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espanolObjetivo El objetivo de este estudio fue validar la version en espanol del Communication Assessment Tool (CAT), para ser utilizada por pacientes estandarizados en un examen clinico objetivo estructurado (OSCE), con el fin de evaluar habilidades de comunicacion centrada en el paciente de manera estandarizada. Metodos Pacientes estandarizados evaluaron a 125 medicos recien graduados durante un OSCE de 12 estaciones. Un total de 1.500 resultados de CAT fueron analizados. Se llevo a cabo analisis factorial exploratorio y confirmatorio, asi como analisis de confiabilidad. Resultados Encontramos un solo factor en la version en espanol del CAT, similar a lo descrito por el autor original. El alfa de Cronbach fue de 0,93 a 0,97. El promedio de «excelentes» fue del 38,07%. Conclusiones La version en espanol del CAT puede ser utilizada en OSCE por pacientes estandarizados para evaluar habilidades de comunicacion de una manera estandarizada. EnglishObjective The aim of this study was to validate the Spanish version of the Communication Assessment Tool (CAT) to be used in an Objective Structured Clinical Evaluation (OSCE) to assess communication skills. Methods Data were collected from standardized patients evaluating 125 recent medical school graduates during a 12-station OSCE. A total of 1,500 completed CAT instruments were analyzed. Exploratory and confirmatory factorial analysis were performed and tested the internal consistency of the tool. Results We found a single factor solution in the Spanish version of the instrument, similar to that described by the original author. Cronbach's alpha was high, ranging from 0.93 to 0.97. The overall mean percentage of ‘excellent’ ratings for the recent graduates was 38.07%. Conclusions The Spanish version of CAT is a feasible tool to be used in OSCE by standardized patients to assess communication skills in a standardized manner.

Background Simulation based learning (SBL) has increased in its use to best equip students for clinical practice. Simulations that mirror the complex realities of clinical practice have the potential to induce a range of emotions, without a clear understanding of their impact on learning and the learner. Students’ emotional states have important effects on their learning process that can be either positive or negative, and are often difficult to predict. We aimed to determine: (1) To what extent achievement emotions are experienced by medical students during a complex simulation based learning activity, i.e. a ward round simulation (WRS). (2) What their performance scores are and too which extent performance scores do correlate with emotions and 3) how these emotions are perceived to impact learning. Methods A mixed methods approach was used in this study. Using an Achievement Emotion Questionnaire, we explored undergraduate medical student’s emotions as they participated in a complex ward round-based simulation. Their performance was rated using an observational ward round assessment tool and correlated with emotions scores. Six focus groups were conducted to provide a deeper understanding of their emotional and learning experiences. Results Students experienced a range of emotions during the simulation, they felt proud, enjoyed the simulation and performed well. Students felt proud because they could show in the complex simulation what they had learned so far. Students reported moderate levels of anxiety and low levels of frustration and shame. We found non-significant correlations between achievement emotions and performance during ward round simulation. Conclusions Placing undergraduate students in high complex simulations that they can handle raises positive academic achievement emotions which seem to support students’ learning and motivation. Electronic supplementary material The online version of this article (10.1186/s12909-019-1753-1) contains supplementary material, which is available to authorized users.

Background Simulation-based education can induce intense learner emotions. The interplay between emotions and learning is less well understood. Gaining greater insights into learner emotions has potential to guide how best we manage emotions and optimise learning. This study aimed to understand learners’ lived emotional experiences in complex simulation and the perceived impact on learning. Methods Eight final-year medical students participated in the study. Wearing video-glasses, participants took part in a ward-based simulation. Video-footage was used to elicitate exploratory interviews and analysed using Template Analysis reflexively. Results Analysis yielded four main themes: ‘nervous anticipation’: encapsulating the fear, anxiety and uncertainty experienced by learners prior to simulation; ‘shock and awe’: feelings of anxiousness and being overwhelmed at the start of a simulation; ‘in the moment: flowing or buffeting with the emotions’: experiencing fear of being judged as incompetent, but also experiencing positive emotions such as satisfaction; ‘safe-landing?’: whilst debriefing aimed to encourage more positive emotions, negative emotions about the simulation could persist even with debriefing. Conclusions Complex simulation can evoke intense emotions in students. If students experienced a positive progression, they reported positive emotions and felt competent which was perceived to have a positive impact on learning. If students experienced failure, they reported strong negative emotions which made them question about their future performance and was perceived as negative for learning. Bringing to the surface these complex emotional dynamics, could permit educators to be aware of and adapt the emotional climate within simulation in order to optimise learning.

Background: Outcomes-based education is a trend in medical education and its assessment is one of the main challenges. The Objective Structured Clinical Examination (OSCE) is one of the tools used to assess clinical competencies. Although Chilean medical schools have used OSCEs for 18 years, there is a vast variability in the way these examinations are administered. Aim: To design and implement an integrated OSCE to assess clinical competencies at the end of the medical program in Chilean medical schools, aiming to reduce variability between these schools. Material and Methods: Seven medical schools, supported by experts from the National Board of Medical Examiners, designed a 12 station OSCE to measure clinical outcomes at the end of the seventh year of medical training. Unlike traditional OSCEs, this new examination incorporated the assessment of clinical reasoning and communication skills, evaluated from patients’ perspective. Results: One hundred twenty-five volunteers took the same exam at five different venues. The internal consistency was 0.62. Following a compensatory approach, 85% of students passed the exam. Communication assessment showed poorer results than those reported in the literature. Conclusions: Among Chilean medical students, the assessment of clinical outcomes in a collaborative way, through a valid and reliable exam, is feasible. A consensus on how to teach and assess clinical reasoning across the medical curriculum is required. The assessment of students’ communication skills requires further development.

Introduction: Ward round skills are essential for doctors in hospital settings. Literature shows medical students deficiencies in these skills. Simulation has been used to train these skills. However, exposing learners to simulation at an early stage may be associated with a high cognitive load and limited learning. This study aims to determine how students experience this load and its interplay with performance and which factors promote and impair learning.Method: Fifty-six final year medical students participated in a simulated ward round training exercise. Both students’ performance and cognitive load were measured to determine if there was any correlation and interviews were carried out to understand which factors support and impair learning.Results: Performance scores revealed deficiencies in ward round skills. Students experienced a cognitive load that weakly correlated with performance. Qualitative findings provided important insights into simulated ward-based learning. It is clear that well-designed clinical scenarios, prioritization tasks, teamwork and feedback support students’ learning process whereas distractions impair learning.Conclusion: WRS proved to be a good teaching method to improve clinical skills at this stage as the cognitive load is not too high to impair learning. Hence, including tasks in the simulation design can enhance the learning process.