Damiano, Rodolfo F.; Cruz, Andrey O. da; Oliveira, José G. de; DiLalla, Lisabeth F.; Tackett, Sean; Ezequiel, Oscarina da Silva; Lucchetti, Giancarlo

doi:10.1590/1806-9282.65.2.232

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Sumário

Review Article • Rev. Assoc. Med. Bras. 65 (2) • Fev 2019 • https://doi.org/10.1590/1806-9282.65.2.232 copiar

Mapping scientific research on the negative aspects of the medical school learning environment

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

OBJETIVO:

Buscou-se entender o panorama dos artigos publicados sobre os ambientes de aprendizagem (AA) das escolas médicas em todo o mundo, com um foco explícito nos aspectos potencialmente negativos do AA como um esforço para identificar áreas especificamente necessitadas de remediação ou intervenção que poderiam evitar futuros comportamentos não profissionais, violência e maus-tratos entre estudantes e médicos.

MÉTODOS:

Foi realizada uma análise bibliométrica em seis bases de dados eletrônicas (PubMed / Medline, Web of Science, Biblioteca Cochrane, SCOPUS, ERIC-ProQuest e PsycINFO) até 31 de dezembro de 2016, incluindo 12 temas: ambiente de aprendizagem - geral, currículo oculto (negativo), comportamentos antiéticos, bullying/trote, violência, discriminação sexual, homofobia, racismo, discriminação social, discriminação de minorias, má conduta profissional e “outros” aspectos negativos.

RESULTADOS:

Dos 9.338 artigos encontrados, 710 preencheram os critérios de inclusão. Os temas mais comuns foram LE geral (233 artigos), comportamentos não profissionais (91 artigos) e discriminação sexual (80 artigos). Aproximadamente 80% dos artigos foram publicados no século XXI.

CONCLUSÃO:

Há um claro aumento em artigos científicos sobre aspectos negativos da escola de medicina LE em periódicos de alta qualidade, especialmente no século XXI. No entanto, mais estudos são necessários para investigar aspectos negativos do LE com maior atenção aos desenhos de estudos experimentais, longitudinais e transculturais.

PALAVRAS-CHAVE:
Ambiente de Aprendizagem; Educação Médica; Estudantes de Medicina; Ética; Profissionalismo

All Studies (N = 710)
Characteristics		No. Studies
Publication year
	Until 1980	15 (2.1%)
	1981-1990	32 (4.4%)
	1991-2000	97 (13.7%)
	2001-2010	236 (33.2%)
	2011-2016	330 (46.5%)
Study Design
	Cross-Sectional	551 (77.6%)
	Longitudinal	75 (10.6%)
	Experimental	41 (5.8%)
	Experience Report	39 (5.5%)
	Case Report	4 (0.6%)
Measurement Methods (only if cross-sectional or longitudinal)
	Quantitative	422 (67.4%)
	Qualitative	160 (25.6%)
	Qualitative / Quantitative	44 (7.0%)
Journals
	Academic Medicine	126 (18.4%)
	Medical Education	67 (9.8%)
	Medical Teacher	48 (7.0%)
	BMC Medical Education	29 (4.2%)
	Teaching and Learning in Medicine	17 (2.5%)
Impact factor journals (WoS)
	No impact factor	188 (26.5%)
	0.000 - 1.00	65 (9.2%)
	1.01 - 3.00	219 (30.8%)
	> 3.00	237 (33.4%)
Countries (by author's affiliation)
	United States	309 (43.5%)
	United Kingdom	61 (8.6%)
	Canada	39 (5.5%)
	Australia	32 (4.5%)
	Netherlands	23 (3.2%)

Rank	Article	No. WoS Citations	No. Google Scholar Citations	Average Citations/Year - WoS
1	Lempp H, Seale C. The hidden curriculum in undergraduate medical education: qualitative study of medical students’ perceptions of teaching. BMJ. 2004;329(7469):770-3.	190	471	15.8
2	Sheehan KH, Sheehan DV, White K, Leibowitz A, Baldwin DC Jr. A pilot study of medical student ‘abuse’. Student perceptions of mistreatment and misconduct in medical school. JAMA. 1990;263(4):533-7.	190	311	7.3
3	Papadakis MA, Hodgson CS, Teherani A, Kohatsu ND. Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Acad Med. 2004;79(3):244-9.	189	358	15.7
4	Christakis DA, Feudtner C. Ethics in a short white coat: the ethical dilemmas that medical students confront. Acad Med. 1993;68(4):249-54.	151	248	6.6
5	Dyrbye LN, Massie FS Jr, Eacker A, Harper W, Power D, Durning SJ, Thomas MR, Moutier C, Satele D, Sloan J, Shanafelt TD. Relationship between burnout and professional conduct and attitudes among US medical students. JAMA. 2010;304(11):1173-80.	149	318	24.8
6	Richman JA, Flaherty JA, Rospenda KM, Christensen ML. Mental health consequences and correlates of reported medical student abuse. JAMA. 1992;267(5):692-4.	122	236	5.1
7	Kassebaum DG, Cutler ER. On the culture of student abuse in medical school. Acad Med. 1998;73(11):1149-58.	97	205	5.4
8	Moffat KJ, McConnachie A, Ross S, Morrison JM. First year medical student stress and coping in a problem-based learning medical curriculum. Med Educ. 2004;38(5):482-91.	95	298	7.9
9	Karnieli-Miller O, Vu TR, Holtman MC, Clyman SG, Inui TS. Medical students’ professionalism narratives: a window on the informal and hidden curriculum. Acad Med. 2010;85(1):124-33.	90	154	15
10	Baxter N, Cohen R, McLeod R. The impact of gender on the choice of surgery as a career. Am J Surg. 1996;172(4):373-6.	87	136	4.3
11	Madigosky WS, Headrick LA, Nelson K, Cox KR, Anderson T. Changing and sustaining medical students’ knowledge, skills, and attitudes about patient safety and medical fallibility. Acad Med. 2006;81(1):94-101.	85	167	8.5
12	Papadakis MA, Osborn EH, Cooke M, Healy K. A strategy for the detection and evaluation of unprofessional behavior in medical students. University of California, San Francisco School of Medicine Clinical Clerkships Operation Committee. Acad Med. 1999;74(9):980-90.	85	127	5
13	Patenaude J, Niyonsenga T, Fafard D. Changes in students’ moral development during medical school: a cohort study. CMAJ. 2003; 168(7): 840–844.	83	223	6.4
14	Hicks LK, Lin Y, Robertson DW, Robinson DL, Woodrow SI. Understanding the clinical dilemmas that shape medical students’ ethical development: questionnaire survey and focus group study. BMJ. 2001; 322(7288): 709–710.	76	207	5.1
15	Roberts LW, Warner TD, Lyketsos C, Frank E, Ganzini L, Carter D. Perceptions of academic vulnerability associated with personal illness: a study of 1,027 students at nine medical schools. Collaborative Research Group on Medical Student Health. Compr Psychiatry. 2001;42(1):1-15.	74	135	4.9
16	Dyrbye LN, Thomas MR, Harper W, Massie FS Jr, Power DV, Eacker A, Szydlo DW, Novotny PJ, Sloan JA, Shanafelt TD. The learning environment and medical student burnout: a multicentre study. Med Educ. 2009;43(3):274-82.	70	153	10
17	Edwards MT, Zimet CN. Problems and concerns among medical students--1975. J Med Educ. 1976;51(8):619-25.	68	98	1.7
18	Stern DT, Frohna AZ, Gruppen LD. The prediction of professional behaviour. Med Educ. 2005;39(1):75-82.	66	130	6
19	Frank E, Carrera JS, Stratton T, Bickel J, Nora LM. Experiences of belittlement and harassment and their correlates among medical students in the United States: longitudinal survey. BMJ. 2006;333(7570):682.	64	162	6.4
20	Wolf TM, Randall HM, von Almen K, Tynes LL. Perceived mistreatment and attitude change by graduating medical students: a retrospective study. Med Educ. 1991;25(3):182-90.	63	116	2.5

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[1] Corresponding Author: Rodolfo F. Damiano, University of São Paulo, Brasil – Institute of Psychiatry R. Dr. Ovídio Pires de Campos, 875 – Cerqueira César – São Paulo – CEP 05403-903 E-mail: damianorf@gmail.com