Professional values at the beginning of medical school: a quasi-experimental study.

BACKGROUND: Teaching professionalism in medical schools is central to medical education and society. We evaluated how medical students view the values of the medical profession on their first day of medical school and the influence of a conference about the competences of this profession on these students' levels of reflection. METHODS: We studied two groups of medical students who wrote narratives about the values of the medical profession and the influence of the COVID-19 pandemic on these values. The first group wrote the narratives after a conference about the competences of the medical profession (intervention group), and the second group wrote the same narratives after a biochemistry conference (control group). We also compared the levels of reflection of these two groups of students. RESULTS: Among the 175 medical students entering in the 2022 academic year, 159 agreed to participate in the study (response rate = 90.8%). There were more references to positive than negative models of doctor‒patient relationships experienced by the students (58.5% and 41.5% of responses, respectively). The intervention group referred to a more significant number of values than the control group did. The most cited values were empathy, humility, and ethics; the main competences were technical competence, communication/active listening, and resilience. The students' perspectives of the values of their future profession were strongly and positively influenced by the pandemic experience. The students realized the need for constant updating, basing medical practice on scientific evidence, and employing skills/attitudes such as resilience, flexibility, and collaboration for teamwork. Analysis of the levels of reflection in the narratives showed a predominance of reflections with a higher level in the intervention group and of those with a lower level in the control group. CONCLUSIONS: Our study showed that medical students, upon entering medical school, already have a view of medical professionalism, although they still need to present a deeper level of self-reflection. A single, planned intervention in medical professionalism can promote self-reflection. The vision of medical professional identity was strongly influenced by the COVID-19 pandemic, positively impacting the formation of a professional identity among the students who decided to enter medical school.

Medical students' and residents' views on euthanasia.

BACKGROUND: Doctors are increasingly faced with end-of-life decisions. Little is known about how medical students approach euthanasia. The objective of this study was to evaluate, among medical students and residents, the view on euthanasia and its variants; correlate such a view with empathy and religiosity/spiritualism; and with the stages of medical training in Brazil. METHODS: This is an exploratory cross-sectional study using an online questionnaire to be filled out on a voluntary basis among medical students and residents, consisting of: socio-demographic data, an empathy questionnaire and questions with elaborate clinical cases that typify situations of the variants of euthanasia. RESULTS: From 1550 invitations, 273 volunteer participants responded (17.6%). The percentages of strong agreement/agreement on the concepts were: passive euthanasia (72.9%); active euthanasia (22.3%), orthothanasia (90.1%), dysthanasia (18.7%), assisted suicide (33%) and sedation (82.8%). Passive euthanasia, active euthanasia, dysthanasia and assisted suicide showed greater refusal with increasing length of medical training. Religious belief and degree of empathy did not significantly influence the opinion about the concepts. Strong agreement/agreement were: passive euthanasia (72.9%); active euthanasia (22.3%), orthothanasia (90.1%), dysthanasia (18.7%), assisted suicide (33%) and sedation (82.8%). CONCLUSIONS: Passive euthanasia, active euthanasia, dysthanasia and assisted suicide showed greater refusal with increasing length of medical training. The external validation of our findings relies on the distinct legal, cultural, and religious frameworks found across various countries.

Experiences of disabled students in undergraduate medical education.

PURPOSE: Since people with disabilities (PwD) are underrepresented in medical education, the authors of this article conducted a qualitative research in the form of an in-depth interview with students with disabilities from a medical school in Brazil, to characterize their experiences in medical education and identify barriers and facilitators to inclusion. MATERIALS AND METHODS: Participants were recruited by snowball sampling, signed an informed consent form, and completed a socioeconomic questionnaire. They were interviewed individually with open-ended questions so that they could develop narratives. RESULTS: The students identified some barriers to inclusion - teachers' lack of knowledge about students' special needs, students' own lack of knowledge about their needs during the medical course, underestimation of the disability by teachers and classmates, difficult access to college buildings - and facilitators, such as acceptance of the disability by professors and colleagues, proactivity of professors and colleagues in adapting practical learning scenarios. CONCLUSION: Students identified peer and teacher acceptance as an important determinant of inclusion, which is in line with the biopsychosocial view of disability. They also reported doubts about their ability to practice medicine, which dialogues with literature research that points to a medical culture that expects nothing less than perfection from students.

Belas artes para estudantes de medicina: motivando debates transformadores / Fine arts for medical students: driving transformative debates

Introdução: Debater artes durante a graduação pode ser uma forma criativa de desenvolver novas percepções e perspectivas para estudantes de medicina. Promover atividades que visem criar momentos envolvendo temáticas humanísticas, simultaneamente ao conhecimento técnico médico, como artes e atividades físicas em um ambiente lúdico, continua sendo um desafio. Nesse contexto, foi criado um Programa Extracurricular de Aperfeiçoamento Global de Estudantes de Medicina (GIPMS) da Universidade de Fortaleza, que incluiu encontros envolvendo diversos estímulos artísticos. Objetivo: O objetivo deste trabalho é avaliar se o contato com a arte durante a graduação no contexto do GIPMS pode gerar percepções, sentimentos e reflexões para proporcionar importantes debates. Métodos: Foi realizado um estudo qualitativo prospectivo com um total de 42 sessões de grupo focal, que foram gravadas e transcritas na íntegra. Cada grupo foi conduzido por 2 mentores, e todos os 6 grupos focais utilizaram questionários qualitativos padronizados nas sessões, que foram realizadas a cada 45 dias. Foi realizada uma análise temática das transcrições, confirmada com o software QSR NVIVO (versão 11). Resultados: Um total de 40 alunos (15 homens e 25 mulheres) participaram deste estudo de um ano. As categorias encontradas foram: Os estímulos artísticos foram capazes de fazer os participantes pensarem (124 citações), sentirem (78, 65 sobre sentimentos positivos e 13 sobre sentimentos negativos) e lembrarem (41). Destacaram-se: a influência da carga horária de estudos no tempo dedicado às artes e às reflexões (61); relação entre arte e vida e produtividade acadêmica (75); mudanças de atitudes proporcionadas pelos estímulos artísticos propostos (38 citações). Conclusões: O programa foi capaz de gerar, de forma inovadora, novas percepções de sentimentos, sensações e reflexões, bem como evocar memórias que proporcionaram debates importantes, que, segundo os próprios alunos, serviram de inspiração para mudar perspectivas e atitudes e proporcionou benefícios subjetivos na vida acadêmica. [au]

Introduction: Debating arts during graduation can be a creative way to develop new perceptions and perspectives for medical students. To promote activities that aim to create moments involving humanistic themes, simultaneously to technical medical knowledge, such as arts and physical activities in a playful setting, remains a challenge. A extracurricular Global Improvement Programme of Medical Students (GIPMS) of the University of Fortaleza was created on this context, and included meetings involving various artistic stimuli. Purpose: The objective of this paper is to evaluate if the contact with art during graduation in the context of GIPMS can generate perceptions, feelings and reflections to provide important debates. Methods: A prospective qualitative study was conducted including a total of 42 focal group sessions, which were recorded and fully transcribed. Each group was conducted by 2 mentors, and all 6 focal groups used standardized qualitative questionnaires each session, which were performed every 45 days. A thematic analysis of the transcripts was performed, confirmed with the QSR NVIVO software (version 11). Results: A total of 40 students (15 men and 25 women) participated in this one-year study. The categories found were: Artistic stimuli were able to make participants think (124 quotes), feel (78, 65 about positive feelings and 13 about negative ones) and remember (41). The following stood out: the influence of the time load of studies in the time dedicated to the arts and the reflections. (61); relationship between the arts and life and academic productivity (75); changes in attitudes provided by the proposed artistic stimuli (38 citations). Conclusions: The program was able to generate, in an innovative way, new perceptions of feelings, sensations and reflections, as well as to evoke memories that provided important debates, which, according to the students themselves, served as inspiration to change perspectives and attitudes and provided subjective benefits in academic life. [au]

Rape culture and ostentatious violence: an analysis from the artifactuality of funk

The present study analyzed, from the perspective of social constructionism, funk songs with a broad media repercussion and significant sharing in streaming services, with lyrics that refer to sexual violence: Baile de Favela and Malandramente. The study was carried out through dialogic analysis and followed by the development of a dialogic map. The results point to the construction of the perfect victim, which trivializes sexual violence by blaming the victim. It also erotizes childhood in the construction of victims and perpetrators, whose puerility is mocked by vulgarizing sexual violence and the exaltation of collective rape, exploring possibilities of sexual relations permeated by gender violence. The findings reveal an alarming scenario. Despite the important role that funk plays as an emancipatory cultural practice, the meanings of sexual violence in the lyrics of the songs exposed the development of conflicting relationships between genders as a social norm.(AU)

Implementation of a residency program in anesthesiology in the Northeast of Brazil: impact on work processes and professional motivation / Implantação de residência em anestesiologia no interior do Nordeste do Brasil: impacto nos processos de trabalho e na motivação profissional / Implantación de residencia en anestesiología en el interior del nordeste de Brasil: impacto en los procesos de trabajo y en la motivación profesional

BACKGROUND AND OBJECTIVES: To understand, through the theory of social representations, the influence exerted by the establishment of a residency program in anesthesiology on anesthetic care and professional motivation in a tertiary teaching hospital in the Northeast of Brazil. METHOD: Qualitative methodology. The theoretical framework comprised the phenomenology and the social representation theory. Five multidisciplinary focus groups were formed with 17 health professionals (five surgeons, five anesthesiologists, two nurses, and five nursing technicians), who work in operating rooms and post-anesthesia care units, all with a prior and a posteriori experience to the establishment of residency. RESULTS: From the response content analysis, the following empirical categories emerged: motivation to upgrade, recycling of anesthesiologists and improving anesthetic practice, resident as an interdisciplinary link in perioperative care, improvements in the quality of perioperative care, and recognition of weaknesses in the perioperative process. It was evident from upper gastrointestinal bleeding secondary to prolonged intubation that the creation of a residency in anesthesiology brings advancements that are reflected in the motivation of anesthesiologists; the resident worked as an interdisciplinary link between the multidisciplinary team; there was recognition of weaknesses in the system, which were identified and actions to overcome it were proposed. CONCLUSION: The implementation of a residency program in anesthesiology at a tertiary education hospital in the Northeast of Brazil promoted scientific updates, improved the quality of care and processes of interdisciplinary care, recognized the weaknesses of the service, developed action plans and suggested that this type of initiative may be useful in remote areas of developing countries. .

JUSTIFICATIVA E OBJETIVOS: Compreender, pela teoria das representações sociais, a influência exercida pela implantação de um programa de residência em anestesiologia nos cuidados anestésicos e na motivação profissional em um hospital de ensino terciário do interior do Nordeste do Brasil. MÉTODO: Metodologia qualitativa. A fenomenologia e a teoria da representação social foram o referencial teórico. Formaram-se cinco grupos focais multidisciplinares, com 17 profissionais de saúde (cinco cirurgiões, cinco anestesiologistas, duas enfermeiras e cinco técnicos de enfermagem) que atuam no Centro Cirúrgico e na Sala de Recuperação Pós-Anestésica, todos com experiência anterior e posterior à implantação da referida residência. RESULTADOS: Da análise de conteúdo das falas, emergiram as seguintes categorias empíricas: motivação para atualização, reciclagem dos profissionais anestesiologistas e melhoria das práticas anestésicas; o residente como um elo interdisciplinar nos cuidados perioperatórios; melhorias na qualidade da assistência perioperatória; reconhecimento de fragilidades no processo perioperatório. Evidenciou-se que a criação de uma residência em anestesiologia traz avanços, que se refletem na motivação dos anestesiologistas; o residente funcionou como um elo interdisciplinar entre a equipe multiprofissional; houve reconhecimento de fragilidades do sistema, identificaram-se as deficiências e apontaram-se ações para superação. CONCLUSÃO: A implantação de um programa de residência em anestesiologia em um hospital de ensino terciário do interior do Nordeste do Brasil promoveu atualizações científicas, melhorou a qualidade da assistência e os processos de cuidados interdisciplinares, reconheceu as fragilidades do serviço, desenvolveu planos de ação e sugeriu que esse tipo de iniciativa pode ser útil em áreas remotas de países em desenvolvimento. .

JUSTIFICACIÓN Y OBJETIVOS: Comprender, por la teoría de las representaciones sociales, la influencia ejercida por la implantación de un programa de residencia en anestesiología en los cuidados anestésicos y en la motivación profesional en un hospital de enseñanza terciaria del interior del nordeste de Brasil. MÉTODO: Metodología cualitativa. La fenomenología y la teoría de la representación social fueron el referente teórico. Se formaron 5 grupos focales multidisciplinarios con 17 profesionales de sanidad (5 cirujanos, 5 anestesistas, 2 enfermeras y 5 técnicos de enfermería), que actúan en el quirófano y en la sala de recuperación postanestésica, todos con experiencia anterior y posterior a la implantación de la referida residencia. RESULTADOS: Del análisis de contenido de los testimonios surgieron las siguientes categorías empíricas: motivación para la actualización, reciclaje de los profesionales anestesistas y mejoría de las prácticas anestésicas; el residente como un eslabón interdisciplinario en los cuidados perioperatorios; mejorías en la calidad de la asistencia perioperatoria; reconocimiento de las fragilidades en el proceso perioperatorio. Quedó demostrado que la creación de una residencia en anestesiología trae avances que se reflejan en la motivación de los anestesistas; el residente funcionó como un eslabón interdisciplinario entre el equipo multiprofesional; hubo un reconocimiento de las fragilidades del sistema, se identificaron las deficiencias y se indicaron las acciones para superarlas. CONCLUSIÓN: La implantación de un programa de residencia en anestesiología en un hospital de enseñanza terciaria del interior del nordeste de Brasil generó actualizaciones científicas, mejoró la calidad de la asistencia y los procesos de cuidados interdisciplinarios, reconoció las fragilidades del servicio, desarrolló planes de acción y mostró que ese tipo de iniciativa puede ser útil en áreas remotas de países en desarrollo. .

[Implementation of a residency program in anesthesiology in the Northeast of Brazil: impact on work processes and professional motivation]. / Implantação de residência em anestesiologia no interior do Nordeste do Brasil: impacto nos processos de trabalho e na motivação profissional.

BACKGROUND AND OBJECTIVES: Understand, through the theory of social representations, the influence exerted by the establishment a residency program in anesthesiology on anesthetic care and professional motivation in a tertiary teaching hospital in the Northeast of Brazil. METHOD: Qualitative methodology. The theoretical framework comprised the phenomenology and the Social Representation Theory. Five multidisciplinary focus groups were formed with 17 health professionals (five surgeons, five anesthesiologists, two nurses, and five nursing technicians), who work in operating rooms and post-anesthesia care units, all with prior and posterior experience to the establishment of residency. RESULTS: From the response content analysis, the following empirical categories emerged: motivation to upgrade, recycling of anesthesiologists and improving anesthetic practice, resident as an interdisciplinary link in perioperative care, improvements in the quality of perioperative care, recognition of weaknesses in the perioperative process. It was evident upper gastrointestinal bleeding secondary to prolonged intubation that the creation of a residency in anesthesiology brings advancements that are reflected in the motivation of anesthesiologists; the resident worked as an interdisciplinary link between the multidisciplinary team; there was recognition of weaknesses in the system, which were identified and actions to overcome it were proposed. CONCLUSION: The implementation of a residency program in anesthesiology at a tertiary education hospital in the Northeast of Brazil promoted scientific updates, improved the quality of care and processes of interdisciplinary care, recognized the weaknesses of the service, developed action plans and suggested that this type of initiative may be useful in remote areas of developing countries.

Empathy among medical students: is there a relation with quality of life and burnout?

BACKGROUND: We aimed to assess medical students' empathy and its associations with gender, stage of medical school, quality of life and burnout. METHOD: A cross-sectional, multi-centric (22 medical schools) study that employed online, validated, self-reported questionnaires on empathy (Interpersonal Reactivity Index), quality of life (The World Health Organization Quality of Life Assessment) and burnout (the Maslach Burnout Inventory) in a random sample of medical students. RESULTS: Out of a total of 1,650 randomly selected students, 1,350 (81.8%) completed all of the questionnaires. Female students exhibited higher dispositional empathic concern and experienced more personal distress than their male counterparts (p<0.05; d ≥ 0.5). There were minor differences in the empathic dispositions of students in different stages of their medical training (p<0.05; f<0.25). Female students had slightly lower scores for physical and psychological quality of life than male students (p<0.05; d<0.5). Female students scored higher on emotional exhaustion and lower on depersonalization than male students (p<0.001; d<0.5). Students in their final stage of medical school had slightly higher scores for emotional exhaustion, depersonalization and personal accomplishment (p<0.05; f<0.25). Gender (ß = 0.27; p<0.001) and perspective taking (ß = 0.30; p<0.001) were significant predictors of empathic concern scores. Depersonalization was associated with lower empathic concern (ß =  -0.18) and perspective taking (ß =  -0.14) (p<0.001). Personal accomplishment was associated with higher perspective taking (ß = 0.21; p<0.001) and lower personal distress (ß =  -0.26; p<0.001) scores. CONCLUSIONS: Female students had higher empathic concern and personal distress dispositions. The differences in the empathy scores of students in different stages of medical school were small. Among all of the studied variables, personal accomplishment held the most important association with decreasing personal distress and was also a predicting variable for perspective taking.