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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2020.tde-18012021-123048
Document
Author
Full name
Alice de Queiroz Constantino Miguel
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2020
Supervisor
Committee
Martins, Milton de Arruda (President)
Baldassin, Sergio Pedro
Costa, Fernanda Magalhães Arantes
Germani, Ana Claudia Camargo Gonçalves
Title in Portuguese
Fatores associados à qualidade de vida dos estudantes de Medicina
Keywords in Portuguese
Educação médica
Estudantes de medicina
Estudo multicêntrico
Fatores associados
Fatores preditivos
Gerenciamento do tempo
Qualidade de vida
Abstract in Portuguese
INTRODUCÃO: A percepção dos estudantes de Medicina quanto a sua Qualidade de Vida no curso é pior do que sua Qualidade de Vida geral. Entre esse grupo, há alta prevalência de sintomas de sofrimento psicossocial. Sabe-se que a percepção da Qualidade de Vida no curso de Medicina está associada ao desempenho acadêmico. O objetivo deste estudo foi avaliar os fatores preditivos de Qualidade de Vida dos estudantes de Medicina brasileiros a partir de uma análise exploratória. ME?TODOS: Estudo transversal e multicêntrico com amostra nacional aleatorizada por sexo e ano do curso. Os dados foram coletados entre agosto de 2011 e agosto de 2012, por meio de uma plataforma eletrônica (plataforma VERAS). Nossos desfechos principais incluíram: autoavaliação da Qualidade de Vida geral (QVg) e da Qualidade de Vida no curso de Medicina (QVcm), medidas usando uma escala analógica de 0 (pior) a 10 (melhor). Selecionamos as seguintes variáveis como preditores: The World Health Organisation Quality of Life Assessment versão abreviada (WHOQOL-BREVE), Questiona?rio para Avaliar a Qualidade de Vida do Estudante e Residente da Área da Saúde (VERAS-Q), Inventário de Depressão de Beck (IDB), Inventário de Ansiedade Traço - Estado (IDATE), Escala de Sonolencia Diurna de Epworth (ESS), Pittsburgh Sleep Quality Index versa?o Português-Brasil (PSQI-BR), Escala Multidimensional de Reatividade Interpessoal de Davis (EMRI), Escala de Resiliência de Wagnild & Young (RS-14), Maslach Burnout Inventory (MBI), o Dundee Ready Education Environment Measure (DREEM). RESULTADOS: Dos 1650 estudantes aleatorizados, 1350 (81,8%) responderam todos os questionários. Ao avaliar a associação entre os resultados do estudo, a QV geral e a QV relacionada ao curso médico apresentaram correlação positiva (0,566; p < 0,001), e a média da QVg e QVcm foram 7,86 (± 1,27) e 6,51 (± 1,56), respectivamente. Ao comparar os preditores e os desfechos de Qualidade de Vida, encontramos uma correlação negativa entre a QVcm e IDB (correlação = -0,397, p < 0,001), PSQI-BR (-0,345, p < 0,001) e escores da ESS (-0,211, p < 0,001). Correlação na mesma direção foi observada entre a QVg e o IDB (-0,339, p < 0,001), IPSQI-BR (-0,276, p < 0,001) e os escores da ESS (-0,092, p < 0,001). Na avaliação pelo modelo de regressão linear múltipla, preditores significativos para maior QV incluíram: IDB acima e abaixo de uma mediana de 8 (6,96 vs. 6 na QVcm, 8,16 vs. 7,53 na QVg), PSQI-BR com mediana de 6 (6,93 vs. 6,06, 8,12 vs. 7,61), ESS na mediana 10 (6,83 vs. 6,13, 7,98 vs. 7,75), nos domínios WHOQOL- breve meio ambiente com mediana de 65,6 (6,03 vs. 7,14, 7,5 vs. 8,37), relações sociais com mediana de 66,7 (6,21 vs. 6,93, 7,62 vs. 8,34), psicológico com mediana de 62,5 (5,96 vs. 7,13, 7,49 vs. 8,31) e saúde física na mediana de 67,9 (6,04 vs. 7,2, 7,59 vs. 8,28), os domínios VERAS-Q gestão de tempo na mediana de 36,4 (5,95 vs. 7,14, 7,63 vs. 8,14), psicológico na mediana de 50 (5,97 vs. 7,07), 7,5 vs. 8,26), saúde física na mediana 53,1 (5,89 vs. 7,14, 7,35 vs. 8,4) e ambiente de ensino na mediana de 57,1 (5,94 vs. 7,12, 7,54 vs. 8,22 ), IDATE- estado na mediana 43 (6,98 vs. 6,01, 8,23 vs. 7,49), IDATE- traço na mediana 45 (7 vs. 5,99, 8,24 vs. 7,49), EMRI- no domínio Angústia Pessoal na mediana de 19 (6,65 vs. 6,34, 8 vs. 7,72), domínios do MBI, incluindo exaustão emocional na mediana de 27 (7,02 vs. 5,94, 8,14 vs. 7,57), despersonalização com mediana de 8 (6,79 vs. 6,19, 8,04 vs. 7,68) e realização pessoal com mediana de 35 (6,23 vs. 6,84, 7,68 vs. 8,1), DREEM pontuação global na mediana de 120 (6 vs. 7,04, 7,63). 8,12) e RS-14 na mediana de 81 (6,24 vs. 6,82, 7,62 vs. 8,15). O modelo de regressão em árvore demonstrou que os alunos com escore de saúde física VERAS-Q >= 60,9 e escore de gestão de tempo VERAS-Q >= 55,7 apresentaram a melhor QVcm com pontuação de 8,08 (9,63%), enquanto aqueles com pontuação de saúde física VERAS-Q < 60,9 associada a um ambiente de ensino VERAS-Q < 56,2 foram associadas a menor QVcm (3,79, 2,15%). Ao avaliar os preditores da QVg domínio de saúde física VERAS-Q com um escore >= 54,7 apresentaram o maior escore de QVg de 8,93 (8,74%), enquanto o menor escore de QVg (5,57, 1,56%) foi encontrado entre os alunos com escore de Saúde física VERAS-Q de < 54,7 associado a um escore de saúde psicológica do WHOQOL-breve < 43,8 e um escore de relações sociais do WHOQOL-breve < 20,9. As correlações encontradas na Modelagem de equações estruturais evidenciam uma associação positiva entre Qualidade de Vida do estudante de Medicina e os construtos Uso de Tempo (1,054, P < 0,000), Físico (0,0, p < 0,000), Percepção de Aprendizado (0,310, p < 0,000) e Realização Pessoal (0,223, p = 0,038). Enquanto com os construtos Despersonalização e Psicológico, a correlação foi negativa (-0,167, p = 0,004 e -0,321, p= 0,012, respectivamente). CONCLUSÕES: Ao avaliar Qualidade de Vida do estudante de Medicina nos seus amplos aspectos, sua percepção em relação a sua saúde física tem maior associação com melhor quanto pior Qualidade de Vida. Nossos dados mostram que a Gestão de tempo é um fator protetor para qualidade de vida do estudante, o que indica que as instituições de ensino, além de revisar seus currículos para incluir tempo livre para estudo e lazer, devem ofertar atividades educacionais para que eles aprimorem esta competência
Title in English
Factors associated with the quality of life of medical students
Keywords in English
Associated factors
Education medical
Multicenter study
Predictive factors
Quality of life
Students medical
Time management
Abstract in English
INTRODUCTION Medical students' perception of their Quality of Life in the course is worse than their overall Quality of Life. Among this group there is a high prevalence of symptoms of psychosocial distress. It is known that the perception of Quality of Life in the medical course is associated with academic performance. The objective of this study was to evaluate the predictive factors of Quality of Life of Brazilian medical students from an exploratory analysis.-. METODOLOGY: Cross-sectional in accordance with the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) guidelines and multicenter study with national sample randomized by sex and year of the course. Data were collected between August 2011 and August 2012, using an electronic platform (VERAS platform). Our outcomes of interest included: personal quality of life (QOLp) measured using a self-reported analog scale with a score ranging from 0 (worst) to 10 (best), and quality of life (QOLmc) related to medical course activities measured using a score ranging from 0 (worst) to 10 (better). We selected the following variables as predictors: The World Health Organization Quality of Life Assessment abbreviated version (WHOQOL-BREF), VERAS-Q is a questionnaire created to evaluate the QOL of students in health professions, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Resilience Scale (RS-14), validity (18,19), Interpersonal Reactivity Multidimensional Scale (IRMS) and Dundee Ready Education Environment Measure (DREEM). RESULTS: Our sample is comprised of 1350 (81,8%) medical students. When evaluating the association between study outcomes, personal QOL and QOL related to medical course presented a positive correlation (0.566; p < 0.001), and mean QOLp and QOLmc were 7.86 (± 1.27) and 6.51 (± 1.56), respectively. When comparing predictors and both quality of life outcome measures, we found a negative correlation between QOL related to medical course and the BDI (correlation = -0.397, p < 0.001), PSQI (-0.345, p < 0.001) and ESS scores (-0.211, p < 0.001). Correlation with the same direction was observed between personal QOL and BDI (-0.339, p < 0.001), PSQI (-0.276, p < 0.001) and the ESS scores (-0.092, p < 0.001). When comparing predictors with both QOL through a multiple linear regression mode significant predictors of higher QOL included: BDI at a median of 8 (6.96 vs. 6 for QOL medical course, 8.16 vs. 7.53 for QOL personal), global PSQI at median of 6 (6.93 vs. 6.06, 8.12 vs. 7.61), ESS at median 10 (6.83 vs. 6.13, 7.98 vs. 7.75), WHO QOL domains scores including environment at median of 65.6 (6.03 vs. 7.14, 7.5 vs. 8.37), social relations at median of 66.7 (6.21 vs. 6.93, 7.62 vs. 8.34), psychological at median of 62.5 (5.96 vs. 7.13, 7.49 vs. 8.31), and physical health at median of 67.9 (6.04 vs. 7.2, 7.59 vs. 8.28), VERAS-Q domains including time management scores at median of 36.4 (5.95 vs. 7.14, 7.63 vs. 8.14), psychological at median of 50 (5.97 vs. 7.07, 7.5 vs. 8.26), physical health at median 53.1 (5.89 vs. 7.14, 7.35 vs. 8.4), and learning environment at median of 57.1 (5.94 vs. 7.12, 7.54 vs. 8.22), IDATE- State score at median 43 (6.98 vs. 6.01, 8.23 vs. 7.49), IDATE- Trait score at median 45 (7 vs. 5.99, 8.24 vs. 7.49), IRMS- Personal Anguish domain score at median of 19 (6.65 vs. 6.34, 8 vs. 7.72), MBI domains including emotional exhaustion at median of 27 (7.02 vs. 5.94, 8.14 vs. 7.57), depersonalization with median of 8 (6.79 vs. 6.19, 8.04 vs. 7.68), and personal accomplishment with median of 35 (6.23 vs. 6.84, 7.68 vs. 8.1), DREEM global score at median of 120 (6 vs. 7.04, 7.63 vs. 8.12), and RS-14 score at median of 81 (6.24 vs. 6.82, 7.62 vs. 8.15). We then attempted to validate our results by running a tree regression model. We demonstrated that the VERAS-Q - physical health domain was the most important factor predicting QOL, followed by VERAS-Q-time management, VERAS-Q-learning environment, WHO QOL-physical health, and Maslach Burnout Inventory-Emotional exhaustion domain. We found that the students with a VERAS-Q-physical health score >= 60.9 and a VERAS-Q-time management score >= 55.7 presented the best QOL related to the medical course with a score of 8.08 (9.63%), while those with VERAS-Q-physical health score < 60.9 associated with a VERAS-Q-learning environment score < 56.2 were associated with the lowest QOL (3.79, 2.15%). When evaluating the predictors of student's personal QOL, the VERAS-Q-physical health domain was the most significant predictor, followed by WHO QOL-psychological health, WHO QOL-environment, and WHO QOL-social relationships domains. Students with a VERAS-Q-physical health score >= 54.7 presented the highest personal QOL score of 8.93 (8.74%), whereas the lowest QOL score (5.57, 1.56%) was found among students with a VERAS-Q-physical health score of < 54.7 associated with a WHO QOL-psychological health score < 43.8 and a WHO QOL-social relationships score < 20.9. Additional combinations of scores were associated with intermediate personal QOL. The correlations found in the Structural equation model analysis show a positive association between the medical student's Quality of Life and the constructs Use of time (1.054, P < 0.000), Physical (0.0, p < 0.000), Perception of learning (0.310, p < 0.000) and personal achievement (0.223, p = 0.038). While with the Depersonalization and Psychological constructs, the correlation was negative (-0.167, p = 0.004 and -0.321, p = 0.012, respectively). CONCLUSION: When assessing medical student's Quality of Life in its broad aspects, his perception in relation to his physical health has a greater association with better the worse Quality of Life. Our data show that Time Management is a protective factor for the student's quality of life, which indicates that educational institutions, in addition to revising their curricula to include free time for study and leisure, should offer educational activities for them to improve this competence
 
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Publishing Date
2021-02-03
 
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