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Background Medical students have a worse perception of Quality of Life (QoL) and a high prevalence of psychosocial suffering when compared to the general population. The objective of this study was to investigate associated factors with Quality of Life of Brazilian medical students from an exploratory analysis in a cross-sectional study described in accordance with the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) guidelines. Methods This is a cross-sectional and multicenter study with national sample randomized by sex and year of the course. Data were collected between August 2011 and August 2012, using an electronic platform (VERAS platform). Our outcomes included: personal quality of life (QoLp) and quality of life related to medical course activities (QoLmc), both measured using a score ranging from 0 (worst) to 10 (best). Variables as predictors: the World Health Organization Quality of Life Assessment abbreviated version (WHOQOL-BREF); VERAS-Q (a questionnaire created to evaluate the QoL of students in health professions); Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Maslach Burnout Inventory (MBI), Resilience Scale (RS-14), Interpersonal Reactivity Multidimensional Scale (IRMS) and Dundee Ready Education Environment Measure (DREEM). Results Our sample is comprised of 1350 (81.8%) medical students. When comparing predictors and both quality of life outcome measures, we found a negative correlation between QoL and the BDI, PSQI and ESS scores. Through a multiple linear regression mode we identified the median of significant predictors to higher QoL. We then run a tree regression model that demonstrated that the VERAS-Q—physical health domain (a domain assessing self-care, self-perception of health, sleep, leisure, physical activity and appearance) was the most important factor predicting QoL. Students with a VERAS-Q-physical health score ≥ 60.9 and a VERAS-Q-time management (address the management of the student's time, free time and whether he can dedicate himself to other activities besides the course) score ≥ 55.7 presented the best QoLmc (score: 8.08–9.63%). Students with a VERAS-Q-physical health score ≥ 79.7 presented the highest QoLp (score 8.93–8.74%). Conclusion Physical symptoms, self-perception of health and self-care assessed by the VERAS-Q physical domain had association with both final outcomes. Time management seems to have a protective role for better Quality of Life. These variables should be taken in consideration when designing interventions to improve Quality of Life among medical students.

Introduction: Empathy is a complex construct that can be understood as the ability to appreciate and respond to an affective experience of another person. It is one of the main competencies in health professionals training due to its relevance in professional-patient relationship. There are several assessment tools for evaluating empathy, with currently no consensus on which would be more appropriate. Objective: To identify, systematically evaluate and summarize information available in literature regarding assessment tools for evaluating empathy in health professions undergraduate students. Method: Up to April 2020 PubMed, EMBASE, CINAHL, Web of Science, Lilacs, Scopus and ERIC and Cochrane Library were systematically searched to identify primary studies which aimed to assess empathy in undergraduate health professions students. Included studies were categorized according to the empathy assessment tool used. Results: Were identified 776 studies and 55 were included. The assessed population included 21,820 students, 97.58% of whom were registered on medicine course. Jefferson Scale of Empathy (72.72%) and Interpersonal Reactivity Index (18.18%) were identified as the main questionnaires used to assess empathy. Conclusion: There was an increase in the number of publications involving the assessment of empathy in the last decade. Most of the studies identified focus on undergraduate medical courses from developed countries, and the instrument most used to assess empathy was the Jefferson Scale of Empathy.

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.

Renata Nunes Achar Fujii,1,2 Renata Kobayasi,1 Sylvia Claassen Enns,1 Patricia Zen Tempski1 1Centro de Desenvolvimento de Educação Médica (CEDEM), Universidade de São Paulo, São Paulo, SP, Brazil; 2Municipal University of São Caetano do Sul, São Caetano do Sul, SP, BrazilCorrespondence: Sylvia Claassen Enns, Centro de Desenvolvimento de Educação Médica (CEDEM), Universidade de São Paulo, Av. Dr. Arnaldo 455, 2 Floor, Room 2343, São Paulo, SP, Brazil, Tel +55(11) 3061 7472, Email dsenns@yahoo.com.brIntroduction: Extracurricular activities in medical education are defined as any social, philanthropic, non-mandatory, and unpaid activities. These activities promote interactions between students and the community in ways that both provide care and create learning opportunities and experiences for both students and the community at large. This study elaborates on the motivational aspects, learnings, and barriers that occur when students participate in these activities.Methods: This is a cross-sectional study of medical students in their first to fifth years. Qualitative analyses have been used to understand the motivation, barriers, and contributions associated with extracurricular activities participation.Results: Of the 586 students enrolled in the medical course, 462 students agreed to participate in the research. The students reported that they were motivated to participate in contributing to society, support their professional choices, integrate their knowledge, gain life experience, develop communication and leadership skills, learn to work in a team, and become more responsible, empathetic, and resilient. Barriers to participation were the limited number of available positions, selection criteria, lack of support from those involved, personal issues, poor time management, risk of lowered academic performance, and lack of physical and financial resources.Discussion: Medical students are motivated to participate in Community-based extracurricular activities (CBEA) and this experience leads to improvement in the curriculum and can develop fundamental skills and attitudes such as leadership, commitment, and responsibility. To maximize the benefits of these activities, schools must support students and ensure that they have the time and chance to participate without physical strain, that were barriers mentioned by the academics.Keywords: quality of life, education, medical, students, medical, community-institutional relationships

Background Considering evidence on competency-based curricula and the benefits of volunteering, this study highlights innovative ideas to improve medical education during the COVID-19 pandemic. We investigated the motivations and perceptions of competencies developed as leadership and management skills in medical students who joined the COVID-19 Volunteering Program in a Brazilian medical school. Methods We performed a cross-sectional, qualitative study involving medical students from the University of São Paulo, Brazil. They were invited to participate in an institutional Volunteering Program during the pandemic and filled out online application forms, including sociodemographic fields and two open-ended questions about their motivation to volunteer and perceptions of their own competencies. At the end of the program, students who were involved in management-related activities were also invited to participate in focus group interviews to track their perceptions about volunteering in this area. Data were submitted to descriptive and content analysis methods. All participants provided informed consent with electronic signatures. Results A total of 286 medical students subscribed to the Volunteering Program: 171 (60%) were men, 152 (53%) were enrolled in their 5th year of medical school, and 158 (55%) were 23-25 years old. One hundred and twelve (44%) students reported that they were motivated by altruistic reasons, 95 (37%) reported duty and 47 (19%) prioritized academic interests. Concerning CanMEDS competencies, 91 (36%) students’ responses matched the Scholar component, followed by 51 (20%) with Collaborator, 49 (20%) with Professional, 32 (13%) with Communicator, 17 (7%) with Leader and 11 (4%) with Health Advocate. In focus groups, students reported the importance of management and leadership skills as a curricular component, motivations to volunteer, and acquired skills from volunteering in management and leadership-related activities, thereby indicating the development of resilient attitudes. Conclusions Students who participated in the School of Medicine of University of Sao Paulo (FMUSP) Volunteering Program reported being motivated to help others (altruistic reasons) and to serve society as future health professionals (duty). Knowledge and work-related competencies prevailed over leadership or soft skills, emphasizing the importance of including such activities in the curriculum. Participating in management-related activities could help develop a more resilient attitude toward medical training. Volunteering programs offer students opportunities to develop competencies essential for their roles as future health professionals. Thus, we should think about including such activities in the curricular structure.

Introdução: A qualidade de vida e a saúde mental dos estudantes de medicina podem afetar o seu desempenho acadêmico, suas habilidades e atitudes com pacientes. Evidências recentes confirmam a importância do ambiente educacional como um dos determinantes da saúde mental e qualidade de vida. Este estudo teve o objetivo de avaliar diferentes aspectos da qualidade de vida dos estudantes de medicina brasileiros em todos os anos do curso. Casuística e Métodos: Estudo transversal de abrangência nacional, com a utilização de questionário validado de qualidade de vida específico para o estudante da área da saúde (Veras-q). Resultados: De uma amostra aleatória de 1.650 estudantes, em 22 escolas médicas de diferentes regiões do país, 1.350 (81,8%) participaram do estudo. Os coeficientes de alfa Cronbach dos domínios do Veras-q variaram entre 0,77 e 0,82. Estudantes do sexo feminino apresentaram menores escores de qualidade de vida nos domínios físico, psicológico e uso do tempo, quando comparadas a seus colegas do sexo masculino (p

Background It has been previously shown that a high percentage of medical students have sleep problems that interfere with academic performance and mental health. Methods To study the impact of sleep quality, daytime somnolence, and sleep deprivation on medical students, we analyzed data from a multicenter study with medical students in Brazil (22 medical schools, 1350 randomized medical students). We applied questionnaires of daytime sleepiness, quality of sleep, quality of life, anxiety and depression symptoms and perception of educational environment. Results 37.8% of medical students presented mild values of daytime sleepiness (Epworth Sleepiness Scale - ESS) and 8.7% presented moderate/severe values. The percentage of female medical students that presented ESS values high or very high was significantly greater than male medical students (p Conclusions There is a significant association between sleep deprivation and daytime sleepiness with the perception of quality of life and educational environment in medical students.

Background There has been a rapid increase in the number of cases of COVID-19 in Latin America, Africa, Asia and many countries that have an insufficient number of physicians and other health care personnel, and the need for the inclusion of medical students on health teams is a very important issue. It has been recommended that medical students work as volunteers, undergo appropriate training, not undertake any activity beyond their level of competence, and receive continuous supervision and adequate personal protective equipment. However, the motivation of medical students must be evaluated to make volunteering a more evidence-based initiative. The aim of our study was to evaluate the motivation of medical students to be part of health teams to aid in the COVID-19 pandemic. Methods and findings We developed a questionnaire specifically to evaluate medical students’ perceptions about participating in the care of patients with suspected infection with coronavirus during the COVID-19 pandemic. The questionnaire had two parts: a) one part with questions on individual characteristics, year in medical school and geographic location of the medical school and b) a second part with twenty-eight statements assessed on a 5-point Likert scale (totally agree, agree, neither agree nor disagree, disagree and totally disagree). To develop the questionnaire, we performed consensus meetings with a group of faculty and medical students. The questionnaire was sent to student organizations of 257 medical schools in Brazil and answered by 10,433 students. We used multinomial logistic regression models to analyze the data. Statements associated with greater odds ratios for participation of medical students in the COVID-19 pandemic were related to a sense of purpose or duty (“It is the duty of the medical student to put himself or herself at the service of the population in the pandemic”), altruism (“I am willing to take risks by participating in practice in the context of the pandemic”), and perception of good performance and professional identity (“I will be a better health professional for having experienced the pandemic”). Males were more prone than females to believe that only interns should participate in the care of patients with COVID-19 (odds ratio 1.36 [coefficient interval 95%:1.24–1.49]) and that all students should participate (OR 1.68 [CI:1.4–1.91]). Conclusions Medical students are more motivated by a sense of purpose or duty, altruism, perception of good performance and values of professionalism than by their interest in learning. These results have implications for the development of volunteering programs and the design of health force policies in the present pandemic and in future health emergencies.

The COVID-19 pandemic demanded a quick shift from presential to e-learning processes. Unlike planned e-learning programs, medical schools have had to quickly deliver the entire medical curriculum using remote strategies. This study aimed to perform a meta-synthesis of previous pandemic situations and describe the experience of the São Paulo University School of Medicine. We searched the Cochrane Central Register of Controlled Trials, Medline, EMBASE, Lilacs, Scopus, Web of Science, and ERIC, using the following keywords: (“SARS” OR “severe acute respiratory syndrome” OR “severe acute respiratory syndrome” OR “Middle East Respiratory Syndrome Coronavirus” OR “middle east respiratory syndrome*” OR “MERS-CoV” OR “Mers” OR “Middle Eastern Respiratory Syndrome*” OR “MERS-CoV*” OR “coronavirus” OR “Coronavirus Infections” OR “coronavirus*” OR “COVID-19” OR “2019-nCoV” OR “SARS-CoV-2”) AND (“online education” OR “Education, Distance” OR “e-learning” OR “course online” OR “flipped classroom”) AND (“lockdown” OR “social distance” OR “quarantine”). The endpoints were the online platforms used for online learning, the model of class, recorded versus online interaction, duration of online lectures, and students' and teachers' perceptions of online learning. We retrieved 38 records; only seven articles studied online education methods related to the pandemic and social distancing rules. The most frequently used online platform was Zoom®. The studies examined both synchronous and asynchronous approaches. There was no evidence regarding duration and students’ and teachers' attitude. This study suggests that the online learning shift was feasible; however, because of the nature of the education shift (pandemic), future studies must further analyze the educational structure.

Resumo: Introdução: A construção de conhecimento é facilitada pela utilização de metodologias inovadoras, centradas no estudante e que lhes permitam participar da elaboração de propostas para soluções de problemas reais. O design thinking (DT) é um processo que propõe a busca, de forma empática, colaborativa e criativa, de soluções para problemas complexos. Neste relato de experiência, aplicou-se o DT à educação médica como um recurso para que a comunidade acadêmica participasse diretamente da qualificação do ensino. Método: Trata-se de relato de experiência com a utilização do DT na reestruturação do sistema de avaliação de uma disciplina em um curso de graduação em Medicina. Resultado: Foi possível viabilizar soluções a partir da prototipagem, de maneira compartilhada e colaborativa, que resultaram na otimização da qualidade do processo avaliativo da disciplina, com a adoção de novos métodos. Conclusão: O DT aplicado ao campo da educação médica permitiu a reflexão sobre um processo inovador e a operacionalização dele na reestruturação da avaliação do conteúdo programático de uma disciplina no curso de graduação em Medicina.

CONTEXT The confirmation of a pandemic by the World Health Organization on March 11, 2020 proved that the SARS-CoV-2 virus would become a worldwide health issue (). The Brazilian situation was no different from other countries: there was pressure on the health system and health workers. According to an article published by former Brazilian Health Ministry members, the country has been preparing itself for the COVID-19 disease since January 10, 2020 (), and in many cities and states, isolation protocols [...]

Background: The importance of the humanistic dimension in the medical profession and how socialization during medical programs can promote humanism or have dehumanizing effects are largely discussed in the medical education literature. Reflection exercises can facilitate student engagement in humanistic attitudes.Method: We performed a qualitative study using the narratives of first-year medical students. The data were analyzed through content analysis. The narratives were used as a strategy to stimulate students' reflection and to understand their perspectives and values at the beginning of the medical program. We asked to them tell us about their role models, professional ideals and previous dehumanizing experiences, in contrast to their experiences of good health care.Results: The study included 167 participants: 67 females (40.1%) and 100 males (59.9%). The participants' average age was 20 years. The analysis of the narratives showed three emergent categories: sociopolitical and economic aspects of medicine, medical humanities and experiences of humanism and dehumanization in health care. In their narratives, the students expressed the desire to become doctors, the desire to help people and improve their lives, and the intention to emulate good role models and contribute to the development of the Brazilian healthcare system. The students indicated that a way to promote humanism in healthcare was to cultivate an integral vision of the human being that includes perceiving his or her context, personal history and complexity. The students emphasized the importance of "going beyond the technical dimension" in the relationship between physician and patient. Some students recognized the transdisciplinary aspects of medicine.Conclusions: The students in their first year of the medical program have a clear understanding of humanism in medical practice, regardless of their social and economic conditions, age, gender, and religion. The students' narratives expressed their expectations for a more humane and fair society characterized by respect, solidarity, and compassion. The use of narratives is a strategy to help students develop critical thinking and to help us get to know our students better: who they are, what they think, and how they feel.

Background: There has been a rapid increase in the number of cases of COVID19 in Latin America, Africa and Asia, in many countries that have an insufficient number of physicians and other health care personnel, and the need for the inclusion of medical students as part of the health teams is a very important issue. It has been recommended that medical students work as volunteers, have appropriate training, do not undertake any activity beyond their level of competence, have continuous supervision and adequate personal protective equipment. However, motivation of medical students must be evaluated in order to make volunteering a more evidence-based initiative. The aim of our study was to evaluate motivation of medical students to be part of the health team to help in the COVID19 pandemic. Methods and Findings: We developed a questionnaire specifically to evaluate medical students perceptions about participating in care of patients with suspected infection due to coronavirus during the COVID19 pandemic. The questionnaire had two parts: a) individual characteristics, year and geographic location of medical school; b) twenty eight statements responded on a 5 point Likert scale (totally agree, agree, neither agree nor disagree, disagree and totally disagree). To develop the questionnaire, we performed consensus meetings of a group of faculty and medical students. The questionnaire was sent to student organizations of 257 medical schools in Brazil and answered by 10,433 students. We used multinomial logistic regression models to analyse the data. Statements with greater odds ratios for participation of medical students in COVID19 pandemic were related to sense of purpose or duty (It is the duty of the medical student to put himself at the service of the population in the pandemic), altruism (I am willing to take risks by participating in practical in the context of pandemic), perception of good performance and professional identity (I will be a better health professional for having experienced the pandemic). Males had higher odds ratios than females (1.36 [95% CI: 1.24 to 1.49] to 1.68 [95% CI: 1.47 to 1.91]). Conclusions: Medical students are motivated by sense of purpose or duty, altruism, perception of good performance and values of professionalism more than their interest in learning. These results have implications in the developing of programs of volunteering and in the design of health force policies in the present pandemic and in future health emergencies.

Background Preceptorship fulfills the requirements of International Guidelines regarding the training of health care professionals as a method of teaching in clinical settings, during the daily work routine. This study aims to analyze the preceptors’ perceptions about preceptorship and their role as educators. Methods Data were collected via a questionnaire with 35 five-point Likert-type scale statements and analyzed using quantitative and qualitative approaches. The qualitative analysis consisted of two open-ended questions: (1) What is Preceptorship? And (2) What is your perception of the preceptor’s role as an educator? Results Out of 619 invited Brazilian preceptors from different health care professions, 327 (52.8%) participated in the study. Among them, 80.7% were females, 35.2% were nurses and 8.9% were physicians. Factor analysis revealed five factors: Pedagogical Competence (F1), Support and educational resources (F2), Educational program planning (F3), Teaching-service integration (F4), and Student presence in the clinical setting (F5). About F1, F3, and F5, professionals from the northeast region had a more positive perception than professionals from the southeast. The item analysis revealed that preceptors learn from the students and consider the service network co-responsible for their training. However, they agreed that only a small part of the health care team participates in the program. Participants described preceptorship as an educational task in a clinical setting, in which active learning methods are used for the training of health care professionals. Preceptorship was considered a bridge between the Unified Health System and the Academic Practice. They envisioned their educator role as a model, tutor, leader, supervisor, and mentor. Conclusion Preceptors expressed a critical view about the nature of preceptorship and their role as educators, recognizing its challenges as well as its potential in clinical settings.

Background/aim We evaluated the association between leisure time physical activity (PA) and quality of life (QoL) in medical students. Our hypothesis was that there was a positive association between volume of PA and various domains of perception of QoL. Methods Data were evaluated from a random sample of 1350 medical students from 22 Brazilian medical schools. Information from participants included the WHO Quality of Life questionnaire-short form (WHOQOL-BREF), a questionnaire specifically designed to evaluate QoL in medical students (VERAS-Q) and questions for both global QoL self-assessment and leisure time PA. According to the amount of metabolic equivalents (METs) spend during PA, volunteers were divided into four groups, according to the volume of PA: (a) no PA; (b) low PA, ≤540 MET min/week; (c) moderate PA, from 541 to 1260 MET min/week and (d) high PA, > 1261 MET min/week. Results Forty per cent of the medical students reported no leisure time PA (46.0% of females and 32.3% of males). In contrast, 27.2% were classified in the group of high PA (21.0% of females and 34.2% of males). We found significant associations between moderate and high levels of PA and better QoL for all measurements. For low levels of PA, this association was also significant for most QoL measurements, with the exceptions of WHOQOL physical health (p=0.08) and social relationships (p=0.26) domains. Conclusion We observed a strong dose-effect relationship between the volume of leisure time PA and QoL in both male and female medical students.

O estagio de desenvolvimento motor e o periodo em que a crianca vivencia suas capacidades motoras e conforme a estimulacao do ambiente e a proposta de tarefas podera alcancar desenvolvimento global satisfatorio. As criancas com sindrome de Down podem alcancar desenvolvimento satisfatorio e ate adequado para sua idade cronologica se receberem estimulos adequados, mesmo apresentando atraso para adquirir habilidades motoras. Na adolescencia o trabalho de desenvolvimento motor deve ser continuado com atividades especializadas como as esportivas para que assim, mantenha-se e refine-se o desenvolvimento adquirido. O objetivo desse artigo e apresentar o programa de estimulacao motora desenvolvido do Instituto de Medicina Fisica e Reabilitacao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (IMREA-HCFMUSP). Acredita-se que, um trabalho de estimulacao motora estruturado de maneira adequada para criancas e adolescentes com sindrome de Down atua como importante meio de intervencao para proporcionar desenvolvimento adequado das habilidades motoras fundamentais e especializadas.

Down Syndrome (SD) is the most common chromosomopathy in humans. It is known that, if properly stimulated, these people have the potential for full social inclusion. The objective of this study is to show the work done with this population by the Physiotherapy service provided by the multiprofessional team at the Clinic for the Care of Persons with DS at the Institute of Physical Medicine and Rehabilitation at HC FMUSP. This clinic develops therapeutic activities for persons up to 18 years of age. The work is carried out in models, which are subdivided into: a DS General Stimulation Model which serves patients up to three years of age whose objectives are focused on the acquisition of motor marks, essential for neuropsychomotor development; a DS Child Development Model which helps children from four to eleven years of age that focuses on the development of more advanced motor skills, strength, posture, improvement of mobility, balance, and proprioception to optimize cerebellar activity and the consequent enhancement of static and dynamic balance; a DS Adolescent Model for those aged twelve to eighteen; and a DS Adult Model starting at age nineteen aimed at orthopedic and postural restoration in addition to providing health guidance. Physiotherapeutic monitoring is fundamental within the clinic for the care of a person with DS, for it stimulates the motor development of these children, along with the multiprofessional team and the family, respecting their time and favoring their potentials, in addition to acting to educate the family on health so as to prevent problems and promote the health of the person with DS and their nuclear family.

A Síndrome de Down (SD) ou trissomia do cromossomo 21 é a cromossomopatia mais comum no ser humano, acontece independente de sexo, etnia ou classe social. No Brasil, nasce aproximadamente uma criança com SD para cada 700 nascimentos. Sabe-se que as pessoas com síndrome de Down, quando bem atendidas e estimuladas, têm potencial para plena inclusão social. Este protocolo foi elaborado pela equipe multiprofissional de Cuidado à Saúde da Pessoa com síndrome de Down do Instituto de Medicina Física e Reabilitação do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Objetivo: Oferecer orientações para o cuidado à saúde da pessoa com Síndrome de Down, nos diferentes níveis de atenção a saúde, em todo o seu ciclo vital. Método: A elaboração do protocolo de cuidado integral à saúde da pessoa com síndrome de Down baseou-se em buscas no sistema PubMed, SciELO e no Cochrane Database of Systematic Reviews utilizando como palavras chaves: “Down Syndrome” e “Síndrome de Down”; “Trisomy 21”, “Trisomíadel Cromosoma 21” e “Trissomia do Cromossomo 21” e “Growth”, “Desarollo” e “Crescimento”. Resultados: Os artigos revistos foram publicados no período de 1972 a 2011 e limitados às línguas: inglesa, espanhola e portuguesa. Priorizamos revisões sistemáticas e metanálises. Foram incluídos também registros prévios a 1972 considerados históricos. Conclusão: Os dados foram analisados por um grupo de especialistas que discutiu os resultados e elaborou este protocolo.

A Sindrome de Down (SD) ou trissomia do cromossomo 21 e a cromossomopatia mais comum no ser humano, acontece independente de sexo, etnia ou classe social. No Brasil, nasce aproximadamente uma crianca com SD para cada 700 nascimentos. Sabe-se que as pessoas com sindrome de Down, quando bem atendidas e estimuladas, tem potencial para plena inclusao social. Este protocolo foi elaborado pela equipe multiprofissional de Cuidado a Saude da Pessoa com sindrome de Down do Instituto de Medicina Fisica e Reabilitacao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. Objetivo: Oferecer orientacoes para o cuidado a saude da pessoa com Sindrome de Down, nos diferentes niveis de atencao a saude, em todo o seu ciclo vital. Metodo: A elaboracao do protocolo de cuidado integral a saude da pessoa com sindrome de Down baseou-se em buscas no sistema PubMed, SciELO e no Cochrane Database of Systematic Reviews utilizando como palavras chaves: “Down Syndrome” e “Sindrome de Down”; “Trisomy 21”, “Trisomiadel Cromosoma 21” e “Trissomia do Cromossomo 21” e “Growth”, “Desarollo” e “Crescimento”. Resultados: Os artigos revistos foram publicados no periodo de 1972 a 2011 e limitados as linguas: inglesa, espanhola e portuguesa. Priorizamos revisoes sistematicas e metanalises. Foram incluidos tambem registros previos a 1972 considerados historicos. Conclusao: Os dados foram analisados por um grupo de especialistas que discutiu os resultados e elaborou este protocolo.

A residência médica pode gerar sonolência diurna e burnout, que afetam a saúde física e mental do médico e prejudicam sua qualidade de vida (QV). Nosso objetivo foi conhecer a QV do médico residente e fatores de influência. Os residentes (n = 136) do Hospital Universitário Evangélico de Curitiba responderam à autoavaliação da QV, WHOQOL - abreviado, escala de sonolência diurna de Epworth e inventário de burnout de Maslach. Observou-se que a nota atribuída à QV na residência foi mais baixa que a nota da QV geral, e 76% dos residentes apresentaram escores patológicos de sonolência diurna, sendo maiores no grupo no primeiro ano e nas mulheres. Na análise de burnout, encontraram-se altos níveis de exaustão emocional (32,1 ± 8,2) e de despersonalização (11,0 ± 6,8), com moderado nível de realização pessoal (33,9 ± 7,0), não tendo havido diferença nos escores de burnout entre os sexos. Obteve-se correlação negativa entre os escores de Epworth, do WHOQOL e da autoavaliação, e correlação positiva entre sonolência diurna e carga horária de trabalho. Medical residency can generate daytime sleepiness and burnout, affecting the young physicians' physical and mental health and jeopardizing their quality of life (QoL). Our aim was to investigate the OoL of medical residents and related factors. Residents (n = 136) at the Evangelical University Hospital in Curitiba answered the short version of the WHO Quality of Life assessment (WHOQOL), the Epworth daytime sleepiness scale, and the Maslach burnout inventory (MBI). The score assigned to QoL during residency was lower than the overall QoL score, and 76% of the residents showed pathological daytime sleepiness scores (with the highest scores in first-year and female students). Analysis of burnout showed high levels of emotional exhaustion (32.1 ± 8.2) and depersonalization (11.0 ± 6.8), with a moderate level of personal achievement (33.9 ± 7.0). There were no differences between the genders in the burnout scores. There was a negative correlation between the Epworth, WHOQOL, and self-assessment scores, and a positive correlation between daytime sleepiness and workload.

PURPOSE To assess perceptions of educational environment of students from 22 Brazilian medical schools and to study the association between these perceptions and quality of life (QoL) measures. METHOD The authors performed a multicenter study (August 2011 to August 2012), examining students' views both of (1) educational environment using the Dundee Ready Education Environment Measure (DREEM) and (2) QoL using the World Health Organization Quality of Life Assessment, abbreviated version (WHOQOL-BREF). They also examined students' self-assessment of their overall QoL and medical-school-related QoL (MSQoL). The authors classified participants' perceptions into four quartiles according to DREEM total score, overall QoL, and MSQoL. RESULTS Of 1,650 randomly selected students, 1,350 (81.8%) completed the study. The mean total DREEM score was 119.4 (standard deviation = 27.1). Higher total DREEM scores were associated with higher overall QoL and MSQoL scores (P < .001 for all comparisons) and younger ages (P < .001). Mean overall QoL scores were higher than MSQoL scores (mean difference, 1.35; 95% confidence interval [CI] 1.28-1.43; P < .001). Multinomial regression models showed significant dose-response patterns: Higher DREEM quartile scores were associated with better QoL. The psychological health domain of WHOQOL-BREF was most closely associated with DREEM scores (odds ratio 4.70; 95% CI = 3.80-5.81). CONCLUSIONS The authors observed a positive association between QoL measures and DREEM scores. This association had a dose-response effect, independent of age, sex, and year of medical training, showing that educational environment appears to be an important moderator of medical student QoL.

Made available in DSpace on 2018-11-26T15:27:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-06-29 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Context Resilience is a capacity to face and overcome adversities, with personal transformation and growth. In medical education, it is critical to understand the determinants of a positive, developmental reaction in the face of stressful, emotionally demanding situations. We studied the association among resilience, quality of life (QoL) and educational environment perceptions in medical students. Methods We evaluated data from a random sample of 1,350 medical students from 22 Brazilian medical schools. Information from participants included the Wagnild and Young's resilience scale (RS-14), the Dundee Ready Educational Environment Measure (DREEM), the World Health Organization Quality of Life questionnaire - short form (WHOQOL-BREF), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). Results Full multiple linear regression models were adjusted for sex, age, year of medical course, presence of a BDI score >= 14 and STAI state or anxiety scores >= 50. Compared to those with very high resilience levels, individuals with very low resilience had worse QoL, measured by overall (beta=-0.89; 95% confidence interval =-1.21 to -0.56) and medical-school related (beta=-0.85; 95% CI=-1.25 to -0.45) QoL scores, environment (beta=-6.48; 95% CI=-10.01 to -2.95), psychological (beta=-22.89; 95% CI=-25.70 to -20.07), social relationships (beta=-14.28; 95% CI=-19.07 to -9.49), and physical health (beta=-10.74; 95% CI=-14.07 to -7.42) WHOQOL-BREF domain scores. They also had a worse educational environment perception, measured by global DREEM score (beta=-31.42; 95% CI=-37.86 to -24.98), learning (beta=-7.32; 95% CI=-9.23 to -5.41), teachers (beta=-5.37; 95% CI=-7.16 to -3.58), academic self-perception (beta=-7.33; 95% CI=-8.53 to -6.12), atmosphere (beta=-8.29; 95% CI=-10.13 to -6.44) and social self-perception (beta=-3.12; 95% CI=-4.11 to -2.12) DREEM domain scores. We also observed a dose-response pattern across resilience level groups for most measurements. Conclusions Medical students with higher resilience levels had a better quality of life and a better perception of educational environment. Developing resilience may become an important strategy to minimize emotional distress and enhance medical training. Univ Sao Paulo, Sch Med, Ctr Dev Med Educ, Sao Paulo, Brazil Evangel Med Sch Parana, Curitiba, Parana, Brazil Univ Sao Paulo, Sch Med, Dept Med, Sao Paulo, Brazil Univ Fed Uberlandia, Dept Obstet & Gynecol, BR-38400 Uberlandia, MG, Brazil State Univ Sao Paulo, Botucatu, SP, Brazil ABC Fdn, Sch Med, Santo Andre, Brazil Sch Med Marilia, Marilia, Brazil Sch Med Rio Preto, Sao Jose Do Rio Preto, Brazil Univ Estadual Campinas, Sch Med, Dept Psychiat, Campinas, Brazil Univ Sao Paulo, Sch Med, Dept Pathol, Sao Paulo, Brazil State Univ Sao Paulo, Botucatu, SP, Brazil

A prática médica depende de um repertório de competências sociais que permitem ao médico desenvolver empatia, habilidades de comunicação, pensamento crítico, capacidade de liderança e tomada de decisões. Nosso objetivo foi analisar as habilidades sociais e a presença de sonolência diurna entre estudantes de Medicina nos quatro primeiros anos do curso. Os estudantes (n = 180) responderam ao Inventário de Habilidades Sociais de Del Prette & Del Prette e à Escala de Sonolência Diurna. Observou-se que não houve diferença dos escores de habilidades sociais nos diferentes anos do curso e que 47,3% dos estudantes apresentaram escores baixos, necessitando de aprimoramento. Estudantes do sexo feminino apresentaram maior autocontrole da agressividade. Entre os estudantes, 50% apresentaram sonolência diurna, cuja presença se associou a menores escores de habilidades sociais, principalmente do fator relativo à autoexposição a desconhecidos ou a situações novas. The practice of medicine requires social skills enabling a doctor to develop empathy, communication skills, critical thinking, leadership skills and the ability to make a decision. Our objective was to evaluate medical students' social skills and the latter's relationship with daytime sleepiness. Students (n=180) responded to the Del Prette & Del Prette Social Skills Questionnaire and the Epworth Sleepiness Scale. We observed that scores for social skills did not differ according to the student's current year of their medical course and that 47.3% of students presented low scores indicating the need for developing these skills. Women were more able to control aggressiveness. 50% of students recorded pathological scores for daytime sleepiness and this was associated with lower scores for social skills,, especially concerning exposure to strangers or new situations.

The term ‘resilience’ has been imported from the language of physics and is used to designate the capacity of a material or body to suffer stress or the imposition of external pressure and return to its original state without becoming deformed after the stimulus of the stressor is withdrawn. In a transdisciplinary context, this term is also used in physiology and psychology to refer to a person’s capacity to resist adversity without developing physical, psychological or social disabilities.

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

Made available in DSpace on 2018-11-26T17:07:15Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-10-26 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Background: To evaluate personal and institutional factors related to depression and anxiety prevalence of students from 22 Brazilian medical schools. Methods: The authors performed a multicenter study (August 2011 to August 2012), examining personal factors (age, sex, housing, tuition scholarship) and institutional factors (year of the medical training, school legal status, location and support service) in association with scores of Beck Depression Inventory (BDI) and State Trait Anxiety Inventory (STAI). Results: Of 1,650 randomly selected students, 1,350 (81.8 %) completed the study. The depressive symptoms prevalence was 41 % (BDI > 9), state-anxiety 81.7 % and trait-anxiety in 85.6 % (STAI > 33). There was a positive relationship between levels of state (r = 0,591, p < 0.001) and trait (r = 0,718, p < 0.001) anxiety and depression scores. All three symptoms were positively associated with female sex and students from medical schools located in capital cities of both sexes. Tuition scholarship students had higher state-anxiety but not trait-anxiety or depression scores. Medical students with higher levels of depression and anxiety symptoms disagree more than their peers with the statements I have adequate access to psychological support and There is a good support system for students who get stressed. Conclusions: The factors associated with the increase of medical students' depression and anxiety symptoms were female sex, school location and tuition scholarship. It is interesting that tuition scholarship students showed stateanxiety, but not depression and trait-anxiety symptoms. Univrs Sao Paulo, Sch Med, Ctr Dev Med Educ, Av Dr Arnaldo 455,Sala 2349, BR-01246903 Sao Paulo, SP, Brazil Univ Sao Paulo, Sch Med, Dept Pathol, Av Dr Arnaldo 455,Sala 2349, BR-01246903 Sao Paulo, SP, Brazil Univ Caxias do Sul, Rua Francisco Getulio Vargas 1130, BR-95070560 Caxias Do Sul, RS, Brazil Univ Fed Rio de Janeiro, Sch Med, Psychiat & Legal Med Dept, Rua Prof Rodolpho Paulo Rocco 255,9 Andar, BR-21941590 Rio De Janeiro, RJ, Brazil Univ Ctr Serra dos Orgaos, Av Alberto Torres 111, BR-25964000 Rio De Janeiro, RJ, Brazil Bionucl Med Teresina, Rua Desembargador Pires de Castro 489, BR-64001390 Teresina, PI, Brazil Sch Med Tocatins, Ave NS 15,109,Sala 18, BR-77020210 Palmas, TO, Brazil Fed Univ Hlth Sci Porto Alegre, Dept Educ & Humanities, Rua Sarmento Leite 245,Sala 412, BR-90050170 Porto Alegre, RS, Brazil Sao Paulo State Univ, Dept Neurol & Psychiat, Sch Med, Rua Rubiao Jr,Caixa Postal 540, BR-18618000 Botucatu, SP, Brazil Fed Univ Rondonia, Sch Med, BR 364 Km 9,5, BR-78900000 Porto Velho, RO, Brazil Marilia Med Sch, Av Monte Carmelo 800,Sala 17, BR-17519030 Sao Paulo, Brazil Ctr Dev Med Educ, Ave Dr Arnaldo 455,1 Andar,Sala 1210, BR-01246903 Sao Paulo, Brazil Sao Paulo State Univ, Dept Neurol & Psychiat, Sch Med, Rua Rubiao Jr,Caixa Postal 540, BR-18618000 Botucatu, SP, Brazil

Background Medical education can affect medical students’ physical and mental health as well as their quality of life. The aim of this study was to assess medical students’ perceptions of their quality of life and its relationship with medical education. Methods First- to sixth-year students from six Brazilian medical schools were interviewed using focus groups to explore what medical student’s lives are like, factors related to increases and decreases of their quality of life during medical school, and how they deal with the difficulties in their training. Results Students reported a variety of difficulties and crises during medical school. Factors that were reported to decrease their quality of life included competition, unprepared teachers, excessive activities, and medical school schedules that demanded exclusive dedication. Contact with pain, death and suffering and harsh social realities influence their quality of life, as well as frustrations with the program and insecurity regarding their professional future. The scarcity of time for studying, leisure activities, relationships, and rest was considered the main factor of influence. Among factors that increase quality of life are good teachers, classes with good didactic approaches, active learning methodologies, contact with patients, and efficient time management. Students also reported that meaningful relationships with family members, friends, or teachers increase their quality of life. Conclusion Quality of teachers, curricula, healthy lifestyles related to eating habits, sleep, and physical activity modify medical students’ quality of life. Lack of time due to medical school obligations was a major impact factor. Students affirm their quality of life is influenced by their medical school experiences, but they also reframe their difficulties, herein represented by their poor quality of life, understood as necessary and inherent to the process of becoming doctors.

Purpose: Medical students’ negative emotions have the potential to hinder their learning, but there is no experimental evidence that this happens. This study investigated the effect of negative emotions on students’ learning processes and outcomes. Method: Eighty-five 5th-year students from a Brazilian medical school were randomly allocated to perform a priming task consisting of reading either (1) a diary describing a patient who died due to inappropriate care caused by unprofessional behaviours (emotional group); (2) a diary describing the same patient receiving appropriate care (neutral group) (3) an irrelevant extract of a local newspaper (control group). Subsequently, emotional reactions were measured, all students studied a medical text, and two tests were administered. Main outcome measures were time spent in studying the text and situational cognitive engagement with study (learning process), and mean scores in the two tests (learning outcomes). Results: The priming task triggered higher levels of emotions in the emotional group relative to both the neutral and the control groups though levels were low. The experimental conditions did not significantly differ in learning processes and outcomes. Discussion: Two tentative explanations for the lack of difference in the performance of three conditions are raised: (1) the level of emotions triggered by the vicarious experience was too low to affect learning, (2) the tests may have been not sensitive enough to capture eventual differences. Methodological choices that may be related to the two explanations are discussed. Keywords: Emotion, Learning, Medical education, Priming task, Research methods

Introdução: Os problemas para a formação em ensino inter profissional (EIP) dos profissionais de saúde para esse novo século são sistêmicos: limitação nas competências para o trabalho em equipe; estratificação persistente das relações de gênero no status dos trabalhadores de saúde; ênfase focada nas habilidades técnicas; dificuldade de análises e compreensões de problemáticas mais amplas do contexto; cuidados esporádicos ao invés de cuidados contínuos; desequilíbrios quantitativos e qualitativos no mercado de trabalho profissional e fragilidade nas capacidades de liderança para melhorar o desempenho do sistema de saúde. O objetivo neste estudo foi avaliar a percepção dos estudantes e professores dos cursos da área da saúde de uma universidade particular em São Paulo sobre a educação interprofissional. Métodos: Foi aplicado um questionário sóciodemográfico para delinear o perfil dos docentes e discentes participantes da pesquisa e este tinha perguntas abertas em relação ao entendimento sobre o que é educação interprofissional e suas experiências. Além deste, foi aplicado o questionário RIPLS que avalia as atitudes e percepções dos estudantes e profissionais para determinar sua prontidão para o aprendizado interprofissinal. Resultados: Os principais resultados evidenciados na pesquisa foram que a formação em Medicina e Enfermagem sugerem maior facilidade para a educação interpofissional do que a formação em Fisioterapia. Quando se compara a percepção da comunidade acadêmica no que diz respeito ao gênero, evidenciamos que os participantes do sexo feminino apresentam maior disponibilidade ao trabalho em equipe e às práticas colaborativas. No que se refere a identidade profissional, os resultados sugerem que os docentes apresentam mais autonomia do que os discentes. Quanto a análise dos PPCs observa-se que as competências não são abordadas no contexto interprofissional. Conclusão: Fica evidente a necessidade de um programa de formação docente nos principios da EIP, além de uma inserção das práticas da EIP e com maior frequência nos currículos dos cursos, afim de melhorar a percepção dos estudantes e docentes na prática colaborativa, para o cuidado em saúde Background: The problems for training in interprofessional education (IPE) of health professionals for this new century are systemic: limitation in competencies for teamwork, persistent stratification of gender relations in the status of health workers, a focused emphasis on technical skills, difficulty in analysis and understanding of broader problematic issues of the context, sporadic instead of continuous care, quantitative and qualitative imbalances in the professional labor market, and fragility in leadership skills to improve the performance of the health system. This study evaluated the perception of students and teachers of health area courses at a private university in São Paulo regarding interprofessional education. Methods: A sociodemographic questionnaire to delineate the teachers and students participating profile and it had open questions regarding the understanding of what interprofessional education is and their experiences. In addition, the RIPLS questionnaire that assesses the attitudes and perceptions of students and professionals to determine their readiness for interprofessional learning were applied. Results: The main results evidenced in the research show that training in Medicine and Nursing allows for greater ease for interprofessional education than training in Physiotherapy. By comparing the perception of the academic community regarding gender, we find that participating women are more available for teamwork and collaborative practices. With regard to professional identity, the result is that teachers propose autonomy more than students. As for the analysis of the PPCs, it is observed that the competences are not addressed in the interprofessional context. Conclusion: To improve the perception of students and teachers in collaborative practice, the need for a teacher training program on IPE principles and more frequent insertion of IPE practices in the curricula of courses is evident, in order to improve the perception of students and teachers in collaborative practice, for the in health

Introdução: Pessoas com síndrome de Down (SD) tem atingido a sétima década e essa mudança pode estar atrelada aos cuidados de saúde ao longo de seu desenvolvimento. Entretanto, quando não há os cuidados de saúde ao longo da vida, na fase adulta é comum o risco aumentado para doenças crônicas não transmissíveis DCNTs e obesidade. Objetivo: Verificar se o desenvolvimento de um programa baseado em estratégias de Educação Alimentar e Nutricional (EAN) pode auxiliar no estado nutricional adequado de pessoas com SD e de seus principais cuidadores. Métodos: Estudo observacional descritivo com 20 jovens adultos com SD e seu principal cuidador acompanhados no ambulatório clínico de um hospital universitário e público na cidade de São Paulo. Foram analisados: condições sociais, perfil bioquímico, consumo percentual médio calórico, teste de bioimpedância, e nível de atividade física. Resultados: Foram selecionadas 23 pessoas com SD e seus respectivos cuidadores. Três desistiram de participar do projeto e nossa amostra passou a ter (n=9) 45% do sexo feminino, (n=11) 55% do sexo masculino e seus principais cuidadores. A idade média das pessoas com SD foi de 24.25 ± 4,9 anos e dos principais cuidadores de 56,5 ± 8,0 anos. Entretanto, no início de março por conta da pandemia do COVID-19 tiveram início as restrições e isolamento social impostas pelo governo da cidade de SP, interferindo nas atividades habituais levando há um aumento do sedentarismo e mudança no contexto alimentar. Desse modo, optamos por parar o estudo com os participantes (n = 8) e seus respectivos cuidadores que já havíamos coletado os dados finais. Todos os participantes foram classificados em sobrepeso. Os alimentos in natura foram os mais consumidos pelas pessoas com SD, seguido dos ultraprocessados. Os cuidadores também tiverem um maior consumo de alimentos in natura e processados. O nível de atividade física de toda a população estudada não apresentou resultados significativos após a intervenção. Entretanto, as estratégias de EAN promoveram melhora no estado nutricional de pessoas com SD, mas não de seus principais cuidadores. Conclusão: Pessoas com SD apresentam condições clínicas e nutricionais potencialmente tratáveis e estratégias de EAN podem auxiliar na melhora de seu estado nutricional, assim como de seus principais cuidadores. Associar o excesso de peso das pessoas com SD exclusivamente à questão genética, pode dificultar o desenvolvimento de um plano terapêutico individualizado e eficaz. O desenvolvimento de programas para o acompanhamento nutricional auxilia nos cuidados e promove qualidade de vida na fase adulta dessa população Introduction: People with Down syndrome (DS) have reached the seventh decade and this change may be linked to health care throughout its development. However, when there is no health care throughout life, an increased risk for chronic non-communicable diseases, CNCDs and obesity is common in adulthood. Objective: To verify if the development of a program based on Food and Nutrition Education (FNE) strategies can help in the adequate nutritional status of people with DS and their main caregivers. Methods: Descriptive observational study with 20 young adults with DS and their main caregiver followed at the clinical outpatient clinic of a public and university hospital in the city of São Paulo. Were analyzed: social conditions, biochemical profile, average percentage caloric consumption, bioimpedance test, and level of physical activity. Results: 23 people with DS and their respective caregivers were selected. Three withdrew from participating in the project and our sample now had (n=9) 45% female, (n=11) 55% male and their main caregivers. The mean age of people with DS was 24.25±4.9 years and that of the main caregivers was 56.5±8.0 years. However, in early March, due to the COVID-19 pandemic, restrictions and social isolation imposed by the government of the city of SP began, interfering with usual activities, leading to an increase in sedentary lifestyle and a change in the food context. Thus, we chose to stop the study with the participants (n = 8) and their respective caregivers who had already collected the final data. All participants were classified as overweight. Fresh foods were the most consumed by people with DS, followed by ultra-processed foods. Caregivers also had a higher consumption of fresh and processed foods. The level of physical activity of the entire population studied did not show significant results after the intervention. However, EAN strategies improved the nutritional status of people with DS, but not their main caregivers. Conclusion: People with DS have potentially treatable clinical and nutritional conditions and EAN strategies can help improve their nutritional status, as well as that of their main caregivers. Associating overweight in people with DS exclusively to genetics can make it difficult to develop an individualized and effective treatment plan. The development of programs for nutritional monitoring assists in care and promotes quality of life in the adult phase of this population

INTRODUÇÃO: No Brasil a atividade extracurricular de extensão é função básica universitária indissociável ao ensino e à pesquisa. Pode ser entendida como toda atividade social, filantrópica, não obrigatória, não remunerada em que há interação entre a instituição universitária e a comunidade por meio da assistência, proporcionando aprendizado e desenvolvimento para ambas. As ligas acadêmicas da Universidade Municipal de São Caetano do Sul têm como princípio norteador a parceria alunos e comunidade, tendo suas atividades sempre dirigidas a atender a demanda dos alunos e da sociedade. O impacto dessas atividades na percepção da qualidade de vida e do ambiente de ensino, além dos fatores motivadores, desmotivadores e as contribuições que estas atividades agregam aos estudantes ainda não foram descritos. MÉTODO: Este é um estudo transversal com estudantes de Medicina da Universidade Municipal de São Caetano do Sul, realizado em novembro de 2018. Os questionários: Vida do Estudante e Residente da Área da Saúde (VERAS-Q), The World Health Organization Quality of Life Assessment - BREF (WHOQOL BREF) e o Dundee Ready Education Environment Measurement (DREEM-12) foram usados para análise quantitativa da percepção da qualidade de vida e do ambiente de ensino. A análise qualitativa foi feita por meio de um questionário com perguntas abertas sobre os aspectos motivadores, as barreiras e as contribuições envolvidas na prática de atividades de extensão. RESULTADOS: Mais de 50% dos estudantes de Medicina participam de atividades de extensão com menor participação durante o primeiro ano e internato. Os estudantes que participam de atividades extracurriculares de extensão apresentaram notas menores na autoavaliação da qualidade de vida geral e menor visão positiva a respeito do quão saudável seria o seu ambiente físico, sobre o cuidado pessoal com a saúde, entre outros. Porém houve maior visão positiva a respeito da satisfação pessoal com a capacidade de desempenhar atividades do dia a dia e sobre acreditarem que muito do que tem visto ser importante para a Medicina. Dentre os fatores motivadores os alunos relataram o desejo de contribuir com a sociedade, a escolha profissional, interação social entre outros. Dentre os aprendizados que as atividades traziam os estudantes mencionaram a integração de conhecimentos, o desenvolvimento de habilidades, atitudes e competências emocionais, dentre outros. As barreiras mencionadas estavam relacionadas à estrutura das atividades, à falta de apoio, à questões pessoais, além de possíveis prejuízos. CONCLUSÃO: Os aprendizados conquistados através das práticas de atividades extracurriculares de extensão contribuem grandemente para a formação médica, dessa forma, reconhecendo as barreiras que limitam a participação dos alunos, a Universidade pode atuar no intuito de minimizá-las e de corrigir os aspectos negativos para que os alunos obtenham o melhor dessas práticas INTRODUCTION: In Brazil, the extracurricular extension activity is a basic university function inseparable from teaching and research. It can be understood as any social, philanthropic, non-mandatory, unpaid activity in which there is interaction between the university institution and the community through assistance, providing learning and development for both. The academic leagues of the Municipal University of São Caetano do Sul have as a guiding principle the partnership of students and community, with their activities always directed to meet the demand of students and society. The impact of these activities on the perception of quality of life and the education environment, in addition to the motivating and demotivating factors and the contributions that these activities add to students have not yet been described. METHODS: This is a cross-sectional study with medical students from the Municipal University of São Caetano do Sul, conducted in November 2018. The questionnaires: Vida do Estudante e Residente da Área da Saúde (VERAS-Q), The World Health Organization Quality of Life Assessment - BREF (WHOQOL BREF) and Dundee Ready Education Environment Measurement (DREEM-12) were used for quantitative analysis of the perception of quality of life and the education environment. The qualitative analysis was done through a questionnaire with open questions about the motivating aspects, barriers and contributions involved in the practice of extension activities. RESULTS: More than 50% of medical students participate in extension activities with less participation during the first year and internship. Students who participate in extracurricular extension activities scored lower in the self-assessment of the overall quality of life and had less positive views about how healthy their physical environment would be, about personal health care, among others. But there was a greater positive view about personal satisfaction with the ability to perform daily activities and about believing that much of what has been studying was important for medicine. Among the motivating factors, students reported the desire to contribute to society, professional choice, social interaction, among others; Among the learnings that the activities brought, the students mentioned the integration of knowledge, the development of skills, attitudes and emotional competences, among others; The barriers mentioned were related to the structure of activities, the lack of support, personal issues, besides possible losses. CONCLUSION: The lessons learned through the practice of extracurricular extension activities contribute greatly to medical training, so if the University recognizes the barriers that limit the participation of students, it can act in order to minimize them and correct the negative aspects so that students get the best of these practices

INTRODUÇÃO: A vasta literatura que busca compreender fatores inerentes à formação médica que incidem sobre a saúde mental dos estudantes, converge em abundância para levantamentos sobre depressão e ansiedade por meio de instrumentos quantitativos consagrados. Ainda assim, fatores relacionados à percepção que os estudantes têm de suas relações interpessoais no cotidiano acadêmico são pouco explorados como fonte de dados sobre manifestações de poder, violência, apoio social e preconceito de gênero nas relações de hierarquia, entre pares e com a instituição. OBJETIVO: O objetivo deste estudo foi investigar como pensam graduandos de medicina do primeiro ao sexto ano a respeito de suas relações interpessoais durante a formação médica, sob o enfoque de gênero, poder e violência. MÉTODOS: O estudo foi desenvolvido em duas etapas. Na primeira, foram sorteados e convidados trinta mulheres e trinta homens, todos graduandos de medicina do primeiro ao sexto ano da Faculdade de Medicina da USP, para participarem de grupos focais. Dez alunos do primeiro ano de 2018 participaram dos quatro encontros propostos, que foram gravados e trouxeram contribuições significativas para a captação de elementos pertinentes à vivência discente para a confecção do instrumento a ser aplicado a todos os graduandos matriculados (segunda etapa). Foi elaborado questionário composto por 70 questões em formato Likert, 5 questões abertas, 9 questões de múltipla escolha e 1 ranking, o qual foi avaliado por uma banca de pesquisadoras da área de antropologia, psicologia e medicina. O convite aos estudantes para participar da segunda etapa foi realizado por e-mail, contendo o link de acesso para o aceite do Termo de Consentimento Livre e Esclarecido, que posteriormente possibilitava acesso ao questionário, ambos hospedados no Google Formulários. RESULTADOS: Na primeira etapa, ficaram evidenciadas percepções estereotipadas sobre gênero; hierarquização da relação médico-paciente e assimetria entre gêneros quanto à frequência de participação nas discussões dos encontros: os homens tomaram a palavra em 63% das vezes e as mulheres 37%. Na segunda etapa, que contou com a participação de 320 estudantes do primeiro ao sexto ano no ano de 2020, a percepção de mulheres e homens se mostrou diferente, sobretudo em relação às situações permeadas por gênero e violência, como por exemplo: ao contrário dos homens, as mulheres acreditam que o gênero figura como critério seletivo para ingresso em determinadas áreas médicas (p < 0,0001); situações de intimidação entre alunos dentro da faculdade foi significativamente mais indicada como tendo sido presenciada pelas mulheres do que pelos homens (p=0,0010); o índice de aprovação sobre a forma como a hierarquia é exercida na faculdade é de 1,3% para as mulheres e 5,5% para os homens (p=0,0018). Uma fração de 12% dos estudantes não têm clareza se há diferença entre os conceitos de gênero e sexualidade, e 40% não sabem se transexualidade e travestilidade têm o mesmo significado. Houve significativo consenso referente a ausência de discussões sobre gênero e sexualidade em sala de aula e também sobre a presença de abordagens pejorativas realizadas por professores sobre o tema. A violência relatada em maior frequência em todos os ciclos de graduação se manifesta em piadas ofensivas, intimidações entre alunos e exclusão social. Em alguns casos, o ciclo de graduação do internato (5º e 6º ano) teve associação com maior frequência com essas violências em comparação aos ciclos iniciais (p < 0,0001). Comportamentos autoritários apareceram como parte do cotidiano em todos os ciclos de graduação, tendo maior incidência no internato (p=0,0001). Para 42% dos participantes, a percepção sobre as interações dos professores com demais funcionários foi indicada como conflituosa. Ao todo, 42,6% dos participantes optariam por não buscar um ou mais setores de apoio ao aluno disponibilizados pela faculdade caso estivessem sob assédio infringido por pares ou professores. CONCLUSÃO: Apesar de compartilharem suas vivências no mesmo ambiente acadêmico, mulheres e homens apresentaram percepções diversas ao expressarem o que pensam, indicando que suas vivências durante a formação em termos de respeito e hierarquia, bem como suas perspectivas profissionais mediante oportunidades para os gêneros, são diferentes. Estímulos em sala de aula que parecem acentuar tais diferenças foram evidenciados, demandando um aprofundamento na temática abrangendo também a população docente para compor dados que contribuiriam para ampliar a discussão e possibilitar a exploração de ações interventivas sobre essa problemática. Se faz necessário a inserção formal de discussões sobre gênero, violência e sexualidade, a fim de preencher essa lacuna na formação médica para mitigar confusões conceituais que podem vir a comprometer a qualidade da atuação profissional do ponto de vista técnico, e que também contribuiriam como incremento de repertório socioemocional - fator protetivo da saúde mental. Há violências inseridas no cotidiano dos estudantes. Seria válido um levantamento mais robusto de dados a esse respeito, de maneira a melhorar a compreensão de elementos que estejam no entorno desse fenômeno entre os graduandos da FMUSP e possibilitar a avaliação de ações interventivas para enfraquecer tais práticas. Os dados que destacam vivências menos respeitosas entre os estudantes do internato em comparação aos demais, sugerem presença expressiva de práticas nocivas à construção de uma cultura organizacional médica profissionalizada e humanizada, em função da proximidade dos alunos desse período com o ambiente profissional INTRODUCTION: The vast literature that seeks to understand factors inherent to the medical training that affect the students\' mental health, converges in abundance for surveys on depression and anxiety through established quantitative instruments. Even so, factors related to the students\' perception of their interpersonal relationships in academic life are little explored as a source of data on manifestations of power, violence, social support, and gender bias in hierarchical relationships, between pairs and within the institution. OBJECTIVE: The aim of this study was to investigate what medical students from the first to the sixth year think about their interpersonal relationships during medical training, under the focus of gender, power, and violence. METHODS: The study was developed in two stages. In the first, thirty women and thirty men, all medical undergraduates from the first to the sixth year at USP\'s Medical School, were randomly selected and invited to participate in focus groups. Ten students from the first year of 2018 participated in the four proposed meetings, which were recorded and brought significant contributions to the capture of elements relevant to the students\' experience and for the preparation of the instrument to be applied to all enrolled undergraduates (second stage). A questionnaire composed of 70 questions was elaborated in Likert format, 5 open questions, 9 multiple choice questions and 1 ranking, which was evaluated by a panel of researchers in the field of anthropology, psychology and medicine. The invitation for students\' participation in the second stage was sent by email and it had the access link for the acceptance of the Free and Informed Consent Term, which later allowed access to the questionnaire, both hosted on Google Forms. RESULTS: In the first stage, stereotyped perceptions about gender were evident; hierarchy of the doctor-patient relationship and asymmetry between genders as to the frequency of participation in the discussions of the meetings: men took the floor 63% of the time and women 37%. In the second stage, which counted with the participation of 320 students from the first to the sixth year in 2020, the perception of women and men was different, especially in relation to situations permeated by gender and violence, such as: unlike men, women believe that gender appears as a selective criterion for entering certain medical areas (p < 0.0001); intimidation situations among students within the college was significantly more indicated as having been witnessed by women than by men (p = 0.0010); the approval rate on the way the hierarchy is exercised in college is 1.3% for women and 5.5% for men (p = 0.0018). A fraction of 12% of the students demonstrated uncertainty regarding whether there is a difference between the concepts of gender and sexuality and 40% do not know whether transsexuality and transvestite have the same meaning. There was a significant consensus regarding the absence of discussions about gender and sexuality in the classroom and also about the presence of pejorative approaches taken by teachers on the subject. The violence reported most frequently in all undergraduate cycles is manifested in offensive jokes, intimidation among students and social exclusion. In some cases, the internship undergraduate cycle (5th and 6th year) was more frequently associated with this violence compared to the initial cycles (p < 0.0001). Authoritarian behaviors appeared as part of everyday life in all undergraduate cycles, with greater frequency at boarding school (p = 0.0001). For 42% of the participants, the perception of the teachers\' interactions with other employees was indicated as conflicting. In all, 42.6% of the participants would choose not to seek one or more sectors of student support provided by the college if they were under harassment violated by peers or teachers. CONCLUSION: Despite sharing their experiences in the same academic environment, women and men presented different perceptions when expressing what they think, indicating that their experiences during training in terms of respect and hierarchy, as well as their professional perspectives through opportunities for genders, are different. Incentives in the classroom that seem to accentuate such differences were evidenced, demanding a deepening of the theme, also encompassing the teaching population to compose data that would contribute to broaden the discussion and enable the exploration of interventional actions on this issue. It is necessary to formally insert discussions about gender, violence and sexuality, in order to fill this gap in medical training and to mitigate conceptual confusions that may compromise the quality of professional performance from a technical point of view, and which would also contribute to increase socio-emotional repertoire - protective factor of mental health. There is violence inserted in the students\' daily lives. A more robust survey of data in this regard would be valid, in order to improve the understanding of elements that are in the vicinity of this phenomenon among FMUSP undergraduates and enable the assessment of interventional actions to weaken such practices. The data that highlights less respectful experiences among boarding students compared to the others, suggest an expressive presence of harmful practices to the construction of a professionalized and humanized medical organizational culture, due to students\' professional environment proximity during this period

Introdução: Feedback é uma ferramenta de ensino poderosa. Para otimizar o feedback em avaliações tipo OSCE (Objective Structured Clinical Examination), uma modificação no papel do avaliador, apelidada de \"avaliador sombra\", foi testada. Os \"avaliadores sombras\" acompanham os estudantes por todas as estações realizando todas as avaliações. Ao término da atividade, realizam feedback do desempenho clínico aos estudantes. Objetivos: Descrever e discutir a experiência na aplicação deste modelo OSCE modificado, avaliar as opiniões dos alunos em relação a este novo método, e apresentar um estudo onde foram realizadas comparações entre o \"avaliador sombra\" e o formato original do examinador OSCE, nomeado de \"avaliador fixo\", com o objetivo de responder se este novo formato de avaliação apresenta vieses em relação ao formato original. Metodologia: Em 2011 foram realizados experimentos com as modificações no papel do avaliador para definir o formato final do \"avaliador sombra\". No período compreendido de fevereiro de 2012 a maio de 2014 foi realizado um protocolo de pesquisa com 415 estudantes do 6º ano de medicina. Destes, 316 estudantes foram randomizados para serem avaliados por avaliadores \"sombras\" e \"fixos\". Para analisar as comparações entre os avaliadores \"sombras\" e \"fixos\", foram utilizados o coeficiente de correlação de Pearson com regressão linear, teste t de Student e gráficos de Bland-Altman. Para aprofundar estas análises, os itens dos checklists foram classificados por domínios para realização de comparações mais específicas. Considerando que esta foi a primeira vez em que esta nova estratégia de avaliador (\"sombra\") foi aplicada, foram realizados questionários de opinião aos 415 estudantes que participaram do OSCE com o \"avaliador sombra\". Resultados: Foram encontradas altas e significativas correlações entre as notas globais por estação dadas aos estudantes pelos avaliadores \"sombras\" e \"fixos\",r = 0,87 (0,85 - 0,89; p < 0,05). Nas análises por domínios (afetivo, psicomotor e cognitivo), os resultados demonstraram maiores correlações entre as notas no domínio cognitivo e menores no afetivo. Não houve diferenças significativas comparando as médias das notas dadas pelos examinadores em relação às notas globais e nos domínios psicomotor e cognitivo. Análises de Teste t e de Bland-Altman demonstraram que as notas dadas aos estudantes no domínio afetivo foram maiores pelos \"avaliadores sombras\", mas a magnitude desta diferença foi muito pequena. De acordo com os questionários aplicados aos 415 estudantes, o feedback realizado pelos \"avaliadores sombras\" contribui para o aprimoramento de habilidades. Mais do que 90% dos estudantes concordaram que o feedback realizado pelo \"avaliador sombra\" é mais efetivo do que outras estratégias de feedback realizadas em outras aplicações de OSCE durante o curso de graduação de medicina até aquele momento. Conclusão: As modificações no papel do avaliador, \"avaliador sombra\", não levaram a vieses significativos nas notas dos estudantes quando comparado ao modelo de avaliador original do OSCE. Esta nova estratégia pode fornecer importantes melhorias na avaliação formativa de competências clínicas Background: Feedback is a powerful learning tool. To improve the opportunity for feedback provided during an Objective Structured Clinical Examination (OSCE), a modification of the examiner\'s role nicknamed the \"shadow examiner\" was tested. In this new strategy, examiners follow the students across all OSCE stations, and may provide important insights for formative assessments of clinical performance Objective: Describe and discuss the experience in applying this modified OSCE, evaluate students\' opinions regarding this new method, and present an experience to analyze comparisons between the \"shadow examiner\" and original examiner OSCE format, nicknamed \"fixed examiner\". The objective of this study was to answer if this new assessment format presents biases in relation to the original format. Methods: In 2011, some experiments were carried out with modifications in the examiner\'s role to define the format of \"shadow examiner\". From February 2012 to May 2014, the research protocol was performed with 415 6th year medical students. Of these, 316 were randomly assigned to assessments made up of \"shadow\" and \"fixed\" examiners. Pearson correlation coefficients with linear regression, Student\'s t-test analysis, Bland-Altman plots were the statistical methods used to compare the assessment modes. To strengthen the analysis, checklist items were classified by domains in order to make specific comparisons. Considering that this was the first application of this new examiner (\"shadow\") strategy was applied, were conducted opinion surveys of the 415 students who participated in the OSCE with the \"shadow examiner\". Results: High correlations for global scores between \"shadow\" and \"fixed\" examiners were observed, r = 0,87 (0,85 - 0,89; p < 0,05). Analysing specific domains (affective, psychomotor and cognitive), the results demonstrated higher correlations for cognitive scores and lower correlations for affective scores. No statistically significant differences between mean examiners\' global scores, psychomotor and cognitive domains were found. T-test and Bland-Altman reviews showed that affective scores from \"shadow examiners\" were significantly higher than those from \"fixed examiners\", but the magnitude of this difference was small. According to the questionnaires applied to the 415 students, feedback from \"shadow examiners\" contributes to skills training, and more than 90% of these students agree that feedback from \"shadow examiners\" is more effective than other feedback formats achieved in other OSCE applications during the medical graduation course up to that time. Conclusion: The modifications in the role of examiner, \"shadow examiner\", did not lead to any important bias in the students\' scores comparing with the original examiner strategy of OSCE. This new strategy may provide important insights for formative assessments of clinical performance