Orientador: Francisco Hashimoto / Banca: Luiz Antonio Nogueira Martins / Banca: Wilka Coronado Antunes Dias / Resumo: O objetivo deste trabalho foi avaliar a prevalência de estresse no estudante de Medicina. A Faculdade de Medicina de Marília (FAMEMA) foi escolhida por utilizar, desde 1997, no lugar do método tradicional, uma nova metodologia de ensino, a Aprendizagem Baseada em Problemas (ABP). Os sujeitos da pesquisa foram quatrocentos e treze estudantes, do ano de 2003, equivalente a 87,5% dos estudantes matriculados naquele ano. Foi aplicado o Inventário de Sintomas de Stress para Adultos de Lipp aos sujeitos da pesquisa durante os meses de abril a outubro de 2003. Observou-se a presença de estresse em 57,83% dos estudantes. A prevalência de estresse foi menor nos estudantes do primeiro ano em relação aos estudantes dos demais anos, e essas diferenças foram estatisticamente significantes. A prevalência de estresse foi maior no gênero feminino em relação ao masculino (p < 0,05). Nos estudantes que apresentaram estresse, 63,71% apresentaram predominância de sintomas psíquicos, 24,05% de sintomas físicos e 12,24% sem predominância. Nos estudantes que apresentaram estresse, 88,19% encontravam-se na fase de resistência, 4,64% na fase de alerta, 5,06% na fase de quase exaustão e 2,11% na fase de exaustão. Esses resultados sugerem que o curso médico é um agente estressor, mesmo numa faculdade que utiliza em seu currículo a ABP e, também, que há uma associação maior entre o estresse e o gênero feminino. Os resultados obtidos nesta pesquisa fazem considerar a necessidade de repensar o ensino médico, dando condições ao estudante de aprender a lidar com o estresse causado pelo curso, pois a maioria dos estudantes ainda se encontra na fase de resistência, portanto, sem uma doença instalada. / Abstract: The aim of this study was to evaluate the incidence of stress among medical students of the Faculdade de Medicina de Marília (FAMEMA). This institution was chosen as it utilizes the Problem Based Learning (PBL) method of teaching, instead of the traditional one since 1997. The research subjects were four hundred and thirteen students, equivalent to 87.5% of all registered the students in 2003. Between April and October of this year was applied to the research subjects the Lipp's Inventory of Symptoms of Stress for Adults. It was observed the presence of stress on 57.83% the students. The prevalence of stress was minor in the sophomore students in relations to those of the other years, and these differences were significant. The prevalence of stress was higher on the female genus comparing to the male genus (p < 0.05). Of the students that presented stress 63.71% presented predominance of psychic symptoms, 24.05% physical symptoms, and 12.24% with no predominance. On the students that presented stress, 88.19% were on the resistance phase, 4.64% on the alert phase, 5.06% on the almost exhausted phase and 2.11% on the exhausted phase. These results suggest that the medical course is a stressor agent; even in a College that utilizes on its curriculum the PBL, as well as there is an association between the stress and the female genus. The results obtained in this research make us to considerer the possibility of acting on the medical teaching, giving conditions for the student to learn to struggle with the stress caused by the course, as the majority of the students still are on the resistance phase, consequently, without an installed disease. / Mestre

Moving to a pass/fail curriculum has generally been associated with decreased levels of stress and increased medical student well-being. However, not much research has been done to identify the specific effect of retaining class rank in a pass/fail curriculum and how this might affect student stress levels. The purpose of the current study was to fill in current research gaps in this area and to provide further insight into some of the factors that contribute to medical student burnout. The study was carried out using the Medical Student Well-Being Index (MSWBI), a self-reported survey that evaluates medical student fatigue, depression, burnout, anxiety/stress, and mental/physical QOL on a weighted and unweighted basis. Additionally, a set of add-on questions developed by the research team were distributed to participants along with the MSWBI. These questions asked the students to determine whether the change to a pass/fail curriculum increased, decreased, or did not change their perceived stress levels and to identify the major sources of their perceived stress. Participants were full-time medical students enrolled at ETSU Quillen College of Medicine from the Fall 2019 to Spring 2020 terms. They were divided by graduation year and asked to complete the MSWBI and IRB-approved add-on questions once per school year during this period. The number of add-on question respondents from each class reporting an increased or unchanged level of stress since switching to a pass-fail system encompassed 62.6% of all respondents. The most common reason provided by respondents for either increased or unchanged levels of stress after switching to a pass/fail curriculum was the continued reporting of class rank. This work will be useful in determining the true sources of student stress within the medical education system. While a pass/fail curriculum may reduce medical students’ perceived stress, this data indicates that class rank remains burdensome for many. Understanding the underlying factors that influence poor medical student well-being can lead to better targeted interventions.

Domestic violence and sexual assault (DVSA) are major health issues on which medical schools across the country fail to adequately educate future physicians. According to the National Coalition Against Domestic Violence, one in three women and one in four men will be a victim of intimate partner violence in their lifetime. The same source reports that one in five women are raped in their lifetime. Because of the widespread nature of these societal problems, the aim of this research was to evaluate the benefit of providing medical students with DVSA education. First and second year medical students at the Quillen College of Medicine attended a mandatory educational lecture on DVSA. We designed a survey to assess the attitudes and knowledge surrounding patient care for DVSA survivors. Students volunteered to complete the same survey before and after the lecture. The surveys were evaluated for statistical significance. A paired t-test showed that the 128 students who took the survey reported a significant increase in comfort level on interviewing, performing a physical exam, and explaining resources to victims of DVSA. Questions regarding knowledge of who should lead exams and the role of emergency contraception in cases of sexual assault also showed statistically significant change by paired t-test analysis following the educational intervention. These findings suggest that medical schools should integrate curriculum on DVSA survivor support in order to increase comfort and knowledge of future physicians in addressing these sensitive topics.

As medical students undergo their clinical years, they exhibit a well-documented loss of idealism, increasingly negative attitudes towards poor and underserved patients, and less interest in working with these patients. Here we describe the pilot year of a longitudinal service-learning requirement implemented as a part of the medical student pre-clinical curriculum. We hypothesized that increased non-clinical contact would decrease the formation of negative attitudes towards underserved patients. Students completed service hours at assigned community sites each semester along with written reflections. Surveys were administered to track attitudes towards the underserved. Written reflections were analyzed qualitatively for thematic content as well as feedback on the experience. The requirement was largely acceptable to medical students, and many found value and enjoyment in the experience. The most common critique was that the required hours were insufficient to develop continuity, and that students desired more thorough briefing beforehand to increase their effectiveness. Students reported practicing clinical skills and communication skills. They identified social determinants of health and learned about their patients. They reflected on their professional identity, motivations for entering medicine, and specialty choices. Students experienced moments of connection and belonging, as well as feelings of guilt, otherness, and awareness of privilege. We continue to explore how working collaboratively and learning reciprocally with community members outside of the hospital and clinic may teach students cultural humility and help insulate students from cynicism and negative views of poor and medically underserved patients. / Urban Bioethics

Background: Poor health costs the Swedish society billions a year and affects every individual who lives with poor health. By a close collaboration between medical doctors, nurses and other health professions there are good opportunities to work with health promotion and for the individual patient’s health.  One way to work with health promotion in health care is to work with Physical activity on referral, FaR®.  Physical activity on referral was created to improve the health among the Swedish population and has been effective against diseases like cardiovascular disease and diabetes. Research has been done on which professional groups that makes the most prescriptions of Physical activity on referral and why patients don’t follow them. Objective: The aim of the study was to investigate the frequency of and the attitude toward prescribing Physical activity on referral, among medical doctors and medical students and to investigate if there were any differences between genders. Method: A web survey was designed and sent to 45 medical doctors at Akademiska Sjukhuset in Uppsala and to 286 medical students in semester 7-9 at Uppsala University. Results: The majority of the participants thought that physical activity had an important role in health promotion and knew about Physical activity on referral. Even though few of the participants had made a prescription of Physical activity on referral, the majority thought that it was an important part in the work with health promotion. The participants thought that more education in Physical activity on referral was needed. The participants prioritized to prescribe Physical activity on referral to patients at risk to get cardiovascular diseases, while patients who were less physical active than the recommendations of Livsmedelsverket got the lowest priority. Conclusion: Physical activity on referral was created to increase physical activity among the Swedish population and to reduce the risk to get diseases that can be related to low physical activity. It is therefore alarming that the participants were less prioritizing patients who were less physical active than the recommendations of Livsmedelsverket when it comes to prescribing Physical activity on referral, than other patients. By medical doctors and nurses working as a team, preventive actions can be taken early and therefore the risk for the individuals to develop secondary diseases can be reduced.

<p>Background: The global human resources for health crisis has affected Uganda deeply as is evidenced by grossly inadequate medical doctor to population ratios. Strategies to increase training and retention initiatives have been identified as the most promising ways to address the problem. In Uganda, the dual track tuition policy of higher education (called the Private Students Scheme or PSS) at the University of Makerere was initiated in the academic year 1993/94, to boost student intake and to supplement university revenue. However, the impact of this scheme on the enrolment and graduation of medical students at this University is unknown. Aim: This study aimed to assess the effect of the PSS on enrolment, time to completion, attrition and number of graduated medical students at Makerere University Medical School after (post-)&nbsp / the Private Students Scheme (PSS). Study design: A quantitative cross-sectional descriptive&nbsp / study based on a retrospective review of enrolment and graduation records of medical students was conducted comparing records of students enrolled five years before and after the&nbsp / privatisation scheme. Numbers enrolled, attrition rates, time to completion and graduation numbers were analysed. Results: There were 895 students enrolled in the study period, 612 (72.2%) males and 236 (27.6%) females. Pre- and post-PSS periods had 401 and 494 enrolments respectively (a net increase of 93 students). During the post-PSS period, 447 (90.5%) government&nbsp / sponsored students were enrolled - 351 (71.1%) males and 143 (28.9% females) / in the same period, 47 (9.5%) private students were enrolled, 30 (63.8%) male and 17 (36.2%) female.&nbsp / Graduation rates for the entire study period were 96% (859), which represented 44% (378) in the pre-PSS and 56% (481) in the post-PSS periods. Private students contributed 8.9% (43) of the graduates 9in the post-PSS period. The majority of students (90.4%) graduated in five years. Thirty four students (3.8%) dropped out in the entire period, constituting significantly more in the pre-PSS - 22 (5.5%) than in the&nbsp / post PSS-period - 12 (2.4%). Males were more likely to drop out: 31 males did so (4.4%) compared with 3 (1.2%) females. In the post-PSS period, males made up 83.3% (10/12) of the attrition&nbsp / rate. Nine of them were government sponsored while three were private students. Conclusions: The PSS resulted in a 10% increase in enrolments when compared to the pre-PSS period.&nbsp / Furthermore the number of private medical student enrolments contributed 8.9% of the total graduations indicating that PSS succeeded in increasing the number of medical doctors graduated at MUSM. More males than females enrolled across all the years which might indicate&nbsp / a tendency for females to pursue non-medical professions which should be discouraged. Attrition of students&nbsp / was low which is encouraging but the finding that males were more likely to drop out than females deserves attention.</p>

<p>Background: The global human resources for health crisis has affected Uganda deeply as is evidenced by grossly inadequate medical doctor to population ratios. Strategies to increase training and retention initiatives have been identified as the most promising ways to address the problem. In Uganda, the dual track tuition policy of higher education (called the Private Students Scheme or PSS) at the University of Makerere was initiated in the academic year 1993/94, to boost student intake and to supplement university revenue. However, the impact of this scheme on the enrolment and graduation of medical students at this University is unknown. Aim: This study aimed to assess the effect of the PSS on enrolment, time to completion, attrition and number of graduated medical students at Makerere University Medical School after (post-)&nbsp / the Private Students Scheme (PSS). Study design: A quantitative cross-sectional descriptive&nbsp / study based on a retrospective review of enrolment and graduation records of medical students was conducted comparing records of students enrolled five years before and after the&nbsp / privatisation scheme. Numbers enrolled, attrition rates, time to completion and graduation numbers were analysed. Results: There were 895 students enrolled in the study period, 612 (72.2%) males and 236 (27.6%) females. Pre- and post-PSS periods had 401 and 494 enrolments respectively (a net increase of 93 students). During the post-PSS period, 447 (90.5%) government&nbsp / sponsored students were enrolled - 351 (71.1%) males and 143 (28.9% females) / in the same period, 47 (9.5%) private students were enrolled, 30 (63.8%) male and 17 (36.2%) female.&nbsp / Graduation rates for the entire study period were 96% (859), which represented 44% (378) in the pre-PSS and 56% (481) in the post-PSS periods. Private students contributed 8.9% (43) of the graduates 9in the post-PSS period. The majority of students (90.4%) graduated in five years. Thirty four students (3.8%) dropped out in the entire period, constituting significantly more in the pre-PSS - 22 (5.5%) than in the&nbsp / post PSS-period - 12 (2.4%). Males were more likely to drop out: 31 males did so (4.4%) compared with 3 (1.2%) females. In the post-PSS period, males made up 83.3% (10/12) of the attrition&nbsp / rate. Nine of them were government sponsored while three were private students. Conclusions: The PSS resulted in a 10% increase in enrolments when compared to the pre-PSS period.&nbsp / Furthermore the number of private medical student enrolments contributed 8.9% of the total graduations indicating that PSS succeeded in increasing the number of medical doctors graduated at MUSM. More males than females enrolled across all the years which might indicate&nbsp / a tendency for females to pursue non-medical professions which should be discouraged. Attrition of students&nbsp / was low which is encouraging but the finding that males were more likely to drop out than females deserves attention.</p>

Patient-centred care has become an important model for health-care delivery, especially in cancer care. The implementation of this model includes patient-centred communication between the clinician and his or her patient. However, most research on patient-centred communication focuses on the clinicians’ initiative: what clinicians should do and what information they should seek to elicit from patients. It is equally important to recognize what each individual patient can contribute about his or her unique perspective on the disease, its treatment, and the effects on what is important to this patient. This thesis reports the development of a system for analyzing over 1500 utterances made by patients in eight video-recorded oncology consultations at the British Columbia Cancer Agency, Vancouver Island Centre. The analysis distinguishes between biomedical information that the patient can provide and patient-centred information, which contributes the individual patient’s unique perspective on any aspect of his or her illness or treatment. The resulting analysis system includes detailed operational definitions with examples, a decision tree, and .eaf files in ELAN software for viewing and for recording decisions. Two psychometric tests demonstrated that the system is replicable: high inter-analyst reliability (90% agreement between independent analysts) on a random sample of the data set and cross-validation to the remainder of the data set. A supplemental idiographic analysis of each consultation illustrates the important role that patient-centred information played in these consultations. This system could be an important tool for teaching clinicians to recognize the individual information that patients can provide and its relevance to their care. / Graduate / 0992 / 0451 / 0350 / shealing@uvic.ca

Magister Public Health - MPH / Background: The global human resources for health crisis has affected Uganda deeply as is evidenced by grossly inadequate medical doctor to population ratios. Strategies to increase training and retention initiatives have been identified as the most promising ways to address the problem. In Uganda, the dual track tuition policy of higher education (called the Private Students Scheme or PSS) at the University of Makerere was initiated in the academic year 1993/94, to boost student intake and to supplement university revenue. However, the impact of this scheme on the enrolment and graduation of medical students at this University is unknown. Aim: This study aimed to assess the effect of the PSS on enrolment, time to completion, attrition and number of graduated medical students at Makerere University Medical School after (post-) the Private Students Scheme (PSS). Study design: A quantitative cross-sectional descriptive study based on a retrospective review of enrolment and graduation records of medical students was conducted comparing records of students enrolled five years before and after the privatisation scheme. Numbers enrolled, attrition rates, time to completion and graduation numbers were analysed. Results: There were 895 students enrolled in the study period, 612 (72.2%) males and 236 (27.6%) females. Pre- and post-PSS periods had 401 and 494 enrolments respectively (a net increase of 93 students). During the post-PSS period, 447 (90.5%) government sponsored students were enrolled - 351 (71.1%) males and 143 (28.9% females); in the same period, 47 (9.5%) private students were enrolled, 30 (63.8%) male and 17 (36.2%) female. Graduation rates for the entire study period were 96% (859), which represented 44% (378) in the pre-PSS and 56% (481) in the post-PSS periods. Private students contributed 8.9% (43) of the graduates 9in the post-PSS period. The majority of students (90.4%) graduated in five years. Thirty four students (3.8%) dropped out in the entire period, constituting significantly more in the pre-PSS - 22 (5.5%) than in the post PSS-period - 12 (2.4%). Males were more likely to drop out: 31 males did so (4.4%) compared with 3 (1.2%) females. In the post-PSS period, males made up 83.3% (10/12) of the attrition rate. Nine of them were government sponsored while three were private students. Conclusions: The PSS resulted in a 10% increase in enrolments when compared to the pre-PSS period. Furthermore the number of private medical student enrolments contributed 8.9% of the total graduations indicating that PSS succeeded in increasing the number of medical doctors graduated at MUSM. More males than females enrolled across all the years which might indicate a tendency for females to pursue non-medical professions which should be discouraged. Attrition of students was low which is encouraging but the finding that males were more likely to drop out than females deserves attention. / South Africa

Magister Public Health - MPH / Aim: This study aimed to assess the effect of the PSS on enrolment, time to completion, attrition and number of graduated medical students at Makerere University Medical School after (post-) the Private Students Scheme (PSS).