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Evaluation of medical ethics competencies in rheumatology: local experience during national accreditation process
  1. Virginia Pascual-Ramos1,
  2. Irazú Contreras-Yáñez1,
  3. Cesar Alejandro Arce Salinas2,
  4. Miguel Angel Saavedra Salinas2,
  5. Mónica Vázquez del Mercado Del Mercado2,
  6. Judith López Zepeda2,
  7. Sandra Muñoz López2,
  8. Janitzia Vázquez-Mellado2,
  9. Luis Manuel Amezcua Guerra2,
  10. Hilda Esther Fragoso Loyo2,
  11. Miguel Angel Villarreal Alarcón2,
  12. Mario Pérez Cristobal2,
  13. Eugenia Nadina Rubio Pérez2,
  14. Alfonso Ragnar Torres Jiménez2,
  15. María del Rocio Maldonado3,
  16. Everardo Álvarez-Hernández2
  17. on behalf of the Mexican Accreditation Council for Rheumatology
  1. 1 Immunology and Rheumatology, Instituto Nacional de Ciencia Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
  2. 2 Mexican Accreditation Council of Rheumatology, Mexico City, Mexico
  3. 3 Department of Internal Medecine, Rheumatology Unit, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
  1. Correspondence to Dr Virginia Pascual-Ramos, Immunology and Rheumatology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City 14080, Mexico; virtichu{at}


Introduction Rheumatologists are the primary healthcare professionals responsible for patients with rheumatic diseases and should acquire medical ethical competencies, such as the informed consent process (ICP). The objective clinical structured examination is a valuable tool for assessing clinical competencies. We report the performance of 90 rheumatologist trainees participating in a station designed to evaluate the ICP during the 2018 and 2019 national accreditations.

Methods The station was validated and represented a medical encounter in which the rheumatologist informed a patient with systemic lupus erythematosus with clinically active nephritis about renal biopsy. A trained patient–actor and an evaluator were instructed to assess ICP skills (with a focus on kidney biopsy benefits, how the biopsy is done and potential complications) in obtaining formal informed consent, delivering bad news and overall communication with patients. The evaluator used a tailored checklist and form.

Results Candidate performance varied with ICP content and was superior for potential benefit information (achieved by 98.9% of the candidates) but significantly reduced for potential complications (37.8%) and biopsy description (42.2%). Only 17.8% of the candidates mentioned the legal perspective of ICP. Death (as a potential complication) was omitted by the majority of the candidates (93.3%); after the patient–actor challenged candidates, only 57.1% of them gave a clear and positive answer. Evaluators frequently rated candidate communications skills as superior (≥80%), but ≥1 negative aspect was identified in 69% of the candidates.

Conclusions Ethical competencies are mandatory for professional rheumatologists. It seems necessary to include an ethics competency framework in the curriculum throughout the rheumatology residency.

  • informed consent
  • education for health care professionals

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  • Contributors V P-R, CA A-S and E A-H were responsible for objective clinical structured examination conception. All the authors contributed to data collection, data analysis and interpretation. V P-R and I C-Y drafted the manuscript. All authors provided a critical revision of the manuscript and approved the final version of the manuscript. V P-R is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval We are reporting the performance of trainees in rheumatology, at a medical ethics station, during a national accreditation process, of which the results must be officially reported on an annual basis to the medical community and the society. In our country, accreditation is mandatory to work as a specialist, and information from certified specialists must be public and updated on an annual basis. Candidates agree upon application to the national accreditation process that the Mexican Accreditation Council for Rheumatology will analyse their performance and publish the results. In the manuscript, all data from candidates were deidentified, and no personal Information was available at any point.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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