Spirituality in Critical Care: An Observational Study of the Perceptions of Professionals, Patients and Families, in Spain and Latin America.

This research aims to describe the perspectives of health care professionals, patients, and family members regarding spiritual care options in intensive care units (ICUs). Participants were recruited consecutively from January to August 2019, during which time data collection was conducted. A total of 1211 Spanish-language questionnaires were collected from 41 ICUs in Spain and Latin America. Approximately 655 participants worked as ICU professionals (74.5% of these participants were women, and 47.5% were nurses). Additionally, 340 questionnaires were sent to patients' families, and patients completed 216 questionnaires; 59.7% of these participants were men, and their mean age was 59.4 years. Most (69.7%) of the critical care professionals considered this type of care to be a part of their profession, 50.1% did not feel competent to provide this type of care, and 83.4% felt that training in this area was necessary. Most families (71.7%) and patients (60.2%) felt that spiritual suffering occurred during their stay in the ICU. The results of this study suggest a perceived deficit in spiritual care in ICUs.

Medical resilience and morality: a survey study on the opinions and actions of exemplary family physicians.

BACKGROUND: Studies conducted to understand how family doctors develop resilience and deal with the challenges posed by work-related stress, usually have focused on identifying the elements that generate resilience from psychological perspectives and their impact on coping strategies. Few have explored the role that personal qualities and values that traditionally motivate family physicians can play as drivers of well-being and resilience. OBJECTIVES: To explore attributes that exemplary family physicians (EFP) consider important for their work and the elements that, for them, are source of gratification and resources in the face of the adversities they encounter in their practice. METHODS: This is an exploratory study carried out by online survey. Eighty six doctors regarded as exemplary by their colleagues answered 7 close and 4 open-ended questions that explored their job satisfaction, the elements of their work that reward them, the difficulties and problems they usually encounter, the resources they use to cope with those problems, and the personal qualities they consider central to their work. Four researchers conducted a thematic (deductive and inductive) analysis of the free text responses received. Based on the results obtained, and through an iterative discussion process, the researchers proposed an integrated set of qualities at the core of their professionalism. RESULTS: 88.4% (76) of the doctors said they were satisfied with their work. However, they face problems (202 comments), including demanding patients, insensitive managers with unshared interests/care goals, excessive paperwork, work overload, or time pressures. Sources of gratification point to personal identity; clinical, relational, and collaborative efficiency; a holistic and comprehensive practice (centred on individuals); and a continuous search for excellence (149) and the root of their resources (135). These elements, in turn, corresponded to the attributes considered essential for the practice of family medicine (131). CONCLUSIONS: For EFPs, certain professional values give meaning to their clinical practice and are a source of well-being and resources. This central focus on professional values and qualities can help for better understand the burnout nature and expand the type of action that promotes resilience. Further studies using a less structured qualitative research will be needed to confirm/expand these results.

[Core values in family medicine revisited]. / Una vuelta a los valores centrales en medicina de familia.

Family medicine has to continually reinvent itself around a core of values that constitutes its navigation system. But accurate data on its impact on the health of people will account for how far the values are actually being implemented. Thus, we can say that family medicine is a specialty based on values and as well as evidence based. The absence of a clarification system of values or its implementation threatens its very existence. Some of the values that are reviewed have shown great recognition and survival over time. Others are presented because they seem sufficiently significant. These are: people, comprehensiveness, trust relationship, patient-centred method, accessibility, continuity, family unity and the community, teamwork, sustainability of the health system, and continuous improvement.

Evaluation of learning outcomes of humanities curricula in medical students. A meta-review of narrative and systematic reviews.

Objectives: To assess the expected learning outcomes of medical humanities subjects in medical studies curricula. To connect those expected learning outcomes with the types of knowledge to be acquired in medical education. Methods: Meta-review of systematic and narrative reviews. Cochrane Library, MEDLINE (Pubmed), Embase, CINAHL, and ERIC were searched. In addition, references from all the included studies were revised, and the ISI Web of Science and DARE were searched. Results: A total of 364 articles were identified, of which six were finally included in the review. Learning outcomes describe the acquisition of knowledge and skills to improve the relationship with patients, as well as the incorporation of tools to reduce burnout and promote professionalism. Programs that focus on teaching humanities promote diagnostic observation skills, the ability to cope with uncertainty in clinical practice, and the development of empathetic behaviors. Conclusion: The results of this review show heterogeneity in the teaching of medical humanities, both in terms of content and at the formal level. Humanities learning outcomes are part of the necessary knowledge for good clinical practice. Consequently, the epistemological approach provides a valid argument for including the humanities in medical curricula.

Assessment of a medical student mentoring programme to improve attitudes related to grief and coping with death.

Objectives: To evaluate the impact of a mentoring programme for medical students doing a palliative care rotation, aimed at improving coping with death and attitudes towards the suffering produced by illness. Methods: A quasi-experimental study without a control group was carried out on second-year medical students. Five 1-h group sessions were conducted. Attitudes towards grief and coping with death were assessed before the mentoring programme began and afterwards, using the Brief Humanizar Scale and the Bugen's Coping with Death Scale, respectively. Results: In terms of the sense of grieving as measured by the Brief Humanizar Scale, the mean score for the 'Burden' factor was 7 points and for the 'Change' factor it was 28.6, indicating that suffering makes more sense as a lever for positive change than as a burden. Regarding Bugen's Coping with Death Scale, the mean score was 127.8 points before the mentoring programme and 139.2 afterwards. Hence, the score after the mentoring programme increased by 11.4 points, improving strategies to cope with death. Conclusion: Medical professionals must cope with death and end-of-life patients. In addition to scientific knowledge, students need to acquire competencies for better coping with the death of patients, with mentoring programmes helping to enhance this process of learning.

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.

Claves del acompañamiento educativo integral a estudiantes de Medicina: una revisión de la bibliografía biomédica / Keys of comprehensive educational mentoring for medical students: a review of biomedical literature

Introducción: Existen razones de orden teórico y empírico que justifican el interés del acompañamiento educativo integral (AEI). El presente trabajo se propone identificar las claves recogidas en la bibliografía médica del AEI en estudiantes de Medicina. Materiales y métodos: Se ha realizado una búsqueda con las palabras ‘Mentor’ y ‘Medical students’ en Medline, EMBASE, Cochrane Database of Systematic Reviews, ScienceDirect, Scopus© y SCIELO Journals, sin fecha inicial hasta mayo de 2019. Resultados: Se revisaron 1.816 títulos, de los que se seleccionaron 169 resúmenes y, de ellos, 51 artículos a texto completo. En la bibliografía médica se destaca que el objetivo fundamental del AEI es lograr un desarrollo integral personal y profesional del estudiante, contar con criterios de selección y formación de mentores excelentes, lo que es clave para lograr una adecuada relación en el AEI, diseñar un plan curricular flexible, que la institución apoye y reconozca el trabajo de AEI, que se tengan en cuenta obstáculos posibles para evitarlos y que se evalúen el proceso, los contenidos y los resultados del plan. Conclusión.: El presente estudio ha identificado claves del AEI en el ámbito médico. Se constata la necesidad de avanzar en la definición de un marco conceptual teórico bien definido y en la obtención de pruebas sobre los resultados formativos.(AU)

Introduction: There are theoretical and empirical reasons that justify the interest of comprehensive educational mentoring (CEM). The present work aims to identify the keys collected in the medical literature of the CEM in medical students. Materials and methods: A search has been carried out, with the words ‘Mentor’ and ‘Medical Students’ in Medline, EMBASE, Cochrane Database of Systematic Reviews, ScienceDirect, Scopus© and SCIELO Journals, with no initial date until May 2019. Results: 1816 titles were reviewed, from which 169 abstracts were selected and, of them, 51 full-text articles were used to obtain keys about CEM. In the medical bibliography it is highlighted that the fundamental objective of CEM is to achieve a comprehensive personal and professional development of the student, that is important designing mentors’ selection criteria and training, achieving an adequate relationship, designing a flexible curricular plan, the institution support and work awarding, taking into account of possible obstacles to avoid them and that the process, contents and results of the plan have to be evaluated. Conclusion: The present study has identified CEM keys in the medical field. It is needed an advance in the definition of a well-focus theoretical conceptual framework and gaining evidence on the training outcomes.(AU)

Una vuelta a los valores centrales en medicina de familia / Core values in family medicine revisited

La medicina de familia tiene que reinventarse continuamente en torno a un núcleo central de valores que constituye su sistema de navegación. Pero también precisa de datos sobre su impacto en la salud de las personas, que darán cuenta de hasta qué punto los valores están siendo realmente puestos en práctica. Por eso se puede afirmar que se trata de una especialidad basada tanto en valores como en pruebas. La ausencia de una clarificación del sistema de valores o de su puesta en práctica pone en riesgo su propia existencia. Algunos de los valores que se revisan han mostrado un gran reconocimiento y pervivencia en el tiempo. Otros se presentan porque parecen suficientemente significativos. Son: las personas, la integralidad, la relación de confianza, el método clínico centrado en el paciente, la accesibilidad, la continuidad, la unidad familiar y la comunidad, el trabajo en equipo, la sostenibilidad del sistema sanitario y la mejora continua

Family medicine has to continually reinvent itself around a core of values that constitutes its navigation system. But accurate data on its impact on the health of people will account for how far the values are actually being implemented. Thus, we can say that family medicine is a specialty based on values and as well as evidence based. The absence of a clarification system of values or its implementation threatens its very existence. Some of the values that are reviewed have shown great recognition and survival over time. Others are presented because they seem sufficiently significant. These are: people, comprehensiveness, trust relationship, patient-centred method, accessibility, continuity, family unity and the community, teamwork, sustainability of the health system, and continuous improvement

La interfaz comunicación clínica-ética clínica: implicaciones para la educación médica / Clinical communication-clinical ethics interface: implications for medical education

Este estudio trata inicialmente de clarificar los aspectos y componentes de una comunicación médico-paciente «centrada en la persona-paciente» y definir los valores éticos de esta práctica. A partir de ahí aborda la inextricable interfaz existente entre comunicación (relación) y ética, y resalta cómo esta unión comunicación-ética se manifiesta en la práctica clínica habitual del médico, en sus acciones, a través de las actitudes y los hábitos del profesional (el carácter). Lo anterior revelará la necesidad ineludible de educar a nuestros estudiantes de medicina en valores y en habilidades para poder realizar una auténtica y eficaz «atención centrada en la persona-paciente». Esto a su vez mostrará cómo este tipo de educación repercute en la persona-médico moldeando su carácter

This study initially seeks to clarify features and components of a "person-patient centred" physician-patient communication, and define the ethical values of this kind of practice. The study addresses the inextricable interface between communication (relationship) and ethics, and it also highlights how this communication-ethics link is reflected in usual physician practice, in their actions, through their attitudes and habits (the character). This will reveal the inescapable need to educate our medical students in values and skills, in order to be able to perform a genuine and effective "patient-centered care." This, in turn, will show how this type of medical education reverberates on the person-doctor by moulding their character

Crisis en la medicina de familia: una perspectiva bioética desde la práctica diaria / Crisis in family medicine: A bioethical perspective from the routine practice

Desde sus comienzos la medicina de familia (MF) ha acercado los bienes sanitarios a la población. Una crisis de la MF es un buen momento para atender a las expectativas sociales y para reformular y radicalizar los principios que guían la especialidad.Se presenta una reflexión ética sobre qué hacer desde el microcosmos de la práctica diaria. Burocracia y nimiedades producen un desgaste moral e impiden que la MF ofrezca el bien específico que le corresponde. La visualización de la MF como portero del sistema, mero filtro de banalidades, área administrativa o como paño de lágrimas del sistema, configura una caricatura social inaceptable.Es vital para la MF alcanzar un compromiso efectivo orientado preferentemente a los grupos o individuos más vulnerables. Pero también necesita con urgencia una recuperación de sentido como área de promoción humana, en la que el profesional no pierda su capacidad moral de desear algo, quererlo, lograrlo y disfrutarlo(AU)

From the beginning, family medicine (FM) has brought health care nearer to the population. A crisis in FM is a good time to look at the social expectations and to reformulate and to strengthen the principles that guide the specialty.An ethical reflection is presented on what to do from the microcosm of daily practice. Bureaucracy and trivialities cause a moral decline which prevents FM from offering the specific service that it should. Its visualisation as doorman to the system, a mere filter of banalities, an administration area or as a handkerchief for the system to cry on, draws a socially unacceptable caricature.It is vital for FM to reach an effective compromise preferably directed at the most vulnerable groups or individuals. But it also urgently needs a sense of recovery as an area of human promotion, in which the professionals do not lose their moral capacity to have something to desire, want, achieve and enjoy(AU)

Bioética de la gestión del tiempo: ¿tiene sentido lo que hago en la consulta? / Bioethics of time management, does it make sense to do this in the clinic?

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Problemas éticos en la prescripción de fármacos de eficacia clínica poco significativa / Ethical problems in prescribing drugs of not very significant clinical effectiveness

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Lectura crítica de artículos científicos que la industria farmacéutica ofrece a los médicos de familia / Critical reading of scientific articles that the pharmaceutical industry offers family doctors

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