Avaliação de Escolas Médicas

Cursos de medicina terão novo sistema de avaliação

CLÁUDIA COLLUCCI

O CFM (Conselho Federal de Medicina) e a Abem (Associação Brasileira de Escolas Médicas) criaram um novo sistema de avaliação e certificação de escolas médicas independente do já adotado pelo governo federal. 

O projeto-piloto começa a ser testado em julho em 20 cursos de medicina. A meta é que, em 2017, todo o sistema esteja implantado. 

Para as entidades, houve uma expansão desenfreada de vagas de medicina – um dos pilares do programa Mais Médicos –, e o sistema de avaliação do Ministério da Educação tem "baixa eficiência". O MEC nega e diz que o modelo paralelo terá limitações. 

Dados do próprio ministério mostram uma piora dos cursos de medicina. Em 2010, de 177 avaliados, 13% tiveram nota 2 (insatisfatória), em escala de 1 a 5. Em 2013, de 154, 17,5% tiveram essa nota. 

Para Milton Arruda Martins, professor da USP e coordenador do novo sistema de avaliação, o acompanhamento do governo é falho. 

"Há pouca continuidade. Muda ministro, acaba verba. Em 20 anos, só em um momento ocorreu corte de vagas em escolas com problemas", diz Martins. Isso aconteceu entre 2008 e 2011, mas muitas faculdades reverteram a decisão na Justiça. 

Para Segisfredo Brenelli, da Abem, o sistema do MEC melhorou, mas ainda tem falhas. "Falta dinheiro, capacitação. O pessoal tenta, mas não dá conta com a abertura indiscriminada de cursos". 

SISTEMA

 

A adesão das faculdades ao novo processo de certificação será voluntária. O sistema prevê, primeiro, que a escola se autoavalie em uma plataforma eletrônica. Depois, ela receberá a visita de avaliadores que vão checar itens como infraestrutura, capacitação dos docentes e projeto pedagógico. 

 

Por fim, a instituição que cumprir os requisitos ganha o certificado de qualidade. As "reprovadas" terão um tempo para corrigir as falhas e voltarão a ser avaliadas. 

"Não tem caráter punitivo. As escolas vão querer a acreditação por uma questão de qualidade e competitividade, como acontece em outros países. Que pai que vai pagar R$ 9.000 de mensalidade em faculdade privada que não seja certificada?", indaga Carlos Vital, presidente do CFM. 

O conselho bancará o custo inicial do sistema, de R$ 1,2 milhão. O modelo enfrenta resistência do conselho regional médico paulista, o maior do Brasil, com 125 mil profissionais. "É inócuo", afirma Bráulio Luna Filho, presidente do Cremesp.

Community-based Education

Livro: Educação Baseada na Comunidade para as Profissões da Saúde: Aprendendo com a Experiência Brasileira

 

A Educação Baseada na Comunidade (EBC) para as profissões da saúde é uma demanda global, e o Brasil vem mostrando-se sensível, pioneiro e inovador nas ações de aproximação entre a Universidade e o Sistema de Saúde, para além do cenário hospitalar. O livro Educação Baseada na Comunidade para as Profissões da Saúde: Aprendendo com a Experiência Brasileira, interessa a docentes, profissionais e gestores do Sistema Único de Saúde (SUS), além dos representantes de Conselhos Locais e Municipais de Saúde, dada a importância e envolvimento de cada um destes grupos nas discussões e pactuações sobre as atividades de EBC. A Organização Pan-Americana de Saúde/Organização Mundial da Saúde (OPAS/OMS) no Brasil, reconhecendo a importância da experiência brasileira em centrar os contextos formativos no cerne dos serviços de saúde das comunidades traduziu o livro para o inglês e espanhol.

O conceito de educação baseada na comunidade (EBC) no contexto da formação de profissionais da saúde é da segunda metade do século XX, mais precisamente da década de 1970. Desde sua proposição, este tem sido um tema que ganhou importância, já que é um referencial para o desenho de currículos de todos os cursos da área da saúde, constando como recomendação de diretrizes e recomendações para o desenho de currículos em praticamente todo o mundo.

Ao mesmo tempo, mostrou-se de grande relevância para que a formação profissional e contribui para aumentar o acesso e a cobertura aos serviços de saúde, devido a que permite fazer uma ponte entre as escolas de profissionais e a realidade dos serviços na Atenção Básica de Saúde.
No Brasil, faz parte de todas as diretrizes curriculares dos cursos da graduação da área da saúde formalmente, desde o ano de 2001, tendo sido reafirmado, mais recentemente, na publicação das novas diretrizes dos cursos de graduação em medicina, publicadas em 2014. Apesar de não se tratar de um conceito novo, existem poucas experiências documentadas sobre os desafios de implementação de disciplinas, módulos ou estágios que tenham a educação baseada na comunidade como um eixo central do seu currículo. Este livro inova ao trazer relatos de experiências e formas únicas e criativas que foram encontradas para aproximar profissional da saúde em formação daqueles cenários, onde certamente atuarão após o término da graduação.

Acesse a versão em inglês da publicação (Community Based Education for the Health Professions) e a versão em espanhol (Educacion basada en la comunidad para las profesiones de salud).

Miscommunication between Health Professionals

When Doctors Don’t Talk to Doctors

By Allison Bond

I could tell my patient was dying. In the final stage of liver failure, she lay listlessly in her hospital bed, her skin ashen and her eyes dull. Intractable intestinal bleeding, likely related to her underlying disease, had landed her in the intensive care unit. Although all patients in intensive care are tenuous, it was clear she was worse off than most.

Her daughter and granddaughter hovered worriedly near her bedside. “What is going to happen to her?” her daughter asked me, her voice wavering.

I proposed a family meeting in a small room nearby to discuss the next steps in her care. As her loved ones and I sat around the table, I explained that our team and the consultants had concluded that one option was to insert a tube to briefly stop the bleeding. The tube was merely a temporary fix, however; for a number of reasons, there was no way to permanently stanch the flow of blood. Alternatively, we could focus on making her as comfortable as possible. Given her underlying liver disease, even if the bleeding stopped, she would live a few days at most. 

“She would never want any of this,” her daughter said softly, dabbing her wet eyes with a tissue. “She’s been saying for months that she knew her time was coming. She was at peace with it.”

Her mother would not want to undergo the procedure – her daughter was sure of that. She would want simply to die peacefully, without pain and surrounded by family.

Yet when we returned to her room, we found that another team had already inserted the tube. I was shocked and livid. Such a critical miscommunication between doctors taking care of the same patient horrified me. 

I apologized profusely and, surprisingly, the family was not upset; the procedure had not been painful, and she died peacefully that night. When her family left the hospital, they expressed gratitude for her care and did not mention the tube.

Yet I felt disturbed, and I couldn’t stop thinking about it. What if the tube placement had ended up being very painful or had caused physical harm? 

Poor communication between doctors and patients, and between doctors and nurses, is discussed relatively frequently. But what about confusion between the teams of doctors who share patients in the hospital or clinic? 

I have seen this happen numerous times during my nascent medical career. Understandably, it is infuriating to patients and their families. It can also prove dangerous. 

Miscommunication between a patient’s physicians is a major contributor to treatment and diagnostic mistakes. And too often, doctors who care for a patient in the hospital fail to communicate at discharge with the patient’s primary care provider, sowing confusion about what happened in the hospital and the plan moving forward. 

A few months after the patient with liver failure passed away, I was caring for a middle-aged woman with metastatic cancer who was in the hospital for pain that had rapidly worsened. Images of her bones showed numerous fractures, and tumors had mangled her skeleton. As part of the medicine team, I worked with four groups of caregivers to figure out how best to treat her bone problems and minimize her pain. 

As I approached her bedside one morning, she glared at me. Her pained grimace had turned to anger. 

“Three different people came into my room this morning before you did, and all of them told me different things!” she sputtered. Each had recommended a different sort of procedure, she said, and it didn’t appear that any of them had discussed the options with each other – or the patient’s main doctors – beforehand.

After that, her nurse and I worked together to minimize visitors to her room so her primary physicians could synthesize the other teams’ suggestions into one cohesive plan. That greatly decreased her frustration and confusion, which allowed us to better evaluate her treatment preferences and needs. 

As doctors, we place much emphasis on working with our patients to choose the right combination of interventions, and rightfully so. Yet I have seen that despite best intentions, patients and loved ones sometimes hear conflicting messages from caregivers about these plans. 

In truth, medical care often entails myriad moving parts, which means the plan for diagnostics or treatment may change. Yet sometimes the way to avoid mixed messages is as simple as fostering a discussion between all members of the care team. Although medical knowledge is important, simply communicating amongst ourselves is a critical part of serving our patients – and one that is too often forgotten. 

* Allison Bond is a resident in internal medicine at Massachusetts General Hospital.

Formação médica no Brasil

Arthur Chioro: "Reestruturar formação médica é primordial para o SUS"

Ministro da Saúde

 Arthur Chioro

 

A expansão e a melhoria do atendimento médico no país é um projeto que abrange inúmeros desafios. Para se mostrar profunda e duradoura, a mudança deve ser realizada nas bases da formação médica, garantindo o aumento e a melhor distribuição da força de trabalho nas cidades e regiões brasileiras. O Ministério da Saúde, junto com a pasta da Educação, vem reunindo esforços para aprimorar as políticas destinadas à garantia do atendimento médico no Sistema Único de Saúde. 

Uma das medidas mais essenciais é a mudança de paradigma no ensino médico. Ainda predomina no Brasil a formação “hospitalocêntrica”, o que gera a falsa percepção de que a maior parte das necessidades de saúde é resolvida na alta complexidade. Por outro lado, o SUS tem como porta de entrada a Atenção Básica, onde cerca de 80% dos problemas de saúde da população podem ser resolvidos sem necessidade de encaminhamento para hospitais e clínicas especializadas. Dessa forma, é primordial direcionar a formação do médico para a Atenção Básica.

O governo federal deu início a esse processo por meio do Mais Médicos, em que uma das frentes é a implementação de mudanças no curso de Medicina. Em 2014, o Conselho Nacional de Educação aprovou novas diretrizes curriculares para promover avanços no sentido de formar médicos com qualidade e perfil mais adequado às necessidades da população. Um deles é a exigência de que 30% do internato da graduação – quando o estudante intensifica seu conhecimento prático – deve ser realizado em unidades básicas de saúde e serviços de emergência do SUS. Além disso, está prevista avaliação progressiva, aplicada a cada dois anos, que permitirá acompanhar o nível dos alunos e a qualidade das faculdades. 

Também precisamos olhar mais para a residência médica, estimular nossos médicos a se interessarem pelas especialidades mais importantes para a saúde pública. O médico de família não é visto como um especialista “prestigioso” e isso precisa mudar se o nosso objetivo é construir uma Atenção Básica resolutiva e humanizada e um SUS mais efetivo. Nosso foco agora é operacionalizar a determinação legal de que, até 2019, para cursar residência na maioria das especialidades será necessário fazer de um a dois anos de residência em Medicina Geral de Família e Comunidade, com atuação na Atenção Básica. As discussões precisam evoluir para efetivamente termos um médico que, independente da especialidade, tenha sólidas bases nesse importante pilar dos sistemas universais de saúde.

As mudanças qualitativas na formação vêm sendo acompanhadas por uma expansão contínua, mas criteriosa, do ensino médico e exigem também a formação de docentes e preceptores. Já é ponto pacífico que faltam médicos no Brasil e, diante disso, precisamos garantir a formação de mais profissionais, sempre com qualidade e foco em vazios assistenciais. A nova lógica que está em curso já autorizou a abertura de 39 cursos de Medicina em cidades sem faculdades – dois na Baixada Santista, Cubatão e Guarujá. Outros 22 estão em vias de autorização.

Sabemos que o caminho é longo e que os resultados virão com o tempo, atravessando mandatos e gestões. No curto prazo, estamos garantindo, com o Mais Médicos, assistência para 63 milhões brasileiros por meio da atuação de 18,2 mil médicos. Mas apenas no longo prazo teremos uma verdadeira transformação no atendimento médico. São projetos como este, no entanto, que trazem os mais importantes frutos: políticas de Estado que buscam soluções definitivas para os problemas que a nossa sociedade enfrenta.

Online Surveys

Simple Steps to Successful Surveys

by Zontziry Johnson 

 

 

When it comes to creating a new survey, where do you like to start? Do you start with a laundry list of questions and then filter from there to the end result? Do you start with a potential list of respondents, and then write the survey questions based on the respondents? Now…where should you start?

Start with purpose

I’ve been in many meetings where the survey project started with the end result (we want a bunch of slides that show us pie charts and slices of the data based on these particular demographics), the audience (how about we start with our customers, then open it up from there), or even the laundry list of questions that the customer wanted to have answered from the survey (we’d like to get a net promoter score to start a feedback loop, but we also want to get satisfaction ratings for customer service, the overall customer experience – how about we ask what color of the product they’ve liked best?). I’ve also sat in meetings where the approach was simply, “We don’t really know what we want to ask, we just want to do a survey.” 

The best place to start when approaching any kind of survey project is with the purpose of the survey itself. Are you (or your client) wanting to measure how your brand rates against other brands? Are you wanting to get a baseline customer satisfaction score? How about trying to decide what features are most important to your potential customers?

It’s all right to be thinking about your respondent audience, your list of questions, and even what you hope the responses will show. Just be certain you come back to the actual intent of your survey, or, as I like to put it, the one burning question you want to have answered from your survey. 

Follow with relevant questions

To me, creating the questions for a survey once you’ve defined your purpose can still be difficult to do because there is always more information that you want to gather from your respondent audience. It doesn’t matter how well a research report has been written, I find myself always walking away with more questions that I wish had been asked in the survey, or hoping there is going to be a follow-up survey to dive deeper into a particular aspect of the report that I found compelling, but just want more data. 

The trick is not to follow that train of thought in the early stages of writing the survey.

How can you avoid that pitfall? Go back to your original purpose for the survey. This can be difficult to do. As much as I love to teach that you come up with that primary purpose and stick to it, I know it’s difficult. For example, you could state that your one burning question is: “Do our customers like us?” But there are so many questions you could ask, from asking about the product offering (is it enough, is it too much, is it too little, is it too difficult to navigate, is it too…) to the entire customer experience (were you greeted when you entered the store, were you asked if you needed help, could you find someone to answer your questions when you needed someone), answering the seemingly simple question, “Do our customers like us?” can end up being a 45-minute survey experience! 

The remedy? Identify things like key performance indicators, and possible narrow down the original question you came up with in step one. For the example, “Do our customers like us?” you could easily narrow that down to something like, “What do our customers like most about us?” or even, “How do our customers like us compared to our competition?”

Personalize the experience

Once you have decided on the survey questions, it’s time for you to plug it in, add any needed logic, and talk about personalization. If all you have is a first name of a potential respondent, it still is worth your while to include that in the survey invitation at a minimum. Everyone expects personalization in any kind of customer interaction, from a newsletter addressed to them to a survey invitation with their name on it. 

Top it off with customization

Customizing your survey should be the very last thing you do. Make sure that everything else is working before you start to customize the survey experience. Customizing should be the icing on the cake, rather than a primary focus. Content first, then you can spend time making it look pretty. This reduces the risk of having a really nice-looking, but poorly-functioning survey. It also reduces the risk of finding that the error in your survey was from the programming, and not the CSS formatting you’d just applied. This same rule applies to many other types of content, but is especially true for a survey. In my own opinion, respondents are far more interested in a survey that is straightforward and doesn’t feel like it’s wasting their time than they are in a survey that looks cool but doesn’t make sense or is terribly long and boring.

Zontziry (Z) Johnson is the Community Manager for QuestionPro. With 9+ years experience in the marketing research industry, she is continually enthralled with the ever-changing possibilities behind how to ask people what they think.

AMEE 2015

Brazil -  FAIMER Regional Institute is honoured to invite the international Health Professions Education (HPE) community to participate in Glasgow' 2015, attending the final plenary, where our Co-Director Eliana Amaral will be one of the speakers presenting a Brazilian perspective of  the community-based HPE.

The AMEE 2015 Conference in Glasgow 4-9th September provides an opportunity to meet participants from 100 countries around the world and to hear about key developments in medical education. 
In the final plenary, leading experts have been asked to highlight in twenty minutes the current position in three important areas. 
Eliana Amaral from Brazil looks at learning in the community, Fiona Patterson from the UK looks at how effective are different selection methods for admission to medical school and Olle ten Cate from the Netherlands explains the concept of EPAs and their application in practice. 
Other developments addressed in Conference Symposia include the flipped classroom, new approaches to simulation, social accountability of a medical school, technology-enhanced learning, new approaches to clinical teaching and revisiting the Miller’s Pyramid.
We would look forward to seeing you in Glasgow and to your contributions to the discussions.


Ronald M Harden
General Secretary

Faculty development

Establishing an Online Professional Learning Community to Promote Faculty Engagement and Excellence

By: Anne O’Bryan, PhD, Todd Kane, MBA, and Melanie Shaw, PhD

In online higher education, adjunct faculty members are an essential resource. These faculty members teach, research, perform service and outreach, and even oversee administrative aspects of higher education institutions (Doe, Barnes, Bowen, Gilkey, Smoak, Ryan, & Palmquist, 2011). Unfortunately, adjunct faculty members often feel isolated and set apart from the full-time faculty, administration, and staff. Dolan (2011) reported adjunct faculty members are generally disappointed with communication, recognition, and a lack of opportunity. One way to improve a sense of belonging is through the development of a strong professional learning community. A successful learning community is primarily focused on student learning, collaboration, and accountability for outcomes (DuFour, 2004). 

Higher education leaders can foster an online professional learning community to promote faculty engagement and teaching excellence in the following ways:

• Establish a faculty development team. An established group of experienced practitioners can serve as a point of contact for anything from classroom management strategies to dealing with difficult students. Having a core team of people to act as mentors and host professional development workshops can help make an online university seem less overwhelming and more like a community.
• Hold regular faculty meetings. Involving all faculty, whether full-time or adjunct, in regularly scheduled meetings is a great way to bring faculty up to speed on policies, procedures, and organizational changes, while simultaneously creating an environment where faculty can get to know one another, share experiences, discuss best practices, and address shared and individual challenges.
• Partner new faculty with experienced faculty. This mentoring partnership allows new faculty to become better acquainted with faculty expectations, gain insight into online classroom management strategies, and form a relationship with a more experienced colleague.
• Make peer review an annual event. The mentor-mentee relationship does not have to end after just one class. Annual peer review allows faculty to share ideas with one another, pass along best practices, ask questions about policy, and share concerns. It is also a great opportunity to remind faculty of any new expectations they should be adhering to as they work with their students. These connections between faculty and peer reviewers extend beyond the peer review period and many times result in long-lasting relationships.
• Be proactive. Reach out to colleagues and offer assistance before they need it. Frequent and ongoing communications to faculty regarding policies, initiatives, and frequently asked questions can help everyone feel connected to the institution while also ensuring information is disseminated in such a way that results in increased performance.
• Give faculty the opportunity to be students. Professional development workshops that are offered in the online environment allow faculty to remember what it is like to be a student. In addition to the learning that takes place, these opportunities create a community wherein faculty can make connections to others, establish a network of relationships, and engage with peers in an online environment. Many times these relationships extend beyond the online environment.

Establishing an online professional learning community allows all online faculty, whether adjunct or full-time, to connect and collaborate with one another. The creation of a faculty development team, at the heart of this professional learning community, allows online universities an effective way to orchestrate faculty development efforts. Leaders in higher education should strive to foster a sense of community among all faculty members. This professional learning community will build faculty retention, ensure standardized processes and policies are enforced across the institution, and promote excellence in teaching leading to student success.

References:

• Doe, S., Barnes, N., Bowen, D., Gilkey, D., Smoak, G., Ryan, S., & … Palmquist, M. (2011). Discourse of the firetenders: Considering contingent faculty through the lens of activity theory. College English, 73(4), 428-449.

• Dolan, V. (2011). The isolation of online adjunct faculty and its impact on their performance. International Review of Research in Open and Distance Learning, 12(2), 62-77.

• DuFour, R. (2004, May). What is a professional learning community? Educational Leadership, 61(8), 6-11.

Anne O’Bryan is an online adjunct instructor at Colorado State University-Global Campus. Todd Kane is the Faculty Training Manager and teaches business at Colorado State University Global Campus. Melanie Shaw serves as an adjunct faculty member at several universities, including Colorado State University Global Campus.