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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The COVID-19 pandemic has posed a massive challenge for not only the healthcare system but also for the medical profession&#44; bringing to light the need for a long-awaited and unavoidable reform to adapt it to the 21st century&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Also imperative&#44; however&#44; is a more profound change in the implicit social contract between health professionals and society&#46; That is&#44; what patients and society expect from the medical profession&#44; and what the latter can expect to find in society&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We come from a thousand-year-old tradition in which the implicit contract&#44; in the words of Jovell<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#44; &#8220;meant that society granted the medical profession a special status and recognition that distinguished it from other professions&#44; and which should imply a higher salary and the power to self-regulate&#8221;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">However&#44; in these terms&#44; it is necessary to question whether this implicit contract is still valid for our current society and&#44; above all&#44; whether it is useful for tackling future challenges&#46; The professional values required&#44; which arise from social change and the bioethical gaze&#44; have been redefined by the social commitment&#44; affectivity and empathy&#44; respect for patient autonomy&#44; commitment to public health&#44; commitment to the environment&#44; advances in medical science&#44; the transfer of knowledge&#44; skills&#44; and attitudes&#44; and the self-regulating nature of the profession<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The previous contract no longer matches the current context of the highly corporatized professional practice&#44; within bureaucratized health organisations&#44; with the centralised management&#44; limitations to professional autonomy&#44; demanding care pressure&#44; disgraceful job insecurity among young people&#44; and low salaries&#46; All of which is associated with disproportionate expectations from society in relation to the possibilities&#44; availability&#44; and access to health care&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Smith<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> spoke about the &#8220;bogus contract&#8221; according to which patients and society expect doctors to provide solutions &#40;bordering on miracles&#41; to all kinds of problems&#44; with low acceptance of finiteness and death&#44; while assuming that doctors have higher status and incomes&#46; This same author called for a new contract that addresses illness&#44; death&#44; and pain as part of life&#44; in which medicine has some&#44; yet limited powers of intervention&#44; which accepts that doctors are not infallible and also need support&#44; and which refrains from extravagant political promises and the demagogy of unlimited power without obligations&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The &#8220;mismatch&#8221; between the implicit contract &#40;what society and people expect from doctors&#41;&#44; and the explicit contract &#40;contractual and labour conditions of professional practice&#41; could be the reason behind the growing unhappiness&#44; or burnout&#44; in the medical profession which includes a large percentage of burnt out&#44; exhausted&#44; and unmotivated professionals<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The consequences of major burnout are significant both professionally&#44; with poorer quality of care&#44; more medical errors&#44; or worse care as perceived by the patient&#44; and personally&#44; with lower levels of empathy&#44; poorer quality of life&#44; job dissatisfaction&#44; or increased risk to mental health in general<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;7</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ofri<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> mentioned that this unhappiness is more profound than the standard definition of burnout&#58; &#8220;The despair I see amongst our colleagues today&#44; however&#44; is more than just burnout&#46; It is a betrayal of trust&#44; the trust we gave to our own profession&#8221;&#46; The burnout epidemic is more related to doctors&#8217; disappointment with the current&#44; industrialised professional practice and the heightened demands of the system that go beyond the provision of care on its own&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In the midst of this&#44; the COVID-19 pandemic arrived&#46; Health professionals have responded to the increased demand in an exemplary manner&#44; according to the outdated contract&#44; with noble displays of altruism and generally going beyond the call of duty&#44; including taking on the risk of infection with insufficient protection&#44; accepting flexible scheduling&#44; working outside their specialisations&#44; and fulfilling uncustomary organisational and care roles&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The pandemic has clearly and obviously exposed the imbalances and asymmetry between the fulfilment of the two parts of the social contract&#46; It has also brought to light how this discrepancy has entailed a high cost to health professionals&#44; from the physical&#44; psychological&#44; or ethical perspective&#44; which is added to the previous hardships&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">However&#44; the pandemic can also represent a turning point and redefining moment for the healthcare field&#46; Among the necessary changes to the post-pandemic practice of medicine&#44; clear coherence between the implicit and explicit contract is essential&#46; A new contract that is&#44; as Jovell mentioned&#44; &#8220;a starting point for redefining the relationship between medicine and society in the current context of social change to thereby be able to face the tension that exists between equity&#44; good quality of care&#44; excess care possibilities&#44; and finite available resources&#8221;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In creating this coherence&#44; certain factors must address adapting contracts and salaries according to the level of responsibility&#44; as well as aspects related to the actual practice of medicine&#44; such as the need to recover professional autonomy&#44; competence&#44; and the feeling of belonging to the profession and institutions<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44; with participation in decision-making at all levels&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Lemaire and Wallace<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> identifies other key aspects such as&#58; detecting toxic aspects in the medical profession that cause and maintain burnout&#44; the need to promote clinical leadership and an organisational culture of support&#44; and considering the well-being of doctors as a core part of patient care and a quality indicator for the entire health system&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Therefore&#44; more than a patient-centred care model&#44; perhaps we should be discussing an &#8220;aligned&#8221; model between treated individuals&#44; health professionals&#44; institutions&#44; and health policies&#46; Cohesively aligning the values&#44; beliefs&#44; roles&#44; and responsibilities of the agents involved in the social contract is therefore a fundamental objective&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The medical profession in the 21st century obviously requires strengthening professional values but can only be carried out when paired with a health system that offers appropriate conditions for professional practice and a society that recognises and agrees that returning professional dignity is not the same as granting privileges&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare they do not have any conflicts of interest&#46;</p></span></span>"
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                      "titulo" => "The covenant"
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                            0 => "D&#46; Ofri"
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                        "tituloSerie" => "Acad Med"
                        "fecha" => "2019"
                        "volumen" => "94"
                        "paginaInicial" => "1646"
                        "paginaFinal" => "1648"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31425190"
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Correspondence
COVID-19 pandemic, professionalism, and the social contract
Pandemia COVID-19, profesionalismo y contrato social
M. Esquerdaa,b,c,
Corresponding author
mesquerda@comll.cat

Corresponding author.
, J. Teresd
a Comissió de Deontologia Consell de Col.legis de Metges de Catalunya, Barcelona, Spain
b Institut Borja de Bioètica, Universitat Ramon Llull, Barcelona, Spain
c Hospital Sant Joan de Déu Terres de Lleida, Lleida, Spain
d Comissió de Deontologia Col.legi de Metges de Barcelona, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The COVID-19 pandemic has posed a massive challenge for not only the healthcare system but also for the medical profession&#44; bringing to light the need for a long-awaited and unavoidable reform to adapt it to the 21st century&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Also imperative&#44; however&#44; is a more profound change in the implicit social contract between health professionals and society&#46; That is&#44; what patients and society expect from the medical profession&#44; and what the latter can expect to find in society&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We come from a thousand-year-old tradition in which the implicit contract&#44; in the words of Jovell<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#44; &#8220;meant that society granted the medical profession a special status and recognition that distinguished it from other professions&#44; and which should imply a higher salary and the power to self-regulate&#8221;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">However&#44; in these terms&#44; it is necessary to question whether this implicit contract is still valid for our current society and&#44; above all&#44; whether it is useful for tackling future challenges&#46; The professional values required&#44; which arise from social change and the bioethical gaze&#44; have been redefined by the social commitment&#44; affectivity and empathy&#44; respect for patient autonomy&#44; commitment to public health&#44; commitment to the environment&#44; advances in medical science&#44; the transfer of knowledge&#44; skills&#44; and attitudes&#44; and the self-regulating nature of the profession<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The previous contract no longer matches the current context of the highly corporatized professional practice&#44; within bureaucratized health organisations&#44; with the centralised management&#44; limitations to professional autonomy&#44; demanding care pressure&#44; disgraceful job insecurity among young people&#44; and low salaries&#46; All of which is associated with disproportionate expectations from society in relation to the possibilities&#44; availability&#44; and access to health care&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Smith<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> spoke about the &#8220;bogus contract&#8221; according to which patients and society expect doctors to provide solutions &#40;bordering on miracles&#41; to all kinds of problems&#44; with low acceptance of finiteness and death&#44; while assuming that doctors have higher status and incomes&#46; This same author called for a new contract that addresses illness&#44; death&#44; and pain as part of life&#44; in which medicine has some&#44; yet limited powers of intervention&#44; which accepts that doctors are not infallible and also need support&#44; and which refrains from extravagant political promises and the demagogy of unlimited power without obligations&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The &#8220;mismatch&#8221; between the implicit contract &#40;what society and people expect from doctors&#41;&#44; and the explicit contract &#40;contractual and labour conditions of professional practice&#41; could be the reason behind the growing unhappiness&#44; or burnout&#44; in the medical profession which includes a large percentage of burnt out&#44; exhausted&#44; and unmotivated professionals<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The consequences of major burnout are significant both professionally&#44; with poorer quality of care&#44; more medical errors&#44; or worse care as perceived by the patient&#44; and personally&#44; with lower levels of empathy&#44; poorer quality of life&#44; job dissatisfaction&#44; or increased risk to mental health in general<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;7</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ofri<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> mentioned that this unhappiness is more profound than the standard definition of burnout&#58; &#8220;The despair I see amongst our colleagues today&#44; however&#44; is more than just burnout&#46; It is a betrayal of trust&#44; the trust we gave to our own profession&#8221;&#46; The burnout epidemic is more related to doctors&#8217; disappointment with the current&#44; industrialised professional practice and the heightened demands of the system that go beyond the provision of care on its own&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In the midst of this&#44; the COVID-19 pandemic arrived&#46; Health professionals have responded to the increased demand in an exemplary manner&#44; according to the outdated contract&#44; with noble displays of altruism and generally going beyond the call of duty&#44; including taking on the risk of infection with insufficient protection&#44; accepting flexible scheduling&#44; working outside their specialisations&#44; and fulfilling uncustomary organisational and care roles&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The pandemic has clearly and obviously exposed the imbalances and asymmetry between the fulfilment of the two parts of the social contract&#46; It has also brought to light how this discrepancy has entailed a high cost to health professionals&#44; from the physical&#44; psychological&#44; or ethical perspective&#44; which is added to the previous hardships&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">However&#44; the pandemic can also represent a turning point and redefining moment for the healthcare field&#46; Among the necessary changes to the post-pandemic practice of medicine&#44; clear coherence between the implicit and explicit contract is essential&#46; A new contract that is&#44; as Jovell mentioned&#44; &#8220;a starting point for redefining the relationship between medicine and society in the current context of social change to thereby be able to face the tension that exists between equity&#44; good quality of care&#44; excess care possibilities&#44; and finite available resources&#8221;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In creating this coherence&#44; certain factors must address adapting contracts and salaries according to the level of responsibility&#44; as well as aspects related to the actual practice of medicine&#44; such as the need to recover professional autonomy&#44; competence&#44; and the feeling of belonging to the profession and institutions<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44; with participation in decision-making at all levels&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Lemaire and Wallace<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> identifies other key aspects such as&#58; detecting toxic aspects in the medical profession that cause and maintain burnout&#44; the need to promote clinical leadership and an organisational culture of support&#44; and considering the well-being of doctors as a core part of patient care and a quality indicator for the entire health system&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Therefore&#44; more than a patient-centred care model&#44; perhaps we should be discussing an &#8220;aligned&#8221; model between treated individuals&#44; health professionals&#44; institutions&#44; and health policies&#46; Cohesively aligning the values&#44; beliefs&#44; roles&#44; and responsibilities of the agents involved in the social contract is therefore a fundamental objective&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The medical profession in the 21st century obviously requires strengthening professional values but can only be carried out when paired with a health system that offers appropriate conditions for professional practice and a society that recognises and agrees that returning professional dignity is not the same as granting privileges&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare they do not have any conflicts of interest&#46;</p></span></span>"
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                    0 => array:2 [
                      "titulo" => "Contrato social y valores en la profesi&#243;n m&#233;dica"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Jovell"
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Adm Sanit"
                        "fecha" => "2005"
                        "volumen" => "3"
                        "paginaInicial" => "495"
                        "paginaFinal" => "503"
                      ]
                    ]
                  ]
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              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Profesionalism&#46; The third logic"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46; Freidson"
                          ]
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                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2001"
                        "editorial" => "The University of Chicago Press"
                        "editorialLocalizacion" => "Chicago"
                      ]
                    ]
                  ]
                ]
              ]
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            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Why are doctors so unhappy&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46; Smith"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1136/bmj.322.7294.1074"
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                        "tituloSerie" => "BMJ"
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                        "volumen" => "322"
                        "paginaInicial" => "1074"
                        "paginaFinal" => "1075"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11337420"
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                  ]
                ]
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                    0 => array:2 [
                      "titulo" => "Burnout among doctors"
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                            0 => "J&#46;B&#46; Lemaire"
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                    0 => array:2 [
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                        "tituloSerie" => "BMJ"
                        "fecha" => "2017"
                        "volumen" => "14"
                        "paginaInicial" => "j3360"
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                    ]
                  ]
                ]
              ]
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                    0 => array:2 [
                      "titulo" => "Descriptive study of assotiation between quality of care and empathy and burnout in primary care"
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                          "autores" => array:5 [
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                            1 => "J&#46;R&#46; Marsal"
                            2 => "M&#46; Buti"
                            3 => "M&#46; Esquerda"
                            4 => "J&#46; Soler-Gonzalez"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s12910-016-0160-y"
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                        "tituloSerie" => "BMC Med Ethics"
                        "fecha" => "2017"
                        "volumen" => "18"
                        "paginaInicial" => "1"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28077127"
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              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Burnout syndrome in internal medicine specialists and factors associated with its onset"
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                          "autores" => array:5 [
                            0 => "C&#46; Mac&#237;a-Rodr&#237;guez"
                            1 => "D&#46; Mart&#237;n Iglesias"
                            2 => "J&#46; Moreno Diaz"
                            3 => "M&#46; Aranda S&#225;nchez"
                            4 => "G&#46; Ortiz Llaurad&#243;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rce.2019.10.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2020"
                        "volumen" => "220"
                        "paginaInicial" => "331"
                        "paginaFinal" => "338"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31892420"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0035"
              "etiqueta" => "7"
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                    0 => array:2 [
                      "titulo" => "en representaci&#243;n del Grupo de trabajo para deliberar sobre el s&#237;ndrome de quemarse por el trabajo burnout en los m&#233;dicos de Espa&#241;a&#59; Componentes del Grupo de trabajo para deliberar sobre el s&#237;ndrome de quemarse por el trabajo burnout en los m&#233;dicos de Espa&#241;a&#46; Work-related burnout syndrome in physicians in Spain"
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                            0 => "E&#46; Bouza"
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                            2 => "E&#46; Palomo"
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                      ]
                    ]
                  ]
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                        "paginaFinal" => "363"
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                        "tituloSerie" => "Acad Med"
                        "fecha" => "2019"
                        "volumen" => "94"
                        "paginaInicial" => "1646"
                        "paginaFinal" => "1648"
                        "link" => array:1 [
                          0 => array:2 [
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Article information
ISSN: 22548874
Original language: English
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