Education, Medical – ABC CARDIOL

ABC

Research Letter

3D Printing in Constrictive Pericarditis Assessment

Juliana Cadilho Abrantes et al. Fernanda Turque Bernardo Fróes Demier Daniel Gama Neves … Davi Shunji Yahiro Tadeu Takao Almodovar Kubo Leonardo Canale Claudio Tinoco Mesquita

Introduction

Constrictive pericarditis is a rare disease, often diagnosed belatedly. Radical pericardiectomy is the recommended procedure in cases of constrictive pericarditis, although it is a complex and time-consuming surgery. These aspects make 3D printing potentially valuable in surgical planning, allowing the healthcare team to study a printed model for better comprehension of the surgical area and more efficient planning.^–

Studies have also shown satisfactory results in medical education, particularly in anatomy,^, with reports of high-fidelity anatomical models, including those with congenital heart defects. However, until now, there have been no reports of using 3D cardiac printing for surgical guidance or teaching about constrictive pericarditis.

[…]

Read Full Article

ABCIC

Original Article

Use of Echocardiography as a Supplementary Tool in Teaching Cardiac Anatomy and Physiology to Medical Students

Caroline de Oliveira Fischer Bacca et al. Silvia R. Froes Toniazzo Franciani Rodrigues da Rocha Luiz Fernando Matias … Thais Naiara Mees Ana Luiza Nardelli Kuhl Nicolas Ramos Marcelo Vier Gambetta

Abstract

Background:

Ultrasonography has been increasingly used in teaching basic medicine. The simultaneous observation of the echocardiographic image and the electrocardiogram allows students to understand the physiological process of the heart and its function within the cardiovascular system.

Objective:

Evaluate the acquisition and retention of knowledge among medical students during the study of cardiac anatomy and physiology through the use of echocardiography.

Methods:

Thirty-four (34) students in the third semester took a pre-test (assessment 1) consisting of 20 multiple-choice questions, 15 of which were related to cardiac anatomy and physiology and 5 were “confusion-inducing questions.” The test was designed by one of the authors, blind to the others. After the theoretical meeting, assessment 2 was carried out with the same questions. The following week, a practical echocardiography meeting was held, aimed at evaluating anatomy and physiology. A post-test (assessment 3) was carried out 30 days after the first meeting to assess knowledge retention. The variables were analyzed by the Kolmogorov-Smirnov, Student’s T, and Wilcoxon tests, with a statistical significance level of p < 0.05.

Results:

The average number of correct answers in assessment 1 was 6.37 ± 2.0 (42.4%), 9.8 ± 2.2 (65.3%) in the second assessment, and 10.3 ± 2.5 (68.6%) in assessment 3. There was a statistical difference between assessment 1 and the other assessments (p = 0.01).

Conclusion:

Early introduction of echocardiography in the medical curriculum proves beneficial for imparting knowledge in cardiac physiology and anatomy, reinforcing theoretical understanding.

Read Full Article

ABC

Original Article

Deduction, Induction and the Art of Clinical Reasoning in Medical Education: Systematic Review and Bayesian Proposal

Marcos Roberto de-Sousa et al. Túlio Roberto Xavier de Aguiar

Abstract

Background

Clinical reasoning is at the core of medical practice and entangled in a conceptual confusion. The duality theory in probability allows to evaluate its objective and subjective aspects.

Objectives

To conduct a systematic review of the literature about clinical reasoning in decision making in medical education and to propose a “reasoning based on the Bayesian rule” (RBBR).

Methods

A systematic review on PubMed was conducted (until February 27, 2022), following a strict methodology, by a researcher experienced in systematic review. The RBBR, presented in the discussion section, was constructed in his undergraduate dissertation in Philosophy at Minas Gerais Federal University. Heart failure was used as example.

Results

Of 3,340 articles retrieved, 154 were included: 24 discussing the uncertainty condition, 87 on vague concepts (case discussion, heuristics, list of cognitive biases, choosing wisely) subsumed under the term “art”, and 43 discussing the general idea of inductive or deductive reasoning. RBBR provides coherence and reproducibility rules, inference under uncertainty, and learning rule, and can incorporate those vague terms classified as “art”, arguments and evidence, from a subjective perspective about probability.

Conclusions

This systematic review shows that reasoning is grounded in uncertainty, predominantly probabilistic, and reviews possible errors of the hypothetico-deductive reasoning. RBBR is a two-step probabilistic reasoning that can be taught. The Bayes theorem is a linguistic tool, a general rule of reasoning, diagnosis, scientific communication and review of medical knowledge according to new evidence.

Read Full Article

ABC

Original Article

Effectiveness of an Active Methodology for Learning ECG during the Internal Medicine Internship

Márcia Cristina Amélia da Silva et al. Maria Elisa Lucena Sales de Melo Assunção

Abstract

Background

Studies have shown a low accuracy of urgent care physicians in interpreting electrocardiogram (ECG) in severe cardiovascular conditions.

Objective

To evaluate the effectiveness of an ECG learning method in internal medicine internships and to know the perception of interns regarding learning before and after the methodology.

Methods

This study used a database with the results of an ECG pre- and post-test of the classes in the internal medicine internship from 2017 to 2022. A qualitative questionnaire was sent with questions for self-assessment of perception of learning.

Results

The study included a total of 227 students, 161 of whom (70.9%) were female. The mean age was 26.4 ± 4.2 years old. The pre-test mean was 3.75 ± 2.0 points, and the post-test mean was 8.48 ± 1.5 points, showing a statistically significant difference, even after stratification by sex, age, and course period (p < 0.001 for all comparisons). Sixty-nine (30%) of the students responded to the qualitative questionnaire. The three predominant feelings prior to learning were despair, fear, and insecurity. After the Club, the predominant feelings were security, tranquility, and confidence.

Conclusion

The level of prior knowledge regarding ECG was low among students in the medical internship, and the proposed methodology was effective for learning ECG, regardless of age, sex, or course period. It was possible to transform negative beliefs regarding ECG learning and make learning meaningful and enjoyable. A more incisive look at medical courses for learning the ECG in a more practical and contextualized way can improve this scenario.

Read Full Article

ABC

Original Article

Learning: New Strategy for Humanized Digital Medical Education and Training in Cardiology

Manoel Fernandes Canesin et al. Fabrício Nogueira Furtado Rodrigo Marques Gonçalves Diogo Cesar Carraro … Thaísa Mariela Nascimento de Oliveira Ricardo Rodrigues Cláudio José Fuganti Cézar Eumann Mesas Laércio Uemura

Abstract

Background

The consolidation of new educational paradigms requires the implementation of innovative strategies to transform students into competent professionals.

Objectives

To assess knowledge and satisfaction of medical students before and after the use of a new humanized digital model of active learning, called virtual case-based learning (VCBL).

Methods

This was a descriptive, documentary analysis of the teaching-learning process of medical students. Data obtained from theoretical knowledge assessment and satisfaction evaluation questionnaires applied in 2018 and 2019 were analyzed, and the new VCBL was compared with the traditional active methodology PBL (problem-based learning). Descriptive and association analyses were made using the Statistical Package for the Social Sciences.

Results

A total of 167 evaluation forms administered to medical students were analyzed. In the evaluation of theoretical knowledge, the 2018 and the 2019 student groups had a mean of 41.7% and 73.3%, respectively (p<0.001). Among the students who responded to the satisfaction evaluation form, 76.0% gave the highest rating to question one, and 83.0% to question two. Nearly 70.0% of students positively evaluated knowledge acquisition with the Paciente 360 platform; 78.0% reported to feel prepared for working in outpatient care; and 94.0% positively evaluated the new method.

Conclusion

In this initial study, the results indicate that the new active method for humanized digital medical education, the VCBL, can help in the betterment of the teaching-learning process, promoting knowledge and satisfaction by the students.

Read Full Article

ABC

Editorial

Medical Education: Interlocutor of Science and Society

José Maria Peixoto

Scientific progress in Cardiology is unquestionable.^, We must have in mind, however, that the propelling of this development lies on education sciences , which transform the world by mobilizing people to knowledge. Despite the debate on what types of knowledge are related to them, according to Kant, education sciences enable individuals to reach autonomy and freedom to live in society.

Traditional science produces knowledge from experiment and observation, using rational methods that guarantee the validity of the results. Nevertheless, these assumptions favor the separation between the subject and the object of study, resulting in a technical-scientific culture that often ignores philosophical thinking, which drives individual’s desire for knowledge.

[…]

Read Full Article

ABC

Research Letter

Physician-Researcher, Medical Practice and Research: The Importance of the Physician-Researcher in Current Medicine

Protásio Lemos da Luz

Medical education and practice in Brazil suffer from countless limitations, among which lacking scientific training stands out. Recently, the physician-researcher has emerged as a figure capable of partially correcting this gap. In this paper, I will seek to evaluate the physician-researcher’s role.

Conventional medicine is dedicated to the application of medical knowledge. Therefore, it deals with the general characteristics of diseases, namely, symptoms, evolution, pathophysiological impairment of organs and systems, etiology, diagnostic and therapeutic methods.

[…]

Read Full Article

IJCS

Viewpoint

A Different Heart in Children´s Literature: The Juvenile Literature in Medical Education

Ana Mallet et al. Fátima Geovanini Luciana Andrade David Kestenberg

Abstract

José Saramago, Nobel Prize in Literature, is the author of a statement that provokes adult readers: “What if children’s stories become mandatory reading for adults? Would they really learn what they’ve been teaching for so long?”. 1 It is in this context that literary texts dedicated to children have been used at times in medical education and clinical practice to bring up often invisible subjectivities.

Read Full Article

ABC

Original Article

Clinical Competence in ST-segment Elevation Myocardial Infarction Management by Recently Graduated Physicians Applying for a Medical Residency Program

Ugo Stocco Aimoli et al. Carlos Henrique Miranda

Abstract

Background:

A significant reduction in the morbidity and mortality related to ST-segment elevation myocardial infarction (STEMI) has been achieved with the development of reperfusion therapies. Early diagnosis and correct initial management are important to ensure this benefit. In Brazil, recent graduates in medicine are responsible for a large part of the initial care provided for these patients.

Objective:

To assess the clinical competence in the diagnosis and initial treatment of STEMI by newly graduated physicians applying for a medical residency program.

Methods:

We assessed the performance of 771 applicants for the direct entry selection process of the FMRP-USP Clinical Hospital Medicine Residency Program, performed in a simulated setting of STEMI, with professional actors and medical evaluators, using a standardized checklist following the recommendations of the Brazilian Guidelines for the management of this disease.

Results:

The general performance score presented a median of 7 and an interquartile range of 5.5-8.0. In relation to the items assessed: 83% required ECG monitoring, 57% requested the insertion of a peripheral venous access catheter, 95% administered acetylsalicylic acid, 80% administered a second antiplatelet agent (p2y12 inhibitor), 66% administered nitrate, 71% administered morphine, 69% recognized the diagnosis of STEMI, 71% assessed the pain duration, 63% recognized the need for immediate transfer, 34% showed adequate communication skills and only 25% insisted on the transfer even in case of non-availability of beds.

Conclusions:

The initial diagnosis and management of STEMI need to be improved in medical undergraduate courses and inserted into the reality of the hierarchical network structure of the Brazilian Unified Health System (SUS).

Read Full Article

ABC

Viewpoint

Cardiology Training in Brazil and Developed Countries: Some Ideas for Improvement

Lucas Colombo Godoy et al. Michael E. Farkouh Isabela C. K. Abud Manta Talia F. Dalçóquio … Remo Holanda de Mendonça Furtado Eric H. C. Yu Carlos Gun José Carlos Nicolau

Abstract

Huge variations exist in cardiology training programs across the world. In developing (middle-income) countries, such as Brazil, to find the right balance between training improvements and social and economic conditions of the country may be a difficult task. Adding more training years or different mandatory rotations, for instance, may be costly and not have an immediate direct impact on enhancing patient care or public health. In this text, we compare the Brazilian cardiology training system with other proposals implemented in developed countries from North America and Europe, aiming to point out issues worth of future discussion. Factors such as training rotations and competencies, and program duration and distribution across the countries are presented. The number of first year cardiology trainees per inhabitants is similar between Brazil and the United States (0.24 medical residents/100,000 inhabitants in Brazil and 0.26 medical residents/100,000 inhabitants in the USA). These numbers should be analyzed considering the inequality in training program distribution across Brazil, since most centers are located in the Southeast and South regions. Having more residency programs in distant areas could improve cardiovascular care in these areas. Duration of cardiology Residency Training is shorter in Brazil (two years) in comparison with developed countries (> 3 years). Brazilian residency programs give less emphasis to scientific research and diagnostic methods. Unifying minimum training requirements across the globe would facilitate the development of international learning opportunities and even professional exchange around the world.

Read Full Article

ABC

Special Article

Brazilian Society of Cardiology – The Women’s Letter

Glaucia Maria Moraes de Oliveira et al. Fátima Elizabeth Fonseca de Oliveira Negri Nadine Oliveira Clausell Maria da Consolação V. Moreira … Olga Ferreira de Souza Ariane Vieira Scarlatelli Macedo Barbara Campos Abreu Marino Carisi Anne Polanczyk Carla Janice Baister Lantieri Celi Marques-Santos Cláudia Maria Vilas Freire Deborah Christina Nercolini Fatima Cristina Monteiro Pedroti Imara Correia de Queiroz Barbosa Magaly Arrais dos Santos Maria Christiane Valéria Braga Braile Maria Sanali Moura de Oliveira Paiva Marianna Deway Andrade Dracoulakis Narriane Chaves Holanda Patricia Toscano Rocha Rolim Roberta Tavares Barreto Teixeira Sandra Mattos Sheyla Cristina Tonheiro Ferro da Silva Simone Cristina Soares Brandão Viviana de Mello Guzzo Lemke Marcelo Antônio Cartaxo Queiroga Lopes

Objective

The primary objective of this document is to stimulate improvements in women’s health conditions in Brazil, with a focus on cardiovascular disease (CVD), which is responsible for 17.5 million premature deaths yearly worldwide. This number is predicted to increase to 23 million by 2030. CVD are responsible for one third of all deaths in Brazil, with similarities between men and postmenopausal women. These data assume even greater importance when we consider that 80% of premature deaths could have been avoided by controlling four risk factors: tobacco use, inappropriate diet, physical inactivity, and harmful alcohol use.

This document further aims to create a permanent discussion group that will play a leadership role in Brazilian healthcare policies, providing administrators with an overall view of the relevance of CVD to women so that they may establish strategic actions to reduce the prevalence of risk factors and improve diagnosis and therapeutic approach, thus reducing mortality and morbidity.

[…]

Read Full Article

ABC

Viewpoint

Medical Societies and Public Universities

Charles Mady

Medical societies are important and strong institutions in our country. We can take as an example the Brazilian Society of Cardiology (Sociedade Brasileira de Cardiologia, SBC), of which most of those reading this text are members. I have never done corporate politics, but I follow it with interest. I am impressed by the determination observed in the fierce disputes between competitors at election time.

These groups, which always include members of university faculties, spend a lot of energy to achieve command positions. Such is the game, which often drifts into tortuous paths. Therefore, the human resources of societies and universities have much in common, since they promote scientific and didactic activities, educating professionals all over the country, using both the face-to-face and the media modalities.

[…]

Read Full Article

ABC

Special Article

1st Guidelines of the Brazilian Society of Cardiology on processes and skills for education in cardiology in Brazil: executive summary

Marcos Roberto de Sousa et al. Ricardo Mourilhe-Rocha Angelo Amato Vincenzo de Paola Ilmar Köhler … Gilson Soares Feitosa Jamil Cherem Schneider Gilson Soares Feitosa-Filho José Carlos Nicolau João Fernando Monteiro Ferreira Nelson Siqueira de Morais

This article summarizes the “1st Guidelines of the Brazilian Society of Cardiology on Processes and Skills for Education in Cardiology in Brazil,” which can be found in full at: . The guideline establishes the education time required in Internal Medicine and Cardiology with Specialization through theoretical and practical training. These requirements must be available at the center forming Specialists in Cardiology and the Cardiology contents.

Read Full Article

ABC

Review Article

Cardiac magnetic resonance and its anatomical planes: How do i do it?

Marcelo Souto Nacif et al. Amarino Carvalho de Oliveira Junior Antonio Carlos Pires Carvalho Carlos Eduardo Rochitte

Due to the increasing use of the cardiac magnetic resonance (CMR) method and the frequent implementation of such method in new services, we describe herein, in a step-by-step format, the acquisition techniques that are necessary for a complete cardiac approach, of the main anatomical planes of the heart used by CMR.

Read Full Article