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Primary health care (PHC) is an intersectoral strategy for the development of people's health. It includes the organization of medical and health care systems and social development actions on the determinants of health, under the principles of law, equity, social justice, respect for cultural diversity, health promotion, coverage and universal access to all preventive and curative services, use of appropriate technologies and promotion of social and community participation. The MAS-Bienestar health care model in Mexico considers PHC as the foundation of the sustainability of the public health system. It requires a determined policy of strategic training of human resources for health, oriented towards PHC. Key experiences in the training of physicians in PHC are reviewed, presenting the case of the Universidad de la Salud (Unisa, in Spanish) and the curricular proposal of the degree in General and Community Medicine, as clues to reorient training in general medicine. The greatest challenge for the training of health professionals with a PHC approach is to exercise joint leadership of the education and health sectors, to create a national system of strategic training of health personnel, guaranteeing their insertion into the public system. [ABSTRACT FROM AUTHOR]

Background: Standard training for ultrasound-guided cyst needle aspiration is currently performed on live patients during residency. This practice presents risk of iatrogenic injury to patients and provides a high-stress learning environment for medical trainees. Simulation training using synthetic cysts in a formalin-embalmed cadaver model may allow for realistic, practical, and effective training free from patient risk. Methods: Thirty first-year medical students viewed an orientation video, then attended a skills workshop to perform cyst needle aspiration in formalin-embalmed cadaver tissue under ultrasound guidance. Participants were randomly assigned to one of three ultrasound-trained instructor-types which included a medical student, clinical anatomist, or an ultrasound fellowship trained emergency medicine physician. After training, participants underwent a 5-min skills test to assess their ability to drain a synthetic cyst independently. Pre- and post-training self-confidence surveys were administered. Results: Ultrasound images of synthetic cysts in formalin-embalmed tissue were clear and realistic in appearance, and sonographic needle visualization was excellent. Participants took an average of 161.5 s and 1.9 attempts to complete the procedure. Two of the 30 participants could not complete the procedure within the time limit. Participants' self-reported confidence with respect to all aspects of the procedure significantly increased post-training. Mean confidence scores rose from 1.2 (95% CI 0.96 to 1.39) to 4.4 (95% CI 4.09 to 4.53) (P < 0.0001) Procedure time, number of attempts, performance scores, and self-confidence outcomes were not significantly affected by instructor type. Conclusions: The use of synthetic cysts in formalin-embalmed cadaveric tissue is feasible, realistic, and efficacious for the teaching of ultrasound-guided needle aspiration to novice medical trainees. This simulation training method can be delivered effectively by multiple instructor types and may allow medical trainees to increase their tactical skill and self-confidence prior to performing ultrasound-guided cyst needle aspiration on live patients. [ABSTRACT FROM AUTHOR]

Negative outcomes in surgical medical residency, such as burnout, pathological stress, and abandonment of specialization, have been addressed by modifying the work and educational environment of the student to improve performance during training. However, due to the low effectiveness of strategies used in medical education and in order to change the perspective of the problem and offer complementary solutions, strategies based on positive psychology have been incorporated. Thus, the personal resources of the student are part of these growing research alternatives, as their optimization allows a higher level of interaction with their learning environment, as well as control over their academic and work performance. ‘Job crafting’ is supported by the job demands-resources theory. This article provides a critical and reflective analysis of personal resources and the favorable role they play in the regulation of work, learning, and well-being of the resident as part of a proposal towards a new approach to the problem of work performance during the postgraduate academic training process.

Abstract Background Standard training for ultrasound-guided cyst needle aspiration is currently performed on live patients during residency. This practice presents risk of iatrogenic injury to patients and provides a high-stress learning environment for medical trainees. Simulation training using synthetic cysts in a formalin-embalmed cadaver model may allow for realistic, practical, and effective training free from patient risk. Methods Thirty first-year medical students viewed an orientation video, then attended a skills workshop to perform cyst needle aspiration in formalin-embalmed cadaver tissue under ultrasound guidance. Participants were randomly assigned to one of three ultrasound-trained instructor-types which included a medical student, clinical anatomist, or an ultrasound fellowship trained emergency medicine physician. After training, participants underwent a 5-min skills test to assess their ability to drain a synthetic cyst independently. Pre- and post-training self-confidence surveys were administered. Results Ultrasound images of synthetic cysts in formalin-embalmed tissue were clear and realistic in appearance, and sonographic needle visualization was excellent. Participants took an average of 161.5 s and 1.9 attempts to complete the procedure. Two of the 30 participants could not complete the procedure within the time limit. Participants’ self-reported confidence with respect to all aspects of the procedure significantly increased post-training. Mean confidence scores rose from 1.2 (95% CI 0.96 to 1.39) to 4.4 (95% CI 4.09 to 4.53) (P

INTRODUCTION: Throughout undergraduate school, it is important to instill a continuous emphasis on cost-conscious thinking across all specialties, including obstetrics and gynecology (OB/GYN). One potential strategy is the implementation of the Choosing Wisely (CW) Campaign. OBJECTIVE: To describe and assess the implementation strategies of the Choosing Wisely (CW) campaign within a medical internship in Obstetrics and Gynecology (OB/GYN). METHODS: This intervention study involved medical teachers and undergraduate medical students at a Brazilian medical school. Initially, teachers identified three common unnecessary clinical scenarios, which were then grouped and adapted to fit the CW recommendation format. Based on the five most frequently occurring recommendations, educational activities were developed, including workshops, banners, and discussions on cost-consciousness in healthcare with undergraduate students and medical doctors. RESULTS: The top five recommendations were as follows: 1. Don’t routinely order hormone levels for menopause diagnosis; 2. Don’t recommend ovarian removal during hysterectomy for premenopausal women without ovarian câncer risk; 3. Don’t prescribe broad-spectrum antibiotics for uncomplicated acute cystitis treatment; 4. Don’t request preventive examinations for colpitis diagnosis; and 5. Don’t request unnecessary exams during low-risk prenatal care, such as kidney and liver function tests. The theoretical and practical components of these educational activities led to increased awareness and subsequent discussions among internship faculty and undergraduate students. CONCLUSION: Implementation of the CW campaign within the medical internship in OB/GYN resulted in a positive impact, fostering reflection among participants and aiding in the avoidance of unnecessary treatments or prescriptions.

Introduction: Point-of-care ultrasound (PoCUS) is a clinical tool that has been used in emergency departments for three decades. However, there are still ongoing concerns regarding the risk of diagnostic errors by non-radiologist physicians and the certification of competencies for its incorporation. Objective: To describe and analyze the conceptual framework of PoCUS use in medical and surgical specialties in Colombia. Results: The implementation of PoCUS improves the sensitivity of physical examination in a timely manner and guides medical education in areas such as anatomy, physiology, and clinical assessment. Furthermore, it allows different specialists to complement their daily practice by facilitating skill acquisition and recognition of tool limitations, according to competency certification and current regulations. Conclusions: PoCUS is an effective tool (with minimal adverse events) for clinical decision-making in the emergency department and even in other clinical practice contexts. The training required to acquire the necessary technical skills for its use is within reach of any physician.

Estimada editora: La investigación científica en pregrado forma parte del desarrollo integral del estudiante de medicina; sin embargo, presenta limitaciones como las reducidas oportunidades de participar en proyectos de investigación, miedo al rechazo por la editorial, ausencia de la cultura investigativa, ausencia de asesores, desinterés de los docentes y la falta de financiamiento (1). A pesar de la baja producción científica estudiantil en América Latina (2), se evidenció un incremento significativo, atribuyendo a la creación de las sociedades científicas. En el Perú, se fundó la Sociedad Científica Peruana de Estudiantes de Medicina (SOCIPEM) el 27 de agosto de 1992 en la ciudad del Cusco, que luego cambiaría de nombre a Sociedad Científico Médico Estudiantil Peruana (SOCIMEP). Undergraduate scientific research is part of the integral development of the medical student, but it has limitations, such as reduced opportunities to participate in research projects, fear of rejection by the editorial, absence of research culture, lack of advisors, disinterest of teachers and lack of funding (1). Despite the low student scientific production in Latin America (2), a significant increase was evident, attributing it to the creation of scientific societies. In Peru, the Peruvian Scientific Society of Medical Students (SOCIPEM) was founded on August 27, 1992 in the city of Cusco, which would later change its name to the Peruvian Medical Student Scientific Society (SOCIMEP).

Abstract Background This study aims to describe the training offered and the availability of professionals required by the Ministry of Health for mental health problems management in the community. Methods A cross-sectional study was carried out on the training offered in mental health in Peruvian universities. A search for programs was conducted using the University Information System database and universities' websites, as well as using the Ministry of Health's database on health personnel and data on the number of enrolled and current students provided by the University Information System database and the Transparency section of the universities. Results There were 214 undergraduate, 55 specialty and 7 subspecialty programmes, of which 39%, 47% and 100%, respectively, were offered in the capital city. The duration ranged from 5 to 7 years for undergraduate programs and from 1 to 3 years for subspecialty and second specialty programs. The cost of undergraduate programs ranged from free of charge up to USD 6863.75 for the first semester of study. Second specialty programs ranged from 720 up to 11 986 USD and subspecialty programs ranged from 2267 up to 9138 USD, with medicine being the most expensive. On the other hand, there are a greater number of psychology students (n = 78 781) pursuing undergraduate studies than working professionals (n = 5368), while in the second specialty of psychiatry there are far fewer students pursuing the specialty (n = 67) than working professionals (n = 454). Conclusions The problem of professional training in mental health requires that the institutions involved in health and education develop policies to decentralize programs, communicate the demand for professionals in certain areas, make them accessible to the low-income population, respond to mental health problems and guarantee their quality. On the other hand, regarding the low number of mental health personnel working, it is suggested to increase the mental health budget to generate more mental health services and employment.

BackgroundMoral distress is a reason for burnout in healthcare professionals, but the clinical settings in which moral distress is most often experienced by medical students, and whether moral distress is associated with burnout and career choices in medical students is unknown. We assessed moral distress in medical students while caring for older patients, and examined associations with burnout and interest in geriatrics.MethodsA cross-sectional survey study of second-, third-, and fourth-year medical students at an American medical school. The survey described 12 potentially morally distressing clinical scenarios involving older adult patients. Students reported if they encountered each scenario, and whether they experienced moral distress, graded on a 1-10 scale. We conducted a principal axis factor analysis to assess the dimensionality of the survey scenarios. A composite moral distress score was calculated as the sum of moral distress scores across all 12 scenarios. Burnout was assessed using the Maslach Abbreviated Burnout Inventory, and interest in geriatrics was rated on a 7-point Likert scale.ResultsTwo-hundred and nine students responded (47%), of whom 90% (188/209) reported moral distress in response to ≥1 scenario with a median (IQR) score of 6 (4-7). Factor analysis suggested a unidimensional factor structure of the 12 survey questions that reliably measured individual distress (Cronbach alpha = 0.78). Those in the highest tertile of composite moral distress scores were more likely to be burnt out (51%) than those in the middle tertile of scores (34%), or lowest tertile of scores (31%) (p = 0.02). There was a trend towards greater interest in geriatrics among those in the higher tertiles of composite moral distress scores (16% lowest tertile, 20% middle tertile, 25% highest tertile, p-for-tend = 0.21). Respondents suggested that moral distress might be mitigated with didactic sessions in inpatient geriatric care, and debriefing sessions with peers and faculty on the inpatient clerkships on medicine, neurology, and surgery, where students most often reported experiencing moral distress.ConclusionsMoral distress is highly prevalent among medical students while caring for older patients, and associated with burnout. Incorporating geriatrics education and debriefing sessions into inpatient clerkships could alleviate medical student moral distress and burnout.

Resumen: Introducción: laa realidad virtual es una herramienta que favorece el logro de diversas competencias en la formación médica. El objetivo de este estudio fue analizar la visibilidad, el impacto y la colaboración en la producción científica sobre la realidad virtual en la educación médica. Métodos: estudio bibliométrico que consistió en la inclusión de los artículos indizados en Scopus entre los años 2012 y 2021 a partir de una estrategia de búsqueda diseñada con operadores lógicos y términos MESH. Los indicadores bibliométricos se estimaron con SciVal y Bibliometrix. Resultados: la mayoría de los artículos se han publicado en revistas del primer cuartil (50,6%), con un incremento desde el 2019 hasta el 2021. Los términos Virtual reality y Medical education son los que condensaron mayor coocurrencia. Los autores Winkler-Schwartz, del Maestro y Konge fueron los más representativos y principalmente Estados Unidos, Alemania, Reino Unido y Australia fueron los países más dominantes. El análisis factorial demostró que la dimensión uno parece relacionarse con la experiencia práctica y la simulación, en tanto que la dimensión 2, con la educación médica. La Journal of Surgical Education es la que tiene más artículos publicados y la de mayor impacto fue la International Journal of Computer Assisted Radiology and Surgery. Conclusiones: en los últimos años la literatura científica sobre la realidad virtual aplicada a la educación médica se ha incrementado. Además, existe una red de colaboración internacional que se ha incrementado en diferentes partes del mundo. Las revistas de impacto son las principales para la divulgación de estas investigaciones. Abstract: Introduction: Virtual reality is a tool that promotes the achievement of various competencies in medical education. The aim of this study was to analyze the visibility, impact, and collaboration in scientific production on virtual reality in medical education. Methods: A bibliometric study consisting of the inclusion of articles indexed in Scopus between 2012 and 2021 based on a search strategy designed with logical operators and MESH terms. Bibliometric indicators were estimated using SciVal and Bibliometrix. Results: Most of the articles were published in first quartile journals (50.6%), with an increase from 2019 to 2021. The terms ''Virtual reality'' and ''Medical education'' condensed the highest co-occurrence. Authors Winkler-Schwartz, Del maestro and Konge were the most representative and mainly USA, Germany, UK and Australia were the most dominant countries. Factor analysis showed that dimension one seems to be related to practical experience and simulation, while dimension two to medical education. The Journal of Surgical Education has the most published articles and the one with the highest impact was the International Journal of Computer Assisted Radiology and Surgery. Conclusions: In recent years the scientific literature on virtual reality applied to medical education has increased. In addition, there is an international collaboration network that has increased in different parts of the world. Impact journals are the main journals for the dissemination of this research.

The objective of the study was to report the experience with teaching medical students the approach to children in situations of domestic sexual violence in the Primary Health Care (PHC) context using clinical simulation. The simulation was performed for students attending the fifth semester, during the Child Health module, of the Medicine Course at the Multicampi School of Medical Sciences, Brazil. This activity was developed at the Clinical Skills and Simulation Laboratory of the school in the second half of 2019. A domestic child sexual violence scenario was then developed and executed. The simulation enabled a critical analysis of child violence, of the medical performance, and of how similar situations are conducted in the Primary Health Care context. As it is a complex and challenging scenario, it was possible to identify that the students have difficulties making decisions. The students evaluated the practice as a successful experience. Therefore, the simulation for teaching the approach to children in situations of domestic sexual violence in the PHC context can be a teaching and learning strategy with significant potential for the theoretical and practical consolidation of the theme in question.

Introduction: Much emphasis has been placed on investigating the attributes of the educational leader, but less attention has been given to understanding his/her leadership experience. Nonetheless, exploring that experience is crucial to reduce the gap between what that person should be doing and what he/she is actually doing. Aim: To understand the meaning of my experience as a leader in medical education from a personal and pragmatic perspective. Methods: I adopt a qualitative approach, supported by an autoethnographic narrative inquiry. For this reason, the manuscript was written in first person. I collected journal records and conducted four (auto)semi-structured interviews to recall critical events (directly or indirectly) related to my life as an educational leader. I analyzed the texts looking for characters, temporality and locations, as well as cultural aspects, tensions and metaphors of my life stories. Results: I composed four resonant plots represented in the following metaphors: a) the original sin, b) the bad son leaves home, c) snakes' heads must be cut off, and d) the apocalypse arrived. Conclusion: My story led me to hold a different understanding of medical education leadership. This understanding accounts for intrapersonal tensions and how the use of power changes you in practice, more than it changes other people around you (as theoretically assumed).

Introduction. The use of simulation in surgery has made it possible to shorten learning curves through deliberate practice. Although it has been incorporated long ago, there are still no clear recommendations to standardize its development and implementation. This manuscript aims to share recommendations based on our experience of more than twelve years of employing and improving a methodology in laparoscopic surgical simulation. Topics for Reflection. To transfer surgical skills to a trainee, we base our methodology on a three-pillar framework: The hardware and infrastructure (tools to train with), the training program itself (what to do), and the feedback (how to improve). Implementing a cost-effective program is feasible: the hardware does not need to be high fidelity to transfer skills, but the program needs to be validated. These pillars have evolved over time by incorporating technology: the on-site guidance from experts has changed to a remote and asynchronous modality by video recording the trainee’s execution, and by enabling remote and asynchronous feedback. The feedback provider does not necessarily have to be an expert clinician in the subject, but a person previously trained to be a trainer. This allows for deliberate practice until mastery has been reached and learning curves are consolidated. Conclusions. Recommendations based on the experience of our center have been presented, explaining the framework of our strategy. Considering these suggestions, it is hoped that our simulation methodology can aid the development and implementation of effective simulationbased programs for other groups and institutions. Introducción. El uso de la simulación en cirugía ha permitido acortar las curvas de aprendizaje mediante la práctica deliberada. A pesar de que se ha incorporado previamente, aún no existen recomendaciones claras para estandarizar su desarrollo e implementación. Este manuscrito pretende compartir recomendaciones basadas en nuestra experiencia, con más de doce años empleando y mejorando una metodología en la simulación quirúrgica laparoscópica. Temas de reflexión. Para transferir las habilidades quirúrgicas a un aprendiz, basamos nuestra metodología en un marco de tres pilares: El hardware y la infraestructura (herramientas con las que entrenar), el programa de entrenamiento (qué hacer), y la retroalimentación (cómo mejorar). La implementación de un programa rentable es factible: el hardware no necesita ser de alta fidelidad para transferir las habilidades, pero el programa necesita ser validado. Estos pilares han evolucionado a lo largo del tiempo incorporando tecnología: la presencia de expertos ha evolucionado a una modalidad remota y asincrónica mediante la grabación en vídeo de la ejecución del alumno, y permitiendo su retroalimentación. Aquel que entrega retroalimentación no tiene que ser necesariamente un clínico experto en la materia, sino una persona previamente formada como instructor. Esto permite una práctica deliberada hasta dominar la habilidad y establecer curvas de aprendizaje. Conclusiones. Se han presentado recomendaciones basadas en la experiencia de nuestro centro, explicando el marco de nuestra estrategia. Teniendo en cuenta estas sugerencias, se espera que nuestra metodología de simulación pueda ayudar al desarrollo e implementación de programas efectivos basados en la simulación a otros grupos e instituciones. Introdução. O uso de simulação em cirurgia tornou possível encurtar as curvas de aprendizagem por meio da prática deliberada. Embora tenha sido incorporado anteriormente, ainda não há recomendações claras para padronizar seu desenvolvimento e implementação. Este manuscrito pretende compartilhar recomendações com base em nossa experiência, com mais de doze anos usando e aprimorando uma metodologia em simulação cirúrgica laparoscópica. Temas de reflexão. Para transferir habilidades cirúrgicas para um aprendiz, baseamos nossa metodologia em uma estrutura de três pilares: o hardware e a infraestrutura (ferramentas para treinar), o programa de treinamento (o que fazer) e feedback (como melhorar). A implementação de um programa rentável é viável: o hardware não precisa ser de alta fidelidade para transferir as habilidades, mas o programa precisa ser validado. Esses pilares evoluíram ao longo do tempo incorporando a tecnologia: a presença de especialistas evoluiu para uma modalidade remota e assíncrona por meio da gravação em vídeo do desempenho do aluno e permitindo seu feedback. Quem dá feedback não precisa ser necessariamente um clínico especialista na área, mas sim uma pessoa previamente treinada como instrutor. Isso permite a prática deliberada até que a habilidade seja dominada e estabeleça curvas de aprendizado. Conclusões. Foram apresentadas recomendações baseadas na experiência do nosso centro, explicando o enquadramento da nossa estratégia. Levando em consideração essas sugestões, espera-se que nossa metodologia de simulação possa ajudar outros grupos e instituições a desenvolver e implementar programas eficazes baseados em simulação.

Background: This study aims to describe the training offered and the availability of professionals required by the Ministry of Health for mental health problems management in the community. Methods: A cross-sectional study was carried out on the training offered in mental health in Peruvian universities. A search for programs was conducted using the University Information System database and universities' websites, as well as using the Ministry of Health's database on health personnel and data on the number of enrolled and current students provided by the University Information System database and the Transparency section of the universities. Results: There were 214 undergraduate, 55 specialty and 7 subspecialty programmes, of which 39%, 47% and 100%, respectively, were offered in the capital city. The duration ranged from 5 to 7 years for undergraduate programs and from 1 to 3 years for subspecialty and second specialty programs. The cost of undergraduate programs ranged from free of charge up to USD 6863.75 for the first semester of study. Second specialty programs ranged from 720 up to 11 986 USD and subspecialty programs ranged from 2267 up to 9138 USD, with medicine being the most expensive. On the other hand, there are a greater number of psychology students (n = 78 781) pursuing undergraduate studies than working professionals (n = 5368), while in the second specialty of psychiatry there are far fewer students pursuing the specialty (n = 67) than working professionals (n = 454). Conclusions: The problem of professional training in mental health requires that the institutions involved in health and education develop policies to decentralize programs, communicate the demand for professionals in certain areas, make them accessible to the low-income population, respond to mental health problems and guarantee their quality. On the other hand, regarding the low number of mental health personnel working, it is suggested to increase the mental health budget to generate more mental health services and employment. [ABSTRACT FROM AUTHOR]

Background: Many GPs are challenged to deliver safe and effective care for patients who use alcohol and other drugs (AOD). The Royal Australian College of General Practitioners (RACGP) developed the AOD GP Education Programme to support Australian GPs and optimise AOD care in the community. How the programme impacted GP participants is not yet fully understood. Aim: To explore the views and experiences of GP participants who completed the AOD GP Education Programme, and AOD experts who were involved in the programme as a presenter or mentor. Design & setting: Situated in the constructivist paradigm, this qualitive descriptive study engaged GPs across Australia. Method: This study employed semi-structured, online, focus groups interviews. Data were analysed thematically. Results: Five focus groups were held with a total of 35 GP participants. Five themes developed, which illustrated that the study participants viewed the programme design as comprehensive and flexible. It has also been shown that participants' individual learning needs were addressed. Impacts of the programme on clinical practice included the following: confidence to care for patients who use AOD; confidence to collaborate with colleagues in delivery of AOD care; confidence to develop AOD professional networks in their community setting; and confidence to manage complex AOD presentations. Conclusion: Participants described the AOD programme as a high quality and positive educational experience. The prioritisation of core treatment skills (whole-person care and structured approaches to behavioural change) was a feature of the professional development programme. The AOD programme design is a practical model to implement for future AOD GP education and continuing professional development.

ABSTRACT Introduction: with the improvement and wide acceptance of laparoscopy in colorectal operations, there was a need for specific training of surgeons in training. There are few studies evaluating the postoperative results of laparoscopic colectomies performed by resident physicians and their impact on patient safety. Purpose: to analyze the surgical and oncological results of laparoscopic colectomies performed by coloproctology residents and compare them with data in the literature. Methods: this is a retrospective analysis of patients undergoing laparoscopic colorectal surgery performed by resident physicians at the Hospital das Clínicas de Ribeirão Preto, between 2014 and 2018. The clinical characteristics of the patients were studied, as well as the main surgical and oncological aspects in a period of one year. Results: we analyzed 191 operations, whose main surgical indication was adenocarcinoma, most of them stage III. The mean duration of surgeries was 210±58 minutes. There was a need for a stoma in 21.5% of the patients, mainly loop colostomy. The conversion rate was 23%, with 79.5% due to technical difficulties, and the main predictors of conversion were obesity and intraoperative accidents. The median length of stay was 6 days. Preoperative anemia was associated with a higher rate of complications (11.5%) and reoperations (12%). Surgical resection margins were compromised in 8.6% of cases. The one-year recurrence rate was 3.2% and the mortality rate was 6.3%. Conclusions: videolaparoscopic colorectal surgery performed by residents showed efficacy and safety similar to data found in the literature.

Introduction: Dropout rates are a constant concern for schools of medicine. Its study and solution are complex, it compromises the future of the student and affects the academic reputation of the program. Objective: Determine the dropout, graduation, and student lag rates of 40 cohorts of the Medicine Pro-gram of the Universidad Tecnológica de Pereira. Materials and methods: Descriptive observational study. Results: The average for inter-semester dropout rates for the Program (TDIP) and institution (TDI) were very similar: 4,1% and 4 %, respectively. The cumulative dropout rates of the Program (TDAP) and dropout per cohort (TDC) were similar (27%), with a tendency to decrease in the last decade and significantly less than that of some medicine programs in the country. The graduation rate (TGP) without delay was 66%. In the group of dropouts, men predominated (35,4% vs 29,5%, p = 0.001), without differences by social stratification or type of high school education institution. Conclusion: The data presented allow to establish comparisons with other programs in Colombia and around the world. Adjusted definitions of cumulative dropout and successful graduation are proposed, providing more accurate information and becoming an important input for academic planning and the design of policies and strategies towards early detection, comprehensive sup-port for vulnerable students, and successful graduation.

Objective: This study aimed to create and validate an instrument to measure pediatric residents’ knowledge about development and behavior. Methods: This was a longitudinal study with the consecutive application of questionnaires to validate an instrument of analysis. The modified Delphi technique was used for validation, which involved judges who were selected based on their expertise. Judges, who were renowned for their knowledge of the subject and willing to participate, were chosen from different states of Brazil. A convenience sample was obtained. The original questionnaire included 45 open questions divided into 13 relevant thematic axes on development and behavior. Results: After the third round using the Delphi technique, the whole questionnaire had a validity index of more than 80% on scope and relevance as well as all thematic axes, and the 44 final questions. Conclusions: The whole questionnaire was considered validated by the 14 expert judges who participated in the study. [ABSTRACT FROM AUTHOR]

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

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Copyright of Saúde e Sociedade is the property of Universidade de Sao Paulo, Faculdade de Saude Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The way in which the study activity is conceived, executed and controlled is decisive in the achievement of educational objectives, especially in integrated disciplines. In this article, its authors reflect on the gaps that hinder the structuring of independent work, in the subjects of the Biological Bases of Medicine discipline that most enable integration, and suggest a group of actions to take into account for its improvement. There are "understanding gaps" that affect the overall perspective and the common integrating logic necessary to establish the internal links between the contents and achieve an adequate structuring of this independent work, which can be improved if the systemic approach is taken into account. of the skills system and the delimitation of knowledge that allow the establishment of internal links in each subject, among other actions. [ABSTRACT FROM AUTHOR]

Copyright of CES Medicina is the property of Universidad CES and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Surgical complications are preventable in up to 50% of cases, actually are various tools to avoid them, one of these are morbidity and mortality conferences. However, there are no guides that define their structure for them to be effective. Objective; Analyze the impact of a new modality of surgical conferences in a sector of benign biliary pathology, called quality evaluation conferences. Methodology: Descriptive observational study where the overall improvement of the sector, the decrease in complications and the quality of patient care are compared. For 6 months, a weekly quality evaluation conference was carried out. It had 5 stages; 1. Analysis of all discharged patients. 2. Review of adverse events. 3. Review of the list and order of patients in the surgical plan. 4. Reproduction of recorded surgeries and review of scientific articles. 5. Review of own scientific works in development., Results: after implementing the conferences, there was a decrease in the number and severity of complications, as well as an improvement in the correct and timely surgical indication. Conclusion; Quality evaluation workshops as an evolution of morbidity and mortality workshops are a novel tool that, when well implemented, can help improve quality standards and in turn be used as a learning option in training centers., (Universidad Nacional de Córdoba)

Resumen: Introducción: Las redes sociales (RS), como plataformas tecnológicas, les permiten a las personas y a las instituciones interactuar, compartir contenidos y formar comunidades. Objetivo: Reconocer cómo docentes de la Facultad de Medicina de la Universidad Pontificia Bolivariana perciben el uso de las RS en las circunstancias impuestas por la pandemia de la COVID-19. Métodos: Investigación cualitativa con enfoque desde la etnometodología; se aplicó un cuestionario con preguntas abiertas a 24 participantes docentes con más de 3 años de labores en la facultad y que, previo al aislamiento social impuesto por la COVID-19, hicieran uso de las RS. El análisis se hizo mediante la comparación entre los datos. Resultados: La pandemia favoreció la generalización del uso de las RS especializadas en las comunidades académicas, la continuidad de las actividades lectivas, el ahorro de tiempo en los desplazamientos, el aumento de las asesorías a los estudiantes y el acceso inmediato y permanente a los contenidos educativos. A su vez, esta contingencia, la pérdida en la comunicación no verbal y, en lo referente a la educación médica, la imposibilidad de remplazar en las prácticas clínicas el encuentro presencial de la tríada docente-estudiante-paciente. Conclusiones: La pandemia de la COVID-19 trajo consigo la apropiación por los docentes de las RS especializadas y con esto dar continuidad a las actividades lectivas; se evidenció el apoyo de estas redes al proceso educativo sin considerarlas sustitutas de la presencialidad. Abstract: Introduction: Social media (SM), as technological platforms, allow people and institutions to interact, share content and form communities. Objective: To recognize how teachers of the Faculty of Medicine of the UPB perceive the use of SM under the circumstances imposed by the COVID 19 pandemic. Methods: A qualitative research with an ethnomethodology approach was used; A questionnaire with open questions was applied to 24 teaching participants with more than 3 years of work at the faculty and who, prior to the social isolation imposed by COVID19, made use of SM. The analysis was done by comparing the data. Results: The pandemic favored the generalization of the use of specialized SM in academic communities, the continuity of teaching activities, time savings on travel, increased counseling for students and immediate and permanent access to educational content. In turn, this contingency showed the loss of non-verbal communication and, with regard to medical education, the impossibility of replacing the clinical practice and the interaction between Medical teacher – student-patient. Conclusions: The COVID-19 pandemic brought with it the appropriation by teachers of specialized SM and with this give continuity to the teaching activities; The support of these networks to the educational process was evidenced without considering them as substitutes for face-to-face presence.

Resumen: Introducción: el aula invertida es una nueva estrategia de la tecnología educativa, basada en un enfoque constructivista que promueve la participación activa del estudiante. El objetivo del estudio fue analizar los indicadores bibliométricos de la producción científica sobre el aula invertida en la educación médica. Métodos: estudio descriptivo y retrospectivo de tipo bibliométrico, basado en las publicaciones científicas de las revistas indexadas en Scopus desde el 2012 hasta el 2021. Se elaboró una estrategia de búsqueda con términos MESH y operadores booleanos («AND» y «OR»). Las métricas de la bibliometría se realizaron con el programa SciVal de Elsevier. Resultados: el 41,8 y 28,3% de las publicaciones fueron en revistas del cuartil Q1 y Q2, respectivamente. Además, la Universidad de Harvard es la que tiene más publicaciones (15), pero la Universidad del Norte de Carolina es la de mayor impacto (54,7 citas por publicación). La revista Academic Medicine (Q1) y Academic Radiology (Q1) presentaron más citas por publicación, con 79,9 y 42,2, respectivamente. El 35,3% de las publicaciones tiene colaboración nacional y 13,4% de tipo internacional. El autor Zheng Binbin (FWCI: 4,64) es el que tiene mayor número de citas esperadas respecto a la media mundial. Conclusiones: existe una tendencia favorable en el número de publicaciones con mayor énfasis en las revistas de alto impacto (Q1 y Q2). Los autores e instituciones con más producción fueron los de Estados Unidos y el tipo de colaboración más frecuente fue la institucional. Abstract: Background: The flipped classroom is a new educational technology strategy, based on a constructivist approach that promotes active student participation. Therefore, the objective of the study was to analyze the bibliometric indicators of the scientific production on the flipped classroom in medical education. Method: Descriptive and retrospective bibliometric study, based on the scientific publications of journals indexed in Scopus from 2012 to 2021. A search strategy was developed with MESH terms and Boolean operators (“AND” and “OR”). The bibliometric metrics were performed with Elsevier's SciVal program. Results: 41.8% and 28.3% of the publications were in Q1 and Q2 quartile journals, respectively. In addition, Harvard University is the one with the most publications (15), but the University of North Carolina has the greatest impact (54.7 citations per publication). The journal Academic Medicine (Q1) and Academic Radiology (Q1) presented more citations per publication, with 79.9 and 42.2, respectively. 35.3% of the publications have national collaboration and 13.4% international. The author Zheng Binbin (FWCI: 4.64) is the one with the highest number of expected citations compared to the world average. Conclusions: There is a favorable trend in the number of publications with greater emphasis on high impact journals (Q1 and Q2). The authors and institutions with the most production were those from the United States and the most frequent type of collaboration was institutional.

RESUMEN Introducción. La pandemia del SARS-CoV-2 se empezó a reportar desde diciembre de 2019 en la localidad de Wuhan, China, luego se presentaron miles de casos en el mundo. Dentro de las medidas adoptadas a nivel mundial en todos los aspectos, se encuentra el distanciamiento social, lo que ha conllevado al cierre de distintos sectores de la economía; entre ellos la educación superior. La educación médica sufre un cambio repentino al suspender las clases presenciales y los campos de práctica; de este modo, se tuvo que afrontar distintos cambios e innovaciones en sus procesos educativos. El objetivo de este trabajo es realizar una revisión sobre las modalidades implementadas y reportadas en la literatura mundial durante la pandemia en las facultades de medicina. Temas a tratar. Educación médica durante pandemia, facultades de medicina, educación virtual, medidas de educación médica durante tiempos de pandemia, experiencias en educación médica previas a la pandemia, educación a distancia y presencialidad asistida por tecnología, plataformas digitales en el proceso de enseñanza, situación futura e interrogantes. Conclusiones. La implementación de la tecnología en la educación médica de una manera única permitirá a los estudiantes desarrollar habilidades de colaboración y mejorar la adaptabilidad. Es todo un reto la educación médica frente a la pandemia de SARS-CoV-2. Cómo citar: Zuluaga-Gómez M.Valencia-Ortiz NL. Educación en facultades de medicina del mundo durante el periodo de contingencia por SARS-COV-2. MedUNAB. 2021;24(1): 92-99. doi: https://doi.org/10.29375/01237047.3942 Palabras claves: Síndrome de Dificultad Respiratoria del Adulto; Infecciones por coronavirus; Pandemias; Educación Superior; Facultades de Medicina; Educación Médica; Educación a Distancia. ABSTRACT Introduction. The SARS-CoV-2 pandemic started being reported in December 2019 in the locality of Wuhan, China. Subsequently, thousands of cases arose around the world. Among the measures adopted worldwide in all aspects is social distancing, which has led to closure of various sectors of the economy, among which is higher education. Medical education experienced a sudden change when on-site classes and fields of practice were suspended. In this way, people had to face different changes and innovations in their educational processes. The objective of this study is to review the implemented and reported modalities in the global literature of faculties of medicine during the pandemic. Areas to be Addressed. Medical education during the pandemic, faculties of medicine, virtual education, medical education measures during the pandemic, experiences in medical education prior to the pandemic, e-learning and on-site education assisted by technology, digital platforms in the teaching process, future situations and questions. Conclusions. Uniquely implementing technology in medical education will allow students to develop collaborative skills and improve their adaptability. This is a challenge to medical education during the SARS-CoV-2 pandemic. Cómo citar: Zuluaga-Gómez M.Valencia-Ortiz NL. Educación en facultades de medicina del mundo durante el periodo de contingencia por SARS-COV-2. MedUNAB. 2021;24(1): 92-99. doi: https://doi.org/10.29375/01237047.3942 Keywords: Respiratory Distress Syndrome, Adult; Coronavirus Infections; Pandemics; Education, Higher; Schools, Medical; Education, Medical; Education, Distance. RESUMO Introdução. A pandemia SARS-CoV-2 começou a ser relatada em dezembro de 2019 na cidade de Wuhan, China, depois milhares de casos foram notificados em todo o mundo. Entre as medidas adotadas mundialmente em todos os aspectos, está o distanciamento social, que tem levado ao fechamento de diversos setores da economia, entre eles, o ensino superior. Aeducação médica sofreu uma mudança repentina com a suspensão de aulas presenciais e dos campos de prática; dessa forma, diferentes mudanças e inovações tiveram de ser enfrentadas em seus processos educacionais. O objetivo deste trabalho é realizar uma revisão sobre as modalidades implementadas e relatadas na literatura mundial durante a pandemia nas faculdades de medicina. Tópicos a abordar. Educação médica durante a pandemia, faculdades de medicina, educação virtual, medidas de educação médica em tempos de pandemia, experiências na educação médica antes da pandemia, educação a distância e educação presencial assistida por tecnologia, plataformas digitais no processo de ensino, situação futura e questões. Conclusões. A implementação da tecnologia na educação médica de uma maneira única permitirá que os alunos desenvolvam habilidades colaborativas e melhorem a adaptabilidade. A educação médica face à pandemia da SARS-CoV-2 é um grande desafio. Cómo citar: Zuluaga-Gómez M.Valencia-Ortiz NL. Educación en facultades de medicina del mundo durante el periodo de contingencia por SARS-COV-2. MedUNAB. 2021;24(1): 92-99. doi: https://doi.org/10.29375/01237047.3942 Palavras-chave: Síndrome do Desconforto Respiratório do Adulto; Infecções por Coronavírus; Pandemias; Educação Superior; Faculdades de Medicina; Educação Médica; Educação a Distância.

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Continuing professional development (CPD) is essential for physicians to maintain and enhance their knowledge, competence, skills, and performance. Web-based CPD plays an essential role. However, validated theory–informed measures of their impact are lacking. The CPD-REACTION questionnaire is a validated theory–informed tool that evaluates the impact of CPD activities on clinicians’ behavioral intentions. Objective: We aimed to review the use of the CPD-REACTION questionnaire, which measures the impact of CPD activities on health professionals’ intentions to change clinical behavior. We examined CPD activity characteristics, ranges of intention, mean scores, score distributions, and psychometric properties. Methods: We conducted a systematic review informed by the Cochrane review methodology. We searched 8 databases from January 1, 2014, to April 20, 2021. Gray literature was identified using Google Scholar and Research Gate. Eligibility criteria included all health care professionals, any study design, and participants’ completion of the CPD-REACTION questionnaire either before, after, or before and after a CPD activity. Study selection, data extraction, and study quality evaluation were independently performed by 2 reviewers. We extracted data on characteristics of studies, the CPD activity (eg, targeted clinical behavior and format), and CPD-REACTION use. We used the Mixed Methods Appraisal Tool to evaluate the methodological quality of the studies. Data extracted were analyzed using descriptive statistics and the Student t test (2-tailed) for bivariate analysis. The results are presented as a narrative synthesis reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Overall, 65 citations were eligible and referred to 52 primary studies. The number of primary studies reporting the use of CPD-REACTION has increased continuously since 2014 from 1 to 16 publications per year (2021). It is available in English, French, Spanish, and Dutch. Most of the studies were conducted in Canada (30/52, 58%). Furthermore, 40 different clinicalbehaviors were identified. The most common CPD format was e-learning (34/52, 65%). The original version of the CPD-REACTION questionnaire was used in 31 of 52 studies, and an adapted version in 18 of 52 studies. In addition, 31% (16/52) of the studies measured both the pre- and postintervention scores. In 22 studies, CPD providers were university-based. Most studies targeted interprofessional groups of health professionals (31/52, 60%). Conclusions: The use of CPD-REACTION has increased rapidly and across a wide range of clinical behaviors and formats, including a web-based format. Further research should investigate the most effective way to adapt the CPD-REACTION questionnaire to a variety of clinical behaviors and contexts. Trial Registration: PROSPERO CRD42018116492; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=116492 [ABSTRACT FROM AUTHOR]

Assessment, in higher education in health, in view of the changes in educational strategies that have been implemented in undergraduate health courses, encompass a variety of forms and instruments both from a qualitative and quantitative point of view, with a view to the development maximum of human learning. Thus, the research question was What are the social representations of teachers and students about the evaluation for the development of professional competence in the training of nurses and doctors carried out through Format 5 and what suggestions to improve its use? Objective: to analyze the social representation of professors and students of Nursing and Medicine courses on the evaluation for the development of professional competence, through Format 5 and to describe the suggestions for improvements on its use. Method: This is a Qualitative Research based on the Theory of Social Representations developed in a college in the interior of São Paulo. 14 professors and 60 students participated, 40 from the Medicine Course and 20 from the Nursing Course, all from the second grade, through a semi-structured interview with two open questions: What is your opinion about the evaluation format of the Educational Unit - F5 adopted in this school? Would you have suggestions for adequacy and improvements in the Formats. The data obtained were organized using the Collective Subject Discourse technique. Results: The organization of the results revealed four central ideas, three of which are equivalent to question 1 and one to question 2, respectively: Importance of Format 5; Formative assessment in the curricular proposal; Feedback via Format 5; Suggestions on the content, use and structure of the Format, presented followed by their speeches. Conclusions: The results obtained emphasized the importance of evaluation for the development of teaching and learning, the relevance of the evaluation format and the indicators of improvement of the evaluation process. [ABSTRACT FROM AUTHOR]

Introduction: ultrasound is one of the most important imaging techniques in medicine with unique advantages: portable, low cost and provides real-time imaging. Objective and Methods: The objective was to evaluate the perception of medical students about the implementation of ultrasound in the medical course through the application of a questionnaire, based on the Likert Scale, containing twelve questions about the course involving topics such as workload and clinical applicability of the information learned with descriptive analysis of the data. Results and Discussion: There is a perception of the need for a longitudinal ultrasound curriculum and the authors suggest, as a first step of this process, the association between Anatomy and Radiology and Imaging Diagnosis with other insertions in Semiology and clinical surgical disciplines with a more robust ultrasound course in later stages of graduation. [ABSTRACT FROM AUTHOR]

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Copyright of International Journal of Education & Health (IJEH) / Revista Internacional de Educação e Saúde is the property of Revista Internacional de Educacao e Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Moral distress is a reason for burnout in healthcare professionals, but the clinical settings in which moral distress is most often experienced by medical students, and whether moral distress is associated with burnout and career choices in medical students is unknown. We assessed moral distress in medical students while caring for older patients, and examined associations with burnout and interest in geriatrics. Methods A cross-sectional survey study of second-, third-, and fourth-year medical students at an American medical school. The survey described 12 potentially morally distressing clinical scenarios involving older adult patients. Students reported if they encountered each scenario, and whether they experienced moral distress, graded on a 1–10 scale. We conducted a principal axis factor analysis to assess the dimensionality of the survey scenarios. A composite moral distress score was calculated as the sum of moral distress scores across all 12 scenarios. Burnout was assessed using the Maslach Abbreviated Burnout Inventory, and interest in geriatrics was rated on a 7-point Likert scale. Results Two-hundred and nine students responded (47%), of whom 90% (188/209) reported moral distress in response to ≥1 scenario with a median (IQR) score of 6 (4–7). Factor analysis suggested a unidimensional factor structure of the 12 survey questions that reliably measured individual distress (Cronbach alpha = 0.78). Those in the highest tertile of composite moral distress scores were more likely to be burnt out (51%) than those in the middle tertile of scores (34%), or lowest tertile of scores (31%) (p = 0.02). There was a trend towards greater interest in geriatrics among those in the higher tertiles of composite moral distress scores (16% lowest tertile, 20% middle tertile, 25% highest tertile, p-for-tend = 0.21). Respondents suggested that moral distress might be mitigated with didactic sessions in inpatient geriatric care, and debriefing sessions with peers and faculty on the inpatient clerkships on medicine, neurology, and surgery, where students most often reported experiencing moral distress. Conclusions Moral distress is highly prevalent among medical students while caring for older patients, and associated with burnout. Incorporating geriatrics education and debriefing sessions into inpatient clerkships could alleviate medical student moral distress and burnout.

Abstract Background The objective of the present study was to describe the knowledge regarding the antibiotic therapy of students of three medical schools in Medellín, Colombia. Methods The study population comprised medical students who were enrolled in three universities. The instrument contained questions regarding their current academic term, the university, the perceived quality of the education received on antibiotic therapy and bacterial resistance, and specific questions on upper respiratory tract infections, pneumonia, urinary tract infections, and skin and soft tissue infections. The information was analyzed by calculating frequencies and measures of dispersion and central tendency. Knowledge regarding the treatment for each type of infection was compared using the Mann–Whitney U test and the Kruskal–Wallis H test. Results We included 536 medical students, of which 43.5% students consider that the university has not sufficiently trained them to interpret antibiograms and 29.6% students consider that the quality of information received on the subject at their university ranges from regular to poor. The mean score for knowledge regarding antibiotic therapy for upper respiratory tract infections was 44.2 (9.9) on a scale from 0 to 100. The median score with regard to the treatment of pneumonia was 52.9 (14.7), that of urinary tract infection was 58.7 (14.8), and that of skin and soft tissue infections was 63.1 (19.4). The knowledge regarding antibiotic therapy for upper respiratory tract infections, pneumonia, and urinary tract infection does not improve with the academic term, the university, or perceived quality of the education received. Conclusion A large proportion of medical students perceive that the training received from the university is insufficient with regard to antibiotic use and bacterial resistance, which is consistent with the limited knowledge reflected in the selection of antibiotic treatment for respiratory, urinary tract, and skin and soft tissue infections. Overall, the situation was identical among all universities, and it did not significantly increase with the completion of an academic term.

Health is a state of complete well-being, where biological, sociocultural and psychosocial factors interact with each other; gender is one of them. Nowadays, it has been proven that differences between sexes and genders have effects on many diseases; these differences are not usually addressed in medical education. Some of the main consequences are the inadequate attention of patients and the existence of various types of discrimination within medical education. The following review will examine how the absence of gender perspective in health education has effects on female patients and medical students, and on LGBT+ patients and medical students. In conclusion, there have been improvements, both in the attention of patients as well as in medical education, but the efforts on the subject must continue, especially in initial training of medical professionals.

Objective: To evaluate the efficacy of an educational intervention (escape room) in the acquisition and retention of knowledge in relation to the Infarction Code, and to compare the knowledge of other teaching methodologies related to the Infarction Code., Methods: A pre-post study was designed without a control group. After one month of the master class on the Infarction Code given to master's degree (doctors and nurses), an educational intervention was carried out consisting of an Escape Room on the same content, with a questionnaire that collected various sociodemographic data, and a knowledge test on the Infarction Code, which was repeated immediately after the activity and at the end of 2 months after the activity, and a test of knowledge on the Infarction Code. immediately after the activity and 2 months after the master class. Likewise, after the activity, a gamified experience evaluation questionnaire (GAMEX) was completed., Results: Thirty-two students received the educational intervention (12 physicians and 20 nurses), and differences were observed between medical and nursing professionals in terms of initial knowledge of simulation and gamification. After the activity, and based on the initial knowledge test, the score increased by 3.49 points, an increase that was also reflected in the test taken two months after the master class, where an increase of 2.08 points was maintained. The participants rated the experience positively, with no significant overall differences between the two professional groups., Conclusions: The nurses had greater knowledge and contact with clinical simulation, virtual reality and gamification. The escape room showed to be a valid method for the assimilation and retention of knowledge in master's degree students. Medical professionals experienced a greater degree of immersion in the activity., (Copyright © 2024. Published by Elsevier España S.L.U.)

Objective: the aim of this study was to investigate possible associations between Burnout, use of hypnotics and sleep quality among medical students. Method: a cross-sectional quantitative study was conducted among medical students of a university center of northeastern Brazil, with the problembased learning (PBL) methodology. The Maslach Burnout Inventory-Student Survey, the Pittsburgh Sleep Quality Index (PSQI) and a sociodemographic questionnaire were applied among pre-clerkship students of the course. Results: the study included 523 students and found 48 (9.2%) with tridimensional diagnosis criteria for Burnout syndrome (BS). Poor sleep quality and use of hypnotic drugs for sleep were associated with BS (p < 0.001 and p = 0.003, respectively). There were no statistical differences in age, gender, religion, marital status, student financing and performing paid work, between individuals with and without BS. Conclusion: there was an association between BS, use of hypnotics and poor sleep quality among pre-clerkship medical students. [ABSTRACT FROM AUTHOR]

The aim of this article is to reflect on the contextual factors that influence medical education, in order to provide some recommendations about the challenges that physicians face. A literature review was conducted to write this reflection paper, and it was found that the education of health professionals has undergone significant changes that are based on the development of biomedical sciences, technology, and pedagogy, and are influenced by the needs of the general population, the requirements of the health systems of each country, and scientific progress. These changes have given rise to challenges inherent to the special characteristics of each country and related to the quantity, quality, and relevance of the training of physicians. In this regard, it has been suggested that, in the face of such changes, it is necessary to design curricula that integrate all aspects of health care, consider the supply and demand of medical services, emphasize professionalism, take into account the pedagogical training of health sciences teachers, comply with quality standards, assist students in selecting undergraduate programs adequately (in this case Medicine), and ensure relevant clinical practice scenarios. It should also be noted that medical education has not adapted adequately to the aforementioned changes in many countries and, therefore, the development of teaching and learning strategies has lagged behind and physicians in such countries do not have the capacity to provide the health care required by the general population in a proper manner.

Despite recognised benefits of Simulation-Based Education (SBE) in healthcare, specific adaptations required within psychiatry have slowed its adoption. This article aims to discuss conceptual and practical features of SBE in psychiatry that may support or limit its development, so as to encourage clinicians and educators to consider the implementation of SBE in their practice. SBE took off with the aviation industry and has been steadily adopted in clinical education, alongside role play and patient educators, across many medical specialities. Concurrently, healthcare has shifted towards patient-centred approaches and clinical education has recognised the importance of reflective learning and teaching centred on learners' experiences. SBE is particularly well-suited to promoting a holistic approach to care, reflective learning, emotional awareness in interactions and learning, cognitive reframing, and co-construction of knowledge. These features present an opportunity to enhance education throughout the healthcare workforce, and align particularly well to psychiatric education, where interpersonal and relational dimensions are at the core of clinical skills. Additionally, SBE provides a strategic opportunity for people with lived experience of mental disorders to be directly involved in clinical education. However, tenacious controversies have questioned the adequacy of SBE in the psychiatric field, possibly limiting its adoption. The ability of simulated patients (SPs) to portray complex and contradictory cognitive, psychological and emotional states has been questioned. The validity of SBE to develop a genuine empathetic understanding of patients, to facilitate a comprehensive multiaxial diagnostic formulation, or to develop flexible interpersonal skills has been criticised. Finally, SBE's relevance to developing complex psychotherapeutic skills is much debated, while issues such as symptom induction in SPs or patients involvement raise ethical dilemmas. These controversies can be addressed through adequate evidence, robust learning design, and high standards of practice. Well-designed simulated scenarios can promote a positive consideration of mental disorders and complex clinical skills. Shared guidelines and scenario libraries for simulation can be developed, with expert psychiatrists, patients and students involvement, to offer SPs and educators a solid foundation to develop training. Beyond scenario design, the nuances and complexities in mental healthcare are also duly acknowledged during the debriefing phases, providing a crucial opportunity to reflect on complex interpersonal skills or the role of emotions in clinicians' behaviour. Considered recruitment and support of SPs by clinical educators can help to maintain psychological safety and manage ethical issues. The holistic and reflexive nature of SBE aligns to the rich humanistic tradition nurtured within psychiatry and medicine, presenting the opportunity to expand the use of SBE to support a range of clinical skills and workforce competencies required in psychiatry.

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Despite recognised benefits of Simulation-Based Education (SBE) in healthcare, specific adaptations required within psychiatry have slowed its adoption. This article aims to discuss conceptual and practical features of SBE in psychiatry that may support or limit its development, so as to encourage clinicians and educators to consider the implementation of SBE in their practice. SBE took off with the aviation industry and has been steadily adopted in clinical education, alongside role play and patient educators, across many medical specialities. Concurrently, healthcare has shifted towards patient-centred approaches and clinical education has recognised the importance of reflective learning and teaching centred on learners' experiences. SBE is particularly well-suited to promoting a holistic approach to care, reflective learning, emotional awareness in interactions and learning, cognitive reframing, and co-construction of knowledge. These features present an opportunity to enhance education throughout the healthcare workforce, and align particularly well to psychiatric education, where interpersonal and relational dimensions are at the core of clinical skills. Additionally, SBE provides a strategic opportunity for people with lived experience of mental disorders to be directly involved in clinical education. However, tenacious controversies have questioned the adequacy of SBE in the psychiatric field, possibly limiting its adoption. The ability of simulated patients (SPs) to portray complex and contradictory cognitive, psychological and emotional states has been questioned. The validity of SBE to develop a genuine empathetic understanding of patients, to facilitate a comprehensive multiaxial diagnostic formulation, or to develop flexible interpersonal skills has been criticised. Finally, SBE's relevance to developing complex psychotherapeutic skills is much debated, while issues such as symptom induction in SPs or patients involvement raise ethical dilemmas. These controversies can be addressed through adequate evidence, robust learning design, and high standards of practice. Well-designed simulated scenarios can promote a positive consideration of mental disorders and complex clinical skills. Shared guidelines and scenario libraries for simulation can be developed, with expert psychiatrists, patients and students involvement, to offer SPs and educators a solid foundation to develop training. Beyond scenario design, the nuances and complexities in mental healthcare are also duly acknowledged during the debriefing phases, providing a crucial opportunity to reflect on complex interpersonal skills or the role of emotions in clinicians' behaviour. Considered recruitment and support of SPs by clinical educators can help to maintain psychological safety and manage ethical issues. The holistic and reflexive nature of SBE aligns to the rich humanistic tradition nurtured within psychiatry and medicine, presenting the opportunity to expand the use of SBE to support a range of clinical skills and workforce competencies required in psychiatry. [ABSTRACT FROM AUTHOR]

Competency-based medical education (CBME) is currently the most common type of curriculum used worldwide. However, its limitations include fragmented learning and difficulties to use properly the knowledge, skills, and attitudes acquired using this educational model. Having this in mind, Entrustable Professional Activities (EPA) emerge as a tool to mediate the transfer of the competency-based curriculum into physicians’ professional practice in graduate medical education. Therefore, based on a narrative review of the existing literature on EPA and the authors’ experience in teaching community-based health care integration services, the aim of this paper is to reflect on the possible use of these activities in undergraduate medical education for the development of a CBME model integrated with primary health care and community medicine. The reflections presented here allow suggesting that, although it is a challenging process, incorporating EPA into undergraduate medical education is appropriate to improve the provision of primary health care to individuals, families, and communities in general.