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[Medical residence in pediatrics: in the field of practice]
Maria Auxiliadora Monteiro Villar1, Maria Helena Cabral de Almeida Cardoso
1Departamento de Cirurgia Pediátrica, Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, 22250-020, Brasil.
Insights
Pediatric practice specificity aids clinical reasoning and diagnostic skills. However, a focus on severity can impede developing these crucial abilities in serious illness.
Area of Science:
- Medical Education
- Pediatrics
- Clinical Reasoning
Context:
- Fernandes Figueira Institute, Oswaldo Cruz Foundation
- Specialized pediatric practice setting
- Qualitative study using thematic interviews
Purpose:
- To explore how pediatric practice specificity influences clinical reasoning development.
- To examine the impact on detecting serious illness evolution.
- To assess the capacity for using diagnostic and therapeutic techniques.
Summary:
- The study found that while pediatric practice specificity is viewed as a unique medical specialty, a 'severity postulate' hinders clinical reasoning.
- A semiotic analysis of thematic interviews revealed medicine is seen as both science and art, with the doctor-patient relationship legitimizing knowledge.
- This focus on severity impedes the ability to detect illness evolution and fully utilize diagnostic/therapeutic skills.
Impact:
- Highlights the need to balance a focus on severity with fostering robust clinical reasoning in pediatrics.
- Informs medical education strategies for pediatric residents.
- Suggests potential improvements in training for managing serious pediatric conditions.
Abstract:
The study focuses on how specificity of pediatric practice at the Fernandes Figueira Institute, Oswaldo Cruz Foundation, contributes to the development of clinical reasoning, the ability to detect evolution in serious illness, and the capacity to use diagnostic and therapeutic techniques. Data were collected using a thematic interview and analyzed by a semiotic model. The results showed a common view of medicine as both science and art, the doctor-patient relationship as legitimating medical knowledge, pediatrics as having its own peculiarities (thus being defined as a medical specialty), and a severity postulate that hinders the development of clinical reasoning and thus the ability to detect evolution in serious illness.