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This study sought to explore the perspective of medical faculty on the mental health of their students. This qualitative study based on a focus group is part of a longitudinal research that studied the mental health of Brazilian students. One group was conducted with faculty employed at a medical school. Topics discussed covered the concept of mental health and medical education. Six professors participated in one group. The mental health of medical students is a construct that encompasses emotional aspects, ability to solve problems and multiple facets of a human being, according to the participants. Artistic practices, moments of socialization and leisure were perceived as stimulating students' good mental health. Excessive demands generate competitiveness and the teacher's expectation of the student's good performance based on their own experience can harm the student's mental health. Participants also highlighted that a pedagogical reformulation that makes sense for the student's learning process is necessary to update traditional curricula. Medical students' mental health is influenced by experiences and exchanges during the medical school, mainly between professor and student, understood as necessary and inherent to the process of becoming physician. The findings of this study show the need for curriculum changes in the medical education process and updating teacher training for good practices that reinforce good mental health.

Este estudio buscó explorar la perspectiva de los profesores de medicina sobre la salud mental de sus estudiantes. Este estudio cualitativo basado en un grupo focal es parte de una investigación longitudinal que estudió la salud mental de estudiantes brasileños. Un grupo se llevó a cabo con profesores empleados en una escuela de medicina. Los temas tratados abarcaron el concepto de salud mental y educación médica. Seis docentes participaron en un grupo. La salud mental de los estudiantes de medicina es un constructo que abarca aspectos emocionales, capacidad de resolución de problemas y múltiples facetas del ser humano, según los participantes. Las prácticas artísticas, los momentos de socialización y el ocio fueron percibidos como estimulantes de la buena salud mental de los estudiantes. Las exigencias excesivas generan competitividad y la expectativa del docente sobre el buen desempeño del estudiante basándose en su propia experiencia puede perjudicar la salud mental del estudiante. Los participantes también resaltaron que es necesaria una reformulación pedagógica que tenga sentido para el proceso de aprendizaje del estudiante para actualizar los currículos tradicionales. La salud mental de los estudiantes de medicina está influenciada por las experiencias y los intercambios durante la carrera de medicina, principalmente entre profesor y estudiante, entendidos como necesarios e inherentes al proceso de convertirse en médico. Los hallazgos de este estudio muestran la necesidad de cambios curriculares en el proceso de formación médica y de actualización de la formación docente hacia buenas prácticas que refuercen la buena salud mental.

Este estudo buscou explorar a perspectiva dos docentes de medicina sobre a saúde mental de seus alunos. Este estudo qualitativo baseado em grupo focal faz parte de uma pesquisa longitudinal que estudou a saúde mental de estudantes brasileiros. Um grupo foi conduzido com professores empregados em uma faculdade de medicina. Os temas discutidos abrangeram o conceito de saúde mental e educação médica. Seis professores participaram de um grupo. A saúde mental dos estudantes de medicina é um construto que engloba aspectos emocionais, capacidade de resolução de problemas e múltiplas facetas do ser humano, segundo os participantes. As práticas artísticas, os momentos de socialização e de lazer foram percebidos como estimuladores da boa saúde mental dos estudantes. Exigências excessivas geram competitividade e a expectativa do professor pelo bom desempenho do aluno com base na própria experiência pode prejudicar a saúde mental do aluno. Os participantes destacaram também que é necessária uma reformulação pedagógica que faça sentido para o processo de aprendizagem do aluno para atualizar os currículos tradicionais. A saúde mental dos estudantes de medicina é influenciada pelas experiências e trocas durante o curso de medicina, principalmente entre professor e aluno, entendidas como necessárias e inerentes ao processo de tornar-se médico. Os achados deste estudo mostram a necessidade de mudanças curriculares no processo de formação médica e de atualização da formação docente para boas práticas que reforcem a boa saúde mental.

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Abstract: Introduction: Emergency medicine is a relatively new medical specialty in Brazil, approved just in 2016. Residency training programs have been implemented ever since. The emergency environment is known to represent a death-and-life tension on the professional team, culminating with high rates of mental illness in this population. The Covid-19 pandemic seems to be affecting these rates of depression, anxiety, and burnout in health professionals. Objective: To assess the symptoms of burnout, depression, and anxiety in Brazilian medical residents of Emergency Medicine during the Covid-19 pandemic and compare the residents' beliefs regarding clinical practice related to Covid-19 patients. Methods: A quantitative study was conducted with a convenience sample of volunteer medical residents from an anonymous online survey, available during April 2020. This investigation collected sociodemographic information and used the Oldenburg Burnout Inventory (OLBI) to measure burnout; the Patient Health Questionnaire (PHQ-9) to measure depression; and the General Anxiety Disorders (GAD-7) to measure generalized anxiety disorder. This study also developed a Covid-19 Impact Questionnaire (CIQ-19) to assess the residents' beliefs and clinical practices related to Covid-19 patients. Results: The survey consisted of 63 respondents, about 26,35% of emergency medicine residents in Brazil. Only 39.6% residents felt safe while working with Covid-19 patients. Mild depressive symptoms were found in 68.2% of the residents, followed by anxiety symptoms in 50.7% and burnout in 54.0% overall. About 12% of the residents do nothing about their mental health status, while some prefer to talk with family or friends (36.1%) and discuss with their team support (24.3%) when they need mental health care. Conclusion: Emergency medicine residents have high rates of mental illness and it could get worse when submitted to stressful and unknown situations, such as the Covid-19 pandemic. Initiatives should be made to improve these physicians' mental health status. It is proposed that health institutions pay medical supervisors a closer and more unique look at physicians in training. A mentoring program proposal is an opportunity to reflect on technical and personal improvements for medical residents.

Resumo: Introdução: Medicina de emergência é uma especialidade relativamente nova no Brasil, aprovada apenas em 2016, e programas de treinamento em residência têm sido instituídos desde então. O ambiente da emergência é conhecido por representar uma tensão entre vida e morte nos profissionais, o que culmina em altos índices de adoecimento mental nessa população. A pandemia da Covid-19 aparenta estar influenciando nas taxas de depressão, ansiedade e burnout de profissionais de saúde. Objetivo: Este estudo teve como objetivos avaliar os sintomas de burnout, depressão e ansiedade em residentes de medicina de emergência brasileiros durante a pandemia da Covid-19 e comparar as crenças deles sobre a prática clínica relacionada aos pacientes com a doença. Método: Um estudo quantitativo foi realizado com uma amostra conveniente de médicos residentes voluntários, por meio de uma pesquisa on-line anônima disponível durante o mês de abril de 2020. Esta investigação coletou informações sociodemográficas e utilizou as seguintes escalas: Oldenburg Burnout Inventory (OLBI) para mensurar burnout, Patient Health Questionnaire (PHQ-9) para mensurar depressão e General Anxiety Disorders (GAD-7) para mensurar transtorno de ansiedade generalizada. Neste estudo, também foi desenvolvido um Questionário sobre o Impacto da Covid-19 (CIQ-19) para acessar as crenças e práticas clínicas relacionadas aos pacientes com Covid-19. Resultado: A pesquisa foi composta de 63 voluntários, aproximadamente 26,35% dos residentes em medicina de emergência no Brasil. Apenas 39,6% dos residentes se sentiram seguros enquanto trabalhavam com pacientes com Covid-19. Encontraram-se sintomas leves de depressão em 68,2%, seguidos de sintomas de ansiedade em 50,7% e burnout em 54,0%. Aproximadamente 12% dos residentes não fazem nada relação à própria saúde mental, alguns preferem conversar com familiares e amigos (36,1%), e outros discutem com a equipe de suporte (24,3%) quando precisam de atendimento. Conclusão: Os residentes de medicina de emergência possuem altos índices de adoecimento mental, e isso pode piorar quando submetidos a situações estressantes e desconhecidas, como a pandemia da Covid-19. Iniciativas devem ser tomadas para melhorar a saúde mental desses médicos. Propõe-se que as instituições de saúde ofereçam aos supervisores médicos uma visão mais próxima e exclusiva sobre os médicos em treinamento. A proposta de um programa de mentoria é uma oportunidade de refletir sobre melhorias técnicas e pessoais para médicos residentes.

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BACKGROUND: 2020 was a challenging year for all healthcare professionals worldwide. In São Paulo, Brazil, the virus SARS-CoV-2 took 47,222 lives up to December 29, 2020. The front line of medical professionals in São Paulo was composed of many residents, who were transferred from their rotations to cover the needs of the pandemic. OBJECTIVE: To identify medical residents' mental health and clinical issues, regarding symptoms of burnout, depression and anxiety during the pandemic, and to compare them among specialties. DESIGN AND SETTING: Quantitative study using a convenience sample of medical resident volunteers who responded to an anonymous online survey that was available during April 2020. METHODS: This investigation collected sociodemographic information and used the Oldenburg Burnout Inventory (OLBI) to measure burnout, the Patient Health Questionnaire (PHQ-9) to measure depression and the General Anxiety Disorder (GAD-7) scale to measure anxiety symptoms. This study also developed a COVID-19 Impact Questionnaire (CIQ-19) to assess the residents' beliefs and clinical practices relating to COVID-19 patients. RESULTS: The sample comprised 1,392 medical residents in São Paulo, Brazil. Clinical specialty physicians showed the highest rates of anxiety symptoms (52.6%) and burnout (51.2%), among the specialties. CONCLUSION: Clinical specialty residents are at higher risk of anxiety, depression and burnout. The symptoms of anxiety and depression have worsened during the COVID-19 pandemic. There is a general need for mental health support interventions for medical resident physicians, which requires reinforcement during this worldwide crisis.

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ABSTRACT BACKGROUND: 2020 was a challenging year for all healthcare professionals worldwide. In São Paulo, Brazil, the virus SARS-CoV-2 took 47,222 lives up to December 29, 2020. The front line of medical professionals in São Paulo was composed of many residents, who were transferred from their rotations to cover the needs of the pandemic. OBJECTIVE: To identify medical residents' mental health and clinical issues, regarding symptoms of burnout, depression and anxiety during the pandemic, and to compare them among specialties. DESIGN AND SETTING: Quantitative study using a convenience sample of medical resident volunteers who responded to an anonymous online survey that was available during April 2020. METHODS: This investigation collected sociodemographic information and used the Oldenburg Burnout Inventory (OLBI) to measure burnout, the Patient Health Questionnaire (PHQ-9) to measure depression and the General Anxiety Disorder (GAD-7) scale to measure anxiety symptoms. This study also developed a COVID-19 Impact Questionnaire (CIQ-19) to assess the residents' beliefs and clinical practices relating to COVID-19 patients. RESULTS: The sample comprised 1,392 medical residents in São Paulo, Brazil. Clinical specialty physicians showed the highest rates of anxiety symptoms (52.6%) and burnout (51.2%), among the specialties. CONCLUSION: Clinical specialty residents are at higher risk of anxiety, depression and burnout. The symptoms of anxiety and depression have worsened during the COVID-19 pandemic. There is a general need for mental health support interventions for medical resident physicians, which requires reinforcement during this worldwide crisis.

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Resumo: Introdução: A pandemia de Covid-19 impôs à educação médica novas modalidades de ensino a distância. Com isso, os programas de mentoria, prática do processo de formação em Medicina, precisaram se adequar à nova situação com a implementação da mentoria virtual destinada aos alunos. Relato de experiência: O grupo de mentoria reforçou a importância desse processo para a formação profissional, principalmente diante dos anseios e das inseguranças causados pela pandemia. A mudança para os encontros virtuais foi bem recebida pelos mentores e mentorandos. Por fim, o processo de mentoria virtual permitiu a discussão de temas mais leves, conversas com menos timidez sobre assuntos difíceis e reforçando a identidade do grupo. Discussão: Os programas de mentoria precisam investir em melhores treinamentos para os mentores, como forma de promover a qualidade do processo grupal, sem contar com os benefícios que isso traria ao mentor que passou a atuar de modo remoto com seus mentorandos. A pandemia acirrou as divergências entre gerações e os domínios das ferramentas virtuais por parte dos grupos de mentores e mentorandos. Os mentores e docentes do processo de formação médica precisam atentar para o sofrimento mental e as fragilidades dos alunos, na tentativa de minimizar esses problemas por meio da mentoria, das narrativas e do compartilhamento de experiências que permitem a suspensão do automatismo cotidiano. Conclusão: Não se observou nenhum tipo de prejuízo acerca da mentoria virtual, e não existe empecilho para que ela continue na modalidade remota, após a pandemia de Covid-19.

Abstract: Introduction: The Covid-19 pandemic imposed new forms of distance learning on medical education. Thus, mentoring programs, a practice in the medical education process, needed to adapt to the new situation with the implementation of virtual mentoring for students. Experience report: The mentoring group reinforced the importance of this process for professional training, especially in view of the anxieties and insecurities caused by the pandemic. The move to virtual meetings was well received by mentors and mentees. Finally, the virtual mentoring process allowed lighter topics to be discussed, more open conversations about difficult issues and reinforced the identity of that group. Discussion: Mentoring programs need to invest in better training for mentors, as a way to promote the quality of the group process, not to mention the benefits that this would bring to the mentor who started to work remotely with their mentors. The pandemic increased the discrepancies between generations and the mastering of virtual tools by mentors and mentees. Mentors and teachers in the medical education process need to pay attention to the mental suffering and weaknesses of students, in an attempt to minimize these problems through mentoring according to the narratives and the sharing of experiences that help break the automatized daily routine. Conclusion: No damage was observed about virtual mentoring, and there would be no obstacle for it to remain in remote mode after the Covid-19 pandemic.

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BACKGROUND: In self-regulated learning, learning is defined as metacognitively guided, intrinsically motivated and strategic. In the context of medical education, the development of self-regulated learning can be associated with better academic and clinical performance. Hence, this report focuses on demonstrating the association between metacognitive awareness and motivation to learn among medical students in the clinical sciences portion of their education (3rd and 4th years of the medical programme) and characterizing medical students' motivational factors. METHODS: We performed a cross-sectional study with a qualitative and quantitative approach involving medical students from the University of Sao Paulo (USP) in Brazil. We have selected validated self-report questionnaires for the evaluation of metacognition (the Schraw and Dennison Metacognitive Awareness Inventory - MAI) and motivation to learn (the Baranik, Barron and Finney Achievement Goals for a Work Domain - AGWD). MAI has two domains: knowledge about cognition and regulation of cognition. AGWD divides achievement goals into mastery approach, mastery avoidance, performance approach and performance avoidance goal orientations. We also performed a qualitative analysis based on an open-ended question: "What motivates me the most in medical training?" RESULTS: One hundred eighty-five students completed the questionnaires: 103 (55.67%) were men, 110 (59.45%) were in their fourth year of the medical programme, and 152 (82.16%) were up to 24 years old. Only the knowledge about cognition domain of MAI was significantly associated with motivation to learn. We found that higher scores on the knowledge about cognition domain of MAI was associated with the mastery approach goal orientation (p = 0.003, median 0.71, IQR 0.23) and that lower scores on this same domain was associated with a mastery avoidance goal orientation (p = 0.034, median 0.65, IQR 0.14). The open-ended question showed that altruism, personal satisfaction, financial feedback, personal and supportive networks and graduating were motivational factors. CONCLUSIONS: Metacognitive awareness and motivation to learn are closely related. This association may represent a potential target for the educational process, as deans and faculty can adopt strategies focused on promoting self-regulated learning concerning students' motivational factors. This could enhance academic outcomes and promote more enjoyable learning.

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Medical error stems from inadequate professional conduct that is capable of producing harm to life or exacerbating the health of another, whether through act or omission. This situation has become increasingly common in Brazil and worldwide. In this study, the aim was to understand what being the victim of medical error is like and to investigate the circumstances imposed on this condition of victims in Brazil. A semi-structured interview was conducted with twelve people who had gone through situations of medical error in their lives, creating a space for narratives of their experiences and deep reflection on the phenomenon. The concept of medical error has a negative connotation, often being associated with the incompetence of a medical professional. Medical error in Brazil is demonstrated by low-quality professional performance and represents the current reality of the country because of the common lack of respect and consideration for patients. Victims often remark on their loss of identity, as their social functions have been interrupted and they do not expect to regain such. It was found, however, little assumption of error in the involved doctors' discourses and attitudes, which felt a need to judge the medical conduct in an attempt to assert their rights. Medical error in Brazil presents a punitive character and is little discussed in medical and scientific circles. The stigma of medical error is closely connected to the value and cultural judgments of the country, making it difficult to accept, both by victims and professionals.

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O erro médico advém de uma conduta profissional inadequada, capaz de produzir dano à vida ou agravo à saúde de outrem, por ação ou omissão. Essa situação tem se tornado cada vez mais comum no cenário brasileiro e o respeito e consideração às vítimas ficam ignorados. Dessa maneira, este estudo tem objetivo de identificar de que modo os profissionais envolvidos com o erro levam em consideração a pessoa da vítima enquanto ser humano. Foi utilizada entrevista semiestruturada realizada com cada uma das 12 pessoas que passaram pela situação do erro médico. Verificou-se que as vítimas se sentem desrespeitadas e sem direitos, quando acometidas pelo erro. Os médicos responsáveis se mostraram pouco disponíveis a ajudar e, menos ainda, a assumirem que erraram, reforçando uma relação desgastada. O estigma do erro médico no Brasil tem uma forte ligação com os juízos de valores impostos, dificultando sua aceitação para a vítima e profissionais.

Medical malpractice results from an inadequate professional conduct leading to damage to somebody´s life or health, due to some action or omission. Such a situation has become more and more common in the Brazilian scenario, and the respect and the concern for the victims are ignored. Thus, this study aims at identifying the ways the professionals involved in malpractice take the victim as a human being into consideration. An individual semi structured interview was performed with twelve individuals who had suffered malpractice. It was found out that the victims feel disrespected and deprived of rights, when they go through such a situation. Doctors didn't show willingness to help, nor they assumed the responsibility for their malpractice, which reinforces a impaired relationship. In Brazil the stigma of malpractice has a strong connection with imposed value judgments, which makes it more difficult to be accepted by both the victim and the professionals.

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O erro médico refere-se a circunstância que atinge a pessoa em decorrência de atuação médica baseada em atitude imprudente, negligente ou imperita. No Brasil tem crescido o número de casos, mas a discussão a respeito da vítima é quase inexistente. Este trabalho buscou delinear a perspectiva da vítima de erro médico. Utilizando uma entrevista semiestruturada, foi possível conhecer as experiências das vítimas e perceber de que maneira enfrentaram os desafios impostos. Observou-se a perplexidade ao descobrir-se vítima, e a dificuldade em aceitar-se como tal. As mudanças impostas pelo erro acarretaram transformações comportamentais e de atitudes, como a falta de confiança nos profissionais médicos. Sofrimento e sentimentos negativos passam a fazer parte da vivência dessas pessoas. Dessa maneira, é necessário criar estratégias que permitam auxílio e cuidado da saúde mental das pessoas envolvidas com o erro médico.

Medical malpractice refers to the circumstance of harming a person as the result of medical performance based on a reckless, negligent or inexpert approach. In Brazil, while the number of such cases is increasing, discussion of the subject is almost absent. The present study sought to elucidate some of the challenges found in the situations of the victims of medical malpractice. The experience of the victims was accessed through a semi-structured interview. The confusion of individuals when they discovered they had become victims was noted, as well as a difficulty in accepting the status of victim. The effects of the malpractice led to transformations both in behavior and in attitudes, such as a lack of confidence in medical professionals. It is therefore necessary to create strategies to help and care for the mental health of victims of medical malpractice.

El error médico se refiere a una circunstancia que afecta a una persona como resultado de una operación médica basada en actitudes imprudentes, negligentes o de impericia. En Brasil se ha incrementado el número de casos, pero la discusión en relación a la víctima es casi inexistente. Este estudio tuvo como objetivo dilucidar algunos de los desafíos presentes en la situación de las víctimas de errores médicos. A partir del empleo de una entrevista semi-estructurada, fue posible el acceso a las experiencias de las víctimas y se logró una aproximación a los modos en que enfrentaron los desafíos impuestos. Se observó la perplejidad de estas personas al percibirse como víctimas y la dificultad en aceptarse en tanto tales. Las transformaciones impuestas por el error dieron lugar a cambios en los comportamientos y las actitudes, por ejemplo, la falta de confianza en los profesionales de la medicina. El sufrimiento y los sentimientos negativos comenzaron a formar parte de las vivencias de estas personas. Por lo tanto, es necesario crear estrategias de acompañamiento y cuidado de la salud mental de las personas afectadas por errores médicos.

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O erro médico refere-se a uma circunstância que atinge a pessoa emdecorrência de uma atuação médica baseada em atitudes imprudente, negligente ouimperita. No Brasil tem crescido o número de casos, mas a discussão a respeito dospressupostos teórico e prático relativos à vítima é quase inexistente. Na tentativa demelhor visualizar essa situação, este estudo realiza uma revisão de literatura para mapearas publicações a respeito de erro médico no Brasil. Realizam-se buscas nas bases dedados Scielo e Scielo Saúde Pública, a partir dos descritores erro médico, evento adversoe má prática, em publicações de janeiro de 2003 a novembro de 2012, no Brasil. Umtotal de 58 publicações são levantadas, sendo 52 no Scielo e 6 no Scielo SP. Desse total,14 fazem referência aos termos erro médico, 42 a evento adverso e 2 para má prática.Ao término da revisão, são selecionados 13 artigos em que os termos erro médicoenquadra-se no conceito original utilizado na pesquisa. O maior número de publicaçõespor ano acontece entre 2009 e 2011. A maior parte da filiação institucional dos autoresestá concentrada no Estado de São Paulo. 92% das publicações estão apresentadas emrevistas ligadas às instituições médicas. A literatura produzida é considerada reduzida equase toda encontrada na área médica, única interessada na produção científica dotema. Entende-se que outras áreas científicas, entre elas a Psicologia, possam debruçaro seu olhar sobre esse panorama, que não é restrito à Medicina, haja vista ser umproblema que envolve o ser humano(AU)

The medical error refers to a condition that affects the person as a result ofa medical operation based on reckless, negligent or inexpert attitudes. In Brazil thenumber of cases has increased, but the discussion of the theoretical and practicalassumptions related to the victim are almost nonexistent. In an attempt to better visualizethis situation, this study conducts a literature review to map the publications aboutmalpractice in Brazil. We conduct searches in Scielo databases and SciELO PublicHealth, from medical error descriptors, adverse events and malpractice in January2003 publications to November 2012, in Brazil. A total of 58 publications are raise, 52in Scielo and 6 in ScieloSP. Of these, 14 refer to the terms medical error, 42 to adverseevents and 2 for malpractice. At the end of the review, we selected 13 articles where he term malpractice is part of the original concept used in research. The largestnumber of publications per year is between 2009 and 2011. Most of the institutionalaffiliation of the authors is concentrated in São Paulo. 92% of the publications arepresented in magazines related to medical institutions. The literature produced isconsidered low and almost all found in the medical field, only interested in the scientificliterature of the subject. It is understood that other scientific areas, including psychology,may be included in this situation, which is not restricted to medicine, but as a probleminvolving human beings(AU)

La negligencia se refiere a una condición que afecta a la persona comoresultado de una actuación médica basada en actitudes imprudentes, negligentes oinexpertos. En Brasil se ha incrementado el número de casos, sin embargo la discusiónde los presupuestos teóricos y prácticos relacionados con la víctima es prácticamenteinexistente. En un intento por visualizar mejor esta situación, este estudio lleva a cabouna revisión de la literatura para mapear las publicaciones sobre negligencia médicaen Brasil. Se realizaron búsquedas en las bases de datos Scielo y Scielo Salud Pública,a partir de descriptores de error médico, eventos adversos y la mala praxis, desdeenero de 2003 hasta noviembre de 2012. Un total de 58 publicaciones fueron levantadassiendo 52 en Scielo y 6 en Scielo Salud Pública. De éstos artículos14 hacen referenciaa los términos errores médicos, 42 a eventos adversos y 2 a mala praxis. Al final de larevisión, se seleccionaron 13 artículos en los que los términos de mala praxis es partedel concepto original utilizado en la investigación. El mayor número de publicacionespor año se encuentra entre los años 2009 y 2011. La mayor parte de la afiliacióninstitucional de los autores se concentra en São Paulo. Siendo que 92% de laspublicaciones se encuentran en revistas relacionadas a las instituciones médicas. Laliteratura producida se considera baja y la mayor parte se concentró en el campo dela medicina, única área interesada en la producción e investigación científica de estetema. Se entiende que otras áreas científicas, incluyendo la psicología, pueden abordaresta situación, que no se limita apenas a la medicina, una vez que es considerado serun problema que involucra seres humanos(AU)