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    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Communication Skills in Candidates for Accreditation in Rheumatology Are Correlated With Candidate&#39;s Performance in the Objective Structured Clinical Examination"
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        "autoresLista" => "Virginia Pascual-Ramos, Diana Elsa Flores-Alvarado, Margarita Portela-Hern&#225;ndez, Mar&#237;a del Roc&#237;o Maldonado-Vel&#225;zquez, Luis Manuel Amezcua-Guerra, Judith L&#243;pez-Zepeda, Everardo &#193;lvarez, Nadina Rubio, Olga Vera Lastra, Miguel &#193;ngel Saavedra, C&#233;sar Alejandro Arce-Salinas"
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            "nombre" => "C&#233;sar Alejandro"
            "apellidos" => "Arce-Salinas"
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            "colaborador" => "A&#46;C&#46; Consejo Mexicano de Reumatolog&#237;a"
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            "entidad" => "Consejo Mexicano de Reumatolog&#237;a&#44; Coyoac&#225;n&#44; Mexico City&#44; Mexico"
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        "titulo" => "Las habilidades de comunicaci&#243;n de los aspirantes a la certificaci&#243;n en Reumatolog&#237;a se asocian con su desempe&#241;o en el examen cl&#237;nico objetivo estructurado"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Accreditation councils of the medical specialties are committed to society to guarantee that certified specialists have the necessary skills and competencies for practicing their profession&#46; This implies developing and applying evaluation tools&#44; establishing cutoff points that determine whether or not a candidate should be accredited and&#44; in short&#44; making decisions that are of crucial relevance for the candidates&#44; health and educational authorities and society in general&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The function of the Mexican Accreditation Council for Rheumatology &#40;CMR&#41; is to annually certify all the candidates who have completed their training in rheumatology in any of the national centers accredited for that purpose&#46; The process of certification implies a multiple-choice test utilizing case reports and a practical evaluation&#46; Until 2012&#44; the latter was based on &#8220;the long case&#8221; with a real patient&#44; widely recognized for its utility in training evaluation&#44; but it is not highly recommended for the evaluation of competencies of &#8220;high consequences&#8221;&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">4&#44;5</span></a> For this reason&#44; since 2013&#44; the CMR implemented an objective structured clinical examination &#40;OSCE&#41; to evaluate clinical skills in the annual certification examination&#46; Throughout the years&#44; the OSCE has been found to have an adequate performance&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The OSCE consists of a circuit of stations&#44; some of which include real patients&#46; The latter are thus known as &#8220;dynamic&#8221; stations&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">8</span></a> Each station &#40;static or dynamic&#41; is assigned a rheumatologist &#40;examiner&#41; who evaluates the candidates using a checklist and scale of general performance&#46; Since 2015&#44; the dynamic stations have an additional instrument for evaluation&#44; designed and adapted to determine the communication skills &#40;CS&#41; of the candidates with respect to the patient&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Effective CS has an impact on patient satisfaction<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">9</span></a> and on the outcome&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">10&#44;11</span></a> Nevertheless&#44; in many countries&#44; formal training in CS is not included in the academic curriculum and is exceptional once undergraduate education is completed&#59; as with other aspects of clinical competencies&#44; CS declines over time and the lack of practice&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">12</span></a> In addition&#44; the teaching model and the training techniques applied in CS are based on a classical model of teacher-trainee in which teaching lacks definite planning&#44; structure and objectives&#46; In our usual clinical work&#44; it is common to confront situations in which communication with the patient and those around him or her is complex&#59; the resident in training is often alone and is not being observed by a specialist with greater experience&#59; thus there is not an adequate feedback&#46; A subject that has been a motive for debate in the area of CS is who should evaluate these skills&#44; the patients or an examiner&#46; It is interesting that it has been demonstrated that standardized patients can efficiently evaluate the CS of trainees and physician examiners&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In the present study&#44; we report the experience of the CMR relative to the evaluation of CS of candidates for accreditation in rheumatology in 2015&#44; 2016 and 2017&#46; The specific objectives were&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0030" class="elsevierStylePara elsevierViewall">To describe and compare the CS of candidates for accreditation in rheumatology evaluated by the patient and by a physician examiner&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Correlate the CS of the candidates with their performance in the OSCE&#46;</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Description of the Candidates and Certification Examination</span><p id="par0040" class="elsevierStylePara elsevierViewall">Mexico has 16 centers certified for the training of specialists in rheumatology&#46; All of the candidates for accreditation have completed at least 4 years of training and have a letter of recommendation from their respective professors of the courses offered in the training centers&#46; Each year&#44; the certification examination is to be held on 2 consecutive days&#59; the OSCE is given on the first day and the multiple-choice test on the second&#46; Both tests are developed by specifically designated committees and follow a strict process that has previously been described&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows&#44; in each year &#40;2015&#44; 2016 and 2017&#41;&#44; the number of candidates&#44; the number of reagents in the multiple-choice test&#44; the total number of stations and the dynamic stations &#40;in which the CS of the candidates were evaluated&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Evaluation of the Communication Skills</span><p id="par0050" class="elsevierStylePara elsevierViewall">Communication skills were evaluated in each of the dynamic stations corresponding to the circuit of each year&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We adapted 2 similar formats for the CS&#44; one directed at the patient and the other for the examiner&#46; Both had identical contents and only the wording was changed&#46; Each format included a single Likert scale&#58; from 1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>unsatisfactory to 9<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>superior&#44; which was utilized to evaluate 8 areas of CS of the candidates &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> and <a class="elsevierStyleCrossRef" href="#sec0080">Anexo A&#44; Supplemental material</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">All of the patients were trained during an session designed to apply the format and to score each candidate&#46; Likewise&#44; all of the examiners were also trained&#46; The evaluation of each candidate was scored by the patient and the examiner on the day of the multiple-choice test&#44; independently &#40;blindly&#41;&#44; immediately after the participation of each trainee&#59; each assigned a single score &#40;from 1 to 9&#41; to each candidate&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In addition&#44; each examiner assigned to a station had 2 tools&#44; a checklist and a scale of overall performance corresponding to the station&#59; at the end of the encounter with each trainee&#44; the examiner assigned a score for each tool&#46; The score for each station was established exclusively by the score of the candidate according to the checklist&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical Analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">We applied descriptive statistics and Student&#39;s <span class="elsevierStyleItalic">t</span>-test&#46; Each candidate was given a score for the multiple-choice test and another &#40;overall&#41; for the OSCE&#44; and the scores for all of the stations included each year were averaged&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">We correlated the CS of each candidate&#44; evaluated by the patient and the examiner using the Pearson correlation coefficient&#46; Likewise&#44; the CS was correlated with the performance in each station&#44; in the OSCE and the multiple-choice test&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The analyses were performed using the SPSS statistical package for PC &#40;v&#46; 20&#59; Chicago&#44; IL&#44; United States&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Communication Skill Score Given by the Examiner and by the Patient</span><p id="par0085" class="elsevierStylePara elsevierViewall">In general&#44; and consistently over 3 years&#44; the candidates were given high scores in CS&#46; In the majority of the stations&#44; the patients gave higher scores to the trainees than did the examiners&#44; as is shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#44; which summarizes the OSCE data of 2015&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">In 2015&#44; there was a slight to moderate correlation&#44; but significant&#44; between the evaluation of the candidate&#39;s CS scored by the patient and that of the examiner in most of the stations &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#59; in later years&#44; there was a moderate correlation between the two evaluations in 40&#37;&#8211;50&#37; of the stations&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Impact of Communication Skills in the Performance in the Stations</span><p id="par0095" class="elsevierStylePara elsevierViewall">In general&#44; over a period of 3 years&#44; the CS score obtained by each trainee correlated with the performance of the candidate in the station&#46; It is interesting that the correlations were more frequently found to be positive and higher when the CS were scored by the patient than by the examiner&#44; as is shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#44; which summarizes the data from 2017&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Correlation of Communication Skills With the Objective Structured Clinical Examination and the Multiple-choice Test</span><p id="par0100" class="elsevierStylePara elsevierViewall">The average of the CS of each trainee &#40;evaluated by the patient or by the examiner&#41; correlated with the overall performance of the candidate in the OSCE &#40;especially in 2015 and 2017&#41;&#59; however&#44; this did not occur with the multiple-choice test&#44; except in 2017&#44; when there was a correlation&#44; although notably lower than that observed with the OSCE&#46; <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> summarizes the data from each year&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">The CMR is committed to Mexican society to guarantee that the accredited specialists have the knowledge&#44; skills and competencies to attend to the health problems that are associated with our specialty&#46; For this&#44; the CMR develops and applies evaluation tools that enable the identification of eventual deficiencies in the training of our specialists&#59; the information derived from the analysis of the evaluations is annually shared with the professors who are going to give the training courses and&#44; jointly&#44; strategies are proposed for the purpose of improving suboptimal areas and&#44; therefore&#44; the quality of our specialists&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The present report evaluates the CS of the candidates for accreditation in rheumatology over 3 consecutive years&#46; Communication skills constitute a basic competence in establishing communication between the physician and the patient that favor a solid&#44; effective and lasting relationship between the two&#46; The benefits of a relationship with these characteristics are also extended to the patient&#39;s family and other support networks that integrate the health systems&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">10</span></a> In recent decades&#44; international consensuses have been developed in the area of physician-patient communications&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">11</span></a> as well as guidelines to be applied in medical schools<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">12</span></a> and to serve as references for professional practice&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a> all of which stresses the importance of this subject&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In general&#44; the candidates for the examination of certification in rheumatology had a good performance in CS in dealing with the patients&#59; however&#44; this was not homogeneous&#44; as is expected and has been described in other populations&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">14</span></a> The patients gave higher scores to the trainees than to the examiners and both evaluations presented significant correlations &#40;low and moderate&#41; between them in more than half of the OSCE stations&#46; Communication skills correlated with the performance of the candidates in the stations&#44; with the overall performance in OSCE&#44; but that was not observed with the multiple-choice test &#40;except in 2017&#41;&#46; The literature provides evidence that efficient CS correlated with the clinical competencies of those being evaluated<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">10&#44;15&#44;16</span></a> and that the general performance of physicians improved after training involving CS<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">17&#44;18</span></a>&#59; in fact&#44; there are educational interventions that have improved confidence in CS in those who had completed the program even months after having participated&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">10</span></a> Even more relevant is the fact that efficient CS have been associated with desired outcomes for the patients&#44; such as better adherence to drug therapy and diet&#44; better pain control and a better physical&#44; functional and psychological well-being&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">9&#44;19&#8211;23</span></a> Finally and within the physician-legal framework that is applied when the patients develop complications or undesirable outcomes&#44; early and sincere communication with the patients has been shown to be crucial&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">24&#8211;28</span></a> It is important to point out that the OSCE has been demonstrated to have a good performance in evaluating CS and identifying specific deficits&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">28</span></a> combined with its adequate performance in the accreditation process&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">One relevant question about CS is whether the patient or an external physician should evaluate it&#46; Interestingly and intuitively&#44; we encountered a better correlation with the performance of the trainees in the stations &#40;and with the OSCE&#41; when the CS were evaluated by the patient&#46; The best correlations were obtained in the last year&#44; which could indicate a certain degree of apprenticeship gained by the patients &#40;and&#44; in general&#44; all the participants in the OSCE&#41;&#44; who are trained year after year to score the candidates&#46; We should point out that the performance of the trainees was established by the examiner&#44; using the checklist&#46; Our results confirm published studies in which standardized patients adequately evaluate the CS of surgical residents with different years of training&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">16&#44;17&#44;24&#44;25</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The present report has certain limitations&#46; Communication skills were evaluated utilizing an adapted tool&#44; that included a Likert scale in which 8 domains were jointly applied&#46; This tool was subjected to a process of validation&#59; although both users &#40;patient and examiner&#41; were trained in its application&#44; the OSCE has also been shown to be a suitable tool for the evaluation of CS&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">17</span></a> In each process of accreditation&#44; 2 consecutive OSCE were applied due to limited space&#46; This could have affected the reproducibility of the results<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">29</span></a>&#59; nevertheless&#44; the physical space&#44; patients and examiners were the same in both circuits&#46; Finally&#44; the validity and reproducibility of the results of an OSCE are determined by its length&#44; that is&#44; by the number of stations included&#46; Over 3 years&#44; we included a maximum of 12 dynamic stations&#44; and the results obtained may not be solid enough for making decisions&#44; especially if the latter have important consequences&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">30</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Currently&#44; physicians are not independent actors in health care&#44; but perform more like leaders or members of multidisciplinary teams<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">3</span></a>&#59; thus&#44; they must acquire and perfect certain professional attributes&#44; the first of which includes CS&#46; Our work is to establish the bases for a specific proposal&#58; integrate residency in rheumatology into a formal&#44; continued education directed at CS&#46; We want to stress that training in CS is favored in the contextual setting of routine practice&#44; with an adequate feedback<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">31&#44;32</span></a> and an environment that requires that those involved have protected time for teaching&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">18&#44;33&#44;34</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">We are what we repeatedly do&#46; Excellence&#44; then&#44; is not an act but a habit&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">&#40;Aristotle&#44; 400 BC&#41;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical Disclosures</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Protection of human and animal subjects</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Confidentiality of data</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Right to privacy and informed consent</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicts of Interest</span><p id="par0160" class="elsevierStylePara elsevierViewall">None of the authors has any financial relationship that could be considered a conflict of interest in relation to this article&#46;</p></span></span>"
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              "identificador" => "abst0025"
              "titulo" => "Introducci&#243;n"
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            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Material y m&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
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            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
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        3 => array:2 [
          "identificador" => "xpalclavsec1084044"
          "titulo" => "Palabras clave"
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          "titulo" => "Introduction"
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          "titulo" => "Material and Methods"
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            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Description of the Candidates and Certification Examination"
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            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Evaluation of the Communication Skills"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Statistical Analysis"
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          "identificador" => "sec0030"
          "titulo" => "Results"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Communication Skill Score Given by the Examiner and by the Patient"
            ]
            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Impact of Communication Skills in the Performance in the Stations"
            ]
            2 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Correlation of Communication Skills With the Objective Structured Clinical Examination and the Multiple-choice Test"
            ]
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          "identificador" => "sec0050"
          "titulo" => "Discussion"
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          "titulo" => "Ethical Disclosures"
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            0 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Protection of human and animal subjects"
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            1 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Confidentiality of data"
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            2 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
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          "identificador" => "sec0075"
          "titulo" => "Conflicts of Interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-03-23"
    "fechaAceptado" => "2017-06-02"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1084043"
          "palabras" => array:4 [
            0 => "Communication skills"
            1 => "Performance"
            2 => "Certification"
            3 => "Rheumatology"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1084044"
          "palabras" => array:4 [
            0 => "Habilidades de comunicaci&#243;n"
            1 => "Desempe&#241;o"
            2 => "Certificaci&#243;n"
            3 => "Reumatolog&#237;a"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The Mexican Accreditation Council for Rheumatology annually certifies trainees in Rheumatology using a multiple-choice test and an objective structured clinical examination &#40;OSCE&#41;&#46; Since 2015&#44; candidate&#39;s communication skills &#40;CS&#41; have been rated by both patients and by physician examiners and correlated with results on the OSCE&#46; This study compared the CS from candidates to annual accreditation in Rheumatology as rated by patients and by physician examiners&#44; and assessed whether these correlated with candidate&#39;s performance in the OSCE&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">From 2015 to 2017&#44; 8 areas of CS were evaluated using a Likert scale&#44; in each OSCE station that involved a patient&#46; Both patient and physician evaluators were trained annually and their evaluations were performed blindly&#46; The associations were calculated using the Pearson correlation coefficient&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In general&#44; candidates were given high CS scores&#59; the scores from patients of the candidate&#39;s CS were better than those of physician examiners&#59; within the majority of the stations&#44; both scores were found to correlate moderately&#46; In addition&#44; the scoring of CS correlated with trainee performance at the corresponding OSCE station&#46; Interestingly&#44; better correlations were found when the skills were rated by the patients compared to physician scores&#46; The average CS score was correlated with the overall OSCE performance for each trainee&#44; but not with the multiple-choice test&#44; except in the 2017 accreditation process&#44; when a weak correlation was found&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CS assessed during a national accreditation process correlated with the candidate&#39;s performance at the station level and with the overall OSCE&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El Consejo Mexicano de Reumatolog&#237;a certifica anualmente reumat&#243;logos mediante una prueba te&#243;rica y un examen cl&#237;nico objetivo estructurado &#40;ECOE&#41;&#46; Desde el a&#241;o 2015&#44; se eval&#250;an las habilidades de comunicaci&#243;n &#40;HC&#41; de los candidatos&#46; Los objetivos fueron comparar las HC evaluadas por el paciente &#40;HCP&#41; y por el m&#233;dico &#40;HCM&#41; y correlacionarlas con el desempe&#241;o de los candidatos en el ECOE&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Durante los a&#241;os 2015&#44; 2016 y 2017&#44; se evaluaron las HC en las estaciones din&#225;micas&#44; mediante una escala de Likert aplicada a 8 &#225;reas&#46; Pacientes y evaluadores fueron entrenados cada a&#241;o para calificar a los aspirantes&#44; lo cual se realiz&#243; el d&#237;a del ECOE&#44; de manera ciega&#44; por ambos&#46; Se calcularon coeficientes de correlaci&#243;n de Pearson&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En general&#44; a lo largo de los 3 a&#241;os&#44; los candidatos obtuvieron puntajes altos en las HC&#46; Los pacientes puntuaron mejor a los candidatos que los evaluadores m&#233;dicos&#46; Las HCP y las HCM correlacionaron entre s&#237; &#40;de leve a moderado&#41; en la mayor&#237;a de las estaciones&#46; El puntaje de las HC de cada candidato correlacion&#243; con su desempe&#241;o en la estaci&#243;n correspondiente&#59; se encontraron mejores correlaciones con las HCP&#46; El promedio de las HC de cada candidato correlacion&#243; con el desempe&#241;o global en el ECOE&#44; pero no as&#237; con la prueba te&#243;rica &#40;salvo en el a&#241;o 2017&#44; cuando hubo una correlaci&#243;n baja&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las HC evaluadas durante un examen de certificaci&#243;n en Reumatolog&#237;a correlacionan con el desempe&#241;o de cada candidato en cada estaci&#243;n y en el ECOE global&#46;</p></span>"
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            "titulo" => "Introducci&#243;n"
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            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
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            "titulo" => "Resultados"
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            "titulo" => "Conclusiones"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0050">Please cite this article as&#58; Pascual-Ramos V&#44; Flores-Alvarado DE&#44; Portela-Hern&#225;ndez M&#44; Maldonado-Vel&#225;zquez MR&#44; Amezcua-Guerra LM&#44; L&#243;pez-Zepeda J&#44; et al&#46; Las habilidades de comunicaci&#243;n de los aspirantes a la certificaci&#243;n en Reumatolog&#237;a se asocian con su desempe&#241;o en el examen cl&#237;nico objetivo estructurado&#46; Reumatol Clin&#46; 2019&#59;15&#58;97&#8211;101&#46;</p>"
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            "apendice" => "<p id="par0170" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Anexo A"
            "titulo" => "Supplementary Data"
            "identificador" => "sec0085"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2015 certification&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2016 certification&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2017 certification&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#46; of candidates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#46; of reagents in the MCT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">222&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total no&#46; of stations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#46; of dynamic stations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Originally there were 13&#44; however&#44; one examiner did not score the communication skills of the candidates&#46;</p> <p class="elsevierStyleNotepara" id="npar0010">MCT&#44; multiple-choice test&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the Accreditation Examination of the Mexican Accreditation Council for Rheumatology and Number of Candidates Each Year&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reception and presentation of the patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Explication to the patient of what the candidate will do during the encounter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">3&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Understanding on the part of the patient the explication concerning the candidate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">4&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Perception &#40;of the patient&#41; as to the candidates interest in the comments made by the patient&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Visual contact between the candidate and the patient&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Empathy of the candidate with respect to the patient&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Care &#40;on the part of the candidate&#41; in performing the examination and&#47;or procedure&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The candidate perceives that the patient feels pain during the examination and&#47;or procedure&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Stations<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CS score &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41; provided by the examiner<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CS score &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41; provided by the patient<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#46; 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#46; 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#46; 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#46; 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#46; 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8804;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#46; 9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8804;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#46; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#46; 11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8804;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#46; 13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8804;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#46; 14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8804;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#46; 15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Pearson correlation coefficient&#46;</p> <p class="elsevierStyleNotepara" id="npar0030">CS&#44; communication skills&#59; NS&#44; not significant&#59; SD&#44; standard deviation&#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"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Station&#47;category of the disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Competencies evaluated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CS<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&#47;CP<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">c</span></a><br><span class="elsevierStyleItalic">r</span> &#40;<span class="elsevierStyleItalic">P</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CS<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a>&#47;CP<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">c</span></a><br><span class="elsevierStyleItalic">r</span> &#40;<span class="elsevierStyleItalic">P</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gout&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Problem solution prescription&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;602 &#40;&#60;&#46;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;399 &#40;&#60;&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rheumatoid arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Problem solution prescription&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;503 &#40;&#60;&#46;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;117 &#40;&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low back pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Medical record&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;542 &#40;&#60;&#46;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;127 &#40;&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rheumatoid arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clinical examination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;360 &#40;&#60;&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;025 &#40;&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rheumatoid arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Medical record&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;530 &#40;&#60;&#46;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;047 &#40;&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gout&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Medical record&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;515 &#40;&#60;&#46;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;363 &#40;&#60;&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Disorders affecting soft tissue&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clinical examination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;291 &#40;&#60;&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;162 &#40;&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Spondyloarthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clinical examination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;038 &#40;&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;119 &#40;&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Antiphospholipid antibody syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Problem solution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;760 &#40;&#60;&#46;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;407 &#40;&#60;&#46;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sj&#246;gren&#39;s syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Medical record&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;271 &#40;&#60;&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;118 &#40;&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inflammatory myopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clinical examination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;471 &#40;&#60;&#46;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;330 &#40;&#60;&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Scleroderma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Medical record&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;790 &#40;&#60;&#46;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;274 &#40;&#60;&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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