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INTRODUCTION: As experienced physiotherapy educators in Brazil, we observed that COVID-19 elucidated challenges in the pedagogy of entry-level education overall, and directions for their remediation. In this commentary, we describe our observations with particular attention to the opportunity for digital and distance teaching and learning in Brazil's exemplary middle-income country. BODY: First, the legislation in Brazil around health professional education, specifically entry-level physiotherapy education, is described concerning distanced learning. Then, we contrast such education before and during the COVID-19 pandemic, and in the aftermath of its peak. Our observations reinforce the need to preserve teaching and learning excellence in physiotherapy education with various approaches including distanced and digital learning; be aware of both advantages and disadvantages; and identify means of balancing these for optimal delivery and learner outcomes. Our collective experience and insights strongly support the need for change in the legislative document governing physiotherapy education in Brazil. CONCLUSION: We hope our experiences will enable other educators to evaluate their contexts, reflect on how best to deliver entry-level physiotherapy education in general and during a pandemic, and reinforce the essentiality of practical face-to-face classes in achieving physiotherapy competencies. Only in this way will global standards of practice be ensured, through quality professional education and the factors that inform and govern these.

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In 2017, the Brazilian Society of Anesthesiology (SBA) and the National Medical Residency Committee (CNRM) presented a joint competence matrix to train and evaluate physicians specializing in Anesthesiology, which was enforced in 2019. The competency-based curriculum aims to train residents in relation to certain results, in that residents are considered capable when they are able to act in an appropriate and effective manner within certain standards of performance. Canada and the United States (US) also use competency-based curriculum to train their professionals. In Canada, the format is the basis for using an evaluation method known as Entrustable Professional Activities (EPA), in which the mentor assesses residents' capacity to perform certain tasks, classified in 5 levels. The US, in turn, uses Milestones as evaluation, in which competencies and sub-competencies are assessed according to residents' progress during training. The present article aims to describe and compare the different competency-based curriculum and the evaluation methods used in the three countries, and proposes a reflection on future paths for medical education in Anesthesiology in Brazil.

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ABSTRACT BACKGROUND: Musculoskeletal disorders account for up to one in four of general-practice consultations and almost one third of complaints in primary-care clinical practice. However, an insufficient amount of time and importance is given to their teaching in most medical schools. OBJECTIVE: To evaluate the acquisition of musculoskeletal competences in our institution, in order to identify flaws and propose changes to correct and improve the musculoskeletal curriculum. DESIGN AND SETTING: Cross-sectional study conducted in São Paulo, Brazil. METHODS: First to fifth-year medical students were enrolled in a survey using the Freedman and Bernstein musculoskeletal examination, in order to evaluate the acquisition of musculoskeletal competencies. Categorical data were analyzed using the chi-square test. Continuous data were analyzed using one-way analysis of variance (ANOVA). The level of significance was set as P < 0.05. RESULTS: A total of 545 students completed the questionnaire: from year 2, 115/167 (29.6%); from year 3, 118/138 (30.4%); from year 4, 98/130 (25.3%); and from year 5, 57/110 (14.7%). None of the students achieved the pass mark (established as 70%). The level of confidence in performing musculoskeletal examination was very low (3.7 ± 2.2; n = 386) and bore no relationship to the percentage of correct answers in the questionnaire (r = 0.331; 95% confidence interval, CI: 0.239-0.417; P < 0.001). CONCLUSION: Undergraduate teaching is the only exposure most general practitioners have to orthopedic problems. Universities are concerned about the adequacy of the musculoskeletal programs taught in their institutions. Student scores were found to be unsatisfactory in all the topics evaluated.

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OBJECTIVE: Several teaching hospitals are currently modifying their curriculum to comply with the changing demands in medical education. As a result, we decided to evaluate whether a competency-based curriculum implemented in a Caribbean teaching hospital fulfilled the requirements as defined by the CanMEDS framework. METHODS: We made use of a triangulation method in the survey to obtain information on the educational process. Two separate methods were used consisting of site visits by visiting professors and a medical educator. The focus was on the structure, content and assessments of the educational activities. RESULTS: Major recommendations included increased involvement of medical specialists in the educational activities in the clinical workplace. There was need for improvement of communication between medical specialists, patients, nurses, trainees and residents. Overall, improvements were observed in the structure of clinical rotations and content of the training programme. CONCLUSION: The implemented assessment programme provided necessary information for effective evaluation of the competency-based curriculum. We were able to identify new and feasible methods for improving the curriculum in our educational setting.

OBJETIVO: Varios hospitales docentes están actualmente modificando sus currículos a fin de satisfacer las demandas cambiantes de la educación médica. Por tal motivo, se tomó la decisión de evaluar si un currículo basado en competencias puesto en marcha en un hospital docente del Caribe cumplía con los requerimientos definidos por el programa de formación médica conocido como CanMEDS Framework. MÉTODOS: Se hizo uso de un método de triangulación en el estudio, a fin de obtener información sobre el proceso educativo. Se usaron dos métodos separados consistentes en visitas de inspección realizadas por profesores visitantes y un educador médico. La atención se centró en la estructura, el contenido, y la evaluación de las actividades educativas. RESULTADOS: Las recomendaciones principales incluyeron la necesidad de aumentar la participación de médicos especialistas en el lugar donde los estudiantes realizan su trabajo clínico. Se vio la necesidad de mejorar la comunicación entre especialistas médicos, pacientes, enfermeras, entrenados, y residentes. En general, se observaron mejoras en la estructura de las rotaciones clínicas y el contenido de los programas de entrenamiento. CONCLUSIÓN: El estudio realizado proveyó la información necesaria para la evaluación efectiva del currículo basado en competencias, e hizo posible identificar métodos nuevos y factibles para mejorar los planes de estudio en nuestro contexto educacional.

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Competência, para fins de organização de currículos na área de saúde, deve ser concebida como a capacidade de mobilizar, articular e colocar em prática conhecimentos, habilidades e atitudes necessárias ao desempenho efetivo das atividades requeridas no contexto do trabalho. Currículos orientados por competência devem alinhar metodologias de ensino-aprendizagem, práticas pedagógicas, diferentes contextos e cenários de aprendizagem, métodos de avaliação e atividades de pesquisa com esse princípio de organização curricular. Caracteristicamente, são centrados na busca ativa pelo conhecimento, interdisciplinaridade, integração teórico-prática e interação ensino-sociedade, trazendo o desenvolvimento da identidade profissional para o centro das atividades de aprendizado. Sua construção envolve, inicialmente, a identificação e definição das competências necessárias à boa prática profissional. Em seguida, a definição de seus componentes e os níveis de desempenho. Posteriormente, deve ser elaborado um programa de avaliação que esteja prioritariamente a serviço do aprendizado (avaliação formativa) e que seja voltado para a detecção de conhecimentos, habilidades e atitudes assimilados pelos estudantes e não para sua classificação dentro de um grupo normativo.

Competency, as a model for organizing the medical curriculum, should be conceived as the ability to mobilize, link, and deploy knowledge, skills, and attitudes that are needed for efficient and effective performance in the context of professional practice. Competency-based medical education should align teaching strategies, educational practices, learning opportunities and settings, evaluation system, and research activities with this organizational principle in the curriculum. The model emphasizes an active search for knowledge, integration of disciplines, interaction between theory and practice, teaching, and social integration, while placing the development of professional identity at the center of the learning experience. Initially, the model's construction encompasses the identification and definition of a set of competencies related to good medical practices. Next, the components of competency and performance levels need to be determined. Finally, educators must develop an evaluation program aimed primarily at the learning process (formative evaluation) and focused on the detection of knowledge, skills, and attitudes assimilated by students rather than on their classification within a normative group.

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