RESUMO OBJETIVO: Determinar se existem diferenças significativas entre os métodos de ensino tutorial, simulação ou discussão de casos clínicos relativos à transmissão de conhecimentos médicos sobre ventilação mecânica. MÉTODOS: Um ensaio clínico randomizado, multicêntrico, aberto e controlado foi realizado usando três métodos de ensino em ventilação mecânica: discussão baseada em casos clínicos, simulação e tutorial on-line. Alunos voluntários do sexto ano de medicina de 11 faculdades responderam a um questionário validado abordando o conhecimento sobre ventilação mecânica para estudantes de medicina antes, imediatamente após e seis meses depois do treinamento presencial, composto por 20 questões de múltipla escolha e cinco questões sobre perfil demográfico dos participantes. RESULTADOS: Imediatamente após o teste, não houve diferença entre as pontuações nos grupos de simulação e caso clínico [15,06 vs 14,63], ao passo que, após algum tempo, houve uma diferença significativa na retenção entre o baseado em caso e a simulação grupos, com a pontuação no grupo simulação 1,46 [1,31; 1,64] vez maior que a pontuação do grupo caso (p-valor <0,001). Na análise multivariada, um indivíduo que recebeu mais de quatro horas de informação apresentou aumento de 20,0% [09,0%; 33,0%] no escore (p-valor=0,001). CONCLUSÕES: Nossos resultados indicam que, em comparação com outras formas de treinamento, a simulação em ventilação mecânica proporciona um conhecimento duradouro a médio prazo. Mais estudos são necessários para melhorar o desenho e a avaliação do treinamento que forneça habilidades mínimas de ventilação mecânica.
SUMMARY OBJECTIVE: To determine if there are significant differences between the tutorial, simulation, or clinical-case-based discussion teaching methods regarding the transmission of medical knowledge on mechanical ventilation. METHODS: A randomized, multicenter, open-label controlled trial was carried out using 3 teaching methods on mechanical ventilation: clinical-case-based discussion, simulation, and online tutorial. Voluntary students of the sixth year of medical school from 11 medical colleges answered a validated questionnaire on knowledge about mechanical ventilation for medical students before, immediately after, and 6 months after in-person training consisting of 20 multiple-choice questions, and 5 questions about the participants' demographic profile. RESULTS: Immediately after the test there was no difference between the scores in the simulation and clinical case groups,[15,06 vs 14,63] whereas, after some time, there was a significant difference in retention between the case-based and simulation groups, with the score in the simulation group 1.46 [1.31; 1.64] times higher than the score of the case group (p-value < 0.001). In the multivariate analysis, an individual who had received more than 4 hours of information showed an increase of 20.0% [09.0%; 33.0%] in the score (p-value = 0.001). CONCLUSIONS: Our results indicate that, in comparison with other forms of training, simulation in mechanical ventilation provides long-lasting knowledge in the medium term. Further studies are needed to improve the designing and evaluation of training that provides minimal mechanical ventilation skills.
OBJECTIVE: To develop and validate a questionnaire to assess the knowledge of mechanical ventilation among final-year medical students in Brazil. METHODS: A cross-sectional study conducted between October 2015 and October 2017 involving 554 medical students was carried out to develop a questionnaire for assessing knowledge on mechanical ventilation. Reproducibility was evaluated with the intraclass correlation coefficient, internal consistency was evaluated with Cronbach’s alpha, and construct validation was evaluated with a tetrachoric exploratory factor analysis. To compare the means of the competences among the same type of assessment tool, the nonparametric Friedman test was used, and the identification of the differences was obtained with Dunn-Bonferroni tests. RESULTS: The final version of the questionnaire contained 19 questions. The instrument presented a clarity index of 8.94±0.83. The value of the intraclass correlation coefficient was 0.929, and Cronbach’s alpha was 0.831. The factor analysis revealed five factors associated with knowledge areas regarding mechanical ventilation. The final score among participants was 24.05%. CONCLUSION: The instrument has a satisfactory clarity index and adequate psychometric properties and can be used to assess the knowledge of mechanical ventilation among final-year medical students in Brazil.
OBJECTIVE: To present self-assessments of knowledge about mechanical ventilation made by final-year medical students, residents, and physicians taking qualifying courses at the Brazilian Society of Internal Medicine who work in urgent and emergency settings. METHODS: A 34-item questionnaire comprising different areas of knowledge and training in mechanical ventilation was given to 806 medical students, residents, and participants in qualifying courses at 11 medical schools in Brazil. The questionnaire’s self-assessment items for knowledge were transformed into scores. RESULTS: The average score among all participants was 21% (0-100%). Of the total, 85% respondents felt they did not receive sufficient information about mechanical ventilation during medical training. Additionally, 77% of the group reported that they would not know when to start noninvasive ventilation in a patient, and 81%, 81%, and 89% would not know how to start volume control, pressure control and pressure support ventilation modes, respectively. Furthermore, 86.4% and 94% of the participants believed they would not identify the basic principles of mechanical ventilation in patients with obstructive pulmonary disease and acute respiratory distress syndrome, respectively, and would feel insecure beginning ventilation. Finally, 77% said they would fear for the safety of a patient requiring invasive mechanical ventilation under their care. CONCLUSION: Self-assessment of knowledge and self-perception of safety for managing mechanical ventilation were deficient among residents, students and emergency physicians from a sample in Brazil.
OBJECTIVE: To describe the profile of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil and to evaluate their quality of life. METHODS: Both a semi-structured questionnaire with 57 questions and the SF-36 questionnaire were sent to research departments within SAMU in the Brazilian state capitals, the Federal District and inland towns in Brazil. RESULTS: Of a total of 902 physicians, including 644 (71.4%) males, 533 (59.1%) were between 30 and 45 years of age and 562 (62.4%) worked in a state capital. Regarding education level, 45.1% had graduated less than five years before and only 43% were specialists recognized by the Brazilian Medical Association. Regarding training, 95% did not report any specific training for their work at SAMU. The main weaknesses identified were psychiatric care and surgical emergencies in 57.2 and 42.9% of cases, respectively; traumatic pediatric emergencies, 48.9%; and medical emergencies, 42.9%. As for procedure-related skills, the physicians reported difficulties in pediatric advanced support (62.4%), airway surgical access (45.6%), pericardiocentesis (64.4%) and thoracentesis (29.9%). Difficulties in using an artificial ventilator (43.3%) and in transcutaneous pacing (42.2%) were also reported. Higher percentages of young physicians, aged 25-30 years (26.7 vs 19.0%; p<0.01), worked exclusively in prehospital care (18.0 vs 7.7%; p<0.001), with workloads >48 h per week (12.8 vs 8.6%; p<0.001), and were non-specialists with the shortest length of service (<1 year) at SAMU (30.1 vs 18.2%; p<0.001) who were hired without having to pass public service exams* (i.e., for a temporary job) (61.8 vs 46.2%; p<0.001). Regarding quality of life, the pain domain yielded the worst result among physicians at SAMU. CONCLUSIONS: The doctors in this sample were young and within a few years of graduation, and they had no specific training in prehospital emergencies. Deficiencies were mostly found in pediatrics and psychiatry, with specific deficiencies in the handling of essential equipment and in the skills necessary to adequately attend to prehospital emergencies. A disrespectful labor scenario was also found; the evaluation of quality of life showed a notable presence of pain on the SF-36 among physicians at SAMU and especially among doctors who had worked for a longer length of time at SAMU.
PURPOSE: Analysis of the relevance of preoperative evaluation to prevent adverse clinical events, pre- and postoperative, on cataract surgery. METHODS: The study includes 1254 patients submitted to cataract surgery at the Instituto da Catarata do Departamento de Oftalmologia da UNIFESP - EPM, in the period of Jan - Dec 2004. Data referring to the preoperative evaluation and adverse clinical events related to anesthesia/surgical procedure were retrospectively collected. RESULTS: Sixteen patients (1.2%) showed an adverse clinical event. Nine hundred thirty-six patients (74.6%) showed at least one altered examination. This factor, nevertheless, did not show any relation to the adverse clinical event (p=0.334). CONCLUSION: Concerning the studied series, the altered laboratory tests, electrocardiogram and/or thorax x-ray has no correlation with the adverse clinical events related to the anesthesia/surgical procedure.
OBJETIVO: Analisar a relevância da avaliação pré-operatória na prevenção de eventos clínicos adversos per e pós-operatórios na cirurgia de catarata. MÉTODOS: Foram incluídos no estudo 1.254 pacientes submetidos à cirurgia de catarata no Instituto da Catarata do Departamento Oftalmologia UNIFESP-EPM, no período de jan-dez 2004. Dados referentes à avaliação pré-operatória e à ocorrência de eventos clínicos adversos relacionados ao procedimento anestésico/cirúrgico foram retrospectivamente coletados. RESULTADOS: Dezesseis pacientes (1,2%) apresentaram evento clínico adverso. Novecentos e trinta e seis pacientes (74,6%) apresentaram pelo menos um exame alterado, porém este fator não mostrou associação com a ocorrência de evento clínico adverso (p=0,334). CONCLUSÃO: Na série estudada a alteração de exames laboratoriais, eletrocardiograma e/ou radiografia de tórax não se correlacionou com a ocorrência de eventos clínicos adversos relacionados ao procedimento anestésico/cirúrgico.