Mental health and quality of life across 6 years of medical training: A year-by-year analysis.

BACKGROUND: Despite growing evidence on medical students' mental health deterioration, studies have primarily used short follow-up periods and not followed the students throughout their medical training. OBJECTIVE: To assess mental health (stress, anxiety, and depression) and quality of life changes throughout their medical program, we followed up with the same cohort of students for 6 years. METHODS: This longitudinal prospective study followed up with the same group of medical students at a Brazilian public medical school from 2014 to 2020. The study analyzed sociodemographic data, mental health (including depression, anxiety, and stress [DASS-21]), quality of life (WHOQOL-BREF), satisfaction from studying to be a physician, and happiness with life. General linear mixed models were used for the analyses. RESULTS: The cohort included 80 Brazilian medical students (63.7% women; mean age = 19.6 years [SD = 2.21]). A high prevalence of depressive symptoms, anxiety, and stress was found throughout medical training, with more than 50% of students having significant symptoms. Mental health, happiness, and quality of life levels tended to be better in the first and last semesters, being worse in the middle of the program. However, satisfaction from studying to become a doctor decreased in the second semester, remained low throughout the program, and never returned to baseline levels. CONCLUSION: Mental health and quality of life levels remained high throughout the medical program, with better levels in the first and last semesters and falling in the middle of the program. These data can help managers and educators understand how psychological distress affects medical students.

Mental health throughout the medical career: A comparison of depression, anxiety, and stress levels among medical students, residents, and physicians.

BACKGROUND: Different stages of a physician's career may be associated with different types of mental health impairment. AIMS: This study aimed to compare symptoms of anxiety, depression, and stress and their associated factors among medical students, medical residents, and physicians. METHODS: A cross-sectional study was conducted. Data collection included sociodemographic data, religiosity (Duke University Religion Index), and mental health (21-item Depression, Anxiety and Stress Scale - DASS-21) data. The comparison between the groups was performed using ANOVA, and the associated factors were evaluated via linear regression models. RESULTS: The sample consisted of 1,417 participants: 778 medical students, 190 medical residents, and 468 established physicians. Medical students had significantly higher depression, anxiety, and stress scores as compared to medical residents and established physicians. However, regarding DASS 21 scores, no significant differences were found between established physicians and medical residents. The factors associated with mental health in the different groups showed that being married and male were associated with better mental health among physicians and medical residents, while the factors of male gender, being in later years of the course, and lower religious attendance were associated with better mental health in students. CONCLUSION: Medical students had worse mental health outcomes when compared to residents and established physicians. Interventions are needed to minimize suffering during medical education and career.

Do different pedagogical conceptions result in different quality of life levels?

OBJECTIVE: The present study aims to compare medical students' quality of life (QoL) at two Brazilian institutions with different pedagogical conceptions. METHODS: We studied students during the first four years of medical school at two institutions (one using active methodologies and small groups and the other using traditional lectures and large groups). We used a demographic questionnaire and the WHOQOL-BREF. RESULTS: 820 medical students were included. No significant differences in quality of life were found in general, nor while evaluating the course phase, except for the physical WHOQOL, which was lower for 2nd-year students at the institution with traditional lectures, even when adjusted for gender. CONCLUSION: Our findings revealed that, despite having very distinct pedagogical conceptions and characteristics, there were no significant differences in medical students' QoL scores between both institutions. These results are surprising and differ from our initial hypothesis, which expected better QoL for those using more active and student-centered methods.

Do different pedagogical conceptions result in different quality of life levels?

SUMMARY OBJECTIVE The present study aims to compare medical students' quality of life (QoL) at two Brazilian institutions with different pedagogical conceptions. METHODS We studied students during the first four years of medical school at two institutions (one using active methodologies and small groups and the other using traditional lectures and large groups). We used a demographic questionnaire and the WHOQOL-BREF. RESULTS 820 medical students were included. No significant differences in quality of life were found in general, nor while evaluating the course phase, except for the physical WHOQOL, which was lower for 2nd-year students at the institution with traditional lectures, even when adjusted for gender. CONCLUSION Our findings revealed that, despite having very distinct pedagogical conceptions and characteristics, there were no significant differences in medical students' QoL scores between both institutions. These results are surprising and differ from our initial hypothesis, which expected better QoL for those using more active and student-centered methods.

RESUMO OBJETIVO O presente estudo tem como objetivo comparar a qualidade de vida (QV) de estudantes de medicina de duas instituições brasileiras com diferentes concepções pedagógicas. MÉTODOS Estudo comparativo incluindo estudantes do 1o ao 4o ano do curso de medicina de duas instituições no Brasil (uma usando metodologias ativas e pequenos grupos e a outra aulas expositivas tradicionais e grandes grupos). Utilizou-se um questionário demográfico e o instrumento WHOQOL-Bref. RESULTADOS Foram incluídos 820 estudantes de medicina. Nenhuma diferença significativa na qualidade de vida foi encontrada no geral e na avaliação por fase do curso, com exceção do WHOQOL físico, que mostrou ser mais baixo para os estudantes da da instituição com aulas tradicionais, mesmo quando ajustado para o gênero. CONCLUSÃO Nossos achados revelaram que apesar de terem concepções e características pedagógicas bem distintas, não se observaram diferenças significativas nos escores de QV dos estudantes de medicina das duas instituições. Esses resultados são surpreendentes e diferem da nossa principal hipótese, uma vez que esperávamos uma melhora de QV para aqueles que usam métodos mais ativos e centrados no estudante.

Current status of Brazilian interprofessional education: a national survey comparing physical therapy and medical schools.

OBJECTIVES: To investigate how many Brazilian medical and physical therapy schools have initiatives and courses related to IPE in their curricula, assessing the barriers and factors associated with their implementation and comparing the differences between both programs. METHODS: This nationwide survey was carried out in 2017 and included representatives of all physical therapy and medical schools in Brasil. Offers of interprofessional activities and related opinions and barriers were evaluated. RESULTS: A total of 76 (33.9%) of the medical and 159 (41.4%) of the physical therapy schools answered the questionnaires. At least 68.4% of the medical schools and 79.2% of the physical therapy schools have IPE initiatives, although the number of mandatory courses and clerkships is still low. Despite recognizing IPE's importance in health education, school representatives see the lack of integration of programs, conflicting schedules, and the lack of institutional support as barriers. In physical therapy, there is a smaller perception of barriers and greater incorporation of mandatory programs in the curriculum. CONCLUSION: These results will help in the development of future interventions that can enhance IPE in curricula in developing countries.

Current status of Brazilian interprofessional education: a national survey comparing physical therapy and medical schools

SUMMARY OBJECTIVES To investigate how many Brazilian medical and physical therapy schools have initiatives and courses related to IPE in their curricula, assessing the barriers and factors associated with their implementation and comparing the differences between both programs. METHODS This nationwide survey was carried out in 2017 and included representatives of all physical therapy and medical schools in Brasil. Offers of interprofessional activities and related opinions and barriers were evaluated. RESULTS A total of 76 (33.9%) of the medical and 159 (41.4%) of the physical therapy schools answered the questionnaires. At least 68.4% of the medical schools and 79.2% of the physical therapy schools have IPE initiatives, although the number of mandatory courses and clerkships is still low. Despite recognizing IPE's importance in health education, school representatives see the lack of integration of programs, conflicting schedules, and the lack of institutional support as barriers. In physical therapy, there is a smaller perception of barriers and greater incorporation of mandatory programs in the curriculum. CONCLUSION These results will help in the development of future interventions that can enhance IPE in curricula in developing countries.

RESUMO OBJETIVOS Investigar quantas escolas médicas e de fisioterapia brasileiras possuem iniciativas e cursos relacionados à EIP nos currículos, avaliando as barreiras e fatores associados com essa implementação e comparando as diferenças entre esses dois cursos. MÉTODOS Essa pesquisa nacional foi conduzida em 2017 e incluiu representantes das escolas médicas e de fisioterapia no Brasil. As ofertas de atividades interprofissionais, assim como as opiniões e barreiras para implementação, foram avaliadas. RESULTADOS Um total de 76 (33,9%) escolas médicas e 159 (41.4%) escolas de fisioterapia respondeu aos questionários. Pelo menos 68,4% das escolas médicas e 79,2% das escolas de fisioterapia possuem iniciativas de EIP, embora o número de cursos obrigatórios e estágios ainda seja baixo. Apesar de reconhecer a importância da EIP na educação em saúde, os representantes das escolas percebem como barreiras a falta de integração entre os cursos, associada a cronogramas incompatíveis e uma falta de suporte institucional. Na fisioterapia, existe menor percepção de barreiras e uma grande incorporação de cursos obrigatórios no currículo. CONCLUSÃO Esses resultados auxiliarão no desenvolvimento de futuras intervenções que promovam a EIP no currículo dos países em desenvolvimento.

Alinhamento de Diferentes Projetos Pedagógicos de Cursos de Medicina com as Diretrizes Curriculares Nacionais / Alignment of Different Pedagogical Projects of Medicine Courses with the National Curricular Guidelines

RESUMO O objetivo desta pesquisa foi analisar os projetos pedagógicos de dois cursos (PPC) de graduação em Medicina para determinar o grau de alinhamento às Diretrizes Curriculares Nacionais (DCN) do ensino médico, visando compreender as diferenças decorrentes dos modelos curriculares adotados. Três especialistas em ensino médico foram convidados a analisar os documentos relativos aos projetos pedagógicos de curso (PPC) e preencher um instrumento de avaliação desenvolvido para avaliar adesão às DCN 2001, previamente publicado, com dez dimensões. O escore calculado por meio do instrumento classifica as escolas em relação ao grau de aderência às DCN, sendo valores de escore de 0 a ≤ 20%, de 20 a ≤ 40%, de 40 a ≤ 60%, de 60 a ≤ 80% e de > 80% considerados, respectivamente, divergente, fracamente aderente, regular aderência, aderente moderadamente e fortemente aderente. Também se realizou análise de conteúdo dos PPC para buscar evidências sobre os domínios no texto. Os escores totais, de 47,5% (IES1) e 82,5% (IES2), mostraram adesão regular do PPC da IES1 e acentuada do PPC da IES2 às DCN 2001. Essas diferenças se manifestaram especialmente nas dimensões da adequação da metodologia de ensino à concepção do curso, da inter-relação das disciplinas na concepção e execução do currículo e na existência de módulos ou temas integradores. As análises dos PPC mostraram que, de maneira geral, há aderência às DCN, em diferentes estágios. Observou-se boa confiabilidade desse instrumento utilizado na análise dos três avaliadores para ambas as instituições de ensino superior (alfa de Cronbach de 0,77 para a IES1 e de 0,75 para a IES2). A comparação das médias dos escores dos avaliadores por dimensão foi submetida a uma análise de significância com o Teste t de Student. Conclui-se que as duas escolas, em intensidade e por caminhos diferentes e respeitando a cultura institucional, incorporaram paulatinamente o arcabouço das diretrizes curriculares nacionais.

ABSTRACT The objective of this research was to analyze the pedagogical projects of two undergraduate medical education courses (CPP) to determine the degree of alignment with the National Curricular Guidelines (NDC) of Medical Education, aiming to understand the differences that arise from the curricular models adopted. Three medical education experts were invited to review the documents relating to the course pedagogical projects (CPP) and to complete an evaluation instrument developed to evaluate adherence to the previously published ten-dimensional DCN 2001. The score calculated from the instrument classifies the schools in relation to the degree of adherence to the DCN, with scores ranging from 0 ≤ to 20%, from 20 to ≤ 40%; 40 to ≤ to 60%; from 60 to ≤ to 80% and from > 80% considered respectively, divergent, poorly adherent, regular adherence, adherent moderately and strongly adherent. Content analysis of PPPs was also conducted to search for evidence on domains in the text. The total scores of 47.5% (Institution of Higher Education 1) and 82.5% (Institution of Higher Education 2), showed regular adherence of the PPC of Institution of Higher Education 1 and marked of the CPP of Institution of Higher Education 2 to DCN 2001. These differences were manifested especially in the dimensions of the adequacy of the teaching methodology to the course design, of the interrelationship of the disciplines in the conception and execution of the curriculum and in the existence of integrating modules or themes. The CPP analyzes showed that, in general, there is adherence to the DCN in different stages. We observed a good reliability of this instrument used in the analysis of the three evaluators for both institutions of higher education (Cronbach's alpha of 0.77 for Institution of Higher Education 1 and Cronbach's alpha of 0.75 for the Institution of Higher Education 2). The comparison of the means of the scores of the evaluators by size was submitted to a significance analysis with the Student t Test. It is concluded that the two schools, in intensity and in different ways and respecting the institutional culture, gradually incorporated the framework of the national curricular guidelines.

Mental health and quality of life of Brazilian medical students: Incidence, prevalence, and associated factors within two years of follow-up.

Medical students' mental health and quality of life (QoL) cause growing concern worldwide, but, to date, few longitudinal studies have followed these students. Our objective was to evaluate the incidence, prevalence, and factors associated with quality of life and symptoms of depression, anxiety, and stress of Brazilian medical students who were followed for a period of two years. Students' mental health (DASS-21), QoL (WHOQOL-Bref), and religiousness (DUREL) were evaluated in four different waves(four semesters). A total of 312 (54.2%) medical students responded to all four waves. Medical students demonstrated a high prevalence and incidence of emotional disorders. Almost half of the students presented high levels of depression, anxiety, and stress during the two-year follow-up; approximately one out of five students without symptoms at the baseline were considered new cases and these problems have a cyclical nature. Baseline factors such as depression, anxiety, stress, having low income, being female, being in the early stages of medical training and non-white were associated with poorer mental health and quality of life in the follow-up. Our results show that medical students have a high prevalence and incidence of mental health disorders during their medical training. This data may help educators plan preventive strategies.

Mapping scientific research on the negative aspects of the medical school learning environment.

OBJECTIVE: We sought to understand the landscape of published articles regarding medical schools' learning environments (LE) worldwide, with an explicit focus on potentially harmful aspects of the LE as an effort to identify areas specifically in need of remediation or intervention that could prevent future unprofessional behaviors, burnout, violence and mistreatment among students and physicians. METHODS: A bibliometric analysis was conducted in six electronic databases (PubMed/Medline, Web of Science, Cochrane Library, SCOPUS, ERIC-ProQuest, and PsycINFO) up to December 31, 2016, including 12 themes: learning environment - general, hidden curriculum (harmful), unethical behaviors, bullying/hazing, violence, sexual discrimination, homophobia, racism, social discrimination, minorities discrimination, professional misconduct, and other negative aspects. RESULTS: Of the 9,338 articles found, 710 met the inclusion criteria. The most common themes were general LE (233 articles), unprofessional behaviors (91 articles), and sexual discrimination (80 articles). Approximately 80% of articles were published in the 21st century. CONCLUSION: There is a definite increase in scientific articles on negative aspects of the medical school LE in high-quality journals, especially in the 21st century. However, more studies are needed to investigate negative LE aspects with greater attention to experimental, longitudinal, and cross-cultural study designs.

Mapping scientific research on the negative aspects of the medical school learning environment

SUMMARY OBJECTIVE: We sought to understand the landscape of published articles regarding medical schools' learning environments (LE) worldwide, with an explicit focus on potentially harmful aspects of the LE as an effort to identify areas specifically in need of remediation or intervention that could prevent future unprofessional behaviors, burnout, violence and mistreatment among students and physicians. METHODS: A bibliometric analysis was conducted in six electronic databases (PubMed/Medline, Web of Science, Cochrane Library, SCOPUS, ERIC-ProQuest, and PsycINFO) up to December 31, 2016, including 12 themes: learning environment - general, hidden curriculum (harmful), unethical behaviors, bullying/hazing, violence, sexual discrimination, homophobia, racism, social discrimination, minorities discrimination, professional misconduct, and other negative aspects. RESULTS: Of the 9,338 articles found, 710 met the inclusion criteria. The most common themes were general LE (233 articles), unprofessional behaviors (91 articles), and sexual discrimination (80 articles). Approximately 80% of articles were published in the 21st century. CONCLUSION: There is a definite increase in scientific articles on negative aspects of the medical school LE in high-quality journals, especially in the 21st century. However, more studies are needed to investigate negative LE aspects with greater attention to experimental, longitudinal, and cross-cultural study designs.

RESUMO OBJETIVO: Buscou-se entender o panorama dos artigos publicados sobre os ambientes de aprendizagem (AA) das escolas médicas em todo o mundo, com um foco explícito nos aspectos potencialmente negativos do AA como um esforço para identificar áreas especificamente necessitadas de remediação ou intervenção que poderiam evitar futuros comportamentos não profissionais, violência e maus-tratos entre estudantes e médicos. MÉTODOS: Foi realizada uma análise bibliométrica em seis bases de dados eletrônicas (PubMed / Medline, Web of Science, Biblioteca Cochrane, SCOPUS, ERIC-ProQuest e PsycINFO) até 31 de dezembro de 2016, incluindo 12 temas: ambiente de aprendizagem - geral, currículo oculto (negativo), comportamentos antiéticos, bullying/trote, violência, discriminação sexual, homofobia, racismo, discriminação social, discriminação de minorias, má conduta profissional e "outros" aspectos negativos. RESULTADOS: Dos 9.338 artigos encontrados, 710 preencheram os critérios de inclusão. Os temas mais comuns foram LE geral (233 artigos), comportamentos não profissionais (91 artigos) e discriminação sexual (80 artigos). Aproximadamente 80% dos artigos foram publicados no século XXI. CONCLUSÃO: Há um claro aumento em artigos científicos sobre aspectos negativos da escola de medicina LE em periódicos de alta qualidade, especialmente no século XXI. No entanto, mais estudos são necessários para investigar aspectos negativos do LE com maior atenção aos desenhos de estudos experimentais, longitudinais e transculturais.

Prevalence, Incidence, and Factors Associated With Substance Use Among Medical Students: A 2-Year Longitudinal Study.

OBJECTIVES: Although there are a number of studies about substance use by medical students, the majority are still cross-sectional. We aimed to investigate prevalence, 2-year incidence, and factors associated with substance use during medical training. METHODS: This longitudinal study included medical students in 4 different waves (with each wave equaling 1 semester). Socio-demographic data, Duke Religion Index (DUREL), DASS-21, and the "Alcohol, Smoking and Substance Involvement Screening Test" (ASSIST) were used. RESULTS: A total of 327 (56.2%) medical students were followed for 2 years. Prevalence of lifetime substance use was 89.9% for alcohol, 34.5% for cannabis, and 17.1% for sedatives. Tobacco had the greatest incidence of use over the 2 years (16.4%), followed by alcohol (13.8%) and cannabis (13.8%). At least 24% of the students would need an intervention for alcohol use, 11.4% for tobacco, and 6.5% for cannabis. Alcohol use during wave 4 was associated with organizational religiosity, and alcohol and tobacco use at the baseline; tobacco use during wave 4 was associated with age, non-organizational religiosity, and cannabis and tobacco use at the baseline; and cannabis use during wave 4 was associated with cannabis and tobacco use at the baseline. CONCLUSIONS: Our results indicate an increase in the incidence of lifetime substance use during medical training. Prior use of substance was associated with a higher chance of use after 2 years, while age and religiousness seem to reduce the chance of use.

Mapping the scientific research on the negative aspects of the medical school learning environment.

OBJECTIVE: We sought to understand the landscape of published articles regarding medical schools' learning environments (LE) worldwide, with an explicit focus on potentially negative aspects of the LE as an effort to identify areas specifically in need of remediation or intervention that could prevent future unprofessional behaviours, burnout, violence and mistreatment among students and physicians. METHODS: A bibliometric analysis was conducted in six electronic databases (PubMed/Medline, Web of Science, Cochrane Library, SCOPUS, ERIC-ProQuest and PsycINFO) through December 31, 2016, including 12 themes: learning environment - general, hidden curriculum (negative), unethical behaviours, bullying/hazing, violence, sexual discrimination, homophobia, racism, social discrimination, minorities' discrimination, professional misconduct, and "other" negative aspects. RESULTS: Of 9,338 articles found, 710 met the inclusion criteria. The most common themes were general LE (233 articles), unprofessional behaviours (91 articles), and sexual discrimination (80 articles). Approximately 80% of articles were published in the 21st century. CONCLUSION: There is a clear increase in scientific articles on negative aspects of the medical school LE in high-quality journals, especially in the 21st century. However, more studies are needed to investigate negative LE aspects with greater attention paid to experimental, longitudinal, and cross-cultural study designs.

Comparison of students' motivation at different phases of medical school.

INTRODUCTION: Knowledge about student motivation allows educators to broaden their understanding and to establish strategies that make it possible to enhance motivation. OBJECTIVES: To investigate the levels of student motivation at different phases of medical education, comparing incoming students' motivation with that of those at the end of their studies, as well as during the different preclinical, clinical, and clerkship cycles. METHOD: Cross-sectional study including students from a Brazilian public university. The questionnaire included sociodemographic data and the Academic Motivation Scale (AMS). Student motivation was compared at different phases of the medical course. RESULTS: 710 students were included. Students in the preclinical phase (1st-2nd years) had higher levels of integrated regulation AMS (e.g.,"Education is a privilege."), introjected regulation AMS (e.g."I come because it is what is expected of me."), and intrinsic motivation AMS (e.g."School is a pleasure"). Students in the clinical phase (3rd-4th years) had higher levels of amotivation (e.g., "I'm wasting my time at school.") and external regulation AMS (e.g., "I'm coming to school to earn a degree"). AMS levels of external regulation, introjected relation, and integrated regulation were different for Clerkship students (5th-6th years) compared to preclinical students, but not for clinical students. Comparing only the first and last years, incoming students had higher levels of integrated regulation AMS and lower levels of amotivation AMS and external regulation AMS. CONCLUSION: Important motivational changes were found during different phases of medical school, with higher levels of motivation during the course's initial semesters. These findings can aid in developing educational strategies to stimulate self-determined education.

Mapping the scientific research on the negative aspects of the medical school learning environment

SUMMARY Objective: We sought to understand the landscape of published articles regarding medical schools' learning environments (LE) worldwide, with an explicit focus on potentially negative aspects of the LE as an effort to identify areas specifically in need of remediation or intervention that could prevent future unprofessional behaviours, burnout, violence and mistreatment among students and physicians. Methods: A bibliometric analysis was conducted in six electronic databases (PubMed/Medline, Web of Science, Cochrane Library, SCOPUS, ERIC-ProQuest and PsycINFO) through December 31, 2016, including 12 themes: learning environment - general, hidden curriculum (negative), unethical behaviours, bullying/hazing, violence, sexual discrimination, homophobia, racism, social discrimination, minorities' discrimination, professional misconduct, and "other" negative aspects. Results: Of 9,338 articles found, 710 met the inclusion criteria. The most common themes were general LE (233 articles), unprofessional behaviours (91 articles), and sexual discrimination (80 articles). Approximately 80% of articles were published in the 21st century. Conclusion: There is a clear increase in scientific articles on negative aspects of the medical school LE in high-quality journals, especially in the 21st century. However, more studies are needed to investigate negative LE aspects with greater attention paid to experimental, longitudinal, and cross-cultural study designs.

RESUMO OBJETIVO: Buscou-se entender o panorama dos artigos publicados sobre os ambientes de aprendizagem (AA) das escolas médicas em todo o mundo, com um foco explícito nos aspectos potencialmente negativos do AA como um esforço para identificar áreas específicamente necessitadas de remediação ou intervenção que poderiam evitar futuros comportamentos não profissionais, violência e maus-tratos entre estudantes e médicos. Métodos: Foi realizada uma análise bibliométrica em seis bases de dados eletrônicas (PubMed/Medline, Web of Science, Biblioteca Cochrane, Scopus, Eric-ProQuest e PsycInfo) até 31 de dezembro de 2016, incluindo 12 temas: ambiente de aprendizagem - geral, currículo oculto (negativo), comportamentos antiéticos, bullying/trote, violência, discriminação sexual, homofobia, racismo, discriminação social, discriminação de minorias, má conduta profissional e "outros" aspectos negativos. Resultados: Dos 9.338 artigos encontrados, 710 preencheram os critérios de inclusão. Os temas mais comuns foram LE geral (233 artigos), comportamentos não profissionais (91 artigos) e discriminação sexual (80 artigos). Aproximadamente 80% dos artigos foram publicados no século XXI. Conclusão: Há um claro aumento em artigos científicos sobre aspectos negativos da escola de medicina LE em periódicos de alta qualidade, especialmente no século XXI. No entanto, mais estudos são necessários para investigar aspectos negativos do LE com maior atenção aos desenhos de estudos experimentais, longitudinais e transculturais.

Are surface and deep learning approaches associated with study patterns and choices among medical students? A cross-sectional study.

BACKGROUND: Different approaches to learning can exert considerable influence on the teaching-learning process in medical education. This study aimed to investigate the association of surface and deep learning with study patterns, preferred type of assessment, practices of cheating and quality of sleep among medical students. DESIGN AND SETTING: Cross-sectional study on medical students enrolled in all six years of a medical school in Juiz de Fora, Brazil. METHODS: Questionnaires were applied to evaluate learning approaches (R-SPQ-2F), study patterns, sources and choices, and quality of sleep. Students' learning approaches (deep or surface) were assessed in relation to their study patterns, study resources, quality of sleep and whether they cheated in tests. RESULTS: Among the 710 students included, 43% frequently studied on the night before an exam, 65% had used psychostimulants to study and more than 46% had cheated in an exam. Regarding quality of sleep, most students (53.4%) reported that their quality of sleep was poor, such that 45.3% slept for fewer than five hours before an exam. Those who studied just prior to an exam, used class summaries, preferred multiple-choice questions and cheated during the test had a more surface-learning approach. On the other hand, those who read books, preferred practical exams and slept better had a deeper approach. CONCLUSION: The type of learning approach was associated with study patterns and choices among medical students. Educators need to be attentive to the type of learning their students use and think of measures that impact teaching and assessment methods.

Comparison of students' motivation at different phases of medical school

SUMMARY INTRODUCTION: Knowledge about student motivation allows educators to broaden their understanding and to establish strategies that make it possible to enhance motivation. OBJECTIVES To investigate the levels of student motivation at different phases of medical education, comparing incoming students' motivation with that of those at the end of their studies, as well as during the different preclinical, clinical, and clerkship cycles. METHOD: Cross-sectional study including students from a Brazilian public university. The questionnaire included sociodemographic data and the Academic Motivation Scale (AMS). Student motivation was compared at different phases of the medical course. RESULTS: 710 students were included. Students in the preclinical phase (1st-2nd years) had higher levels of integrated regulation AMS (e.g.,"Education is a privilege."), introjected regulation AMS (e.g."I come because it is what is expected of me."), and intrinsic motivation AMS (e.g."School is a pleasure"). Students in the clinical phase (3rd-4th years) had higher levels of amotivation (e.g., "I'm wasting my time at school.") and external regulation AMS (e.g., "I'm coming to school to earn a degree"). AMS levels of external regulation, introjected relation, and integrated regulation were different for Clerkship students (5th-6th years) compared to preclinical students, but not for clinical students. Comparing only the first and last years, incoming students had higher levels of integrated regulation AMS and lower levels of amotivation AMS and external regulation AMS. CONCLUSION: Important motivational changes were found during different phases of medical school, with higher levels of motivation during the course's initial semesters. These findings can aid in developing educational strategies to stimulate self-determined education.

RESUMO INTRODUÇÃO: O conhecimento sobre a motivação dos estudantes possibilita aos educadores ampliar sua compreensão e estabelecer estratégias que possam potencializá-la. OBJETIVOS: Investigar a motivação do estudante em diferentes momentos da formação médica, comparando-se a motivação de alunos ingressantes e do final do curso, assim como nas diferentes fases pré-clínica, clínica e internato. MÉTODOS: Estudo transversal incluindo estudantes de uma universidade pública brasileira. O questionário incluiu dados sociodemográficos e a Escala de Motivação Acadêmica (EMA). A motivação dos estudantes foi comparada nas diferentes fases do curso. RESULTADOS: Foram incluídos 710 estudantes de medicina. Houve diferenças significantes entre a motivação nas diferentes fases do curso de medicina. Estudantes nas fase pré-clínica (1o e 2o anos) possuíam maiores níveis de EMA regulação integrada (e.g. "Educação é um privilégio"), EMA regulação introjetada (e.g. "venho porque é isso que esperam de mim") e EMA motivação intrínseca (e.g. "universidade é um prazer"). já estudantes da fase clínica (3o e 4o anos) possuíam maiores níveis de EMA desmotivação (e.g. "estou perdendo meu tempo na universidade") e EMA regulação externa (e.g. "venho à universidade para conseguir o diploma"). Os estudantes do internato (5o e 6o anos) obtiveram resultados não significantes em relação ao período clínico, mas diferentes em relação ao pré-clínico na EMA regulação externa, EMA regulação introjetada e EMA regulação Integrada. Comparando-se apenas o primeiro com o último semestre do curso, os alunos ingressantes possuíam maiores níveis de EMA regulação integrada e menores níveis de EMA desmotivação e EMA regulação externa. CONCLUSÃO: Foram encontradas mudanças motivacionais importantes entre as diferentes fases da formação médica, tendo maiores níveis de motivação nos períodos iniciais do curso. Esses achados podem auxiliar o desenvolvimento de estratégias educacionais que estimulem a educação autodeterminada.

Translation, Transcultural Adaptation, and Validation of the Empathy, Spirituality, and Wellness in Medicine Scale to the Brazilian Portuguese Language.

Construct: The Empathy, Spirituality, and Wellness in Medicine Scale (ESWIM) is a 43-item multidimensional scale developed to investigate different dimensions of physicians and medical students. Background: Medical education research requires the use of several different instruments with dozens of items that evaluate each construct separately, making their application slow and increasing the likelihood of students providing a large number of incomplete or missing responses. To provide an alternative measure, this study aims to translate, adapt, and validate the multidimensional ESWIM instrument for Brazilian medical students. This is a very promising instrument because it is multidimensional, relatively short, and cost free; it evaluates important constructs; and it has been explicitly designed for use in the medical context. Approach: The English-language instrument was translated and adapted into the Brazilian Portuguese language using standard procedures: translation, transcultural adaptation, and back-translation. ESWIM was administered to students in all years of the medical curriculum. A retest was given 45 days later to evaluate reliability. To assess validity, the questionnaire also included sociodemographic data, the Duke Religion Index, the Empathy Inventory, the brief version of the World Health Organization Quality of Life (WHOQOL-Bref), and the Oldenburg Burnout Inventory. Results: A total of 776 medical students (M age = 22.34 years, SD = 3.11) were assessed. The Brazilian Portuguese version of ESWIM showed good internal consistency for the factor of Empathy (α = 0.79-0.81) and borderline internal consistency for the other factors: Openness to Spirituality (α = 0.61-0.66), Wellness (α = 0.57-0.68), and Tolerance (α = 0.56-0.65). The principal component analysis revealed a four-factor structure; however, the confirmatory factor analysis showed a better fit for a three-factor structure. We found a significant positive correlation between ESWIM empathy and empathy measured by the Empathy Inventory (r = .444, p < .01), as well as negative correlations between ESWIM empathy and burnout (r = -.145 to -.224, p < .01). ESWIM openness to spirituality was also significantly correlated with different subscales of religiosity (r = .301-.417, p < .01), and ESWIM wellness was significantly correlated with the WHOQOL-Bref factors (r = .390-.673, p < .01). The test-retest reliability (applied to 83 students) was high for all factors except Tolerance. Conclusion: This study provides supportive evidence regarding the reliability and validity of ESWIM empathy scores. The ESWIM scale opens a new field of research in relation to openness to spirituality by introducing a scale that measures this openness attitude. Despite borderline internal consistency, ESWIM wellness was strongly associated with quality of life and had good test-retest reliability. Thus, ESWIM appears to be a valid option for evaluating these constructs in medical students.

Using traditional or flipped classrooms to teach "Geriatrics and Gerontology"? Investigating the impact of active learning on medical students' competences.

BACKGROUND: The present study aims to investigate the effect of two educational strategies to teach geriatrics (flipped classroom-FL and traditional lectures-TR) in relation to a control group (no intervention) on students' competences. METHOD: An intervention study was conducted during the third year of medicine. Two different educational strategies (flipped classroom and traditional lectures) were incorporated into a theoretical-practical discipline of geriatrics. Students were evaluated about their attitudes towards older persons (Maxwell-Sullivan, UCLA geriatric attitudes), empathy (Maxwell-Sullivan), knowledge (Palmore and cognitive knowledge), skills (standardized patient assessment), and satisfaction with the activities. RESULTS: A total of 243 students were assessed. The FL group demonstrated greater gains in knowledge among students and improved attitude compared to the TR. We found no differences in the skills using a standardized patient. In addition, students exposed to FL felt more prepared to treat older people, believed they had more knowledge, were more satisfied, and evaluated the discipline's format better in relation to the traditional group. CONCLUSIONS: Strategies in teaching geriatrics can impact students' knowledge, attitudes, and satisfaction with the course. We found that the way this teaching is delivered can influence students' learning, since there were differences between active and traditional strategies.

Geographical distribution of medical graduates from a public university.

OBJECTIVE:: To evaluate the geographic distribution and career trajectory of medical graduates and the factors associated with their choice of practice location. METHOD:: A cross-sectional study involving graduates from December 2001 to December 2010 was conducted. A self-administered questionnaire collected demographics and geographic information (place of birth, place of residence at the time of medical school admission, place of residency training and practice location), and reason for choosing the current location. Statistical analyses assessed trends in geographic distribution of graduates, and identified factors associated with location choice (through the population density of the location chosen for professional practice). RESULTS:: A total of 563 graduates completed the questionnaire. Of those, 4.3% (n=24) reported family medicine as their medical specialty, 19.9% (n=112) reported other primary care specialties (internal medicine, pediatrics, surgery and obstetrics-gynecology) and the others chose subspecialties. Larger cities were more likely to be chosen for practice, particularly for newly-graduated doctors. Job invitations received during medical residency training increased the likelihood of choosing high-populated cities. In contrast, job invitations received during medical school increased the likelihood of choosing cities less populated. Amongst those in cities with lower population density, proximity to family members was an additional influencing factor; those who chose more densely populated cities did so because of better infrastructure and recreational options. CONCLUSION:: Most of the physicians included in this study pursue subspecialties training and were practicing medicine in large cities. Knowing the multiple factors that influenced the choice of practice location can assist in planning future strategies to reduce physician workforce misdistribution.

Geographical distribution of medical graduates from a public university / Distribuição geográfica e trajetória dos médicos egressos de instituição pública

Summary Objective: To evaluate the geographic distribution and career trajectory of medical graduates and the factors associated with their choice of practice location. Method: A cross-sectional study involving graduates from December 2001 to December 2010 was conducted. A self-administered questionnaire collected demographics and geographic information (place of birth, place of residence at the time of medical school admission, place of residency training and practice location), and reason for choosing the current location. Statistical analyses assessed trends in geographic distribution of graduates, and identified factors associated with location choice (through the population density of the location chosen for professional practice). Results: A total of 563 graduates completed the questionnaire. Of those, 4.3% (n=24) reported family medicine as their medical specialty, 19.9% (n=112) reported other primary care specialties (internal medicine, pediatrics, surgery and obstetrics-gynecology) and the others chose subspecialties. Larger cities were more likely to be chosen for practice, particularly for newly-graduated doctors. Job invitations received during medical residency training increased the likelihood of choosing high-populated cities. In contrast, job invitations received during medical school increased the likelihood of choosing cities less populated. Amongst those in cities with lower population density, proximity to family members was an additional influencing factor; those who chose more densely populated cities did so because of better infrastructure and recreational options. Conclusion: Most of the physicians included in this study pursue subspecialties training and were practicing medicine in large cities. Knowing the multiple factors that influenced the choice of practice location can assist in planning future strategies to reduce physician workforce misdistribution.

Resumo Objetivo: Avaliar a distribuição geográfica e a trajetória dos médicos e fatores associados à escolha para o local da prática médica. Método: Estudo transversal envolvendo graduados entre 2001 a 2010, utilizando-se questionário autoaplicado com dados sociodemográficos, informações de localização geográfica (local de nascimento, local onde residia quando entrou na faculdade de medicina, local onde realizou a residência médica e local de prática profissional), e as razões para escolha do local de sua fixação. Análises estatísticas avaliaram as tendências da distribuição dos egressos e os fatores associados com a escolha do local para a prática médica. Resultados: 563 egressos completaram o questionário. Destes, 4,3% (n=24) eram médicos de família, 19,9% (n=112) tinham especialidades em grandes áreas (medicina interna, pediatria, cirurgia e ginecologia-obstetrícia), enquanto os outros escolheram subespecialidades. Houve predomínio da escolha de cidades de grande porte para a prática profissional. Convites para trabalhar recebidos durante a residência médica aumentaram a escolha de cidades de maior densidade populacional. Por outro lado, os convites recebidos durante a graduação influenciaram a escolha de cidades de mais baixa densidade populacional. Para estes últimos, a presença da família no local foi fator de influência, enquanto, para os que escolheram cidades de maior densidade populacional, os fatores de influência foram melhor infraestrutura e mais opções de diversão. Conclusão: A maioria dos médicos deste estudo fixou-se em grandes cidades e escolheu subespecialidades. Conhecer os múltiplos fatores que influenciaram a escolha do local para prática profissional pode auxiliar no planejamento de estratégias para reduzir a má distribuição do trabalho médico.