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.

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

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.

Comunicación consciente para acompañar de forma eficaz: protocolo de 5 pasos

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. Ojetivo: 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.

[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)]

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.