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Breaking bad news (BBN) is necessary in medical practice and requires training. The purpose of this study is to evaluate the efficacy and mainly explore the components involved in medical students' and residents' performance after a flipped educational intervention to train them to break bad news. A randomized controlled before-after study was conducted with 43 medical students and residents in the intervention group and 41 in the control group. The intervention combined an online multimedia program (DocCom) with a two-hour workshop. BBN performance was assessed at two clinical stations using Objective Structured Clinical Examination and analyzed using a mixed between-within subject analysis of variance. A factor analysis was conducted to analyze the performance by checklist components. The intervention group improved its overall performance in BBN over time (p = 0.000; Eta[superscript 2] = 0.38) and when compared to the control group (p = 0.01; Eta[superscript 2] = 0.12). The factor analysis revealed two main components: Factor 1--"giving bad news and responding with empathy"--and Factor 2--"using general communication skills". Performance analysis by these components revealed that the improvement occurred mainly in Factor 1 (over time, p = 0.000; Eta[superscript 2] = 0.48, group x time, p = 0.000; Eta[superscript 2] = 0.38). The intervention combining DocCom Module 33 and a workshop had a moderate effect on the improvement of medical students' and medical residents' BBN overall performance in standardized encounters. This improvement was mainly related to communication skills for giving bad news and responding with empathy, in which the intervention effect was large over time and between groups.

Effective doctor-patient-family communication is an integral and sensitive part of health care, assessing its quality is essential to identify aspects needing disclosure and, if necessary, improvement. Cross-sectional study aimed to analyze the sources of evidence of validity and the number of participants needed to reliably apply the Quality of Communication Questionnaire (QoC) through Generalizability Theory (GT). The mean age of the 150 patients hospitalized at the end of life was 50.5 (SD = 13.8) years, the mean hospital length of stay was 7.5 (SD = 10.2) days, 56.9% were male. Regarding the 105 patients' family members of patients whose mean length of hospital stay was 9.5 (SD = 9.1) days, their mean age was 42.2 (SD = 14.7) years, 69.5% were female. GT was used to quantify the minimum number of questionnaires needed, with the aim of reaching a reliable estimate of QoC with G-coefficients. To reach a reliability of.90, there is a need for 25 for the Eρ2 questionnaires and 35 for the Φ. The exact estimation identified the minimum number of questionnaires required for the evaluation of physicians by patients. To obtain a reliability of.90, there is a need for 30 and 40 questionnaires for the G-coefficients. A practical and fast application makes it possible to use QoC in its entirety or alone to evaluate general communication or communication about palliative care. Furthermore, based on these results, it was possible to identify which aspects were effective or ineffective in these contexts. [ABSTRACT FROM AUTHOR]

We administered the Jefferson Scale of Empathy and the Groningen Reflection Ability Scale to 61 of 64 entering medical students who self-selected a problem-based learning curricular track and to 163 of 198 who self-selected a lecture-based track (response rates of 95.3% and 82.3%, respectively, with no statistically significant differences in mean age or sex). Mean empathy and self-reflection ability scores were significantly higher among students who chose problem-based learning. Women scored higher than men in empathy. Women choosing problem-based learning had the highest empathy scores. Studies comparing students' performance and achievements in different curricular tracks should consider differences in personal characteristics such as capability for empathy and self-reflection that may cause students to prefer one pedagogic approach over another and affect their outcomes.

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Assessment of communication between physicians and patients' family members is essential to improving healthcare quality. To adapt the Quality of Communication Questionnaire (QoC) for family members and to analyze its validity evidence for use in Brazil. Data were collected between 2017 and 2019, with family members of patients in intensive care (IC) and palliative care (PC) from five public hospitals in the South Brazil. The QoC was adapted for family members for use in Brazil, and its cross-cultural adaptation was carried out. The clarity and cultural appropriateness of the pre-final version were evaluated by 30 family members of patients in IC. The final version was responded by 198 family members of patients. All items were considered clear, and appropriate to Brazilian culture. The goodness of fit index for proposed model had CFI 0.96 (CI95%: 0.94 – 0.98), TLI 0.95 (CI95%: 0.92 – 0.97), RMSEA 0.07 (CI90%: 0.06 – 0.08), and χ2/df 2.18. Cronbach's alpha coefficient (α) among family members of patients in PC was 0.88 for the general communication (first subscale) and 0.80 for the end-of-life communication (second subscale). However, among family members of patients in IC, α was 0.86 for the first subscale and only 0.53 for the second subscale. The QoC for family members and its cross-cultural adaptation were carried out successfully. It has strong validity evidence among those with loved ones in PC, but only the QoC general communication subscale has strong validity evidence among those with loved ones in IC. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic required the restructuring of educational models, including the rapid transition from face-to-face to remote education. The aim of this qualitative research was to understand the effect of the COVID-19 pandemic on undergraduate professors’ work and health at a public university in the state of São Paulo. Semi-structured interviews were conducted with 17 undergraduate faculty of humanities, biological and exact sciences form August to September 2020. The interviews were recorded and transcribed. From the content analysis, four thematic categories emerged: (1) changes in the work routine and their impacts, including adjustment to remote work and the difficulties in establishing boundaries between work and their personal life; (2) changes in the dynamics between faculty and students and the possibility of rethinking teaching practice; (3) the relationship between faculty and the university with emphasis on the decision-making process, support for the transition to remote teaching, and concerns about the quality of teaching; and (4) anguish and fears related to the pandemic that added to the set of work-related stressors. Our findings showed that actions towards the communicational dynamics, as well as actions towards faculties’ mental health should be implemented. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to understand the teachinglearning experience in the Communication in Healthcare class among students, teaching assistants, and health professionals, as well as its applications to professional practice. Methods: This is a qualitative study with a theoretical approach based on Gadamer's Philosophical Hermeneutics and a methodological framework based on Minayo and Bardin's thematic content analysis. Communication in Healthcare is an elective multiprofessional class, which lasts one semester and is offered regularly. All former students (n = 368) were invited to participate by email, and 30 participated in these focus groups (13 students, 8 teaching assistants, and 9 health professionals). The online focus groups took place on an online platform, and they were video-recorded and subsequently transcribed. Through cross-sectional and vertical analysis, the main themes were identified. Results: The Communication in Healthcare class was an important step for personal, professional, and interprofessional formation and development of communication competence. The following dominant themes were identified: 1) motivation for signing up, 2) prior expectations, 3) meaning of the experience and shaping moments, 4) how the teaching-learning experience was retained and what was retained, 5) repercussions in relation to self, others, and professional life, and 6) reflections about the curriculum, interprofessional dialogue, and formation. Conclusions: The teaching-learning experience was important for the formation of communicational competence. This research contributes to medical education and opens teaching-learning paths for communication skills, empathy, dialogue, and interprofessionalism. Future studies with a philosophical hermeneutic framework and online focus groups are indicated for the comprehension of educational interventions in health. [ABSTRACT FROM AUTHOR]

The Quality of Communication Questionnaire (QoC) was culturally adapted for Brazil due to its importance and use in several studies and different scenarios. The objective of this study was to evaluate the validity evidence of the Brazilian version of the QoC. A validation study was carried out involving 253 patients admitted to five public hospitals in Southern Brazil. Data were analyzed using descriptive analysis, Cronbach's alpha (α) to assess internal consistency, exploratory factor analysis, and goodness-of-fit index. One hundred and three patients were in intensive care (IC), and 150 were in palliative care (PC). The participants' mean age was 51 years (SD = 14.2). QoC,and its general communication subscale, and end-of-life communication subscale means were 5.5 (SD = 1.6), 8.8 (SD = 1.5), and 5.5 (SD = 1.6) respectively. Among patients in IC, QoC Cronbach's alpha was.75, and.84 in the general communication subscale and.51 in the end-of-life communication subscale. Among patients in PC, QoC Cronbach's alpha was.83, and.88 in the general communication subscale, and.71 in the end-of-life communication subscale. The root mean square error of approximation was.07 (90% CI:.04 –.08); Tucker-Lewis index was.97 (95% CI:.95 –.98); comparative fit index was.98 (95% CI:.97 –.99), and χ2/df ratio was 1.33 (χ2[53] = 70.858, p =.05). The authors conclude that the general communication subscale of QoC Brazilian version has good validity evidence for patients in IC and PC, whereas the end-of-life communication subscale is only valid for patient in PC. [ABSTRACT FROM AUTHOR]