quinta-feira, 12 de setembro de 2013

Ensino Superior

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World university rankings: how much influence do they really have?


Grete Luxbacher


Massachusetts Institute of Technology in Cambridge
 Brian Snyder/ Reuters/Corbis
Global university rankings are a competitive business – not only for universities, but for the companies that research and publish them. They are simultaneously criticised and lauded. And while few can agree on which methodology is the most robust, there is consensus that global university rankings are here to stay, that no ranking is all encompassing and that their influence is growing. Students, universities and governments are taking note and action.

The first international rankings, the Academic Ranking of World Universities or Shanghai Rankings, were published in 2003 by Shanghai Jiao Tong University in China. These were initially used to establish the standing of Chinese universities internationally following the launch of a government initiative to create world-class universities.

But in today's more internationalised sector, governments across the world are using rankings to measure their global competitiveness. The Shanghai Rankings were soon followed by the QS World University Rankings and Times Higher Education World University Rankings. With students and academics facing greater options and opportunities, the existence of three ready-made lists of the world's best universities have heightened competition the world over and governments are now paying closer attention, even utilising rankings to make policy decisions.

Education has become a top priority in emerging economies and many are looking to form partnerships with world leading universities. The Brazilian government's national scholarship programme, Science Without Borders, aims to send 100,000 students and researchers in primarily STEM subject areas to some of the world's best institutions. These partner universities were selected based on their position in the QS and Times rankings. In an effort to ensure quality, India's University Grants Commission also requires any foreign university wanting to partner with Indian universities to be ranked among the top 500 in the world.

University rankings are also impacting immigration policy. With the number of internationally mobile students projected to grow due to changing demographics and rising incomes in developing countries, overseas students are big business. They contributed over £10bn to the UK economy in 2011-2012 alone. As a result the UK government is looking to attract 90,000 more overseas students by 2018.

However, the current debate surrounding UK immigration policy has led to an increasingly negative perception among overseas students, making them feel 'unwelcome'. This has led to a sharp decline in the number of Indian and Pakistani students studying in the UK. Immigration policy is also impacting the recruitment of top academics and researchers. France has capitalised on this and opened its borders to Indian students by easing visa restrictions.

Other countries looking to improve their standings in the rankings have also opened their borders. Countries such as Denmark and the Netherlands have changed their immigration laws to favour those who have graduated from top global universities. In points based systems, graduates from the highest ranked universities in the QS, Times and Shanghai Rankings are awarded more points.

In a bid to make itself more attractive to international academics and expatriates, Russian authorities recently instituted a new legislation that will recognise degrees from foreign universities that are among the top 300 inthese rankings. However, those students who have not graduated from top universities or from former Soviet republics (excluding Uzbekistan) will still need to undergo a lengthy certification process.

This development is in line with other initiatives the Russian government is introducing to improve its global competitiveness, such as sending more students abroad to study at elite universities. Russia is also taking steps to overhaul its own higher education sector as a result of its poor performance in the global university rankings. Following an independent audit of its universities, 15 were selected to receive special grants to improve their compliance with rankings criteria.

Other countries such as Germany, France, Japan and Singapore have introduced similar programmes to improve their higher education systems and build world-class universities. In Asia in particular, the university rankings have created a 'reputation race', which sees both universities and governments closely monitoring the changing criteria for university rankings.

Making policy decisions based on university rankings is not a simple process. Global university rankings have their limitations. The indicators and criteria used are not all encompassing and often measured via proxies. There is a greater overall emphasis on research than teaching, despite the context of rising tuition fees, when prospective students are looking for the complete package. This emphasis also puts universities that are more focused on the arts and humanities at a disadvantage due to the heavy weighting of citations to measure research influence.

Much of the controversy surrounding the university rankings concerns their methodologies and which is the most robust – or, conversely, most gameable. There are various shortcuts universities can take to improve their scores such as taking on part-time professors that are highly cited.

Ultimately, university rankings are a tool. When using a particular ranking, it is important to be aware of its limitations as well as its intended audience. While QS design their rankings primarily for students, other rankings are aimed more overtly at university leadership. Any list only highlights a small percentage of the world's universities and as a result, many institutions, particularly in developing countries, are at a distinct disadvantage.

Like them or loathe them, however, university rankings seem to be here to stay. In Asia and Latin America, companies have begun to produce regional rankings. And with US president Barack Obama planning to create his own own 'Obamarank' league table of US universities in an attempt to nudge down the cost of college education, the global interest in ranking higher education only looks set to grow.



http://www.theguardian.com/higher-education-network/blog/2013/sep/10/university-rankings-influence-government-policy

quarta-feira, 11 de setembro de 2013

Mérito acadêmico



Six Steps for Turning Your Teaching into Scholarship





In 1997 Ernest Boyer identified the concept of the Scholarship of Teaching. This was the first time that TEACHING had been identified as legitimate scholarship. Over time this idea has evolved into the movement called “SoTL” or the Scholarship of Teaching and Learning. Many of us are scholarly teachers; we read the literature, plan, assess, reflect, and revise. But what makes our teaching scholarship is very different. Lee Shulman (1999) clearly delineated the difference. To be scholarship, teaching must become public, be an object of critical review and evaluation by members of one’s community, and it must be built upon and developed.

This can seem time consuming and overwhelming. Below are some ideas to help you get started on the process. 

Step 1: Identify a possible project through reflection. We ALL do something particularly well in our teaching. Take a minute and write down what YOU do well. Don’t be shy; this is a time to begin to own your success. Next reflect on your students from the past year, did you notice anything different about their approaches to the classroom, their learning, or the subject that made you pause or create a new challenge you did not have before? This exercise is often most successful if you debrief with colleagues you feel comfortable with. 

Step 2: Choose a topic and generate your research questions. Look back on your previous writing, think about conversations you’ve had with colleagues, and begin to conceptualize what you want to study that addresses either the goal approach (something you do well) or the issue approach (a specific challenge). I like Pat Hutchings’ approach, she asks, “What works? What is! Vision of the possible. Vision of the future!” As you begin your research, ask yourself, what is the vision of the possible and what is the vision of the future? Keep in mind the topic should be doable within the realm of your current teaching assignments, have the necessary resources, and be something you can complete in a timely manner. After you have generated your questions, ask a colleague to review them to clarify the meaning.

Step 3: Look at the literature. You can, of course, look at the education literature on teaching and learning, BUT you can also look at your discipline’s journals. Many disciplines have wonderful SoTL articles in the field. For example, the business literature is filled with information on teamwork and managing discussions. Ask for assistance, teaching center personnel and librarians would be delighted to point you in the right direction.

Step 4: Find the right context. Before you begin to design the study, seek out a few journals that might be interested in your questions and look at their author guidelines. Kennesaw State has put together a list of the major journals in annotated form. (http://cetl.kennesaw.edu/teaching-journals-directory)

Step 5: Design the study. A primary rule of SoTL is to use your discipline-based methods first. Most SoTL articles use a combination of quantitative and qualitative methodologies, so whatever mode you feel most comfortable in should be your starting point. Meaningful SoTL involves many approaches from action research, to case studies, to quasi-experimental design to phenomenological studies to the occasional controlled study. For quantitative data consider using scales, tests, Likert scale surveys, or student grades. For more qualitative data consider interviews, observations, open-ended questions, and focus groups.

Step 6: Write the article. This is where SoTL often differentiates from traditional scholarship. Here again, reflection is the key. Not only do you report results but you write about what you learned and the insights you gleaned from your specific study that can be applied to the general approach to teaching. For example, an article of mine on studying students who went from a passive lecture model to a more active learning pedagogy presented lessons learned and provided guidelines and suggestions for any teacher who was considering a major shift in style.

One final point, like any research there are ethical concerns to consider when undertaking this type of research. It is wise to check with your institution’s review board to find out its process for initiating SoTL studies.

With a bit of reflection, you can contribute to the scholarship of teaching and learning to help us all be better teachers.

References:
Boyer, E. Scholarship Reconsidered: Priorities for the Professoriate. San Francisco: Jossey- Bass, 1990.
Hutchings, P. Approaching the scholarship of teaching and learning. In Opening Lines: Approaches to the Scholarship of Teaching and Learning. Carnegie Foundation for the Advancement of Teaching, 2001.
Qualters, D. & J. Barr. What Matters in the Scholarship of Teaching and Learning. In What Matters in Learning and Teaching, Sylvia & Barr editors. 2011
Shulman, L. Take Learning Seriously, Change. 1999: 31:10-17.


Dr. Donna Qualters is Director of the Center for the Enhancement of Learning and Teaching at Tufts University and an Associate Professor of Community Medicine and an Adjunct Associate Professor of Education.

quinta-feira, 5 de setembro de 2013

Recursos Humanos na Saúde



Falta consistência ao programa Mais Médicos, diz brasileiro da OMS


CLÁUDIA COLLUCCI - SÃO PAULO

O brasileiro Mario Roberto Dal Poz, 62, que coordenou por dez anos a área de recursos humanos em saúde da OMS (Organização Mundial da Saúde), afirma que a vinda de médicos estrangeiros é "uma medida de curto prazo que não se sustenta". 


Dal Poz, 63, que se aposentou na OMS e voltou a ocupar o cargo de professor na Uerj (Universidade Estadual do Rio de Janeiro), diz que vários países adotam programas consistentes para atrair profissionais às regiões ermas.

O Canadá e a Austrália, por exemplo, oferecem um pacote de benefícios que inclui busca por emprego para o cônjuge do médico (a), suporte escolar para os filhos, suporte psicológico e social, rede de apoio e sistemas de supervisão à distância. A seguir, trechos da entrevista à Folha.


Folha - A chegada dos médicos cubanos acirrou ainda mais o embate entre o Ministério da Saúde e os médicos. O sr. vê alguma chance de acordo?
 

Mario Roberto Dal Poz - É uma situação muito ruim. Não há ninguém da área de saúde pública que ache positivo um conflito com o Ministério da Saúde nesses termos. Ninguém conversa com ninguém. Mas tem um aspecto positivo na cooperação com Cuba. O programa cubano na área de medicina de família é muito reconhecido no campo internacional, e é ruim essa crítica de que os médicos cubanos são mal formados.

A questão é que a vinda dos médicos estrangeiros é uma medida de curto prazo que não se sustenta. Muitos países que têm esse problema de déficit de médicos e de desigualdade na distribuição. É uma crise global. 


Por que?
 

Temos uma crise mundial de falta de médico que só tende a piorar. Os EUA estão ampliando a cobertura por mecanismo de seguro. Isso vai exigir mais médicos daqui uns anos. Na Europa, também está crescendo o déficit de médicos e enfermeiros. A previsão é nos próximos dez anos haverá um déficit de 1 milhão de médicos.

No Brasil, expandimos os serviços através do SUS e dos planos e saúde privados, e as pessoas estão demandando mais serviços de saúde.

Em geral, os países industrializados têm mecanismos de regulação médica muito mais detalhada do que o Brasil tem. Eles determinam um X número de especialistas que pode entrar nos sistema. A abertura de novas escolas médicas é muito limitada, muito controlada.
 

Como são nos países os programas para a fixação de médicos nas regiões distantes?
 

Um das coisas mais difíceis é a pessoa sair do seu conforto, migrar. E ela só faz isso quando está certa de que será para melhor. Mas não é só salário que atrai o médico. Em Manchester [cidade inglesa], por exemplo, há mais médicos de Malawi [país africano] do que em Malawi. Além de ótimos salários, eles têm condições para criar os filhos e rede social de apoio, de proteção.

Os cubanos estão vindo como parte da sua formação, eles têm uma carreira que inclui trabalho no exterior.

A Austrália tem uma experiência muito interessante de contratação de médicos rurais, que também envolve médicos de outros países. Parte do programa inclui buscar emprego para o marido ou a mulher, suporte escolar para os filhos, suporte psicológico e social, rede de apoio, sistemas de supervisão à distância, internet. A mesma coisa acontece no Canadá.

Todos os programas de sucesso têm quatro componentes: o primeiro é a formação, buscam médicos que provêm de áreas rurais ou que estudaram em escolas rurais.

O segundo elemento é a regulação. Às vezes, são subsidiadas certas especialidades que não são tão atrativas quanto outras. O terceiro elemento são incentivos econômicos, condições de trabalho, equipamentos, tecnologia. O quarto elemento envolve programas de apoio profissional e pessoal, supervisão e medidas que tenham reconhecimento público. Na Tailândia, o rei promove um encontro e premia os dez melhores médicos rurais. 


Como o sr. avalia o programa "Mais Médicos"?
 

Não há um conjunto de medidas, de intervenções que deem sustentabilidade ao programa. Nem no tipo de contrato, que não prevê direitos trabalhistas. 


Precisamos mesmo de tantos médicos? As enfermeiras não poderiam estar ocupando funções reservadas hoje ao médico, como o parto?
 

É importante ter médico, mas não só medico. E têm lugares que talvez nem precisasse de médicos, bastaria um outro profissional qualificado, dependendo do que precisa ser feito. Essa é uma discussão que também precisa ocorrer. Para fazer promoção de saúde, o médico não é necessariamente o melhor.

Em vários outros países, o médico é reservado para funções mais nobres.

Nos países nórdicos o parto normal não é feito pelos médicos. Você tem parteira de nível técnico ou superior fazendo isso. Será que não deveríamos discutir essas coisas no Brasil?

sexta-feira, 30 de agosto de 2013

Pesquisa qualitativa









Richard Krueger Picture

Dr. Richard Krueger on Qualitative Listening



I thought if I really wanted to learn about listening during qualitative interviews I would go to an expert, someone who has been doing it and teaching it for several years.
So I contacted Dr. Richard Krueger, professor emeritus at the University of Minnesota. You may know Dr. Krueger from a focus group workshop or qualitative methods course you took from him or from one of his many books that you keep as a close reference (as I do).
It was an true honor and a real pleasure to interview Dr. Krueger. I’ve been a dedicated follower of his work since I took my first focus group workshop with him in 2001.
Read on . . . you’re in for a real treat!


Eliot: I think listening is so important to qualitative work; in fact, I believe it’s the very essence of collecting high value data.

Krueger: I think you’re right on target. This is one of the major challenges of people starting to do qualitative research. They underestimate the time, the discipline, the amount of effort and the skills needed to be a good listener. I know of nothing else in life, well, except spouses listening carefully to each other or children listening to their parents, which requires the same level of listening acuity. But many times in qualitative interviews, as in relationships we become casual listeners, tuning in, tuning out and not paying a lot of attention because we’re waiting to speak our views on the topic. And all we hear are the first few words.

Eliot: How would you define listening for someone new to qualitative research? 

Krueger: Everyone thinks they are a good listener. But there’s a considerable difference between informal listening and the listening needed when involved in disciplined inquiry. When listening in a research mode, you need to engage in a different way. It takes preparation, mindfulness, discipline, concentration, and strategies for capturing the data. In addition, you must create the appropriate environment that fosters an effective interview.

Eliot: One word that really pops out at me in your definition is the word discipline. Can you say more about how discipline relates to listening?

Krueger: I’ve watched a lot of novices do focus groups. Part of what they need to learn is the self-discipline it takes to hold back on their own point of view. So often when you’re hearing someone talk, what’s going through your mind is, “How do I feel about that?” One of the key pieces of discipline is to suspend for a while your point of view; also to have the discipline to control your body so that you don’t telegraph certain reactions to it. If the interviewer doesn’t like what they hear, and they react, it can influence the person they’re interviewing. And that can change the results. Discipline doesn’t come easily—it takes lots of practice. The people who have the most problem tend to be those in an administrative or supervisory role—those that are regularly trying to persuade or convince other people to take action. For example, if we ask a public health nurse to go out to do interviews in the community, it can be very hard for them to switch off being a nurse and allow themselves to be able to hear the person’s response and control their own response to that person.

Eliot: It seems like an essential component that should be taught as part of any qualitative course.

Krueger: Yes, but in the courses I’ve seen students take at universities this aspect of self-discipline, of controlling your own reactions and controlling what your body is doing—and being aware of it—is not even mentioned.

Eliot: So, as someone who has taught qualitative methods in academia for a number of years and trained hundreds of people in focus group workshops, how do you teach qualitative listening? 

Krueger: Teaching people to listen is a challenge because they first need to un-learn many habits and patterns that they’ve had for years. Listening to a conversation with friends is different from listening in a research interview.  When listening in a research mode the interviewer is guided by a specific purpose. There is a reason for the interview that is described in a plan that is typically reviewed and critiqued by others. Then the researcher uses systematic and verifiable processes in gathering and analyzing the data. When I teach people to listen in a research mode I emphasize three aspects of the interview process: preparation, interviewing and follow-up.

Eliot: Let’s start with the first of those three aspects. How can an interviewer prepare to listen? What does that entail?

Krueger: Preparation for listening consists of getting your body and mind in tune for the listening experience. It means that you think about setting aside your personal opinions and get yourself focused on understanding the person you’ll be interviewing. Preparation also means carefully thinking through the questions you plan to ask. You spend time developing these questions, sequencing them and considering potential follow-up questions. And you also need to create the proper environment for the interview that will be relaxing and comfortable for the participants.

Eliot: I know that the more prepared I feel the more confident I am going into the interview. What about during the interview itself? You mentioned the need to “un-learn” bad listening habits. Are you talking about things like interrupting, finishing people’s sentences . . . those kind of bad habits?

Krueger: Yes, it’s those things and others. I think there’s a couple of things that people regularly do and don’t even know they’re doing them. Like they may jump in on a topic or move to another topic prematurely. Maybe it’s a feeling they have that they need to be in control. Or it could be even how we look at people. One of the simple things when trying to gain rapport is to make eye contact in such a way that the individual gets the feeling that you think what they are saying is important. In casual conversations we rarely do those kinds of things.  And, at times, you also want to turn your body so your shoulders are square with the interviewee, facing them.

Eliot: You also said we need to set aside personal opinions, especially during the interview. It’s one thing to set aside personal opinions that you’re aware but what about the ones we’re not aware of? My implicit biases sometimes sneak up on me during an interview.

Krueger: Yes, they will catch you by surprise. When I talk about it in class I refer to implicit biases as hot buttons. People have hot buttons they’re not even aware of until someone pushes them—something is said and you feel yourself having an emotional reaction. The person who is inciting it didn’t intend to–it may be something they said quite innocently that caused the reaction. Part of it is just having the awareness. Interviewers should know that it happens to everyone. Things could be said in a group that bother you because they conflict with your values, or your judgment, or something that’s troubling to you. If you’re aware that that might happen that’s the key thing. And if it happens to you, you must have the discipline to control your behavior.

Eliot: In your book (Focus Groups: A Practical Guide for Applied Research), you talk about the need to listen and think simultaneously during the interview. I find doing this particularly difficult since I’m not good at multi-tasking. I’m either listening intently or thinking about a good probe or paraphrase to use next. What strategies would you suggest for developing this parallel talent?

Krueger: Yes, without a doubt this is difficult to do. Some things that might help are to:
  • Get very comfortable with your questions ahead of time. Practice asking them and try to anticipate the range of responses that you might receive for each question.  It is difficult to concentrate when everything is new to the interviewer, but if you have already heard or anticipated the comments, then you are able to quickly see the pattern and capture it in your notes.
  • Get comfortable with brief pauses. Don’t feel that you need to jump in immediately when someone stops talking. Sometimes the 5 – 10 second pause elicits new insights from another participant.
  • Have a colleague with you when doing the focus group, an assistant moderator or recorder, to take notes and observe the conversation. This person doesn’t speak until the end of the group when the moderator invites comments or a summary. If the moderator has missed something important the assistant moderator can bring it up at the end of the focus group.
  • Think about three simple things: Are they clear? Do they make sense? Do I need to ask for an example?
  • Pay attention to time. In a focused interview your key questions tend to be in the middle or at the end of the interview. Be sure to allow sufficient time for these critical questions.

Eliot: I love your first point about practicing and anticipating responses in order to imagine what could possibly come up. What a fabulous idea but how seldom people actually take the time to do it.

Krueger: Yes. What people don’t often think about is what was not said and if there is a reason for it not being said. For example, if we’re talking about the inconveniences of airline travel and what the airline can do to help with that, one of the things we anticipate someone will say is that they expect a proper apology when things go wrong–not one made on a loud speaker that is garbled but one that is direct and personal. But if we go into a focus group and we don’t hear that, then at some point we may want to bring it up and say, “What about apologies from the airline?” We analyze what we receive but we can’t analyze what we could have received.

Eliot: When you suggested asking yourself, “Are they clear? Do they make sense? Do I need an example?” I thought, if only we could all keep those three little things in mind as a mini-checklist. 

Krueger: Yes, I think it would help. One of the things that’s interesting to do during election year is listen to people who are running for federal or higher level state offices as they are being interviewed. Regularly you find the answer does not fit the question. The answer sounds very good and they use a lot of interesting language but if you’re listening closely you’ll find that they didn’t really answer the question. They used something called a pivot in which they gave part of an answer and then moved to what they really wanted to talk about. There are some interviewers who are very good, like Charlie Rose, where, if the person doesn’t answer a question, they come back with the same question or a modified question.

Eliot: Also in your book, you write: “It is not enough to be an empty vessel, listening and absorbing the comments of participants.” I sometimes find myself lapsing into this passive listening state, especially with a fascinating respondent. What are your suggestions for maintaining a state of active listening?

Krueger: This regularly happens. It tends to occur when you are interviewing someone who is truly entertaining. They are clever with their words, they use humor or they tell fascinating stories. Sometimes you hear about a topic that is spellbinding and you just want to hear more. Some people have a gift for telling stories or describing events. And it can be easy to lapse into the passive listening mode and just enjoy the story. But in these moments you might think about these things:
  • If I had to explain this concept to someone else, do I have enough information?
  • Is this person telling me something new that I haven’t heard before?
  • Is this person taking me off topic?  And if so, will it help my research effort?
  • Does this seem logical and rational?
  • Do I need to ask for specific examples?

Eliot: Along the same line, what about listening to the rambler. How do we respectfully listen, not knowing if there will be a morsel in there somewhere or how long it will take to get to it? 

Krueger: Ramblers can take you off topic and jump to areas that are of little or no interest to the research. Or sometimes the rambler will stay on topic but continually repeat what they’ve said earlier. The first time someone rambles off topic make a mental note and be ready to interrupt the next time they move off topic. In addition, be sure this person understands the question being asked. Sometimes people ramble because they don’t understand the question. Another way to handle the rambler is to look directly at him or her, and ask the question. You might also consider mentioning in your introductory ground rules that: “My job as moderator is to keep the group on topic and to finish on time. And as a result I may need to interrupt people in order to move to the next questions. So my apologies in advance if I interrupt you.” This becomes a bigger problem when you do telephone focus groups. On the telephone you cannot give people visual signals like not looking at them, laying down your pen, or looking at other people.

Eliot: I find it harder to listen in focus groups than during individual interviews. I notice that when I’m listening to one focus group participant the others kind of blur in the background causing me to get a little anxious about excluding the rest of the group. What suggestions do you have for listening in a group?

Krueger: This is an important reason why audio recordings are essential. When moderating you will need to develop a rapid means of note taking. The audio recording is valuable because it allows you to review all comments in detail at a later time. Also in the focus groups don’t expect everyone to speak for equal amount of time. Some participants often have more insight or experience and you should expect them to be more articulate. But don’t forget those who are silent. Pay attention to who is not talking and look at them. Call on them and invite them to share their thoughts. Some of the most productive comments come from those participants.

Eliot: Good listeners tell us that listening is much more than listening to words. There’s also facial expression, tone, word choice, body language and other stimuli to watch for. Can you speak a little about your experience with this? 

Krueger: Don’t go overboard with body language. Body language is complicated and difficult to interpret in focus groups. Often these are people who you’ve never seen before and you have no history or patterns of their normal behavior. That makes it difficult to interpret body language. Just look for the obvious. When you see something that might be interesting, try to get the person to describe their feelings. It is risky to assume that you know the meaning of the body language unless the person actually tells you what they are feeling.

Eliot: When I’m listening to the response of one participant and catch another participant frowning or shaking their head, reacting in some way, I’ll call on them and say, “It looks like you have something to say about that. What would you like to add?”

Krueger: Yes, that’s good. That’s very good. Or you could say, “Tell me more,” or better yet, “How do you feel about that?” What people say cognitively is not always the driver of behavior; emotions may be more of a driver. So as I’m listening to people I’m watching for when they become engaged, when they become emotional at some level.

Eliot: Finally, I’ve heard you talk several times about the moments immediately after the focus group and how important that window of time is to capture additional information. Is that because your recall is the best at that time in case you might not have been listening as closely as you should have been?

Krueger: The moments immediately after an interview are critical. This is a time to get your notes in order, to jot down additional observations, to discuss the interview with colleagues that were present, and to begin the analytic effort. This is a time when I want to hear from other members of the team about possible things that I missed that I did not pick up the first time—words or concepts or big ideas. I might ask the others, “What of all the things you heard today were the most important?” “Were there any surprises? Were there any quotes that were exceptionally stunning? What things should I have probed deeper on?

Eliot: That sounds like a very valuable process. It’s like you’re taking advantage of the collective listening of all the people who were in the room for the focus group.

Krueger: That’s right. I find it especially helpful if you have someone local from the community. They will pick up on things that others have not. Or people with different backgrounds will see things that others do not pick up on.

Eliot: Wrapping up, what final recommendations would you have for qualitative researchers who want to develop better listening skills?

Krueger: Some things that I think would helpful are the following:
  • Get a mentor or a coach to watch you and offer suggestions. It is difficult to self-diagnose your own listening ability. If it is impractical for the coach to watch you, they might listen to the audio recording to help you identify strengths and weaknesses.
  • Ask the person interviewed for their feedback (if it’s appropriate). You might say, “I’m going to be doing more interviews like this. What suggestions might you have to make the interview better? Or, “How could I have listened to you better?”
  • Use a mirror to fine-tune your facial expressions, such as smiling, looking surprised, and looking like you want more information.
  • Don’t forget the power of the pause. The best interviewers I’ve seen know just when to use the pause to elicit more insight. Rookies tend to speak too quickly and move on to the next question. The expert knows when to wait for more.
  • Watch others who are really good at it. You can talk about the concept of waiting for an answer, but it’s not until you actually see someone do it, and you think, “Wow, that works really well.” Sometimes just watching a master do some of these things and then having someone sit next to you and say, “Watch this; do this; try this . . .” That’s how you get much better.
Eliot: Thank you Dr. Krueger for sharing such important and useful information. You’ve really helped me unpack the important aspects of good qualitative listening and I know that your practical, well-tested suggestions will inspire many to take qualitative interviewing to the next level.



quarta-feira, 28 de agosto de 2013

Recursos para a Saúde





Recursos para a Saúde

A Abrasco - Associação Brasileira de Saúde Coletiva publicou em sua página em 21/08/2013 uma súmula da apresentação feita pelo Ministério de Planejamento, Orçamento e Gestão em reunião de negociação interministerial com representantes do Movimento Saúde +10 para buscar soluções para o financiamento da saúde.

Reproduzo o material abaixo para estimular ainda mais o debate. Quanto mais a sociedade opinar, mais rica será a discussão e  mais avançaremos nesta importante questão.

Roberto Z. Esteves
Administrador - Educação Médica

 




Governo e Sociedade entendem que é preciso melhorar a qualidade da prestação de serviços com saúde, por melhoria de gestão e Aumento de recursos. Regra Atual: Recursos para saúde no ano anterior corrigido pela variação do PIB nominal do ano anterior.
 

Nos últimos anos, os recursos efetivos têm sido superiores ao mínimo legal
 

Pagamento de pessoal em 45 hospitais universitários federais não são computados como recurso para saúde:

Em 2012 foram gastos R$ 3 bilhões

Estimativa de R$ 6 bilhões/ano quando os 45 hospitais da rede já tiverem feito as ampliações

9 hospitais já tiveram autorização para ampliação – R$ 727 milhões/ano:  Piauí, Brasília, Maranhão, Triângulo Mineiro, Santa Maria, Espírito Santo,   Amazonas, Rio Grande do Norte e Minas Gerais

Orçamento da União 2013 – R$ 2,2 trilhões

46% destinados às despesas financeiras – juros e amortização

54% destinados às despesas primárias
 

RIGIDEZ ORÇAMENTÁRIA

Despesas primárias 2013 – R$ 1,2 trilhão
Despesas obrigatórias – R$ 893 bilhões
previdência, pessoal, abono, seguro-desemprego, LOAS, etc.
Despesas Discricionárias – R$ 272 bilhões – 13% do orçamento

Áreas protegidas – Educação, Saúde, Brasil Sem Miséria, PAC e Ciência, Tecnologia e Inovação – R$ 206 bilhões
Demais obrigatórias – Benefícios dos servidores – R$ 8 bilhões
Cortes Efetuados – R$ 22 bilhões
Todas demais áreas – R$ 36 bilhões
 
Proposta de 10% de RCB para a saúde implicaria aumento de R$ 39 bilhões em 2013
 
Valor superior ao total das áreas não protegidas – R$ 36 bilhões
 
Logo, para ampliar os recursos para a Saúde é necessário discutir a fonte de financiamento
 
Por exemplo, CPMF financiava 0,7% do PIB para saúde – representaria R$ 34 bilhões em 2013
 
INADEQUAÇÃO DA RECEITA CORRENTE BRUTA (RCB) COMO PARÂMETRO DE REFERÊNCIA

RCB inclui receitas que pertencem a outros entes
 
 
Não é bom parâmetro, pois RCB do ano corrente só é conhecida em janeiro do ano seguinte.
 
Dificuldade operacional em se apurar o valor mínimo. Outras vinculações usam resultados de anos anteriores:
 
reajuste do salário mínimo – variação do PIB real de 2 anos antes + INPC
regra atual de recursos para saúde – variação PIB nominal do ano anterior
 
Dificuldade de planejar a despesa de saúde correspondente
 
O não cumprimento da regra é crime de responsabilidade
 
RESUMO
Governo tem ampliado os recursos para saúde pública e entende a qualidade do serviço de saúde como prioridade. 
A qualidade do serviço de saúde passa pelo financiamento e pela melhoria da gestão
 
Dificuldades com a proposta de vinculação com a RCB:
 
Proposta, sem novas fontes para 2014, implicaria cortes de R$ 39 bilhões em outras áreas prioritárias. RCB não é receita exclusiva do Governo Federal, pois inclui as transferências aos demais entes. O parâmetro do mesmo exercício do gasto traz dificuldades para planejar e executar com qualidade os recursos da saúde
 
Ministério do Planejamento, Orçamento e Gestão | Agosto de 2013

sábado, 24 de agosto de 2013

Público e privado na Saúde



Reflexão

O SUS que temos e o SUS que queremos

Roberto Zonato Esteves

Em países que realmente encaram a saúde como um dever do Estado, as pessoas têm atendimento público de qualidade e a opção de pagarem por um atendimento privado, se quiserem. No Brasil, temos um sistema que estimula o atendimento privado como forma de diminuir a demanda por serviços públicos e deixa o atendimento público para os que não tem escolha.

Vendo a questão como um defensor dos princípios do SUS, fico muito preocupado com políticas de estado que enfraquecem os seus alicerces. Se o Estado deixasse de estimular, com o abatimento no Imposto de Renda da Pessoa Física, o cidadão a ter um plano de saúde e limitasse os gastos crescentes com o financiamento de planos de saúde dos funcionários públicos, teríamos uma classe média instruída e ciente de seus direitos a pressionar pelo adequado financiamento do SUS e a qualidade do atendimento. Aumentaria muito a chance de êxito de conseguirmos a aprovação dos 10% das RBU para a saúde.

Com a redução dos miseráveis observada nos últimos vinte anos, temos uma nova classe média emergente que passa a ser consumidora de produtos e serviços e que tem como “sonhos de consumo”  casa, carro e plano privado de saúde, nesta ordem. A inclusão social está gerando um nicho para os planos privados de saúde de clientes capazes de pagar pouco por um atendimento um pouco melhor ( será?) que o público.
 

É lógico que para atender esta nova demanda, precisaremos de médicos e outros profissionais de saúde, ambulatórios, hospitais, laboratórios etc que drenarão ainda mais recursos públicos. O Estado não injetará mais recursos no sistema público mas estimulará o escape para a saúde suplementar.

Vendo esta questão pelo ângulo de estudioso da Educação das Profissões de Saúde, preocupa-me ver que o Governo propõe ações como o Mais Médicos e a extensão dos cursos de Medicina para 8 anos quando, na verdade, investe maciçamente em estimular o modelo privado. Quando pretende melhorar a distribuição de médicos no Brasil e a sua presença no sistema público mas estimula de forma velada e indireta a criação de postos de trabalho na saúde suplementar, mostra que o pensamento neoliberal que norteia os nossos governos sobrepõe-se claramente aos ideais da reforma sanitária.

Como motivar nossos alunos a formarem e trabalhar para o SUS quando o próprio governo emite sinais tão claros de que considera o SUS um sistema pobre para pobres e que sua visão de sociedade igualitária é aquela onde todos  pagam por seu plano privado de saúde?


 

quarta-feira, 21 de agosto de 2013

Educação à distância



Applying the Seven Principles for Good Practice to the Online Classroom




Almost 25 years have passed since Chickering and Gamson offered seven principles for good instructional practices in undergraduate education. While the state of undergraduate education has evolved to some degree over that time, I think the seven principles still have a place in today’s collegiate classroom. Originally written to communicate best practices for face-to-face instruction, the principles translate well to the online classroom and can help to provide guidance for those of us designing courses to be taught online.


1. Encourage contact between students and faculty. Students need to know how to contact their online instructors and should be encouraged to communicate with us when needed. In my online courses, I identify multiple means of contacting me (email, Skype, Twitter, etc) and clearly post times when I’ll be available to chat during online office hours. While few students utilize the online office hours I provide, offering this time communicates to students that I am available if they need assistance and that I value this interaction.

2. Develop reciprocity and cooperation among students. For those of us who believe that people learn through socially constructing their understanding based on their experiences, this principle is critical. Online courses should not be independent study classes. Online instructors need to build collaborative structures into their courses to promote student-to-student interaction. In my experience, I find that students who feel isolated in an online course have difficulty being successful. In my online courses, I incorporate collaborative and interactive ventures early on. I also try to foster discussions where students communicate with one another, share ideas, and debate concepts. While interacting with the instructor is important in an online class, it is also important that students have a space where they can discuss concepts with one another as well.

3. Encourage active learning. Learning is not a passive activity. For students to learn, they must actively engage with the content in thoughtful, purposeful ways. As you develop your online course, consider ways to build active learning into the course content. This can include utilizing tools with a course management system (discussions, for instance) or other tools (GoAnimate, Animoto). But active learning isn’t limited to technological avenues in online courses. Someone teaching science online could utilize hands-on lab activities developed with common everyday items. Someone teaching psychology or sociology online could have students conduct observational work at a park or at the mall.

4. Give prompt feedback. This can be tricky, especially with instructors teaching larger online classes. While grading hundreds of papers can be overwhelming, students need to receive prompt feedback to know whether they are being successful or what they need to do to improve. If you have a few larger assignments in your class that you know will take more time to provide quality, constructive feedback, communicate this to your students. You should also include some smaller assignments that will not take as long to assess. While some experienced online instructors use the course management system to build automated responses into their courses, I believe that some students still need personalized feedback on their work that comes directly from their instructor.

5. Emphasize time on task. Learning takes time. Students and faculty working in online spaces need to realize this. Just because an online course may be more flexible schedule-wise does not mean that it won’t require a significant time commitment. It’s important for instructors to communicate expected time commitments but also be realistic with their expectations. Assigning students to read a 500 page book in a day may not be completely realistic. Have high expectations but respect students’ need to have time to interact with the content and learn.

6. Communicate high expectations. While it’s important to have high expectations for students, it is also critical that these expectations are clearly communicated to students. Likewise, it is helpful to communicate clear expectations for participation and for interaction. Do you want your students to log on daily? Do they need to submit assignments in a certain format? Is it okay for them to use emoticons in their discussion posts? These are just a few of the areas that online instructors need to consider as they develop an online course for the first time.

7. Respect diverse talents and ways of learning. Students learn in a variety of ways. While there will undoubtedly be some text-based content in an online course, it cannot be the only mode of delivery or assessment. Draw on the host of multimedia options available online to deliver content to students and to assess them. Instead of typing out some long lesson on the Middle Ages, check out YouTube or Vimeo for some available videos. Or better yet, use a screencasting tool like Jing to record a customized lesson. Instead of assigning a ten-page paper, have students create a video where they demonstrate what they’ve learned.

Dr. Oliver Dreon is the director of the Center for Academic Excellence at Millersville University.