Health state perception of people close to retirement age: Relationship with lifestyle habits and subjects' characteristics.

Aim: Societal ageing increases the need for correct and healthy ageing to ensure the well-being of older adults. Practical strategies are needed to acquire healthy habits for the ageing process. This study aims to analyse the lifestyle habits of subjects who are retired or close to retirement and identify factors that could influence their perceived health and that could be related to these habits. Methods: A Spanish observational, descriptive, cross-sectional study of subjects close to retirement-age. Socio-demographic, family, work, leisure, social, and clinical-psychological indicators were evaluated. Results: 1,700 participants (581 employed; 714 retirees; 405 other-status) were included, average age 63 years, 52% women. Most reported a satisfactory social life (90%), were in live-in relationships (74%), non-smoking (80%), followed a Mediterranean diet (73%), and took medicines daily (70%). Perceived health (EQ-VAS) was 75.9/100, with low disability (12-WHODAS) (7.4/100) and moderate/severe depression. Women reported higher disability (p < 0.001) and depression (p < 0.001), a better social life, and healthier lifestyle, but lower physical/work activity. Retirees reported less depression, better social life, healthier lifestyle, higher physical/work activity, and better sleeping habits. The multivariate model showed a significant association of health-status with disability level, number of chronic diseases, sleep habits, exercise, diet, and alcohol consumption. When depression level was introduced, age and being a woman were also related. Conclusions: Retirement does not mean worse health but rather an opportunity to reinforce favourable health activities and improve lifestyle factors. Incorporating the differences related to gender and employment status in health-perception will facilitate the design of healthy ageing strategies.

A Multifaceted Educational Intervention in the Doctor-Patient Relationship for Medical Students to Incorporate Patient Agendas in Simulated Encounters.

From the beginning of their clinical training, medical students demonstrate difficulties when incorporating patient perspectives. This study aimed to assess if students, after an instructional programme, increased their sensitivity towards patients' needs and carried out bidirectional conversations. An observational study involving 109 medical students prior to their clerkships was designed. They attended a five-step training programme designed to encourage the use of communication skills (CSs) to obtain patients' perspectives. The course developed experiential and reflective educational strategies. The students improved their use of CSs throughout three sessions, and the overall score for these patient consultations went up in the opinions of both the external observer (EO) (5; 6.6; 7.5) and the simulated patients SPs (5.3; 6.6; 7.8). Most of the students (83.9%) considered that the CSs addressed were useful for clinical practice, particularly the interviews and the feedback received by the SP and the lecturer. The programme seems to help the students use CSs that facilitate a more bidirectional conversation in a simulated learning environment. It is feasible to integrate these skills into a broader training programme. More research is needed to assess whether the results are applicable to students in real settings and whether they influence additional outcomes.

Autoevaluación de adquisición de competencias en estudiantes de grado de Medicina mediante simulación clínica / Self-assessment of skill acquisition in clinical simulations for medical undergraduate students

Introducción: La autopercepción que tienen los estudiantes para desarrollar su práctica clínica es la manera más acertada de evaluar cuán preparados se sienten y cuáles son sus habilidades. La universidad desarrolla un programa de simulación que permite a los alumnos potenciar su propio aprendizaje, con situaciones de feedback de los instructores de simulación.Sujetos y métodos.El estudio tuvo lugar en el curso académico 2019-2020. Los estudiantes de tercer año completaron tres escenarios de simulación; los de cuarto año, cuatro; y los de quinto año, tres. Antes y después de cada sesión de simulación, completaron un cuestionario electrónico de autopercepción de competencias técnicas y no técnicas.Resultados.De los 121 estudiantes de tercer curso, 79 (65,3%) contestaron a la encuesta inicial y 68 (61,2%) a la encuesta final. En cuarto curso participaron 111 alumnos, y contestaron la encuesta inicial 63 alumnos (56,8%) y 68 la final (61,2%). El quinto curso estuvo compuesto por 97 estudiantes, de los cuales 94 (96,9%) contestaron la encuesta inicial y 69 (71,1%) la final. Todos los ítems de la encuesta de autopercepción mejoraron de forma estadísticamente significativa (p < 0,001) en la encuesta final. Las puntuaciones iniciales medias en la dimensión no técnica fueron más altas que las puntuaciones medias en la dimensión técnica para todos los cursos de estudio.Conclusiones.Los resultados que obtuvimos mostraron una mejora en la autopercepción de las habilidades de los estudiantes y en su confianza para realizar las tareas de las simulaciones. Los alumnos de cursos superiores se sienten más seguros tanto en habilidades técnicas como en no técnicas, como la comunicación. (AU)

Introduction: The self-perception that students have to develop their clinical practice is the most accurate way to assess how prepared they feel and what their abilities are. The University develops an innovative and complete simulation program that allows students to enhance their own learning and that of their classmates, with feedback situations from the simulation instructors of the faculty itself.Subjects and methods.The study took place in the academic year 2019-2020. During the study period, 3rd-year students completed 3 simulation scenarios, 4th-year students 4 cases, and 5th-year students completed 3 scenarios. Before and after each simulation session, they anonymously and voluntarily completed an electronic questionnaire on self-perception of technical and non-technical skills.Results.Of the 121 third-year students, 79 (65.3%) answered the initial questionnaire and 68 (61.2%) the final questionnaire. In the fourth year, 111 students participated, and 63 students (56.8%) answered the initial questionnaire and 68 (61.2%) the final one. The fifth course was composed of 97 students, of which 94 (96.9%) answered the initial questionnaire and 69 (71.1%) the final one. All the items of the self-perception survey improved in a statistically significant way (p < 0.001) in the final survey. The mean baseline scores on the non-technical dimension were higher than the mean scores on the technical dimension for all study courses.Conclusions.The results we obtained showed an improvement in the self-perception of the students' abilities and in their confidence to perform the tasks of the simulations. Higher grade students feel more confident in both technical and non-technical skills, such as communication. (AU)

Medical empathy in medical students in Madrid: A proposal for empathy level cut-off points for Spain.

This study evaluates the degree of empathy among medical students and its influencing factors at three critical moments of their degree studies (beginning of first year and end of third and sixth years) as well as establishes low-, medium-, and high-empathy cut-off points to obtain valid and reliable results that can be extrapolated to the general population. This cross-sectional study of the eight (public and private) medical schools in the province of Madrid, used an electronic questionnaire with the Jefferson Scale of Empathy (JSE), Medical Student Well-Being Index, and other independent characteristics as measuring instruments. Of the 2,264 student participants, 1,679 (74.0%) were women, with a 50.7% participation rate. No significant differences were found in empathy levels by academic year. Regarding range, percentile and cut-off point tables were established to identify students with high, medium, and low empathy levels. Women (p<0.001), volunteer workers (p<0.001), and those preferring general specialties (internal medicine, psychiatry, pediatrics, or family medicine) scored higher on the JSE (p<0.02). Moreover, 41.6% presented high level of psychological distress. Women reported a lower well-being level and a higher risk of psychological distress (p = 0.004). In sum, the empathy of medical students in Madrid did not differ among the three critical moments of their university studies. The established cut-off points could be taken into account when accessing the medical degree and identifying students with low levels of empathy to implement curricular interventions to rectify this perceived deficiency. There was a high percentage of medical students with high levels of psychological distress.

The evolution of multiple sclerosis in Spain over the last decade from the patient's perspective.

BACKGROUND: Updated information about self-reported experience and satisfaction with care of MS patients (PwMS) in Spain is scarce. We aim to describe, from PwMS' perspective, the disease impact, the quality of life and the satisfaction level with the social and healthcare support in Spain, and its evolution over the last decade. METHODS: Multicentre observational study, based on a cross-sectional nationwide survey, completed by 432 PwMS in Spain throughout 2018. The results were compared with those of a similar study carried out in 2007 (370 patients), whose database was retrieved as baseline information. RESULTS: 432 patients recruited from 61 neurology units fully completed the study e-survey (mean age: 43.7 years; 71.4% women). The personal profile of patients was largely similar between the 2007 and 2018 samples. The proportion of patients who identified themselves as having relapsing-remitting MS was higher in 2018 (77.1% vs. 56.7 in 2007; p = 0.0001). Overall, 2018 patients considered themselves more labour-active, less disabled, more independent in movement, and as higher family income earners. The proportion of patients satisfied or very satisfied with healthcare services accessibility increased over time (54.9% in 2007 vs. 66.2 in 2018; p = 0.0009). Similarly, more patients considered their health condition to be good or very good in 2018 (55.8% vs. 33.7% in 2007; p = 0.0001). In contrast, there seems to be little progress in social support terms and opportunities equality. CONCLUSIONS: Health condition of PwMS seems to have improved over the last decade, which could be the result of an increasingly effective health care. However, more social protection measures are needed.

Analyzing Differences in Perception between Oncologists and Patients to Adapt Pharmacological Treatment for Breakthrough Cancer Pain: Observational ADAPTATE Study.

Background: Transmucosal fentanyl (TF), used for breakthrough cancer pain (BTcP) treatment, has different formulations with distinctive attributes. The hypothesis is that, in shared decision making for the prevention of certain therapeutic problems, doctors and patients assign different value to the characteristics of treatment options. Aim: The aim of this study was to assess the discordance between the oncologists' opinion of attributes of TF and patients' expectations in BTcP treatment. Methods: This is a multicenter, cross-sectional observational study using simultaneous written surveys of doctors and patients suffering from BTcP episodes. The opinion of Spanish oncologists and patients regarding the importance of 14 different attributes of TF treatment (start of action, potency, duration, presentations and doses available, ease of use, titration, administration time, need for saliva, oral mucositis, rhinitis, adverse events, risk of abuse, evidence available, and need for instructions or health personnel to handle the medication), using two surveys, one for each group. Results: Sixty-three clinical oncologists and 272 patients participated in the study. The patients' satisfaction with and knowledge of BTcP treatment was 6.4 and 6.8 points, respectively (scale 1-9). The attributes with the highest relevance were shared by both groups, although their priority differed. Significant differences were observed in the greater importance given by oncologists (onset and duration of analgesia, need for saliva, presence of mucositis, and time required for patient education) and patients (risk of opioid abuse/aberrant behavior). Conclusion: Our results confirm that some aspects that most concern patients about the treatment of BTcP differ from those to which oncologists attach most importance. Increased patient awareness and education about BTcP and its treatment could lead to greater satisfaction and better patient involvement in therapeutic decisions. Certain barriers need to be overcome, such as lack of time in consultations and poor communication skills of oncologists that hinder patient health education.

Medical students' attitudes towards communication skills training: a longitudinal study with one cohort.

Objectives: To explore medical students' attitudes towards communication skills and the evolution of these attitudes from their first to fourth academic years. Methods: A cohort of 91 medical students completed the Communication Skills Attitudes Scale (CSAS) at the beginning of their medical studies and at the end of their fourth year after having engaged in a training program in communication skills with experiential characteristics (individual encounters with simulated patients, observations in small groups, feedback, and practice). We analyzed students' positive and negative global attitudes and their affective, cognitive, and respect dimensions towards learning communication skills. Results: Medical students' attitudes toward communication skills declined from their first (52.8) to fourth year (49.6) (p=.011). Along with this significant decrease in positive attitudes, a significant increase in negative attitudes toward communication skills was also observed in trained students (32.2 vs. 34.2; p=.023). The decline in students' attitudes mainly involves a decline in their affective (51.4 vs. 47.3, p=.001) but not cognitive (18.3) attitudes. Female students have more positive attitudes towards communication skills than male students. Conclusions: The decline in students' attitudes, mainly in the affective dimension, could be related to their accumulated learning experiences during the learning process and particularly their experiential training in communication skills. Nevertheless, the importance students give to communication skills in the cognitive dimension remains unchanged. Students' gender also seems to influence their attitudes. Further research is needed to assess the role of other factors involved in this decrease in positive and affective attitudes.

Medical resilience and morality: a survey study on the opinions and actions of exemplary family physicians.

BACKGROUND: Studies conducted to understand how family doctors develop resilience and deal with the challenges posed by work-related stress, usually have focused on identifying the elements that generate resilience from psychological perspectives and their impact on coping strategies. Few have explored the role that personal qualities and values that traditionally motivate family physicians can play as drivers of well-being and resilience. OBJECTIVES: To explore attributes that exemplary family physicians (EFP) consider important for their work and the elements that, for them, are source of gratification and resources in the face of the adversities they encounter in their practice. METHODS: This is an exploratory study carried out by online survey. Eighty six doctors regarded as exemplary by their colleagues answered 7 close and 4 open-ended questions that explored their job satisfaction, the elements of their work that reward them, the difficulties and problems they usually encounter, the resources they use to cope with those problems, and the personal qualities they consider central to their work. Four researchers conducted a thematic (deductive and inductive) analysis of the free text responses received. Based on the results obtained, and through an iterative discussion process, the researchers proposed an integrated set of qualities at the core of their professionalism. RESULTS: 88.4% (76) of the doctors said they were satisfied with their work. However, they face problems (202 comments), including demanding patients, insensitive managers with unshared interests/care goals, excessive paperwork, work overload, or time pressures. Sources of gratification point to personal identity; clinical, relational, and collaborative efficiency; a holistic and comprehensive practice (centred on individuals); and a continuous search for excellence (149) and the root of their resources (135). These elements, in turn, corresponded to the attributes considered essential for the practice of family medicine (131). CONCLUSIONS: For EFPs, certain professional values give meaning to their clinical practice and are a source of well-being and resources. This central focus on professional values and qualities can help for better understand the burnout nature and expand the type of action that promotes resilience. Further studies using a less structured qualitative research will be needed to confirm/expand these results.

Patient experience and self-perceived biopsychosocial burden of people living with multiple sclerosis: An epidemiological survey (BPS-MuScle study) in Spain.

BACKGROUND: Updated information on the self-perceived biopsychosocial burden and the healthcare experience among people living with multiple sclerosis in Spain is scarce.We aim to describe the self-reported disease experience of patients diagnosed with MS in Spain and to estimate their biopsychosocial burden. METHODS: Multicentre epidemiological study based on a cross-sectional nationwide survey completed by a geographically stratified sample of MS patients in Spain. RESULTS: A total of 490 surveys completed at 61 neurology units across Spain were analysed. Mean age was 43.7 ± 10.0 years (range:21-72), 71.4% were women. Most patients identified themselves as having relapsing-remitting MS (77.1%), 81.9% retained independent mobility. Most patients considered their health condition to be good (39.4%) or very good (13.1%). Mean EuroQoL questionnaire score was 69.2 ± 21.5. Most patients expressed high level of satisfaction with access to and quality of health care. However, 53.7% considered that sadness or depression interfered with their daily life. Concerns about social support were also mentioned. CONCLUSION: Most people living with MS in Spain consider that their health condition is at least good but more psychological support and social protection measures are needed. Insights obtained from this study may help to better manage the condition in the future.

Multi-source evaluation of an educational program aimed at medical students for interviewing/taking the clinical history using standardized patients.

Introduction: Simulations with standardized patients (SP) have long been used for teaching/assessing communication skills. The present study describes and evaluates an experiential training methodology aimed at medical students and based on interviews with standardized simulated patients. The training was focused on developing basic communication skills and taking medical histories. Methods: Longitudinal observational study of a cohort of third-year medical students. Three interviews with SP were carried out and videotaped. These interviews were assessed by the students, the SPs and the professors of the relevant subject areas. Results: 83 students conducted the interviews. The self-evaluations performed by the students showed an improvement between the first and third interviews, as demonstrated by the increase of 6.7% (CI 95%=3.6-10.0%) (p<0.001) in the percentage of detected items. The SPs stated an improvement of 8.5% (CI 95%=2.9-14.1) (p=0.003) from the first to the third interview regarding the percentage of students that showed a level of interest in, and ease with, the patients' concerns. Finally, the teachers found a mean percentage of items identified in the third written clinical history of 61.4% (CI 95%=59.1-63.7) of the total available. Conclusions: This educational program, carried out with standardized simulated patients, showed positive signs of improvement from the first to the third interview, in both the student self-evaluations and the level of interest and ease perceived by the SPs. Additionally, the mean level of information recorded in the written medical histories was considered to be acceptable.

Genotype scores in energy and iron-metabolising genes are higher in elite endurance athletes than in nonathlete controls.

Information about the association of energy and iron-metabolising genes with endurance performance is scarce. The objective of this investigation was to compare the frequencies of polymorphic variations of genes involved in energy generation and iron metabolism in elite endurance athletes versus nonathlete controls. Genotype frequencies in 123 male elite endurance athletes (75 professional road cyclists and 48 elite endurance runners) and 122 male nonathlete participants were compared by assessing 4 genetic polymorphisms: AMPD1 c.34C/T (rs17602729), PPARGC1A c.1444G/A (rs8192678) HFEH63D c.187C/G (rs1799945) and HFEC282Y c.845G/A (rs1800562). A weighted genotype score (w-TGS; from 0 to 100 arbitrary units (a.u.)) was calculated by assigning a corresponding weight to each polymorphism. In the nonathlete population, the mean w-TGS value was lower (39.962 ± 14.654 a.u.) than in the group of elite endurance athletes (53.344 ± 17.053 a.u). The binary logistic regression analysis showed that participants with a w-TGS > 38.975 a.u had an odds ratio of 1.481 (95% confidence interval: 1.244-1.762; p < 0.001) for achieving elite athlete status. The genotypic distribution of polymorphic variations involved in energy generation and iron metabolism was different in elite endurance athletes vs. controls. Thus, an optimal genetic profile in these genes might contribute to physical endurance in athlete status. Novelty Genetic profile in energy generation and iron-metabolising genes in elite endurance athletes is different than that of nonathletes. There is an implication of an "optimal" genetic profile in the selected genes favouring endurance sporting performance.

Empatía médica en residentes y tutores de medicina familiar y comunitaria. La visión del profesional y del paciente / Clinical empathy among family and community medicine residents and tutors. The view of physicians and patients

OBJETIVO: Determinar el grado de empatía de residentes y tutores de medicina de familia. Saber si existe relación entre la empatía autopercibida por los médicos y la valorada por sus pacientes. DISEÑO: Estudio observacional transversal mediante encuesta. Emplazamiento: Unidad Docente de Atención Primaria, Madrid. PARTICIPANTES: Se envió una encuesta por correo electrónico a todos los tutores y residentes de familia de la Unidad Docente. Respondieron 50 residentes (39,4%) y 41 tutores (45%). Un total de 428 pacientes fueron captados de forma oportunista en un Centro de Salud. Se entrevistó a sus médicos. Mediciones principales: La empatía se midió mediante la Escala de Empatía Médica de Jefferson y la Escala de Percepciones de los Pacientes sobre la Empatía Médica de Jefferson. RESULTADOS: Los tutores puntuaron 2,53 puntos más alto en empatía cognitiva que los residentes (p = 0,04). Las puntuaciones de la empatía emocional de los tutores son menores en aquellos de mayor edad (r = -0,32; p < 0,05). Los residentes españoles (el 82%) y sin experiencia laboral previa puntuaron más alto en empatía global (p = 0,02). Los residentes de último año obtuvieron calificaciones significativamente más bajas en empatía que el resto de sus compañeros. Se observó correlación positiva (r = 0,72; p = 0,01) entre la autopercepción de la empatía del profesional y la referida por sus pacientes. CONCLUSIONES: Los residentes con experiencia profesional previa, los de último año de residencia y los de origen latinoamericano presentan puntuaciones más bajas de empatía. Existe fuerte relación entre la empatía autopercibida por los médicos y la visión que sus pacientes tienen sobre la misma

AIM: To determine the degree of clinical empathy among family medicine residents and tutors. To gauge whether there is a relationship between physicians' self-perceived empathy levels and their patients' assessments. Study design: Observational, cross-sectional survey. LOCATION: Primary Care Teaching Unit. Madrid. PARTICIPANTS: A survey was sent by email to all the Teaching Unit's family medicine tutors and residents. Responses were received from 50 residents (39.4%) and 41 tutors (45%). In addition, 428 patients were opportunistically recruited at a healthcare centre and their doctors were also interviewed. Primary measurement instruments: Empathy was measured using the Jefferson Scale of Empathy and the Jefferson Scale of Patient Perceptions of Physician Empathy. RESULTS: The tutors scored 2.53 points higher for cognitive empathy than the residents (P = .04). Emotional empathy scores declined among older tutors (r = -0.32; P = .05). The Spanish students (82% of the total) without previous work experience scored higher for overall empathy (P = .02). Final-year residents recorded significantly worse empathy assessments than the other residents. A positive correlation (r = 0.72; P = .01) was observed between physicians' self-perceived empathy and their patients' perceptions. CONCLUSIONS: Residents with previous work experience, final-year residents and those of Latin American origin score lower for empathy. There is a strong relationship between physicians' self-perceived empathy and their patients' views of their empathy levels

Barriers to teaching communication skills in Spanish medical schools: a qualitative study with academic leaders.

BACKGROUND: In recent years, Spanish medical schools (MSs) have incorporated training in communication skills (CS), but how this training is being carried out has not yet been evaluated. OBJECTIVE: To identify the barriers to the introduction and development of CS teaching in Spanish MSs. METHODS: In a previous study, 34 MSs (83% of all MSs in Spain) were invited to participate in a study that explored the factual aspects of teaching CS in these schools. The person responsible for teaching CS at each school was contacted again for this study and asked to respond to a single open-ended question. Two researchers independently conducted a thematic analysis of the responses. RESULTS: We received responses from 30 MSs (85.7% of those contacted and 73% of all MSs in Spain). Five main thematic areas were identified, each with different sub-areas: negative attitudes of teachers and academic leaders; organisation, structure and presence of CS training in the curriculum; negative attitudes of students; a lack of trained teachers; and problems linked to teaching methods and necessary educational logistics. CONCLUSIONS: The identified barriers and problems indicate that there are areas for improvement in teaching CS in most Spanish MSs. There seems to be a vicious circle based on the dynamic relationship and interdependence of all these problems that should be faced with different strategies and that requires a significant cultural shift as well as decisive institutional support at the local and national levels. The incorporation of CS training into MS curricula represents a major challenge that must be addressed for students to learn CS more effectively and avoid negative attitudes towards learning CS.

[Clinical empathy among family and community medicine residents and tutors. The view of physicians and patients]. / Empatía médica en residentes y tutores de medicina familiar y comunitaria. La visión del profesional y del paciente.

AIM: To determine the degree of clinical empathy among family medicine residents and tutors. To gauge whether there is a relationship between physicians' self-perceived empathy levels and their patients' assessments. STUDY DESIGN: Observational, cross-sectional survey. LOCATION: Primary Care Teaching Unit. Madrid. PARTICIPANTS: A survey was sent by email to all the Teaching Unit's family medicine tutors and residents. Responses were received from 50 residents (39.4%) and 41 tutors (45%). In addition, 428 patients were opportunistically recruited at a healthcare centre and their doctors were also interviewed. PRIMARY MEASUREMENT INSTRUMENTS: Empathy was measured using the Jefferson Scale of Empathy and the Jefferson Scale of Patient Perceptions of Physician Empathy. RESULTS: The tutors scored 2.53 points higher for cognitive empathy than the residents (P=.04). Emotional empathy scores declined among older tutors (r= -0.32; P=.05). The Spanish students (82% of the total) without previous work experience scored higher for overall empathy (P=.02). Final-year residents recorded significantly worse empathy assessments than the other residents. A positive correlation (r=0.72; P=.01) was observed between physicians' self-perceived empathy and their patients' perceptions. CONCLUSIONS: Residents with previous work experience, final-year residents and those of Latin American origin score lower for empathy. There is a strong relationship between physicians' self-perceived empathy and their patients' views of their empathy levels.

Promocionando la Promoción de la Salud: percepciones de estudiantes de medicina sobre un programa educativo para cambio de conductas en atención primaria / Promoting Health Promotion: Medical students perceptions about an educational program on behavioral change in primary care

Objetivo: Valorar si un programa formativo ofrecido por médicos de familia en el currículum oficial de medicina sobre principios y estrategias para ayudar a los pacientes a cambiar conductas de riesgo (APCCR) produce cambios en sus percepciones, opiniones y actitudes con relación a este tipo de intervenciones. Diseño: Estudio cuasiexperimental antes-después. Emplazamiento: Una facultad de medicina. Participantes: Todos los alumnos de 4.o curso de medicina (n = 110). Intervenciones: Formación experiencial sobre estrategias comunicativas para APCCR. Mediciones: Opiniones y percepciones evaluadas antes y después del curso mediante cuestionario ad hoc. Resultados: Tras el curso, los estudiantes (n = 103) cambiaron sus ideas sobre la motivación como factor «interno» (15, 13%) a "interno-externo" (71, 61%) (p = 0,003), reforzando sus opiniones sobre la capacidad del médico para APCCR (alta: 72, 62%; baja: 10, 12%; p = 0,008). Los alumnos se consideraron más capaces de respetar la autonomía de los pacientes cuando estos toman decisiones o siguen conductas consideradas perjudiciales (fácil: 58, 50%; difícil: 28, 24%; p = 0,001) e incrementaron su percepción sobre su capacidad para afrontar este tipo de entrevistas (83, 72% vs. 1, 1%; p < 0,001). Conclusiones: Esta formación parece contribuir a crear en estudiantes percepciones y actitudes positivas relacionadas con aspectos claves a la hora de afrontar una entrevista para APCCR, lo cual supone un aspecto preliminar clave para implementar este tipo de estrategias

Objective: To evaluate whether a training program offered by family physicians in the official medical curriculum on principles and strategies to help patients change risk behaviours (HPCRB), produces changes in perceptions, opinions, and attitudes regarding this type of intervention. Design: Quasi-experimental before-after study. Setting: A School of Medicine. Participants: All students in their 4th year (n = 110). Interventions: Experiential training course on communicative strategies for HPCRB. Measurements: Opinions and perceptions were evaluated before and after the course using an ad hoc survey. Results: After the course, students (n = 103) changed their ideas about motivation as an "internal" (15, 13%) to ‘internal-external’ factor (71, 61%) (P = .003), reinforcing their opinions about the clinician's ability for HPCRB (high: 72, 62%; low: 10, 12%; P = .008). They considered themselves more capable to respect patient autonomy when they make decisions or follow harmful behaviours (easy: 58, 50%; difficult: 28, 24%; P = .001), and increased their perception of their ability to cope with this type of interview (83, 72% vs. 1, 1%; P < .001). Conclusions: This training course seems to contribute to creating positive perceptions and attitudes in students, as regards key aspects when conducting an interview for HPCRB. This is a key preliminary aspect to implement this type of strategy

Medical students' perceptions towards learning communication skills: a qualitative study following the 2-year training programme.

OBJECTIVES: This study aimed to gain an understanding of the perceptions of 4th-year medical students about a training course in communication skills with 'experiential learning' characteristics, completed over the past two years. METHODS: Twenty 4th-year medical students were invited to participate in a qualitative study with focus groups. These students were selected randomly, stratifying by gender, from all 4th-year medical students (106) at the Francisco de Vitoria University (Madrid). The students had just completed their communication skills training taught in small groups, with simulated patient interviews and feedback. The focus-group facilitator used an open-ended discussion guide to explore the students' perceptions. Thematic analysis was used to identify salient themes from these discussions. RESULTS: Sixteen students participated in two focus groups. The discussions revealed two contrasting perceptions: while this learning is considered useful, it nevertheless brings about a great deal of stress, especially regarding student exposure to peers in small-group sessions when interviewing standardised patients, and summative assessment. This generates a range of negative feelings in students that could affect perspective and attitude towards the importance of doctor-patient relationships. CONCLUSIONS: Experiential learning is effective in improving students' communication skills. However, these results suggest that use of such strategies requires a strong focus on "student-centred" teaching approaches, in order to minimise some sensitive topics that may arise during the learning. Further research is needed to refine these strategies depending on the teaching situation and to identify different ways of implementing these experiential methods.

Medical students' attitudes toward communication skills learning: comparison between two groups with and without training.

OBJECTIVE: The value students give to communication skills (CS), acquiring them, or other related matters can influence the effectiveness of educational programs. In this study, we explored first and fourth year medical students' attitudes toward CS and their learning, assessing the possible influence they have on programmed experiential training in a medical school. SUBJECTS AND METHODS: Two hundred and twenty first and fourth year medical students completed the Communication Skills Attitudes Scale, analyzing the positive and negative, and affective and cognitive attitude subscales toward learning. RESULTS: Fourth year students trained in CS showed less positive attitudes toward CS than first year untrained students. Cognitive and affective attitudes displayed different patterns in both groups; while affective attitudes decreased in fourth year students, cognitive attitudes did not vary significantly between groups. Accumulated learning experiences seem to be more influential than sex. CONCLUSION: The findings suggest that students' attitudes toward CS could decline as a result of CS training. Nevertheless, students' attitudes at the cognitive and fundamental level stay fairly unchanged. Learning CS with experiential methods seems to be challenging for students at a personal level; so, educators should personalize these methods as much as possible. However, further studies using longitudinal research designs should be performed for exploring students' attitudes changes over time.

[Promoting Health Promotion: Medical students perceptions about an educational program on behavioral change in primary care]. / Promocionando la Promoción de la Salud: percepciones de estudiantes de medicina sobre un programa educativo para cambio de conductas en atención primaria.

OBJECTIVE: To evaluate whether a training program offered by family physicians in the official medical curriculum on principles and strategies to help patients change risk behaviours (HPCRB), produces changes in perceptions, opinions, and attitudes regarding this type of intervention. DESIGN: Quasi-experimental before-after study. SETTING: A School of Medicine. PARTICIPANTS: All students in their 4th year (n=110). INTERVENTIONS: Experiential training course on communicative strategies for HPCRB. MEASUREMENTS: Opinions and perceptions were evaluated before and after the course using an ad hoc survey. RESULTS: After the course, students (n=103) changed their ideas about motivation as an 'internal' (15, 13%) to 'internal-external' factor (71, 61%) (P=.003), reinforcing their opinions about the clinician's ability for HPCRB (high: 72, 62%; low: 10, 12%; P=.008). They considered themselves more capable to respect patient autonomy when they make decisions or follow harmful behaviours (easy: 58, 50%; difficult: 28, 24%; P=.001), and increased their perception of their ability to cope with this type of interview (83, 72% vs. 1, 1%; P<.001). CONCLUSIONS: This training course seems to contribute to creating positive perceptions and attitudes in students, as regards key aspects when conducting an interview for HPCRB. This is a key preliminary aspect to implement this type of strategy.

Estudio Opinaudit: usos clínicos en dolor irruptivo, ¿se sigue la evidencia científica? / Opinaudit study: clinical uses in breakthrough pain, is scientific evidence being followed up?

Introducción: El dolor irruptivo oncológico (DIO) es un problema de salud frecuente, mal conocido e incorrectamente tratado a pesar de los avances en su tratamiento. Las sociedades científicas implicadas en su manejo han publicado recientemente recomendaciones para la optimización de su diagnóstico y tratamiento. Objetivos: Conocer el grado de conocimiento y de acuerdo de los profesionales con las recomendaciones de las sociedades científicas, la autopercepción del seguimiento de las mismas por los médicos y su seguimiento real en la clínica. Material y métodos: Estudio descriptivo de las opiniones de los profesionales recogidas en un cuestionario electrónico en dos momentos secuenciales entre los que intermedió una autovaloración (self-audit) de hábitos clínicos. Los profesionales evaluaron el grado de acuerdo y la aplicación de 12 recomendaciones de las guías en cinco pacientes con DIO en seguimiento en consulta. Resultados: En el estudio participaron 202 médicos de unidades del dolor y cuidados paliativos de ámbito nacional con una media de 11,9 años de experiencia laboral. La edad media fue 47,9 años y el 45 % fueron mujeres. El 86,6 % conocía el documento de recomendaciones. Las recomendaciones que alcanzaban menor grado de acuerdo o se percibían como menos aplicadas por los profesionales fueron: 1. La recomendación relacionada con el seguimiento del paciente durante la titulación del tratamiento: el 78,7 % y el 18,3 % de los encuestados mostraron un acuerdo pleno o parcial con la misma y el 59,4 % la aplicaba casi siempre. 2. La recomendación sobre la prevención de efectos secundarios del tratamiento con opioides desde el inicio: el 76,7 % y el 18,8 % mostraron acuerdo pleno o parcial, el 66,3 % la aplicaba casi siempre. 3. La recomendación sobre la necesidad de que el paciente esté recibiendo opioides para el tratamiento del dolor basal: el 56,4 % y el 35,6 % mostraron acuerdo pleno o parcial, el 66,8 % la aplicaba casi siempre. Tras el self-audit de historias clínicas, las recomendaciones sobre el seguimiento de los pacientes y la prevención de efectos secundarios no se aplicaban en el 15 y 20 % de las ocasiones, en línea con las percepciones previas de los especialistas. Sin embargo, la recomendación sobre la utilización previa de opioides para el dolor basal reveló un incumplimiento menor (7 %) al percibido (33,2 %). Conclusiones: Los profesionales de Unidades del Dolor y de Unidades de Cuidados Paliativos tienen una percepción realista y precisa de la calidad de su trabajo en los pacientes con dolor irruptivo, así como de los aspectos mejorables de su práctica clínica diaria en relación con el seguimiento y la aplicación de las recomendaciones basadas en la evidencia científica

Introduction: Breakthrough pain (BTP) is a common health problem, badly known and poorly treated in spite of the advancement in its treatment. Guidelines have been published recently by Scientific Societies involved in their management in order to improve the diagnosis and treatment. Objectives: To know the degree of knowledge and professional agreement with Scientific Societies recommendations, the auto perception in the follow-up and the real follow-up by doctors in their outpatient clinics. Materials and methods: A descriptive study from professionals' opinions that were recorded in an electronic survey at two sequential times. A self-audit of clinical habits was performed between them. Professionals evaluated the level of agreement and the application of 12 recommendations from the guidelines in five patients with BPT in their outpatient clinics. Results: A total of 202 doctors from breakthrough pain units and palliative care participated in the study, at a national level; the mean of professional experience was 11.9 years. Mean age was 47.9 years and 45 % were women. Recommendations' document was known by 86.6 %. Recommendations with lower degree of agreement or considered less followed-up by professionals were: 1. Recommendation related to the patient's follow-up during medication titration process: 78.7 % and 18.3 % of surveyed were totally or partially agree with it while 59.4 % always applied it. 2. Recommendation related to prevention of opioid side effects from the beginning of the treatment: 56.4 % and 18.8 % of surveyed were totally or partially agree with it while 66.3 % always applied it. 3. Recommendation related to the need of the patient of receiving opioids for baseline pain: 76.7 % and 35.6 % of surveyed were totally or partially agree with it while 66.8 % always applied it. After clinical records self-audit, recommendations regarding patients' follow-up and prevention of side effects were not applied between 15 and 20 % of the times, in line to previous perceptions from specialists. However, recommendation related to the use of opioids for baseline pain isclosed a lower breach (7 %) than perceived (33.2 %). Conclusions: Professionals from Pain Units and Palliative Care Units have a realistic and accurate perception of the quality of their job in patients with breakthrough pain as well as the improvement areas in their daily job regarding the follow-up and application of recommendations based in scientific evidence