Uma Estratégia de Redução do Estresse entre Estudantes Médicos / A Strategy for Stress Reduction among Medical Students

Resumo: Introdução: O curso de graduação em Medicina expõe os alunos a uma quantidade significativa de estresse, o que pode gerar consequências negativas para o aprendizado, a motivação e o contato com os pacientes. Algumas técnicas e práticas têm sido indicadas para auxiliar no manejo e na redução do estresse, como é o caso da meditação que já é utilizada em escolas médicas. Este estudo avaliou os efeitos de um programa de redução do estresse e desenvolvimento da empatia em medicina (Redemed©) sobre a percepção de estresse de seus participantes e possíveis grupos de acolhimento. Método: Este é um ensaio quase experimental cuja amostra foi composta por 40 estudantes que compuseram o grupo controle e 47 alunos de um grupo de intervenção que participaram de oito encontros semanais de duas horas divididas em: 30 minutos de teoria sobre como o estresse influencia o estado de saúde, 60 minutos de vivências interpessoais e 30 minutos de ioga e meditação. Ambos os grupos, antes e depois do curso, responderam ao questionário sobre estresse percebido (PSS - Escala de Cohen). Resultados: Após os oito encontros semanais, o grupo intervenção apresentou melhora significativa (p = 0,030), demonstrando que a participação no curso Redemed© mostrou-se eficaz no controle do estresse entre os estudantes do presente estudo. Os alunos também foram questionados quanto à autopercepção sobre se sentirem ou não apoiados por outros grupos. Os três grupos de acolhimentos mais citados entre os alunos, tanto do grupo ativo como do controle, foram: amigos/família, centro acadêmico e a equipe do esporte que praticavam. Após as oito semanas, enquanto o grupo controle permaneceu com as mesmas indicações, no grupo intervenção foram citados: amigos/família, Redemed© e centro acadêmico. Conclusão: Este estudo mostrou que o programa Redemed©, com encontros durante oito semanas utilizando a meditação como sua técnica central, foi eficaz na redução do estresse percebido pelos estudantes de Medicina que participaram dessa intervenção quando comparado ao grupo controle (p = 0,000). As práticas integrativas e complementares podem ser uma ferramenta importante dentro das escolas médicas, de modo a levar os estudantes a lidar melhor com o estresse a que estão expostos ao longo do curso.

Abstract: Introduction: Undergraduate medical students experience a considerable amount of stress, which can negatively affect their learning, motivation and contact with patients. Some techniques and practices for stress management and reduction, such as meditation, have been recommended and used in medical schools. This study evaluated the effects of a Stress Reduction and Empathy Development Program in Medicine (REDEMED©) on participants' perception of stress and possible support groups. Method: This is a quasi-experimental trial whose sample comprised 40 students in a control group and 47 students in an intervention group. The students in the intervention group participated in eight weekly sessions lasting two hours each. The course hours were divided into: 30 minutes of theoretical content on how stress influences one's health, 60 minutes of interpersonal practices and 30 minutes of yoga and meditation practices. Both groups, before and after the program, answered the questionnaire on perceived stress (PSS - Cohen's scale). Results: After the eight weekly meetings, the intervention group showed significant improvement (p = 0.030), showing that participation in the REDEMED© course proved to be effective in stress control among the students in the study. The students were also questioned about their self-perception of whether or not they felt they were supported by any other groups. The three support groups most often referred to by the students, in both the intervention and the control group, were: friends/family, the Students' Union and their sports team. After eight weeks, while the control group still referred to the same groups, the intervention group mentioned friends/family, REDEMED© and the Students' Union. Conclusion: This study showed that the REDEMED© program, meeting for eight weeks using meditation as its central technique, was effective in reducing the stress perceived by medical students who participated in this intervention when compared to the control group (p = 0,000). Integrative and complementary practices can be an important tool within medical schools, empowering students to better cope with the stress they are exposed to throughout the course.

Guidance on Healthy Eating Habits from the Medical Student's Perspective / Orientação de Hábitos Alimentares Saudáveis sob o Olhar do Estudante de Medicina

ABSTRACT Although nutrition is one of the most significant aspects of good health and well-being, preventing many diseases and reducing premature death and disability, most medical curricula still do not cover this topic in depth, devoting only a few hours to it. This leaves an important gap in the training of medical professionals, in a context of an increase in chronic diseases, where healthy eating is essential, not only for prevention but also to guarantee treatment success. The present study interviewed medical students from the first to the sixth years of graduation, in order to understand what they consider to be a healthy diet and whether they consider themselves capable of guiding their future patients in the adoption and practice healthy eating habits. This is a qualitative study in which semi-structured interviews were conducted with 28 undergraduate medical students of a public university in the state of São Paulo. The data were analyzed using the technique of Content Analysis, with a thematic representational approach. Two major themes emerged, showing possible gaps in the students' knowledge about nutrition and the difficulty they have in helping their patients switch to healthier eating habits, given that they themselves have difficulty doing the same. There is a need for medical schools to promote students' health, both physical and mental, in response to the high demands of the courses. This may include health promotion activities aimed at the students themselves, encouraging them to adopt healthier lifestyles, especially healthier eating habits, so that they can share their own experiences with future patients. This may benefit their professional practice, giving them greater confidence when giving nutrition guidance to their patients, as they will have already experienced and applied the principles in their own lives. Patient-centered care can be a way to address this system and help patients effectively switch to healthier habits, thereby reducing suffering and improving quality of life. Empowerment through activities that receive and support the student and the patient is an essential tool for behavioral change.

RESUMO The rising number of students leagues in the Escola Paulista de Medicina of the Universidade Federal de São Paulo (EPM-Unifesp) leads to questions about their meaning to students and their role in medical training, as well as concerns about learning distortions, early specialization, social relevance, and insertion in the Brazilian national health system, called the Sistema Único de Saúde (SUS). In order to try and clarify these questions, this qualitative study analyzes the statues of the leagues, and the statements of tutors and students, gathered by means of four focal groups with students and two interviews with the tutors. We found 45 leagues currently running at the EPM-Unifesp, most of them associated with a medical specialty. The main motivators for joining in a league were: the search for practical activities, the desire to gain more experience of a particular specialty, the desire for more knowledge, and the need to be recognized as a responsible adult. Of the leagues studied, few conducted research or university extension activities, focusing on treatment and theoretical classes, supervised by professors, non-teacher physicians, resident doctors, or more senior students. The tutors are in charge of the organizational aspects. The leagues can reproduce graduation models, such as an overburdoning with activities and poor expository classes. Concerning insertion in the SUS, the leagues could be a means of training future SUS professionals. Although students claim that they intend to specialize in the league's field, the tutors disagree that they lead to early specialization. We consider that while leagues fill gaps in the learning and expectations of the course, they are limited in regards to the impact of their activities on medical training and their social relevance. They can subvert the curricular structure and favor early specialization. We recommend that universities pay closer attention to students leagues, observing their number, selection process, activities, tutors involved and explicit objectives, with the purpose of evaluating their roles in the curriculum and medical training.

Evaluation of inflammatory markers in the practice of meditation in students of medicine: controlled clinical trial

INTRODUCTION Stress, depression and anxious symptoms are more pronounced in medical students than in students in other courses. Chronic psychological stressors are associated with inflammation. The markers considered most evident for low-grade chronic inflammation associated with diseases are pro inflammatory cytokines and C-reactive protein (CRP). OBJECTIVE To evaluate the effects of a course of stress reduction and empathy development in medical students (REDEMED) through inflammatory markers. METHODS Controlled clinical trial, whose sample consisted of 55 students of the active group, who performed eight weekly classes of two hours of meditation techniques and exercises to explore interpersonal experiences, and 54 students who composed the control group. Blood was taken from both groups before and after the eight-week course for analysis of inflammatory markers: C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α). RESULTS Due to loss of students to follow-up and problems with processing some blood samples, analysis included results from only 31 from the active group and 29 from the control group. There were no significant differences between the control and active groups in relation to the inflammatory markers PCR and TNF-α. DISCUSSION REDEMED did not present significant alterations of the inflammatory markers evaluated in this group of medical students in the evaluated period. Investigations of different biomarkers and other categories (genetic, neurobiological, etc.) could be carried out for the same purpose.(AU)

How does a meditation course impact on the empathy level of medical students?

Objective: To investigate the empathy levels throughout the years of graduation on medical students before and after a course of Stress Reduction and Empathy Development (REDEMED). METHODThe course was comprised of eight two hour meetings, where meditation practices and group activities focused on interpersonal skills were proposed. Thirty-one students who completed the course composed the active group, while 29 students were in the control group. RESULTSThe mean scores of the JSE-S for the active group before and after the course were, respectively: 1st year: 118.5 and 123; 2nd year: 120 and 124; 3rd year: 123 and 126; 4th year: 122.5 and 131; 5th and 6th years: 128 and 127. In the control group, the mean initial scores and the scores after 9 weeks were: 1st year: 120.5 and 115; 2nd year: 115 and 118; 3rd year: 114 and 116; 4th: 111.5 and 114.5; 5th and 6th years: 116 and 115. When analyzing by graduation year, the first year of medical school was the only group that presented a significant difference in change of JSE-S (p: 0.001) when compared to the control group of the same year. DISCUSSION Completing the REDEMED course proved to be effective in the development of empathy among students.(AU)

A stress reduction course impact on medical students of different graduation years

OBJECTIVE To investigate the impact of a stress reduction and empathy development course (REDEMED) on perceived stress levels of medical students in different undergraduate years. METHOD Medical students from the 1st to the 6th year were invited to an initial lecture in which the REDEMED course program was presented (8 weekly meetings of 2 hours duration about interpersonal experiences and meditation). Stakeholders comprised the active group (n = 31) and other volunteer students constituted the control group (n = 29). RESULTSThe mean scores in the PSS of the active group at week 0 and at week 9 were, respectively: 1st year (34.5 and 24); 2nd year (30 and 22); 3rd year (34 and 24) 4th (27.5 and 20); 5th and 6th year combined (27 and 25). In the control group, the initial and final mean scores were respectively: 1st year (27 and 29); 2nd year (28 and 25) 3rd year (26 and 24); 4th (30.5 and 27.5); 5th and 6th combined (30 and 25). The first year of medical school students was the only group that presented a significant stress variation (p: 0.000) when compared to the control group of the same year. DISCUSSIONThis strategy could be used in undergraduate medical coursesto help on stress symptoms reduction especially at the beginningof the course when it presented greater impact. (AU)