Telemedicine and Education: A Brazilian Experience

Discipline of Telemedicine, Faculty of Medicine of the University of So Paulo, Brazil.

L W Chao,
P S P Silveira and
G M Bhm



The Faculty of Medicine of the University of So Paulo created a
Discipline of Telemedicine in 1997. The main responsibilities are
teaching, research and service to the community. The present activities of the discipline are reported. Considering that the fast progress of telecommunication is changing many aspects of medical practice and education, it is concluded that faculties of medicine should reevaluate their curriculum and educational aims. The need of education of telemedicine at university-level is stressed.



Since 1997 the Faculty of Medicine of the University of So Paulo has a discipline of Telemedicine (FMUSP-DTM). The academic community felt that the expansion of information technology into health care delivery and medical education is an innovative and revolutionary event of such magnitude that a special discipline was needed to follow its evolution and to teach it.

The Telemedicine societies, as yet, do not discuss the educational aspects of telemedicine1. It is our opinion that they should merit more attention and at the meetings they should be discussed. Some of the main interrogations are:

- What are the responsibilities of the Medical Schools in the development and utilization of telemedicine?

- What are the responsibilities of the Medical Schools towards the wealth of educational programs available in the worldwide webs?

- What should a physician know about the legal and ethical aspects of telemedicine and how, where and when he should get this knowledge?

- To what extent does (and will) telemedicine modify the patient-physician relationship and how, where and when should the medical students be prepared to face these changes?

- Which telemedicine techniques need special training from the practitioners and how and where shall they be trained to master them?

Of course, these questions may be considered of secondary importance or even irrelevant but not without a thorough reflection. The FMUSP-DTM created a site to discuss telemedicine and education - – and these questions are waiting for your comments.


Course Evaluation:

The Web Page and the multimedia presentation were the only abilities of the students that were examined. A score table was used for this purpose. For an acceptable performance the following items were obligatory

Opening Page with a descriptive title, summary and paper wall; Page with the main topics and an image illustrating the theme; Page with external links, minimum 3 links with a short description of the content of each link; Authorship page; In the case of failure in any of the above items, an explanation and another chance was given to the group.

To the several aspects of readability and navigability + or – was given and, thus, a discriminative mark was established for each group. The performance of the students was highly gratifying, they did their exercises with great enthusiasm.

The works of all groups were disponibilized in the site of the Faculty of Medicine and they may be appreciated at: Also a tele-education project - - was launched with the students with the following aims:

To maintain a site in the Internet where the medical students of the FMUSP can exchange ideas and tools concerning their medical education;

To start communication with their colleagues from other Medical Schools to enhance medical education;

To participate of the efforts of the FMUSP-DTM to divulge medical and health information to the population in general (see SAUDETOTAL).

Education at postgraduate level shall start in March 1999. The course will be given during four weeks scheduled as 15 hours/week. The proposed program is similar to what was given to the undergraduate students. telemedicine is new, both as technology and area of knowledge and, therefore, there are no basic differences in educating undergraduates or postgraduates, unless medical skills or responsibilities are involved. As yet, we do not have any health care delivery in operation at our hospital.



The group in charge of the new discipline constructed a site – http:\\ – offering informations on health and medicine for professionals, aiming continuos medical education and knowledge support for laymen. This part was and is more developed because it is our conviction that medical and health education should be given to the population in general. The universal medicalization imposed by the Medical System went to far in monopolizing knowledge and taking away the confidence of people to deal with their health problems. The burden of useless consultations is enormous in every sense, mainly psychologically and economically.

The site started in January 1997 and now (September 1998) has about 2,000 htm-files and gets 460,000 hits per month. The 20 most consulted files in order of interest, from July to September, were:

The number of consultations and e-mail inquires certainly confirm the public’s interest and the need of disponibilizing medical and health informations. The dialogue between public and Saudetotal must be used for educational purposes in the Faculty of Medicine. The participation of students and residents is very important.



The need of telemedicine education at university-level is starting to be stressed2,3 and experiences in this field should be exchanged. The fast progress of telecommunication is changing many aspects of the medical practice and education. Medical schools should reevaluate their curriculum and prepare the students to use the new telemedicine and telecare techniques. They should also offer continuous educational programs for physicians and health professionals in general, as well as educating the country’s population in matters of health and medicine. For this purpose disciplines or centers of telemedicine may be very useful, at least, the FMUSP-DTM pretends to accept this challenge and fulfil its responsibilities.


Activities of the FMUSP-DTM

Education in the Medical Faculty
An optative course of 30 hours is offered to the undergraduate students. The present objectives of the teaching program are:

To familiarize the student with the basic concepts of telemedicine

To familiarize the student with tele-education and teleconferences

To qualify the student to present a medical topic as a htm

To qualify the student to elaborate a Web Page

The program consists of lectures with or without practical demonstrations and exercises.


History of telemedicine and basic concepts

Ethics, legal aspects and data security in telemedicine

Worldwide Webs

Telemedicine in a hospital (telemedicine is not operating in our University Hospital)

Lectures with practical demonstrations:

Power Point and MS Word (for those who were not able to use these programs)

Internet, Intranet and Extranet

Medical sites, Medline



Exercises (for group of 3 students):

Elaboration of a Web Page (this year each group chose a different medical theme from a list of 89 topics)

Multimedia presentation of a medical topic (the same that was used for the Web Page)

All students of the 3rd semester (172 individuals) participated in the first course given by the FMUSP-DTM in 1998.



1 –Abstracts from The American Telemedicine Association: Third Annual Meeting, April 5-8, 1998, Orlando, Florida. Telemedicine Journal 1998;4:57-124

2 –Kortesluoma R-L, Rajaniemi H. Telemedcine: university-level education in Finland. Journal of Telemedicine and Telecare 1998;4:61

3 – Ferrer-Roca O. The telemedicine body of knowledge. Journal of Telemedicine and Telecare 1998;4:183-184



Prof. Gyrgy M. Bhm

Faculdade de Medicina
Av. Dr. Arnaldo 455
So Paulo (SP) CEP 01239-903
Fax: 0055-11-3064