Uso do emprego da reflexão estruturada como ferramenta para aumentar a acurácia diagnóstica de casos dermatológicos em alunos de Medicina

• Ano de defesa: 2017
• Autor(a) principal: TEIXEIRA, P. R. B
• Orientador(a): MOURA, Alexandre Sampaio
• Banca de defesa: AGUILAR, C. R , FARIA, Rosa Malena Delbone de
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade José do Rosário Vellano
• Programa de Pós-Graduação: Programa de Mestrado em Ensino em Saúde
• Departamento: Pós-Graduação
• País: Brasil
• Palavras-chave em Português: Dermatologia. Diagnostico Clínico. Educação Médica. Educação de Graduação em Medicina
• Palavras-chave em Inglês: Dermatology. Clinical Diagnosis. Medical Education. Medical Undergraduation Education
• Área do conhecimento CNPq: CIENCIAS DA SAUDE::MEDICINA
• Link de acesso: http://tede2.unifenas.br:8080/jspui/handle/jspui/234

Introduction: The teaching of dermatology faces difficulties due to the short available time for teaching the specialty and it is of great importance due to the crescent demand of dermatological cases in primary care. The use of structured reflection to increase diagnostic accuracy has gained prominence as a teaching strategy and has already been evaluated in different scenarios in medical graduation. This strategy, however, has not yet been evaluated in relation to dermatological cases. Goals: The present study evaluated the impact of structured reflection on the diagnostic accuracy of dermatological cases at undergraduate level. Methods: The study was carried out in two phases (training phase and evaluation phase) with students of the 4th year of the UNIFENAS medical course. The students were divided into two groups (control (GC) and reflection (GR)). In the training phase, the two groups resolved the same 12 dermatological clinical cases, but the CG was asked to point out the most likely diagnosis and then to do a distracting activity, while the GR pointed out the diagnosis and then performed a reflexive activity on the case. In the evaluation phase, performed after 7 days, both groups were asked to freely give the diagnosis to another 12 clinical cases. The diagnostic accuracy in the evaluation phase was compared between the two groups and, within a same group, the accuracy between the first and second phases in different types of lesions was compared. Results: Thirty-one students were included, 19 for GR and 22 for GC. The groups were similar in relation to age, gender and performance in the dermatology module. Both groups (CG and GR) showed a statistically significant improvement in accuracy in the evaluation phase compared to the training phase (p <0.001), but there was no difference in performance between the groups (p = 0.495). Stratified analysis showed that students from the structured reflection group improved their diagnostic accuracy of lesions classified as “papules and plaques” and worsened their accuracy for those classified as “pigmented lesions”, showing a different pattern of performance from the control group. When stratified by case difficulty, both groups showed improvement in their performance comparing the training phase with the evaluation phase but no statistically significant difference was observed between the two groups. Conclusion: Overall diagnostic accuracy in the evaluation phase was similar between the reflection group and the control group. However, students who used structured reflection showed an improvement in accuracy for papule/plaque-type lesions that was not observed in the control group. New studies are needed to better evaluate the potential of using structured reflection in the teaching of dermatology, particularly in defining if different type of lesions require different teaching strategies