Brazilian educational guidelines reinforce patient-centered care communication skills as an important competence for medical students. The Four Habits Coding Scheme (4HCS) is an instrument used for teaching and assessing clinicians’ communication skills in a person-centered care approach. We aimed to translate and culturally adapt the 4HCS into Brazilian Portuguese. The translation process was accomplished in seven stages: initial translation, reconciliation, back translation, review by the author, independent review, consensus version through Delphi technique, review by a language coordinator, and pretest. During pretest, three independent observers assessed four medical consultations, which were performed by medical students and residents, that had been recorded in a real healthcare scenario. Reviewers had difficulty in reaching consensus on expressions referring to understanding the person as a whole, such as “Engage in small talk”, “Expansion of concerns”, “Elicit full agenda”, “Use patient’s frame of reference”, and “Explore plan acceptability”. They also had difficulty in reaching consensus on the translation of the word “clinician”, which was first translated as “physician”. Historical and cultural issues in the physician-patient relationship may have influenced this result. The Brazilian 4HCS is a culturally, conceptually, semantically and operationally sound instrument. It may represent an important advance for strengthening the person-centered care model in Brazil.
Introduction: Nonverbal communication is an important part of the medical interview. However, nonverbal skills are still underestimated in medical education and instruments for their teaching and assessing in medical schools are scarce. Objective: We aimed to translate and culturally adapt the Relational Communication Scale for Observational measurement of doctor-patient interactions (RCS-O) to Brazilian Portuguese. Methods: We translated the RCS-O in seven stages: initial translation, reconciliation, back translation, review by the author, independent review, consensus version through the Delphi technique, review by a language coordinator, and pre-test. We used video recordings of four medical consultations performed by medical students and residents to pre-test the instrument. During this phase, three independent observers assessed the medical students and residents’ performance in real health care scenarios through the use of the recordings. Results: Most of the difficulties regarding the translation and cultural adaptation were related to the polysemic meaning of some items. Words and expressions such as “stimulating”, “warmth”, “desire”, “relaxed”, “conversation to a deeper level”, “deeper relationship”, “casual”, and “intensely” required adaptation in order to remove the potential sexual connotation that could arise from overintimacy in the physician-patient relationship. Conclusion: The Brazilian version of the RCS-O is a culturally, conceptually, semantically and operationally valid instrument. It may represent an important advance for the strengthening of learning and assessing nonverbal communication in medical education. We hope this study may encourage health educators to invest in the teaching and assessment of nonverbal communication skills in other countries.
Introdução: Cerca de 60% da nossa comunicação é não verbal. No entanto, poucas intervenções destinadas a melhorar o comportamento não verbal de médicos e estudantes de Medicina são relatadas na pesquisa em educação médica. Como uma habilidade treinável, a existência de instrumentos adequados para ensinar e avaliar o comportamento não verbal de médicos e estudantes de medicina torna-se essencial. Objetivos: Traduzir e adaptar culturalmente a Relational Communication Scale for Observational measurement of doctor-patient interactions (RCS-O) para a língua portuguesa do Brasil. Material e métodos: O processo de tradução e adaptação cultural foi realizado em estágios que incluíram retrotradução, revisão de itens por um comitê de especialistas através da técnica de Delphi modificada e préteste. Resultados: O título da escala e três itens necessitaram de modificações após retrotradução e comentários da autora. A coordenadora de linguagem ajustou o título da escala e 9 (26,4%) itens que pertenciam, em sua maioria, aos domínios de intimidade e foram alterados em virtude de suas características polissêmicas. Da mesma forma, após o pré-teste e como sugerido pelos observadores, duas palavras foram substituídas pelas coordenadoras de pesquisa e linguagem em decorrência de seus significados ambíguos. Conclusão: A versão final brasileira da RCS-O resultou em uma escala adequada que poderá, após sua validação, ser introduzida como instrumento de ensino e avaliação das habilidades de comunicação interpessoal nas escolas médicas brasileiras. Esperamos que este estudo possa encorajar educadores em saúde a investirem no ensino e na avaliação de habilidades de comunicação não verbal, no Brasil e em outros países, para que os componentes culturais da comunicação possam ser melhor explorados.Palavras-chave: Educação Médica. Relações Médico-paciente. Comunicação não verbal. Comparação transcultural. Avaliação do impacto na saúde.
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