An update on simulation training in rhinology: a systematic review of evidence.

BACKGROUND: Rhinological procedures demand a high degree of technical expertise and anatomical knowledge. Because of limited surgical opportunities, ethical considerations and the complexity of these procedures, simulation-based training has become increasingly important. This review aimed to evaluate the effectiveness of simulation models used in rhinology training. METHODS: Searches were conducted on PubMed, Embase, Cochrane and Google Scholar for studies conducted between July 2012 and July 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis ('PRISMA') protocol defined a final list of articles. Each validated study was assigned a level of evidence and a level of recommendation based on the Oxford Centre of Evidence-Based Medicine classification. RESULTS: Following exclusions, 42 articles were identified which encompassed six types of simulation models and 26 studies evaluated validity. The rhinological skills assessed included endoscopic sinus surgery (n = 28), skull base/cerebrospinal fluid leak repair (n = 14), management of epistaxis and/or sphenopalatine artery ligation (n = 8), and septoplasty and septorhinoplasty (n = 6). All studies reported the beneficial impact of their simulation models on trainee development. CONCLUSION: Simulation training in rhinology is a valuable adjunct to traditional surgical education. Although evidence is of moderate quality, the findings highlight the importance of simulation-based training in rhinology training.

A survey of the perceptions and practices of faculty in clinical neuropsychology doctoral training programs: is heterogeneity the norm?

Objective: Doctoral education is a cornerstone in the training of clinical neuropsychologists. However, we know little about perceptions, practices, and needs of the faculty who oversee doctoral training in clinical neuropsychology (CN). Method: Seventy-one faculty from 45 doctoral programs providing CN training completed at least part of a survey assessing characteristics of their programs, current training practices and views, and challenges to CN doctoral training. Results: Over half of CN faculty reported having zero or only one CN colleague. CN faculty reported that the goals of CN doctoral training are research training, clinical training, and acquisition of knowledge and skills reflected in the Houston Conference Guidelines (HCG). CN faculty reported that doctoral trainees obtain more clinical hours than faculty would like and endorsed alternative clinical metrics, including competency-based ratings. CN faculty are divided about the benefits of a required two-year postdoctoral CN fellowship. Conclusions: The HCG states that specialization in CN begins at the doctoral level. CN faculty in doctoral programs are fully immersed in the early development and education of future CN researchers and practitioners. Tensions between clinical and research training in CN at the doctoral level-and student overemphasis on accruing clinical hours-might place CN at risk for failing to make research innovations necessary for our field to evolve and thrive. More CN doctoral faculty are needed to serve as mentors to students, especially for students from backgrounds that have been historically excluded and marginalized. A greater voice from CN doctoral faculty in CN governance is needed.

Efecto de la deuda económica sobre el bienestar psicológico de los residentes de cirugía: Resultados de un estudio nacional en Colombia / Effect of financial debt on the psychological well-being of surgery residents: Results of a national study in Colombia

Introducción. La deuda económica durante la residencia en cirugía general puede afectar el desempeño profesional, las decisiones de vida y el bienestar psicológico. La información disponible en Colombia es limitada. El objetivo de este estudio fue cuantificar la deuda económica del residente de cirugía general, identificar los factores asociados y evaluar su efecto en el bienestar psicológico. Métodos. Estudio de corte transversal analítico. Se invitó a 380 residentes a diligenciar una encuesta sobre los aspectos relacionados con su deuda económica y se utilizó el WHO-index para evaluar su bienestar psicológico. Resultados. Un total de 259 residentes participaron en el estudio (67,6 %). El 56 % posee una deuda económica promedio de COP $88.000.000 ((US$21.826)). Un alto nivel de endeudamiento se relacionó con el año de residencia, el tipo de institución (privada) y la solicitud de préstamos. Se identificó algún trastorno mental en 14,7 % y un bajo nivel de bienestar psicológico en 56,4 % de los participantes. No se identificó ninguna asociación entre una elevada deuda económica y el bajo bienestar psicológico. Conclusiones. La deuda económica tiene un efecto sobre los residentes. El endeudamiento de los residentes de cirugía en Colombia es altamente prevalente, y no se correlaciona con un pobre bienestar psicológico. La autodeterminación favorece el bienestar psicológico en el posgrado en cirugía general. Existe la necesidad de educación financiera en los residentes. Se requieren nuevos estudios que evalúen las causas del pobre bienestar psicológico.

Introduction. Financial debt during surgery residency can affect professional performance, life decisions, and psychological well-being. The information available in Colombia is limited. The objective of this study is to quantify the financial debt of the general surgery resident, identify the associated factors and evaluate their effect on psychological well-being. Methods. A cross-sectional study was carried out. A total of 380 residents were invited to complete a survey on aspects related to their financial debt, and the WHO-index to evaluate their psychological well-being. Results. A total of 259 residents participated in the study (67.6%). 56% have an average economic debt of $88,000,000 COP (US$21,826). High debt was related to level of residence, type of institution (private), and loan application. Some mental disorder was identified in 14.7% and a low level of psychological well-being in 56.4% of the participants. No association was identified between high financial debt and low psychological well-being. Conclusions. Economic debt has an effect on residents. Financial debt among surgical residents in Colombia is highly prevalent; however, it does not correlate with poor psychological well-being. Self-determination favors psychological well-being in the postgraduate course in general surgery. Likewise, the need for financial education in residents is imminent. New studies are required that thoroughly evaluate the causes of poor well-being.

Supporting nursing students with dyslexia: The situation in France in 2022 and outlook / L'accompagnement des étudiants en soins infirmiers avec une dyslexie. État des lieux en France en 2022 et perspectives

Introduction: The number of students with disabilities in higher education is increasing. Dyslexia is the most common form of disability. Few reports on this subject focus on health-sector education in France. Objectives: The survey sought to characterize and understand the support provided in nursing training institutes with regard to dyslexia. Methods: A mixed survey was carried out in 2022, mainly involving disability referents in nursing institutes. A national questionnaire collected 113 responses from metropolitan and overseas France, then three focus groups brought together twenty-eight participants from ten different regions. Results: In 2022, the most frequent measures were related to assessments and institutional communication. However, they lacked structure. There were still gaps, especially in the area of work placement. Discussion: In addition to the disability referents, all stakeholders must be made aware of the needs of students with dyslexia. Greater visibility of disability could also change attitudes in the health care sector. Conclusion: Specific support for dyslexia has been introduced in nursing training institutes. Its development requires a change in the attitudes of the stakeholders. It could then be extended to other health training courses.

Introduction: Le nombre d'étudiants en situation de handicap augmente dans l'enseignement supérieur. La dyslexie en constitue la forme la plus fréquente. Peu de communications sur ce sujet ciblent les formations en santé en France. Objectifs: L'enquête menée cherchait à caractériser et à comprendre l'accompagnement mis en place en instituts de formations en soins infirmiers (Ifsi) au regard de la dyslexie. Méthodes: Une enquête mixte a été réalisée en 2022 principalement auprès de référents handicap en Ifsi. Un questionnaire national a recueilli 113 réponses de métropole et d'Outre-Mer, puis trois focus groups ont réuni 28 participants originaires de dix régions différentes. Résultats: Au moment de l'étude, les mesures les plus fréquentes concernaient les évaluations et la communication institutionnelle. Cependant, elles manquaient de structuration. Des zones lacunaires persistaient, notamment en stage professionnel. Discussion: Au-delà des référents handicap, l'ensemble des acteurs doivent être sensibilisés aux besoins des étudiants avec une dyslexie. Une plus grande visibilité du handicap pourrait également faire évoluer les mentalités dans le milieu soignant. Conclusion: L'accompagnement spécifique concernant la dyslexie est initié en Ifsi. Son développement nécessite un changement de regard des parties prenantes. Il pourra secondairement se prolonger à d'autres formations en santé.

Supporting nursing students with dyslexia: The situation in France in 2022 and outlook / L'accompagnement des étudiants en soins infirmiers avec une dyslexie. État des lieux en France en 2022 et perspectives

INTRODUCTION: The number of students with disabilities in higher education is increasing. Dyslexia is the most common form of disability. Few reports on this subject focus on health-sector education in France. OBJECTIVES: The survey sought to characterize and understand the support provided in nursing training institutes with regard to dyslexia. METHODS: A mixed survey was carried out in 2022, mainly involving disability referents in nursing institutes. A national questionnaire collected 113 responses from metropolitan and overseas France, then three focus groups brought together twenty-eight participants from ten different regions. RESULTS: In 2022, the most frequent measures were related to assessments and institutional communication. However, they lacked structure. There were still gaps, especially in the area of work placement. DISCUSSION: In addition to the disability referents, all stakeholders must be made aware of the needs of students with dyslexia. Greater visibility of disability could also change attitudes in the health care sector. CONCLUSION: Specific support for dyslexia has been introduced in nursing training institutes. Its development requires a change in the attitudes of the stakeholders. It could then be extended to other health training courses.

Introduction: Le nombre d'étudiants en situation de handicap augmente dans l'enseignement supérieur. La dyslexie en constitue la forme la plus fréquente. Peu de communications sur ce sujet ciblent les formations en santé en France. Objectifs: L'enquête menée cherchait à caractériser et à comprendre l'accompagnement mis en place en instituts de formations en soins infirmiers (Ifsi) au regard de la dyslexie. Méthodes: Une enquête mixte a été réalisée en 2022 principalement auprès de référents handicap en Ifsi. Un questionnaire national a recueilli 113 réponses de métropole et d'Outre-Mer, puis trois focus groups ont réuni 28 participants originaires de dix régions différentes. Résultats: Au moment de l'étude, les mesures les plus fréquentes concernaient les évaluations et la communication institutionnelle. Cependant, elles manquaient de structuration. Des zones lacunaires persistaient, notamment en stage professionnel. Discussion: Au-delà des référents handicap, l'ensemble des acteurs doivent être sensibilisés aux besoins des étudiants avec une dyslexie. Une plus grande visibilité du handicap pourrait également faire évoluer les mentalités dans le milieu soignant. Conclusion: L'accompagnement spécifique concernant la dyslexie est initié en Ifsi. Son développement nécessite un changement de regard des parties prenantes. Il pourra secondairement se prolonger à d'autres formations en santé.

Simulation-based training program on patient safety management: A quasi-experimental study among new intensive care unit nurses.

BACKGROUND: Patient safety is an essential responsibility of nurses. However, newly graduated nurses experience patient safety incidents due to a lack of patient safety competency. In particular, intensive care unit nurses provide care to critical patients, making it difficult for new nurses to maintain patient safety. Therefore, it is necessary to improve the patient safety competency of newly graduated nurses working in the intensive care unit. OBJECTIVES: To analyze the effects of a simulation-based training program on patient safety management on the patient safety competency, patient safety management activity, communication self-efficacy, and teamwork of newly graduated nurses working in an intensive care unit. DESIGN: A quasi-experimental study. SETTINGS: The study was conducted at a university in Korea. PARTICIPANTS: A total of 44 newly graduated nurses working in the intensive care unit of a university hospital. METHODS: A simulation-based training program on patient safety management was applied to the experimental group (n = 22), while only the usual hospital training program was used for the control group (n = 22). A structured questionnaire survey comprising Patient Safety Competency Self-Evaluation, Patient Safety Management Activities, the Korean version of the self-efficacy questionnaire, and K-self assessment of teamwork was conducted at baseline test (T1), post test (T2), and follow-up test (T3). Data were analyzed using a repeated measures ANOVA. RESULTS: The experimental group showed significantly higher patient safety competency, patient safety knowledge, and patient safety skills, along with higher communication self-efficacy scores than the control group (p < .05) after the intervention and at four weeks after the intervention. CONCLUSIONS: The simulation-based training program on patient safety management effectively improved the patient safety competency, patient safety knowledge, and patient safety skills as well as communication self-efficacy of newly graduated nurses working in an intensive care unit.

Effects of Creatine Supplementation after 20 Minutes of Recovery in a Bench Press Exercise Protocol in Moderately Physically Trained Men.

BACKGROUND: The aims of this study were to analyse the effect of creatine supplementation on the performance improvement in a bench pressing (BP) strength test of muscle failure and to evaluate muscle fatigue and metabolic stress 20 min after the exercise. METHODS: Fifty young and healthy individuals were randomly assigned to a creatine group (n = 25) or a placebo group (n = 25). Three exercise sessions were carried out, with one week of rest between them. In the first week, a progressive load BP test was performed until the individuals reached the one repetition maximum (1RM) in order to for us obtain the load-to-velocity ratio of each participant. In the second week, the participants conducted a three-set BP exercise protocol against 70% 1RM, where they performed the maximum number of repetitions (MNR) until muscle failure occurred, with two minutes of rest between the sets. After one week, and following a supplementation period of 7 days, where half of the participants consumed 0.3 g·kg-1·day-1 of creatine monohydrate (CR) and the other half consumed 0.3 g·kg-1·day-1 of placebo (PLA, maltodextrin), the protocol from the second week was repeated. After each set, and up to 20 min after finishing the exercise, the blood lactate concentrations and mean propulsive velocity (MPV) at 1 m·s-1 were measured. RESULTS: The CR group performed a significantly higher number of repetitions in Set 1 (CR = 14.8 repetitions, PLA = 13.6 repetitions, p = 0.006) and Set 2 (CR = 8 repetitions, PLA = 6.7 repetitions, p = 0.006) after supplementation, whereas no significant differences were seen in Set 3 (CR = 5.3 repetitions, PLA = 4.7 repetitions, p = 0.176). However, there was a significant increase in blood lactate at minute 10 (p = 0.003), minute 15 (p = 0.020), and minute 20 (p = 0.015) after the exercise in the post-supplementation period. Similarly, a significant increase was observed in the MPV at 1 m·s-1 in the CR group with respect to the PLA group at 10, 15, and 20 min after the exercise. CONCLUSIONS: Although the creatine supplementation improved the performance in the strength test of muscle failure, the metabolic stress and muscle fatigue values were greater during the 20 min of recovery.

Developing Authentic Mentorship Through Professional Organizations.

Harsh realities in pandemic fatigue, burnout, inequities, and isolation are impacting academic pharmacy. Mentoring programs, especially inter-institutional programs such as those provided within the Sections and Special Interest Groups (SIGs) of the American Association of Colleges of Pharmacy (AACP), may combat some of these issues. Unfortunately, year after year, Academy members continue to request information from these groups on mentoring, whether it be the opportunity to pair up, for advice on how to be better mentors, or for guidance on how to develop a program on mentoring for the Sections and SIGs without an existing program. The need for authentic mentoring is vital to the success and retention of faculty and staff within the Academy. Therefore, it may be appropriate to take a closer look at why, despite ongoing mentoring programs scattered within AACP Sections and SIGs, these programs are unable to fulfill the needs of participants.

A webinar series to educate applicants about the UK academic foundation programme: a longitudinal cross-sectional study.

BACKGROUND: The UK academic foundation programme (AFP) is a competitive programme for medical graduates and forms the initial stage of the integrated clinical academic pathway. The application is complex and targeted education is beneficial. As online technologies improve, virtual medical education is becoming more common. Currently, webinar education, particularly that of webinar series, are poorly evidenced. An online course was created to investigate the acceptability and effectiveness of webinars for medical education. METHODS: A six-part, one-hour sessional webinar course was developed following a focus group with academic foundation doctors. A pre- and post-course cross-sectional questionnaire study evaluated participant demographics, webinar opinion and self-rated understanding of the AFP via Google Form (Google, USA). Where applicable a five-point Likert scale (1-Strongly disagree to 5-strongly agree) was utilised and analysis using non-parametric paired statistical analysis. RESULTS: Medical students (n=303) from 35 UK universities completed the pre-course questionnaire. Most students had not received targeted education on the AFP. They rated webinars useful for education (mean=4.2 s.d. 0.7). After the course, participants (n=66) expressed it was significantly convenient (mean=4.7), effective (mean=4.7) and suitably interactive (mean=4.4) (p<0.001 compared to neutral). Participants preferred short sessions over multiple days to the concept of a full-day event (mean=4.6 vs 3.1, p<0.001). Paired analysis of participants completing both forms (n=47) demonstrates a significant increase in self-rated understanding of AFP content, portfolio building, application process, acute clinical scenarios, interview technique and overall confidence in acquiring an AFP post (p<0.001). Follow-up identified 43 participants who completed the course were successful in their AFP application. This represents 7.8% of all successful AFP applicants in 2021. CONCLUSIONS: This study evidences an accessible and effective webinar series for AFP education. Comprehensive webinar courses for similar topics and demographics may provide valuable utility in the provision of future medical education. TRIAL REGISTRATION: Ethics requirements were waived for this study by Bristol University Ethics Committee. All participants in this study consented for anonymous use of their data. As such the trial is not registered.

The void: COVID-19 restrictions and junior doctor education opportunities.

BACKGROUND: In the setting of the COVID-19 pandemic, the modes of hospital service delivery, education, training, and the context surrounding them has undergone enormous change and disruptions. OBJECTIVE: This study aimed to understand the 'lived-experience' of junior doctors in relation to their education, training, and professional development during the pandemic. METHODS: A qualitative study based on thematic and cohort narrative analysis. 20 junior doctors who trained at an Australian tertiary paediatric hospital during the time of COVID-19 restrictions were interviewed. Based on a phenomenological approach, the interviews examined junior doctors' experiences in relation to medical education, adaptive education styles and the value attributed by participants to different forms of education provided to them. RESULTS: Four overarching themes were identified regarding trainee perceptions of the impact of COVID-19 restrictions on learning opportunities, both positive and negative. These were: 'The void' - learning expectations junior doctors felt were missed, education affordances, peers and networks, and professional identity. CONCLUSION: The pace with which educators have adapted to new teaching modes should be harnessed to incite equally novel curriculum evolution, smart investment in clinical moments, reconnect learning communities and create robust virtual learning environments.

Towards a collaborative-integrative model of education and training in neurosurgery in low and middle-income countries.

BACKGROUND: Neurosurgery inequity between High-Income Countries and Low- and Middle-Income Countries is striking. Currently, several models of education and training are available each has advantages and limitations. Our goal is to suggest an integrative model of Education and Training with international collaboration which will assure the most cost-effective Training Model. MATERIALS AND METHODS: The authors reviewed the literature narratively and examined in broad stroke the different existing models of international education and training programs to analyze their strengths, limitations, and cost-effectiveness in addressing the needs of Neurosurgery in Low and middle-Income Countries. RESULTS: Several international institutions have been involved in Education and Training in Global Neurosurgery. The most common models for international education include short-term surgical mission and boot camps, a full residency training program in HICs, and a full residency training Program in Local or regional World Federation of Neurosurgical Societies (WFNS) reference centers in Low and Middle-Income Countries, and online education. In Africa, both Local residency training centers and WFNS reference centers are available and provide full training programs in Neurosurgery. Among them, WFNS Rabat Training Center is the first established center in Africa in 2002. This program is supported by the WFNS Foundation and by the Africa 100 Project. Some of these education models face currently challenges such as sustainability, financial support, and ethical issues. CONCLUSION: Training neurosurgeons from Low and Middle-Income countries in local and regional WFNS Training centers might be the most cost-effective model of training that helps close the gap in neurosurgery. This training Model is duplicable and may be integrated into a global cohesive and collaborative model of education with international institutions.

Perception Precedes Reality: A Simulation and Procedural Bootcamp Improves Residents' Comfort With Transitioning to Clinical Anesthesiology Training.

Background The transition from internship to clinical anesthesiology (CA) training is often difficult given the differences in workflow, procedures, environment, and clinical situations. The primary aims of this study were to determine if a standardized introductory bootcamp could improve clinical knowledge and self-perceived comfort level of new anesthesiology residents in performing common operating room procedures and management of common intraoperative problems. The secondary aim of the study was to see if a standardized bootcamp could be replicated at other programs. Methods The introduction to anesthesiology resident bootcamp was developed at one institution in 2015 then expanded to a second program in 2019. The bootcamp was a one-day experience consisting of simulation and task trainers that all rising first-year CA residents (CA-1) participated in during their first month of anesthesiology training. All participating residents were given a survey immediately before and after the bootcamp. The average ratings of the questions were calculated and used as the primary measure. The Anesthesia Knowledge Test (AKT) was used as a surrogate measure of participant knowledge. Results From 2015 to 2020, a total of 105 residents completed the pre-survey and 109 completed the post-survey across the two sites. The improvement in average rating was significant (Pre: 2.04±0.46 versus Post: 3.09±0.52 p<0.0001). Individual item analysis also showed significant improvement on all of the eight items (p<0.0001). Analyses by site revealed the same results at both average score and item level. There was no significant cohort difference in either AKT-0 (Control: 57.84±26.86 versus Intervention 50.13±25.14, p=0.14) or AKT-1 (Control: 41.06±26.42 versus Intervention 41.70±26.60, p=0.90) percentile scores. Conclusions Incorporation of an introduction to anesthesia bootcamp for new residents significantly improves participant comfort level and is reproducible across institutions. However, it does not improve resident performance on standardized tests.

Avanços e limitações das redes sociais como estratégia de comunicação no Sistema Único de Saúde: relatode experiências em Unidades deSaúde daFamília / Advancements and limitations of social networking as communicationstrategy in SUS: experience report in Family Health Units

As redes sociais podem representar importante papel na Atenção Básica do Sistema Único de Saúde no acesso e divulgação de informações. É objetivo desse estudo relatar as experiências desenvolvidas por estagiários e professores do curso de Odontologia da UFRNe preceptores das USF Panatise Parque das Dunas, Natal/RN. As atividades realizadas foram planejadas em disciplina anterior ao estágio e contaram com a participação desses mesmos atores. Considerando o contexto da pandemia da COVID-19, as atividades foram adaptadas para serem desenvolvidas em formato virtual. A partir do Instagram, WhatsApp e Google Meet foi possível divulgar informações sobre o funcionamento e ações desenvolvidas nas USF, criar posts informativos sobre saúde bucal, envolver gestantes em ações educativas, promover maior aproximação com a comunidade, criação de respostas automáticas às perguntas mais frequentes, entre outras atividades. As redes sociais são potente ferramenta na comunicação e divulgação em saúde, permitindo estabelecimento de vínculos, como mais uma via no acesso às informações e relação de diálogo permanente com a população, sinalizando possíveis avanços no controle social. O conhecimento prévio de estagiários e preceptores sobre as redes sociais viabilizou o desenvolvimento de ações que não fazem parte do contexto tradicional da formação em Odontologia, trazendo benefícios ao aprendizado de todos e avanços na relação das USF com a comunidade. É fundamental que o poder público viabilize infraestrutura e logística necessárias para a inclusão das redes sociais no processo de trabalho das equipes da Atenção Básica, incorporando-as como elemento de sua política de comunicação em saúde (AU).

Social networks can perform animportant role in Unified Health System (SUS)regarding access and dissemination of information. This study aims to report the experiencesdeveloped by interns and professors of UFRN's Dentistrycourse, and by preceptors of USF Panatis and USF Parque das Dunas, at Natal/RN. The activities were planned in a discipline previous to the internship, and the same actors participated in them. Considering the COVID-19 pandemic context, the activities were adapted into virtual format. From Instagram, WhatsApp, and Google Meet, it was possible to disseminate information on the functioning and actions developed at the USF, to create informative posts onoral health, to involve pregnant peoplein educational actions, to promote closeness with the community, to give automated responses to the most frequent questions, among other activities. Social networks are a powerful tool in communication and dissemination on health care, allowing links to be established asyetanother way of accessing information and keeping a permanent dialogue with the population, indicating possible advancements in social control. The priorknowledge that interns and preceptors had on social networking enabled the development of actions which are not part of the traditional context of dental training, so it benefited everyone's learning and allowed advancementsinthe relationship between the USF and the community. It is crucial for the government to enable the necessary infrastructure and logistics for the inclusion of social networking in the work process of Primary Careteams, incorporating it as element of its policy onhealth communication (AU).

Estágio curricular obrigatório no Sistema Único de Saúde: saber aonde ir, para não ser levado a qualquer lugar / Mandatory curricular internship at Brazilian Unified Health System: knowing where to go to not be taken anywhere

O estágio curricular obrigatório configura-se, simultaneamente,como dispositivo pedagógico e desafio permanente para os cursos de Odontologia, tendo em vistaseu papel estratégico na articulação do processo formativo com o Sistema Único de Saúde(SUS). O presente artigo éuma revisão integrativasobre o tema,constituída a partir de 29 artigos cujo objetivo foicriar uma interpretaçãoampliada dessesestudos.Os aspectos positivos mais mencionados relacionaram-seàscaracterísticas do processo de trabalho vivenciado nas unidades de saúdeenfatizando a utilização de tecnologias leves, tradicionalmente ausentes no ambiente clínico-cirúrgico nas disciplinas tradicionais. Quantoaos pontos negativos, além das limitações institucionais, emergiram a dificuldade dos professores/preceptores noacompanhamentodos estagiáriose o distanciamento dosdentistasdas interações nas equipes multiprofissionais. Infere-se daanálise empreendida que ainda não existe um consenso acerca da função estruturante dos estágios nos ProjetosPedagógicos, sendo compreendidos, essencialmente, como atividadesdesenvolvidaspara melhorar a qualidade da formação, com foco exclusivamente nos discentes.Cursos de Odontologia que buscam serinovadores e protagonistas de mudanças devem imputar ao estágio um papel diferenciado, valorizando seu potencial agregador de elementos que, conjuntamente, significam o núcleo central da formação em Odontologia articulada ao SUS. Para essa valorização,é fundamental que haja permanente envolvimento e participação dos docentes, estudantes e, especialmente, profissionais de saúde e comunidade vinculados às Unidades de Saúde, cenário privilegiado do estágio, nas quais esse dispositivo pedagógico poderia ser desenvolvido de forma plena e compatível com a luta por saúde bucal universal, de qualidade, equânime e pública (AU).

The mandatory curricular internship is set up simultaneously as pedagogical device and permanent challenge for dental programs, considering its strategic role in the articulation of the training process with the Brazilian Unified Health System (SUS). This article is an integrative review on the subject, made from 29 articles whose objective was to create an enlarged interpretation of these studies. The most mentioned positive aspects were related to the characteristics of the work process experienced in thehealth units, emphasizing the use of soft technologies, traditionally absent in the clinical-surgical environment in the traditional disciplines. As for the negative aspects, beyond institutional limitations, there emerged the difficulty of teachers/preceptors in following the interns and the distancing of the dentists from interactions in multi-professional teams. It can be inferred from the analysis that there is not yet a consensus on the structuring role of the internships in the Pedagogical Projects. They are understood, essentially, as activities developed to enhance training quality, with focus exclusively on the students. Dental programs that seek to be innovative and protagonists of changes must give to the internship a differentiated role, valuingits potential of aggregating elements which together stand for the core of dental training articulated with SUS. It is fundamental the permanent involvement and participation of teachers, students and, especially, health care professionals and community associated to the Health Units (USF), the internship's privileged setting, in which this pedagogical device could be developed in a compatible way with the struggle for universal oral health, one of quality, equal and public (AU).

Discriminações e preconceitos: temas que precisam de muito debate na formação dos profissionais de saúde / Discrimination and prejudice: topics that require extensive debate in the training of healthcare professionals

Conteúdos curriculares relativos às Ciências Humanas e Sociais têm muita importância no desenvolvimento de habilidades que vão construir competências relacionadas ao comportamento dos egressos. O curso de Odontologia da Univates aborda, desde o início da formação temáticas relacionadas a discriminação e ao preconceito de forma integrada no seu currículo. O trabalho apresenta relatos de experiências de quatro estudantes durante os estágios com o objetivo de identificar, reconhecer e discutir questões relacionadas ao preconceito e discriminação no desenvolvimento do estágio extramuros, apresentando os desafios e dificuldades encontradas nesse processo. Através de relatos subjetivos podemos perceber os diferentes itinerários de formação que os estudantes percorrem, além da ampliação das oportunidades de contato com essas temáticas. Nos relatos são descritas atividades de aprendizagem realizadas durante o curso e que são retomadas no enfrentamento das situações vivenciadas nos estágios. Dramatizações, leitura de materiais, desafios propostos no CBL (Challenge Based Learning), produções de resumoseparticipações em congressos vão sendo elencadas como referências importantes no atendimento de populações específicas como indígenas, imigrantes, pessoas com pele preta e que fazem uso de tornozeleiras eletrônicas, além de contatos com pessoas transexuaise portadores de necessidades especiais. Essas experiências, muitas vezes, são possíveis pela presença dos estudantes nas redes de saúde. O estágio extramuros amplia as experiências de atendimento aos estudantes, contribuindo para uma formação mais generalista e humanista. O contato dos estudantes com diferentes realidades é benéfico para o desenvolvimento de novas perspectivas a partir dos conteúdos trabalhados de forma teórica e, quando integrados, podem contribuir para uma formação mais cidadã (AU).

Curriculum subjects related to Human and Social Sciences are important to the development of skills that will build the abilities related to the behavior of graduates. From the beginning of training, the Univates Dentistry course addresses themes related to discrimination and prejudice in an integrated way in its curriculum. This academic project features reports of four students during their internships, aiming to identify, recognize and discuss issues related to prejudice and discrimination in the development of the internship, presenting the challenges encountered in this process. Through subjective reports it is possible to understand the different paths that graduation students go through, and the expansion of opportunities to get in touch with these themes. In the reports, the students describe many learning activities applied during the course that later were used in situations experienced in the internships. Acting, relevant paper reading, challenges proposed in the CBL (Challenge Based Learning), production of overviews and reports and participation in conferences are some of the important references in the care of specific populations such as indigenous people, immigrants, people with black skin, convicted people with electronic anklets, transsexuals and individuals with special needs. These experiences are often only possible due to the presence of students in the public health and care systems. The internship expands the student service experiences, contributing for a more humanized and real graduation. The contact of students with different realities is beneficial for the development of new perspectives from the content learned theoretically and, when combined, can build up to a more humanized graduation (AU).

The Regional Distribution of Psychiatric Residency Positions Funded by the Department of Veterans Affairs and Its Relationship to Rural Veteran Populations.

OBJECTIVE: The authors evaluated the distribution of psychiatry residency positions funded by the Department of Veterans Affairs between 2014 and 2020 with respect to geographic location and hospital patient population rurality. METHODS: The authors collected data on psychiatry residency positions from the Veterans Affairs' Office of Academic Affiliations Support Center and data on hospital-level patient rurality from the Veterans Health Administration Support Service Center. They examined the chronological and geospatial relationships between the number of residency positions deployed and the size of the rural patient populations served. RESULTS: Between 2014 and 2020, the Department of Veterans Affairs has substantially increased the number of rural hospitals hosting psychiatry residency programs, as well as the number of residency positions at those hospitals. However, several geographic regions serve high numbers of rural veterans with few or no psychiatry resident positions. CONCLUSIONS: While the VA efforts to increase psychiatry residency positions in rural areas have been partially successful, additional progress can be made increasing support for psychiatry trainees at Veterans Affairs hospitals and community-based outpatient clinics that serve large portions of the rural veteran population.

La internacionalización de la educación superior y de las universidades médicas como fuente de desarrollo / The internationalization of higher education and medical universities as a source of development

RESUMEN Fundamento: la internacionalización es un medidor de la actividad de la educación superior a nivel mundial. Objetivo: caracterizar el rol de la internacionalización de la educación superior en diferentes partes del mundo, incluyendo a Cuba y especificando en la educación médica de la provincia de Holguín, Cuba. Método: se realizó una revisión bibliográfica sistemática para desarrollar un análisis reflexivo sobre la temática. La búsqueda se efectuó entre marzo 2019-diciembre 2021, en diferentes bases de datos y buscadores. Se accedió a revistas especializadas nacionales e internacionales. Las palabras clave utilizadas fueron: internacionalización, educación superior, educación médica, mercantilización de la salud, cooperación, colaboración. Tras la identificación de los estudios preseleccionados, se llevó a cabo la lectura de los títulos y resúmenes para comprobar su pertinencia con el estudio. Desarrollo: la internacionalización es una tendencia que genera intercambios de conocimientos y contribuye al desarrollo de la educación superior. En Cuba es un elemento necesario para conquistar estándares internacionales de excelencia académica, calidad y pertinencia. La Universidad de Ciencias Médicas de Holguín ha progresado en su compromiso social de elevar el desarrollo científico en la esfera de la educación médica en el ámbito mundial, al alcanzar resultados relevantes en las características que distinguen este proceso. Conclusiones: la internacionalización de la educación superior tiene un impacto positivo a nivel mundial. Cuba, a pesar de ser un país en vías de desarrollo tiene como premisa de la internacionalización, la colaboración y cooperación con el resto de los países del planeta.

ABSTRACT Background: internationalization is a measure of the activity of higher education worldwide. Objective: to characterize the role of the internationalization of higher education in different parts of the world, including Cuba and specifying in medical education in the province of Holguín, Cuba. Method: a systematic bibliographic review was carried out to develop a reflexive analysis on the subject. The search was carried out from March 2019 to December 2021, in different databases and search engines. National and international specialized journals were accessed. The keywords used were: internationalization, higher education, medical education, commercialization of health, cooperation, collaboration. After identifying the preselected studies, the titles and abstracts were read to check their relevance to the study. Development: internationalization is a trend that generates exchanges of knowledge and contributes to the development of higher education. In Cuba, it is a necessary element to achieve international standards of academic excellence, quality and relevance. Holguín University of Medical Sciences has progressed in its social commitment to elevate scientific development in the field of medical education worldwide, by achieving relevant results in the characteristics that distinguish this process. Conclusions: the internationalization of higher education has a positive impact worldwide. Cuba, despite being a developing country, has the premise of internationalization, collaboration and cooperation with the rest of the countries on the planet.

Latin american residents' surgical education after the pandemic: what strategies have emerged for adapting to this new era? / Pandemia de covid-19 e educação cirúrgica de residentes da américa latina. que estratégias surgiram para se adaptar a esta nova era?

ABSTRACT BACKGROUND: The COVID-19 pandemic has had a negative effect on surgical education in Latin America, decreasing residents' surgical training and supervised clinical practice. AIMS: This study aimed to identify strategies that have been proposed or implemented to adapt surgical training and supervised clinical practice to COVID-19-related limitations in Latin America. METHOD: A literature review was performed between April and May 2021, divided into two searches. The first one sought to identify adaptation strategies in Latin America for surgical training and supervised clinical practice. The second one was carried out as a complement to identify methodologies proposed in the rest of the world. RESULTS: In the first search, 16 of 715 articles were selected. In the second one, 41 of 1,637 articles were selected. Adaptive strategies proposed in Latin America focused on videoconferencing and simulation. In the rest of the world, remote critical analysis of recorded/live surgeries, intrasurgical tele-mentoring, and surgery recording with postoperative feedback were suggested. CONCLUSIONS: Multiple adaptation strategies for surgical education during the COVID-19 pandemic have been proposed in Latin America and the rest of the world. There is an opportunity to implement new strategies in the long term for surgical training and supervised clinical practice, although more prospective studies are required to generate evidence-based recommendations.

RESUMO RACIONAL: A pandemia de COVID-19 teve um efeito negativo na educação cirúrgica na América Latina, diminuindo o treinamento cirúrgico dos residentes e a prática clínica supervisionada. OBJETIVOS: Identificar estratégias que foram propostas ou implementadas para adaptar o treinamento cirúrgico e a prática clínica supervisionada às limitações relacionadas ao COVID-19 na América Latina. MÉTODOS: Foi realizada revisão de literatura entre abril-maio de 2021, dividida em duas buscas. O primeiro procurou identificar estratégias de adaptação em América Latina para treinamento cirúrgico e prática clínica supervisionada. A segunda foi realizada como complemento para identificar metodologias propostas no resto do mundo. RESULTADOS: Na primeira busca, foram selecionados 16 dos 715 artigos. Na segunda, foram selecionados 41 dos 1.637 artigos. Estratégias adaptativas propostas na América Latina com foco em videoconferência e simulação. No resto do mundo, foram sugeridas análises críticas remotas de cirurgias gravadas/ao vivo, tele-mentoria intra-cirúrgica e gravação de cirurgia com feedback pós-operatório. CONCLUSÕES: Múltiplas estratégias de adaptação para educação cirúrgica durante a pandemia de COVID-19 foram propostas na América Latina e no resto do mundo. Há uma oportunidade de implementar novas estratégias a longo prazo para treinamento cirúrgico e prática clínica supervisionada, embora mais estudos prospectivos sejam necessários para gerar recomendações baseadas em evidências.

Supervised Internship: attributions and limitations from the perspective of nursing supervisors, faculty advisor and managers / Internado Curricular Supervisado: atribuciones y limitaciones desde la perspectiva de la enfermera supervisora, asesora de la facultad y gerente / Estágio Curricular Supervisionado: atribuições e limitações na perspectiva do enfermeiro supervisor, docente orientador e gestor

ABSTRACT Objectives: to describe the attributions and limitations in internship nursing supervisors', faculty advisors' and managers' work in the process of carrying out Supervised Internship in nursing education. Methods: a qualitative exploratory-descriptive research. Interviews were conducted between February and July 2018 with 26 participants: four managers, nine faculty advisors, six primary care nursing supervisors and seven hospital care nursing supervisors. Data analysis was performed using the Content Analysis technique. Results: among the main attributions are participation in the organization of the field, mediation between educational and health institutions, presentation of the world of work; as limitations are the high number of institutions in the field, work overload, lack of commitment or lack of didactic preparation towards student education. Final Considerations: we evidenced the need to (re)define and clarify everyone's roles and (re)think the integration strategies for monitoring students.

RESUMEN Objetivos: describir las atribuciones y limitaciones en el desempeño de enfermeras supervisoras de internado, asesoras de facultad y gerentes en el proceso de realización del Internado Curricular Supervisado en la educación de enfermería. Métodos: investigación cualitativa exploratoria descriptiva. Las entrevistas se realizaron entre febrero y julio de 2018, con 26 participantes, como cuatro gerentes, nueve asesores de la facultad, seis enfermeras supervisoras de atención primaria y siete enfermeras supervisoras de atención hospitalaria. El análisis de los datos se realizó mediante la técnica de Análisis de Contenido. Resultados: entre las principales atribuciones, se destacó la participación en la organización del campo, mediación entre instituciones educativas y de salud, presentación del mundo del trabajo; como limitaciones, el alto número de instituciones en el campo, la sobrecarga de trabajo, la falta de compromiso o falta de preparación didáctica en cuanto a la formación de los estudiantes. Consideraciones Finales: se evidenció la necesidad de (re) definir y clarificar los roles de todos y (re) pensar las estrategias de integración para el seguimiento de los estudiantes.

RESUMO Objetivos: descrever as atribuições e limitações na atuação dos enfermeiros supervisores de estágio, docentes orientadores e gestores no processo de realização do Estágio Curricular Supervisionado na formação do enfermeiro. Métodos: pesquisa qualitativa exploratória-descritiva. Foram realizadas entrevistas, entre fevereiro e julho de 2018, com 26 participantes, como quatro gestores, nove docentes orientadores, seis enfermeiros supervisores da atenção básica e sete enfermeiros supervisores da atenção hospitalar. A análise dos dados ocorreu pela técnica de Análise de Conteúdo. Resultados: dentre as principais atribuições, destacaram-se a participação na organização do campo, mediação entre instituição de ensino e de saúde, apresentação do mundo do trabalho; como limitações, o elevado número de instituições no campo, a sobrecarga de trabalho, descompromisso ou falta de preparo didático para com a formação discente. Considerações Finais: evidenciou-se a necessidade de (re)definir e clarificar os papéis de todos e (re)pensar as estratégias de integração para o acompanhamento dos discentes.