Sensibilidade moral e a formação ética do estudante de medicina

Abstract

This thesis, developed in the Postgraduate Program in Public Health at the Universidade do Vale do Rio dos Sinos (UNISINOS), aimed to investigate the health conditions of university students in the health area at the Mineiros and Trindade campuses of the Centro Universitário Mineiros-UNIFIMES, Goiás, in 2022. All students signed a Free and Informed Consent Form. It is expected that the study will contribute to gathering information about the ethical formation of medical students and the influence of the hidden curriculum on their socialization so that they can avoid these events. Based on this, the thesis presents two articles: (I) Moral Sensitivity and the Ethical Formation of Medical Students, a qualitative study; (II) a cross-sectional study that explores the relationship between moral sensitivity and the hidden curriculum, through the application of statistical tests. The study sample consisted of 128 medical students who were taking the mandatory internship. The first article was a qualitative study, through focus group discussion, aimed at understanding the aspects that influence ethical training during college among medical students in the last two years of the course. In this study, it was observed that teaching was considered theoretical and abstract, not guided by reflection on clinical practice, and the methodologies used were not active. The ethical climate in the practice locations was demonstrated by competition with other professionals, with hostility and conflict. The attitude of the preceptor doctors was one of continuous criticism and devaluation of the students. These situations point to the influence of the hidden curriculum, hindering the formation of moral sensitivity in the ethical training of medical students. The second article, which is part of the umbrella project of the doctoral group, is university-based and whose data collection was through a self-administered, standardized and pre-tested questionnaire. Data collection took place in the classroom and the questionnaire included questions about moral sensitivity and the hidden curriculum. Training was provided to a team to help administer the questionnaire, unfortunately they did not fulfill the commitment. A pilot test was carried out. Afterwards, I applied the questionnaires at the Mineiros Unit, in practically all classes, and another colleague applied them to two classes. A third colleague applied the questionnaires at the Trindade Unit. All data was coded. Data entry was done using EpiData version 3.1 software, in double entry. Afterwards, the typing was compared with original forms in order to eliminate typing errors. Data consistency and analysis were performed using Statano software. In July 2024, we performed a statistical analysis of the data. The results were not satisfactory, that is, p was insignificant. Therefore, we raised the hypothesis of submitting the collection of more data to the ethics committee again. In other words, applying the questionnaire again to current medical internship students and thus adding them to the previous group. The ethics committee approved it and the questionnaires were applied and coded. However, typing was not performed and this information was not entered into the database. To develop this second article, we used a cross-sectional study, with a quantitative approach, with the application of two selfadministered questionnaires: the Moral Sensitivity Questionnaire (MSQ) and the Hidden Curriculum Questionnaire (C³), answered by 128 students enrolled in the 9th semester or later. The data were subjected to descriptive statistical analysis (mean and standard deviation), internal consistency assessment by Cronbach's alpha and bivariate correlation tests, with the aid of SPSS software. This research did not show significant data. It will be necessary to increase the N in order to achieve significance. Therefore, we decided to conduct a study of the demographic profile of the Moral Sensitivity of Medical Students in internships. We used data from the database to conduct this survey. This study indicated that the demographic profile is predominantly female, white, single, without children and without paid work, and identifies as Catholic. The mean moral sensitivity was 3.581 (SD +/- 0.42) and was correlated with religion (p = 0.0009), with greater sensitivity among non-Catholics, with a mean of 3.76 (SD +/- 0.39). The questionnaire was divided into six dimensions: “Respect for patient autonomy” with a mean of 4.49 (SD +/- 0.5), “Modified autonomy” with a mean of 3.792 (SD +/- 0.82), “Moral conflict” with a mean of 2.896 (SD +/- 0.69), “Professional knowledge” with a mean of 2.810 (SD +/- 0.83), “Moral meaning” with a mean of 3.884 (SD +/- 0.65), “Teamwork” with a mean of 3.618 (SD +/-0.72). The variables that demonstrated an association were students who have children in relation to the “modified autonomy” dimension, and religion in relation to “modified autonomy”, “moral conflict” and “teamwork”. The study concluded that among the six dimensions assessed by the MSQ questionnaire, the one that presented the greatest moral sensitivity was “Respect for Patient Autonomy”, while “Professional Knowledge” obtained the lowest average, which suggests that technical mastery is not yet sufficiently integrated with ethical principles in the training process. Among the sociodemographic variables analyzed, religion was the one that was most associated with moral sensitivity, with an impact on three dimensions of the questionnaire, indicating that personal values interfere in the ethical construction of students. These findings reinforce the need for curricula that articulate technical knowledge and ethical training in an inseparable way, incorporating personal experiences, listening spaces and reflective practices in the clinical environment.