto FONDEDOC revisamos la formación actual de los estudiantes de medicina en pesquisa y abordaje inicial de pacientes víctimas de VIFAS, y generamos una propuesta para fortalecer el desarrollo de competencias afines en el currículo de pregrado. Este artículo presenta los productos finales de ese proyecto. Se discute sobre la discordancia entre la magnitud del problema en Chile y la formación actual de nuestros médicos, se entrega un listado de competencias básicas para pesquisar y brindar una primera respuesta, y se ofrece una propuesta para fortalecer el currículo de pregrado en esta área. (AU)

The figures on sexual abuse and domestic violence are very high in Chile and they cut across the whole span of socioeconomic classes. 25.9 percent of children have suffered severe violence at home (kicks, punches, bites, burns, weapon agressions) and 8.7 percent refer having experimented sexual abuse. One third of Chilean women have suffered domestic violence, which translates in 45 women dying for this cause during 2015. Doctors are in a unique positoin to identify victims and to cut the violence cycle, however their training on this regard is scarce. The Institute of Medicine of the USA postulates the most effective way of improving the response to domestic violence is educating doctors, and has made a call to faculties to provide the competencies needed to their students. Several medical schools in USA and Canada are already doing so; in Chile this is not happening yet. Between 2013 and 2014 through a FONDEDOC project we reviewed the existing curriculum of Medical School in relation to identifying and to initially approach patients suffering domestic violence-sexual abuse, and we generated a proposal to strengthen the development of pertinent competencies in undergraduate curriculum. This article exposes the product of this project. The discrepancy between the magnitude of the problem in Chile and the current training of our doctors is discussed. A list of basic competencies to identify and deliver the first response is presented, and a proposal to strengthen undergraduate curriculum in this area is offered.(AU)

A Escola Médica de Pádua: medicina e filosofia no período moderno / The Paduan School of Medicine: medicine and philosophy in the modern era

Trata-se de contribuição parcial ao entendimento da história da recepção e transmissão dos textos clássicos hipocráticos e galênicos na Itália do período moderno. Observando-se rotuli e puncti da Escola Médica da Universidade de Pádua, que registram as disciplinas e os conteúdos ministrados no período compreendido entre 1500 e 1600, pode-se conhecer o currículo oficial dessa famosa escola. A consulta a tais documentos mostra o compromisso da formação médica oficial com a tradição, em especial com Hipócrates, Galeno, Avicena e Aristóteles.

Mudanças curriculares no ensino médico brasileiro: um debate crucial no contexto do Promed / Curricular changes in brazilian medical education: a crucial discussion in the context of Promed

A educação médica passa por modificações na doutrina e na prática da formação profissional, conectada à contemporaneidade do mundo globalizado. No contexto do Sistema Único de Saúde (SUS), aumenta o interesse de diferentes sujeitos em relação ao ensino médico, devido aos aspectos políticos e comunitários e com repercussões nas mudanças nos serviços de saúde. Iniciativas de incentivo às mudanças curriculares em medicina são adotadas para incrementar melhorias na formação médica. Nesse contexto se insere o Projeto de Incentivo a Mudanças Curriculares para os Cursos de Medicina (Promed). Com o objetivo de analisar a percepção de alunos sobre mudanças curriculares na educação médica, pesquisamos seis cursos médicos, em três estados brasileiros, usando questionários e entrevistas. Alguns pressupostos das Diretrizes Curriculares Nacionais não foram incrementados, mas o desdobramento do Promed possibilitou um programa ampliado de incentivos a mudanças curriculares. Mesmo tendo caráter exploratório, este estudo aponta a necessidade de estudos prospectivos para conhecer os impactos dos incentivos às mudanças curriculares do ensino médico, sintonizando-o, assim, com as necessidades de saúde da população.

Medical Education is undergoing modifications in the doctrine and in the practice of professional education as a consequence of today's globalized world. With respect to the Brazilian Health System, different subjects show increasing interest in medical education and in changes in the healthcare services. There are initiatives for encouraging changes in the medical curriculum for improving medical education. The Program for the Encouragement of Curricular Changes in Medical Courses (Promed) was implemented in this context. In order to analyze the opinion of students about changes in the curriculum of the medical course, we studied six medical schools in three Brazilian states, using questionnaires and interviews. Some of the propositions of the National Curriculum Guidelines have not been met but Promed gave rise to a new extensive program of changes in the medical curriculum. Even having exploratory character, this work clearly indicates the need for prospective studies in order to know the impact of Promed on medical education for adapting it to the healthcare needs of the population.

An Evaluation on the Effectiveness of K University Education of Medicine by Graduates at Practice / 한국의학교육

Most of the medical schools are confronted with various changes to medical curricula in Korea. Some of them already established a steering group to plan a new curriculum. The study's target is the graduates who had undertaken their 6 year-medical course of Medical School at K University. The purpose of the study is to ascertain how well the medical course they had undertaken had equipped them for practice. The questionnaire explored the level of factual content, the adequacy of their skills training, and the development of attitudes and personal attributes during the course. A total of 204 graduates replied, a response rate of 67.5%. The results can be summarized as follows. The graduates' views on the preclinical course they had undertaken at school of medicine show that they felt there were 'too much' anatomy, biochemistry, and pathology. Their views on the clinical course were shown relatively to be adequate level of factual content in comparison with preclinical course. The graduates' views were also sought concerning the help they had received in acquiring certain skills during their education. Only in the area of 'History-taking' and 'Physical examination' did most feel that the skills had been 'well covered' or 'partially covered'. A part of the survey focused on the attitudes and personal attributes that it was hoped medical students would have acquired by the time they qualified. In most cases the respondents did feel that they had acquired the 15 items' attributes listed, at least partially, by the time they had qualified.

Review of Medical Curriculum in Post-graduate Course of Korea / 한국의학교육

Medical curriculum of post-graduate course was reviewed to identify current problems and to seek the alternatives for better education for 23 universities. The major findings are as follows: The avera ge number of post-graduate students is 120 in the master's course and 94 in the doctor's course. In only four out of 23 universities, the educational aims and objectives of post-graduate course in medicine are clearly defined in written form. Classroom teaching was given to the students in forms of formal lecture, conference, seminar, discussion and so on. Only eight universities give a lecture regularly according to the lecture schedule. Some universities offer lectures in the evening or in the weekend for the students' convenience. In about 50% of universities, students were evaluated through a set of written exam, oral test, report, presentation and discussion. Obligation of thesis presentation was prescribed in 20 universities of the master's course and in 22 universities of the doctor's course. The students of all 23 universities of master's course and 22 of doctor's course have to pass comprehensive exam for the graduation of the course. For completing doctor's course, the students of 22 universities (97%) still have to pass the secondary foreign language test. In more than 70% of universities, associate professors and assistant professors with doctor's degree are allowed to supervise and examine the thesis. Based on the above results, establishment of educational aims and objectives, reinforcement of teaching and learning activities, modification of foreign language test for entrance and graduation the course, and increase in faculty members and research funds should be needed for the improvement of post-graduate program in medicine.