Applying the Generalizability Theory to Identify the Sources of Validity Evidence for the Quality of Communication Questionnaire.

Effective doctor-patient-family communication is an integral and sensitive part of health care, assessing its quality is essential to identify aspects needing disclosure and, if necessary, improvement. Cross-sectional study aimed to analyze the sources of evidence of validity and the number of participants needed to reliably apply the Quality of Communication Questionnaire (QoC) through Generalizability Theory (GT). The mean age of the 150 patients hospitalized at the end of life was 50.5 (SD = 13.8) years, the mean hospital length of stay was 7.5 (SD = 10.2) days, 56.9% were male. Regarding the 105 patients' family members of patients whose mean length of hospital stay was 9.5 (SD = 9.1) days, their mean age was 42.2 (SD = 14.7) years, 69.5% were female. GT was used to quantify the minimum number of questionnaires needed, with the aim of reaching a reliable estimate of QoC with G-coefficients. To reach a reliability of .90, there is a need for 25 for the Eρ2 questionnaires and 35 for the Φ. The exact estimation identified the minimum number of questionnaires required for the evaluation of physicians by patients. To obtain a reliability of .90, there is a need for 30 and 40 questionnaires for the G-coefficients. A practical and fast application makes it possible to use QoC in its entirety or alone to evaluate general communication or communication about palliative care. Furthermore, based on these results, it was possible to identify which aspects were effective or ineffective in these contexts.

Needs of family members of patients in intensive care and their perception of medical communication.

OBJECTIVE: To understand the perception of medical communication and needs of family members with loved ones in intensive care. METHODS: The study was mainly qualitative and exploratory, with thematic analysis of comments made by 92 family members with loved ones in intensive care units when answering in-person interviews comprising the Quality of Communication Questionnaire (QoC) and open-ended questions about their need for additional help, the appropriateness of the place where they received information, and additional comments. RESULTS: The participants' mean age was 46.8 years (SD = 11.8), and most of them were female, married and had incomplete or completed elementary education. The following themes were found: perception of characteristics of medical communication; feelings generated by communication; considerations about specific questions in the QoC; family members' needs; and strategies to overcome needs regarding communication. Characteristics that facilitated communication included attention and listening. Characteristics that made communication difficult included aspects of information sharing, such as inaccessible language; lack of clarity, objectivity, sincerity, and agreement among the team; limited time; and inadequate location. Feelings such as shame, helplessness, and sadness were cited when communication was inadequate. Family members' needs related to communication included more details about the loved one's diagnosis, prognosis, and health condition; participation in decisionmaking; and being asked about feelings, spirituality, dying and death. Others were related to longer visitation time, psychological support, social assistance, and better infrastructure. CONCLUSION: It is necessary to enhance medical communication and improve hospital infrastructure to improve the quality of care for family members.

Afinal, quem é "difícil"? Revisão integrativa sobre pacientes, médicos e relações difíceis / In the final analysis, who is "problematic"? An integrative review of patients, physicians and problematic relationships

Resumo O objetivo deste estudo foi sintetizar a literatura sobre as características de pacientes, médicos e relações médico-paciente consideradas "difíceis". Foi realizada uma revisão integrativa de estudos primários publicados entre janeiro de 2016 e setembro de 2021, em português, inglês e espanhol. De 3.414 artigos identificados nas bases Embase, PubMed, Scopus e Lilacs, 19 foram analisados qualitativamente. Sete estudos foram efetuados na Europa, oito na América do Norte, dois na América do Sul e dois na China, totalizando 1.694 pacientes, 1.903 médicos assistentes, 101 residentes e 160 acadêmicos de medicina. Médicos e/ou acadêmicos de medicina consideravam difíceis os pacientes com: condições clínicas como doenças psicossomáticas e crônicas; sintomas e queixas como dor; emoções fortes; problemas na obtenção e no compartilhamento de informações, nas tomadas de decisão, na adesão ao plano terapêutico e no seu autocuidado; e certas características sociodemográficas e de vulnerabilidade. Pacientes ou seus familiares consideravam difíceis os médicos que não os escutavam, eram preconceituosos e pareciam não se importar com seus filhos, entre outros aspectos. Sugere-se o ensino de comunicação médica e intervenções sistêmicas para melhorar as relações médico-paciente.

Abstract The scope of this study was to assess the literature on the characteristics of patients, physicians, and physician-patient relationships considered 'problematic.' An integrative review of primary studies published between January 1, 2016, and September 30, 2021, in Portuguese, English and Spanish was conducted, Of the 3,414 papers identified in the PubMed, Embase, Scopus and Lilacs databases, 19 were selected for qualitative analysis. Seven studies were carried out in Europe, eight in North America, two in South America and two in China, totaling 1,694 patients, 1,903 assistant physicians, 101 residents and 160 medical academics. Physicians and academics considered the following to be problematic: patients with clinical conditions such as psychosomatic and chronic illnesses; symptoms and complaints such as pain; powerful emotions; problems in obtaining and sharing information, in decision-making, in the adherence to the therapeutic plan and in their self-care; and some sociodemographic and vulnerability characteristics. Among other aspects, patients, or their relatives, considered physicians to be problematic when they did not listen to them or appear to care about their children, Teaching medical communication and systemic interventions are recommended to improve physician-patient relationships.

[In the final analysis, who is "problematic"? An integrative review of patients, physicians and problematic relationships]. / Afinal, quem é "difícil"? Revisão integrativa sobre pacientes, médicos e relações difíceis.

The scope of this study was to assess the literature on the characteristics of patients, physicians, and physician-patient relationships considered 'problematic.' An integrative review of primary studies published between January 1, 2016, and September 30, 2021, in Portuguese, English and Spanish was conducted, Of the 3,414 papers identified in the PubMed, Embase, Scopus and Lilacs databases, 19 were selected for qualitative analysis. Seven studies were carried out in Europe, eight in North America, two in South America and two in China, totaling 1,694 patients, 1,903 assistant physicians, 101 residents and 160 medical academics. Physicians and academics considered the following to be problematic: patients with clinical conditions such as psychosomatic and chronic illnesses; symptoms and complaints such as pain; powerful emotions; problems in obtaining and sharing information, in decision-making, in the adherence to the therapeutic plan and in their self-care; and some sociodemographic and vulnerability characteristics. Among other aspects, patients, or their relatives, considered physicians to be problematic when they did not listen to them or appear to care about their children, Teaching medical communication and systemic interventions are recommended to improve physician-patient relationships.

O objetivo deste estudo foi sintetizar a literatura sobre as características de pacientes, médicos e relações médico-paciente consideradas "difíceis". Foi realizada uma revisão integrativa de estudos primários publicados entre janeiro de 2016 e setembro de 2021, em português, inglês e espanhol. De 3.414 artigos identificados nas bases Embase, PubMed, Scopus e Lilacs, 19 foram analisados qualitativamente. Sete estudos foram efetuados na Europa, oito na América do Norte, dois na América do Sul e dois na China, totalizando 1.694 pacientes, 1.903 médicos assistentes, 101 residentes e 160 acadêmicos de medicina. Médicos e/ou acadêmicos de medicina consideravam difíceis os pacientes com: condições clínicas como doenças psicossomáticas e crônicas; sintomas e queixas como dor; emoções fortes; problemas na obtenção e no compartilhamento de informações, nas tomadas de decisão, na adesão ao plano terapêutico e no seu autocuidado; e certas características sociodemográficas e de vulnerabilidade. Pacientes ou seus familiares consideravam difíceis os médicos que não os escutavam, eram preconceituosos e pareciam não se importar com seus filhos, entre outros aspectos. Sugere-se o ensino de comunicação médica e intervenções sistêmicas para melhorar as relações médico-paciente.

Communication in healthcare: experience of students and professionals from teaching- learning to practice in health.

Objectives: This study aimed to understand the teaching-learning experience in the Communication in Healthcare class among students, teaching assistants, and health professionals, as well as its applications to professional practice. Methods: This is a qualitative study with a theoretical approach based on Gadamer's Philosophical Hermeneutics and a methodological framework based on Minayo and Bardin's thematic content analysis. Communication in Healthcare is an elective multiprofessional class, which lasts one semester and is offered regularly. All former students (n = 368) were invited to participate by email, and 30 participated in these focus groups (13 students, 8 teaching assistants, and 9 health professionals). The online focus groups took place on an online platform, and they were video-recorded and subsequently transcribed. Through cross-sectional and vertical analysis, the main themes were identified. Results: The Communication in Healthcare class was an important step for personal, professional, and interprofessional formation and development of communication competence. The following dominant themes were identified: 1) motivation for signing up, 2) prior expectations, 3) meaning of the experience and shaping moments, 4) how the teaching-learning experience was retained and what was retained, 5) repercussions in relation to self, others, and professional life, and 6) reflections about the curriculum, interprofessional dialogue, and formation. Conclusions: The teaching-learning experience was important for the formation of communicational competence. This research contributes to medical education and opens teaching-learning paths for communication skills, empathy, dialogue, and interprofessionalism. Future studies with a philosophical hermeneutic framework and online focus groups are indicated for the comprehension of educational interventions in health.

A pandemia da COVID-19 e o trabalho docente: percepções de professores de uma universidade pública no estado de São Paulo, Brasil / The COVID-19 pandemic and teachers' work: perceptions of teachers from a public university in the state of São Paulo, Brazil

Resumo A pandemia da COVID-19 exigiu a reestruturação dos modelos educacionais nas universidades, incluindo a rápida transição para o ensino remoto. Realizamos uma pesquisa qualitativa com o objetivo de compreender a percepção de professores universitários sobre os efeitos da pandemia da COVID-19 para a rotina de trabalho e para a saúde dos docentes de uma universidade pública no estado de São Paulo. Foram realizadas entrevistas semiestruturadas com 17 docentes de cursos de graduação das ciências humanas, biológicas e exatas, entre agosto e setembro de 2020. As entrevistas foram gravadas e transcritas na íntegra. Da análise de conteúdo, quatro categorias temáticas emergiram: (1) mudanças na rotina de trabalho e seus impactos, incluindo a adaptação ao trabalho remoto e dificuldade em estabelecer limites entre trabalho e rotina pessoal; (2) alterações na dinâmica entre professor/alunos e possibilidade de repensar a prática docente; (3) relação dos docentes com a universidade, o processo de tomada de decisões, suporte para a transição ao ensino remoto e preocupações com a qualidade do ensino; e (4) angústias e medos relacionamos à pandemia que se somaram aos estressores do trabalho. Os resultados ressaltam a necessidade de ações direcionadas à gestão educacional, às dinâmicas comunicacionais e à saúde mental.

Abstract The COVID-19 pandemic required the restructuring of educational models, including the rapid transition from face-to-face to remote education. The aim of this qualitative research was to understand the effect of the COVID-19 pandemic on undergraduate professors' work and health at a public university in the state of São Paulo. Semi-structured interviews were conducted with 17 undergraduate faculty of humanities, biological and exact sciences form August to September 2020. The interviews were recorded and transcribed. From the content analysis, four thematic categories emerged: (1) changes in the work routine and their impacts, including adjustment to remote work and the difficulties in establishing boundaries between work and their personal life; (2) changes in the dynamics between faculty and students and the possibility of rethinking teaching practice; (3) the relationship between faculty and the university with emphasis on the decision-making process, support for the transition to remote teaching, and concerns about the quality of teaching; and (4) anguish and fears related to the pandemic that added to the set of work-related stressors. Our findings showed that actions towards the communicational dynamics, as well as actions towards faculties' mental health should be implemented.

The COVID-19 pandemic and teachers' work: perceptions of teachers from a public university in the state of São Paulo, Brazil. / A pandemia da COVID-19 e o trabalho docente: percepções de professores de uma universidade pública no estado de São Paulo, Brasil.

The COVID-19 pandemic required the restructuring of educational models, including the rapid transition from face-to-face to remote education. The aim of this qualitative research was to understand the effect of the COVID-19 pandemic on undergraduate professors' work and health at a public university in the state of São Paulo. Semi-structured interviews were conducted with 17 undergraduate faculty of humanities, biological and exact sciences form August to September 2020. The interviews were recorded and transcribed. From the content analysis, four thematic categories emerged: (1) changes in the work routine and their impacts, including adjustment to remote work and the difficulties in establishing boundaries between work and their personal life; (2) changes in the dynamics between faculty and students and the possibility of rethinking teaching practice; (3) the relationship between faculty and the university with emphasis on the decision-making process, support for the transition to remote teaching, and concerns about the quality of teaching; and (4) anguish and fears related to the pandemic that added to the set of work-related stressors. Our findings showed that actions towards the communicational dynamics, as well as actions towards faculties' mental health should be implemented.

A pandemia da COVID-19 exigiu a reestruturação dos modelos educacionais nas universidades, incluindo a rápida transição para o ensino remoto. Realizamos uma pesquisa qualitativa com o objetivo de compreender a percepção de professores universitários sobre os efeitos da pandemia da COVID-19 para a rotina de trabalho e para a saúde dos docentes de uma universidade pública no estado de São Paulo. Foram realizadas entrevistas semiestruturadas com 17 docentes de cursos de graduação das ciências humanas, biológicas e exatas, entre agosto e setembro de 2020. As entrevistas foram gravadas e transcritas na íntegra. Da análise de conteúdo, quatro categorias temáticas emergiram: (1) mudanças na rotina de trabalho e seus impactos, incluindo a adaptação ao trabalho remoto e dificuldade em estabelecer limites entre trabalho e rotina pessoal; (2) alterações na dinâmica entre professor/alunos e possibilidade de repensar a prática docente; (3) relação dos docentes com a universidade, o processo de tomada de decisões, suporte para a transição ao ensino remoto e preocupações com a qualidade do ensino; e (4) angústias e medos relacionamos à pandemia que se somaram aos estressores do trabalho. Os resultados ressaltam a necessidade de ações direcionadas à gestão educacional, às dinâmicas comunicacionais e à saúde mental.

Needs of family members of patients in intensive care and their perception of medical communication / Necessidades de familiares de pacientes em terapia intensiva e sua percepção da comunicação médica

ABSTRACT Objective: To understand the perception of medical communication and needs of family members with loved ones in intensive care. Methods: The study was mainly qualitative and exploratory, with thematic analysis of comments made by 92 family members with loved ones in intensive care units when answering in-person interviews comprising the Quality of Communication Questionnaire (QoC) and open-ended questions about their need for additional help, the appropriateness of the place where they received information, and additional comments. Results: The participants' mean age was 46.8 years (SD = 11.8), and most of them were female, married and had incomplete or completed elementary education. The following themes were found: perception of characteristics of medical communication; feelings generated by communication; considerations about specific questions in the QoC; family members' needs; and strategies to overcome needs regarding communication. Characteristics that facilitated communication included attention and listening. Characteristics that made communication difficult included aspects of information sharing, such as inaccessible language; lack of clarity, objectivity, sincerity, and agreement among the team; limited time; and inadequate location. Feelings such as shame, helplessness, and sadness were cited when communication was inadequate. Family members' needs related to communication included more details about the loved one's diagnosis, prognosis, and health condition; participation in decisionmaking; and being asked about feelings, spirituality, dying and death. Others were related to longer visitation time, psychological support, social assistance, and better infrastructure. Conclusion: It is necessary to enhance medical communication and improve hospital infrastructure to improve the quality of care for family members.

RESUMO Objetivo: Compreender a percepção da comunicação médica e das necessidades de familiares com entes queridos em terapia intensiva. Métodos: O estudo foi principalmente qualitativo e exploratório, com análise temática dos comentários feitos por 92 familiares com entes queridos em unidades de terapia intensiva ao responderem entrevistas presenciais, incluindo o Quality of Communication Questionnaire e perguntas abertas sobre sua necessidade de mais ajuda, a adequação do local onde recebiam informações e outros comentários. Resultados: A média de idade dos participantes foi 46,8 anos (desviopadrão de 11,8), e a maioria deles era do sexo feminino, casada e tinha educação fundamental incompleta ou completa. Foram encontrados os seguintes temas: percepção das características da comunicação médica; sentimentos gerados pela comunicação; considerações sobre questões específicas do Quality of Communication Questionnaire; necessidades dos familiares; e estratégias para suprir as necessidades relativas à comunicação. As características que facilitaram a comunicação incluíram atenção e escuta. As características que dificultaram a comunicação incluíram aspectos de compartilhamento de informações, como linguagem inacessível; falta de clareza, objetividade, sinceridade e concordância entre a equipe; tempo limitado e localização inadequada. Sentimentos como vergonha, impotência e tristeza foram citados quando a comunicação era inadequada. As necessidades dos familiares relacionadas à comunicação incluíam mais detalhes do diagnóstico, do prognóstico e da condição de saúde do ente querido; participação na tomada de decisões e ser questionado sobre sentimentos, espiritualidade, morrer e morte. Outros estavam relacionados às visitas mais longas, ao apoio psicológico, à assistência social e à melhor infraestrutura. Conclusão: É necessário otimizar a comunicação médica e a infraestrutura hospitalar para melhorar a qualidade da assistência a familiares.

Adaptation of the Quality of Communication Questionnaire for Family Members and Its Validity Evidence for Use in Brazil.

Assessment of communication between physicians and patients' family members is essential to improving healthcare quality. To adapt the Quality of Communication Questionnaire (QoC) for family members and to analyze its validity evidence for use in Brazil. Data were collected between 2017 and 2019, with family members of patients in intensive care (IC) and palliative care (PC) from five public hospitals in the South Brazil. The QoC was adapted for family members for use in Brazil, and its cross-cultural adaptation was carried out. The clarity and cultural appropriateness of the pre-final version were evaluated by 30 family members of patients in IC. The final version was responded by 198 family members of patients. All items were considered clear, and appropriate to Brazilian culture. The goodness of fit index for proposed model had CFI 0.96 (CI95%: 0.94 - 0.98), TLI 0.95 (CI95%: 0.92 - 0.97), RMSEA 0.07 (CI90%: 0.06 - 0.08), and χ2/df 2.18. Cronbach's alpha coefficient (α) among family members of patients in PC was 0.88 for the general communication (first subscale) and 0.80 for the end-of-life communication (second subscale). However, among family members of patients in IC, α was 0.86 for the first subscale and only 0.53 for the second subscale. The QoC for family members and its cross-cultural adaptation were carried out successfully. It has strong validity evidence among those with loved ones in PC, but only the QoC general communication subscale has strong validity evidence among those with loved ones in IC.

Quality of Communication Questionnaire for Patients Hospitalized in Intensive and Palliative Care: Validity Evidence for Use in Brazil.

The Quality of Communication Questionnaire (QoC) was culturally adapted for Brazil due to its importance and use in several studies and different scenarios. The objective of this study was to evaluate the validity evidence of the Brazilian version of the QoC. A validation study was carried out involving 253 patients admitted to five public hospitals in Southern Brazil. Data were analyzed using descriptive analysis, Cronbach's alpha (α) to assess internal consistency, exploratory factor analysis, and goodness-of-fit index. One hundred and three patients were in intensive care (IC), and 150 were in palliative care (PC). The participants' mean age was 51 years (SD = 14.2). QoC,and its general communication subscale, and end-of-life communication subscale means were 5.5 (SD = 1.6), 8.8 (SD = 1.5), and 5.5 (SD = 1.6) respectively. Among patients in IC, QoC Cronbach's alpha was .75, and .84 in the general communication subscale and .51 in the end-of-life communication subscale. Among patients in PC, QoC Cronbach's alpha was .83, and .88 in the general communication subscale, and .71 in the end-of-life communication subscale. The root mean square error of approximation was .07 (90% CI: .04 - .08); Tucker-Lewis index was .97 (95% CI: .95 - .98); comparative fit index was .98 (95% CI: .97 - .99), and χ2/df ratio was 1.33 (χ2[53] = 70.858, p = .05). The authors conclude that the general communication subscale of QoC Brazilian version has good validity evidence for patients in IC and PC, whereas the end-of-life communication subscale is only valid for patient in PC.

Consenso Abem para o ensino de comunicação nas escolas médicas brasileiras / ABEM consensus for the brazilian medical schools' communication curriculum

Resumo: Introdução: A comunicação é uma competência essencial para o(a) médico(a) e outras categorias profissionais, e deve ser desenvolvida durante sua formação profissional. A elaboração de um projeto de comunicação, incluindo um consenso brasileiro, visou subsidiar as escolas médicas a preparar os estudantes de Medicina para se comunicarem efetivamente com os(as) cidadãos/cidadãs brasileiros(as), de características plurais intra e inter-regionais, pautando-se no profissionalismo e nos princípios do Sistema Único de Saúde (SUS). Objetivo: Este manuscrito apresenta o consenso para o ensino de comunicação nas escolas médicas brasileiras. Método: O consenso foi construído colaborativamente com 276 participantes, experts em comunicação, docentes, profissionais de saúde e discentes, de 126 escolas médicas e cinco instituições de saúde, ao longo de nove encontros presenciais em congressos e de encontros virtuais quinzenais ou mensais. Nos encontros, compartilharam-se as experiências dos participantes e o material bibliográfico, incluindo os consensos internacionais, e apresentou-se o consenso em construção, com discussão em grupos para elencar novos componentes para o consenso brasileiro, seguida por debate com todos para pactuá-los. A versão final foi aprovada em reunião virtual, com convite a todos(as) os(as) participantes em julho de 2021. Após submissão, diversas alterações foram requeridas, o que demandou novos encontros para revisão da versão final do consenso. Resultado: O consenso tem como pressupostos que a comunicação deve ser centrada nas relações, pautada nos princípios do SUS, na participação social e no profissionalismo, e embasada nas Diretrizes Curriculares Nacionais do curso de graduação em Medicina, em referenciais teóricos e nas evidências científicas. São descritos objetivos específicos para desenvolver a competência em comunicação nos estudantes, abrangendo: fundamentos teóricos; busca e avaliação crítica da literatura; elaboração e redação de documentos; comunicação intrapessoal e interpessoal no ambiente acadêmico-científico, na atenção à saúde em diversos contextos clínicos e na gestão em saúde. Recomenda-se a inserção curricular da comunicação do início ao final do curso, integrada a outros conteúdos e áreas de saber. Conclusão: Espera-se que esse consenso contribua para a revisão ou implementação da comunicação nos currículos das escolas médicas brasileiras.

Abstract: Introduction: Communication is an essential competence for the physician and other professional categories, and must be developed their professional training. The creation of a communication project including a Brazilian consensus aimed to subsidize medical schools in preparing medical students to communicate effectively with Brazilian citizens, with plural intra and inter-regional characteristics, based on the professionalism and the Brazilian Unified System (SUS) principles. Objective: The objective of this manuscript is to present the consensus for the teaching of communication in Brazilian medical schools. Method: The consensus was built collaboratively with 276 participants, experts in communication, faculty, health professionals and students from 126 medical schools and five health institutions in face-to-face conference meetings and biweekly or monthly virtual meetings. In the meetings, the participants' experiences and bibliographic material were shared, including international consensuses, and the consensus under construction was presented, with group discussion to list new components for the Brazilian consensus, followed by debate with everyone, to agree on them. The final version was approved in a virtual meeting with invitation to all participants in July 2021. After the submission, several changes were required, which demanded new meetings to review the consensus final version. Result: The consensus is based on assumptions that communication should be relationship-centered, embedded on professionalism, grounded on the SUS principles and social participation, and based on the National Guidelines for the undergraduate medical course, theoretical references and scientific evidence. Specific objectives to develop communication competence in the students are described, covering: theoretical foundations; literature search and its critical evaluation; documents drafting and editing; intrapersonal and interpersonal communication in the academicscientific environment, in health care and in health management; and, communication in diverse clinical contexts. The inclusion of communication in the curriculum is recommended from the beginning to the end of the course, integrated with other contents and areas of knowledge. Conclusion: It is expected that this consensus contributes the review or implementation of communication in Brazilian medical schools' curricula.

Distribuição da semiologia do adulto nas escolas médicas do Brasil / Distribution of adult semiology in medical schools in Brazil

Resumo: Introdução: A semiologia é a base da prática clínica e seu ensino é essencial no curso de Medicina. Este estudo foi desenvolvido por haver uma lacuna no conhecimento sobre sua distribuição no Brasil. Objetivo: Este estudo teve como objetivo analisar a distribuição da semiologia do adulto nas escolas médicas brasileiras. Método: Trata-se de um estudo transversal descritivo realizado com 226 escolas médicas brasileiras que disponibilizavam a distribuição de semiologia na internet entre as 335 ativas, em dezembro de 2020 (67,5%). As variáveis estudadas foram região geográfica, administração, gratuidade e tempo de existência da escola, carga horária do curso, do internato e de semiologia, e ano(s) ou semestre(s) em que a semiologia era ofertada no currículo. A análise dos dados foi descritiva, e analisaram-se as associações com os testes: t de Student, análise de variância, qui-quadrado de Pearson, U de Mann-Whitney, Kruskal-Wallis e Wilcoxon. Admitiu-se um nível de significância de p < 0,05. Resultado: A semiologia foi mais frequentemente ofertada apenas no quarto semestre (n = 40), seguida por sua oferta em dois semestres: quarto e quinto e terceiro e quarto. Entre as 226 escolas, 142 integravam os conteúdos em módulos ou eixos (62,8%). Entre 117 escolas que forneciam a carga horária de semiologia, mediana foi de 240,0 horas (P25-75 = 165,4 - 338,2), sem diferença estatística por região geográfica, administração, gratuidade e tempo de existência da escola. A mediana da carga teórica de semiologia [77,5 horas (P25-75 = 51,7 - 123,5)] foi menor do que a carga prática [147,0 horas (P25-75 = 64,5 - 180,0)], Z = -3,99, p < 0,01. A mediana da porcentagem da carga horária de semiologia no curso foi de 2,9% (P25-75 = 2,0 - 4,0). Conclusão: A semiologia é mais frequentemente ofertada no quarto semestre, e sua carga horária não difere por características geográficas, de administração e tempo de existência das escolas estudadas.

Abstract: Introduction: Semiology is the basis of clinical practice and its teaching is essential in the medical course. This study was developed to fill a gap in the knowledge about its distribution in Brazil. Objective: To analyze the distribution of adult semiology in Brazilian medical schools. Method: Cross-sectional descriptive study with 226 Brazilian medical schools that provided the distribution of semiology on the Internet among the 335 active schools in December 2020 (67.5%) The variables studied were school geographic region, administration and free tuition, time of existence of the course, course load of the regular course, clerkship and semiology, and year(s) or semester(s) in which semiology was offered in the curriculum. Data analysis was descriptive and the associations were analyzed using: Student's t, Chi-square, Analysis of Variance, Mann-Whitney-U, Kruskal Wallis and Wilcoxon tests. The significance level was set at p < 0.05. Result: Semiology was more frequently offered only in the 4th semester (n = 40), followed by its offer in two semesters, the 4th and 5th and 3rd and 4th. Among the 226 schools, 142 integrated semiology into modules or axes (62.8%). Among the 117 schools that provided the semiology course load, its median was 240.0 hours (P25-75 = 165.4 - 338.2), with no statistical difference by geographic region, type of administration and time of existence of the course. The median of the theoretical course load [77.5 hours (P25-75 = 51.7 - 123.5)] was lower than the practical course load [147.0 hours (P25-75 = 64.5 - 180.0)], Z = - 3,99, p < 0,01. The median of the percentage of semiology course load during the course was 2.9% (P25-75 = 2.0 - 4.0). Conclusion: Semiology is more frequently offered in the 4th semester and its median course load is similar in Brazilian geographic regions and by school administration type and time of existence of the assessed schools.

Development of a new instrument to assess the quality of physicians' delivery of bad news / Desenvolvimento de um novo instrumento para avaliar a qualidade da comunicação de más notícias pelos médicos

Abstract: Introduction: Most instruments to assess physicians' delivery of bad news have been developed for patients with cancer and then adapted to other contexts. In clinical practice, some news may not be considered bad by the physicians but may have an important negative impact on the patients' life. Yet, instruments to assess this communication across diverse clinical settings are needed. Objective: To develop, from the patients' perspective, an instrument to assess how physicians deliver bad news in clinical practice. Method: This study was conducted using an exploratory qualitative approach by means of semi-structured, in-depth interviews with 109 patients from two referral hospitals in Brazil. Content analysis was used to generate categories, from which the initial instrument items were developed. The clarity and relevance of the items were evaluated by a committee of 11 medical professionals and 10 patients. Results: The instrument included items about the physicians' attitudes, such as attention, respect, and sincerity, as well as items about sharing information using language that patients could understand. The initial instrument had 19 items, answered in a 5-point Likert scale with labeled endpoints. After evaluation by the committee of judges, 2 items were modified, and 3 were excluded. The final instrument thus had 16 items. Conclusion: A new 16-item instrument was developed from the patients' perspective to assess physicians' delivery of bad news. After additional validation, this instrument may be useful in real and diverse bad news settings in clinical practice.

Resumo: Introdução: A maioria dos instrumentos para avaliar a comunicação de más notícias pelos médicos foi desenvolvida para pacientes com câncer e adaptada a outros contextos. Na prática clínica, muitas notícias podem não ser consideradas tão ruins pelos médicos, mas possuem um impacto importante negativo na vida dos pacientes. Assim, ainda há a necessidade de instrumentos para avaliar essa comunicação nos diversos cenários clínicos. Objetivo: desenvolver, a partir da perspectiva dos pacientes, um instrumento para avaliar como os médicos comunicam más notícias na prática clínica. Método: o estudo foi realizado usando uma abordagem qualitativa exploratória, através de entrevistas semiestruturadas em profundidade com 109 pacientes em dois hospitais de referência no Brasil. A análise de conteúdo foi utilizada para gerar categorias, a partir das quais os itens iniciais do instrumento foram desenvolvidos. A clareza e a relevância dos itens foram avaliadas por um comitê de 11 profissionais médicos e 10 pacientes. Resultados: O instrumento incluiu itens sobre as atitudes dos médicos como atenção, respeito e sinceridade e sobre o compartilhamento de informações compreensíveis na linguagem do paciente. O instrumento inicial foi composto por 19 itens, respondidos em uma escala-Likert de 5 pontos. Após avaliação do comitê de juízes, 2 itens foram modificados e 3 foram excluídos; ficando o instrumento final com 16 itens. Conclusão: um novo instrumento com 16 itens foi desenvolvido a partir da perspectiva dos pacientes para avaliar a comunicação de más notícias pelos médicos. Após validação adicional, este instrumento poderá ser útil em cenários reais e diversos de más notícias da prática clínica.

Percepção de pacientes sobre a comunicação médica e suas necessidades durante internação na unidade de cuidados intensivos / Patients' perception of medical communication and their needs during the stay in the intensive care unit

RESUMO Objetivo: Conhecer a percepção de pacientes sobre a comunicação médica, bem como suas necessidades durante internação na unidade de cuidados intensivos. Métodos: Estudo transversal descritivo e qualitativo exploratório, com 103 pacientes internados ou com alta recente da unidade de cuidados intensivos de quatro hospitais da Grande Florianópolis (SC). Foram estudadas variáveis sociodemográficas e clínicas dos pacientes, sua nota para qualidade da comunicação médica pelo Quality of Communication Questionnaire, seus comentários espontâneos com reflexões ou justificativas para as notas dadas e suas respostas sobre como se sentiam e que ajuda complementar gostariam de receber. Os dados quantitativos foram analisados com estatística descritiva e analítica e os qualitativos com análise de conteúdo temática. Resultados: A média do Quality of Communication Questionnaire foi 5,1 (desvio-padrão - DP = 1,3), sendo 8,6 (DP = 1,3) na subescala de comunicação geral e 2,1 (DP =1,8) na de terminalidade de vida. A linguagem médica teve compreensão variável. Alguns médicos pareciam "apressados", segundo alguns pacientes. Outros pacientes gostariam de informações mais frequentes e detalhadas e/ou serem respeitados e levados "mais a sério" quando referiam sentir dor. Ansiedade, tristeza e/ou medo estavam entre os sentimentos referidos. Outras necessidades abrangeram silêncio, mais tempo para visitas, presença de acompanhante, atenção psicológica e de serviço social, banheiro que pudessem usar e melhor qualidade da comida na unidade de cuidados intensivos. Conclusão: A qualidade da comunicação médica com os pacientes é boa e poderia melhorar com maior disponibilidade de tempo do médico e da equipe para ela. Outras necessidades sentidas incluem respeito, alívio da dor e adaptações na dinâmica e no ambiente da unidade de cuidados intensivos.

ABSTRACT Objective: To understand the perception of patients about medical communication as well as their needs during hospitalization in the intensive care unit. Methods: This study was cross-sectional descriptive and qualitative exploratory including 103 patients admitted to or recently discharged from the intensive care units of four hospitals in Greater Florianópolis, Santa Catarina state, Brazil. The patients' sociodemographic and clinical variables were studied, as were the score they gave to the quality of medical communication through the Quality of Communication Questionnaire and their spontaneous comments with reflections or justifications for the scores given, and their responses on how they felt and what complementary help they would have liked to receive. The quantitative data were analyzed by descriptive and analytical statistics, and the qualitative data were analyzed by thematic content analysis. Results: The mean Quality of Communication Questionnaire score was 5.1 (standard deviation - SD = 1.3), with 8.6 (SD = 1.3) on the general communication subscale and 2.1 (SD = 1.8) on the end-of-life communication subscale. The patients had a variable understanding of medical language. Some physicians seemed to be "rushed", according to some patients. Other patients would like to receive more frequent and detailed information and/or be respected and taken "more seriously" when they reported pain. Anxiety, sadness, and fear were among the reported feelings. Other needs included silence, more time for visits, the presence of a companion, psychological and social-work care, a bathroom that they could use, and better food in the intensive care unit. Conclusion: The quality of medical communication with patients is good but could improve if physicians and the healthcare team had more time for patients. Other felt needs included respect, pain relief, and adjustments in the intensive care unit dynamics and environment.

Patients' perception of medical communication and their needs during the stay in the intensive care unit. / Percepção de pacientes sobre a comunicação médica e suas necessidades durante internação na unidade de cuidados intensivos.

OBJECTIVE: To understand the perception of patients about medical communication as well as their needs during hospitalization in the intensive care unit. METHODS: This study was cross-sectional descriptive and qualitative exploratory including 103 patients admitted to or recently discharged from the intensive care units of four hospitals in Greater Florianópolis, Santa Catarina state, Brazil. The patients' sociodemographic and clinical variables were studied, as were the score they gave to the quality of medical communication through the Quality of Communication Questionnaire and their spontaneous comments with reflections or justifications for the scores given, and their responses on how they felt and what complementary help they would have liked to receive. The quantitative data were analyzed by descriptive and analytical statistics, and the qualitative data were analyzed by thematic content analysis. RESULTS: The mean Quality of Communication Questionnaire score was 5.1 (standard deviation - SD = 1.3), with 8.6 (SD = 1.3) on the general communication subscale and 2.1 (SD = 1.8) on the end-of-life communication subscale. The patients had a variable understanding of medical language. Some physicians seemed to be "rushed", according to some patients. Other patients would like to receive more frequent and detailed information and/or be respected and taken "more seriously" when they reported pain. Anxiety, sadness, and fear were among the reported feelings. Other needs included silence, more time for visits, the presence of a companion, psychological and social-work care, a bathroom that they could use, and better food in the intensive care unit. CONCLUSION: The quality of medical communication with patients is good but could improve if physicians and the healthcare team had more time for patients. Other felt needs included respect, pain relief, and adjustments in the intensive care unit dynamics and environment.

OBJETIVO: Conhecer a percepção de pacientes sobre a comunicação médica, bem como suas necessidades durante internação na unidade de cuidados intensivos. MÉTODOS: Estudo transversal descritivo e qualitativo exploratório, com 103 pacientes internados ou com alta recente da unidade de cuidados intensivos de quatro hospitais da Grande Florianópolis (SC). Foram estudadas variáveis sociodemográficas e clínicas dos pacientes, sua nota para qualidade da comunicação médica pelo Quality of Communication Questionnaire, seus comentários espontâneos com reflexões ou justificativas para as notas dadas e suas respostas sobre como se sentiam e que ajuda complementar gostariam de receber. Os dados quantitativos foram analisados com estatística descritiva e analítica e os qualitativos com análise de conteúdo temática. RESULTADOS: A média do Quality of Communication Questionnaire foi 5,1 (desvio-padrão - DP = 1,3), sendo 8,6 (DP = 1,3) na subescala de comunicação geral e 2,1 (DP =1,8) na de terminalidade de vida. A linguagem médica teve compreensão variável. Alguns médicos pareciam "apressados", segundo alguns pacientes. Outros pacientes gostariam de informações mais frequentes e detalhadas e/ou serem respeitados e levados "mais a sério" quando referiam sentir dor. Ansiedade, tristeza e/ou medo estavam entre os sentimentos referidos. Outras necessidades abrangeram silêncio, mais tempo para visitas, presença de acompanhante, atenção psicológica e de serviço social, banheiro que pudessem usar e melhor qualidade da comida na unidade de cuidados intensivos. CONCLUSÃO: A qualidade da comunicação médica com os pacientes é boa e poderia melhorar com maior disponibilidade de tempo do médico e da equipe para ela. Outras necessidades sentidas incluem respeito, alívio da dor e adaptações na dinâmica e no ambiente da unidade de cuidados intensivos.

Community Health course load before clerkship in Brazilian medical schools / Carga horária de saúde coletiva antes do internato em escolas médicas brasileiras

Abstract: Introduction: The limits of the Community Health (CH) course load (CL) before medical clerkship (MC) in undergraduate medical courses are not defined neither in the National Curriculum Guidelines nor in other documents, and have not been investigated in a comprehensive way in national studies. Objective: To analyze the community health course load before clerkship in Brazilian medical schools. Method: Cross-sectional study of schools acknowledged by the Ministry of Education, which started activities until December 31, 2017. The sites of the 323 existing schools were accessed and the schools that had their curricula available in the internet with details of the CH CL before MC were included. The variables were school geographic region and administration type, medical course CL and CH CL before MC, also including epidemiology, biostatistics and occupational health course loads. Data were analyzed using descriptive statistics, Pearson chi-square (Ӽ2) for categorical variables and Mann-Whitney-U (U) and Kruskal Wallis Ӽ2 tests for continuous variables. Results: Out of 323 existing medical schools, 222 were included (68.7%). Among the included schools, 83 were tuition-free (37.4%) and 139 were not (62.6%). The median of the CH CL before MC was 440.0 hours (P25-75 = 300.0 - 640.0), equivalent to 5.4% (P25-75 = 3.5 - 7.8) of the medical course CL. The median of the CH CL before MC in hours in private and municipal schools was, respectively, 480.0 (P25-75 = 330.7 - 679.2) and 576.0 (P25-75 = 360.0 - 766.0), and of state and federal schools, respectively, 337.0 (P25-75 = 281.2 - 524.2) and 370.0 (P25-75 = 300.0 - 480.0), Ӽ2(3) = 11.48, p = .009. The median of the total CH CL in non-tuition-free schools was 500.0 hours (P25-75 = 336.0 - 690.0) and in the tuition-free schools, it was 364.0 hours (P25-75 = 285.0 - 504.0), U = 4.259.0, z = -3.26, p = .001. The median of epidemiology and biostatistics CL in hours before MC in the 124 schools was 88.0 (P25-75 = 60.0 - 120.0), whereas the occupational health CL in 63 schools was 40.0 (P25-75 = 33.0 - 60.0). Conclusions: The CH CL before clerkship varies widely, being higher in non-tuition-free medical schools.

Resumo: Introdução: Os limites da carga horária (CH) de saúde coletiva (SC) antes do internato (AI) não estão definidos nas Diretrizes Curriculares Nacionais, nem em outros documentos, e não foram investigados de forma abrangente em estudos nacionais. Objetivo: Analisar a CH de SC AI em escolas médicas (EM) brasileiras. Método: Estudo transversal, com escolas reconhecidas pelo Ministério da Educação que iniciaram as atividades até 31 de dezembro de 2017. Os sites das 323 escolas existentes foram consultados, e foram incluídas aquelas que disponibilizavam seus currículos na internet com detalhamento de CH de SC AI. As variáveis foram região geográfica e administração da escola, CH do curso de medicina e CH de SC AI, incluindo também as CH de epidemiologia, bioestatística e saúde do trabalhador. Os dados foram analisados usando-se estatística descritiva, teste de qui-quadrado (Ӽ2) de Pearson para variáveis categóricas e testes Mann-Whitney-U (U) e Ӽ2 de Kruskal-Wallis para variáveis contínuas. Resultados: Foram incluídas 222 das 323 EM existentes (68,7%), sendo 83 gratuitas (37,4%) e 139 não gratuitas (62,6%). A mediana da CH total de SC AI foi de 440,0 horas (P25-75 = 300,0 - 640,0), equivalente a 5,4% (P25-75 = 3,5 - 7,8) da CH total do curso. A mediana da CH de SC AI em horas das escolas privadas e municipais foi de, respectivamente, 480,0 (P25-75 = 330,7 - 679,2) e 576,0 (P25-75 = 360,0 - 766,0); no caso das estaduais e federais, a mediana foi de, respectivamente, 337,0 (P25 - 75 = 281,2 - 524,2) e 370,0 (P25-75 = 300,0 - 480,0), Ӽ2(3) = 11,48, p = 0,009. As escolas não gratuitas tiveram mediana de CH total de SC de 500,0 horas (P25-75 = 336,0 - 690,0) e as gratuitas de 364,0 horas (P25-75 = 285,0 - 504,0), U = 4.259,0, z = - 3,26, p = 0,001. A mediana da CH, em horas, de epidemiologia e bioestatística AI entre 124 escolas foi de 88,0 (P25-75 = 60,0 - 120,0) e de saúde do trabalhador entre 63 foi de 40,0 (P25-75 = 33,0-60,0). Conclusões: A CH de SC AI apresenta grande variação, sendo maior em escolas não gratuitas.

Surgery course load in Brazilian medical schools / Carga horária de cirurgia em escolas médicas do Brasil

Abstract: Introduction: Surgery is an important curricular component of undergraduate medical courses. This study was conducted because the surgery course load in Brazilian medical has not been systematically explored at the national level. Objective: To analyze the surgery course load in Brazilian medical schools. Method: A cross-sectional, descriptive study was carried out with Brazilian medical schools acknowledged by the Ministry of Education, which had begun their activities prior to December 31, 2017 and, as of September 2018, had their curriculum matrix and/or political-pedagogical project with the surgery course load available on the internet. The variables studied were total medical curriculum course load and surgery course load before and during clerkship, as well as the schools' geographic region and fee status. Data analysis was performed using descriptive statistic Student t-test, analysis of variance, and Mann-Whitney U and Kruskal-Wallis tests, with the null hypothesis rejected for p < .05. Results: The study included 205 of the country's 323 existing medical schools, of which 175 had available information on the surgery course load during the clerkship, 157 before the clerkship, and 129 had information on course load before and after the clerkship. The median total surgery course load in hours was 815.0 (P25 - 75 = 677.5 - 992.0; minimum = 340.0 h; maximum =1,665.0), while the mean surgery course load before clerkship in hours was 268.7 (SD = 140.3; minimum = 32.0; maximum = 780.0), with no difference between geographic regions or fee status. During the clerkship, the median course load was 540.0 hours (P25 - 75 = 400.0 - 712.0; minimum = 170.0 h; maximum = 1,410.0), with no difference between geographic regions, but with higher values in medical schools with no tuition fees. Regarding the total curriculum course load, the mean percentage of the surgery course load before clerkship was 3.2% (SD = 1.7), the median percentage during the clerkship was 6.4% (P25 - 75 = 5.0 - 8.2), the median percentage of the total surgery course load was 6.4% (P25 - 75 = 5.0 - 8.2%, and the median percentage of surgery course load (both periods) was 9.7% (P25 - 75 = 8.3 - 11.8%). Conclusions: Despite the considerable variation in the surgery course load limits, the median of total surgery and the mean of surgery course load before clerkship were similar across geographic regions and fee statuses. The median surgery course load during clerkship was also similar across regions but higher in tuition-free medical schools. The values found in this study can help schools' administrators to assess and plan the surgery course load in their institutions.

Resumo: Introdução: A cirurgia é um importante componente dos currículos dos cursos de graduação em Medicina. Este estudo foi realizado por não se conhecer a carga horária de cirurgia nas escolas médicas brasileiras. Objetivo: Analisar a carga horária de cirurgia de escolas médicas brasileiras. Método: Este estudo foi transversal e descritivo, realizado em escolas médicas brasileiras reconhecidas pelo Ministério da Educação que iniciaram atividades até 31 de dezembro de 2017 e disponibilizavam matriz curricular e/ou projeto político-pedagógico com carga horária de cirurgia na internet até setembro de 2018. As variáveis estudadas foram carga horária total e de cirurgia antes do internato e durante esse período, região geográfica e gratuidade das escolas. Os dados foram analisados por meio de estatística descritiva, teste t de Student, análise de variância e testes U de Mann-Whitney e de Kruskal-Wallis, rejeitando-se a hipótese nula quando p < 0,05. Resultados: Foram incluídas 205 das 323 escolas médicas existentes, das quais 175 disponibilizavam carga horária de cirurgia no internato; 157, antes do internato; e 129, disponibilizavam ambas as cargas horárias. A mediana da carga horária total de cirurgia foi de 815,0 horas (P25 - 75 = 677,5 - 992,0; limites: 340,0 - 1.665,0 horas), e a carga horária média antes do internato foi de 268,7 horas (desvio padrão = 140,3; limites: 32,0 - 780,0), ambas sem diferença estatística por região geográfica ou gratuidade da escola. A mediana da carga horária do internato foi de 540,0 horas (P25 - 75 = 400,0 - 712,0; limites: 170,0 - 1.410,0), sem diferença estatística por região geográfica, mas maior nas escolas gratuitas. Em relação à carga horária total do currículo do curso, a porcentagem média da carga horária de cirurgia antes do internato foi 3,2% (desvio padrão = 1,7); a porcentagem mediana da carga horária de cirurgia no internato, 6,4% (P25 - 75 = 5,0 - 8,2); e a porcentagem mediana da carga horária de ambos os períodos foi de, 9,7% (P25 - 75 = 8,3 - 11,8). Conclusões: Apesar da variação nos limites extremos da carga horária de cirurgia, a mediana de seu total e sua média antes do internato são semelhantes por região geográfica e gratuidade da escola, e sua mediana no internato é também semelhante por região, mas maior em escolas médicas gratuitas. Os valores encontrados neste estudo podem ajudar os gestores na avaliação e no planejamento da carga horária de cirurgia em suas escolas.

Media and scientific communication about the COVID-19 pandemic and the repercussions on the population's mental health: A protocol for a systematic review and meta-analysis.

BACKGROUND: Good communication strategies are essential in times of crisis, such as the coronavirus pandemic. The dissemination of inaccurate information and the need for social isolation to control coronavirus disease 2019 (COVID-19) have shown a negative impact on the population, causing damage to mental health, with the appearance or worsening of symptoms of stress, fear, anxiety, and depression. Thus, the systematic review study is intended to gather evidence on the impact of information about COVID-19 on the mental health of the population. METHODS: This systematic review protocol is conducted using the guidelines of the preferred reporting items for systematic reviews and meta-analyses protocols and the Cochrane Handbook for Systematic Reviews of Interventions. The review aims to include published studies that address the exposure of the general population to information about COVID-19, through observational and experimental studies, which consider the following outcomes: fear, stress, anxiety, and depression. Thus, a comprehensive research strategy will be conducted in the following databases: PubMed / Medline, Scopus, Web of Science, EMBASE, Science Direct, CINAHL, PsycINFO and Cochrane Central Register of Controlled Trials (CENTRAL). Two independent reviewers will perform all procedures, such as study selection, data collection, and methodological evaluation. Disagreements will be forwarded to a third reviewer. RevMan 5.3 software will be used for data analysis. RESULTS: This systematic review will provide evidence of the influence of access to and consumption of media and scientific information about COVID-19 on the mental health of the population. It will consider information about the characterization of the study and the population studied, clinical and epidemiological information on mental health, and data on access to and consumption of media and scientific information. DISCUSSION: The results should inform about the consequences of communication about the new coronavirus on the emergence or worsening of psychological and psychiatric symptoms, allowing to develop strategies to achieve effective communication of information to promote the mental health of the population. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020182918.

Total and Pediatrics Course load of Brazilian Medical Schools / Carga Horária Total e de Pediatria de Escolas Médicas Brasileiras

Abstract: Introduction: Brazilian guidelines for undergraduate medical courses recommend a minimum curricular course load (CL) of 7,200 hours and the Brazilian Society of Pediatrics recommends that 10% of this load be allocated to pediatrics. The aim of this study was to analyze the total course load and the course load in pediatrics of Brazilian medical schools' curriculum. Method: Cross-sectional and descriptive study. Of the 294 existing medical schools in Brazil in October 2017, those with curricular matrix/grid or political-pedagogical project of the course and pediatrics CL available on their homepage were included. The studied variables included total curricular CL, pediatrics CL and year of inclusion of pediatrics in the curriculum. Data were analyzed using descriptive statistics, calculating absolute and relative frequencies for categorical variables and mean and Standard Deviation (SD) and median and 25-75 percentile (P25-75) for continuous variables. Results: One hundred and fifty-one medical schools were included (51.4% of the total). The curriculum CL median was 7,975 hours (P25-75=7,440-8,550), with a mean of 4,665.7 hours (SD=593.8) before clerkship and 3,388.1 hours (SD=430.3) during clerkship. The mean pediatrics' CL was 778.2 hours (SD=180.8), with a median CL of 220 hours (P25-75=160-300) before clerkship and 514 (P25-75= 405-640) during clerkship. The median pediatrics practice course load before clerkship (n=70) was 123 (SD=90-180). The mean of the proportion between general pediatrics and the curricular CL was 9.7% (SD= 2,2), and 68.5% schools had a CL >720 hours. The median of the proportion between the CL in pediatrics clerkship and in the course was 16% (P25-75=12.5-18.9), ranging from 6% to 26%. The median of the proportion between pediatrics CL before pediatrics clerkship and course load was 4.7% (P25-75=3.6-6.5), ranging from 1% to 13%. Two schools started the teaching of pediatrics in the first year (1,3%), 19 in the second (12.6%), 63 in the third (41.7%) e 67 in the fourth year of the medical course (44.4%). Conclusions: The schools meet the minimum curricular course load established by the national guidelines, tending to exceed it, and not all of them meet the minimum pediatrics course load requirement of 720 hours recommended by the Brazilian Society of Pediatrics.

Resumo: Introdução: As Diretrizes Curriculares Nacionais (DCN) para os Cursos de Graduação em Medicina recomendam uma carga horária (CH) curricular mínima de 7.200 horas, e a Sociedade Brasileira de Pediatria preconiza que 10% dessa CH seja alocada na pediatria. O objetivo deste estudo foi analisar a CH curricular total e de pediatria de escolas médicas brasileiras. Método: Trata-se de um estudo transversal, descritivo. Das 294 escolas médicas existentes no Brasil em outubro de 2017, foram incluídas no estudo as que continham em sua página oficial da internet a matriz/grade curricular ou o projeto político-pedagógico do curso e a CH de pediatria. As variáveis incluíram o CH curricular do curso e de pediatria e o ano de inserção de pediatria no currículo. Os dados foram analisados por estatística descritiva. As variáveis categóricas foram analisadas com frequência relativa e absoluta e as contínuas com média e Desvio-Padrão (DP) e mediana e percentil 25-75 (P25-75). Resultados: Foram incluídas 151 do total de escolas (51,4% do total). A mediana da CH dos cursos foi de 7.975 horas (P25-75 = 7.440-8.550), com média de 4.665,7 horas (DP = 593,8) antes do internato e de 3.388,1 horas (DP = 430,3) no internato. A média da CH total de pediatria foi de 778,2 (181,6), e a mediana da CH antes do internato foi de 220 horas (P25-75 = 160-300) e no internato de 514 (P25-75 = 405-640). A mediana da CH prática de pediatria antes do internato (n = 70) foi de 123 (DP = 90-180). A média da proporção entre CH total de pediatria e do curso foi de 9,7% (DP = 2,2), tendo 68,5% das escolas uma CH acima de 720 horas. A mediana da proporção entre a CH no internato de pediatria e a do curso foi de 16% (P25-75 = 12,5-18,9), com limites entre 6% e 26%. A mediana da proporção entre a CH antes do internato de pediatria e a do curso foi de 4,7% (P25-75 = 3,6-6,5), com limites entre 1% e 13%. Duas escolas iniciam o ensino da pediatria no primeiro ano do curso (1,3%), 19 no segundo (12,6%), 63 no terceiro (41,7%) e 67 no quarto ano (44,4%). Conclusões: As escolas cumprem a CH mínima do currículo estabelecida pelas DCN, tendendo a excedê-la, e nem todas cumprem a CH de 720 horas de pediatria recomendada pela Sociedade Brasileira de Pediatria.