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En los últimos 10 años las habilidades comunicativas se han introducido en los estudios de grado de las facultades de Medicina españolas (FFMM), sin embargo, no disponemos de datos fiables sobre cómo esto se está realizando. Este es el objetivo de este estudio. Métodos Estudio observacional. Los responsables de la enseñanza de habilidades comunicativas en las 41 FFMM del listado oficial del Ministerio de Sanidad responden a un cuestionario enviado electrónicamente. Resultados Respondieron 35 FFMM, el 85,3%. Organización curricular: 27 FFMM (79,4%) tienen estos contenidos compartidos con otros: 22 (64,7%) en periodo preclínico, 10 (29,5%) en cursos clínicos, ligados al aprendizaje en las pasantías. En 25 (71,4%) la enseñanza es obligatoria. Predominan los docentes clínicos (29; 85,3%), aunque el 35,3% (12) no lo son, la mayoría de estos, psicólogos (8). Predominan las clases magistrales y los seminarios con grupos reducidos. Aunque el role-playing es frecuente (26 FFMM), se hace «demostrativamente» (95%) y no todos los alumnos pueden ensayar y recibir feedback. Los pacientes simulados son poco utilizados (17). La evaluación es habitualmente mediante exámenes escritos (28 FM). Treinta FFMM incluyen algún tipo de evaluación práctica, generalmente en las pasantías. Conclusiones Aunque la mayoría de las FFMM españolas incorporaron algunos contenidos sobre habilidades comunicativas, esta incorporación parece estar aún lejos de ajustarse a los requerimientos para un aprendizaje eficaz. Se precisan estudios que revelen las circunstancias en las que se produce esta incorporación y las dificultades y barreras que las FFMM deben afrontar, para mejorar este tipo de formación en el futuro. post-print 518 KB

Objetivo: en su carácter de profesión de atención de la salud enfocadaen cuidar a las personas, la Enfermería requiere habilidades decomunicación sólidas. Sobre la base de un consenso internacional deexpertos, se presenta una propuesta sobre resultados de aprendizajeen la comunicación clínica para planes de estudio de las carreras degrado de Enfermería en países de habla hispana. Método: un comitéorientador, compuesto por 5 enfermeros y expertos en comunicación enciencias de atención de la salud, elaboró la primera lista de habilidadesde comunicación específicas para la carrera de Enfermería. Un comité de7 asesores científicos internacionales revisó y mejoró dicha propuesta.Se seleccionó a 70 expertos de 14 países a través del procedimiento demuestreo “bola de nieve”, y se los invitó a participar en un proceso deconsenso Delphi modificado a distancia en dos rondas de encuesta. Serealizó un análisis estadístico para establecer el nivel de consenso finalcorrespondiente a cada ítem. Resultados: se presentó un cuestionariocon 68 resultados de aprendizaje en comunicaciones clínicas para quelo evaluara el panel. En la primera ronda Delphi, el panel llegó a unconsenso estadístico en todos los ítems evaluados. No fue necesariauna segunda ronda para conciliar posiciones. Conclusión: se presentauna propuesta académica, aprobada con un elevado nivel de consensointernacional, a fin de orientar y unificar los resultados de aprendizajeen los planes de estudio sobre comunicación clínica para carreras degrado de Enfermería en países de habla hispana. Objective: as a health care profession focused on caring forpeople, Nursing requires sound communication skills. Based on aninternational expert consensus, a proposal on learning outcomes inclinical communication for undergraduate Nursing education curriculain Spanish speaking countries is presented. Method: a steeringcommittee, consisting of 5 nurses and experts in communication inhealth care sciences, drew up the first list of communication skillsspecific to the Nursing degree. Their proposal was reviewed andimproved by a committee of 7 international scientific advisers. 70experts from 14 countries were selected using a snowball samplingprocedure and invited to participate in a distance modified Delphiconsensus process in two survey rounds. Statistical analysis wascarried out to establish the final consensus level for each item.Results: a questionnaire with 68 learning outcomes in clinicalcommunications was submitted for panel assessment. In the firstDelphi round, the panel reached a statistical consensus on all theitems assessed. There was no need for a second round to reconcilepositions. Conclusion: an academic proposal, approved by a highlevel of international consensus, is presented to guide and unifythe learning outcomes on the clinical communication curriculum forundergraduate Nursing studies in Spanish speaking countries. Objetivo: como profissão orientada à atenção da saúde, focada nocuidado às pessoas, a Enfermagem precisa desenvolver habilidadesde comunicação sólidas. Com base em um consenso internacionalde especialistas, apresenta-se uma proposta sobre os resultados deaprendizagem na comunicação clínica para planos de estudos emcursos de Enfermagem em países hispanofalantes. Método: umcomitê orientador, composto por 5 enfermeiros e especialistas emcomunicação em ciências de atenção à saúde, elaborou a primeiralista de habilidades comunicacionais específicas para o curso deEnfermagem. Outro comitê de 7 assessores científicos internacionaisrevisou e melhorou a referida proposta. Foram selecionados 70especialistas de 14 países pelo procedimento de amostragem “bola deneve”, sendo convidados para participar em um processo de consensoDelphi modificado a distância em duas rodadas de pesquisa. Foirealizada a análise estatística para estabelecer o nível de consensofinal correspondente a cada item. Resultados: foi apresentado umquestionário com 68 resultados de aprendizagem em comunicaçõesclínicas para serem avaliados pelo painel. Na primeira rodada Delphi, opainel chegou a um consenso estatístico em todos os itens avaliados.Não foi necessária uma segunda rodada para conciliar posições.Conclusão: apresenta-se uma proposta acadêmica aprovada com umelevado nível de consenso internacional a fim de orientar e unificar osresultados de aprendizagem nos planos de estudo sobre comunicaçãoclínica para cursos de Enfermagem em países hispanofalantes.

espanolLa Comunicacion Clinica Centrada en la Persona (CCCP), supone en la practica clinica actual una herramienta de primer orden para que el medico alcance sus objetivos clinicos. Sin embargo, su consideracion como tecne no deberia de ocultar aspectos como el tipo de verdad que revela, la realidad del paciente (en cuanto que ser humano y persona) a la que se dirige o las consecuencias de su aplicacion en la practica clinica. El presente ensayo pretende clarificar estos aspectos resaltando asi que la CCCP y la practica de la medicina si bien suelen ser consideradas desde aproximaciones eminentemente pragmaticas, conllevan presupuestos que trascienden las verdades de tipo cientifico y considera al paciente como una realidad compleja, unica, multidimensional y con potencialidades diversas; en un encuentro clinico que senala el imperativo moral de la medicina (y de la CCCP) de actuar en beneficio del paciente. Ante una practica de tal naturaleza la educacion del medico debe de priorizar el desarrollo de su capacidad reflexiva, que incluye al propio aprendiz (“busqueda personal”), lo que exige una ensenanza integral que incorpore estrategias educativas que ayuden al aprendiz a dar sentido a esa busqueda. EnglishThe Person-Centered Clinical Communication (CCCP), in current clinical practice, is a first line tool for the physician to get clinical objectives. However, to consider it as tecne should not hide aspects such as: the type of truth it reveals, the reality of the patient (as a human being and person) to which is focused or the consequences of implementing in practice. This essay intends to clarify these aspects highlighting that the CCCP and the practice of medicine although they are usually considered from eminently pragmatic approaches, carry presuppositions that overcome scientific truths and consider the patient as a complex, unique, multidimensional reality and with different potentialities; in which the clinical encounter points out the moral imperative of medicine (and also of the CCCP) of acting for the benefit of the patient. In the face of such a challenging practice, the physician’s education should prioritize the development of his/her reflexive ability, which includes the own apprentice him/herself (“personal search”), demanding a comprehensive education that incorporates educational strategies for helping the learner to make sense of that searching.

This essay aims to broaden the understanding of the nature of the physician–patient relationship. To do so, the concept of medical philia that Pedro Laín Entralgo proposes is analysed and is considered taking into consideration the relational trait of the human being and the structure of human action as a story of the permanent tension that exists between freedom and truth, where the ontological foundation of the hermeneutic of the "Gift" and the analogy of “Love” as the central dynamic of this action, helps explain the nature of the doctor-patient relationship as a "friendship relationship". This understanding offers a perspective differing from just the utilitarian considerations of current "patient-centred" approaches and proposed the redirection of the teaching of medicine to more humanistic approaches. The dynamic of the doctor-patient relationship proposed here in its most genuine essence is effectively expressed in physician concrete attitudes that the patient usually captures and relates as the “the doctor’s way of being”. Goya's painting, Self-portrait with Dr Arrieta (1820), can be taken as an outstanding artistic representation of this expanded dimension of the medical act, capturing the “medical friendship” in action. post-print 699 KB

Spiritual and emotional care is an important part of the person, especially in situations such as changes in health or a community coping with a pandemic. However, nurses report scarce university training in this area of care. The aim of the study is to define a catalogue of learning outcomes for spiritual and emotional care for undergraduate nurses. The design used a mixed method for the development and validation of learning outcomes. The first phase designs the catalogue of learning outcomes through a coordinating group and uses a bibliographic search and nursing legislation. The second phase validates the proposal through a group of experts, with a questionnaire using the modified Delphi technique in two rounds. The initial proposal was 75 learning outcomes, of which 17 were eliminated, 36 changed their wording and the experts proposed 7 new ones. The experts validated 65 learning outcomes: 14 for Assessment and diagnosis; 5 for Planning; 17 for Intervention; 4 for Evaluation and quality; 8 for Communication and interpersonal relationship and 17 for Knowledge and intrapersonal development. In conclusion, the academic curriculum can include these learning outcomes to help undergraduate nurses in the process of acquiring knowledge, skills and attitudes in spiritual and emotional care. post-print 641 KB

Resumen: Objetivo: Valorar si un programa formativo ofrecido por médicos de familia en el currículum oficial de medicina sobre principios y estrategias para ayudar a los pacientes a cambiar conductas de riesgo (APCCR) produce cambios en sus percepciones, opiniones y actitudes con relación a este tipo de intervenciones. Diseño: Estudio cuasiexperimental antes-después. Emplazamiento: Una facultad de medicina. Participantes: Todos los alumnos de 4.o curso de medicina (n = 110). Intervenciones: Formación experiencial sobre estrategias comunicativas para APCCR. Mediciones: Opiniones y percepciones evaluadas antes y después del curso mediante cuestionario ad hoc. Resultados: Tras el curso, los estudiantes (n = 103) cambiaron sus ideas sobre la motivación como factor «interno» (15, 13%) a «interno-externo» (71, 61%) (p = 0,003), reforzando sus opiniones sobre la capacidad del médico para APCCR (alta: 72, 62%; baja: 10, 12%; p = 0,008). Los alumnos se consideraron más capaces de respetar la autonomía de los pacientes cuando estos toman decisiones o siguen conductas consideradas perjudiciales (fácil: 58, 50%; difícil: 28, 24%; p = 0,001) e incrementaron su percepción sobre su capacidad para afrontar este tipo de entrevistas (83, 72% vs. 1, 1%; p

Objective The value students give to communication skills (CS), acquiring them, or other related matters can influence the effectiveness of educational programs. In this study, we explored first and fourth year medical students' attitudes toward CS and their learning, assessing the possible influence they have on programmed experiential training in a medical school. Subjects and methods Two hundred and twenty first and fourth year medical students completed the Communication Skills Attitudes Scale, analyzing the positive and negative, and affective and cognitive attitude subscales toward learning. Results Fourth year students trained in CS showed less positive attitudes toward CS than first year untrained students. Cognitive and affective attitudes displayed different patterns in both groups; while affective attitudes decreased in fourth year students, cognitive attitudes did not vary significantly between groups. Accumulated learning experiences seem to be more influential than sex. Conclusion The findings suggest that students' attitudes toward CS could decline as a result of CS training. Nevertheless, students' attitudes at the cognitive and fundamental level stay fairly unchanged. Learning CS with experiential methods seems to be challenging for students at a personal level; so, educators should personalize these methods as much as possible. However, further studies using longitudinal research designs should be performed for exploring students' attitudes changes over time.

Introducción La crisis por COVID-19 supuso en marzo del 2020 el cierre de las universidades del país, con interrupción total de actividad presencial. Para afrontar el último cuatrimestre 2019/20 en confinamiento, nuestra Facultad de Medicina elaboró y aplicó un programa docente íntegramente online con un enfoque «autorregulativo» (enfocado en el aprendizaje autónomo del alumno). Este estudio presenta las opiniones de profesores y alumnos. Métodos Las características educativas del Programa online ante COVID-19 (POLAC), para primero y segundo cursos, estructuración, organización de la intervención y resultados académicos, han sido descritos en otro trabajo. Este estudio mediante encuestas online, explora opiniones de profesores y alumnos tras su desarrollo. Dos investigadores codificaron temática e independientemente las respuestas abiertas obtenidas, clasificándolas en categorías. Resultados Respondieron los ocho profesores implicados y un número variable por asignatura de alumnos, recibiéndose 234 cuestionarios (17%). Los alumnos destacan de positivo la optimización de recursos docentes utilizados, la utilidad de las herramientas online, especialmente autoevaluaciones y sistema de gestión de dudas. El desarrollo de las prácticas y aspectos propios de la presencialidad se destacaron como negativos. La dedicación de los profesores recibió comentarios, tanto positivos como negativos. Los profesores resaltaron la potenciación de la autonomía del alumno, la utilidad de las herramientas online y la necesidad adicional de presencialidad. Conclusión Globalmente, los comentarios positivos y negativos están en línea con las fortalezas y debilidades tanto de la enseñanza online como de enfoques docentes «autorregulativos». Se precisan estudios de diseños más robustos para comprobar el alcance real de estos resultados. post-print 333 KB

Health professionals and students in training are key for early diagnosis of cancer. The objective of this study was to evaluate the awareness of Family Medicine (FM) residents and Medicine and Nursing undergraduate students in Spain regarding the European Code Against Cancer (ECAC). This was a descriptive, cross-sectional, and multicenter study.Teaching Units of FM of Cordoba and Ceuta and Schools of Medicine and Nursing of the Universities of Cordoba and Francisco de Vitoria of Madrid (Spain).residents of FM and Medicine and Nursing undergraduate Spanish students.self-administered questionnaire to assess the awareness about the ECAC. A total of 651 subjects participated (52.4% [95% CI 48.5-56.2] Nursing students, 34% [95% CI 30.3-37.6] Medicine students, and 13.6% [95% CI 11.0-16.3] FM residents). Of the total subjects participated, 74.8% were women. Mean age: 22.34 years (standard deviation, 4.68; range, 18-52; 95% CI, 21.98-22.70). A total of 76.8% (95% CI 73.5-80.1) declared to be unaware of the ECAC. Those referring to be aware of the ECAC mainly knew it through degree subjects (7.5% [95% CI 5.5.5-9.6]). Residents of FM (p 0.001), older participants (p 0.001), and those belonging to the Teaching Units (p = 0.002) showed a better awareness of the ECAC. Our findings reveal the unawareness on the ECAC in three out of four participants. The access to the advice described in the ECAC through the Medicine and Nursing Schools and FM Teaching Units is poor. The awareness of the ECAC of postgraduate residents is higher than that the awareness of the undergraduate students.

La necesidad de que estudiantes de medicina y residentes adquieran habilidades comunicativas como parte esencial de su competencia clínica es algo que actualmente no se discute. Sin embargo, sí parece pertinente ahora revisar el qué y el cómo de este aprendizaje: Saber qué deberían ellos dominar para afrontar mejor los retos clínicos futuros y cómo podemos nosotros ayudarles para que adquieran esas habilidades comunicativas (HC). post-print 235 KB

Medicine is at the heart of healthcare. Healthcare systems have contributed to increasing the life expectancy and the wellbeing of millions of people worldwide during the 20 th century [1] and they represent an asset of utmost importance in achieving fairness in accessing health-related prevention, promotion and recovery from illness [2]. Thus one of the driving purposes of medical education must be to enhance the performance of health systems for meeting the needs of patients and populations in an equitable and efficient way. A crucial factor in this endeavor will be the successful adaptation of professional education for local and national leadership in workforce teams that are capable of extending reach to all people. The purpose of this paper is to explore a deeper understanding that a person centered approach is essential as to how this can be achieved. Health is about people. The goal of physicians and all health professionals, irrespective of nationality and specialty is to share a common global vision for the future. [3] In this, all health professionals in all countries should be educated to gather knowledge, and to engage in critical reasoning and practice to high ethical standards so that they are competent to participate in person-centered and people-centered health systems as members of locally responsive and globally connected teams. The ultimate vision must be to assure universal coverage of high-quality comprehensive services that are essential to advancing opportunity for health equity within and between countries [4]. The aspiration for better health commonly shared will resonate with aspiring young professionals who seek value and meaning in their work.

Background: In recent years, Spanish medical schools (MSs) have been incorporating training in communication skills (CS), although how this is being carried out has not yet been evaluated. Objective: to identify the barriers to the introduction and development of CS teaching in Spanish MSs. Methods: Eighty three percent of Spanish MSs (34) were invited to participate in a previous study that explored factual aspects of teaching CS in these schools. The responsible for the teaching this domain were contacted at each school and asked to respond to an open-ended question. Two researchers independently conducted a thematic analysis of the responses. Results: We received responses from 30 MSs, (85.7% of those contacted and 73% of all MSs in Spain). Five main thematic areas were identified, each with different sub-areas: negative attitudes of teachers and academic leaders, type of organisation, structure and presence in the CS curriculum, negative attitudes of students, lack of trained teachers and problems linked to teaching methods and necessary educational logistics. Conclusions: The barriers and problems identified indicate there are areas for improvement in the teaching CS in most Spanish MSs. These problem areas must be addressed in order for students to learn these skills more effectively. There is a vicious circle in the dynamic relationship and interdependence of these problems: negative attitudes of teachers and academic leaders tend to marginalise the incorporation of these skills within the curriculum. Limited investment in educational methodologies and evaluative structures along with scarce promotion and training for teachers tend to foster negative attitudes among both students and faculty. This represents a major challenge and will require a significant cultural shift as well as decisive institutional support at the local and national level. This support is essential for the successful introduction of new educational models in line with the latest trends in teaching and clinical practice.

Background In recent years, Spanish medical schools (MSs) have incorporated training in communication skills (CS), but how this training is being carried out has not yet been evaluated. Objective To identify the barriers to the introduction and development of CS teaching in Spanish MSs. Methods In a previous study, 34 MSs (83% of all MSs in Spain) were invited to participate in a study that explored the factual aspects of teaching CS in these schools. The person responsible for teaching CS at each school was contacted again for this study and asked to respond to a single open-ended question. Two researchers independently conducted a thematic analysis of the responses. Results We received responses from 30 MSs (85.7% of those contacted and 73% of all MSs in Spain). Five main thematic areas were identified, each with different sub-areas: negative attitudes of teachers and academic leaders; organisation, structure and presence of CS training in the curriculum; negative attitudes of students; a lack of trained teachers; and problems linked to teaching methods and necessary educational logistics. Conclusions The identified barriers and problems indicate that there are areas for improvement in teaching CS in most Spanish MSs. There seems to be a vicious circle based on the dynamic relationship and interdependence of all these problems that should be faced with different strategies and that requires a significant cultural shift as well as decisive institutional support at the local and national levels. The incorporation of CS training into MS curricula represents a major challenge that must be addressed for students to learn CS more effectively and avoid negative attitudes towards learning CS.

Health professionals and students in training are key for early diagnosis of cancer. The objective of this study was to evaluate the awareness of Family Medicine (FM) residents and Medicine and Nursing undergraduate students in Spain regarding the European Code Against Cancer (ECAC). This was a descriptive, cross-sectional, and multicenter study. Location: Teaching Units of FM of Cordoba and Ceuta and Schools of Medicine and Nursing of the Universities of Cordoba and Francisco de Vitoria of Madrid (Spain). Participants: residents of FM and Medicine and Nursing undergraduate Spanish students. Intervention: self-administered questionnaire to assess the awareness about the ECAC. A total of 651 subjects participated (52.4% [95% CI 48.5–56.2] Nursing students, 34% [95% CI 30.3–37.6] Medicine students, and 13.6% [95% CI 11.0–16.3] FM residents). Of the total subjects participated, 74.8% were women. Mean age: 22.34 years (standard deviation, 4.68; range, 18–52; 95% CI, 21.98–22.70). A total of 76.8% (95% CI 73.5–80.1) declared to be unaware of the ECAC. Those referring to be aware of the ECAC mainly knew it through degree subjects (7.5% [95% CI 5.5.5–9.6]). Residents of FM (p

Objective This study explores whether an Experiential Training Programme (ETP) in communication skills (CS) improves students' ability to identify patients clues compared to those who follow a non-experiential training throughout their medical studies. Method Intervention Group (IG): 85 4th-year medical students who received the ETP and Control Group (CG): 67 recently graduated students who did not receive it. Their immediate (written) response was requested to three expressions offered by patients containing communicative clues. The answers were grouped into 2 categories: Clue recognised and response patient-centred and the opposite. Three researchers analysed the answers. Results Responses 366 (65 from the CG and 77 from the IG): 280 did not recognise clues: 131 (62%) in IG and 149 (96%) in CG and 86 recognised them: 80 (37.9%) in IG and 6 (3.9%) in CG (p = 0.000). Some clues were more elusive than others (p = 0,003). Conclusions The students who received the ETP in CS showed greater ability to explore patients perspective taking advantage of different types of communicative clues than those who did not receive it in a non-relational context. Practice implications Further research is needed to assess whether this ability is maintained in simulated or real clinical situations. pre-print 222 KB

Family medicine (FM) residents and medical and nursing students play an important role in the development of preventive and health-promoting activities. The objective was to evaluate the health-related lifestyles and cancer-preventive behaviors of medical and nursing students and FM residents in relation to the European Code Against Cancer (ECAC). This was a descriptive, cross-sectional study performed in Spain. Medical and nursing students and FM residents completed a self-administered questionnaire focused on health-related habits and clinical behaviors related to the ECAC. A total of 740 participants completed the questionnaire. About 12.2% (95% CI [9.8-14.5]) were smokers, and 77.3% (95% CI [74.3-80.3]) sporadically consumed alcohol; 34.2% (95% CI [30.8-37.6]) practiced physical activity 2-3 times a week, and 12.1% (95% CI [9.8-14.5]) were overweight or obese. About 54.2% (95% CI [50.6-57.8]) regularly consumed vegetables. Differences were detected in the completion of screening tests for colorectal cancer (p 0.001), breast cancer (p = 0.023), cervical cancer (p = 0.006), and prostate-specific antigen determination (p 0.001) in relation to the participants' academic profiles. Our results reveal heterogeneous practices between the participants in terms of health-related habits. Awareness about the risks of smoking and being overweight were high; however, the perception of the risks associated with solar exposure and alcohol consumption was poor. There was general agreement upon the importance of performing screening tests for breast, cervical, and colorectal cancer, but there were discrepancies related to the need to perform the prostate cancer screening test.

Resumen Objetivo El objetivo de este estudio fue evaluar la eficacia del cribado oportunista a traves de la palpacion del pulso para la deteccion de fibrilacion auricular en sujetos asintomaticos de edad ≥ 65 anos frente a la busqueda activa de pacientes de la misma edad con sintomas y/o complicaciones y secuelas asociadas. Material y metodos Se realizo un ensayo clinico controlado aleatorizado por cluster en 48 centros de atencion primaria del Sistema Nacional de Salud espanol. Se aleatorizo a un total de 368 medicos y enfermeras. Los investigadores del grupo experimental (GE) realizaron el cribado oportunista para la fibrilacion auricular, mientras que los investigadores del grupo control (GC) realizaron una busqueda activa en pacientes sintomaticos. Se realizo un ECG en los pacientes que tenian un pulso irregular para confirmar el diagnostico de fibrilacion auricular. Resultados Un total de 5.465 pacientes con una edad media de 75,61 fueron seleccionados para el GE y 1.525 pacientes para el GC, con una edad media de 74,07 anos. El 58,6% eran mujeres, sin diferencias significativas entre los grupos. El pulso era irregular en el 4,3 y el 15% de los pacientes del GE y el GC, respectivamente (p Conclusiones La busqueda activa, a traves de la palpacion del pulso, de fibrilacion auricular en pacientes de edad ≥ 65 anos con sintomas o signos indicativos es una estrategia mas eficaz que el cribado oportunista en pacientes asintomaticos. Registro del ensayo clinico Registrado en ClinicalTrials.gov (NCT01291953; 8 de febrero de 2011).

Objective: The goal of this study was to assess the effectiveness of opportunistic screening through pulse palpation in the early detection of atrial fibrillation in subjects aged ≥ 65 years versus detection through an active search for patients with symptoms and/or complications and sequelae associated. -Material and methods: This was a cluster randomized controlled trial performed in 48 primary care centers of the Spanish National Healthcare System. A total of 368 physicians and nurses were randomized. The researchers in the Experimental Group (EG) performed opportunistic screening for auricular fibrillation, whereas the researchers in the Control Group (CG) actively searched for symptomatic patients. An ECG was performed on patients found to have an irregular heartbeat to confirm the diagnosis of auricular fibrillation. -Results: A total of 5,465 patients with a mean age of 75.61 were recruited for the EG, and 1,525 patients with a mean age of 74.07 were recruited for the CG. Of these, 58.6% were female, without significant differences between groups. Pulse was irregular in 4.3% and 15.0% of the patients in the EG and the CG, respectively (p

Starting from the idea that “medical problems” are always “problems of living” that reflect the existence of a “vital dimension” that is different from the biological, psychological and sociocultural dimensions, this article describes central features of this dimension. From this viewpoint, its inescapable importance in the clinical act is highlighted, an importance that shapes the tasks that are inherent to it – diagnosis and decision making – but also the very process of the doctor-patient relationship. It is argued that “the subjective truth” implicit in the “vital dimension” (in the “existential self”) can only be approached through reflection and interpretation in the context of a dialogue between the professional and the patient/family with the objective of deciding on the action(s) that can better lead to reaching some concrete wishes or desires (values), that in turn require the participants to take on obligations and responsibilities. This relational perspective defines the “person centered” clinical approach as a practice based on dialogue, importantly involving deliberation and collaboration (“collaborative deliberation”). In this dialogue, the emotions, integral elements of the life dimension of its protagonists, play a decisive role both in attaining clinical effectiveness and in building and maintaining the relational process (encouraging or reducing trust) that is indispensable in a clinical activity that is an eminently moral act. Finally, the main challenges that doctors face when implementing this clinical focus and the educational challenges it entails are outlined.

Background: “Person centered medicine” has recently emerged as a new alternative to “patient centered medicine” with the aim of representing a different focus for clinical practice. However, it is still necessary to clarify its conceptual bases and its identifying features. Objectives : To review the conceptual bases of Person Centered Medicine and highlight its main features. Methods: A non systematic review of the literature on the person and patient centered medicine field and particularly the works that George Engel published in 1977 and 1980 in which this author proposed the biopsychosocial (BPS) model as an alternative to the biomedical one. Results: The a nalysis led to identify one element, a “life dimension” that differs from the biopsychosociocultural determinants that are typical of the BPS and that until now has not been well understood. The “life dimension” takes shape in the interpretation that the person makes of a series of concrete experiences and their consequences, “problems of living”, that are liable to be considered “medical problems”. This is what leads the person to adopt the condition of being a patient (patienthood). Consequently, any medical problem is above all a problem of living or, in other words, a manifestation of a “life or existential dimension” that is inherent to the person (personhood). This perspective requires the physician to consider this dimension along with the model's other components in any clinical interaction, and it is the basis for the use of a hermeneutic or interpretative methodology that has communication and dialogue as its main tools. Conclusions: The term “person centered medicine” reflects the clinical focus that takes into account the “life dimension” of the person. Further research is needed to elucidate the meaning of this dimension as a basis to clarify both the concept of this clinical approach and its main practical elements.

espanolIntroduccion. La crisis por la COVID-19 supuso en marzo de 2020 el cierre de las universidades del pais, con interrupcion total de la actividad presencial. Este estudio presenta el diseno, el desarrollo y los resultados generales de una formacion totalmente en linea con un enfoque docente ‘autorregulativo’ (enfocado al aprendizaje autonomo del alumno), que una escuela de Medicina realizo durante los meses de confinamiento (ultimo cuatrimestre del curso 2019/2020). Sujetos y metodos. Se describen las caracteristicas educativas del Programa OnLine Ante COVID-19 para los cursos de primero y segundo de Medicina, estructuracion, organizacion de la intervencion, utilizacion de las herramientas y plataformas. Se comparan los resultados academicos del grupo de alumnos en los que se interviene con alumnos del curso anterior. Resultados. De 14 asignaturas participaron 10, y 111-158 (primer curso) y 110-139 (segundo curso) alumnos. La plataforma utilizada fue Moodle. Las sesiones sincronas fueron 49. El 83,7% de alumnos realizo autoevaluaciones. Se realizaron tres foros/asignatura. Se expusieron mas de 500 dudas y hubo 107 tutorias. Los resultados de los examenes finales (global de las asignaturas) mostraron un 17,7% mas de aptos y un 11,1% menos de no aptos respecto al curso anterior. Conclusiones. El programa en su diseno (enfoque centrado en el alumno) y desarrollo (completamente en linea) se mostro viable para el desarrollo del aprendizaje ‘autorregulativo’ no presencial. El uso de herramientas en linea habituales, una estructura academica centralizada y una organizacion en modulos semanales son elementos que han podido contribuir a su viabilidad y aplicacion inmediata. Son necesarios nuevos estudios para comprobar el alcance real de este tipo de enfoques educativos EnglishIntroduction. The Covid-19 crisis led to the closure of the country’s universities in March 2020, with total interruption of face-to-face activity. This study presents the design, development and general results of a totally online training with a ‘self-regulatory’ teaching approach, which a School of Medicine carried out during lockdown months (2019/20 last semester). Subjects and methods. The educational features of OnLine Program Because Covid19 (POLAC) for the 1st and 2nd medicine years are described, the structure and organization of the intervention. Use of tools and web-programs and comparison of academic results between the group of these students with students from previous year. Results. Ten out of 14 subjects participated and between 111-158 (1st) and 110-139 (2nd) students. Moodle web-program. Synchronous sessions: 49, self-evaluations carried out by 83.7% students. Forums: 3 forums / subject. Exposed doubts > 500; Tutorials: 107; Results of the final exams (global of subjects): a 17.7% of increase in the number of ‘pass’ grades and a 11.1% of decrease of ‘not pass’ grades regarding previous year. Conclusions. The design (student-centered approach) and development (completely online) of the POLAC is practicable for the development of non-face-to-face ‘self-regulatory’ learning. Using common online tools, a centralized academic structure, and an organization in weekly units are elements that may contribute to viability and immediate implementation. New studies are needed to verify the real scope of this type of instructional approaches

Background: Family medicine (FM) residents and medical and nursing students play an important role in the development of preventive and health-promoting activities. Objective: To evaluate the health-related lifestyles and cancer-preventive behaviors of medical and nursing students and FM residents in relation to the European Code Against Cancer (ECAC). Methods: This was a descriptive, cross-sectional study performed in Spain. Medical and nursing students, and FM residents completed a self-administered questionnaire focused on health-related habits and clinical behaviors related to the ECAC. Results: A total of 740 participants completed the questionnaire. 12.2% (95% CI [9.8–14.5]) were smokers and 77.3% (95% CI [74.3–80.3]) sporadically consumed alcohol; 34.2% (95% CI [30.8–37.6]) practiced physical activity 2–3 times a week, and 12.1% (95% CI [9.8–14.5]) were overweight or obese. 54.2% (95% CI [50.6–57.8]) regularly consumed vegetables. Differences were detected in the completion of screening tests for colorectal cancer (p < 0.001), breast cancer (p = 0.023), cervical cancer (p = 0.006), and prostate-specific antigen determination (p < 0.001) in relation to the participants’ academic profiles. Conclusion: Our results reveal heterogeneous practices between the participants in terms of health-related habits. Awareness about the risks of smoking and being overweight were high, however, the perception of the risks associated with solar exposure and alcohol consumption was poor. There was general agreement upon the importance of performing screening tests for breast, cervical, and colorectal cancer, but there were discrepancies related to the need to perform the prostate cancer screening test. pre-print 322 KB

Objective: This study aimed to gain an understanding of the perceptions of 4th-year medical students about a training course in communication skills with 'experiential learning' characteristics, completed over the past two years.Methods: Twenty 4th-year medical students were invited to participate in a qualitative study with focus groups. These students were selected randomly, stratifying by gender, from all 4th-year medical students (106) at the Francisco de Vitoria University (Madrid). The students had just completed their communication skills training taught in small groups, with simulated patient interviews and feedback. The focusgroup facilitator used an open-ended discussion guide to explore the students' perceptions. Thematic analysis was used to identify salient themes from these discussions. Results: Sixteen students participated in two focus groups. The discussions revealed two contrasting perceptions: while this learning is considered useful, it nevertheless brings about a great deal of stress, especially regarding student exposure to peers in small-group sessions when interviewing standardised patients, and summative assessment. This generates a range of negative feelings in students that could affect perspective and attitude towards the importance of doctor-patient relationships. Conclusions: Experiential learning is effective in improving students' communication skills. However, these results suggest that use of such strategies requires a strong focus on "student-centred" teaching approaches, in order to minimise some sensitive topics that may arise during the learning. Further research is needed to refine these strategies depending on the teaching situation and to identify different ways of implementing these experiential methods. post-print 206 KB

Resumen: Empatizar, negociar, tomar decisiones compartidas o informar a los pacientes representan habilidades comunicativas importantes tanto para la relación médico-paciente como para el aprendizaje mediante estrategias educativas experienciales y significativas. Estas habilidades requieren una monitorización constante de la interacción, favoreciendo la adquisición de una perspectiva más amplia que permite una comprensión más profunda de uno mismo y del otro. Sin embargo, en nuestro contexto cultural, muchos estudiantes y residentes presentan dificultades importantes para el desarrollo de este tipo de habilidades metacognitivas lo que repercute en la asunción y el aprendizaje de una práctica clínica centrada en la persona de posibles consecuencias futuras. El autor utiliza su experiencia de más de 25 años en contextos clínicos y educativos para ejemplificar algunas de estas dificultades a la vez que destaca el papel que algunos condicionantes culturales y psicológicos pueden tener en su desarrollo. Este es el primero de 2 artículos. Abstract: Empathize, negotiate, shared decisions making or inform patients, represent important communication skills both for the doctor-patient relationship and for learning through experiential and significant educational strategies since they need a constant monitoring of the interaction, they favour the acquisition of a broader perspective that allows a deeper understanding of oneself and the other. However, in our cultural context, many students and residents present important difficulties for the development of this type of metacognitive skills, which affects the assumption and learning of a person centered clinical practice with possible future consequences. The author uses his experience of more than twenty five years in both clinical and educational contexts to exemplify some of these difficulties while highlighting the role that some cultural and psychological factors may have in their development. This paper is the first of two. Palabras clave: Relación médico-paciente, Aprendizaje experiencial, Educación médica, Metacognición, Habilidades comunicativas, Barreras culturales, Keywords: Physician-patient relationship, Experiential learning, Medical education, Metacognition, Communication skills, Cultural barriers

Background: Obstructive sleep apnea (OSA) is a chronic illness that increases in prevalence with age. Treatment includes continuous positive airway pressure (CPAP) devices. Studies about the use of CPAP in the elderly are scarce. The main objective of this study is to determine whether CPAP contributes to improvement in health-related quality of life (HRQL) in elderly patients with OSA. Method: This was a prospective, pre-/postintervention assessment of a cohort of patients ≥65 years of age with OSA diagnosis by polysomnography who were being treated with CPAP and were physically independent and had good cognitive status. We determined HRQL before and after 3 months of CPAP treatment using the Short Form-36 Health Survey (SF-36, a 36-item, patient-reported survey) and Sleep Apnea Quality of Life Index (SAQLI). The effect of CPAP on daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS). Results: Of the 103 participants with a mean age of 71.5 ± 4.19 years, 66% were male. After 3 months of therapy, the mean CPAP usage was 6.3 ± 1.41 hr/day. The effectiveness of CPAP in controlling the OSA was demonstrated (mean difference pre- and posttherapy: 34.30 ± 18.52 events/hr, p < .001). Postintervention, the categories of the SF-36 improved meaningfully ( p < .001). Moreover, all categories of SAQLI improved ( p < .001) with the exception of “symptoms” ( p = .073). ESS scores also improved significantly (difference = 5.2 ± 4.47, p < .001) postintervention. Conclusion: Therapy with CPAP in elderly patients with OSA helps improve their HRQL and reduces daytime sleepiness.

This article describes the difficulties that the humanities and social and behavioral sciences(H&CSC) traditionally have for incorporating themselves as full members in medicaleducation analysing the reasons why this came about since the beginning of the 20thcentury. The hegemony in medical education of biomedicine is identified as the core of thisdifficulty and consequence of the multiple barriers and problems described for thisincorporation. Using the metaphor of the "russian dolls" and the concepts of "domain andepistemic field", arguments for understanding the scope and consequences of this"ideological hegemony" are offered. Finally, two strategies are also proposed which, to theextent they respond to the essential arguments on which biomedical hegemony is founded,they can be considered of enough importance and scope to counterweight the biomedicalhegemony and contribute to an effective integration of H&CSC: the need to incorporate aseducational axis an "expanded ratio" that incorporates epistemological and anthropologicalperspectives that overcome materialistic empiricism, claiming the validity of methodologiesdifferent from the purely quantitative ones, and second, to insist on the practical utility ofH&CSC and their methodologies for solving the current problems the medical practice needto face.

Objective: To evaluate the effectiveness of motivational interviewing (MI) in improving medication adherence in older patients being treated by polypharmacy. Methods: Cluster randomized clinical trial in 16 primary care centers with 27 health care providers and 154 patients. Thirty-two health care providers were assigned to an experimental (EG) or control group (CG). Interventions: MI training program and review of patient treatments. Providers in the EG carried out MI, whereas those in the CG used an “advice approach”. Three follow-up visits were completed, at 15 days and at 3 and 6[0] months. Medication adherence in both groups was compared (p