Empatia, bem-estar, burnout, saúde mental e abertura as crenças espirituais dos pacientes: as diferenças de gênero dos estudantes de medicina nas diferentes fases do curso

Abstract

The relevance of questions involving medical students’ mental health and well-being has been widely discussed in recent decades. It has thus been able to exert an influence on empathy itself and the doctor-patient relationship. In this context, studies have shown that there are biological and comportmental differences between genders for determined behaviors. Nevertheless, this question is still infrequently discussed in the field of medical education and little is known regarding the influence of gender on mental health and empathy during the different phases of medical training. Objectives: This study’s primary objective is to investigate whether differences exist regarding gender in terms of empathy, burnout, tolerance, openness to spirituality, well-being, and mental health in medical students, and if these differences are influenced by the course phase in which those students are enrolled. As a secondary objective, a translation, adaptation, and validation of the Empathy, Spirituality, and Wellness in Medicine Survey (ESWIM) was undertaken for use in Brazil. Methods: A cross-sectional study was conducted using students from all six years of course work at a Brazilian medical school. The following were evaluated: quality of life (WHOQOL-Bref), burnout (Oldenburg), mental health (DASS-21), empathy (EI and ESWIM), and tolerance, well-being, and openness to spirituality (ESWIM). The ESWIM scale was translated and transculturally adapted for use in Brazil. Outcomes were then compared between the genders as well as among the preclinical, clinical, and clerkship phases of medical studies. Results: A total of 776 students were included in this study. The ESWIM scale’s Portuguese language version demonstrated good psychometric properties, and confirmatory factorial analysis was shown in three dimensions – empathy, well-being, and openness to spirituality. In relation to the primary objective, important differences were observed between the genders and among the phases of medical studies. Women showed greater levels of empathy, flexibility, altruism, sensitivity, burnout, tolerance, anxiety, and stress, while men had greater levels of well-being and quality of life. The final phases of coursework were associated with poorer levels of empathy, altruism, sensitivity, and exhaustion, but with better levels of well-being and physical and psychic quality of life. As medical training advanced, the differences between genders present during the early years (greater empathy, worse quality of life and mental health in women) tended to diminish and become insignificant during the clerkship phase. Conclusions: It was found that differences in empathy and mental health between men and women diminished during the course’s more advanced phases. These results can indicate that the approach in medical schools’ teaching-learning processes has not considered gender specificities, and thus have not reinforced important positive characteristics for the practice of medicine like empathy, flexibility, altruism, sensitivities of women, nor developed actions promoting the advancement of these characteristics in men. On the contrary, the curriculum seems to approach students as a “uniform body”. Educators should consider these findings when restructuring curriculum to respect and valorize the peculiarities of genders, thus fostering their potential.