1- Population and sample
An observational cross-sectional study was carried out, including students from the 1st, 3rd and 5th years (except for the DCBM-UALG, in which the study was carried out in the 3rd, 4th and 5th years), in the 2018/2019 academic year, of the MIM of different portuguese universities randomly selected to represent the universe of schools: University of Minho Medical School (EM-UM), Univsersity of Porto Faculty of Medicine (FMUP), Institute of Medical Sciences Abel Salazar (ICBAS), Univsersity of Coimbra Faculty of Medicine (FMUC), Nova Medical School (NMS) Lisbon, University of Beira Interior Health Sciences Faculty (FCS-UBI), Biomedic Sciences Department of the University of Algarve (DCBM-UALG).
The sample size was calculated for a confidence level of 95% and a margin of error of 5%. In this study, only 1st, 3rd and 5th grade students were included (except DCBM-UALG students, where the study was carried out in the 3rd, 4th and 5th grade students) of the MIM of the randomly selected colleges: EM-UM, FMUP, ICBAS, FMUC, NMS, FCS-UBI, DCBM-UALG - in the academic year 2018/2019 as of a total of 3582 students. This value did not take into account possible dropouts along the course nor differences in numerus clauses between the years of study frequency
2- Data Harvest Instrument
Levels of Compassion
In order to evaluate the levels of compassion along the course of the MIM, a questionnaire was organized in three parts:
- Characteristics of the student: Sex, curricular year and college.
- The 7 items related to the dimension of compassion, from the Jefferson Scale of Medical Empathy - version for medical students. For each item, agreement was requested on a scale of 1 (Strongly disagree) to 7 (Strongly agree).
The compassion dimension is studied through 7 items, the maximum possible value being 49 points, corresponding to the lowest level of compassion, since, taking into account the content of the items and the fact that the sentences are in the negative, a value that tent for the maximum is equivalent to a lesser degree of compassion and the questionnaire in the Portuguese version is shorter in item than the original10,11.
3- Curriculum Plans
The curriculum plans were consulted on each university site. Only objective data were used with reference to the concept of compassion and/or the pillars that form for compassion in teaching objectives of the curricular unit12, 13, 14, 15, 16, 17, 18.
4- Data Collection
Levels of Compassion
The questionnaire was applied in October and November of 2018, via Google Forms, and it was left to a student and/or the course committee of each university to share the form for the respective curricular year via social network Facebook, a reminder ten days after the invitation. The form explained the purpose of the study and allowed participant to anonymously participate via Google Forms and that they consented to the use of the data obtained. Instruments were installed to verify duplication of responses.
The size of the population of the students of the studied faculties in the curricular years was obtained, through the page of Access to Higher Education19. With respect to the University of Medicine of the DCBM-UAlg, this value was obtained in the university’s page.
Information for Critical Analysis of Curriculum Plans
In each curricular plan, the Credit Units (CU) of each year was analysed, attending only to the common ones to all the students, excluding the optional CUs.
In each CU, both the scientific area in which it was integrated and the value of EUROPEAN CREDIT TRANSFER SYSTEM (ECTS) were identified, corresponding to the student's workload in acquiring and developing the competencies defined in their objectives.
In order to evaluate whether the CU presented a focus on the compassionate attitude and/or communicational development, we used the evaluation of the objectives, learning outcomes and teaching methodology.
The CUs whose values could not be obtained were not part of the calculations performed for the analysis. Due to lack of detailed explanation of CU, the 6th year of FCS-UBI was not included in the study.
Organization of data for Critical Analysis
In order to interpret the analysis of the curricular plans, the data were organized numerically in percentage values, since each curricular year and even each University presented a different number of CU and a different valuation of each CU.
Because CUs differed between colleges/faculties, they were grouped by major scientific areas, following the division conducted by EM-UM. For standardization, this division was applied to all curricular plans. As major scientific areas were considered:
- Community Health and Social and Human Sciences (SC-CSH),
- Biological and Biomedical Sciences (CBB),
- Pathology (P),
- Clinic (C)
- Multidisciplinary (M).
Levels of Compassion:
The variables used in the investigation of levels of compassion were gender, the year of attendance and the medical school attended.
Curriculum Plan Analysis
The variables required for the analysis of formal curricula were average number of CUs that focused on the compassion and/or pillars of compassion and the average number of ECTS referring to CUs that addressed the compassion and/or pillars of compassion.
6- Statistical Analysis
A descriptive and inferential analysis was performed with SPSS Software for Windows version 19.0, after verifying the normality of the data. Non-parametric tests (Kolmogorov-Smirnov test, Kruskal Wallis test, Mann Whitney test and Chi-square test) were used and the value of p<0.03 was defined as statistically significant.