The Computer Book of The Internal Medicine Resident: Competence acquisition and achievement of learning objectives

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Oristrell, J.C. Oliva, A. Casanovas, R. Comet, R. Jordana, M. Navarro" "autores" => array:6 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Oristrell" "email" => array:1 [ 0 => "joristrell@tauli.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.C." "apellidos" => "Oliva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Casanovas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "R." "apellidos" => "Comet" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "R." "apellidos" => "Jordana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "M." "apellidos" => "Navarro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital de Sabadell, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Estadística, Fundació Parc Taulí, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Enfermedades Infecciosas, Hospital de Sabadell, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El Libro Informático del Residente de Medicina Interna: adquisición de competencias y consecución de objetivos docentes" ] ] "textoCompleto" => "<elsevierMultimedia ident="tb0005"></elsevierMultimedia>BackgroundThe Spanish Society of Internal Medicine has in recent years made a notable effort to define the training schedule and competencies that should achieved by medical residents during their specialized training in Internal Medicine.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Based on these competencies, our team of tutors recently developed and validated software based on self-assessment questionnaires that analyze the acquisition of clinical and communication competencies over the course of the specialized training in Internal Medicine.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>During their training, medical residents in Internal Medicine usually conduct rotations in various medical specialty departments, in the Department of Internal Medicine itself and in the Emergency Department. These residents are subjected to various levels of patient load, responsibility, organization of departments and relationships among the healthcare teams. In this study, we analyzed the impact these variables had on the process of acquisition of competencies for medical residents.Materials and methodsConstruction and validation of the “Computer Book of Internal Medicine Residents” for the analysis of clinical and communication competenciesThe construction and validation of self-assessment questionnaires on clinical and communication competencies for Internal Medicine residents have been described previously.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> A total of 22 electronic questionnaires were designed for the self-assessment of each of the rotations of specialized training in Internal Medicine (3 questionnaires for the initial rotation period for Internal Medicine, 7 for the rotation period for medical specialties, 6 for the senior resident rotations by specific Internal Medicine areas [hospitalization, doctor's office diagnostics, geriatric medicine, infectious diseases, systemic diseases and palliative care], 4 for each rotation period in the Emergency Department, a general questionnaire halfway through the residency and a final self-assessment questionnaire). Junior resident rotations were considered those that took place during the first 2 years of residence; senior resident rotations were those that took place in the last 3 years of specialization. The collection of questionnaires to complete during the training period was organized as the “Computer Book of Internal Medicine Residents” (CBIMR) using Microsoft Access 2000® (Microsoft), with restricted access to the responses by means of personal access codes.Professional participants and study periodAll Department of Internal Medicine residents of the Corporació Sanitaria Parc Taulí (Healthcare Corporation Parc Tauli, CSPT) (20 residents) participated in this study for a period of 40 months (November 2009 to February 2013). CSPT is a public university hospital with 714 beds serving a reference population of 394,000 inhabitants. The Department of Internal Medicine is accredited for the training of 5 Internal Medicine residents per year, offers 4 resident tutors and has offered 3 training posts per year in the most recent sessions. The department's healthcare, teaching and research activity can be viewed online.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Characteristics of the departments where the rotations are conductedThe questionnaires for each rotation period include various items (questions) referring to the characteristics of the departments where the rotation is conducted. These characteristics include the healthcare activity, protocolization, responsibilities assumed by the resident, work environment, organization of the department and teamwork (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The healthcare activity is quantified using a generic question with a score between 1 and 5 (“The intensity of dedication to health care was 1=minimal; 5=maximum”). “Intense healthcare activity” was considered the achievement of a maximum score on this item. The questionnaires included questions related to the number of medical records and discharge reports performed per week, the number of patients treated in each of the most common pathologies of the rotation and the number of techniques performed (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Assumed responsibility was assessed using the item “Is your responsibility appropriate for your level of knowledge?” and quantified on a scale of 1 (insufficient) to 5 (excessive), with a middle point at 3 (appropriate) and allowing for intermediate scores of 2 or 4. The protocolization, the environment that facilitates learning and the degree of organization of the department's activities were also scored on a scale of 1 (minimum) to 5 (maximum), considering the values ≤3 as suboptimal. Finally, the “teamwork” variable was obtained from the average of 3 items relating to the team included in the questionnaires for each rotation period (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), as has been previously described.<a class="elsevierStyleCrossRef" href="#bib0010">2</a><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Learning outcomesFor each rotation period, 4 variables for the learning outcomes were analyzed: clinical competence, communication skills, the achievement of learning objectives and overall satisfaction with the rotation. The variable “clinical competence” was obtained for each rotation period by calculating the average response to items on clinical competencies specific to the rotation (between 6 and 54 items, depending on the type of rotation), all of which were scored on a scale of 1 (minimum) to 5 (maximum). The variable “communication skills” was obtained from the average of 3 items on communication competencies common to all rotations, also scored between 1 (minimum) and 5 (maximum). The description of the items on clinical and communication competencies contained in the questionnaires for each rotation, as well as the reliability and validity of the CBIMR for the analysis of these competencies in Internal Medicine resident teams, has been described previously.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> The questionnaires for all rotation periods also included a question on the achievement of learning objectives and a question on overall satisfaction with the completed rotation, both scored on a scale of 1 (minimum) to 5 (maximum).Association between the characteristics of the departments and learning outcomesWe analyzed the association between the values of clinical competence achieved and each of the characteristics of the departments (healthcare activity, protocolization, responsibilities assumed by the resident, environment facilitating learning, organization of the department and team work) using bivariate descriptive analysis (Student's t-test for the comparison of means; Pearson's r for the correlation between numerical variables). Given that the items included to derive the variable “clinical competence” differ according to the type of rotation,<a class="elsevierStyleCrossRef" href="#bib0010">2</a> we performed a subanalysis of these associations taking into account only the rotations by the Department of Internal Medicine. We also analyzed the associations between the rest of the variables of learning outcomes (communication skills, the achievement of learning objectives and overall satisfaction with the rotation) and the characteristics of the departments using bivariate analyses. Finally, we performed a multiple linear regression analysis to identify the characteristics of the departments, which were independently associated with each of the learning outcomes. In these multivariate models, we included the variables that had shown a significant association in the bivariate analysis, as well as variables such as the seniority of the resident (senior versus junior) or the type of rotation (Internal Medicine versus other departments). All statistical analyses were performed with the IBM SPSS® statistical package (version 21.0).ResultsA total of 176 entries were recorded in the CBIMR of the 238 registries to have been completed during the study period (73.9% response rate), corresponding to a self-assessment, by 20 medical residents of Internal Medicine, from 166 rotations (68 rotations in medical specialties, 71 assessments of rotation periods in Internal Medicine and 27 assessments of rotation periods in emergency departments). The 10 remaining entries corresponded to overall assessments at the midpoint (n=6) or end of the residency (n=4). In total, 84 entries for senior residents (74.3% response rate) and 92 entries for junior residents (73.6% response rate) were recorded. The mean and standard deviation values for each item of healthcare activity, protocolization, work environment, assumed responsibility, teamwork and learning outcomes are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.Factors associated with the acquisition of clinical competenciesThe values for clinical competence were significantly higher for senior residents than for junior residents, both when analyzing all rotations (3.65±0.69 vs. 3.35±0.60; p=.008) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) and when specifically analyzing the rotations through the Department of Internal Medicine (3.78±0.60 vs. 3.34±0.69; p=.04).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Healthcare activityThe acquisition of clinical competencies was not associated with the number of medical records or discharge reports performed per week, the number of patients treated or the total number of techniques performed, but it was associated with the generic variable “the intensity of the healthcare dedication was 1=minimal; 5=maximum” (r=0.46; p<.001) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). This association was also observed when analyzing only the junior resident entries (r=0.29; p=.01), the senior resident entries (r=0.59; p<.001) or the entries of the rotations through the Department of Internal Medicine (r=0.28; p=.05). The healthcare activity in 33.5% (n=59) of the rotations was categorized as “intense healthcare activity” (maximum score of 5). These rotations represent 23.3% of the entries of the rotations through Internal Medicine by junior residents, 25.4% of the rotations through medical specialties, 43.6% of the rotations through Internal Medicine by senior residents and 69.2% of the rotations through the Emergency department. Intense healthcare activity was significantly associated with a greater acquisition of clinical competencies (3.82±0.62 vs. 3.34±0.60; p<.001). Similar results were obtained when analyzing only the rotations through hospital units, excluding the rotations through the Emergency department (3.82±0.51 vs. 3.33±0.60; p<.001) or when analyzing only the rotations through the Department of Internal Medicine (3.91±0.57 vs. 3.55±0.65; p=.06).ProtocolizationThe mean protocolization of the departments was assessed at 3.88±0.87 points on a scale from 1 to 5. Some 27.7% (n=44) of the rotations took place in departments whose protocolization was judged suboptimal (score ≤3). This occurred in 37% of the entries of rotations through Internal Medicine by junior residents, in 34.8% of the rotations through medical specialties, in 20% of the rotations through the Emergency department and in 14.6% of the rotations through Internal Medicine of senior residents. The protocolization of the departments was associated with a greater acquisition of clinical competencies (r=0.52; p<.001) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Similar correlations were obtained when separately analyzing the rotations of junior residents (r=0.63; p<.001), senior residents (r=0.48; p<.001) and rotations that took place in the Department of Internal Medicine of (r=0.41; p=.004).Resident responsibilityThe responsibility assumed by the resident was assessed at 3.44±0.72 points and was similar for senior and junior residents (3.49±0.73 and 3.41±0.72, respectively; p=.50). In 10.8% of the rotations, the residents considered their assumed responsibilities to be excessive (score maximum of 5). These rotations more often corresponded to training periods in Internal Medicine for senior residents (17.9% of these rotations) or to rotation periods in medical specialties (11.9% of rotations through specialties), registering in only 6.7% of the rotations through Internal Medicine for junior residents or in 8.3% of the rotations through the Emergency department. The greater assumption of responsibility was associated with a greater acquisition of clinical competencies (r=0.23; p=.006) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). This correlation was also observed when analyzing separately the rotations conducted in Internal Medicine (r=0.38; p=.009). Similarly, the assumption of excessive responsibilities was associated with a greater acquisition of clinical competencies in all rotations (3.94±0.71 vs. 3.46±0.61; p=.004), as well as in the rotations through Internal Medicine (4.14±0.67 vs. 3.57±0.62; p=.03).Organization of departments, work environment and teamworkThe organization of the departments was assessed at a mean of 3.67±1.07 points. Some 34.2% of the rotations took place in departments whose organization was judged suboptimal (score ≤3). This occurred in 56.2% of the rotations through the Emergency department, in 50.0% of the rotations through medical specialties, in 18.7% of the rotations through Internal Medicine by senior residents and in none of the entries for Internal Medicine by junior residents. The item referring to the organization of the department was not correlated with the clinical competence variable (r=0.17; p=.18) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), although suboptimal organization was associated with inferior results in clinical competence (3.24±0.60 vs. 3.56±0.58; p=.04). A significant correlation was observed between the organization of the departments and the acquisition of clinical competencies when separately analyzing the rotations through the Department of Internal Medicine (r=0.56; p=.01). The presence of an environment that facilitated learning was correlated with the acquisition of clinical competencies, both when analyzing all rotations (r=0.47; p<.001) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) and when examining only the rotations through the Department of Internal Medicine (r=0.54; p=.001). Finally, teamwork was also associated with a greater acquisition of clinical competencies, both when analyzing all rotations (r=0.58; p<.001) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) and when examining only the rotations through the Department of Internal Medicine (r=0.59; p=.001).Continuing education activitiesAttendance at clinical sessions, medical literature sessions and the presentation of sessions was very high in all rotations (88.5%, 82.6% and 70.6%, respectively). Only attendance at medical literature sessions was associated with a greater acquisition of clinical competencies (3.52±0.62 vs. 3.22±0.56; p=.03).Multivariate analysisIn the multivariate analysis, resident seniority, a greater healthcare activity, protocolization, the assumption of responsibilities and an environment facilitating learning were the independent factors associated with the acquisition of clinical competencies (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Factors associated with the acquisition of communication competenciesThe values for communication skills were significantly higher in senior residents than in junior residents (4.22±0.66 vs. 3.87±0.69; p=.001) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). A significant association was observed between the intensity of healthcare activity (r=0.40; p<.001), the facilitating environment (r=0.38; p<.001), protocolization (0.52; p<.001) and teamwork (r=0.64; p<.001) on one hand and communication competencies on the other (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Communication skills were also significantly correlated with clinical competence (r=0.70, p<.001), in both the entries corresponding to senior residents and those of junior residents. The multivariate analysis showed that teamwork, greater clinical competence and seniority were factors that were independently associated higher self-assessments in communication skills (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).Factors associated with the achievement of learning objectivesGreater healthcare activity (r=0.49; p<.001), department protocolization (r=0.61; p<.001), greater assumption of responsibilities (r=0.21; p<.05), department organization (r=0.46; p<.001), an environment facilitating learning (r=0.59; p<.001), teamwork (r=0.63; p<.001), the acquisition of clinical competencies (r=0.66; p<.001) and the acquisition of communication skills (r=0.56; p<.001) were significantly correlated with the achievement of learning objectives (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). In the analysis multivariate, the acquisition of clinical and communication competencies and an environment facilitating learning were significantly associated with the achievement of learning objectives (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).Factors associated with resident satisfactionOverall satisfaction with the rotation was correlated with the understanding of rotation objectives (r=0.48; p<.001), the achievement of these objectives (r=0.76; p<.001), an environment facilitating learning (r=0.82; p<.001), teamwork (r=0.60; p<.001), the intensity of the healthcare activity (r=0.37; p<.001), the degree of protocolization (r=0.54; p<.001), department organization (r=0.62; p<.001) and the level of clinical (r=0.48; p<.001) and communication competencies acquired (r=0.46; p<.001) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). In the multivariate analysis, overall satisfaction with the rotation was associated with an environment that facilitated learning and with the achievement of learning objectives (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).DiscussionIn our study, intense healthcare activity, the assumption of responsibilities, the protocolization of diseases and an environment that facilitated learning were the key factors correlated with clinical competencies.The intensity of the healthcare activity was one of the variables that most influenced the acquisition of clinical competencies by the medical residents. To date, most studies on this issue have focused on the effects of intense healthcare dedication on resident fatigue and, as a result, on medical errors and patient safety.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a> Based on these observations, European and American laws adopted various provisions to limit the work hours of medical residents,<a class="elsevierStyleCrossRef" href="#bib0030">6</a> thus creating intense controversy about the possibility that reducing this schedule could result in decreased clinical competence in future specialists.<a class="elsevierStyleCrossRefs" href="#bib0035">7–11</a> In our study, the acquisition of clinical competencies was correlated with intense healthcare activity but not with the number of patients treated. These results could due to the fact that the acquisition of clinical competencies is more related, in reality, with qualitative aspects of healthcare work.<a class="elsevierStyleCrossRefs" href="#bib0060">12,13</a> Care for more complex patients or simply the more exhaustive clinical approaches could be qualified by the resident as intense healthcare activity, without necessarily having the resident care for a high number of patients. The association that we observed between the intensity of the healthcare work and the acquisition of clinical competencies was a linear correlation. Therefore, our results do not confirm the hypothesis of Have et al.,<a class="elsevierStyleCrossRef" href="#bib0065">13</a> which states that the relationship between healthcare activity and the acquisition of clinical competencies follows an inverted “U” distribution, with a progressive increase in the acquisition of competencies as the healthcare activity increases, until it reaches a maximum, followed by a decrease in acquisition of competencies under conditions of maximum healthcare activity.As has been remarked by various authors,<a class="elsevierStyleCrossRefs" href="#bib0070">14,15</a> another element that influences the acquisition of clinical competencies by medical residents is their level of responsibility in patient care. In Spain, specialized healthcare training through the resident medical intern system allows for a progressive assumption of responsibilities by the doctors in training, ensuring the necessary learning by the physician and the safety of the patient. Although a small percentage of residents considered the degree of assumed responsibility excessive in some of their rotations, our results suggest that, if patient safety is ensured, increased accountability and autonomy of residents facilitate the acquisition of clinical competencies.In our study, the rotations in departments with greater levels of protocolization were associated with higher levels of clinical competence. It is known that protocolization reduces the variability in clinical practice and facilitates the application of more cost-effective treatments.<a class="elsevierStyleCrossRefs" href="#bib0080">16,17</a> However, few studies have been published that analyze how the growing number of clinical practice guidelines and protocols affect the learning process of new doctors. In general, medical residents tend to positively assess clinical practice guidelines given that they increase the residents’ self-confidence; however, residents often have difficulties in critically assessing and using them properly.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> Our study was based on self-assessment questionnaires and, therefore, the items on clinical competence (such as the question “Do you consider yourself sufficiently competent to handle patients with septic shock”) reference the subjective perception of feeling competent to handle certain medical problems,<a class="elsevierStyleCrossRef" href="#bib0010">2</a> i.e., our items on clinical competence actually measured the resident's self-confidence in clinical management. The correlation observed between protocolization and clinical competence could therefore be due to the effect that protocolization has on resident self-confidence.Various professional societies and medical accreditation organizations have highlighted the need for a proper work environment to facilitate learning during specialized medical training.<a class="elsevierStyleCrossRefs" href="#bib0030">6,19,20</a> This would include various aspects such as appropriate physical spaces for healthcare and teaching tasks, adequate organization of departments and facilities for team work. Our results support the importance of a work environment in the acquisition of clinical competencies, in the achievement of learning objectives and in the overall satisfaction with the rotation conducted.Clinical competence, teamwork and seniority were, in our experience, the variables most associated with the acquisition of communication competencies. The association between clinical and communication competencies has been previously documented in a study using medical examinations with structured objectives.<a class="elsevierStyleCrossRef" href="#bib0105">21</a>Teamwork was also strongly associated with communication competencies. This correlation could be due to the fact that communication competencies, as has been described, facilitate team work<a class="elsevierStyleCrossRef" href="#bib0110">22</a> or that, vice versa, team work facilitates the acquisition of communication skills.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> In our opinion, it is likely that certain skills, such as knowing how to listen and being empathic, are common in effective communication and for working in a team.<a class="elsevierStyleCrossRefs" href="#bib0110">22,24</a>Lastly, in our study, the end-points associated with high satisfaction in the rotation were an environment that facilitated learning and the achievement of learning objectives. Both end-points have been previously indicated as important factors for the satisfaction of medical residents.<a class="elsevierStyleCrossRefs" href="#bib0125">25–27</a>It is important to highlight that the strengths of our study include the fact that this is a prospective study based on computerized questionnaires that were previously validated for the analysis of the acquisition of clinical and communication competencies during the training of Internal Medicine residents. Moreover, the rate of involvement was very high, over 70% for both senior and junior residents, which minimizes the possibility of selection biases.Among the limitations, it is worth indicating that our study is based on self-assessment questionnaires, which are probably less reliable for studying competencies than other techniques such as multiple-choice examinations, objective structured clinical examinations, mini-clinical evaluation exercises (mini-CEX) and the 360-degree feedback.<a class="elsevierStyleCrossRefs" href="#bib0140">28,29</a> In a previous study, we were able to demonstrate that self-assessments allow for the analysis of competence acquisition by teams of residents, although this methodology was not useful for the interindividual comparison of these residents.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> We were also unable to include in the analysis a number of issues that could have had an impact on the acquisition of competencies, such as the degree of supervision by the head physician and/or tutor<a class="elsevierStyleCrossRef" href="#bib0150">30</a> or the attendance at training courses. We were also unable to analyze the acquisition of other competencies necessary for professional development in Internal Medicine,<a class="elsevierStyleCrossRef" href="#bib0155">31</a> such as research competencies, professional competencies and resource management, despite the fact that the questionnaires included various items on these issues. Our study was conducted at a single center, and therefore we cannot ensure that the results can be extrapolated to other healthcare settings.In conclusion, there are various factors that are related to the operation of departments, which are potentially modifiable and that significantly influence the acquisition of clinical and communication competencies and the achievement of learning objectives of medical residents.Authorship<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">1.Concept and design of the manuscript: J. Oristrell.</li><li class="elsevierStyleListItem" id="lsti0010">2.Data collection: J.C. Oliva and J. Oristrell.</li><li class="elsevierStyleListItem" id="lsti0015">3.Data analysis and interpretation: J.C. Oliva and J. Oristrell.</li><li class="elsevierStyleListItem" id="lsti0020">4.Drafting, review and approval of the submitted manuscript: J. Oristrell, J.C. Oliva, A. Casanovas, R. Comet, R. Jordana and M. Navarro.</li></ul>Conflicts of interestDr. J. Oristrell, A. Casanovas, R. Jordana and R. Comet (as developers) and the Fundació Pair Tau (Sponsor) are co-owners of the software program CBIMR used in this study." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres307804" "titulo" => array:6 [ 0 => "Abstract" 1 => "Background" 2 => "Objectives" 3 => "Methods" 4 => "Results" 5 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec290883" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres307803" "titulo" => array:6 [ 0 => "Resumen" 1 => "Antecedentes" 2 => "Objetivos" 3 => "Métodos" 4 => "Resultados" 5 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec290884" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Background" ] 5 => array:3 [ "identificador" => "sec0020" "titulo" => "Materials and methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Construction and validation of the “Computer Book of Internal Medicine Residents” for the analysis of clinical and communication competencies" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Professional participants and study period" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Characteristics of the departments where the rotations are conducted" ] 3 => array:2 [ "identificador" => "sec0040" "titulo" => "Learning outcomes" ] 4 => array:2 [ "identificador" => "sec0045" "titulo" => "Association between the characteristics of the departments and learning outcomes" ] ] ] 6 => array:3 [ "identificador" => "sec0050" "titulo" => "Results" "secciones" => array:10 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Factors associated with the acquisition of clinical competencies" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Healthcare activity" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Protocolization" ] 3 => array:2 [ "identificador" => "sec0070" "titulo" => "Resident responsibility" ] 4 => array:2 [ "identificador" => "sec0075" "titulo" => "Organization of departments, work environment and teamwork" ] 5 => array:2 [ "identificador" => "sec0080" "titulo" => "Continuing education activities" ] 6 => array:2 [ "identificador" => "sec0085" "titulo" => "Multivariate analysis" ] 7 => array:2 [ "identificador" => "sec0090" "titulo" => "Factors associated with the acquisition of communication competencies" ] 8 => array:2 [ "identificador" => "sec0095" "titulo" => "Factors associated with the achievement of learning objectives" ] 9 => array:2 [ "identificador" => "sec0100" "titulo" => "Factors associated with resident satisfaction" ] ] ] 7 => array:2 [ "identificador" => "sec0105" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0110" "titulo" => "Authorship" ] 9 => array:2 [ "identificador" => "sec0115" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-05-24" "fechaAceptado" => "2013-07-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec290883" "palabras" => array:6 [ 0 => "Educational measurement" 1 => "Self-assessment" 2 => "Competency-based education" 3 => "Clinical competence" 4 => "Internship and residency" 5 => "Internal Medicine" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec290884" "palabras" => array:6 [ 0 => "Evaluación" 1 => "Autoevaluación" 2 => "Educación basada en competencias" 3 => "Competencia clínica" 4 => "Residentes" 5 => "Medicina Interna" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "BackgroundThe Computer Book of the Internal Medicine resident (CBIMR) is a computer program that was validated to analyze the acquisition of competences in teams of Internal Medicine residents. ObjectivesTo analyze the characteristics of the rotations during the Internal Medicine residency and to identify the variables associated with the acquisition of clinical and communication skills, the achievement of learning objectives and resident satisfaction. MethodsAll residents of our service (n=20) participated in the study during a period of 40 months. The CBIMR consisted of 22 self-assessment questionnaires specific for each rotation, with items on services (clinical workload, disease protocolization, resident responsibilities, learning environment, service organization and teamwork) and items on educational outcomes (acquisition of clinical and communication skills, achievement of learning objectives, overall satisfaction). Associations between services features and learning outcomes were analyzed using bivariate and multivariate analysis. ResultsAn intense clinical workload, high resident responsibilities and disease protocolization were associated with the acquisition of clinical skills. High clinical competence and teamwork were both associated with better communication skills. Finally, an adequate learning environment was associated with increased clinical competence, the achievement of educational goals and resident satisfaction. ConclusionsPotentially modifiable variables related with the operation of clinical services had a significant impact on the acquisition of clinical and communication skills, the achievement of educational goals, and resident satisfaction during the specialized training in Internal Medicine." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "AntecedentesEl Libro Informático del Residente de Medicina Interna es un programa que ha sido validado para cuantificar la adquisición de competencias durante el periodo de formación en Medicina Interna. ObjetivosEste estudio se propone analizar las características de las rotaciones durante la formación en Medicina Interna e identificar las variables asociadas con la adquisición de competencias clínicas y comunicativas, la consecución de los objetivos docentes y la satisfacción del residente. MétodosParticiparon todos los residentes de nuestro servicio (n=20) durante un período de 40 meses. El Libro Informático del Residente de Medicina Interna está constituido por 22 cuestionarios de autoevaluación específicos para cada período de rotación, con ítems referentes a las características de los servicios dónde se desarrolló la rotación y a los resultados docentes (competencia clínica y comunicativa, consecución de los objetivos docentes y satisfacción global). ResultadosLa dedicación asistencial intensa, con elevada responsabilización del residente y la protocolización se asociaron a una mayor adquisición de competencias clínicas. Una elevada competencia clínica y el trabajo en equipo se asociaron a mejores resultados en habilidades comunicativas. Finalmente, un entorno facilitador para el aprendizaje se asoció a mayor competencia clínica, mayor consecución de los objetivos docentes y mayor satisfacción global. ConclusionesDiversos factores relacionados con el funcionamiento de los servicios influyeron de forma significativa en la adquisición de competencias, la consecución de los objetivos docentes y la satisfacción de los médicos residentes durante la formación especializada en Medicina Interna." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Oristrell J, Oliva JC, Casanovas A, Comet R, Jordana R, Navarro M. El Libro Informático del Residente de Medicina Interna: adquisición de competencias y consecución de objetivos docentes. Rev Clin Esp. 2014;214:8–16." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Abbreviation: SD, standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Items on healthcare activity</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Common to all rotations</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• The intensity of the healthcare dedication has been (1=minimal; 5=maximum) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.1 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Approximate no. of patients treated (total diseases, by rotation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">115.7 (95.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Approximate no. of shifts/month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.4 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Specifics of certain rotations</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Approximate no. of medical records in hospitalization/week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.7 (2.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Approximate no. of discharge reports in hospitalization/week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.8 (2.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Approximate no. of first visits in outpatient office per week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.9 (2.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• No. of emergency visits attended daily (emergency department rotation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.2 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Approximate no. of requested autopsies (by rotation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.3 (0.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• No. of thoracentesis procedures (by rotation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.6 (1.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• No. of paracentesis procedures (by rotation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5 (5.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• No. of arthrocentesis procedures (by rotation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.05 (0.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• No. of peripheral routes (by rotation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.1 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• No. of arterial blood gas analyses (by rotation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.7 (2.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• No. of arterial catheterizations (by rotation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.3 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• No. of subclavian lines inserted (by rotation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.05 (0.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• No. of jugular lines inserted (by rotation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.2 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• No. of urinary catheters (by rotation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.03 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• No. of lumbar punctures (by rotation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0 (1.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• No. of cardiopulmonary resuscitations performed (by rotation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.6 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• No. of endotracheal intubations (by rotation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.3 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• No. of tumor punctures or adenopathies (by rotation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.05 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Protocolization item</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Do you have information to help direct decisions -protocols-? (1=minimum; 5=maximum) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.9 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Work environment item</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• In your opinion, does the environment facilitate learning? (1=minimum; 5=maximum) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.0 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Department organization item</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• What is your assessment of the department's organization? (1=minimum; 5=maximum) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.7 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Responsibility item</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Are your responsibilities appropriate for your knowledge level? (1=insufficient; 3=sufficient; 5=excessive) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.4 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Team work item</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• How would you assess your relationship with the medical team? (1=minimum; 5=maximum) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.3 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• How would you assess your relationship with the nursing team? (1=minimum; 5=maximum) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.1 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Do you feel integrated in the team? (1=minimum; 5=maximum) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.3 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Learning outcomes item</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Clinical competence (1=minimum; 5=maximum) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.5 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Skills communication (1=minimum; 5=maximum) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.0 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Achievement of learning objectives (1=minimum; 5=maximum) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.7 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Are you satisfied overall with the rotation? (1=minimum; 5=maximum) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.0 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab455044.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Items on healthcare activity, protocolization, work environment, organization, assumed responsibility, team work and learning outcomes." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "Abbreviation: SD, standard deviation; NS, not significant." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Acquisition of clinical competence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Acquisition of communication competence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Achievement of learning objectives \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Overall satisfaction \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Resident seniority</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Senior residents; mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.65 (0.69)<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.22 (0.66)<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.71 (0.85) NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.86 (1.15) NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Junior residents; mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.35 (0.60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.87 (0.69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.61 (0.80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.11 (0.89) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Healthcare activity; Pearson's r \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.46<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.40<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.49<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.37<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Activity (quantified)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medical Histories/week; Pearson's r \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.17<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.22<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.24<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Discharge reports/week; Pearson's r \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total no. of patients treated; Pearson's r \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total no. of techniques performed; Pearson's r \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Protocolization; Pearson's r \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.52<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.52<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.61<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.54<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Responsibility assumed; Pearson's r \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.23<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.21<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Department organization; Pearson's r \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.46<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.62<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Work environment; Pearson's r \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.47<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.38<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.59<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.82<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Team work; Pearson's r \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.58<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.64<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.63<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.60<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab455043.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "p<.05" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "**" "nota" => "p<.001" ] ] ] "descripcion" => array:1 [ "en" => "Association among a number of department characteristics and learning outcomes (bivariate analysis)." ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Typical error \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p value \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Variables associated with the acquisition of clinical competence</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Seniority \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.217 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.103 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.039 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Protocolization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.230 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.074 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Responsibility assumed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.197 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.068 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Intensity of the healthcare dedication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.167 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.066 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.016 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Environment facilitating learning \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.150 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.062 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.012 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Variables associated with the acquisition of communication skills</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Clinical competence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.501 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.076 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Team work \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.373 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.065 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Seniority \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.189 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.079 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.018 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Variables associated with the achievement of learning objectives</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Clinical competence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.437 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.127 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Environment facilitating learning \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.305 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.065 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Communication skills \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.258 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.109 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.020 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Variables associated with overall satisfaction</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Environment facilitating learning \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.587 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.058 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Achievement of learning objectives \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.538 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.070 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab455045.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Factors associated with the learning outcomes (multivariate analysis)." ] ] 3 => array:5 [ "identificador" => "tb0005" "tipo" => "MULTIMEDIATEXTO" "mostrarFloat" => false "mostrarDisplay" => true "texto" => array:1 [ "textoCompleto" => "What we know?In recent years, the Spanish Society of Internal Medicine has made a notable effort to define the training schedule and competencies that should achieved by medical residents during their training in Internal Medicine. This study analyzes which factors correlate with the acquisition of clinical competencies.What this article provides?The intense dedication to providing care, the accountability assumed by residents, the creation of protocols for healthcare activities and integration into structured healthcare environments are associated with better acquisition of clinical competencies.The Editors" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Competencias básicas en Medicina Interna" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.M. Porcel" 1 => "J. Casademont" 2 => "P. Conthe" 3 => "B. Pinilla" 4 => "R. Pujol" 5 => "J. García-Alegría" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2011.03.003" "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2011" "volumen" => "211" "paginaInicial" => "307" "paginaFinal" => "311" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21531405" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El Libro Informático del residente de Medicina Interna: validez y fiabilidad de un cuestionario para la autoevalución de competencias en residentes de Medicina Interna" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "equipo de residentes de Medicina Interna de la Corporació Sanitària i Universitària Parc Taulí" "etal" => false "autores" => array:6 [ 0 => "J. Oristrell" 1 => "A. Casanovas" 2 => "R. Jordana" 3 => "R. Comet" 4 => "M. Gil" 5 => "J.C. Oliva" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2012.04.004" "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2012" "volumen" => "212" "paginaInicial" => "520" "paginaFinal" => "537" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22683030" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Servei de Medicina Interna Memòria 2012. Available from: <a id="intr0010" class="elsevierStyleInterRef" href="http://www.tauli.cat/tauli/cat/Lacorporacio/elscentres/HS/webs/MInterna/presentacio/activitat.htm">http://www.tauli.cat/tauli/cat/Lacorporacio/elscentres/HS/webs/MInterna/presentacio/activitat.htm</a> [accessed 26.07.13]." ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Working conditions and supervision for residents in Internal Medicine programs: recommendations. American College of Physicians" ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "1989" "volumen" => "110" "paginaInicial" => "657" "paginaFinal" => "663" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2930096" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review: effects of resident work hours on patient safety" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K.E. Fletcher" 1 => "S.Q. Davis" 2 => "W. Underwood" 3 => "R.S. Mangrulkar" 4 => "L.F. McMahon" 5 => "S. Saint" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2004" "volumen" => "141" "paginaInicial" => "851" "paginaFinal" => "857" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15583227" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "ACGME Program Requirements for Graduate Medical Education in Internal Medicine. Available from: <a id="intr0015" class="elsevierStyleInterRef" href="http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/140_internal_medicine_07012009.pdf">http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/140_internal_medicine_07012009.pdf</a> [accessed 27.07.13]." ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Duty hour recommendations and implications for meeting the ACGME core competencies: views of residency directors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.M. Antiel" 1 => "S.M. Thompson" 2 => "F.W. Hafferty" 3 => "K.M. James" 4 => "J.C. Tilburt" 5 => "M.P. Bannon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4065/mcp.2010.0635" "Revista" => array:6 [ "tituloSerie" => "Mayo Clin Proc" "fecha" => "2011" "volumen" => "86" "paginaInicial" => "185" "paginaFinal" => "191" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21307391" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of reduction in working hours for doctors in training on postgraduate medical education and patients’ outcomes: systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.R. Moonesinghe" 1 => "J. Lwery" 2 => "N. Shahi" 3 => "A. Millen" 4 => "J.D. Beard" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2011" "volumen" => "342" "paginaInicial" => "d1580" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21427046" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Impact of resident duty hours reform on the Internal Medicine core clerkship: results from the clerkship directors in Internal Medicine Survey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.R. Kogan" 1 => "R. Pinto-Powell" 2 => "L.A. Brown" 3 => "P. Hemmer" 4 => "L.M. Bellini" 5 => "D. Peltier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.ACM.0000246873.04942.a8" "Revista" => array:6 [ "tituloSerie" => "Acad Med" "fecha" => "2006" "volumen" => "81" "paginaInicial" => "1038" "paginaFinal" => "1044" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17122465" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Restricting resident work hours: the good, the bad, and the ugly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Peets" 1 => "N.T. Ayas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e3182413bc5" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2012" "volumen" => "40" "paginaInicial" => "960" "paginaFinal" => "966" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22297631" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The European working time directive. An uncontrolled experiment in medical care and education" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Axelrod" 1 => "D.J. Shah" 2 => "A.B. Jena" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2012.148065" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2013" "volumen" => "309" "paginaInicial" => "447" "paginaFinal" => "448" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23385268" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Beyond counting hours: the importance of supervision, professionalism, transitions of care, and workload in residency training" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.J. Schumacher" 1 => "S.R. Slovin" 2 => "M.P. Riebschleger" 3 => "R. Englander" 4 => "P.J. Hicks" 5 => "C. Carraccio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACM.0b013e318257d57d" "Revista" => array:6 [ "tituloSerie" => "Acad Med" "fecha" => "2012" "volumen" => "87" "paginaInicial" => "883" "paginaFinal" => "888" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22622207" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationship between resident workload and self-perceived learning on inpatient medicine wards: a longitudinal study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E.M. Haney" 1 => "C. Nicolaidis" 2 => "A. Hunter" 3 => "B.K.S. Chan" 4 => "T.G. Cooney" 5 => "J. Bowen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1472-6920-6-35" "Revista" => array:5 [ "tituloSerie" => "BMC Med Educ" "fecha" => "2006" "volumen" => "6" "paginaInicial" => "35" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16824224" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autonomy-supportive medical education: let the force be within you!" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.D. Baldwin" 1 => "M.S. Craig" 2 => "L.C. Garfunkel" 3 => "P. Harris" 4 => "L.P. Shone" 5 => "E. Biondi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACM.0b013e31826cdc3f" "Revista" => array:6 [ "tituloSerie" => "Acad Med" "fecha" => "2012" "volumen" => "87" "paginaInicial" => "1468" "paginaFinal" => "1469" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23111259" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The importance of supporting autonomy in medical education" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.C. Williams" 1 => "E.L. Deci" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "1998" "volumen" => "129" "paginaInicial" => "303" "paginaFinal" => "308" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9729184" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.M. Grimshaw" 1 => "I.T. Russell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1993" "volumen" => "342" "paginaInicial" => "1317" "paginaFinal" => "1322" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7901634" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Teaching residents established guidelines and standards of care to strengthen their cost-containment practices" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.P. Marconi" 1 => "A.L. Nager" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Manage Care" "fecha" => "2010" "volumen" => "19" "paginaInicial" => "46" "paginaFinal" => "51" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Residents find clinical practice guidelines valuable as educational and clinical tools" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Helwig" 1 => "D. Bower" 2 => "M. Wolff" 3 => "C. Guse" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Family Med" "fecha" => "1998" "volumen" => "30" "paginaInicial" => "431" "paginaFinal" => "435" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Committee opinion no. 500: professional responsibilities in obstetric-gynecologic medical education and training" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "American College of Obstetricians and Gynecologists. Committee on Ethics" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/AOG.0b013e31822c999a" "Revista" => array:6 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "2011" "volumen" => "118" "paginaInicial" => "400" "paginaFinal" => "404" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21775874" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Residents’ perspectives on the learning environment: data from the accreditation council for graduate medical education resident survey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K.D. Holt" 1 => "R.S. Miller" 2 => "I. Philibert" 3 => "J.K. Heard" 4 => "T.J. Nasca" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACM.0b013e3181ccc1db" "Revista" => array:6 [ "tituloSerie" => "Acad Med" "fecha" => "2010" "volumen" => "85" "paginaInicial" => "512" "paginaFinal" => "518" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20182130" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationship of resident characteristics, attitudes, prior training and clinical knowledge to communication skills performance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T.S. Laidlaw" 1 => "D.M. Kaufman" 2 => "H. MacLeod" 3 => "S. van Zanten" 4 => "D. Simpson" 5 => "W. Wrixon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2929.2005.02345.x" "Revista" => array:6 [ "tituloSerie" => "Med Educ" "fecha" => "2006" "volumen" => "40" "paginaInicial" => "18" "paginaFinal" => "25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16441319" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Learning in interprofessional teams: AMEE Guide no 38" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Hammick" 1 => "L. Olckers" 2 => "C. Campion-Smith" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/01421590802585561" "Revista" => array:6 [ "tituloSerie" => "Med Teach" "fecha" => "2009" "volumen" => "31" "paginaInicial" => "1" "paginaFinal" => "12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19253148" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Focus on improving relational communication skills and discussing what matters most" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Bickel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACM.0b013e31826cdd10" "Revista" => array:6 [ "tituloSerie" => "Acad Med" "fecha" => "2012" "volumen" => "87" "paginaInicial" => "1471" "paginaFinal" => "1472" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23111261" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessing competence in communication and interpersonal skills: the Kalamazoo II report" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Participants in the American Academy on Physician and Patient's Conference on Education and Evaluation of Competence in Communication and Interpersonal Skills" "etal" => false "autores" => array:5 [ 0 => "F.D. Duffy" 1 => "G.H. Gordon" 2 => "G. Whelan" 3 => "K. Cole-Kelly" 4 => "R. Frankel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acad Med" "fecha" => "2004" "volumen" => "79" "paginaInicial" => "495" "paginaFinal" => "507" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15165967" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Participants in the working conditions of surgery residents and quality of care study. Surgery resident working conditions and job satisfaction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.L. Davenport" 1 => "W.G. Henderson" 2 => "S. Hogan" 3 => "R.M. Mentzer Jr." 4 => "J.B. Zwischenberger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.surg.2008.03.038" "Revista" => array:6 [ "tituloSerie" => "Surgery" "fecha" => "2008" "volumen" => "144" "paginaInicial" => "332" "paginaFinal" => "338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18656643" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Learning, satisfaction, and mistreatment during medical internship" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.R. Duagherty" 1 => "D.C. Baldwin" 2 => "B.D. Rowley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "1998" "volumen" => "279" "paginaInicial" => "1194" "paginaFinal" => "1199" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9555759" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factores de insatisfacción de los médicos internos residentes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Ríos Zambudio" 1 => "F. Sánchez Gascón" 2 => "L. González Moro" 3 => "M. Guerrero Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin" "fecha" => "2003" "volumen" => "121" "paginaInicial" => "634" "paginaFinal" => "636" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of clinical competence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V. Wass" 1 => "C. van der Vleuten" 2 => "J. Shatzer" 3 => "R. Jones" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(00)04221-5" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2001" "volumen" => "357" "paginaInicial" => "945" "paginaFinal" => "949" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11289364" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment in medical education" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Cox" 1 => "D.M. Irby" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra054784" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2007" "volumen" => "356" "paginaInicial" => "387" "paginaFinal" => "396" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17251535" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Measuring the intensity of resident supervision in the Department of Veteran Affairs: the resident supervision index" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Byrne" 1 => "M. Kashner" 2 => "S.C. Gilman" 3 => "D.C. Aron" 4 => "G.W. Cannon" 5 => "B.K. Chang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACM.0b013e3181d5a954" "Revista" => array:6 [ "tituloSerie" => "Acad Med" "fecha" => "2010" "volumen" => "85" "paginaInicial" => "1171" "paginaFinal" => "1181" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20305532" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "The CanMEDs framework. Available from: <a id="intr0020" class="elsevierStyleInterRef" href="http://www.collaborativecurriculum.ca/en/modules/CanMEDS/CanMEDS-intro-background-01.jsp">http://www.collaborativecurriculum.ca/en/modules/CanMEDS/CanMEDS-intro-background-01.jsp</a> [accessed 26.07.13]." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000021400000001/v1_201402030902/S2254887413001185/v1_201402030902/en/main.assets" "Apartado" => array:4 [ "identificador" => "1901" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021400000001/v1_201402030902/S2254887413001185/v1_201402030902/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887413001185?idApp=WRCEE"]

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The Computer Book of The Internal Medicine Resident: Competence acquisition and achievement of learning objectives

El Libro Informático del Residente de Medicina Interna: adquisición de competencias y consecución de objetivos docentes

J. Oristrella,

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joristrell@tauli.cat

Corresponding author.

, J.C. Olivab, A. Casanovasa, R. Cometa, R. Jordanaa, M. Navarroc

a Servicio de Medicina Interna, Hospital de Sabadell, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, Spain

b Unidad de Estadística, Fundació Parc Taulí, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, Spain

c Servicio de Enfermedades Infecciosas, Hospital de Sabadell, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, Spain

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medical residents in Internal Medicine usually conduct rotations in various medical specialty departments&#44; in the Department of Internal Medicine itself and in the Emergency Department&#46; These residents are subjected to various levels of patient load&#44; responsibility&#44; organization of departments and relationships among the healthcare teams&#46; In this study&#44; we analyzed the impact these variables had on the process of acquisition of competencies for medical residents&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Materials and methods</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Construction and validation of the &#8220;Computer Book of Internal Medicine Residents&#8221; for the analysis of clinical and communication competencies</span><p id="par0040" class="elsevierStylePara elsevierViewall">The construction and validation of self-assessment questionnaires on clinical and communication competencies for Internal Medicine residents have been described previously&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> A total of 22 electronic questionnaires were designed for the self-assessment of each of the rotations of specialized training in Internal Medicine &#40;3 questionnaires for the initial rotation period for Internal Medicine&#44; 7 for the rotation period for medical specialties&#44; 6 for the senior resident rotations by specific Internal Medicine areas &#91;hospitalization&#44; doctor&#39;s office diagnostics&#44; geriatric medicine&#44; infectious diseases&#44; systemic diseases and palliative care&#93;&#44; 4 for each rotation period in the Emergency Department&#44; a general questionnaire halfway through the residency and a final self-assessment questionnaire&#41;&#46; Junior resident rotations were considered those that took place during the first 2 years of residence&#59; senior resident rotations were those that took place in the last 3 years of specialization&#46; The collection of questionnaires to complete during the training period was organized as the &#8220;Computer Book of Internal Medicine Residents&#8221; &#40;CBIMR&#41; using Microsoft Access 2000<span class="elsevierStyleSup">&#174;</span> &#40;Microsoft&#41;&#44; with restricted access to the responses by means of personal access codes&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Professional participants and study period</span><p id="par0045" class="elsevierStylePara elsevierViewall">All Department of Internal Medicine residents of the <span class="elsevierStyleItalic">Corporaci&#243; Sanitaria Parc Taul&#237;</span> &#40;Healthcare Corporation Parc Tauli&#44; CSPT&#41; &#40;20 residents&#41; participated in this study for a period of 40 months &#40;November 2009 to February 2013&#41;&#46; CSPT is a public university hospital with 714 beds serving a reference population of 394&#44;000 inhabitants&#46; The Department of Internal Medicine is accredited for the training of 5 Internal Medicine residents per year&#44; offers 4 resident tutors and has offered 3 training posts per year in the most recent sessions&#46; The department&#39;s healthcare&#44; teaching and research activity can be viewed online&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Characteristics of the departments where the rotations are conducted</span><p id="par0050" class="elsevierStylePara elsevierViewall">The questionnaires for each rotation period include various items &#40;questions&#41; referring to the characteristics of the departments where the rotation is conducted&#46; These characteristics include the healthcare activity&#44; protocolization&#44; responsibilities assumed by the resident&#44; work environment&#44; organization of the department and teamwork &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The healthcare activity is quantified using a generic question with a score between 1 and 5 &#40;&#8220;The intensity of dedication to health care was 1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>minimal&#59; 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>maximum&#8221;&#41;&#46; &#8220;Intense healthcare activity&#8221; was considered the achievement of a maximum score on this item&#46; The questionnaires included questions related to the number of medical records and discharge reports performed per week&#44; the number of patients treated in each of the most common pathologies of the rotation and the number of techniques performed &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Assumed responsibility was assessed using the item &#8220;Is your responsibility appropriate for your level of knowledge&#63;&#8221; and quantified on a scale of 1 &#40;insufficient&#41; to 5 &#40;excessive&#41;&#44; with a middle point at 3 &#40;appropriate&#41; and allowing for intermediate scores of 2 or 4&#46; The protocolization&#44; the environment that facilitates learning and the degree of organization of the department&#39;s activities were also scored on a scale of 1 &#40;minimum&#41; to 5 &#40;maximum&#41;&#44; considering the values &#8804;3 as suboptimal&#46; Finally&#44; the &#8220;teamwork&#8221; variable was obtained from the average of 3 items relating to the team included in the questionnaires for each rotation period &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; as has been previously described&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Learning outcomes</span><p id="par0055" class="elsevierStylePara elsevierViewall">For each rotation period&#44; 4 variables for the learning outcomes were analyzed&#58; clinical competence&#44; communication skills&#44; the achievement of learning objectives and overall satisfaction with the rotation&#46; The variable &#8220;clinical competence&#8221; was obtained for each rotation period by calculating the average response to items on clinical competencies specific to the rotation &#40;between 6 and 54 items&#44; depending on the type of rotation&#41;&#44; all of which were scored on a scale of 1 &#40;minimum&#41; to 5 &#40;maximum&#41;&#46; The variable &#8220;communication skills&#8221; was obtained from the average of 3 items on communication competencies common to all rotations&#44; also scored between 1 &#40;minimum&#41; and 5 &#40;maximum&#41;&#46; The description of the items on clinical and communication competencies contained in the questionnaires for each rotation&#44; as well as the reliability and validity of the CBIMR for the analysis of these competencies in Internal Medicine resident teams&#44; has been described previously&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The questionnaires for all rotation periods also included a question on the achievement of learning objectives and a question on overall satisfaction with the completed rotation&#44; both scored on a scale of 1 &#40;minimum&#41; to 5 &#40;maximum&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Association between the characteristics of the departments and learning outcomes</span><p id="par0060" class="elsevierStylePara elsevierViewall">We analyzed the association between the values of clinical competence achieved and each of the characteristics of the departments &#40;healthcare activity&#44; protocolization&#44; responsibilities assumed by the resident&#44; environment facilitating learning&#44; organization of the department and team work&#41; using bivariate descriptive analysis &#40;Student&#39;s <span class="elsevierStyleItalic">t</span>-test for the comparison of means&#59; Pearson&#39;s <span class="elsevierStyleItalic">r</span> for the correlation between numerical variables&#41;&#46; Given that the items included to derive the variable &#8220;clinical competence&#8221; differ according to the type of rotation&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> we performed a subanalysis of these associations taking into account only the rotations by the Department of Internal Medicine&#46; We also analyzed the associations between the rest of the variables of learning outcomes &#40;communication skills&#44; the achievement of learning objectives and overall satisfaction with the rotation&#41; and the characteristics of the departments using bivariate analyses&#46; Finally&#44; we performed a multiple linear regression analysis to identify the characteristics of the departments&#44; which were independently associated with each of the learning outcomes&#46; In these multivariate models&#44; we included the variables that had shown a significant association in the bivariate analysis&#44; as well as variables such as the seniority of the resident &#40;senior versus junior&#41; or the type of rotation &#40;Internal Medicine versus other departments&#41;&#46; All statistical analyses were performed with the IBM SPSS<span class="elsevierStyleSup">&#174;</span> statistical package &#40;version 21&#46;0&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">A total of 176 entries were recorded in the CBIMR of the 238 registries to have been completed during the study period &#40;73&#46;9&#37; response rate&#41;&#44; corresponding to a self-assessment&#44; by 20 medical residents of Internal Medicine&#44; from 166 rotations &#40;68 rotations in medical specialties&#44; 71 assessments of rotation periods in Internal Medicine and 27 assessments of rotation periods in emergency departments&#41;&#46; The 10 remaining entries corresponded to overall assessments at the midpoint &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41; or end of the residency &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#46; In total&#44; 84 entries for senior residents &#40;74&#46;3&#37; response rate&#41; and 92 entries for junior residents &#40;73&#46;6&#37; response rate&#41; were recorded&#46; The mean and standard deviation values for each item of healthcare activity&#44; protocolization&#44; work environment&#44; assumed responsibility&#44; teamwork and learning outcomes are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Factors associated with the acquisition of clinical competencies</span><p id="par0070" class="elsevierStylePara elsevierViewall">The values for clinical competence were significantly higher for senior residents than for junior residents&#44; both when analyzing all rotations &#40;3&#46;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;69 vs&#46; 3&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;60&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;008&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41; and when specifically analyzing the rotations through the Department of Internal Medicine &#40;3&#46;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;60 vs&#46; 3&#46;34<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;69&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;04&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Healthcare activity</span><p id="par0075" class="elsevierStylePara elsevierViewall">The acquisition of clinical competencies was not associated with the number of medical records or discharge reports performed per week&#44; the number of patients treated or the total number of techniques performed&#44; but it was associated with the generic variable &#8220;the intensity of the healthcare dedication was 1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>minimal&#59; 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>maximum&#8221; &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;46&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; This association was also observed when analyzing only the junior resident entries &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;29&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#44; the senior resident entries &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;59&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; or the entries of the rotations through the Department of Internal Medicine &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;28&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; The healthcare activity in 33&#46;5&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>59&#41; of the rotations was categorized as &#8220;intense healthcare activity&#8221; &#40;maximum score of 5&#41;&#46; These rotations represent 23&#46;3&#37; of the entries of the rotations through Internal Medicine by junior residents&#44; 25&#46;4&#37; of the rotations through medical specialties&#44; 43&#46;6&#37; of the rotations through Internal Medicine by senior residents and 69&#46;2&#37; of the rotations through the Emergency department&#46; Intense healthcare activity was significantly associated with a greater acquisition of clinical competencies &#40;3&#46;82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;62 vs&#46; 3&#46;34<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;60&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Similar results were obtained when analyzing only the rotations through hospital units&#44; excluding the rotations through the Emergency department &#40;3&#46;82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;51 vs&#46; 3&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;60&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; or when analyzing only the rotations through the Department of Internal Medicine &#40;3&#46;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;57 vs&#46; 3&#46;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;65&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;06&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Protocolization</span><p id="par0080" class="elsevierStylePara elsevierViewall">The mean protocolization of the departments was assessed at 3&#46;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;87 points on a scale from 1 to 5&#46; Some 27&#46;7&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>44&#41; of the rotations took place in departments whose protocolization was judged suboptimal &#40;score &#8804;3&#41;&#46; This occurred in 37&#37; of the entries of rotations through Internal Medicine by junior residents&#44; in 34&#46;8&#37; of the rotations through medical specialties&#44; in 20&#37; of the rotations through the Emergency department and in 14&#46;6&#37; of the rotations through Internal Medicine of senior residents&#46; The protocolization of the departments was associated with a greater acquisition of clinical competencies &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;52&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Similar correlations were obtained when separately analyzing the rotations of junior residents &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;63&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; senior residents &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;48&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and rotations that took place in the Department of Internal Medicine of &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;41&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Resident responsibility</span><p id="par0085" class="elsevierStylePara elsevierViewall">The responsibility assumed by the resident was assessed at 3&#46;44<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;72 points and was similar for senior and junior residents &#40;3&#46;49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;73 and 3&#46;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;72&#44; respectively&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;50&#41;&#46; In 10&#46;8&#37; of the rotations&#44; the residents considered their assumed responsibilities to be excessive &#40;score maximum of 5&#41;&#46; These rotations more often corresponded to training periods in Internal Medicine for senior residents &#40;17&#46;9&#37; of these rotations&#41; or to rotation periods in medical specialties &#40;11&#46;9&#37; of rotations through specialties&#41;&#44; registering in only 6&#46;7&#37; of the rotations through Internal Medicine for junior residents or in 8&#46;3&#37; of the rotations through the Emergency department&#46; The greater assumption of responsibility was associated with a greater acquisition of clinical competencies &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;23&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;006&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; This correlation was also observed when analyzing separately the rotations conducted in Internal Medicine &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;38&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;009&#41;&#46; Similarly&#44; the assumption of excessive responsibilities was associated with a greater acquisition of clinical competencies in all rotations &#40;3&#46;94<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;71 vs&#46; 3&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;61&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41;&#44; as well as in the rotations through Internal Medicine &#40;4&#46;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;67 vs&#46; 3&#46;57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;62&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;03&#41;&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Organization of departments&#44; work environment and teamwork</span><p id="par0090" class="elsevierStylePara elsevierViewall">The organization of the departments was assessed at a mean of 3&#46;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;07 points&#46; Some 34&#46;2&#37; of the rotations took place in departments whose organization was judged suboptimal &#40;score &#8804;3&#41;&#46; This occurred in 56&#46;2&#37; of the rotations through the Emergency department&#44; in 50&#46;0&#37; of the rotations through medical specialties&#44; in 18&#46;7&#37; of the rotations through Internal Medicine by senior residents and in none of the entries for Internal Medicine by junior residents&#46; The item referring to the organization of the department was not correlated with the clinical competence variable &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;17&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;18&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; although suboptimal organization was associated with inferior results in clinical competence &#40;3&#46;24<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;60 vs&#46; 3&#46;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;58&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;04&#41;&#46; A significant correlation was observed between the organization of the departments and the acquisition of clinical competencies when separately analyzing the rotations through the Department of Internal Medicine &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;56&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46; The presence of an environment that facilitated learning was correlated with the acquisition of clinical competencies&#44; both when analyzing all rotations &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;47&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41; and when examining only the rotations through the Department of Internal Medicine &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;54&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Finally&#44; teamwork was also associated with a greater acquisition of clinical competencies&#44; both when analyzing all rotations &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;58&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41; and when examining only the rotations through the Department of Internal Medicine &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;59&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Continuing education activities</span><p id="par0095" class="elsevierStylePara elsevierViewall">Attendance at clinical sessions&#44; medical literature sessions and the presentation of sessions was very high in all rotations &#40;88&#46;5&#37;&#44; 82&#46;6&#37; and 70&#46;6&#37;&#44; respectively&#41;&#46; Only attendance at medical literature sessions was associated with a greater acquisition of clinical competencies &#40;3&#46;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;62 vs&#46; 3&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;56&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;03&#41;&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Multivariate analysis</span><p id="par0100" class="elsevierStylePara elsevierViewall">In the multivariate analysis&#44; resident seniority&#44; a greater healthcare activity&#44; protocolization&#44; the assumption of responsibilities and an environment facilitating learning were the independent factors associated with the acquisition of clinical competencies &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Factors associated with the acquisition of communication competencies</span><p id="par0105" class="elsevierStylePara elsevierViewall">The values for communication skills were significantly higher in senior residents than in junior residents &#40;4&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;66 vs&#46; 3&#46;87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;69&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; A significant association was observed between the intensity of healthcare activity &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;40&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; the facilitating environment &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;38&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; protocolization &#40;0&#46;52&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and teamwork &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;64&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; on one hand and communication competencies on the other &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Communication skills were also significantly correlated with clinical competence &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;70&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; in both the entries corresponding to senior residents and those of junior residents&#46; The multivariate analysis showed that teamwork&#44; greater clinical competence and seniority were factors that were independently associated higher self-assessments in communication skills &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Factors associated with the achievement of learning objectives</span><p id="par0110" class="elsevierStylePara elsevierViewall">Greater healthcare activity &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;49&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; department protocolization &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;61&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; greater assumption of responsibilities &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;21&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#44; department organization &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;46&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; an environment facilitating learning &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;59&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; teamwork &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;63&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; the acquisition of clinical competencies &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;66&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and the acquisition of communication skills &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;56&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; were significantly correlated with the achievement of learning objectives &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; In the analysis multivariate&#44; the acquisition of clinical and communication competencies and an environment facilitating learning were significantly associated with the achievement of learning objectives &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Factors associated with resident satisfaction</span><p id="par0115" class="elsevierStylePara elsevierViewall">Overall satisfaction with the rotation was correlated with the understanding of rotation objectives &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;48&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; the achievement of these objectives &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;76&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; an environment facilitating learning &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;82&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; teamwork &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;60&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; the intensity of the healthcare activity &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;37&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; the degree of protocolization &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;54&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; department organization &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;62&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and the level of clinical &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;48&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and communication competencies acquired &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;46&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; In the multivariate analysis&#44; overall satisfaction with the rotation was associated with an environment that facilitated learning and with the achievement of learning objectives &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p></span></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">In our study&#44; intense healthcare activity&#44; the assumption of responsibilities&#44; the protocolization of diseases and an environment that facilitated learning were the key factors correlated with clinical competencies&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The intensity of the healthcare activity was one of the variables that most influenced the acquisition of clinical competencies by the medical residents&#46; To date&#44; most studies on this issue have focused on the effects of intense healthcare dedication on resident fatigue and&#44; as a result&#44; on medical errors and patient safety&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> Based on these observations&#44; European and American laws adopted various provisions to limit the work hours of medical residents&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> thus creating intense controversy about the possibility that reducing this schedule could result in decreased clinical competence in future specialists&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;11</span></a> In our study&#44; the acquisition of clinical competencies was correlated with intense healthcare activity but not with the number of patients treated&#46; These results could due to the fact that the acquisition of clinical competencies is more related&#44; in reality&#44; with qualitative aspects of healthcare work&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> Care for more complex patients or simply the more exhaustive clinical approaches could be qualified by the resident as intense healthcare activity&#44; without necessarily having the resident care for a high number of patients&#46; The association that we observed between the intensity of the healthcare work and the acquisition of clinical competencies was a linear correlation&#46; Therefore&#44; our results do not confirm the hypothesis of Have et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> which states that the relationship between healthcare activity and the acquisition of clinical competencies follows an inverted &#8220;U&#8221; distribution&#44; with a progressive increase in the acquisition of competencies as the healthcare activity increases&#44; until it reaches a maximum&#44; followed by a decrease in acquisition of competencies under conditions of maximum healthcare activity&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">As has been remarked by various authors&#44;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a> another element that influences the acquisition of clinical competencies by medical residents is their level of responsibility in patient care&#46; In Spain&#44; specialized healthcare training through the resident medical intern system allows for a progressive assumption of responsibilities by the doctors in training&#44; ensuring the necessary learning by the physician and the safety of the patient&#46; Although a small percentage of residents considered the degree of assumed responsibility excessive in some of their rotations&#44; our results suggest that&#44; if patient safety is ensured&#44; increased accountability and autonomy of residents facilitate the acquisition of clinical competencies&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In our study&#44; the rotations in departments with greater levels of protocolization were associated with higher levels of clinical competence&#46; It is known that protocolization reduces the variability in clinical practice and facilitates the application of more cost-effective treatments&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a> However&#44; few studies have been published that analyze how the growing number of clinical practice guidelines and protocols affect the learning process of new doctors&#46; In general&#44; medical residents tend to positively assess clinical practice guidelines given that they increase the residents&#8217; self-confidence&#59; however&#44; residents often have difficulties in critically assessing and using them properly&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Our study was based on self-assessment questionnaires and&#44; therefore&#44; the items on clinical competence &#40;such as the question &#8220;Do you consider yourself sufficiently competent to handle patients with septic shock&#8221;&#41; reference the subjective perception of feeling competent to handle certain medical problems&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> i&#46;e&#46;&#44; our items on clinical competence actually measured the resident&#39;s self-confidence in clinical management&#46; The correlation observed between protocolization and clinical competence could therefore be due to the effect that protocolization has on resident self-confidence&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Various professional societies and medical accreditation organizations have highlighted the need for a proper work environment to facilitate learning during specialized medical training&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;19&#44;20</span></a> This would include various aspects such as appropriate physical spaces for healthcare and teaching tasks&#44; adequate organization of departments and facilities for team work&#46; Our results support the importance of a work environment in the acquisition of clinical competencies&#44; in the achievement of learning objectives and in the overall satisfaction with the rotation conducted&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Clinical competence&#44; teamwork and seniority were&#44; in our experience&#44; the variables most associated with the acquisition of communication competencies&#46; The association between clinical and communication competencies has been previously documented in a study using medical examinations with structured objectives&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Teamwork was also strongly associated with communication competencies&#46; This correlation could be due to the fact that communication competencies&#44; as has been described&#44; facilitate team work<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> or that&#44; vice versa&#44; team work facilitates the acquisition of communication skills&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> In our opinion&#44; it is likely that certain skills&#44; such as knowing how to listen and being empathic&#44; are common in effective communication and for working in a team&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;24</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Lastly&#44; in our study&#44; the end-points associated with high satisfaction in the rotation were an environment that facilitated learning and the achievement of learning objectives&#46; Both end-points have been previously indicated as important factors for the satisfaction of medical residents&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#8211;27</span></a>It is important to highlight that the strengths of our study include the fact that this is a prospective study based on computerized questionnaires that were previously validated for the analysis of the acquisition of clinical and communication competencies during the training of Internal Medicine residents&#46; Moreover&#44; the rate of involvement was very high&#44; over 70&#37; for both senior and junior residents&#44; which minimizes the possibility of selection biases&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Among the limitations&#44; it is worth indicating that our study is based on self-assessment questionnaires&#44; which are probably less reliable for studying competencies than other techniques such as multiple-choice examinations&#44; objective structured clinical examinations&#44; mini-clinical evaluation exercises &#40;mini-CEX&#41; and the 360-degree feedback&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a> In a previous study&#44; we were able to demonstrate that self-assessments allow for the analysis of competence acquisition by teams of residents&#44; although this methodology was not useful for the interindividual comparison of these residents&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> We were also unable to include in the analysis a number of issues that could have had an impact on the acquisition of competencies&#44; such as the degree of supervision by the head physician and&#47;or tutor<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> or the attendance at training courses&#46; We were also unable to analyze the acquisition of other competencies necessary for professional development in Internal Medicine&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> such as research competencies&#44; professional competencies and resource management&#44; despite the fact that the questionnaires included various items on these issues&#46; Our study was conducted at a single center&#44; and therefore we cannot ensure that the results can be extrapolated to other healthcare settings&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In conclusion&#44; there are various factors that are related to the operation of departments&#44; which are potentially modifiable and that significantly influence the acquisition of clinical and communication competencies and the achievement of learning objectives of medical residents&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Authorship</span><p id="par0170" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Concept and design of the manuscript&#58; J&#46; Oristrell&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Data collection&#58; J&#46;<span class="elsevierStyleSmallCaps">C</span>&#46; Oliva and J&#46; Oristrell&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0185" class="elsevierStylePara elsevierViewall">Data analysis and interpretation&#58; J&#46;C&#46; Oliva and J&#46; Oristrell&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Drafting&#44; review and approval of the submitted manuscript&#58; J&#46; Oristrell&#44; J&#46;C&#46; Oliva&#44; A&#46; Casanovas&#44; R&#46; Comet&#44; R&#46; Jordana and M&#46; Navarro&#46;</p></li></ul></p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Conflicts of interest</span><p id="par0195" class="elsevierStylePara elsevierViewall">Dr&#46; J&#46; Oristrell&#44; A&#46; Casanovas&#44; R&#46; Jordana and R&#46; Comet &#40;as developers&#41; and the <span class="elsevierStyleItalic">Fundaci&#243; Pair Tau</span> &#40;Sponsor&#41; are co-owners of the software program CBIMR used in this study&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The Computer Book of the Internal Medicine resident &#40;CBIMR&#41; is a computer program that was validated to analyze the acquisition of competences in teams of Internal Medicine residents&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To analyze the characteristics of the rotations during the Internal Medicine residency and to identify the variables associated with the acquisition of clinical and communication skills&#44; the achievement of learning objectives and resident satisfaction&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">All residents of our service &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41; participated in the study during a period of 40 months&#46; The CBIMR consisted of 22 self-assessment questionnaires specific for each rotation&#44; with items on services &#40;clinical workload&#44; disease protocolization&#44; resident responsibilities&#44; learning environment&#44; service organization and teamwork&#41; and items on educational outcomes &#40;acquisition of clinical and communication skills&#44; achievement of learning objectives&#44; overall satisfaction&#41;&#46; Associations between services features and learning outcomes were analyzed using bivariate and multivariate analysis&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">An intense clinical workload&#44; high resident responsibilities and disease protocolization were associated with the acquisition of clinical skills&#46; High clinical competence and teamwork were both associated with better communication skills&#46; Finally&#44; an adequate learning environment was associated with increased clinical competence&#44; the achievement of educational goals and resident satisfaction&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Potentially modifiable variables related with the operation of clinical services had a significant impact on the acquisition of clinical and communication skills&#44; the achievement of educational goals&#44; and resident satisfaction during the specialized training in Internal Medicine&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El Libro Inform&#225;tico del Residente de Medicina Interna es un programa que ha sido validado para cuantificar la adquisici&#243;n de competencias durante el periodo de formaci&#243;n en Medicina Interna&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Este estudio se propone analizar las caracter&#237;sticas de las rotaciones durante la formaci&#243;n en Medicina Interna e identificar las variables asociadas con la adquisici&#243;n de competencias cl&#237;nicas y comunicativas&#44; la consecuci&#243;n de los objetivos docentes y la satisfacci&#243;n del residente&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Participaron todos los residentes de nuestro servicio &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41; durante un per&#237;odo de 40 meses&#46; El Libro Inform&#225;tico del Residente de Medicina Interna est&#225; constituido por 22 cuestionarios de autoevaluaci&#243;n espec&#237;ficos para cada per&#237;odo de rotaci&#243;n&#44; con &#237;tems referentes a las caracter&#237;sticas de los servicios d&#243;nde se desarroll&#243; la rotaci&#243;n y a los resultados docentes &#40;competencia cl&#237;nica y comunicativa&#44; consecuci&#243;n de los objetivos docentes y satisfacci&#243;n global&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La dedicaci&#243;n asistencial intensa&#44; con elevada responsabilizaci&#243;n del residente y la protocolizaci&#243;n se asociaron a una mayor adquisici&#243;n de competencias cl&#237;nicas&#46; Una elevada competencia cl&#237;nica y el trabajo en equipo se asociaron a mejores resultados en habilidades comunicativas&#46; Finalmente&#44; un entorno facilitador para el aprendizaje se asoci&#243; a mayor competencia cl&#237;nica&#44; mayor consecuci&#243;n de los objetivos docentes y mayor satisfacci&#243;n global&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Diversos factores relacionados con el funcionamiento de los servicios influyeron de forma significativa en la adquisici&#243;n de competencias&#44; la consecuci&#243;n de los objetivos docentes y la satisfacci&#243;n de los m&#233;dicos residentes durante la formaci&#243;n especializada en Medicina Interna&#46;</p>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Oristrell J&#44; Oliva JC&#44; Casanovas A&#44; Comet R&#44; Jordana R&#44; Navarro M&#46; El Libro Inform&#225;tico del Residente de Medicina Interna&#58; adquisici&#243;n de competencias y consecuci&#243;n de objetivos docentes&#46; Rev Clin Esp&#46; 2014&#59;214&#58;8&#8211;16&#46;</p>"
      ]
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      0 => array:7 [
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviation</span>&#58; SD&#44; standard deviation&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Items on healthcare activity</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Common to all rotations</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; The intensity of the healthcare dedication has been &#40;1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>minimal&#59; 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>maximum&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;1 &#40;0&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; Approximate no&#46; of patients treated &#40;total diseases&#44; by rotation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">115&#46;7 &#40;95&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; Approximate no&#46; of shifts&#47;month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;4 &#40;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Specifics of certain rotations</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; Approximate no&#46; of medical records in hospitalization&#47;week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;7 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; Approximate no&#46; of discharge reports in hospitalization&#47;week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;8 &#40;2&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; Approximate no&#46; of first visits in outpatient office per week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;9 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; No&#46; of emergency visits attended daily &#40;emergency department rotation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;2 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; Approximate no&#46; of requested autopsies &#40;by rotation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;3 &#40;0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; No&#46; of thoracentesis procedures &#40;by rotation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;6 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; No&#46; of paracentesis procedures &#40;by rotation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;5 &#40;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; No&#46; of arthrocentesis procedures &#40;by rotation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;05 &#40;0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; No&#46; of peripheral routes &#40;by rotation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;1 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; No&#46; of arterial blood gas analyses &#40;by rotation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;7 &#40;2&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; No&#46; of arterial catheterizations &#40;by rotation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;3 &#40;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; No&#46; of subclavian lines inserted &#40;by rotation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;05 &#40;0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; No&#46; of jugular lines inserted &#40;by rotation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2 &#40;0&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; No&#46; of urinary catheters &#40;by rotation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;03 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; No&#46; of lumbar punctures &#40;by rotation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;0 &#40;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; No&#46; of cardiopulmonary resuscitations performed &#40;by rotation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;6 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; No&#46; of endotracheal intubations &#40;by rotation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;3 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8226; No&#46; of tumor punctures or adenopathies &#40;by rotation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;05 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Protocolization item</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Do you have information to help direct decisions -protocols-&#63; &#40;1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>minimum&#59; 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>maximum&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;9 &#40;0&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Work environment item</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; In your opinion&#44; does the environment facilitate learning&#63; &#40;1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>minimum&#59; 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>maximum&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;0 &#40;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Department organization item</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; What is your assessment of the department&#39;s organization&#63; &#40;1&#61;minimum&#59; 5&#61;maximum&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;7 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Responsibility item</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Are your responsibilities appropriate for your knowledge level&#63; &#40;1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>insufficient&#59; 3<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>sufficient&#59; 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>excessive&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;4 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Team work item</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; How would you assess your relationship with the medical team&#63; &#40;1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>minimum&#59; 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>maximum&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;3 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; How would you assess your relationship with the nursing team&#63; &#40;1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>minimum&#59; 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>maximum&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;1 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Do you feel integrated in the team&#63; &#40;1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>minimum&#59; 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>maximum&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;3 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Learning outcomes item</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Clinical competence &#40;1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>minimum&#59; 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>maximum&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;5 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Skills communication &#40;1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>minimum&#59; 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>maximum&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;0 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Achievement of learning objectives &#40;1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>minimum&#59; 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>maximum&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;7 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Are you satisfied overall with the rotation&#63; &#40;1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>minimum&#59; 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>maximum&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;0 &#40;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Items on healthcare activity&#44; protocolization&#44; work environment&#44; organization&#44; assumed responsibility&#44; team work and learning outcomes&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviation</span>&#58; SD&#44; standard deviation&#59; NS&#44; not significant&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Acquisition of clinical competence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Acquisition of communication competence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Achievement of learning objectives&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Overall satisfaction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Resident seniority</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Senior residents&#59; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;65 &#40;0&#46;69&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;22 &#40;0&#46;66&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;71 &#40;0&#46;85&#41; NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;86 &#40;1&#46;15&#41; NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Junior residents&#59; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;35 &#40;0&#46;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;87 &#40;0&#46;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;61 &#40;0&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;11 &#40;0&#46;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Healthcare activity&#59; Pearson&#39;s r</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;46<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;40<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;49<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;37<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Activity &#40;quantified&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Medical Histories&#47;week&#59; Pearson&#39;s <span class="elsevierStyleItalic">r</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;17<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;22<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;24<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Discharge reports&#47;week&#59; Pearson&#39;s <span class="elsevierStyleItalic">r</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total no&#46; of patients treated&#59; Pearson&#39;s <span class="elsevierStyleItalic">r</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total no&#46; of techniques performed&#59; Pearson&#39;s <span class="elsevierStyleItalic">r</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;52<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;61<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Responsibility assumed&#59; Pearson&#39;s r</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;21<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Department organization&#59; Pearson&#39;s r</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;46<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;62<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Work environment&#59; Pearson&#39;s r</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;38<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;59<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Team work&#59; Pearson&#39;s r</span>&nbsp;\t\t\t\t\t\t\n
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              "identificador" => "bib0040"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of reduction in working hours for doctors in training on postgraduate medical education and patients&#8217; outcomes&#58; systematic review"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;R&#46; Moonesinghe"
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                            2 => "N&#46; Shahi"
                            3 => "A&#46; Millen"
                            4 => "J&#46;D&#46; Beard"
                          ]
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                    0 => array:1 [
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                        "tituloSerie" => "BMJ"
                        "fecha" => "2011"
                        "volumen" => "342"
                        "paginaInicial" => "d1580"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21427046"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0045"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Impact of resident duty hours reform on the Internal Medicine core clerkship&#58; results from the clerkship directors in Internal Medicine Survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;R&#46; Kogan"
                            1 => "R&#46; Pinto-Powell"
                            2 => "L&#46;A&#46; Brown"
                            3 => "P&#46; Hemmer"
                            4 => "L&#46;M&#46; Bellini"
                            5 => "D&#46; Peltier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.ACM.0000246873.04942.a8"
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                        "tituloSerie" => "Acad Med"
                        "fecha" => "2006"
                        "volumen" => "81"
                        "paginaInicial" => "1038"
                        "paginaFinal" => "1044"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17122465"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0050"
              "etiqueta" => "10"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Restricting resident work hours&#58; the good&#44; the bad&#44; and the ugly"
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                        0 => array:2 [
                          "etal" => false
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                            0 => "A&#46; Peets"
                            1 => "N&#46;T&#46; Ayas"
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e3182413bc5"
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                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2012"
                        "volumen" => "40"
                        "paginaInicial" => "960"
                        "paginaFinal" => "966"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22297631"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            10 => array:3 [
              "identificador" => "bib0055"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The European working time directive&#46; An uncontrolled experiment in medical care and education"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Axelrod"
                            1 => "D&#46;J&#46; Shah"
                            2 => "A&#46;B&#46; Jena"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2012.148065"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2013"
                        "volumen" => "309"
                        "paginaInicial" => "447"
                        "paginaFinal" => "448"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23385268"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            11 => array:3 [
              "identificador" => "bib0060"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Beyond counting hours&#58; the importance of supervision&#44; professionalism&#44; transitions of care&#44; and workload in residency training"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46;J&#46; Schumacher"
                            1 => "S&#46;R&#46; Slovin"
                            2 => "M&#46;P&#46; Riebschleger"
                            3 => "R&#46; Englander"
                            4 => "P&#46;J&#46; Hicks"
                            5 => "C&#46; Carraccio"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ACM.0b013e318257d57d"
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                        "tituloSerie" => "Acad Med"
                        "fecha" => "2012"
                        "volumen" => "87"
                        "paginaInicial" => "883"
                        "paginaFinal" => "888"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22622207"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relationship between resident workload and self-perceived learning on inpatient medicine wards&#58; a longitudinal study"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            1 => "C&#46; Nicolaidis"
                            2 => "A&#46; Hunter"
                            3 => "B&#46;K&#46;S&#46; Chan"
                            4 => "T&#46;G&#46; Cooney"
                            5 => "J&#46; Bowen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1472-6920-6-35"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Med Educ"
                        "fecha" => "2006"
                        "volumen" => "6"
                        "paginaInicial" => "35"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16824224"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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            13 => array:3 [
              "identificador" => "bib0070"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Autonomy-supportive medical education&#58; let the force be within you&#33;"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;D&#46; Baldwin"
                            1 => "M&#46;S&#46; Craig"
                            2 => "L&#46;C&#46; Garfunkel"
                            3 => "P&#46; Harris"
                            4 => "L&#46;P&#46; Shone"
                            5 => "E&#46; Biondi"
                          ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ACM.0b013e31826cdc3f"
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                        "tituloSerie" => "Acad Med"
                        "fecha" => "2012"
                        "volumen" => "87"
                        "paginaInicial" => "1468"
                        "paginaFinal" => "1469"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23111259"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The importance of supporting autonomy in medical education"
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                        0 => array:2 [
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                          "autores" => array:2 [
                            0 => "G&#46;C&#46; Williams"
                            1 => "E&#46;L&#46; Deci"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "1998"
                        "volumen" => "129"
                        "paginaInicial" => "303"
                        "paginaFinal" => "308"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9729184"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of clinical guidelines on medical practice&#58; a systematic review of rigorous evaluations"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;M&#46; Grimshaw"
                            1 => "I&#46;T&#46; Russell"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "Lancet"
                        "fecha" => "1993"
                        "volumen" => "342"
                        "paginaInicial" => "1317"
                        "paginaFinal" => "1322"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7901634"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Teaching residents established guidelines and standards of care to strengthen their cost-containment practices"
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                          "etal" => false
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                            0 => "G&#46;P&#46; Marconi"
                            1 => "A&#46;L&#46; Nager"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Manage Care"
                        "fecha" => "2010"
                        "volumen" => "19"
                        "paginaInicial" => "46"
                        "paginaFinal" => "51"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Residents find clinical practice guidelines valuable as educational and clinical tools"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Helwig"
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                            2 => "M&#46; Wolff"
                            3 => "C&#46; Guse"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "Family Med"
                        "fecha" => "1998"
                        "volumen" => "30"
                        "paginaInicial" => "431"
                        "paginaFinal" => "435"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Committee opinion no&#46; 500&#58; professional responsibilities in obstetric-gynecologic medical education and training"
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                        0 => array:2 [
                          "colaboracion" => "American College of Obstetricians and Gynecologists&#46; Committee on Ethics"
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                        "tituloSerie" => "Obstet Gynecol"
                        "fecha" => "2011"
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                        "paginaInicial" => "400"
                        "paginaFinal" => "404"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21775874"
                            "web" => "Medline"
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                ]
              ]
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            19 => array:3 [
              "identificador" => "bib0100"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Residents&#8217; perspectives on the learning environment&#58; data from the accreditation council for graduate medical education resident survey"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            3 => "J&#46;K&#46; Heard"
                            4 => "T&#46;J&#46; Nasca"
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Acad Med"
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                        "paginaFinal" => "518"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20182130"
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                ]
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            ]
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              "identificador" => "bib0105"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Relationship of resident characteristics&#44; attitudes&#44; prior training and clinical knowledge to communication skills performance"
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                    0 => array:2 [
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                        "tituloSerie" => "Med Educ"
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                        "volumen" => "40"
                        "paginaInicial" => "18"
                        "paginaFinal" => "25"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16441319"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
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              "identificador" => "bib0110"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Learning in interprofessional teams&#58; AMEE Guide no 38"
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                    0 => array:2 [
                      "doi" => "10.1080/01421590802585561"
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                        "tituloSerie" => "Med Teach"
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                        "volumen" => "31"
                        "paginaInicial" => "1"
                        "paginaFinal" => "12"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19253148"
                            "web" => "Medline"
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                    ]
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                ]
              ]
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              "identificador" => "bib0115"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Focus on improving relational communication skills and discussing what matters most"
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                    0 => array:2 [
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                        "tituloSerie" => "Acad Med"
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                        "volumen" => "87"
                        "paginaInicial" => "1471"
                        "paginaFinal" => "1472"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23111261"
                            "web" => "Medline"
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                    ]
                  ]
                ]
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              "identificador" => "bib0120"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Assessing competence in communication and interpersonal skills&#58; the Kalamazoo II report"
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                            4 => "R&#46; Frankel"
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                    ]
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                  "host" => array:1 [
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                        "tituloSerie" => "Acad Med"
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                        "paginaInicial" => "495"
                        "paginaFinal" => "507"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15165967"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Participants in the working conditions of surgery residents and quality of care study&#46; Surgery resident working conditions and job satisfaction"
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                        0 => array:2 [
                          "etal" => false
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                            3 => "R&#46;M&#46; Mentzer Jr&#46;"
                            4 => "J&#46;B&#46; Zwischenberger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.surg.2008.03.038"
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                        "tituloSerie" => "Surgery"
                        "fecha" => "2008"
                        "volumen" => "144"
                        "paginaInicial" => "332"
                        "paginaFinal" => "338"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18656643"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Learning&#44; satisfaction&#44; and mistreatment during medical internship"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;R&#46; Duagherty"
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                            2 => "B&#46;D&#46; Rowley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1998"
                        "volumen" => "279"
                        "paginaInicial" => "1194"
                        "paginaFinal" => "1199"
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                        "paginaFinal" => "949"
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Article information

ISSN: 22548874
Original language: English

DOI:10.1016/j.rceng.2013.09.003

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