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Objective: To analyze the medical students' perception about simulated consultations before and after training using the SPIKES protocol. Methods: Quasi-experimental study, with a qualitative approach. It counted with the participation of 20 students as Simulated Physicians (SF), and 20 students as Simulated Patients (SP), all belonging to a medical course. Data were obtained from the responses given to a reflective question, applied before and after training with the SPIKES. The treatment and the analysis of the data were guided by the stages of thematic analysis. Results: In the category "Simulated Medical Student's Self-Perception", the subcategories "Nervousness and Insecurity" were predominant after the first consultation, while "Tranquility and Security" after the second consultation after training. In the category "Simulated Medical Student's Perception about the Educational Process", the subcategory "Reflective Learning" emerged in the students' speeches, especially after the second consultation. In the speeches of SP, it was evidenced the improvement of the care provided by SF after training. Conclusion: The strategy used for the development of communication skills showed evidence of short-term effectiveness. Innovation: The research resulted in a teaching protocol for students in pre-clinical stages that involves four stages: simulation, self-assessment, feedback and new simulations.

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We aimed to determine the prevalence of anxiety and to identify associated factors among multi-professional residents in Brazil during the early days of the COVID-19 pandemic. A cross-sectional study included a sample of 752 multi-professional residents selected by snowball technique. Symptoms of anxiety were measured by the Beck anxiety inventory scale (≥ 16 cut-off). We used WHOQOL-BREF to access the health-related quality of life and the Maslach Burnout Inventory to measure the burnout syndrome. PR and respective 95% confidence intervals (CI) were calculated using the Poisson regression model. The prevalence of anxiety was 41.2% (310/752). Some variables were strongly associated with anxiety: afraid of getting COVID-19; extra work demand during COVID-19 pandemic; sweating/wheezing/increased heart rate during work; feeling safe when using personal protective equipment at work, and psychological support from residence preceptors. Residents with symptoms of anxiety showed high emotional exhaustion at work (36.6 ± 9.6 vs. 24.7 ± 10.7, P = 0.001) and depersonalization (8.9 ± 6.0 vs. 5.6 ± 4.9, P = 0.001). Correlations coefficients between emotional exhaustion versus Physical WHOQOL-BREF and between emotional exhaustion versus Psychological WHOQOL-BREF were significantly lower among residents without anxiety (P = 0.027 and P = 0,03, respectively). The prevalence of anxiety was high and strongly associated with several variables, particularly with being afraid of getting COVID-19, the perception of workload, somatization (sweating, wheezing and increased heart rate during work), feeling unsafe when using personal protective equipment, and lack of psychological support from residence preceptors. Anxiety was associated with increased emotional exhaustion and depersonalization and low health-related quality of life during the COVID-19 pandemic in Brazil. Low WHOQOL-BREF environment domain, and high emotional exhaustion MBI domain increased the chances of presenting symptoms of anxiety.

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Abstract Introduction: Assessing professionalism represents a challenge for medical educators given the nature of its construct, which comprises diverse values, beliefs, and principles. Understanding this psychological phenomenon is fundamental for reaching the goals in medical education. Objective: This study aimed to translate into Brazilian Portuguese and to validate the Penn State College of Medicine Professionalism Questionnaire. Method: The questionnaire was translated, and cross-culturally adapted into Brazilian Portuguese using data from 249 medical students. An exploratory factor analysis was conducted, using a polychoric matrix and the Robust Diagonally Weighted Least Squares method of extraction. The following model adequacy indexes and criteria were used: Root Mean Square Error of Approximation (RMSEA) adjustment indexes <0.08, Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) >0.90. Result: The exploratory factor analysis obtained a KMO = 0.920, and a significant Bartlett's test of sphericity (2719.0, gl = 630; P <0.001). The parallel analysis yielded a three-factor solution, which showed adequate levels of reliability: Professional-Patient Relationship, Professional Development and Ethical Commitment. The three-factor solution was the best one found to represent the data. Conclusion: The questionnaire evidenced good psychometric properties and appropriateness to evaluate medical students' professionalism, contributing to reach more desirable ethical standards in medical education.

Resumo Introdução: Avaliar o profissionalismo representa um desafio para os educadores médicos dada a natureza de seu construto que compreende diversos valores, crenças e princípios. A compreensão desse fenômeno psicológico é fundamental para o alcance dos objetivos da educação médica. Objetivo: Este estudo teve como objetivos traduzir para o português brasileiro e validar o Questionário de Profissionalismo da Penn State College of Medicine. Método: O questionário foi traduzido e adaptado transculturalmente para o português brasileiro com dados de 249 estudantes de Medicina. Na condução da análise fatorial exploratória, utilizaram-se uma matriz policórica e o método de extração Robust Diagonally Weighted Least Squares. Os seguintes índices e critérios de adequação do modelo foram usados: índices de ajuste da raiz quadrada da média do erro de aproximação (RMSEA) < 0,08, índice de ajuste comparativo (CFI) e índice de Tucker-Lewis (TLI) > 0,90. Resultado: A análise fatorial exploratória obteve um KMO = 0,920 e um teste de esfericidade de Bartlett significativo (2719,0, gl = 630; P < 0,001). A análise paralela resultou em uma solução de três fatores que apresentou níveis adequados de confiabilidade: relacionamento profissional-paciente, desenvolvimento profissional e compromisso ético. A solução de três fatores foi considerada a melhor para representar os dados. Conclusão: O questionário evidenciou boas propriedades psicométricas e adequação para avaliar o profissionalismo dos estudantes de Medicina, contribuindo para o alcance de padrões éticos mais desejáveis na educação médica.

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BACKGROUND: Health-related quality of life is frequently used as an outcome measure that improves the quality of care. The SF-36 and RAND-36 were derived from the Medical Outcomes Study. OBJECTIVE: The present study aimed to validate the RAND-36 in Brazil, in healthy individuals and patients with liver disease. METHODS: Confirmatory factor analysis (CFA) was conducted by using JASP Software. The parameters of the items were estimated using the Robust Diagonally Weighted Least Squares (RDWLS) approach. Comparative fit index (CFI), Goodness-of-fit index (GFI), Tucker-Lewis Index (TLI) and the root mean square error of approximation (RMSEA) were evaluated. Internal consistency was measured using the Composite reliability index. Convergent validity between RAND-36 domains and Work Ability Index (WAI) was conducted. RESULTS: This validation study included 763 individuals, 400 (52.4%) with chronic liver disease. The most prevalent liver diseases were hepatitis C (13.9%), alcoholic liver disease (11.8%), and steatosis (12.1%). The measurement model tested using the CFA obtained the following adjustment indicators: X2 (df): 599.65 (498); CFI: 0.998; GFI: 0.998; TLI: 0.998; RMSEA: 0.016 (90%CI: 0.011-.021). Convergent validity of RAND-36 and total WAI ranged from medium to large correlation. CONCLUSION: The RAND-36 is effective in measuring the perception of health-related quality of life in individuals with and without chronic liver disease. The results of our study support the developer's claims for the reliability of the RAND-36 version 1 as a measure of health-related quality of life. The evidence for the construct validity of the RAND-36 was substantial.

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ABSTRACT Background: Health-related quality of life is frequently used as an outcome measure that improves the quality of care. The SF-36 and RAND-36 were derived from the Medical Outcomes Study. Objective The present study aimed to validate the RAND-36 in Brazil, in healthy individuals and patients with liver disease. Methods: Confirmatory factor analysis (CFA) was conducted by using JASP Software. The parameters of the items were estimated using the Robust Diagonally Weighted Least Squares (RDWLS) approach. Comparative fit index (CFI), Goodness-of-fit index (GFI), Tucker-Lewis Index (TLI) and the root mean square error of approximation (RMSEA) were evaluated. Internal consistency was measured using the Composite reliability index. Convergent validity between RAND-36 domains and Work Ability Index (WAI) was conducted. Results: This validation study included 763 individuals, 400 (52.4%) with chronic liver disease. The most prevalent liver diseases were hepatitis C (13.9%), alcoholic liver disease (11.8%), and steatosis (12.1%). The measurement model tested using the CFA obtained the following adjustment indicators: X2 (df): 599.65 (498); CFI: 0.998; GFI: 0.998; TLI: 0.998; RMSEA: 0.016 (90%CI: 0.011-.021). Convergent validity of RAND-36 and total WAI ranged from medium to large correlation. Conclusion: The RAND-36 is effective in measuring the perception of health-related quality of life in individuals with and without chronic liver disease. The results of our study support the developer's claims for the reliability of the RAND-36 version 1 as a measure of health-related quality of life. The evidence for the construct validity of the RAND-36 was substantial.

RESUMO Contexto: A qualidade de vida relacionada à saúde é frequentemente usada como uma medida de resultado que melhora a qualidade da atenção à saúde. O SF-36 e o RAND-36 foram derivados do Medical Outcomes Study. Objetivo O presente estudo teve como objetivo validar o RAND-36 no Brasil, em indivíduos saudáveis e pacientes com doença hepática. Métodos: A análise fatorial confirmatória (AFC) foi realizada usando o software JASP. Os parâmetros do elemento foram estimados usando o método Robust Diagonally Weighted Least Squares (RDWLS). O índice de ajuste comparativo (CFI), o índice de adequação (GFI), o índice de Tucker-Lewis (TLI) e o erro quadrático médio de aproximação (RMSEA) foram avaliados. A consistência interna foi medida pelo índice de confiabilidade composta. A validade convergente foi realizada entre os domínios do RAND-36 e o Índice de Capacidade para o Trabalho (ICT). Resultados : Este estudo de validação incluiu 763 indivíduos, 400 (52,4%) com doença hepática crônica. As doenças hepáticas mais prevalentes foram hepatite C (13,9%), doença alcoólica do fígado (11,8%) e esteatose (12,1%). O modelo de medida testado com a AFC obteve os seguintes indicadores de ajuste: X2 (gl): 599,65 (498); CFI: 0,998; GFI: 0,998; TLI: 0,998; RMSEA: 0,016 (90%CI: 0,011-0,021). A validade convergente do RAND-36 e do ICT total variou de média a grande correlação. Conclusão: O RAND-36 é eficaz para medir a percepção da qualidade de vida relacionada à saúde em indivíduos com e sem doença hepática crônica. Os resultados do nosso estudo apoiam as afirmações dos desenvolvedores sobre a confiabilidade do RAND-36 versão 1 como uma medida de qualidade de vida relacionada à saúde. A evidência para a validade do construto do RAND-36 foi substancial.

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Resumen Los profesionales de la salud de las Unidades de Cuidados Intensivos (UCI) enfrentan situaciones de sufrimiento humano, competitividad y demanda, que podrían perjudicar su calidad de vida y su salud mental. El objetivo del estudio fue describir los trastornos mentales comunes y la calidad de vida relacionada con la salud en profesionales de la salud de la UCI en Salvador, Brasil. Este estudio transversal con 195 profesionales utilizó un cuestionario sociodemográfico y laboral, el Self-Reporting Questionnaire (SRQ-20) de trastornos mentales comunes y el 36-Item Short Form Health Survey (SF-36v2) de calidad de vida relacionada con la salud. El 29.7 % de los profesionales presentaron trastornos mentales comunes, especialmente entre profesionales de enfermería (RP = 2.28; IC 1.19-4.39; p = .007). La calidad de vida relacionada con la salud para todos los profesionales estuvo disminuida, principalmente en función social (44.25 ± 10.15) y rol emocional (45.86 ± 10.58). El SRQ-20 correlacionó fuertemente con los dominios dolor corporal (r = -.502), salud general (r = -.526), vitalidad (r = -.656), función social (r = -.608), salud mental (r = -.631) y el componente de salud mental (r = -.638) del SF-36v2 (p < .01). Los profesionales con trastornos mentales comunes mostraron una calidad de vida relacionada con la salud más deteriorada, esencialmente en dominios del componente de salud mental, y refirieron también dolor corporal. Es necesario discutir e implementar estrategias de evaluación, prevención y promoción de la salud mental entre los profesionales de las UCI para que sean consideradas dentro de las políticas de salud laboral.

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Introducción: Existen pocos estudios sobre los trastornos mentales comunes y calidad de vida relacionada con la salud mental en trabajadores de salud bucal. Objetivo: Describir los trastornos mentales comunes y la calidad de vida relacionada con la salud mental en trabajadores de equipos de salud bucal en atención primaria de salud del Sistema Único de Salud de la Región Metropolitana de Salvador de Bahía, Brasil. Métodos: Estudio transversal y descriptivo, que utilizó el Cuestionario de declaración de síntomas para evaluar trastornos mentales comunes, el Cuestionario de salud para calidad de vida relacionada con la salud y un cuestionario de caracterización sociodemográfica. Resultados: Conformaron la muestra 161 profesionales (59,6 por ciento odontólogos y 40,4 por ciento auxiliares de salud bucal). El promedio de la puntuación para Cuestionario de declaración de síntomas fue mayor para los odontólogos (p = 0,032). Los dominios de salud mental del Cuestionario de salud fueron menores y significativos en odontólogos. Tres factores del Cuestionario de declaración de síntomas presentaron alta correlación negativa con los dominios de salud mental del Cuestionario de salud. Conclusiones: Los odontólogos presentaron mayores síntomas de trastornos mentales comunes y deterioro de la calidad de vida relacionada con la salud mental que los auxiliares de salud bucal, siendo necesarias estrategias de promoción de la salud mental para trabajadores de los equipos de salud bucal(AU)

Introduction: Few studies are available about common mental disorders and mental health-related quality of life among dental healthcare providers. Objective: Describe the common mental disorders and the mental health-related quality of life of members of oral health teams from the primary health care section of the Unified Health System in the Metropolitan Region of Salvador de Bahia, Brazil. Methods: A descriptive cross-sectional study was conducted based on the Symptom reporting questionnaire for the evaluation of common mental disorders, the Health questionnaire about health-related quality of life, and a sociodemographic characterization questionnaire. Results: The study sample was composed of 161 professionals, of whom 59.6 percent were dentists and 40.4 percent were dental auxiliaries. Dentists obtained a higher average score in the Symptom reporting questionnaire (p = 0.032), whereas their scores in the mental health domains of the Health questionnaire were lower and significant. Three factors in the Symptom reporting questionnaire exhibited a high negative correlation with the mental health domains of the Health questionnaire. Conclusions: Dentists presented greater symptoms of common mental disorders and mental health-related quality of life deterioration than dental auxiliaries. It is therefore necessary to implement mental health promotion strategies aimed at members of oral health teams(AU)

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BACKGROUND: COVID-19 pandemic caused increased workload and stress for health professionals involved in the care of such patients. We aimed to describe the health-related quality of life, and burnout in frontline physicians diagnosed with anxiety during the COVID-19 pandemic. METHODS: This was a cross-sectional study conducted during the first-wave phase of COVID-19, from September to October 2020. Questionnaires were sent electronically to 450 physicians from State of Bahia, assessing symptoms of anxiety, health-related quality of life (HRQOL) and burnout syndrome. For the categorical variables, the Pearson's chi-square test was used and difference between means was compare using the Mann-Whitney test. was Groups with and without anxiety symptoms were compared using prevalence ratios (PR). Pearson's correlation measured the correlation between WHOQOL-BREF and MBI (Maslach Burnout Inventory) domains. The Fisher r-to-z transformation was used to assess the significance of the difference between two correlation coefficients. The significance level was <0.05. RESULTS: Out of the 450 physicians, 223 (49,6%) completely answered the questionnaire and 38 (17%) showed symptoms of anxiety. Physicians with anxiety had higher scores in emotional exhaustion (EE) (38.31 ± 8.59 vs 25.31±0.87; p = 0.0001) and depersonalization (DP) (9.0 ± 5.6 vs 5.9 ± 5.3; p = 0.001) domains, and lower scores in personal accomplishment (PA) (32.1 ± 8.2 vs 36.3 ± 7.6; p = 0.004), than those without anxiety. All correlations between WHOQOL-BREF domains and MBI in physicians without anxiety were significant (p = 0.01). CONCLUSION: Physicians with anxiety showed more emotional exhaustion, less personal accomplishment, and lower quality of life. All domains of WHOQOL BREF were correlated with all MBI domains among physicians without anxiety. Differences in correlation according to anxiety were remarkable in psychological HOQOL BREF domain and emotional exhaustion and depersonalization MBI domains. The effect of anxiety leading to poorer levels of perceived health needs to be further investigated.

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ABSTRACT Background: COVID-19 pandemic caused increased workload and stress for health professionals involved in the care of such patients. We aimed to describe the health-related quality of life, and burnout in frontline physicians diagnosed with anxiety during the COVID-19 pandemic. Methods: This was a cross-sectional study conducted during the first-wave phase of COVID19, from September to October 2020. Questionnaires were sent electronically to 450 physicians from State of Bahia, assessing symptoms of anxiety, health-related quality of life (HRQOL) and burnout syndrome. For the categorical variables, the Pearson's chi-square test was used and difference between means was compare using the Mann-Whitney test. was Groups with and without anxiety symptoms were compared using prevalence ratios (PR). Pearson's correlation measured the correlation between WHOQOL-BREF and MBI (Maslach Burnout Inventory) domains. The Fisher r-to-z transformation was used to assess the significance of the difference between two correlation coefficients. The significance level was <0.05. Results: Out of the 450 physicians, 223 (49,6%) completely answered the questionnaire and 38 (17%) showed symptoms of anxiety. Physicians with anxiety had higher scores in emotional exhaustion (EE) (38.31 ± 8.59 vs 25.31±0.87; p = 0.0001) and depersonalization (DP) (9.0 ± 5.6 vs 5.9 ± 5.3; p = 0.001) domains, and lower scores in personal accomplishment (PA) (32.1 ± 8.2 vs 36.3 ± 7.6; p = 0.004), than those without anxiety. All correlations between WHOQOL-BREF domains and MBI in physicians without anxiety were significant (p = 0.01). Conclusion: Physicians with anxiety showed more emotional exhaustion, less personal accomplishment, and lower quality of life. All domains of WHOQOL BREF were correlated with all MBI domains among physicians without anxiety. Differences in correlation according to anxiety were remarkable in psychological HOQOL BREF domain and emotional exhaustion and depersonalization MBI domains. The effect of anxiety leading to poorer levels of perceived health needs to be further investigated.

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Abstract: Objective: to evaluate the implementation of the Choosing Wisely (CW) campaign strategies at a medical clinic internship. Methods: This interventional study involved internship teachers and students, using online questionnaires on the SurveyMonkey platform, and face-to-face activities. Using the Delphi technique, teachers identified three unnecessary situations that commonly occur in practice. The recommendations were grouped by frequency and subject, adapted to the CW format. A Likert scale was used to classify the specialists' opinion aiming to obtain the final list of recommendations. Before the introduction of the CW campaign, we conducted an Objective Structured Clinical Examination (OSCE). Two groups of students were compared: one group that underwent the same OSCE evaluation before the implementation of the CW campaign (110), and another group that participated of all educational actions (n = 98). The CW campaign was implemented by developing educational actions using the recommendations during workshops, banners, and theoretical evaluation, in addition to an Objective Structured Clinical Examination (OSCE). Results: after grouping the recommendations, 24 items remained. The specialists selected eight recommendations by frequency, addressing unnecessary behaviors such as requesting multiple exams, overuse of non-hormonal anti-inflammatory drugs, the indication of digestive endoscopy in younger patients with dyspepsia, excessive chest X-rays in intensive care unit, prescribing antibiotic prophylaxis for longer than recommended, routine indication of allergic tests, inadequate initial screening for thyroid assessment, and spirometry in asymptomatic patients. The educational actions resulted in a process of awareness and discussion among the participants, evidenced by theoretical evaluation (> 95%), as well as in the OSCE, where the level of successes was higher in the exposed group when compared to the nonexposed group (p = 0.001). Conclusion: the implementation of the CW campaign improved the clinical skills of medical clinic internship students and allowed positive discussions about cost-consciousness in health.

Resumo: Objetivo: avaliar a implementação de estratégias da campanha Choosing Wisely (CW) no internato de clínica médica. Métodos: Este estudo de intervenção envolveu professores e alunos do internato, por meio de questionários on-line na plataforma SurveyMonkey e atividades presenciais. Usando a técnica Delphi, os professores identificaram três situações desnecessárias que geralmente ocorrem na prática. As recomendações foram agrupadas por frequência e assunto e adaptadas ao formato CW. Utilizou-se uma escala Likert para classificar a opinião dos especialistas, obtendo-se a lista final de recomendações. Antes da introdução da campanha da CW, realizamos um Exame Clínico Objetivo Estruturado (OSCE). Foram comparados dois grupos de estudantes: um grupo que realizou a avaliação OSCE antes da implantação da campanha CW (110) e outro que participou de todas as ações educativas (n = 98). Implementamos a campanha da CW, desenvolvendo ações educativas usando as recomendações durante oficinas, banners e avaliação teórica, além de um Exame Clínico Objetivo Estruturado (OSCE). Resultados: após o agrupamento das recomendações, restaram 24 itens. Os especialistas selecionaram oito recomendações, abordando comportamentos desnecessários como solicitação de vários exames, uso excessivo de anti-inflamatórios não hormonais, indicação de endoscopia digestiva para pacientes mais jovens com dispepsia, excesso de radiografia de tórax em unidade de terapia intensiva, prescrição de profilaxia antibiótica por mais tempo do que o recomendado, indicação de rotina de testes alérgicos, triagem inicial inadequada para avaliação da tireóide e espirometria em pacientes assintomáticos. As ações educativas resultaram em conscientização e discussão entre os participantes, evidenciado por meio de avaliação teórica (> 95%), bem como no OSCE, onde o nível de sucessos foi maior no grupo exposto quando comparado ao grupo não exposto (p = 0,001). Conclusão: a implementação da campanha CW melhorou as habilidades clínicas dos estudantes do internato em clínica médica e permitiu discussões positivas sobre custo-consciência em saúde.

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BACKGROUND: The 36-Item Short Form Health Survey questionnaire (SF-36) is a widely used instrument for evaluating health-related quality-of-life (HRQoL). The psychometric validation of the SF-36 version 2.0 (SF-36v2) in HIV-infected patients had not yet conducted in Brazil. AIM: To test data quality, reliability and validity of the SF-36v2 as a measure of HRQoL among Brazilian individuals living with HIV. METHODS: A cross-sectional study included 393 HIV-infected patients in whom HRQoL was assessed by using the SF-36v2 questionnaire. Demographic characteristics, socioeconomic status and clinical data were also collected. The SF-36 version 1 translated into Brazilian-Portuguese was adapted and introduced version 2 improvements according to the instrument developers. SPSS version 21 was used for data analyses. Confirmatory factor analysis (CFA) and structural equation modelling were performed using AMOS SPSS version 18. T-test for independent samples was used to compare differences between mean levels of HRQoL components in different groups. Linear multiple regression techniques were used to analyze the relationship between Physical Component Summary (PCS), Mental Component Summary (MCS) and independent variables. RESULTS: We performed the CFA and tested the hypothetical measurement model. We included five parameters to improve the adherence of data to the model. All indicators met the requirement suggested by specialized literature (χ2 (gl): 980.7 (527); CFI: 0.949; GFI: 0.873; TLI: 0.943; RMSEA: 0.047; 90% IC: 0.042-0.051). Multiple regression analyses revealed that depression (p=0.001), family income (p=0.007), sex (p=0.001) and age (p<0.021) were associated with MCS. Comorbidities (p=0.001), health self-perception (p=0.001), age (p=0.001), and sex (p=0.025) were associated with PCS. CONCLUSIONS: A consistent validation of the SF-36v2 in Brazilian HIV patients were shown. Further studies with SF-36v2 psychometric analyses would be required in other populations to establish Brazilian normative data.

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Background. The Choosing Wisely (CW) campaign informs physicians and the public about safety and quality in medical practice. Objective. To evaluate a CW campaign in a medical internship in pediatrics. Methods. An interventionist study with teachers of medicine and pediatric internship students in which the Delphi technique was applied using online questionnaires. Specialists identified 3 unnecessary situations that commonly occur in clinical practice. Following the Objective Structured Clinical Examination (OSCE) model evaluation, a group of students who participated in the educational interventions was compared with another group that was not exposed to the campaign. Results. Most students evaluated the CW campaign content as excellent (64%) or very good (31.6%). The level of successes in the OSCE evaluation was higher in the exposed group when compared with the nonexposed group (P = .001). Conclusions. The CW campaign improved the clinical skills of pediatric internship students.

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BACKGROUND: Training in the use of cost-conscious strategies for medical students may prepare new physicians to deliver health care in a more sustainable way. Recently, a role-modeling cost-conscious behaviors scale (RMCCBS) was developed for assessing students' perceptions of their teachers' attitudes to cost consciousness. We aimed to translate the RMCCBS into Brazilian Portuguese, adapt the scale, transculturally, and validate it. METHODS: We adopted rigorous methodological approaches for translating, transculturally adapting and validating the original scale English version into Brazilian Portuguese. We invited all 400 undergraduate medical students enrolled in the 5th and 6th years of a medical course in Northeast Brazil between January and March 2017 to participate. Of the 400 students, 281 accepted to take part in the study. We analyzed the collected data using the SPSS software version 21 and structural equation modeling (SEM) was performed using AMOS SPSS version 18. We conducted exploratory factor analysis (EFA), varimax rotation, with Kaiser Normalization and Principal Axis Factoring extraction method. We conducted confirmatory factor analysis (CFA), using the SEM. We used the following indexes of adherence of the model: Comparative fit index (CFI), Goodness-of-fit index (GFI) and Tucker-Lewis Index (TLI). We considered the Bayesian Information Criterion (BIC) for Sample-size adjusted. The root mean square error of approximation was calculated. Values below 0.08 were considered acceptable. Composite reliability analyzes were performed to evaluate the accuracy of the instrument. Values above 0.70 were considered satisfactory. RESULTS: Of the 281 undergraduate medical students, 195 (69.3%) were female. Mean age of participants was 25.0 ± 2.6 years. In the EFA, the KMO was 0.720 and the Bartlett sphericity test was significant (p < 0.001). We conducted the EFA into two factors: role-modeling cost-conscious behaviors in health (seven items) and health waste behaviors (six items). The 13 item-scale was submitted to composite reliability analyzes, obtaining values of 0.813 and 0.761 for the role-modeling cost-conscious behaviors and the health waste behaviors factors, respectively. CONCLUSIONS: We concluded that the cost-conscious behaviors scale has good psychometric properties and is a valid and reliable instrument for evaluating medical students' perception of their teachers' cost-conscious behaviors.

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BACKGROUND: VERAS survey multicenter project, carried out in 2011-2012, evaluated the quality of life (QoL) of students from 22 Brazilian medical schools. AIM: To evaluate QoL of undergraduate medical students, taking Veras-q national data as comparison. MATERIAL AND METHODS: We evaluated the QoL of 197 medical students in a Brazilian private medical school at Salvador, Bahia, Brazil in 2014. Students in the first two years were grouped in Phase I; those in years three and four were grouped in Phase II. Those in the internship (fifth and sixth years) were grouped in Phase III. RESULTS: Students from Phase I group had better QoL averages than those from Phase II. Phase I students presented significantly (p < 0.05) better scores in the Psychological and Use of Time domains. Compared to Phase II students, those in Phase III obtained better scores in the Physical and Environmental domains. Female students had significantly lower (p < 0.01) scores than male students in Physical, Psychological and Use of Time domains. Compared to the national sample survey, these students had higher (p < 0.01) scores in all domains, except for the Physical domain in Phase II (p < 0.4352). CONCLUSIONS: These students had a better quality of life than those surveyed in the national Veras-q study. Female students had lower scores. Adjusted schedules and lower work overload, as consequences of effective interdisciplinarity in curricular components, may have contributed to higher students' QoL.

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ABSTRACT Background: VERAS survey multicenter project, carried out in 2011-2012, evaluated the quality of life (QoL) of students from 22 Brazilian medical schools. Aim: To evaluate QoL of undergraduate medical students, taking Veras-q national data as comparison. Material and Methods: We evaluated the QoL of 197 medical students in a Brazilian private medical school at Salvador, Bahia, Brazil in 2014. Students in the first two years were grouped in Phase I; those in years three and four were grouped in Phase II. Those in the internship (fifth and sixth years) were grouped in Phase III. Results: Students from Phase I group had better QoL averages than those from Phase II. Phase I students presented significantly (p < 0.05) better scores in the Psychological and Use of Time domains. Compared to Phase II students, those in Phase III obtained better scores in the Physical and Environmental domains. Female students had significantly lower (p < 0.01) scores than male students in Physical, Psychological and Use of Time domains. Compared to the national sample survey, these students had higher (p < 0.01) scores in all domains, except for the Physical domain in Phase II (p < 0.4352). Conclusions: These students had a better quality of life than those surveyed in the national Veras-q study. Female students had lower scores. Adjusted schedules and lower work overload, as consequences of effective interdisciplinarity in curricular components, may have contributed to higher students' QoL.

Antecedentes: El proyecto multicéntrico VERAS evaluó la calidad de vida de estudiantes de medicina en los años 2011-2012. Objetivo: Evaluar la calidad de vida de un grupo de estudiantes de medicina y compararla con los datos del proyecto VERAS. Material y Métodos: Se evaluó calidad de vida en 197 estudiantes de medicina de universidades privadas de Salvador, Bahía, Brasil en 2014. Los estudiantes de los dos primeros años fueron agrupados en la fase I, aquellos de tercer y cuarto año en fase II y los del internado en fase III. Resultados: Los estudiantes en fase I tuvieron mejor calidad de vida que aquellos en fase II. Los estudiantes en fase I tuvieron mejores puntajes en los dominios psicológico y uso del tiempo. Los estudiantes en fase III tuvieron mejores puntajes en los dominios físico y ambiental que los estudiantes en fase II. Las mujeres obtuvieron menores puntajes en los dominios físico, psicológico y uso del tiempo, que los hombres. Al comparar con el estudio nacional, estos estudiantes tuvieron mejores puntajes en todos los dominios, excepto el físico en estudiantes en fase II. Conclusiones: Estos estudiantes tuvieron mejor calidad de vida que sus pares estudiados previamente. Las mujeres tuvieron puntajes más bajos que los hombres. Una menor carga de trabajo, como consecuencia de un currículo multidisciplinario, puede haber influido en esta mejor calidad de vida.

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Resumo O ensino das humanidades na graduação de medicina, principalmente da ética e bioética, é imprescindível para o sucesso da futura relação médico-paciente. A arte cinematográfica vem se destacando como instrumento eficaz de ensino-aprendizagem, pois prepara o aluno para refletir e lidar com diversos conflitos da prática médica. Trata-se de estudo descritivo, com método qualitativo e emprego da técnica de análise temática a partir do documentário "À margem do corpo" como recurso didático para identificar as principais temáticas éticas abordadas pelos alunos e seus posicionamentos em relação a elas. Participaram deste estudo 50 alunos do segundo período de curso de medicina. Quatro temáticas principais foram discutidas: vulnerabilidade e redução da autonomia; objeção de consciência; desumanização e negligência na assistência à saúde; e aborto.

Abstract The teaching of the humanities in medical education, especially ethics and bioethics, is essential for the future doctor-patient relationship. The use of cinematographic art as a teaching-learning instrument has emerged as an effective and contributory method in this process, as it makes the student more reflective and prepared to deal with the various conflicts of medical practice. This is a descriptive study, with uses a qualitative methodology, applying the thematic analysis technique that aimed to evaluate the use of the film "À Margem do Corpo" as a teaching-learning instrument of medical ethics and also to identify the main ethical issues faced by the students and their positions in front of them. A group of 50 students from the second period of the medical course participated in the study. Four main themes were discussed: vulnerability and reduced autonomy; objection of conscience; dehumanization and neglect in health care; abortion.

Resumen La enseñanza de las humanidades en la carrera de grado de medicina, principalmente de la ética y la bioética, es imprescindible para la futura relación médico-paciente. La utilización del arte cinematográfico como instrumento de enseñanza-aprendizaje viene destacándose como un método eficaz y contributivo en este proceso, pues torna al alumno más reflexivo y preparado para lidiar con los diversos conflictos de la práctica médica. Se trata de un estudio descriptivo, con metodología cualitativa, aplicando la técnica de análisis temático que tuvo como objetivo evaluar la utilización de la película "Al Margen del Cuerpo" como instrumento de enseñanza-aprendizaje de la ética médica e identificar las principales temáticas éticas abordadas por los alumnos y sus posicionamientos frente a éstas. Participó de este estudio un grupo-clase del segundo período de la carrera de medicina compuesta por 50 alumnos. Se discutieron cuatro temáticas principales: vulnerabilidad y reducción de la autonomía; objeción de conciencia; deshumanización y negligencia en la asistencia sanitaria; y aborto.

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Resumo As diretrizes curriculares para o curso de graduação em medicina preconizam formação médica humanista, reflexiva e ética. Determinam também que o profissional médico esteja apto para acompanhar o processo de morte, sendo fundamental para isso a avaliação de métodos ativos de ensino-aprendizagem das humanidades e da ética e bioética no curso de medicina. Este artigo propõe avaliar o uso da obra "As intermitências da morte" de José Saramago como ferramenta de ensino da ética e bioética, abordando essencialmente reflexões individuais e coletivas ao lidar com o tema da morte. Trata-se de estudo descritivo com análise qualitativa de avaliação da obra em questão por alunos de medicina da Escola Bahiana de Medicina e Saúde Pública. Conclui-se que esse instrumento é recomendado no ensino das humanidades, comprovando que sua leitura atribuiu capacidades subjetivas ao estudante para lidar com situações relacionadas à morte respeitando os princípios da bioética.

Abstract The curriculum guidelines for undergraduate medical courses recommend that medical training should be humanistic, reflective, and ethical. Furthermore, medical professionals should be able to provide support in the process of death, with the evaluation of active methodologies for the teaching and learning of humanities, ethics, and bioethics a fundamental part of medical courses. The present study evaluates the use of the novel "Death with interruptions" as a teaching tool for ethics and bioethics, addressing individual and collective reflections when dealing with the theme of death. This is a descriptive study with a qualitative approach, analyzing the evaluation of a literary work by medical students from the Escola Bahiana de Medicina e Saúde Pública (the Bahia School of Medicine and Public Health). The study concluded that this instrument is recommended for the teaching of humanities, finding that its reading encouraged the development of subjective abilities in students to deal with situations related to death, respecting the principles of bioethics.

Resumen Las directrices del plan de estudios de la Licenciatura en Medicina abogan por una formación médico-humanista, reflexiva y ética. También determina que el profesional de medicina es capaz de acompañar el proceso de la muerte, siendo fundamental la importancia de la evaluación de métodos activos de enseñanza en las humanidades, la ética y la bioética en la carrera de medicina. El estudio tiene como objetivo evaluar el uso de la obra literaria "Las intermitencias de la muerte" como herramienta de enseñanza de la Ética y Bioética, de las reflexiones para enfrentar el tema de la muerte. Se trata de un estudio descriptivo, con análisis cualitativo de la evaluación por parte de los estudiantes de medicina de una obra literaria. El estudio reveló la recomendación de este instrumento en la enseñanza de las humanidades, lo que demuestra que la lectura asigna capacidades subjetivas de los estudiantes para enfrentar situaciones relacionadas con la muerte.

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A condução de mulheres cardiopata em fase reprodutiva traz dilemas de escolhas frente à expectativa de gestações futuras. O planejamento familiar no acompanhamento dessas pacientes visa à redução da morbimortalidade materno-fetal. O objetivo deste estudo foi identificar orientações de planejamento familiar e condutas contraceptivas em pacientes submetidas a cirurgia para troca valvar, além de descrever o perfil da valvopatia e tipo de prótese. Para tanto, fez-se um estudo transversal, retrospectivo e descritivo, realizado em um centro público da Bahia no período de 2009 a 2013. A amostra foi constituída de pacientes em idade fértil (15-49 anos) submetidas acirurgia de troca valvar. Revistos os prontuários de 70 pacientes, a média de idade foi 33,67±8,037 anos. Os resultados indicaram que o acometimento univalvar ocorreu em 42 casos (60%), tendo como diagnóstico predominante Insuficiência Mitral isolada, com 19 (45,24%) casos. Quanto ao tipo de prótese utilizada, 61 (87,1%) pacientes receberam a biológica enquanto nove (12,9%) a metálica. Observou-se que 64 (91,4%) pacientes apresentaram histórico de cardiopatia reumática. Não houve registro de orientação de planejamento familiar. Concluiu-se que pacientes submetidas a cirurgia para troca valvar não recebiam orientações sobre planejamento familiar ou histórico gestacional; havia um comprometimento predominante univalvar e por insuficiência mitral, assim como uso preferencial de próteses biológicas.

The follow up of childbearing age women with cardiac disease carries choices' dilemmas related to the expectation of future pregnancies. Family planning for those patients aims reducing maternal-fetal morbimortality. The objective of this study was to identify family planning orientations and contraceptive measures in patients subjected to heart valve replacement surgery, besides describing the valvulopathy profile and the kind of prosthesis. Therefore, this cross-sectional, retrospective and descriptive study was made by using medical records from a public center in the period between 2009 and 2013. The sample consists of childbearing age patients (15-49 years old) who underwent heart valve replacement. We reviewed 70 charts and the mean age was 33,67 ±8,037 years old. Univalvular injury occurred in 42 (60%) patients, mitral insufficiency is the most predominant diagnostic, 19 (45,24%) cases. Regarding the type of prosthesis, 61 (87,1%) received bioprosthesis while nine (12,9%) received metallic one. A history of rheumatic fever was identified for 64 (91,4%) patients. There was no record related to family planning orientations or contraceptive measures. In conclusion, the there is a lack of family planning orientations or gestational history records in the charts for the patients who underwent heart valve replacement, there is predominantly univalvular injury due to mitral insufficiency, besides the preferential choice for bioprosthesis.

La conducción de mujeres cardiópata en fase reproductiva trae dilemas de elecciones frente a la expectativa de futuras gestaciones. Planificación familiar en el acompañamiento de estas pacientes visa la reducción de morbimortalidad materno-fetal. El objetivo de este estudio fue identificar las orientaciones de planificación familiar y conductas contraceptivas en pacientes sometidas a cambio valvar y describe el perfil de la enfermedad de la válvula y el tipo de prótesis. De esta forma se ha hecho un estudio transversal, retrospectivo y descriptivo, realizado en centro de la Bahia en 2009 a 2013. La muestra consiste en pacientes en edad fértil (15 ­ 49 años) sometidas a cambio valvar. Revisados 70 prontuarios, la media de edad fue de 33,67±8,037 años. Acometimiento univalvar ocurrió en 42 casos (60%), teniendo como diagnostico predominante Insuficiencia Mitral aislada, con 19 (45,24%). En cuanto al tipos de prótesis utilizadas en la cirugía, 61 (87,1%) pacientes recibieron la biológica mientras nueve (12,9%) metálica. Fue observado que 64 (91,4%) pacientes presentaron cardiopatía reumática. No hubo registro de orientación de planificación familiar. El estudio demuestra comprometimiento predominante univalvar y por insuficiencia mitral y uso preferencial de prótesis biológicas. Se constató aún inexistencia de registro de orientaciones sobre planificación familiar o histórico gestacional en los prontuarios.

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O objetivo deste estudo foi verificar a concordância dos critérios de indicação cirúrgica identificados com o proposto pelas Diretrizes de Valvopatias da Sociedade Brasileira de Cardiologia dos pacientes submetidos à troca valvar única decorrente de insuficiência mitral no período de 2007 a 2013, bem como estabelecer o perfil biológico clínico e cirúrgico desses. Tratou-se de um estudo transversal, retrospectivo e descritivo, realizado em um centro de cardiologia. A população do estudo consistiu em pacientes submetidos a cirurgias para troca mitral secundária a insuficiência no período de 2007 a 2013. Os resultados informaram que, do total de 70 prontuários revisados, 61% eram de pacientes do sexo masculino. A idade média foi de 45 anos. Após a análise das informações, notou-se que, em 17%, não foram identificados critérios indicados nas diretrizes. Nesses casos, evidenciou-se uma tendência (63%) à intervenção precoce da lesão. Critérios específicos de indicação foram revelados em 68%, enquanto que em 15% os dados estavam incompletos. Quanto às classes funcionais da New York Heart Association estavam distribuídos entre II (13%) e III/IV (77%). Além disso, 56% apresentavam histórico de febre reumática. Dos resultados ecocardiográficos 81% apresentavam insuficiência mitral importante, enquanto 9% apresentavam moderada. Não foram registrados óbitos intraoperatórios, porém 9% apresentaram complicações. Em 75% optou-se por utilização de valva biológica. Concluiu-se que houve moderada adesão aos critérios de indicação e o perfil biológico clínico e cirúrgico desses pacientes foi compatível com a literatura.

The purpose of this study was to verify the agreement of the surgical indication criteria identified with the proposition by the Brazilian Society of Cardiology Valvopathy Guidelines for patients submitted to single valve replacement due to mitral insufficiency from 2007 to 2013, as well as to establish the biological clinical and surgical profile. This was a cross-sectional, retrospective and descriptive study carried out in a cardiology center. The study population consisted of patients undergoing surgeries for mitral secondary replacement due to failure in the period from 2007 to 2013. The results reported that from the total of 70 charts reviewed, 61% were male patients. The average age was 45 years. After analyzing the information, it was noted that for 17%, no criteria indicated in the guidelines were identified. In these cases, there was a tendency (63%) of early intervention to the lesion. Specific indication criteria were revealed in 68%, while in 15% the data were incomplete. The functional classes of the New York Heart Association were distributed between II (13%) and III / IV (77%). In addition, 56% had a history of rheumatic fever. From echocardiographic findings, 81% had significant mitral regurgitation, while 9% had moderate mitral insufficiency. No intraoperative deaths were recorded, but 9% had complications. In 75% we chose to use biological valve. In conclusion, there was moderate adherence to the indication criteria and the biological and clinical profile of these patients was compatible with the literature.

El objetivo de este estudio fue verificar la concordancia de los criterios de indicación quirúrgica identificados con el propuesto por las Directrices de Valvopatias de la Sociedad Brasileña de Cardiología de los pacientes sometidos al cambio valvular único resultante de insuficiencia mitral en el período de 2007 a 2013, así como establecer el perfil biológico y los procedimientos quirúrgicos. Se trató de un estudio transversal, retrospectivo y El objetivo de este estudio fue verificar la concordancia de los criterios de indicación quirúrgica identificados con el propuesto por las Directrices de Valvopatias de la Sociedad Brasileña de Cardiología de los pacientes sometidos al cambio valvular único resultante de insuficiencia mitral en el período de 2007 a 2013, así como establecer el perfil biológico y los procedimientos quirúrgicos. Se trató de un estudio transversal, retrospectivo y descriptivo, realizado en un centro de cardiología. La población del estudio consistió en pacientes sometidos a cirugías para cambio mitral secundario debido a insuficiencia en el período de 2007 a 2013. Los resultados informaron que del total de 70 prontuarios revisados, el 61% eran de pacientes del sexo masculino. La edad media fue de 45 años. Después del análisis de las informaciones, se notó que, en el 17%, no se identificaron criterios indicados en las directrices. En estos casos, se evidenció una tendencia (63%) a la intervención temprana de la lesión. Los criterios específicos de indicación se revelaron en un 68%, mientras que en el 15% los datos estaban incompletos. En cuanto a las clases funcionales de la New York Heart Association se distribuyeron entre el II (13%) y el III / IV (77%). Además, el 56% presentaba un historial de fiebre reumática. De los resultados ecocardiográficos el 81% presentaba insuficiencia mitral importante, mientras que el 9% presentaba moderada. No se registraron muertes intraoperatorias, pero el 9% presentó complicaciones. En un 75% se optó por la utilización de la válvula biológica. Se concluyó que hubo moderada adhesión a los criterios de indicación y el perfil biológico clínico y quirúrgico de esos pacientes fue compatible con la literatura.

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A formação essencialmente biomédica já não atende às necessidades de saúde da sociedade. A educação médica tem sido desafiada a assumir um currículo comprometido com uma práxis humanizada. Este estudo analisa a percepção do docente sobre a proposta humanística no currículo do curso de medicina de uma instituição privada de ensino. Pesquisa exploratória descritiva, de natureza qualitativa, realizada com 19 docentes. Dados analisados por meio da técnica de análise de conteúdo, que gerou três categorias: Como é (des) envolvido o humanismo no currículo de medicina, com quatro subcategorias: intuitiva, formação profissional, cuidado singular e investimento institucional; Como pode ser (des)envolvido o humanismo no currículo, com cinco subcategorias: organização curricular, conteúdo, metodologia, formação dos profissionais e pesquisa; Limitações para o (des)envolvimento do humanismo no currículo, com duas subcategorias: currículo e vem de berço. A discussão evidencia que o humanismo é abordado no currículo, porém, apresenta-se de forma desarticulada, revelando que o tratamento dado ao tema está vinculado a componentes específicos e ao cenário no qual é desenvolvido, assim como à prática individual do docente. Isso destaca a necessidade de uma elaboração coletiva de estratégias que fortaleçam a práxis pedagógica docente com base nos princípios humanísticos.(AU)

Considering University as a powerful territory of social changing, this study discuss the humanistic formation and it possibilities on medical formation. The Objective is investigate how docents understand and reproduce the humanistic formation in it pedagogic practice. As method realizes an exploratory descriptive study (qualitative approach), that 19 docents, of a private institution of higher education, identified as leaders, answered a semi-structured quiz. The analysis of the results indicate three categories : The docents recognizes the theme as important, claim it development based on personal references and common sense perspectives differing of an ethic-epistemological perspective; The docents recognizes the need of institutional compromise and suggest possibilities of development based on inclusion of disciplines, thematic axis and interdisciplinary manners, using actives teaching methods; The docents identify as limiter for the development, the belief of scientific objectivity (that separate docent practices and professional) and the conception that the humanization is only possible if was related to a social-genetic legacy. The final consideration reflex about the importance of including humanistic themes in a live curriculum context. That could fortify the pedagogic-docent praxis, bounded structurally to public health politics. (AU)