A COVID-19 tornou-se a principal hipótese diagnóstica em muitas consultas. Este caso enaltece a necessidade de manter a abordagem holística, característica da Medicina Geral e Familiar. Mulher de 43 anos, com antecedentes de perturbação de ajustamento, fibromialgia e miomas uterinos, habitualmente medicada com: duloxetina; lorazepam; desogestrel. Foi avaliada numa “ADR-Comunidade” por cefaleias, náuseas, disgeusia, odinofagia, tosse, dispneia, mialgias e astenia, sem febre. Foi-lhe prescrito teste para COVID-19 e aconselhadoisolamento. Foi contactada no âmbito do “Trace COVID-19®”, constatando-se esquecimentos na toma do anticoncecional e amenorreia. Equacionou-se uma gravidez, negada pela utente. O teste para COVID-19 deu negativo, todavia, houve agravamento sintomático que motivou referenciação à urgência, onde se diagnosticou uma gravidez de 11 semanas. A COVID-19 mimetiza várias situações clínicas. A desvalorização da amenorreia e a abordagem direcionada na ADR conduziram ao atraso diagnóstico, impossibilitando a interrupção voluntária da gravidez perante uma gravidez não-desejada.
Background
Arts-based pedagogical tools have been increasingly incorporated into medical education. Visual Thinking Strategies (VTS) is a research-based, constructivist teaching methodology that aims to improve visual literacy, critical thinking, and communication skills through the process of investigating works of art. Harvard Medical School pioneered the application of VTS within medical education in 2004. While there are several studies investigating the use of VTS, there is a need to systematically assess the different programs that exist for medical education and their efficacy in improving relevant clinical skills. This systematic review aims to critically analyse the available evidence of the effectiveness of VTS in medical education to guide future research and provide a framework to adapt medical curricula.
Methods
A systematic search of PubMed, PsycINFO, and Cochrane CENTRAL databases (through November 2022) was conducted to identify studies of VTS-based interventions in undergraduate and postgraduate medical education. Two reviewers independently screened citations for inclusion criteria, extracted data, and assessed risk of bias. The extracted data was then narratively synthesized.
Results
Of 5759 unique citations, 10 studies met the inclusion criteria. After reference review, one additional study was included. Therefore, 11 studies were included in our review. Of these, eight reported VTS-based interventions for undergraduate medical students and three reported interventions in residency training, specifically in dermatology and ophthalmology. The main goal of most studies was to increase observational or visual diagnostic skills. Three of the studies in undergraduate medical education and two in postgraduate achieved a statistically significant improvement in observational skills in post-course evaluations. Some studies reported increased tolerance for ambiguity and empathy.
Conclusions
Although the studies varied considerably in study design, learning objectives, and outcomes, findings consistently indicate that the VTS approach can serve as a vehicle to develop crucial clinical competencies, encouraging more in-depth visual analysis that could be applied when observing a patient. Despite some limitations of the included studies (lack of control groups, self-selection bias, or non-standard outcome measures), the results of this review provide support for greater inclusion of VTS training in the medical curriculum.
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