RESUMO
ABSTRACT In general, students have few opportunities to address their emotions under the guidance of an experienced physician, which can undermine their self-confidence to deal with real patients in stressful situations. Emotional detachment and cynicism are defense mechanisms, which can emerge as a consequence. The consolidation of a professional identity committed to patients' interests can become a challenge when medical students are not comfortable in their role as caregivers. In general, we consider that the undergraduate medical curriculum has been insufficient in providing appropriate environments for students to reflect on professional identity formation and on the future challenges of their profession. Objective: To develop an in-depth debriefing to address students' emotions and professional identity formation in the context of a simulation activity with simulated patients at a medical school in Brazil. Methods: The authors conducted a simulated medical consultation activity using standardized patients (SPs) with an in-depth debriefing based on the feelings of the patient and the student. During each encounter the formation and consolidation of professional identity was discussed. Fourth- and sixth-year medical students (n=551) participated and answered a questionnaire about the activity and the learning outcome. Results: The students felt comfortable during the activity, due to "openness to dialogue", "proximity with colleagues and teachers" and the "judgment-free environment". More than 90% reported that what they had learned would be useful in their professional and personal lives, providing a greater "understanding of emotions", "empathy", "ability to listen" and "ability to deal with conflicts". More than half of them were motivated to study, especially "doctor-patient relationship", "treatment", "common diseases" and "medicine in general". Students considered the activity important for retrieving the initial reasons that had led them to embarking on the medical profession in the first place. Conclusions: Reflecting on disease and its impact on patients' daily life may motivate learning in medicine, allowing for the recovery of the personal and social meaning of its practice. In-depth debriefing was important to nurture professional identity committed to empathy and patients' interests. Activities planned to discuss the influence and importance of emotions in medical practice can help students to reconcile personal and professional identities.
RESUMO Em geral, os estudantes de medicina têm poucas oportunidades para refletir sobre suas emoções guiados por um médico mais experiente, e isto pode levar a uma diminuição da sua autoconfiança para lidar com pacientes reais, particularmente em situações de estresse. Como consequência podem surgir o distanciamento emocional e o cinismo. Neste contexto, a consolidação de uma identidade profissional comprometida com os interesses do paciente pode ser um desafio se os estudantes não estiverem confortáveis em seus papéis de cuidadores. Muitas vezes, o currículo médico não cria oportunidades suficientes para refletir sobre o desenvolvimento da identidade profissional e sobre os desafios da prática médica futura. Objetivo: Desenvolver um debriefing estendido e profundo para abordar a dimensão afetiva das consultas médicas e a formação da identidade profissional no contexto de uma atividade de simulação com pacientes padronizados em uma escola médica no Brasil. Métodos: Os autores conduziram uma atividade de simulação de consultas médicas com paciente padronizado com um debriefing estendido baseado nas emoções do paciente e do estudante. Durante cada um dos encontros a formação e consolidação da identidade profissional foram abordadas. Alunos do quarto e sexto ano médicos (n=551) participaram das atividades e responderam um questionário sobre a atividade e sobre os objetivos alcançados. Resultados: Os estudantes sentiram-se confortáveis durante a atividade devido a "abertura para o diálogo", "proximidade com professores e colegas" e um "ambiente livre de julgamentos". Mais de 90% dos estudantes considerou que o aprendizado será aplicado tanto em suas vidas profissionais como em suas vidas pessoais, por um maior "entendimento das emoções", "empatia", "habilidade para ouvir" e "habilidade para lidar com conflitos". Mais da metade dos estudantes sentiu-se motivada a estudar, especialmente "relação médico-paciente", "tratamento", "doenças comuns" e "medicina em geral". A atividade foi considerada importante para resgatar a motivação inicial que os levaram a escolher o curso médico. Conclusões: Refletir sobre as doenças e seus impactos na vida dos pacientes pode motivar os estudantes a aprender medicina, permitindo o resgate do significado pessoal e social de sua prática. O aprofundamento do debriefing foi importante para nutrir uma identidade profissional comprometida com a empatia e com os interesses dos pacientes. Atividades planejadas para abordar a influência e a importância das emoções na prática médica podem ajudar os estudantes no processo de reconciliação entre suas identidades pessoal e profissional.
RESUMO
OBJECTIVE: To evaluate the serological and parasitological status of patients with chronic Chagas disease (CD) after chemotherapy with benzonidazole. METHODS: Retrospective study of patients treated with benzonidazole (5 mg/kg/day for 60 days) between 1980 and 2010. Twenty-nine patients who had CD confirmed by two reagent immunological tests and/or one positive xenodiagnosis before treatment were included. Conventional serology (ELISA and IIF) and parasitological tests (haemoculture and N-PCR) were performed. RESULTS: At the time of treatment, the mean age of patients was 36 ± 7.24 years (20-39 years) and the time post-treatment varied from 1 to 29 years. After chemotherapy, all individuals had reagent ELISA and 93.1% had positive results for the IIF test. T. cruzi DNA was detected by N-PCR in 48.3%. Negative results were observed in 41.4% and inconclusive ones in 10.3%. Haemoculture was negative for all individuals. CONCLUSIONS: Our results suggest that N-PCR may be useful in the early identification of therapeutic failure of CD. Although it is difficult to determine parasitological cure in negative N-PCR cases, we can infer that this condition represents a declination of parasitaemia as a favourable consequence of aetiological treatment.
Assuntos
Doença de Chagas/tratamento farmacológico , DNA de Protozoário/análise , Nitroimidazóis/uso terapêutico , Parasitemia/tratamento farmacológico , Reação em Cadeia da Polimerase/métodos , Tripanossomicidas/uso terapêutico , Trypanosoma cruzi/genética , Adulto , Fatores Etários , Anticorpos Antiprotozoários/sangue , Anticorpos Antiprotozoários/imunologia , Doença de Chagas/sangue , Doença de Chagas/imunologia , Doença Crônica , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Técnica Indireta de Fluorescência para Anticorpo/métodos , Humanos , Masculino , Parasitemia/sangue , Parasitemia/imunologia , Reação em Cadeia da Polimerase/normas , Estudos Retrospectivos , Falha de Tratamento , Trypanosoma cruzi/imunologia , Adulto JovemRESUMO
BACKGROUND: After 100 years of research, Chagas disease (CD) remains an important public health problem in Latin America. The symptomatic chronic phase is usually characterized by cardiac or digestive involvement and diagnosis currently relies on the measurement of Trypanosoma cruzi-specific antibodies produced in response to the infection. However, the detection of parasite DNA in seronegative persons has been reported. METHODS: The prevalence of CD in a population with esophageal disorders was assessed by conventional serology. We also detected T. cruzi DNA in blood samples of seronegative and inconclusive patients by nested polymerase chain reaction (N-PCR). RESULTS: The seroprevalence of CD determined by conventional serologic tests (indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assay (ELISA)) was 79% in 513 patients with esophageal disorders. Out of 41 blood samples, N-PCR was positive in 31 (76%) cases for which serology was negative or inconclusive. CONCLUSIONS: As all patients presented with clinical signs suggestive of the digestive form of CD and most of them were born in endemic areas, we highlight the importance of improving diagnosis of the disease and the implications for blood bank screening. Our data suggest that N-PCR is effective in the detection of T. cruzi DNA in patients with inconclusive or negative serology, and it may eventually be useful in the determination of the etiology of megaesophagus.