Avaliação do efeito da simulação realística em relação à indução de empatia e compaixão em estudantes de medicina durante a disciplina de psicologia e medicina: um ensaio clínico do tipo crossover
Data
2023-03
Orientador
Shansis, Flávio Milman
Banca
Silva, Guilherme Liberato Da
Kliemann, Lúcia
Timmers, Luis Fernando Saraiva Macedo
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Resumo
Introdução: A empatia e compaixão são habilidades essenciais na relação médico- paciente. A inserção da simulação realística (SR), com pacientes simulados (PSs), é uma forma de aquisição de conhecimentos através de habilidades e competências, por meio das metodologias ativas (MAs). Hipótese: Espera-se que os níveis de empatia e de compaixão dos alunos, submetidos à simulação realística, com paciente simulado, sejam maiores ao final da Disciplina de Psicologia e Medicina do que em relação ao seu início. Objetivo: Avaliar a eficácia da metodologia de simulação realística no aumento dos níveis de empatia e compaixão em um ambiente de simulação realística, durante a Disciplina de Psicologia e Medicina, realizada durante o quinto semestre do Curso de Medicina da Universidade do Vale do Taquari (Univates). Metodologia: Trata-se de um ensaio clínico controlado, cuja amostra experimental foi constituída por alunos de duas turmas do Curso de Medicina da Univates que cursaram a disciplina em dois semestres consecutivos. O grupo controle foi composto por, aproximadamente, 30% do número total de alunos das outras dez turmas restantes do Curso de Medicina da Univates, escolhidos de forma randômica. Os participantes do grupo experimental responderam às escalas de Índice de Reatividade Interpessoal (IRI), Índice de Empatia (IE) e Escala de Empatia de Jefferson - versão para estudantes (JSE-S), através de uma auto avaliação, no início e no final do semestre. Os participantes dos dois grupos-controle responderam às escalas IRI, IE E JSE-S no início e no final do semestre, também através do envio destas escalas auto-preenchidas. O Inventário de Personalidade para o DSM-5 (PID- 5) foi respondido apenas no início do semestre por ambos os grupos. Os dados aqui apresentados foram coletados entre Setembro de 2021 e Junho de 2022. Resultados: A amostra total do estudo contou com 171 estudantes de medicina. Destes, 73 fizeram parte do grupo experimental e 98 do grupo-controle. O grupo-controle positivo foi composto por alunos que já haviam cursado a Disciplina com a utilização da simulação realística (N=49). O grupo-controle negativo foi composto por alunos que já haviam realizado esta Disciplina, porém com metodologia tradicional ou então por alunos que ainda não cursaram a disciplina (N=49). Foi possível identificar maiores níveis de empatia na escala IRI, no início do semestre, para o Grupo Experimental em relação
aos demais Grupos Controle; no entanto, nossos resultados não demonstraram diferenças estatisticamente significativas nos níveis de empatia do Grupo Experimental quando comparados o início e o final do semestre. Por outro lado, os resultados sugerem que as características associadas à empatia parecem estar mais relacionadas aos domínios de personalidade - aferidos pelo PID-5 - do que com a intervenção de simulação realística em sala de aula. Houve correlação positiva entre IRI e IE ao final do semestre para o grupo experimental, indicando que o perfil dos alunos ("o que o indivíduo é") estaria se aproximando mais daquilo que o profissional médico ”deveria reproduzir”. Ainda, nossos resultados não conseguiram demonstrar, para o Grupo Controle Positivo, um efeito duradouro da metodologia ativa de simulação realística. Conclusões: Apesar de a intervenção proporcionar a vivência, o confronto e a exposição, simulando situações da prática médica real, isso não se refletiu em aumento dos níveis de empatia e compaixão ao final do semestre, contrariando a hipótese inicial do presente estudo e confirmando a hipótese nula.
Introduction: Empathy and compassion are essential skills in the doctor-patient relationship. The insertion of realistic simulation (SR), with simulated patients (SPs), is a way of acquiring knowledge through skills and competences, through active methodologies (AMs). Hypothesis: It is expected that the levels of empathy and compassion of students, submitted to realistic simulation, with a simulated patient, will be higher at the end of the Psychology and Medicine Discipline than in relation to the beginning. Objective: To evaluate the effectiveness of the realistic simulation methodology in increasing levels of empathy and compassion in a realistic simulation environment, during the Psychology and Medicine Course, held during the fifth semester of the Medicine Course at the University of Vale do Taquari (Univates). Methodology: This is a controlled clinical trial, whose experimental sample was composed by students from two groups of the Medicine Course at Univates who attended the discipline in two consecutive semesters. The control group consisted of approximately 30% of the total number of students from the other ten remaining classes of the Univates Medical Course, chosen randomly. Participants of the experimental group responded to the Interpersonal Reactivity Index (IRI), Empathy Index (IE) and Jefferson Empathy Scale - student version (JSE-S) scales, through a self-assessment, at the beginning and at the end of the semester. Participants in the other two control groups answered the IRI, IE and JSE-S scales at the beginning and end of the semester, also by sending these self-completed scales. The Personality Inventory for the DSM-5 (PID-5) was answered only at the beginning of the semester by both groups. The data presented here were collected between September 2021 and June 2022. Results: The total study sample consisted of 171 medical students. 73 of these were part of the experimental group and 98 of the control group. The positive control group was composed of students who had already participated in the discipline using realistic simulation (N=49). The negative control group was composed of students who had already participated in this discipline, but with traditional methodology, or students who had not yet participated in the discipline (N=49). It was possible to identify higher levels of empathy in the IRI scale, at the beginning of the semester, for the Experimental Group in relation to the other Control Groups; however, our results didn’t demonstrate statistically significant differences in the levels of empathy in the Experimental Group when comparing the beginning and end of the semester. On the other hand, the results suggest that the characteristics associated with empathy seem to be more related to the personality domains - measured by the PID-5 - than with the realistic simulation intervention in the classroom. There was a positive correlation between IRI and IE at the end of the semester for the experimental group, indicating that the students' profile ("what the individual is") would be closer to what the medical professional "should reproduce". Furthermore, our results failed to demonstrate, for the Positivo Control Group, a durable effect of the active realistic simulation methodology. Conclusions: Although the intervention provides experience, confrontation and exposure, simulating real practice situations, this was not reflected in increased levels of empathy and compassion at the end of the semester, contrary to the initial hypothesis of the study and confirming the null hypothesis.
Introduction: Empathy and compassion are essential skills in the doctor-patient relationship. The insertion of realistic simulation (SR), with simulated patients (SPs), is a way of acquiring knowledge through skills and competences, through active methodologies (AMs). Hypothesis: It is expected that the levels of empathy and compassion of students, submitted to realistic simulation, with a simulated patient, will be higher at the end of the Psychology and Medicine Discipline than in relation to the beginning. Objective: To evaluate the effectiveness of the realistic simulation methodology in increasing levels of empathy and compassion in a realistic simulation environment, during the Psychology and Medicine Course, held during the fifth semester of the Medicine Course at the University of Vale do Taquari (Univates). Methodology: This is a controlled clinical trial, whose experimental sample was composed by students from two groups of the Medicine Course at Univates who attended the discipline in two consecutive semesters. The control group consisted of approximately 30% of the total number of students from the other ten remaining classes of the Univates Medical Course, chosen randomly. Participants of the experimental group responded to the Interpersonal Reactivity Index (IRI), Empathy Index (IE) and Jefferson Empathy Scale - student version (JSE-S) scales, through a self-assessment, at the beginning and at the end of the semester. Participants in the other two control groups answered the IRI, IE and JSE-S scales at the beginning and end of the semester, also by sending these self-completed scales. The Personality Inventory for the DSM-5 (PID-5) was answered only at the beginning of the semester by both groups. The data presented here were collected between September 2021 and June 2022. Results: The total study sample consisted of 171 medical students. 73 of these were part of the experimental group and 98 of the control group. The positive control group was composed of students who had already participated in the discipline using realistic simulation (N=49). The negative control group was composed of students who had already participated in this discipline, but with traditional methodology, or students who had not yet participated in the discipline (N=49). It was possible to identify higher levels of empathy in the IRI scale, at the beginning of the semester, for the Experimental Group in relation to the other Control Groups; however, our results didn’t demonstrate statistically significant differences in the levels of empathy in the Experimental Group when comparing the beginning and end of the semester. On the other hand, the results suggest that the characteristics associated with empathy seem to be more related to the personality domains - measured by the PID-5 - than with the realistic simulation intervention in the classroom. There was a positive correlation between IRI and IE at the end of the semester for the experimental group, indicating that the students' profile ("what the individual is") would be closer to what the medical professional "should reproduce". Furthermore, our results failed to demonstrate, for the Positivo Control Group, a durable effect of the active realistic simulation methodology. Conclusions: Although the intervention provides experience, confrontation and exposure, simulating real practice situations, this was not reflected in increased levels of empathy and compassion at the end of the semester, contrary to the initial hypothesis of the study and confirming the null hypothesis.
Descrição
Palavras-chave
Compaixão; Empatia; Metodologias ativas; Simulação realística; Compassion; Empathy; Active methodologies; Realistic simulation
Citação
DANTAS, Raul Prates. Avaliação do efeito da simulação realística em relação à indução de empatia e compaixão em estudantes de medicina durante a disciplina de psicologia e medicina: um ensaio clínico do tipo crossover. 2023. Dissertação (Mestrado) – Curso de Ciências Médicas, Universidade do Vale do Taquari - Univates, Lajeado, 24 mar. 2023. Disponível em: http://hdl.handle.net/10737/3713.