Expanding Global Surgery Education in Brazil: Perspectives after the 35th Brazilian Surgical Congress

The 35th Brazilian Congress of Surgery marked a turning point for surgical education in the country. For the first time, the Brazilian College of Surgeons included Global Surgery on the main congressional agenda, providing a unique opportunity to rethink how surgical skills are taught from a public health perspective. This discussion prompts us to consider why and how Global Surgery education should be expanded in Brazil. Although Brazilian researchers and institutions have contributed to the fields expansion since 2015, Global Surgery education initiatives are still incipient in our country. Relying on successful strategies can be a starting point to promote the area among national surgical practitioners. In this editorial, we discuss potential strategies to expand Global Surgery education opportunities and propose a series of recommendations at the national level.

Educational action to monitor children's growth and development based on the theory of meaningful learning

OBJECTIVE

Evaluating the effect of an educational program on the knowledge of Primary Health Care nurses regarding the surveillance of growth and development during childcare appointments.

METHOD

A before-after intervention study with 30 nurses. The nurses' knowledge and practice assessment were done using a tool that had been developed and validated. The educational activity was carried out, linking child growth and development indicators with public policies for early childhood and nurses' practices. David Ausubel's Significant Learning Theory was used as a teaching-learning strategy. The same instrument was reapplied after one month. Descriptive statistics were used in the analysis and the proportion test, Wilcoxon test and Item Response Theory with the Rasch model were applied.

RESULTS

The nurses checked more items right in the instrument after the intervention; there was an increase in the scores of correct answers and a decrease in the item response difficulty index in the knowledge and practice section, post-intervention.

CONCLUSION

The educational activity had a positive effect, affecting changes in nurses' knowledge and practice, which enabled childcare consultations to become more qualified.

Perception of graduates about the education of Nursing Technicians

OBJECTIVES

to interpret the perception of graduates from the nursing technician program on the learning process developed during their education.

METHODS

a qualitative study was conducted from March to September 2021, based on interviews with 20 graduates from a nursing technician program at a school in the Midwest of São Paulo, using thematic analysis and the NVivo tool.

RESULTS

the following themes were identified: traditional teaching methods, active learning strategies, valuing proactivity and experiences in professional practice.

FINAL CONSIDERATIONS

according to the graduates, the teaching process is essentially based on traditional methods, although there are initiatives to implement active strategies and recognition of the importance of advancing student proactivity and practical experience.

The effect of Problem-Based Learning on Care Management skills: A quasi-experimental study

OBJECTIVE

to assess the preliminary effect of Problem-Based Learning on Care Management skills.

METHOD

a quasi-experimental pre- and post-test conducted with students attending the Bachelor's Degree in Nursing offered by an educational institution. The sample was comprised by 29 (Experimental Group) and 74 (Control Group) students. The Experimental Group solved four scenarios under the Problem-Based Learning method with the 7 steps proposed by McMaster University, in a Care Management program in distance mode. The self-reporting instrument assessed the pre- and post-test Care Management skills in both groups. Mean values were obtained and descriptive and inferential statistics were performed (Student's t, paired t, linear regression).

RESULTS

the Experimental Group obtained higher scores in analytical, action-related and global skills than the Control Group (p<0.05). No differences were recorded in interpersonal skills or in use of the information. The Control presented no significant differences before and after usual teaching, whereas differences were in fact reported in the Experimental Group (p<0.05).

CONCLUSION

despite the fact that there is little evidence on the development of Nursing Care Management skills, the current study shows that Problem-Based Learning is an effective and significant method in remote education.

Nursing technicians' professional training in patient safety: A mixed-methods study

OBJECTIVE

to analyze nursing technicians' training in patient safety.

METHOD

a convergent parallel mixed-methods study, where qualitative and quantitative elements were concomitantly implemented and equally prioritized, carried out in three technical colleges linked to a federal public institution in the Brazilian Northeast region. In the qualitative phase, semi-structured interviews were conducted with 24 professors and thematic analysis was applied. In the quantitative study, of the survey type, an instrument was used to screen terms about patient safety with 84 students. The results were combined during the general data interpretation, which was based on the Patient Safety Curricular Guide.

RESULTS

two thematic categories emerged: The professors' understanding about the theme of patient safety in nursing technicians' training; and Application and projection of the teaching of patient safety in nursing technicians' training. In the quantitative study, among the 46 screening terms, their identification in the theoretical-practical context predominated in Courses A and C, totaling 36 (78.3%) and 25 (54.3%), respectively. Theoretical teaching stood out in Course B, with 26 terms (56.5%).

CONCLUSION

professional training of Nursing Technician students has a technical focus and does not fully contemplate patient safety issues in the teaching-learning process and, thus, constitutes a challenge for training institutions and professors alike.

Anatomical description of the brain wax models of Museu da Pharmacia de Ouro Preto

BACKGROUND

In 1839, the Escola de Farmácia de Ouro Preto pioneered the teaching of pharmaceutical sciences in Brazil. At the end of the 19th century, the Escola de Farmácia possessed a French collection of anatomical models, some made of wax and paper-mâché. The models were a critical part of teaching anatomy, particularly in an era of paradigm changes about how the human brain works.

OBJECTIVE

The present study aimed to anatomically describe the brain models through a comparative analysis with the current anatomical description.

METHODS

Comparative analysis of the brain models with modern anatomical descriptions.

RESULTS

In the individual analysis of the wax models, we verified excellent anatomical accuracy of the cortical and subcortical regions. Our results identified internal structures, like the basal ganglia and white matter. Compared with modern anatomical books and websites, the wax brain models have high scientific quality.

CONCLUSION

The models of the present study gave students hands-on experience of human anatomy in the 19^th century. Nowadays, the models are part of the memory of Universidade Federal de Ouro Preto and Museu da Pharmacia de Ouro Preto . The collection of wax models shows the appreciation of neuroanatomy teaching at the turn of the century concomitant with advances in neurology and anatomy around the world.

Barreras para el desarrollo profesional continuo: una encuesta a fisioterapeutas argentinos/as

OBJETIVO

Conocer las barreras que los/as kinesiólogos/as argentinos presentan a la hora de emprender o mantener su desarrollo profesional continuo. Materiales y método: Se realizó un estudio descriptivo y transversal mediante una encuesta anónima y virtual a través de Google Forms en el mes de julio de 2021.

RESULTADO

229 profesionales completaron el cuestionario. 157 (68,6%) ejercían en la provincia de Córdoba, 19 (8,3%) en Buenos Aires, 11 (4,8%) en Santa Fe y el resto en otras provincias. 106 (46,3%) llevaban trabajando entre 1 a 5 años en la profesión, 42 (18,3%) entre 5 y 9 años, 34 (14,8%) entre 10 y 15 años y 47 (20,5%) más de 15 años. 128 (55,9%) se desempeñaban en el área de traumatología y ortopedia, 77 (31,9%) en respiratorio. 178 (77,7%) pertenecía al sector privado, 17 (7,4%) al sector público y 34 (14,8%) a ambos sectores. Conclusión: Del total de encuestados, el 84,3% manifestó tener barreras para realizar su desarrollo profesional continuo; el 15,7% declaró no tener inconvenientes. La principal barrera fue la economía personal, seguida de la percepción de costo beneficio y la falta de tiempo.

LATIN AMERICAN RESIDENTS' SURGICAL EDUCATION AFTER THE PANDEMIC: WHAT STRATEGIES HAVE EMERGED FOR ADAPTING TO THIS NEW ERA?

BACKGROUND

The COVID-19 pandemic has had a negative effect on surgical education in Latin America, decreasing residents' surgical training and supervised clinical practice.

AIMS

This study aimed to identify strategies that have been proposed or implemented to adapt surgical training and supervised clinical practice to COVID-19-related limitations in Latin America.

METHOD

A literature review was performed between April and May 2021, divided into two searches. The first one sought to identify adaptation strategies in Latin America for surgical training and supervised clinical practice. The second one was carried out as a complement to identify methodologies proposed in the rest of the world.

RESULTS

In the first search, 16 of 715 articles were selected. In the second one, 41 of 1,637 articles were selected. Adaptive strategies proposed in Latin America focused on videoconferencing and simulation. In the rest of the world, remote critical analysis of recorded/live surgeries, intrasurgical tele-mentoring, and surgery recording with postoperative feedback were suggested.

CONCLUSIONS

Multiple adaptation strategies for surgical education during the COVID-19 pandemic have been proposed in Latin America and the rest of the world. There is an opportunity to implement new strategies in the long term for surgical training and supervised clinical practice, although more prospective studies are required to generate evidence-based recommendations.

Reading fluency during the COVID-19 pandemic: a longitudinal and cross-sectional analysis

BACKGROUND

International studies performed during the periods of social isolation highlighted the potential loss of student's learning skills. The present study fills a gap in Brazilian research on this topic and focuses on the development of reading fluency.

OBJECTIVE

To investigate the development of the reading fluency of students in the early years of elementary school during e-learning as a result of the social distancing measures put into effect due to the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

Students from grades 2 to 5 were recorded. The number of words read per minute and of those read correctly per minute were analyzed. Descriptive statistical analysis was performed, using analysis of variance (ANOVA) for repeated measures with Bonferroni correction in the longitudinal study, and the t-test in the cross-sectional study.

RESULTS

In the cross-sectional study, 162 students participated. Only the comparison between the 2nd grade classes of 2020 and 2021 showed a statistically significant difference. In the prepandemic classes, the students had better results in reading accuracy than the students assessed during the pandemic. The longitudinal study included 75 students, who improved in fluency rate and accuracy as expected between March and December 2020. In March 2021, the results showed a drop, which may be related to school closures during the Brazilian summer vacation.

CONCLUSIONS

The present research demonstrates the results of Brazilian students in terms of the development of reading fluency during the pandemic. There was an expressive development in grades 2 and 3, with stability in the following grades. The 2nd grade class of 2021 suffered a major impact due to the pandemic.

Cesarean childbirth: an institutional socio-clinical study of the professional practices and discourses

OBJECTIVE

to analyze how the social, historical, economic and professional elements influence the institutionalization process of cesarean childbirth in Brazil and France.

METHOD

a qualitative study grounded on the theoretical framework of the institutional socioclinic. The data were produced through focus groups and individual interviews, supported by semi-structured scripts, with health professionals, mothers and fathers and a research diary. The study had 83 participants. The analysis was based on the theoretical framework and thematic analysis. Cross analysis was developed between the different types of data, services and groups, as well as between countries.

RESULTS

the participants were characterized in terms of schooling, employment, level of training and workplace. The countries researched have their own peculiar health and educational structure and are marked by a social-historical-economic construction outlined by patriarchy. The New Public Management influences both contexts and makes health care precarious. The technical and organizational dimensions reinforce an intellectual and social division of work and knowledge in health.

CONCLUSION

the institutionalization process of childbirth in the countries is marked by social, economic and professional aspects. Practices and speeches of the professionals in their work process influence the occurrence, or not, of cesarean sections.

Validation of a questionnaire on the use of Interactive Response System in Higher Education

OBJETIVO

this study aims to design and validate a questionnaire to measure the students' perception of the use of IRS as a technopedagogical resource in the classroom.

METHOD

a 24 items questionnaire (Interactive Response System for the Improvement of the Teaching-Learning Process) was designed ad hoc for this research and applied to 142 university students.

RESULTS

both the exploratory and confirmatory factorial analysis yielded 3 dimensions: classroom environment, teaching-learning processes and learning assessment. The results obtained both in reliability (Cronbach's alpha= 0.955) and in the Confirmatory Factor Analysis (χ2/df=1.944, CFI=0.97; GFI=0.78; RMR=0.077; RMSEA=0.08) reveal highly satisfactory indices.

CONCLUSION

statistical analyses confirm that this instrument is a valid, reliable, and easy-to-apply tool for professors to evaluate the student perception of student-centred learning.

Development of an animated infographic on Permanent Health Education

OBJECTIVE

to create an animated infographic on the concept of Permanent Health Education according to the National Policy and its main differences compared to continuing education and health education.

METHOD

a methodological study that analyzed context and knowledge gaps with a literature review and brainstorming; synthesized knowledge into a concept map; built and validated a script; created a didactic design; and produced infographic media. 18 representatives from the Center for Permanent Education and Humanization participated in the stages of context analysis and synthesis of knowledge, and six specialists participated in the validation of the script.

RESULTS

through the combination of texts, images, audios, animations and transitions, the concepts, principles and legal journey of the Permanent Education policy were presented with examples from daily work and, at the end, the difference compared to continuing education and health education is presented. The specialist on the theme evaluated the infographic positively as it has clear information that meet the needs of the target audience; favors learning; and is able to circulate in the scientific environment.

CONCLUSION

the infographic includes content on Permanent Health Education as it represents the daily work scenario and encourages reflection by the health care workers.

Discharge guidance and telephone follow-up in the therapeutic adherence of heart failure: randomized clinical trial

OBJECTIVE

to evaluate the effectiveness of the behavioral intervention of discharge guidance and telephone follow-up in the therapeutic adherence, re-hospitalization and mortality of patients with heart failure.

METHOD

randomized clinical trial without blinding, including 201 patients diagnosed with heart failure admitted to the emergency room, who were randomized in Control Group and Intervention Group. Intervention was carried out with specific discharge guidance in the Intervention Group, who were contacted for solving doubts via phone calls after 7 and 30 days, and the adherence to treatment was evaluated after 90 days with the Morisky test, the Brief Medical Questionnaire and the non-drug adherence test in both groups. The Generalized Estimating Equations Model was used (p<0.05%).

RESULTS

One-hundred and one patients were randomly sorted in the Control Group and in the Intervention Group, their average age being 62.6±15.2. The Intervention Group had higher drug and non-drug therapeutic adherence compared to the Control Group (p<0.001) and there were lower re-hospitalization and death rates in the Intervention Group after 90 days.

CONCLUSION

discharge guidance with telephone follow-up was effective and resulted in greater therapeutic adherence, as well as in decrease of re-hospitalization and death rates in patients with heart failure. Clinical Trial Registration (REBEC): RBR- 37n859.

Translation to Brazilian Portuguese, cultural adaptation and reproducibility of the questionnaire "Ankylosing Spondylitis: What do you know?"

CONTEXT AND OBJECTIVE:

Ankylosing spondylitis (AS) generates inflammation and pain in entheses, peripheral joints and the spine. Education regarding AS can improve patients' disability. Thus, it is important to assess patients' knowledge. There is no instrument in the literature for assessing knowledge of AS in Portuguese. The aim here was to translate to the Brazilian Portuguese language, culturally adapt and test the reliability of the questionnaire "Ankylosing Spondylitis: What do you know?" and to correlate the findings with other factors.

DESIGN AND SETTING:

Original article regarding validation of questionnaire, produced at the Federal University of Sao Paulo (Unifesp).

METHODS:

For translation and cultural adaptation, Guilleman methodology was used. After the first phase, the reliability was tested on 30 patients. Correlations between these scores and other factors were examined.

RESULTS:

In the interobserver assessment, the Pearson correlation coefficient and Cronbach's alpha were 0.831 and 0.895, respectively. In the intraobserver evaluation, the intraclass correlation coefficient and Cronbach's alpha were 0.79 and 0.883, respectively. At this stage, the score for area of knowledge A showed correlations with ethnicity and education; the score for area D, with age; the total score and scores for areas A and B with "social aspects" of SF-36; and the score for area D with "pain", "vitality" and "emotional aspects" of SF-36.

CONCLUSION:

The Brazilian version of the questionnaire "Ankylosing Spondylitis: What do you know?" was created. It is reproducible and correlates with education level, ethnicity and the SF-36 domains "social aspects" and "emotional aspects".