The Ph.D. thesis is called “Prospective Study of Pain Intensity in Cancer”. It was defended on 15 April at 2:30 pm by Paulo Pina, Professor in Bioethics of the Faculty of Medicine and doctor of Internal Medicine.
The thesis that addressed the study of pain associated with cancer brought together, for the first time, on zoom, Professors António Barbosa, his supervisor and José Melo Cristino, President of the panel.
Defending as “a fundamental right that every person should have access to an efficient plan to control and stabilize pain”, Paulo Pina added to his vast academic curriculum another title, the Ph.D. in Palliative Care.
From the usual protocol situation of thesis defences, evaluated by solemn persons in academic costume, the covid-19 pandemic made meetings to be banned as a dangerous cause of possible contagion and spread of the disease.
What changes are we seeing today? And what effects will they have from now on? Has the paradigm of human relationship changed?
We asked the questions and talked to the different stakeholders. Without a planned study or hasty conclusions, there was always something that became common, the lack of human contact, even if the success of a thesis is not affected, yet it was also realized that distance can only be spatial.
When did you have the notion that the defence of your thesis would be different from the usual and presented in front of a computer that would take you to the panel?
Paulo Pina: The panel was appointed by order on 22 January. I expected a date for the defence in March. However, it was at the beginning of that month that the epidemic became widespread, with the ending of the FMUL's teaching activities. I thought the defence date would be postponed sine die. However, at the beginning of April, seeing that the classes at some Faculties and some courses were already taking place by videoconference, I started to think that this would also happen with the defences of the pending dissertations. And, in fact, it was just the time for FMUL to outline the process, check the availability of the President of the Panel and of the other members. The confirmation that it would be a different defence from the usual only happened when I was offered a specific date, at the end of the first fortnight of the state of emergency that prevailed in Portugal.
Were there any plans to postpone the whole process? Did you have to review deadlines, or steps? Did you need to change or adapt your presentation?
Paulo Pina: No, I didn't think about postponing it. It was at a time when what I wanted to do was to proceed with the act of public defence as quickly as possible. In fact, when I thought that classes would probably not be resumed soon, personal anguish increased when I anticipated that theses defences would also be delayed. So when the date was communicated to me, there was happiness associated with realization.
Of course, the fact that it was a distance defence, out of the natural order of my memory (I had seen some conventional public defences), in such an unusual process, brought some concern. This was not only associated with the nervousness of the extraordinary situation (I think that until the end of the defence, whether in person or at a distance, there is always apprehension about the questions posed by the panel members). My main concern was regarding the most operational aspects: signal quality, optical fibre interference, computer camera image, sound pick-up noises, etc. Minor things that don’t matter much in a public act of conventional thesis defence, but that in this new format, became important to clarify. So, I didn't need to change deadlines, I kept the steps, and I didn't need to adjust my presentation.
We noticed that you felt relieved when it was confirmed that the defence of the thesis would be by zoom? How did it go?
Paulo Pina: I think it went very well. I was not the only one to feel the emotion of this innovative act at FMUL. This distance defence was the first of the President of the Panel, of the entire panel, including my Supervisor, Professor António Barbosa. IAT's support was invaluable: early information on how to install zoom and sending the respective support manual, facilitating acts regarding setting the platform up the day before.
This innovation, which at first seemed to promote distancing, worked successfully. The distance was only spatial, because I think there was an emotional approximation of the participants, due to the confinement of all, the situation in the country, and this particular event (thesis), The values of the FMUL and the ceremony behind Doctoral Examinations were in question; given that each panel member was in a space of his choice (in my case, I was at home), some of the formality (associated with clothing, posture and voice placement) was relieved. As such, the final sensation - which still exists - was pleasant. The questions were asked, the answers given encompassed the topics of the thesis (pain, cancer and palliative care), the interventions were all very pertinent, framed by a rigorous conduction of the President of the Panel, Professor Melo Cristino. I didn't even feel the time passing. In short, the whole process was natural and elegant.
Faced with a new reality, could we have opened new perspectives of human interaction, or are there distances that can never be broken, especially when we work in areas such as Palliative Care?
Paulo Pina: The thesis was centred on the Palliative Care specialty. In this scientific area, the pillars of medical intervention are communication, symptomatic control (multimodal and multidimensional) and family support. Teleconsultation is essential to clarify doubts, follow up, adjust dosages, anticipate phenomena, but it never replaces the careful attention of a consultation or physical visits. Palliative care practitioners reiterate procedures of non-abandonment, anticipation of problems, binding alliances, all of which depend on a continuous face-to-face relationship, in which the family is brought in to be involved as they are aware of the values of the sick person and are care providers in some situations. Communication is vital, in doses proportional to the patient's attention and culture.
With this pandemic, there was limited access of loved ones and informal caregivers to hospitals where patients were being cared for. As much as the multidisciplinary teams dedicated themselves to the patients, the containment of the presence of the direct family contributed to some suffering that cannot be validated or perceived. The physical distance, the use of masks, aprons and shields also had a great impact on facial recognition by patients with cognitive limitations and attention deficits. It must be said that in this difficult time that the country is going through, the use of tablets and phones made families very close, on the one hand, but on the other it was painful to hear the patients constantly asking why the family did not visit (not all were able to understand what the coronavirus was…). As a palliative care practitioner, I continue to train resilience and hope daily, and I know the best will happen.
The scenario and dynamics are new, it was necessary that it be so. But, what about now? Could we have found, in the midst of the crisis, new solutions for interaction, and see some of these interactions as new work tools?
José Melo Cristino - President of the Scientific Council of FMUL, Director of the Clinical Pathology Service and of the Department of Complementary Means of Diagnosis and Therapy at the Northern Lisbon University Hospital Centre (CHULN).
“Conducting doctoral exams by videoconference is more convenient and allows one to achieve the intended objectives. However, in my opinion, it is a different experience, for the worse. It becomes more impersonal, distant and loses the formality (and some dignity) that the act should have, as has always happened in our Faculty. Sometimes there are small interferences that distract and make us lose concentration, or the quality of the sound or image transmission is poor. The audience is present but it is mostly invisible, as if they were watching something that is not supposed to be seen. Finally, I recognize the need to use this modality under current conditions, but I look forward to returning to the conventional model of one of the most important academic acts at FMUL, in a space with dignity to match it, the renewed Aula Magna2”
António Barbosa - Head of Psychiatry and Mental Health Service at the Northern Lisbon University Hospital Centre (CHULN) and Full Professor at the Faculty of Medicine of the University of Lisbon, as well as Director of the Psychiatry and Medical Psychology University Clinic. He co-founded the Bioethics Centre and its Palliative Care and Grief Centres.
“This first experience of a distance doctoral exam took place curiously in the disciplinary area of palliative care and reminded me of a pioneering experience in our Faculty in 2005 of a first Blended Learning postgraduate course in the same area, for all mainland and islands at a time when it was essential to take this training to the whole country. This experience resulted in the confirmation of its accessibility, flexibility and technical functionality, the relevance of the methodology and the comparability of the results obtained in the assessment with those of the face-to-face Master Degree in Palliative Care. It had a remarkable multiplier effect."
This doctoral experience also took place without any technical problems and constitutes a very positive moment for the committed involvement of all, for the facility to transparently expand the conditions of greater assistance (although invisible), for the greater flexibility of the scheduling and integration of members of the panel abroad (given the increasing internationalization of our faculty) and the resulting drastic reduction in travel costs. The candidate's possibilities for interaction with the panel members were fluid and the final meeting between panel members took place very easily. Above all, what is missing is the more direct personal contact beMariana Passos, Ema Geraldes and Filipa Lopes – working at the Advanced Training Institute, have also given support and assistance in these sessions.en the members of the panel, a relevant aspect not only for an academic interface, but also as an opportunity to deepen the individual relationship amnong colleagues that the university truly consists of. We therefore have one more effective resource for special contexts.”
Mariana Passos, Ema Geraldes and Filipa Lopes – working at the Advanced Training Institute, have also given support and assistance in these sessions.
When you realized that we were going to have classes at a distance, what were your main concerns?
Mariana, Ema and Filipa: Well, first of all, when faced with this situation, the first thought was to ensure that all classes were conducted within normal limits and keeping the timetable previously established. In order to do it, it was necessary to liaise with the Scientific Committees, with the Coordinators of the Course Units, with professors and students, in order to understand the opening and adaptation by all the participants to this new type of classes.
Another aspect to highlight is undoubtedly the acquisition of new learning and skills, which we had to acquire and manage, in a short time, through the ZOOM videoconference platform. This type of classes required a large amount of time on our part, regarding the preparation of the room, the tests with lecturers and students, and monitoring of the room during the class.
In addition to these new tasks, it was necessary to continue all other tasks, to which the academic tests were added. It was necessary to reorganize the administrative process of academic exams, master and doctoral degrees, in order to make it viable to have them by ZOOM videoconference. In the first tests, this task led to some anxiety on the part of all those involved, due to the responsibility and the solemnity of the academic act. In view of this new reality, we have a positive balance, since the activities have been successful. From a professional point of view, we have acquired new technical skills and from a personal point of view we feel confident about the institution.
Can you describe the prestart finetuning and the start? What went worse, what were the successes?
Mariana, Ema and Filipa: In a first start, what went worse was the initial difficulty of replacing classes with this new type. We had to schedule new dates to safeguard classes until the end of the academic year, for the benefit of the students. As successes we can highlight the enthusiasm of both lecturers and students when they realized that they could trust this way of having master degree and doctoral classes, of carrying out Public Tests and theses committees. The availability of all stakeholders and joint learning was extraordinary.
Have we started a new era of classes?
Mariana, Ema and Filipa: By following this whole process, we concluded that this modality, although it is going well, is not the most desired by students and lecturers.
The main reason is the human need for visual contact, to be physically with others, being at the Faculty of Medicine of the University of Lisbon to excel in its humanistic dimension, be in proximity to the other.
On the other hand, we have an opposite opinion in relation to the Academic Tests, which took place in an articulated manner with the candidates and the members of the Panel. The services ensure, in the best possible way and in a short period of time, the management of the videoconferences, in order to keep the tests previously scheduled.