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)

Teaching Urology to Undergraduates: A Prospective Survey of What General Practitioners Need to Know.

BACKGROUND: Higher education training in Medicine has considerably evolved in recent years. One of its main goals has been to ensure the training of students as future adequately qualified general practitioners (GPs). Tools need to be developed to evaluate and improve the teaching of Urology at the undergraduate level. Our objective is to identify the knowledge and skills needed in Urology for the real clinical practice of GPs. METHODS: An anonymous self-administered survey was carried out among GPs of Primary Care and Emergencies which sought to evaluate urological knowledge and necessary urological skills. The results of the survey were exported and descriptive statistics were performed using IBM SPSS Statistics version 19.0. RESULTS AND LIMITATIONS: A total of 127 answers were obtained, in which 'Urological infections', 'Renal colic', 'PSA levels and screening for prostate cancer', 'Benign prostatic hyperplasia', 'Hematuria', 'Scrotal pain', 'Prostate cancer diagnosis', 'Bladder cancer diagnosis', 'Urinary incontinence', and 'Erectile dysfunction' were rated as Very high or High formative requirements (>75%). Regarding urological skills, 'Abdominal examination', 'Interpretation of urinalysis', 'Digital rectal examination', 'Genital examination', and 'Transurethral catheterization' were assessed as needing Very high or High training in more than 80% of the surveys. The relevance of urological pathology in clinical practice was viewed as Very high or High in more than 80% of the responses. CONCLUSIONS: This study has shown helpful results to establish a differentiated prioritization of urological knowledge and skills in Primary Care and Emergencies. Efforts should be aimed at optimizing the teaching in Urology within the Degree of Medicine which consistently ensures patients' proper care by future GPs.

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.

Cinco cuestiones esenciales para acompañar en el sufrimiento / Five essential questions to accompany in the suffering

El sufrimiento aparece de manera natural y espontánea cuando no tenemos recursos para hacer frente a una situación que se convierte en una amenaza. Acompañar el sufrimiento no es tarea fácil y requiere destrezas, habilidades y conocimientos, así como desarrollo personal. Identificar y abordar el sufrimiento es una de las principales funciones de la práctica clínica. Poder identificar cómo esta experiencia afecta a los profesionales sanitarios, así como generar estrategias para hacerle frente podría protegernos y facilitar el ejercicio de la ayuda. Este artículo tiene como objetivo principal realizar una revisión teórica, acompañada de claves prácticas, para presentar cinco cuestiones previas que configuran un conocimiento esencial para el acompañamiento. Se pretende estimular la reflexión y el aprendizaje de habilidades que nos permitan desarrollar nuestras acciones desde la consciencia y en coherencia con nuestros valores y objetivos

Suffering appears naturally and spontaneously when we do not have resources to deal with a threat. Accompanying suffering is not an easy task and requires skills, abilities and knowledge, as well as personal development. Identifying and addressing suffering is one of the main functions in clinical practice. To be able to identify how this experience affects healthcare professionals, and to generate strategies to face it, could protect us and facilitate the exercise of helping others. The main objective of this article is to realize a theoretical review, accompanied by practical keys, in order to present five previous questions that constitute an essential knowledge for accompaniment. It is intended to stimulate reflection and learning skills that allow us to develop our actions from consciousness and in coherence with our values and objectives

Comunicación consciente para acompañar de forma eficaz: protocolo de 5 pasos / Conscious communication to accompany effectively: protocol of 5 steps

Las personas con enfermedades crónicas y graves, necesitan ser escuchadas, entendidas y atendidas a su ritmo. Los profesionales necesitan herramientas sencillas y eficientes que les faciliten una buena comunicación con sus pacientes, en el menor tiempo posible. OBJETIVO: describir un protocolo sistemático de comunicación en cinco pasos. MÉTODO: Se ha diseñado un enfoque cualitativo basado en la revisión documental, que ha incluido la revisión bibliográfica y de evidencias para apoyar el análisis y poder llegar a conclusiones con la información extraída del proceso. RESULTADO: Como resultado se propone un protocolo básico de comunicación fundamentado en el counselling y en los principios de la bioética moderna, capaz de facilitar las funciones de informar, motivar la adhesión terapéutica, promover cambios de conducta, abordar situaciones de comunicación difícil y, especialmente, de tener un encuentro auténtico con el paciente y su familia. Por conclusión sin comunicación eficaz no hay encuentro, y sin encuentro, la relación clínica entre profesional y paciente se puede convertir en un intercambio de palabras vacías, de imposiciones de tratamientos, que difícilmente el paciente va a cumplir adecuadamente. Los tiempos cambian y la Medicina participativa va encontrando un lugar más adecuado en el entorno clínico

People with chronic and serious diseases, need to be heard, understood and answered at their own pace. Professionals need simple and efficient tools to have good communication with their patients, in the shortest possible time. The aim of this paper is to describe a systematic communication in five steps, protocol based on counselling and on the principles of bioethics, to facilitate the information skills, motivate therapeutic adherence, promote behavioral changes, deal with difficult situations and to have an authentic encounter with the patient and his family. It is concluded that without effective communication there is no encounter, and without encounter, the clinical relationship between professional and patient can become an exchange of empty words, of impositions of treatments, which the patient will hardly adequately comply with. Times change and participatory medicine is finding a more appropriate place in the clinical environment

Fiabilidad de un cuestionario empleado para la aplicación en el seguimiento longitudinal de la opinión y percepciones de la medicina de familia de los estudiantes de medicina de la Universidad de Zaragoza / Reliability of a questionnaire used in the long-term follow up of the opinion and perceptions of family medicine by medical students of the University of Zaragoza (Spain)

Objetivo: La medicina de familia aborda determinados aspectos y perspectivas que suelen quedar relegados en la formación de otros niveles de atención por lo que cada vez cobra mayor importancia la necesidad de que los estudiantes tomen contacto con la atención primaria. El objetivo de este estudio es el de evaluar la fiabilidad del cuestionario del grupo Unimedifam (FIS PI070975) para conocer la evolución longitudinal de las expectativas y conocimientos sobre medicina de familia de los estudiantes de medicina. Diseño: Estudio de fiabilidad de un cuestionario. Emplazamiento: Alumnos de medicina de la Universidad de Zaragoza. Participantes: Contamos con un total de 371 alumnos de los cursos 1.°, 3.°, 5.° y 6.°. Método: La consistencia interna del cuestionario se determinó con el coeficiente alfa de Cronbach y su estabilidad en una prueba test-retest. Resultados: En la escala A del cuestionario encontramos que 3 ítems de 19 son poco estables; en la escala B 8 de 26 y en la escala C, 3 ítems de 38. El valor de alfa de Cronbach de la escala A es de 0,722, de la escala B de 0,861 y el de la escala C, 0,663.ConclusionesLas 3 escalas están entre los valores adecuados, excepto la escala C que aun así se encuentra muy próxima. Las conclusiones de este proceso de validación pueden servir de referencia y extrapolarse al cuestionario UNIMEDFAM a nivel estatal (AU)

Aim: Family medicine deals with certain aspects and perspectives that are often left behind in the training of other levels of care, thus the need for medical students to make contact with Primary Care is of increasing importance. The aim of this study is to evaluate the reliability of the questionnaire of the UNIMEDIFAM group (FIS PI070975) for the long-term outcome of expectations and knowledge about family medicine. Design: Reliability of a questionnaire. Setting: University of Zaragoza.Participants371 students from the 1st, 3rd, 5th, and 6th years. Method: The internal consistency of the questionnaire was determined using Cronbach's alpha coefficient, and the stability using the test-retest. Results: On scale A of the questionnaire we found that three of 19 items were unstable, in 8 of 26 on scale B, and 3 of 38 items on scale C. The Cronbach's alpha value of scale A was 0.722, 0.861 on scale B, and 0,663 on scale C. Conclusions: The 3 scales are within the appropriate values, except scale C, which is very close. The findings of this validation process can serve as a reference that may be extrapolated to the UNIMEDIFAM national questionnaire(AU)

[Reliability of a questionnaire used in the long-term follow up of the opinion and perceptions of family medicine by medical students of the University of Zaragoza (Spain)]. / Fiabilidad de un cuestionario empleado para la aplicación en el seguimiento longitudinal de la opinión y percepciones de la medicina de familia de los estudiantes de medicina de la Universidad de Zaragoza.

AIM: Family medicine deals with certain aspects and perspectives that are often left behind in the training of other levels of care, thus the need for medical students to make contact with Primary Care is of increasing importance. The aim of this study is to evaluate the reliability of the questionnaire of the UNIMEDIFAM group (FIS PI070975) for the long-term outcome of expectations and knowledge about family medicine. DESIGN: Reliability of a questionnaire. SETTING: University of Zaragoza. PARTICIPANTS: 371 students from the 1st, 3rd, 5th, and 6th years. METHOD: The internal consistency of the questionnaire was determined using Cronbach's alpha coefficient, and the stability using the test-retest. RESULTS: On scale A of the questionnaire we found that three of 19 items were unstable, in 8 of 26 on scale B, and 3 of 38 items on scale C. The Cronbach's alpha value of scale A was 0.722, 0.861 on scale B, and 0,663 on scale C. CONCLUSIONS: The 3 scales are within the appropriate values, except scale C, which is very close. The findings of this validation process can serve as a reference that may be extrapolated to the UNIMEDIFAM national questionnaire.