Communicating value to patients-a high-value care communication skills curriculum.

INTRODUCTION: With rising health care costs in the United States, trainees will be increasingly challenged in discussing testing stewardship with patients. OBJECTIVE: We piloted a high-value care (HVC) communication skills curriculum utilizing the Four Habits Model for communication. We hoped residents would 1) learn to apply the Four Habits communication model to HVC discussions with standardized patients (SP) and 2) improve value-based communication skills through training in a high-intensity curriculum with feedback from trained faculty facilitators and peers. METHODS: Thirty interns at the University of Minnesota were randomized to a standard HVC communication SP encounter (n = 15) or a high-intensity HVC communication skills curriculum (n = 15). The high-intensity curriculum included video and audio-recorded SP encounters followed by facilitated small group discussions/feedback. Experiences were reported in a post-intervention survey; communication skills were assessed with the CARE empathy scale. RESULTS: 70% (21/30) of interns (57% high intensity, 43% standard) responded to the survey. In total, 88% of high intensity v. 44% of standard interns agreed/strongly agreed that the curriculum was valuable for their communication skills. High-intensity interns were more likely to report that feedback was valuable with subsequent incorporation of feedback into future patient encounters. High-intensity participants also reported higher levels of interest in future HVC curricula (55% vs 22%). CONCLUSION: There was no difference in overall performance on the CARE empathy scale. Our HVC high-intensity skills curriculum was well received by interns and provided opportunities to practice structured conversations and debrief around testing stewardship.

Educación emocional. Abordaje del proceso de la muerte en la escuela / Emotional education. Approach to the process of death at schooll

El tema de la muerte es raramente abordado en las escuelas, existiendo una negación a la misma, propia de valores y arraigos presentes en la sociedad occidental actual. La educación socio-emocional en las escuelas, es un área emergente con escasos programas rigurosos y bien diseñados en relación a la muerte y el duelo; educar hacia el proceso de pérdida y lo que esta genera en las personas, debería incluirse como contenido curricular. Realizar un análisis sistemático sobre las diferentes propuestas metodológicas orientadas a la educación para la muerte(AU)

The issue of death is rarely addressed in schools, there is a denial of it, typical of values and roots present in today's Western society. Social-emotional education in schools is an emerging area with few rigorous and well-designed programs in relation to death and grief; educate towards the process of loss and what it generates in people, should be included as curricular content. Carry out a systematic analysis on the different methodological proposals aimed at education for death(AU)

Implications of State Dental Board Disciplinary Actions for Teaching Dental Students About Emotional Intelligence.

The primary emphasis in dental education is on developing students' cognitive intelligence (thinking) and technical intelligence (doing), while emotional intelligence (being) receives less emphasis. The aim of this study was to explore a potential consequence of the paucity of emotional intelligence education by determining the level of emotional intelligence-related (EI-R) infractions in state dental board disciplinary actions and characterizing the types of those infractions. For this study, 1,100 disciplinary action reports from 21 state dental boards were reviewed, and disciplinary infractions were classified as cognitive intelligence-related (CI-R) infractions, technical intelligence-related (TI-R) infractions, and EI-R infractions. EI-R infractions were then subcategorized into emotional intelligence clusters and competencies using the Emotional and Social Competency Inventory (ESCI). The results showed that 56.6% of the infractions were EI-R. When the EI-R infractions were subcategorized, the four competencies most frequently violated involved transparency, teamwork and collaboration, organizational awareness, and accurate self-assessment. Understanding the frequency and nature of EI-R infractions may promote awareness of the need for increased attention to principles of emotional intelligence in dental education and may encourage integration of those principles across dental curricula to help students understand the impact of emotional intelligence on their future well-being and livelihood.

Conectividad cerebral en la regulación emocional: la solución de problemas emocionales / Brain connectivity in emotional regulation: the emotional solving problems

La solución de problemas emocionales es un mecanismo de regulación emocional que utiliza estrategias cognitivo-lingüísticas para reducir el impacto afectivo de una situación y lograr un objetivo propuesto. Es considerado un mecanismo saludable junto con la revaluación, a diferencia de la supresión y la rumiación. Estudios con técnicas de neuroimágenes han propuesto áreas cerebrales asociadas al funcionamiento de los diferentes mecanismos de regulación emocional. En este trabajo se propuso investigar los gradientes de conectividad cerebral de sustancia blanca asociados a la solución de problemas emocionales, con el objetivo de proponer una red de conectividad neuronal de este mecanismo de regulación emocional. Para evaluar la efectividad de la solución de problemas emocionales se utilizó una tarea conductual desarrollada recientemente basada en la recuperación semántica esforzada con estímulos de alto impacto afectivo. Participaron del estudio 32 mujeres jóvenes (M= 24,34; DS=5,24). Se obtuvieron coeficientes de correlación de Pearson entre las medidas del porcentaje de acierto de la tarea conductual y la anisotropía fraccional de los fascículos de sustancia blanca de interés. Los resultados proponen un red neuronal de solución de problemas emocionales en la que participarían principalmente el Fascículo Arqueado y Fronto Occipital Inferior del hemisferio izquierdo, cruciales en la implementación de estrategias de carácter léxico y semántico para la disminución del impacto afectivo (AU)

Emotional solving problems is an emotional regulation mechanism that implements cognitive-linguistics strategies to reduce the affective impact in a situation and to accomplish a proposed objective. Together with the reappraisal, it is considered a healthy mechanism, in difference with suppression and rumination. Researches that have used neuroimaging techniques have proposed cerebral areas associated to the functioning of the different emotional regulation mechanisms. The objective of this research was to study the brain connectivity gradients of white matter associated to emotional solving problems, to propose a brain connectivity network of this emotional regulation mechanism. The efficacy of emotional solving problems was measured with a behavioral task recently developed, based on semantic effortful retrieval with high affective impact stimulus. 32 young women (M= 24,34; DS=5,24) participated of the study. Correlations of Pearson were performed between accuracy measures of the behavioral task and fractional anisotropy of the white matter fascicles of interest. The results propose a brain connectivity network of emotional solving problems with the main participation of the Arcuate and Fronto Occipital Inferior fascicles of left hemisphere, both crucial in the implementation of lexical and semantic strategies to the reduction of affective impact (AU)

Comunicación afectiva y manejo de las emociones en la formación de profesionales de la salud / Affective communication and the emotions manage in the professionals of the health formation

El insuficiente desarrollo de habilidades para la expresión y regulación de las emociones, que en situaciones comunicativas diversas, manifiesta parte significativa del estudiantado joven que se forma en los cursos regulares diurnos de las carreras de ciencias médicas y la importancia que esto tiene para lograr un aprendizaje de calidad a favor de un exitoso desempeño personal y profesional futuro, exige la revisión del proyecto educativo formativo, así como del currículo para poder corregir, compensar y superar estas deficiencias con que llegan a la educación superior; para que como futuros/as profesionales puedan elevar la satisfacción de la población respecto a los servicios de salud y la calidad de la atención deberán saber atender las necesidades emocionales de pacientes y las propias. El siguiente trabajo propone reflexionar acerca de la necesidad de crear condiciones en el proceso de enseñanza-aprendizaje (PEA) con estudiantes de las carreras de ciencias médicas para contribuir al desarrollo de su educación emocional(AU)

The insufficient development of abilities for the expression and regulation of the emotions that in diverse talkative situations, apparent significant part of the young student body that is formed in the courses regular dailies of the careers of medical sciences and the importance that this has to achieve a learning of quality in favor of a successful personal acting and future professional demands the revision of the formative educational project, as well as of the curriculum to be able to correct, to compensate and to overcome these deficiencies with which they arrive to the superior education. So that as professional futures they can rise the population's satisfaction regarding the services of health and the quality of the attention they will know how to assist the emotional necessities of patient and the own ones. The following work intends to meditate about the necessity of creating conditions in the Process of Teaching Learning (PEA) with students of the careers of medical sciences to contribute to the development of its emotional education(AU)

Comunicación afectiva y manejo de las emociones en la formación de profesionales de la salud / Affective communication and the emotions manage in the professionals of the health formation

El insuficiente desarrollo de habilidades para la expresión y regulación de las emociones, que en situaciones comunicativas diversas, manifiesta parte significativa del estudiantado joven que se forma en los cursos regulares diurnos de las carreras de ciencias médicas y la importancia que esto tiene para lograr un aprendizaje de calidad a favor de un exitoso desempeño personal y profesional futuro, exige la revisión del proyecto educativo formativo, así como del currículo para poder corregir, compensar y superar estas deficiencias con que llegan a la educación superior; para que como futuros/as profesionales puedan elevar la satisfacción de la población respecto a los servicios de salud y la calidad de la atención deberán saber atender las necesidades emocionales de pacientes y las propias. El siguiente trabajo propone reflexionar acerca de la necesidad de crear condiciones en el proceso de enseñanza-aprendizaje (PEA) con estudiantes de las carreras de ciencias médicas para contribuir al desarrollo de su educación emocional.

The insufficient development of abilities for the expression and regulation of the emotions that in diverse talkative situations, apparent significant part of the young student body that is formed in the courses regular dailies of the careers of medical sciences and the importance that this has to achieve a learning of quality in favor of a successful personal acting and future professional demands the revision of the formative educational project, as well as of the curriculum to be able to correct, to compensate and to overcome these deficiencies with which they arrive to the superior education. So that as professional futures they can rise the population's satisfaction regarding the services of health and the quality of the attention they will know how to assist the emotional necessities of patient and the own ones. The following work intends to meditate about the necessity of creating conditions in the Process of Teaching Learning (PEA) with students of the careers of medical sciences to contribute to the development of its emotional education.

The effect of relational training on intelligence quotient: a case study / El efecto del entrenamiento en comportamiento relacional sobre el cociente de inteligencia: un estudio de caso

BACKGROUND: Relational training protocols based on Relational Frame Theory (RFT) are showing promising results in increasing intelligence quotient. This case study aimed at analyzing the effect of a training protocol in fluency and flexibility in relational responding on intelligence quotient with a 4-year-old child. METHOD: The child's cognitive and psychomotor development was evaluated before and after the implementation of the training protocol using the McCarthy's Aptitudes and Psychomotricity Scale (MSCA). The training protocol consisted of a multiple-exemplar-training (MET) in relational framing in accordance with COORDINATION (Phases 1 and 2), OPPOSITION (Phase 3 and 4), and COMPARISON (Phases 5 and 6). The MET protocol was implemented in approximately 12 hours throughout five and one half months. RESULTS: The training was effective in establishing relational responding in OPPOSITION and COMPARISON frames as well as in promoting fluency and flexibility in all the three types of trained relations. After this training, the child showed an increase above 1.5 SD in the General Cognitive Index of the MSCA (from 106 to 131). CONCLUSIONS: This case study adds further empirical evidence of the potential of RFT training to improve cognitive abilities and intelligence

ANTECEDENTES: los protocolos de entrenamiento relacional basados en la Teoría del Marco Relacional (TMR) están mostrando resultados prometedores en el incremento del cociente de inteligencia. El objetivo de este estudio de caso fue analizar el efecto de un entrenamiento en fluidez y flexibilidad en comportamiento relacional sobre el cociente de inteligencia en un niño de 4 años. MÉTODO: se evaluó el desarrollo cognitivo y psicomotor del niño a través de las Escalas de Aptitudes y Psicomotricidad de McCarthy (MSCA). La intervención consistió en un entrenamiento relacional en múltiples ejemplos para enmarcar en COORDINACIÓN (Fases 1 y 2), OPOSICIÓN (Fases 3 y 4) y COMPARACIÓN (Fases 5 y 6). El entrenamiento se aplicó en 12 horas aproximadamente durante cinco meses y medio, y resultó eficaz en generar comportamiento relacional para enmarcar en OPOSICIÓN y COMPARACIÓN y en promover fluidez y flexibilidad en los tres marcos relacionales. RESULTADOS: el niño mostró un incremento superior a 1.5 DT en el Índice Cognitivo General del MSCA (de 106 a 131). CONCLUSIONES: este estudio añade evidencia al potencial de los entrenamientos basados en la TMR para mejorar las habilidades cognitivas e inteligencia

Emotional intelligence and its role in recruitment of nursing students.

This article considers the concept of emotional intelligence and how it can be used in the recruitment and development of nursing students. The links between emotional intelligence and the qualities of compassion and caring are examined. The ethical difficulties surrounding the use of emotional intelligence tests are explored and the value of using a variety of recruitment methods is emphasised. The article suggests that emotional intelligence is an ability which may be developed through nurse education programmes, even if not fully present at interview. The contribution of service users to the recruitment of nursing students is examined, suggesting that they offer some important observations about interviewees. These observations may be more valid than the insights gained from the use of emotional intelligence tests.

Bioethical dimensions of cultural psychosomatics: the need for an ethical research approach.

Contemporary psychosomatics is a research-based technical discipline and its social power depends on how scientific knowledge is obtained and applied in practice, considering cultural contexts. This article presents the view that the dialogical principles on which bioethical discourse is based are more inclusive than professional ethics and philosophical reflection. The distinction is advanced between rule-guided behavior and norm-justifiable acts (substantiation and justification). The practical implications of good practices in the generation of valid, reliable, generalizable and applicable knowledge are emphasized. For practitioners and researchers, the need to reflect on the distinction between patient and research participant can avoid the therapeutic misunderstanding, a form of abuse of the doctor-patient relationship. In addition, in resource-poor settings, the dilemma presented by the know-do gap (inapplicability of research results due to financial or social constraints) is part of the ethics' realm of the profession. Future prospects include a wider use of research results in practice, but avoidance of the know-do gap (the disparity between what is known and what can be done, particularly in settings with limited resources) requires a synthetic and holistic approach to medical ethics, combining moral reflection, theoretical analysis and empirical data.

Quantifying the physical, social and attitudinal environment of children with cerebral palsy.

PURPOSE: To develop an instrument to represent the availability of needed environmental features (EFs) in the physical, social and attitudinal environment of home, school and community for children with cerebral palsy. METHOD: Following a literature review and qualitative studies, the European Child Environment Questionnaire (ECEQ) was developed to capture whether EFs needed by children with cerebral palsy were available to them: 24, 24 and 12 items related to the physical, social and attitudinal environments, respectively. The ECEQ was administered to parents of 818 children with cerebral palsy aged 8-12 years, in seven European countries. A domain structure was developed using factor analysis. RESULTS: Parents responded to 98% of items. Seven items were omitted from statistical models as the EFs they referred to were available to most children who needed them; two items were omitted as they did not fit well into plausible domains. The final domains, based on 51 items, were: Transport, Physical - home, Physical - community, Physical - school, Social support - home, Social support - community, Attitudes - family and friends, Attitudes - teachers and therapists, Attitudes - classmates. CONCLUSION: ECEQ was acceptable to parents and can be used to assess both the access children with cerebral palsy have to the EFs that they need and how available individual EFs are.

Understanding the stigma of hyperemesis gravidarum: qualitative findings from an action research study.

BACKGROUND: Severe nausea and vomiting in pregnancy (hyperemesis gravidarum) can be a distressing and debilitating condition when it is uncontrolled. For all concerned, hyperemesis gravidarum can be difficult to treat satisfactorily, and women tend to be admitted to a hospital several times during early pregnancy. Our research objectives were to describe the experience of hyperemesis gravidarum from the perspective of affected women and to explore with health care professionals the barriers and facilitators to caring for women with the condition. METHODS: A qualitative research design was used. A total of 18 women were interviewed, of whom 8 had two or more interviews. Seven focus groups were conducted with health care professionals. Thematic data analysis was undertaken. RESULTS: The main themes emerging from the women's data were the effect and burden of the symptoms of the condition and feeling unpopular with staff. From the practitioner data, the main themes were the validity (or invalidity) of hospitalization for women, skepticism of the severity of symptoms, the psychological and social dimensions of the condition, and inadequate primary care services. CONCLUSIONS: The main findings revealed that hyperemesis gravidarum is a debilitating condition and that the unhelpful attitudes of practitioners may affect whether women access timely and appropriate care. Many women appear to be unsupported by primary care services and are distressed when perceived either as "time wasters" or someone else's responsibility. We propose that a tailored assessment and care plan for each woman is needed to help them control their symptoms, which ideally should be delivered in the community.