Ensino da cirurgia ambulatorial ao graduando de medicina no âmbito da Atenção Primária à Saúde

Abstract

Introduction: Brazilian national curricular guidelines for undergraduate Medical courses encourage competency-based learning, which represents a challenge in the area of surgery, where traditional educational approaches, providing information in lecture format (passive learning), are predominant. In the scope of primary health care teaching, there is a need to acquire skills in minor surgical ambulatory procedures, which were not included in the curricula of subjects and internship in family and community medicine of the proposing institution. Objectives: To systematize the teaching of ambulatory surgery in the Internship of Family and Community Medicine (IMFC, as per its Portuguese acronym) at the Federal University of Rio Grande do Norte (UFRN) and to compare the student performance using this new educational model in relation to the traditional one. Methods: The study is characterized as quasi-experimental, exploratory and analytical. It involved students from the fifth year of UFRN Medical College in the first half of 2018 (control group) and second half of 2018 (intervention group) and had a collaborative team of students and residents as monitors/actors, as well as a group of evaluators consisted of preceptors/professors working in IMFC. The methodological course involved several steps such as: structuring the fields of practice; preceptors training; preparation of video lessons; provision of standardized silicone bench models for teaching; theoretical and practical class; stimulation to the accomplishment of procedures in the practice fields and elaboration of simulated evaluation stations. Instruments based on Objective Structured Assessment of Technical Skills (OSATS) were used to assess student performance in the stations. The evaluation was initially applied to the control group and, subsequently, to the intervention group. Statistical analysis was performed using Student’s t-test for continuous variables and Pearson’s Chi-square test for categorical variables. We considered the significance level of p <0.05. Results: The control group had 100% participation of students in OSATS and the intervention group had participation of 68.6% (35 of 51 students). The mean age was similar (24.5 vs 25.3 years, p=0.497), with male predominance in both groups (59.5% vs 60%, p=0.996). The overall performance score of intervention group was higher than the control group (5.44 (SD ± 1.75) vs 3.15 (SD ± 1.47), p <0.001). When considering the proportion of competence level scores (above 5.0) with insufficient scores (below 5.0), we noted a higher number of students with acquired competence in performing ambulatory surgical procedures (ASP) in the intervention group, when compared to the control (57.1% vs 9.5%, p <0.001). The study has allowed us to assess video classes on the Internet domain, the improvement of bench models of the project partner company, which is a systematized theoretical-practical class model, the development of ASP simulation stations, besides the increase of procedures in patients assisted in basic health units. Conclusions: The study has allowed us to systematize the teaching of ambulatory surgery at the IMFC of UFRN through the development of teaching-learning methods and the evaluation of some ambulatory surgical procedures, and also found improvements of competence in the intervention group through comparative analysis.