Downloaded from http://jme.bmj.com/ on June 22, 2015 - Published by group.bmj.com
Brief report
BRIEF REPORT
Perception of illegal practice of medicine by Brazilian medical students Liliane Lins,1,2 Suzana Herbas,1 Larissa Lisboa,1 Hannah Damasceno,1 Marta Menezes1 1
Study and Research Group on Ethics and Bioethics, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil 2 Faculty of Medicine, Center for Transdisciplinary Research and Education in Bioethics, Federal University of Bahia, Salvador, Bahia, Brazil Correspondence to Dr Liliane Lins, Study and Research Group on Ethics and Bioethics, Bahiana School of Medicine and Public Health, R Frei Henrique, 8, Nazaré, Salvador, Bahia CEP: 40050-420, Brazil; lilianelinskusterer@ bahiana.edu.br Received 29 October 2012 Revised 26 February 2013 Accepted 5 November 2013 Published Online First 22 November 2013
ABSTRACT Introduction Illegal practice of medicine by medical students is a worldwide problem. In Brazil, information about this issue is scarce. Objective To describe the perception of illegal practice of medicine by medical students. Methods A cross-sectional study in a stratified random sample of 130 medical students in the 6th to 12th semesters from a private faculty of medicine in Salvador, State of Bahia, Brazil, from September to October 2011. Students responded to a standardised questionnaire about the illegal practice of medicine by medical students. Results Knowing medical students who practised medical activities without supervision was reported by 86% of the respondents, and 93.8% had heard about someone who performed such practices. Medical specialties most often associated with illegal practice were general medicine (78.8%) and occupational health (55.9%). Illegal practice of medicine was more common in peripheral cities/towns (83.9%) than in the State capital, Salvador City (52.4%). Only 10.5% of illegal activities were reported to the authorities. Unsupervised medical practice was more often reported in the 8th–9th semester (56.8%) and 10th–11th semester (54.4%) of medical school. Conclusions Illegal practice of medicine was commonly reported by the medical students questioned. The high frequency of reported illegal practice for financial reasons highlights the need for greater availability of paid internships for medical students. Educational institutions represent the social control responsible for supervising the activities of academics.
INTRODUCTION
To cite: Lins L, Herbas S, Lisboa L, et al. J Med Ethics 2014;40:432–434. 432
Illegal practice of medicine is an undeniable problem not only in Brazil, but around the world.1 It can result from the practice of qualified professionals who exceed the limits of the profession, or of any person without the professional and legal capacity for the activity. Such illegal practice, when exercised by medical students, is the focus of this study. In most countries, medical students have the right to participate, under supervision, in acts and medical procedures to improve their performance to a desired degree of efficiency. Under adequate supervision, students must have direct contact with sick people to acquire a basic knowledge of techniques and learn how to deal with medical problems. Students and doctors should be aware of ethical, legal and social implications of these procedures,
knowing that medical student practice without proper supervision is illegal. Medical students cannot be punished by The Council of Medicine for improper professional exercise, as they are not graduated doctors. Therefore, any punishment is up to Penal and Civil codes. In Brazil, there are few formal records of illegal practice of medicine by medical students.1–7 However, it seems to be a widespread practice according to medical students and healthcare professionals.6 7 Owing to the absence of data, hazards and damage to the population and medical community may be underestimated. We aimed to investigate the perception of illegal practice of medicine by Brazilian medical students.
METHODS This cross-sectional study was carried out at a faculty of medicine in Salvador, Bahia, from September to October 2011. Sample size was calculated based on a population of 700 students, using the Epi Info STATCALC tool, V.3.5.1. It was assumed that 60% of the students would report that a student had carried out an illegal medical activity, and that 50% of results would be the unexpected one, with a CI of 95%, resulting in a sample of n=81. In order to compensate for the design effect, the sample size was increased to 130. A stratified random sample, proportional to the semester (18–19 students from each semester), was taken. A questionnaire was developed for the purposes of the study. A literature review was carried out in Medline, LILACS, SciELO and academic Google databases using the following descriptors: ‘medical students’ and ‘illegal medicine’. The questionnaire contained three discursive questions about the illegal practice of medicine, identification of the agencies responsible for overseeing illegal shift work, and knowledge about laws and codes controlling the illegal practice of medicine. Discursive questions were analysed by thematic analysis. The questionnaire also included nine multiple-choice questions about the existence of any discussion on the theme at medical school. Students were asked if they knew of any student who performed medical activities without supervision, the medical area in which it occurred, the reason for it, the place of the illegal practice, the frequency, the academic year of the student, and if the illegal activity was reported to the authorities. Most of these questions could receive more than one answer. Questionnaires were applied during classroom visits. Data were analysed
Lins L, et al. J Med Ethics 2014;40:432–434. doi:10.1136/medethics-2012-101190
Downloaded from http://jme.bmj.com/ on June 22, 2015 - Published by group.bmj.com
Brief report using Epi Info software. All the students were informed and signed the consent form. The study protocols were approved by the ethics review board of Bahiana School of Medicine and Public Health, under protocol number 124/11, in conformation with the Brazilian Health National Council Resolution 196/96, as well as the Declaration of Helsinki, 2008.
Ninety per cent of the students believed that the Code of Medical Ethics regulates illegal activity of medical students. Finally, 30 students answered that punishment for illegal practice is in the Civil and Penal codes, and only 12 (9.5%) attributed punishment power to Consumer Law.
DISCUSSION RESULTS Just over half (55%) of the 130 medical students were female, and the mean±SD age was 23.4 ± 2.08 years (range 20–33). Knowing another medical student who practised medical activities without supervision was reported by 86% of the students interviewed; 93.8% of the 130 interviewed had heard about someone who performed such practices. When considering the medical specialty in which it occurred, students reported frequencies of 78.8% for general medicine, 55.9% for the occupational health, 48.0% for orthopaedics, 24.4% for paediatrics, and 7.2% for other specialties. Illegal practice of medicine was more common in peripheral cities/towns (83.9%) than in the State capital, Salvador City (52.4%). Seventy-two per cent of students reported that such activities occurred weekly, 11.3% fortnightly, and 16.8% ‘monthly and more rarely’. According to 62.8% of the students, the topic ‘Activity without medical supervision’ was never discussed in their academic environment, which includes internships, peer tutoring and academic leagues. Sixty-eight per cent of the students answered that the unsupervised activity was motivated by money. In 53.6% of the cases, it was practised to acquire extra knowledge, 52% to buy personal belongings, 17% to obtain social status among classmates, and 2.4% for other reasons. Only 10.5% of illegal activities were reported to authorities (Council of Medicine, Police and Public Ministry). Unsupervised medical practice was more commonly reported in the 8th–9th semester (56.8%) and 10th–11th semester (54.4%) of medical school (table 1). Illegal practice of medicine was defined as carrying out medical activities without Brazilian Federal Council of Medicine (BFCM) inscription or without medical training by 81 (62.3%) students; 14.6% of them defined illegal practice as an activity that violates the Code of Medical Ethics. Unsupervised medical practice was qualified as an illegal act by 27% of those interviewed. When asked which organisation is responsible for overseeing illegal medical practice, 100 (77.6%) students referred to the BFCM. Other organisations were also mentioned, such as the Brazilian Public Ministry of Justice (3.9%), Police Department (3.9%), State Health Office (3.2%), Health Surveillance (1.6%), and other agencies (3.2%).
Table 1 Academic year of the medical course when unsupervised medical practice occurred as reported by 130 medical students, Salvador, Brazil, 2011 Year
N*
Per cent
2nd 3rd 4th 5th 6th
5 39 74 71 48
3.6 30.0 56.8 54.4 37.3
*More than one alternative was possible.
Lins L, et al. J Med Ethics 2014;40:432–434. doi:10.1136/medethics-2012-101190
Initially, it must be emphasised that our main objective was not to quantify the illegal practice in medical education, but to identify its perception by medical students in the academic environment. The results of this study indicate the existence of illegal practice of medicine by medical students in Salvador City and surrounding towns. Most students recognised that medical practice without supervision is an illegal and punishable activity; however, the majority could not identify the main organisation responsible for punishing such practices. These aspects are relevant because they may suggest how students are unaware of ethical concerns about the consequences of illegal practice of medicine, which underestimates its harmful potential. It is important to introduce academics to active methods in the field of ethics in medical education as a way to develop their commitment and academic responsibility.8 These concepts are essential to scientific integrity, as a main ethics priority of teaching staff at educational institutions. Students involved in illegal medical practice were predominantly in the 4th and 5th years, in agreement with literature reports on medical students’ internships.9 Our results differ from those of other authors who observed most parallel curriculum activities in the last academic year, when clinical practice becomes more satisfying to medical students.10 11 Illegal activities predominate in the areas of general medicine and occupational health, with a reported frequency of 78.8% and 55.9%, respectively. Other studies reported aspects of the parallel curriculum among specialties, although they did not deal with the illegal nature of this practice.9 10 Financial necessity was identified as the main motivation for students to practice medicine without supervision. A previous study11 emphasised the practice of medicine by students as illegal and described the financial motive as the most prevalent. Other studies published so far did not consider this variable, or have simply reported it as third in importance, with a low percentage compared with other motivations.9 10 12 The need to acquire extra knowledge was identified by students as the second most prevalent reason (53.6%) for the practice, confirming literature reports.9 10 It has been shown that medical practice performed by students under supervision has a positive effect on the outcome of patients, and that the lack of supervision is harmful to patients.13 Tomorrow’s Doctors 200914 indicates the method of shadowing (or supervised practice) as the most beneficial for student learning. This is why the increased occurrence of volunteer shifts is generating concerns about academic performance and patient care. Patients are vulnerable to mistakes made by unsupervised students, and it is important to remember that they tend to see a medical student in a position of trust and responsibility. Of the students questioned, only 62.8% had discussed illegal medical practice in the academic environment. Medical schools should be responsible for identifying illegal practice by medical students and act against inappropriate behaviour. Identification of illegal practice by medical students is dependent on reporting to authorities. Our data show that illegal practice was only reported in 10.5% of cases. In conclusion, this study indicates that illegal practice of medicine is common in the Brazilian academic environment. The high frequency of illegal practice for financial motives highlights 433
Downloaded from http://jme.bmj.com/ on June 22, 2015 - Published by group.bmj.com
Brief report the need for a greater availability of paid internships for medical students. Educational institutions represent the social control responsible for supervising activities of academics. Contributors All authors included on this paper fulfil the criteria of authorship. LiL and MM contributed to conception and design. LaL, LiL, SH and HD worked on data collection, analysis and interpretation. LiL wrote the article, and all authors reviewed it and approved it for publication. Competing interests None.
4
5 6 7 8
Ethics approval Ethics review board of Bahiana School of Medicine and Public Health. Provenance and peer review Not commissioned; externally peer reviewed.
9 10
REFERENCES 1
2
3
434
Revista Época/ Sociedade. O perigo dos falsos doutores. 2011. http://cnj.myclipp.inf. br/default.asp?smenu=noticias&dtlh=158639&iABA=Not%EDcias&exp= (accessed 26 Feb 2013). Folha de São Paulo. Médica acusada de contratar falso médico no Rio presta depoimento. 2010. http://www1.folha.uol.com.br/cotidiano/783082-medicaacusada-de-contratar-falso-medico-no-rio-presta-depoimento.shtml (accessed 26 Feb 2013). Conselho Federal de Medicina. CRM denuncia exercício ilegal da profissão praticado no Piauí. 2009. http://portal.cfm.org.br/index.php?option=com_content&view= article&id=8518&catid=3:portal (accessed 26 Feb 2013).
11 12
13 14
Globo. Estudantes de Medicina são presos por se passarem por falsos médicos. 2013. http://g1.globo.com/mg/vales-mg/noticia/2013/07/estudantes-de-medicinasao-presos-por-se-passarem-por-falsos-medicos.html (accessed 06 Oct 2013). Correio da Paraíba. Estudantes de Medicina dão plantão ilegal. 2010. http://achix. achanoticias.com.br/noticia.kmf?cod=9519859&indice=0 (accessed 26 Feb 2013). Jornal da Facom. Quase Profissionais. 2007. http://www.jornaldafacom.ufba.br/ ed12/materias/saude_quaseprofissionais.html (accessed 26 Feb 2013). Silva IRF. A Ética e o Estudante de Medicina. Revista Médica do H.S.E. http://www. hse.rj.saude.gov.br/profissional/revista/36/etica.asp (accessed 26 Feb 2013). The Center for Academic Integrity Center for Academic Integrity. The Fundamental Values of Academic Integrity. 1999. http://www.academicintegrity.org/icai/ resources-2.php (accessed 23 Oct 2012). Stella R, Taquette SR, Costa-Macedo LM, et al. Currículo Paralelo: uma realidade na formação dos estudantes de Medicina da UERJ. Rev Bras Educ Med 2003;27:171–6. Tavares AP, Ferreira RA, França EB, et al. O “Currículo Paralelo” dos estudantes de medicina da Universidade Federal de Minas Gerais. Rev Bras Educ Med 2007;31:254–65. http://www.scielo.br/scielo.php? (accessed 23 Oct 2012). Ambrósio MR, Spíndola EB, Santos GT, et al. Exercício profissional da medicina por estudantes. Rev Bras Educ Med 2001;25:28–38. Tavares CHF, Maia JA, Muniz MCH, et al. O Currículo Paralelo dos Estudantes da Terceira Série do Curso Médico da Universidade Federal de Alagoas. Rev Bras Educ Med 2007;31:245–53. Kilminster SM, Jolly BC. Effective supervision in clinical practice settings: a literature review. Med Educ 2000;34:827–40. Tomorrow’s Doctors. General Medical Council. September 2009:55. http://www. gmc-uk.org/TomorrowsDoctors_2009.pdf_39260971.pdf (accessed 23 Oct 2012).
Lins L, et al. J Med Ethics 2014;40:432–434. doi:10.1136/medethics-2012-101190
Downloaded from http://jme.bmj.com/ on June 22, 2015 - Published by group.bmj.com
Perception of illegal practice of medicine by Brazilian medical students Liliane Lins, Suzana Herbas, Larissa Lisboa, Hannah Damasceno and Marta Menezes J Med Ethics 2014 40: 432-434 originally published online November 22, 2013
doi: 10.1136/medethics-2012-101190 Updated information and services can be found at: http://jme.bmj.com/content/40/6/432
These include:
References Email alerting service
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This article cites 5 articles, 0 of which you can access for free at: http://jme.bmj.com/content/40/6/432#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Undergraduate (96) Occupational and environmental medicine (15) Epidemiologic studies (75)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Brief report
BRIEF REPORT
Perception of illegal practice of medicine by Brazilian medical students Liliane Lins,1,2 Suzana Herbas,1 Larissa Lisboa,1 Hannah Damasceno,1 Marta Menezes1 1
Study and Research Group on Ethics and Bioethics, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil 2 Faculty of Medicine, Center for Transdisciplinary Research and Education in Bioethics, Federal University of Bahia, Salvador, Bahia, Brazil Correspondence to Dr Liliane Lins, Study and Research Group on Ethics and Bioethics, Bahiana School of Medicine and Public Health, R Frei Henrique, 8, Nazaré, Salvador, Bahia CEP: 40050-420, Brazil; lilianelinskusterer@ bahiana.edu.br Received 29 October 2012 Revised 26 February 2013 Accepted 5 November 2013 Published Online First 22 November 2013
ABSTRACT Introduction Illegal practice of medicine by medical students is a worldwide problem. In Brazil, information about this issue is scarce. Objective To describe the perception of illegal practice of medicine by medical students. Methods A cross-sectional study in a stratified random sample of 130 medical students in the 6th to 12th semesters from a private faculty of medicine in Salvador, State of Bahia, Brazil, from September to October 2011. Students responded to a standardised questionnaire about the illegal practice of medicine by medical students. Results Knowing medical students who practised medical activities without supervision was reported by 86% of the respondents, and 93.8% had heard about someone who performed such practices. Medical specialties most often associated with illegal practice were general medicine (78.8%) and occupational health (55.9%). Illegal practice of medicine was more common in peripheral cities/towns (83.9%) than in the State capital, Salvador City (52.4%). Only 10.5% of illegal activities were reported to the authorities. Unsupervised medical practice was more often reported in the 8th–9th semester (56.8%) and 10th–11th semester (54.4%) of medical school. Conclusions Illegal practice of medicine was commonly reported by the medical students questioned. The high frequency of reported illegal practice for financial reasons highlights the need for greater availability of paid internships for medical students. Educational institutions represent the social control responsible for supervising the activities of academics.
INTRODUCTION
To cite: Lins L, Herbas S, Lisboa L, et al. J Med Ethics 2014;40:432–434. 432
Illegal practice of medicine is an undeniable problem not only in Brazil, but around the world.1 It can result from the practice of qualified professionals who exceed the limits of the profession, or of any person without the professional and legal capacity for the activity. Such illegal practice, when exercised by medical students, is the focus of this study. In most countries, medical students have the right to participate, under supervision, in acts and medical procedures to improve their performance to a desired degree of efficiency. Under adequate supervision, students must have direct contact with sick people to acquire a basic knowledge of techniques and learn how to deal with medical problems. Students and doctors should be aware of ethical, legal and social implications of these procedures,
knowing that medical student practice without proper supervision is illegal. Medical students cannot be punished by The Council of Medicine for improper professional exercise, as they are not graduated doctors. Therefore, any punishment is up to Penal and Civil codes. In Brazil, there are few formal records of illegal practice of medicine by medical students.1–7 However, it seems to be a widespread practice according to medical students and healthcare professionals.6 7 Owing to the absence of data, hazards and damage to the population and medical community may be underestimated. We aimed to investigate the perception of illegal practice of medicine by Brazilian medical students.
METHODS This cross-sectional study was carried out at a faculty of medicine in Salvador, Bahia, from September to October 2011. Sample size was calculated based on a population of 700 students, using the Epi Info STATCALC tool, V.3.5.1. It was assumed that 60% of the students would report that a student had carried out an illegal medical activity, and that 50% of results would be the unexpected one, with a CI of 95%, resulting in a sample of n=81. In order to compensate for the design effect, the sample size was increased to 130. A stratified random sample, proportional to the semester (18–19 students from each semester), was taken. A questionnaire was developed for the purposes of the study. A literature review was carried out in Medline, LILACS, SciELO and academic Google databases using the following descriptors: ‘medical students’ and ‘illegal medicine’. The questionnaire contained three discursive questions about the illegal practice of medicine, identification of the agencies responsible for overseeing illegal shift work, and knowledge about laws and codes controlling the illegal practice of medicine. Discursive questions were analysed by thematic analysis. The questionnaire also included nine multiple-choice questions about the existence of any discussion on the theme at medical school. Students were asked if they knew of any student who performed medical activities without supervision, the medical area in which it occurred, the reason for it, the place of the illegal practice, the frequency, the academic year of the student, and if the illegal activity was reported to the authorities. Most of these questions could receive more than one answer. Questionnaires were applied during classroom visits. Data were analysed
Lins L, et al. J Med Ethics 2014;40:432–434. doi:10.1136/medethics-2012-101190
Downloaded from http://jme.bmj.com/ on June 22, 2015 - Published by group.bmj.com
Brief report using Epi Info software. All the students were informed and signed the consent form. The study protocols were approved by the ethics review board of Bahiana School of Medicine and Public Health, under protocol number 124/11, in conformation with the Brazilian Health National Council Resolution 196/96, as well as the Declaration of Helsinki, 2008.
Ninety per cent of the students believed that the Code of Medical Ethics regulates illegal activity of medical students. Finally, 30 students answered that punishment for illegal practice is in the Civil and Penal codes, and only 12 (9.5%) attributed punishment power to Consumer Law.
DISCUSSION RESULTS Just over half (55%) of the 130 medical students were female, and the mean±SD age was 23.4 ± 2.08 years (range 20–33). Knowing another medical student who practised medical activities without supervision was reported by 86% of the students interviewed; 93.8% of the 130 interviewed had heard about someone who performed such practices. When considering the medical specialty in which it occurred, students reported frequencies of 78.8% for general medicine, 55.9% for the occupational health, 48.0% for orthopaedics, 24.4% for paediatrics, and 7.2% for other specialties. Illegal practice of medicine was more common in peripheral cities/towns (83.9%) than in the State capital, Salvador City (52.4%). Seventy-two per cent of students reported that such activities occurred weekly, 11.3% fortnightly, and 16.8% ‘monthly and more rarely’. According to 62.8% of the students, the topic ‘Activity without medical supervision’ was never discussed in their academic environment, which includes internships, peer tutoring and academic leagues. Sixty-eight per cent of the students answered that the unsupervised activity was motivated by money. In 53.6% of the cases, it was practised to acquire extra knowledge, 52% to buy personal belongings, 17% to obtain social status among classmates, and 2.4% for other reasons. Only 10.5% of illegal activities were reported to authorities (Council of Medicine, Police and Public Ministry). Unsupervised medical practice was more commonly reported in the 8th–9th semester (56.8%) and 10th–11th semester (54.4%) of medical school (table 1). Illegal practice of medicine was defined as carrying out medical activities without Brazilian Federal Council of Medicine (BFCM) inscription or without medical training by 81 (62.3%) students; 14.6% of them defined illegal practice as an activity that violates the Code of Medical Ethics. Unsupervised medical practice was qualified as an illegal act by 27% of those interviewed. When asked which organisation is responsible for overseeing illegal medical practice, 100 (77.6%) students referred to the BFCM. Other organisations were also mentioned, such as the Brazilian Public Ministry of Justice (3.9%), Police Department (3.9%), State Health Office (3.2%), Health Surveillance (1.6%), and other agencies (3.2%).
Table 1 Academic year of the medical course when unsupervised medical practice occurred as reported by 130 medical students, Salvador, Brazil, 2011 Year
N*
Per cent
2nd 3rd 4th 5th 6th
5 39 74 71 48
3.6 30.0 56.8 54.4 37.3
*More than one alternative was possible.
Lins L, et al. J Med Ethics 2014;40:432–434. doi:10.1136/medethics-2012-101190
Initially, it must be emphasised that our main objective was not to quantify the illegal practice in medical education, but to identify its perception by medical students in the academic environment. The results of this study indicate the existence of illegal practice of medicine by medical students in Salvador City and surrounding towns. Most students recognised that medical practice without supervision is an illegal and punishable activity; however, the majority could not identify the main organisation responsible for punishing such practices. These aspects are relevant because they may suggest how students are unaware of ethical concerns about the consequences of illegal practice of medicine, which underestimates its harmful potential. It is important to introduce academics to active methods in the field of ethics in medical education as a way to develop their commitment and academic responsibility.8 These concepts are essential to scientific integrity, as a main ethics priority of teaching staff at educational institutions. Students involved in illegal medical practice were predominantly in the 4th and 5th years, in agreement with literature reports on medical students’ internships.9 Our results differ from those of other authors who observed most parallel curriculum activities in the last academic year, when clinical practice becomes more satisfying to medical students.10 11 Illegal activities predominate in the areas of general medicine and occupational health, with a reported frequency of 78.8% and 55.9%, respectively. Other studies reported aspects of the parallel curriculum among specialties, although they did not deal with the illegal nature of this practice.9 10 Financial necessity was identified as the main motivation for students to practice medicine without supervision. A previous study11 emphasised the practice of medicine by students as illegal and described the financial motive as the most prevalent. Other studies published so far did not consider this variable, or have simply reported it as third in importance, with a low percentage compared with other motivations.9 10 12 The need to acquire extra knowledge was identified by students as the second most prevalent reason (53.6%) for the practice, confirming literature reports.9 10 It has been shown that medical practice performed by students under supervision has a positive effect on the outcome of patients, and that the lack of supervision is harmful to patients.13 Tomorrow’s Doctors 200914 indicates the method of shadowing (or supervised practice) as the most beneficial for student learning. This is why the increased occurrence of volunteer shifts is generating concerns about academic performance and patient care. Patients are vulnerable to mistakes made by unsupervised students, and it is important to remember that they tend to see a medical student in a position of trust and responsibility. Of the students questioned, only 62.8% had discussed illegal medical practice in the academic environment. Medical schools should be responsible for identifying illegal practice by medical students and act against inappropriate behaviour. Identification of illegal practice by medical students is dependent on reporting to authorities. Our data show that illegal practice was only reported in 10.5% of cases. In conclusion, this study indicates that illegal practice of medicine is common in the Brazilian academic environment. The high frequency of illegal practice for financial motives highlights 433
Downloaded from http://jme.bmj.com/ on June 22, 2015 - Published by group.bmj.com
Brief report the need for a greater availability of paid internships for medical students. Educational institutions represent the social control responsible for supervising activities of academics. Contributors All authors included on this paper fulfil the criteria of authorship. LiL and MM contributed to conception and design. LaL, LiL, SH and HD worked on data collection, analysis and interpretation. LiL wrote the article, and all authors reviewed it and approved it for publication. Competing interests None.
4
5 6 7 8
Ethics approval Ethics review board of Bahiana School of Medicine and Public Health. Provenance and peer review Not commissioned; externally peer reviewed.
9 10
REFERENCES 1
2
3
434
Revista Época/ Sociedade. O perigo dos falsos doutores. 2011. http://cnj.myclipp.inf. br/default.asp?smenu=noticias&dtlh=158639&iABA=Not%EDcias&exp= (accessed 26 Feb 2013). Folha de São Paulo. Médica acusada de contratar falso médico no Rio presta depoimento. 2010. http://www1.folha.uol.com.br/cotidiano/783082-medicaacusada-de-contratar-falso-medico-no-rio-presta-depoimento.shtml (accessed 26 Feb 2013). Conselho Federal de Medicina. CRM denuncia exercício ilegal da profissão praticado no Piauí. 2009. http://portal.cfm.org.br/index.php?option=com_content&view= article&id=8518&catid=3:portal (accessed 26 Feb 2013).
11 12
13 14
Globo. Estudantes de Medicina são presos por se passarem por falsos médicos. 2013. http://g1.globo.com/mg/vales-mg/noticia/2013/07/estudantes-de-medicinasao-presos-por-se-passarem-por-falsos-medicos.html (accessed 06 Oct 2013). Correio da Paraíba. Estudantes de Medicina dão plantão ilegal. 2010. http://achix. achanoticias.com.br/noticia.kmf?cod=9519859&indice=0 (accessed 26 Feb 2013). Jornal da Facom. Quase Profissionais. 2007. http://www.jornaldafacom.ufba.br/ ed12/materias/saude_quaseprofissionais.html (accessed 26 Feb 2013). Silva IRF. A Ética e o Estudante de Medicina. Revista Médica do H.S.E. http://www. hse.rj.saude.gov.br/profissional/revista/36/etica.asp (accessed 26 Feb 2013). The Center for Academic Integrity Center for Academic Integrity. The Fundamental Values of Academic Integrity. 1999. http://www.academicintegrity.org/icai/ resources-2.php (accessed 23 Oct 2012). Stella R, Taquette SR, Costa-Macedo LM, et al. Currículo Paralelo: uma realidade na formação dos estudantes de Medicina da UERJ. Rev Bras Educ Med 2003;27:171–6. Tavares AP, Ferreira RA, França EB, et al. O “Currículo Paralelo” dos estudantes de medicina da Universidade Federal de Minas Gerais. Rev Bras Educ Med 2007;31:254–65. http://www.scielo.br/scielo.php? (accessed 23 Oct 2012). Ambrósio MR, Spíndola EB, Santos GT, et al. Exercício profissional da medicina por estudantes. Rev Bras Educ Med 2001;25:28–38. Tavares CHF, Maia JA, Muniz MCH, et al. O Currículo Paralelo dos Estudantes da Terceira Série do Curso Médico da Universidade Federal de Alagoas. Rev Bras Educ Med 2007;31:245–53. Kilminster SM, Jolly BC. Effective supervision in clinical practice settings: a literature review. Med Educ 2000;34:827–40. Tomorrow’s Doctors. General Medical Council. September 2009:55. http://www. gmc-uk.org/TomorrowsDoctors_2009.pdf_39260971.pdf (accessed 23 Oct 2012).
Lins L, et al. J Med Ethics 2014;40:432–434. doi:10.1136/medethics-2012-101190
Downloaded from http://jme.bmj.com/ on June 22, 2015 - Published by group.bmj.com
Perception of illegal practice of medicine by Brazilian medical students Liliane Lins, Suzana Herbas, Larissa Lisboa, Hannah Damasceno and Marta Menezes J Med Ethics 2014 40: 432-434 originally published online November 22, 2013
doi: 10.1136/medethics-2012-101190 Updated information and services can be found at: http://jme.bmj.com/content/40/6/432
These include:
References Email alerting service
Topic Collections
This article cites 5 articles, 0 of which you can access for free at: http://jme.bmj.com/content/40/6/432#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Undergraduate (96) Occupational and environmental medicine (15) Epidemiologic studies (75)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
