Medical Students' Participation in Extracurricular Activities: Motivations, Contributions, and Barriers. A Qualitative Study.

Introduction: 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.

Sleepiness, sleep deprivation, quality of life, mental symptoms and perception of academic environment in medical students.

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 <  0.05). Students with lower ESS scores presented significantly greater scores of quality of life and perception of educational environment and lower scores of depression and anxiety symptoms, and these relationships showed a dose-effect pattern. Medical students reporting more sleep deprivation showed significantly greater odds ratios of presenting anxiety and depression symptoms and lower odds of good quality of life or perception of educational environment. 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.

Preceptors' perception of their role as educators and professionals in a health system.

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.

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.

Medical Students' Perception of Their Educational Environment and Quality of Life: Is There a Positive Association?

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.

Necroptotic Cell Death Signaling and Execution Pathway: Lessons from Knockout Mice.

Under stress conditions, cells in living tissue die by apoptosis or necrosis depending on the activation of the key molecules within a dying cell that either transduce cell survival or death signals that actively destroy the sentenced cell. Multiple extracellular (pH, heat, oxidants, and detergents) or intracellular (DNA damage and Ca(2+) overload) stress conditions trigger various types of the nuclear, endoplasmic reticulum (ER), cytoplasmatic, and mitochondrion-centered signaling events that allow cells to preserve the DNA integrity, protein folding, energetic, ionic and redox homeostasis, thus escaping from injury. Along the transition from reversible to irreversible injury, death signaling is highly heterogeneous and damaged cells may engage autophagy, apoptotic, or necrotic cell death programs. Studies on multiple double- and triple- knockout mice identified caspase-8, flip, and fadd genes as key regulators of embryonic lethality and inflammation. Caspase-8 has a critical role in pro- and antinecrotic signaling pathways leading to the activation of receptor interacting protein kinase 1 (RIPK1), RIPK3, and the mixed kinase domain-like (MLKL) for a convergent execution pathway of necroptosis or regulated necrosis. Here we outline the recent discoveries into how the necrotic cell death execution pathway is engaged in many physiological and pathological outcome based on genetic analysis of knockout mice.

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

Empathy among medical students: is there a relation with quality of life and burnout?

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<0.05; d ≥ 0.5). There were minor differences in the empathic dispositions of students in different stages of their medical training (p<0.05; f<0.25). Female students had slightly lower scores for physical and psychological quality of life than male students (p<0.05; d<0.5). Female students scored higher on emotional exhaustion and lower on depersonalization than male students (p<0.001; d<0.5). Students in their final stage of medical school had slightly higher scores for emotional exhaustion, depersonalization and personal accomplishment (p<0.05; f<0.25). Gender (ß = 0.27; p<0.001) and perspective taking (ß = 0.30; p<0.001) were significant predictors of empathic concern scores. Depersonalization was associated with lower empathic concern (ß =  -0.18) and perspective taking (ß =  -0.14) (p<0.001). Personal accomplishment was associated with higher perspective taking (ß = 0.21; p<0.001) and lower personal distress (ß =  -0.26; p<0.001) scores. CONCLUSIONS: Female students had higher empathic concern and personal distress dispositions. The differences in the empathy scores of students in different stages of medical school were small. Among all of the studied variables, personal accomplishment held the most important association with decreasing personal distress and was also a predicting variable for perspective taking.

Avaliação da percepção do ambiente de ensino e sua relação com a qualidade de vida em estudantes de medicina / Assessment of learning environment perception and its relationship to quality of life in medical students

INTRODUÇÃO: O ambiente de ensino da faculdade de medicina influencia a aprendizagem e o bem-estar dos estudantes. O objetivo do nosso estudo foi avaliar a percepção do ambiente de ensino e sua associação com a qualidade de vida de estudantes de 22 escolas médicas brasileiras. MÉTODOS: Este é um estudo multicêntrico, com coleta de dados em uma plataforma eletrônica (plataforma VERAS), no qual foram utilizados os questionários: DREEM (Dundee Ready Education Environment Measure) para avaliação da percepção do ambiente de ensino e VERAS-Q, WHOQOL-BREF e a autoavaliação para a avaliação da percepção da qualidade de vida. Foram comparadas as diferenças de percepção do ambiente de ensino e qualidade de vida entre os sexos e os diferentes anos do curso. RESULTADOS: De 1.650 estudantes randomizados, 1.350 (81,8%) completaram todos os questionários da plataforma VERAS. A média do escore total do DREEM (119,4 ± 27,1) revelou que a percepção do ambiente de ensino é mais positiva que negativa. Houve uma pequena diferença significativa entre a média dos escores dos estudantes do sexo masculino (121,0 ± 27,2) e feminino (118,0 ± 27,0) (p=0,048). Estudantes do sexo feminino apresentaram médias dos escores significativamente menores nos domínios Acadêmico e Social do DREEM (p < 0,001). As médias dos escores dos estudantes do último ano do curso foram significativamente menores em relação aos estudantes do ciclo básico no escore total e em todos os domínios do DREEM (p < 0,05), exceto no Acadêmico. Os itens que tiveram média abaixo de 2,0 (n=11), sinalizando áreas problemáticas do curso, estiveram presentes em todos os domínios do DREEM. Estudantes do sexo feminino apresentaram menores médias dos escores de qualidade de vida no escore total e nos domínios Físico, Psicológico e Uso do Tempo do VERAS-Q (p < 0,001). Estudantes dos últimos anos do curso tiveram escores menores no escore total e no domínio Ambiente de Ensino do VERAS-Q (p < 0,05). Entre os respondentes, 40%...

INTRODUCTION: The educational environment of medical school influences students' learning and well-being. The aim of this study was to assess perceptions of the educational environment among students from 22 Brazilian medical schools and to determine the association between these perceptions and quality of life measures. METHODS: This is a multi-centre study with a random sample of medical students from different years in medical school. We used educational environment (Dundee Ready Education Environment Measure - DREEM questionnaire) and quality of life (VERAS-Q, WHOQOL-BREF questionnaires and self-assessment) perception measures in an electronic survey. Differences in educational environment perceptions and quality of life were evaluated across genders and years in medical school. RESULTS: From 1,650 invited students, 1,350 (81.8%) completed all questionnaires. Total DREEM scores (119.4 ± 27.1) revealed that the perceptions of the educational environment were positive. There was a small significant difference between male (121.0 ± 27.2) and female (118.0 ± 27.0) students (p=0.048). Female students had significantly lower mean scores on the Academic and Social DREEM domains (p < 0,001). The mean scores of students in final years were significantly lower than of those in the basic cycle in the total DREEM score and in all domains of DREEM (p < 0.05), except in the Academic domain. Items that had a mean score below 2.0 (n = 11), indicating problem areas of the program, were present in all domains of the DREEM. Female students had lower scores on physical, psychological and time management domains and the total score of the VERAS-Q compared to male students (p < 0.001). Students in the final years of medical school had lower total scores and in the learning environment domain of the VERAS-Q (p < 0.05). Among the respondents, 40% declared that their quality of life in medical school is good, but 59% affirmed that they cannot manage their...

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

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.

Tumor necrosis factor-á signaling cascades in apoptosis, necrosis, necroptosis and cell proliferation

Tumor necrosis factor-á (TNF-á) is a multifunctional cytokine involved in host defense, inflammation, apoptosis, autoimmunity, organogenesis and lymphoid microarchitecture. Many of these activities may be explained by the ability of this cytokine to induce distinct signal transduction pathways that recruit regulatory proteins involved in differentiation, cell death or cell proliferation. In this review, we discuss the contribution of caspases -3, -6, -7 and -8, and of cyclin-dependent kinases (CDKs), cyclin B and cyclin-dependent kinase inhibitors (CKI p21 and p27), as well as retinoblastoma tumor suppressor in the signaling cascades triggered by TNF-á to induce apoptosis, necrosis and cellular proliferation in the murine cell lines NIH3T3 and WEHI-164 and the human cervical carcinoma cell line HeLa-S3. Based on the findings of many literature reports and our own data, we discussed a model in which caspases are continuously activated throughout the cell cycle and kept at a critical threshold level by IAP (inhibitor of apoptosis) antagonists. Following the release of Smac/Diablo and HtrA2/OMI from mitochondria in response to diverse stimuli, this threshold is overcome and results in amplified caspase activation and cell death. An alternative, caspase-independent mechanism of cell death is induced in NIH3T3 fi broblasts by a combination of TNF and the pan-caspase inhibitor z-VADfmk. This cell death phenotype, known as necroptosis, displays some morphological features of apoptosis and necrosis. Although caspases are critical regulators of the TNF signaling pathway during cellular life and death, the mechanisms involved in the fine regulation of their dual effects remain to be fully elucidated.