The aim of this study was to assess empathy in family medicine trainees and to compare the level of empathy in first and final year trainees. Type of study: Cross-sectional. Location: Healthcare Regional Administrations (HRA) in Portugal. Population: Family medicine trainees in Portuguese HRA. Methods: We gave an anonymous, self-administered questionnaire, including the Jefferson Scale of Physician Empathy (JSPE), adapted and validated for Portugal, to a convenience sample of family medicine residents. The surveys were distributed in person or sent by personal e-mail. Statistical analysis was performed using SPSS (R) 19.0. Results:We collected 304 questionnaires. Of these, 84 were from trainees who began their training in 2012 (response rate (RR)=20.6%). The remaining 220 questionnaires were from trainees who began their training in 2016 (RR=42.3%). Most of the trainees were enrolled in programs in the Lisbon and Tejo Valley regions (52.4% and 61.4% respectively). There were no significant differences in gender between the two groups. There were no significant differences in the median levels (M) of empathy [ME(2012)=119.00; ME(2016)=118.00; p=0.678] between the first and final year trainees. Prior training in communication skills was not associated with a higher empathy score. Female participants had significantly higher empathy scores (p=0.008). Conclusions: Our results were comparable to national and international studies on empathy in medical students and trainees. Empathy does not seem to be associated with residency or undergraduate training. The low response rate obtained limits the representativeness of the sample and the validity of the findings. However this study presents an initial look at the variation in empathy during family medicine residency training in Portugal.

Resumo Pretende-se conhecer as dificuldades sentidas pelos médicos de família (MF) na abordagem dos doentes com transtornos mentais (TM) e conhecer as suas propostas para melhorar os cuidados os cuidados de saúde mental (CSM

To describe the worldwide use of the International Classification of Primary Care (ICPC) and other classifications in primary care settings and to identify details of ICPC use in each country. Methods: A research survey with a questionnaire requiring self-completion was emailed to members of the WONCA International Classification Committee (WICC) and family physicians (FP) from each country recognized by the United Nations (UN). Results: We obtained the e-mail addresses of representatives from 109 countries and received 61 responses (out of 259 requests sent) to the questionnaire from 52 different countries; 30 were obtained from Europe, 8 from Asia, 7 from America, 6 from Africa, and 1 from Oceania. In 34 countries (17%), a version of ICPC was available in a national language. ICPC was used in primary care setting in 27 countries (14%), but it was a mandatory standard in only 6 (3%). Assessment of the topics accounted for in the clinical records showed that 10 countries used ICPC to classify the patient’s reasons for encounter and diagnosis, while just 5 countries used ICPC to classify the patient’s reasons for encounter, diagnosis, and processes of care. Of the 24 countries responding that the use of ICPC for clinical records was not promoted in primary care, 19 used the 10th edition of the International Classification of Diseases (ICD), 3 used other classifications, and 2 did not use any classification. Conclusions: Although the response rate to the questionnaire was low, we concluded that ICPC use is not widespread globally. Even for those countries reporting the use of ICPC in primary care, it is usually not a mandatory standard.

IntroductionGood patient outcomes correlate with the physicians’ capacity for good clinical judgement. Multimorbidity is common and it increases uncertainty and complexity in the clinical encounter. However, healthcare systems and medical education are centred on individual diseases. In consequence, recognition of the patient as the centre of the decision-making process becomes even more difficult. Research in clinical reasoning and medical decision in a real-world context is needed. The aim of the present review is to identify and synthesise available qualitative evidence on primary care physicians’ perspectives, views or experiences on decision-making with patients with multimorbidity.Methods and analysisThis will be a systematic review of qualitative research where PubMed, CINAHL, PsycINFO, Embase and Web of Science will be searched, supplemented with manual searches of reference lists of included studies. Qualitative studies published in Portuguese, Spanish and English language will be included, with no date limit. Studies will be eligible when they evaluate family physicians’ perspectives, opinions or perceptions on decision-making for patients with multimorbidity in primary care. The methodological quality of studies selected for retrieval will be assessed by two independent reviewers before inclusion in the review using the Critical Appraisal Skills Programme (CASP) tool. Thematic synthesis will be used to identify key categories and themes from the qualitative data. The Confidence in the Evidence from Reviews of Qualitative research approach will be used to assess how much confidence to place in findings from the qualitative evidence synthesis.Ethics and disseminationThis review will use published data. No ethical issues are foreseen. The findings will be disseminated to the medical community via journal publication and conference presentation(s).PROSPERO registration numberID 91978.