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.

Competence in Spiritual and Emotional Care: Learning Outcomes for the Evaluation of Nursing Students.

Spiritual and emotional care is an important part of the person, especially in situations such as changes in health or a community coping with a pandemic. However, nurses report scarce university training in this area of care. The aim of the study is to define a catalogue of learning outcomes for spiritual and emotional care for undergraduate nurses. The design used a mixed method for the development and validation of learning outcomes. The first phase designs the catalogue of learning outcomes through a coordinating group and uses a bibliographic search and nursing legislation. The second phase validates the proposal through a group of experts, with a questionnaire using the modified Delphi technique in two rounds. The initial proposal was 75 learning outcomes, of which 17 were eliminated, 36 changed their wording and the experts proposed 7 new ones. The experts validated 65 learning outcomes: 14 for Assessment and diagnosis; 5 for Planning; 17 for Intervention; 4 for Evaluation and quality; 8 for Communication and interpersonal relationship and 17 for Knowledge and intrapersonal development. In conclusion, the academic curriculum can include these learning outcomes to help undergraduate nurses in the process of acquiring knowledge, skills and attitudes in spiritual and emotional care.

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)

Ibero-American Consensus on Communication Skills for Nursing Degree students. / Consenso Ibero-americano sobre Habilidades Comunicacionais para Estudantes de Graduação em Enfermagem.

OBJECTIVE: as a health care profession focused on caring for people, Nursing requires sound communication skills. Based on an international expert consensus, a proposal on learning outcomes in clinical communication for undergraduate Nursing education curricula in Spanish speaking countries is presented. METHOD: a steering committee, consisting of 5 nurses and experts in communication in health care sciences, drew up the first list of communication skills specific to the Nursing degree. Their proposal was reviewed and improved by a committee of 7 international scientific advisers. 70 experts from 14 countries were selected using a snowball sampling procedure and invited to participate in a distance modified Delphi consensus process in two survey rounds. Statistical analysis was carried out to establish the final consensus level for each item. RESULTS: a questionnaire with 68 learning outcomes in clinical communications was submitted for panel assessment. In the first Delphi round, the panel reached a statistical consensus on all the items assessed. There was no need for a second round to reconcile positions. CONCLUSION: an academic proposal, approved by a high level of international consensus, is presented to guide and unify the learning outcomes on the clinical communication curriculum for undergraduate Nursing studies in Spanish speaking countries.

The "Medical friendship" or the true meaning of the doctor-patient relationship from two complementary perspectives: Goya and Laín.

This essay aims to broaden the understanding of the nature of the physician-patient relationship. To do so, the concept of medical philia that Pedro Laín Entralgo proposes is analysed and is considered taking into consideration the relational trait of the human being and the structure of human action as a story of the permanent tension that exists between freedom and truth, where the ontological foundation of the hermeneutic of the "Gift" and the analogy of "Love" as the central dynamic of this action, helps explain the nature of the doctor-patient relationship as a "friendship relationship". This understanding offers a perspective differing from just the utilitarian considerations of current "patient-centred" approaches and proposed the redirection of the teaching of medicine to more humanistic approaches. The dynamic of the doctor-patient relationship proposed here in its most genuine essence is effectively expressed in physician concrete attitudes that the patient usually captures and relates as the "the doctor's way of being". Goya's painting, Self-portrait with Dr Arrieta (1820), can be taken as an outstanding artistic representation of this expanded dimension of the medical act, capturing the "medical friendship" in action.

Consenso Ibero-americano sobre Habilidades Comunicacionais para Estudantes de Graduação em Enfermagem / Ibero-American Consensus on Communication Skills for Nursing Degree students / Consenso Iberoamericano sobre Habilidades de Comunicación para Estudiantes de Grado de Enfermería

Resumo Objetivo: como profissão orientada à atenção da saúde, focada no cuidado às pessoas, a Enfermagem precisa desenvolver habilidades de comunicação sólidas. Com base em um consenso internacional de especialistas, apresenta-se uma proposta sobre os resultados de aprendizagem na comunicação clínica para planos de estudos em cursos de Enfermagem em países hispanofalantes. Método: um comitê orientador, composto por 5 enfermeiros e especialistas em comunicação em ciências de atenção à saúde, elaborou a primeira lista de habilidades comunicacionais específicas para o curso de Enfermagem. Outro comitê de 7 assessores científicos internacionais revisou e melhorou a referida proposta. Foram selecionados 70 especialistas de 14 países pelo procedimento de amostragem "bola de neve", sendo convidados para participar em um processo de consenso Delphi modificado a distância em duas rodadas de pesquisa. Foi realizada a análise estatística para estabelecer o nível de consenso final correspondente a cada item. Resultados: foi apresentado um questionário com 68 resultados de aprendizagem em comunicações clínicas para serem avaliados pelo painel. Na primeira rodada Delphi, o painel chegou a um consenso estatístico em todos os itens avaliados. Não foi necessária uma segunda rodada para conciliar posições. Conclusão: apresenta-se uma proposta acadêmica aprovada com um elevado nível de consenso internacional a fim de orientar e unificar os resultados de aprendizagem nos planos de estudo sobre comunicação clínica para cursos de Enfermagem em países hispanofalantes.

Abstract Objective: as a health care profession focused on caring for people, Nursing requires sound communication skills. Based on an international expert consensus, a proposal on learning outcomes in clinical communication for undergraduate Nursing education curricula in Spanish speaking countries is presented. Method: a steering committee, consisting of 5 nurses and experts in communication in health care sciences, drew up the first list of communication skills specific to the Nursing degree. Their proposal was reviewed and improved by a committee of 7 international scientific advisers. 70 experts from 14 countries were selected using a snowball sampling procedure and invited to participate in a distance modified Delphi consensus process in two survey rounds. Statistical analysis was carried out to establish the final consensus level for each item. Results: a questionnaire with 68 learning outcomes in clinical communications was submitted for panel assessment. In the first Delphi round, the panel reached a statistical consensus on all the items assessed. There was no need for a second round to reconcile positions. Conclusion: an academic proposal, approved by a high level of international consensus, is presented to guide and unify the learning outcomes on the clinical communication curriculum for undergraduate Nursing studies in Spanish speaking countries.

Resumen Objetivo: en su carácter de profesión de atención de la salud enfocada en cuidar a las personas, la Enfermería requiere habilidades de comunicación sólidas. Sobre la base de un consenso internacional de expertos, se presenta una propuesta sobre resultados de aprendizaje en la comunicación clínica para planes de estudio de las carreras de grado de Enfermería en países de habla hispana. Método: un comité orientador, compuesto por 5 enfermeros y expertos en comunicación en ciencias de atención de la salud, elaboró la primera lista de habilidades de comunicación específicas para la carrera de Enfermería. Un comité de 7 asesores científicos internacionales revisó y mejoró dicha propuesta. Se seleccionó a 70 expertos de 14 países a través del procedimiento de muestreo "bola de nieve", y se los invitó a participar en un proceso de consenso Delphi modificado a distancia en dos rondas de encuesta. Se realizó un análisis estadístico para establecer el nivel de consenso final correspondiente a cada ítem. Resultados: se presentó un cuestionario con 68 resultados de aprendizaje en comunicaciones clínicas para que lo evaluara el panel. En la primera ronda Delphi, el panel llegó a un consenso estadístico en todos los ítems evaluados. No fue necesaria una segunda ronda para conciliar posiciones. Conclusión: se presenta una propuesta académica, aprobada con un elevado nivel de consenso internacional, a fin de orientar y unificar los resultados de aprendizaje en los planes de estudio sobre comunicación clínica para carreras de grado de Enfermería en países de habla hispana.

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.

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.

Health-Related Lifestyles and Cancer-Preventive Behaviors of Medical and Nursing Students and Family Medicine Residents in Relation to the European Code Against Cancer.

Family medicine (FM) residents and medical and nursing students play an important role in the development of preventive and health-promoting activities. The objective was to evaluate the health-related lifestyles and cancer-preventive behaviors of medical and nursing students and FM residents in relation to the European Code Against Cancer (ECAC). This was a descriptive, cross-sectional study performed in Spain. Medical and nursing students and FM residents completed a self-administered questionnaire focused on health-related habits and clinical behaviors related to the ECAC. A total of 740 participants completed the questionnaire. About 12.2% (95% CI [9.8-14.5]) were smokers, and 77.3% (95% CI [74.3-80.3]) sporadically consumed alcohol; 34.2% (95% CI [30.8-37.6]) practiced physical activity 2-3 times a week, and 12.1% (95% CI [9.8-14.5]) were overweight or obese. About 54.2% (95% CI [50.6-57.8]) regularly consumed vegetables. Differences were detected in the completion of screening tests for colorectal cancer (p < 0.001), breast cancer (p = 0.023), cervical cancer (p = 0.006), and prostate-specific antigen determination (p < 0.001) in relation to the participants' academic profiles. Our results reveal heterogeneous practices between the participants in terms of health-related habits. Awareness about the risks of smoking and being overweight were high; however, the perception of the risks associated with solar exposure and alcohol consumption was poor. There was general agreement upon the importance of performing screening tests for breast, cervical, and colorectal cancer, but there were discrepancies related to the need to perform the prostate cancer screening test.

Awareness of the European Code Against Cancer of Family Medicine Residents and Nursing and Medicine Students in Spain.

Health professionals and students in training are key for early diagnosis of cancer. The objective of this study was to evaluate the awareness of Family Medicine (FM) residents and Medicine and Nursing undergraduate students in Spain regarding the European Code Against Cancer (ECAC). This was a descriptive, cross-sectional, and multicenter study. LOCATION: Teaching Units of FM of Cordoba and Ceuta and Schools of Medicine and Nursing of the Universities of Cordoba and Francisco de Vitoria of Madrid (Spain). PARTICIPANTS: residents of FM and Medicine and Nursing undergraduate Spanish students. INTERVENTION: self-administered questionnaire to assess the awareness about the ECAC. A total of 651 subjects participated (52.4% [95% CI 48.5-56.2] Nursing students, 34% [95% CI 30.3-37.6] Medicine students, and 13.6% [95% CI 11.0-16.3] FM residents). Of the total subjects participated, 74.8% were women. Mean age: 22.34 years (standard deviation, 4.68; range, 18-52; 95% CI, 21.98-22.70). A total of 76.8% (95% CI 73.5-80.1) declared to be unaware of the ECAC. Those referring to be aware of the ECAC mainly knew it through degree subjects (7.5% [95% CI 5.5.5-9.6]). Residents of FM (p < 0.001), older participants (p < 0.001), and those belonging to the Teaching Units (p = 0.002) showed a better awareness of the ECAC. Our findings reveal the unawareness on the ECAC in three out of four participants. The access to the advice described in the ECAC through the Medicine and Nursing Schools and FM Teaching Units is poor. The awareness of the ECAC of postgraduate residents is higher than that the awareness of the undergraduate students.

Training health providers to address unhealthy alcohol use in primary care: a cross-sectional, multicenter study.

BACKGROUND: Health professionals' training is a key element to address unhealthy alcohol use in Primary Care (PC). Education about alcohol use can be effective in improving PC provider's knowledge and skills addressing alcohol-related problems. The aim of the study was to evaluate the training of health professionals to address unhealthy alcohol use in PC. METHODS: An observational, descriptive, cross-sectional, multicenter study was performed. LOCATION: PC centres of the Spanish National Health System (SNHS). PARTICIPANTS: Family physicians, residents and nurses completed an online questionnaire that inquired about their training (none, basic, medium or advanced), knowledge and preventive practices aimed at reducing unhealthy alcohol use. The study population was recruited via random sampling, stratified by the regions of the SNHS's PC centre, and by email invitation to members of two Spanish scientific societies of Family Medicine. RESULTS: A total of 1760 professionals participated in the study. Sixty-seven percent (95% CI: 67.5-71.8) reported not having received specific training to address unhealthy alcohol use, 30% (95% CI: 27.4-31.7) reported having received basic training, and 3% (95% CI: 2.3-4.0) medium/advanced training. The training received was greater in younger providers (p < 0.001) who participated in the PAPPS (Preventive Activities and Health Promotion Programme) (p < 0.001). Higher percentages of providers with intermediate or advanced training reported performing screening for unhealthy alcohol use (p < 0.001), clinical assessment of alcohol consumption (p < 0.001), counselling of patients to reduce their alcohol intake (p < 0.001) or to abstain, in the cases of pregnant women and drivers (p < 0.001). CONCLUSION: Our study reveals a low level of training among Spanish PC providers to address unhealthy alcohol use. A higher percentage of screening, clinical assessment and counselling interventions aimed at reducing unhealthy alcohol use was reported by health professionals with an intermediate or advanced level of training.

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.

Barreras culturales y psicológicas en la relación clínica y educativa en estudiantes y residentes de medicina españoles (II) / Cultural and psychological barriers in clinical and educational relationship in Spanish students and residents (II)

Empatizar, negociar, tomar decisiones compartidas o informar a los pacientes, representan habilidades comunicativas importantes tanto para la relación médico-paciente como para el aprendizaje mediante estrategias educativas experienciales y significativas. Estas habilidades requieren una monitorización constante de la interacción, favoreciendo la adquisición de una perspectiva más amplia que permite una comprensión más profunda de uno mismo y del otro. Sin embargo, en nuestro contexto cultural, muchos estudiantes y residentes presentan dificultades importantes para el desarrollo de este tipo de habilidades metacognitivas, lo que repercute en la asunción y el aprendizaje de una práctica clínica centrada en la persona de posibles consecuencias futuras. El autor utiliza su experiencia de más de 25 años en contextos clínicos y educativos para ejemplificar algunas de estas dificultades, a la vez que destaca el papel que algunos condicionantes culturales y psicológicos pueden tener en su desarrollo. Este es el segundo de 2 artículos

Empathize, negotiate, shared decisions making or inform patients, represent important communication skills both for the doctor-patient relationship and for learning through experiential and significant educational strategies since they need a constant monitoring of the interaction, they favour the acquisition of a broader perspective that allows a deeper understanding of oneself and the other. However, in our cultural context, many students and residents present important difficulties for the development of this type of metacognitive skills, which affects the assumption and learning of a person centered in clinical practice with possible future consequences. The author uses his experience of more than 25 years in both clinical and educational contexts to exemplify some of these difficulties while highlighting the role that some cultural and psychological factors may have in their development. This paper is the second of two

Barreras culturales y psicológicas en la relación clínica y educativa en estudiantes y residentes de medicina españoles (I) / Cultural and psychological barriers in clinical and educational relationship in Spanish medical students and residents (I)

Empatizar, negociar, tomar decisiones compartidas o informar a los pacientes representan habilidades comunicativas importantes tanto para la relación médico-paciente como para el aprendizaje mediante estrategias educativas experienciales y significativas. Estas habilidades requieren una monitorización constante de la interacción, favoreciendo la adquisición de una perspectiva más amplia que permite una comprensión más profunda de uno mismo y del otro. Sin embargo, en nuestro contexto cultural, muchos estudiantes y residentes presentan dificultades importantes para el desarrollo de este tipo de habilidades metacognitivas lo que repercute en la asunción y el aprendizaje de una práctica clínica centrada en la persona de posibles consecuencias futuras. El autor utiliza su experiencia de más de 25 años en contextos clínicos y educativos para ejemplificar algunas de estas dificultades a la vez que destaca el papel que algunos condicionantes culturales y psicológicos pueden tener en su desarrollo. Este es el primero de 2 artículos

Empathize, negotiate, shared decisions making or inform patients, represent important communication skills both for the doctor-patient relationship and for learning through experiential and significant educational strategies since they need a constant monitoring of the interaction, they favour the acquisition of a broader perspective that allows a deeper understanding of oneself and the other. However, in our cultural context, many students and residents present important difficulties for the development of this type of metacognitive skills, which affects the assumption and learning of a person centered clinical practice with possible future consequences. The author uses his experience of more than twenty five years in both clinical and educational contexts to exemplify some of these difficulties while highlighting the role that some cultural and psychological factors may have in their development. This paper is the first of two

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

Impact of a primary care training program on the prevention and management of unhealthy alcohol use: A quasi-experimental study.

OBJECTIVE: To assess the impact of a training program targeted to Primary Care (PC) professionalson the acquisition of communication skills, attitudes, and knowledge about the prevention and management of unhealthy alcohol use. METHODS: A quasi-experimental, pre- and post-intervention study was performed in PC centers of Cordoba (Spain). Family doctors, residents and nurses participated in the study. The intervention was based on a motivational interviewing training program, which consisted in a workshop on learning skills, attitudes and knowledge about the alcohol management. PC providers were videotaped with a standardized patient in order to check the clinical and communication competencies acquired. A descriptive, bivariate and multivariate analysis was carried out (p < 0.05). RESULTS: PC providers' communication skills and attitudes showed significant improvements in the variables studied (p < 0.001), as well as in the clinical interview evaluation parameters. CONCLUSION: The present study reveals the impact of a training program targeted to PC professionals on communication skills, attitudes, and knowledge about the prevention and management of patients with unhealthy alcohol use. PRACTICE IMPLICATIONS: Training activities targeted to PC providers represent a valuable strategy to improve communication skills, attitudes and knowledge of these professionals in their clinical practice.

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.

[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.