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18troesophageal reflux disease and autoimmune thyroidi-tis leads to the destabilization of the first phase of the antioxidant system, which is manifested by a decrease in the total antioxidant activity, which, in turn, activates the components of the second phase - the glutathione system.
Conclusions.
Gastroesophageal disease, as well as its combination with autoimmune thyroiditis in students, is accompanied by an increase in Klotho protein synthesis and decrease the activity of the glutathione peroxidase and glutathione reductase, which can be considered as bi-omarker of the second phase of the antioxidant system.
References
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PROBLEM-BASED LEARNING AT THE MEDICAL UNIVERSITY FROM THE STUDENT'S VIEW
Koloskova O.,
Doctor of medical sciences, Professor, Head of the Department of Paediatrics and Paediatric Infectious Diseases Bukovinian State Medical University, Ukraine
Gerush I.,
Candidate of medical sciences, Associate Professor of the Department of Bioorganic and Biological Chemistry
and Clinical Biochemistry Bukovinian State Medical University, Ukraine
Khodorovskyy V.,
Candidate of medical sciences, Associate Professor, Head of the Educational Department Bukovinian State
Medical University, Ukraine Bilous T.,
Doctor of medical sciences, Associate Professor of the Department of Paediatrics and Paediatric Infectious Diseases Bukovinian State Medical University, Ukraine
Korotun O.
Candidate of medical sciences, Associate Professor of the Department of Paediatrics and Paediatric Infectious
Diseases Bukovinian State Medical University, Ukraine
Abstract
Problem-based learning is a personality-oriented pedagogical method that motivates students to deep study the subject by actively gaining experience in solving problems open to discussion. Aim of the study was to assess the level of motivation for learning and self-esteem of students in the learning process by the method of problem-based learning of higher medical education. Studied of the feedback of 6th-year students, taking into account the method of PBL, which was used in the educational process, as well as their self-assessment of their motivation in the learning process. It was found that problem-based learning using a virtual patient significantly increases the motivation of students to learn, improves the communicative qualities of future doctors, stimulates the formation of teamwork skills, promotes the development of independent thinking and independent decision-making, shifts the emphasis from the teacher as the center of the educational process towards the independent acquisition of scientific information and its analysis.
Keywords: education, problem-based learning, medical students.
Introduction. Cognitive teaching methods (leam-ing cognition) serve the process of obtaining new information, knowledge, and competencies by subjects of learning for their transformation, memorization and use in everyday professional activities. For persons receiving higher medical education, there are special requirements for the quality of undergraduate training given the highest level of responsibility in the future, the rapid pace of updating medical knowledge, which requires the formation of skills of continuous self-education in the professional process. Higher medical education especially requires the development and implementation of modern pedagogical technologies, improving the quality control of the educational process and objective means of assessing the level of educational and professional competence of the future doctor [4, 7, 12].
Based on this, the improvement of methods of educational cognition for students of higher medical educational institutions (cognitive teaching methods) will never lose its relevance. Like all processes in society, teaching methods are constantly evolving, they are improving under the influence of growing demands on the results of medical training. There are changes and complementarities of cognitive learning methods. Such mutual penetration should be recognized as a method of the problem-based learning (PBL) on virtual patients in order to avoid medical errors, which was formed on the platform of the method of teaching disciplines of such methods, in particular, as a research method, hypotheses, as well as the method of errors [1, 6, 9, 13]. The latter method is based on the use of errors as a basis for deepening professional knowledge and competencies, where the medical error is a source of conflict resolution and an impetus to acquire new knowledge and acquire new competencies. An error, which is an exception to the rule, in this sense motivates students to find out and learn its causes, which increases the likelihood of avoiding similar mistakes in the further professional activities of young doctors [3, 5].
Problem-based learning is a personality-oriented pedagogical method that motivates students to deep study the subject by actively gaining experience in solving problems open to discussion [14]. The PBL method differs from others by stimulating students' motivation for active learning, constructivism, and the central position of the student rather than the teacher in the learning process [2, 8]. As the clinical problem offered to students activates independent acquisition of knowledge necessary for its solution, it promotes the formation of abilities and skills of independent search of the necessary scientific information, and also its independent application which can be reproduced further in own professional activity of the doctor in a particular clinical situation [10, 11].
Aim of the study: To assess the level of motivation for learning and self-esteem of students in the learning process by the method of problem-based learning in the senior year of higher medical education.
Material and methods. During 2015-2019 the Bukovinian State Medical University (BSMU) participated in the grant project Erasmus+ EACEA TAME (Training Against Medical Error) №561583-EPP-1-2015-1-KZ-EPPKA2-CBHE -JP (2015-2944 / 001-
001). The main strategic goal of the project was to avoid mistakes in medical practice, in particular, in providing medical care to children, and one of the tactical goals - to motivate students to self-realization, in particular, in teamwork, which will further reduce the risk of erroneous decisions in practice.
In total, within the framework of the project, the classes were conducted according to the method of PBL on cases of medical errors with 68 6th year students majoring in "General Medicine" (24 classes of 3 hours each), who were interviewed at the end of the cycle of these classes.
Unified software "OpenLabyrinth" was used to create clinical cases. The process of creating clinical cases lasted from 3 to 6 months of work on each of them and included the following stages: (1) determining the topic of the clinical case; (2) selection of a clinical prototype from real medical practice; (3) identification of medical errors inherent in this case; (4) direct writing of the clinical case; (5) internal review by teachers of clinical departments not involved in the creation of the case; (6) external review (by teachers of Zaporizhia State Medical University - partners in the TAME project); (7) conducting trial classes with students; (8) receiving and processing student feedback on teaching methods; (9) making final adjustments; (10) the use of the case in the learning process on an ongoing basis.
Motivation to study 68 6th year students, whose average age was 22.43 ± 0.12 years, the percentage of girls - 72.06% and boys - 27.94%, was assessed after classes using clinical cases through an anonymous questionnaire using a questionnaire, which contained 32 questions, the answers to which respondents gave in points from 1 ("it's not mine ..") to 7 points ("it's my choice..."). In this paper, we present an analysis of the feedback of 6th-year students, taking into account the method of PBL, which was used in the educational process, as well as their self-assessment of their motivation in the learning process.
The obtained results were evaluated using the methods of variation statistics.
Results and discussion. Based on the fact that the respondents formulated their answers to 32 questions of the questionnaire in the form of a score from 1 to 7 points, of which the minimum score reflected a complete denial of the thesis set out in the question, and the maximum - instead, absolute agreement with it, and the maximum amount grades was 224 points, respectively, we analyzed some aspects of student self-assessment of learning by the method of PBL. Thus, the highest score was given to questions related to the usefulness, in formativeness, importance of the material presented in the cases, the need to learn new material to solve them, which was estimated by students at 83.34% of the maximum possible amount of points. Thus, the graduates understood and appreciated this teaching method quite highly, but they felt a little worse in the learning process. Thus, questions that covered their feelings during training, in particular, the ability to imagine similar situations, develop their own scenario, develop their approach to this method of teaching, uncertainty in the persuasiveness of the data, lack of diligence in cases of medical errors, etc. - received a score of 78.36% of the
maximum possible amount of points. Many students have not yet formed a vision of the possibility of further application of the acquired skills in the process of PBL, for example, in other areas of activity (77.4%). At the same time, the vision of one's own mistakes in the perspective of gaining experience was estimated at 76.47% of the maximum possible number of points, and the obtained self-confidence in solving similar clinical situations in the process of learning and personal professional activity - at 80.32% from the maximum.
The results of the discrete assessment of students' communication skills in the PBL process were illustrative. Thus, the need for the help of a tutor in solving complex clinical situations was estimated at 76.68% of the maximum possible amount of points, and therefore the respondents saw the possibilities of their own and / or teamwork. However, independence in solving even complex problems as their credo was assessed by students only in 68.07% of the possible, and the importance of teamwork as a way to overcome difficulties - only in 66.49% points.
Thus, the analysis of the results of students' self-assessment of their feelings and motivational incentives to gain new knowledge in the process of PBL, based on the avoidance of medical errors, revealed weaknesses in the training of future doctors. Thus, with a fairly high constellation of evaluations of the method itself as new, interesting, and useful, students, however, don't see themselves confident in the teamwork, still, the easiest way to obtain information is to contact the teacher, but rather appreciate their ability to solve clinical cases. Thus, the maximum score (7 points) on information support by a tutor in case of difficulties was given by 22.07% of students, and 6 points as an assessment of independent search for answers - 38.23% of respondents, and only 14% of graduates identified teamwork as a priority.
Thus, the introduction of the method of problem-based learning in the 6th year of the medical faculty appears now extremely necessary, as it helps graduates of higher medical educational institutions develop teamwork skills that will further reduce the risk of medical errors.
The PBL method significantly influenced the motivation of students to obtain and assimilate new knowledge and information. Answers to questions about the further development of their ideas under the influence of participation in the analysis of cases, the need for self-education to overcome difficulties in solving proposed clinical situations, the impetus to find their approach to this method of learning, the need for effort and diligence possible constellation 80.79% points. This reflects the unconditional motivational component of the PBL method and emphasizes the importance of its implementation in the everyday learning process.
At the same time, the self-assessment of the role of lack of self-effort (70.69% of the maximum possible amount of points) indicated a significant reserve to increase motivation to acquire new knowledge of medical graduates, as most openly (with a score of 7 points) training was recognized by only 16.17% of responding sixth-year students.
Finally, it worth mentioning that students who worked in the TAME project using the PBL method by analyzing cases based on virtual patients were more motivated and interested in learning, showed better results in compiling modular tests in paediatrics and therapy, and demonstrated a higher level of theoretical knowledge when writing an integrated licensing exam "STEP-2".
Conclusions. One of the most studied cognitive teaching methods - problem-based learning using a virtual patient significantly increases the motivation of students to learn; improves the communicative qualities of future doctors; stimulates the formation of teamwork skills; promotes the development of independent thinking and independent decision-making; shifts the emphasis from the teacher as the center of the educational process towards the independent acquisition of scientific information and its analysis.
This method of teaching using clinical cases that contain medical errors can be recommended for implementation and incorporation in the curriculum of medical schools regularly in combination with the traditional method of teaching.
References
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ИСПОЛЬЗОВАНИЕ ЛЕЧЕБНО-ОЗДОРОВИТЕЛЬНЫХ УЧРЕЖДЕНИЙ ДЛЯ ОКАЗАНИЯ
ПСИХОЛОГО-ПСИХИАТРИЧЕСКОЙ ПОМОЩИ ПРИ ЧРЕЗВЫЧАЙНЫХ СИТУАЦИЯХ
Динмухаметов А.Г.,
доцент кафедры анестезиологии и реаниматологии, медицины катастроф, кандидат медицинских наук Казанский государственный медицинский университет
Каток А.А.
ассистент кафедры психиатрии с курсом наркологии Казанский государственный медицинский университет
USE OF HEALTH-IMPROVING INSTITUTIONS TO PROVIDE PSYCHOLOGICAL AND PSYCHIATRIC CARE IN EMERGENCY SITUATIONS
Dinmukhametov A.,
pulpit anesteziologii and reanimatologii, medicine of the catastrophes
associate professor Kazan State Medical University Katok A.
pulpit a psychiatries with course narkologii
assistant
Kazan State Medical University
Аннотация
Значительное количество людей может подвергнуться значительному риску при возникновении аварий и катастроф чрезвычайных ситуаций различной природы. Факторы риска аварий и промышленных катастроф на объектах экономики, возможные механизмы их развития, с учётом формирования величины и структуры санитарных потерь приводит к необходимости всестороннего анализа возможностей здравоохранения административных территорий по оказанию медицинской помощи поражённым в крупномасштабных чрезвычайных ситуациях при массовых поражениях людей. Возникает необходимость при организации оказания медицинской помощи использования дополнительного коечного фонда, имеющегося в санаторно-курортных и других лечебно-оздоровительных учреждениях.
Нами предлагается оказание психиатрической и психологической помощи населению в чрезвычайных ситуациях различной природы организовать в выше перечисленных учреждениях.
Abstract
A significant number of people may be exposed to a significant risk in the event of accidents and disasters of various nature. Risk factors of accidents and industrial disasters at economic facilities, possible mechanisms of their development, taking into account the formation of the size and structure of sanitary losses, leads to the need for a comprehensive analysis of the health care capabilities of administrative territories to provide medical care to those affected in large-scale emergency situations with mass injuries of people. There is a need for the organization of medical care to use an additional bed fund available in sanatorium-resort and other health-improving institutions.
We propose to organize the provision of psychiatric and psychological assistance to the population in emergency situations of various nature in the above-listed institutions.
Ключевые слова: АХОВ (аварийные химически опасные вещества), чрезвычайные ситуации, зоны риска, потенциально опасные объекты, санитарные потери, психологическая и психиатрическая помощь.
Keywords: AHOV (emergency chemical hazmats), exceeding situations, zones of the risk, potentially dangerous objects, sanitary losses, psychological and psychiatric help.
