Validation of the Clinical Decisions and Diagnostic Workshops (CD/DW) method for the medicine undergraduate course

Orientador: Li Li MinDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias HumanasResumo: Objetivamos validar um modelo pedagógico para a graduação médica, original, nacional, embasado em concepções inovadoras, chamado método Decisões Clínicas e Oficinas Diagnosticas (DC/OD), verificar a eficácia do mesmo para a aquisição cognitiva e de competências clínicas e aferir opiniões sobre a proposta DC/OD. Estudo transversal, feito dentro da disciplina de neurologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM/Unicamp). Após a definição da propriedade dos temas escolhidos (os quais atendiam às diretrizes curriculares nacionais para a graduação médica), foram elaborados três kits DC/OD, sobre Acidente Vascular Cerebral (AVC), Cefaléias e Convulsões/Epilepsias, fundamentados na bibliografia pertinente. O estudo, então, foi conduzido em duas partes: piloto e comparativo. A primeira iniciou-se pela análise semântica, de conteúdo e do valor pedagógica da proposta, feita por docentes de medicina, médicos e educadores. Após as adequações sugeridas pelos profissionais, os três kits foram aplicados a um subgrupo de 17 alunos do 4° ano de graduação médica da FCM, os quais registraram opiniões sobre a proposta. As sugestões dos alunos foram aplicadas ao material, se pertinentes, e, após isso, foi sorteado um dos kits (AVC) para iniciar o estudo comparativo. Nesta etapa, foram definidos dois grupos de alunos (grupos 1 e 2, com 35 e 33 alunos, respectivamente). O grupo 1 foi submetido ao método DC/OD e o grupo 2 a uma aula expositiva e discussão tradicional de casos, ambos sobre AVC. Todos fizeram o teste de Conhecimentos, Atitudes e Percepções (CAP) versando sobre AVC, antes e após as intervenções, às quais tiveram a mesma carga horária. A validação e demonstração de eficácia, bem como a descrição das opiniões dos participantes, foram possíveis através das análises estatísticas do CAP e de questionários apropriados aplicados. Verificamos que o método foi bem aceito por discentes e docentes, com conteúdos, linguagem e valor pedagógico considerados apropriados pela maioria dos profissionais. Em ambos os grupos, no estudo comparativo, houve aquisição cognitiva, estatisticamente significativa, mostrando que o método DC/OD foi eficaz. Os grupos pré-intervenção eram homogêneos e após a intervenção as notas do grupo DC/OD foram discretamente superiores às do grupo controle. A principal crítica foi a longa extensão da segunda etapa da proposta (OD) e as principais sugestões foram dividir as oficinas e disponibilizar imagens animadas nas estações do material de convulsões/epilepsias. Concluímos que o método DC/OD foi considerado adequado e mostrou-se eficaz. Assim, agrega mais uma opção pedagógica para a graduação médica, somando valores aos modelos já existentes e consagrados. O principal fator limitante para implementação do método é a motivação docente. Necessários estudos futuros para verificar reprodutibilidade e melhor análise de eficácia e custo-benefícioAbstract: We aimed to validate a national and original pedagogical model for the medicine undergraduate course. This model is called CD/DW (Clinical Decisions/Diagnostic Workshops) and is based on innovative conceptions. The objectives were: 1) to check the effectiveness of the method, in regard to the cognitive and clinical competences acquisition and 2) to collect opinions of the users on CD/DW method. We carried out a cross-sectional study within the Neurology Department of FCM/ Unicamp (Faculty of Medical Sciences of Campinas State University). The development of study method followed extensive review of neurological themes in keeping with the guidelines of national curricula for the medical undergraduate course. We develop three CD/DW kits about Stroke, Headaches, and Convulsions/Epilepsies. The method development had two parts: an experimental and a comparative one. The former was started by the semantic and content analysis, and by the pedagogical value proposal, carried out by medical undergraduate teachers, physicians and educators. After the suggested adequacies by the professionals, the three kits were applied to seventeen student sub-group of the 4th year of medical undergraduate course from FCM/Unicamp, who registered their opinions about the proposal. The students' suggestions, if pertinent, were incorporated to the material. We chose the theme Stroke to start the comparative study. During this stage, it was defined two groups of students (groups: 1 and 2, with 35 (thirty-five) and 33 (thirty-three) students, respectively). Group 1 was submitted to CD/DW method and group 2 to a presentation class, and a traditional subject discussion, both of them about Stroke. All students underwent the (KAP) Knowledge, Attitudes and Perceptions test about Stroke, before and after the interventions. In addition, we collect open participants' opinions and questionnaires. The opinions showed that CD/DW was well accepted by students and teaching staff. The comparative study showed that both groups had cognitive acquisition, and in the post test KAP, the CD/DW group' grades were higher than the control group. The main criticism was the long duration of second stage proposal (DW). We concluded that CD/DW method was considered adequate and effective. It is an original pedagogical option for the medical undergraduate course, adding values to the established existent modelsMestradoCiencias BiomedicasMestre em Ciências Médica

A Brazilian Original Pedagogical Approach To The Teaching Of Neurology.

The two-arm Clinical Decisions/Diagnostic Workshop (CD/DW) approach to undergraduate medical education has been successfully used in Brazil. Present the CD/DW approach to the teaching of stroke, with the results of its pre-experimental application and of a comparative study with the traditional lecture-case discussion approach. Application of two questionnaires (opinion and Knowledge-Attitudes-Perceptions-KAP) to investigate the non-inferiority of the CD/DW approach. The method was well accepted by teachers and students alike, the main drawback being the necessarily long time for its completion by the students, a feature that may better cater for different educational needs. The comparative test showed the CD/DW approach to lead to slightly higher cognitive acquisition as opposed to the traditional method, clearly showing its non-inferiority status. The CD/DW approach seems to be another option for teaching neurology in undergraduate medical education, with the bonus of respecting each learner`s time.72747-5

Evaluation of the oxidative and inflammatory profile of patients with migraine

Among one of the most commonly seen and primary headaches is migraine. Oxidative stress and inflammation is discussed to be implicated in the pathogenesis of migraine. However, further knowledge about this issue is necessary because data are in part controversial and the possible underlying mechanisms remain inconclusive to date. To evaluate and compare the oxidative and inflammatory profile of patients with migraine 47 volunteers were divided into 3 groups: 15 women with chronic migraine (WCM); 17 women with episodic migraine (WEM) and 15 men with migraine (MM) and enrolled in this study.Total antioxidant status; the enzymatic activity of the antioxidant agents Catalase (CAT), Glutathione S-transferase (GST) and Superoxide Dismutase (SOD); oxidative stress markers malondialdehyde (MDA) and carbonylated proteins; blood count and neutrophil/lymphocyte ratio; uric acid, c-reactive protein and cholesterol total and fractions were determined in pacients with migraine in the interictal phase. The group male participants (MM) displayed a reduction in total antioxidant status, as well as a lower value for antioxidant enzymes, but had no significant alterations in markers related to damage by oxidative stress compared to women. These findings suggest that there is a difference in the oxidative profile between the sexes among migraine patients. This may allow a better understanding of patients profile with different migraine phenotypes and identify new markers that might help understanding the pathophysiology and migraine patient management

Application of the Medical Chronicle and Diagnostic Workshop method for web-based medical education

Orientador: Li Li MinTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: A educação médica via web (EMVW) em Ambientes Virtuais de Aprendizagem (AVA) vem crescendo muito, e apresenta potenciais vantagens. Os desenhos bem estruturados e comprovadamente eficazes para uso em AVA são pouco utilizados, pois, em geral, verifica-se apenas a "digitalização" da sala de aula, ou o AVA serve apenas como depósito de textos. O uso isolado de tecnologias também não garante resultados. Necessitam-se métodos com características pedagógicas positivas, capazes de guiar a aprendizagem, enfocando o método clínico e objetivando melhora da capacidade diagnóstica, considerada frequentemente inadequada, nas avaliações de profissionais. Assim, esta pesquisa propôs a utilização do método Crônica Médica/Oficina Diagnóstica (CM/OD), que procura reunir as características pedagógicas que favorecem o aprendizado em AVA e visa, fundamentalmente, melhorar a habilidade diagnóstica do graduando em Medicina. Há uma leitura inicial motivadora (CM) e um programa estruturado de construção do conhecimento, feito a partir de casos, quase sempre reais, acoplados aos recursos audiovisuais (OD). Foram elaborados dois conjuntos CM/OD, sobre Acidente Vascular Encefálico (AVE) e Crises Epilépticas/Epilepsias. Ambos foram inseridos em um AVA. Essa pesquisa objetivou fundamentar teoricamente a proposta CM/OD para EMVW em AVA e apresentá-la por meio de material suplementar sobre Crises Epilépticas/Epilepsias. Além disto, inferir opiniões dos estudantes expostos e verificar a eficácia do método para melhorar a capacidade diagnóstica dos graduandos em Medicina, em longo prazo, por meio de um estudo longitudinal, cuja coleta de dados foi feita utilizando um questionário de opiniões e questionários de conhecimentos e habilidades diagnósticas (CHD). O método CM/OD permite o aprendizado ativo, inicialmente individual, com autoavaliação, reflexão e interatividade, usando várias estratégias de ensino com exemplos práticos e reais, proporcionando um bom tempo de exposição, de forma repetida, e com gabarito baseado em evidências. O material suplementar permite a sua replicação em um módulo ou disciplina de qualquer curso médico. As opiniões dos expostos mostram que o método estimula a leitura pré e a pós-atividade; que a CM motiva; que o gabarito da oficina sana dúvidas; e que as principais sugestões foram o uso de redes sociais e uma discussão coletiva final. Os questionários CHD1, CHD2 e CHD3 foram respondidos por 81 alunos. A média geral do CHD1 foi de 1,59, desvio-padrão de 0,71. Durante o seguimento, 66 estudantes acessaram o AVA, denotando uma alta taxa de participação, e apresentaram significativa melhora das notas em longo prazo, pois tiveram maiores notas no CHD 2 (t = 8,88, p-valor < 0,05) e também no CHD 3 (t = 8,39, p-valor <0,05). Os resultados foram atribuídos às características pedagógicas positivas do método, já que o tempo de exposição à aula teve pouca influência nas notas finais. Concluiu-se que o método CM/OD para AVA reúne características pedagógicas positivas; pode ser adaptado e replicado em um AVA básico; foi bem aceito pelos estudantes; e apresentou eficácia satisfatória na melhora da capacidade diagnóstica dos graduandos em Medicina, mesmo em longo prazoAbstract: Web-Based Medical Education (WBME) in Virtual Learning Environments (VLE) has become increasingly available and presents potential advantages. Well-structured and effective VLE designs are scarce and little used since, in general, only classroom digitalization is observed, or the VLE is used only for text storage. The isolated use of technologies does not guarantee results, either. Methods with positive pedagogical characteristics are needed to guide students¿ learning, focusing on the clinical method and improved diagnostic skills, which are frequently considered inadequate in professional evaluations. Thus, we have proposed the method Medical Chronicle/ Diagnostic Workshop (MC/DW), that aims to combine teaching characteristics favoring VLE learning, and, mainly, to improve the diagnostic skills of undergraduate medical students. The students were initially exposed to a motivating reading (MC) and a structured program of knowledge construction, based on real cases plus audiovisual aids (DW). Two sets were elaborated (MC/DW) on Stroke and Epileptic Seizures/Epilepsies, both part of a VLE. This work aimed to provide a theoretical basis of the MC/ DW proposal for WBME in VLE, through supplementary material on Epileptic Seizures / Epilepsies. It also aimed to infer the students¿ opinions and verify the effectiveness of the method in improving the diagnostic skills of undergraduate medical students in the long term, by applying a longitudinal intervention study consisting of an opinion survey and a Knowledge and Diagnostic Skills questionnaire (KDS) to collect data. The MC/DW method allowed an active, initially individual learning experience, combined with self-evaluation, critical thinking and interactivity, using several teaching strategies, real cases, long term exposure, repetition, and evidence-based feedback. The supplementary material allows replicating the method as a module or discipline in any medical course. The students¿ comments revealed that the method stimulates pre- and post-reading, and that the MC is highly motivating; the DW¿s answer key sheet removes doubts, offering suggestions to use social networks and a final collective reflection on the topic. The questionnaires KDS 1, 2, and 3 were answered by 81 students. The KDS1¿s general mean was 1.59, and the standard deviation was 0.71. A total of 66 students used VLE, showing a high rate of participation and a significant grade improvement in the long term, with higher means in KDS 2 (t = 8,88, p-value < 0,05) and KDS 3 (t = 8,39, p-value <0,05). These results were attributed to the positive pedagogical characteristics of the method, since time of class exposure had little influence on the final grades. It was concluded that the MC/DW method in VLE presented positive teaching characteristics, and may be adapted and replicated to a basic VLE; it was well-accepted by the students and satisfactorily effective in improving the diagnostic capacity of undergraduate medical students, in the long runDoutoradoNeurologiaDoutor em Ciências Médica

Web-Based Undergraduate Medical Education in a Virtual Learning Environment Using an Original Pedagogical Approach: an Observational Longitudinal Study

ABSTRACT Background Asynchronous Web-based Medical Education in Virtual Learning Environments (VLEs) has grown steadily because of its many advantages. Various configurations and instructional methods are presently available. The existing proposals are poorly structured and/or not very effectively used for teaching diagnostic skills to undergraduate medical students in Brazil. A robust instructional method with positive pedagogical characteristics is needed. Thus, we have proposed a pedagogically-structured method for VLEs that includes a motivating initial reading (Medical Chronicle – MC), and a knowledge building program, using real cases coupled with audiovisual resources (Diagnostic Workshop – DW). We aimed to verify its acceptance, as well as the efficacy of the MC/DW method in improving the diagnostic ability of medical students, in the long term. Methods An opinion survey, two MC/DW materials and two Knowledge and Diagnostic Skills (KDS) questionnaires on stroke and epilepsy were developed, and two medical student groups were followed up in this 2013 longitudinal observational study. The students answered a KDS1, and attended a traditional lecture on one of the topics. They also accessed a VLE to apply the MC/DW method on stroke or epilepsy. We applied the same questionnaire (KDS2 and KDS3, respectively), one month and 5-6 months after the KDS1. We analyzed the mean KDS1 score of all the students, and the mean pairwise of those who accessed and those who did not access the VLEs during these three stages. An opinion survey was applied, and the results were analyzed by descriptive statistics. Results 87 students participated in the study, but six were excluded as they did not answer the questionnaires. The KDS1 general mean score was 1.59 (SD0.71). We found that 66 students (81.5%) accessed the VLE, showing a significant improvement in diagnostic skills in the KDS2 (mean5.65, p<0.05) and KDS3 (mean 4.57, p<0.05), with non-significant variations for those who did not access it. The MC was considered at least good for 62 students (94%), with 52 students (78.8%) finding that a checklist was sufficient to clear up all their DW doubts. Conclusions The MC/DW method in VLE proved to be effective for improving the diagnostic capability of the undergraduate medical students in the long term, and it was well accepted by the students. It presents several positive pedagogical characteristics and can be replicated

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora