Innovative, integrative, and interactive in-class activity on metabolic regulation: Evaluating educational impacts.

Medical students tend to have difficulties in developing a holistic view of metabolic pathway and hormone regulation. To address this issue, an interactive activity was implemented for first-year medical students at the School of Medicine, University of Minho, Portugal. Students' previous knowledge on metabolic pathways was evaluated by a pre-test followed by an interactive activity. In the supervised activity, students were challenged to elaborate a diagrammatic representation regarding enzymes, co-factors, and hormonal metabolic regulation in early fasting during the night, as well as in well-fed conditions. The activity was concluded with a post-test to determine the students' learning gains and a few days later students were evaluated by a final exam. Afterwards, students evaluated the activity by filling a questionnaire. Results from four different cohorts showed that the activity resulted in significant learning gains, particularly favoring students who have less prior knowledge. The comparison between the pre-test and the final exam also revealed significant learning gains for low achievers students. On the questionnaires, the majority of the students rated the activity as good or very good. Students agreed that this activity promotes: (a) reactivation of previous knowledge; (b) a better understanding of the interconnections between the metabolic pathways; (c) the application of learned concepts in real scenarios; and (d) sharing knowledge with peers. This study describes an active, unpretentious, and easily implemented activity available for early medical and biochemical curricula.

Depression in medical students: insights from a longitudinal study.

BACKGROUND: Factors associated with depression of medical students are poorly understood. The purpose of this study is to determine the prevalence of depression in medical students, its change during the course, if depression persists for affected students, what are the factors associated with depression and how these factors change over time. METHODS: A prospective, longitudinal observational study was conducted at the Medical School of the University of Minho, Portugal, between academic years 2009-2010 to 2012-2013. We included students who maintained their participation by annually completing a questionnaire including Beck Depression Inventory (BDI). Anxiety and burnout were assessed using the State Trait Anxiety Inventory and Maslach Burnout Inventory. Surveys on socio-demographic variables were applied to evaluate potential predictors, personal and academic characteristics and perceived difficulties. ANOVA with multiple comparisons were used to compare means of BDI score. The medical students were organized into subgroups by K-means cluster analyses. ANOVA mixed-design repeated measurement was performed to assess a possible interaction between variables associated with depression. RESULTS: The response rate was 84, 92, 88 and 81% for academic years 2009-2010, 2010-2011,2011-2012 and 2012/2013, respectively. Two hundred thirty-eight medical students were evaluated longitudinally. For depression the prevalence ranged from 21.5 to 12.7% (academic years 2009/2010 and 2012/2013). BDI scores decreased during medical school. 19.7% of students recorded sustained high BDI over time. These students had high levels of trait-anxiety and choose medicine for anticipated income and prestige, reported more relationship issues, cynicism, and decreased satisfaction with social activities. Students with high BDI scores at initial evaluation with low levels of trait-anxiety and a primary interest in medicine as a career tended to improve their mood and reported reduced burnout, low perceived learning problems and increased satisfaction with social activities at last evaluation. No difference was detected between men and women in the median BDI score over time. CONCLUSIONS: Our findings suggest that personal factors (anxiety traits, medicine choice factors, relationship patterns and academic burnout) are relevant for persistence of high levels of BDI during medical training. Medical schools need to identity students who experience depression and support then, as early as possible, particularly when depression has been present over time.

Measuring Medical Students' Empathy: Exploring the Underlying Constructs of and Associations Between Two Widely Used Self-Report Instruments in Five Countries.

PURPOSE: Understanding medical student empathy is important to future patient care; however, the definition and development of clinical empathy remain unclear. The authors sought to examine the underlying constructs of two of the most widely used self-report instruments-Davis's Interpersonal Reactivity Index (IRI) and the Jefferson Scale of Empathy version for medical students (JSE-S)-plus, the distinctions and associations between these instruments. METHOD: Between 2007 and 2014, the authors administered the IRI and JSE-S in three separate studies in five countries, (Brazil, Ireland, New Zealand, Portugal, and the United Kingdom). They collected data from 3,069 undergraduate medical students and performed exploratory factor analyses, correlation analyses, and multiple linear regression analyses. RESULTS: Exploratory factor analysis yielded identical results in each country, confirming the subscale structures of each instrument. Results of correlation analyses indicated significant but weak correlations (r = 0.313) between the total IRI and JSE-S scores. All intercorrelations of IRI and JSE-S subscale scores were statistically significant but weak (range r = -0.040 to 0.306). Multiple linear regression models revealed that the IRI subscales were weak predictors of all JSE-S subscale and total scores. The IRI subscales explained between 9.0% and 15.3% of variance for JSE-S subscales and 19.5% for JSE-S total score. CONCLUSIONS: The IRI and JSE-S are only weakly related, suggesting that they may measure different constructs. To better understand this distinction, more studies using both instruments and involving students at different stages in their medical education, as well as more longitudinal and qualitative studies, are needed.

Clarifying changes in student empathy throughout medical school: a scoping review.

Despite the increasing awareness of the relevance of empathy in patient care, some findings suggest that medical schools may be contributing to the deterioration of students' empathy. Therefore, it is important to clarify the magnitude and direction of changes in empathy during medical school. We employed a scoping review to elucidate trends in students' empathy changes/differences throughout medical school and examine potential bias associated with research design. The literature published in English, Spanish, Portuguese and French from 2009 to 2016 was searched. Two-hundred and nine potentially relevant citations were identified. Twenty articles met the inclusion criteria. Effect sizes of empathy scores variations were calculated to assess the practical significance of results. Our results demonstrate that scoped studies differed considerably in their design, measures used, sample sizes and results. Most studies (12 out of 20 studies) reported either positive or non-statistically significant changes/differences in empathy regardless of the measure used. The predominant trend in cross-sectional studies (ten out of 13 studies) was of significantly higher empathy scores in later years or of similar empathy scores across years, while most longitudinal studies presented either mixed-results or empathy declines. There was not a generalized international trend in changes in students' empathy throughout medical school. Although statistically significant changes/differences were detected in 13 out of 20 studies, the calculated effect sizes were small in all but two studies, suggesting little practical significance. At the present moment, the literature does not offer clear conclusions relative to changes in student empathy throughout medical school.

NEO-FFI: Psychometric properties of a short personality inventory in Portuguese context / NEO-FFI: Propriedades psicométricas de um inventário reduzido de personalidade no contexto português

The aim of this study was to assess the psychometric properties (validity and reliability) of the Portuguese adaptation of the NEO Five-Factor Inventory (NEO-FFI) and to compare the obtained structure to the original North American version. The methods of analysis used for cross-validation of the factorial structure were the Principal Axis Factoring (PAF) and the Confirmatory Factor Analysis (CFA). PAF reproduced the original structure of NEO-FFI and CFA revealed a satisfactory fit of single-factor models for the five dimensions. The reliability analysis showed high values of internal consistency which are congruent with previous international adaptations of the NEO-FFI. Multidimensional analysis showed significant main effects of gender and academic qualifications on personality using age as covariant. The findings suggest that the Portuguese version of the NEO-FFI is a reliable instrument to measure the five dimensions of personality. (AU)

O objetivo deste estudo foi avaliar as propriedades psicométricas (validade e fidelidade) da adaptação portuguesa do NEO-FFI e comparar a estrutura obtida com a versão original americana. Como métodos para a validação cruzada da estrutura fatorial foram usados a Análise Fatorial de Eixos Principais (PAF) e uma Análise Fatorial Confirmatória (CFA). A PAF reproduziu a estrutura original do NEO-FFI e a CFA revelou modelos uni-factoriais de ajustamento satisfatório para cada uma das cinco dimensões. A análise de fidelidade revelou elevados valores de consistência interna, congruentes com as adaptações prévias internacionais do NEO-FFI. A análise multidimensional revelou efeitos principais significativos do género e das qualificações académicas na personalidade, usando a idade como co-variante. Os resultados sugerem que a versão portuguesa do NEO-FFI é um instrumento fiável para medir as cinco dimensões da personalidade. (AU)

A experiência de transição para a fase clínica de alunos de medicina detentores de grau prévio: um estudo de caso / The experience of graduate entry students in the transition to the clinical phase: a case study

Introdução. Internacionalmente tem-se assistido à extensão da oferta formativa de cursos de Medicina de menor duração a candidatos detentores de um grau acadêmico superior prévio. Este estudo de caso procura compreender a experiência dos estudantes licenciados nestes cursos, a fim de identificar fatores que condicionem a sua formação durante o inicio da aprendizagem clínica em contexto hospitalar. Sujeitos e métodos. Os participantes são estudantes licenciados do curso de medicina da Universidade do Minho em Portugal (n = 5) que atravessam a transição entre a fase pré-clínica e a fase clínica do curso. No final da primeira unidade curricular clínica realizou-se um grupo de discussão. Os transcritos foram analisados segundo os princípios de Grounded-Theory. Resultados. Os participantes relataram facilidade no contacto com os pacientes e utilização de competências de estudo durante a aprendizagem. Apontaram como dificuldades principais o primeiro contacto com a morte e a doença no meio hospitalar, a quantidade de conhecimentos a adquirir na antes de iniciarem a formação clínica e a transferência dos mesmos para a prática clínica. Conclusões. Este estudo de caso revelou que as principais dificuldades dos estudantes licenciados se relacionavam com lidar com pacientes e com a mobilização para a prática da grande quantidade de conteúdo aprendido na fase pré-clínica. Estas dificuldades poderão ser minoradas pela inclusão de maior contacto com pacientes e com a prática clínica na fase pré-clínica

Introduction. Internationally, medical schools have been offering more fast-track undergraduate medical degree to graduate applicants. This case study aims to understand graduate entry students' experience in medical schools, namely to identify factors that condition their transition to the clinical training in hospitals. Subjects and methods. Participants are medical graduate students from the University of Minho in Portugal (n = 5) going through the transition from a pre-clinical to a clinical part of a 4 year graduate entry curriculum. A focus group was conducted at the end of the first clinical course. The discussion was transcribed and analyzed using Grounded-Theory principles. Results. Participants described they were comfortable with contacting patients, and that they applied study skills developed prior to entry medical school to their learning. The main difficulties pointed out their were the first contact with death and disease in the hospital environment, the large amount of content to be learned before starting clinical training, and the transfer of knowledge to clinical practice. Conclusions. This case study revealed that the main difficulties presented by medical graduate-entry students were related to the first contacts with patients and the practical application of a huge amount of knowledge, learned during the pre-clinical part of the curriculum, to the clinical practice. These difficulties could be attenuated by including more contact with patients and clinical practice during the pre-clinical part of the course

Introducción. En el ámbito internacional se ha extendido la oferta formativa de estudios de medicina de menor duración para candidatos que están en posesión de otros grados de educación superior previos. Este estudio de caso trata de comprender la experiencia de los estudiantes procedentes de otros grados en estos cursos con el fin de identificar los factores que limitan su aprendizaje clínica en el contexto hospitalario. Sujetos y métodos. Los participantes son estudiantes de posgrado de la Facultad de Medicina de la Universidad de Minho en Portugal (n = 5), que realizan la transición entre la fase preclínica y clínica del grado. Al final del primer curso clínico se llevó a cabo un grupo de discusión. Las transcripciones se analizaron de acuerdo con los principios de grounded theory. Resultados. Los participantes refirieron facilidad para el contacto con los pacientes y para el uso de técnicas de estudio durante su aprendizaje. Las principales dificultades son el primero contacto con la muerte y la enfermedad en el ámbito hospitalario, el volumen de conocimientos que se deben adquirir antes de embarcarse en la formación clínica y su transferencia a la práctica clínica. Conclusiones. Este estudio de caso reveló que las principales dificultades de los estudiantes procedentes de otros grados se relacionaron con el trato de los pacientes y con la aplicación a la práctica de los numerosos contenidos aprendidos en la fase preclínica. Estas dificultades se pueden reducir mediante un mayor contacto con los pacientes y la práctica clínica en la fase preclínica

Individual characteristics and student's engagement in scientific research: a cross-sectional study.

BACKGROUND: In light of the increasing recognition of the importance of physician scientists, and given the association between undergraduate research experiences with future scientific activity, it is important to identify and understand variables related to undergraduate students' decision to engage in scientific research activities. The present study assessed the influence of individual characteristics, including personality traits and socio-demographic characteristics, on voluntary engagement in scientific research of undergraduate medical students. METHODS: For this study, all undergraduate students and alumni of the School of Health Sciences in Minho, Portugal were invited to participate in a survey about voluntary engagement in scientific research activities. Data were available on socio-demographic, personality and university admission variables, as part of an ongoing longitudinal study. A regression model was used to compare (1) engaged with (2) not engaged students. A classification and regression tree model was used to compare students engaged in (3) elective curricular research (4) and extra-curricular research. RESULTS: A total of 466 students (88%) answered the survey. A complete set of data was available for 435 students (83%).Higher scores in admission grade point average and the personality dimensions of "openness to experience" and "conscientiousness" increased chances of engagement. Higher "extraversion" scores had the opposite effect. Male undergraduate students were two times more likely than females to engage in curricular elective scientific research and were also more likely to engage in extra-curricular research activities. CONCLUSIONS: This study demonstrated that student' grade point average and individual characteristics, like gender, openness and consciousness have a unique and statistically significant contribution to students' involvement in undergraduate scientific research activities.

Empathy in senior year and first year medical students: a cross-sectional study.

BACKGROUND: The importance of fostering the development of empathy in undergraduate students is continuously emphasized in international recommendations for medical education. Paradoxically, some studies in the North-American context using self-reported measures have found that empathy declines during undergraduate medical training. Empathy is also known to be gender dependent- (highest for female medical students) and related to specialty preference - (higher in patient-oriented than technology-oriented specialties). This factor has not been studied in Portuguese medical schools. METHODS: This is a cross-sectional study of undergraduate medical students on self-rated measures of empathy collected at entrance and at the conclusion of the medical degree, and on the association of empathy measures with gender and specialty preferences in one medical school in Portugal. Empathy was assessed using the Portuguese adaptation of the Jefferson Scale of Physician Empathy-students version (JSPE-spv) among three cohorts of undergraduate medical students in the first (N = 356) and last (N = 120) year. The construct validity of JSPE-spv was cross-validated with Principal Component Analysis and Confirmatory Factor Analysis. Reliability was assessed using Cronbach' Alpha. Global JSPE-spv score differences were examined by year of medical school, gender and specialty preferences (people-oriented vs technology-oriented specialties). RESULTS: The empathy scores of students in the final year were higher as compared to first year students (F (1,387) = 19.33, p < .001, ɳ2p = 0.48; π = 0.99). Female students had higher empathy scores than male students (F (1,387) = 8.82, p < .01, ɳ 2p = 0.23; π = 0.84). Significant differences in empathy were not found between the students who prefer people-oriented specialties compared to those who favor the technology-oriented specialties (F (1,387) = 2.44, p = .12, ɳ 2p = 0.06; π = 0.06). CONCLUSIONS: This cross-sectional study in one medical school in Portugal showed that the empathy measures of senior year students were higher than the scores of freshmen. A longitudinal cohort study is needed to test variations in students' empathy measures throughout medical school.

[Jefferson scale of physician lifelong learning: translation and adaptation for the portuguese medical population]. / Aprendizagem ao longo da vida do médico: tradução e adaptação da escala de Jefferson.

The competence and professionalism of doctors depend on the process of Lifelong Learning (LLL). In the Portuguese settings, in which the re-certification of physicians' skills or knowledge is currently not required, the exercise of LLL is left to personal motivation and initiative. The importance of LLL has been highlighted in numerous international recommendations and has already led, in the United States, to the development and validation of a scale for measuring physician LLL - the Jefferson Scale of Physician Life Long Learning (JSPLL). The lack of valid instruments to measure LLL adapted to the Portuguese contexts was the basis for this work, which presents the translation and adaptation of JSPLL, and the subsequent validation of the translated version to the Portuguese medical community. The translation and validation of the English version of JSPLL (JSPLL-VP) was conducted with physicians of Health Care institutions in the District of Braga, Portugal, in 2007. Methods of both qualitative (translation, assessment of the translation, retro translation) and quantitative nature (internal consistency analysis, factor analysis and analysis of response frequencies) resulted in a factor analysis that replicated, with the exception of three items, the distribution of the original scale by four factors: professional learning beliefs and motivation, scholarly activities, attention to learning opportunities and technical skills in seeking information. The results show that the JSPLL-VP is a valid Scale fit for purpose. Cronbach's alpha coefficients for the whole scale (.89) and for each factor, confirmed the internal consistency of the Scale. Additionally, differences were found between mean and standard deviations for different Scale factors. In summary, this work provides a new validated tool to monitor physician's LLL in Portugal. The transversal characterization of LLL of specific medical professionals - by specialty or by type of institution - or longitudinal studies in relation with profiles of medical training can contribute to the quality of Medical Education at the pre- or post-graduate levels.