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Point of care ultrasonography (POCUS) has evolved to become the fifth pillar of the conventional physical examination, and use of POCUS protocols have significantly decreased procedure complications and time to diagnose. However, lack of experience in POCUS by preceptors in medical schools and nephrology residency programs are significant barriers to implement a broader use. In rural and low-income areas POCUS may have a transformative effect on health care management.

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Objective: This umbrella review aims to ascertain the extent to which immersive Virtual Reality (VR) and Augmented Reality (AR) technologies improve specific competencies in healthcare professionals within medical education and training, in contrast to traditional educational methods or no intervention. Methods: Adhering to PRISMA guidelines and the PICOS approach, a systematic literature search was conducted across major databases to identify studies examining the use of VR and AR in medical education. Eligible studies were screened and categorized based on the PICOS criteria. Descriptive statistics and chi-square tests were employed to analyze the data, supplemented by the Fisher test for small sample sizes or specific conditions. Analysis: The analysis involved cross-tabulating the stages of work (Development and Testing, Results, Evaluated) and variables of interest (Performance, Engagement, Performance and Engagement, Effectiveness, no evaluated) against the types of technologies used. Chi-square tests assessed the associations between these categorical variables. Results: A total of 28 studies were included, with the majority reporting increased or positive effects from the use of immersive technologies. VR was the most frequently studied technology, particularly in the "Performance" and "Results" stages. The chi-square analysis, with a Pearson value close to significance (p = 0.052), suggested a non-significant trend toward the association of VR with improved outcomes. Conclusions: The results indicate that VR is a prevalent tool in the research landscape of medical education technologies, with a positive trend toward enhancing educational outcomes. However, the statistical analysis did not reveal a significant association, suggesting the need for further research with larger sample sizes. This review underscores the potential of immersive technologies to enhance medical training yet calls for more rigorous studies to establish definitive evidence of their efficacy.

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INTRODUCTION: Transvenous temporary pacemaker (TvTP) implantation is a critical procedure often performed under time limitations, playing a crucial role in patient survival. However, the amount of training provided for resident cardiologists is variable, due to the availability of patients. Thus, the use of simulators for this cardiologic procedure could be used as training tools. OBJECTIVE: The present study aimed to develop a simulator system for TvTP implantation based on electrograms, called ETTIS (Electrogram-guided Transvenous Temporary-pacemaker Implantation Simulator), and to evaluate its educational potential and cardiology residents' perceived learning efficacy as a training tool. METHODOLOGY: The development of the ETTIS involved three stages: (1) Adaptation of an anatomical mannequin; (2) Design and manufacture of electronic circuits and software capable of identifying the catheter contact site within the heart chambers and reproducing electrograms in both surfaces (mode-on) and intracavitary (mode-off); (3) To evaluate its educational potential, a modified Likert questionnaire was administered to nine cardiology experts. Additionally, to evaluate the perceived learning efficacy, another modified Likert questionnaire was given to six cardiology residents both before and after training with the ETTIS. Descriptive statistics with measures of position and dispersion were employed, and the weighted Kappa test was used for agreement analysis. RESULTS: A high rate of acceptance (over 90%) was found among experts who evaluated the ETTIS. The cardiology residents showed significant self-perceived learning gains, as evidenced by a lack of agreement between their responses to a questionnaire before and after training. CONCLUSION: The ETTIS is a promising tool for medical training, displaying both educational potential and efficacy. It has been shown to be effective in learning a variety of skills, including cardiac catheterization and electrophysiology. Additionally, the ETTIS is highly engaging and allows cardiology residents to practice in a safe and controlled environment.

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Introducción: Este artículo reporta los avances y desafíos observados por un equipo de profesores involucrados en la orientación de la lectura y escritura académica al iniciar la preparación profesional en el programa de Medicina de la Universidad Industrial de Santander, desde un enfoque de géneros discursivos. Objetivo: Analizar la reorientación del perfil curricular y las decisiones pedagógicas de los profesores de la asignatura Taller de Lenguaje, orientada en el primer semestre de los años 2020 y 2021. Metodología: El artículo se orienta por el modelo de "reflexión sobre la acción" para la investigación pedagógica, el diseño de la enseñanza y el aprendizaje de las profesiones. Análisis y resultados: Se introdujo a los estudiantes en su cultura disciplinar por la vía de su léxico especializado y del contacto inicial con la terminología médica en su discurso científico. A su vez, se abordó, desde la lectura, el género disciplinar artículo de investigación y su componente el resumen o abstract; y desde la escritura, los géneros de formación glosario y bibliografía anotada. Se estudiaron temas puntuales de escritura, como los discursos referidos y el uso de signos ortográficos, de manera articulada con la producción de dichos géneros. Conclusiones: El avance principal de la pedagogía implementada consiste en la pertinencia de los textos elegidos y de los saberes lingüísticos ofrecidos en la formación profesional de los estudiantes de recién ingreso. El currículo actualmente integra la enseñanza de competencias generales referidas a prácticas, géneros y aspectos normativos de la comunicación académica con la enseñanza de competencias específicas para leer y escribir textos propios de cada disciplina. Finalmente, surgen desafíos como el de articular enfoques entre los profesores de Taller de Lenguaje y los de Medicina, o el de pensar en formas de evaluar el impacto del Taller de Lenguaje con indicadores ajustados a las disciplinas.

Introduction: This article reports the progress and challenges observed by a team of professors involved in the teaching of academic reading and writing at the beginning of professional training in the Medicine undergraduate program at Universidad Industrial de Santander, using a genre-based approach. Objective: To analyze the reorientation of the curricular design as well as the educational decisions made by professors of the subject, Taller de Lenguaje, taught during the first semester of 2020 and 2021. Methodology: The present study is guided by the reflection-on-action model for pedagogical research, teaching design, and professional training. Analysis and results: Students were introduced to their disciplinary culture by means of specialized vocabulary and initial contact with medical terminology and its scientific discourse. Regarding the reading practice, the research article was addressed along with the abstract as one of its components. In turn, students wrote training genres such as glossaries and annotated bibliographies. Specific issues related to academic writing such as the use of reported speech and punctuation marks were studied in parallel to the production of such genres. Conclusions: The main progress with the implemented pedagogy lies in the relevance of the chosen texts and the linguistic knowledge made available for the professional training of first year students. The current curriculum integrates the teaching of general competences related to practices, genres, and normative aspects of academic communication, with the teaching of specific skills to read and write texts particular to each discipline. Finally, challenges arise as to the articulation of approaches among professors in charge of Taller de Lenguaje and professors from the Faculty of Medicine, or as to the assessment of the impact of Taller de Lenguaje by means of subject-oriented indicators.

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En los últimos meses del curso escolar 2020-2021, debido a la pandemia de la covid-19 fue necesario modificar el proceso formativo de los estudiantes de sexto año de la carrera de Medicina en la Universidad de Ciencias Médicas de Santiago de Cuba, lo cual incluía a los internos en las modalidades rotatoria y vertical de dicha enseñanza. En el presente artículo se comunican brevemente algunos aspectos relacionados con el aporte asistencial de estos universitarios en los centros de aislamientos, ante el llamado de las autoridades gubernamentales de la provincia, donde demostraron sentido de responsabilidad, amor al prójimo y compromiso durante la atención a los pacientes con diagnósticos de sospecha o definitivo de la enfermedad.

In the last months of 2020-2021 academic year, due to the pandemic of covid-19, it was necessary to modify the training process for the sixth year students of Medicine degree at the University of Medical Sciences in Santiago de Cuba, which included interns in rotation and vertical models of said teaching. In this work, some aspects related to their care contribution in the isolation centers, after the call of the governmental authorities in the province, are shortly communicated, where they demonstrated the sense of responsibility, love for their fellow men and commitment during the care to patients with presumptive or positive diagnoses of the disease.

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BACKGROUND: Lumbar puncture is an essential medical procedure whose objective is to obtain cerebrospinal fluid. Lumbar puncture is considered a complex procedure, mainly for novice residents who suffer from stress and low confidence, which may result in harm to the patient. METHODS: The LPVirSim, has been developed in four stages: i) requirements analysis through user-centred design; ii) prototyping of the virtual environment and the haptic component; iii) preliminary tests with Ph.D. students and physicians using two haptic devices (Omega.7 and Sigma.7); iv) a user study where physicians evaluated the usability and user experience. RESULTS: The LPVirSim integrates non-technical skills and the possibility of representing different patients for training. Usability increased from 61.76 to 68.75 in the preliminary tests to 71.43 in the user study. CONCLUSIONS: All the results showed good usability and demonstrated that the simulator arouses interest and realistically represents a Lumbar puncture, through the force and visual feedback.

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Introducción: El progreso de la medicina contrasta con prevalecientes estigmas de deshumanización en la práctica médica y en la relación médico-paciente, que refuerza la necesidad de sustentar la formación médica sobre la base de la educación emocional y el desarrollo de competencias para el manejo de las emociones. Objetivo: Exponer la importancia de la educación emocional y la adquisición de competencias emocionales en la formación médica. Métodos: Se realizó una revisión sistemática exploratoria, que empleó Web of Science y Scopus como fuentes de información de los trabajos publicados entre 2012 y 2022. La búsqueda estuvo basada en el estudio de las variables: educación emocional, competencias emocionales y formación médica. Resultados: Del análisis de contenido de los artículos seleccionados se identificaron cuatro temáticas principales: generalidades de la educación emocional; la relación entre la educación emocional y el aprendizaje, fundamentada en la necesidad de potenciar en los estudiantes la autoestima; la importancia de la educación emocional en la formación de médicos; y las estrategias para favorecer la educación emocional en el proceso formativo de los estudiantes de medicina. Conclusiones: Se determinó que la educación emocional se convierte en una innovación educativa de gran importancia, que responde a las necesidades sociales contemporáneas, y busca lograr un equilibrio entre lo cognitivo y el manejo de las emociones(AU)

Introduction: The progress in medicine is not consistent with prevailing stigmas of dehumanization in the medical practice and in the doctor-patient relationship, which reinforces the need to sustain medical training on the basis of emotional education and the development of competences for managing emotions. Objective: To expose the importance of emotional education and the acquisition of emotional competences in medical training. Methods: An exploratory systematic review was conducted, using Web of Science and Scopus as sources of information to collect papers published between 2012 and 2022. The search was based on the study of the variable's emotional education, emotional competences and medical training. Results: Four main themes were identified with the content analysis applied in the selected articles: generalities of emotional education; relationship between learning and emotional education, based on the need to enhance self-esteem in students; the importance of emotional education in the training of physicians; and strategies to favor emotional education in the training process of medical students. Conclusions: Emotional education was concluded to become an educational innovation of great importance, responding to contemporary social needs, as well as it seeks to achieve a balance between the cognitive and the management of emotions(AU)

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Introduction: Medical students are vulnerable to psychological distress and face a number of stressors such as academic pressures, economic concerns, and difficulties in interpersonal relationships. The quality of their educational training may also impact their mental health and subjective well-being. Objective: to describe their perception of subjective well-being and the impact of medical training on their own mental health. Methods: We surveyed 119 medical students and administered the "Perception survey on vocation, living and recreational habits, training and professional attitudes," the CAGE questionnaire, the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-2 (PHQ-2). Results: Students' mean age was 22.5±2.28 years old and 59.7 % of participants were women, their lifestyle habits were scored as acceptable, and the employment of cell-phones and social networks ranged 76-99%; 24.1 % recognized a problematic alcohol, 67.2 % reported anxiety according to the GAD-7, and 49.6 % depression according to PHQ-2. Symptoms of anxiety were frequent among females and were higher when the perceived quality of training and student/teacher ratio were lower. Discussion: Students' perceptions of lower quality of training and resources seemed to be associated with higher levels of anxiety, which may suggest that educational policies and resources should be carefully revised and implemented to improve students' health and well-being.

Introducción: los estudiantes de medicina son vulnerables al malestar psicológico y se enfrentan a una serie de factores estresantes como las presiones académicas, las preocupaciones económicas y las dificultades en las relaciones interpersonales. La calidad de su formación educativa también puede influir en su salud mental y bienestar subjetivo. Objetivo: describir su percepción de bienestar subjetivo y el impacto de la formación médica en su propia salud mental. Metodología: se encuestó a 119 estudiantes de medicina y se les administró la "Encuesta de percepción sobre vocación, hábitos de vida y recreación, formación y actitudes profesionales", el cuestionario CAGE, el Trastorno de Ansiedad Generalizada-7 (TAG-7) y el Cuestionario de Salud del Paciente-2 (PHQ-2). Resultados: la edad media de los estudiantes fue de 22,5±2,28 años y el 59,7 % de los participantes eran mujeres; sus hábitos de vida se calificaron como aceptables, y el empleo de teléfonos móviles y redes sociales osciló entre el 76 y el 99 %; el 24,1 % reconoció un consumo problemático de alcohol, el 67,2 % manifestó ansiedad según el TAG-7, y el 49,6 % depresión según el PHQ-2. Los síntomas de ansiedad eran frecuentes entre las mujeres y eran mayores cuando la calidad percibida de la formación y la proporción alumnos/profesor eran menores. Discusión: la percepción por parte de los estudiantes de una menor calidad de la formación y de los recursos parecía estar asociada a mayores niveles de ansiedad, lo que puede sugerir que las políticas y los recursos educativos deberían revisarse y aplicarse cuidadosamente para mejorar la salud y el bienestar de los estudiantes.

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Introduction: The breasts are a female symbol, impacts self-image and self-esteem. Breast reconstructive and oncoplastic surgeries have an important role in minimizing injuries. In Brazil less than a third of public health system (SUS) users have access to immediate reconstructive surgery. The low rate of breast reconstructions has multiple causes and the deficiency in availability and surgeons' technical qualification play a role. In 2010, the Breast Reconstruction and Oncoplastic Surgery Improvement Course was created by professors of the Mastology Department of Santa Casa de São Paulo and State University of Campinas (UNICAMP). The objectives of this study were to evaluate the impact of the techniques learned on patients' management by the surgeons enrolled in the Course, as well as to characterize their profile. Methods: All students enrolled in the Improvement Course between 2010 and 2018 were invited to answer an online questionnaire. Students who did not agree to answer the questionnaire or answered them incompletely were excluded. Results: Total students included: 59. The mean age: 48.9 years, male (72%) with more than 5 years of Mastology practice (82.2%), from all regions of Brazil, 1.7% from the North, 33.9% from the Northeast, 44.1% from the Southeast, and 12% from the South. Most of the students considered they had little or no knowledge of breast reconstruction (74.6%) and 91,5% did not consider they had enough aptitude to perform breast reconstructions after finishing residency. After the Course, 96.6% considered themselves apt to perform such surgeries. Over 90% of the students considered the Course had impacted their practice and changed their surgical strategy view. Before the Course, 84.8% of the students stated that less than half of their patients who were operated on for breast cancer had breast reconstruction, compared to 30.5% after the Course. Conclusion: The Breast Reconstruction and Oncoplastic Surgery Improvement Course studied here positively impacted the mastologists' management of patients. New training centers worldwide can help a lot of women with breast cancer.

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Objective: To analyze the medical students' perception about simulated consultations before and after training using the SPIKES protocol. Methods: Quasi-experimental study, with a qualitative approach. It counted with the participation of 20 students as Simulated Physicians (SF), and 20 students as Simulated Patients (SP), all belonging to a medical course. Data were obtained from the responses given to a reflective question, applied before and after training with the SPIKES. The treatment and the analysis of the data were guided by the stages of thematic analysis. Results: In the category "Simulated Medical Student's Self-Perception", the subcategories "Nervousness and Insecurity" were predominant after the first consultation, while "Tranquility and Security" after the second consultation after training. In the category "Simulated Medical Student's Perception about the Educational Process", the subcategory "Reflective Learning" emerged in the students' speeches, especially after the second consultation. In the speeches of SP, it was evidenced the improvement of the care provided by SF after training. Conclusion: The strategy used for the development of communication skills showed evidence of short-term effectiveness. Innovation: The research resulted in a teaching protocol for students in pre-clinical stages that involves four stages: simulation, self-assessment, feedback and new simulations.

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Introducción: El Dr. C. Oscar B. Alonso Chil (1930-2021) formó parte de los médicos que permanecieron en Cuba después del triunfo de la Revolución. Fue fundador de servicios de asistencia en medicina interna y geriatría, y realizó importantes contribuciones a la docencia médica. Objetivo: Exponer la trayectoria de Oscar B. Alonso Chil como médico y docente de la medicina cubana revolucionaria, a través de su historia de vida. Métodos: Se realizó un estudio de tipo descriptivo y de corte cualitativo, donde se utilizó la técnica de la historia de vida, centrada en el aspecto profesional. Para ello se hizo una entrevista semiestructurada al testimoniante como fuente fundamental de información. Se validó el testimonio oral mediante la revisión de la documentación oficial en su expediente docente y la literatura científica existente relacionada con el tema, además de entrevistas a sus alumnos y compañeros de trabajo. Desarrollo: Se constató que fundó servicios; organizó la actividad docente; realizó tutorías, publicaciones y asesorías; y fue miembro de tribunales y consejos científicos. Cada una de sus actividades las desempeñó con gran compromiso e incondicionalidad a su profesión, lo cual le generó mucha satisfacción con la vida. Llegó a ostentar las más altas distinciones por su trabajo: Especialista de Segundo Grado en Medicina Interna, y Profesor Titular, Consultante y de Mérito de la Universidad de Ciencias Médicas de La Habana. Conclusiones: Oscar B. Alonso Chil contribuyó al desarrollo de la medina interna en Cuba en la etapa revolucionaria. Este profesor representa un modelo para los estudiantes de ciencias médicas por su prestigio profesional y científico(AU)

Introduction: Ph.D. Oscar B. Alonso Chil (b. 1930-d. 2021) was one of the physicians who stayed in Cuba after the triumph of the Revolution. He was a founder of the healthcare services for internal medicine and geriatrics, and made important contributions to medical teaching. Objective: To present the professional career of Oscar B. Alonso Chil as a physician and teacher of revolutionary Cuban medicine, through his life history. Methods: A descriptive and qualitative study was carried out, using the life history technique, focused on the professional aspect. For this purpose, a semistructured interview was conducted with the testimony witness as a fundamental source of information. The oral testimony was validated by reviewing the official documentation in his teaching file and the existing scientific literature related to the subject; in addition to interviews with his students and coworkers. Development: It was observed that he founded services, organized the teaching activity, supervised research, made publications and consultancies, and was a member of scientific boards and councils. He performed each of these activities with great commitment and unconditionality to his profession, which gave him great satisfaction with life. He achieved holding the highest distinctions for his work: second-degree specialist in Internal Medicine, as well as Full Professor, Faculty Consultant and Emeritus Professor of the University of Medical Sciences of Havana. Conclusions: Oscar B. Alonso Chil contributed to the development of internal medicine in Cuba during the revolutionary period. This professor represents a role model for students of medical sciences due to his professional and scientific prestige(AU)

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OBJECTIVE: To describe and analyze the exposure to ionizing radiation of orthopedic residents. METHOD: A prospective study was carried out to evaluate the degree of exposure to ionizing radiation with a bandage dosimeter placed under the lead apron for medical residents for 10 months. An online survey measured the degree of knowledge about radiation safety. RESULTS: 54 resident physicians participated. 55.6% report having knowledge of the existence of radiological protection equipment and 40.7% report that they had previous training in its use. 77.8% use the leaded apron and 31.5% use thyroid protection. 81.5% were positioned less than 1 meter from the source of the X-ray production of the arc in C. The total mean radiation exposure was 2.9 ± 2.17 mSv (95% confidence interval: 1.25-14.28; p = 0.424). CONCLUSIONS: Orthopedic residents present radiation doses below the International Commission on Radiological Protection recommended limit. However, there is a lack of knowledge of radiation protection and as well as a lack of interest and ignorance of the adverse effects of radiation.

OBJETIVO: Describir y analizar la exposición a radiación ionizante de los residentes de ortopedia. MÉTODO: Se realizó un estudio prospectivo para evaluar el grado de exposición a radiación ionizante con un dosímetro de placa colocado debajo del mandil plomado a médicos residentes, por 10 meses. Mediante una encuesta en línea se midió el grado de conocimientos sobre seguridad radiológica. RESULTADOS: Participaron 54 médicos residentes. El 55.6% refiere tener conocimiento de la existencia de equipo de protección radiológica y el 40.7% refiere que tuvo entrenamiento previo en su uso. El 77.8% utiliza el mandil plomado y el 31.5% la protección tiroidea. El 81.5% se posicionó a menos de 1 metro de la fuente de producción de rayos X del arco en C. La exposición a la radiación media total fue de 2.9 ± 2.17 mSv (intervalo de confianza del 95%: 1.25-14.28; p = 0.424). CONCLUSIONES: Los médicos residentes de ortopedia presentan dosis de radiación menores que el límite recomendado por la International Commission on Radiological Protection. Sin embargo, existe una falta de conocimientos sobre protección radiológica, así como falta de interés e ignorancia de los efectos adversos de la radiación.

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Resumo: Introdução: O caminhar das escolas médicas em direção à transformação do modelo formativo tradicional em uma perspectiva inovadora e avançada de formação, inclusive no âmbito da saúde mental, vem sendo observado desde a implantação da Estratégia Saúde da Família (ESF). Objetivo: O presente estudo buscou compreender a formação médica inicial em saúde mental, sob a perspectiva do médico atuante na atenção primária à saúde (APS). Método: Para tanto, adotou-se uma abordagem qualitativa, de caráter exploratório, descritivo, na qual, por meio de entrevistas com médicos atuantes na APS de um município do Nordeste do Brasil, produziram-se dados, cujo corpus foi tratado com base na aplicação da análise temática de conteúdo. A coleta de dados do estudo ocorreu entre junho de 2020 e junho de 2021, quando os profissionais médicos atuantes na ESF municipal foram convidados a participar. Trata-se, portanto, de uma amostra intencional, não probabilística. Dos sete médicos atuantes na rede municipal de saúde em nível da ESF, cinco foram incluídos no estudo. Resultado: Os resultados do estudo apontam a formação médica em saúde mental ainda vinculada a uma visão biomédica, em que se valoriza o cenário hospitalar como espaço de práticas e se subutiliza a APS no desenvolvimento de competências e habilidades profissionais, produzindo lacunas que afetam a atuação médica no contexto do cuidado de saúde mental na APS. Os relatos evidenciam, ainda, deficiências na formação relacionadas à valorização de questões pertinentes à medicalização e à dificuldade em conceder autonomia no cuidado em saúde mental. Conclusão: A formação médica em saúde mental deve aproximar-se da realidade de atuação do médico generalista, a fim de prepará-lo para as demandas que enfrentará em seu cotidiano na APS.

Abstract: Introduction: The trajectory of medical schools towards the transformation of the traditional training model to an innovative and advanced perspective of training, including in the field of mental health, has been observed since the implementation of the Family Health Strategy. Objective: The present study sought to understand the initial medical training in mental health, from the perspective of the physician working in Primary Health Care (PHC). Method: For this purpose, a qualitative, exploratory, descriptive approach was adopted, in which data were obtained through interviews with physicians working in the PHC of a municipality in the Northeast of Brazil, whose corpus was treated based on the application of the thematic content analysis. Data collection for the study took place between June 2020 and June 2021, when medical professionals working in the municipal Family Health Strategy (FHS) were invited to participate. It is, therefore, an intentional, non-probabilistic sample. Of the seven physicians working in the municipal health network at the FHS level, five were included in the study. Results: The study results indicate that medical training in mental health is still related to a biomedical vision, in which the hospital scenario is valued as a space for practices and PHC is underutilized in the development of professional skills and abilities, producing gaps that affect performance in the context of mental health care in PHC. The speeches also show deficiencies in the training related to the appreciation of issues related to medicalization and the difficulty in granting autonomy in mental health care. Conclusion: Medical training in mental health should approach the reality of the general practitioner's work, in order to prepare them for the demands they will face in their daily routine in PHC.

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RESUMO Considerando as atuais dificuldades enfrentadas em serviços de saúde mental e suas possíveis relações com a formação de profissionais de saúde, este artigo visa discutir como o ensino de medicina foi configurado subjetivamente por uma estudante universitária e as possíveis relações desse processo com alguns dos atuais desafios da reforma psiquiátrica brasileira. Este trabalho baseou-se num estudo de caso realizado ao longo de quatro meses com uma estudante de medicina de uma faculdade pública do Distrito Federal, onde se faz uso de metodologias ativas de aprendizagem. Foram utilizadas como referenciais a Teoria da Subjetividade, a Epistemologia Qualitativa e a metodologia construtivo-interpretativa de González Rey. Os resultados da pesquisa apontam para a organização de uma subjetividade social do ensino de medicina marcada por processos relacionados ao modelo biomédico, apesar das mudanças institucionais que visam promover um ensino pautado num modelo de atenção biopsicossocial. A participante expressa uma configuração subjetiva em que o cuidado articula-se ao controle e à medicalização, cujo desenvolvimento parece ter sido favorecido pela subjetividade social de seu contexto de ensino. Além disso, pode-se dizer que a subjetividade social do ensino de medicina está possivelmente relacionada a uma subjetividade social manicomial, ainda presente em serviços substitutivos, como os Centros de Atenção Psicossocial, dificultando as mudanças propostas pela reforma psiquiátrica. Por fim, este trabalho enfatiza o caráter subjetivo da aprendizagem, por meio do qual se articulam processos relacionados a diferentes âmbitos de vida da pessoa, como o educacional, o familiar e o cultural.

RESUMEN Teniendo en cuenta las dificultades actuales que enfrentan los servicios de salud mental y sus posibles relaciones con la formación de profesionales de la salud, este artículo tiene como objetivo discutir cómo la enseñanza de la medicina fue configurada subjetivamente por un estudiante universitario y las posibles relaciones de este proceso con algunos de los desafíos actuales de reforma psiquiátrica brasileña. Este trabajo se basó en un estudio de caso realizado durante cuatro meses con una estudiante de medicina de una universidad pública del Distrito Federal, donde se utilizan metodologías activas de aprendizaje. La Teoría de la Subjetividad, la Epistemología Cualitativa y la metodología constructivo-interpretativo de González Rey fueron utilizados como referentes. Los resultados de la investigación apuntan a la organización de una subjetividad social en la educación médica marcada por procesos relacionados con el modelo biomédico, a pesar de los cambios institucionales que tienen como objetivo promover una enseñanza basada en un modelo de atención biopsicosocial. La participante expresa una configuración subjetiva en la que el cuidado está vinculado al control y a la medicalización, cuyo desarrollo parece haber sido favorecido por la subjetividad social de su contexto de enseñanza. Además, se puede decir que la subjetividad social de la educación médica posiblemente esté relacionada con la subjetividad social manicomial, aún presente en servicios comunitarios, como los Centros de Atención Psicosocial, lo que dificulta los cambios propuestos por la reforma psiquiátrica. Finalmente, este trabajo expone el carácter subjetivo del aprendizaje, a través del cual se articulan procesos relacionados con diferentes áreas de la vida de la persona, como la educación, la familia y la cultura.

ABSTRACT Considering the current challenges faced in mental health services and their possible relationships with the training of health professionals, this article aimed to discuss how the teaching of medicine was subjectively configured by an undergraduate and the possible relationships of this process with some of the current challenges of the Brazilian psychiatric reform. This study was based on a case study carried out over four months with a medical student from a public college in the Federal District, where active learning methodologies are used. The Theory of Subjectivity, Qualitative Epistemology and the constructive-interpretative methodology of González Rey were used as framework. The results indicate the organization of a social subjectivity of medicine teaching marked by processes related to the biomedical model, despite institutional changes that aim to promote teaching based on a biopsychosocial care model. The participant expresses a subjective configuration in which care is linked to control and medicalization, whose development seems to have been favoured by the social subjectivity of her teaching context. In addition, it can be said that the social subjectivity of medical education is possibly related to a mental hospital social subjectivity, still present in substitute mental health services, such as Psychosocial Care Centers, making the changes proposed by the psychiatric reform more difficult to be accomplished. Finally, this study emphasizes the subjective aspect of learning, through which processes related to different areas of a person's life are articulated, such as education, family and culture.

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Introducción: El desempeño asistencial del residente de gastroenterología en cuanto al diagnóstico y tratamiento de pacientes con enfermedades digestivas condiciona su pertinencia profesional en la salud pública. Objetivo: Profundizar en el proceso de formación del residente de gastroenterología. Métodos: Se realizaron un análisis epistemológico y un diagnóstico fáctico del proceso de formación del residente de gastroenterología en cuanto a la atención a pacientes con neoplasias digestivas, en el Hospital General Docente Dr. Juan Bruno Zayas de Santiago de Cuba, durante el bienio 2017-2018, a partir de la observación del desempeño asistencial, la aplicación de una encuesta a residentes y de entrevistas a especialistas de esa rama en la provincia. Resultados: Existieron inconsistencias en esta formación como resultado de una visible polarización médico-instrumental de la práctica en la asistencia, orientada hacia la endoscopia digestiva diagnóstica y terapéutica en detrimento de lo preventivo. Conclusiones: Pudo confirmarse que no se había sistematizado lo suficiente la dimensión de asistencia a pacientes con neoplasias digestivas a partir de la integración formativa de la prevención, el diagnóstico y la terapéutica en la praxis endoscópica de ese profesional.

Introduction: The heath care performance of the gastroenterology resident conditions his professional pertinence in the public health as for the diagnosis and treatment of patients with digestive diseases. Objective: To deepen in the training process of the gastroenterology resident. Method: An epistemologic analysis and factic diagnosis of the training process of the gastroenterology resident regarding the care to patients with digestive neoplasm in Juan Bruno Zayas Teaching General Hospital from Santiago de Cuba during the biennium from the observation of the health care performance, the survey to residents and interviews to specialists of this branch in the province. Results: There were inconsistencies in this training as a result of a visible polarization doctor-tools of practice in the care, orientated to the endoscopic and therapeutic digestive endoscopy contrary to the preventive procedure. Conclusion: It could be confirmed that the care dimension had not been sufficiently systematized while giving care to patients with digestive neoplasm taking into account the training integration of prevention, diagnosis and therapeutics in the endoscopic praxis of this professional.

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Este artigo relata a experiência da implementação do curso de especialização em saúde coletiva, realizada pela UNA-SUS/UFBA, por meio do Instituto de Saúde Coletiva (ISC) e da Faculdade de Medicina da Universidade Federal da Bahia, para a formação dos médicos vinculados ao Programa Mais Médicos (PMM) no estado da Bahia. A análise da experiência foi apresentada com base na formulação de Donabedian sobre estrutura, processo e resultado, aplicada ao curso. Para isso, foram estabelecidos critérios das três dimensões e indicadores de análise, que mostraram, ao final, uma análise positiva da proposta analisada. Os resultados apontaram que o curso apresentou uma estrutura inovadora, do ponto de vista teórico e metodológico, pelos dispositivos utilizados e pela articulação de suas atividades. No processo, foram fundamentais as experiências e vivências do tutor da aprendizagem e, por último, a importância dos projetos de intervenção focados na realidade do médico.

This paper reports the experience carried out by UNA-SUS ­ UFBA, with support from the Institute of Public Health and the Faculty of Medicine of the University of Bahia, to implement a specialization course in public health for the training of Mais Médicos Program physicians in Bahia, Brazil. The experience was analyzed based on Donabedian's formulation about structure, process and result, applied to the course. For this purpose, the study established criteria for each dimension and analysis indicators, which showed a positive analysis of the proposal. Results showed that the course presented an innovative structure, from a theoretical and methodological perspective, due to the resources used and the articulation of its activities. The professor's experiences and the intervention projects focused on the physician's reality were fundamental in the process.

Este artículo describe la experiencia en la implementación del Curso de Especialización en Salud Colectiva realizado por la UNA-SUS-UFBA a través del Instituto de Saúde Coletiva y la Facultad de Medicina de la Universidad da Bahia para la formación de Médicos incluidos en el Programa Más Médicos (PMM) en el estado de Bahía. El análisis de la experiencia se presentó a partir de la formulación de estructura, proceso y resultado de Donabedian, aplicada al curso. Para ello, se establecieron criterios de las tres dimensiones e indicadores de análisis, que permitieron realizar un análisis positivo de la propuesta analizada. Los resultados mostraron que el curso presentó una estructura innovadora desde el punto de vista teórico y metodológico, debido a los dispositivos utilizados y la articulación de sus actividades. Las experiencias y vivencias del tutor de aprendizaje fueron fundamentales en el proceso y también la importancia de los proyectos de intervención con énfasis en la realidad del médico.

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O equilíbrio que o senso comum permite pode ser a resposta para que a interferência da ciência não incorra em transformação da ação médica, processo semelhante ao que ocorre em uma linha de montagem de uma fábrica. É preciso combinar ciência e arte, objetividade e subjetividade, em que a compaixão constitua a essência de toda a relação humana, princípio da medicina e necessária para que a prática médica conspire em busca do bem-estar que todos almejam e merecem.

The balance that the common sense allows can be the answer so that the necessary interference of science does not incur in the transformation of the medical action in the same process that occurs in an assembly line of a factory. It is necessary to combine science and art, objectivity and subjectivity, in which compassion constitutes the essence of the whole human relationship, the principle of medicine and necessary for medical practice to conspire in search of the well-being that everyone desires and desires.

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El cambio curricular es un proceso de transformaciones que expresa las modificaciones operadas en la sociedad en términos epidemiológicos, frente a la emergencia y reemergencia de parasitosis, en estrecha relación con la geografía médica y los condicionamientos sociales, económicos y políticos bajo los que se desarrolla la sociedad; por tanto, reconocer y tratar los principales parásitos que afectan al hombre y las enfermedades parasitarias asociadas a ellos resulta esencial para la formación médica de estos tiempos. La presente investigación tiene como objetivo comparar los resultados en las calificaciones en el examen de parasitología del 9no semestre de dos de las universidades públicas de la provincia del Guayas, Ecuador, en el periodo de noviembre de 2020. Se realizó un estudio exploratorio/descriptivo de la variable "Evaluación", que contuvo medidas de posición, dispersión y contraste de la normalidad, y el desempeño fue determinado mediante las listas de apreciación de competencias, establecido como instrumento de evaluación. De igual forma, se utilizó la técnica estadística de comparación de medias a través de la Prueba t para muestras independientes con un nivel de significancia del (5%). Los datos fueron procesados empleando el Programa Estadístico para Ciencias Sociales (SPSS v25). Concluyendo, que los estudiantes de la universidad de ESPOL tuvieron mejor puntuación en relación con la media, y menos dispersión en sus resultados con respecto a la UG. En líneas generales la mayoría de los estudiantes obtuvieron un alto desempeño de las competencias, siendo fundamental la constancia en la mejora del proceso de enseñanza de la parasitología(AU)

Curriculum change is a transformation process that expresses the changes that have taken place in society in epidemiological terms, in the face of the emergence and re-emergence of parasites, in close relation to the medical geography and the social, economic and political conditions under which society develops; therefore, recognizing and treating the main parasites that affect man and the parasitic diseases associated with them is essential for medical training in these times. The objective of this research is to compare the results in the qualifications in the parasitology exam of the 9th semester of two of the public universities of the province of Guayas, Ecuador, in the period of November 2020. An exploratory/descriptive study of the variable "Evaluation", which contained measures of position, dispersion and contrast of normality, and performance, was determined through the competency assessment lists, established as an evaluation instrument. Similarly, the statistical technique of comparison of means was used through the t-test for independent samples with a significance level of (5%). The data was processed using the Statistical Program for Social Sciences (SPSS v25). Concluding, that the students of the ESPOL University had a better score in relation to the average, and less dispersion in their results with respect to the UG. In general terms, most of the students obtained a high performance of the competences, being fundamental the constancy in the improvement of the parasitology teaching process(AU)

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La especialización médica es un gran desafío porque necesita preparar un profesional recién egresado en el especialista que la po-blación quiere y necesita para asegurar mejores condiciones de atención a la salud. La construcción de un sistema para la capacitación de estos profesionales es un gran desafío dada la característica de la formación en servicio, es decir, los profesionales en formación trabajan directamente en la asistencia, dependiendo de instalaciones adecuadas, aparatos, tutores médicos y un programa teórico que garantice el desarrollo del aprendizaje según los parámetros técnicos más actuales. Un desafío adicional es la cantidad y diversidad de instituciones involucradas, desde hospitales universitarios con tradición docente hasta hospitales privados donde el desempeño se limita a la prestación de servicios. En este artículo, buscamos mostrar la trayectoria de la construcción de este sistema en Brasil, que desde hace cerca de 40 años se ha mejorado y ampliado ante la creciente demanda de atención de calidad por parte de la población.

Medical specialization is a challenge because it needs to prepare a newly graduated professional as the specialist that the population wants to ensure better conditions in health care. The construction of a system for training these professionals is a challenging given the characteristic of in-service training where professionals work directly with patients, depending on adequate facilities, equipment, medical tutors, and theoretical programs that guarantee the development of learning within the most current technical parameters. An additional challenge is the number and diversity of institutions involved, including university hospitals that have a tradition of teaching and private hospitals where the performance is based on practice. We seek to show in this article the trajectory of the construction of this system in Brazil, which for about 40 years has been improving and expanding to fulfill the population ́s growing demand for quality care.

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Resumo: Introdução: Aspectos pessoais, como a maternidade e a paternidade podem representar grandes desafios acadêmicos e profissionais, uma vez que requerem tempo, envolvimento afetivo, atenção e cuidado. Principalmente no curso de Medicina, caracterizado pela extensa rotina de estudos e carga horária, essa conjuntura pode ser ainda mais impactante. Objetivo: Este estudo teve como objetivos avaliar o impacto da maternidade/paternidade no rendimento acadêmico de estudantes de Medicina, e analisar as principais percepções, motivações e desafios deles durante a formação médica. Método: Trata-se de um estudo transversal, quanti-qualitativo de abordagem descritiva e analítica que avaliou o perfil e as percepções de 85 mães/pais estudantes de Medicina em todo o país. Como instrumento de coleta, foi empregado um formulário virtual, semiestruturado, contendo questões sociodemográficas de única escolha e de percepções utilizando a escala Likert. A fim de avaliar o impacto da maternidade/paternidade no rendimento acadêmico, parte dos respondentes de uma das instituições avaliadas teve seus rendimentos acadêmicos obtidos para a comparação com amostras aleatórias e não identificadas de estudantes sem filhos da mesma instituição. Resultado: Os estudantes possuem clareza e não se arrependem de suas escolhas pessoais (93%), têm orgulho de ser mãe/pai universitários (93%) e ressaltam a importância e essencialidade da rede de apoio (88%). Ao serem questionados quanto ao rendimento acadêmico, as mães e os pais estudantes de Medicina expressaram limitação na compatibilidade dos afazeres e responsabilidades pessoais e profissionais (42%) e relataram que as obrigações parentais comprometem o rendimento no curso de Medicina (53%). Neste âmbito, porém, nossos dados apontam para um rendimento acadêmico de mães e pais similar aos de estudantes sem filhos. Conclusão: Os estudantes de Medicina com filhos, apesar de relatarem limitação na capacidade de associar os afazeres e as responsabilidades pessoais e acadêmicas, não se arrependem das suas escolhas e têm orgulho de exercer a dupla função. Além disso, eles apresentam rendimento acadêmico semelhante ao de estudantes sem filhos, apesar de acreditarem que as obrigações da maternidade/paternidade comprometem o seu rendimento acadêmico. Destacam-se a essencialidade da rede de apoio para realização das atividades acadêmicas e a uniformidade dessas percepções entre variáveis como sexo, estado civil e ciclo acadêmico.

Abstract: Introduction: Personal aspects such as maternity and paternity can represent major academic and professional challenges, as they require time, emotional involvement, attention and care. Mainly in the medical schools, characterized by the extensive study routine and workload, this situation can be even more impactful. Objective: To assess the impact of parenthood on the academic performance of medical students, as well as to analyze their main views, motivations and challenges during medical training. Method: Cross-sectional, quantitative-qualitative study with a descriptive and analytical approach that evaluated the profile and perceptions of 85 parents who are studying medicine in Brazil. A semi-structured virtual questionnaire was used containing single-choice sociodemographic questions and evaluation of views using the Likert scale. In order to assess the impact of parenthood on academic performance, the academic performance of some of the respondents from one of the institutions evaluated was considered for comparison with random and unidentified samples of childless students from the same institution. Result: Students are clear and do not regret their personal choices (93%), are proud to be parent students (93%) and emphasize the importance and essentiality of the support network (88%). When asked about academic performance, the parents who are medical students express limitations in the compatibility of personal and professional responsibilities (42%) and report that parental duties compromise their performance at medical school (53%). In this context, however, our data indicate that the academic performance of mothers and fathers is similar to that of childless students. Conclusion: Medical students with children, despite reporting limitations in the ability to combine personal and academic responsibilities, do not regret their choices and are proud to exercise both roles. Furthermore, their academic performance is similar to that of childless students, despite believing that parental duties compromise their academic performance. They highlight the essential role played by the support network for performing academic activities and these perceptions between variables such as gender, marital status and academic cycle are distinctively uniform.