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Authors
Abstract(s)
Introdução: O raciocínio clínico é uma competência fulcral para a prática médica. A
sua avaliação desempenha um papel importante na prevenção do erro médico e das
suas implicações socioeconómicas; portanto, deve ter por base as melhores práticas
internacionais. No entanto, o conhecimento atual acerca da avaliação do raciocínio
clínico nas escolas médicas portuguesas é escasso.
Objetivos: Esta dissertação pretende aprofundar o conhecimento atual acerca da
avaliação do raciocínio clínico em Portugal, analisando a prevalência de aplicação de
diversos métodos de avaliação e identificando os principais obstáculos associados.
Métodos: Foi aplicado um questionário entre maio e julho de 2023 a todos os
docentes responsáveis por unidades curriculares do 4º ao 6º ano do Mestrado
Integrado em Medicina. Recorreu-se ao software SPSS®, versão 28.0 para o Microsoft
Windows® e a um nível de significância de 5% (p-value < 0,05). Os dados foram
predominantemente analisados por meio de estatísticas descritivas.
Resultados: Foram recolhidas 75 respostas de 8 escolas de Medicina em Portugal,
representando aproximadamente metade da população-alvo. A maioria dos docentes
tem mais de 30 anos de experiência em avaliação. A recolha, interpretação e síntese de
informação clínica, assim como a geração de um diagnóstico diferencial são os
domínios mais avaliados, constatando-se um défice na avaliação dos aspetos
interpessoais do raciocínio clínico face ao que seria desejável. As perguntas de escolha
múltipla constituem o método de avaliação mais aplicado. Os métodos aplicados em
contexto simulado e clínico, por observação direta, estão em défice nos currículos.
Entre os principais obstáculos identificados, destacam-se a falta de tempo e de recursos
humanos.
Conclusão: É necessária uma maior implementação de métodos em contexto
simulado e em meio clínico, permitindo uma avaliação mais completa do raciocínio
clínico, incluindo dos seus aspetos interpessoais. Neste sentido, é fundamental um
maior investimento em recursos humanos, aumentando a contratação de profissionais
e promovendo a formação em metodologias de avaliação do raciocínio clínico. Além
disso, propõe-se uma priorização do contacto dos alunos com a prática clínica.
Introduction: Clinical reasoning is essential for medical practice. Assessing this core competency in undergraduate education plays a vital role in preventing medical errors and their socio-economic implications; hence, it should be conducted with basis on the best international practices. However, knowledge regarding the assessment of clinical reasoning in Portuguese medical schools is currently limited. Objectives: This study aims to deepen the current understanding of clinical reasoning assessment in Portugal by analyzing the prevalence of various common assessment methods and identifying their main associated barriers. Methods: A questionnaire was administered between May to July 2023 to all faculty members responsible for curricular units in the senior years of the Medical Integrated Master's degree in Portugal. The SPSS® software, version 28.0 for Microsoft Windows®, was utilized with a significance level of 5% (p-value < 0.05). Data was predominantly analyzed through descriptive statistics. Results: 75 responses were collected from 8 medical schools in Portugal, representing roughly half of the target population. The majority of faculty members have over 30 years of experience in assessment. Gathering, interpreting, and synthesizing clinical information, as well as generating a differential diagnosis are perceived as the most commonly assessed domains of clinical reasoning, while there being a lack of assessment of its interpersonal aspects. Multiple-choice questions is the most used method of assessment. Methods applied in simulated and clinical environments, particularly the direct observation, were perceived to be in considerable deficit in the curricula. The main identified barriers include lack of faculty time and human resources. Conclusion: There is a need for an increased implementation of methods in simulated and clinical environments, allowing for a more comprehensive assessment of clinical reasoning, including its interpersonal aspects. In order to achieve this, more investment in human resources is pivotal, namely by increasing faculty recruitment and promoting more training courses on clinical reasoning assessment. Moreover, a prioritization of student exposure to clinical practice during undergraduate education is also proposed.
Introduction: Clinical reasoning is essential for medical practice. Assessing this core competency in undergraduate education plays a vital role in preventing medical errors and their socio-economic implications; hence, it should be conducted with basis on the best international practices. However, knowledge regarding the assessment of clinical reasoning in Portuguese medical schools is currently limited. Objectives: This study aims to deepen the current understanding of clinical reasoning assessment in Portugal by analyzing the prevalence of various common assessment methods and identifying their main associated barriers. Methods: A questionnaire was administered between May to July 2023 to all faculty members responsible for curricular units in the senior years of the Medical Integrated Master's degree in Portugal. The SPSS® software, version 28.0 for Microsoft Windows®, was utilized with a significance level of 5% (p-value < 0.05). Data was predominantly analyzed through descriptive statistics. Results: 75 responses were collected from 8 medical schools in Portugal, representing roughly half of the target population. The majority of faculty members have over 30 years of experience in assessment. Gathering, interpreting, and synthesizing clinical information, as well as generating a differential diagnosis are perceived as the most commonly assessed domains of clinical reasoning, while there being a lack of assessment of its interpersonal aspects. Multiple-choice questions is the most used method of assessment. Methods applied in simulated and clinical environments, particularly the direct observation, were perceived to be in considerable deficit in the curricula. The main identified barriers include lack of faculty time and human resources. Conclusion: There is a need for an increased implementation of methods in simulated and clinical environments, allowing for a more comprehensive assessment of clinical reasoning, including its interpersonal aspects. In order to achieve this, more investment in human resources is pivotal, namely by increasing faculty recruitment and promoting more training courses on clinical reasoning assessment. Moreover, a prioritization of student exposure to clinical practice during undergraduate education is also proposed.
Description
Keywords
Avaliação Meio Clínico Perguntas de Escolha Múltipla Raciocínio Clínico Simulação