Marco Antonio de Carvalho Filho

University Medical Center Groningen · Weckenbach Institute

Cavaleiro and de Carvalho Filho outline the evolving understanding of feedback in medical education, highlighting its significance while considering future research opportunities.

O estudo por aborda os desafios no ensino das Ciências Moleculares e Celulares (CMC) no curso de graduação em Enfermagem, com a proposta de combinar a Pesquisa Baseada em Design (DBR) e o modelo ADDIE de Design Instrucional para sanar as dificuldades do aluno e promover maior aproveitamento da disciplina. Essas metodologias foram aplicadas na disci...

The art of improvisation is linked to the art of living to argue that learning improvisation is crucial to medical education; it connects expectation with intentional action geared toward engaging together.

In this article, we propose developing a “pedagogy of connection” based on the history and evolution of medical education in Brazil. This pedagogy emerged from the intersection of the healthcare and higher educational systems, both dedicated to the principles of social justice and universal access, in response to the country's efforts to address th...

The high rates of depression, burnout, and increased risk of suicide among medical students, residents, and physicians in comparison with other careers signal a mental health crisis within our profession. We contend that this crisis coupled with the inadequate acquisition of interpersonal skills during medical education results from the interaction...

Despite the ubiquity of healthcare simulation and the humanities in medical education, the two domains of learning remain unintegrated. The stories suffused within healthcare simulation have thus remained unshaped by the developments of narrative medicine and the health humanities. Healthcare simulation, in turn, has yet to utilize concepts like co...

Problem: Although the practice of medicine is often emotionally challenging, medical curricula seldom systematically address the emotional development of medical students. To fill this gap, the authors developed and evaluated an innovative pedagogical activity based on music to nurture medical students' emotional development. The authors believe t...

Background Diagnostic errors have been attributed to reasoning flaws caused by cognitive biases. While experiments have shown bias to cause errors, physicians of similar expertise differed in susceptibility to bias. Resisting bias is often said to depend on engaging analytical reasoning, disregarding the influence of knowledge. We examined the role...

Introduction Feedback is crucial to promote learning and improve performance. However, we lack a nuanced understanding of how medical teachers reflect on and internalise (or not) student feedback (SF). This study aims to fill this gap by exploring how teachers make sense of SF to improve their performance and nurture their personal and professional...

Background Patient simulation has been used in medical education to provide a safe and supportive learning environment for learners to practice clinical and interpersonal skills. However, simulation involving pediatric populations, particularly in child and adolescent psychiatry, is rare and generally does not reflect the child-caregiver dyad or th...

Background Patient simulation has been used in medical education to provide a safe and supportive learning environment for learners to practice clinical and interpersonal skills. However, simulation involving pediatric populations, particularly in child and adolescent psychiatry, is rare and generally does not reflect the child-caregiver dyad or th...

Design thinking, an approach traditionally used to develop or improve products, services, or processes within design and engineering sectors, has emerged as a novel pedagogical approach. As design thinking becomes more widely established within education contexts, it is important to gain deeper insight as to how such learning environments operate....

Background/aims: Advance Care Planning (ACP) and Advance Directives (AD) were developed in high-income countries and are considered important means to achieve goal-concordant end-of-life care. However, it is unclear how low- and middle-income countries have incorporated (or not) ACP/AD. We aimed to map and compare the current state of ACP/AD in Lat...

Background Advance Directives (AD) are a strategy developed in high-income countries to achieve goal-concordant end-of-life care. However, it is unclear how AD have been regulated and implemented in the context of Latin American (LA) countries. We aimed to map the current regulatory state of AD in LA, which is important for the development and refi...

Background Racist interactions in clinical practice remain a pervasive reality for Black healthcare providers. We sought to develop a framework to inform supervisors’ actions when confronting racism in clinical practice and protecting trainees under their oversight. Methods We conducted a qualitative study in which experienced supervisors responded...

In this commentary, we examine how to use the recently developed educational method called Co-constructive Patient Simulation (CCPS) to improve continuous professional development in healthcare. CCPS invites learners to participate in the creation of meaningful simulated scenarios while fostering reflection-in/on/for-action and community-building....

Introduction: Medical professionals meet many transitions during their careers, and must learn to adjust rapidly to unfamiliar workplaces and teams. This study investigated the use of a digital educational escape room (DEER) in facilitating medical students' learning around managing uncertainty in transitioning from classroom to clinical placement...

Digital games are increasingly used to support learning across a diverse range of cognitive, affective and psychomotor domains in health professions education. Game‐based learning will likely become an important competency for educators. However, educators can perceive game building as out of their reach due to a lack of expertise in digital techno...

Background Racist interactions in clinical practice remain a pervasive reality for Black healthcare providers. We sought to develop a framework to inform supervisors’ actions when confronting racism in clinical practice and protecting trainees under their oversight. Methods We conducted a prospective study in which experienced supervisors responded...

COVID-19 struck the world and stretched the healthcare system and professionals. Medical students engaged in the pandemic effort, making personal and professional sacrifices. However, the impact of these sacrifices on students` professional development is still unknown. We applied constructivist grounded theory to individual audio diaries (total ti...

Objective to describe the elaboration of a virtual learning object to teach the Nursing History academic discipline. Method a descriptive and exploratory study of the experience report type about the elaboration of a learning object as an active methodology in remote classes of the Nursing History academic discipline using the Analysis, Design, De...

Acute crises of decompensation of a chronic disease are, in most cases, handled in an Emergency Room setting. In these services, emergency care professionals face several challenges, such as incomplete information on the patient’s disease, scarce resources, and the pressure of having to make decisions in a short time. In this context, what can be d...

As crises agudas de descompensação de uma doença crônica são, na maioria das vezes, manejadas em ambiente de pronto-socorro. Nesses serviços, os profissionais emergencistas enfrentam vários desafios, como falta de informação completa sobre a doença do paciente, escassez de recursos e a pressão de ter que tomar decisões em pouco tempo. Nesse context...

Described here is the implementation of a lung ultrasound course for physiotherapists focused on the acquisition and retention of knowledge and skills. Initially, we provided online lectures in a virtual learning environment (VLE), in which we taught the semiquantification of edema through a lung ultrasound score (LUS). Afterward, the physiotherapi...

The authors discuss how interprofessional education could ease the transition into collaborative practice by laying the foundation for interprofessional boundary crossing, suggesting that virtual IPE be used to nurture interprofessional feedback-seeking behaviours.

Background Physicians may receive diagnostic information in different orders, and there is a lack of empirical evidence that the order of presentation may influence clinical reasoning. Objective We investigated whether diagnostic accuracy of chest pain cases is influenced by the order of presentation of the history and electrocardiogram (EKG) to c...

Context Racist interactions in clinical practice remain a pervasive reality for Black healthcare providers. Supervisors charged with the oversight, protection, and support of their racially minoritized trainees are often inconsistent in their approach and have limited guidance to inform their actions. Methods We designed an empirical study in whic...

Introduction Racist interactions in clinical practice remain a pervasive reality for Black healthcare providers. Supervisors charged with the oversight, protection, and support of their racially minoritized trainees are often inconsistent in their approach and have limited guidance to inform their actions. Methods We designed an empirical study in...

Background Racist interactions in clinical practice remain a pervasive reality for Black healthcare providers. Objective We sought to provide supervisors with guidance to inform their actions when confronting racism in daily clinical practice. Methods We conducted in 2021 an empirical study in which experienced supervisors responded to seven short,...

Objective To assess whether scales of physical functional performance and the surprise question (“Would I be surprised if this patient died in 6 months?”) predict life support limitations and mortality in critically ill nonsurgical patients. Methods We included 114 patients admitted from the Emergency Department to an intensive care unit in this p...

Introduction Medical schools worldwide are creating inclusion policies to increase the admission of students from vulnerable social groups. This study explores how medical students from vulnerable social groups experience belongingness as they join the medical community. Methods This qualitative study applied thematic analysis to 10 interviews wit...

Interpersonal communication is critical in training, licensing, and post-graduate maintenance of certification in veterinary medicine. Simulation has a vital role in advancing these skills, but even sophisticated simulation models have pedagogic limitations. Specifically, with learning goals and case scenarios designed by instructors, interaction w...

Objective: To assess whether scales of physical functional performance and the surprise question (“Would I be surprised if this patient died in 6 months?”) predict life support limitations and mortality in critically ill nonsurgical patients. Methods: We included 114 patients admitted from the Emergency Department to an intensive care unit in this...

Objective: To assess whether scales of physical functional performance and the surprise question ("Would I be surprised if this patient died in 6 months?") predict life support limitations and mortality in critically ill nonsurgical patients. Methods: We included 114 patients admitted from the Emergency Department to an intensive care unit in th...

Context The transition from medical student to junior doctor is challenging. Junior doctors need to become part of the physician community of practice (CoP), while dealing with new responsibilities, tasks, and expectations. At the same time, they need to learn how to navigate the frontiers and intersections with the other communities of practice th...

Objective Innovations in contemporary medical education could inform remedies to address enduring challenges such as the marginalization and stigmatization of psychiatry, of mental illnesses, and of those affected by them. Methods In blending the works of Bleakley, Bligh, and Brown (2011) and of Kumagai and Naidu (2015), we developed an overarchin...

The Covid‐19 pandemic has challenged medical educators internationally to confront the challenges of adapting their present educational activities to a rapidly evolving digital world. In this article, the authors use anatomy education as proxy to reflect on and remap the past, present, and future of medical education in the face of these disruption...

Background Novel virus outbreaks, such as the COVID-19 pandemic, may increase psychological distress among frontline workers. Psychological distress may lead to reduced performance, reduced employability or even burnout. In the present study, we assessed experienced psychological distress during the COVID-19 pandemic from a self-determination theor...

Context: The psychological realm of medical students` moral experiences is explored tangentially in medical education literature, often in the context of ethics or professionalism education. This study deepens our understanding by (1) investigating the nature of moral dilemmas experienced at the onset of clinical practice, (2) exploring students` e...

Objectives: Co-constructive patient simulation (CCPS) is a novel medical education approach that provides a participatory and emotionally supportive alternative to traditional supervision and training. CCPS can adapt iteratively and in real time to emergent vicissitudes and challenges faced by clinicians. We describe the first implementation of CCP...

Objectives This study describes the development and implementation of a model to assess students’ communication skills highlighting the use of reflective writing. We aimed to evaluate the usefulness of the students’ reflections in the assessment of communication skills. Design Third-year and fourth-year medical students enrolled in an elective cou...

Introduction Including palliative care (PC) in overloaded medical curricula is a challenge, especially where there is a lack of PC specialists. We hypothesised that non-specialised rotations could provide meaningful PC learning when there are enough clinical experiences, with adequate feedback. Objective Observe the effects of including PC topics...

Background: Bias in reasoning rather than knowledge gaps has been identified as the origin of most diagnostic errors. However, the role of knowledge in counteracting bias is unclear. Objective: To examine whether knowledge of discriminating features (findings that discriminate between look-alike diseases) predicts susceptibility to bias. Design...

Background As the global population ages, palliative care is ever more essential to provide care for patients with incurable chronic conditions. However, in many countries, doctors are not prepared to care for dying patients. Palliative care education should be an urgent concern for all medical schools all around the world, including Latin America...

Medical Professionalism and the Social Contract: Reflections on the COVID-19 Pandemic (text in English)

Introduction One-minute preceptor (OMP) and SNAPPS (a mnemonic for Summarize history and findings; Narrow the differential; Analyze the differential; Probe the preceptor about uncertainties; Plan management; and Select case-related issues for self-study) are educational techniques developed to promote learners’ expression of clinical reasoning duri...

The medical education community acknowledges the importance of including the humanities in general, and the liberal arts in particular, in the education of health professionals. Among the liberal arts, theater is especially helpful for educators wanting to bring experiences that are both real and challenging to the learning encounter in an interact...

Objectives: This study aimed to analyse the effect of a portfolio with three activities fostering students' reflection, self-efficacy and teaching of communication skills and professionalism. Methods: A cross-sectional study was applied with a sample of third- and fourth-year medical students in one Portuguese and three Brazilian universities. A...

Background Diagnostic errors have often been attributed to biases in physicians’ reasoning. Interventions to ‘immunise’ physicians against bias have focused on improving reasoning processes and have largely failed. Objective To investigate the effect of increasing physicians’ relevant knowledge on their susceptibility to availability bias. Design...

La educación médica no es inmune a las angustias que producen los cambios contemporáneos abruptos en nuestro mundo, como la pandemia COVID-19. Inesperadamente, y con muy poca antelación, las personas ya no pueden enseñar o aprender junto a otras personas. El impacto en el corazón de los procesos educativos de las profesiones sanitarias no tiene pre...

Context: Staying motivated when working and learning in complex workplaces can be challenging. When complex environments exceed trainees' aptitude, this may reduce feelings of competence, which can hamper motivation. Motivation theories explain how intrapersonal and interpersonal aspects influence motivation. Clinical environments include addition...

Preparing medical students to provide emergency care is one of the biggest challenges in health education, as novices must articulate a wide spectrum, ever-growing knowledge of a generalist physician in the shortest possible time. Previous experience has shown that a problem-based e-Learning environment, presenting clinical cases to be solved by st...

Objectives This study investigated the associations between self-assessed empathy levels by physicians in training and empathy levels as perceived by their patients after clinical encounters. The authors also examined whether patient assessments were valid and reliable tools to measure empathy in physicians in training. Design A multicentric, obser...

Teaching and learning practices often fail to incorporate new concepts in the ever-evolving field of medical education. Although medical education research provides new insights into curricular development, learners’ engagement, assessment methods, professional development, interprofessional education, and so forth, faculty members often struggle t...

The point of care ultrasound (POCUS) presents itself as the fifth pillar of the physical examination, pairing with inspection, percussion, palpation and auscultation. After the initial usage, in the beginning of the 80’s for the evaluation of abdominal trauma, the POCUS became a daily practice in the critical patient evaluation, either in Critical...

2 Abstract Purpose. Medical students and clinical teachers thrive to establish meaningful learning relationships in overwhelmed and ever-shorter clinical rotations. The challenge for medical educators is to design pedagogical approaches capable of bonding students and teachers into the same community of practice (CoP). In this work, the authors exp...

Background: Ultrasonography is increasingly used in health care. Students often struggle to acquire these techniques. This struggle may be caused by lower selfregulatory skills could cause performance issues. We evaluated the regulatory processes of students engaging in well-defined ultrasonography tasks using self-regulated learning microanalysis,...

Background: The benefits of Point-of-care ultrasonography (PoCUS) for patient care has led to the development of POCUS post-graduate training courses worldwide. It is important to understand the impact of such courses for improvement and dissemination purposes. Method: This study evaluated the impact of the 2-day course PoCUS-Braga on participants’...

The authors argue oath taking to be an expression of context specific social processes and that seemingly universal concepts might be conceived variably.

Purpose To map and understand the influences of the hidden curriculum on the professional identity development of medical students based on the socialization process as proposed by Cruess et al. in a South American medical school. Method Between 2014 and 2016, the authors performed 13 focus groups interviews with a total of 102 final-year medical...

Background Empathy is a fundamental humanistic component of patient care which facilitates efficient and patient-centered clinical encounters. Despite being the principal recipient of physician empathy little work on how patients perceive/report receiving empathy from their physicians has been undertaken. In the context of doctor-patient interactio...

Background Empathy is a fundamental humanistic component of patient care which facilitates efficient and patient-centered clinical encounters. Despite being the principal recipient of physician empathy little work on how patients perceive/report receiving empathy from their physicians has been undertaken. In the context of doctor-patient interactio...

AIMS: In this article, we want to share our perspective on how simulation sessions could contribute to change reality, building a safe environment in which facilitators can role-modeling students to develop emotional competence. Noteworthy, acknowledging and legitimating emotions are also essential components of creating a safe environment for stud...

AIMS: This article discusses the main issues related to the use and structuring of a simulation center, namely, logistics, use of resources and alignment between the pedagogical project and simulated activities.METHODS: A narrative literature review, with search in Web of Science, PubMed, SciELO and Google Scholar databases, included articles publi...

Objective: To develop an in-depth debriefing to address students’ emotions and professional identity formation in the context of a simulation activity with simulated patients at a medical school in Brazil. Methods: The authors conducted a simulated medical consultation activity using standardized patients (SPs) with an in-depth debriefing based on...

Purpose: Lung ultrasound is an accurate and accessible tool to quantify lung edema. Furthermore, left ventricle filling pressures (LVFP) can be assessed with transthoracic echocardiography (TTE) by the E/e' ratio (E/e'). The present study aimed to assess the correlation between E/e' and lung edema quantified by a simplified lung ultrasound score (...

Objectives To examine if the empathy levels of first-year medical students are amenable to didactic interventions idealized to promote values inherent to medical professional identity. Methods This is a pretest-posttest study designed to assess the empathy levels of first-year medical students (n=166) comprising two consecutive classes of a Brazil...

Purpose Endothelial barrier dysfunction is a hallmark of sepsis, and is at least partially mediated by pathways that regulate endothelial barrier assembly during angiogenesis. Not surprisingly, increased levels of key angiogenic proteins such as VEGF-A and Angiopoietin-2 have been described in sepsis. The purpose of this study was to investigate if...