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.

Orientadores: Eliana Martorano Amaral, Angelica Maria Bicudo Zeferino / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T11:06:13Z (GMT). No. of bitstreams: 1 Domingues_RosangelaCurvoLeite_D.pdf: 2568394 bytes, checksum: ef02de041cdb4116f477edbaf37a5267 (MD5) Previous issue date: 2008 / Resumo: Objetivo: Relacionar o Conceito Global Itemizado com o Conceito Geral dos alunos do 4º ano de Medicina, atribuídos por três tipos de avaliadores (docentes, colegas e próprio aluno) e compará-lo com os outros métodos de avaliação das competências esperadas no atendimento em unidade de atenção primária. Sujeitos e métodos: Foram estudadas as notas atribuídas a estudantes do 4º ano (n=106), por docentes (n=19), pelos próprios alunos e por colegas, ao final de um módulo de ensino que se desenvolve em 6 unidades básicas de saúde, sob supervisão de docentes e tutores de Ginecologia e Obstetrícia (GO), Clínica Médica (CM) e Pediatria (Ped). Os docentes forneceram uma nota (0 a 10) que resumia as competências do aluno no semestre, cuja média foi definida como Conceito Geral (CG). Depois de duas semanas, os mesmos docentes preencheram o formulário pré-testado do Conceito Global Itemizado (CGI) para os mesmos alunos, que continha 6 domínios de competências técnicas (CGIt) e 7 de competências humanísticas (CGIh). Os alunos preencheram formulários iguais (de CG e de CGI) para realizar sua auto-avaliação e apenas a parte das competências humanísticas (CGIh) para anonimamente avaliar 3-4 colegas que compunham o seu grupo. Por meio de um instrumento auto-respondido, também expressaram sua opinião sobre o exercício de se auto-avaliar e de avaliar seus colegas. As notas de CGI foram comparadas com notas provindas de outros métodos de avaliação: Provas Teóricas (Pt), Portfólio (Pf) e Avaliação Estruturada (AE). A análise estatística incluiu estatísticas descritivas, análise fatorial, coeficientes de Cronbach, testes de Friedman e de Wilcoxon para dados emparelhados, coeficientes de correlação de Pearson e de Spearman, modelos de análise de variância (ANOVA) e distâncias Euclidianas. Assumiu-se o nível de significância de 5%. Foi utilizado o programa SPSS Versão 10.0. O projeto foi aprovado pelo Comitê de Ética e Pesquisa da instituição. Resultados: Houve predominância de notas elevadas e discriminação reduzida entre os alunos. A consistência interna do questionário de CGI foi elevada para todos os avaliadores (alfa de Cronbach > 0,881). As notas de CG dos alunos foram significativamente inferiores às dos docentes (diferença de medianas = 0,41). As notas de CG foram significativamente inferiores às notas do CGI na avaliação docente (diferença de medianas = 0,13), mas não na auto avaliação e tiveram maior concordância e correlação com as notas de CGIt (r= 0,873 docente, r= 0,715 auto-avaliação) do que com as de CGIh (r= 0,614 docente, r= 0,481 auto-avaliação). As notas de CGIh foram significativamente mais elevadas do que as de CGIt, tanto na auto-avaliação (diferença de medianas = 0,17) quanto na avaliação docente (diferença de medianas = 0,19), com modestas correlações entre elas (r= 0,62 docentes, r= 0,61 auto-avaliação). Os alunos atribuíram notas significativamente mais baixas para os colegas do que para si mesmos (CGIh, diferença de medianas = 0,36). As correlações entre as notas dos três tipos de avaliadores para todos os domínios do CGI foram muito pobres e, em geral, não significativas. As notas dos docentes de Ped foram significativamente inferiores às dos docentes de GO e CM (diferenças de medianas entre 0,50 e 0,67), com correlações baixas entre elas (-0,02<r<0,48). A maior discordância ocorreu entre as notas de GO e Ped, em todos os métodos. Os domínios que tiveram maior impacto na confiabilidade do CGI foram: Exame físico, Solução de problemas, Capacidade de auto-reflexão e Julgamento clínico. Hábitos de trabalho poderia ser excluído do instrumento itemizado. 90,6% dos alunos/avaliadores avaliaram todos os seus colegas de grupo. Houve indicações de reciprocidade e constância no padrão das notas entre pares e situações sugestivas de conflitos interpessoais. Os alunos se sentiram mais confortáveis e preparados para a auto-avaliação do que para a avaliação dos colegas (diferença de 34,4% e 17,7%, respectivamente) e julgaram a auto-avaliação mais justa e valiosa do que a avaliação dos colegas (diferença de 4,2% e 34,7%, espectivamente). Houve diferenças significativas entre as distribuições das notas de todos os métodos, com notas mais elevadas na AE (mediana = 9,27). Houve correlação forte e significativa (r= 0,719) e maior concordância entre as notas da AE e as do CGI. Conclusão: Os alunos foram mais rigorosos consigo mesmo do que os docentes no CG e nos atributos técnicos do CGI e com seus pares nos atributos humanísticos do CGI. As notas do CG foram inferiores às do CGI para os docentes, mas não para os próprios alunos e enfocaram principalmente as competências técnicas dos estudantes. O CGI mostrou-se uma estratégia válida e confiável para compor o conjunto de métodos de avaliação dos estudantes do 4º ano de medicina, em estágio clínico. / Abstract: Purpose: To correlate the Global Itemized Rating with the Global Overall Rating attributed to Y4 medical students by three types of assessors (faculty, peers and self), and to compare it with other assessment methods used to evaluate learners in clinical clerkship, at the primary level of care. Subjects and Methods: The focus of the present study were ratings attributed to Y4 medical students (n= 106) by faculty members (n= 19), by own students and peers, at the end of a teaching module conducted at 6 primary care centers, and supervised by faculties and tutors from Obstetric and Gynecology (O&G), Internal Medicine (IM) and Pediatrics (Ped). Faculties provided a summative global numeric rating, ranging from 0 to 10, which summarized student's competencies during the clerkship. Faculty global scores across disciplines were averaged and defined as a Global Overall Rating (GOR). Two weeks after securing GOR ratings for all students, the same faculty members assessed the same students using in a pre-tested Global Itemized Rating, named GIR, which encompassed thirteen domains: six referred to technical skills (GIRt), and seven to humanistic skills (GIRh). Students completed similar GOR and GIR forms for self-assessment, and the humanistic scoring components of the GIR form to anonymously assess three to five working-group peers. Students answered a questionnaire on their perceptions to the experience as self and peer raters. GIR ratings were compared with ratings from other assessment methods: Multiple-choice questions (MCQs), Portfolio (Pf) and Real-case structured clinical assessment (RC-SCA). Statistical analyses included descriptive statistics, factor analysis, Cronbach's alpha, Friedman test, Wilcoxon signed rank test, Pearson and Spearman correlation coeffients, ANOVA models and Euclidean distances. Statistical significance was set at P<0.05. Statistical analyses were performed using SPSS program, version 10.0. Ethical approval was obtained. Results: Distributions were negatively skewed and reduced discrimination among students was observed. GIR internal consistency was high, across all types of raters (Cronbach's alpha > 0.881). Students' GOR ratings were significantly lower than faculties' (median difference = 0.41). GOR ratings were significantly lower than GIR ratings for faculty (median difference = 0.13), but not for self, and showed stronger agreement and correlation with GIRt (r= 0.873 for faculty and r= 0.715 for self) than with GIRh (r= 0.614 for faculty and r= 0.481 for self). GIRh ratings were significantly higher than GIRt (median difference = 0.17 for self and 0.19 for faculty), with modest correlations between them (r= 0.62 for faculty and r= 0.61 for self). Learners attributed lower mean ratings to their fellow students than to themselves (CGIh median difference = 0.36). Correlations between faculty, self and peer scores were very poor in all domains, and generally non significant. Ped scores were significantly lower than O&G and IM (median differences between 0.50 and 0.67), with low correlations between them (-0.02<r<0.48). O&G and Ped scores showed greater disagreement, in all methods. The domains that had greater impact on the reliability of the scale were: Physical examination, Problem-solving, Self- reflective skills and Clinical Judgment. Work habits could be excluded from the itemized form. 90.6% of the learners/raters assessed all their group-peers. Patterns of reciprocity and constancy in ratings, and some situations suggesting conflicts were noticed in working groups. Learners expressed to be more comfortable and prepared for self than for peer assessment (difference = 34.4% and 17.7%, respectively), and considered self-assessment more fair and valuable than peer assessment (difference = 4.2% and 34,7%, respectively). There were significant differences between score distributions in all assessment methods, with higher ratings in RC-SCA (median = 9.27). RC-SCA and GIR showed strong and significant correlations (r= 0.719) and greater agreement. Conclusion: Learners were sctricter with themselves than faculty in GOR and in GIR technical domains, and with their colleagues in GIR humanistic domains. GOR ratings were lower than GIR ratings for faculty, but not for self, and focused mainly on students' technical skills. GIR has shown to be a valid and reliable strategy, which can make up the set of assessment methods used to evaluate fouth-year students in clinical clerkship. / Doutorado / Ciencias Biomedicas / Doutor em Tocoginecologia

Orientador: Marco Antonio de Carvalho Filho / Texto em português e inglês / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T06:22:43Z (GMT). No. of bitstreams: 1 Schweller_Marcelo_D.pdf: 4044666 bytes, checksum: bfb3e3b0eea72e97978494a9fa282598 (MD5) Previous issue date: 2014 / Resumo: A relação médico-paciente é o fundamento da prática da medicina. Entre os fatores que permitem o sucesso dessa parceria, a empatia se destaca como um dos mais importantes, e existem evidências que associam a atitude empática do médico com a satisfação do paciente, a adesão ao tratamento e melhores desfechos clínicos. Apesar de sua importância, a maioria dos estudos revela uma tendência de perda de empatia durante o curso de graduação em medicina, sendo o currículo oculto a causa mais comumente relacionada a este fenômeno. Várias estratégias têm sido propostas para preservar ou aumentar a empatia desses estudantes. O objetivo deste estudo é avaliar o impacto de metodologias ativas de ensino nos níveis de empatia de estudantes de medicina em diferentes estágios de formação. No primeiro estudo, duas turmas consecutivas de estudantes do primeiro ano (n = 166) participaram de uma disciplina curricular concebida com o intuito de oferecer um contato inicial positivo com a prática médica, através de uma série de atividades com apelo realístico e espaço para debate e reflexão. Os níveis de empatia foram avaliados através da Escala Jefferson de Empatia Médica (JSPE) antes e após o curso. A média inicial foi de 117,9 e subiu para 121,3 após a intervenção (p<0,001), com um tamanho do efeito de 0,38. O aumento foi maior entre os estudantes com menores níveis iniciais de empatia. No segundo estudo, estudantes de duas turmas do quarto ano médico (n=124) e do sexto ano médico (n=123) participaram de consultas médicas simuladas com pacientes padronizados, seguidas de um feedback aprofundado com o objetivo de lidar com os sentimentos do paciente e dos estudantes. Após a atividade, houve um aumento significativo nos níveis de empatia para o quarto ano (de 115,8 a 121,1; p<0,001; tamanho do efeito=0,61) e para o sexto ano (de 117,1 a 123,5; p<0,001; tamanho do efeito=0,64). O terceiro estudo examinou a percepção dos estudantes sobre os desfechos de aprendizagem relacionados com a atividade de simulação descrita acima através de um questionário anônimo. Os estudantes sentiram-se confortáveis durante a atividade, devido à "abertura ao diálogo", à "proximidade com colegas e professores" e ao "ambiente livre de julgamento". Mais da metade deles perceberam-se motivados a estudar, especialmente a "relação médico-paciente", a "terapêutica", as "doenças mais prevalentes" e "medicina em geral". Cerca de 90% relatou que o aprendizado será útil em suas vidas pessoal e profissional, em função de uma maior "compreensão dos sentimentos", "empatia", "capacidade de ouvir" e de "lidar com conflitos". Estes resultados sugerem que é possível manter ou mesmo aumentar os níveis de empatia de estudantes de medicina através de metodologias ativas de ensino em diferentes estágios da formação médica. Além disso, atividades com apelo realístico que apresentem a medicina de uma forma positiva podem se tornar um fórum para o debate de temas relacionados com o currículo oculto, o que estimula a reflexão sobre o tema. Esse tipo de atividade pode motivar o estudante no processo de ensino-aprendizagem, permitindo a recuperação do significado pessoal e social da prática da medicina / Abstract: A meaningful doctor-patient relationship is the foundation of the practice of medicine. Empathy stands out as one of the most important factors to ensure the success of this partnership, and there is evidence associating doctor¿s empathetic attitude with greater patient satisfaction, treatment adherence and better clinical outcomes. In spite of its importance in patient care, most studies reveal a tendency for empathy loss during medical school, with the work overload and the hidden curriculum being the most commonly cited causes of this phenomenon. Several strategies have been proposed to preserve or heighten empathy levels in medical students, with varying results. The purpose of this study is to examine the impact of active teaching methodologies on the empathy levels of medical students at different stages of their training. In the first study, two consecutive classes of first-year medical students (n=166) participated in a curricular course designed to be a positive initial outlook on the medical practice, through a series of different activities with real-world appeal and based on reflection. Students¿ empathy levels were assessed using the Jefferson Scale of Physician Empathy (JSPE) before and after the course. The mean pretest JSPE score was 117.9 and increased to 121.3 after the intervention (p<0.001), with an effect size of 0.38. The increase was greater among students with lower initial JSPE scores. In the second study, two classes of fourth-year (n = 124) and two classes of sixth-year (n = 123) medical students participated in simulated medical consultations with standardized patients, followed by an in-depth debriefing dealing with the feelings of the patient and the students. After the activity, there was a significant increase in the empathy levels of fourth-year students (from 115.8 to 121.1, p<0.001, effect size = 0.61) and sixth-year students (from 117.1 to 123.5, p<0.001, effect size = 0.64). The third study examined the students¿ perceptions on the learning outcomes related to the simulation activity described above through an anonymous questionnaire. Students felt comfortable during the activity, due to "openness to dialogue", "proximity with colleagues and professors" and the "environment free of judgment". More than half of them were motivated to study, especially the "doctor-patient relationship", "treatment", "common diseases" and "medicine in general". Approximately 90% reported that what they learned would be useful in their professional and personal lives, providing a greater "understanding of emotions", "empathy", "ability to listen" and "ability to deal with conflicts". These results suggest that it is possible to maintain or even to increase medical students¿ empathy levels through active teaching methodologies at different stages of medical training. Activities with real-world appeal that present medicine in a positive way may also become a forum for debating topics related to the hidden curriculum, allowing students to reflect and cope. This practice may even motivate learning in medicine, allowing for the recovery of the personal and social meaning of its practice / Doutorado / Clinica Medica / Doutor em Clínica Médica

Orientador: Maria Helena Salgado Bagnato / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Educação / Made available in DSpace on 2018-08-21T11:24:17Z (GMT). No. of bitstreams: 1 Andrade_MarciaReginaSelpade_D.pdf: 3594605 bytes, checksum: 56c04b5f9b5a7471551d9b58c08251d5 (MD5) Previous issue date: 2012 / Resumo: Essa pesquisa aborda as propostas de currículo integrado de duas escolas médicas de Santa Catarina, a Universidade Federal de Santa Catarina - UFSC e a Universidade Comunitária da Região de Chapecó - UNOCHAPECÓ. A investigação teve como finalidade compreender o processo de construção e recontextualização do currículo integrado a partir da análise dos Projetos Pedagógicos e por meio de entrevistas semiestruturadas com professores e coordenadores dos respectivos cursos de medicina. Buscou problematizar como a integralidade curricular é recontextualizada nos dois cursos de medicina? quais as principais características dos currículos integrados? quais os caminhos pelos quais se expressam a mudança curricular? A partir das questões norteadoras que envolveram a pesquisa foi possível nessa trajetória identificar: a) no Campo de Recontextualização Oficial as principais influências das políticas e programas de incentivo a mudança curricular. Nesse contexto compreendemos que as políticas mobilizam os sujeitos e grupos sociais, os discursos e as práticas curriculares, porém, em processos contínuos de interpretações e ressignificações; b) no Campo de Recontextualização Pedagógica foi situado as características de currículos integrados. Nesse campo identificamos que os currículos das duas escolas médicas foram organizados numa perspectiva modular e espiral. Os projetos também revelam a dinâmica e a complexidade de sua operacionalização. Na análise das entrevistas foi possível perceber os principais atores sociais envolvidos no processo de mudanças, as dificuldades, os avanços, e os desafios tanto na elaboração como na implementação das propostas curriculares integradas. Assim, essa pesquisa mostra as ambivalências das motivações e as influências das políticas no contexto das mudanças e construção da proposta curricular. Porém, consideramos que tais influências e motivações são recontextualizadas e reinterpretadas nos diferentes contextos a partir da história de vida pessoal e profissional de cada ator social e das complexas conexões com a coletividade, a cultura e as relações de poder. Portanto, não se buscou apenas apontar resistências, ou a aceitação de uma mudança curricular, mas compreender que as propostas curriculares, entendidas como artefato social e histórico buscam além da integração do conhecimento, a visão integrada do ser humano. Nesse sentido uma recontextualização da formação médica está em percurso. / Abstract: This research discusses the proposed integration of the curriculum of two medical schools of Santa Catarina, The Federal University of Santa Catarina (UFSC) and the Community University for the Region of Chapecó - (UNOCHAPECÓ). The aim of the research is to understand the process of development and re-contextualization of an integrated curriculum from the analysis of pedagogical projects and through semi-structured interviews with teachers and coordinators of the respective medical courses. We sought to consider the problem of; How to integrate the curriculum and re-contextualize the two courses of medicine? What are the main characteristics of the integrated curricula? What are the ways through which we express the curricular change? Using these questions to direct the research it was possible in this way to identify: (a) in the area of official re-contextualization, the primary influences of policies and programs to encourage curricular change. In this context we understand that the policies mobilize individuals and social groups, in the communication and curriculum practices, providing that there is a continuous processes of interpretation and re-interpretation. (b) the attributes of integrated curricula were placed within the area of pedagogical re-contextualization. In this area we have identified that the curricula of the two medical schools were organized in a modular and spiral approach. The projects also revealed the dynamics and complexity of its operation. In the analysis of the interviews it was possible to realize the principle social players involved in the process of change, the difficulties, the advances and challenges both in the preparation and the implementation of integrated curricular proposals. Thus, this study shows the ambivalence of the motivations and influences of the policies in the context of the changes and development of the proposed curriculum. However, we believe that such influences and motivations are re-contextualized and re-interpreted in different ways due to the personal and professional history of each participant and the complex connections with the collectivity, the culture and power relationships. Therefore, we not only sought to identify resistance or acceptance of a curriculum change, but to understand that the proposed curriculum, understood as a social and historical tool, aims to look beyond the integration of knowledge and also as an integrated vision of humanity. In this sense a re-contextualization of medical training is being formed. / Doutorado / Ensino e Práticas Culturais / Doutor em Educação

Background Latin America is undergoing a human resource crisis in health care in terms of labor shortage, misdistribution and poor orientation to primary care. Workforce data are needed to inform the planning of long-term strategies to address this problem. This study aimed to evaluate the academic and motivational profile, as well as the professional expectations, of Latin American medical students. Results We conducted an observational, cross-sectional, multi-country study evaluating medical students from 11 Spanish-speaking countries in 2011–2012. Motivations to study medicine, migration intentions, intent to enter postgraduate programs, and perceptions regarding primary care were evaluated via a self-administered questionnaire. Outcomes were measured with pilot-tested questions and previously validated scales. A total of 11,072 valid surveys from 63 medical schools were gathered and analyzed. Conclusions This study describes the profile and expectations of the future workforce being trained in Latin America. The obtained information will be useful for governments and universities in planning strategies to improve their current state of affairs regarding human resources for health care professions.

Objectives: This study aimed to assess residents' and fellows' knowledge of finance principles that may affect their personal financial health. Methods: A cross-sectional, anonymous, web-based survey was administered to a convenience sample of residents and fellows at two academic medical centers. Respondents answered 20 questions on personal finance and 28 questions about their own financial planning, attitudes, and debt. Questions regarding satisfaction with one's financial condition and investment-risk tolerance used a 10-point Likert scale (1=lowest, 10=highest). Of 2,010 trainees, 422 (21%) responded (median age 30 years; interquartile range, 28-33). Results: The mean quiz score was 52.0% (SD = 19.1). Of 299 (71%) respondents with student loan debt, 144 (48%) owed over $200,000. Many respondents had other debt, including 86 (21%) with credit card debt. Of 262 respondents with retirement savings, 142 (52%) had saved less than $25,000. Respondents' mean satisfaction with their current personal financial condition was 4.8 (SD = 2.5) and investment-risk tolerance was 5.3 (SD = 2.3). Indebted trainees reported lower satisfaction than trainees without debt (4.4 vs. 6.2, F (1,419) = 41.57, p < .001). Knowledge was moderately correlated with investment-risk tolerance (r=0.41, p < .001), and weakly correlated with satisfaction with financial status (r=0.23, p < .001). Conclusions: Residents and fellows had low financial literacy and investment-risk tolerance, high debt, and deficits in their financial preparedness. Adding personal financial education to the medical education curriculum would benefit trainees. Providing education in areas such as budgeting, estate planning, investment strategies, and retirement planning early in training can offer significant long-term benefits.

Lung cancer is the second most prevalent cancer in men and women in the United States and the overall leading cause of cancer-related deaths. Due to this high prevalence, lung cancer screening is a critical procedure in all Family Medicine practices. However, screening is particularly important in rural Appalachian clinics, as this area experiences especially high rates of mortality due to lung cancer. The United States Preventive Services Task Force recommends annual low-dose computed tomography (LDCT) lung cancer screening in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. The goal of this project is assess readiness of clinical providers of the risks and benefits of lung cancer screening, to encourage screening when appropriate, and ultimately increase then number of LDCT annual screenings. Provider knowledge was assessing using a lung cancer screening knowledge and practice survey. Participants then attended an educational sessions that provided information on the importance of screening and when it is appropriate to administer LDCT. Finally, a second survey was administered, again to assess knowledge and practice. Data analysis is currently in process. A t-test will be executed to determine if there is a statistically significant difference between survey scores before and after the educational session. It is expected that the educational program will lead to increases in provider knowledge and more appropriate screenings. The results of this study have important ramifications for this area; because Appalachia has disproportionately high mortality due to lung cancer, it is imperative that the disease be identified as early as possible to ensure the most effective treatment. This project illustrates a method to increase screenings.

Objective: To evaluate the differences among Primary Care (PC) labor perceptions of medical students from Latin America according to their country. Methods: Observational, analytic and cross-sectional multicountry study that evaluated 9 561 first and fifth-year medical students from 63 medical schools of 11 Latin American countries through a survey. To evaluate the perceptions on the PC work, a previously validated scale was used. Tertiles of the scores were created in order to compare the different countries. Crude and adjusted prevalence ratios were calculated using simple and multiple Poisson regression. A p-value<0.05 was considered statistically significant. Findings: 52.9% of the subjects were female and the mean age was 20.4±2.9 years. 35.5% were fifth-year students. Statistically significant differences were found between the study subjects’ country, using Peru as reference. Students from Chile, Colombia, Mexico and Paraguay perceived PC work more positively compared with Peruvian students, while those from Ecuador showed less favorable opinions. No differences were found among the perceptions of Bolivian, Salvadoran, Honduran and Venezuelan students when compared to their Peruvian peers. Conclusions: Perceptions of PC among medical students from Latin America vary according to the country. Considering such differences can be of major importance for potential local specific interventions for the improvement of PC in these. / Tesis

LGBT+ patients, medical students, and healthcare providers have been shown to experience significant health disparities and poor health outcomes, to less frequently seek out healthcare, and to often face discrimination in healthcare settings. Researchers suggest the lack of high quality and in-depth training on LGBT+ health and communication skills may contribute to hostile clinic cultures and reinforce implicit and explicit biases towards LGBT+ patients. Despite the growing body of research and interest in curriculum reforms, there has not been an up to date, comprehensive review of LGBT+ health trainings and resources at U.S. medical schools since 2015. We conducted a systematic review of available information on the presence of LGBT+ trainings, support groups, and resources for medical students, residents, and faculty at all M.D.-granting institutions who are part of the Association of American Medical Colleges (AAMC). The systematic review was conducted between May and September 2020 through Google using pre-determined keyword search strategies. Collected information included type of programming, targeted audience, and length of training among others that was built into an easily accessible online database of LGBT+ health curriculums and resources. Similar to 2015, most U.S. medical schools (52%) do not have or do not provide easily accessible information about LGBT+ trainings for their students. Even fewer medical schools (39%) report that they require their students to take some form of LGBT+ health training, and almost no information is easily available on LGBT+ trainings for residents and medical school faculty. Our findings suggest that medical schools have made some progress in creating more inclusive curricula and training environments compared to 2015. However, there has not been a consensus in how medical students should be trained to be more aware of and to address biases, discrimination, and poor health outcomes affecting their LGBTQ+ patients and colleagues.

Most medical students across the U.S. currently receive intubation skills training on low fidelity simulation (LFS) plastic mannequins. A limitation of these LFS models is that they do not allow students to attain complete familiarity and proficiency with intubation in a real-world clinical setting. For several years now, ETSU has been utilizing the Thiel embalming technique, which allows for greater joint flexibility and preservation of soft tissues compared to traditional embalming techniques. Our study set out to evaluate the efficacy of Thiel cadavers versus LFS plastic mannequins in assessing whether one model was more suitable in teaching intubation skills. After IRB approval, we exposed thirty-two first-and second-year medical students to both LFS models and Thiel embalmed cadavers in order to assess preparedness and confidence for performing intubations, and overall transference to patient care. Participants were shown an instructional video and given a brief lecture on the steps of a successful intubation by the primary investigators of the project before they were asked to practice intubation on both a Thiel cadaver as well as a LFS plastic mannequin. Participants were randomly assigned to note which teaching method to practice on first (Thiel cadaver or LFS model). Students were given written instructions during the procedure, and they completed a pre and post survey assessing preparedness, confidence, transference to patient care, and overall preference between the Thiel cadaver and LFS model for education. Our study significantly concluded that students felt better prepared and more confident by practicing on the Thiel cadaver and unanimously thought that it had better transference to clinical care. Overall, students also felt that the Thiel cadaver provided more knowledge, and close to two thirds of subjects preferred the Thiel cadaver over the LFS mannequin for learning intubation skills while a third of subjects said that both models should be used in training.