Introdução: o curso de medicina é marcado por inúmeros fatores geradores de estresse que podem influenciar a qualidade de vida do estudante, exigindo dele adaptação e mudança de estilo de vida. É necessário conhecer esses fatores para poder prevenir e intervir sobre eles, visando à melhoria da qualidade de vida no curso de medicina. Objetivo: conhecer a qualidade de vida do estudante de medicina e os fatores interrelacionados que a influenciam. Métodos: o estudo foi realizado em duas fases. Na primeira fase foi realizada a modalidade de pesquisa qualitativa com grupos focais em seis escolas médicas, com grupos de estudantes heterogêneos em relação ao sexo e ano do curso. Os dados assim coletados nortearam a construção de um inventário de avaliação da qualidade de vida no curso de medicina (IQVEM), utilizado na segunda fase do estudo. Na segunda fase, realizada na modalidade de pesquisa quantitativa, foram estudados 800 estudantes oriundos de 75 escolas médicas brasileiras, públicas e privadas, matriculados entre o 1º e 6º anos, presentes ao Encontro Científico dos Estudantes de Medicina, no ano de 2004. Estes estudantes responderam a um caderno de respostas contendo os seguintes instrumentos de avaliação: auto-avaliação, WHOQOL - abreviado, escala de sonolência diurna de Epworth e IQVEM. Resultados: a nota atribuída à QV no curso foi mais baixa que a nota da QV geral, sendo inferior no sexo feminino e no grupo de estudantes do 3º e 4º anos. Também nesse grupo foram encontrados os piores escores no domínio psicológico e de relações sociais do WHOQOL - abreviado, quando comparados aos outros anos do curso. Muitos estudantes apresentaram escores altos de sonolência diurna (>10, 48,1%), sendo que a porcentagem de estudantes do sexo feminino com escores elevados (54,9%) foi maior do que no sexo masculino (42,5%, p = 0,002). A presença de sonolência diurna esteve associada à queda dos escores físico, psicológico e ambiental do WHOQOL - abreviado no grupo de estudante como um todo. Não foram encontradas diferenças entre estudantes de escolas públicas e privadas na nota de autoavaliação, nos domínios do WHOQOL - abreviado e no escore de sonolência diurna. No IQVEM foi observado que 45,4% dos estudantes estão insatisfeitos com o curso. Afirmaram que não aproveitam a vida como poderiam, não se alimentam bem e não cuidam da sua saúde. São comuns os sentimentos de tristeza e desânimo, insatisfação com a vida afetiva e sexual, principalmente nas mulheres e nos estudantes do 3º e 4º anos. Os estudantes de medicina afirmaram que ter supervisão em atividades práticas, participar de projetos de desenvolvimento social, boas aulas, professores com didática e o contato com o paciente melhoram a qualidade de vida no curso. Estudantes do 5º e 6º anos têm melhor relação com os professores, enxergam o curso como muito competitivo e apresentaram melhores escores no domínio de relação social do WHOQOL. A falta de tempo livre para estudo, lazer, relacionamentos e repouso foi expressa como um dos principais fatores de diminuição da qualidade de vida no curso. A análise fatorial mostrou como importantes fatores determinantes da qualidade de vida no curso os aspectos de qualidade de vida geral, gestão de tempo, interação social, satisfação com o curso, insegurança quanto ao futuro profissional e saúde mental. O grupo do 3º e 4º anos apresentou os piores escores de qualidade de vida no curso e nos domínios do IQVEM, o que sugere ser este um momento de crise durante o curso, notado principalmente no sexo feminino. Conclusão: melhorar a qualidade de vida no curso de medicina depende de medidas como ensinar o estudante a valorizar a vida, cuidar da sua saúde física e mental, estabelecer e manter relacionamentos e desenvolver resiliência, além de medidas institucionais como desenvolvimento docente, supervisão em atividades práticas, oferecer oportunidade de participar de projetos de desenvolvimento social e iniciação científica, garantir tempo livre para estudo, diminuir a competitividade, estabelecer programas de exercícios físicos, promoção de saúde, serviços de apoio e suporte ao estudante. Oferecer melhores condições de aprendizado resulta em melhoria na qualidade de vida no curso, possibilitando ao estudante amadurecer sem prejudicar a saúde física e mental no processo de vir a ser médico. / Introduction: medical course has several factors that generate stress and can influence quality of life of medical students. It is necessary to know better these factors in order to improve the quality of life of students during the medical course. Objective: To study quality of life of medical students in Brazil and the factors that influence quality of life. Methods: the study was developed in two phases. In the first study a qualitative approach was used, with focus groups in six medical schools, with groups that were heterogeneous considering gender and year of medical school. Data obtained in the focus groups was used to develop a questionnaire to evaluate the quality of life of medical student (QOLMS) that was used in the second phase of the study. In the second phase of the study 800 medical students, from 75 medical schools in Brazil, that were present in a medical students meeting (Encontro Científico de Estudantes de Medicina), in 2004, were interviewed. They filled the following questionnaires: self-evaluation of quality of life, WHOQOL - bref, Epworth daytime sleepiness scale and QOLMS. Results: The score attributed to quality of life in medical course was significantly lower than the score attributed to quality of life in general, and was lower in female students and in the students from the third and forth years of medical course. These students had also lower scores in the psychological and social relationship domains of WHOQOL - bref, when compared to students from the other years. Many students presented high scores of daytime sleepiness (>10, 48.1%), and the percentage of female students with high scores of daytime sleepiness (54.9%) was higher than male students (42.5%, p = 0.002). The presence of daytime sleepiness was associated to lower scores of physical health, psychological and environment domains of WHOQOL - bref, considering all medical students. There were no significant differences between students from public and private medical schools concerning self-evaluation of quality of life, domains of WHOQOL - bref and daytime sleepiness scores. In the QOLMS questionnaire it was shown that 45.4% medical students are not satisfied with medical course. They said that they did not enjoy life the way they wanted, did not have a healthy diet and did not take care of their health. Feelings of sadness and dissatisfaction with affective and sexual life were present, mainly in females and in students from the third and forth years. Factors that improve quality of life of medical students were the presence of a good supervision in practical activities, participation in projects of social development, good classes, good teachers and the contact with patients. Medial students from the fifth and sixty years have a better relationship with the teachers, see the medical course as very competitive and have better scores in the social relationships domain of WHOQOL - brief. The lack of free time to study, leisure, relationships and rest was considered a major factor in decreasing quality of life in medical course. Factor analysis of QOLMS showed that the following factors are important concerning quality of life in medical course: quality of life in general, management of time, social interaction, satisfaction with medical course, uncertainty concerning professional future and mental health. The group of medical students from the third and forth years showed the lowest scores of quality of life in medical course and in the domains of QOLMS, and these values were lower in females. Conclusion: In order to improve quality of life during medical course it is important to teach medical students how take care of their physical and mental health, establish and maintain relationships and develop resilience. It is also important to make changes in educational environment such as training of teachers, improvement in supervision of practical activities, offer opportunities of engagement in social projects and research and protected time to study, establish programs of health promotion and services of student support. Better learning environment results in an improvement of quality of life of students in medical course and allows the student to learn the medical profession without decreasing his/her physical and mental health.

O ensino universitário na área médica foi reconhecido internacionalmente pela diversidade e inovação pedagógica trazendo relevância para as discussões sobre a docência e para a formação pedagógica nesse contexto. Diante disso, objetivou-se refletir acerca da experiência de docentes em um curso de Medicina, com vistas à identificação de limites e possibilidades para o desenvolvimento de uma prática inovadora. Entendendo inovação como ruptura paradigmática, de caráter emancipatória e argumentativa, tomou-se o conceito de docência inovadora que articula as dimensões institucional, profissional e pessoal. A partir desse referencial teórico, realizou-se uma investigação qualitativa, utilizando pesquisa-ação baseada no itinerário de Paulo Freire, adaptado por Bueno, que propiciaram dois momentos de pesquisa: investigativo e educativo. O estudo foi desenvolvido no período de fevereiro de 2016 a dezembro de 2017 e, de forma colaborativa, participaram da pesquisa nove docentes de uma Instituição de Ensino Superior Privado no Sul do país que ministravam o módulo de Interação Comunitária. O projeto foi aprovado pelo comitê de ética de pesquisa (Parecer nº 1350157/2016) e o Termo de Consentimento Livre e Esclarecido devidamente foi devidamente assinado pelos participantes. Os dados foram coletados por meio de entrevista convergente, grupo focal e registro em diário de campo. Foram categorizados em dois tópicos: 1) Características dos docentes e sua experiência; e 2) Identificando limites e possibilidades para docência inovadora. Assim, identificaram-se os seguintes limites: a necessidade de revisão do modelo de desenvolvimento docente adotado tradicionalmente nas instituições de ensino; a não articulação entre teoria e prática pela organização no processo ensino-aprendizagem; e o aperfeiçoamento constante das habilidades relacionais dos docentes demandado pela diversidade das relações. Tais limites serviram de base para o planejamento do momento educativo, para o qual foram desenvolvidos três encontros que buscaram conhecer a realidade, analisá-la e propor novos caminhos. Nesse contexto, identificaram-se as seguintes possibilidades: 1) Tomar o conhecimento docente e sua realidade como ponto de partida para a reflexão e aprendizado de forma a propiciar a construção de novos conhecimentos e o trabalho colaborativo no espaço institucional; 2) Construir processos educativos que utilizem reflexão e análise para transformar a realidade e produzir conhecimento; e 3) Utilizar o diálogo como instrumento de aprimoramento e qualificação das interações. Refletir sobre inovação no contexto atual exige que se extrapole o modelo tecnicista e sejam então consideradas as dimensões: institucional, pedagógica e pessoal da docência / The university teaching in the medical area has been internationally recognized for its diversity and pedagogical innovation, making the discussions on teaching and the pedagogical training in this context relevant. Hence, the objective to reflect on the experience of teachers at a Medical School, aiming to identify limits and possibilities for the development of an innovative practice, was stablished. Understanding innovation as a paradigmatic rupture, with an emancipatory and argumentative character, the concept of innovative teaching was adopted, articulating the institutional, professional and personal dimensions. Relying on this theoretical framework, a qualitative research was carried out, using action research based on Paulo Freire\'s itinerary, adapted by Bueno, which provided two research moments: the investigative and the educational ones. The study was carried out from February 2016 to December 2017 and, collaboratively, nine teachers from a Private Higher Education Institution in Southern Brazil who taught the Community Interaction module participated in the study. The project was approved by the research ethics committee (Case No. 1350157/2016) and the Term of Free and Informed Consent was duly signed by the participants. Data were collected through convergent interview, focal group and field diary record. They were categorized into two topics: 1) Teachers\' characteristics and experience; and 2) Identifying limits and possibilities for innovative teaching. Thus, the following limits were identified: the need to revise the teacher\'s development model which is traditionally adopted in educational institutions; the nonarticulation between theory and practice by the organization in the teaching-learning process; and the constant improvement of the teachers\' relational skills demanded by the diversity of relationships. These limits served as a basis for the planning of the educational moment, for which three meetings were developed aiming to know the reality, analyze it and propose new paths. In this context, the following possibilities were identified: 1) To take teacher\'s knowledge and its reality as a starting point to reflect and learn so as to enable the construction of new knowledge and collaborative work in the institutional environment; 2) To build educational processes that use reflection and analysis to transform reality and produce knowledge; and 3) To use the dialogue as an instrument for enhancement and qualification of interactions. To ponder on innovation in the current context requires the technicist model be extrapolated and the institutional, pedagogical and personal dimensions of teaching be considered

Introdução: A formação médica tem sido muito discutida recentemente em virtude do crescimento do número de instituições e da crescente percepção de necessidade de um controle social para a qualidade do egresso. A exemplo da avaliação desencadeada por crise similar de crescimento desordenado das faculdades de medicina na década de 70, é oportuna a avaliação abrangente do perfil dos egressos dessas instituições. A medicina vem sofrendo diversas transformações impostas pelas modificações sociais da globalização, o que sem dúvida apresentou impacto sobre o perfil dos alunos egressos. Objetivos: 1. Avaliar o perfil do profissional médico egresso da FMRP-USP de acordo com a década de formação; 2. Avaliar a distribuição geo-espacial dos egressos da FMRP-USP; 3. Avaliar o envolvimento com o currículo informal e o currículo oculto ao longo das décadas de formação; 4. Avaliar o envolvimento com educação continuada dos egressos da FMRP-USP; 5. Avaliar a aderência à profissão e o envolvimento com outros tipos de atuação profissional ao longo das décadas de formação; 6. Avaliar aspectos relacionados à remuneração dos egressos; 7. Constituir um banco de dados atualizado dos egressos da FMRP-USP que favoreça contatos futuros e projetos para o resgate da história da instituição. Metodologia: Foram realizadas entrevistas sistematizadas através de instrumento dedicado desenvolvido para o presente trabalho e testado em estudo piloto. A identificação dos egressos envolveu diversas estratégias, incluindo a rede mundial de computadores, comissões de formatura para encontro de turmas, bancos de endereços disponíveis, anúncio em páginas da rede mundial de computadores da FMRP-USP e de seu hospital universitário e dados do CREMESP e CFM. O projeto foi aprovado no Comitê de Ética em Pesquisa do HC-FMRP-USP. Resultados: Foram incluídos 1064 egressos (24.9% do total) distribuídos, estratificados em 5 grupos de acordo com a década de formação. Esse trabalho documentou o perfil dos egressos da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRPUSP) de modo pioneiro, sendo extremamente representativo ao se considerar o número de egressos incluídos de acordo com parâmetros com que tais estudos de levantamento (\"survey\") são analisados. Demonstrou a distribuição geográfica dos alunos, que embora mais concentrados no Estado de São Paulo, possuem distribuição nacional, tanto no que se refere aos profissionais médicos, quanto aos profissionais com pós-graduação stricto sensu que se inserem nas mais conceituadas universidades do país, estes últimos com 50% do inserção fora do Estado de São Paulo Ao longo do tempo, o perfil dos egressos demonstrou modificações significativas do ponto de vista demográfico (maior representação do gênero feminino - de 6,5% nas turmas mais antigas para 36% nas mais novas), do envolvimento com atividades extracurriculares em atividades mais relacionadas à prática clínica em detrimento de atividades mais sociais (pouco mais de 40% nas turmas mais antigas versus mais de 70% nas mais novas ) e da busca por especialidades médicas que representem maior poder aquisitivo e qualidade de vida, por exemplo oftalmologia/otorrinolaringologia (15,2% nas turmas mais jovens versus 6,6% nas mais antigas). A busca por educação continuada teve alta porcentagem entre os egressos, com até 42,2% de pós-graduação stricto sensu e 98,5% de especialistas entre os egressos com 20 a 29 anos de formado. A inserção profissional foi caracterizada por atividade médica continuada, tanto em ambiente privado como público (SUS), com uma percentagem relativamente significativa ainda realizando plantões para complementação de renda, principalmente nos mais jovens (54,5% versus 14,0 nos mais antigos). Finalmente, detecta-se o desejo de se reaproximar da instituição formadora, mantendo contato de diversas formas, como o desejo de receber malas diretas da FMRPUSP mais de 80 % do total dos egressos, chegando a 96,6% nos mais jovens, mas que ainda requer uma liderança mais efetiva. Conclusões: A amostra de 1064 egressos constituída demonstrou que há grande valorização pela busca contínua de atualização profissional, representada tanto pela busca de programas de residência, pós-graduação e títulos de especialista. Apesar de ser um fator influente, o tempo de formado não prejudicou esse interesse. A influência do perfil docente pode ser refletida na proporção razoável de profissionais que buscam a docência como forma de inserção inicial ou quando se desvinculam da atividade médica. / Introduction: Medical education has been much discussed recently due to the growing number of institutions and the growing realization of the need for a social control to the quality of graduates. Like the assessment triggered by similar crisis of uncontrolled growth of medical schools in the 70s, is timely comprehensive the evaluation of the profile of the graduates of these institutions. The medicine has undergone several transformations imposed by the social changes of globalization, which undoubtedly had an impact on the profile of students graduating. Objectives: 1. Assess the profile of the professional of medicine graduate in the FMRP-USP according to the decade of formed; 2. Assess the geo-spatial distribution of graduates of the FMRP-USP; 3. Assess engagement with the informal curriculum and with the hidden curriculum throughout the decades of formed; 4. Assess involvement of graduates of the FMRP-USP in continuing education; 5. Assess adherence to the medical profession and involvement in other types of professional performance throughout the decades of formed; 6. Assess aspects related to the remuneration of graduates; 7. Establish a updated database of the FMRP-USP graduates that encourages future contacts and projects to rescue the history of the institution. Methodology: Interviews were systematically conducted through a dedicated questionary tool developed for this study and tested in a pilot study. The identification of the graduates involved several strategies, including the World Wide Web, graduation commissions for meeting groups, databases of addresses, ad pages of the World Wide Web of the FMRP-USP and its university hospital and CREMESP data and CFM. The project was approved by the Research Ethics Committee of the HC-FMRP-USP. Results: Were included 1064 graduates (24.9% of total) distributed in 5 groups according to the decade of formed. This work documented the profile of graduates of Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP) in a pioneering way, being extremely representative when considering the number of graduates included according to parameters such survey studies (\"survey\") are analyzed. It demonstrated the geographic distribution of students, who although more concentrated in São Paulo, have national distribution, both with regard to medical professionals, as professionals with stricto sensu pos-graduate working into the most prestigious universities in the country. Over time, the profile of graduates showed significant changes from the demographic point of view (greater representation of females), involvement with extra-curricular activities with more activities related to clinical practice at the expense of more social activities and the search for medical specialties representing higher income and quality of life. Some values of the FMRP-USP have proved perennial over time, as the fact of being imbued in the formation of their students the continued search for specialization in various levels. The professional insertion was characterized by continuing medical activity, both in private and public (SUS), with a relatively significant percentage still performing shifts for supplementary revenue. Finally, it detects the desire to reconnect to the educational institution, maintaining contact in many ways, but still requires more effective leadership. Conclusions: The sample composed of 1064 graduates showed that there is great appreciation for the continuous pursuit of professional development, represented both by seeking residency programs, postgraduate and specialist titles. Despite being an influential factor, the time since graduation did not harm that interest. The influence of the teacher profile can be reflected in reasonable proportion of professionals seeking teaching as initial insertion or at the end of your medical activity.

Introduction: The field of patient safety has increased in prominence over the last decade in response to information about the harm that occurs to patients in their journeys through healthcare. Healthcare education has also responded with the introduction of patient safety into many undergraduate and postgraduate curricula. Understanding how to influence healthcare worker behaviours is key to these responses. A vital area is the influence that individual factors have on patient safety behaviours. A model of the influences on patient safety has been proposed (Jackson 2008). There is little research in undergraduates that explores this area. This thesis presents a longitudinal series of studies following a cohort of students through a medical curriculum to answer the primary question: which individual factors influence learning about patient safety? Additionally to this how could these factors be tested in relation to patient safety for medical students? Methods: The series of studies used the Medical Research Council’s framework for the evaluation of complex interventions together with Kirkpatrick’s framework to test a conceptual model of individual factors relevant to medical students in patient safety. Measurable outcomes relevant to medical students needed to be identified for each level in Kirkpatrick’s hierarchy. Study 1 used focus group data, when the students were in year 1 of the curriculum, to identify the conceptual model of the influences on patient safety for medical students at level Kirkpatrick’s level 1. Study 2 tested the conceptual model at level 2a when the cohort of students was in year 3. The study used validated questionnaires to test associations between reflective ability, and knowledge and attitudes to patient safety (Kember 1999, Patey 2007). Study 3 occurred in year five. This study identified associations between reflective ability, safe behaviours and error behaviours, in a standardised simulated ward setting. This was used to establish an association between individual factors and behaviours at level 3. Results: Pilot/Study 1: The interpretation of data from seven focus groups involving sixty students identified reflection and intellectual development as individual factors which influenced learning about error. Study 2: Sixty-one students participated and the questionnaires showed acceptable levels of reliability; Cronbach alpha for the reflection questionnaire was 0.71 and the patient safety questionnaire 0.90. The following significant associations were demonstrated: • Reflection and knowledge of actions to take for patient safety, correlation coefficient 0.44 (p=0.0002). • Critical reflection and intentions regarding patient safety, correlation coefficient 0.40 (p=0.0007) Study 3: Forty-eight students participated and the self-administered questionnaires showed acceptable levels of internal consistency, Cronbach alpha for reflection was 0.70 and for critical reflection was 0.78. The generalisability coefficient for the judgments about safe behaviour was 0.84 and for the error behaviours was 0.52. The following significant association was demonstrated: • Reflection and knowledge based errors, correlation coefficient r -0.30 (p=0.03) There were no significant correlations between critical reflection and error, and reflection and safe behaviour. Discussion: The results of these studies in a single cohort identify reflection as an individual factor that influences error behaviours as shown below add greater depth to Jackson’s model (Jackson 2008). The link between reflective thinking and a reduced rate of knowledge-based errors appears to be associated with thoughtful action with reflection rather than critical reflection transforming meaning frameworks. This series of studies identify an association between reflection and error and give a new perspective on the use of reflection in patient safety education.

Medical schools in the United States serve to train the next generation of physicians, admitting students who will continue to advance each school’s mission. Admission committees are tasked with identifying those candidates who will be successful academically and who promote the objectives of the school with respect to mission. The Quillen College of Medicine at East Tennessee State University in northeast Tennessee seeks to attract and retain physicians with an interest in rural and primary care medicine. A total of 630 students were included in this study representing classes from 2001 to 2011. This study examined admissions data including MCAT scores, undergraduate GPAs, admission interview scores, and admission committee rating scores along with USMLE Step 1 scores to determine if there is any correlation of these variables with graduates selecting a primary care career or a rural practice location. With respect to data available at admission, only MCAT scores were shown to have a significant correlation to specialty choice. None of the admission data significantly correlated with practice location. USMLE Step 1 scores had a weak negative relationship with specialty choice and a negligible relationship with practice location. This study provides the admission committee information that these variables are insufficient by themselves to predict whether a medical student applicant will select a primary care specialty or practice in a rural location. Other data, perhaps even subjective data, would need to be analyzed to predict how well the admissions committee is addressing the college’s mission with its selection of medical students.

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Current research examining the effects of resistive exercise programs in children with cerebral palsy (CP) has not met national guidelines for the duration of training. The lack of improvement in gross motor abilities after resistive training may be attributed to insufficient duration. Additionally, plyometric training has not been used as a treatment, despite evidence suggesting that it can improve running, throwing, and jumping skills. The current study evaluated the optimum duration and effects on gross motor abilities of a plyometric training treatment for three participants with spastic, unilateral CP using a multiple baseline, multiple probe design. Treatment was designed using the National Strength and Conditioning Association’s guidelines for intensity, volume, frequency, and variety of training. Treatment resulted in improvements in GMFM 66 scores, agility, and broad jump distance for all three participants. Consistency preceded improvements in distance or height. The optimum duration was dependent on the individual child and the outcome measure. Ongoing training is necessary to maintain running speed. However,slight declines or maintenance of performance in the GMFM, agility, and power tests at follow-up may be attributed to inconsistency in performance rather than decline.

No description available.