Introduction: The educational environment (EE) of medical education is the set of factors of a material and affective nature that permeates the tripod formed by the educational institution, by the teacher and by the student. A healthy environment results in quality learning and, consequently, a professional with a higher level of competence and satisfaction. Objectives: To analyze the educational environment of a medical school public university in Brazil in the view of its students and to investigate the presence of association between the sociodemographic variables of the students and their perceptions about the EE. Methods: A cross-sectional observational study with medical students from four different periods of the course, using the questionnaire DREEM and a sociodemographic questionnaire. Results: 210 students participated. Although DREEM's overall score shows that students have a more positive rather than negative view of EE in general, there was a large discrepancy in results among the groups surveyed, indicating that the more students progress in the medical course, the more negative your view on the educational environment. The perception about the general teaching environment and social relations was negative in the four groups. Female students, white, and those who lived outside Rio de Janeiro before attending in medical school perceived EE more negatively. The perception of EE by students who entered the system of racial or social quotas and those who did not join the quota system was similar. Conclusion: the analysis of the educational environment the students' dissatisfaction with the traditional Flexnerian models. Low-income, self-declared non-white and female students experience more problems and negative
Objetivo: Conhecer a percepção de estudantes de Medicina sobre o que é ser médico no Brasil. Método: Estudo qualitativo por meio de entrevista semiestruturada com estudantes dos ciclos básico, clínico e internato de uma instituição pública de ensino. O roteiro de entrevista respondido por escrito continha dados sociodemográficos e pergunta aberta sobre o que é ser médico, hoje, no Brasil. Foi realizada análise de conteúdo dos dados textuais, com apoio do software webQDA. Resultados: Participaram 210 estudantes, 107 do sexo feminino e 103 do sexo masculino, sendo 70 do ciclo básico (primeiro período), 83 do ciclo clínico (quarto e nono períodos) e 42 do internato (décimo segundo período). Os dados textuais deram origem a três categorias: concepção do que é ser médico; desafios da prática médica; e sofrimento procedente do aprendizado e exercício da Medicina. Em cada categoria foram observadas diferenças nas percepções dos estudantes à medida que avançam no curso. A concepção do que é ser médico no ciclo básico se aproxima do perfil do egresso preconizado pelas Diretrizes Curriculares Nacionais e vai se afastando dela nos períodos mais avançados, assim como evidenciam maiores desafios nos últimos anos e quanto mais adiantado o período, mais frequentemente externado o sofrimento inerente ao ambiente educacional e ao exercício da medicina. Conclusões: A percepção dos pesquisados evidencia a desilusão em relação ao que é ser médico hoje no Brasil e o desafio do exercício da profissão de acordo com o perfil do egresso preconizado nas Diretrizes Curriculares Nacionais devido às barreiras enfrentadas.
Resumo: Introdução: A construção da identidade médica (IM) é fenômeno dinâmico influenciado por fatores relacionados ao estudante, ao ambiente educacional e à sociedade. Objetivo: Este estudo teve como objetivo sintetizar o conhecimento produzido a respeito dos aspectos referentes ao estudante na construção da IM. Método: Trata-se de uma revisão integrativa de estudos empíricos publicados em periódicos indexados na MEDLINE e LILACS, utilizando a expressão medical identity e os descritores identity crisis, social identification, physician’s role e professional role. Os critérios de inclusão foram: textos completos disponíveis em português, espanhol, francês ou inglês de estudos empíricos sobre fatores que influenciam na formação da IM com foco nos aspectos relacionados ao estudante e tendo médicos ou estudantes de graduação em Medicina como participantes. Resultado: Na primeira etapa, identificaram-se 1.365 artigos. Foram triados 194 artigos para leitura em profundidade. Destes, incluíram-se 18 para análise temática com classificação em categorias em diálogo com a literatura, tendo como base o conceito de IM saudável. A maioria dos artigos foi publicada na última década. Identificaram-se três categorias: expectativa versus realidade, referente ao que o estudante pensa sobre o que um médico é ou deveria ser; médico “super-herói”, relativa à percepção caricaturada da medicina criada pelos próprios alunos e oferecida pela sociedade por meio de programas, séries e filmes televisivos; e modelagem de papéis, que diz respeito à importância da experiência prática do estudante supervisionada por um preceptor ou docente. A IM construída ao longo do curso médico influencia na forma como a medicina é exercida e, quando ela não é congruente com a realidade que o recém-formado encontra, provoca sofrimento no médico e interfere na atuação profissional dele. Conclusão: Instituições de ensino, professores e preceptores devem estar atentos às expectativas e às idealizações de seus alunos sobre o que é ser um médico e o papel desse profissional na sociedade, de maneira a promover intervenções que auxiliem em uma construção identitária mais saudável e mais resiliente às intempéries peculiares à profissão médica.
Background: In 1912 the Hahnemann Medical Faculty to graduate homeopathic physicians was created. This was one of the courses that originated the present Federal University of the State of Rio de Janeiro – UNIRIO. Homeopathy in UNIRIO was consolidated during the 80s and 90s through the relationship with other specialties. In 1999, the interface of Homeopathy and the curriculum guidelines of the Brazilian Ministry of Education justified the inclusion of Homeopathy as a compulsory subject in the medical course at UNIRIO. In 2001 a University program to improve the development of research called “Homeopathy - Health and Quality of Lifeâ€ÂÂ, was created to integrate the activities of Teaching, Research and Extension. Aim: To evaluate the relevance of the compulsory teaching of Homeopathy in the medical area at the Federal University of the State of Rio de Janeiro – UNIRIO, Brazil. Methods: A prospective longitudinal qualitative and quantitative research was used with semi-structured questionnaires with open and closed questions at the beginning and end of each semester. Undergraduate students from the third year of the UNIRIO Medical Faculty (2008/March till 2009/September) who accepted the “Consent Formâ€ÂÂ, were included. Students who didn't respond adequately to the questions were excluded. This research was approved and registered at the Brazilian Research Ethics Center. Microsoft Office Excel 2007 used to data collection and analysis. Results: Total number of students attending the course during the four semesters: 304. 70% answered the questionnaires. 60% of the students had heard of homeopathy before attending the homeopathy course (67% as patients, 21% as patients and through media, 6% through media and 6% by other means of contact). 86% consider that homeopathy brought new knowledge to the medical and academic training. 72% consider that this knowledge could be applicable to their future career. Conclusion: Most students aim to learn the guiding principles of homeopathy. Their aim is to know all available treatment, modalities and alternatives to allopathy in medical education. They considered that the learning of Homeopathy is a part of general medical training due to the fact that it has been a recognized medical specialty in Brazil since 1980. The student’s opportunity to learn homeopathy during the undergraduate course in medical schools widens the individuality concept, “the doctor-patient relationship and the holistic vision of the patientâ€ÂÂ. These results demonstrate the relevance of teaching homeopathy in the medical curriculum and the need to spread the teaching of homeopathy as a compulsory course for all other medical universities.
Introduction: The Medical Identity (MI) construction is a dynamic phenomenon influenced by factors related to the student, the educational environment and society. Objective: To synthesize the produced knowledge about the student-related aspects regarding the construction of the MI. Method: This is an integrative review of empirical studies published in journals indexed in the MEDLINE and LILACS databases, using the term Medical Identity and the descriptors Identity Crisis, Social Identification, Physician’s Role and Professional Role. The inclusion criteria were: full texts available in Portuguese, Spanish, French or English of empirical studies on factors that influence the development of MI focused on student-related aspects and having physicians or undergraduate medical students as participants. Results: In the first stage, 1,365 articles were identified. Subsequently, 194 articles were chosen for in-depth reading. Of these, 18 were included for thematic analysis with classification into categories in dialogue with the literature, based on the concept of healthy MI. Most articles were published in the last decade. Three categories were identified: expectation versus reality, related to what the student thinks about what a physician is or should be; the ‘superhero’ physician, related to the caricatured perception of Medicine created by the students themselves and offered by society through TV programs, series and films; and role modeling, which concerns the importance of the student’s practical experience supervised by a preceptor or teacher. The MI built throughout the medical course influences the way medicine is practiced and when it is not consistent with the reality that the recently graduated student encounters, it causes suffering to the physician and interferes with their professional performance. Conclusion: Educational institutions, teachers and preceptors must be aware of the expectations and ideals of their students about what it means to be a physician and the role of this professional in society, aiming to promote interventions that help establishing a healthier and more resilient identity construction, particular to the medical profession.
Background: In 1966, the Gaffrée and Guinle University Hospital – GGUH was incorporated into the Federal University of the State of Rio de Janeiro – UNIRIO. Since then the Homeopathy clinic has had it's service there. Since the creation of medical residency in Homeopathy in 2004, there has been a significant increase of treatment in the number of patients and also a significant increase in the inter-relationship with other specialists and hospital services. A wide variety of patients have been treated at the GGUH on a daily basis. Many patients have been examined and treated with homeopathy alone, while others were also examined in other specialties, making homeopathic treatment an adjunct to classical therapy and vice versa. Given the expressive number of medical consultations (around 2500/year), this outstanding result in our clinical and academic practice has created the relevance and need for the verification of the epidemiological profile of these patients. Epidemiological studies are needed to clearly show the population included in this hospital, which is considered to be a reference in the Brazilian Health System (SUS). Aims: To demonstrate the epidemiological and clinical homeopathic profile in the ambulatory of homeopathy at the Gaffrée and Guinle University Hospital (GGUH) of the Federal University of the Staate of Rio de Janeiro - UNIRIO, Brazil. Methodology: Cross-sectional study of 140 medical records randomly selected from the ambulatory of homeopathy at GGUH. The sample represents 50% of the monthly average of the clinical service from January to October 2009. The medical records incorrectly completed for the data analysis were excluded. Microsoft Office Excel 2007 used to data collection and analysis. Results and Discussion: A total of 100 records were selected for analysis (71.4%). Average age: 50 years old, 69% being between 41 and 80 years old. Gender: 79% women and 21% men. Marital status: 46% married, 36% single, 10% divorced and 8% widowed. Color: 61% white, 31% colored and 8% black. Education: Only 12% obtained an undergratuadion degree. Groups of diseases: Group-01 (48%) high prevalence: 19% respiratory, 15% osteoarticular and 14% psychiatric; Group-02 (45%) medium prevalence: 11% gastrointestinal, 9% cardiovascular, 8% genitourinary, 6% neurological, 6% dermatologic and 5% endocrine; Group-03 (7%) low prevalence: 3% otological, 2% immunological, 1% oncological and 1% ophtalmological. 82% of the patients were treated solely with homeopathy and 18% with homeopathy and allopathy. Clinical-homeopathic diagnosis: 53% functional, 38% lesional; 9% sensorial. Constitutional diagnoses: 31% sulfuric, 25% phosphoric, 22% carbonic, 22% mixed. Miasmatic / diathesic diagnosis: 47% sycotic, 28% psoric, 12.5% mixed, 9.5% tuberculinic, 3% syphilinic. Conclusion: This study demonstrated a higher prevalence of women over 50 years old with respiratory, osteoarticular and psychiatric diseases. Most of them had a sulfuric constitution and presented functional diseases of sycotic origin. Homeopathy was the most adopted treatment during the period studied. This knowledge led to the creation of the “Homeopathic Clinical Identification Summary†which is used in the GGUH ambulatory. Epidemiological and clinical data were extracted from this summary with the objective to construct clinical trials.
Background: In 2004, the deployment of Homeopathy in the pediatric ward at the University Hospital of Gaffrée Guinle – UNIRIO (HUGG at the Federal University of the State of Rio de Janeiro) was initiated in conjunction with both the Pediatric and Homeopathy Service. A research project approved by the HUGG Ethics and Research Committee was prepared to survey the most prevalent diseases. A team composed of medical students and doctors participating in the homeopathy course was formed and underwent training, enabling them to use the established protocols of action. A partnership was established with the Fluminense Federal University(Universidade Federal Fluminense – UFF), for the supply of drugs. In early 2009, the research project started, followed by homeopathic treatment in the pediatric ward. Aim: To demonstrate the diseases and treatment using homeopathic therapy on patients in the pediatric ward at the HUGG-UNIRIO-Brazil. Methodology: A sectional clinical study was carried out on patients participating in a research approved and registered by the Brazilian Research Ethics Committee, named,"The study of the effect of Homeopathic Treatment as an Adjunct Therapy on patients Hospitalized in the Pediatric Ward of HUGG". Criteria of Inclusion: Newborns up to the age of 16 of both sexes were admitted to the pediatric ward of HUGG, from May to October 2009. The diagnosis for admission being: respiratory, gastrointestinal and/or dermatologic diseases. A consent form had to be accepted and signed by the person responsible. Inclusion depended on the availability of having the appropriate homeopathic medicine in stock. Criteria of Exclusion: Cases of discontinuation of the homeopathic treatment or medical records not completed correctly. The medical records were analyzed individually. Microsoft Office Excel 2007 was used for data collection and analysis. Results: 32 patients admitted: 80% treated with Homeopathy; Diagnosis for admission: 73% respiratory, 11.5% dermatological, 4% gastrointestinal and 11.5% other diseases (malnutrition, adenomegaly, eyelid edema); 37% had secondary diseases. An average of 4.7 medicaments (min 01-max09) was used per patient, 31% repeated the medication in two different dinamizations. “Diagnosis for admission and medication usedâ€ÂÂ: a) respiratory: 79% Pulmao histaminum, 32% Antimonium tartaricum, 21% Natrum sulfuricum, 21% Sambucus nigra, 16% Ipecacuanha, 16% Nux vomica, 16% Medorrhinum; b) dermatological: 100% Apis mellifica, 33% Dulcamara, 33% Mezereum, 33% Psorinum, 33% Rhus toxicodendron, 33% Alumina; c) gastrointestinal: 100% Ipecacuanha, 50% Gambogia, 50% Alumina. Dinamizations used: 5, 6, 12, 30 and 200CH, and 200FC. 55.5% of the medication used were only local effect medicines, 45.5% of the medication used were in association with the general effect medicines. Conclusion: The need to use several homeopathic medicines was obseved. The practice of inpatients was shown to be similar to the emergency outpatient when using medicine for local effect and medicine for general effect. Due to the positive results obtained with homeopathy, patients not initially foreseen in the research were included in this study on demand from parents or persons responsible for the children. This study demonstrates the need for a greater number of patients to allow the creation of prescription protocols and case-control studies to identify the most effective homeopathic prescription techniques.
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