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The teaching of humanitarian attitudes by observation of the doctor-patient relationship in practice was welcomed by students. The environment in which this educational programme was carried out was considered adequate. The outpatient service schedule and the limited time available for student instruction on the part of staff doctors made this activity productive. The programme motivated students towards higher achievement and the pursuit of medical responsibility as well as more developed humanitarian behaviour patterns.

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The frequency of symptoms of anxiety and depression is greater among asthma patients than among patients with chronic obstructive pulmonary disease, which can make clinical control difficult.

BackgroundDiagnostic errors have often been attributed to biases in physicians’ reasoning. Interventions to ‘immunise’ physicians against bias have focused on improving reasoning processes and have largely failed.ObjectiveTo investigate the effect of increasing physicians’ relevant knowledge on their susceptibility to availability bias.Design, settings and participantsThree-phase multicentre randomised experiment with second-year internal medicine residents from eight teaching hospitals in Brazil.InterventionsImmunisation: Physicians diagnosed one of two sets of vignettes (either diseases associated with chronic diarrhoea or with jaundice) and compared/contrasted alternative diagnoses with feedback. Biasing phase (1 week later): Physicians were biased towards either inflammatory bowel disease or viral hepatitis. Diagnostic performance test: All physicians diagnosed three vignettes resembling inflammatory bowel disease, three resembling hepatitis (however, all with different diagnoses). Physicians who increased their knowledge of either chronic diarrhoea or jaundice 1 week earlier were expected to resist the bias attempt.Main outcome measurementsDiagnostic accuracy, measured by test score (range 0–1), computed for subjected-to-bias and not-subjected-to-bias vignettes diagnosed by immunised and not-immunised physicians.ResultsNinety-one residents participated in the experiment. Diagnostic accuracy differed on subjected-to-bias vignettes, with immunised physicians performing better than non-immunised physicians (0.40 vs 0.24; difference in accuracy 0.16 (95% CI 0.05 to 0.27); p=0.004), but not on not-subjected-to-bias vignettes (0.36 vs 0.41; difference −0.05 (95% CI −0.17 to 0.08); p=0.45). Bias only hampered non-immunised physicians, who performed worse on subjected-to-bias than not-subjected-to-bias vignettes (difference −0.17 (95% CI −0.28 to −0.05); p=0.005); immunised physicians’ accuracy did not differ (p=0.56).ConclusionsAn intervention directed at increasing knowledge of clinical findings that discriminate between similar-looking diseases decreased physicians’ susceptibility to availability bias, reducing diagnostic errors, in a simulated setting. Future research needs to examine the degree to which the intervention benefits other disease clusters and performance in clinical practice.Trial registration number68745917.1.1001.0068.

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Introduction Medical training is consistently described as emotionally challenging. Students commonly encounter situations that are likely to trigger emotional reactions, but the influence of emotional reactions to these situations on learning is unclear. This experiment examined the effects of negative emotions on medical residents’ learning of scientific information. Methods Sixty first-year internal medicine residents (i.e. physicians in training to become specialists) at the São Paulo University Medical School were randomly assigned to watching a video clip either presenting an emotional (experimental group) or a neutral (control group) version of the same situation. Subsequently, all residents studied the same scientific text. Main outcome measurements were learning processes (inferred through study time and cognitive engagement) and outcomes (recall accuracy). Data were analyzed using chi-square and independent t‑tests. Results The experimental group spent significantly less time ( p < 0.001) studying the text and performed significantly worse on the free recall test ( p < 0.001) than the control group. Discussion Negative emotions decreased time invested in a learning task and the amount of knowledge gained from it, possibly because they automatically activated avoidance attitudes or captured part of the residents’ cognitive resources, hindering processing of the learning material. Future studies should further explore the underlying mechanisms of this effect and how it can be diminished. Electronic supplementary material The online version of this article (10.1007/s40037-019-00525-8) contains supplementary material, which is available to authorized users.

Introduction The retention of cardiopulmonary resuscitation skills and the ideal frequency of retraining remain unanswered. This study investigated the retention of cardiopulmonary resuscitation skills by medical students for up to 42 months after training. Methods In a cross-sectional study, 205 medical students received 10 hours of training in basic life support in 3 practical classes, during their first semester at school. Then, they were divided into 4 groups, according to the time elapsed since the training: 73 after 1 month, 55 after 18 months, 41 after 30 months, and 36 after 42 months. Nineteen cardiopulmonary resuscitation skills and 8 potential technical errors were evaluated by mannequin-based simulation and reviewed using filming. Results The mean retention of the skills was 90% after 1 month, 74% after 18 months, 62% after 30 months, and 61% after 42 months (P < 0.001). The depth of chest compressions had the greatest retention over time (87.8%), with no significant differences among groups. Compressions performed greater than 120 per minute were less likely to be done with adequate depth. Ventilation showed a progressive decrease in retention from 93% (n = 68) after 1 month to 19% (n = 7) after 42 months (P < 0.001). All 205 students were able to turn the automated external defibrillator on and deliver the shock. Conclusions The depth of chest compressions and the use of an automated external defibrillator were the skills with the highest retention over time. Based on a skills retention prediction curve, we suggest that 18 to 24 months as the minimum retraining interval to maintain at least 70% of skills.