Fenomenología de la angustia moral: implicancias para la humanización de la educación y la práctica médica

En el contexto de la salud, la angustia moral (AM) se refiere a las emociones negativas que surgen cuando una persona conoce el curso de acción correcto en una situación determinada pero no es capaz de seguirlo debido a impedimentos personales, jerárquicos o institucionales. La AM se ha relacionado con diversos problemas profesionales, tales como desorientación vocacional, baja motivación laboral, trato despersonalizado a los pacientes, abandono de funciones y cambios de especialidad o profesión. Si bien este fenómeno no ha sido suficientemente estudiado en Chile, se asume que existe e incluso habría aumentado durante la pandemia de COVID-19, siendo desconocidas sus repercusiones. En consecuencia, este artículo tiene como objetivos, en primer lugar, promover el estudio fenomenológico de la AM en nuestro país, considerando la importancia de prevenir su potencial impacto adverso en la salud mental de futuros profesionales, y, en segundo lugar, destacar la necesidad de incluir enfoques narrativos en la educación médica, a fin de desarrollar una aproximación más holística hacia la comprensión de los pacientes y de su condición de vulnerabilidad. En última instancia, se espera que el abordaje de las implicancias de la AM en la educación y la práctica médica contribuya con su humanización, optimizando la calidad de la atención en salud.

In the healthcare context, moral distress (MD) refers to the negative emotions that arise when a person knows the correct course of action in a given situation but is not able to follow it due to personal, hierarchical or institutional impediments. MD has been related to various professional problems, such as vocational disorientation, low work motivation, depersonalized treatment of patients, abandonment of duties, and changes of specialty or profession. Although this phenomenon has not been sufficiently studied in Chile, it presumably exists and would have even increased during the COVID-19 pandemic, leaving its repercussions unknown. Accordingly, this article has the objectives, firstly, to promote the phenomenological study of MD in our country, considering the importance of preventing its potential adverse impact on the mental health of future professionals, and, secondly, to highlight the need to include narrative approaches in medical education, in order to develop a more holistic approach to understanding patients and their condition of vulnerability. Ultimately, it is expected that addressing the implications of MD in medical education and practice will contribute to its humanization, optimizing the quality of healthcare.

[Phenomenology of moral distress: implications for the humanization of medical education and practice]. / Fenomenología de la angustia moral: implicancias para la humanización de la educación y la práctica médica.

In the healthcare context, moral distress (MD) refers to the negative emotions that arise when a person knows the correct course of action in a given situation but is not able to follow it due to personal, hierarchical or institutional impediments. MD has been related to various professional problems, such as vocational disorientation, low work motivation, depersonalized treatment of patients, abandonment of duties, and changes of specialty or profession. Although this phenomenon has not been sufficiently studied in Chile, it presumably exists and would have even increased during the COVID-19 pandemic, leaving its repercussions unknown. Accordingly, this article has the objectives, firstly, to promote the phenomenological study of MD in our country, considering the importance of preventing its potential adverse impact on the mental health of future professionals, and, secondly, to highlight the need to include narrative approaches in medical education, in order to develop a more holistic approach to understanding patients and their condition of vulnerability. Ultimately, it is expected that addressing the implications of MD in medical education and practice will contribute to its humanization, optimizing the quality of healthcare.

[Perception of the educational environment in residents of medical specialties in Chilean universities]. / Percepción del ambiente educacional de postgrado en residentes de especialidades médicas de universidades chilenas.

BACKGROUND: The Learning Environment (LE) influences the performance of students, learning, social life, mental health, and the future of work. AIM: To assess the learning environment (LE) among medical residents of 64 specialties. MATERIAL AND METHODS: Two validated instruments "Postgraduate Hospital Education Environment Measure" (PHEEM) and "Ambulatory Care Learning Educational Environment" (ACLEEM), and open questions were answered online by 1259 residents from 15 universities. A descriptive and analytical statistical analysis and semantic deductive-inductive analyses of open questions were performed. RESULTS: LE was positive rather than negative (PHEEM of 100.5 points (79-116) and ACLEEM of 138.5 points (120-157)). An age over 32 years, male sex, studying in a private university, being in first year of residence and being in a non-surgical specialty were associated with a better PHEEM score (p < 0.05). For ACLEEM, the first year of specialty, a non-surgical specialty and studying in a private university were associated with better scores (p < 0.05). Two programs had excellent LE (Pathological Anatomy and Ophthalmology) and no specialty had a very poor performance or many problems. Aspects of teaching, clinical activities, and teachers were strengths reported by students. Aspects to improve were teaching, protected times and clinical activities. CONCLUSIONS: LE among medical specialties had more positive than negative features, but with areas that should be improved.

Percepción del ambiente educacional de postgrado en residentes de especialidades médicas de universidades chilenas / Perception of the educational environment in residents of medical specialties in Chilean universities

BACKGROUND: The Learning Environment (LE) influences the performance of students, learning, social life, mental health, and the future of work. Aim: To assess the learning environment (LE) among medical residents of 64 specialties. MATERIAL AND METHODS: Two validated instruments "Postgraduate Hospital Education Environment Measure" (PHEEM) and "Ambulatory Care Learning Educational Environment" (ACLEEM), and open questions were answered online by 1259 residents from 15 universities. A descriptive and analytical statistical analysis and semantic deductive-inductive analyses of open questions were performed. Results: LE was positive rather than negative (PHEEM of 100.5 points (79-116) and ACLEEM of 138.5 points (120-157)). An age over 32 years, male sex, studying in a private university, being in first year of residence and being in a non-surgical specialty were associated with a better PHEEM score (p < 0.05). For ACLEEM, the first year of specialty, a non-surgical specialty and studying in a private university were associated with better scores (p < 0.05). Two programs had excellent LE (Pathological Anatomy and Ophthalmology) and no specialty had a very poor performance or many problems. Aspects of teaching, clinical activities, and teachers were strengths reported by students. Aspects to improve were teaching, protected times and clinical activities. CONCLUSIONS: LE among medical specialties had more positive than negative features, but with areas that should be improved.

Coping processes that foster accommodation to loss in old age.

Aim: Flexible adjustment or accommodation to loss is healthy; however, little is known about how it can be achieved in old age. We sought to identify and characterize effective coping processes for achieving accommodation at this stage of life. Our aim was to foster the activation of the psychological resources of those who must deal with significant losses to which they will inevitably need to adapt.Method: Qualitative study with a sample of men (n = 16) and women (n = 19) aged 60 years and up. Information was collected through observation and content analysis applied to 35 in-depth interviews, using Atlas-Ti (v7).Results: Eighteen coping processes implemented in response to loss were identified and characterized. Although no single process led to full adjustment by itself, the difference between the participants who accommodated and those who lacked accommodation was reflected in the predominance of certain processes. This approach enabled us to identify 13 effective processes, such as the search for meaning and the use of humor, which were generally used by participants who had achieved accommodation. The processes regarded as ineffective, such as avoidance and procrastination, were used more often by those who displayed insufficient accommodation.Conclusion: It was confirmed that accommodation to losses in old age not only results from "the passage of time"; rather, it can be fostered by people's active efforts. Knowledge of these practices can help practitioners orient mental health interventions for older adults who have difficulty coping in healthy ways and preserving their subjective well-being.