Effectiveness of a Mindfulness-Based Programme on Perceived Stress, Psychopathological Symptomatology and Burnout in Medical Students.

OBJECTIVES: Medical students display a high prevalence of psychopathological symptomatology, stress and burnout, which may continue in their time as resident and fully qualified doctors. The aim of this study is to evaluate and compare the effects of a mindfulness-based programme on these variables in an experimental group of medical students who underwent the intervention programme compared to a control group who did not. METHODS: A quasi-experimental study of two independent groups (experimental and control) with two repeated measures (pre and post) was performed. Eight sessions of 2-h duration each were held over the course of 16 weeks. A total of 143 students participated in the study, 68 in the intervention group and 75 in the control group. A sociodemographic questionnaire was administered along with the Symptom Checklist-90-R (SCL-90-R), the Perceived Stress Scale (PSS) and the Maslach Burnout Inventory-Student Survey (MBI-SS). RESULTS: Our study revealed a clear improvement compared to the control group in perceived stress and psychopathological symptomatology, in the Global Severity Index, Positive Symptom Total and the primary symptom dimensions of somatization, obsessive compulsive, interpersonal sensitivity and anxiety of the SCL-90-R. The improvement was significant at both intra- and intergroup level. No impact was found on the level of burnout. CONCLUSIONS: The mindfulness-based programme that was used resulted in an improvement in psychopathological symptomatology and stress, with no effect observed on BO score. This study can contribute to the design of a training programme to promote effective self-care and stress management strategies for both medical students and doctors.

¿Han llegado los millennials a la Facultad de Medicina? Perfil de personalidad de estudiantes de Medicina 1999-2014 / Have millennials arrived at Medical School? Personality profile of medical students 1999- 2014

INTRODUCCIÓN: La formación necesaria de un médico requiere no solo la adquisición de conocimientos y habilidades clínicas, sino también el desarrollo de actitudes y valores, características relacionadas con el perfil de personalidad. El presente estudio se centra en valorar el perfil de personalidad de los estudiantes de Medicina, en relación con variables sociodemográficas y al cambio generacional. MATERIAL Y MÉTODO: Estudio observacional transversal realizado a 675 estudiantes de Medicina, de 1999 a 2014. Se les administró un cuestionario sociodemográfico y el cuestionario NEO-PI-R para valorar el perfil de personalidad. RESULTADOS: En el presente estudio, las puntuaciones medias más altas han sido en la dimensión responsabilidad, seguido de amabilidad y apertura a la experiencia; la más baja ha sido neuroticismo. En relación al género, las mujeres presentan mayores puntuaciones en neuroticismo, extraversión, amabilidad y responsabilidad. Los estudiantes millennials obtuvieron puntuaciones significativamente más altas en las dimensiones de extraversión, amabilidad y responsabilidad. Estos estudiantes son más asertivos, sociables, compasivos, y con mayor tendencia a cumplir con el deber, la organización, el orden y la autodisciplina. Pero se detecta también en este grupo mayor puntuación en ansiedad y rasgos obsesivos, suponiendo un mayor riesgo de estrés y burnout. CONCLUSIONES: Se han encontrado diferencias significativas en los perfiles de personalidad según el género y según la generación, siendo estas congruentes con los perfiles de personalidad descritos en la literatura en la generación millennial

OBJECTIVE: Medical training not only requires the acquisition of knowledge and clinical skills, but also the development of attitudes and values, characteristics related to the personality profile. The present study focuses on assessing the personality profile of medical students, in relation to sociodemographic variables and generational change. MATERIAL AND METHODS: Cross-sectional observational study performed on 675 medical students,from 1999 to 2014. A sociodemographic questionnaire and the NEO-PI-R questionnaireto assess the personality profile was administrated. RESULTS: In the present study, the highest mean scores were in the responsibility dimension, followed by kindness and openness to the experience. The lowest was neuroticism. As regards gender, women had higher scores in neuroticism, extraversion, kindness, and responsibility. The millennial students obtained significantly higher scores in the dimension of extraversion, kindness, and responsibility. These students are more assertive, sociable, compassionate, and more likely to fulfil their duty, organisation, order, and self-discipline. But this group also has a higher score in anxiety and obsessive traits, assuming an increased risk of stress and burn-out. CONCLUSIONS: Significant differences have been found in the personality profiles between gender and among the millennial medical students, consistent with the personality profiles described in the literature on the millennium generation

Síntomas psicopatológicos, estrés y burnout en estudiantes de medicina / Psychopathological symptoms, stress and burnout among medical students

INTRODUCCIÓN: Diferentes estudios muestran unos elevados niveles de estrés y burnout en médicos y estudiantes de medicina. El objetivo del presente estudio es determinar en los primeros cursos de medicina, en la Facultad de Medicina de Lleida, el grado de estrés percibido por los estudiantes, la sintomatología reportada y el grado de burnout, así como la relación entre estas variables y la posibilidad de detectar estudiantes de alto riesgo. METODOLOGÍA: Estudio transversal con 118 estudiantes (79,7% de segundo curso) de la Facultad de Medicina de la Universidad de Lleida. Se utiliza la escala de estrés percibido Perceived Stress Scale, el cuestionario de 90 síntomas Sympton Checklist-90-R y el cuestionario de burnout académico Maslach Burnout Inventory Student Survey. RESULTADOS: Las puntuaciones en estrés percibido son superiores al baremo, en el cuestionario de 90 síntomas alcanzan valores de una muestra de pacientes psicosomáticos, y un 16,95% igualan o superan la puntuación en el índice de severidad global, correspondiente al baremo de pacientes psiquiátricos. En las escalas de burnout académico se encuentran puntuaciones superiores en Agotamiento e Ineficacia Académica, no en Cinismo. Se han hallado diferencias en función del género. Las 3 variables muestran una correlación entre ellas. CONCLUSIONES: La muestra estudiada presenta unas puntuaciones elevadas en los test administrados. Se aplican puntos de corte que permiten detectar los casos de mayor gravedad en afección, hallándose un porcentaje notable (superior al 15%). Con los resultados obtenidos se propone la necesidad de que desde las facultades de medicina se incluyan programas de prevención, detección y abordaje de dificultades en salud mental, ya sean generales o específicos

INTRODUCTION: Different studies show high levels of stress and burnout in physicians and medical students. The aim of the present study is to determine the degree of stress perceived by the students, the psychopathological symptomatology and the degree of burnout, as well as the relationship between these variables in the first medical courses in the Faculty of Medicine of Lleida, detecting high risk students. METHODOLOGY: A cross-sectional study involving 118 students (79.7% 2nd year) of the Medical Faculty of the University of Lleida. Were assessed in perceived stress (Perceived Stress Scale), symptomatology (Sympton Checklist-90-R) and academic burnout (Maslach Burnout Inventory Student Survey). RESULTS: Perceived stress scores are above the scale. Scores on the symptomatology are at values of a sample of psychosomatic patients, and 16.95% exceed the score corresponding to the scale of psychiatric patients at global severity index. On the scales of academic burnout scores are higher in Exhaustion and Academic Inefficacy, not in Cynicism. In the 3 variables there are differences based on gender. The 3 variables show a correlation between them. CONCLUSIONS: The sample studied had high scores in the administered tests. Cut-off points are used to detect cases of greater severity in pathology, with a notable percentage (greater than 15%). With the results obtained, it is proposed that medical schools should include programs for the prevention, detection and management of mental health difficulties, whether general or specific

Evaluando la enseñanza de la bioética: formando «médicos virtuosos» o solamente médicos con habilidades éticas prácticas / Assessing bioethics education: Teaching to be virtuous doctors or just doctors with practical ethical skills

Objetivo: La bioética se ha incorporado en la formación de las Facultades de Medicina las últimas décadas. Diversos estudios analizan el desarrollo ético-moral de los estudiantes y el efecto de la educación ética, midiendo la evolución del razonamiento moral de Kohlberg (médicos virtuosos), y la sensibilidad ética para resolver casos clínicos (médicos con habilidades éticas). El objetivo del estudio es valorar el impacto de la formación en ética en estas dos variables en nuestro ámbito. Diseño: Estudio observacional transversal. Emplazamiento: Facultad de Medicina, Universidad de Lleida. Participantes: Un total de 175 estudiantes de tercer curso de medicina (78 antes de realizar bioética y 97 después de realizar bioética, en diferentes cursos). Intervención: Formación reglada en bioética. Mediciones principales: Se administra un cuestionario sociodemográfico, el Defining Issue Test de Rest como medida del razonamiento moral, y el Problem Identification Test de Hébert como medida de la sensibilidad ética. Resultados: Se halla una relación consistente y significativa entre razonamiento moral y sensibilidad ética. Las mujeres presentan mayor razonamiento posconvencional, es decir, mayor desarrollo moral. No se aprecian cambios en el estadio de razonamiento moral global de Kohlberg con la formación ética. Sí se incrementa de forma significativa y global la sensibilidad ética, medida en forma de Problem Identification Test. Conclusión: No se hallan diferencias en el desarrollo moral de estudiantes de medicina antes y después de la formación reglada en bioética, pero sí con respecto a las habilidades en resolución de casos. Se plantea si esta mejora es suficiente para formar médicos preparados para los nuevos retos

Objective: In the last decades, bioethics has been incorporated into the academic training of the Medical Schools. Some studies analyze the ethical-moral development of medical students and the effect of ethical education in other countries. This evaluation is done by measuring Kohlberg's moral reasoning (virtuous doctors), or ethical sensitivity to resolve clinical cases (physicians with ethical skills). The following study is proposed to assess the impact of bioethics training on these two variables, in Spanish medical students. Design: Observational cross-sectional study. Site: Faculty of Medicine, University of Lleida. Participants: 175 students from third year of medicine (78 before bioethics and 97 after bioethics, in different courses) were conducted. Intervention: Bioethics course. Main measurements: A socio-demographic questionnaire, the Rest Defining Issue test scale, and Problem Identification Test with clinical vignettes were administered. Results: A consistent and significant correlation has been found between moral reasoning and ethical sensitivity. Women presented greater post-conventional reasoning. There were no changes in Kohlberg's stage of global moral reasoning with ethical training. There were changes in ethical sensitivity with bioethical training, with a significantly and globally improvement. Conclusion: In our study, training in bioethics does not improve moral development but rather the ethical problem solving skills. It is asked if this improvement is enough to train doctors prepared for the new challenges

[Assessing bioethics education: Teaching to be virtuous doctors or just doctors with practical ethical skills]. / Evaluando la enseñanza de la bioética: formando «médicos virtuosos¼ o solamente médicos con habilidades éticas prácticas.

OBJECTIVE: In the last decades, bioethics has been incorporated into the academic training of the Medical Schools. Some studies analyze the ethical-moral development of medical students and the effect of ethical education in other countries. This evaluation is done by measuring Kohlberg's moral reasoning (virtuous doctors), or ethical sensitivity to resolve clinical cases (physicians with ethical skills). The following study is proposed to assess the impact of bioethics training on these two variables, in Spanish medical students. DESIGN: Observational cross-sectional study. SITE: Faculty of Medicine, University of Lleida. PARTICIPANTS: 175 students from third year of medicine (78 before bioethics and 97 after bioethics, in different courses) were conducted. INTERVENTION: Bioethics course. MAIN MEASUREMENTS: A socio-demographic questionnaire, the Rest Defining Issue test scale, and Problem Identification Test with clinical vignettes were administered. RESULTS: A consistent and significant correlation has been found between moral reasoning and ethical sensitivity. Women presented greater post-conventional reasoning. There were no changes in Kohlberg's stage of global moral reasoning with ethical training. There were changes in ethical sensitivity with bioethical training, with a significantly and globally improvement. CONCLUSION: In our study, training in bioethics does not improve moral development but rather the ethical problem solving skills. It is asked if this improvement is enough to train doctors prepared for the new challenges.

Miedo a la muerte en estudiantes de Medicina / Fear of death in medical students

OBJETIVO: El presente estudio tiene como objetivo detectar, describir y analizar el miedo a la muerte de los estudiantes de Medicina de la Universidad de Lleida de los cursos comprendidos entre 1998-2014, y conocer si este miedo se relaciona con variables como el género, la edad, las pérdidas personales, las creencias hacia la muerte y la influencia del plan de estudios. MÉTODO: Forman parte del estudio 676 estudiantes de Medicina de los cursos comprendidos entre 1998-2014, a los que se administra la escala revisada de Collett-Lester de miedo a la muerte y un cuestionario de variables sociodemográficas y biográficas. Resultado: El análisis de las variables encuestadas indica que los estudiantes de Medicina presentan un nivel intermedio de miedo a la muerte y al proceso de morir; los resultados varían según el género, la edad, las pérdidas personales, las creencias hacia la muerte y el plan de estudios. CONCLUSIONES: Con los resultados obtenidos se propone la necesidad de que desde las facultades de Medicina se incluya o se enfatice en un abordaje más orientado a la muerte y el sufrimiento que permita al estudiante de Medicina obtener mayores conocimientos y formarse en acompañar al morir y la muerte

OBJECTIVE: This study aims to detect, describe and analyse the fear of death of medical students of the University of Lleida from the academic years between 1998-2014, and to know if this fear is related to variables such as gender, age, personal losses, beliefs about death and the influence of the curriculum. Method: The study included 676 medical students, from the academic years between 1998 and 2014, who were given the revised Collett-Lester Fear of Death Scale and a questionnaire on sociodemographic and biographical variables. RESULT: The analysis of the variables surveyed indicates that medical students present an intermediate level of fear of death and the process of dying. The results vary according to gender, age, personal losses, beliefs about death and the curriculum. CONCLUSIONS: With the results obtained, it is proposed that medical schools should include or highlight a more death and suffering orientated approach to enable students to obtain greater knowledge and receive training in accompanying death and death

Empathy and burnout of emergency professionals of a health region: A cross-sectional study.

The objective of this study is to assess the association between levels of empathy and burnout of emergency professionals in all the assistance levels.A cross-sectional observational study was conducted in the health region of Lleida and the Pyrenees with 100 professionals from the field of Urgency. Participation reached 40.8%. Empathy and burnout were measured using the Spanish versions of the Jefferson Scale of Physician Empathy (JSPE) and Maslach Burnout Inventory (MBI) respectively. The total MBI score and its 3 dimensions (emotional exhaustion, depersonalization, and personal accomplishment) were analyzed. The JSPE and MBI scores were categorized into tertiles that were identified as "low," "moderate," and "high" levels.The median (interquartile range) was 112 (102-123) and 37 (27-53.5) for the JSPE and MBI scores respectively. Professionals with high burnout (MBI≥47) showed the lowest levels of empathy, that is, JSPE score of 105 (98-114); those with moderate burnout (31≤MBI < 47) had a JSPE score of 114 (104.5-120.5); and those with low burnout (MBI < 31) had a JSPE score of 120.5 (105.8-127.2). In addition, the highest levels of empathy were associated with the lowest levels of burnout, especially in depersonalization, and to a lesser extent in personal accomplishment. There were no differences in empathy and burnout for any of the other study variables.Our findings suggest that the empathy of emergency professionals is associated with burnout. Hence, reducing professional burnout could help keep emergency professionals' empathy levels high, which in turn would ensure a better quality of care. Nevertheless, it would be necessary to carry out prospective studies to describe the profiles of burnout and empathy as well as their association and evolution.

La empatía médica, ¿nace o se hace? Evolución de la empatía en estudiantes de medicina / The medical empathy, is it born or is it done? Evolution of the empathy in medical students

INTRODUCCIÓN Y OBJETIVOS: La empatía es una de las competencias básicas en el aprendizaje de la medicina, relacionándose con mejor relación médico-paciente, mejor competencia profesional y menor estrés profesional. Algunos estudios en el ámbito anglosajón muestran una disminución de la empatía durante el aprendizaje de la medicina. El presente estudio pretende medir el grado de empatía en estudiantes de medicina de nuestro medio, comparándolo con una serie de variables sociodemográficas y su evolución durante los estudios de medicina. Material y MÉTODO: Se administra el cuestionario TECA de medida de empatía, que mide 4 subescalas (comprensión empática, adopción de perspectivas, alegría empática y estrés empático), así como un cuestionario sociodemográfico, a 191 estudiantes de 1. °, 3. ° y segundo ciclo (4. ° y 5. °) de Medicina de la Facultad de Medicina de Lleida. RESULTADOS: En nuestra muestra se aprecia una progresión de la empatía durante los cursos de medicina. Presentan mayor empatía las estudiantes femeninas, también mayor estrés empático. Los estudiantes masculinos presentan menor empatía, menor progresión de esta durante los cursos y menor estrés empático. Presentan menor empatía los estudiantes que prefieren la serie House y los que tienen familiares médicos. Presentan mayor empatía los estudiantes que han realizado voluntariado, y los que han tenido un amigo enfermo. No se halla relación entre empatía y especialidad deseada. CONCLUSIONES: Existen diversas variables que se relacionan con mayor empatía en estudiantes de medicina: mujeres, estudiantes de cursos avanzados, vivencias cercanas de enfermedades graves y los implicados en actividades de voluntariado

OBJECTIVE: Empathy is one of the basic skills in medicine that promotes better doctor-patient relationship, best professional competition and less professional stress. We don't found studies in our area. This study aims to measure the degree of empathy in medical students in our area and associated factors. DESIGN: Cross-sectional study. LOCATION: Faculty of Medicine, University of Lleida (Spain). PARTICIPANTS: Pass in class of 1st, 3rd and second cycle of Medicine, at 191 students.173 students (90%) completed the questionnaire. MAIN MEASUREMENTS: TECA questionnaire to measure general empathy with 4 subscales (empathic understanding, perspective taking, empathic happiness and empathic stress), and a sociodemographic questionnaire. RESULTS: We found a progression in empathy during medical courses. Women have greater empathy but also increased empathic stress. Men have less general empathy, less progression of empathy and less emphatic stress. Students that show a preference to House TV movie have less empathy and those with family doctors. Voluntary students have greater empathy and those who have had a sick friend. We don't have found relationship between empathy and preferred specialty. CONCLUSIONS: There are several variables that are related to empathy in medical students: Women, advanced courses, experiences close to serious illnesses and those involved in voluntary activities

[The medical empathy, is it born or is it made? Evolution of the empathy in medical students]. / La empatía médica, ¿nace o se hace? Evolución de la empatía en estudiantes de medicina.

OBJECTIVE: Empathy is one of the basic skills in medicine that promotes better doctor-patient relationship, best professional competition and less professional stress. We don't found studies in our area. This study aims to measure the degree of empathy in medical students in our area and associated factors. DESIGN: Cross-sectional study. LOCATION: Faculty of Medicine, University of Lleida (Spain). PARTICIPANTS: Pass in class of 1st, 3rd and second cycle of Medicine, at 191 students. 173 students (90%) completed the questionnaire. MAIN MEASUREMENTS: TECA questionnaire to measure general empathy with 4 subscales (empathic understanding, perspective taking, empathic happiness and empathic stress), and a sociodemographic questionnaire. RESULTS: We found a progression in empathy during medical courses. Women have greater empathy but also increased empathic stress. Men have less general empathy, less progression of empathy and less emphatic stress. Students that show a preference to House TV movie have less empathy and those with family doctors. Voluntary students have greater empathy and those who have had a sick friend. We don't have found relationship between empathy and preferred specialty. CONCLUSIONS: There are several variables that are related to empathy in medical students: Women, advanced courses, experiences close to serious illnesses and those involved in voluntary activities.

Los niños y adolescentes, ¿pueden tomar decisiones sanitarias? ¿cómo podemos valorarlo? / Can children and adolescents make health-related decisions? How can this be assessed?

El ejercicio de la medicina ha cambiado profundamente durante las últimas décadas, paralelamente a su progreso y a los cambios sociales. Uno de los cambios más importantes es el paso de un modelo basado en la beneficencia a un model basado en la autonomía, donde los pacientes participan en las decisiones sanitarias. En pediatría, el rol de agente activo recae sobre los padres. Pero los niños menoers de edat ¿pueden tomar decisiones sanitarias? Tomar decisiones implica ser competente. La competencia es un fenómeno de todo o nada, o ¿puede haber grados? ¿Cuando podemos afirmar que un niño o adolescente es competente para tomar decisiones sanitarias? El nivell de competencia exigido, ¿es el mismo para cualquier decisión? ¿Es posible valorar objetivamente la competencia en los menores? ¿Puede ser útil implicar a los niños en las decisiones? Este artículo revisa estas cuestiones, y incide especialmente en posibles instrumentos prácticos para medir la competencia en el menor(AU)

Medical practice has changed significantly over the last decades, along the lines of medical progress and social changes. One of the most important changes is the transition from a model of medical relationship based on beneficence to a model based on autonomy, in which patients actively participate in health decisions. In pediatrics, parents have often been the active agents of decisions related to their children. However, can children and adolescents make health decisions? Making a decision implies being competent; however, is competency an "all or nothing" matter, or can it have degrees? When is it possible to say that a child or an adolescent is competent to make a health-related decision? Is the level of competency expected to be the same for any kind of decision? Is it possible to objectively measure the competence of minors? Would it be useful to involve children on decision-making processes? This article looks into all these questions and pays special attention to the possible practical instruments to measure minors' competency(AU)