Teaching skills for medical residents: are these important? A narrative review of the literature

ABSTRACT BACKGROUND: There is extensive evidence, mainly from the United States and Canada, that points towards the need to train medical residents in teaching skills. Much of the "informal curriculum", including professional values, is taught by residents when consultants are not around. Furthermore, data from the 1960s show the importance of acquiring these skills, not only for residents but also for all doctors. ­Teaching moments can be identified in simple daily situations, like discussing a clinical situation with patients and their families, planning patients' care with the healthcare team or teaching peers and medical students. The aim here was to examine the significance of resident teaching courses and estimate the effectiveness of these courses and the state of the art in Brazil. METHODS: We conducted a review of the literature, using the MEDLINE, PubMed, SciELO and LILACS databases to extract relevant articles describing residents-as-teachers (RaT) programs and the importance of teaching skills for medical residents. This review formed part of the development of a doctoral project on medical education. RESULTS: Original articles, reviews and systematic reviews were used to produce this paper as part of a doctoral project. CONCLUSIONS: RaT programs are important in clinical practice and as role models for junior learners. ­Moreover, these educational programs improve residents' self-assessed teaching behaviors and teaching confidence. On the other hand, RaT program curricula are limited by both the number of studies and their methodologies. In Brazil, there is no such experience, according to the data gathered here, except for one master's thesis.

Factors influencing the decision to pursue emergency medicine as a career among medical students in Singapore

<p><b>INTRODUCTION</b>The introduction of the residency programme in Singapore allows medical students to apply for residency in their graduating year. Our study aimed to determine the interest levels and motivating factors for pursuing emergency medicine (EM) as a career among medical students in Singapore.</p><p><b>METHODS</b>A self-administered questionnaire was distributed to Year 1-5 medical students in 2012. Participants indicated their interest in pursuing EM as a career and the degree to which a series of variables influenced their choices. Influencing factors were analysed using multinomial logistic regression.</p><p><b>RESULTS</b>A total of 800 completed questionnaires were collected. 21.0% of the participants expressed interest in pursuing EM. Perceived personality fit and having done an elective in EM were strongly positive influencing factors. Junior medical students were more likely to cite the wide diversity of medical conditions and the lack of a long-term doctor-patient relationship to be negative factors, while senior medical students were more likely to cite personality fit and perceived prestige of EM as negative factors.</p><p><b>CONCLUSION</b>Careful selection of EM applicants is important to the future development of EM in Singapore. Our study showed that personality fit might be the most important influencing factor in choosing EM as a career. Therefore, greater effort should be made to help medical students explore their interest in and suitability for a particular specialty. These include giving medical students earlier exposure to EM, encouraging participation in student interest groups and using appropriate personality tests for career guidance.</p>

A formação na modalidade Residência Médica: contribuições para a qualificação e provimento médico no Brasil / Medical residency training: contributions for qualification and provision of physicians in Brazil / Entrenamiento en el modo de Residencia Médica: aportes para la cualificación y la prestación de servicios médicos en Brasil

Objetivo: Apresenta-se uma experiência de implantação de programa de Residência Médica em âmbito nacional, tecendo-se considerações sobre algumas dificuldades encontradas durante o processo. Métodos: São expostos os conceitos de interiorização da formação, descentralização e desconcentração, problematizando-se os usos de cada um desses a partir da experiência relatada. Resultados: Alguns dos desafios percebidos apontam na direção de reorganizar a implantação de processos semelhantes para evitar a baixa ocupação de vagas de Residência Médica e qualificar o acompanhamento dos profissionais que se tornam preceptores. Conclusão: Entende-se que esta proposta contribui na qualificação e no provimento de médicos para o Sistema Único de Saúde no Brasil.

Objective: This paper discusses medical residency training. The experience of implementing a national medical residency program is introduced and considerations about the issues that came across during this process are commented. Methods: Concepts about training internalization, decentralization and deconcentration, debating the meaning of these terms from the experience reported. Results: Some of the challenges perceived indicate the need to reorganize similar processes to overcome the low occupancy of places in medical residency and to enable skills for the follow up of preceptors-to-be. Conclusion: This innovation is a contribution for qualification and provision of physicians for the Brazilian Unified Health System.

Objetivo: El tema de ese artículo es la formación en la modalidad de residencia médica. Se presenta una experiencia de implementación de programa a nivel nacional, tejiendo algunas consideraciones sobre algunas dificultades encontradas durante el proceso. Métodos: Están expuestos los conceptos de la interiorización de la formación, descentralización y desconcentración problematizando sobre los usos de cada uno a partir de la experiencia reportada. Resultados: Algunos de los desafíos percibidos apuntan a la dirección de reorganizar la implantación de procesos similares para evitar la baja ocupación de vacantes de la residencia médica y cualificar el seguimiento de los profesionales que se convierten en preceptores. Conclusión: Se entiende que esa propuesta contribuye a la cualificación y a la provisión de médicos para el Sistema Único de Salud en Brasil.

Preceptoria em medicina de família e comunidade: desafios e realizações em uma atenção primária à saúde em construção / Preceptorship in family and community medicine: challenges and achievements in a primary health care in progress

O fortalecimento da Atenção Primária à Saúde (APS) depende diretamente da formação de médicos especialistas em cuidados primários. Este texto tem como objetivo relatar as experiências de formação em Medicina de Família e Comunidade (MFC) no município do Rio de Janeiro entre os anos 2008 e 2016, tendo como objeto de reflexão o desenvolvimento de preceptores no âmbito da especialização médica, por meio do relato de experiência de três programas de Residência Médica em MFC (PRMFC): da Secretaria Municipal de Saúde (SMS), da Universidade Federal do Rio de Janeiro e da Escola Nacional de Saúde Pública. Dentro do cenário de reforma da APS no Rio de Janeiro criou-se a demanda por médicos especialistas para atuação na rede levando à ampliação dos PRM já estabelecidos e à criação do PRMFC-SMS, propiciando novos espaços de ensino em muitas unidades de saúde da rede municipal. Por caminhos distintos esses PRM avançaram na capacitação de seus preceptores, ofertando cursos e ações locais permanentes, na busca por maior qualificação profissional e melhor equilíbrio entre as responsabilidades de cuidado e de ensino. Investimentos permanentes no fortalecimento dos PRM e na capacitação de preceptores são essenciais para consolidar a reforma na APS em todo o Brasil.(AU)

Strengthening Primary Health Care (PHC) relies directly on training medical specialists in primary care. This text aims to report the Family Medicine training experiences in Rio de Janeiro between 2008 and 2016. It brings to reflection the development of preceptors in medical specialization through an experience report on three Family Medicine medical residency programs, namely, the Municipal Health Secretariat program, the Federal University of Rio de Janeiro program and the National School of Public Health program. The PHC reform in Rio de Janeiro created a demand for medical specialists working in networks, leading to the expansion of already established medical residency programs and the establishment of a new program sponsored by the Municipal Health Secretariat, providing new teaching positions in several health facilities within the municipal network. These three residency programs progressed through different paths to provide training to their preceptors, offering permanent courses and local actions seeking higher professional qualification and better balance between care and education responsibilities. Permanent investments to strengthen medical residency programs and preceptors training are essential to consolidate the PHC reform nationwide.(AU)