Workshops of the Pedagogic Week 2021 of Centro Universitario FMABC / As oficinas da Semana Pedagógica de 2021 do curso de Medicina do Centro Universitário FMABC

INTRODUCTION: Delivering quality medical education is a hot topic. The current discussion essentially addresses content versus competencies. Extensive curricula and matrices, and traditional assessments are against go against the modern concepts of medical education. Remote education stimulated this discussion and brought the opportunity to review the academic load and assessment. REPORT: In January 2021, a pedagogic workshop of the Medicine course of Centro Universitário FMABC was held. It began with a lecture by a visiting professor and coordinator of the medical school accreditation system on remote activities during the pandemic. Next, the person responsible for the Progress Test made a history of the latest assessments, and a professor who is a member of the Accreditation Committee of the Medical Schools presented a summary of the main insufficient points of the last assessment. Afterward, the students presented the last internal evaluations. Finally, the matrices of the course, from the 1st to the 4th year, were presented and compared with those of three other medical schools, and each year coordinator prepared their suggestions for changes to the matrices. Lastly, students, professors, and the course coordination presented a report and proposals, encouraging the integration of the academic community, the reassessment of teaching plans, repetition of content, and recognition of matrices of each year, offering ideas and tools, to reflection on remote learning, and opportunities for change and improvement in teaching, and learning. CONCLUSION: The disciplines showed willingness for integrative activities, extension, and creation of elective disciplines, complementing failures caused by the Pandemic.

INTRODUÇÃO: A entrega da educação médica de qualidade é um tema em ebulição. A discussão atual aborda essencialmente conteúdos versus competências. Currículos e matrizes extensas, e avaliações tradicionais estão na contramão. O ensino remoto estimulou a discussão e a revisão da carga acadêmica e das avaliações. RELATO: Em janeiro de 2021 foi realizada uma oficina pedagógica do Curso de Medicina do Centro Universitário FMABC. Começou com a palestra de um professor convidado e coordenador do sistema de acreditação de escolas médicas, sobre atividades remotas durante a pandemia. A seguir, a responsável pelo Teste do Progresso fez um histórico das últimas avaliações, e um professor membro da comissão de acreditação de escolas médicas apresentaram uma síntese dos principais pontos insuficientes da última avaliação. Na sequência, os discentes apresentaram as últimas avaliações internas. Finalmente, foram apresentadas as matrizes do curso, do 1º ao 4º ano, comparadas com as de mais três escolas médicas, e cada coordenador de ano preparou suas sugestões para alterações de matrizes. Por último, discentes, docentes e a coordenação do curso apresentaram um relatório e propostas, estimulando a integração da comunidade acadêmica, a reavaliação dos planos de ensino, as repetições de conteúdo e o reconhecimento de matrizes de cada ano, oferecendo ideias e ferramentas, para a reflexão sobre o ensino remoto e as oportunidades de mudanças e aprimoramento do ensino e do aprendizado. CONCLUSÃO: As disciplinas mostraram disposição para as atividades integrativas, de extensão e de criação de disciplinas eletivas complementando falhas provocadas pela Pandemia.

I Fórum Paulista de Serviços de Apoio ao Estudante de Medicina — Forsa Paulista — “A Carta de Marília” / I Forum of Paulista Medical Student Support Services — Forsa Paulista — “The Letter of Marília”

RESUMO No dia 12 de maio de 2016, estiveram reunidos na cidade de Marília, no I Fórum de Serviços de Apoio aos Estudantes de Medicina (Forsa), realizado durante o 10° Congresso Paulista de Educação Médica (CPEM), representantes de serviços de apoio discente, bem como docentes e estudantes de Medicina, a fim de discutir e elencar estratégias de fortalecimento dos serviços de apoio à saúde discente, estritamente necessárias no contexto violento em que se inserem as escolas médicas. Foi criado um documento, denominado “A Carta de Marília”. Em 13 de outubro de 2016, esse documento foi referendado pelo XI Fórum Cobem dos Serviços de Apoio (Forsa Cobem) durante o 54º Congresso Brasileiro de Educação Médica na cidade de Brasília.

ABSTRACT On May 12, 2016 the first Forum for Support Services for Medical Students (Forsa) held in the city of Marilia during the 10th Paulista Congress of Medical Education (CPEM), gathered representatives of student support services, as well as teachers and medical students in order to discuss and rank strategies to enhance the services to support student health, strictly necessary in the violent setting in which medical schools operate. A document was created and named “The Letter of Marilia.” On October 13, 2016, this document was endorsed by the XI COBEM Forum for Support Services (FORSA COBEM) during the 54th Brazilian Medical Education Congress in Brasília.

Relationship among Medical Student Resilience, Educational Environment and Quality of Life.

CONTEXT: Resilience is a capacity to face and overcome adversities, with personal transformation and growth. In medical education, it is critical to understand the determinants of a positive, developmental reaction in the face of stressful, emotionally demanding situations. We studied the association among resilience, quality of life (QoL) and educational environment perceptions in medical students. METHODS: We evaluated data from a random sample of 1,350 medical students from 22 Brazilian medical schools. Information from participants included the Wagnild and Young's resilience scale (RS-14), the Dundee Ready Educational Environment Measure (DREEM), the World Health Organization Quality of Life questionnaire - short form (WHOQOL-BREF), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). RESULTS: Full multiple linear regression models were adjusted for sex, age, year of medical course, presence of a BDI score ≥ 14 and STAI state or anxiety scores ≥ 50. Compared to those with very high resilience levels, individuals with very low resilience had worse QoL, measured by overall (ß=-0.89; 95% confidence interval =-1.21 to -0.56) and medical-school related (ß=-0.85; 95%CI=-1.25 to -0.45) QoL scores, environment (ß=-6.48; 95%CI=-10.01 to -2.95), psychological (ß=-22.89; 95%CI=-25.70 to -20.07), social relationships (ß=-14.28; 95%CI=-19.07 to -9.49), and physical health (ß=-10.74; 95%CI=-14.07 to -7.42) WHOQOL-BREF domain scores. They also had a worse educational environment perception, measured by global DREEM score (ß=-31.42; 95%CI=-37.86 to -24.98), learning (ß=-7.32; 95%CI=-9.23 to -5.41), teachers (ß=-5.37; 95%CI=-7.16 to -3.58), academic self-perception (ß=-7.33; 95%CI=-8.53 to -6.12), atmosphere (ß=-8.29; 95%CI=-10.13 to -6.44) and social self-perception (ß=-3.12; 95%CI=-4.11 to -2.12) DREEM domain scores. We also observed a dose-response pattern across resilience level groups for most measurements. CONCLUSIONS: Medical students with higher resilience levels had a better quality of life and a better perception of educational environment. Developing resilience may become an important strategy to minimize emotional distress and enhance medical training.

Depression in medical students: cluster symptoms and management.

BACKGROUND: Rates of depression among medical students have been shown to be high and related to year of study and other factors. We report on cluster of symptoms related to depression and their association with other difficulties in specific domains. METHODS: 481 (Response rate=79.8%) medical students completed a questionnaire about areas of difficulty in the medical school (studies, leisure, colleagues, professors, and patients), and Beck Depression Inventory (BDI). We studied correlation among areas of difficulty and clusters of BDI along with year in the course. RESULTS: Two areas which contributed most difficulty were studies and leisure. The significant associations for studies were seen between somatic cluster of depressive symptoms and the level of the course. Difficulties associated with leisure activities and with colleagues were correlated with the affective cluster of symptoms of depression. Activities related to clinical matters especially working with patients in the internship year were associated with somatic clusters. The different associations confirmed that rather than relying on scores emphasis should be placed on clusters of symptoms. LIMITATIONS: Sample from a single medical school. CONCLUSIONS: Although the clusters are associated with specific difficulties, it is important that educators and health professionals are aware of streesors the medical students face. The correlations if confirmed in future studies with qualitative factors could guide the development of more specific therapeutic or curriculum interventions.

Does ragging play a role in medical student depression - cause or effect?

BACKGROUND: Medical students experience a lot of stress what may contribute to symptoms of depression. In this study we set out to look at the environmental factors which may be contributing in one medical school in Brazil. METHODS: We assessed depressive symptoms using Beck's Depression Inventory in 465 and 267 medical students in 2001 and 2006 respectively. We explored possible social and environmental causes using qualitative data. RESULTS: Nearly 15% scored above the cut off for depression in both the samples. Males in the pre-clinical stage in 2006 showed an increase in depressive symptoms than males in the same cycle in 2001 (aOR=7.36 [95% CI=0.85-63.5] p=0.07). Qualitative data confirmed that factors such as ragging and low social involvement were correlated with depressive symptoms in pre-clinical stage males. LIMITATIONS: The sample size was small both for quantitative and qualitative aspects of the study. CONCLUSIONS: It appears that ragging plays an important role in the genesis of depressive symptoms in medical students.

Suicidal ideation among students enrolled in healthcare training programs: a cross-sectional study / Ideação suicida entre estudantes da área da saúde: um estudo transversal

Objective: We aimed to assess the presence of suicidal ideation, depressive symptoms and symptoms of hopelessness in three healthcare training programs. Method: The study's population comprised all students enrolled at the Medical School of the Fundação do ABC, Brazil, from 2006 to 2007 compared to students enrolled in nursing and pharmacy programs. We applied the Beck Scale for Suicidal Ideation, the Beck Depression Inventory and the Beck Hopeless Scale to assess psychiatric symptomatology. The general response rates of the medical, nursing, and pharmacy students were 56 percent, 56 percent and 61 percent, respectively. Results: There was no difference regarding the presence of suicidal ideation among medical, nursing and pharmacy students. There was also no difference regarding the presence of either depression or hopelessness in medical students in comparison to nursing and pharmacy students. In comparison to nursing and pharmacy students, significantly higher severity rates in terms of hopelessness were observed only among medical students. Conclusion: Although we did not observe significant differences regarding suicidal ideation and depression among the three healthcare programs, our findings suggest that the presence of suicidal ideation is indeed a source of concern. Early identification of these symptoms is crucial in order to offer appropriate support and treatment and prevent deaths by suicide.

Objetivo: Objetivou-se avaliar a presença de ideação suicida, sintomas depressivos e sintomas de desesperança entre três cursos da área da saúde. Método: A população do estudo consistiu de todos os estudantes de medicina matriculados na Faculdade de Medicina da Fundação do ABC, Brasil, durante 2006 e 2007, comparados com os alunos matriculados nos cursos de enfermagem e farmácia. Aplicamos a Escala de Ideação Suicida de Beck, o Inventário de Depressão de Beck e a Escala de Desesperança de Beck para avaliar sintomatologia psiquiátrica. A taxa de resposta entre os estudantes de medicina, enfermagem e farmácia foi de 56 por cento, 56 por cento e 61 por cento, respectivamente. Resultados: Não houve diferença em relação à presença de ideação suicida entre os estudantes de medicina, enfermagem e farmácia. Também não houve diferença em relação à presença de depressão ou desesperança nos estudantes de medicina em comparação com os alunos de enfermagem e farmácia. Taxas de gravidade significativamente mais elevadas foram observadas apenas em desesperança entre os estudantes de medicina em comparação com os alunos de enfermagem e farmácia. Conclusão: Embora não tenhamos observado diferenças significativas entre os três cursos da área da saúde com relação à ideação suicida e depressão, a presença de ideação suicida é um achado preocupante. A identificação precoce destes sintomas é fundamental, de modo a se oferecer apoio e tratamento adequados e prevenir mortes por suicídio.

Suicidal ideation among students enrolled in healthcare training programs: a cross-sectional study.

OBJECTIVE: We aimed to assess the presence of suicidal ideation, depressive symptoms and symptoms of hopelessness in three healthcare training programs. METHOD: The study's population comprised all students enrolled at the Medical School of the Fundação do ABC, Brazil, from 2006 to 2007 compared to students enrolled in nursing and pharmacy programs. We applied the Beck Scale for Suicidal Ideation, the Beck Depression Inventory and the Beck Hopeless Scale to assess psychiatric symptomatology. The general response rates of the medical, nursing, and pharmacy students were 56%, 56% and 61%, respectively. RESULTS: There was no difference regarding the presence of suicidal ideation among medical, nursing and pharmacy students. There was also no difference regarding the presence of either depression or hopelessness in medical students in comparison to nursing and pharmacy students. In comparison to nursing and pharmacy students, significantly higher severity rates in terms of hopelessness were observed only among medical students. CONCLUSION: Although we did not observe significant differences regarding suicidal ideation and depression among the three healthcare programs, our findings suggest that the presence of suicidal ideation is indeed a source of concern. Early identification of these symptoms is crucial in order to offer appropriate support and treatment and prevent deaths by suicide.

The characteristics of depressive symptoms in medical students during medical education and training: a cross-sectional study.

BACKGROUND: Medical education and training can contribute to the development of depressive symptoms that might lead to possible academic and professional consequences. We aimed to investigate the characteristics of depressive symptoms among 481 medical students (79.8% of the total who matriculated). METHODS: The Beck Depression Inventory (BDI) and cluster analyses were used in order to better describe the characteristics of depressive symptoms. Medical education and training in Brazil is divided into basic (1st and 2nd years), intermediate (3rd and 4th years), and internship (5th and 6th years) periods. The study organized each item from the BDI into the following three clusters: affective, cognitive, and somatic. Statistical analyses were performed using analysis of variance (ANOVA) with post-hoc Tukey corrected for multiple comparisons. RESULTS: There were 184 (38.2%) students with depressive symptoms (BDI > 9). The internship period resulted in the highest BDI scores in comparison to both the basic (p < .001) and intermediate (p < .001) periods. Affective, cognitive, and somatic clusters were significantly higher in the internship period. An exploratory analysis of possible risk factors showed that females (p = .020) not having a parent who practiced medicine (p = .016), and the internship period (p = .001) were factors for the development of depressive symptoms. CONCLUSION: There is a high prevalence towards depressive symptoms among medical students, particularly females, in the internship level, mainly involving the somatic and affective clusters, and not having a parent who practiced medicine. The active assessment of these students in evaluating their depressive symptoms is important in order to prevent the development of co-morbidities and suicide risk.

Traços de ansiedade entre estudantes de medicina / Anxiety traits among medical students

Objetivo: Avaliar traços de ansiedade entre estudantes de Medicina. Método: Aplicação do Inventário de Ansiedade Traço a todos os 603 estudantes matriculados no curso médico da Faculdade de Medicina do ABC em 2001. Resultados: 80% (481) dos estudantes das seis séries responderam ao questionário, sendo que 20,1% marcaram mais de 49 pontos, sugerindo a ocorrência de traços de ansiedade alta e 79,9% marcaram entre 33 e 49 pontos sugerindo ansiedade média. Nenhum estudante marcou menos que 33 pontos (traços de ansiedade leve). O maior percentual de traço de ansiedade alta foi encontrado no sexto ano (26,8%) e o menor no terceiro ano (11.6%). Conclusões: O curso médico parece estar associado ao desenvolvimento de quadros ansiosos nos estudantes de Medicina. Maiores taxas de sintomatologia ansiosa foram encontradas no início do curso, sugerindo dificuldades na adaptação de novos métodos de ensino, assim como no quarto ano que antecede o internato e no sexto ano quando surgem, após uma “ilha de calmaria” no terceiro ano, as provas de residência. A existência de programas que possam identificar – e tratar – esses alunos, precocemente, é fundamental para o aprimoramento de futuros médicos.

Objetive: To evaluate the presence and intensity of anxiety traits among medical students. Method: The Spielberger TraitAnxiety Inventory was applied to 603 regularly matriculated students at ABC Medical School, Sao Paulo, Brazil. Results:86.9% (524) of all six grades students answered the Inventory,20.1% had scored 49 or more anxiety-traits symptoms, suggesting a high level of a anxiety traits and 79.9% scoredbetween 33 and 49 points suggesting a moderated level of anxiety traits. None of students scored mild level of anxietytraits. The highest frequency scores of high level anxiety occurred during the sixth grade (26.8%) and the lesser in the third grade (11.6%). Conclusions: The medical course seems to be associated with the development of anxiety diseases. Higher scores of anxiety symptoms were found at first and last grades suggesting adaptive problems in the beginning (confronting new teaching methods) and the ending (more intensive patients contact) of the course when the residency evaluations are coming, but both are separated for “peace interval” at third grade. The need of programs to identify and to take care of these students is deeply important to a good performance of the future doctors.