Graziela Moreto

La erosión de la empatía en estudiantes de Medicina: reporte de un estudio realizado en una universidad en São Paulo, Brasil

Objetivo: evaluar el grado de empatia en un grupo de estudiantes de Medicina en una universidad en Sao Paulo, Brasil. Material y metodos: estudio descriptivo, comparativo y transversal. Muestra no probabilistica de 205 alumnos. El estudio se realizo de octubre de 2012 a febrero de 2013. La evaluacion de la empatia se efectuo usando la escala de empatia medica de Jefferson (eemj), version para estudiantes de Medicina, y la escala multidimensional de reactividad interpersonal (emri) de Davis, aplicandose simultaneamente a cada alumno. La eemj contiene 20 items que se responden de acuerdo con la escala de Likert en su variante de siete puntos (Completamente de acuerdo=7 / Completamente en desacuerdo=1); la puntuacion final maxima es de 140 (20x7). Esta escala evalua atributos cognitivos de la empatia. Los estudiantes fueron divididos en dos grupos, de acuerdo con el ano de la carrera profesional: el grupo basico (estudiantes de 1o y 2o) y el grupo de los internos (de 5o y 6o); se comparo el puntaje de empatia entre ambos grupos. Resultados: la mayoria de los estudiantes de Medicina –en ambos grupos– correspondio al sexo femenino. Al aplicar la eemj se obtuvo un puntaje de empatia significativamente menor (p<0.01) en el grupo de los internos, mientras que al aplicar la emri de Davis no se encontro diferencia significativa entre los puntajes de empatia de los estudiantes de los ultimos anos y de los primeros. No obstante, al comparar ambas escalas la media de los puntajes obtenidos con la emri fue siempre menor que la obtenida con la eemj (p<0.01); en la emri, los puntajes mas bajos correspondieron a la dimension afectiva cuando fue comparada con la cognitiva. Conclusiones: el nivel de empatia puede cambiar y, en este caso, deteriorarse. Intervenir en este proceso consistiria mas que en ensenar cosas nuevas –“ensenar a ser empatico”–, en prevenir su perdida.

Reflexiones sobre la enseñanza de la empatía y la educación médica

Three essential topics are discussed in this essay: the growing disproportion between technology and humanism; evaluation of empathy and medical education; and finally, how to promote empathy with the education of the emotions. It is concluded that empathy is a bridge between evidence-based medicine and patient-centered medicine; this is a practical way to incorporate technical developments and derived them into an effective patient care.

SOBRAMFA has promoted family medicine education in Brazil since 1992.

Editor ) Family medicine is not taught in Brazilian medical schools and family medicine faculty staff are absent in academic settings. Inspired by other countries associations of family medicine teachers, SOBRAMFA, the Brazilian Society for Family Medicine, was founded in 1992 as the first such society in Brazil to establish the basis and scientific method for family medicine, spreading its philosophy among medical students, residents and doctors.

Overcoming challenges in primary care in Brazil: successful experiences in family medicine education

Abstract Since 1988, Brazil has built a national health system procuring a response that meets universal health care. The government created the Family Health Strategy (FHS) to help improve access to health services through primary health care teams developing interdisciplinary actions. Scarcity of doctors with family medicine (FM) competencies in Brazil limits the FHS effectiveness. The lack of family physicians can be traced primarily to the medical schools where training supports other specialties besides FM. Innovation is required to bring students to the specialty and medical marketplace. The authors relate their experience and advances in designing alternatives to seize solutions to address challenges related to strategic aspects of FM that can improve medical education practices. Challenges presented exemplify means to expose students to key principles of FM practice such as continuity, commitment and longitudinal care, together with other attributes of FM practice such as team work and interprofessional action. A key asset in overcoming the challenges for primary health care through improved FM practice is the exposure of students to FM practitioners that mentor student practices as role models in different settings where health care is provided.

Innovations in Family Medicine Education: Getting Students Involved and Training Young Family Doctors in Private Practice

Our experience in Brazil shows that when medical students get in contact with family medicine in medical schools –which usually lacks the academic component of the discipline and the real practice of a family doctor in private practice- they don’t want to be part of it. Thus innovation is required to bring new leaders for our specialty, something that the private medical market is asking for. In this paper, the authors relate their experience in two different subjects. First, how to involve medicals students in the family medicine scenario. The value of exposing medical students to the real world of family practice (particularly in a country with little formal medical school experience in the discipline), demonstrates the broad perspective family doctors have and the basket of services they could be in charge. Students realize how family medicine core values, when put into practice, are good resources to become better physicians. Despite the specialty they will choose in the future, they consider family doctors as remarkable teachers who make the difference in their education. Second, how to prepare the young doctors who join SOBRAMFA staff for the growing opportunities in private practice in Sao Paulo (Brazil). They describe an innovative learning agenda composed by an assorted routine of regular meetings which permits to combine a busy work schedule with scientific learning, and develop competences, professionalism and perceive personal success in their lives.