Resumo: Introdução: Como os profissionais da área médica terão que lidar com a questão da morte, este trabalho teve como objetivos identificar os sentimentos dos estudantes de Medicina e dos médicos residentes do Brasil ante o morrer e a morte, e compreender como eles vivenciam a própria formação durante a graduação e a especialização para esse enfrentamento. Método: Trata-se de uma revisão sistemática da literatura feita com base na metodologia PRISMA. A revisão foi conduzida entre agosto e dezembro de 2019 com os descritores “estudantes de medicina”, “medical students”, “morte” e “death”, pesquisados na Biblioteca Virtual de Saúde (BVS). Resultados: Dos 372 artigos identificados na busca, 18 estudos publicados atendiam a todos os critérios de inclusão e exclusão estabelecidos. Quanto à análise dos artigos em relação aos sentimentos dos estudantes de Medicina e dos médicos residentes perante situações de morte, percebeu-se que a maioria dos estudos relatou experiências negativas, como medo, insegurança, tristeza, raiva e culpa. Apesar de ainda serem incipientes as disciplinas e estratégias institucionalizadas, parece que, com o decorrer do curso e da prática profissional, os sentimentos negativos são amenizados, porque se vivenciam com mais frequência contextos de terminalidade e morte, oportunizando, assim, o aprendizado por meio da observação e postura perante essas situações práticas, visto que a morte e suas interfaces fazem parte do cotidiano médico. Conclusões: Os estudantes de Medicina e os médicos residentes do Brasil apresentam desconforto e dificuldade em lidar com os processos de morte e do morrer. Para modificar esse cenário de despreparo, é consenso entre eles a necessidade de incluir disciplinas teórico-práticas de Tanatologia, Cuidados Paliativos e Psicologia Médica no currículo das faculdades de Medicina e reformular o conteúdo delas de forma a abordar mais profundamente o processo de morte no contexto prático.
SUMMARY BACKGROUND The aim of this study was to perform a cross-cultural adaptation of the Objective Structured Assessment of Technical Skill (OSATS) tool into Brazilian Portuguese and to determine its reproducibility and validity in Brasil. METHODS A Brazilian Portuguese version of OSATS was created through a process of translation, back-translation, expert panel evaluation, pilot testing, and then its validation. For the construct and the concurrent validities, twelve participants were divided into a group of six experts and six novices, who had to perform tasks on a simulation model using human placentas. Each participant was filmed, and two blinded raters would then evaluate their performance using the traditional subjective method and then the Brazilian Portuguese version of OSATS. RESULTS The Brazilian Portuguese version of OSATS had the face, content, construct, and concurrent validities achieved. The average experts’ score and standard deviations were 34 and 0.894, respectively, for Judge 1 and 34.33 and 0.816 for Judge 2. In the case of novices, it was 13.33 and 2.388 for Judge 1 and 13.33 and 3.204 for Judge 2. The concordance between the judges was evident, with the Correlation Coefficient (Pearson) of 0.9944 with CI 95% between 0.9797 and 0.9985, with p < 10-10, evidencing the excellent reproducibility of the instrument. CONCLUSION This preliminary study suggests that the Brazilian Portuguese version of OSATS can reliably and validly assess surgical skills in Brasil.
Purpose: To develop and validate a new test of specific technical skills required for microsurgical varicocelectomy. Materials and Methods: An electronic questionnaire was sent to 558 members of the Brazilian Society of Urology for the validation of the task-specific checklist (TSC) for assessment of microsurgical varicocelectomy. Participants who had experience in this procedure were selected as judges. For construct validation, 12 participants including attending urologists and urological residents in training were recruited for voluntary participation. We formed a group of three experts and a group of nine novices, who had to perform the steps of microsurgical varicocelectomy on a simulation model using human placenta. Each participant was filmed and two blinded raters would then evaluate their performance using the TSC of microsurgical varicocelectomy. Results: 14 judges were recruited. The assessment tool was reformulated, according to the judges suggestions and had the content validity achieved. The final version of the TSC was comprised of the task-specific score, a series of 4 items scored in a binary fashion designed for microscopic sub-inguinal varicocelectomy. The differences between the performance of participants with different levels of experience reflected the construct validity. The reliability between the raters was high. The mean time required to complete the training of microsurgical varicocelectomy in simulation model was significantly shorter for experts compared to novices (201 vs. 496 seconds, p=0.01). Conclusions: This preliminary study suggests that the task-specific checklist of microsurgical varicocelectomy is reliable and valid in assessing microsurgical skills.
Introduction Robotic surgery has expanded on it's surgical application and it is also noted an increase in surgical procedures complexity. Occurrence of emergency situations that require conversion of the minimally invasive access route to open access routes is uncommon. The urgent undocking of the robotic platform is a complex and neglected process in robotic surgery training. Objective To establish specific actions and comands for a safe emergency robotic undocking in a simulation environment. Method Two surgical teams, interventional group (IG) and control group (CG), were submitted to a simulation environment in which there was a need for emergency undocking of the robotic system. The intervention group underwent training with the robotic undocking for life emergency support (RULES) protocol. Result Undocking time of the robotic platform from the IG was reduced by 66% and the CG by only 20%. After RULES protocol training, during the second simulation, the IG acquired more critical actions necessary for emergency undocking and developed more non‐technical skills. Conclusion The RULES protocol proved to be effective, promoting an improvement in technical and non‐technical skills of all surgical team menbers, resulting in more effective actions that resut in a coordinated and faster robotic undocking. It is also concluded that the surgeon and bed side surgeon are the key elements for the efficient robotic system undocking in emergency situations.
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