The Different Perspectives In The Assessment Of Learners During Supervised Clinical Clerkship [os Diferentes Olhares Na Avaliação De Alunos Em Estágio Clínico Supervisionado]

Objective. to compare medical students' global itemized ratings (GIR) and real-case structured clinical assessment (RC-SCA), generated by faculty members from three different specialties (Gynecology-O&G, Internal Medicine-IM, Pediatrics-Ped). MethOd. 106 Y4 learners were assessed by one faculty member from each specialty, who filled in GIR, consisting of 6 technical domains (mean score GIRt) and 7 humanistic domains (mean score GIRh), on a 0-10 scale, and resultant RC-SCA, from direct attendance observation. Statistical analyses used Cron-bach coefficient, Friedman and Wilcoxon paired tests, Pearson and Spearman correlation coefficients, Euclidean distances. Significance level=5%. Results. High internal consistency was observed in the three GIR (> 0.92). Ratings were negatively skewed. Ped scores were significantly lower than O&G and IM (median differences between 0.50 and 0.67), with low correlations between them (-0.02<R<0.48). the domains that had greater impact on the reliability of GIR were: clinical judgment (O&G and Ped), problem-solving (IM), and self-reflective skills (Ped). O&G and Ped scores showed the smallest agreement; GIRt Ped scores showed the greatest disagreement with all the other scores. cOnclusiOn. the specialties have different views on how to evaluate students' skills, inspite of using similar instruments, which can be a reflection of their "culture". the challenge remains to minimize these differences through faculty development activities.554458462Daelmans, H.E., Hoogenboom, R.J., Donker, A.J., Scherpbier, A.J., Stehouwer, C.D., van der Vleuten, C.P., Effectiveness of clinical rotations as a learning environment for achieving competences (2004) Med Teach, 6, pp. 305-12Kilminster, S., Jolly, B., Effective supervision in clinical practice: A literature review (2000) Med Educ, 34, pp. 827-9(2001), Brasil. Ministério da Educação. Conselho Nacional de Educação. Câmara de Educação Superior. Resolução CNE/CES n.4, 7 de nov 2001.- Diretrizes NacionaisKilminster, S., Cottrell, D., Grant, J., Jolly, B., AMEE Guide n° 27: Effective educational and clinical supervision (2007) Med Teach, 29, pp. 2-19Daelmans, H.E., Overmeer, R.M., van der Hem-Stoktoos, H.H., Scherpbier, A.J., Stehouwer, C.D., van der Vleuten, C.P., In-training assessment: Qualitative study of effects on supervision and feedback in undergraduate clinical rotation (2006) Med Educ., 40, pp. 51-8Swick, S., Hall, S., Beresin, E., Assessing the ACGME competencies in psychiatry training programs (2006) Acad Psychol., 30, pp. 330-51Koens, F., Rademakers, J.J.D.M.J., Cate, O.T.J.T., Validation of core medical knowledge by postgraduates and specialists (2005) Med Educ, 39, pp. 911-7Ribeiro, M.M.F., Amaral, C.F.S., Medicina centrada no paciente e ensino médico: A importância do cuidado com a pessoa e o poder do médico (2008) Rev Bras Educ Med, 32, pp. 90-7Misch, D.A., Evaluating physicians professionalism and humanism: The case for humanism connoisseurs (2002) Acad Med, 77, pp. 489-95Pulito, A.R., Donnelly, M.B., Plymale, M., Factors in faculty evaluation of medical students' performance (2007) Med Educ, 41, pp. 667-75Bergovec, M., Kuzman, T., Rojnic, M., Makovic, A., Is there grade inflation at medical schools? Case study of the Zagreb University School of Medicine (2003) Croat Med J., 44, pp. 92-7Speer, A.J., Solomon, D.J., Fincher, R.M., Grade inflation in internal medicine clerkship: Results of a national survey (2000) Teach Learn Med, 12, pp. 112-6Nahum, G.G., Facs, F., Evaluating medical student obstetrics and gynecology clerkship performance: Which assessment tools are most reliable? (2004) Am J Obstet Gynecol, 191, pp. 1762-71Fincher, R.M.E., Lewis, L.A., Jackson, T.W., Why students choose primary care or nonprimary care career (1994) Am J Med, 97, pp. 410-7Batenburg, V., Smal, J.A., Lodder, A., Melker, R.A., Are professional attitudes related to gender and medical specialty? (1999) Med Educ, 33, pp. 489-93Haidet, P., Dains, J.E., Paterniti, D.A., Hechet, L., Chang, T., Tseng, E., Medical student's attitudes toward the doctor-patient relationship (2002) Med Educ, 36, pp. 568-74Myers, I.B., MacCaulley, M., Queen, N., Hammer, A., (1998) MBTI Manual: a guide in the development and use of the Myers-Briggs Type Indicator, , Palo Alto: Consulting Psychologist Press IncCalegari, M.L., Gemignani, O.H., (2006) Temperamento e carreira, , São Paulo: Summus EditorialBitran, M.C., Zuniga, D., Lafuente, M.G., Viviani, P.G., Mena, B.C., Influenza da personalidad y el estilo de aprendizaje en la elleción de especialidad médica (2005) Rev Med Chile, 133, pp. 1191-9Kassler, W.J., Wartman, S.A., Silliman, R.A., Why medical students choose primary care careers (1991) Acad Med, 66, pp. 41-3Bland, K.I., Isaacs, G., Contemporary trends in student selection of medical specialties (2002) Arch Surg, 137, pp. 259-67Bouriscot, K.A.M., Roberts, T.E., Pell, G., Standard setting for clinical competence at graduation from medical school: A comparison of passing scores across five medical schools (2006) Adv Health Sci Edu Theory Pract, 11, pp. 173-83Southgate, L., Hays, R.B., Norcini, J., Mulholland, H., Ayres, B., Wooliscroft, J., Setting performance standards for medical practice: A theoretical framework (2001) Med Educ, 35, pp. 474-8

Monitoring Growth [acompanhamento Do Crescimento]

Objective: To present concepts related to growth assessment, with emphasis on aspects concerning the evaluation of individuals. Sources of data: The present paper is based on reports published by the WHO regarding the use anthropometry for the assessment of nutritional status; on original articles; and on book chapters about the same topic, as well as on the criticisms of auxologists of this type of assessment when employed at the individual level. Summary of the findings: Concepts concerning reference, skeletal maturity, mid-parental target height, z score, short stature, growth rate, body mass index, and their assumptions and limitations are presented. Conclusions: The assessment of the nutritional status of a population is based on cut-off points, taking into consideration that whoever is below or above that point presents a nutritional problem. Clinical evaluation is based on the idea of variability, which can be both biological and social, and on the idea that it is the clinician's task to establish whether a child within or outside given parameters presents normal growth and nutritional status. When monitoring the growth of a child or adolescent, the most important parameter to be considered is growth rate.79SUPPL. 1S23S32Tanner, J.M., (1981) A History of the Study of Human Growth, , London: Cambridge University Press(1978) A Growth Chart for International Use in Maternal and Child Health Care, , World Health Organization, GenevaMeasuring change in nutritional status (1983) Guidelines for Assessing the Nutritional Impact of Supplementary Feeding Programmes for Vulnerable Groups, , GenevaUse and interpretation of anthropometric indicators of nutritional status (1986) Bull WHO, 64, pp. 929-941(1995) Physical StatusThe Use and Interpretation of Anthropometry. Report of a WHO Expert Committee, , Who Technical Report Series, No 854Falkner, F., Tanner, J.M., (1986) Human Growth, Vol. 3. 2a Ed., 3. , New York: PlenumCameron, N., The use and abuse of growth charts (1999) Human Growth in Context, pp. 65-74. , Johnston FE, Zemel B, Eveleth PB, editores. London: Smith-GordonCole, T.J., The use and construction of anthropometric growth reference standards (1993) Nutr Res Rev, 6, pp. 19-50Morley, D., (1973) Paediatric Priorities in the Developing World, , London: Butterworths & CoMorley, D., Woodland, M., (1979) See How They Grow: Monitoring Child Growth for Appropriate Health Care in Developing Countries, , London: Macmillan Education LtdGómez, F., Desnutrición (1946) Bol Med Hosp Infant, 3, pp. 543-551Seoane, N., Lathan, M.C., Nutritional anthropometry in the identification of malnutrition in childhood (1971) Env Child Health, 17, pp. 99-104Waterlow, J.C., Classification and definition of protein-caloric malnutrition (1972) BMJ, 3, pp. 566-569Habicht, J.P., Martorell, R., Yarbrough, C., Malina, R.M., Klein, R.E., Height and weight standards for preschool children. How relevant are ethnic differences in growth potential? (1974) Lancet, 1, pp. 611-614Waterlow, J.C., Buzina, R., Keller, W., Lane, J.M., Nichaman, M.Z., Tanner, J.M., The presentation and use of height and weight data for comparing the nutritional status of groups of children under the age of 10 years (1977) Bull Who, 55, pp. 489-498(1998) Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation on Obesity, , World Health Organization: GenevaHamill, P.V.V., Drizd, T.A., Johnson, C.L., Reed, R.B., Roche, A.F., Moore, W.M., Physical growth: National Center for Health Statistics percentiles (1979) Am J Clin Nutr, 32, pp. 607-629Marques, R.M., Marcondes, E., Berquó, E.S., Prandi, R., Yunes, J., (1982) Crescimento e Desenvolvimento Pubertário em Crianças e Adolescentes Brasileiros: II - Altura e Peso, , São Paulo: Editora Brasileira de Ciência LtdaMarcondes, E., (1999) Pediatria Básica. 2a Ed., , São Paulo: SarvierTanner, J.M., Whitehouse, R.H., Takahishi, M., Standards from birth to maturity for height, weight, height velocity, and weight velocity: British Children, 1965. I (1965) Arch Dis Child, 41, pp. 454-471Tanner, J.M., Whitehouse, R.H., Takahishi, M., Standards from birth to maturity for height, weight, height velocity, and weight velocity: British Children, 1965. II (1965) Arch Dis Child, 41, pp. 613-635Tanner, J.M., Whitehouse, R.H., Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty (1976) Arch Dis Child, 51, pp. 170-179Kuczmarski, R.J., Ogden, C.L., Grummer-Strawn, L.M., Flegal, K.M., Guo, S.S., Wei, R., CDC growth charts: United States (2000) Adv Data, 8, pp. 1-27Freeman, J.V., Cole, T.J., Chinn, S., Jones, P.R.M., White, E.M., Preece, M.A., Cross sectional stature and weight reference curves for the UK, 1990 (1990) Arch Dis Child, 73, pp. 17-24Tanner, J.M., Growth as a measure of the nutritional and hygienic status of a population (1992) Horm Res, 38 (SUPPL. 1), pp. 106-115Cole, T.J., Some questions about how growth standards are used (1996) Horm Res, 45, pp. 18-23Tanner, J.M., The use and abuse of growth standards (1986) Human Growth, Vol. 3. 2a Ed., 3, pp. 95-112. , Falkner F, Tanner JM, editores. New York: PlenumGreulich, W.W., Pyle, S.I., (1959) Radiographic Atlas of Skeletal Development of Hand and Wrist. 2a Ed., , Stanford: Stanford University PressTanner, J.M., Whitehouse, R.H., Cameron, N., Marshall, W.A., Healy, M.J.R., Goldstein, H., (1983) Assessment of Skeletal Maturity and Prediction of Adult Height. 2a Ed., , London: Academic PressCastilho, S.D., Barros, F.A.A., Crescimento pós menarca (2000) Arq Bras Endocr Metabol, 44, pp. 195-204Tanner, J.M., (1962) Growth at Adolescence. 2a Ed., , Oxford: Blackwell Scientific PublicationsLacey, K.A., Parkin, J.M., The normal short child: Community study of children in Newcastle upon Tyne (1974) Arch of Dis Child, 49, pp. 417-424Rappaport, R., Tratamentos dos atrasos do crescimento (1985) Baixa Estatura. Anais Nestlé, 41, pp. 17-32Tanner, J.M., Métodos auxológicos no diagnóstico diferencial da baixa estatura (1985) Baixa Estatura, Anais Nestlé, 41, pp. 1-16LaFranchi, S., Hanna, C.E., Mandel, S.H., Constitutional delay of growth: Expected versus final adult height (1991) Pediatrics, 87, pp. 82-87Wilton, P., Wallström, A., An overview of the diagnoses in the Kabi Pharmacia International Growth Study (1991) Acta Paediatr Scand Suppl, 379, pp. 93-98Cowell, C.T., Short stature (1995) Clinical Paediatric Endocrinology, pp. 137-172. , Brook CDG, editor. Oxford: Blackwell Science LtdFox, L.A., Zeller, W.P., Evaluation of short stature (1995) Comprehensive Therapy, 21, pp. 115-121Rekers-Mombarg, L.T.M., Cole, T.J., Massa, G.G., Wit, J.M., Longitudinal analysis of growth in children with idiopathic short stature (1997) Ann Hum Biol, 24, pp. 569-583Moore, K.C., Donaldson, D.L., Ideus, P.L., Gifford, R.A., Moore, W.V., Clinical diagnoses of children with extremely short stature and their response to growth hormone (1993) J Pediatr, 122, pp. 687-692Maes, M., Underwood, L.E., Growth failure in chronic disease: Pathophysiology and treatment (1997) Int Semin Paediatr Gastroent Nutr, 6, pp. 3-7Ebbeling, C.B., Pawlk, D.B., Ludwig, D.S., Childhood obesity: Publichealth crisis, common sense cure (2002) Lancet, 360, pp. 473-482Popkin, B., An overview on the nutrition transition and its health implications: The Bellagio meeting (2002) Publ Health Nutr, 5, pp. 93-103Must, A., Dallal, G.E., Dietz, W.H., Reference data for obesity: 85th and 95th percentiles of body mass index (w/ht2) and triceps skinfold thickness (1991) Am J Clin Nutr, 53, pp. 839-846Cole, T.J., Bellizzi, M.C., Flegal, K.M., Dietz, W.H., Establishing a standard definition for child overweight and obesity worldwide: International survey (2000) BMJ, 320, pp. 1-6Reilly, J.J., Assessment of childhood obesity: National reference data or international approach? (2002) Obes Res, 10, pp. 838-840Kramer, M.S., McLean, F.H., Olivier, M., Willis, D.M., Usher, R., Body proportionality and head and length 'sparing' in growth-retarded neonates: A critical reappraisal (1989) Pediatrics, 84, pp. 717-723Martorell, R., Ramakrishnan, U., Schroeder, D.G., Melgar, P., Neufeld, L., Intrauterine growth retardation, body size, body composition and physical performance in adolescence (1998) Eur J Clin Nutr, 52 (SUPPL. 1), pp. 43-53Gallo, P.R., Amigo, H., Leone, C., Factores de riesgo em el retardo de crecimiento em niños de bajo nível sócio-económico (2000) Arch Latinoam Nutr, 40, pp. 121-125Guimarães, L.V., Latorre, M.D., Barros, M.B., Fatores de risco para a ocorrência de déficit em em pré-escolares (1999) Cad Saúde Públ, 15, pp. 605-615Barker, D.J.B., (1998) Mothers, Babies and Health in Later Life. 2a Ed., , Edinburgh: Churchill LivingstonePaz, I., Seidman, D.S., Danon, Y.L., Laor, A., Stevenson, D.K., Gale, R., Are children small for gestational age at increased risk of short stature? (1993) Am J Dis Child, 147, pp. 337-339Haeffner, L.S.B., Barbieri, M.A., Rona, J.R., Bettiol, H., Silva, A.A.M., The relative strength of weight and height at birth in contrast to social factors as determinants of height at 18 years in Brazil (2002) Ann Hum Biol, 29, pp. 627-64

Evaluación de conocimientos médicos: diagnóstico de afecciones dermatológicas prevalentes Evaluation of medical skills: diagnosis of prevalent dermatological lesions

Objetivo. La enseñanza de la dermatología es a menudo poco apreciada, a pesar de las frecuentes afecciones dermatológicas en la práctica clínica. El objetivo de este estudio es valorar los conocimientos de médicos no dermatólogos y de estudiantes del curso de medicina de la Facultad de Ciencias Médicas de la Universidad Estatal de Campinas, Brasil, en el tratamiento de pacientes con afecciones dermatológicas. Entre los estudiantes había 24 que integraban un nuevo modelo curricular, después de la reforma educativa, lo que permitió un mayor número de actividades relacionadas con la especialidad. Sujetos y métodos. Este estudio se desarrolló a través de un examen escrito con diez casos clínicos y sus imágenes. El sujeto evaluado debía marcar una de las cinco alternativas para cada pregunta. Este instrumento se administró a 83 médicos y 55 estudiantes de medicina, de forma anónima. Entre el grupo de médicos, ocho eran especialistas en Dermatología y sirvieron como referencia para el estudio. Resultados. Los estudiantes del nuevo plan de estudios obtuvieron un promedio de 6,34 en relación con la puntuación de los dermatólogos, considerada de 10, la más alta posible. La puntuación promedio de los otros estudiantes fue de 3,82, y la de los médicos no especialistas de las unidades básicas, de 3,32. Conclusiones. El estudio permitió demostrar que los cambios en la enseñanza de la Dermatología fueron importantes para la adquisición de conocimientos de la especialidad por los alumnos que siguieron el nuevo currículo de la facultad y para asumir que los médicos no especialistas del Programa de Salud Familiar que prestan servicios en atención primaria de las regiones estudiadas no recibían formación suficiente para el ejercicio de la especialidad en la calidad de médicos con formación general.<br>Aim. Instruction in dermatology is often under-valued, in spite of the frequency of dermatological complaints in clinical practice. The aim of this study is to evaluate the skill of doctors who are not dermatologists as well as the students of the Medical School at the Campinas State University, Brazil, in the treatment of patients with dermatological lesions. Among the students, there are 24 participating in a new model of curriculum, which came as a result of a revision of teaching methods, which allows a greater number of activities relating to this specialty. Subjects and methods. This study was designed by using a writing test which contains ten clinical cases and the images relating to these cases. The person being evaluated was required to choose one of five alternatives for each question. This instrument was applied anonymously to 83 doctors and 55 medical students. In this group of doctors, eight were specialists in dermatology and served as a point of reference for the study. Results. Students of the new curriculum had an average of 6.34 considering the note of dermatologists as ten, the maximum score possible. The average of the other students was 3.82 and the average of the non-specialist doctors attending in primary care units was 3.32. Conclusions. The research demonstrated that the change in teaching of dermatology was a relevant factor for the acquisition of knowledge in this area in the new curriculum at the university. It also supported what had been previously supposed, that non-specialists in the Family Health Program who attend patients at health primary care in the regions evaluated did not receive adequate training for the performance of this specialty as expected to general practitioners