Utilização do feedback para ensino de habilidade de aferição de pressão arterial entre estudantes de medicina: estudo controlado randomizado

Abstract

Introduction: Feedback in medical education in the last 30 years has been the focus of research in the area of medical education and its use has been associated with improved learning by favoring the acquisition of knowledge, skills and attitudes. Several characteristics of this method, such as the level to be achieved, the reevaluation time, type, source, scenario and whom offers the feedback, may interfere in the response to its application. Despite the publications about the importance of feedback in medical education, most of the scientific evidence comes from studies that demonstrate its effectiveness in the short term, and notably, there is still little evidence of studies on this subject in Brazil. Objectives: To evaluate the impact of the use of mid-term feedback for learning how to measure blood pressure among first-year medical students, comparing it with a control group that did not receive feedback, and the scientific evidence available in the literature about the effectiveness of feedback in medical education through a systematic review of randomized clinical trials. Methods: Controlled, randomized study, using or not feedback provided by the teacher, for students of the 1st period of medicine. After a theoretical-practical training in blood pressure assessment, the students were randomized into control (CG) and intervention (GI) groups. To evaluate the ability immediately after the training (T1), the students were submitted to a simulated patient evaluation, using a checklist according to the 7th Brazilian Arterial Hypertension Directive. GI students received feedback immediately after the assessment while the GC received no feedback. After 3 months (T2), each student had been re-evaluated in the same manner as (T1). Results: A total of 92 (82.8%) medical students from the 1st period participated in the study, 45 of the CG and 47 of the GI. In T1 (after the classes about measuring blood pressure), there were no differences in sociodemographic data, nor in the measured ability (GI = 23.23 + 4.36) vs. GC = 23.44 + 3.14), p = 0.792, d = 0.05). In T2 (after 3 months), there was a significant difference in the GI (score = 23.97 + 3.82) in relation to the CG (score = 20.91 + 4.87), p <0.001, d = 0.69. While in the GI, there was a maintenance in the scores after 3 months (T1 = 23.23 and T2 = 23.97, p = 0.335), in the CG there was a significant decrease in the scores (T1 = 23.44 and T2 = 20.91; p = 0.002). Both groups had the same practice of blood pressure measurement after T1 (p = 0.617), which did not influence the results. Conclusion: The results of this trial suggest that receiving feedback leads to greater retention of the learning ability to measure blood pressure in the medium term. The successful results of this study suggest the importance of Brazilian medical schools to adopt this tool in teaching, contributing to the centralization of teaching in the student and to critical-reflexive formation of the egress. New research with application of this tool shall be of use to teach other skills in different periods of medical education.