At what stage in the undergraduate curriculum is it best to train in family medicine? A study from two medical schools in Spain.

BACKGROUND: A course in family medicine (FM) could dispel the possibility of negative stereotyping about this speciality, and instil in students a greater interest. However, when is it preferable: at the beginning or at the end of undergraduate training? OBJECTIVES: To determine changes in knowledge and attitudes towards FM by medical students completing a course in primary care at the beginning or the end of the undergraduate training and whether those changes anticipate the choice of speciality. METHODS: Students from Albacete and Seville medical schools (primary care course in second and sixth years, respectively) were asked to respond to the 'valuation of attitudes towards and knowledge of family medicine questionnaire' (CAMF). Students from Albacete answered before and after the course, and in Seville second-year students answered at the end of the first trimester. All students were invited to respond again at the end of their undergraduate training. Afterwards, we investigated the score on the speciality exam (order for the election from highest to lowest score) and their choice of speciality. The outcome measures were the MIR exam score, the number in the ranking, the chosen speciality and the result of the CAMF. RESULTS: In Albacete 88 and 64 and in Seville 50 and 98 students responded in their second and sixth years, respectively. In Albacete, mean CAMF scores were 15.4, 22.7 before and after the course, and 21.8 at the end while in Seville, 13.9 in the second year, and 23.5 in the sixth year. Logistic regression analysis showed an association of the choice of FM only with the score on the speciality exam (OR: 0.667; 95%CI: 0.553-0.806). CONCLUSION: There were no significant differences between CAMF scores at the end of undergraduate training. Only the score on the speciality exam predicts FM choice: the higher the score, the lower the probability of choosing FM.

Predictors for choosing the specialty of Family Medicine from undergraduate knowledge and attitudes.

CONTEXT AND OBJECTIVE: A cold climate towards primary care (PC) within medical academia could form a barrier against choosing family medicine (FM) as a career option. This study was designed to determine whether medical students' knowledge of and attitudes towards FM predicted their career choice. DESIGN AND SETTING: Cohort study conducted at two different medical schools. METHODS: After completing a PC course at the Albacete Medical School in 2005-2006, 81 second-year students were asked to give responses to a questionnaire. In their sixth year (2009-2010), 79 students in Albacete and 42 in Seville (taken as an unexposed cohort) were asked to give responses too. Their choice of specialty was investigated in 2011. RESULTS: In Albacete, the questionnaire was answered by 79 second-year and 76 sixth-year students; in Seville, it was answered by 26 sixth-year students. After completing the PC course, 69.3% said they would like to become a family doctor. This percentage decreased to 40.3% at the end of the undergraduate course (P < 0.0001). In the sixth year, the attitudes towards FM worsened, yet these were significantly more favorable than those in Seville. Only 12 students chose FM; they obtained significantly worse scores in their specialty selection examination than their peers (P < 0.0001). CONCLUSION: In the Albacete Medical School, the students' opinion about FM worsened over the undergraduate course, although it was still better than the Seville students' stance. In any case, FM was seen to be a minority option.

Predictors for choosing the specialty of Family Medicine from undergraduate knowledge and attitudes / Preditores da escolha da especialidade Medicina de Família a partir de competências e atitudes de alunos de graduação

ABSTRACT: CONTEXT AND OBJECTIVE: A cold climate towards primary care (PC) within medical academia could form a barrier against choosing family medicine (FM) as a career option. This study was designed to determine whether medical students' knowledge of and attitudes towards FM predicted their career choice. DESIGN AND SETTING: Cohort study conducted at two different medical schools. METHODS: After completing a PC course at the Albacete Medical School in 2005-2006, 81 second-year students were asked to give responses to a questionnaire. In their sixth year (2009-2010), 79 students in Albacete and 42 in Seville (taken as an unexposed cohort) were asked to give responses too. Their choice of specialty was investigated in 2011. RESULTS: In Albacete, the questionnaire was answered by 79 second-year and 76 sixth-year students; in Seville, it was answered by 26 sixth-year students. After completing the PC course, 69.3% said they would like to become a family doctor. This percentage decreased to 40.3% at the end of the undergraduate course (P < 0.0001). In the sixth year, the attitudes towards FM worsened, yet these were significantly more favorable than those in Seville. Only 12 students chose FM; they obtained significantly worse scores in their specialty selection examination than their peers (P < 0.0001). CONCLUSION: In the Albacete Medical School, the students' opinion about FM worsened over the undergraduate course, although it was still better than the Seville students' stance. In any case, FM was seen to be a minority option.

RESUMO CONTEXTO E OBJETIVO: Um clima frio para a atenção primária na academia médica constitui uma barreira para escolher Medicina de Família (MF) como opção de carreira. Este estudo foi concebido para determinar se o conhecimento e as atitudes dos estudantes de medicina em relação à MF predizem a escolha da carreira. TIPO DE ESTUDO E LOCAL: Estudo de coorte realizado em duas faculdades de medicina. MÉTODOS: Depois de terem completado um curso de Cuidados Primários na Faculdade de Medicina de Albacete, em 2005-2006, 81 alunos do segundo ano foram convidados a responder a um questionário. No seu sexto ano (2009-2010), 79 estudantes de Albacete assim como 42 de Sevilha, tomados como coorte não exposta, foram convidados a responder também. Todos eles foram investigados sobre a escolha da especialidade em 2011. RESULTADOS: Em Albacete, 79 e 76 estudantes responderam no segundo e sexto anos, respectivamente, e 26 em Sevilha. Depois de terem concluído o curso de cuidados primários, 69,3% disseram que gostariam de se tornar médicos de família. Esta percentagem diminuiu para 40,3% no final da graduação (P < 0,0001). No sexto ano, as atitudes com relação à MF pioraram, mas estas foram significativamente mais favoráveis do que as de Sevilla. Apenas 12 alunos escolheram a MF; eles obtiveram pontuação significativamente piores no exame do que seus pares (P < 0,0001). CONCLUSÃO: Na Faculdade de Medicina de Albacete, a opinião dos alunos sobre a MF ao longo da graduação piorou; contudo ainda era melhor que as dos estudantes de Sevilha. Em qualquer caso, MF foi opção minoritária.

[Choice of Family Medicine at the exams for Spanish resident doctors in 2011 and 2013]. / Elección de Medicina Familiar en los exámenes para médicos residentes españoles de 2011 y 2013.

BACKGROUND: Family Medicine (FM) is regarded as one of the specialities less interesting to those who choose for resident physicians (MIR) in Spain. Our objective is to know the priority given to the choice of FM in 2011 and 2013 MIR exams, and what factors might be associated with this choice. METHODS: We obtained information on the website of the Ministry of Health for the graduates who could choose a speciality (11552 y 9182). The variables analyzed were: number obtained in the opposition, sex, speciality chosen, chosen city, medical school where they studied (for 117 and 155 students of a previous cohort study). We calculated the probability of choice of FM in relation to the order number in the exam and the other variables (Kaplan-Meier). RESULTS: 1963 and 1772 chose FM, respectively in 2011 and 2013. The median of the order number to choose FM was 7894 (95%CI:7720-8068) and 6561 (95%CI:6442-6680). There were gender differences, as women chose FM with fewer number and a higher proportion (p<0.00001). CONCLUSIONS: Graduates enrolled in the MIR exam have not special preference for FM. Women show a greater interest in this speciality.

Introducción: la Medicina Familiar (MF) está considerada entre las especialidades que menos interesan a quienes optan por ser médicos internos residentes (MIR) en España. Nuestro objetivo es describir la prioridad concedida a la elección de MF en las convocatorias MIR 2011 y 2013, y qué factores podrían estar asociados con esta elección. Métodos: de la web del Ministerio de Sanidad de España se obtuvo información de los opositores que optaron a plaza (11552 y 9182). Las variables analizadas han sido: número obtenido en la oposición, sexo, especialidad elegida, ciudad elegida, facultad donde estudiaron (para 117 y 155 en un estudio de cohorte previo). Se calculó la probabilidad de elección de MF en relación con el número de orden en la oposición y otras variables (Kaplan-Meier). Resultados: la MF fue elegida por 1963 y 1772, respectivamente en 2011 y 2013. La mediana del número en la oposición para elegir MF fue 7894 (IC 95 % 7720-8068) y 6561 (IC 95 % 6442-6680). Existían diferencias por sexo: las mujeres elegían MF con menor número y en mayor proporción (p < 0.00001). Conclusiones: los opositores MIR no tienen una especial preferencia por la MF. Las mujeres muestran un mayor interés por esta especialidad.

Conocimientos sobre violencia de género de la población que consulta en Atención Primaria / Knowledge of gender-based violence in the population seen in Primary Care

Objetivo: Determinar conocimientos y actitudes hacia la violencia de género de la población consultante en Atención Primaria y su relación con factores sociodemográficos y experiencias personales.DiseñoEstudio descriptivo transversal.EmplazamientoCentros de Salud urbanos.ParticipantesPacientes ≥ 18 años que acuden a consulta de Atención Primaria.Mediciones principalesSe utilizó un cuestionario que incluía preguntas relativas a conocimientos, actitudes y experiencias vividas en relación con la violencia de género y en el ámbito doméstico, y que también recogía edad, sexo, nivel de estudios, estado civil y detección de experiencias personales de violencia de género mediante la versión corta del Woman Abuse Screening Tool (WAST).ResultadosRespondieron 673 personas, de 18-86 años, con un 68% de mujeres. Solo un 18,2% tenía un adecuado conocimiento sobre quién se considera que ejerce la violencia de género. La mitad de los participantes consideraban que la violencia de género incluía lesiones físicas, psicológicas, cohibición de libertad y violación. A través de un análisis de regresión logística se encontró una asociación independiente con el conocimiento de la respuesta correcta sobre qué es la violencia de género del estado civil, siendo menos probable en los casados con respecto a los viudos (OR: 0,28; IC 95%: 0,11-0,72) considerar que la violencia de género implica lesión física (OR: 2,55; IC 95%: 1,28-5,08), pero no lesiones psicológicas (OR: 0,52; IC 95%: 0,28-0,96), y no dar la respuesta correcta sobre qué es la violencia doméstica (OR: 0,06; IC 95%: 0,03-0,12).ConclusionesExiste una gran dispersión en las respuestas con relación a qué consideran los pacientes que es la violencia de género y qué aspectos abarca(AU)

Objective: To determine the knowledge and attitudes towards gender-based violence in the Primary Care patient population and their relationship with sociodemographic factors and personal experience.DesignA descriptive, cross-sectional study.SettingUrban Health Centres.ParticipantsPatients ≥18 years-old who were seen in a Primary Care clinic.Materials and methodA questionnaire was used that included questions associated with knowledge, attitudes and experience of gender-based violence in the domestic environment. Variables such as, age, sex, education level, marital state were recorded, as well as the detection of personal experiences of Gender-Based Violence using the short Woman Abuse Screening Tool (WAST).ResultsA total of 673 people, from 18- 86 years, responded, of which 68% were women. Only 18.2% had sufficient knowledge on who is considered to exercise gender-based violence. Half of the participants believed that gender-based violence included physical and psychological injuries, inhibition of freedom and rape. In the logistic regression analysis an independent relationship was found with the knowledge of the correct response on what is gender-based violence by marital state, being less likely in married people as regards widowers (OR: 0.28; CI 95%: 0.11-0.72), to consider that gender-based violence involves physical injury (OR: 2.55; CI 95%: 1.28-5.08), but not psychological injury (OR: 0.52; CI 95%: 0.28-0.96), and not giving the correct response on what is domestic violence (OR:0.06; CI 95%: 0.03-0.12).ConclusionsThere is a wide variation in the results as regards what patients believe gender-based violence is and what aspects it covers(AU)

[Knowledge of gender-based violence in the population seen in primary care]. / Conocimientos sobre violencia de género de la población que consulta en Atención Primaria.

OBJECTIVE: To determine the knowledge and attitudes towards gender-based violence in the Primary Care patient population and their relationship with sociodemographic factors and personal experience. DESIGN: A descriptive, cross-sectional study. SETTING: Urban Health Centres. PARTICIPANTS: Patients ≥18 years-old who were seen in a Primary Care clinic. MATERIALS AND METHOD: A questionnaire was used that included questions associated with knowledge, attitudes and experience of gender-based violence in the domestic environment. Variables such as, age, sex, education level, marital state were recorded, as well as the detection of personal experiences of Gender-Based Violence using the short Woman Abuse Screening Tool (WAST). RESULTS: A total of 673 people, from 18-86 years, responded, of which 68% were women. Only 18.2% had sufficient knowledge on who is considered to exercise gender-based violence. Half of the participants believed that gender-based violence included physical and psychological injuries, inhibition of freedom and rape. In the logistic regression analysis an independent relationship was found with the knowledge of the correct response on what is gender-based violence by marital state, being less likely in married people as regards widowers (OR: 0.28; CI 95%: 0.11-0.72), to consider that gender-based violence involves physical injury (OR: 2.55; CI 95%: 1.28-5.08), but not psychological injury (OR: 0.52; CI 95%: 0.28-0.96), and not giving the correct response on what is domestic violence (OR:0.06; CI 95%: 0.03-0.12). CONCLUSIONS: There is a wide variation in the results as regards what patients believe gender-based violence is and what aspects it covers.

Experiencias en relación con la Violencia de Género de la población que consulta en Atención Primaria / Experience in gender violence in the general population within the Primary Care setting

Objetivo. Conocer la prevalencia de violencia de género padecida por la población consultante en Atención Primaria y su relación con factores sociodemográficos y otras experiencias personales. Diseño. Estudio observacional, descriptivo, transversal. Emplazamiento. Centros de Salud urbanos. Participantes. Pacientes de 18 o más años que acuden a consulta de Atención Primaria. Mediciones principales. Se utilizó un cuestionario diseñado ad hoc, que incluía preguntas relativas a las experiencias vividas en relación con la violencia de género y en el ámbito doméstico, junto a la versión corta del Woman Abuse Screening Tool (WAST). También recogía edad, sexo, nivel de estudios y estado civil, así como conocimientos y actitudes con respecto a este tema. Resultados. Respondieron al cuestionario 673 personas. De las 662 personas que respondieron a la pregunta sobre si ha sufrido algún tipo de violencia en sus relaciones sentimentales, 76 dieron una respuesta afirmativa (11,48%; IC 95%: 8,98-13,98%). Esta respuesta era más probable encontrarla en viudos y separados (p<0,00001), mientras que entre los más jóvenes predominaba el no haber sufrido violencia (p=0,01), sin diferencias para otras variables sociodemográficas. Mediante regresión logística, la edad fue la única variable asociada independiente con haber sufrido violencia de género (OR: 1,02; IC95%: 1,005-1,036). Para el test WAST se obtuvieron 560 respuestas, de las que un 12,0 % (IC95%: 9,2-14,7%) fueron positivas. La concordancia entre la respuesta a la pregunta sobre si ha sufrido algún tipo de violencia en sus relaciones sentimentales y el resultado del WAST fue muy baja (Kappa: 0,153; IC 95%: 0,038-0,243). A la pregunta “¿qué ha hecho?” (en caso de violencia en alguna relación sentimental), la respuesta más frecuente es alejarse del agresor. Hasta un 42,1% de los participantes decía conocer a alguna persona que hubiera padecido violencia de género. Conclusiones. Existe un contacto frecuente de las personas que acuden a consulta de atención primaria con la violencia de género, siendo considerable el número de personas que afirman haber sufrido maltrato (AU)

Objectives. To determine the prevalence of gender violence in the general population in the primary care setting and its association with sociodemographic factors and other personal experience. Design. Cross-sectional, observational, descriptive study. Setting. Urban primary care centres. Participants. Patients aged 18 years or over who attended the Primary Care centre. Main measurements. An ad hoc designed questionnaire that included questions on experience of domestic violence and the short version of the Woman Abuse Screening Tool (WAST), were used. Sociodemographic variables and knowledge and attitudes towards gender violence were also collected. Results: A total of 673 persons responded to the questionnaires. Of the 662 subjects who answered the question on whether they had suffered any type of abuse by their partner, 75 answered affirmatively (11.48%; 95% CI: 8.98-13.98%). This response was more probable in widowed or separated subjects (p<0.00001). Amongst young people there was a predominance of not having suffered abuse (p=0.01). There were no differences regarding the other sociodemographic variables. Logistic regression analysis revealed that age was the only variable that demonstrated an independent association with having suffered gender violence (OR: 1.02; 95% CI: 1.005 – 1.036). A total of 560 responses were obtained in the WAST questionnaire and 12.0% were positive (95% CI; 9.2 – 14.7%). Its concordance with the question on history of domestic violence was very low (Kappa: 0.153; 95% CI: 0.038-0.243). In the case of previous abuse, in answer to the question “What did you do? the most frequent response was to get away from the aggressor. Up to 42.1% said they knew someone who was a victim of gender violence. Conclusions. In the primary care setting there is frequent contact with persons suffering gender violence. There are a considerable number of persons who admit to being abused (AU)

[Design and validation of a questionnaire for the detection of major depression in elderly patients]. / Diseño y validación de un cuestionario para la detección de depresión mayor en pacientes ancianos.

BACKGROUND AND OBJECTIVE: The aim of this study was to design and validate a scale to detect major depressive disorders in elderly individuals in primary care (Detection of Depression in the Elderly Scale [DDES]). METHODS: We performed an observational and cross-sectional study for the validation of a scale, administered by means of a personal interview, in 259 patients aged 65 years old or older. Available instruments were reviewed and the questions were designed. Subsequently, a first pilot study was performed. In a second pilot study the reproducibility of the instrument was analyzed. The gold standard was the result of a standardized psychiatric interview performed by psychiatrists (DSM-IV criteria and SCAN interviews). RESULTS: The intraclass correlation coefficients corresponding to the test-retest and inter-rater reliability were 0.858 (95% confidence interval [CI], 0.634-0.946) and 0.908 (95% CI, 0.726-0.969) respectively. Two hundred sixteen subjects underwent an assessment, in which primary care and psychiatric evaluations were blinded. Major depression was diagnosed in 81 patients (37.5%; 95% CI, 31.1-44.4). The internal consistency of the DDES was good (Cronbach's alpha = 0.79). Exploratory factorial analysis revealed an 8-component structure (55.8% of explained variance). A cutoff score of 15 or more for the DDES showed sensitivity of 90.1% (95% CI, 80.95-95.33), specificity of 74.8% (95% CI, 66.48-81.71) and a likelihood ratio (+) of 3.58 (95% CI, 2.65-4.83). CONCLUSIONS: The DDES is a clinically useful instrument for the detection of major depression in elderly patients in primary care.

Diseño y validación de un cuestionario para la detección de depresión mayor en pacientes ancianos / Design and validation of a questionnaire for the detection of major depression in elderly patients

Fundamento y objetivo: Elaborar y validar una escala para detectar trastornos depresivos mayores (TDM) en ancianos que utilizan las consultas de atención primaria (Escala para la Detección de Depresión en Ancianos [EDDA]). Métodos: Estudio observacional transversal para validar una escala, administrada mediante entrevista personal, en 259 pacientes de 65 o más años. Tras revisar los instrumentos disponibles y elaborar los ítems, se realizó una primera prueba piloto o pretest. En una segunda prueba piloto se analizó la reproducibilidad del instrumento. El estándar de oro fue el resultado de una entrevista psiquiátrica estandarizada realizada por psiquiatras (criterios DSM-IV y entrevista SCAN). Resultados: Los coeficientes de correlación intraclase (CCI) correspondientes a la fiabilidad intra e interobservador fueron, respectivamente, de 0,858 (intervalo de confianza [IC] del 95%, 0,634-0,946) y 0,908 (IC del 95%, 0,726-0,969). El número de sujetos válidos para el estudio fue de 216 ancianos, en quienes se realizó, de forma ciega, una valoración en consultas de atención primaria y de psiquiatría. En éstas se objetivó la existencia de un TDM en 81 de ellos (37,5%; IC del 95%, 31,1-44,4). La EDDA mostró una elevada coherencia interna (* de Cronbach = 0,79). El análisis factorial determinó que existían 8 factores capaces de explicar el 55,8% de la varianza total. Para una puntuación mayor o igual a 15, la EDDA presenta una sensibilidad del 90,1% (IC del 95%, 80,95-95,33), una especificidad del 74,8% (IC del 95%, 66,48-81,71) y un cociente de probabilidad positivo de 3,58 (IC del 95%, 2,65-4,83). Conclusiones: La EDDA es un instrumento clínicamente útil para la detectar los TDM de los ancianos en la atención primaria

Background and objective: The aim of this study was to design and validate a scale to detect major depressive disorders in elderly individuals in primary care (Detection of Depression in the Elderly Scale [DDES]). Methods: We performed an observational and cross-sectional study for the validation of a scale, administered by means of a personal interview, in 259 patients aged 65 years old or older. Available instruments were reviewed and the questions were designed. Subsequently, a first pilot study was performed. In a second pilot study the reproducibility of the instrument was analyzed. The gold standard was the result of a standardized psychiatric interview performed by psychiatrists (DSM-IV criteria and SCAN interviews). Results: The intraclass correlation coefficients corresponding to the test-retest and inter-rater reliability were 0.858 (95% confidence interval [CI], 0.634-0.946) and 0.908 (95% CI, 0.726-0.969) respectively. Two hundred sixteen subjects underwent an assessment, in which primary care and psychiatric evaluations were blinded. Major depression was diagnosed in 81 patients (37.5%; 95% CI, 31.1-44.4). The internal consistency of the DDES was good (Cronbach's alpha = 0.79). Exploratory factorial analysis revealed an 8-component structure (55.8% of explained variance). A cutoff score of 15 or more for the DDES showed sensitivity of 90.1% (95% CI, 80.95-95.33), specificity of 74.8% (95% CI, 66.48-81.71) and a likelihood ratio (+) of 3.58 (95% CI, 2.65-4.83). Conclusions: The DDES is a clinically useful instrument for the detection of major depression in elderly patients in primary care