Blog do Curso de Medicina da Universidade Estadual de Maringá para a discussão de temas de Educação Médica, Educação das Profissões da Saúde e áreas correlatas.
Blog of University of Maringá Medical School for the discussion of issues of Medical Education, Health Professions Education and related areas.
Governo debate revalidação de diplomas de medicina alcançados em Cuba
O ministro da Saúde, Alexandre Padilha, reuniu-se na sexta-feira (23/9), em Cuba, com estudantes de medicina brasileiros que estão se graduando em instituições cubanas.
O encontro foi realizado na Escola Latino-Americana de Medicina (ELAM) com o intuito de debater a revalidação dos diplomas cubanos, para que os profissionais possam exercer a medicina do Brasil. As informações são do Ministério da Saúde.
De acordo com o texto do Ministério, o ministro tratou de parceria com a ELAM para permitir que estudantes brasileiros que cursaram medicina em Cuba, ao voltarem para o Brasil, “façam aprimoramento do seu currículo sob supervisão de instituições brasileiras, para fazer a revalidação do seu currículo e poder trabalhar como médico no Brasil.”
Participou também da reunião o vice-presidente de Saúde Pública de Cuba, Roberto Gonzales Martín.
- Esses médicos, ao voltarem para o Brasil, ficarão um tempo nas faculdades estaduais fazendo aprimoramento supervisionado, mas já em serviço, trabalhando. É mais uma medida para ampliar o número de médicos nas regiões onde há carência: nos municípios do interior, ou nas regiões mais pobres das grandes cidades.
Segundo ele, os cerca de 500 médicos brasileiros formados em Cuba em processo de revalidação do diploma no Brasil vão se beneficiar da parceria com a Elam.
O ministro visitou também dois centros de pesquisa cubanos – o Centro de Engenharia Genética e Biotecnologia (CIGB) e o Centro de Imunologia Molecular (CIM) -, que estão conduzindo estudos e desenvolvendo medicamentos envolvidos nos acordos de cooperação assinados quinta-feira entre Brasil e Cuba.
Os acordos abrangem 58 pesquisas e 12 produtos de alta tecnologia para tratamento de doenças como câncer, diabetes.
Revalida
Um novo modelo de revalidação de diplomas, cuja primeira edição ocorreu neste ano, está sendo implantado no país. O Exame Nacional de Revalidação de Diplomas (Revalida) permitirá aos formados em instituições estrangeiras validarem seus diplomas com mais uniformidade e em até um ano.
A primeira etapa do exame, composta de provas objetivas e discursivas, foi realizada no dia 11 de setembro, e deverá ter seu resultado divulgado no próximo dia 3.
A segunda e última fase da seleção está prevista para o dia 15 de outubro, e avaliará as habilidades clínicas práticas dos candidatos.
Atenção Primária à Saúde e a Necessidade de Internações por Causas Sensíveis
Acaba de ser publicado um trabalho fundamental para todos os interessados no sucesso do SUS, ao demonstrar a relação entre as intervenções na APS e a eficiência e performance do sistema como um todo.
Parte fundamental deste trabalho foi realizado pela Profª Drª Palmira Bonolo, amiga querida e fellow do FAIMER- Brasil.
The Influence of Primary Care and Hospital Supply on
Ambulatory Care–Sensitive Hospitalizations Among
Adults in Brazil, 1999–2007
James Macinko, Veneza B. de Oliveira,Maria A. Turci,Frederico Guanais, Palmira F. Bonolo e Maria F. Lima-Costa
Am. J. Public Health, 2011; 101: 1963-1970.
doi : 10.2105/AJPH.2010.198887
Objectives. We assessed the influence of changes in primary care and hospital supply on rates of ambulatory care–sensitive (ACS) hospitalizations among adults in Brazil.
Methods. We aggregated data on nearly 60 million public sector hospitalizations between 1999 and 2007 to Brazil’s 558 microregions. We modeled adult ACS hospitalization rates as a function of area-level socioeconomic factors, health services supply, Family Health Program (FHP) availability, and health needs by using dynamic panel estimation techniques to control for endogenous explanatory variables.
Results. The ACS hospitalization rates declined by more than 5% annually. When we controlled for other factors, FHP availability was associated with lower ACS hospitalization rates, whereas private or nonprofit hospital beds were associated with higher rates. Areas with highest predicted ACS hospitalization rates were those with the highest private or nonprofit hospital bed supply and with low (<25%) FHP coverage. The lowest predicted rates were seen for areas with high (>75%) FHP coverage and very few private or nonprofit hospital beds.
Conclusions. These results highlight the contribution of the FHP to improved health system performance and reflect the complexity of the health reform processes under way in Brazil.
A primeira etapa do Exame Nacional de Revalidação dos Diplomas Médicos (Revalida), realizada no domingo, 11, contou com a presença de 78% dos inscritos. A avaliação, realizada pelo Instituto Nacional de Estudos e Pesquisas Educacionais (Inep) foi aplicada em Brasília, Porto Alegre, Manaus, Fortaleza, Rio de Janeiro e Campo Grande.
Os participantes poderão acessar o gabarito preliminar das provas escritas, objetivas e o padrão de respostas para as questões discursivas, a partir das 19h de segunda-feira, 12, e poderão entrar com recursos nos dias 13 e 14 de setembro. O resultado final da primeira etapa do Revalida e a convocação para a segunda etapa serão divulgados em 3 de outubro.
Os aprovados nesta primeira fase devem fazer nova inscrição, na página eletrônica do Revalida, para a prova da segunda etapa, a de habilidades clínicas, marcada para 15 e 16 de outubro, em Brasília. Essa prova terá dez questões.
O Revalida oferece às universidades públicas que firmaram convênio de credenciamento com o Inep os subsídios para o reconhecimento dos diplomas obtidos em instituições estrangeiras. Participam do exame brasileiros e estrangeiros, em situação legal no Brasil, que tenham diploma expedido por instituição de ensino superior reconhecida pelas autoridades educacionais do país do curso.
Concluída a fase de aplicação das provas, o Inep encaminhará o resultado a cada universidade que tiver candidatos inscritos. No processo de revalidação de diplomas médicos deste ano, 37 instituições federais, estaduais e municipais de educação superior estão credenciadas a emitir certificado.
Até 2010, os estudantes formados em medicina em universidades fora do Brasil precisavam revalidar os diplomas em instituição pública brasileira, mas cada universidade adotava procedimentos próprios.
O Ministério da Saúde (MS), o Conselho Nacional de Secretários de Saúde (Conass) e a representação da Organização Pan-Americana da Saúde (OPAS/OMS) no Brasil, lançaram a segunda edição do livro "As Redes de Atenção à Saúde", de Eugênio Vilaça Mendes. A obra tem como objetivo contribuir para a ampliação do debate sobre o SUS, colocando essas questões centrais que se articulam em torno de uma proposta moderna de implantação das Redes de Atenção à Saúde (RASs). A obra está estruturado em cinco capítulos: as situações das condições de saúde e os sistemas de atenção à saúde; as redes de atenção à saúde: revisão bibliográfica, fundamentos, conceito e elementos constitutivos; os modelos de atenção à saúde; as mudanças na atenção à saúde e a gestão da clínica e; uma experiência bem-sucedida de rede de atenção à saúde no SUS: o programa mãe curitibana (PMC). Faça o download do livro clicando aqui.
Segue uma cópia do trabalho "Communications gaps in teaching pediatric outpatient scenario: a qualitative analysis" do nosso amigo Prof. Ricardo Sukiennik (UFCSPA) e colaboradores e apresentado no AMEE 2011 que ocorreu em Viena entre os dias 28-31/08/2011. Parabéns aos autores pelo sucesso do trabalho!
Segue uma cópia do trabalho "Improving Educational Practices: Art professionals collaborating with health teams" de Carlos Eduardo Garcia e colaboradores e apresentado no AMEE 2011 que ocorreu em Viena entre os dias 28-31/08/2011.
Infelizmente, a foto abaixo não reflete de forma fidedigna a riqueza dos recursos visuais utilizados na apresentação durante a sessão de pôsteres, de forma que anexo também uma foto da Profª. Denise Afonso junto ao poster para vocês terem uma ideia da layout final.
Segue uma cópia do trabalho "Building a Community od practice of residency preceptor through blended learning" da nossa amiga Profª Denise Afonso e colaboradores e apresentado no AMEE 2011 que ocorreu em Viena entre os dias 28-31/08/2011. Parabéns aos autores pelo sucesso do trabalho!
Atuar em área de pobreza dará bônus para residência
O Ministério da Saúde, em parceria com o Ministério da Educação, lançou, nesta sexta-feira (02/09/2011), mais uma ação estratégica para atrair médicos para atuarem em Unidades Básicas de Saúde (UBS) em municípios onde há carência desses profissionais. O Programa de Valorização dos Profissionais na Atenção Básica vai conceder até 20% de pontuação adicional na nota final das provas de residência aos egressos do curso de Medicina que optarem por atuar nos municípios de extrema pobreza e em periferias das grandes metrópoles. A bonificação já poderá ser utilizada nos exames que serão realizados em novembro de 2012.Pelo programa, serão abertas duas mil vagas, que poderão ser preenchidas a partir de fevereiro de 2012. "A concessão do benefício representa um avanço. Consideramos que essa é uma das maneiras mais efetivas de disponibilizar, de forma rápida, médicos para ampliar a assistência à população", afirma o chefe de gabinete do Ministério da Saúde, Mozart Sales.Segundo ele, o benefício da pontuação na residência trará vantagem aos estudantes, já que atualmente há uma concorrência exacerbada por vaga (são, em média, 10 mil vagas para 13.800 formandos ao ano). "A intenção também é valorizar na prova de residência o profissional que ganha experiência prática atuando na Atenção Básica, área estratégica na atenção à saúde pública", acrescenta.As medidas foram publicadas na portaria 2.087 publicada no Diário Oficial da União e estão acordadas entre o Ministério da Saúde, o Conselho Nacional de Residência Médica, o Conselho Nacional de Secretários Estaduais de Saúde (CONASS), o Conselho Nacional de Secretários Municipais de Saúde (CONASEMS), e outras entidades de classe.
CRITÉRIOS
Os municípios serão definidos até o final do ano e listados em edital específico. Os profissionais de saúde deverão atuar nas regiões estabelecidas pelo período de um a dois anos para ganhar a pontuação. O Conselho Nacional de Residência Médica divulgará nos próximos dias, por meio de resolução, os índices de pontuação. Quem atuar durante um ano terá 10% de pontuação adicional na nota final. Já aqueles que participarem do programa durante dois anos receberão 20%.Pelo programa, os profissionais serão tutoriados por instituições de ensino, que darão suporte semi-presencial e a distância por meio do programa Telessaúde, que oferece assistência e educação na área de saúde por comunicação à distância. Mais de 70 instituições estão envolvidas. "A tutoria é essencial para garantir a qualidade do atendimento desses médicos à população", afirma Sales.Aos profissionais que participarem durante dois anos do programa será oferecido curso de especialização em saúde da família, sob a responsabilidade das universidades públicas que integram o Sistema Universidade Aberta do SUS (UNA-SUS).O governo federal financiará a operação dos núcleos de Telessaúde, além de custear os cursos de especialização em saúde da família e as atividades dos tutores. Aos municípios caberá a contratação dos profissionais, o pagamento dos salários e o custeio de moradias, quando houver necessidade.
It's a typical scene: a few minutes before 11:00 on a Tuesday morning and about 200 sleepy-looking college students are taking their seats in a large lecture hall - chatting, laughing, calling out to each other across the aisles. Class begins with a big "shhhh" from the instructor, Lee Friedman.
Chemistry instructor Lee Friedman teaching a class at the University of Maryland, College Park. (Photo: Emily Hanford)
This is an introductory chemistry class at the University of Maryland, College Park. For the next hour and 15 minutes, Friedman will lecture and the students will take notes. By the end of class, the three large blackboards at the front of the room will be covered with equations and formulas.
It's a lot to absorb, says student Jimmy Orr. "When it's for an hour you kind of zone out for a little bit," he says.
Student Marly Dainton says she doesn't think she'll remember much from this class.
"I'm going to put it to short-term memory," she says. Once she takes the exam, Dainton expects she'll forget a lot of what she learned.
One of the Oldest Teaching Methods
Research conducted over the past few decades shows it's impossible for students to take in and process all the information presented during a typical lecture, and yet this is one of the primary ways college students are taught, particularly in introductory courses.
It's a tradition going back thousands of years.
"Before printing, it was very difficult to create books, and so someone would read the books to everybody who would copy them down," says Joe Redish, a professor of physics at the University of Maryland. He points out that the word "lecture" comes from the Latin word meaning "to read."
Redish is trying to change the way college students are taught. He says lecturing has never been an effective teaching method, and now that information is so easily accessible, lecturing is a waste of time.
"With modern technology, if all there is is lectures, we don't need faculty to do it," Redish says. "Get 'em to do it once, put it on the web, and fire the faculty."
Redish has been teaching at the University of Maryland since 1970. When he started, he lectured because that's the way he had been taught. But after a few years in the classroom, Redish was meeting with one of his mentors, a famous physicist named Lewis Elton who had begun doing research on education.
Physics professor Joe Redish at the University of Maryland. (Photo: Emily Hanford)
"He asked me, 'How's your teaching?'"
Redish told him it was going well, but that he seemed to be most effective with the students "who do really well and are motivated" about physics.
Elton looked at Redish, smiled, and said, "They're the ones who don't really need you."
"That was like an arrow to the breast!" says Redish.
He knew that Elton was right. Most of the students in his lecture classes were not motivated to learn physics, and they didn't seem to be learning much. Redish thought back on his own experience as a college student and realized that he didn't learn much in lecture classes either.
"When I had a question, I would find the TA," he says. "He would explain stuff to me. I would find other students. I learned how to learn physics on my own."
How People Learn
Redish wanted to reach the students who weren't teaching themselves. So he began trying to better understand how people learn.
This was the 1970s and 80s, a time when cognitive scientists were making big breakthroughs in their understanding of how the human brain processes and retains information. At the same time, a small and growing group of physicists was becoming interested in the questions that kept Redish up at night: What do students learn in a traditional lecture-based physics class, and are there ways to teach them better?
Cognitive scientists determined that people's short-term memory is very limited – it can only process so much at once. A lot of the information presented in a typical lecture comes at students too fast and is quickly forgotten.
Physics education researchers, among whom Redish is now a leader, determined that the traditional lecture-based physics course where students sit and passively absorb information is not an effective way for students to learn. A lot of students can repeat the laws of physics and even solve complex problems, but many are doing it through rote memorization. Most students who complete a standard physics class never understand what the laws of physics mean, or how to apply them to real-world situations. (Read more about what physicists learned.)
Educating Everyone
It may seem obvious that lecturing isn't the best method to get students thinking and learning. Project-based learning and other interactive approaches have been popular in elementary and secondary schools for a long time, and of course the discussion-based seminar is an age-old approach. But lecturing is still the dominant teaching method in large classes at the college level, and also at many high schools - especially in the sciences. Experts say different approaches to teaching large classes can help more students learn, and help them learn better.
Harvard physics professor Eric Mazur preparing to teach class. (Photo: Emily Hanford)
"We want to have a class where everyone can be successful because we need everyone to be successful," says Brian Lukoff, an education researcher at Harvard who is studying ways to more effectively teach large classes.
"We need to educate a population to compete in this global marketplace," says Lukoff. We can't do that by relying on a few motivated people to teach themselves. "We need a much larger swath of [the] population to be able to think critically and problem-solve."
Lukoff works with Harvard physicist Eric Mazur, one of the pioneers in developing a new way to teach large classes. Mazur calls his approach "peer instruction."
Discovering a New Way to Teach
Like Redish at the University of Maryland, Mazur began his teaching career by giving lectures. But in the early 1990s Mazur read about the research being done by Redish and other physicists interested in education. Mazur realized that even many of his Harvard students were getting through class by memorizing information but not really understanding the fundamental concepts of physics.
One day, after he discovered this, Mazur decided to spend a big chunk of class time reviewing a fundamental concept. Half his students had gotten a question about this concept wrong on a recent test. So Mazur gave what he thought was a thorough and thoughtful explanation of the concept. He went slowly, putting all kinds of helpful diagrams up on the board.
"I thought I'd nailed it," he says. "I thought it was the best explanation one could possibly give of this question."
Mazur triumphantly turned around. "Any questions?" he asked. The students just stared at him.
"Nobody raised their hand and said, well but what if this and what if that, simply because they were so confused they couldn't," he says. "I didn't know what to do. But I knew one thing. I knew that 50 percent of the students had given the right answer."
So for reasons he can't remember, Mazur told the students to discuss the question with each other.
Eric Mazur teaching his class at Harvard. (Photo: Emily Hanford)
"And something happened in my classroom which I had never seen before," he says. "The entire classroom erupted in chaos. They were dying to explain it to one another and to talk about it."
Mazur says after just a few minutes of talking to each other, most of the students seemed to have a much better understanding of the concept he'd been trying to teach.
"The 50 percent who had the right answer effectively convinced the other 50 percent," he says.
Here's what Mazur has figured out about what goes on when the students talk with each other during peer instruction:
"Imagine two students sitting next to one another, Mary and John. Mary has the right answer because she understands it. John does not. Mary's more likely, on average, to convince John than the other way around because she has the right reasoning."
But here's the irony. "Mary is more likely to convince John than professor Mazur in front of the class," Mazur says.
"She's only recently learned it and still has some feeling for the conceptual difficulties that she has whereas professor Mazur learned [the idea] such a long time ago that he can no longer understand why somebody has difficulty grasping it."
That's the irony of becoming an expert in your field, Mazur says. "It becomes not easier to teach, it becomes harder to teach because you're unaware of the conceptual difficulties of a beginning learner."
Peer Instruction
Mazur now teaches all of his classes using a "peer-instruction" approach. Rather than teaching by telling, he teaches by questioning. Mazur says it's a particularly effective way to teach large classes.
Harvard students Ryan Duncan (right) and Kevin Mazige in their lab for Eric Mazur’s physics class. (Photo: Emily Hanford)
Here's how he does it: Before each class, students are assigned reading in the textbook. Pretty standard for a lecture class, but if you talk to college students you'll find that many of them don't bother with the reading ahead of time. They come to class to figure out what information the professor thinks is important, then they go to the textbook to read up on what they didn't understand.
"In my approach I've inverted that," says Mazur.
He expects students to familiarize themselves with the information beforehand so that class time can be spent helping them understand what the information means.
To make sure his students are prepared, Mazur has set up a web-based monitoring system where everyone has to submit answers to questions about the reading prior to coming to class. The last question asks students to tell Mazur what confused them. He uses their answers to prepare a set of multiple-choice questions he uses during class.
Mazur begins class by giving a brief explanation of a concept he wants students to understand. Then he asks one of the multiple-choice questions. Students get a minute to think about the question on their own and then answer it using a mobile device that sends their answers to Mazur's laptop.
Next, he asks the students to turn to the person sitting next to them and talk about the question. The class typically erupts in a cacophony of voices, as it did that first time he told students to talk to each other because he couldn't figure out what else to do.
Once the students have discussed the question for a few minutes, Mazur instructs them to answer the question again.
You can see a video of Mazur's peer instruction approach in action here:
Then the process repeats with a new question.
What Mazur has found over nearly 20 years of using peer instruction is that many more students choose the right answer after they have talked with their peers. And it's not because they're blindly following their neighbor's lead. By the end of the semester, students have a deeper understanding of the fundamental concepts of physics than they did when Mazur was just lecturing. Students end up understanding nearly three times as much now, measured by a widely-used conceptual test.
In addition to having a deeper grasp of concepts, students in Mazur's classes are better at solving conventional physics problems, despite the fact that Mazur no longer spends class time at the board doing problems. He says this shows something that may seem obvious.
"If you understand the material better, you do better on problem-solving," Mazur says. "Even if there's less of it done in class." Peer instruction has proven effective in a range of subjects from psychology to philosophy.
A Skeptical Audience
College students typically come into peer instruction courses skeptical.
"Basically my entire life I have been in a situation where a teacher stands up and talks and then you take notes and try to absorb the information as well as you can," says Ryan Duncan, a sophomore in Eric Mazur's physics class at Harvard.
"I've developed a pretty good system to deal with that and revamping my entire education 'philosophy' for this one class was a bit daunting."
But Duncan says he has come to appreciate Mazur's approach.
His classmate Stacey Lyne says she has too. She says it will be frustrating to go back to the traditional approach when she takes classes from other teachers.
"I know I'm frustrated now with some of my other classes when I go to lecture and I have to just sit there and take in information and I don't really get the opportunity to think about what I have just learned," she says. Lyne says she's learning more in this new way.
But getting Lyne's other professors to stop lecturing will be a hard sell. Change is slow in the academy, and professors tend to be rewarded for focusing on their research, often at the expense of their teaching.
Apresentei o relato da nossa experiência no último congresso da AMEE - Association for Medical Education in Europe - realizado entre os dias 27 e 31 de Agosto em Viena. Foram apresentados os dados referentes ao período até Março de 2011 e a discussão foi muito boa.
Agradeço a todos os que têm nos prestigiado, inclusive com matérias e comentários.
Chemistry instructor Lee Friedman teaching a class at the University of Maryland, College Park. (Photo: Emily Hanford)
Physics professor Joe Redish at the University of Maryland. (Photo: Emily Hanford)
Harvard physics professor Eric Mazur preparing to teach class. (Photo: Emily Hanford)
Eric Mazur teaching his class at Harvard. (Photo: Emily Hanford)
Harvard students Ryan Duncan (right) and Kevin Mazige in their lab for Eric Mazur’s physics class. (Photo: Emily Hanford)