Pedro Alejandro Gordan

InsuOnline, a Serious Game to Teach Insulin Therapy to Primary Care Physicians: Design of the Game and a Randomized Controlled Trial for Educational Validation

BACKGROUND Physicians´ lack of knowledge contributes to underuse of insulin and poor glycemic control in adults with diabetes mellitus (DM). Traditional continuing medical education have limited efficacy, and new approaches are required. OBJECTIVE We report the design of a trial to assess the educational efficacy of InsuOnline, a game for education of primary care physicians (PCPs). The goal of InsuOnline was to improve appropriate initiation and adjustment of insulin for the treatment of DM. InsuOnline was designed to be educationally adequate, self-motivating, and attractive. METHODS A multidisciplinary team of endocrinologists, experts in medical education, and programmers, was assembled for the design and development of InsuOnline. Currently, we are conducting usability and playability tests, with PCPs and medical students playing the game on a desktop computer. Adjustments will be made based on these results. An unblinded randomized controlled trial with PCPs who work in the city of Londrina, Brazil, will be conducted to assess the educational validity of InsuOnline on the Web. In this trial, 64 PCPs will play InsuOnline, and 64 PCPs will undergo traditional instructional activities (lecture and group discussion). Knowledge on how to initiate and adjust insulin will be assessed by a Web-based multiple choice questionnaire, and attitudes regarding diabetes/insulin will be assessed by Diabetes Attitude Scale 3 at 3 time points-before, immediately after, and 6 months after the intervention. Subjects´ general impressions on the interventions will be assessed by a questionnaire. Software logs will be reviewed. RESULTS To our knowledge, this is the first research with the aim of assessing the educational efficacy of a computer game for teaching PCPs about insulin therapy in DM. We describe the development criteria used for creating InsuOnline. Evaluation of the game using a randomized controlled trial design will be done in future studies. CONCLUSIONS We demonstrated that the design and development of a game for PCPs education on insulin is possible with a multidisciplinary team. InsuOnline can be an attractive option for large-scale continuous medical education to help improving PCPs´ knowledge on insulin therapy and potentially improving DM patients´ care. TRIAL REGISTRATION Clinicaltrials.gov: NCT01759953; http://clinicaltrials.gov/show/NCT01759953 (Archived by WebCite at http://www.webcitation.org/6Dq8Vc7a6).

O ensino da anatomia: integração do corpo humano e meio ambiente

A constante evolucao da tecnologia educacional faz emergir a necessidade de suscitar reflexoes sobre a pratica pedagogica, e este processo dever ser discutido entre educadores e profissionais da saude. Neste contexto, o ensino da Anatomia Humana precisa ser repensado a fim de corresponder as expectativas deste novo e atual momento. Na tentativa de apresentar alternativas de solucao, implantamos um projeto de extensao na Universidade Estadual de Londrina que ensina Anatomia Humana promovendo uma integracao das relacoes entre corpo humano e meio ambiente. Nele, os participantes desenvolveram atividades interdisciplinares de pesquisa-acao com o emprego de diferentes metodos de ensino-aprendizagem dialogados, com alunos do ensino fundamental de uma escola publica. Os resultados obtidos foram positivos no sentido de aliar o conhecimento de uma ciencia basica como a Anatomia ao conhecimento ambiental, num modelo de processo ensino-aprendizagem diferenciado. Acima de tudo, a formacao educacional se elabora por meio de um trabalho de flexibilidade critica e de construcao continua de identidade entre o professor e o grupo de estudantes, considerando a realidade social da populacao regional.

Kidney Transplantation: The Use of Abnormal Kidneys

We transplanted 6 anatomically abnormal kidneys: a horseshoe kidney that after division was transplanted into 2 recipients; 1 kidney with ureteral stones and hydronephrosis; 1 ectopic and 1 hydronephrotic kidney; 2 kidneys with extensive ureteric lesions, donated as free organs. All these kidneys ultimately had normal function in the recipients, long-term in 4.2 patients died but in neither was the death caused by the renal abnormality.

A serious game prototype for education of medical doctors and students on insulin management for treatment of diabetes mellitus

This paper describes the construction of a serious game prototype for training doctors and medical students about insulin management for the treatment of diabetes mellitus (DM). There are a few simulators that are educationally useful for this aim, but they are little attractive for the user, so we intend to create a tool that includes game elements to make it more fun and appealing. A series of hypothetical, clinical cases with increasing complexity are used to develop a minimum curriculum for training, incorporating all the principal aspects of insulin therapy for DM in the context of primary health care. We chose to develop an Adventure game, based on a minimum curriculum of contents about insulin management. The game presents a series of clinical scenarios and asks the players to make decisions about the best diagnostic and therapeutic options for each case. After each decision, the players receive feedback, comparing their decisions with the recommendations from the best-quality medical literature, and have access to additional educational resources (texts, algorithms, links to guidelines).

Effectiveness of a serious game for medical education on insulin therapy: a pilot study

OBJECTIVE We report the preliminary assessment of InsuOnline©, a serious game designed for medical education on insulin therapy. MATERIALS AND METHODS We conducted a pilot study with 41 undergraduate medical students and Internal Medicine residents to assess the educational effectiveness of InsuOnline©, as compared to a traditional educational activity (lecture, cases discussion). Knowledge, skills and beliefs on insulin therapy were evaluated by a questionnaire applied before, immediately after, and 3 months after both interventions. RESULTS Mean knowledge/skills score was improved from 68% to 89% in traditional education group (n = 23; p < 0.001), and from 61% to 90% in game group (n = 18; p < 0.001). After 3 months, mean score decreased (to 80% in traditional education group, and to 78% in game group; p < 0.001 for both) but remained significantly higher than at baseline in both groups (p < 0.001 for both). Although mean score was lower in game group than in traditional education group at baseline (p = 0.04), no difference remained between groups either immediately or 3 months post-intervention. Score increment was better with the game (29%) than with traditional education (21%; p = 0.04). Beliefs improved in the game group only. CONCLUSIONS InsuOnline© is at least as effective as a traditional educational activity for medical education on insulin therapy, and it can a good option for large-scale continuing medical education on diabetes.

O processo de ensino e aprendizagem do raciocínio clínico pelos estudantes de medicina da Universidade Estadual de Londrina

Um dos aspectos mais relevantes nas atuais discussoes sobre ensino, e de grande impacto na pratica clinica, e a forma como os medicos elaboram o raciocinio clinico. Esta pesquisa teve como intuito compreender o processo de raciocinio desenvolvido pelos estudantes do curso de Medicina da Universidade Estadual de Londrina, identificando o processo de ensino-aprendizagem do raciocinio clinico, sua concepcao e as dificuldades que emergem de seu processo de aprendizagem. Trata-se de uma pesquisa com abordagem qualitativa, cuja amostra foi formada por 16 internos do sexto ano de Medicina. Os participantes da pesquisa foram entrevistados sobre a concepcao e o processo de ensino-aprendizagem do raciocinio clinico, e o resultado foi avaliado por analise de discurso. O processo de ensino-aprendizagem do raciocinio trata dos aspectos relatados pelos estudantes: o docente como modelo profissional, a importância da comunicacao no atendimento clinico e as condicoes favoraveis ao aprendizado. A apropriacao do aprendizado do raciocinio clinico abrangeu as dificuldades e os significados expressos de raciocinio clinico pelos entrevistados. A analise qualitativa forneceu dados que podem levar a compreender melhor esse processo de raciocinio.

Custos educacionais totais de currículo integrado de enfermagem

Innovative changes in undergraduate Nursing programs have brought about new methodologies and the need for cost evaluation. This study aims to develop a model for cost estimation, and to estimate educational costs of an integrated Nursing curriculum at a public university. This is a case study conducted in stages: model development, data collection, analysis and interpretation. The cost-construction model consisted of six steps: data collection; educational and support activity costs; four-year course educational costs; educational support costs; joint product costs and total educational costs. Findings showed a total educational cost per student/year US

Total educational costs of an integrated nursing curriculum

3,788.82. Course team faculty included 97 members. The cost analysis in faculty contact hours is the most appropriate cost unit as it most consistently reflects faculty time devoted to teaching. The knowledge about educational costs provided information that may be useful for a different approach to the integrated curriculum management, with a view to putting its educational objectives in practice.Innovative changes in undergraduate Nursing programs have brought about new methodologies and the need for cost evaluation. This study aims to develop a model for cost estimation, and to estimate educational costs of an integrated Nursing curriculum at a public university. This is a case study conducted in stages: model development, data collection, analysis and interpretation. The cost-construction model consisted of six steps: data collection; educational and support activity costs; four-year course educational costs; educational support costs; joint product costs and total educational costs. Findings showed a total educational cost per student/year US

InsuOnline, an Electronic Game for Medical Education on Insulin Therapy: A Randomized Controlled Trial With Primary Care Physicians

3,788.82. Course team faculty included 97 members. The cost analysis in faculty contact hours is the most appropriate cost unit as it most consistently reflects faculty time devoted to teaching. The knowledge about educational costs provided information that may be useful for a different approach to the integrated curriculum management, with a view to putting its educational objectives in practice. DESCRIPTORS: curriculum; costs and cost analysis; education higher; education, nursing; faculty nursing; undergraduate course

The New Challenge: The Aging Process in the Brazilian Amazonia

Innovative changes in undergraduate Nursing programs have brought about new methodologies and the need for cost evaluation. This study aims to develop a model for cost estimation, and to estimate educational costs of an integrated Nursing curriculum at a public university. This is a case study conducted in stages: model development, data collection, analysis and interpretation. The cost-construction model consisted of six steps: data collection; educational and support activity costs; four-year course educational costs; educational support costs; joint product costs and total educational costs. Findings showed a total educational cost per student/year US