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Introduction: Background: a healthy food intake pattern, specifically the Mediterranean diet (MedDiet), is a factor associated with reduced risk, lower prevalence, and better management of chronic diseases. However, there is limited information regarding how patients integrate proposals for adherence to this food pattern in their daily lives. Objective: to identify factors and conditions that influence adherence to the MedDiet in Chile. Methods: an exploratory qualitative study was applied in 35 to 65-year-old patients of both sexes who presented at least one diagnostic criterion of metabolic syndrome (MetS). Through in-depth interviews and focal groups, knowledge, assessment, attitudes, and practices associated with changes and maintenance of healthy eating habits, with emphasis on the MedDiet, were investigated. Information analysis was carried out under the grounded theory approach using the ATLAS.ti software. Results: participants recognized the value of healthy eating, including the MedDiet, but declared low knowledge (identification of single foods items) together with facilitators (variety of ingredients) and limiting factors (taste, availability/cost of some items, family dynamics) for its routine adoption. In addition, change in eating habits generates a high initial cognitive and emotional load that requires not only individual but also relational effort as it implies modifications of family and collective practices. Conclusions: information obtained on barriers and opportunities to adhere to healthy eating such as the MedDiet is key to design and implement nutritional interventions based on this food pattern and that can be sustainable in time for chronic disease management in Chile.
Introducción: Antecedentes: un estilo de alimentación saludable, específicamente la dieta mediterránea (DMed), es un factor asociado a bajo riesgo, menor prevalencia y mejor manejo de las enfermedades crónicas. Sin embargo, existe información limitada respecto a cómo los pacientes incorporan propuestas de este patrón alimentario en su vida cotidiana. Objetivo: identificar factores y condiciones que pueden influir en la adherencia a la DMed en Chile. Métodos: estudio cualitativo exploratorio en 17 pacientes de ambos sexos de entre 35 y 65 años que presentaban algún criterio diagnóstico de síndrome metabólico (SMet). Mediante entrevistas en profundidad y grupos focales se indagaron el conocimiento, la valoración, las actitudes y las prácticas asociadas a cambios y mantenimiento de alimentación con énfasis en la DMed. El análisis de la información se realizó bajo el enfoque de teoría fundada usando el software ATLAS.ti. Resultados: los participantes reconocieron el valor de una alimentación saludable tipo DMed, pero declararon bajo conocimiento (identificación de algunos alimentos aislados, dinámica familiar) de ella, junto con facilitadores (variedad de ingredientes) y limitantes (sabor, disponibilidad/costo de algunos alimentos) para su adopción rutinaria. Además, el cambio de hábitos alimentarios genera alta carga cognitiva y emocional inicial que requiere esfuerzo no solo individual sino también relacional, pues implica modificaciones de prácticas familiares y colectivas. Conclusiones: la información obtenida sobre barreras y oportunidades para adherir a una alimentación saludable como la DMed resulta clave para diseñar e implementar intervenciones nutricionales basadas en este patrón alimentario y que puedan ser sostenibles en el tiempo para el enfrentamiento de las enfermedades crónicas en Chile.
Assuntos
Dieta Mediterrânea , Síndrome Metabólica , Masculino , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Chile/epidemiologiaRESUMO
High sense of purpose in life, a fundamental domain of eudaimonic well-being, has been consistently associated with lower risk for various obesity-related chronic diseases. Although this psychological feature correlates with some health behaviors as potential mediators, its association with healthy eating remains less explored. In addition, studies of these psycho-behavioral and health relationships in the South American population are lacking. This research sought to assess: (1) the cross-sectional association between self-reported purpose in life and overall healthy eating patterns, and (2) healthy food intake as a potential mediator of the inverse relationship between purpose in life and waist circumference. Data collected of 2060 US adults from the MIDUS study (5 ± 12 years, 55% women, mostly white people, and 42.5% obese) and 223 Chilean adults from the CHILEMED study (46.6 ± 9 years, 58.3% women, and 71.3% obese) were used. Anthropometric and sociodemographic variables were collected. Sense of purpose was assessed using the purpose in life subscale of the Ryff's psychological well-being questionnaire. Diet quality was evaluated using healthy eating or low-fat diet indexes, according to extant food intake data in each cohort. The relationship between these variables was estimated by bivariate and multivariate linear regressions with appropriate adjustments. To establish whether a better diet quality could mediate a link of purpose in life and improved nutritional status (assessed by waist circumference), the association between these three variables was tested by bootstrapping-based mediation analysis. Our results show significant associations of sense of purpose with healthy eating and low-fat dietary patterns in both US and Chilean cohorts, respectively, even after adjusting for sociodemographic variables. According to the mediation analysis, the relationship between sense of purpose and waist circumference, as an indicator of abdominal obesity, appears to be partially mediated by healthier food intake in both samples. In conclusion, our findings suggest a plausible mechanism underlying the favorable impact of this well-being dimension on physical health. Given its protective effects, interventions aimed at increasing purpose in life may facilitate adherence to better dietary patterns, which, in turn, will reduce the risk for obesity-related chronic diseases.
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Dieta Saudável , Dieta , Adulto , Humanos , Feminino , Masculino , Circunferência da Cintura , Estudos Transversais , Chile/epidemiologia , Índice de Massa Corporal , Obesidade/epidemiologia , Comportamento Alimentar , Doença Crônica , Ingestão de AlimentosRESUMO
Psychosocial status and lifestyle are key risk factors of non-communicable diseases (NCDs), which, in turn, are main drivers of healthcare costs and morbimortality worldwide, including Chile. Mediterranean diet (MedDiet) is one of the healthiest dietary patterns under study. However, its impact on high-risk conditions, such as metabolic syndrome (MetS), and NCDs outside the Mediterranean Basin remains mostly unexplored. Even though Central Chile has an environment, food production, and culinary traditions comparable to those present in Mediterranean countries, few studies -some with significant methodological limitations- have evaluated the effect of MedDiet on health and/or disease in Chilean subjects. Importantly, a Mediterranean lifestyle is a modus vivendi that integrates physical health with mental and social well-being. Psychological well-being (PWB) is associated with healthy behaviors, positive health outcomes, and longevity, thereby emerging as a novel healthcare goal. We report here an ongoing randomized controlled clinical trial in Chilean patients with MetS seeking to test whether (1) a PWB theory-based intervention facilitates induction to and increases long-term adherence to a locally adapted MedDiet, and (2) a MedDiet intervention -implemented alone or combined with well-being promotion- is more effective at reversing MetS compared to individuals following a low-fat diet without psychological support. The CHILEan MEDiterranean (CHILEMED) diet intervention study is a 1-year trial including patients with MetS living in Chile. Participants will be assigned randomly by a computer-generated random number sequence to one of the three intervention arms: a) low-fat diet as control group, b) MedDiet alone, and c) MedDiet plus well-being support. Patients will be followed-up by individual and/or group online nutritional sessions or phone cal as well as 6- and 12-month in-person re-assessment of medical history, medication use, food intake, PWB, anthropometrics/physical exam, and blood collection for laboratory analysis. The primary outcome of the trial will be the effect of the MedDiet -with or without PWB intervention- on overall reversal of MetS compared to low-fat diet alone. Based on a statistical superiority trial, expected impact, and patient loss, the estimated study sample is 339 subjects (113 individuals per arm in 3 equal-sized groups). Currently, we have enrolled 179 patients, predominantly women, evenly distributed by age (group means ranging from 45.7 to 48,9 years-old), 3/4 are obese with almost all of them showing abdominal obesity, 70% are hypertensive, whereas <10% exhibit diabetes. If findings turn out as expected (e.g., MedDiet -with or without PWB intervention- is better than the low-fat diet for reversion of MetS at 1-year follow-up), CHILEMED will provide further beneficial evidence of the MedDiet on NCD risk conditions beyond the Mediterranean region.
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El aumento de la prevalencia de problemas de salud mental y burnout en estudiantes y profesionales de la salud en Chile y el mundo, asociado a la actual pandemia de COVID-19, ha visibilizado un viejo problema que urge abordar: el agotamiento crónico y los problemas de salud mental que sufren los estudiantes a lo largo de su formación. Para resolverlo, se requiere mucho más que mejorar el acceso a servicios de salud mental o propiciar iniciativas puntuales que promuevan el bienestar. Es preciso revisar la cultura institucional, remover las barreras al bienestar e introducir iniciativas que permitan la'seguridad psicológica', característica de ambientes educacionales que favorecen el bienestar y el aprendizaje significativo. En un futuro cercano, las instituciones formadoras tendrán que demostrar que sus estudiantes y docentes tienen niveles adecuados de bienestar, y que implementan y evalúan regularmente el impacto de las políticas curriculares destinadas a asegurar este objetivo. En este artículo revisaremos la situación de salud mental de los estudiantes de medicina, particularmente del síndrome de agotamiento profesional o burnouty sus consecuencias; describiremos algunas evidencias de intervenciones exitosas para reducir elburnout,incluyendo una experiencia nacional, y analizaremos la relación entre la cultura médica y el bienestar estudiantil. Finalmente, reflexionaremos sobre las características de los ambientes educacionales que permiten un aprendizaje profundo y significativo, y que compatibilizan la excelencia académica con el bienestar de los aprendices.
The increasing prevalence of mental health problems and burnout in students and health professionals in Chile and the world, associated with the COVID-19 pandemic, has made visible an old problem that urges to address: chronic exhaustion and mental health problems suffered by students throughout their training. Solving this problem requires much more than improved access to mental health ser-vices or specific wellness interventions. It is necessary to review the institutional culture, remove barriers to well-being and introduce initiatives that allow psychological safety, a characteristic of educational environments that favor well-being and meaningful learning. Shortly, training institutions will have to demonstrate that their students and teachers have adequate levels of well-being and that they regularly implement and evaluate the impact of curricular policies aimed at ensuring this objective. In this article, we will review the mental health situation of medical students, particularly the burnout syndrome and its consequences. We will describe evidence of successful interventions to reduce burnout, including a national experience, and analyze the relationship between medical culture and student well-being. Finally, we will reflect on the characteristics of educational environments that allow deep and meaningful learning and that reconcile academic excellence with the well-being of learners.
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Saúde Mental , Esgotamento Psicológico , Médicos , Estudantes , Saúde do EstudanteRESUMO
BACKGROUND: Medical students experience high levels of psychological stress during clinical training. However, most medical curricula do not teach self-care skills. The COVID-19 pandemic has disrupted medical education causing increased distress among students. AIM: To report the implementation and impact of an eight-week multifaceted mindfulness-based self-care program on medical students' distress and well-being during the COVID-19 pandemic. MATERIAL AND METHODS: One hundred twenty-three fourth-year medical students attended the program as part of a mandatory course from April to May 2020, during the rising phase of COVID-19 in Chile. They were evaluated using validated tests before and immediately after the program. The measures included burnout, dispositional mindfulness, perceived stress, traumatic stress reactions, general well-being, resilience, and stress coping strategies. RESULTS: Burnout prevalence decreased from 48% to 24%, whereas students with high dispositional mindfulness increased from 25% to 44%. Burnout reduction was mostly due to decreased emotional exhaustion. Additionally, students reported lower levels of stress, self-blaming, and traumatic stress reactions alongside an increased use of active coping strategies and resilience levels after the program. CONCLUSIONS: A formal educational intervention, teaching self-awareness and self-regulation skills can help reduce medical students' distress and promote their well-being even amidst a pandemic.
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Esgotamento Profissional , COVID-19 , Atenção Plena , Estudantes de Medicina , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/prevenção & controle , Humanos , Pandemias , SARS-CoV-2 , Autocuidado , Estresse Psicológico/epidemiologiaRESUMO
ABSTRACT Background: Medical students experience high levels of psychological stress during clinical training. However, most medical curricula do not teach self-care skills. The COVID-19 pandemic has disrupted medical education causing increased distress among students. Aim: To report the implementation and impact of an eight-week multifaceted mindfulness-based self-care program on medical students' distress and well-being during the COVID-19 pandemic. Material and Methods: One hundred twenty-three fourth-year medical students attended the program as part of a mandatory course from April to May 2020, during the rising phase of COVID-19 in Chile. They were evaluated using validated tests before and immediately after the program. The measures included burnout, dispositional mindfulness, perceived stress, traumatic stress reactions, general well-being, resilience, and stress coping strategies. Results: Burnout prevalence decreased from 48% to 24%, whereas students with high dispositional mindfulness increased from 25% to 44%. Burnout reduction was mostly due to decreased emotional exhaustion. Additionally, students reported lower levels of stress, self-blaming, and traumatic stress reactions alongside an increased use of active coping strategies and resilience levels after the program. Conclusions: A formal educational intervention, teaching self-awareness and self-regulation skills can help reduce medical students' distress and promote their well-being even amidst a pandemic.
Antecedentes: Los estudiantes de medicina experimentan altos niveles de estrés y burnout durante la formación clínica. Sin embargo, la mayoría de los planes de estudios médicos no enseñan habilidades de autocuidado. La pandemia de COVID-19 ha conmocionado la educación médica provocando mayor distrés entre los estudiantes. Objetivo: Informar sobre la implementación y el impacto de un programa multifacético de autocuidado -basado en mindfulness (atención consciente)-sobre el distrés y el bienestar de los estudiantes de medicina durante la pandemia de COVID-19. Material y Métodos: Ciento veintitrés estudiantes de medicina de cuarto año asistieron al programa como parte de un curso obligatorio de abril a mayo de 2020, durante la fase ascendente de COVID-19 en Chile. Fueron evaluados mediante pruebas validadas antes e inmediatamente después del programa. Las medidas incluyeron burnout, mindfulness disposicional, estrés percibido, reacciones de estrés traumático, bienestar general, resiliencia y estrategias de afrontamiento del estrés. Resultados: La prevalencia del burnout disminuyó del 48% al 24%, mientras que los estudiantes con alto mindfulness aumentaron del 25% al 44%. La reducción del burnout se debió principalmente a la disminución del agotamiento emocional. Además, los estudiantes informaron niveles más bajos de estrés, autoinculpación y reacciones de estrés traumático junto con un mayor uso de estrategias activas de afrontamiento y mayores niveles de resiliencia, después del programa de autocuidado. Conclusiones: Una intervención educativa formal que enseñe habilidades de autoconciencia y autorregulación puede ayudar a reducir el burnout de los estudiantes de medicina y promover su bienestar incluso en medio de una pandemia.
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Humanos , Estudantes de Medicina , Esgotamento Profissional/prevenção & controle , Esgotamento Profissional/epidemiologia , Atenção Plena , COVID-19 , Autocuidado , Estresse Psicológico , Pandemias , SARS-CoV-2RESUMO
Chile is currently experiencing a progressive epidemiological transition towards chronic diseases. In this country, >50% of annual deaths are attributed to cardiovascular disease and cancer. Moreover, health surveys have shown high prevalence of obesity, diabetes, hypertension, and elevated cardiovascular disease risk. In addition, mental health issues are also frequent among Chilean adults. On the other hand, the agri-food system contributes to 21-37% of greenhouse gases emissions worldwide. Overall, current health and food chain situation calls out for design and implementation of evidence-based feasible and effective nutritional interventions needed to promote physical and mental health along with addressing food sustainability in Chile. Nowadays, the Mediterranean diet is recognized as one of the healthiest dietary patterns based on observational and interventional studies linked to a wide variety of health outcomes. However, a Mediterranean lifestyle goes well beyond food intake: it includes promotion of psychosocial resources, community life as well as cultural traditions. Indeed, Mediterranean lifestyle is a true modus vivendi that integrally promotes physical, mental, and social well-being. In addition, the Mediterranean diet stands out for its environmental sustainability because it is characterized mainly as a plant-based dietary pattern with low carbon and water footprints. Remarkably, Central Chile has a Mediterranean-like setting with plant and animal food production and availability patterns comparable to those present in countries located around the Mediterranean Sea. Therefore, this article reviews how promotion of Mediterranean lifestyle adherence in Chile offers great potential for management of the ongoing epidemiological transition to chronic diseases as well to promote psychological well-being within a unique food system and dietary sustainability vision for this Latin American country.
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Dieta Mediterrânea , Saúde Ambiental , Saúde Mental , Chile/epidemiologia , Humanos , Estilo de VidaRESUMO
Medical resilience is a dynamic capacity, which has the potential to improve the well-being of physicians and to enhance the quality of the clinical relationship. Strategies to promote resilience are important to achieve a sustainable medical practice and improve patient care. Mindfulness training has demonstrated to be an effective tool to promote resilience in physicians. This paper contextualizes the place of mindfulness in medical practice and describes the ways through which it can contribute to resilience in medicine. The concept of mindfulness, its relationship with health practice is reviewed and the benefits of the practice of mindfulness in the clinical relationship are described. We suggest that the benefits achieved through a mindfulness-based medical practice are mediated by two axes. One is the nonspecific and specific effect of mindfulness-based practices and the other is the integration of explicit and implicit knowledge of clinical practice. We conclude that medical practice that integrates mindfulness can contribute to the challenge of achieving greater levels of individual, staff and institutional resilience. There is a need to have continuing mindfulness training programs for health professionals and to integrate this concept in the curriculum of health care professionals.
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Atenção Plena , Assistência ao Paciente/psicologia , Relações Médico-Paciente , Resiliência Psicológica , Esgotamento Psicológico/psicologia , Empatia , Humanos , Estresse PsicológicoRESUMO
Chemical and electrical synapses are the two major communication systems that permit cell-to-cell communication within the nervous system. Although most studies are focused on chemical synapses (glutamate, γ-aminobutyric acid, and other neurotransmitters), clearly both types of synapses interact and cooperate to allow the coordination of several cell functions within the nervous system. The pineal gland has limited independent axonal innervation and not every cell has access to nerve terminals. Thus, additional communication systems, such as gap junctions, have been postulated to coordinate metabolism and signaling. Using acutely isolated glands and dissociated cells, we found that gap junctions spread glycogenolytic signals from cells containing adrenoreceptors to the entire gland lacking these receptors. Our data using glycogen and lactate quantification, electrical stimulation, and high-performance liquid chromatography with electrochemical detection, demonstrate that gap junctional communication between cells of the rat pineal gland allows cell-to-cell propagation of norepinephrine-induced signal that promotes glycogenolysis throughout the entire gland. Thus, the interplay of both synapses is essential for coordinating glycogen metabolism and lactate production in the pineal gland.
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Comunicação Celular/fisiologia , Sinapses Elétricas/metabolismo , Glicogenólise/fisiologia , Norepinefrina/metabolismo , Glândula Pineal/metabolismo , Animais , Feminino , Masculino , Ratos , Ratos Sprague-DawleyRESUMO
BACKGROUND: The burnout syndrome affects more than half of students and professionals involved in healthcare worldwide and is characterized by emotional exhaustion, depersonalization and a low perception of self-efficacy. Several studies indicate that when students are burnt-out, clinical work, professionalism and ethical behavior, as well as empathy, are negatively affected, while the risk of academic attrition, depression and suicidal ideation tend to increase. At a national level, recent information shows that one out of every two medical students suffer burnout at the beginning of the clinical cycle, a situation that does not improve after finishing undergraduate medical training. There is no consensus on which are the most appropriate strategies to face the problem of burnout in students and health-care professionals. Some studies indicate that the experience of medical and health educators may be key to the design of effective strategies to address this problem. AIM: To identify the burnout risk and protection factors of students at different medical schools. MATERIAL AND METHODS: In this study -in which 34 expert health educators from eight Chilean medical schools and other health-related schools participated- we used a qualitative methodology based on the appreciative inquiry to explore the key elements associated with the occurrence of burnout, identify protective and risk factors, as well as discuss possible effective interventions to prevent it. RESULTS: There are personal, academic and contextual elements that act as protective or risk factors of burnout. In addition, the educators identified key elements to design organizational and curricular interventions to face the problem of burnout at a local level. CONCLUSIONS: Burnout is a serious problem in the formation of health care professionals. Teacher training aimed at promoting student'well-being must include the teaching of communication skills that consider both the generation gap and the profile of the professional medical schools intend to form.
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Esgotamento Profissional/etiologia , Esgotamento Profissional/prevenção & controle , Estudantes de Ciências da Saúde/psicologia , Chile , Humanos , Fatores de Proteção , Fatores de Risco , Faculdades de Medicina , AutocuidadoRESUMO
Medical resilience is a dynamic capacity, which has the potential to improve the well-being of physicians and to enhance the quality of the clinical relationship. Strategies to promote resilience are important to achieve a sustainable medical practice and improve patient care. Mindfulness training has demonstrated to be an effective tool to promote resilience in physicians. This paper contextualizes the place of mindfulness in medical practice and describes the ways through which it can contribute to resilience in medicine. The concept of mindfulness, its relationship with health practice is reviewed and the benefits of the practice of mindfulness in the clinical relationship are described. We suggest that the benefits achieved through a mindfulness-based medical practice are mediated by two axes. One is the nonspecific and specific effect of mindfulness-based practices and the other is the integration of explicit and implicit knowledge of clinical practice. We conclude that medical practice that integrates mindfulness can contribute to the challenge of achieving greater levels of individual, staff and institutional resilience. There is a need to have continuing mindfulness training programs for health professionals and to integrate this concept in the curriculum of health care professionals.
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Humanos , Relações Médico-Paciente , Resiliência Psicológica , Atenção Plena , Assistência ao Paciente/psicologia , Estresse Psicológico , Empatia , Esgotamento Psicológico/psicologiaRESUMO
Background: The burnout syndrome affects more than half of students and professionals involved in healthcare worldwide and is characterized by emotional exhaustion, depersonalization and a low perception of self-efficacy. Several studies indicate that when students are burnt-out, clinical work, professionalism and ethical behavior, as well as empathy, are negatively affected, while the risk of academic attrition, depression and suicidal ideation tend to increase. At a national level, recent information shows that one out of every two medical students suffer burnout at the beginning of the clinical cycle, a situation that does not improve after finishing undergraduate medical training. There is no consensus on which are the most appropriate strategies to face the problem of burnout in students and health-care professionals. Some studies indicate that the experience of medical and health educators may be key to the design of effective strategies to address this problem. Aim: To identify the burnout risk and protection factors of students at different medical schools. Material and Methods: In this study -in which 34 expert health educators from eight Chilean medical schools and other health-related schools participated- we used a qualitative methodology based on the appreciative inquiry to explore the key elements associated with the occurrence of burnout, identify protective and risk factors, as well as discuss possible effective interventions to prevent it. Results: There are personal, academic and contextual elements that act as protective or risk factors of burnout. In addition, the educators identified key elements to design organizational and curricular interventions to face the problem of burnout at a local level. Conclusions: Burnout is a serious problem in the formation of health care professionals. Teacher training aimed at promoting student'well-being must include the teaching of communication skills that consider both the generation gap and the profile of the professional medical schools intend to form.
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Humanos , Estudantes de Ciências da Saúde/psicologia , Esgotamento Profissional/etiologia , Esgotamento Profissional/prevenção & controle , Faculdades de Medicina , Autocuidado , Chile , Fatores de Risco , Fatores de ProteçãoRESUMO
Increasing scientific evidence shows that the Mediterranean lifestyle -including a characteristic dietary pattern as well as psychosocial and cultural features- has beneficial effects on human health. However, production and use of some of the distinctive components (e.g., olive oil, red wine, nuts, legumes, fish and seafood) of the Mediterranean diet (MedDiet) are not exclusively confined to the Mediterranean Basin, but are also found in other world regions, including California, Southwestern Australia, South Africa, and Chile. Central Chile exhibits a Mediterranean climate and Chilean agriculture and culinary traditions show striking similarities to Mediterranean countries. Using a MedDiet index adapted to food habits in Chile, we found that only 10% of the adult population displays this healthy eating behavior. Furthermore, high scores in the MedDiet index correlate with lower prevalence of overweight, obesity, and metabolic syndrome in Chilean adults. High adherence to a Mediterranean-like diet is also associated with better psychological wellbeing. Finally, a pilot study investigating the effects of a Mediterranean diet in Chile -as part of a 'food-at-work intervention'- showed a significant improvement in diet quality which was associated with a 35% reduction in the prevalence of the metabolic syndrome. Increased appreciation and application of a Mediterranean-like dietary pattern may therefore improve health and quality of life in the population of Chile, where non-communicable chronic diseases are increasingly common.
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Doenças Cardiovasculares/epidemiologia , Dieta Mediterrânea , Promoção da Saúde , Estilo de Vida , Doenças Cardiovasculares/prevenção & controle , Chile/epidemiologia , HumanosRESUMO
BACKGROUND: Throughout medical education, students are gradually incorporated into authentic clinical practice scenarios. AIM: To describe the use of clinical learning strategies by Chilean students and compare them according to sex and year of training. MATERIAL AND METHODS: The Clinical Learning Strategies Questionnaire (CEACLIN) was applied to 336 students from the 4th to 6th year of medicine at a Chilean university. RESULTS: The most frequently reported strategies were related to the search for autonomy, reliable environments for learning, observation of others and attention to emotions. The less frequent was the handling of academic burden. Gender accounted for significant differences in eight of the 11 strategies identified by CEACLIN, while years of training accounted for five of the 11. The cluster analysis identified two groups: the first group comprised nine CEACLIN strategies, with a slightly higher proportion of women and 5th and 6th year students. The second group consisted mainly of men in the 4th year. CONCLUSIONS: Reported strategies include a set of actions oriented to the development of autonomy and confidence through the search for valid information and learning from and with others. These findings are associated with sex and year of training.
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Estágio Clínico , Educação Médica/métodos , Aprendizagem , Estudantes de Medicina , Chile , Competência Clínica , Análise por Conglomerados , Feminino , Humanos , Masculino , Inquéritos e Questionários , UniversidadesRESUMO
Background: Throughout medical education, students are gradually incorporated into authentic clinical practice scenarios. Aim: To describe the use of clinical learning strategies by Chilean students and compare them according to sex and year of training. Material and Methods: The Clinical Learning Strategies Questionnaire (CEACLIN) was applied to 336 students from the 4th to 6th year of medicine at a Chilean university. Results: The most frequently reported strategies were related to the search for autonomy, reliable environments for learning, observation of others and attention to emotions. The less frequent was the handling of academic burden. Gender accounted for significant differences in eight of the 11 strategies identified by CEACLIN, while years of training accounted for five of the 11. The cluster analysis identified two groups: the first group comprised nine CEACLIN strategies, with a slightly higher proportion of women and 5th and 6th year students. The second group consisted mainly of men in the 4th year. Conclusions: Reported strategies include a set of actions oriented to the development of autonomy and confidence through the search for valid information and learning from and with others. These findings are associated with sex and year of training.
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Humanos , Masculino , Feminino , Estudantes de Medicina , Estágio Clínico , Educação Médica/métodos , Aprendizagem , Universidades , Análise por Conglomerados , Chile , Inquéritos e Questionários , Competência ClínicaRESUMO
At the end of May 2017, the third version of the Latin American Conference on Resident Education, LACRE, was held in Chile; it convened 433 people from 14 regional countries. Chronic stress and emotional exhaustion of residents was one of the topics discussed. Reports from different countries documented that about half of residents suffer from burnout. This is, they are emotionally drained, indifferent towards their patients and with a sense of low personal fulfillment at work. This article describes the contributions presented in LACRE about interventions or institutional programs designed to reduce burnout and promote self-care of residents. The relevance of these initiatives is discussed in the current global context, considering the available evidence on the effectiveness of interventions to promote well-being among residents. International experts are making renewed and eloquent calls to medical educators and organizations to get involved in the solution of the erosion of resident wellbeing during the residence.
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Humanos , Esgotamento Profissional/prevenção & controle , Carga de Trabalho/psicologia , Internato e Residência/tendências , Corpo Clínico/psicologia , Qualidade de Vida , Fatores de Risco , América LatinaRESUMO
BACKGROUND: The Mental Health Continuum-Short Form (MHC-SF) is a multidimensional measure of well-being designed to assess emotional, psychological and social well-being. It has been translated into different languages; however, there is no validated Spanish version. Our aim was to provide the Spanish-speaking community with a validated version of the MHC-SF. METHOD: We translated the questionnaire into Spanish (s-MHC-SF) and assessed its validity in a sample of 3,355 Chilean adults. The data was subjected to a confirmatory factor analysis using the original correlated-traits three-factor model and a recently described bifactor model. RESULTS: The scores obtained with s-MHC-SF had excellent reliability (α = .94). While the correlated-traits three-factor model provided an acceptable fit to the data, the bifactor model yielded a superior fit. According to measurement invariance results, both models could be used to compare scores over gender, geographical region, age, and time in the sample. CONCLUSION: s-MHC-SF is a valid questionnaire for the evaluation of personal well-being in Spanish-speaking populations.
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Saúde Mental , Inquéritos e Questionários , Adolescente , Adulto , Afeto , Idoso , Idoso de 80 Anos ou mais , Chile , Análise Fatorial , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Tradução , Adulto JovemRESUMO
At the end of May 2017, the third version of the Latin American Conference on Resident Education, LACRE, was held in Chile; it convened 433 people from 14 regional countries. Chronic stress and emotional exhaustion of residents was one of the topics discussed. Reports from different countries documented that about half of residents suffer from burnout. This is, they are emotionally drained, indifferent towards their patients and with a sense of low personal fulfillment at work. This article describes the contributions presented in LACRE about interventions or institutional programs designed to reduce burnout and promote self-care of residents. The relevance of these initiatives is discussed in the current global context, considering the available evidence on the effectiveness of interventions to promote well-being among residents. International experts are making renewed and eloquent calls to medical educators and organizations to get involved in the solution of the erosion of resident wellbeing during the residence.
Assuntos
Esgotamento Profissional/prevenção & controle , Internato e Residência/tendências , Corpo Clínico/psicologia , Carga de Trabalho/psicologia , Humanos , América Latina , Qualidade de Vida , Fatores de RiscoRESUMO
Introducción: El burnout es un síndrome caracterizado por agotamiento emocional, despersonalización y bajo sentido de logro personal. Los médicos residentes de especialidad y subespecialidad constituyen una población de riesgo por la alta carga laboral y la interferencia con su vida personal. Nuestro objetivo fue evaluar la prevalencia de burnout y su asociación con variables sociodemográficas, en residentes de especialidad y subespecialidad de la Pontificia Universidad Católica de Chile (PUC). Métodos: Se realizó una encuesta electrónica a los residentes de especialidad y subespecialidad de la PUC, que incluyó el "Inventario de Burnout de Maslach" (22 preguntas divididas en 3 dimensiones). Se sumaron los puntos de cada dimensión y se clasificó a los residentes en riesgo de burnout al presentar altos índices de agotamiento emocional y/o despersonalización. El análisis estadístico incluyó un análisis univariado y multivariado. Resultados: 415 encuestas fueron contestadas (tasa de respuesta 86 por ciento). El 38,3 por ciento de los residentes cumplió criterios de burnout, con un 41,9 por ciento en residentes de especialidad y 24,1por ciento en residentes de subespecialidad. En el análisis por subgrupos, la mayor prevalencia se encontró en especialidades quirúrgicas (55,3por ciento). Los residentes extranjeros, los programas de especialidad (comparados con subespecialidad) y los programas de especialidades quirúrgicas se asociaron de manera independiente a burnout (OR 3,8 IC95 por ciento 1,4-10,5, p=0,01; OR 2,3 IC95 por ciento 1,3-4,1, p<0,01 y OR 1,7 IC95 por ciento 1,1-2,7; p=0,02, respectivamente). La carga laboral horaria no se asoció de manera independiente a burnout (p=0,19). Conclusión: Los residentes de especialidad y subespecialidad presentan una alta prevalencia de burnout. Adicionalmente, ser extranjero, el pertenecer a un programa de especialidad y los programas de especialidades quirúrgicas se asocian de manera independiente a burnout.(AU)
Introduction: Burnoutis a pathological syndrome characterized by emotional exhaustion, depersonalization and low sense of personal accomplishment. Residents from medical specialties and subspecialties constitute a population at risk for high work overload and interference in personal life. The aim of this study was to evaluate the prevalence of burnout and its associations with sociodemographic variables, in specialty and subspecialty residents of the Pontificia Universidad Católica de Chile (PUC). Methods: An electronic survey was answered by residents of specialty and subspecialty of PUC. It included the "Maslach Burnout Inventory" (which consists of 22 questions divided into 3 dimensions). The points of each dimension were added and burnout was defined as a high score on depersonalization or emotional exhaustion subscales. Statistical analysis included an univariate and multivariate analysis. Results: 415 surveys were answered (response rate 86 percent). 38.3 percent of residents met criteria for burnout, with a percentage of 41.9 percent for specialty residents and 24.1 percent for subspecialty residents. In the subgroup analysis, the highest prevalence was found in surgical specialties (55.3 percent). Foreign residents, medical residency programs (compared to sub specialization programs) and surgical programs were independently associated with burnout (OR 3.8 IC95 percent1.4-10.5, p=0.01; OR 2.3 IC95 percent 1.3-4.1, p<0.01 y OR 1.7 IC95% 1.1-2.7; p=0.02, respectively). There was no independent association between duty hours and burnout (p=0.19). Conclusion: Specialty and subspecialty residents have a high prevalence of burnout. Additionally, foreign residents, participation in a speciality residency (compared to subspecialties programs) and surgical residencies are independently associated to burnout. (AU)
Assuntos
Humanos , Masculino , Feminino , Esgotamento Psicológico , Corpo Clínico Hospitalar , Inquéritos e Questionários , MedicinaRESUMO
RATIONALE AND OBJECTIVES: Radiology teachers are well trained in their specialty; however, when working in academic institutions, faculty development and promotion through the education pathway tends to be based on their teaching knowledge and skills. The aim of this study is to assess psychometric properties of the Medicina Universidad Católica-Radiology 32 items (MEDUC-RX32), an instrument designed to evaluate the performance of postgraduate radiology teachers and to identify the best teachers. MATERIALS AND METHODS: Mixed methodology was used, including qualitative and quantitative phases. The psychometric properties of the MEDUC-RX32 survey were performed by factor analysis (validity), Cronbach alpha coefficient, and G coefficient (reliability). The residents assessed their teachers and simultaneously voted for the "best teacher," which was used as a gold standard for the receiver operating characteristic curves construction comparing their votes with the global score. RESULTS: A total of 28 residents answered 164 surveys. The global score was 6.23 ± 0.8 (scale from 1 to 7). The factor analysis showed six domains of the resident's perception: (1) tutorial teaching, feedback, and independent learning; (2) communication and teamwork; (3) learning objectives; (4) respectful behavior; (5) radiological report; and (6) teaching and care support. The tutor's strengths were related with respectful behavior and teamwork. The instrument is highly reliable with a Cronbach alpha of 0.937 and a G coefficient of 0.831 (with a minimum of 8 residents). The MEDUC-RX32 instrument has a sensitivity of 91.7% and specificity of 83.3% to identify tutors as best teachers with at least one vote with an area under the receiver operating characteristic curve of 0.931 with a cutoff of 5.94. CONCLUSIONS: The MEDC-RX32 instrument is a multidimensional, valid, and highly reliable method to evaluate radiology teachers, identifying teachers with excellence in tutorial teaching in a postgraduate radiology program.