INTRODUCTION
The Academic Medical Leagues, as defined by the Brazilian Association of Medical Academic
Leagues (ABLAM), are civil and scientific student organizations, autonomous student
initiatives, indefinite duration, non-profit, which bring together undergraduate medical
students and university professors.1,2,3. Among the primary objectives of an Academic League (AL), we highlight the promotion
of knowledge and the complementation of academic training in a specific area of Medicine
through activities based on the pillars of teaching, research and extension3.
In teaching activities, undergraduates have access to theoretical classes, discussions
of clinical cases, symposia, courses, congresses, and practical activities, such as
supervised monitoring of hospital and outpatient services. Within the research pillar
of the ALs, there is the realization of scientific projects and questioning existing
studies, which can generate quite significant impacts on academics, as it encourages
critical thinking and scientific reasoning4. In turn, health promotion activities related to extension practices include health
campaigns in collaboration with community centers and non-governmental organizations5.
In Brazil, in the mid-1920s, the first AL was created: the League for Combating Syphilis,
promoted by the University of São Paulo Medical School, with the aim of medically
and socially intervening in a public health problem at the time3. However, the consolidation of these student entities took place only during the
military dictatorship due to the emergence of questions regarding the university teaching
model and the applicability of the contents established in the curriculum. Thus, a
greater space was created to form ALs in medical schools2,3.
Medical students’ adherence to ALs is increasing, as demonstrated by their current
panorama in Brazil, about 3,600 leagues registered with ABLAM, an institution that
promotes the standardization and organization of this type of extracurricular activity6. On the other hand, there is no knowledge of many ALs that resemble the Brazilian
model in other countries. The international concept of the “National Academic League”
is a presentation of AL, quite common in elementary and high schools in the United
States. It differs from the Brazilian model in that its main objective is the recognition
and motivation of academics participating in school championships in questions and
answers7.
The foreign conception that comes closest to an AL, especially in North America and
Europe, is “societies,” defined by a group of students who share the same interest
and aim to promote an activity or belief. They are recognized not only in the academic
field but also in the professional field. Societies are also distinguished from the
national molds of AL since cultural diversity is a subject that is constantly represented
and addressed.
Although there are significant differences between national entities and foreign “societies,”
it is observed that both have the common objective of integrating students and teachers,
providing more specific knowledge about a certain area within academic training, in
addition to the development of external projects7.
With the advent of ALs in the educational context, there is the emergence of broader
associations, which encompass several student entities for regulating and assisting
their functioning. The Brazilian Association of Plastic Surgery Leagues (ABLCP) is
an association linked to the Brazilian Society of Plastic Surgery (SBCP), considered
its academic segment, thus establishing the proximity of the Academic Plastic Surgery
Leagues (PSL) with the SBCP.
Created in 2013 by 12 medical students from different states in Brazil, ABLCP had,
and maintains, the purpose of regularizing PSLs across the country in a direct relationship,
helping to carry out student activities, valuing Teaching axes, Research and Extension,
and promoting the fields of Reconstructive and Aesthetic Plastic Surgery8.
Based on the literature analysis on the topic, it is still incipient, given the scarcity
of publications found. Only certain works referring to specific and specific Academic
Medical Leagues are observed, such as Andreoni S et al.2, Araújo R et al.4, Nardelli MJ et al.9 and Okamoto JM et al.10, with no bibliography referring to the PSLs nationwide. Thus, it is justified the
purpose of the present study.
OBJECTIVE
The present work aimed to describe the performance of the Academic Plastic Surgery
Leagues linked to the Brazilian Association of Plastic Surgery Leagues (ABLCP), aiming
to understand their respective performances.
METHODS
This is a cross-sectional, descriptive, multicenter study with a qualitative and quantitative
approach through the application of an online questionnaire to the Leagues linked
to the Brazilian Association of Plastic Surgery Leagues. The research protocol was
approved by the institution’s Research Ethics Committee (process number: 03337212.7.0000.5505),
following the ethical principles of the Declaration of Helsinki and the requirements
of the National Health Council (Resolutions 466/12 and 510/16).
Initially, a literature review was performed at MEDLINE, Scientific Electronic Library
Online (SciELO), Latin American and Caribbean Literature in Health Sciences (LILACS)
and Google Scholar from January 2011 to April 2020 in Portuguese, Spanish and English.
Other sources were also consulted, such as books. The descriptors used were “Plastic
Surgery,” “Education,” “Medical Education,” and “Medical Student,” while the non-descriptive
term used was “Academic League.” The following search strategy was developed: (“Plastic
Surgery” AND “Education” AND “Academic League”) OR (“Medical Education” AND “Medical
Student”).
The inclusion criteria considered were scientific articles published in full, available
in the databases, and in the previously mentioned languages, written between January
2015 and June 2020. As for the theme, the included studies addressed AL and its importance
in the learning of medical students, the profile of ALs of different medical modalities,
and the current panorama of the teaching model of the discipline of Plastic Surgery
in Brazilian universities.
On the other hand, articles that addressed non-profit activities not related to AL,
that discussed the making of other types of profiles of medical students without having
AL as a central theme, or that reflected on any teaching models in Brazilian universities
that were not in the discipline of Plastic Surgery were not included. Articles were
excluded if, after surveying the full articles, they were found to not correlate with
this study.
The articles included were categorized according to the corresponding author, year,
country of origin, specialty, results, journal and impact factor of 2018. The information
referring to the country of origin and the specialty refer to the corresponding author.
If this were not indicated in the article, the main author would be employed and,
in the absence of data, the senior author.
After reading the full articles, an online questionnaire was developed on the Google
Forms platform with 12 open questions and seven multiple-choice questions representing
the data collection instrument.
The questionnaire consisted of 19 questions built to avoid the bias shown in the Bias
Catalog in Questionnaires11 and was applied to 78 current PSL presidents linked to ABLCP, corresponding to 100%
participation of the associated Leagues.
The ALs were evaluated in terms of data related to the advisor, such as the number
of advisors and professional ties, the association with Plastic Surgery services,
the actions of AL in the three pillars of Teaching, Research and Extension, and the
frequency of meetings and practical activities.
As for the ALs’ activity places, they were classified as nonexistent, burn treatment
unit, minor surgery operating room and breast reconstruction surgery. Data collections
were carried out between January and March 2020. The questionnaire made addressed
the aspects according to Annex 1.
RESULTS
There were 29 articles available in full. After reading the titles and abstracts,
six articles were included, all of which were in Portuguese. The categorization is
indicated in the Table 1.
Table 1 - Categorization of articles according to corresponding author, year, country of origin,
specialty, results, periodical and impact factor
Corresponding author |
Year |
Country of origin |
Specialty |
Results |
Periodical |
Impact factor |
Lucas Azevedo Portela2 |
2019 |
Brazil |
Angiology and vascular surgery |
As for the profile of the AL, 42.9% took monthly theoretical classes, and 85.7% of
the leagues carried out practical activities. Most leagues (71.4%) reported carrying
out scientific activities. The performance of students in the tests demonstrated a
significant increase in members.
|
Jornal Vascular Brasileiro |
0.38 |
Julio Wilson Fernandes12 |
2016 |
Brazil |
Plastic Surgery |
The Plastic Surgery program of the Medicine course at Positivo University in Curitiba
is taught in the discipline of Clinical Surgery II, addressing aesthetics, birth defects,
trauma, burns and post-tumor repair.
|
Revista Brasileira de Educação Médica |
0.35 |
Diego Inácio Goergen13 |
2017 |
Brazil |
General Surgery (residency) |
In the survey of experience reports (seven from medical leagues, four from other areas
and four from multidisciplinary leagues), there is variability between academic leagues,
although most of them hold periodic meetings and participate in scientific events.
Many leagues have Extension activities, with activities in the community in different
segments.
|
Arquivos Catarinenses de Medicina |
- |
Pedro Tadao Hamamoto Filho3 |
2011 |
Brazil |
General Physician |
Students are motivated by the search for AL due to professional qualification and
socialization; however, many AL fill curriculum gaps. The importance of evaluating
them lies in detecting deviations, such as subversion of the curricular structure,
early specialization and reinforcement of academic vices.
|
Revista Brasileira de Educação Médica |
0.35 |
Gabriela Yea-Huey Yang14 |
2019 |
Brazil |
Medical Student at the Rio de Janeiro State University |
The League of Applied Anatomy has actions that aim to apply knowledge and confer responsibility
to promote actions that bring changes for the university itself and the local community.
The AL promotes collective activities and the formation of leaders. Participation
in the league takes place as a member, manager or advisor.
|
Revista Brasileira de Educação Médica |
0.35 |
Luciana Thurler Tedeschi15 |
2018 |
Brazil |
Medical Student at Fluminense Federal University |
Concerning the group of members, those with a presence above 75% had an increase of
22 percentage points in relation to the group of non-members. There was no statistically
significant growth for the group of members with less than 75% presence. Thus, the
growth of knowledge was significantly greater in the group participating in the League.
|
Journal of the Brazilian Colleges of Surgeons |
0.23 |
Table 1 - Categorization of articles according to corresponding author, year, country of origin,
specialty, results, periodical and impact factor
The survey of data from PSLs of medical schools in Brazil resulted in a total of 78
PSLs and 1873 members in 58 cities arranged in 20 federative units. For analysis of
the data obtained, they were divided between the respective regions of the country.
The region with the highest representativeness, with the highest number of members
and ALs, was the Southeast region, and the one with the least representativeness was
the North region, as shown in Figure 2. In addition to the representativeness, the average of members per AL in the regions
is also observed. Table 2 shows the distribution of ALs and members in each state.
Table 2 - Distribution of PS Leagues and members in the state of each region of Brazil.
Region |
State |
Number of leagues |
Number of members |
North |
Amazonas |
1 |
12 |
Northeast |
Alagoas |
1 |
11 |
Bahia |
4 |
66 |
Ceará |
3 |
28 |
Maranhão |
1 |
18 |
Paraíba |
1 |
26 |
Pernambuco |
1 |
10 |
Piauí |
2 |
22 |
Sergipe |
1 |
10 |
Midwest |
Brasília |
3 |
108 |
Goiás |
5 |
108 |
Mato Grosso |
2 |
32 |
Mato Grosso do Sul |
3 |
24 |
Southeast |
Espírito Santo |
1 |
35 |
Minas Gerais |
10 |
279 |
Rio de Janeiro |
5 |
147 |
São Paulo |
21 |
526 |
South |
Paraná |
4 |
121 |
Rio Grande do Sul |
6 |
194 |
Santa Catarina |
3 |
97 |
Total |
20 |
79 |
1873 |
Table 2 - Distribution of PS Leagues and members in the state of each region of Brazil.
Figure 2 - Number of Plastic Surgery Academic Leagues, total members and the average of members
per PSL, in absolute and relative values.
Figure 2 - Number of Plastic Surgery Academic Leagues, total members and the average of members
per PSL, in absolute and relative values.
Regarding the orientation of the PSLs, regarding the number of advisors, it was found
that most had only one advisor, and the other 19 (24.35%) had more than one advisor.
The main advisors were stratified between members associated with SBCP, full members
of SBCP and others without links to SBCP. Figure 3 shows that all advisors were linked to SBCP.
Figure 3 - Absolute frequency of the PSL advisors profile.
Figure 3 - Absolute frequency of the PSL advisors profile.
Figure 4 shows that 44 PSLs (56.41%) are linked to a service in Plastic Surgery.
Figure 4 - Number of services linked to Academic Leagues, in absolute frequency.
Figure 4 - Number of services linked to Academic Leagues, in absolute frequency.
In addition, the offer of the three pillars (Teaching, Research and Extension) for
the members was evaluated simultaneously, and it was found that 61 (78.20%) PSLs meet
the criteria. Figure 5 shows the comparison of criteria between regions.
Figure 5 - Academic leagues that offer the academic the three pillars (Teaching, Research and
Extension) simultaneously, in relative frequency.
Figure 5 - Academic leagues that offer the academic the three pillars (Teaching, Research and
Extension) simultaneously, in relative frequency.
As shown in Figure 6, 77 leagues (98.71%) included Teaching for the members, and, except in the South
region, all PSLs offer Teaching. It is observed that the majority stimulates and offers
Research and often offers Extension to the academics.
Figure 6 - Areas of operation of ALs - 6.a. Teaching, 6.b. Research and 6.c. Extension - in relative
frequency.
Figure 6 - Areas of operation of ALs - 6.a. Teaching, 6.b. Research and 6.c. Extension - in relative
frequency.
Regarding the teaching promoted, most of the PSLs, 59 (75.64%), promote internships
and weekly or monthly classes, and 19 (24.35%) promote only classes.
The average number of classes held per month by the PSLs is 2.46, with an average
of 2 in the North region, 2.78 in the Northeast region, 2.69 in the Midwest region,
in the Southeast region of 2.37 and 2.15 monthly classes in the South region. All
PSLs claim to have teaching activities through classes, and the topics covered were
stratified, as shown in Figure 7.
Figure 7 - Distribution of the topics covered in PSLs classes, in absolute and relative frequency,
stratified in only aesthetic Plastic Surgery, only reconstructive Plastic Surgery
and both themes.
Figure 7 - Distribution of the topics covered in PSLs classes, in absolute and relative frequency,
stratified in only aesthetic Plastic Surgery, only reconstructive Plastic Surgery
and both themes.
Concerning the number of places of practical activities of the ALs, the distribution
is shown in Figure 8 and the classification and distribution of these in Figure 9.
Figure 8 - Absolute and relative frequency of the number of AL activity places.
Figure 8 - Absolute and relative frequency of the number of AL activity places.
Figure 9 - Places of academic league activities, in absolute frequency.
Figure 9 - Places of academic league activities, in absolute frequency.
The activities carried out by the members were classified according to their functions
as active assistants in surgery, as only observational activities and both forms of
activity. The frequency of this classification is shown in Figure 10. Participation in other activities was 17 (21.79%) PSLs in graduate school and 43
(55.12%) in monitoring.
Figure 10 - Absolute and relative frequency of the classification of the internships in observational,
active or both.
Figure 10 - Absolute and relative frequency of the classification of the internships in observational,
active or both.
The survey of data also allowed the analysis of the periodicity of the meetings between
the members, qualifying them according to Figure 11. The advisor’s presence in the meetings was in 65.38% of the PSLs and the members
were present in all meetings.
Figure 11 - Frequency of meetings held by PSLs, in absolute and relative frequency.
Figure 11 - Frequency of meetings held by PSLs, in absolute and relative frequency.
The Research was analyzed by scientific production, presentations at congresses and
magazine publications. As shown in Figure 12, only 27 (34.61%) PSLs developed scientific works, being classified according to
the form of exposure of the work.
Figure 12 - PSLs that developed Research and presentation at regional and national congresses
in absolute frequency.
Figure 12 - PSLs that developed Research and presentation at regional and national congresses
in absolute frequency.
The participation in campaigns and/or social actions can be seen in Figure 13, divided by the realization of the campaigns promoted by ABLCP, Orange June and Pink
October, and other activities such as donation campaigns or with the Civil Police.
Figure 13 - PSLs that developed campaigns and/or social actions in relative and absolute frequency.
Figure 13 - PSLs that developed campaigns and/or social actions in relative and absolute frequency.
Through an open response, the positive and negative points of the PSLs were evaluated,
with the majority highlighting the promotion of the tripod (teaching, Research and
Extension) as the main positive point. On the other hand, the most cited negative
points are regarding the difficulty of offering activities in the field of Research.
DISCUSSION
Regarding the motivation for the entrance of academics in the ALs, the growing search
for extracurricular internships is noteworthy, which corroborates that the student’s
expectations are not fulfilled in the formal curricula and that there is content that
is not actually seen during graduation1,3,9,10.
It is assumed, according to the number of PSLs linked to ABLCP, in line with the studies
analyzed, that Plastic Surgery is not addressed in the desired way in the traditional
curriculum of Brazilian universities, making it necessary to create AL, according
to academics and admission to these student associations, to fill in the gaps left
by the institutions’ curriculum as to their specialty. Corroborating this, some authors
advocate the importance of Plastic Surgery in medical education since the specialty
has five major areas of activity: Aesthetics, Congenital Defects and Deformities,
Trauma, Burns and Repair after tumors12-17.
The present study revealed that although the ALs are based on the university tripod,
78.2% of the Plastic Surgery Leagues linked to ABLCP had activities on the three axes
simultaneously, with the Southeast region having the largest number of Leagues, also
presenting the highest index of leagues with activities in the EPE, in this regard,
according to the study by Santana et al.1 It is believed that from this tripod, the ALs can lead to a differentiated training
in health, such as anticipating the participation of members in the fields of activity,
also helping to fill gaps left in the graduation in important topics for the training
of doctors17.
One hundred percent of the PSLs have at least one advisor; in addition, all leagues
had advisers linked to the SBCP, with 35.89% associate members and 64.11% full members.
The presence of teaching supervision in the league’s activities increases the members’
performance since it optimizes the students’ learning by having a specialist reference
and a better teaching-learning process1.
When there is no teaching supervision, there would be a greater possibility of illegal
practice of medicine3. It has demonstrated that the presence of PSL, from the development of activities
with plastic surgeons, increased the rate of students who were interested in the specialty18, corroborating that the ALs assist in directing the choice of medical specialty by
academics since they serve as a test to find out if there is an affinity for that
specialty19.
In the case of the teaching axis, this is offered by 77 PSLs (98.31%) analyzed. This
is possibly due to the variety of options such as theoretical classes, organization
of symposia and lectures, development of research projects, discussion of clinical
cases, seminars, short courses and participation in medical services or activities
with the community1. As for the frequency of meetings, it was seen that 41.02% of PSLs held biweekly
meetings.
ALs generally do not have Extension as a well-developed activity, replicating the
university’s failure to provide extension projects3. Dissonant of the national scenario, it was seen that 87.17% of the PSLs had extension
activities, with the North and Midwest regions having the highest rates. This type
of activity contributes to a better understanding of the functioning of public health
since the academic student has the chance to observe different realities experienced
in the different collective spaces for conducting actions20.
Despite the high number of extension activities within the PSLs, it is described that
a good part of the activities of the ALs are specific actions of an assistentialist
nature, and in addition, there should be a reorientation of the focus on health actions
for the community1. The inclusion of continued actions for the prevention and promotion of health and
the reframing of practices not only as a circumscribed field of specialized learning
but also as an environment of constructive, supportive action directed at the most
vulnerable, perceived in the integrality of the person and the network care.
The medical school of Botucatu/UNESP, when evaluating its ALs, showed that the Research
axis had a lower performance than that of Teaching3. In dissonance, it was found in the present study that 84.61% of the PSLs had activities
in this area, with the Leagues in the Northeast region having the lowest indexes.
The Research can raise theoretical discussions and be applied in the population approach,
just as this can serve us for research and learning opportunities, both theoretical
and practical3. In addition, contact with Research provides the opportunity to exercise full reasoning
through the scientific method and practice the exercise of scientific creativity,
the satisfaction of intellectual curiosity, improvement of a critical spirit, learning
and consolidation of other knowledge necessary for complementation of the undergraduate
training21.
Regarding the practical activities, such as monitoring in operating rooms, wards,
intensive burn units, and others, these are activities that provide members of PSLs
with experience in health practices, in addition to integrating academics into the
multidisciplinary team routines of institutions, strengthening their contact with
the population, enabling clinical-scientific development.
On the other hand, they can become spaces of “prior specialization” when inserted
without the proper guidance and supervision by teachers21. In this study, it was observed that, in addition to the existing guidance in all
PSLs associated with ABLCP, 79.49% of these had a place of practical activity, with
the minor surgery center being the most representative.
Medical schools must strive to promote basic knowledge of plastic surgery to be sedimented
in all trainees, regardless of their future specialization12. In this way, PSLs can contribute to promoting and constructing knowledge in this
area through their theoretical and practical activities supervised by a trained mentor.
Thus, Academic Leagues have, in part, a role in building medical knowledge10,18,20, from Research and theoretical activities, as well as in the training of doctors,
due to the gain in communication skills in extension activities with the community,
in addition to social development, such as in the construction of leadership.
Therefore, as seen in the present study, it is necessary to increase the number of
mentors and, as can be seen, some regions offer less research activity than others
for PSLs to be instruments in medical education. Formulating online remote research
systems and searching for partnerships with universities and research centers can
enhance this area22.
In addition, the importance of entities that aim to assist and supervise the development
of PSLs, such as ABLCP, is highlighted in order to contribute to a more solid formation
in the disciplines related to Plastic Surgery since the lack of regulation may lead
not to only to uncontrolled growth of AL, but also a lack of characterization of them
as a university extension3.
CONCLUSION
The role of the PSLs in training students occurs mainly in Teaching, Extension related
to campaigns and Research through presentations at regional congresses. In this context,
the requirement of alignment, inspection and stimulation of PSL activity in Brazil.
As demonstrated above, the relationship between associates and a suitable tutor is
essential to promote a positive influence on the members of the PSLs, who can be the
new generation of Plastic Surgeons. Most PSLs offer the three pillars (Teaching, Research
and Extension) and maintain several practical activities, theoretical classes, social
actions and scientific productions.
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Annex 1. Questionnaire applied to the presidents of leagues affiliated to ABLCP.
Does your league have an advisor? |
( ) Yes, only 1 |
( ) Yes, more than 1 |
( ) No |
( ) Others: (Which?___________________________) |
Your advisor is: |
( ) An associate member of SBCP |
( ) Not a member of SBCP |
( ) A member of the Brazilian Society of Aesthetic Medicine |
( ) A member of the Brazilian Society of Medicine and Plastic and Aesthetic Surgery |
( ) A member of the Brazilian Academy of Plastic Surgery |
( ) Others: (Which?___________________________) |
What is the current number of League members? |
What is the frequency of your League meetings? |
( ) Weekly |
( ) Fortnightly |
( ) Monthly |
( ) Bimonthly |
( ) Semiannual |
How many League meetings are professors present per month? |
( ) 1 |
( ) 2 |
( ) 3 |
( ) 4 |
( ) 5 |
( ) Others: (Which?___________________________) |
What is the League’s field of action? (Several possible) |
( ) Extension (carrying out campaigns or social actions) |
( ) Teaching (weekly or monthly classes or internships) |
( ) Research (presentation and/or publication of scientific articles) |
What activities does the League promote to members? |
( ) Internships |
( ) Weekly or monthly classes |
( ) Weekly or monthly internships and classes |
( ) The League has no teaching activities |
How many theoretical classes are held per month in the League? |
What are the topics covered by such classes? (Several possible) |
Note: if there is a selection of themes and, together, the option that “the League
does not have teaching activities in classes,” the last one will be considered.
|
( ) Reconstructive Plastic Surgery |
( ) Aesthetic Plastic Surgery |
( ) Ethics in Plastic Surgery and Patient Approach |
( ) The League does not have teaching activities in classes |
Is your league linked to a Plastic Surgery service? |
( ) Yes |
( ) No |
If so, what is the linked service? (If your League is not linked, write “Absent”) |
Practical activities are carried out in which places? (Several possible) |
Note: if there is a selection of topics and, together, the option that “the League
does not have practical activities,” the last one will be considered.
|
( ) Burns Treatment Unit |
( ) Small Activities Surgical Center |
( ) Breast Reconstruction Surgical Center |
( ) The League has no practical activities |
In practical activities, which functions do members have? (Several possible) |
Note: if there is a selection of topics and, together, the option that “the League
does not have practical activities,” the last one will be considered.
|
( ) As assistants and active participants in surgeries |
( ) As only observers of surgery |
( ) The League has no practical activities |
In the last year, did you develop a research project? (2019-2020) |
( ) Yes |
( ) No |
Which one(s)? |
Did you present scientific papers at congresses (2019-2020)? (Several possible) |
Note: if there is a selection of themes and, together, the option “No, we do not present
scientific papers (2019-2020)”, the last one will be considered.
|
( ) Yes (Regional) |
( ) Yes (National) |
( ) Yes (International) |
( ) No, we did not present scientific papers (2019-2020) |
Did you publish an article in a scientific journal (2019-2020)? (Several possible) |
Note: if there is a selection of themes and, together, the option “No, we do not publish
in scientific journals (2019-2020)”, the last one will be considered.
|
( ) Yes (National) |
( ) Yes (International) |
( ) No, we did not publish in scientific journals (2019-2020) |
Do you participate in Graduate activities? |
( ) Yes |
( ) No |
Do you participate in monitoring or other activities with residents? |
( ) Yes |
( ) No |
As for campaigns or social actions, which types does the League promote? |
( ) Burning Campaign (Orange July) |
( ) Pink October Campaign |
( ) Both above |
( ) The League has no extension in campaigns and social actions |
( ) Others: (Which one?___________________________) |
Does the League participate in the campaigns carried out by ABLCP? |
( ) Yes, the League participates in ABLCP campaigns |
( ) No, the League runs its own campaigns but does not participate in the actions
of ABLCP
|
( ) The League has no extension in campaigns and social actions |
League positive points? |
League negative points? |
1. Universidade Federal de São Paulo, Cirurgia plástica, São Paulo, SP, Brazil
2. Universidade de Mogi das Cruzes, Medicina, Mogi das Cruzes, SP, Brazil
3. Universidade Tiradentes, Medicina, Aracaju, SE, Brazil
4. Faculdade de Medicina São Leopoldo Mandic, Medicina, Campinas, SP, Brazil
5. Universidade Salvador, Medicina, Salvador, BA, Brazil
Corresponding author: Lydia Masako Ferreira Rua Botucatu, 740, 2º andar, São Paulo, SP, Brazil. Zip code: 04023-900, E-mail:
lydiamferreira@gmail.com
Article received: October 14, 2021.
Article accepted: April 07, 2022.
Conflicts of interest: none.