Patricia Tempski

What do medical students think about their quality of life? A qualitative study

BackgroundMedical 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.MethodsFirst- 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.ResultsStudents 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.ConclusionQuality 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.

Teaching and learning resilience: a new agenda in?medical education

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of external pressure and return to its original state without becoming deformed after the stimulus of the stressor is withdrawn.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.

Relationship among Medical Student Resilience, Educational Environment and Quality of Life

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 (β=-0.89; 95% confidence interval =-1.21 to -0.56) and medical-school related (β=-0.85; 95%CI=-1.25 to -0.45) QoL scores, environment (β=-6.48; 95%CI=-10.01 to -2.95), psychological (β=-22.89; 95%CI=-25.70 to -20.07), social relationships (β=-14.28; 95%CI=-19.07 to -9.49), and physical health (β=-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 (β=-31.42; 95%CI=-37.86 to -24.98), learning (β=-7.32; 95%CI=-9.23 to -5.41), teachers (β=-5.37; 95%CI=-7.16 to -3.58), academic self-perception (β=-7.33; 95%CI=-8.53 to -6.12), atmosphere (β=-8.29; 95%CI=-10.13 to -6.44) and social self-perception (β=-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.

A intervenção fisioterapêutica no ambulatório de cuidado a pessoa com síndrome de Down no Instituto de Medicina Física e Reabilitação HC FMUSP

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.

Leisure time physical activity and quality of life in medical students: results from a multicentre study

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.

Protocolo de cuidado à saúde da pessoa com Síndrome de Down - IMREA/HCFMUSP

The Down syndrome (DS) or chromosome 21 trisomy is the most common chromosomopathy in human beings, it occurs regardless of gender, ethnicity, or social class. In Brazil, there is approximately one child born with DS for every 700 births. It is known that people with Down syndrome well cared-for and stimulated have potential for full social inclusion. This protocol was prepared by the Down Syndrome Personal Health Care multiprofessional team at the IMREA/HCFMUSP. Objective: Is to offer orientation in the health care of a person with Down Syndrome, in the different levels of attention to health, throughout his/her life. Method: The preparation of the total care protocol for the health of a person with Down syndrome was based on searches in the PubMed and SciELO systems and on the Cochrane Database of Systematic Reviews using the keywords: Down syndrome and Syndrome of Down, Trisomy 21, “Trisomia del Cromosoma 21”, Chromosome 21 trisomy, Growth, “Desarollo”, and “Crescimento”. Results: The articles reviewed were published from 1972 to 2011 and limited to the languages: English, Spanish, and Portuguese. Records previous to 1972 were also included for being considered historical. Conclusion: The data was analyzed by a group of specialists that discussed the results and prepared this protocol.

Protocolo de estimulação motora à criança e ao adolescente dos 4 aos 17 anos de idade do ambulatório de cuidado à pessoa com síndrome de Down

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.