[Evolution of the communication profile of family medicine residents]. / Evolución del perfil comunicacional de los médicos residentes de medicina de familia.

AIMS: To study the development of patient relation skills, as used during interviews with patients for health problems that are common within their specialty, in family medicine residents during the third year of their residency program. METHODS: Quasi-experimental (before-after), national-level, multicenter study. The participants were 193 third-year residents in family medicine at 8 training units who were trained between 1996 and 1999. During this period all residents participated in the usual training and clinical activities included in the National Plan for this specialty. The GATHA-RES questionnaire was used to evaluated six clinical scenarios in video recordings of encounters with standardized patients (3 at the start of the third year and 3 at the end of the third year). Descriptive, bivariate and multivariate statistical analyses were used. RESULTS: A total of 1,024 interviews were analyzed. The time spent with each patient decreased significantly at the end of the residency program; the duration of the visit was directly proportional to the score on the GATHA-RES questionnaire (p < 0.05). Improvements were seen in formal and organizational aspects of the interview. In contrast, skills related with the exploration of personal and contextual aspects of the problem, and negotiating skills, were worse at the end of the study. The variables that best predicted residents' communicational profile were age (inverse relation), duration of the interview, training of the tutor in clinical interviewing, and teaching unit. CONCLUSIONS: Residents learn to shorten the duration of the visit to the detriment of communication skills that are basic to appropriate care for their patients' health problems. These results suggest the need for substantial changes in the training of family medicine residents in Spain.

Programa de formación en técnicas de entrevista clínica: el proyecto COMCORD / Trainning programme in techniques for clinical interviews: the COMCORD project

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[The care of the terminal patient as viewed by the family physician]. / Cuidado del enfermo terminal visto por el médico de familia.

We made a survey among physicians of primary care teams (PCT) from Vizcaya to assess their opinion about the care of the patient with cancer in the terminal period. A total of 85% of the surveyed physicians responded; 70% considered that the care given was inadequate; 90% thought that the patients wishes to die at home. 50% felt that the patient should know the diagnosis, although 85% believed that it was virtually always unknown to him in practice. The most commonly found symptoms were anorexia, asthenia, pain, depression and anxiety, which resulted in serious management difficulties for 25-45% of physicians. 65% were assisted by nurses. The participation of the rest of the team and of specialists was irrelevant. Most felt frustration (59%) and dissatisfaction (78%) with those patients. The physicians find great difficulty to communicate with the patient, and need more information, training and cooperation. Is should be clear that the aim is the well being of the patient, thus diminishing the frustration of the professionals.