tag:blogger.com,1999:blog-7218808471520023252024-03-12T21:02:01.232-03:00Educação MédicaBlog 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.Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.comBlogger1198125tag:blogger.com,1999:blog-721880847152002325.post-7583492745796013542019-10-25T08:08:00.001-03:002019-10-25T08:08:34.407-03:00Equity in Health<div class="separator" style="clear: both; text-align: center;">
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<span style="color: #073763;"><span style="font-size: x-large;"><b><span style="font-family: sans-serif; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);">DARWIN DECLARATION</span></b></span></span></div>
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<b><span style="color: #0b5394;"><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuombDcd5QxZTkZG2sk7j1kMMBt8VyzLVSq-HrlTdzo9Tq6tahQTqQVAFrfBmnNNO2otpum7bURtZgdRL8_IgEslqK4XO18DuoE7Eq68Z6PRzKtfgZyFQ2NOXGNeS0nYVO-j-VoMC-sRc/s1600/Sem+t%25C3%25ADtulo1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="282" data-original-width="602" height="298" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuombDcd5QxZTkZG2sk7j1kMMBt8VyzLVSq-HrlTdzo9Tq6tahQTqQVAFrfBmnNNO2otpum7bURtZgdRL8_IgEslqK4XO18DuoE7Eq68Z6PRzKtfgZyFQ2NOXGNeS0nYVO-j-VoMC-sRc/s640/Sem+t%25C3%25ADtulo1.png" width="640" /></a></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 60px; top: 282.178px; transform: scaleX(0.944666);">The Network: Towards Unity for </span><span style="font-family: sans-serif; left: 60px; top: 307.178px; transform: scaleX(0.94918);">Health (TUFH) an official non-</span><span style="font-family: sans-serif; left: 60px; top: 332.178px; transform: scaleX(0.908363);">state actor of WHO, is an </span><span style="font-family: sans-serif; left: 60px; top: 357.178px; transform: scaleX(0.917118);">international organization that </span><span style="font-family: sans-serif; left: 60px; top: 382.178px; transform: scaleX(0.912284);">works with national, state, and </span><span style="font-family: sans-serif; left: 60px; top: 407.178px; transform: scaleX(0.913882);">community partners to foster </span><span style="font-family: sans-serif; left: 60px; top: 432.178px; transform: scaleX(0.92059);">equitable community-oriented </span><span style="font-family: sans-serif; left: 60px; top: 457.178px; transform: scaleX(0.888524);">health services, education and </span><span style="font-family: sans-serif; left: 60px; top: 482.178px; transform: scaleX(0.907423);">research with the goal of </span><span style="font-family: sans-serif; left: 60px; top: 507.178px; transform: scaleX(0.933365);">improving health locally and </span><span style="font-family: sans-serif; left: 60px; top: 532.178px; transform: scaleX(0.954963);">globally. </span><span style="font-family: sans-serif; left: 60px; top: 582.178px; transform: scaleX(0.924993);">The participants of TUFH 2019 in Darwin, collectively, as a result of the Global Solutions Challenge Inclusive </span><span style="font-family: sans-serif; left: 60px; top: 607.178px; transform: scaleX(0.897946);">Process, curated and endorse the following declaration. </span><span style="font-family: sans-serif; left: 65px; top: 657.178px; transform: scaleX(1.02875);"> </span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 65px; top: 657.178px; transform: scaleX(1.02875);">ACHIEVING EQUITABLE HEALTH CARE BY RESPONDING TO POPULATION HEALTH NEEDS </span><span style="font-family: sans-serif; left: 60px; top: 707.178px; transform: scaleX(0.877425);">Whereas, </span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 60px; top: 732.178px; transform: scaleX(0.9);">1.</span><span style="font-family: sans-serif; left: 90px; top: 732.178px; transform: scaleX(0.909517);">The world desires and the future deserves Universal Health Coverage and Equitable Health Care for ALL; </span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 60px; top: 757.178px; transform: scaleX(0.9);">2.</span><span style="font-family: sans-serif; left: 90px; top: 757.178px; transform: scaleX(0.904148);">Universal Health Coverage and Equitable Health Care for the disadvantaged, neglected, and minorities </span><span style="font-family: sans-serif; left: 90px; top: 782.178px; transform: scaleX(0.91473);">rarely exists; </span><span style="font-family: sans-serif; left: 60px; top: 807.178px; transform: scaleX(0.9);"> </span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 60px; top: 807.178px; transform: scaleX(0.9);">3.</span><span style="font-family: sans-serif; left: 90px; top: 807.178px; transform: scaleX(0.926466);">The voices of marginalized populations including but not limited to First Nations, Indigenous, Elderly, </span><span style="font-family: sans-serif; left: 90px; top: 832.178px; transform: scaleX(0.894543);">Women, Migrants and Refugees, and people living in remote and rural areas are not adequately represented </span><span style="font-family: sans-serif; left: 90px; top: 857.178px; transform: scaleX(0.90151);">or invited to the table where health, system and funding decisions are made; </span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 60px; top: 882.178px; transform: scaleX(0.9);">4.</span><span style="font-family: sans-serif; left: 90px; top: 882.178px; transform: scaleX(0.897392);">Non-health sectors are not adequately represented or invited to the table where health, system and funding </span><span style="font-family: sans-serif; left: 90px; top: 907.178px; transform: scaleX(0.881966);">decisions are made; </span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 60px; top: 932.178px; transform: scaleX(0.9);">5.</span><span style="font-family: sans-serif; left: 90px; top: 932.178px; transform: scaleX(0.895157);">There is often a disconnect between the wisdom and ideas of the elders and the youth where both voices are </span><span style="font-family: sans-serif; left: 90px; top: 957.178px; transform: scaleX(0.904956);">often lost in healthcare discussion; </span><span style="font-family: sans-serif; left: 60px; top: 982.178px; transform: scaleX(0.9);"> </span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 60px; top: 982.178px; transform: scaleX(0.9);">6.</span><span style="font-family: sans-serif; left: 90px; top: 982.178px; transform: scaleX(0.912212);">Institutions who adopt and implement social accountability and interprofessional education and practice </span><span style="font-family: sans-serif; left: 90px; top: 1007.18px; transform: scaleX(0.892352);">standards aren’t recognized; </span><span style="font-family: sans-serif; left: 60px; top: 1032.18px; transform: scaleX(0.9);"> </span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 60px; top: 1032.18px; transform: scaleX(0.9);">7.</span><span style="font-family: sans-serif; left: 90px; top: 1032.18px; transform: scaleX(0.9068);">Climate change is increasingly effecting the environment, health and healthcare; </span><span style="font-family: sans-serif; left: 60px; top: 1057.18px; transform: scaleX(0.9);"> </span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 60px; top: 1057.18px; transform: scaleX(0.9);">8.</span><span style="font-family: sans-serif; left: 90px; top: 1057.18px; transform: scaleX(0.913205);">Health Education and Training is rarely tailored to, addresses community needs, or informed by community </span><span style="font-family: sans-serif; left: 90px; top: 1082.18px; transform: scaleX(0.92758);">implementation; </span><span style="font-family: sans-serif; left: 60px; top: 1107.18px; transform: scaleX(0.9);"> </span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 60px; top: 1107.18px; transform: scaleX(0.9);">9.</span><span style="font-family: sans-serif; left: 90px; top: 1107.18px; transform: scaleX(0.918426);">Global siloed policy recommendations, consuming the majority of financial resources, are majorly </span><span style="font-family: sans-serif; left: 90px; top: 1132.18px; transform: scaleX(0.904339);">ineffective as they are not developed with and by the communities they are targeted to impact and do not </span><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);">often engage and support the work of local clinicians and teams. </span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 155px; top: 85.5111px; transform: scaleX(0.960054);">We collectively declare we will work toward inclusiveness, education, and advocacy.</span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 60px; top: 135.511px; transform: scaleX(0.951384);">We will work toward INCLUSIVENESS defined by: </span><span style="font-family: sans-serif; left: 60px; top: 160.511px; transform: scaleX(0.9);"> </span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 60px; top: 160.511px; transform: scaleX(0.9);"> 1.</span><span style="font-family: sans-serif; left: 90px; top: 160.511px; transform: scaleX(0.923569);">A global effort of caring for each other returning the human spirit to health care including community </span><span style="font-family: sans-serif; left: 90px; top: 185.511px; transform: scaleX(0.898371);">voices, culture, lived experiences, empathy, and compassion. </span><span style="font-family: sans-serif; left: 60px; top: 210.511px; transform: scaleX(0.9);"> </span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 60px; top: 210.511px; transform: scaleX(0.9);">2.</span><span style="font-family: sans-serif; left: 90px; top: 210.511px; transform: scaleX(0.915496);">Frequent and consistent communication in the creation of priorities for local action between and within the </span><span style="font-family: sans-serif; left: 90px; top: 235.511px; transform: scaleX(0.916719);">health sector both regionally and globally and with and for the people and communities of the world. </span><span style="font-family: sans-serif; left: 60px; top: 260.511px; transform: scaleX(0.9);"> </span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 60px; top: 260.511px; transform: scaleX(0.9);">3.</span><span style="font-family: sans-serif; left: 90px; top: 260.511px; transform: scaleX(0.912295);">Frequent and consistent communication in the creation of joint priorities of action beyond the health sector </span><span style="font-family: sans-serif; left: 90px; top: 285.511px; transform: scaleX(0.907319);">with non-health sectors. </span><span style="font-family: sans-serif; left: 60px; top: 335.511px; transform: scaleX(0.955239);"> </span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 60px; top: 335.511px; transform: scaleX(0.955239);">We will work toward EDUCATION defined by: </span><span style="font-family: sans-serif; left: 60px; top: 360.511px; transform: scaleX(0.9);"> </span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 60px; top: 360.511px; transform: scaleX(0.9);">4.</span><span style="font-family: sans-serif; left: 90px; top: 360.511px; transform: scaleX(0.907716);">Alternative health practitioners (e.g. community health workers) and emerging healthcare professionals are </span><span style="font-family: sans-serif; left: 90px; top: 385.511px; transform: scaleX(0.90365);">engaged, competently trained, certified, and represented in health workforce policies and practices. </span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 60px; top: 410.511px; transform: scaleX(0.9);">5.</span><span style="font-family: sans-serif; left: 90px; top: 410.511px; transform: scaleX(0.905454);">The next generation of health workforce leadership is prepared by creating greater opportunities for students </span><span style="font-family: sans-serif; left: 90px; top: 435.511px; transform: scaleX(0.917646);">with mentorship being one of the opportunities. </span><span style="font-family: sans-serif; left: 60px; top: 460.511px; transform: scaleX(0.9);"> </span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 60px; top: 460.511px; transform: scaleX(0.9);">6.</span><span style="font-family: sans-serif; left: 90px; top: 460.511px; transform: scaleX(0.896575);">Capitalize on the advancement of technology to enhance the sharing and education for academics, health </span><span style="font-family: sans-serif; left: 90px; top: 485.511px; transform: scaleX(0.906877);">workers and students regionally and around the world. </span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 60px; top: 510.511px; transform: scaleX(0.9);">7.</span><span style="font-family: sans-serif; left: 90px; top: 510.511px; transform: scaleX(0.897448);">Healthcare Education is tailored to and addresses community needs and incorporates community best </span><span style="font-family: sans-serif; left: 90px; top: 535.511px; transform: scaleX(0.906122);">practices (e.g. field case studies) reflecting what people are doing and not publishing. This includes the </span><span style="font-family: sans-serif; left: 90px; top: 560.511px; transform: scaleX(0.925495);">formation of additional health education and training platforms from communities, in communities, by </span><span style="font-family: sans-serif; left: 90px; top: 585.511px; transform: scaleX(0.918421);">communities, and for communities. </span><span style="font-family: sans-serif; left: 60px; top: 635.511px; transform: scaleX(0.957593);"> </span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 60px; top: 635.511px; transform: scaleX(0.957593);">We will work toward ADVOCACY defined by: </span><span style="font-family: sans-serif; left: 60px; top: 660.511px; transform: scaleX(0.9);"> </span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 60px; top: 660.511px; transform: scaleX(0.9);">8.</span><span style="font-family: sans-serif; left: 90px; top: 660.511px; transform: scaleX(0.923063);">Advocacy to ensure the voice of marginalized populations including but not limited to First Nations, </span><span style="font-family: sans-serif; left: 90px; top: 685.511px; transform: scaleX(0.904275);">Indigenous, Elderly, Women, Migrants and Refugees, and people living in remote and rural areas are </span><span style="font-family: sans-serif; left: 90px; top: 710.511px; transform: scaleX(0.887495);">adequately represented at the table where health, system and funding decisions are made. </span><span style="font-family: sans-serif; left: 60px; top: 735.511px; transform: scaleX(0.9);"> </span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 60px; top: 735.511px; transform: scaleX(0.9);">9.</span><span style="font-family: sans-serif; left: 90px; top: 735.511px; transform: scaleX(0.915695);">Provide international structures and systems for the structural implementation of Social Accountability (e.g. </span><span style="font-family: sans-serif; left: 90px; top: 760.511px; transform: scaleX(0.893018);">curriculum accreditation that responds to and does not increase disadvantages). </span><span style="font-family: sans-serif; left: 60px; top: 785.511px; transform: scaleX(0.89982);"> </span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 60px; top: 785.511px; transform: scaleX(0.89982);">10.</span><span style="font-family: sans-serif; left: 90px; top: 785.511px; transform: scaleX(0.908013);">A global effort recognizing the climate change and its impact on the environment, health, and healthcare. </span><span style="font-family: sans-serif; left: 60px; top: 810.511px; transform: scaleX(0.922357);"> </span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 60px; top: 810.511px; transform: scaleX(0.922357);">11.</span><span style="font-family: sans-serif; left: 90px; top: 810.511px; transform: scaleX(0.909681);">Demonstrate through evidence that Social Accountability, Interprofessional Education, and the Integrated </span><span style="font-family: sans-serif; left: 90px; top: 835.511px; transform: scaleX(0.904902);">Health Team create positive impact toward students, health professionals, and community.</span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 60px; top: 860.511px; transform: scaleX(0.89982);">12.</span><span style="font-family: sans-serif; left: 90px; top: 860.511px; transform: scaleX(0.91834);">Support the certification and recognition of institutions as the global leaders in implementing Social </span><span style="font-family: sans-serif; left: 90px; top: 885.511px; transform: scaleX(0.911297);">Accountability, Interprofessional, and Population Health that includes, at a minimum, the standards as listed </span><span style="font-family: sans-serif; left: 90px; top: 910.511px; transform: scaleX(0.935152);">below: </span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 90px; top: 910.511px; transform: scaleX(0.935152);"> </span><span style="font-family: sans-serif; left: 105px; top: 937.178px;">•</span><span style="font-family: sans-serif; left: 120px; top: 935.511px; transform: scaleX(0.916888);">Policies, curricula, and regulatory standards that promote social accountability, community involvement, </span><span style="font-family: sans-serif; left: 120px; top: 960.511px; transform: scaleX(0.901572);">and interprofessional education and practice; </span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 120px; top: 960.511px; transform: scaleX(0.901572);"> </span><span style="font-family: sans-serif; left: 105px; top: 987.178px;">•</span><span style="font-family: sans-serif; left: 120px; top: 985.511px; transform: scaleX(0.926304);">Environmental Impact of Healthcare including the monitoring waste production, efficiency, challenging </span><span style="font-family: sans-serif; left: 120px; top: 1010.51px; transform: scaleX(0.888655);">the need of single use devices; </span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 120px; top: 1010.51px; transform: scaleX(0.888655);"> </span><span style="font-family: sans-serif; left: 105px; top: 1037.18px;">•</span><span style="font-family: sans-serif; left: 120px; top: 1035.51px; transform: scaleX(0.917819);">Inclusion of the student and patient/community voice in the development of policies, curricula and </span><span style="font-family: sans-serif; left: 120px; top: 1060.51px; transform: scaleX(0.896101);">regulatory standards; </span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 120px; top: 1060.51px; transform: scaleX(0.896101);"> </span><span style="font-family: sans-serif; left: 105px; top: 1087.18px;">•</span><span style="font-family: sans-serif; left: 120px; top: 1085.51px; transform: scaleX(0.913638);">Holistic approach in delivering quality health that includes the healthcare team driven by patient goals </span><span style="font-family: sans-serif; left: 120px; top: 1110.51px; transform: scaleX(0.879665);">verses silos. </span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 120px; top: 1110.51px; transform: scaleX(0.879665);"> </span><span style="font-family: sans-serif; left: 105px; top: 1137.18px;">•</span><span style="font-family: sans-serif; left: 120px; top: 1135.51px; transform: scaleX(0.921925);">Ensure training from communities, in communities, by communities, and for communities. </span></span></span></span></b></div>
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<b><span style="color: #0b5394;"><span style="font-family: sans-serif; font-size: large; left: 361.667px; top: 226.056px; transform: scaleX(1.05005);"><span style="font-family: sans-serif; left: 90px; top: 1157.18px; transform: scaleX(0.904699);"><span style="font-family: sans-serif; left: 60px; top: 1185.51px; transform: scaleX(0.903616);">TUFH commits to be a vibrant and effective network of networks that realizes, implements, and assesses the </span><span style="font-family: sans-serif; left: 60px; top: 1210.51px; transform: scaleX(0.896067);">effectiveness of the above actions.</span></span></span></span></b></div>
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Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-63468662241367088852019-09-28T07:06:00.002-03:002019-09-28T07:06:53.632-03:00Community-based Medicine<div class="separator" style="clear: both; text-align: center;">
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<span style="color: #0c343d;"><span style="font-size: x-large;">From Classrooms to Neighborhoods -- A Reality Students Must Be Prepared For</span></span> </h1>
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<span style="color: #134f5c;"><span style="font-size: large;"><b><span itemprop="name">Alejandro Avelino Bonilla</span> </b></span></span></div>
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<span style="color: #134f5c;"><span style="font-size: large;"><b><img alt="Resultado de imagem para Alejandro Avelino Bonilla" class="rg_ic rg_i" data-atf="1" height="320" id="CfrPwS7-zYwkSM:" src="https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcQVTNUgeoCBe6Afwb0covgSZMk8ZVRXBtoxWYg9kWLNOCFMZb0R" style="height: 150px; margin-left: 1px; margin-right: 1px; margin-top: 17px; width: 150px;" width="320" /></b></span></span></div>
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<section class="article-content" itemprop="articleBody"><span style="color: #134f5c;"> </span><span style="color: #134f5c;"><span style="font-size: large;"><b>In recent decades, medical education has been changing around the world in an effort to improve quality, equity, and relevance among other characteristics. A good example for this is the accreditation process of many medical institutions around the world. Besides this, institutions are also aiming to reach what has been defined as social accountability, and it is the main topic of the must-read, <i>“Global Consensus for Social Accountability of Medical Schools.” <sup>1</sup></i> Both topics have been widely explored by The Network: TUFH and its members during the last years and are reflected on The Fortaleza Declaration (2014)<sup>2</sup> and the Tunis Declaration (2017)<sup>3</sup> seeking global learning objectives for health professionals and to enhance health and social justice in the social accountability context respectively. </b></span></span><br />
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<span style="color: #134f5c;"> </span><span style="color: #134f5c;"><span style="font-size: large;"><b>Accreditation and social accountability are topics that deserve their own review and discussion, but both are related to an issue I want to highlight, the disparity between what is taught and learned during the undergraduate period and what is really useful and needed to work with, and in, communities. From the accreditation perspective, standards are given in order to develop programs and activities in the communities (depending on the national standard that is widely used), meaning that students will, for sure, be in touch with the communities and their surroundings in non-clinical or outreach activities. On the other hand, social accountability has a much bigger picture of the community and includes relevance, quality, cost-effectiveness, and equity to the activities developed in the community.<sup>4,5</sup> </b></span></span><br />
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<span style="color: #134f5c;"><span style="font-size: large;"><b>We, as health educators, talk about the relevance of community-based practices and that students must be in touch with the community (even though some students and even teachers may be slightly against it), but community-based practices are not the same as socially accountable actions, neither being a social accountability program. Therefore, students are being taken to communities to perform activities, within accreditation standards, but they might not be socially accountable and it endangers the development of health care students and the reason is quite simple, during and around four to seven years, health care education institutions train students to face and treat health issues in a clinical context (of course this does not apply to all medical institutions but for most it does), and then, they are taken to a more social context where they do not have the tools and environment they are used to, so they must face a completely new reality. This situation can be so deeply entrenched that even the country's health system is not designed to respond to the needs of the community outside the hospital, so what do we expect from students when it comes to commitment and delivery within the community? Why do we proudly say that our students perform activities in the community when we are not really having the desired effect on them nor on the community? Or at least in most communities because even faced with these difficulties, some students actually “fall in love” with the community’s health and that’s what brings us to this discussion. </b></span></span><br />
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<span style="color: #134f5c;"><span style="font-size: large;"><b>Recently in Latin America there was a debate about the voluntary interruption of pregnancy as a right, Argentina<sup>6</sup> and Colombia<sup>7</sup> just to cite some examples, and many institutions refused to train their students about this type of care. In the specific case of Colombia when the students where asked, many reported that they received little or almost no training about the topic. If this happens with a subject that is specific, what might be happening when we try to teach and inform students around health in the communities, and even more complex, social accountability issues?</b></span></span><br />
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<span style="color: #134f5c;"><span style="font-size: large;"><b>Now, from the community context, are they involved in the planning, execution, and follow up of these community-based practices or social accountable activities? Do we even ask them what they need and what is a priority for them? Or do we just assume that we know what is best because we are the health professionals? A highly involved and active community is not a common thing but is not impossible to find or to nurture. Yet it does require time and work and once it is archived, it can basically guarantee the sustainability part of the impact of the intervention. This brings us to the “the elephant in the room,” are we involving the community? Are we working for the community, in the community, or with the community? Most of the community-based activities tend to be focused on building capacities for the students, but not all of them aim for building capacities for the community as well. These activities ended up being used as a means to reach the objectives with the students, instead of being the end itself and forming students along the way.</b></span></span><br />
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<span style="color: #134f5c;"><span style="font-size: large;"><b>So, if we combine these factors, students are being formed on a clinical level and then taken to perform community-based practices that do not meet the needs of the community, ultimately we will have newly graduated doctors that do not possess the theoretical and practical knowledge to answer a community’s health needs, and additionally, communities that do not feel like they can identify with these newly graduated doctors. Isn’t this a problem we are facing worldwide? Of course, it has other contributing causes, but this is one we can face now.</b></span></span><br />
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<span style="color: #134f5c;"><span style="font-size: large;"><b>The solution can be found in the problem itself once we face it. Building programs and curriculums around the needs of the community -- with the community -- will allow students to face these needs in a much more real scenario, while during classes students will receive education in primary health care. This is a solution that does not require additional funding, it requires a restructuring and prioritization, something that is extensively addressed during the actions of primary health care and community-based primary health care.</b></span></span><br />
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<span style="color: #134f5c;"><span style="font-size: large;"><b>There are many programs and institutions that are changing the health related education paradigm and that we all can meet in the next The Network: TUFH Social Accountability: From Evidence to Action Conference in Darwin, Australia, which demands that institutions, teachers, students, and policymakers among others participate in this must attend event.</b></span></span><br />
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<span style="color: #134f5c;"><span style="font-size: large;"><b>This is just a short reflection on a subject that requires a wide and rich debate with different perspectives to support primary health care as a reality that will last over time and that will deliver the impact we are looking for -- education and health promotion, disease prevention, early detection and treatment, and the improvement of the quality of life of the entire population. It may sound idealistic, but Ayn Rand stated it best, <i>“Anyone who fights for the future, lives in it today.”</i></b></span></span><br />
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<u><span style="color: #134f5c;"><span style="font-size: large;"><b>Works Cited</b></span></span></u><br />
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<span style="color: #134f5c;"> </span><ul>
<li><span style="color: #134f5c;"><span style="font-size: large;"><b>Abdalla, Mohamed Elhassan, y Charles Boelen. “Social Accountability of Medical Schools: The New Frontier For Development”, 2012, 7–31.</b></span></span></li>
<li><span style="color: #134f5c;"><span style="font-size: large;"><b>Awases, Magdalena, Rebecca Bailey, Charles Boelen, y Mario Dal Poz. “Global consensus on social accountability of medical schools”. <i>Sante publique (Vandoeuvre-les-Nancy, France)</i> 23, núm. 3 (2010): 247–50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21896218" target="_blank">www.ncbi.nlm.nih.gov/pubmed/21896218</a>.</b></span></span></li>
<li><span style="color: #134f5c;"><span style="font-size: large;"><b>Boelen, Charles, Jeffery E Heck, y World Health Organization. Division of Development of Human Resources for Health. “Defining and measuring the social accountability of medical schools”, 1995. <a href="http://apps.who.int//iris/handle/10665/59441" target="_blank">apps.who.int//iris/handle/10665/59441</a>.</b></span></span></li>
<li><span style="color: #134f5c;"><span style="font-size: large;"><b>Cañón, Laura Natalia Cruz. “Facultades de medicina, reprobadas en Interrupción Voluntaria del Embarazo”. <i>El Espectador.</i> 2019. <a href="https://www.elespectador.com/noticias/salud/facultades-de-medicina-reprobadas-en-interrupcion-voluntaria-del-embarazo-articulo-865163" target="_blank">www.elespectador.com/noticias/salud/</a>.</b></span></span></li>
<li><span style="color: #134f5c;"><span style="font-size: large;"><b>Garcia, Glenn. “Abortion in Argentina”. <i>The Lancet</i> 393, núm. 10173 (2019): 744. <a href="https://doi.org/10.1016/s0140-6736(18)32767-3" target="_blank">doi.org/10.1016/s0140-6736(18)32767-3</a>.</b></span></span></li>
<li><span style="color: #134f5c;"><span style="font-size: large;"><b>Goñi, Uki. “‘Thousands’ of young girls denied abortion after rape in Argentina”. THe Guardian, 2019. <a href="https://www.theguardian.com/global-development/2019/mar/05/thousands-young-girls-denied-abortion-argentina" target="_blank">www.theguardian.com/global-development/</a>.</b></span></span></li>
<li><span style="color: #134f5c;"><span style="font-size: large;"><b>Members of The Network; TUFH. “The Fortaleza Declaration”. Fortaleza, Brasil, 2014. <a href="https://thenetworktufh.org/declarations/" target="_blank">thenetworktufh.org/declarations/</a>.</b></span></span></li>
<li><span style="color: #134f5c;"><span style="font-size: large;"><b>———. “Tunis Declaration”. Hammamet, Tunisia, 2017. <a href="https://thenetworktufh.org/declarations/" target="_blank">thenetworktufh.org/declarations/</a>.</b></span></span></li>
</ul>
<span style="color: #134f5c;"><span style="font-size: large;"><b> </b></span></span><br /><span style="color: #134f5c;"><span style="font-size: large;"><b> </b></span></span><br /><span style="color: #134f5c;"><span style="font-size: large;"><b> </b></span></span><br /><u><span style="color: #134f5c;"><span style="font-size: large;"><b>Footnotes</b></span></span></u></section><section class="article-content" itemprop="articleBody"><span style="color: #134f5c;"><span style="font-size: large;"><b> </b></span></span></section><section class="article-content" itemprop="articleBody"><u><span style="color: #134f5c;"><span style="font-size: large;"><b></b></span></span></u><ul>
<li><span style="color: #134f5c;"><span style="font-size: large;"><b><sup>1</sup> Magdalena Awases et al., “Global consensus on social accountability of medical schools”, Sante publique (Vandoeuvre-les-Nancy, France) 23, núm. 3 (2010): 247–50, <a href="http://www.ncbi.nlm.nih.gov/pubmed/21896218" target="_blank">www.ncbi.nlm.nih.gov/pubmed/21896218</a>.</b></span></span></li>
<li><span style="color: #134f5c;"><span style="font-size: large;"><b><sup>2</sup> Members of The Network; TUFH, “The Fortaleza Declaration” (Fortaleza, Brasil, 2014), <a href="https://thenetworktufh.org/declarations/" target="_blank">thenetworktufh.org/declarations/</a>.</b></span></span></li>
<li><span style="color: #134f5c;"><span style="font-size: large;"><b><sup>3</sup> Members of The Network; TUFH, “Tunis Declaration” (Hammamet, Tunisia, 2017), <a href="https://thenetworktufh.org/declarations/" target="_blank">thenetworktufh.org/declarations/</a>.</b></span></span></li>
<li><span style="color: #134f5c;"><span style="font-size: large;"><b><sup>4</sup> Charles Boelen, Jeffery E Heck, y World Health Organization. Division of Development of Human Resources for Health, “Defining and measuring the social accountability of medical schools”, 1995, <a href="http://apps.who.int//iris/handle/10665/59441" target="_blank">apps.who.int//iris/handle/10665/59441</a>.</b></span></span></li>
<li><span style="color: #134f5c;"><span style="font-size: large;"><b><sup>5</sup> Mohamed Elhassan Abdalla y Charles Boelen, “Social Accountability of Medical Schools: The New Frontier For Development”, 2012, 7–31.</b></span></span></li>
<li><span style="color: #134f5c;"><span style="font-size: large;"><b><sup>6</sup> Glenn Garcia, “Abortion in Argentina”, The Lancet 393, núm. 10173 (2019): 744, https://doi.org/10.1016/s0140-6736(18)32767-3; Uki Goñi, “‘Thousands’ of young girls denied abortion after rape in Argentina”, THe Guardian, 2019, <a href="https://www.theguardian.com/global-development/2019/mar/05/thousands-young-girls-denied-abortion-argentina" target="_blank">www.theguardian.com/global-development/2019/mar/05/</a>.</b></span></span></li>
<li><span style="color: #134f5c;"><span style="font-size: large;"><b><sup>7</sup> Laura Natalia Cruz Cañón, “Facultades de medicina, reprobadas en Interrupción Voluntaria del Embarazo”, El Espectador, 2019, <a href="https://www.elespectador.com/noticias/salud/facultades-de-medicina-reprobadas-en-interrupcion-voluntaria-del-embarazo-articulo-865163" target="_blank">www.elespectador.com/noticias/salud/</a>.</b></span></span></li>
</ul>
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<span style="font-size: large;"><b><i>* Alejandro Avelino Bonilla is a physician and epidemiology postgraduate student from Juan N. Corpas University in Bogotá, Colombia. He is a National Research Leader in the Colombian Medical Student Association ACOME and member of the advisory board of The Network: TUFH. For more than three years he was a student representative for his University, as well as founder and co-president of the Colombian Association of Students Representatives of Higher Education ACREES. Alejandro also previously served as a Latin Americas´ representative and president of SNO.</i></b></span><br />
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Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-22495029257691434892019-09-23T19:10:00.000-03:002019-09-23T19:10:02.335-03:00Programa Médicos pelo Brasil<div class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNprEaJKk36Jb6cFoNjBO_UqQdPpoOHwY2Nmwgn7m16Z38wWrSUrmIP5junZzBMzTF1DMtzeliOKLuAhBFUWT3kRQ3tI3wggcOnmz3ov7Y_ysoz5RtCYW7vB9MmzY9Fr4qryFlO9b51GM/s1600/Sem+t%25C3%25ADtulo.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="184" data-original-width="902" height="130" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNprEaJKk36Jb6cFoNjBO_UqQdPpoOHwY2Nmwgn7m16Z38wWrSUrmIP5junZzBMzTF1DMtzeliOKLuAhBFUWT3kRQ3tI3wggcOnmz3ov7Y_ysoz5RtCYW7vB9MmzY9Fr4qryFlO9b51GM/s640/Sem+t%25C3%25ADtulo.bmp" width="640" /></a></div>
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<span style="font-size: x-large;"><span style="font-family: arial, helvetica, sans-serif;"><strong>NOTA AOS MÉDICOS E À SOCIEDADE</strong></span></span></div>
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<span style="font-family: 'Arial', sans-serif; font-size: 10pt;"> </span></div>
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<span style="color: #38761d;"><span style="font-size: large;"><b><span style="font-family: "Arial", sans-serif;">O
Conselho Federal de Medicina (CFM) foi surpreendido com a nota
divulgada pela imprensa informando que o relatório da Comissão Mista do
Congresso Nacional que discute a Medida Provisória nº 890/2019, que cria
o Programa Médicos pelo Brasil, deve prever a inclusão de 1.800 médicos
cubanos, além da permissão de que médicos brasileiros formados no
exterior que não foram aprovados no Exame Nacional de Revalidação de
Diplomas Médicos Expedidos por Instituições de Educação Superior
Estrangeiras (Revalida) tenham o direito de prestar a prova para
ingressar no Programa, mesmo sem registro em Conselho Regional de
Medicina (CRM).</span></b></span></span></div>
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<span style="color: #38761d;"><span style="font-size: large;"><b> </b></span></span></div>
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</b></span></span><div style="text-align: justify;">
<span style="color: #38761d;"><span style="font-size: large;"><b><span style="font-family: "Arial", sans-serif;">Essa
notícia surpreende e decepciona, pois não corresponde à proposta
apresentada pelo Ministério da Saúde ao CFM por ocasião do planejamento
do Programa Médicos pelo Brasil.</span></b></span></span></div>
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<span style="color: #38761d;"><span style="font-size: large;"><b> </b></span></span></div>
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</b></span></span><div style="text-align: justify;">
<span style="color: #38761d;"><span style="font-size: large;"><b><span style="font-family: "Arial", sans-serif;">O
CFM tem posicionamento público em relação a essa questão e é inflexível
quanto à obrigatoriedade de que qualquer médico, para exercer sua
profissão no Brasil, tenha de ter diploma revalidado, estar registrado
nos Conselhos de Medicina e ser portador de inscrição no CRM. Não há
exceções a essas normas. O CFM não admite nenhum tipo de flexibilização
dessas obrigações legais, que garantem qualidade e segurança no
atendimento à população, realizado por profissionais qualificados.</span></b></span></span></div>
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<span style="color: #38761d;"><span style="font-size: large;"><b> </b></span></span></div>
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</b></span></span><div style="text-align: justify;">
<span style="color: #38761d;"><span style="font-size: large;"><b><span style="font-family: "Arial", sans-serif;">O
CFM solicita que o relator da proposta na Comissão Mista do Congresso
Nacional, o senador e médico Confúcio Moura (MDB-RO), como profissional
da medicina e conhecedor da catástrofe que é o atendimento da população
por médicos desqualificados, resista à pressão de setores interessados
em que o Revalida não seja aplicado aos intercambistas cubanos e aos
brasileiros formados no exterior, o que contraria promessa de campanha
do presidente Jair Bolsonaro, e mantenha em seu relatório a
obrigatoriedade de que todos os médicos que pleiteiam entrar no Programa
Médicos pelo Brasil sejam portadores de inscrição no CRM, em obediência
à lei e pela segurança da assistência médica a todos os brasileiros.</span></b></span></span></div>
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<span style="color: #38761d;"><span style="font-size: large;"><b> </b></span></span></div>
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</b></span></span><div style="text-align: justify;">
<span style="color: #38761d;"><span style="font-size: large;"><b><span style="font-family: "Arial", sans-serif;">O
CFM, em passado recente, sob outros governos, sempre atuou contra
medidas que ameaçavam a qualidade e a segurança da boa assistência à
população brasileira, e novamente o fará caso essas propostas
equivocadas sejam aprovadas, desvirtuando e contaminando o Programa
Médicos pelo Brasil.</span></b></span></span></div>
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<span style="color: #38761d;"><span style="font-size: large;"><b> </b></span></span></div>
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</b></span></span><div align="right" style="margin: 0cm 0cm 0.0001pt; text-align: center; text-indent: 42.55pt;">
<span style="font-size: large;"><b><span style="font-family: arial, helvetica, sans-serif;"><i>Brasília, 17 de setembro de 2019. </i></span></b></span></div>
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</b></span><div align="center" style="margin: 0cm 0cm 0.0001pt; text-align: center; text-indent: 42.55pt;">
<span style="font-size: large;"><b><span style="font-family: arial, helvetica, sans-serif;"><strong>CONSELHO FEDERAL DE MEDICINA</strong></span></b></span></div>
Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-54469604563352226032019-09-12T10:03:00.000-03:002019-09-12T10:03:04.915-03:00Internacionalização<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4Q2dhgFGDPuePxdkMkb_TsDfcMvSnVu8tv6Svw_bOPiEqWf9gMT4IwWlpWHuxi3bIbCMo2_At4lgxZeUqJS9CoZCMtIIRC-35s5ROX9TByrG44-g-_CA6si22hdPdI1A0cIpx4hGZ6lA/s1600/logo-green.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="80" data-original-width="250" height="204" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4Q2dhgFGDPuePxdkMkb_TsDfcMvSnVu8tv6Svw_bOPiEqWf9gMT4IwWlpWHuxi3bIbCMo2_At4lgxZeUqJS9CoZCMtIIRC-35s5ROX9TByrG44-g-_CA6si22hdPdI1A0cIpx4hGZ6lA/s640/logo-green.jpg" width="640" /></a></div>
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<header class="article-header clearfix"> <h1 class="article-title" itemprop="headline">
<a href="http://noticias.uem.br/index.php?option=com_content&view=article&id=23904:uem-e-selecionada-a-participar-de-programa-de-internacionalizacao&catid=986:pgina-central&Itemid=101" itemprop="url" title="UEM é selecionada a participar de programa de internacionalização"> <span style="color: #4c1130;">UEM é selecionada a participar de programa de internacionalização</span></a> </h1>
</header> <aside class="article-aside article-aside-full"><span style="color: #741b47;"><span style="font-size: large;"><b><span itemprop="name">Tereza Parizotto</span></b></span></span></aside><aside class="article-aside article-aside-full"><span style="color: #741b47;"><span style="font-size: large;"><b><span itemprop="name"> </span></b></span></span></aside><aside class="article-aside article-aside-full"><i><span style="font-size: large;"><b>Foram apenas três universidades brasileiras escolhidas para formação pelo American Council on Education que visa fomentar o desenvolvimento de planos estratégicos de internacionalização</b></span></i></aside><aside class="article-aside article-aside-full"><span style="color: #741b47;"><span style="font-size: large;"><b> </b></span></span></aside><span style="color: #741b47;"><span style="font-size: large;"><b> </b></span></span><div class="separator" style="clear: both; text-align: center;">
<span style="color: #741b47;"><span style="font-size: large;"><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrVEyBmRiTYC4c4xUln6VDdTJwrnBiHCJtp7mPNCyfcRHAJvgfT51J0o0YgaBLZaHC61h-BzjRk9NWa78n9ycAu_EGdHBKSPDa5cefkgpUF8kc76c3dprdNhgTQd7zGGmvlPT2LMfO8_I/s1600/sandra.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrVEyBmRiTYC4c4xUln6VDdTJwrnBiHCJtp7mPNCyfcRHAJvgfT51J0o0YgaBLZaHC61h-BzjRk9NWa78n9ycAu_EGdHBKSPDa5cefkgpUF8kc76c3dprdNhgTQd7zGGmvlPT2LMfO8_I/s640/sandra.jpg" width="640" /></a></b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>A UEM (Universidade Estadual de Maringá) está entre as três instituições brasileiras de ensino superior selecionadas pela Capes (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) para participar do <i>American Council on Education</i> (ACE), Laboratório de Internacionalização, que será realizado em Washington. As Universidades Federais do Pará e de Goiás completam o trio.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>O objetivo do projeto, que abrange um ano e meio de formação e tutoria, é ajudar as instituições participantes a desenvolverem planos abrangentes e estratégicos de internacionalização, definindo áreas prioritárias, objetivos, metas e ações. Além dos encontros em Washington, estão previstas reuniões em Brasília e visitas da comitiva americana à UEM.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>A assessora de cooperação internacional, Sandra Schiavi (foto acima), e o diretor de pesquisa da UEM, Luiz Fernando Cótica (foto abaixo), representam a Universidade nesta iniciativa, que teve início no começo deste mês.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtbe5v1FSugGFmZZ1wd4Vm2xWnJTWoSPgzrAy1H7sAi4KWPG5EQLlWsyE7MoEt5aC6nlNgvJD5SVez1X_za9aFj044Eo89eWIxo0NnR6IG8WC2lj_AzSrb80D75tkQYZAsrp0TjkUsUl0/s1600/Cotica.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="900" data-original-width="900" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtbe5v1FSugGFmZZ1wd4Vm2xWnJTWoSPgzrAy1H7sAi4KWPG5EQLlWsyE7MoEt5aC6nlNgvJD5SVez1X_za9aFj044Eo89eWIxo0NnR6IG8WC2lj_AzSrb80D75tkQYZAsrp0TjkUsUl0/s400/Cotica.jpg" width="400" /></a></b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Sandra Schiavi comenta que a UEM já tem um processo de internacionalização estruturado e que a busca atual é agregar ações isoladas em um projeto mais abrangente e institucionalizado, capaz de elevar o patamar da Universidade nesta área, possibilitando, inclusive, que ela se torne referência em modelo de internacionalização no Paraná. “Neste sentido o curso a participação no ACE será um importante impulsionador”, opina a assessora.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Para Schiavi é necessário ir além dos acordos de cooperação e programas de mobilidade com instituições estrangeiras. O processo de internalização deve permear, ainda segundo a assessora, o ensino, a pesquisa, a extensão e os currículos de docentes, discentes e agentes universitários, a comunicação e tantas outras áreas. São qualificações que precisam ser feitas até como contrapartida na participação no programa americano.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>A seleção da UEM ao <i>American Council on Education</i> tem uma relação direta com o resultado alcançado no último edital do Programa Institucional de Internacionalização (PrInt). É o que pensa Sandra Schiavi.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Criado pela Capes, o PrInt visa a fomentar o desenvolvimento de planos estratégicos de internacionalização como meio de melhorar a qualidade dos cursos de pós-graduação nacionais e de conferir maior visibilidade internacional à pesquisa científica realizada no Brasil. A assessora de cooperação internacional lembra que apesar de não ter seu projeto contemplado no programa, a UEM chegou “quase lá” o que contribuiu para carimbar seu passaporte rumo a formação oferecida pelo ACE</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Além das três universidades brasileiras também participam do programa as seguintes instituições: <i>Bethany College (WV), California State University, San Bernardino, Loyola Marymount University (CA), Mercer University (GA), Purdue University Northwest, Rhodes College (TN), Sinclair College (OH), Southern Illinois University, SUNY - The College of Brockport, University of California San Diego, University of Delaware, University of Missouri, Kansas City, University of Nebraska-Lincoln, University of North Georgia e York College of Pennsylvania.</i></b></span></span></div>
Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-63941564293320389772019-09-09T16:23:00.000-03:002019-09-09T16:24:14.290-03:00Gamification<div class="separator" style="clear: both; text-align: center;">
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<span style="color: #274e13; font-family: "batang" , "serif"; font-size: 20.0pt; line-height: 115%;">Startup “gamifica” o aprendizado de alunos de medicina</span><span style="font-family: "batang" , "serif"; font-size: 20.0pt; line-height: 115%;"></span></h1>
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<b><span style="color: #38761d; font-family: "batang" , "serif"; font-size: 14.0pt;">O biólogo Vinicius Gusmão e o
engenheiro de automação Sandro Nhaia decidiram, em 2016, que era o momento de
unir suas áreas de competência em um empreendimento: a MedRoom. A startup
surgiu com o objetivo de utilizar a modelagem 3D para auxiliar professores de
medicina a ensinarem por meio da realidade virtual (RV). Com a premissa de
potencializar o aprendizado dos alunos, desenvolvendo um ambiente imersivo
dentro dos óculos de RV, a startup dialoga com as duas pontas do setor da saúde
para fazer o seu negócio crescer: as universidades, onde apresenta sua solução
para o corpo docente e procura gerar novas funcionalidades para sua tecnologia;
e os hospitais, com o objetivo de validar cientificamente cada aspecto médico
das aulas que cria dentro da sua ferramenta. Para saber mais, não perca o novo
episódio do Terra Inovação! </span></b><b><span style="font-family: "batang" , "serif"; font-size: 14.0pt;"></span></b></div>
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<iframe frameborder="0" height="373" src="https://p1.trrsf.com.br/playerttv/ganesha-backend/iframe.html?country=br&contentid=8926394" width="660"></iframe>Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-44127011540440964562019-08-27T16:31:00.000-03:002019-08-27T16:31:23.342-03:00Mudanças curriculares na Medicina<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4Q2dhgFGDPuePxdkMkb_TsDfcMvSnVu8tv6Svw_bOPiEqWf9gMT4IwWlpWHuxi3bIbCMo2_At4lgxZeUqJS9CoZCMtIIRC-35s5ROX9TByrG44-g-_CA6si22hdPdI1A0cIpx4hGZ6lA/s1600/logo-green.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="80" data-original-width="250" height="204" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4Q2dhgFGDPuePxdkMkb_TsDfcMvSnVu8tv6Svw_bOPiEqWf9gMT4IwWlpWHuxi3bIbCMo2_At4lgxZeUqJS9CoZCMtIIRC-35s5ROX9TByrG44-g-_CA6si22hdPdI1A0cIpx4hGZ6lA/s640/logo-green.jpg" width="640" /></a></div>
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<span style="color: #783f04;"><b><span style="font-size: x-large;">Medicina da UEM desenvolve ações de desenvolvimento docente do Curso e da Universidade</span></b></span><br />
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<span style="color: #b45f06;"><span style="font-size: large;"><b>O Conselho Acadêmico e o Núcleo Docente Estruturante do Curso de Medicina da UEM participará nos próximos dias de ações de desenvolvimento docente.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>O primeiro evento, um curso de extensão voltado aos professores dos 11 departamentos que oferecem componentes curriculares para o Curso, terá o seu primeiro encontro no dia 29 de agosto de 2019 à noite. O objetivo principal será a avaliação do projeto pedagógico do Curso à luz das atuais Diretrizes Curriculares Nacionais (DCN, 2014) e um estudo comparativo com outros modelos curriculares.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>Nos dias 02 e 03 de setembro de 2019, participaremos de uma mesa-redonda sobre o ensino de graduação na UEM onde coordenadores apresentarão experiências exitosas e desafios de seus Cursos.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>Estas discussões visam embasar mudanças que valorizem o ensino de graduação e estimulem a sua integração com a extensão, pesquisa e pós-graduação.</b></span></span></div>
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<br />Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-91394290759192656882019-08-26T16:23:00.000-03:002019-08-26T16:23:14.944-03:00Preprints<div class="separator" style="clear: both; text-align: center;">
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<i><span style="color: #741b47;"><span style="font-size: large;">Sociologist says journal dismissed her paper because she'd shared it elsewhere as a preprint -- even though the publication had a pro-preprint policy. How often does this happen?</span></span></i></div>
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<span style="color: #741b47;"><span style="font-size: large;">By<a class="username" href="https://www.insidehighered.com/users/colleen-flaherty" title="View user profile."> Colleen Flaherty</a></span></span> </h2>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Most academics have lots of rejection stories. Far fewer have rejection stories like Alison Gerber’s.</b></span></span><br />
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<span style="color: #741b47;"><span style="font-size: large;"><b>The U.S.-trained postdoctoral researcher in sociology at Lund University in Sweden recently got a terse email from the editor of an unnamed journal saying she couldn’t publish her paper because Gerber had already shared it in the preprint repository SocArXiv.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>“One of the reviewers who agreed to evaluate your paper for the journal had the presence of mind to plug the title into a search engine,” the email reads. “He asked if he should review the paper for us given that it is already published (without the benefit of peer review). Of course not.”</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>The email’s haughty tone in itself is stunning, if not unusual. But Gerber was struck by the idea that sharing her preprint with other social scientists made her ineligible to formally publish it elsewhere. After all, many sociologists and academics in dozens of other fields are pushing for increased sharing of manuscripts and data in preprint archives in the name of transparency and better science. The idea behind unrefereed preprints is to get research in the public domain faster than the traditional peer-review process allows, to get feedback from colleagues that might make eventually published papers better, and to find potential collaborators.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Luckily, Gerber didn’t take the editor’s word for it and asked a librarian to help her investigate. The trusty librarian (also unnamed) soon reported back to Gerber what she’d expected all along: that the journal had no policy against publishing papers that had been submitted elsewhere as preprints. In fact, the journal had a policy encouraging preprint sharing.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Gerber declined requests for an interview and that she name the journal. She did say that the journal's editorial team worked mostly in the U.S., United Kingdom and Canada. Beyond that, she referred questions to her Twitter thread about her misadventure. According to her account, Gerber sent a polite follow-up to the journal editor, who soon admitted the error and said the paper would be considered for publication after all.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Interest in Gerber’s mini-saga was high -- probably for a number of reasons. A supposedly “blind” reviewer had searched for her paper title, which could have easily given away her name, gender and academic credentials even if she’d just shared it at a conference and not on SocArXiv. Both the reviewer and the editor did not know their journal's own policy on preprints. And the exchange revealed either a misunderstanding of or antipathy for preprint repositories on the part of at least one journal.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>What is the purpose of a preprint repository such as a SocArXiv and how does it differ from that of a traditional publication? Can, and should, the two systems really coexist? Philip Cohen, professor of sociology at the University of Maryland at College Park and a member of SocArXiv’s steering committee, said that he and his collaborators designed the platform “not to replace journals but to supplement them.”</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>The point of preprint repositories “is to get work out faster and for free, and then still use the peer-review system for validating what's good and/or important,” Cohen added via email. “Almost everyone in the journal disciplines, as opposed to humanities, is still publishing in journals, even if they are also posting papers on systems like SocArXiv. Journals are how we get formal recognition and get tenure.”</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Preprint archives typically have some standards for publication, but they are nowhere near as stringent as most peer-reviewed journals, which publish on regular schedules and are space-limited. SocArXiv papers, for instance, are moderated before they appear online -- a process that takes up to two days, not months. SocArXiv's <a href="http://docs.google.com/document/d/1-VQKAkBHJtAnde-lSgNaS0eA3heXNfwAmXhmyBLzN5E/edit?usp=sharing" target="_blank">policy</a> says that papers must be scholarly, relevant to the social sciences, "plausibly categorized" and correctly attributed, and in moderated languages.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Even if the journal Gerber submitted to doesn’t have a problem with preprints, do other publications have policies against them? Jessie Daniels, a professor of sociology at Hunter College and the Graduate Center of the City University of New York who has written several books on digital sociologies, said that the vast majority of academic journals have no issue with preprints.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Situations like Gerber’s aren’t common because blind reviewers aren’t typically googling paper titles, she added. But academics as a group remain “woefully ignorant about open access, scholarly communication and the way the landscape of knowledge production is changing in the digital era.”</b></span></span></div>
Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-64891632539605879432019-08-25T09:22:00.000-03:002019-08-25T09:24:44.699-03:00Universidade e Sociedade<br />
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<h1 class="entry-title">
<span style="color: #073763;"><span style="font-size: x-large;">“A sociedade mudou e nós não percebemos”</span></span></h1>
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<span style="color: #0b5394;"><b><span style="font-size: large;">No USP Talks, reitores das três universidades estaduais paulistas enfatizam necessidade de uma maior interação com a sociedade</span></b></span><br />
<span style="color: #0b5394;"><b><span style="font-size: large;"><br /></span></b></span>
<span style="color: #0b5394;"><b><span style="font-size: large;"><br /></span></b></span></div>
<span style="color: #0b5394;"><b><span class="vcard author author_name" style="font-size: large;"><a href="https://jornal.usp.br/author/hertonusp-br/" rel="author" title="Posts de Herton Escobar">Herton Escobar</a></span></b></span>
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<span style="color: #0b5394;"><b><span style="font-size: large;"><br /></span></b></span></div>
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<figure class="wp-caption aligncenter" id="attachment_267856" style="width: 1130px;"><span style="color: #0b5394;"><b><span style="font-size: large;"><img alt="" class="size-full wp-image-267856" data-id="267856" height="237" src="https://jornal.usp.br/wp-content/uploads/2019/08/20190823_00_usptalks_reitores_universidades_publicas_1130px.jpg" width="640" /></span></b></span><figcaption class="wp-caption-text"><span style="font-size: small;"><b>Os
reitores Marcelo Knobel (Unicamp), Vahan Agopyan (USP) e</b></span></figcaption><figcaption class="wp-caption-text"><span style="font-size: small;"><b>Sandro
Valentini (Unesp) e o jornalista Herton Escobar durante </b></span></figcaption><figcaption class="wp-caption-text"><span style="font-size: small;"><b>debate sobre
educação </b></span></figcaption><figcaption class="wp-caption-text"><span style="font-size: small;"><b>Foto: Cecília Bastos/USP Imagens</b></span></figcaption></figure><span style="color: #0b5394;"><b><span style="font-size: large;">
<span style="color: white;">.</span></span></b></span><br />
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<span style="color: #0b5394;"><b><span style="font-size: large;">As universidades precisam interagir mais com a sociedade, e se
comunicar melhor com ela, reconhecendo que as demandas e a percepção
pública dessas instituições estão em constante evolução.
</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">“Esse é o nosso grande desafio”, disse o reitor da USP, Vahan
Agopyan. “Não porque a universidade ficou isolada numa torre de marfim”,
como se costuma dizer, mas porque “a sociedade mudou, e nós não
percebemos”, completou.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">Os comentários foram feitos na última edição do <a href="http://usptalks.prp.usp.br/pt/home/" rel="noopener" target="_blank">USP Talks</a>,
que reuniu os reitores das três universidades estaduais paulistas para
falar sobre os desafios da educação no Brasil, no último dia 20, em São
Paulo.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">Segundo Vahan, a sociedade hoje é “mais exigente, mais preparada e
tem expectativas maiores” do que antigamente, que precisam ser levadas
em conta na maneira como as universidades se relacionam com ela. “Não
adianta falar em número de <i>papers</i> ou prestígio do <i>paper</i>,
porque não é o que a sociedade deseja”, disse. “Quero que a sociedade
entenda que a universidade é onde ela vai conseguir ter as suas
discussões e o seu desenvolvimento. Essa é a nossa meta.”</span></b></span></div>
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<figure class="wp-caption aligncenter" id="attachment_267942" style="width: 800px;"><span style="color: #0b5394;"><b><span style="font-size: large;"><img alt="" class="wp-image-267942 size-full" data-id="267942" height="336" src="https://jornal.usp.br/wp-content/uploads/2019/08/20190823_00_usptalks_reitores_univ_publicas.jpg" width="640" /></span></b></span><figcaption class="wp-caption-text"><span style="font-size: small;"><b>Comunicação
com a sociedade, melhor formação e internacionalização foram</b></span></figcaption><figcaption class="wp-caption-text"><span style="font-size: small;"><b>alguns dos
temas destacados pelos reitores no evento especial do </b></span></figcaption><figcaption class="wp-caption-text"><span style="font-size: small;"><b>USP Talks –
Foto: Cecília Bastos/USP Imagens</b></span></figcaption></figure><span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">O reitor da Universidade Estadual de Campinas (Unicamp), Marcelo
Knobel , falou sobre a necessidade de dar mais flexibilidade ao sistema e
ampliar a multidisciplinaridade da formação universitária, buscando
melhorar a preparação dos alunos para os novos desafios do século 21 —
incluindo a capacidade de se adaptar rapidamente a novas carreiras e
novas tecnologias que deverão surgir, muitas vezes de forma inesperada.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">“Estamos indo na contramão do mundo inteiro no que se refere à
maneira de ensinar e ao que ensinamos”, disse Knobel. “Nosso sistema é
engessado, extremamente conteudista, rígido e muito, muito complicado.
Tudo no sentido contrário do que a tendência mundial indica.”</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">“Sem dúvida precisamos avançar e começar a educar para o século 21, e
não continuar ensinando como no século 19”, destacou, também, o reitor
da Universidade Estadual Paulista (Unesp), Sandro Valentini. Ele lembrou
da sua origem simples no interior paulista, filho de um funileiro
mecânico, e disse que entende a educação como uma forma de emancipação.
“Todos os jovens deveriam ter essa oportunidade.”</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">Valentini destacou também o papel da internacionalização, “não apenas
para atingir rankings, mas para transformar os jovens”; e a importância
de demonstrar o impacto social das pesquisas feitas nas universidades,
“muito importante para recuperar ou fortalecer a nossa legitimidade
perante a sociedade”.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">Cada reitor fez uma apresentação individual de 15 minutos, e na
sequência participaram de um debate com a plateia, em que foram
levantados diversos temas. Entre eles, o programa Future-se, do governo
federal, e a CPI das universidades, na Assembleia Legislativa do Estado
de São Paulo (Alesp).</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">Os vídeos do evento estão disponíveis abaixo e no <a href="https://goo.gl/gMNCzk" rel="noopener" target="_blank">canal do USP Talks</a> no YouTube, onde é possível assistir também a todos os eventos anteriores do programa.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"><br /></span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"><iframe allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen="" frameborder="0" height="464" src="https://www.youtube.com/embed/u8AGf2GTRxA" width="826"></iframe>
<iframe allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen="" frameborder="0" height="464" src="https://www.youtube.com/embed/9gfPyMr30VE" width="826"></iframe>
<iframe allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen="" frameborder="0" height="464" src="https://www.youtube.com/embed/tvWpCqbvqJQ" width="826"></iframe>
<iframe allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen="" frameborder="0" height="464" src="https://www.youtube.com/embed/1lYlgEvyaek" width="826"></iframe></span></b></span>
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<span style="font-weight: normal;"><span style="font-size: large;">Serviço</span></span></h3>
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<span style="font-size: large;">O USP Talks é uma iniciativa da USP, com o objetivo de aproximar as
universidades da sociedade. Os eventos são realizados mensalmente, no
auditório do Museu de Arte de São Paulo (Masp), com entrada gratuita e
transmissão ao vivo pela internet. Para saber mais e acompanhar a
programação, siga nossas páginas nas redes sociais: <a href="http://www.facebook.com/usptalks/" rel="noopener" target="_blank">Facebook</a>, <a href="https://goo.gl/gMNCzk" rel="noopener" target="_blank">YouTube</a> e <a href="http://twitter.com/USPTalks" rel="noopener" target="_blank">Twitter</a>.</span></div>
Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-17701486017850968242019-08-06T11:30:00.000-03:002019-08-06T11:30:26.905-03:00Overestimation of results<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgclEjpTdpiYCQ-24un82_kqnf5OAefCGYiFpCRHBDHSQ12NYfudAhyphenhyphen1tezriyvoAOaqgSgTMZlxRg-bW6zExcCiEVeSeSq7tdkkXHXEY5GazrZ0yrwIvK_5VGexcOJOoDDcG9yEUtFiGw/s1600/Sem+t%25C3%25ADtulo.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="117" data-original-width="234" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgclEjpTdpiYCQ-24un82_kqnf5OAefCGYiFpCRHBDHSQ12NYfudAhyphenhyphen1tezriyvoAOaqgSgTMZlxRg-bW6zExcCiEVeSeSq7tdkkXHXEY5GazrZ0yrwIvK_5VGexcOJOoDDcG9yEUtFiGw/s1600/Sem+t%25C3%25ADtulo.jpg" /></a></div>
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<span style="color: #4c1130;"><span style="font-size: x-large;">Abstract ‘Spin’</span></span></h1>
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<span style="font-size: large;"><i><b>Study says authors exaggerate their findings in paper abstracts, and that's a problem when readers take them at face value.</b></i></span><br />
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<span style="color: #741b47;"><span style="font-size: large;">By<a class="username" href="https://www.insidehighered.com/users/colleen-flaherty" title="View user profile."> Colleen Flaherty</a></span></span> </h2>
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<span style="color: #741b47;"><span style="font-size: large;"><b>We’ve all been told not to judge a book by its cover. But we shouldn’t be judging academic studies by their abstracts, either, according to a<a href="https://ebm.bmj.com/content/early/2019/07/04/bmjebm-2019-111176" target="_blank"> new paper </a>in <em>BMJ Evidence-Based Medicine</em>. The study -- which found exaggerated claims in more than half of paper abstracts analyzed -- pertains to psychology and psychiatry research. It notes that “spin” is troublesome in those fields because it can impact clinical care decisions. But the authors say that this kind of exaggeration happens in other fields, too.</b></span></span><br />
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<span style="color: #741b47;"><span style="font-size: large;"><b>“Researchers are encouraged to conduct studies and report findings according to the highest ethical standards,” the paper says, meaning “reporting results completely, in accordance with a protocol that outlines primary and secondary endpoints and prespecified subgroups and statistical analyses.”</b></span></span><br />
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<span style="color: #741b47;"><span style="font-size: large;"><b>Yet authors are free to choose “how to report or interpret study results.” And in an abstract, in particular, they may include “only the results they want to highlight or the conclusions they wish to draw.”</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>In a word: spin.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Based on the idea that randomized controlled trials often inform how patients are treated, researchers used PubMed to find these kinds of studies. Their sample included those published from 2012-17 in well-regarded psychology and psychiatry journals: <em>JAMA Psychiatry</em>, <em>American Journal of Psychiatry</em>, <em>Journal of Child Psychology and Psychiatry</em>, <em>Psychological Medicine</em>, <em>British Journal of Psychiatry</em> and <em>Journal of the American Academy of Child and Adolescent Psychiatry</em>.<em> </em></b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Crucially, they analyzed only trials with results that were not statistically significant, and therefore were susceptible to spin -- 116 in all.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Evidence of spin included focusing only on statistically significant results, interpreting nonsignificant results or equivalent, using favorable rhetoric with regard to the nonsignificant results and declaring that an intervention was beneficial despite its statistical insignificance.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>How often did articles’ abstracts exaggerate the actual findings? More than half the time, or 56 percent. Spin happened in 2 percent of titles, 21 percent of abstract results sections and 49 percent of abstract conclusion sections. Fifteen percent of abstracts had spin in both their results and conclusion sections.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Spin was more common in studies that compared a proposed treatment with typical care or placebo than in other kinds of studies. But industry funding was not associated with a greater likelihood of exaggeration, as just 10 of 65 spun trials had any of this kind of funding.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>The study notes several limitations, including that looking for spin is inherently subjective work. But it says that it’s important to guard against spin because researchers have an ethical obligation to honestly and clearly report their results and because spinning an abstract “may mislead physicians who are attempting to draw conclusions about a treatment for patients.” Physicians read only an article abstract, versus the entire article, a majority of the time, it says, citing<a href="https://link.springer.com/article/10.1046%2Fj.1525-1497.2000.00202.x" target="_blank"> prior research</a> on the matter, and <a href="https://www.bmj.com/content/329/7464/470" target="_blank">many editorial decisions </a>are based on the abstract alone. Positive results are also more likely to be published in the first place, the paper notes, citing one study that found 15 percent of peer reviewers asked authors to spin their manuscripts.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>What’s to be done? Journal editors may consider inviting reviewers to comment on the presence of spin, the article suggests.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Reporting guidelines also are used by several journals already to “ensure accurate and transparent reporting of clinical trial results, and the use of such guidelines improves trial reporting,” the paper says. While the recent <a href="http://www.consort-statement.org/" target="_blank">Consolidated Standards of Reporting Trials</a> on abstracts don’t contain language discouraging spin, it says, “research reporting could be improved by discouraging spin in abstracts.”</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Lead author Sam Jellison, a medical student at Oklahoma State University, underscored that his paper is <a href="https://jamanetwork.com/journals/jama/fullarticle/185952" target="_blank">not the first</a> to explore academic spin. Yet making more readers “aware of what spin is might be the first and largest step to take to fight this problem,” he said. Jellison said that the existing literature suggests spin is not unique to psychology and psychiatry, and that those fields are actually “middle of the road” in terms of prevalence.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Philip Cohen, a professor of sociology at the University of Maryland at College Park who<a href="https://familyinequality.wordpress.com/" target="_blank"> blogs</a> about research, pointed out that reviewers already look at abstracts as part of their process, so in addition to the journal editor, "reviewers should be able to see if the abstract is overstating the findings.”</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Still, a common way that sociologists inflate research findings in general is to mention those that are not statistically significant while downplaying the lack of significance, attributing it to a small sample or using phrases such as “does not reach statistical significance,” he said, “as if the effect is just trying but can't quite get there.”</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Beyond questions of spin, Cohen said there is surely a problem with “people only publishing, or journals only accepting, dramatic findings,” he said. So the greatest source of exaggeration is probably in what gets published at all, with null findings or those that contradict existing positive results never seeing the light of day -- what Cohen noted has been called the "file drawer" problem.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>While psychology isn't alone in the spin room, the field has had its share of data integrity and public perception problems. A <a href="https://www.insidehighered.com/news/2015/08/28/landmark-study-suggests-most-psychology-studies-dont-yield-reproducible-results" target="_blank">landmark study</a> in 2015, for example, found that most psychology studies don’t yield reproducible results.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Brian Nosek, a professor of psychology at the University of Virginia and lead author on the reproducibility study, said that spin involves two “connected problems,” neither of which is easy to solve. Authors are “incentivized to present their findings in the best possible light for publishability and impact, and readers often don't read the paper.”</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>As an author, he said, “even if I want to avoid spin,” it’s “entirely reasonable for me to try make the narrative of my title and abstract as engaging as possible so that people will read the paper.” And at the same time, it’s “very difficult to capture the complexity of almost any research finding in a phrase or short abstract.” It’s really a “skill” to present “complex findings briefly without losing accuracy.”</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>As a reader, Nosek continued, “even if I want to make the best possible decisions based on research evidence, I don't have time to read and evaluate everything deeply." In some cases, he said, "I need to be able to trust that the information conveyed briefly is accurate and actionable.”</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Ultimately, when “decisions are important, we should have higher expectations of readers to gather the information necessary to make good decisions,” he said. “But we need to recognize pragmatic realities and develop better tools for readers to calibrate the confidence in the claims they see in brief, and provide cues prompting them to dig more deeply when the evidence is uncertain.”</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>It’s also “in our collective interest to provide authors more training in communicating their findings in abstracts and press releases," Nosek added.</b></span></span></div>
Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-81109919687258226372019-07-30T14:46:00.001-03:002019-07-30T14:46:36.013-03:00Bibliometrics<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPvwrUHcv0IANy8nEcDOXRmT-Se1d8BdEjODJJfhCgWlFqjWOQ_CIGUJD280sEZkN6xvoVZrfCDOlYy_5kiBRox3uPcByiewdCX0_CVxyM7XCMXM3lZoJgYXhBq-Onn05hzcbbVcKT4vU/s1600/jornalusp-logo2.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="82" data-original-width="484" height="54" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPvwrUHcv0IANy8nEcDOXRmT-Se1d8BdEjODJJfhCgWlFqjWOQ_CIGUJD280sEZkN6xvoVZrfCDOlYy_5kiBRox3uPcByiewdCX0_CVxyM7XCMXM3lZoJgYXhBq-Onn05hzcbbVcKT4vU/s320/jornalusp-logo2.png" width="320" /></a></div>
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<h1 class="entry-title">
<span style="color: #783f04;"><span style="font-size: x-large;">Significado real do número de citações de um artigo científico</span></span></h1>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>Tibor Rabóczkay*</b></span></span></div>
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<span style="font-size: large;"><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgppMUhmIIlpjcgFuW41opJhHnfv3ZXsQMDHeP9ty2ZaF3tuY0MqR6HFJv4U0_4_4NpRbiXiVb0uIfgfwtqhaAmr0APoAxR4uzBtMXrB3M6EHw6hAHnAoQsCUkROiKS1sDRugb1FBH47mA/s1600/20190726_01_tibor-raboczkay.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="420" data-original-width="420" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgppMUhmIIlpjcgFuW41opJhHnfv3ZXsQMDHeP9ty2ZaF3tuY0MqR6HFJv4U0_4_4NpRbiXiVb0uIfgfwtqhaAmr0APoAxR4uzBtMXrB3M6EHw6hAHnAoQsCUkROiKS1sDRugb1FBH47mA/s400/20190726_01_tibor-raboczkay.png" width="400" /></a></b></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b><span class="wpsdc-drop-cap">A</span> cientometria procura medir o
impacto de artigos científicos, jornais científicos, institutos de
pesquisa e pesquisadores. Para isso recorre a indicadores de produção,
que supõe serem significativos. Entre esses, a contagem da quantidade de
artigos (<em>papers</em>, como os cientistas gostam de chamar). São
critérios importantes para a alocação de verbas. Desses indicadores
examinaremos, no presente, o <em>número de citações</em>.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>
</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>O número de citações pode ter algum papel
válido na história da ciência, quando estamos interessados em ver a
influência consolidada de um determinado cientista ou instituição no
progresso do conhecimento científico no decorrer dos tempos. Ao ser
aplicado aos tempos recentes ou o presente, porém, a contagem não só
perde significado, mas representa grave ameaça ao progresso científico,
como mostramos a seguir.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b><u>Primeiro</u>. A busca por maior número de
citações obriga o cientista a trabalhar em assuntos da moda,
independentemente da importância prática ou científica de tais assuntos.
Com temas em voga, aumenta a chance do <em>paper</em> ser citado. Essa
atitude, porém, prejudica as outras exigências às quais o pesquisador é
submetido – a criatividade e a inovação. Assuntos fora das linhas de
pesquisa já testadas e em andamento envolvem o risco de insucesso. Isso
prejudica o número de <em>papers</em> produzidos e, consequentemente,
afeta a carreira do cientista, além de lhe trazer dificuldades para
obter as verbas necessárias para prosseguir em suas pesquisas. Correrá
também o perigo de perder o emprego ou o regime de trabalho.
Lembremo-nos de que já ocorreu de os burocratas e órgãos da imprensa
considerarem improdutivos aqueles docentes-pesquisadores universitários
que no decorrer de determinado intervalo de tempo, aparentemente, “só”
davam aulas. Então, pode parecer prudente deixar as incertezas da
inovação e da criatividade real de lado.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>
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<span style="color: #b45f06;"><span style="font-size: large;"><b><u>Segundo</u>. As áreas de investigação
científica, independentemente de sua importância teórica ou prática, têm
número de pesquisadores muito diferentes, fato que afeta o número de
citações. A simples comparação de citações, portanto, sem levar em conta
o número de profissionais atuantes na área, não tem significado.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b><u>Terceiro</u>. Muitas vezes a citação é apenas uma formalidade e não reflete mérito. É praxe fazer uma introdução ao <em>paper</em> enumerando
– com a indicação da origem – o que já foi feito no assunto até para
posicionar a contribuição e a originalidade dos autores. A contribuição
histórica, eventualmente, pode receber algum comentário, porém,
frequentemente, se reduz a um ato quase contábil.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b><u>Quarto</u>. Um <em>paper</em> que apresente um
erro pode receber um grande número de citações, pois dificilmente os
cientistas da área resistiriam a apontar o erro.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b><u>Quinto</u>. Como julgar o mérito de um artigo
científico que recebeu apenas uma ou duas citações por ano – mas durante
mais de 50 anos? Como comparar a “validade” do trabalho no tempo, com o
número de citações? Vale a pena manter o autor nos quadros da
universidade? As citações podem não se distribuir uniformemente no
tempo. Por exemplo, um artigo tendo por assunto o isolamento do vírus
zika, publicado em 1952, pouco citado após a publicação, conta com 23
citações entre 1971 e 2014, e 1.040 nos últimos quatro anos, num total
de 1.086 citações até a escrita do presente comentário. O autor
possivelmente teria perdido seu emprego, ou seu regime de trabalho, se
prevalecessem os critérios burocráticos e ilusionistas.</b></span></span></div>
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</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b><u>Sexto</u>. Um artigo submetido a publicação,
normalmente, é enviado para um assessor que trabalhe na mesma área.
Embora anônimo – teoricamente – sabe-se que não poucas vezes o assessor
tenha condicionado o <em>aceite</em> à citação de seus próprios <em>papers</em>. Sugestão geralmente aceita diante da garantia de publicação.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b><u>Sétimo</u>. Deve-se mencionar, ainda, os grupos
de ajuda recíproca em se citarem. Ou o caso oposto, das omissões entre
grupos ou cientistas rivais. Não é fácil detectar artifícios ou uma
omissão para os avaliadores. Esses casos só serão percebidos por alguém
que necessite consultar em detalhes a matéria citada.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>Conclusão: o uso do número de citações para
avaliar a importância de um artigo científico – fora do âmbito
histórico – não é adequado, pois a única coisa que o número de citações
mede com segurança é <em>o número de citações</em> – o resto é fantasia.</b></span></span></div>
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<span style="font-size: large;"><b>* <i>Tibor Rabóczkay é professor titular aposentado do Instituto de Química (IQ-USP) </i></b></span></div>
Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-18174932538885190712019-07-23T10:00:00.000-03:002019-07-23T10:00:02.059-03:00Learning styles<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdm7ics4pw5YaEjNgTwv2DS3EFV0nGfHPIIE5NnPDYtziCceD3IbsYuZFcvqW5fl5PhOMMEwUVPcl00WyjSBaPXgBalhlRL87J9zhMHhnBIrk8GsizZInb1DFN7C5gxNUJ11iTy1nf9E0/s1600/Sem+t%25C3%25ADtulo.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="117" data-original-width="405" height="184" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdm7ics4pw5YaEjNgTwv2DS3EFV0nGfHPIIE5NnPDYtziCceD3IbsYuZFcvqW5fl5PhOMMEwUVPcl00WyjSBaPXgBalhlRL87J9zhMHhnBIrk8GsizZInb1DFN7C5gxNUJ11iTy1nf9E0/s640/Sem+t%25C3%25ADtulo.jpg" width="640" /></a></div>
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<h1 class="article-header__title t_article-title" itemprop="name">
<span style="color: #0c343d;">The Problem with "Learning Styles"</span></h1>
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<span style="color: #134f5c;"><span style="font-size: large;"><b>There is little scientific support for this fashionable idea—and stronger evidence for other learning strategies</b></span></span></div>
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<span style="color: #134f5c;"><span style="font-size: large;"><b>By <span itemprop="author" itemscope="" itemtype="http://schema.org/Person"><span itemprop="name"><a href="https://www.scientificamerican.com/author/cindi-may/">Cindi May</a></span></span></b></span></span><br />
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<span itemprop="author" itemscope="" itemtype="http://schema.org/Person"><span itemprop="name"><br /></span></span>
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<div class="mura-region-local">
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<span style="color: #134f5c;"><span style="font-size: large;"><b>When it comes to home projects, I
am a step-by-step kind of girl. I read the instructions from start to
finish, and then reread and execute each step. My husband, on the other
hand, prefers to study the diagrams and then jump right in. Think
owner’s manual versus IKEA instructions. This preference for one
approach over another when learning new information is not uncommon.
Indeed the notion that people learn in different ways is such a
pervasive belief in American culture that there is a thriving industry
dedicated to identifying learning styles and training teachers to meet
the needs of different learners.</b></span></span></div>
<span style="color: #134f5c;"><span style="font-size: large;"><b>
</b></span></span><div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="color: #134f5c;"><span style="font-size: large;"><b>Just because a notion is popular, however, doesn’t make it true. A <a href="http://journals.sagepub.com/doi/abs/10.1111/j.1539-6053.2009.01038.x" target="_blank">recent review</a>
of the scientific literature on learning styles found scant evidence to
clearly support the idea that outcomes are best when instructional
techniques align with individuals’ learning styles. In fact, there are
several <a href="http://people.cs.vt.edu/~shaffer/CS6604/Papers/Validity_2006.pdf" target="_blank">studies</a>
that contradict this belief. It is clear that people have a strong
sense of their own learning preferences (e.g., visual, kinesthetic,
intuitive), but it is less clear that these preferences matter.</b></span></span></div>
<span style="color: #134f5c;"><span style="font-size: large;"><b>
</b></span></span><div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="color: #134f5c;"><span style="font-size: large;"><b><a href="https://www.ncbi.nlm.nih.gov/pubmed/29533532" target="_blank">Research</a>
by Polly Hussman and Valerie Dean O’Loughlin at Indiana University
takes a new look at this important question. Most previous
investigations on learning styles focused on classroom learning, and
assessed whether instructional style impacted outcomes for different
types of learners. But is the classroom really where most of the serious
learning occurs? Some might argue that, in this era of flipped
classrooms and online course materials, students master more of the
information on their own. That might explain why instructional style in
the classroom matters little. It also raises the possibility that
learning styles do matter—perhaps a match between students’ individual
learning styles and their study strategies is the key to optimal
outcomes.To explore this possibility, Hussman and O’Loughlin asked students
enrolled in an anatomy class to complete an online learning styles
assessment and answer questions about their study strategies. More than
400 students completed the <a href="http://vark-learn.com/" target="_blank">VARK</a>
(visual, auditory, reading/writing, kinesthetic) learning styles
evaluation and reported details about the techniques they used for
mastering material outside of class (e.g., flash cards, review of
lecture notes, anatomy coloring books). Researchers also tracked their
performance in both the lecture and lab components of the course. </b></span></span></div>
<div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="color: #134f5c;"><span style="font-size: large;"><b>Scores on the VARK suggested that most students used multiple
learning styles (e.g., visual + kinesthetic or reading/writing + visual +
auditory), but that no particular style (or combination of styles)
resulted in better outcomes than another. The focus in this study,
however, was not on whether a particular learning style was more
advantageous. Instead, the research addressed two primary questions:
First, do students who take the VARK questionnaire to identify their
personal learning style adopt study strategies that align with that
style? Second, are the learning outcomes better for students whose
strategies match their VARK profile than for students whose strategies
do not?</b></span></span></div>
<span style="color: #134f5c;"><span style="font-size: large;"><b>
</b></span></span><div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="color: #134f5c;"><span style="font-size: large;"><b>Despite knowing their own, self-reported learning preferences, nearly
70% of students failed to employ study techniques that supported those
preferences. Most visual learners did not rely heavily on visual
strategies (e.g., diagrams, graphics), nor did most reading/writing
learners rely predominantly on reading strategies (e.g., review of notes
or textbook), and so on. Given the prevailing belief that learning
styles matter, and the fact many students blame poor academic
performance on the lack of a match between their learning style and
teachers’ instructional methods, one might expect students to rely on
techniques that support their personal learning preferences when working
on their own.</b></span></span></div>
<span style="color: #134f5c;"><span style="font-size: large;"><b>
</b></span></span><div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="color: #134f5c;"><span style="font-size: large;"><b>Perhaps the best students do. Nearly a third of the students in the
study did choose strategies that were consistent with their reported
learning style. Did that pay off? In a word, no. Students whose study
strategies aligned with their VARK scores performed no better in either
the lecture or lab component of the course.</b></span></span></div>
<span style="color: #134f5c;"><span style="font-size: large;"><b>
</b></span></span><div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="color: #134f5c;"><span style="font-size: large;"><b>So most students are not employing study strategies that mesh with
self-reported learning preferences, and the minority who do show no
academic benefit. Although <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/bjop.12214" target="_blank">students believe that learning preferences influence performance</a>,
this research affirms the mounting evidence that they do not, even when
students are mastering information on their own. These findings suggest
a general lack of student awareness about the processes and behaviors
that support effective learning. Consistent with this notion, Hussman
and O’Loughlin also found negative correlations between many of the
common study strategies reported by students (e.g., making flashcards,
use of outside websites) and course performance. Thus regardless of
individual learning style or the alignment of the style with study
techniques, many students are adopting strategies that simply do not
support comprehension and retention of information.</b></span></span></div>
<div style="text-align: justify;">
<br /></div>
<span style="color: #134f5c;"><span style="font-size: large;"><b>
</b></span></span><div style="text-align: justify;">
<span style="color: #134f5c;"><span style="font-size: large;"><b>Fortunately, cognitive science has identified a number of methods to
enhance knowledge acquisition, and these techniques have fairly
universal benefit. Students are more successful when they <a href="https://www.tandfonline.com/doi/abs/10.1080/00140137808931764" target="_blank">space out their study sessions</a> over time, <a href="http://journals.sagepub.com.nuncio.cofc.edu/doi/10.2466/pms.1994.78.1.320" target="_blank">experience the material in multiple modalities</a>, <a href="http://psych.wustl.edu/memory/Roddy%20article%20PDF's/Roediger%20&%20Karpicke%20(2006)_PsychSci.pdf" target="_blank">test themselves on the material</a> as part of their study practices, and <a href="http://wixtedlab.ucsd.edu/publications/Psych%20218/Craik_Lockhart_1972.pdf" target="_blank">elaborate on material to make meaningful connections</a>
rather than engaging in activities that involve simple repetition of
information (e.g., making flashcards or recopying notes). These
effective strategies were identified decades ago and have convincing and
significant empirical support. Why then, do we persist in our belief
that learning styles matter, and ignore these tried and true techniques?</b></span></span></div>
<span style="color: #134f5c;"><span style="font-size: large;"><b>
</b></span></span><div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="color: #134f5c;"><span style="font-size: large;"><b>The popularity of the learning styles mythology may stem in part from
the appeal of finding out what “type of person” you are, along with the
desire to be treated as an individual within the education system. In
contrast, the notion that universal strategies may enhance learning for
all belies the idea that we are unique, individual learners. In
addition, most empirically-supported techniques involve planning (e.g.,
scheduling study sessions over a series of days) and significant effort
(e.g., taking practice tests in advance of a classroom assessment), and
let’s face it, we don’t want to work that hard.</b></span></span></div>
</div>
<span style="color: #134f5c;"><span style="font-size: large;"><b><span itemprop="author" itemscope="" itemtype="http://schema.org/Person"><span itemprop="name"> </span></span></b></span></span></div>
</div>
Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-14538580500465265962019-07-22T22:23:00.000-03:002019-07-22T22:23:31.849-03:00Peer coaching<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpW9h5ffHah0XJnux_CBONoqMkh8QakECxbwkglXBVp7r98BGbzaY1vgsa7yofmt7zeuymVlXesvHVZPiqxjhIcFNTOl4YLIpgu_V0CzQIXBSkvi9-eKoC3h1T1hbutNH-wi1ku-kR8zc/s1600/edutopia-enews-header-2017.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="174" data-original-width="1040" height="106" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpW9h5ffHah0XJnux_CBONoqMkh8QakECxbwkglXBVp7r98BGbzaY1vgsa7yofmt7zeuymVlXesvHVZPiqxjhIcFNTOl4YLIpgu_V0CzQIXBSkvi9-eKoC3h1T1hbutNH-wi1ku-kR8zc/s640/edutopia-enews-header-2017.gif" width="640" /></a></div>
<br />
<br />
<h1 class="h1 ">
<span style="color: #660000;"><span style="font-size: x-large;">Tapping Into the Expertise in the Building</span></span></h1>
<div class="css-fn6d52">
<span style="color: #990000;"><span style="font-size: large;"><b><i>The
triad model of peer coaching takes advantage of a powerful professional
learning resource available to teachers—their colleagues.</i></b></span></span><br />
<br />
</div>
<div class="css-u6w0kd">
<span style="color: #990000;"><span style="font-size: large;"><b>By <span><a href="https://www.edutopia.org/profile/kristin-rouleau">Kristin Rouleau</a></span></b></span></span></div>
<div class="css-u6w0kd">
<span style="color: #990000;"><span style="font-size: large;"><b><span> </span></b></span></span></div>
<div class="css-u6w0kd">
<span style="color: #990000;"><span style="font-size: large;"><b><span><br /></span></b></span></span></div>
<div class="css-u6w0kd">
<span style="color: #990000;"><span style="font-size: large;"><b><span> <div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCOAujfAZsUiPsc6g_4O6ej2CYAHbWdTYKIPXdnAcTP9aD54YRuLLpyxaGOP1mh8bpyex1xxhV6ZJlJM2djzKZAUH7jQRcS6zClLhlM-OBw5Mki9ETRYO2Bl4goNi3r2ZFnDAcL7PqauI/s1600/Sem+t%25C3%25ADtulo.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="788" data-original-width="1400" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCOAujfAZsUiPsc6g_4O6ej2CYAHbWdTYKIPXdnAcTP9aD54YRuLLpyxaGOP1mh8bpyex1xxhV6ZJlJM2djzKZAUH7jQRcS6zClLhlM-OBw5Mki9ETRYO2Bl4goNi3r2ZFnDAcL7PqauI/s640/Sem+t%25C3%25ADtulo.jpg" width="640" /></a></div>
</span></b></span></span></div>
<div class="css-u6w0kd">
<div class="css-dp2cnt css-3nkyqp">
</div>
<div class="css-1gd7y0g" style="text-align: center;">
<span style="font-size: small;"><b>©iStock/SolStock</b></span></div>
<div class="css-1gd7y0g">
<span style="color: #990000;"><span style="font-size: large;"><b> </b></span></span></div>
<div class="css-1gd7y0g">
<span style="color: #990000;"><span style="font-size: large;"><b> </b></span></span></div>
<div style="text-align: justify;">
<span style="color: #990000;"><span style="font-size: large;"><b>In
my travels to schools around the world, I have yet to encounter
educators who wouldn’t benefit from peer coaching as an approach to
professional learning.</b></span></span><br />
<span style="color: #990000;"><span style="font-size: large;"><b>
</b></span></span><br />
<span style="color: #990000;"><span style="font-size: large;"><b>As in any field, professional learning should support teachers in
improving their practice—there’s no point investing resources in
professional learning if it’s not going to make a difference in what
happens in classrooms for students. Professional learning needs to focus
on the right work that’s going to impact teacher practice and student
learning.</b></span></span><br />
<span style="color: #990000;"><span style="font-size: large;"><b>
</b></span></span><br />
<span style="color: #990000;"><span style="font-size: large;"><b>Unfortunately, professional learning hasn’t always been effective or
focused on teachers’ real problems of practice. Traditional models can
be expensive and often disrupt student learning by pulling teachers away
from class, and teachers often find them uninspiring when implemented
from the top down.</b></span></span><br />
<br />
<span style="color: #990000;"><span style="font-size: large;"><b>
</b></span></span><h3 class="section-heading">
<span style="color: #990000;"><span style="font-size: large;"><u>The Experts in the Building</u></span></span></h3>
<span style="color: #990000;"><span style="font-size: large;"><b>
</b></span></span><span style="color: #990000;"><span style="font-size: large;"><b>Fortunately, teachers have access to the best professional learning
resource there is: other teachers. And through a lens focused on change
from the inside out, starting with practices that teachers themselves
have identified as important for advancing student learning, teachers
can help one another develop skills to more precisely meet the needs of
their students.</b></span></span><br />
<span style="color: #990000;"><span style="font-size: large;"><b>
</b></span></span><br />
<span style="color: #990000;"><span style="font-size: large;"><b>In its simplest form, peer coaching is when peers engage in an
observation-feedback cycle to learn with and from one another. Peer
coaching can be done vertically, with an expert coach giving feedback to
teachers, and can be especially powerful with a horizontal approach: a
team of classroom teachers committed to helping each other improve.</b></span></span><br />
<span style="color: #990000;"><span style="font-size: large;"><b>
</b></span></span><br />
<span style="color: #990000;"><span style="font-size: large;"><b>To be honest, peer coaching in general has a mixed record of success
reported in the literature. Without a specific focus, defined roles, and
a clear understanding of how to give effective feedback, the process
can be less than inspiring for some participants. However, focusing on a
couple of key elements can result in a positive experience.</b></span></span><br />
<span style="color: #990000;"><span style="font-size: large;"><b>
</b></span></span><br />
<span style="color: #990000;"><span style="font-size: large;"><b>First, before plunging into observations, the team should agree on a
standard of practice to give feedback on. By agreeing about what they
are watching for and articulating a shared vision of success, the team
can give specific, actionable feedback based on the standard of
practice. Without this agreement at the outset, the feedback frequently
becomes more about the teacher being observed than the practice.</b></span></span><br />
<span style="color: #990000;"><span style="font-size: large;"><b>
</b></span></span><br />
<span style="color: #990000;"><span style="font-size: large;"><b>Second, I advocate a triad model for coaching. A triad model is
democratic and mutually supportive because each team member takes turns
as coach, coachee, and observer. This means that everyone, regardless of
experience or expertise, gets to participate fully.</b></span></span><br />
<br />
<div>
<h3 class="section-heading">
<span style="color: #990000;"><span style="font-size: large;"><u>The Triad Model of Peer Coaching</u></span></span></h3>
<span style="color: #990000;"><span style="font-size: large;"><b>
</b></span></span><span style="color: #990000;"><span style="font-size: large;"><b>Here are some steps to get started.</b></span></span><br />
<span style="color: #990000;"><span style="font-size: large;"><b>
</b></span></span><ol>
<li><span style="color: #990000;"><span style="font-size: large;"><b>Teachers agree on their focus—the strategy, specific learning,
or segment of the lesson to be worked on—and develop a plan for teaching
the lesson.</b></span></span></li>
<li><span style="color: #990000;"><span style="font-size: large;"><b>One teacher—the first coachee—volunteers to teach the lesson.</b></span></span></li>
<li><span style="color: #990000;"><span style="font-size: large;"><b>The team agrees on the look-fors—the standards of practice they are aiming to achieve—and the kind of feedback they’ll provide.</b></span></span></li>
<li><span style="color: #990000;"><span style="font-size: large;"><b>The coachee teaches the lesson. The coach and observer are in the
room for the lesson (or lesson segment), or it’s recorded for them to
watch later.</b></span></span></li>
<li><span style="color: #990000;"><span style="font-size: large;"><b>The coach’s role is to observe and take notes on bright spots and
suggestions for refinement and innovation, based on the agreed-upon
look-fors.</b></span></span></li>
<li><span style="color: #990000;"><span style="font-size: large;"><b>The observer’s role is to collect data about student actions and add additional observations focused on the look-fors.</b></span></span></li>
<li><span style="color: #990000;"><span style="font-size: large;"><b>Once everyone has taken notes and reflected on the lesson, the
triad meets. The observer facilitates this meeting, prompts descriptive
feedback and reflection, and focuses the group on the intended outcomes.
The coach provides feedback to the coachee, who reflects on and
discusses what is shared. The observer also invites the team to reflect
on the process.</b></span></span></li>
<li><span style="color: #990000;"><span style="font-size: large;"><b>Finally, the trio determines what adjustments will be made and
their next steps to further develop the selected practice in all of
their classrooms.</b></span></span></li>
</ol>
<br />
<span style="color: #990000;"><span style="font-size: large;"><b>The benefit of a triad model is that with two peers on the case,
the coachee receives different perspectives on the actions that
contribute to teaching and learning. The observer serves to keep the
debrief focused on outcomes and the agreed-upon look-fors, while the
coach and coachee dig into the mechanics of what happened during the
teaching and learning session.</b></span></span><br />
<span style="color: #990000;"><span style="font-size: large;"><b>
</b></span></span><br />
<span style="color: #990000;"><span style="font-size: large;"><b>Compared with other forms of professional learning, an obvious
attraction of peer coaching is that it doesn’t involve flights, hotel
rooms, and subs. The greatest investment—and it is a big one—is teacher
time. There are some ways to minimize the impact of this, however: Teams
don’t need to focus on an entire lesson—a 15-minute segment featuring a
specific strategy may be all that’s needed if that strategy is the
team’s focus. Recording a lesson segment and sharing it digitally means
teachers can support each other without finding class coverage or
aligning their schedules.</b></span></span><br />
<span style="color: #990000;"><span style="font-size: large;"><b>
</b></span></span><br />
<span style="color: #990000;"><span style="font-size: large;"><b>A triad peer coaching model is both accessible and powerful. When
teachers own their professional learning and it’s based on the areas of
improvement and innovation they’ve identified as important to their
students, peer coaching can be an effective component to any school’s
professional learning model.</b></span></span><br />
</div>
</div>
</div>
Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-58907049884881757092019-07-17T10:34:00.001-03:002019-07-17T10:34:46.036-03:00Profissão: Enfermeiro<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4WxFaG_iMTd5cy5qxCguKhBDVnCB5mNGAtF4x2c4lXbppA9RWyLk6iHAOpZwreJ2TQJYlPGZLw1d43eUuS1vgKmtY3tgqeJs0sqHw68i-jho7dqAUgxwcjUI9Dov9Jo2H1totBMjZLP4/s1600/Inesco.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="195" data-original-width="497" height="125" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4WxFaG_iMTd5cy5qxCguKhBDVnCB5mNGAtF4x2c4lXbppA9RWyLk6iHAOpZwreJ2TQJYlPGZLw1d43eUuS1vgKmtY3tgqeJs0sqHw68i-jho7dqAUgxwcjUI9Dov9Jo2H1totBMjZLP4/s320/Inesco.bmp" width="320" /></a></div>
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<div class="td-post-header">
<header class="td-post-title">
<h1 class="entry-title">
<span style="color: #4c1130;"><span style="font-size: x-large;">ENFERMAGEM: PROTAGONISMO INVISÍVEL SOCIALMENTE</span></span></h1>
<span style="color: #741b47;"><span style="font-size: large;"><b>Simone Peruzzo *</b></span></span></header><header class="td-post-title"><span style="color: #741b47;"><span style="font-size: large;"><b> </b></span></span></header><header class="td-post-title"><span style="color: #741b47;"><span style="font-size: large;"><b> </b></span></span></header></div>
<span style="color: #741b47;"><span style="font-size: large;"><b>
</b></span></span><div class="Standard" style="text-align: justify; text-justify: inter-ideograph;">
<span style="color: #741b47;"><span style="font-size: large;"><b>Escolhi
uma profissão que tem como premissa a ciência e a arte do cuidar.
Enfermeira. Profissional do cuidado, da atenção às pessoas no seu
desequilíbrio saúde-doença, nas fragilidades, receios, limitações e
perdas. Acima de tudo, somos profissionais do compromisso com a vida.
Ciente da responsabilidade que essas características trazem, vejo a
necessidade de levar à sociedade a reflexão sobre a invisibilidade
social da categoria, apesar de seu protagonismo em todas as áreas da
saúde.</b></span></span></div>
<span style="color: #741b47;"><span style="font-size: large;"><b>
</b></span></span><div class="td-g-rec td-g-rec-id-content_inlineleft ">
</div>
<span style="color: #741b47;"><span style="font-size: large;"><b>
</b></span></span><div class="Standard" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="Standard" style="text-align: justify; text-justify: inter-ideograph;">
<span style="color: #741b47;"><span style="font-size: large;"><b>A
Enfermagem está presente em todas as etapas da vida das pessoas, com a
responsabilidade de levar atenção e prestar cuidado diferenciado às
necessidades de cada uma dessas fases, com qualidade e segurança. Nos
serviços de saúde, seja qual for a complexidade, é o profissional de
Enfermagem que acolhe, que identifica fragilidades, que acompanha
procedimentos, prepara para exames e cirurgias, que está atento a
reações e a necessidade de demandas pontuais e específicas. Apesar dessa
multiplicidade de funções exercidas por enfermeiros, técnicos e
auxiliares de enfermagem, é comum o entendimento equivocado e a
reclamação “só fui atendido pela enfermeira”.</b></span></span></div>
<span style="color: #741b47;"><span style="font-size: large;"><b>
</b></span></span><div class="Standard" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="Standard" style="text-align: justify; text-justify: inter-ideograph;">
<span style="color: #741b47;"><span style="font-size: large;"><b>A
consulta de Enfermagem, realizada pelo enfermeiro, não é uma
subconsulta ou um atendimento de segunda categoria, mas sim uma
atribuição prevista por Lei do Exercício Profissional, em protocolos
elaborados por diferentes instâncias, inclusive o Ministério da Saúde,
bem como protocolos institucionais de diversos serviços de saúde, tanto
públicos como privados.</b></span></span></div>
<span style="color: #741b47;"><span style="font-size: large;"><b>
</b></span></span><div class="Standard" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="Standard" style="text-align: justify; text-justify: inter-ideograph;">
<span style="color: #741b47;"><span style="font-size: large;"><b>O
enfermeiro realiza a consulta baseado em conhecimentos técnicos,
científicos e metodológicos adquiridos em cinco anos de graduação, em
especializações, mestrado e doutorado. </b></span></span></div>
<div class="Standard" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="Standard" style="text-align: justify; text-justify: inter-ideograph;">
<span style="color: #741b47;"><span style="font-size: large;"><b>Portanto, o enfermeiro é um
profissional capacitado para realização de consulta que aborda as
necessidades básicas do paciente. Ele pode e deve realizar consulta de
enfermagem, fazer procedimentos, solicitar exames complementares,
prescrever medicações previstas nos protocolos institucionais, baseado
no raciocínio clínico, exame físico, diretrizes clínicas e terapêuticas.
Pode ainda orientar o paciente e familiares quanto aos diferentes
tratamentos e encaminhar para outros profissionais.</b></span></span></div>
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</b></span></span><div class="Standard" style="text-align: justify; text-justify: inter-ideograph;">
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<span style="color: #741b47;"><span style="font-size: large;"><b>Os
técnicos e auxiliares de enfermagem atuam sob a supervisão do
enfermeiro e juntos formam a grande força de trabalho da saúde. No
sistema público, chegam a ocupar mais de 60% das funções, garantindo
acolhimento e resolutividade na assistência, promoção da saúde e
prevenção de doenças, além de assumir muitos papéis na gestão. No
Paraná, temos mais de 100 municípios com enfermeiros comandando
Secretarias Municipais de Saúde, uma função complexa que exige domínio
de gestão, conhecimento de políticas públicas e capacidade de liderança,
que é uma das características da profissão.</b></span></span></div>
<span style="color: #741b47;"><span style="font-size: large;"><b>
</b></span></span><div class="Standard" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="Standard" style="text-align: justify; text-justify: inter-ideograph;">
<span style="color: #741b47;"><span style="font-size: large;"><b>A
invisibilidade social a que a categoria está submetida tem sido
responsável por um quadro de desmotivação profissional, evasão de mão de
obra, baixa autoestima, desgaste e adoecimento dos trabalhadores pela
sobrecarga da jornada, entre outros fatores. Pelo fato de estar e cuidar
das pessoas de forma permanente e contínua, é necessário um olhar de
cuidado com esses profissionais, é necessário cuidar de quem cuida.</b></span></span></div>
<span style="color: #741b47;"><span style="font-size: large;"><b>
</b></span></span><div class="Standard" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Nem
todos sabem, mas apesar de enfrentar plantões de intensa atividade, o
profissional de Enfermagem não tem um espaço de descanso digno nos
serviços de saúde, ao contrário de outras profissões que também atuam em
plantões. Essa é uma das lutas da categoria que precisa de
visibilidade, assim como a jornada de 30 horas semanais, a definição de
um piso salarial que atenda minimamente as necessidades básicas de
sustento dos profissionais e o dimensionamento adequado das equipes de
Enfermagem, de forma a garantir segurança nos serviços oferecidos à
população.</b></span></span></div>
<span style="color: #741b47;"><span style="font-size: large;"><b>
</b></span></span><div class="Standard" style="text-align: justify; text-justify: inter-ideograph;">
<br /></div>
<div class="Standard" style="text-align: justify; text-justify: inter-ideograph;">
<span style="color: #741b47;"><span style="font-size: large;"><b>A
sociedade pode ser uma força a mais na luta por melhores condições de
trabalho à categoria. Temos momentos de grande reconhecimento e
gratidão, principalmente de familiares que acompanham a dedicação dos
profissionais em restabelecer a saúde dos enfermos. Mas, é necessário
que esse reconhecimento individual possa também ser traduzido em
respeito e projeção social. Informem-se, conheçam nossa formação e
reconheçam nossa capacidade, habilidade e liderança. A Enfermagem cuida
das pessoas nos momentos de maior fragilidade física e emocional e,
portanto, precisa ser valorizada. Onde há vida, há Enfermagem. Valorizar
esses profissionais, é valorizar a vida!</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>
</b></span></span><div class="Standard" style="text-align: justify; text-justify: inter-ideograph;">
<span style="color: #741b47;"><span style="font-size: large;"><b><em>* Simone Peruzzo é enfermeira e atual presidente do</em> <strong><i>Conselho Regional de Enfermagem do Paraná -COREN-PR</i></strong></b></span></span></div>
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<span style="font-size: large;"><b>Fonte: Artigo publicado originalmente no jornal Gazeta do Povo online, em 5 de julho 2019</b></span>Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-32440423429481960522019-06-30T22:43:00.001-03:002019-06-30T22:43:58.832-03:00Inclusão na Universidade<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4Q2dhgFGDPuePxdkMkb_TsDfcMvSnVu8tv6Svw_bOPiEqWf9gMT4IwWlpWHuxi3bIbCMo2_At4lgxZeUqJS9CoZCMtIIRC-35s5ROX9TByrG44-g-_CA6si22hdPdI1A0cIpx4hGZ6lA/s1600/logo-green.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="80" data-original-width="250" height="204" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4Q2dhgFGDPuePxdkMkb_TsDfcMvSnVu8tv6Svw_bOPiEqWf9gMT4IwWlpWHuxi3bIbCMo2_At4lgxZeUqJS9CoZCMtIIRC-35s5ROX9TByrG44-g-_CA6si22hdPdI1A0cIpx4hGZ6lA/s640/logo-green.jpg" width="640" /></a></div>
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<span style="color: #783f04;"><span style="font-size: x-large;"><b>Pessoas com necessidades especiais: inclusão na sociedade e na universidade</b></span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9XtwX9TNJQBYt-Q_-GdHFPvnDgktrb1HUvvKrJhkrVxCsXln3Zotaply8rT84Wfu4b9v7tKGpJcK0m9PaiRdUO-unYvvTNPj7Mscf8EezObWWPf7JfWQBkLG6qE2D8TS6EHGbr4KUkiE/s1600/64497095_1419046734910077_5233020958406606848_o.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="600" data-original-width="1145" height="334" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9XtwX9TNJQBYt-Q_-GdHFPvnDgktrb1HUvvKrJhkrVxCsXln3Zotaply8rT84Wfu4b9v7tKGpJcK0m9PaiRdUO-unYvvTNPj7Mscf8EezObWWPf7JfWQBkLG6qE2D8TS6EHGbr4KUkiE/s640/64497095_1419046734910077_5233020958406606848_o.jpg" width="640" /></a></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>Os alunos da Turma X da disciplina interprofissional "Atenção em Saúde" pertencentes aos 7 Cursos da área da Saúde da UEM ( Biomedicina, Educação Física, Enfermagem, Farmácia, Medicina, Odontologia e Psicologia) definiram as questões da Equidade e da Inclusão como prioridades para intervenção e como parte das atividades planejadas organizaram no último dia 27de junho de 2019 uma mesa-redonda com o tema: "Pessoas com necessidades especiais:inclusão na sociedade e na universidade". </b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>Os debatedores foram Raquel de Araújo Bonfim e Fabiana Polpeta Medeiros, representantes da <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwjt0pKzy5LjAhXYLLkGHZGGBREQFjAAegQIABAC&url=http%3A%2F%2Fanpr.com.br%2F&usg=AOvVaw3VUou_igTYu33PIdBkHZJ-" target="_blank">ANPR</a> (Associação Norte Paranaense de Reabilitação), Tania Alvarez Silva pelo <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwirmOeay5LjAhVXH7kGHbFRAaUQFjAAegQIBhAC&url=http%3A%2F%2Fwww.pen.uem.br%2Fpropae&usg=AOvVaw06QfwwsdgRhPAMkmOHYXcv" target="_blank">PROPAE</a> (Programa Multidisciplinar de Pesquisa e Apoio à Pessoa com Necessidades Educativas Especiais) da UEM e Wellington Liziero Dias, aluno do Curso de Biomedicina como representante dos alunos com necessidades especiais. </b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1D2w1HsizG-aBrQGgXlJjSthWtJW5hu8_P8k4UeheTeosFGL3LpDc8OHdM1vk_gNhP8TBKubjMWiwtVYKOVmTYnHrdbYZvsQWg2-ebhoxczq2wbIoTVDu9I7saYD2KborW0pPZw9PpKI/s1600/64595537_1418669384947812_5234584678689669120_n.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="960" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1D2w1HsizG-aBrQGgXlJjSthWtJW5hu8_P8k4UeheTeosFGL3LpDc8OHdM1vk_gNhP8TBKubjMWiwtVYKOVmTYnHrdbYZvsQWg2-ebhoxczq2wbIoTVDu9I7saYD2KborW0pPZw9PpKI/s640/64595537_1418669384947812_5234584678689669120_n.jpg" width="640" /></a></b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>O evento contou com a presença de alunos, professores e servidores da UEM e membros da comunidade externa. </b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>* <span style="color: black;"><i>Este evento integra as atividades desenvolvidas pela UEM em conjunto com a Secretaria Municipal de Saúde de Maringá e a sociedade. Contou com o apoio da <a href="https://www.hum.uem.br/hospital/ensino-pesquisa-e-extens%C3%A3o" target="_blank">DEPE/HURM-UEM</a> e do Projeto PróSaúde/PET-Saúde.</i></span> </b></span></span></div>
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Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-29646383696124894262019-06-23T16:09:00.001-03:002019-06-23T16:09:56.241-03:00Empathy<img alt="" src="data:image/png;base64,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<span style="color: #073763;"><span style="font-size: x-large;"><strong>Empathy in healthcare is finally making a comeback</strong></span></span></h1>
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<span style="color: #0b5394;"><b><span style="font-size: large;">Jeremy Howick </span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">A doctor friend – let’s call her Anne – was teaching three smart medical students who were told to diagnose a woman complaining of nonspecific pain and anxiety. After 20 minutes of questions, the students wrote seven pages of notes and recommended two drugs: a painkiller and an antidepressant. Anne considered the students’ analysis and agreed that it was based on sound medical evidence. But something told her there was more to the story.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">She sat beside the patient, asked general questions and listened carefully. After a few minutes, the woman broke down in tears and told her about a personal tragedy involving a family member. After some comforting, the woman’s tears, shoulder pain and anxiety went away. Anne’s dose of empathy cured the woman, without the need of resorting to drugs. This is an important consideration, given that even relatively mild painkillers may <a href="https://www.bmj.com/content/352/bmj.i20.long">contribute to the opioid crisis</a> as some patients subsequently seek stronger and stronger drugs.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">The high value now placed on good empathic communication in medicine is relatively new. Until the 1970s, the doctor-patient relationship was often paternalistic. An anxious patient was less likely to be given a shoulder to cry on and more likely to be given a prescription for Valium (“mother’s little helper”).</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">In the best enactment of the paternalistic doctor, the fictional surgeon Sir Lancelot Spratt, in the 1969-70 British TV series Doctors in the House, tells a patient who has become distressed at being diagnosed with a serious tumour: “This is nothing whatsoever to do with you.” Colleagues tell me that the scene is an accurate depiction of how things were. At that time, there was little if any communication skills training. Many doctors believed it was an innate skill that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500973/#R2">could not be taught</a>.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">The 1980s saw a change, with the General Medical Council (which set standards for medical doctors in the UK) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1679819/?page=1">requiring that communication skills – including empathy – be taught</a> to medical students, and growing recognition in the field that it is an important skill to have.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">By the 1990s, communication skills teaching had become a staple of medical school and continuing medical education in the <a href="https://www.ncbi.nlm.nih.gov/pubmed/8468764">US</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/1760608">Canada</a> and the <a href="https://www.ncbi.nlm.nih.gov/pubmed/18275414">UK</a>. And within the domain of communication skills, <a href="https://blogs.bmj.com/bmj/2016/10/14/jeffrey-aronson-when-i-use-a-word-a-word-about-empathy/">empathy was emerging as a key component</a>.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">Certainly, the current focus on good communication hasn’t made the problem of “<a href="https://www.bmj.com/too-much-medicine">too much medicine</a>” go away. But promoting empathic communication as a therapeutic agent makes it more likely that people who can do without potentially harmful drugs, like tranquillisers and opioids, don’t get them.</span></b></span></div>
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<u><span style="color: #0b5394;"><span style="font-size: large;">Measuring the effects</span></span></u></h2>
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<span style="color: #0b5394;"><b><span style="font-size: large;">We’ve recently <a href="https://journals.sagepub.com/doi/full/10.1177/0141076818769477">quantified the effects of therapeutic empathy</a> the same way drug effects are quantified. More and more carefully controlled trials are comparing what happens with healthcare practitioners who practice empathic, positive communication (being <a href="http://www.caremeasure.org/">positive is a part of empathy</a>), with those who carry on as usual. The results are overwhelmingly encouraging, with empathic and positive communication improving conditions ranging from <a href="https://www.ncbi.nlm.nih.gov/pubmed/17451796">lung function</a> and <a href="https://www.researchgate.net/publication/265005989_Effectiveness_of_psychological_support_based_on_positive_suggestion_with_the_ventilated_patient">length of hospital stay</a>, to <a href="https://www.ncbi.nlm.nih.gov/pubmed/22323376">pain</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/20506122">patient satisfaction</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223324/">quality of life</a>. There is even evidence that it makes the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720820/">common cold go away</a> faster.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">From related research, we also understand more about how positive empathic communication works. First, you need empathy in order to make a correct diagnosis. Without it, patients may not share symptoms, especially embarrassing ones.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">Next, an empathic doctor will help put a patient at ease and reduce their stress. Dozens of trials suggest that relaxation reduces <a href="http://journals.sagepub.com/doi/abs/10.1177/204946371000400105">pain</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/25574576">depression and anxiety</a> and even <a href="https://www.ncbi.nlm.nih.gov/pubmed/15942415">lowers the risk of heart disease</a>.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">Being positive also activates the patient’s brain in such a way that the patient makes his or her own painkilling endorphins. Empathic positive communication also increases patient <a href="https://www.ncbi.nlm.nih.gov/pubmed/26009529">satisfaction</a>. Satisfaction, in turn, is correlated with <a href="https://bmjopen.bmj.com/content/3/1/e001570">safer and better health outcomes</a>.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">By contrast, unfriendly doctors are less likely to get enough information from patients to make the right diagnoses or prescribe the right treatment. One study even showed that unempathic doctors could cause <a href="http://www.bmj.com/content/316/7148/1878">harm</a> by scaring patients away from medical care when they need it.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">Like all studies, our review had limitations. For example, the studies in the review were small and mostly “unblinded”. A blind trial is one where the researchers or participants – or both (double-blind) – don’t know which treatment they are getting. Blinding is hard to achieve as doctors know if they have been trained to provide more empathy.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">Another limitation is that the effect was small. For example, empathic and positive communication reduced pain by an average of half a point on a ten-point scale. However, this small effect is important, especially if we take harms and drug options into account.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">Many commonly used over-the-counter drugs, on the other hand, barely outperform placebos for <a href="https://www.ncbi.nlm.nih.gov/pubmed/26863524">back pain</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/28700091">cancer pain</a> and many <a href="https://www.ncbi.nlm.nih.gov/pubmed/26068955">chronic conditions</a>, yet they can have serious side effects. By contrast, a key finding of the study was that positive empathic communication does not seem to harm patients.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span><figure class="align-center "> <span style="color: #0b5394;"><b><span style="font-size: large;"><img alt="" height="448" src="https://images.theconversation.com/files/271181/original/file-20190426-194600-h87jxy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" width="640" /> </span></b></span><figcaption><span style="color: #0b5394;"><b><span style="font-size: large;"> <span style="color: black;"><span style="font-size: small;"><span class="caption">A dose of empathy can even speed recovery from the common cold.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1234611025?src=JA_tBihNi0DXXAlyCxNwGw-1-9&size=medium_jpg">RomarioIen/Shutterstock</a></span></span></span></span></b></span> </figcaption> </figure><span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
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<span style="color: #0b5394;"><span style="font-size: large;"> </span></span></h2>
<h2 style="text-align: justify;">
<u><span style="color: #0b5394;"><span style="font-size: large;">Before there was a word for it</span></span></u></h2>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">It’s been called <a href="http://pchealthcare.org.uk/">person-centred care</a>, <a href="https://jcompassionatehc.biomedcentral.com/">compassionate care</a>, the <a href="https://balint.co.uk/">Balint</a> method, and <a href="https://www.pointofcarefoundation.org.uk/our-work/schwartz-rounds/">Schwarz rounds</a>, among other things. It’s a <a href="http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780199590681.001.0001/acprof-9780199590681-chapter-10">useful philosophical exercise</a> to disambiguate these terms, and I’m among those who are <a href="https://journals.sagepub.com/doi/full/10.1177/0141076818781403">doing just that</a>. Yet beneath all the apparent differences, they all share the goal of putting care back into healthcare.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">In the last two decades, empathy has emerged as the <a href="https://blogs.bmj.com/bmj/2016/10/14/jeffrey-aronson-when-i-use-a-word-a-word-about-empathy/">most popular</a> and arguably the <a href="https://journals.sagepub.com/doi/full/10.1177/0141076818769477">most evidence-based</a> of these “caring” therapies. Research on empathy in healthcare is blossoming, with the number of medical journals using the term in research papers increasing tenfold over the last few decades.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">The <a href="https://www.gmc-uk.org/-/media/documents/06---generic-professional-capabilities---published-version_pdf-64818615.pdf">GMC considers empathy</a> to be an essential component of good communication, and there are now training courses on the subject in the <a href="http://empathetics.com/our-products/">US</a>, <a href="https://www.phc.ox.ac.uk/research/oxford-empathy-programme">UK</a> and <a href="https://www.sacap.edu.za/blog/psychology/what-is-empathy/">South Africa</a>.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">Yet the word “empathy” is quite new in the English language, first appearing in <a href="http://www.oed.com/view/Entry/61284?redirectedFrom=empathy#eid">1895</a>. It was originally borrowed from the <a href="https://blogs.bmj.com/bmj/2016/10/14/jeffrey-aronson-when-i-use-a-word-a-word-about-empathy/">German word “einfülung” and French word “empathie”</a>. It is defined as the ability to understand or appreciate another person’s feelings or experience (“<a href="https://www.tandfonline.com/doi/abs/10.1080/00201741003784663">expressive understanding</a>”). In healthcare, it has come to capture the idea of practitioners taking time to <a href="https://journals.sagepub.com/doi/full/10.1177/0141076818781403">understand the patient’s condition, showing they understand, then caring for them</a>. Understanding, communicating and caring all pre-date the word “empathy”.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">Throughout the history of medicine, and across cultures, prominent medical practitioners and other smart people have recognised that treating a patient requires more than just dispensing medicine. King Solomon (990—931 BC) wrote: “Pleasant words are a honeycomb, sweet to the soul, and health to the bones” (Proverbs 16:24). Hippocrates (460-370 BC) famously said that “it is more important to know what sort of person has a disease than to know what sort of disease a person has”. Sun Szu-Miao (died 682, known as China’s King of Medicine) instructed doctors: “Commit oneself with great compassion to save every living creature”. Hospice care in medieval times focused on – literally – hospitality for very sick patients.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">Empathy got squeezed out as medicine became more professional and scientific. In the 18th century, paternalism wasn’t just normal, it was valued. Patients were expected to unquestioningly do what doctors like Sir Lancelot Spratt told them. The <a href="https://archive.org/details/b22376446">American Medical Association’s first code of ethics</a> (1847) stated:</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span><blockquote>
<i><b><span style="font-size: large;">"The obedience of a patient to the prescriptions of his physician
should be prompt and implicit. He should never permit his own crude
opinions as to their fitness to influence his attention to them."</span></b></i><br />
</blockquote>
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<span style="color: #0b5394;"><b><span style="font-size: large;">The paternalistic model faded throughout the 20th century. Sigmund Freud established the importance of psychology, which requires talking to patients in a non-paternalistic way, and in the 1960s Hungarian psychoanalyst <a href="https://balint.co.uk/balint-quotations/">Michael Bailint</a> claimed that the “doctor is a drug”, and introduced his training for medical students.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">Meanwhile, the thalidomide scandal damaged trust in medicine. From out in left field, Ivan Illich even claimed in the 1970s that <a href="https://jech.bmj.com/content/57/12/919">medicine did more harm than good</a>. This put patients on a more equal footing with healthcare practitioners and required more mutual understanding. Today, healthcare practitioners in most developed countries couldn’t get away with ignoring patient views, even if they wanted to.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span><figure class="align-center "> <span style="color: #0b5394;"><b><span style="font-size: large;"><img alt="" height="414" src="https://images.theconversation.com/files/271184/original/file-20190426-194627-1f382j1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" width="640" /> </span></b></span><figcaption><span style="color: #0b5394;"><b><span style="font-size: large;"> <span style="color: black;"><span style="font-size: small;"><span class="caption">Baby born to a mother who had taken thalidomide while pregnant.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/w/index.php?curid=4247382">Otis Historical Archives National Museum of Health and Medicine/Wikimedia</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></span></span></span></b></span> </figcaption> </figure><span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">The move towards empathic communication has been helped by famous medical practitioners, such as <a href="http://atulgawande.com/book/being-mortal/">Atul Gawande</a>, who writes about the importance of good communication in end-of-life care, and <a href="https://www.ranaawdishmd.com/">Rana Awdish</a>, who realised how important empathy was when she became a patient.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
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<div style="text-align: justify;">
<span style="color: #0b5394;"><b><span style="font-size: large;">As strange as it seems to us, paternalism was not as bad as it appears. At the time when paternalism was the norm, “village doctors” lived in their patients’ communities, and knew their patients well. This helped them understand things about the patients that are now being eroded as <a href="https://www.bmj.com/content/337/bmj.a867">continuity of care is less common</a>.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
<h2 style="text-align: justify;">
<span style="color: #0b5394;"><span style="font-size: large;"> </span></span></h2>
<h2 style="text-align: justify;">
<u><span style="color: #0b5394;"><span style="font-size: large;">Is empathy innate?</span></span></u></h2>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
<div style="text-align: justify;">
<span style="color: #0b5394;"><b><span style="font-size: large;">Some people still believe that empathic communication – or any communication, for that matter – can’t be taught. Either you are born to be a good empathic communicator, or you are not. Some other practitioners I’ve spoken to believe that all or, at any rate, the vast majority of healthcare practitioners already communicate with empathy. Both those statements are only partly true.</span></b></span></div>
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<div style="text-align: justify;">
<span style="color: #0b5394;"><b><span style="font-size: large;">We all know people who have different levels of communication skills. But that doesn’t mean that we can’t improve those skills. In fact, a systematic review of 13 trials (1,466 healthcare practitioners) found that <a href="https://jcompassionatehc.biomedcentral.com/articles/10.1186/s40639-016-0024-9">empathic communication can be taught</a>. Practitioners who start off being great communicators probably improved less than those who started off with less “innate” skill. But that doesn’t mean they didn’t improve. Just as Olympic gold medallists still benefit from good coaching, good communicators probably benefit from practice and training.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
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<div style="text-align: justify;">
<span style="color: #0b5394;"><b><span style="font-size: large;">It’s also only partly true that the great majority of healthcare practitioners already communicate empathy very well. Our latest <a href="https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-017-0967-3">research</a> found that the extent to which patients feel that their practitioners express empathy varies widely. In our study, we analysed the combined data from 64 published studies on doctor empathy. In the studies, the <a href="http://www.caremeasure.org/">patients were asked</a> ten questions such as: Does your doctor really listen to you? Did they make you feel at ease? And: Did your doctor put together a helpful plan of action for you? The highest empathy rating is 50.</span></b></span></div>
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<div style="text-align: justify;">
<span style="color: #0b5394;"><b><span style="font-size: large;">We found substantial variability. Female practitioners were ranked as more empathic than male practitioners (43/50 versus 35/50), allied health professionals, such as physiotherapists, more empathic than doctors (45/50 versus 40/50), and practitioners from Australia and the US (45/50) being ranked as slightly more empathic than their counterparts in the UK (43/50), Germany (41/50) and China (41/50).</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">Our research also showed a link between spending more time with patients and greater patient-rated empathy. We don’t know whether spending more time caused more empathy, whether greater empathy caused practitioners to spend time, or whether empathy and more time are inseparable.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
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<div style="text-align: justify;">
<span style="color: #0b5394;"><b><span style="font-size: large;">Among healthcare practitioners who were rated as less empathic (or who spend less time), it could be that they simply aren’t empathic or don’t want to spend more time with their patients. (Time, after all, is money in many healthcare practices.) But this seeming lack of empathy or willingness to spend more time with patients could be a result of outside pressures.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
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<div style="text-align: justify;">
<span style="color: #0b5394;"><b><span style="font-size: large;">A recent study found that for every hour spent with patients, doctors spent <a href="https://annals.org/aim/fullarticle/2546704/allocation-physician-time-ambulatory-practice-time-motion-study-4-specialties">two hours doing paperwork</a>. That and other system-level factors are leading to <a href="https://www.bmj.com/content/358/bmj.j3360">burnout</a> and <a href="https://www.bmj.com/content/362/bmj.k3705">worse care</a>.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
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<div style="text-align: justify;">
<span style="color: #0b5394;"><b><span style="font-size: large;">It stands to reason that healthcare managers, and society at large, have to be empathic towards healthcare practitioners if we would like them to be empathic towards us. When system-level pressures are a <a href="https://www.bmj.com/content/357/bmj.j2527">contributing cause of suicide among junior doctors in the UK</a>, society is failing to be empathic towards our healthcare practitioners.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span><figure class="align-center "> <span style="color: #0b5394;"><b><span style="font-size: large;"><img alt="" height="426" src="https://images.theconversation.com/files/271186/original/file-20190426-194616-15i8wil.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" width="640" /> </span></b></span><figcaption><span style="color: #0b5394;"><b><span style="font-size: large;"> <span style="color: black;"><span style="font-size: small;"><span class="caption">Allied health professionals are more empathic than doctors, according to one survey.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1212240370?src=aMP07lUnPZPDLmL091HvZA-1-40&size=medium_jpg">goodluz/Shutterstock</a></span></span></span></span></b></span></figcaption><figcaption><span style="color: #0b5394;"><b><span style="font-size: large;"><span class="attribution"> </span></span></b></span></figcaption><figcaption><span style="color: #0b5394;"><b><span style="font-size: large;"><span class="attribution"> </span></span></b></span> </figcaption> </figure><span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
<h2 style="text-align: justify;">
<u><span style="color: #0b5394;"><span style="font-size: large;">Dismissing the sceptics</span></span></u></h2>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
<div style="text-align: justify;">
<span style="color: #0b5394;"><b><span style="font-size: large;">Most people believe that empathy in medicine is a good thing, but there are some sceptics. Some worry that too much empathy <a href="https://link.springer.com/article/10.1007/s11606-018-4443-5">leads to burnout</a>. And it’s easy to see how this might happen.</span></b></span></div>
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<div style="text-align: justify;">
<span style="color: #0b5394;"><b><span style="font-size: large;">A doctor who is always empathic with their patients might actually experience the emotions of all their patients, and this could be draining. Trying to prevent this “compassion fatigue” is one explanation for why empathy seems to <a href="https://www.ncbi.nlm.nih.gov/pubmed/22455699">decline throughout medical school</a>. Students may learn to protect themselves against that kind of burnout by becoming less empathic. But this only applies if you need to actually experience the emotions of another (this is called “affective empathy”).</span></b></span></div>
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<div style="text-align: justify;">
<span style="color: #0b5394;"><b><span style="font-size: large;">Affective empathy is often impossible. For example, I’ll never know what it actually feels like to give birth to a baby. Luckily, you don’t need to actually experience someone else’s emotions to be empathic. I did my best to be empathic to my wife when she was delivering our baby by trying to imagine how much pain and anxiety she was experiencing and doing my best to support her.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
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<br /></div>
<div style="text-align: justify;">
<span style="color: #0b5394;"><b><span style="font-size: large;">Also, some evidence suggests that empathy actually <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880744/">reduces fatigue and burnout</a>. Meanwhile, where it might be a risk factor for fatigue or burnout, <a href="https://www.ncbi.nlm.nih.gov/pubmed/25796117">good leadership is needed to prevent it</a>, and there is some evidence that <a href="https://www.ncbi.nlm.nih.gov/pubmed/23667348">mindfulness</a> may mitigate the extra fatigue caused by empathy. Moreover, empathic care improves patient satisfaction, reduces the risk of being sued for medical malpractice and thus removes a major source of stress.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
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<br /></div>
<div style="text-align: justify;">
<span style="color: #0b5394;"><b><span style="font-size: large;">Some people also claim that we don’t need empathy in really important cases. If you get into a serious car accident, you need a paramedic to do something not stop and ask you how you feel. A patient with advanced stage cancer who wants treatment needs prompt action more than long heart-to-heart chats.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
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<div style="text-align: justify;">
<span style="color: #0b5394;"><b><span style="font-size: large;">Even with less serious illnesses, some patients don’t really want an empathic doctor – they want paternalism. But since empathy is defined as the ability to understand a patient, I don’t think these cases are against empathy. </span></b></span></div>
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<div style="text-align: justify;">
<span style="color: #0b5394;"><b><span style="font-size: large;">We can assume that someone who is in a car accident needs a paramedic without talking to them about their feelings. In fact, talking to them in that circumstance would be unempathic. Likewise, for someone who wants to be told what to do, an empathic doctor who understands their patient’s needs will act paternalistically. Forcing empathy on someone is not empathic.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
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<div style="text-align: justify;">
<span style="color: #0b5394;"><b><span style="font-size: large;">In surgery, and other medical procedures that demand skill, we might only care about the person’s skill. If I need surgery, I want the surgeon with the best track record in that kind of surgery. I don’t care if they are empathic or even if they can talk.</span></b></span></div>
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<div style="text-align: justify;">
<span style="color: #0b5394;"><b><span style="font-size: large;">But the decision to have surgery or not often does require an empathic conversation. For example, a conversation I had with my doctor led to <a href="http://www.jeremyhowick.com/ran-first-marathon-saved-nhs-2000/">me avoiding recommended surgery</a>, saving the NHS thousands of pounds. I even recovered well enough to run a marathon.</span></b></span></div>
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<div style="text-align: justify;">
<span style="color: #0b5394;"><b><span style="font-size: large;">Healthcare managers worry that empathy takes more time and is therefore unrealistic in a cash-strapped healthcare system. In fact, we found a <a href="https://www.ncbi.nlm.nih.gov/pubmed/28823250">link between time spent with patients and empathy</a>. What we don’t know is whether the additional time was cost effective. If the longer consultations lead to reduced medication and fewer hospital admissions, then it could be cost effective. A <a href="https://www.southampton.ac.uk/medicine/academic_units/projects/empathica.page">research team in Southampton</a>, Oxford and Keele is doing more research to investigate this.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;"> </span></b></span></div>
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<br /></div>
<div style="text-align: justify;">
<span style="color: #0b5394;"><b><span style="font-size: large;">More importantly, expressing empathy doesn’t necessarily take more time. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439824/">Empathic body language</a> – looking at the patient instead of a screen, nodding to acknowledge the patient is heard, and smiling – doesn’t take more time. And one study even showed that when doctors sat beside their patients (empathic body language), as opposed to standing up, patients thought they spent <a href="https://www.ncbi.nlm.nih.gov/pubmed/21719234">more time although it was the same</a>.</span></b></span></div>
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<span style="color: #0b5394;"><b><span style="font-size: large;">From my research in this field, it is clear that most areas of healthcare (bar those emergency situations) could benefit from being more empathic. But it is also clear that systems need to change so that healthcare practitioners can spend more time on empathy than on paperwork. In the words of the physician William Osler: “The good physician treats the disease; the great physician treats the patient who has the disease.”</span></b></span></div>
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Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-63455256895405891932019-06-22T09:45:00.000-03:002019-06-22T09:45:07.960-03:00Hospitais Universitários do Paraná<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgjQGs4mLx2zncT3_uqdKV6BpSOG3amO6Pf0m7D-Dpbf_uknvuSTWvdwx6LfzyQhYDM7Bjlu8JVfAThcU7HPTdvDXTl_Chj0BDNmPNVMtzOR3QykeEhf1IHMnvN7YJuKCiTWZUwPTzI9k/s1600/7.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="96" data-original-width="330" height="186" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgjQGs4mLx2zncT3_uqdKV6BpSOG3amO6Pf0m7D-Dpbf_uknvuSTWvdwx6LfzyQhYDM7Bjlu8JVfAThcU7HPTdvDXTl_Chj0BDNmPNVMtzOR3QykeEhf1IHMnvN7YJuKCiTWZUwPTzI9k/s640/7.png" width="640" /></a></div>
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<span style="font-size: x-large;"><span style="color: #274e13;"><span style="font-family: "Trebuchet MS", sans-serif;">Hospitais universitários atendem quase 400 mil paranaenses ao ano, além de ensinar e produzir ciência</span></span></span></h2>
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<span style="color: #38761d;"><span style="font-size: large;"><span style="font-family: "Trebuchet MS", sans-serif;"><i>Ligados às universidades estaduais, eles são as principais portas de entrada pelo Sistema Único de Saúde
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAKtXh9roCZT46lyCxRKwRyB58r9cYICBzG0wI7puB1gLAQcyAeCFFOiHMkLdx75Is5eHIdpML6TlppxtvznIkkOQclf4ur5enNZWU08pzC14b2AskwmhpaQIy1hZ-ekq4otgJnuHN4Eg/s1600/1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1068" data-original-width="1600" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAKtXh9roCZT46lyCxRKwRyB58r9cYICBzG0wI7puB1gLAQcyAeCFFOiHMkLdx75Is5eHIdpML6TlppxtvznIkkOQclf4ur5enNZWU08pzC14b2AskwmhpaQIy1hZ-ekq4otgJnuHN4Eg/s640/1.jpg" width="640" /></a></div>
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<span style="font-size: large;"><b><span style="color: #38761d;"><span style="font-family: "Trebuchet MS", sans-serif;">Criados como hospitais ensino, para a formação dos acadêmicos das
áreas de saúde, os quatro hospitais universitários das instituições
estaduais de ensino superior do Paraná desempenham papel de destaque,
prestando serviços gratuitos e de qualidade à população. Cerca de 392
mil pessoas são atendidas, anualmente, nestas quatro unidades que,
seguramente, são a principal porta de entrada para o Sistema Único de
Saúde (SUS) na comunidade onde estão inseridos.</span></span></b></span></div>
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<span style="font-size: large;"><b><span style="color: #38761d;"><span style="font-family: "Trebuchet MS", sans-serif;">Com 123 leitos e atendimento exclusivo pelo SUS, o HU da Universidade
Estadual de Maringá (UEM), por exemplo, recebe a população da
macrorregião Noroeste do Paraná, com 115 municípios, onde residem 2
milhões de habitantes. Em 2018, passaram pelo hospital mais de 60 mil
pessoas em áreas como pediatria, cirurgia, ortopedia, ginecologia e
obstetrícia. Quando ele foi criado, em 1988, Maringá e região não
dispunham de um hospital público para atendimento, o que evidencia,
inclusive, sua importância histórica.</span></span></b></span></div>
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<span style="font-size: large;"><b><span style="color: #38761d;"><span style="font-family: "Trebuchet MS", sans-serif;">A superintendente do hospital, Elisabete Koyabashi, chama a atenção
para o fato de que os Hospitais Universitários viveram diferentes formas
de inserção no sistema de saúde no Brasil e ganharam maior relevância
assistencial a partir da década de 1980, quando os setores filantrópico e
privado tiveram uma retração na prestação de serviços ao sistema
público de saúde. “Os HUs foram então reconhecidos como estratégicos
tanto na formação de profissionais de saúde para a rede quanto nos
atendimentos de alta complexidade”, afirma a médica.</span></span></b></span></div>
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<span style="font-size: large;"><b><span style="color: #38761d;"><span style="font-family: "Trebuchet MS", sans-serif;">Na região dos Campos Gerais, o HU da Universidade Estadual de Ponta
Grossa (UEPG) também faz a diferença, a começar pelo volume de
internamentos que, nos últimos cinco anos, aumentou 440%. Em números,
significa dizer que a unidade, com nove anos de existência, passou de
2,5 mil para 11 mil internamentos neste período, enquanto que o volume
de consultas médicas no ambulatório saltou de 31 mil para 72 mil anuais.</span></span></b></span></div>
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<span style="font-size: large;"><b><span style="color: #38761d;"><span style="font-family: "Trebuchet MS", sans-serif;">"O HU mudou todo o cenário da saúde dos Campos Gerais. Pacientes que
antigamente teriam que ser atendidos em Curitiba ou na região
metropolitana, recebem, hoje, tratamento em Ponta Grossa", comemora a
diretora geral do hospital, Tatiana Menezes Cordeiro.</span></span></b></span></div>
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<span style="font-size: large;"><b><span style="color: #38761d;"><span style="font-family: "Trebuchet MS", sans-serif;">Destacando que o HU também é referência em atendimento de traumas,
Tatiana Cordeiro explica os acidentes de trânsito respondem por grande
parte do número de procedimentos. "Ponta Grossa é o maior entroncamento
rodo-ferroviário do Brasil e, em função disso, o volume de acidentes
automobilísticos é imenso. Boa parte dessas vítimas é atendida no
serviço de ortopedia e traumatologia do nosso hospital", diz a diretora.</span></span></b></span></div>
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<span style="color: #274e13;"><span style="font-size: large;"><b><span style="font-family: "Trebuchet MS", sans-serif;"><strong>Referência nacional</strong></span></b></span></span></div>
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<span style="font-size: large;"><b><span style="color: #38761d;"><span style="font-family: "Trebuchet MS", sans-serif;">Em Londrina, o hospital universitário da UEL é o mais antigo em
atividade entre os quatro, completando 48 anos de fundação este ano. É
também a maior unidade de saúde do interior do Paraná, atuando 100% com o
SUS, com oferta de 300 leitos para internações. A unidade abriga o
Centro de Tratamento de Queimados, considerado como referência nacional.</span></span></b></span></div>
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<span style="font-size: large;"><b><span style="color: #38761d;"><span style="font-family: "Trebuchet MS", sans-serif;">O HU da UEL também é referência em outras áreas como, por exemplo, a
de Transplante de Medula Óssea, Unidade de Isolamento para Pacientes
Portadores de Moléstias Infectocontagiosas e Maternidade para Gestantes
de Alto Risco.</span></span></b></span></div>
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<span style="font-size: large;"><b><span style="color: #38761d;"><span style="font-family: "Trebuchet MS", sans-serif;">Pelo hospital passam pacientes de cerca de 250 municípios paranaenses
e de mais de 100 cidades de outros estados. Dados de 2018 revelam a
realização de mais de 10 mil cirurgias e de quase 13 mil internações.
Somente no Pronto-Socorro foram 25.642 consultas.</span></span></b></span></div>
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<span style="color: #274e13;"><span style="font-size: large;"><b><span style="font-family: "Trebuchet MS", sans-serif;">Parâmetro em Alta Complexidade</span></b></span></span></div>
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<span style="font-size: large;"><b><span style="color: #38761d;"><span style="font-family: "Trebuchet MS", sans-serif;">Os números na área de saúde pública do Estado não seriam os mesmos
sem a presença do hospital da Universidade Estadual do Oeste do Paraná
(Unioeste) que responde, anualmente, por cerca de 70 mil atendimentos.</span></span></b></span></div>
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<span style="font-size: large;"><b><span style="color: #38761d;"><span style="font-family: "Trebuchet MS", sans-serif;">Inaugurado em maio de 1989, na época com a oferta de 85 leitos,
atualmente o HU conta com 243 leitos. É referência em alta complexidade
para 119 municípios e o maior prestador de serviço do Sistema Único de
Saúde das regiões Oeste e Sudoeste, abrangendo cinco regionais de saúde e
uma população de cerca de dois milhões de habitantes.</span></span></b></span></div>
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<span style="font-size: large;"><b><span style="color: #38761d;"><span style="font-family: "Trebuchet MS", sans-serif;">Parâmetro em alta complexidade nas áreas de trauma-ortopedia,
cirurgia vascular e procedimentos em cardiologia intervencionista,
cirurgia vascular, cirurgia cardiovascular e neurologia/neurocirurgia, o
hospital ocupa um espaço de quase 38 mil metros quadrados, com uma área
construída de mais ou menos 27 mil metros quadrados.</span></span></b></span></div>
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<span style="font-size: large;"><b><span style="color: #38761d;"><span style="font-family: "Trebuchet MS", sans-serif;">Neste espaço funciona uma estrutura que engloba Ambulatórios de
Especialidades, Centro Cirúrgico, Centro Obstétrico, Unidades de
Tratamento Intensivo e de Cuidados Intermediários, Pronto-Socorro,
Diagnóstico por Imagem, Banco de Leite Humano, Centro de Atenção e
Pesquisa em Anomalias Craniofaciais e Serviço de Verificação de Óbitos
Regional.</span></span></b></span></div>
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<span style="font-size: large;"><b><span style="color: #38761d;"><span style="font-family: "Trebuchet MS", sans-serif;">Um novo hospital pode integrar esta rede. A partir da implantação,
este ano, do curso de Medicina da Universidade Estadual do Centro-Oeste
(Unicentro) criou-se um movimento em Guarapuava, com apoio de vereadores
locais, para que a universidade seja gestora do Hospital Bernardo Ribas
Carli, com 600 funcionários e 120 leitos.</span></span></b></span></div>
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<span style="color: #274e13;"><span style="font-size: large;"><b><span style="font-family: "Trebuchet MS", sans-serif;">Zero Infecções</span></b></span></span></div>
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<span style="font-size: large;"><b><span style="color: #38761d;"><span style="font-family: "Trebuchet MS", sans-serif;">O HU da UEPG mantém, na UTI Adulto, o projeto Melhorando a Segurança
do Paciente em Larga Escala no Brasil, do Programa de Apoio ao
Desenvolvimento Institucional do SUS, com resultados relevantes na
redução das infecções associadas à assistência em saúde. </span></span></b></span></div>
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<span style="font-size: large;"><b><span style="color: #38761d;"><span style="font-family: "Trebuchet MS", sans-serif;">As duas Unidades de Terapia Intensiva do hospital têm mantido, nos
últimos seis meses, a taxa zero em infecções de trato urinário. Quanto à
pneumonia associada à ventilação mecânica, outra complicação
relativamente comum nas UTIs, ambas as unidades atingiram a taxa zero,
em janeiro de 2019. </span></span></b></span></div>
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<span style="font-size: large;"><b><span style="color: #38761d;"><span style="font-family: "Trebuchet MS", sans-serif;">A infecção na corrente sanguínea associada ao uso de cateter vem
registrando decréscimos constantes e, em janeiro, foi zerada em uma das
unidades do HU.</span></span></b></span></div>
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<span style="font-size: large;"><b><span style="color: #38761d;"><span style="font-family: "Trebuchet MS", sans-serif;">Na Maternidade, são oito partos por dia e o setor, na concepção da
diretora do hospital, revolucionou o atendimento obstétrico em Ponta
Grossa e região. O índice de parto natural é digno de países
desenvolvidos e a humanização do atendimento obstétrico é referência na
região: mais de 70% dos partos realizados no HU da UEPG são partos
normais, respeitando tanto os desejos da gestante quanto as indicações
médicas para cada caso.</span></span></b></span></div>
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<span style="color: #274e13;"><span style="font-size: large;"><b><span style="font-family: "Trebuchet MS", sans-serif;">Ampliação da capacidade</span></b></span></span></div>
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<b><span style="font-family: "Trebuchet MS", sans-serif;">Com duas obras importantes em andamento HU da UEM </span></b></div>
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<b><span style="font-family: "Trebuchet MS", sans-serif;">pode dobrar capacidade de atendimento </span></b></div>
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<span style="color: #38761d;"><span style="font-size: large;"><b><span style="font-family: "Trebuchet MS", sans-serif;">O HU da UEM também registra uma atuação importante na área de parto
humanizado. Além disso, é referência em atendimentos no Ambulatório de
Tratamento de Feridas e Serviço de Informação de Medicamentos, e nos
serviços de alta complexidade como transplante de córnea, cirurgia
bariátrica e implante coclear.</span></b></span></span></div>
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<span style="color: #38761d;"><span style="font-size: large;"><b><span style="font-family: "Trebuchet MS", sans-serif;">O hospital praticamente irá dobrar sua capacidade atual quando entrar
em funcionamento o prédio da Clínica para Adultos, uma nova ala com
mais de oito mil metros quadrados e capacidade para 108 novos leitos
hospitalares. A obra, que teve início em 2016, demandou um custo
aproximado de R$ 17 milhões em investimentos provenientes do governo do
Paraná, por meio da Secretaria de Estado da Saúde e do Fundo Estadual de
Saúde.</span></b></span></span></div>
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<span style="color: #38761d;"><span style="font-size: large;"><b><span style="font-family: "Trebuchet MS", sans-serif;">O reitor da UEM, Julio Cesar Damasceno, destaca que o processo de
expansão do hospital deve continuar com a conclusão de outra obra
importante que é o novo centro cirúrgico, cujo projeto engloba onze
salas cirúrgicas, central de esterilização, área para atendimento
pós-cirúrgico e salas de aula. “Estamos em negociação com a Secretaria
de Estado da Saúde para a liberação de recursos para a finalização do
centro”, diz o gestor, destacando que serão necessários R$ 7 milhões
para finalizar a construção.</span></b></span></span></div>
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<span style="color: #38761d;"><span style="font-size: large;"><b><span style="font-family: "Trebuchet MS", sans-serif;">Outro hospital que também está aumentando a capacidade de atendimento
é o de Ponta Grossa. Atualmente com 168 leitos, a unidade irá
acrescentar 20 novos leitos assim que construção da nova ala da
Maternidade, em andamento, estiver concluída. </span></b></span></span></div>
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<span style="color: #38761d;"><span style="font-size: large;"><b><span style="font-family: "Trebuchet MS", sans-serif;">Também em fase de conclusão das obras, o Centro de Hematologia, o
primeiro na região de Ponta Grossa a atender pelo SUS, terá dez leitos
para internamento, sete cadeiras para infusão de quimioterapia,
consultório de hematologista, farmácia para manipulação de
quimioterápicos e laboratório especializado em diagnóstico e pesquisa
hematológica, além de adequações na agência transfusional para aférese.</span></b></span></span></div>
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<span style="color: #38761d;"><span style="font-size: large;"><b><span style="font-family: "Trebuchet MS", sans-serif;">A Unioeste está construindo uma nova ala, dedicada exclusivamente ao
tratamento de queimados. A obra está praticamente finalizada, faltam
alguns retoques finais e a cabine de gerador. A previsão é finalizar no
final desse mês.</span></b></span></span></div>
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<span style="color: #274e13;"><span style="font-size: large;"><b><span style="font-family: "Trebuchet MS", sans-serif;"><strong>Formação profissional</strong></span></b></span></span></div>
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<span style="font-size: small;"><span style="font-family: "Trebuchet MS", sans-serif;">Os hospitais de ensino são responsáveis pela formação direta de mais de 92.000 profissionais por ano no país</span></span></h5>
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<span style="color: #38761d;"><span style="font-size: large;"><b><span style="font-family: "Trebuchet MS", sans-serif;">Os hospitais de ensino no Brasil são responsáveis pela formação
direta de mais de 92.000 profissionais por ano, sendo impactante para a
sustentação de vários serviços. Estes profissionais formados dentro dos
HUs são aproveitados nas redes pública e privada, trazendo maior
competência e qualidade de atendimento. </span></b></span></span></div>
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<span style="color: #38761d;"><span style="font-size: large;"><b><span style="font-family: "Trebuchet MS", sans-serif;">Além da formação profissional nas Residências Médica, de Enfermagem,
de Fisioterapia e Multiprofissionais, os quatro HUs ligados às
universidades estaduais também servem de campo de estágio para os alunos
de graduação em Medicina, Fisioterapia, Enfermagem, Nutrição,
Fonoaudiologia, entre outros.</span></b></span></span></div>
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<span style="color: #38761d;"><span style="font-size: large;"><b><span style="font-family: "Trebuchet MS", sans-serif;">"Ponta Grossa é um polo educacional e nós somos campo de estágio
prático para todos os cursos da área da saúde da UEPG. Também ofertamos
vagas às demais instituições da região, em nível superior e técnico",
assinala a diretora Tatiana Cordeiro, destacando, que muitos dos
especialistas formados pelas residências continuam a atuar no próprio
HU.</span></b></span></span></div>
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<span style="color: #38761d;"><span style="font-size: large;"><b><span style="font-family: "Trebuchet MS", sans-serif;">Vale lembrar ainda que os hospitais universitários têm outra
característica de suma importância à sociedade, que é a produção
científica, resultado das inúmeras pesquisas em nível de pós-graduação,
traduzidas em dissertações de mestrado e teses de doutorado ou de
artigos apresentados em congressos.</span></b></span></span></div>
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<span style="color: #274e13;"><span style="font-size: large;"><b><span style="font-family: "Trebuchet MS", sans-serif;"><strong>Eficiência de gestão</strong></span></b></span></span></div>
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<span style="font-family: "Trebuchet MS", sans-serif;"> </span></h5>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipPfbJe1CZkhivHxShrGqnmTR9Mzn1sWTKwh6T_IQ5cRtZVVHdn7mo07MVVz4ZmE6deqXhe8N3LXb7AmUnetzfKX-WMFDMBf9B97k-ldx-X8tbUeBGKnqTPxGUsFJ1cabpfHtOAicD4mk/s1600/4.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1068" data-original-width="1600" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipPfbJe1CZkhivHxShrGqnmTR9Mzn1sWTKwh6T_IQ5cRtZVVHdn7mo07MVVz4ZmE6deqXhe8N3LXb7AmUnetzfKX-WMFDMBf9B97k-ldx-X8tbUeBGKnqTPxGUsFJ1cabpfHtOAicD4mk/s640/4.jpg" width="640" /></a><span style="font-size: small;"><b><span style="font-family: "Trebuchet MS", sans-serif;"> </span></b></span></div>
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<b><span style="font-size: small;"><span style="font-family: "Trebuchet MS", sans-serif;">Gestão de qualidade otimiza recursos e favorece diminuição de custos</span></span></b></div>
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<span style="color: #38761d;"><b><span style="font-size: large;"><span style="font-family: "Trebuchet MS", sans-serif;">Em Maringá, o HU está implementando a gestão de qualidade e a
Metodologia Lean, com foco na agilização e efetividade nos atendimentos e
processos. A proposta é otimizar os recursos recebidos e favorecer a
diminuição de custos. Apesar de ainda ser precoce mensurar os resultados
das medidas, especialmente na redução de custos já é possível, segundo a
superintendente do hospital, sentir alguns impactos. Elisabete
Kobayashi explica que a redução do tempo de permanência do paciente no
Pronto-Atendimento e a diminuição do tempo de espera de atendimento e
exames são bons indicadores, assim como a agilização de leitos para a
internação. São conquistas que o hospital vem acumulando após a
implementação do método.</span></span></b></span></div>
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<span style="color: #274e13;"><b><span style="font-size: large;"><span style="font-family: "Trebuchet MS", sans-serif;"><strong>Complexo de Saúde</strong></span></span></b></span></div>
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<span style="color: #38761d;"><b><span style="font-size: large;"><span style="font-family: "Trebuchet MS", sans-serif;">Os atendimentos realizados pelos HUs vão muito além dos leitos
hospitalares. Muitos integram um complexo de saúde que dá suporte e
amplia a prestação de serviços.</span></span></b></span></div>
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<span style="color: #38761d;"><b><span style="font-size: large;"><span style="font-family: "Trebuchet MS", sans-serif;">O HU da UEL, por exemplo, conta, além do Centro de Tratamento de
Queimados, já citado, com o Hemocentro Regional, o Banco de Leite
Humano, a Unidade de Transplante de Medula Óssea, o Banco de Olhos, a
Unidade de Quimioterapia, o e a Central de Controle de Intoxicações.</span></span></b></span></div>
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<span style="color: #38761d;"><b><span style="font-size: large;"><span style="font-family: "Trebuchet MS", sans-serif;">Em Maringá também funciona o Centro de Controle de Intoxicações que
dá suporte para o tratamento de quem foi picado por animais peçonhentos
ou ingeriu ou inalou veneno, entre eles agrotóxicos usados nas lavouras,
com registro de cerca de três mil atendimentos por ano.</span></span></b></span></div>
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<span style="color: #38761d;"><b><span style="font-size: large;"><span style="font-family: "Trebuchet MS", sans-serif;">Os atendimentos feitos pela Clínica Odontológica, pela Unidade de
Psicologia Aplicada, pelo Laboratório de Ensino e Pesquisa em Análises
Clínicas e a Farmácia Ensino também fazem a diferença para a população
assistida. </span></span></b></span></div>
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<span style="color: #38761d;"><b><span style="font-size: large;"><span style="font-family: "Trebuchet MS", sans-serif;">Destaque ainda para o Hemocentro Regional de Maringá, que faz coleta
de sangue em 30 municípios, produz e distribui hemocomponentes, como
hemácias, plasma e plaquetas, a mais de 30 hospitais.</span></span></b></span></div>
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<span style="color: #274e13;"><b><span style="font-size: large;"><span style="font-family: "Trebuchet MS", sans-serif;"><strong>Banco de Leite Humano</strong></span></span></b></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXpzQmX2MusfiW1xMalmKM0plBsVBbQKULKzUMQb0ycg13GHRmdHAQ2mLfg9qdUzKWpp2ZDbxqDaS8hf5nOW1pcGH4L2wicVduEAmReYNo-mq-0LQ5mm_JRL2pixMTT8JGVdgCXgT7bF4/s1600/5.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="673" data-original-width="807" height="532" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXpzQmX2MusfiW1xMalmKM0plBsVBbQKULKzUMQb0ycg13GHRmdHAQ2mLfg9qdUzKWpp2ZDbxqDaS8hf5nOW1pcGH4L2wicVduEAmReYNo-mq-0LQ5mm_JRL2pixMTT8JGVdgCXgT7bF4/s640/5.jpg" width="640" /></a><span style="font-size: small;"><b><span style="font-family: "Trebuchet MS", sans-serif;"> </span></b></span></div>
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<b><span style="font-size: small;"><span style="font-family: "Trebuchet MS", sans-serif;">O Banco de Leite Humano de Maringá <span style="background-color: inherit; color: inherit;">capta, processa e distribui, </span></span></span></b></div>
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<b><span style="font-size: small;"><span style="font-family: "Trebuchet MS", sans-serif;"><span style="background-color: inherit; color: inherit;">mensalmente, cerca de 300 litros de leite</span></span></span></b></div>
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<span style="color: #38761d;"><span style="font-size: large;"><b><span style="font-family: "Trebuchet MS", sans-serif;">Inúmeros bebês que, por diferentes razões, não podem receber o leite
da própria mãe e dele necessitam como fator vital, são beneficiados
pelos Bancos de Leite Humano, outro serviço que os HUs prestam.</span></b></span></span></div>
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</div>
<div style="text-align: justify;">
<span style="color: #38761d;"><span style="font-size: large;"><b><span style="font-family: "Trebuchet MS", sans-serif;">O de Maringá, por exemplo, capta, processa e distribui, mensalmente,
cerca de 300 litros de leite materno para unidades de terapia intensiva
de cinco hospitais locais.</span></b></span></span></div>
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<span style="color: #38761d;"><span style="font-size: large;"><b><span style="font-family: "Trebuchet MS", sans-serif;">Em 2018, o Banco de Leite Humano do HU da Unioeste coletou 3.377
litros, atendendo 215 crianças de zero a dois anos. Também foram
registrados 1.822 doadoras de leite humano e distribuiu 2.849 litros de
leite.</span></b></span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgO6vKcnNRXC_uO-W0YwphYhyphenhyphenitXEdy6RFYCpDkbrBPQDdVVuqGBronU_3b8DK_fvvOfgCaJAUoF_hwos6qhlro3NYDmqbCeNAZVwvtlFPACgQgoFnDuKx5SClmee6vWj1uDaIKZHXAbIo/s1600/6.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="245" data-original-width="1470" height="106" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgO6vKcnNRXC_uO-W0YwphYhyphenhyphenitXEdy6RFYCpDkbrBPQDdVVuqGBronU_3b8DK_fvvOfgCaJAUoF_hwos6qhlro3NYDmqbCeNAZVwvtlFPACgQgoFnDuKx5SClmee6vWj1uDaIKZHXAbIo/s640/6.jpg" width="640" /></a></div>
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Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-41544632247582568092019-06-06T08:18:00.000-03:002019-06-06T08:18:40.228-03:00Burnout<div class="separator" style="clear: both; text-align: center;">
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<a href="http://www.asc.uem.br/index.php?option=com_content&view=article&id=23792:precisa-se-falar-sobre-burnout-o-esgotamento-profissional&catid=986:pgina-central&Itemid=101" itemprop="url" title="Precisa-se falar sobre Burnout, o esgotamento profissional">
<span style="color: #660000;"><span style="font-size: x-large;">Precisa-se falar sobre Burnout, o esgotamento profissional</span></span></a>
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<aside class="article-aside article-aside-full"><span style="color: #990000;"><span style="font-size: large;"><b><span itemprop="name">Matheus Teixeira</span>
</b></span></span></aside><div style="text-align: justify;">
<section class="article-full has-article-tools"><div class="article-content-main">
<span style="color: #990000;"><span style="font-size: large;"><b> </b></span></span><br />
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<span style="color: #990000;"><span style="font-size: large;"><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLQ6LFBbyXW-mOkaUTybgwzTSSoniXjDSl98U96fxUsuhLIYn2l0pfLxkGkRKPz7AXD7TDDbgbHMTPn-jNua2Lj5xfUhjrHT5FRBv91SFPfdTmMm3j69y3PE1xVXiOoT1AHoyoZFf49XQ/s1600/2019-06-05_Professor_Lucas_Psicologia-1735.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1068" data-original-width="1600" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLQ6LFBbyXW-mOkaUTybgwzTSSoniXjDSl98U96fxUsuhLIYn2l0pfLxkGkRKPz7AXD7TDDbgbHMTPn-jNua2Lj5xfUhjrHT5FRBv91SFPfdTmMm3j69y3PE1xVXiOoT1AHoyoZFf49XQ/s640/2019-06-05_Professor_Lucas_Psicologia-1735.jpg" width="640" /></a></b></span></span><span style="font-size: small;"><b> </b></span><br />
<span style="font-size: small;"><b>Doutor em Psicologia, Lucas Soldera estimula que pessoas previnam-se com hábitos saudáveis e tempo para lazer</b></span><br />
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<span style="color: #990000;"><span style="font-size: large;"><b>Profissionais especializados e a sociedade estão cada vez mais com os
olhos voltados à Síndrome de Burnout, do Esgotamento Profissional ou
simplesmente Burnout. Isso é justificável pelo fato de que no mundo
atual há enormes cobranças na vida profissional – na qual muitas vezes
as qualificações precisam beirar a perfeição, as atribuições são maiores
que a carga horária de trabalho, a concorrência é exorbitante e as
cobranças vêm de todos os lados, todo o tempo.</b></span></span><br />
<br />
<span style="color: #990000;"><span style="font-size: large;"><b>De língua inglesa, “burnout” significa “combustão”. <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwjbmeb23NTiAhU2K7kGHW6WDeUQFjAAegQIABAB&url=http%3A%2F%2Fwww.cpr.uem.br%2Findex.php%2Fguiadefontes%2F1773-lucas-martins-soldera&usg=AOvVaw3ZsFc4iHghDxsnkSyutwFN" target="_blank">Lucas Martins Soldera</a>, chefe do Departamento de Psicologia (DPI) da Universidade
Estadual de Maringá (UEM), compara que, ao invés da gasolina, o
combustível é a energia humana, ou seja, ocorre quando o paciente fica
“esgotado física e psiquicamente, principalmente por questões
relacionadas ao ambiente de trabalho”. Diferentemente do que possa
parecer, o Burnout não atinge apenas o trabalhador, mas igualmente pode
acometer estudantes e desempregados. “O trabalho não é só desempenhar
uma função, é se relacionar, criar sentido naquilo que faz e ter prazer
em uma determinada atividade, com carteira assinada ou não”, observa o
doutor em Psicologia.</b></span></span><br />
<br />
<span style="color: #990000;"><span style="font-size: large;"><b>Ainda de acordo com o professor, as causas do Esgotamento
Profissional estão ligadas principalmente a: aumento de pressão,
cobranças e responsabilidades; tensão; estresse; condições ruins de
trabalho; carga horária excessiva; falta de férias e de autonomia; e
conflito de valores pessoais com a atividade desempenhada. “Cada dia
mais é frequente a necessidade da produtividade, da excelência e da
competitividade. Vivemos num mundo de trabalho que está sendo
precarizado”, aborda Soldera. Ferramentas que deveriam facilitar o dia a
dia, inclusive o profissional, como o smartphone, estão contribuindo
para o esgotamento. “Trabalhamos constantemente, em tempo integral, e
não percebemos”.</b></span></span><br />
<br />
<br />
<u><span style="color: #990000;"><span style="font-size: large;"><strong>Histórico</strong></span></span></u><br />
<span style="color: #990000;"><span style="font-size: large;"><strong>O Burnout não é novo, foi descoberto em
1974 pelo psicólogo Herbert Freudenberger, de acordo com a Revista
Brasileira de Medicina do Trabalho. E há 20 anos, a <a href="http://bvsms.saude.gov.br/bvs/saudelegis/gm/1999/prt1339_18_11_1999.html" rel="noopener" target="_blank">Portaria 1.339/99 do Ministério da Saúde</a>
já o colocava como uma “dificuldade física e mental relacionada com o
trabalho”. Soldera acrescenta que desde 2010 o Burnout também aparece
listado na Classificação Internacional de Doenças (CID) e fala que nem
sempre se manifesta sozinho, pode vir associado, por exemplo, a
depressão, Lesão por Esforço Repetitivo (LER) e Distúrbio Osteomuscular
Relacionado ao Trabalho (Dort). No mês de maio, a Organização Mundial da
Saúde (OMS) informou que incluiu o Burnout na 11ª Revisão da CID
(CID-11) como “síndrome resultante do estresse crônico no local de
trabalho que não foi gerenciado com sucesso”.</strong></span></span><br />
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<h4>
<u><span style="color: #990000;"><span style="font-size: large;">Sintomas e tratamento</span></span></u></h4>
<span style="color: #990000;"><span style="font-size: large;"><b>Para ser diagnosticada com Burnout por psicólogo ou psiquiatra, o
chefe do DPI informa que a pessoa deve estar em uma situação constante e
prolongada de esgotamento. Os principais sintomas, apontados por ele,
são:</b></span></span><br />
<br />
<div style="text-align: justify;">
<span style="color: #990000;"><span style="font-size: large;"><b>• Atitudes negativas;</b></span></span></div>
<div style="text-align: justify;">
<span style="color: #990000;"><span style="font-size: large;"><b>• Falta de significado no que faz;</b></span></span></div>
<div style="text-align: justify;">
<span style="color: #990000;"><span style="font-size: large;"><b>• Desprazer nas atividades cotidianas;</b></span></span></div>
<div style="text-align: justify;">
<span style="color: #990000;"><span style="font-size: large;"><b>• Autodesvalorização;</b></span></span></div>
<div style="text-align: justify;">
<span style="color: #990000;"><span style="font-size: large;"><b>• Distúrbios do sono;</b></span></span></div>
<div style="text-align: justify;">
<span style="color: #990000;"><span style="font-size: large;"><b>• Cansaço;</b></span></span></div>
<div style="text-align: justify;">
<span style="color: #990000;"><span style="font-size: large;"><b>• Dor de cabeça frequente;</b></span></span></div>
<div style="text-align: justify;">
<span style="color: #990000;"><span style="font-size: large;"><b>• Dificuldade de concentração;</b></span></span></div>
<div style="text-align: justify;">
<span style="color: #990000;"><span style="font-size: large;"><b>• Distanciamento das relações pessoais;</b></span></span></div>
<div style="text-align: justify;">
<span style="color: #990000;"><span style="font-size: large;"><b>• Sensação de fracasso;</b></span></span></div>
<div style="text-align: justify;">
<span style="color: #990000;"><span style="font-size: large;"><b>• Mudança repentina de humor;</b></span></span></div>
<div style="text-align: justify;">
<span style="color: #990000;"><span style="font-size: large;"><b>• Alteração no batimento cardíaco.</b></span></span></div>
<br />
<span style="color: #990000;"><span style="font-size: large;"><b>A psicoterapia, correlacionada ou não com prescrição de remédios como
ansiolíticos e antidepressivos, é a forma mais adequada de tratamento,
conforme o doutor, que enfatiza que a automedicação não cabe jamais. “Em
muitos casos, a efetiva mudança de rotina e estilo de vida já auxilia
muito”, estimula o psicólogo.</b></span></span><br />
<br />
<h4>
<u><span style="color: #990000;"><span style="font-size: large;">Prevenção do Burnout</span></span></u></h4>
<span style="color: #990000;"><span style="font-size: large;"><b>O trabalhador tem que permitir-se ir a eventos culturais e de lazer,
ter vida social saudável, praticar modalidades esportivas, frequentar
uma religião caso tenha interesse, dedicar um tempo para não fazer nada e
tirar férias de verdade, que é “ter um tempo seu, distante daquilo que
você faz no dia a dia”.</b></span></span><br />
<br />
<h4>
<u><span style="color: #990000;"><span style="font-size: large;">Serviços de apoio</span></span></u></h4>
<span style="color: #990000;"><span style="font-size: large;"><b>Professores e técnicos administrativos da UEM podem procurar o
Ambulatório Médico e de Enfermagem, no Bloco 01 do câmpus sede, em
Maringá (PR). Informações podem ser obtidas por meio do telefone (44)
3011-4266.</b></span></span><br />
<br />
<span style="color: #990000;"><span style="font-size: large;"><b>Estudantes da UEM que precisarem de apoio podem recorrer à <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwis8Obc3NTiAhXwErkGHSVvDeAQFjAAegQIABAC&url=http%3A%2F%2Fwww.upa.uem.br%2Fframe_1.htm&usg=AOvVaw2eIo_6uqSKC4j2xnrU9Z2i" target="_blank">Unidade de Psicologia Aplicada</a> (UPA): Avenida Mandacaru, 1.690, também em Maringá.
O telefone para tirar dúvidas é o (44) 3011-9070 /9072.</b></span></span><br />
<br />
<span style="color: #990000;"><span style="font-size: large;"><b>Para a comunidade externa, há serviços privados e também a <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwiYp9K73NTiAhWBLLkGHcf6C-oQFjAAegQIAhAB&url=http%3A%2F%2Fwww.saude.gov.br%2Facoes-e-programas%2Frede-de-atencao-psicossocial-raps&usg=AOvVaw0y7Xvv1eaNHWEH0HOnNlu-" target="_blank">Rede de Atenção Psicossocial</a> (RAPS), encontrada no Sistema Único de Saúde (SUS).</b></span></span></section></div>
</section></div>
</article></div>
</div>
</div>
</div>
</div>
</div>
Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-20049489257000912562019-05-26T07:00:00.000-03:002019-05-26T07:00:15.403-03:00Privacy and intellectual property rights<div class="separator" style="clear: both; text-align: center;">
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<span style="font-size: x-large;"><span style="color: #20124d;">Whose Dissertation Is It, Anyway?</span></span></h1>
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<i><span style="color: #351c75;"><span style="font-size: large;"><b>Balking at a requirement to upload a copy of his doctoral thesis to an online database run by library services company ProQuest, one student pushes back.</b></span></span></i><br />
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<span style="color: #351c75;"><span style="font-size: large;">By</span></span><span style="color: #351c75;"><span style="font-size: large;"><b><a class="username" href="https://www.insidehighered.com/users/lindsay-mckenzie" title="View user profile."> Lindsay McKenzie</a></b></span></span></h2>
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<span style="color: #351c75;"><span style="font-size: large;"><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjU4jXVD8xaM3aoFwoFXDOrnoHdwj-A5gSk1TPr3fU9ARSXGvT7Hf0csc-SMc1lZAU0gB_1x_ZESyDbgmm3tD62_e2mdCGsOeGh-w1WBZ3OBm-xOmkz5fS93Hoi-wxYutc-CAEeq69D2MQ/s1600/Sem+t%25C3%25ADtulo.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="768" data-original-width="1024" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjU4jXVD8xaM3aoFwoFXDOrnoHdwj-A5gSk1TPr3fU9ARSXGvT7Hf0csc-SMc1lZAU0gB_1x_ZESyDbgmm3tD62_e2mdCGsOeGh-w1WBZ3OBm-xOmkz5fS93Hoi-wxYutc-CAEeq69D2MQ/s640/Sem+t%25C3%25ADtulo.jpg" width="640" /></a></b></span></span></div>
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<span style="color: #351c75;"><span style="font-size: large;"><b>Rob Schlesinger is not your typical college student. A lawyer who worked in higher education administration for more than 25 years, he decided to take time off from his day job two years ago to pursue a doctorate degree in education at Manhattanville College in Purchase, N.Y.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>Getting an Ed.D. degree is a lifelong dream for Schlesinger. He defended his dissertation proposal, “Ethics Education in the Undergraduate Curriculum: An Action Research Analysis,” earlier this year. He said his experience at the college has been mostly positive, but it recently took an unexpected turn.</b></span></span><br />
<span style="color: #351c75;"><span style="font-size: large;"><b><br /></b></span></span>
<span style="color: #351c75;"><span style="font-size: large;"><b>In an article published on the blog <a href="https://scholarlykitchen.sspnet.org/2019/04/08/guest-post-the-dissertation-publication-requirement-its-time-for-reexamination/" target="_blank"><i>The Scholarly Kitchen</i></a> last month, Schlesinger wrote of the shock he felt upon learning that all doctoral students at Manhattanville are required to submit their dissertations to an online database run by for-profit library services company ProQuest.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>Schlesinger was even more surprised by the reaction he received from faculty members, administrators and fellow students when he voiced his objection to this policy.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>“One would think that I was Oliver Twist asking for more porridge or I had said that I was writing my opus in crayon,” he wrote.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>Requiring students to publish dissertations, particularly online, may put vulnerable students who have been victimized, threatened or stalked at risk, said Schlesinger. He believes it could also jeopardize the safety of people mentioned in the research, even if they are anonymized.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>“My legal -- and moral -- concerns about this practice stem from the issues it raises with privacy and intellectual property rights, as well as contract law,” he said.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>Aside from privacy concerns, Schlesinger believes that as the author of his dissertation, he should have the right to decide how his work is published and distributed. He also questions whether it is defensible under contract law for colleges to make the publication of a dissertation a degree requirement.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>“My argument here is not against publishing online; rather, it is for giving dissertation authors -- the doctoral students themselves -- a say in the disposition of their work,” wrote Schlesinger.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>Ray Harris, director of the law firm Fennemore Craig, said Schlesinger raises valid concerns about privacy, but Harris notes issues around anonymity in qualitative research can usually be identified and resolved early on through discussions about appropriate research design.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>If the candidate and the university cannot reach agreement, then the candidate is left with a “Hobson’s choice” of risking harm or withdrawing from the degree program.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>Harris expects that most universities would be willing to accommodate serious concerns about publishing students' work online because it is the right thing to do, and because of the liability risk institutions face if harm results from a publication.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>“If the university insists on publication in exceptional circumstances where publication is objectively inappropriate, then I believe courts should deal with that situation under traditional contract doctrines,” he said.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>The requirement for students to upload their doctoral theses to ProQuest is “bordering on universal” at U.S. institutions, said Rick Anderson, associate dean for collections and scholarly communications at the Marriott Library at the University of Utah.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>“This practice amounts to outsourcing the digital archiving of locally produced theses and dissertations,” Anderson said in an email. By putting dissertations in a virtual space that is curated by another entity, institutions can free up institutional server space and staff time for other uses, he said.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>“I don’t have a problem with this system being the default arrangement, but I think students should have the option to decline,” said Anderson. “A thesis or dissertation is the author’s original work, and it should be treated as such -- not institutional property. At the very least, if the institution is going to impose such a requirement on its graduate students, that fact should be made very clear before the student matriculates, and an agreement to that effect should be made in writing.”</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>Barbara Fister, a librarian at Gustavus Adolphus College in Minnesota (who also blogs for<i> Inside Higher Ed</i>) noted that this is not the first time scholars have voiced concern at the requirement to publish their work with ProQuest. In the past, scholars have been surprised to learn that their work was being sold by ProQuest through third-party retailers such as Amazon. ProQuest <a href="https://www.insidehighered.com/news/2014/11/12/proquest-ends-dissertation-sales-through-amazon" target="_blank">stopped selling dissertations</a> on Amazon in 2014 following a number of complaints.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>People forget that it is a long-standing practice for hard copies of doctoral theses to be made available in libraries for anyone to read, Fister said by email. “It’s public proof of your attainment of knowledge and your membership in the discipline. It was never controversial so far as I know,” she said.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>When dissertations started to become widely available online, however, the situation changed. Some publishers became hesitant about publishing commercial books from authors who had recently published their doctoral thesis on the same topic, said Fister.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>“Ownership per se is not at issue here. Authors retain copyright,” said Fister. “The issue is the nonexclusive right to distribute copies of a dissertation. ProQuest pays royalties on sales and dissertations may be embargoed, but that appears to be a decision made by institutions rather than individual authors or ProQuest.”</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>Jessica Horowitz, director of academic relations at ProQuest, said the company publishes dissertations and theses from more than 3,100 universities.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>“The universities we work with set their own policies on publication requirements, and while we can’t give exact numbers, we find that many do require their students to publish with ProQuest,” she said in an email.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>Publication with ProQuest benefits universities because it boosts the visibility of their graduate programs and makes their research widely available, said Horowitz.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>“Most dissertation authors welcome the added visibility that dissemination through ProQuest offers,” she added.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>ProQuest Dissertations and Theses Global, as the database is officially called, has been a designated off-site dissertation repository for the U.S. Library of Congress <a href="https://urldefense.proofpoint.com/v2/url?u=https-3A__www.loc.gov_item_prn-2D99-2D007_&d=DwMFAg&c=WMhnfwkfN4LR6wX29ZSgFCZf_hw4vy5MAv7iZJNaAD4&r=WVo4jmq4Jv1gxEwlakLk1BrptrEhl8s4Tu951m5tNjM&m=VcDCY8NkMG9z4ZGHE4WPpWmIC-J_p-h5slLHOCgRB1Y&s=YqixlAF_Jd8VDi6VsU6tY8isEmznnizJfq8fb-oYGec&e=" target="_blank">since 1999</a>. All dissertations sent to ProQuest become part of the official national collection.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>ProQuest is committed to offering flexibility to authors, said Horowitz.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>“Authors’ agreements are nonexclusive with ProQuest. Authors retain copyright and full control of their work and may submit it anywhere they wish,” she said. “ProQuest is governed by any embargo that the author or university places on a work and can, upon request, remove online works within 24 hours.”</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>After speaking with his advisers, Schlesinger was granted an exception to the requirement to publish with ProQuest. He has encouraged other students to request the same but said none have yet done so.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>Students should be made aware of the requirement to publish with ProQuest at the beginning of their studies, said Schlesinger. He also objected to the college encouraging students to have their work professionally edited to meet ProQuest’s standards, which he considers an unfair and costly expense.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>Schlesinger said he objected to publishing his work online because it hampered the ability of his research interviewees to speak openly with him. When he shared this concern, his supervisors suggested he was “not masking his data well enough.” He argued it is often very easy to unmask anonymous sources in educational research, particularly if they are identified as college presidents or deans.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>By not publishing online, Schlesinger is not saying he doesn’t want others to benefit from his research. In fact, he wants the opposite.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>“For practitioners, dissertations and journal articles aren’t that helpful,” he said. “If I identify useful information in my dissertation, I want to boil it down into articles and practice guides that will likely be much more widely read.”</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>Manhattanville's School of Education has since revised its <a href="http://mville.libguides.com/ld.php?content_id=46094302" target="_blank">dissertation policy</a> to say that “should a student appeal electronic filing, then a bound copy would be required.”</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>Tracy Muirhead, interim vice president for institutional advancement at Manhattanville, said in an email that filing with ProQuest is "not a graduation requirement" but doctoral students are "very strongly encouraged to use the electronic filing option."</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>She said the college's doctoral faculty members will be discussing the issues raised by Schlesinger at an upcoming retreat. But faculty members generally support uploading dissertations to ProQuest and believe it "helps to share with others, both externally and internally, the research that Manhattanville doctoral students have undertaken."</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>While he is happy he doesn't have to publish his dissertation online, Schlesinger said he wants the college to make it clearer to other students that they also have the option to make an appeal. Many students are still under the impression that filing with ProQuest is mandatory, he said.</b></span></span><br />
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<span style="color: #351c75;"><span style="font-size: large;"><b>"I can see the argument for encouraging students to publish their dissertations on ProQuest, and have spoken with several faculty members who believe that it is a really good thing for the students' careers," said Schlesinger. "But to gloss over the situation does not do the issue, or the college itself, justice."</b></span></span><br />
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Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-21792646637299060482019-05-25T08:57:00.001-03:002019-05-25T08:57:18.775-03:00Poetry to treat and heal<br />
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<hgroup> <h1 class="article-title" itemprop="headline">
<span style="color: #660000;"><span style="font-size: x-large;">How Doctors Use Poetry</span></span></h1>
<span style="font-size: x-large;"> </span><h2 class="article-subtitle" itemprop="alternativeHeadline">
<span style="font-size: x-large;"> <i><span style="font-size: large;">A Harvard medical student describes how he is learning to both treat and heal. </span></i> </span></h2>
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<span style="color: #990000;"><b><span style="font-size: large;">By Danny W. Linggonegoro</span></b></span></div>
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<span style="color: #990000;"><b><span style="font-size: large;"><span class="dropcap">O</span>ne part of the Hippocratic Oath, the vow taken by many physicians, requires us to “remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.” When I, along with my medical school class, recited that oath at my white coat ceremony a year ago, I admit that I was more focused on the biomedical aspects than the “art.” I bought into the mechanism of insulin lowering blood sugar. I bought into the concept of diabetes-induced kidney damage. I bought into the idea of small intestinal bacterial overgrowth in patients with diabetes. But art’s—poetry’s—role in the modern practice of medicine?</span></b></span></div>
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<span style="color: #990000;"><b><span style="font-size: large;">I’ve changed my mind. Physicians are beginning to understand that the role of language and human expression in medicine extends beyond that horizon of uncertainty where doctor and patient must speak to each other about a course of treatment. The restricted language of blood oxygen levels, drug protocols, and surgical interventions may conspire against understanding between doctor and patient—and against healing. As doctors learn to communicate beyond these restrictions, they are reaching for new tools—like poetry.</span></b></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrPAq0wi0yZMZRCBt-WMqS7Cvn_Ef4IidVHejGTRso3oPICtLwfw7Yu8psSGf9fEaMa2czIuqAc_4_sYQwwiPKk6ipez17RhLgXor_fe2j6iEJC-cdZ3AkNPFYvUIJMF2ksQz2RvgMP8s/s1600/15302_a7e00935bd22418f319b10051ed4349e.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="500" data-original-width="733" height="436" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrPAq0wi0yZMZRCBt-WMqS7Cvn_Ef4IidVHejGTRso3oPICtLwfw7Yu8psSGf9fEaMa2czIuqAc_4_sYQwwiPKk6ipez17RhLgXor_fe2j6iEJC-cdZ3AkNPFYvUIJMF2ksQz2RvgMP8s/s640/15302_a7e00935bd22418f319b10051ed4349e.png" width="640" /></a></div>
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<span style="color: #990000;"><b><span style="font-size: large;"><br /></span></b></span> <span style="color: #990000;"><b><span style="font-size: large;">Researchers have demonstrated with functional magnetic resonance imaging that reciting poetry engages the primary reward circuitry in the brain, called the mesolimbic pathway. So does music—but, the researchers found, poetry elicited a unique response.<sup>1</sup> While the mechanism is unclear, it’s been suggested that poetic, musical, and other nonpharmacologic adjuvant therapies can reduce pain and the use and dosage of opioids.<sup>2</sup></span></b></span></div>
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<span style="color: #990000;"><b><span style="font-size: large;">One randomized clinical trial by researchers at the University of Maranhão studied the effect of passive listening to music or poetry on the pain, depression, and hope scores of 65 adult patients hospitalized in a cancer facility. They found that both types of art therapy produced similar improvements in pain intensity and depression scores. Only poetry, however, increased hope scores. The researchers conjectured that poetry can break the so-called law of silence, according to which talking about one’s perception of illness is taboo. After listening to poems from <i>Linhas Pares</i> by Claudia Quintana, one participant said “I feel calmer when I hear those words. That agony, that sadness passes. They are important words, they show me that I’m not alone.”<sup>3</sup></span></b></span></div>
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<i><span style="color: #990000;"><b><span style="font-size: large;">Poetry is a way to both embrace the hospital encounter, and escape from it.</span></b></span></i></blockquote>
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<span style="color: #990000;"><b><span style="font-size: large;">In another study, 28 Iranian women undergoing chemotherapy for breast cancer participated in eight weekly sessions of group poetry therapy. Their quality of life, as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire, showed improvements.<sup>4</sup></span></b></span></div>
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<span style="color: #990000;"><b><span style="font-size: large;">Insights like these are already making their way into the clinic. Sarah Friebert, a physician at Akron’s Children’s Hospital, has integrated poetry into her clinical practice. She runs a pediatric palliative care center where children are visited by a writer-in-residence who helps them create poems and stories. On discharge, patients and families can request home visits on a monthly basis, and patients can submit completed work for publication.</span></b></span></div>
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<span style="color: #990000;"><b><span style="font-size: large;"><br /></span></b></span> <span style="color: #990000;"><b><span style="font-size: large;">I learned about Friebart’s program at a poster session at the 9<sup>th</sup> Annual Hippocrates Poetry and Medicine Symposium, which I attended this year in Chicago along with three of my medical school classmates. We were all supported by <a href="https://www.poetryfoundation.org/" target="_blank">the Poetry Foundation</a> and the Poetry in America Initiative. Armed with a bit of training in how to use a video camera and how to do an interview, we camped out in the lobby of Northwestern Medical School, interviewing a slate of researchers and poets alike. In one interview, we met with Catherine Belling, an associate professor of medical education, and asked her how she thinks poetry can be used in the medical sense.</span></b></span></div>
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<span style="color: #990000;"><b><span style="font-size: large;">“Poetry is a beautifully condensed form of what all of language does, which is what captures the real world and turns it something manageable and meaningful,” she told us. Physicians and patients can sometimes assume that the other party is on the same page, she said, when they are not. Language is not always transparent and sometimes our vocabulary is insufficient to describe our mood. Poetry is, in some ways, uniquely capable of addressing this problem. “Poetry has a structure, which is something we can experience with our bodies,” Belling says. The medical evidence suggests that this is true in more ways than one.</span></b></span></div>
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<span style="color: #990000;"><b><span style="font-size: large;">We also interviewed the poet Eric Elshtain, who uses poetry on the wards to teach children the power of self-expression at Children’s Hospital University of Illinois. He’s found that many of his patients (whom he likes to call “students”) write haikus about the things that make them human, like sports or their favorite stuffed animal, rather than their experience in a hospital bed. Poetry, he said, is a way to both embrace the hospital encounter, and escape from it.</span></b></span></div>
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Rafael Campo and Mark Doty in conversation at the 9th Annual Hippocrates Poetry and Medicine Symposium.</div>
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<span style="color: #990000;"><b><span style="font-size: large;">Midway through the conference, we filmed one of the plenary events of the day: a discussion between our mentor, the physician and poet Rafael Campo, and the poet Mark Doty, a National Book Award winner who came to prominence with his poems about the AIDs epidemic. Campo and Doty lamented that medical professionals can get too easily caught up in treating disease. When pharmacology and procedures end, there is still a space for healing. While a sonnet a day won’t help a diabetic’s blood glucose, it might help with preventing diabetes burnout—the state in which he grows tired of managing his condition. When physicians care for their patients, they have a responsibility both to treat, and to heal. And poetry can help with healing.</span></b></span></div>
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<span style="color: #990000;"><b><span style="font-size: large;"> </span></b></span><span style="color: #990000;"><b><span style="font-size: large;">As Campo and Doty talked, I thought about Doty’s poetry reading the night before, when his sublime words prompted all of us to gaze at the horizon of our mortality. One of the poems he shared was “This Your Home Now,” set in a barbershop called Willie’s:</span></b></span></div>
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<i><span style="color: #990000;"><b><span style="font-size: large;">… the men I have outlived …<br />—though in truth I have not forgotten one of you,<br />may I never forget one of you—these layers of men,<br />arrayed in their no-longer-breathing ranks.<br />Willie, I have not lived well in my grief for them;<br />I have lugged this weight from place to place<br />as though it were mine to account for,<br />and today I sit in your good chair …</span></b></span></i><br />
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<span style="color: #990000;"><b><span style="font-size: large;"> </span></b></span><span style="color: #990000;"><b><span style="font-size: large;">The poem reminded me that each person has a story of griefs and happiness; that my mundane day at the hospital may be someone’s worse day of their life. In my first year of medical school, I’ve been taught how to conduct a thorough history. That means asking patients about their illness, medical history, medications, and about how their illness is affecting their life. The problem is, all of this needs to fit inside the boundaries of an electronic medical record template.</span></b></span></div>
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<span style="color: #990000;"><b><span style="font-size: large;">I’ve decided that I’ll learn how to meet my patients beyond the chart documents; that I’ll encourage them to write their own empowering stories; that I will heal as well as treat. In other words, that I’ll honor each and every word in the oath I took last year.</span></b></span></div>
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<span style="color: #990000;"><b><span style="font-size: large;"><br /></span></b></span> <span style="color: #990000;"><b><span style="font-size: large;"> </span></b></span><span style="color: #990000;"><b><span style="font-size: large;"><i>*<span style="color: black;"> Danny W. Linggonegoro is a medical student at Harvard Medical School.</span></i></span></b></span></div>
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<span style="color: #990000;"><b><span style="font-size: large;"><i>This article was supported by <a href="https://www.poetryfoundation.org/" target="_blank">the Poetry Foundation</a>, an independent literary organization and publisher of </i><a href="https://www.poetryfoundation.org/poetrymagazine" target="_blank">Poetry</a><i> magazine.</i></span></b></span></div>
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<span style="color: #990000;"><b><span style="font-size: large;"><i><br /></i></span></b></span> <span style="color: #990000;"><b><span style="font-size: large;"> </span></b></span><u><span style="color: #990000;"><b><span style="font-size: large;">References</span></b></span></u></div>
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<span style="color: #990000;"><b><span style="font-size: large;"> </span></b></span><span style="color: #990000;"><b><span style="font-size: large;">1. Wassiliwizky, E., Koelsch, S., Wagner, V., Jacobsen, T., & Menninghaus, W. The emotional power of poetry: Neural circuitry, psychophysiology and compositional principles. <i>Social Cognitive and Affective Neuroscience</i> 12, 1229-1240 (2017).</span></b></span></div>
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<span style="color: #990000;"><b><span style="font-size: large;"> </span></b></span><span style="color: #990000;"><b><span style="font-size: large;">2. Huang, S.T., Good, M., & Zauszniewski, J.A. The effectiveness of music in relieving pain in cancer patients: A randomized controlled trial. <i>International Journal of Nursing Studies</i> 47, 1354-1262 (2010).</span></b></span></div>
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<span style="color: #990000;"><b><span style="font-size: large;"> </span></b></span><span style="color: #990000;"><b><span style="font-size: large;">3. Arruda, M.A., Garcia, M.A., & Garcia, J.B. Evaluation of the effects of music and poetry in oncologic pain relief: A randomized clinical trial. <i>Journal of Palliative Medicine</i> 19, 943-948 (2016).</span></b></span></div>
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<span style="color: #990000;"><b><span style="font-size: large;"> </span></b></span><span style="color: #990000;"><b><span style="font-size: large;">4. Gozashti, M.A., Moradi, S., Elyasi, F., & Daboui, P. Improvement in patient-reported outcomes after group poetry therapy of women with breast cancer. <i>Social Determinants of Health</i> 3 (2017).</span></b></span></div>
Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-78902006534772785382019-05-20T11:42:00.002-03:002019-05-20T11:42:51.749-03:00Is Active Learning Always Effective?<div class="separator" style="clear: both; text-align: center;">
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<span style="color: #660000;"><span style="font-size: x-large;">Active Learning That Distracts from Learning</span></span></h1>
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<span style="color: #990000;"><span style="font-size: large;"><b>By: <a href="https://www.facultyfocus.com/author/ff-lagier/" rel="author" title="Posts by Adriana J. LaGier, PhD">Adriana J. LaGier, PhD</a></b></span></span></div>
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<div class="shareaholic-canvas shareaholic-ui shareaholic-resolved-canvas ng-scope" data-app-id="17424468" data-app="share_buttons" data-link="https://www.facultyfocus.com/articles/effective-teaching-strategies/active-learning-that-distracts-from-learning/" data-summary="Because I teach mixed demographic courses, I often look out at a sea of distracted and unmotivated faces. Motivation is a large part of learning (Pintrich and deGroot, 2003). So, I use active learning activities, such as think-pair-share, to not only motivate students (Marbach-Ad et al., 2001), but also to enhance student learning (Bonwell and Eison, 1919; Freeman et al., 2014). If I’m being honest, active learning also has the added perk of distracting students from the monotony of my voice." data-title="Active Learning That Distracts from Learning" id="shr_canvas2">
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<div class="shareaholic-canvas shareaholic-ui shareaholic-resolved-canvas ng-scope" data-app-id="17424468" data-app="share_buttons" data-link="https://www.facultyfocus.com/articles/effective-teaching-strategies/active-learning-that-distracts-from-learning/" data-summary="Because I teach mixed demographic courses, I often look out at a sea of distracted and unmotivated faces. Motivation is a large part of learning (Pintrich and deGroot, 2003). So, I use active learning activities, such as think-pair-share, to not only motivate students (Marbach-Ad et al., 2001), but also to enhance student learning (Bonwell and Eison, 1919; Freeman et al., 2014). If I’m being honest, active learning also has the added perk of distracting students from the monotony of my voice." data-title="Active Learning That Distracts from Learning" id="shr_canvas2">
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<span style="color: #990000;"><span style="font-size: large;"><b>Because I teach mixed demographic courses, I often look out at a sea
of distracted and unmotivated faces. Motivation is a large part of
learning (Pintrich and deGroot, 2003). So, I use active learning
activities, such as think-pair-share, to not only motivate students
(Marbach-Ad et al., 2001), but also to enhance student learning (Bonwell
and Eison, 1919; Freeman et al., 2014). If I’m being honest, active
learning also has the added perk of distracting students from the
monotony of my voice. Yet, in the past few years, I have begun to wonder
if I have taken it too far? Am I simply using active learning as a way
of keeping bored students active?</b></span></span></div>
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<span style="color: #990000;"><span style="font-size: large;"><b>Recently, I created a set of tactile active learning activities
developed to capture my kinesthetic learners. These activities range
from using balloons to work on why cells are small to playing with PVC
pipes to feel the rigidity of a microtubule.</b></span></span></div>
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<span style="color: #990000;"><span style="font-size: large;"><b>I have been happily entering the classroom with my tactile-inspired
kits being absolutely certain that I would engage students and enhance
their learning. However, I have noticed a rather curious and alarming
trend. When I implement my kinesthetic activities, more students are
missing the corresponding test question. For example, on one particular
question about cell size, when I used my balloon activity, I went from
53 ± 3% students getting it right to 35 ± 4% students getting it right.
So instead of capturing more students, I lost upwards of 15% of them.</b></span></span></div>
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<span style="color: #990000;"><span style="font-size: large;"><b>This led me to ask the
question: in my attempt to capture and motivate students, am I distracting them
from learning? I feel that I use active learning appropriately because I align
learning activities with well-constructed learning goals and/or critical
inquiry ideals. Therefore, I believe that I am engaging unmotivated students rather
than simply keeping them busy. However, I do wonder if by engaging them in the
activity, I am taking their attention away from learning the content.</b></span></span></div>
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<span style="color: #990000;"><span style="font-size: large;"><b>Noticing this trend in my
assessment outcomes has been eye-opening. For now, I watch for activities that
are negatively impacting student success on assessments. When I notice that the
activity distracts from student learning, I dial back on the active learning
and work on capturing student attention prior to teaching them the content.
Based on this experience, I continuously remind myself that engaging students
doesn’t always mean that the engagement is useful for learning the material at
hand. In my attempt to have an enjoyable, maybe even fun, class, I may be
sacrificing student attention and learning.</b></span></span></div>
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<span style="color: #990000;"><span style="font-size: large;"><strong><u>References</u>:</strong></span></span></div>
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</b></span></span></div>
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<span style="color: #990000;"><span style="font-size: large;"><b>Bonwell, C. C., and J.A.
Eison. 1991. Active learning: creating excitement in the classroom. ASHE-ERIC
Higher Education Report No. 1, Washington, D.C.: The George Washington
University, School of Education and Human Development.</b></span></span></div>
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<span style="color: #990000;"><span style="font-size: large;"><b>
</b></span></span></div>
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<span style="color: #990000;"><span style="font-size: large;"><b>Freeman, S., Eddy, S.L.,
McDonough, M., Smith, M.K., Okoroafor, N., Jordt, H., and M.P. Wenderoth. 2014.
Active learning increases student performance in science, engineering, and
mathematics. <em>Proceedings of the National Academy
of Sciences</em>, 111, 8410-8415.</b></span></span></div>
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<span style="color: #990000;"><span style="font-size: large;"><b>
</b></span></span></div>
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<span style="color: #990000;"><span style="font-size: large;"><b>Marbach-Ad G., Seal O. and P. Sokolove. 2001.
Student attitudes and recommendations on active learning: a student-led survey
gauging course effectiveness. <em>J. Coll. Sci. Teach</em>, 30, 434–438.</b></span></span></div>
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<span style="color: #990000;"><span style="font-size: large;"><b>
</b></span></span></div>
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<span style="color: #990000;"><span style="font-size: large;"><b>Pintrich
P.R. and E.V. De Groot.
2003. A Motivational Science Perspective on the Role of Student Motivation in
Learning and Teaching Contexts. <em>Journal of
Educational Psychology</em>, 95, 667-686.</b></span></span></div>
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<span style="color: #990000;"><span style="font-size: large;"><b><em>Adriana LaGier is associate professor of biology at Grand View University.</em></b></span></span></div>
Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-20118547906904172662019-05-19T21:08:00.001-03:002019-05-19T21:08:36.703-03:00Medical school<div class="separator" style="clear: both; text-align: center;">
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<span style="color: #783f04;"><span style="font-size: x-large;">Medical students are skipping class in droves — and making lectures increasingly obsolete</span></span></h1>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>By <span class="author-name author-main">Orly Nadell Farber</span> </b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZ3CCEPSJUf9zmLSPGMSHlQirweEf6-7E_mffQd2oML642m2rtONSDSmMvp94eR0RhxDNL9vIakUoUySSY4QBHW9gryuONS2VcpbTK6NMRr4tthxjCEKg3pN-rpu_35ChAOWN_2Uue4Bg/s1600/snapshot.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="406" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZ3CCEPSJUf9zmLSPGMSHlQirweEf6-7E_mffQd2oML642m2rtONSDSmMvp94eR0RhxDNL9vIakUoUySSY4QBHW9gryuONS2VcpbTK6NMRr4tthxjCEKg3pN-rpu_35ChAOWN_2Uue4Bg/s640/snapshot.jpg" width="640" /></a></b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b><span class="big-cap-wrap"><span class="big-cap">T</span></span>he future doctors of America cut class. Not to gossip in the bathroom or flirt behind the bleachers. They skip to learn — at twice the speed.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>Some medical students follow along with class remotely, watching sped-up recordings of their professors at home, in their pajamas. Others rarely tune in. At one school, attendance is so bad that a Nobel laureate recently lectured to mostly empty seats.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>Nationally, nearly one-quarter of second-year medical students <a href="https://www.aamc.org/download/488336/data/y2q2017report.pdf" rel="noopener" target="_blank">reported</a> last year that they “almost never” attended class during their first two, preclinical years, a 5 percent increase from 2015.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>The AWOL students highlight increasing dissatisfaction and anxiety that there’s a mismatch between what they’re taught in class during those years and what they’re expected to know — or how they’re tested — on national licensing exams. Despite paying nearly <a href="https://www.aamc.org/data/tuitionandstudentfees/" rel="noopener" target="_blank">$60,000 a year</a> in tuition, medical students are turning to unsanctioned online resources to prepare for Step 1, the make-or-break test typically taken at the end of the preclinical years.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>These self-guided med students are akin to a group of American tourists wandering through Tokyo without a map. Like a tour guide hired on the street, the online learning tools — including memory aids, videos, and online quizzes — can enhance the educational journey, or send the students down a dead end.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>Lawrence Wang, a third-year M.D.-Ph.D. student at the University of California, San Diego, and the National Institutes of Health, said he relied heavily on these resources during his first two years of medical school.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>“There were times that I didn’t go to a single class, and then I’d get to the actual exam and it would be my first time seeing the professor,” he said. “Especially, when Step was coming up, I pretty much completely focused on studying outside materials.”</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>Wang isn’t alone. According to 2017 data from the Association for American Medical Colleges, 1 in 4 preclinical students watches educational videos — like those on YouTube — on a daily basis. And according to two video developers, tens of thousands of medical students subscribe to their products — one of which costs $250 for two years, the other $370 for one year.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>Leaders in medical education have begun to scramble. Some medical schools, like Harvard, have done away with lectures for the most part. Instead of spending hours in an auditorium, Harvard students learn the course content at home and then apply the knowledge in mandatory small group sessions.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>Other institutions, like Johns Hopkins, are moving in the same direction, but have yet to make a full switch. Hopkins cut down on lectures and boosted sessions that require active student participation. Preclinical lecture attendance hovers around 30 to 40 percent, according to Dr. Nancy Hueppchen, associate dean for curriculum.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>For many students, she said, licensing exam prep begins on day one of medical school: “They have this parallel curriculum going along with what we’re teaching them.”</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>Step 1, an eight-hour multiple choice test, is a big deal. Performance on the exam, though it’s taken before most students even begin training in a hospital, heavily influences which medical specialties they can eventually pursue after school and at what hospitals they can pursue them.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>With medical schools grading pass-fail, the Step 1 score is an increasingly significant piece of information that’s used to sort through residency applications, Hueppchen said. When she took the exam, it was only used as a pass-fail test. Today, residency programs rely on the score more heavily; students and faculty suspect that it’s used as a cutoff for making admissions decisions.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>Ryan Carlson, a third-year M.D.-Ph.D. student at the University of Washington, said that his school focused on teaching “what they thought was important for a physician to know.” But medical students have to know more than what is relevant to a practicing clinician to succeed on Step. The exam focuses on rare diseases and other minutiae, said Carlson, who now tutors for the test.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>Hueppchen acknowledged that students at Hopkins and elsewhere “express some distrust that they’re getting everything they need — or that we’re being meticulous in pointing out what they need — to study for and excel on the Step 1 exam.”</b></span></span></div>
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<figure class="media media-align-center media-break" id="attachment_356780"><span style="color: #b45f06;"><span style="font-size: large;"><b><img alt="" class="media-content size-large wp-image-356780" height="360" src="https://www.statnews.com/wp-content/uploads/2018/08/image1-1024x576.jpeg" width="640" /></b></span></span><figcaption class="media-label"><span style="font-size: small;"><b><span class="media-caption">SketchyMedical produces visual memory aids with elaborate illustrations, like this one of the major drugs targeting the sympathetic nervous system.</span> <cite class="media-credit">Stephen Wang at SketchyMedical</cite></b></span></figcaption></figure></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>That distrust has spawned a cottage industry of online study aids. Most are a far cry from your high school SAT prep course.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b><a href="https://www.sketchymedical.com/#!/home" rel="noopener" target="_blank">SketchyMedical</a> is one of the most popular guides. The company, built in 2013 by three then-medical students at the University of California, Irvine, produces visual memory aids with elaborate illustrations to help students learn and retain the voluminous material they’re expected to know.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>Dr. Andrew Berg and his co-founders, Drs. Saud Siddiqui and Bryan Lemieux, started sketching pictures and pairing them with stories while taking microbiology in their second year of medical school.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>“We were just bombarded with different names of bacteria, viruses, and fungi, and we were having a tough time keeping them all straight,” he said.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>The sketches helped them, and now other students are using them, too.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>Imagine it’s test day and a med student is asked which drug she would use to treat a patient’s postoperative gastrointestinal blockage. The student closes her eyes and mentally enters the world of “Acetyl-Cola,” a bustling port town that’s depicted in one of SketchyMedical’s cartoons. Outside a storefront, the student finds construction workers, motorcyclists wearing brain-shaped helmets, piles of dripping-wet fish, and a man sporting an adrenal gland-shaped beanie.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>A colon-shaped mixing truck pouring out cement is an unfortunate, but effective, symbol for defecation, and a worker wearing a name tag reading “Beth” and drinking a cola reminds the student of the drug bethanechol, given to treat intestinal obstructions.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>The illustrations are turned into narrated videos, which teach drug names and their mechanisms and side effects. SketchyMedical has also produced videos on microbiology and pathology.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b><a href="https://www.youtube.com/watch?v=8Dv3zZbDvig" rel="noopener" target="_blank">Berg compares</a> the work of Sketchy to hieroglyphics in ancient Egypt. But for many, Sketchy evokes a different technique used a thousand years later in ancient Greece: method of loci, also called a memory palace or journey.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>Memory palaces are typically imagined spaces in which a person can store information like a string of numbers or a series of words. Each piece of information is placed somewhere inside the palace. When the palace builder wants to recall an item, she can take a mental stroll through the space to retrieve it. This technique famously enabled Cicero, the Roman statesman and philosopher, to commit his speeches to memory.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>“We accidentally stumbled upon these visual learning techniques, but now looking back we see there’s a lot of evidence supporting visual learning,” Berg said.</b></span></span></div>
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<i><span style="font-size: large;"><b>“That was the biggest learning curve of med school — it wasn’t so much how do I do well in it, it was, how do I use all these crazy resources that are being marketed to me to best meet my goal of passing Step.”</b></span></i></div>
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<i><span style="font-size: large;"><b>Ryan Carlson, third-year M.D.-Ph.D. student at the University of Washington</b></span></i></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>SketchyMedical is not the only extracurricular resource students rely on. An entire industry cropped up in the last few years, marketing videos and self-quizzing features to preclinical students. Dr. Jason Ryan, the creator of Boards and Beyond, is a name (and voice) familiar to medical students across the country.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>Ryan, a faculty member at University of Connecticut School of Medicine, creates explanatory videos that track along with the content in First Aid, a Step preparatory book that Ryan said is more like “an encyclopedia of terms” than a real study aid. Ask any medical student if they use First Aid, and they’ll point you to their heavily annotated, tattered copy.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>While both Ryan and Berg consider their products supplements to regular medical education, many students view them as necessary investments for success. Choosing which ones to use can be a challenge, however.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>“That was the biggest learning curve of med school — it wasn’t so much how do I do well in it, it was, how do I use all these crazy resources that are being marketed to me to best meet my goal of passing Step,” Carlson said.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>This expanding corner of the medical education industry is both a product of a new attitude among students — born from anxiety surrounding exam prep — and a disrupter of the traditional classroom education. Med schools now have to think more creatively about how they train their future doctors, Berg said.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>In 2015, Harvard Medical School revamped its curriculum for the first two years to enable clinical exposure and boost class attendance with a flipped-classroom model: Students learn the content at home, and then apply it during in-class exercises. Dr. Richard Schwartzstein, director of education scholarship, said the program now emphasizes problem-solving and critical thinking — skills seen as essential to practicing medicine — instead of factual recall.</b></span></span></div>
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<span style="color: #b45f06;"><span style="font-size: large;"><b>But while medical schools are de-emphasizing pure memorization, the national licensing exams have yet to reconsider, he acknowledged. Still, Schwartzstein is not a huge fan of external resources, citing their focus on memorization and pattern recognition as major weaknesses.</b></span></span></div>
<span style="color: #b45f06;"><span style="font-size: large;"><b>
</b></span></span><div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="color: #b45f06;"><span style="font-size: large;"><b>“You don’t have to actually teach pattern recognition,” he said. “We all are born with the capability of recognizing pattern.” He advises students to stick to Harvard-developed videos and their recommended readings. Like many medical schools, Harvard gives students a dedicated study period — six to eight weeks without coursework — to “prepare in whatever way they deem most appropriate to take the boards,” he said.</b></span></span></div>
<span style="color: #b45f06;"><span style="font-size: large;"><b> </b></span></span><div style="text-align: justify;">
<aside class="read-more standard"><div class="read-more-text">
<span style="color: #b45f06;"><span style="font-size: large;"><b><br /></b></span></span></div>
</aside></div>
<div style="text-align: justify;">
<span style="color: #b45f06;"><span style="font-size: large;"><b>Hueppchen said that the outside resources “may have value in day-to-day studying, they may have value in studying for Step 1,” but Hopkins has not vetted them so it doesn’t recommend them to students either.</b></span></span></div>
<span style="color: #b45f06;"><span style="font-size: large;"><b>
</b></span></span><div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="color: #b45f06;"><span style="font-size: large;"><b>The National Board of Medical Examiners, which works with state medical boards to set the minimum standards for medical licensing and administers the Step exam, also doesn’t endorse these products — or their use as hard lines for residency admissions, said Dr. Michael Barone, vice president of licensure programs. The group “is aware of some secondary uses of scores,” he said, but the test’s primary purpose is to report licensure alone.</b></span></span></div>
<span style="color: #b45f06;"><span style="font-size: large;"><b>
</b></span></span><div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="color: #b45f06;"><span style="font-size: large;"><b>So long as Step still requires intensive rote memorization, companies like SketchyMedical and Boards and Beyond will likely remain in business.</b></span></span></div>
<span style="color: #b45f06;"><span style="font-size: large;"><b>
</b></span></span><div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="color: #b45f06;"><span style="font-size: large;"><b>Both Berg and Ryan agree that physicians no longer need to memorize as much as they did in the past. Ryan’s grandmother was one of the first female physicians to graduate from her medical school in the 1940s. Back then, he said, she had to remember everything. “If she had to go to a book every time she saw a patient, she’d never be able to work through the day.”</b></span></span></div>
<span style="color: #b45f06;"><span style="font-size: large;"><b>
</b></span></span><div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="color: #b45f06;"><span style="font-size: large;"><b>Today, there’s much more to know, and medicine is evolving so rapidly — with new drugs, guidelines, and practices — that physicians can’t possibly remember it all. Instead, they look information up on their cellphones, using a variety of apps on the clinic floors. But preclinical students still need to commit board-tested material to memory, a task often compared to drinking from a firehose.</b></span></span></div>
<span style="color: #b45f06;"><span style="font-size: large;"><b>
</b></span></span><div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="color: #b45f06;"><span style="font-size: large;"><b>Needing to memorize for boards and learn in parallel for their institutions is the breeding ground for anxiety that Hueppchen said “has truly detracted from the joy of learning.” It has even detracted from the joy of teaching, she added.</b></span></span></div>
<span style="color: #b45f06;"><span style="font-size: large;"><b>
</b></span></span><div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="color: #b45f06;"><span style="font-size: large;"><b>Berg said he tries to bring joy to memorization: “I think that what I hope to contribute the most is making studying more fun.”</b></span></span></div>
<div class="danger-zone" style="text-align: justify;">
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Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-50056521615963472352019-05-08T20:03:00.001-03:002019-05-08T20:03:41.610-03:00Integração Ensino-Serviços<br />
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<header class="article-header clearfix">
<h1 class="article-title" itemprop="headline">
<a href="http://noticias.uem.br/index.php?option=com_content&view=article&id=23656:uem-e-regional-de-saude-discutem-projetos-em-parceria&catid=986:pgina-central&Itemid=101" itemprop="url" title="UEM e Regional de Saúde discutem projetos em parceria">
<span style="color: #274e13;"><span style="font-size: x-large;">UEM e Regional de Saúde discutem projetos em parceria</span></span></a>
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</header>
<span style="color: #38761d;"><span style="font-size: large;"><b><span itemprop="name">Paulo Pupim</span></b></span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTcQefSeR1NO-oTPA9djGGqzckMsibO4a6z8bpuec0RxNVUim8iS_L94qVuXq6BNPJc5sdrs-rzKyu_fIwK-AqLvTvy73Fc_eZ4BTVZLZl-Y7JEDZY9X05Xo-Z8hlx2kG961caOpmse5A/s1600/Sem+t%25C3%25ADtulo.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1000" data-original-width="1600" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTcQefSeR1NO-oTPA9djGGqzckMsibO4a6z8bpuec0RxNVUim8iS_L94qVuXq6BNPJc5sdrs-rzKyu_fIwK-AqLvTvy73Fc_eZ4BTVZLZl-Y7JEDZY9X05Xo-Z8hlx2kG961caOpmse5A/s640/Sem+t%25C3%25ADtulo.png" width="640" /></a></div>
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<b><span itemprop="name">Ideia é desenvolver ações que fortaleçam a saúde pública na região via SUS</span></b></div>
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<span style="font-size: large;"><b><span style="color: #38761d;">Coordenadores dos cursos de Enfermagem e Medicina, da Universidade
Estadual de Maringá, se reuniram, hoje (6), no Gabinete da Reitoria, com
representantes da 15ª Regional de Saúde, e o reitor e o vice-reitor da
UEM, Julio Damasceno e Ricardo Dias Silva, respectivamente.</span></b></span></div>
<span style="font-size: large;"><b><span style="color: #38761d;">
</span></b></span><div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="font-size: large;"><b><span style="color: #38761d;">Participaram do encontro, além de Damasceno e Silva, o diretor da 15ª
RS, Ederlei Alkamim; servidores técnicos de departamentos da Regional; e
os coordenadores dos cursos de Enfermagem, Grace Jacqueline Aquiles, e
de Medicina, Roberto Esteves, ambos professores.</span></b></span></div>
<span style="font-size: large;"><b><span style="color: #38761d;">
</span></b></span><div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="font-size: large;"><b><span style="color: #38761d;">Os participantes discutiram a questão da integração e parcerias da
UEM com a Regional de saúde para desenvolver ações voltadas ao
desenvolvimento regional da saúde pública e do ensino de graduação em
saúde.</span></b></span></div>
<span style="font-size: large;"><b><span style="color: #38761d;">
</span></b></span><div style="text-align: justify;">
<br /></div>
<div style="text-align: justify;">
<span style="font-size: large;"><b><span style="color: #38761d;">Outra pauta foi a elaboração de propostas visando o fortalecimento da
Educação Permanente em Saúde na região. Alguns assuntos de relevância
para a saúde pública da região, como a atual crise que envolve o
Laboratório de Ensino e Pesquisa em Análises Clínicas (Lepac), da UEM, e
o Hospital Universitário Regional de Maringá (HUM), também estiveram na
pauta.</span></b></span></div>
<span style="font-size: large;"><b><span style="color: #38761d;">
</span></b></span><div style="text-align: justify;">
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<div style="text-align: justify;">
<span style="font-size: large;"><b><span style="color: #38761d;">A reunião ainda serviu para a discussão de propostas de avanços na
integração da UEM com a 15ª RS e outros setores estratégicos do
município e região, que resultem em ações de melhoria e consolidação do
Sistema Único de Saúde (SUS) na região.</span></b></span></div>
<span style="font-size: large;"><b><span style="color: #38761d;">
</span></b></span><div style="text-align: justify;">
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<span style="font-size: large;"><b><span style="color: #38761d;">Com sede em Maringá, a 15ª Regional de Saúde, ligada à Secretaria de
Saúde do Paraná (Sesa), engloba 30 municípios, incluindo o de Maringá.</span></b></span></div>
Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-16517601951850934272019-04-26T11:36:00.000-03:002019-04-26T11:36:05.911-03:00PET-Saúde / Interprofissionalidade<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhI_EYrPsS8AZGxHNh04ZaEfv0KsFpht18ocDhmBfPozva0fBY_NpYpQuHsa8jpSdZXHZt41zLW1rwE0DZNAOfo1yubb3sb6Ww1tGidDLk4wJmWIuI2DGHSFUDmgQXQ3pMNp6Fo2Q7lKsM/s1600/grupal_pet_abril_19.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="424" data-original-width="648" height="209" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhI_EYrPsS8AZGxHNh04ZaEfv0KsFpht18ocDhmBfPozva0fBY_NpYpQuHsa8jpSdZXHZt41zLW1rwE0DZNAOfo1yubb3sb6Ww1tGidDLk4wJmWIuI2DGHSFUDmgQXQ3pMNp6Fo2Q7lKsM/s320/grupal_pet_abril_19.png" width="320" /></a></div>
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<h1 class="text-uppercase font-weight-light mt-xl text-color-primary">
<span style="color: #20124d;"><span style="font-size: x-large;">Brasil inicia programa de educação interprofissional com mais de 6.000 participantes</span></span></h1>
<h1 class="text-uppercase font-weight-light mt-xl text-color-primary">
<span style="color: #20124d;"><span style="font-size: x-large;"> </span></span></h1>
<h1 class="text-uppercase font-weight-light mt-xl text-color-primary">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKLlgB-Dq0HD-wx8dhXDVJ6TbkbfcT94OFDwOZ7tCumbC5k67GzV8VLmy31sYvHvKgy4y8ePf0HCqKZm1iQNO4Z8w7o-iMi5XBGHHHFTtlFFTi5kAmCxMIMJ0RN-nGyAcOS1klJ8HNyA8/s1600/grupal_pet_abril_19.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="499" data-original-width="1167" height="272" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKLlgB-Dq0HD-wx8dhXDVJ6TbkbfcT94OFDwOZ7tCumbC5k67GzV8VLmy31sYvHvKgy4y8ePf0HCqKZm1iQNO4Z8w7o-iMi5XBGHHHFTtlFFTi5kAmCxMIMJ0RN-nGyAcOS1klJ8HNyA8/s640/grupal_pet_abril_19.png" width="640" /></a></div>
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<span style="color: #351c75;"><span style="font-size: large;"><b>No dia 1º de abril de 2019, o Brasil iniciou o Programa de Educação
pelo Trabalho para a Saúde (PET-Saúde), como parte das ações para
implementar o plano de Educação Interprofissional em Saúde (EIP),
elaborado pelo Ministério da Saúde, Ministério da Educação, Conselho
Nacional de Saúde e universidades, em resposta ao chamado da Organização
Pan-Americana da Saúde (OPAS / OMS) no ano de 2016.</b></span></span></div>
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<span style="color: #351c75;"><span style="font-size: large;"><b>
</b></span></span></div>
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<div style="text-align: justify;">
<span style="color: #351c75;"><span style="font-size: large;"><b>O PET-Saúde / Interprofissionalidade tem como objetivo utilizar a EIP
para promover mudanças nos cursos de graduação da área da saúde, para
implementar a integração ensino-serviço-comunidade com foco no sistema
de saúde e o desenvolvimento da docência em saúde.</b></span></span></div>
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<span style="color: #351c75;"><span style="font-size: large;"><b>
</b></span></span></div>
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<div style="text-align: justify;">
<span style="color: #351c75;"><span style="font-size: large;"><b>O programa, que está em sua nona edição e tem duração de dois anos,
conta com 6.573 participantes, sendo 1.102 professores, 2.063
profissionais de saúde e 3.288 estudantes de diferentes carreiras da
área da saúde, os quais recebem bolsa mensal. 120 projetos elaborados
por secretarias de saúde e universidades de todas as regiões do país
foram contemplados para desenvolver atividades educacionais com foco na
EIP.</b></span></span></div>
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<span style="color: #351c75;"><span style="font-size: large;"><b>
</b></span></span></div>
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<div style="text-align: justify;">
<span style="color: #351c75;"><span style="font-size: large;"><b>A maioria dos projetos aprovados já realizou eventos para marcar o início das atividades do programa.</b></span></span></div>
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<span style="color: #351c75;"><span style="font-size: large;"><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGsYimmg6KxY5SuNLt4RA9_Zzo6sscuolZK-KLint5gWDeLS_4HxlEC4ydV4lf-CfCCMjZ1P84hItKsJZQa0HJwSrTB_XWAa_ZkfkbgA8mJ0mggdrF0XD9yTKgP1uXw-jVw_ezpMtIXRE/s1600/28.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="400" data-original-width="600" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGsYimmg6KxY5SuNLt4RA9_Zzo6sscuolZK-KLint5gWDeLS_4HxlEC4ydV4lf-CfCCMjZ1P84hItKsJZQa0HJwSrTB_XWAa_ZkfkbgA8mJ0mggdrF0XD9yTKgP1uXw-jVw_ezpMtIXRE/s640/28.png" width="640" /></a></b></span></span></div>
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<span style="color: #351c75;"><span style="font-size: large;"><b>
</b></span></span></div>
<div style="text-align: justify;">
<u><span style="color: #351c75;"><span style="font-size: large;"><strong>O que é o PET-Saúde</strong></span></span></u></div>
<div style="text-align: justify;">
<span style="color: #351c75;"><span style="font-size: large;"><b>
</b></span></span></div>
<div style="text-align: justify;">
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<div style="text-align: justify;">
<span style="color: #351c75;"><span style="font-size: large;"><b>O PET-Saúde é um programa instituído em 2008 pelos Ministérios da
Educação e da Saúde do Brasil que possibilita a aprendizagem em serviços
de saúde, por meio da formação de grupos tutoriais, envolvendo
estudantes, profissionais saúde, professores e usuários dos serviços de
saúde, a fim de promover processos educativos mais próximos da realidade
do trabalho em saúde.</b></span></span></div>
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<span style="color: #351c75;"><span style="font-size: large;"><b>
</b></span></span></div>
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<div style="text-align: justify;">
<span style="color: #351c75;"><span style="font-size: large;"><b>Das edições anteriores do programa há evidências de que o PET-Saúde
constitui uma importante iniciativa para a implementação da EIP. No
entanto, é somente nesta edição que o tema da EIP aparece explicitamente
em todo o conjunto normativo do programa.</b></span></span></div>
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<div style="text-align: justify;">
<span style="color: #351c75;"><span style="font-size: large;"><b>
</b></span></span></div>
<div style="text-align: justify;">
<span style="color: #351c75;"><span style="font-size: large;"><b>Prevê-se que, nos próximos dois anos, o PET-Saúde /
Interprofissionalidade garantirá a sustentabilidade da Educação
Interprofissional e da Prática Colaborativa no Brasil, uma vez que os
objetivos do programa buscam atuar em todos os níveis organizacionais,
alcançando desde políticas de saúde, diretrizes curriculares, projetos
pedagógicos, qualificação docente, apoio institucional, a mudanças nas
relações profissionais nos serviços de saúde e instituições formadoras,
com a expectativa de formar profissionais mais aptos para o trabalho
colaborativo e, consequentemente ofertar uma atenção em saúde de
qualidade.</b></span></span></div>
<h1 class="text-uppercase font-weight-light mt-xl text-color-primary" style="text-align: justify;">
<span style="color: #351c75;"><span style="font-size: large;"> </span></span></h1>
<h1 class="text-uppercase font-weight-light mt-xl text-color-primary" style="text-align: justify;">
<span style="color: #351c75;"><span style="font-size: large;">=============================================</span></span></h1>
<h1 class="text-uppercase font-weight-light mt-xl text-color-primary" style="text-align: justify;">
<span style="color: #351c75;"><span style="font-size: large;"> <span style="color: black;"><i>Nota: A Universidade Estadual de Maringá, em cooperação com a Secretaria de Saúde de Maringá, participa do PET-Saúde / Interprofissionalidade com 5 grupos tutoriais com docentes, discentes e preceptores da gestão e dos serviços. As atividades iniciaram em Abril/2019 e estamos na fase inicial do cumprimento do plano de trabalho acordado.</i></span></span></span></h1>
Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-71023887265559747412019-04-25T11:46:00.001-03:002019-04-25T11:46:39.580-03:005ª Mostra Paranaense de Pesquisas em Saúde/4º Prêmio InovaSaúde Paraná<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4WxFaG_iMTd5cy5qxCguKhBDVnCB5mNGAtF4x2c4lXbppA9RWyLk6iHAOpZwreJ2TQJYlPGZLw1d43eUuS1vgKmtY3tgqeJs0sqHw68i-jho7dqAUgxwcjUI9Dov9Jo2H1totBMjZLP4/s1600/Inesco.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="195" data-original-width="497" height="125" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4WxFaG_iMTd5cy5qxCguKhBDVnCB5mNGAtF4x2c4lXbppA9RWyLk6iHAOpZwreJ2TQJYlPGZLw1d43eUuS1vgKmtY3tgqeJs0sqHw68i-jho7dqAUgxwcjUI9Dov9Jo2H1totBMjZLP4/s320/Inesco.bmp" width="320" /></a></div>
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<span style="color: #274e13;"><span style="font-size: x-large;"><b>5ª Mostra Paranaense de Pesquisas em Saúde/4º Prêmio InovaSaúde Paraná</b></span></span><br />
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" 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<br />Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0tag:blogger.com,1999:blog-721880847152002325.post-73447679511086872462019-04-10T10:49:00.000-03:002019-04-10T10:49:04.698-03:00Telemedicine in remote areas<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgy1VQeXNehviYxNbneHBgsSZSdUzkVVx567s6YwNHh3uvpAKqkK1X-vIFL9RdRMCP9QM-gqBjfbBlMRmAzFU20TzVkEkIjurB2PitRC4PvW30feRTJGSO8W4kdIiuiMZwiJoXh6R_VNns/s1600/Sem+t%25C3%25ADtulo.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="104" data-original-width="256" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgy1VQeXNehviYxNbneHBgsSZSdUzkVVx567s6YwNHh3uvpAKqkK1X-vIFL9RdRMCP9QM-gqBjfbBlMRmAzFU20TzVkEkIjurB2PitRC4PvW30feRTJGSO8W4kdIiuiMZwiJoXh6R_VNns/s1600/Sem+t%25C3%25ADtulo.bmp" /></a></div>
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<span style="color: #4c1130;"><span style="font-size: x-large;">An interesting telemedicine story from Brazil told in Israel</span></span></h1>
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<span style="color: #741b47;"><span style="font-size: large;">Here's how providers at the Hospital Israelita Albert Einstein in Brazil take care of workers on an oil platform away from the continent. </span></span></h2>
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<span style="font-size: small;"><b><em>Photo: Roy Habani</em></b></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Telemedicine as a technology is gaining ground all over the world. How it is being used on an oil platform in Brazil provides a fascinating look at how effective it can be both as a means to deliver care and in lowering costs.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>The story was shared by Dr. Eduardo Cordioli, general telemedicine manager at the Hospital Israelita Albert Einstein in Sao Paolo, Brazil. Cordiolo was a speaker at the recently-concluded MedinIsrael digital health conference in Tel Aviv, which aimed to highlight how Israel has adopted digital health as a national strategy and where the technology is globally.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Hospital Israelita Albert Einstein is a teaching hospital, with a medical school and separate nursing school. The main hospital, which is a private hospital, has 650 beds but executives also manages two public Brazilian hospitals together with the city where they are located and the Brazilian ministry of health. They also have locations for clinics and ambulatory care. It employs 14,000 people.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Caring for oil platform workers far from the mainland is tricky and in virtually all instances prior to the launch of the telemedicine program required urgent, immediate evacuations from the platform via a helicopter to a hospital on the mainland with the necessary resources.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>But in 2017, the hospital conducted 965 telemedicine visits between urgent care nurses on the oil platform and physicians at the hospital on the continent. Here’s the type of connected devices – shown in the presentation – that the telemedicine program relied on for diagnosis.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b><img alt="" class="alignnone size-full wp-image-453995" height="480" src="https://medcitynews.com/uploads/2019/04/IMG_0754.jpg" width="640" /></b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b><span style="color: black;"><span style="font-size: small;"><em>Photo: Roy Habani</em></span></span> </b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Of those 965 appointments, a whopping 93.2 percent let to patient discharge. Only 6.8 percent of the visits therefore needed evacuations – that’s a 50 percent reduction from when the telemedicine program was not in place, Dr. Cordioli said. And there appears to be an even better statistic. Of those 6.8 percent requiring evacuations, the majority — 71.4 percent —required non-urgent flights.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Previously, the evacuations were a 100 percent urgent evacuations as the urgent care nurses on the oil platform would not have been able to judge the acuity of the problem. Urgent helicopter evacuations are far more expensive than planned ones, Dr. Cordioli explained.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Later, in an interview Dr. Sidney Klajner, president of the Hospital Israelita Albert Einstein, said that through the telemedicine program, even myocardial infarctions or heart attacks, were able to be diagnosed.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Since the telemedicine program was launched in 2012, the number of video visits have seen an exponential increase. Just in the last three years, the number of appointments went from 7,000 in 2016 to 45,000 in 2017 to 80,000 video visits in 2018.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>“We have a huge country and there is a lot of differences between the states. We have rich states like Sao Paolo, Sao Paolo city and the southeast of the country but we have very poor regions also with people who have no access to medicine to care and specialists for example,” Klajner said.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Telemedicine attempts to bridge this very gap. For instance in the northeast portion of Brazil, there is a shortage of specialists and so in ICUs, the telemedicine program is aimed to connect “generalists” with specialists like neurologists and cardiologists. These specialists are now responsible for a certain number of “virtual beds,” he explained.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>Aside from this, the hospital has also created a proprietary dermatology app to help in diagnosing skin problems remotely.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>“The team can suggest diagnosis or urgent biopsy based on the picture [through the app] and the patient history,” Klajner explained.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>He noted that the focus on telemedicine is only part of the digital transformation that is underway at the hospital. Another big change was the removal of an innovation center from the hospital’s research institute about four or five years ago. The innovation center was created to rapidly innovate, prototype and validate ideas within the hospital ecosystem. This is both meant to encourage innovative thinking among hospital employees including physicians and encourage external collaboration.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>For instance, a year and a half ago an incubator was created, he said. More than 1,000 Brazilian startups have been able to submit their ideas. The hospital has also acquired a health IT startup that has developed a next-generation sequencing software.</b></span></span></div>
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<span style="color: #741b47;"><span style="font-size: large;"><b>So, it’s not just telemedicine that the health system that serves nearly 1.5 million people is looking at for a digital transformation. But the telemedicine story on the oil platform is certainly compelling.</b></span></span></div>
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Robertohttp://www.blogger.com/profile/13186530112521790618noreply@blogger.com0