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prioritizing training evaluation and constructive feedback centered on the performance levels of the residents in the real-life working context&#59; and &#40;<span class="elsevierStyleItalic">e</span>&#41; using a broad range of evaluation tools and methods&#46; In Intensive Care Medicine&#44; a group of experts in the year 2004 defined for the first time at Spanish national level the competencies to be acquired by professionals wishing to dedicate themselves to the care of the critically ill<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a>&#46; Posteriorly&#44; at European level&#44; a program was developed that contemplated all the previously mentioned principles&#58; the Competency Based Training in Intensive Care Medicine in Europe &#40;CoBaTrICE&#59; <a href="http://www.cobatrice.org/">www&#46;cobatrice&#46;org</a>&#41; initiative&#44; which includes a bundle of 102 minimum competencies defining work in this particular specialty&#44; and which was born out of the consensus reached by over 500 clinicians and 1400 patients and relatives&#46; The aim of this European initiative was to harmonize the training programs in Intensive Care Medicine in all the countries in order to ensure quality and facilitate the translational flow of professionals<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">6&#8211;9</span></a>&#46; Competency Based Training in Intensive Care Medicine in Europe has been adopted by 15 European countries and is in the process of adoption by a similar number of additional countries<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;10</span></a>&#44; including Spain&#44; within the current legislative framework<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">11&#44;12</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Although some medical specialties have already defined their programs based on lists of competencies&#44; the CBME model has not yet become the predominant training method because its application requires organizational and cultural changes&#44; resources and particularly more dedication of teaching time&#44; as well as the training of tutors and staff members in education evaluation and feedback techniques<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">13&#8211;15</span></a>&#46; Research in this field is still limited&#44; since the model has been applied in a partial and scantly structured manner<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a>&#46; There is no validated standard model for implementing CBME&#44; though the key elements for its effective application are<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">16&#44;17</span></a>&#58; &#40;<span class="elsevierStyleItalic">a</span>&#41; the active participation of residents in their training processes&#59; &#40;<span class="elsevierStyleItalic">b</span>&#41; the supervision&#44; follow-up and frequent evaluation of the acquisition of competencies of the residents on the part of their tutors&#59; and &#40;<span class="elsevierStyleItalic">c</span>&#41; the availability of valid and reliable evaluation tools&#46; In line with these requirements&#44; the present study was carried out with the following objectives&#58; &#40;<span class="elsevierStyleItalic">1</span>&#41; to determine the degree of satisfaction of tutors and residents with the methodology used for implementing CoBaTrICE and &#40;<span class="elsevierStyleItalic">2</span>&#41; to determine the validity and reliability of the global assessment scales used by the tutors to evaluate resident performance in the real-life clinical setting&#46; As a more general objective&#44; the study sought to standardize a method for the implementation of CoBaTrICE based on the satisfaction of residents and tutors&#44; and including reliable and reproducible performance assessment scales&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Methods and participants</span><p id="par0015" class="elsevierStylePara elsevierViewall">The study was approved by the Ethics Committee of La Fe Health Research Institute &#40;<span class="elsevierStyleItalic">Instituto de Investigaci&#243;n Sanitaria La Fe</span>&#44; Valencia&#44; Spain&#41;&#44; and consent was obtained from all the participants &#40;15 residents and 5 tutors&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Study setting</span><p id="par0020" class="elsevierStylePara elsevierViewall">The study was carried out in the Department of Intensive Care Medicine &#40;DICM&#41; of <span class="elsevierStyleItalic">Hospital Universitario y Polit&#233;cnico La Fe</span> &#40;Valencia&#44; Spain&#41; &#8211; a reference hospital of the triple-province Valencian Community&#46; The DICM cares for 2200 adult patients&#47;year with mainly medical disorders&#46; The Department has 32 beds distributed between the Intensive Care Unit &#40;ICU&#41; &#40;24 beds&#41; and the Intermediate Care Unit &#40;8 beds&#41;&#46; The staff comprises 15 physicians&#44; and of these&#44; 5 are resident tutors accredited by the Teaching Commission of the hospital&#46; The physician&#47;patient ratio is 1&#58;3&#8211;4 during the normal work shift&#44; and two staff physicians and two residents in training are present during the on duty periods&#46; The nurse&#47;patient ratio is 1&#58;2&#46; The Department has three residents in each of the training program years&#46; The specialty program in turn covers a period of 5 years and is distributed into three stages&#58; stage 1 &#40;S1&#41; &#40;R1&#8211;R2&#41;&#58; 6 residents&#59; stage 2 &#40;S2&#41; &#40;R3&#8211;R4&#41;&#58; 6 residents&#44; and stage 3 &#40;S3&#41; &#40;R5&#41;&#58; 3 residents&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Intervention</span><p id="par0025" class="elsevierStylePara elsevierViewall">The implementation of CoBaTrICE was started in the DICM in March 2016&#44; based on three actions&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Training of the tutors&#46; Training evaluation oriented toward the improvement of learning and performance levels is the cornerstone of the CBME model<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a>&#44; and its core element is constructive feedback delivered to the resident by the tutor and the staff members&#46; For this reason&#44; all the physicians in the Department received a 12-h clinical feedback course based on simulations and role plays imparted by acknowledged experts in this field<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Multiple objective and structured training assessment exercises based on direct observation of workplace performance at the patient bedside<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">20&#8211;22</span></a>&#46; The assessments involved a clinical evaluation mini-exercise &#40;mini-CEX&#41;&#44; the assessment of acute care patients &#40;Acute Care Assessment Tools &#91;ACAT&#93;&#41;&#44; and the direct observation of procedural performance &#40;Direct Observation Procedural Skills&#41;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">23&#44;24</span></a>&#46; A global assessment scale was designed to evaluate performance in the management of clinical cases&#44; with another specific scale for the evaluation procedures and techniques&#44; with the purpose of facilitating objective and structured communication between the tutor and resident during the feedback sessions<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">24&#44;25</span></a>&#46; The items and scores assigned to each item of the assessment scales were selected by a group of 6 tutors in Intensive Care Medicine based on the Delphi method&#46; The final model was generated by an iterative test model and evaluation of the scales&#44; with the participation of 6 tutors&#44; three fifth year residents&#44; and an expert in education psychology&#46; Individualized improvement plans were established after each feedback session&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Creation of an electronic portfolio to facilitate reflection and facilitate management of the learning process on the part of the resident and the tutor &#40;E-MIR-INTENSIVE&#174;&#44; IIS La Fe&#44; <a href="https://emir-intensive.portres.i3net.es/">https&#58;&#47;&#47;emir-intensive&#46;portres&#46;i3net&#46;is&#47;</a>&#41;&#46; The portfolio is the property of the resident and registers all the results of the training evaluations&#44; plans&#44; comments and training and healthcare activities carried out&#46; The portfolio also includes a series of short intervention protocols in response to different disease conditions and for the performance of routine techniques and procedures in Intensive Care Medicine&#46; The protocols were developed by the members of the Department and are based on the most current clinical guides applicable to each case&#46; The protocols help the residents to know exactly what they are expected to do in each situation&#44; and seek to reduce clinical variability&#46; Prior to implementation of the program&#44; training lectures were held for all members of the Department&#44; seeking to facilitate comprehension of the principles of the new teaching model&#44; the structure of CoBaTrICE&#44; and the use of the previously mentioned training evaluation tools<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">26&#44;27</span></a>&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Objective 1&#46;</span> In order to determine the degree of satisfaction of the tutors and residents with the methods used to introduce CoBaTrICE&#44; in December 2016 and 9 months after implementation of the program&#44; a 22-item questionnaire was administered on an anonymous and voluntary basis to all the tutors &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41; and residents &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41; in order to explore the four core dimensions of the CBME model &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#58; methodology of the training evaluations &#40;MTE&#41;&#44; quality of feedback provided by the tutors &#40;QFT&#41;&#44; promotion of learning self-regulation &#40;PLS&#41; and usefulness of the electronic portfolio &#40;UEP&#41;&#46; A 5-point Likert scale was used to score the answers &#40;1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8220;Strongly disagree&#8221;&#44; 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8220;Strongly agree&#8221;&#41;&#46; The questionnaire also comprised two open-ended questions to address aspects referred to improvement of the program&#46; Selection of the initial repertoire of items of the questionnaire was based on the review of previous studies on the dimensions defining the CBME model<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3&#44;4</span></a>&#44; as well as on the evaluation of learning environments<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a> and the application of portfolios in specialized medical education&#46; Following discussion within the research team regarding relevance&#44; applicability&#44; absence of redundancies and clarity in drafting the items&#44; consensus was reached on the final version of the administered questionnaire&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The basic descriptors per items and per dimensions of the questionnaire were obtained after evidencing the internal consistency of the tool based on the Cronbach alpha test and the bivariate associations between them using Kendall&#39;s tau measure&#46; Comparative analyses were made of the responses of the residents and of the tutors based on the nonparametric Kruskal&#8211;Wallis test&#44; with <span class="elsevierStyleItalic">a posteriori</span> comparisons between groups &#40;2<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2&#41; using the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span>-test with Bonferroni correction&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Objective 2&#46;</span> Between April and June 2017&#44; an additional study was made to determine the validity and reliability of the global assessment scales designed on an <span class="elsevierStyleItalic">ad hoc</span> basis to measure the resident performance levels&#46; The aim was to determine possible significant differences in the results obtained in the evaluations of the residents dependent upon the observing tutor&#44; self-evaluation &#40;SE&#41; of the resident&#44; and the training stage of the latter&#46; Two residents per training stage from R2 onwards participated &#40;S1 &#91;R2&#93;&#58; 2 residents&#44; S2 &#91;R3&#8211;R4&#93;&#58; 2 residents and S3 &#91;R5&#93;&#58; 2 residents&#41;&#46; The tutors&#44; in randomized groups of three each&#44; simultaneously evaluated the performance of each participating resident in the management of three clinical cases &#40;acute coronary syndrome&#44; septic shock&#44; and acute respiratory failure&#41;&#46; The forms corresponding to the assessment scale and the intervention protocols can be consulted at <a href="https://emir-intensive.portres.i3net.es/">https&#58;&#47;&#47;emir-intensive&#46;portres&#46;i3net&#46;is&#47;</a>&#46; The residents self-evaluated their performance with the same model&#44; integrating 15 performance criteria based on a 6-point response scale scored according to the existence during the exercise of major omissions or errors with a clear potential influence upon the patient prognosis &#40;1&#8211;3 points&#41;&#44; minor omissions or errors with no influence upon the prognosis &#40;4&#8211;5 points&#41;&#44; and complete and orderly performance &#40;6 points&#41;&#46; The external evaluations made by the tutors &#40;ET&#41; and the SE of the residents yielded 96 different assessments &#40;72 ET and 24 SE&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The descriptors of the assessments made by the tutors and residents were obtained&#46; Both ET &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;30&#41; and SE by the residents &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;98&#41; were seen to be homogeneous among the different clinical cases&#46; Considering the global evaluations&#44; we analyzed the structure of the scale based on principal axis factor analysis&#59; its reliability based on internal consistency analysis&#59; and the generalizability index and inter-rater reliability based on calculation of the intraclass correlation coefficient&#46; Calculation of the ET-SE relationship was made based on the bivariate correlation index&#46; Factorial &#40;3<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2&#41; analysis of variance &#40;ANOVA&#41; was used to analyze the effect upon the results of the evaluations of the educational stage of the residents &#40;S1&#58; R2&#59; S2&#58; R3&#8211;R4&#59; S3&#58; R5&#41; and the type of evaluation &#40;SE <span class="elsevierStyleItalic">versus</span> ET&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Results</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Results of objective 1</span><p id="par0065" class="elsevierStylePara elsevierViewall">The 15 residents and 5 tutors answered 100&#37; of the questions &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The basic descriptors&#44; internal consistency and bivariate relationships among the dimensions of the questionnaire for assessment of the implantation of CoBaTrICE are detailed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; All the dimensions showed high mean scores &#40;range 3&#46;79&#8211;4&#46;28&#41; and adequate internal consistency &#40;range 0&#46;68&#8211;0&#46;81&#41;&#44; evidencing their relative independence &#40;significant correlations&#58; <span class="elsevierStyleItalic">T</span><span class="elsevierStyleInf">MTE-UEP</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;34&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#59; <span class="elsevierStyleItalic">T</span><span class="elsevierStyleInf">PLS-UEP</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;54&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; The assessments of the residents and tutors referred to each item of the questionnaire yielded high scores &#40;range of scores among residents&#58; 3&#46;27&#8211;4&#46;53&#59; range of scores among tutors&#58; 4&#46;0&#8211;5&#46;0&#41;&#46; The residents assigned the highest assessment scores to the following items&#58; &#8220;Allows residents and tutors to reflect upon the areas of learning where further improvement is needed&#8221; &#40;MTE&#41;&#44; &#8220;The evaluation forms incorporate tools that are useful for correctly addressing the clinical cases&#8221; &#40;MTE&#41;&#44; &#8220;Tools are included that are very useful for evaluating training progression of the residents&#8221; &#40;MTE&#41; and &#8220;Better documentation and organization of the evidences of my training are allowed&#8221; &#40;UEP&#41;&#46; The tutors in turn assigned the highest assessment scores to the following three items of the UEP&#58; &#8220;It facilitates the documentation of the training experiences and achievements of the residents&#8221;&#44; &#8220;It affords a global view of the resident training process&#44; as well as of the strengths and weaknesses&#8221; and &#8220;It enhances awareness of the scope &#40;volume and types of cases addressed&#41; of the training experiences&#8221;&#46; In contrast&#44; the residents assigned lower scores to the items&#58; &#8220;The tutors are better able to adjust their behavior to the characteristics of each resident&#8221; &#40;QFT&#41;&#44; &#8220;Tutor feedback is richer and adjusted to the performance level of the residents&#8221; &#40;QFT&#41; and &#8220;Autonomous learning is encouraged&#8221; &#40;PLS&#41; &#8211; with means &#40;<span class="elsevierStyleItalic">M</span>&#41; of 3&#46;27&#44; 3&#46;57 and 3&#46;60&#44; respectively&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The Kruskal&#8211;Wallis test &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41; showed the assessments of the residents and tutors to be homogeneous in MTE&#44; PLS and UEP&#44; while the tutors assigned higher scores to QFT &#40;4&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5 points <span class="elsevierStyleItalic">versus</span> 3&#46;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41;&#46; The Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span>-test in turn revealed significant differences in QFT between the scores of the tutors and residents referred to the first &#40;S1<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>tutors&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; and second training stages &#40;S2<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>tutors&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#46; The assessments of the tutors and residents referred to the specific items were homogeneous&#44; with the exception of three corresponding to QFT that were scored higher by the tutors &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#58; &#8220;Allows communication to be more specific and centered on the needs of the residents&#8221;&#44; &#8220;The tutors are better able to adjust their behavior to the characteristics of each resident&#8221; and &#8220;Tutor feedback is richer and adjusted to the performance level of the residents&#8221;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The responses to the open-ended questions evidenced that the residents and tutors considered the training evaluation methodology compared with the traditional methodology to be characterized by&#58; &#40;<span class="elsevierStyleItalic">a</span>&#41; greater objectiveness and use of shared criteria among tutors&#59; &#40;<span class="elsevierStyleItalic">b</span>&#41; greater centering of feedback in the performance levels of the residents&#59; and &#40;<span class="elsevierStyleItalic">c</span>&#41; better adjustment to their training needs&#46; Among the aspects amenable to improvement&#44; emphasis was placed on the need to&#58; &#40;<span class="elsevierStyleItalic">a</span>&#41; standardize the training evaluations timetable&#59; &#40;<span class="elsevierStyleItalic">b</span>&#41; improve their compatibility with care overload&#59; &#40;<span class="elsevierStyleItalic">c</span>&#41; expand the clinical protocols of the portfolio&#44; and &#40;<span class="elsevierStyleItalic">d</span>&#41; improve navigation within the portfolio&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Results of objective 2</span><p id="par0080" class="elsevierStylePara elsevierViewall">Having evidenced data adequacy &#40;Kaiser&#8211;Meyer&#8211;Olkin &#91;KMO&#93;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;87&#59; Bartlett&#39;s test of sphericity&#44; chi-squared &#40;66&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>465&#46;1&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; a principal axis factor analysis was performed&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> reflects its unifactorial structure&#44; presents the descriptors of the items &#40;<span class="elsevierStyleItalic">M</span> range 4&#46;55&#8211;5&#46;65&#41; and shows the corresponding factor saturations &#40;range 0&#46;35&#8211;0&#46;75&#41;&#46; The internal consistency of the scale &#40;Cronbach alpha<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;88&#41;&#44; the discriminating indices of the items &#40;mean total item correlation 0&#46;60&#41; and the generalizability indices &#40;<span class="elsevierStyleItalic">G</span><span class="elsevierStyleInf">items</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;99&#59; <span class="elsevierStyleItalic">G</span><span class="elsevierStyleInf">subjects</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;94&#41; were adequate&#46; Inter-rater reliability also showed satisfactory values &#40;intraclass correlation coefficient<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;85&#44; 95&#37; confidence interval &#91;95&#37;CI&#93; 0&#46;78&#8211;0&#46;91&#44; <span class="elsevierStyleItalic">F</span><span class="elsevierStyleInf">48&#46;672</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#46;1&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The evaluations made by the tutors of the performance levels of the residents in dealing with the clinical cases&#44; and the SE established by the residents themselves&#44; yielded high values &#40;ET&#58; <span class="elsevierStyleItalic">M</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#46;2&#44; standard deviation &#91;SD&#93;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;46&#59; EA&#58; <span class="elsevierStyleItalic">M</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46;7&#44; SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;63&#41;&#44; evidencing the existence of a significant relationship between both types of evaluation &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;69&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The results of the ANOVA test revealed the existence of significant principal effects of the type of evaluation upon the assessments derived from them &#40;<span class="elsevierStyleItalic">F</span>&#91;1&#46;60&#93;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#46;1&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#44; <span class="elsevierStyleItalic">&#40;</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;29&#93;&#44; with SE exhibiting values significantly lower than for ET&#46; The training stage of the residents also showed significant principal effects &#40;<span class="elsevierStyleItalic">F</span>&#91;1&#46;60&#93;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#46;1&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#44; <span class="elsevierStyleItalic">&#40;</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;42&#41;&#44; with the observation of a growing progression of the results of the evaluations between stages &#40;<span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">E1</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46;5&#59; <span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">E2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#46;1&#59; <span class="elsevierStyleItalic">M</span><span class="elsevierStyleInf">E3</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#46;3&#41; &#8211; with significantly higher values in S2&#8211;S3 <span class="elsevierStyleItalic">versus</span> S1 &#40;differences <span class="elsevierStyleItalic">M</span>&#58; S2&#8211;S1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;64&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#59; S3&#8211;S1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;79&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">The results of the present study reflect high satisfaction among the residents and tutors with the methodology used to implement CoBaTrICE&#44; as well as adequate reliability and reproducibility of the forms of the global assessment scale used in the training evaluation exercises&#46; The participants positively rated all of the explored dimensions&#58; MTE&#44; PLS&#44; UEP and QFT&#46; The results are particularly significant in relation to the first three dimensions&#44; with strong emphasis on the adequacy of the training evaluations &#40;&#8220;They allow a fairer evaluation than the traditional system&#8221;&#41;&#44; the promotion of autoregulation and reflection of the residents &#40;&#8220;Allows residents and tutors to reflect upon the areas of learning where further improvement is needed&#8221;&#41; and the usefulness of the portfolio &#40;&#8220;It affords a global view of the resident training process&#44; as well as of the strengths and weaknesses&#8221;&#41;&#46; The training evaluation and consequent feedback provided by the tutor are the key elements for effective implementation of the CBME&#46; The frequent evaluations together with periodic and detailed review of the achievements and pending objectives are crucial for ensuring progression of the residents&#46; In order to take full advantage of the potential of the CBME as a driver of learning&#44; healthcare quality and patient safety&#44; we need effective management of the information and documentation generated during the process&#44; as well as a detailed analysis of the adequacy of the evaluation methods used&#44; with a view to introducing possible modifications in order to secure their increased acceptance among all those involved<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a>&#46; In this context&#44; the portfolios are particularly useful tools in the CBME model&#44; since they allow the tutors and residents improved management of the teaching-learning processes and boost self-awareness&#44; self-guidance and reflection on the part of the residents regarding their performance levels &#8211; while also serving as an instrument for quality control of the training process<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">30&#44;31</span></a>&#46; Their use is recommended by the accrediting government institutions of the United Kingdom&#44; the United States and Canada<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">32&#44;33</span></a>&#46; With regard to the quality dimension of feedback&#44; although the assessments of the residents were positive &#40;&#8220;It allows the feedback sessions with the tutors to be more productive&#8221;&#41;&#44; they fell short of the ratings obtained with the rest of the dimensions&#44; and were significantly lower than those of the tutors &#8211; particularly in relation to &#8220;The tutors are better able to adjust their behavior to the characteristics of each resident&#8221;&#46; This discrepancy should cause us to ask ourselves whether the clinical feedback provided by the tutors was adequate and sufficient&#44; and should lead us to consider the need to maintain it over time or complement it with other actions to promote the analysis and discussion of good practices&#46; Effective feedback requires us not only to focus on performance levels but also to effectively respond to the cognitive&#44; emotional and behavioral dimensions implicated in the activity of the residents&#46; It is necessary to create a stimulating environment in which the professional feels comfortable on reflecting in depth upon the mental model behind his or her actions<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a>&#46; The acquisition of these skills can be facilitated through the training of tutors and staff members in coaching techniques&#44; for in addition to serving as instructors&#44; these professionals must act as facilitators and guides to help residents discover their needs&#44; set goals and design realistic strategies for reaching them<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A crucial aspect in order for evaluation to be effective is the reliability&#44; accuracy and reproducibility of the measurement instruments used<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a>&#46; In this study we chose the global assessment scale model&#44; since it offers greater objectiveness than checklists&#44; which are less costly and easier to use but are also less discriminating<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a>&#46; The forms of the global assessment scale created <span class="elsevierStyleItalic">ad hoc</span> were seen to afford adequate psychometric features&#44; a unifactorial structure&#44; strong internal consistency&#44; inter-rater reliability in application and generalizability of the results&#46; It can be concluded that they were reliable and valid for assessing the performance level of the residents through direct observation of their actions in real-life settings at the patient bedside&#44; and for providing the pertinent and consequent constructive feedback&#46; We also confirmed the discriminating validity of the assessment scales between training stages&#44; evidencing that the residents in the more advanced stages achieved significantly higher scores in the management of the clinical cases&#46; In this way&#44; although the CBME places greater importance on the progression of the acquisition of competencies than on the time dimension of medical education&#44; significant effects were observed regarding the training stages of the program&#44; and which explain 42&#37; of the variance of the results of the evaluations&#46; The study also evidenced average to high correlation between ET and SE of the residents&#44; evidencing that the assessments of the former are higher than the latter&#46; These results suggest that the CBME model can help residents to make more realistic judgments of their own performance levels<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The present study has a number of limitations&#44; including particularly its observational design&#44; the limited number of participants&#44; and the fact that it was carried out in a single institution&#46; The results obtained therefore might not be extrapolatable to other Departments&#44; since a range of factors may influence effective implementation of the CBME<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a>&#46; In relation to this latter aspect&#44; it also would be interesting to know the effect of the intervention upon the quality of communication and feedback between the residents and those staff members that are not tutors&#59; this possible association has not yet been explored&#44; due to the gradual incorporation of the latter to the program&#46; Lastly&#44; in order to establish whether CoBaTrICE affords improved competency levels among residents in training than the traditional model based on clinical rotations&#44; a cluster-based randomized trial is being carried out with the participation of 14 Departments of Intensive Care Medicine belonging to 14 Spanish reference hospitals with three residents per year<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a>&#46; Despite its limitations&#44; this study provides a model for the implementation of a CBME program that was well accepted by the tutors and residents&#44; and in which use was made of measurement instruments of confirmed validity and reliability<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a>&#46; To the best of our knowledge&#44; no publications have been made involving the analysis of acceptance on the part of tutors and residents of a specific methodology for implementing CoBaTrICE&#44; and the validity of a concrete global assessment scale model for training evaluation in this specific setting has not been established to date&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conclusions</span><p id="par0100" class="elsevierStylePara elsevierViewall">The methodology used for the implementation of CoBaTrICE was positively rated by both the tutors and residents&#46; The latter demanded increased quality of the feedback provided by the tutors&#46; The forms of the global assessment scale used in the training evaluation exercises were seen to be valid and reliable in assessing the performance level of the residents through direct observation of their actions in the real-life setting at the patient bedside&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Authorship</span><p id="par0105" class="elsevierStylePara elsevierViewall">Study conception &#40;C&#41;&#44; literature review &#40;LR&#41;&#44; questionnaires &#40;QU&#41;&#44; study development and data acquisition &#40;D&#41;&#44; statistical analyses &#40;S&#41;&#44; drafting of the manuscript &#40;Draft&#41;&#44; critical review &#40;CR&#41; and final draft &#40;FD&#41;&#46;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Alvaro Castellanos&#58; C&#44; LR&#44; D&#44; Draft&#44; FD&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0115" class="elsevierStylePara elsevierViewall">Maria Jesus Broch&#58; C&#44; D&#44; CR&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0120" class="elsevierStylePara elsevierViewall">Marcos Barrios&#58; D&#44; CR&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0125" class="elsevierStylePara elsevierViewall">Dolores Sancerni&#58; QU&#44; S&#44; CR&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0130" class="elsevierStylePara elsevierViewall">Maria Castillo&#58; QU&#44; S&#44; CR&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Carlos Vicent&#58; D&#44; CR&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0140" class="elsevierStylePara elsevierViewall">Ricardo Gimeno&#58; D&#44; CR&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0145" class="elsevierStylePara elsevierViewall">Paula Ramirez&#58; D&#44; CR&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8226;</span><p id="par0150" class="elsevierStylePara elsevierViewall">Francisca Perez&#58; D&#44; CR&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#8226;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Rafael Garcia-Ros&#58; C&#44; LR&#44; QU&#44; D&#44; S&#44; Draft&#44; FD&#46;</p></li></ul></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Financial support</span><p id="par0160" class="elsevierStylePara elsevierViewall">This study has been partially funded by the <span class="elsevierStyleGrantSponsor" id="gs1">VLC-BIOMED program of the University of Valencia</span> and the <span class="elsevierStyleGrantSponsor" id="gs2">La Fe Health Research Institute</span> &#40;<span class="elsevierStyleItalic">Instituto de Investigaci&#243;n Sanitaria La Fe</span>&#44; Valencia&#44; Spain&#41; &#40;10-COBATRICE-2015-A&#44; Principal investigator&#58; Alvaro Castellanos-Ortega&#41;&#44; and by the program for the promotion of scientific research&#44; technological development and innovation of the Valencian Community&#44; of the <span class="elsevierStyleGrantSponsor" id="gs3"><span class="elsevierStyleItalic">Conseller&#237;a de Educaci&#243;n&#44; Investigaci&#243;n&#44; Cultura y Deporte</span> of the <span class="elsevierStyleItalic">Generalitat Valenciana</span></span> &#40;GV-AICO-2018-126&#44; Principal investigator&#58; Rafael Garcia-Ros&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflicts of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">Alvaro Castellanos-Ortega is the creator of the e-MIR-Intensive electronic portfolio and holds participation in the benefits of the application&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">M&#46;J&#46; Broch-Porcar&#44; M&#46; Barrios de Pedro&#44; M&#46;C&#46; Fuentes&#44; D&#46; Sancerni&#44; C&#46; Vicent-Perales&#44; R&#46; Gimeno-Costa&#44; P&#46; Ram&#237;mez-Galleymore&#44; F&#46; P&#233;rez-Esteban and R&#46; Garc&#237;a-Ros declare that they have no conflicts of interest in relation to the present article&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">1&#46; To determine the satisfaction of tutors and residents with a specific methodology used to implement CoBaTrICE&#46; 2&#46; To determine the reliability and validity of the global rating scales designed <span class="elsevierStyleItalic">ad hoc</span> to assess the performance of the residents for training purposes&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Prospective cohort study&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Participants</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">All the residents and tutors of the ICU Department of the Hospital Universitario y Polit&#233;cnico la Fe de Valencia&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Intervention</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CoBaTrICE implementation started in March 2016&#44; it was based on&#58; &#40;1&#41; Training the tutors in feedback techniques&#59; &#40;2&#41; Performing multiple objective and structured work based assessments to achieve the competences of the program&#59; and &#40;3&#41; The use of an electronic portfolio to promote learning reflection and to collect the evidence that learning was taking place&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Methods</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The acceptance of CoBaTrICE was explored through a satisfaction survey conducted after 9 months of implementation of the training program&#46; The 15 residents and 5 tutors of the ICU Department were asked about the methodology of the formative assessments&#44; the quality of the feedback&#44; self-learning regulation and the electronic portfolio usefulness&#46; The validity of the global rating scales was assessed through the tests alfa de Cronbach&#44; reliability and generalizability indexes&#44; and intraclass correlation coefficient&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The implementation of CoBaTrICE was satisfactory in all the dimensions studied&#46; The global rating scales used for formative purposes showed reliability and validity&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The methodology used to implement CoBaTrICE was highly valued by tutors and residents&#46; The global rating scales used for formative purposes showed reliability and validity&#46;</p></span>"
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        "resumen" => "<span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objetivos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">&#40;<span class="elsevierStyleItalic">1</span>&#41; Determinar la satisfacci&#243;n de tutores y residentes con la metodolog&#237;a utilizada para la implementaci&#243;n de CoBaTrICE&#44; y &#40;<span class="elsevierStyleItalic">2</span>&#41; determinar la validez y la fiabilidad de las escalas de valoraci&#243;n global dise&#241;ados <span class="elsevierStyleItalic">ad hoc</span> para analizar el desempe&#241;o de los residentes con fines formativos&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Dise&#241;o</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo de cohortes&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Participantes</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Todos los residentes y tutores del Servicio de Medicina Intensiva del Hospital Universitario y Polit&#233;cnico La Fe de Valencia&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Intervenci&#243;n</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">En marzo del 2016 se inici&#243; la implementaci&#243;n de CoBaTrICE sustentada en&#58; &#40;<span class="elsevierStyleItalic">1</span>&#41; formaci&#243;n de los tutores en t&#233;cnicas de retroalimentaci&#243;n&#59; &#40;<span class="elsevierStyleItalic">2</span>&#41; realizaci&#243;n por los residentes de m&#250;ltiples ejercicios reales de evaluaci&#243;n objetiva y estructurada para adquirir las competencias del programa&#44; y &#40;<span class="elsevierStyleItalic">3</span>&#41; uso de un portafolio electr&#243;nico para registrar las evidencias del progreso y estimular la reflexi&#243;n&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">La satisfacci&#243;n con CoBaTrICE se evalu&#243; mediante una encuesta realizada tras 9 meses de implementaci&#243;n a los 15 residentes y 5 tutores del servicio&#46; Se pregunt&#243; sobre la metodolog&#237;a de las evaluaciones&#44; calidad de la retroalimentaci&#243;n&#44; autorregulaci&#243;n del aprendizaje y utilidad del portafolio&#46; Se determinaron la consistencia interna &#40;alfa de Cronbach&#41;&#44; &#237;ndices de generalizabilidad y fiabilidad interjueces &#40;&#237;ndice de correlaci&#243;n intraclase&#41; de las escalas de valoraci&#243;n global&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La aplicaci&#243;n de CoBaTrICE fue satisfactoria en todas las dimensiones estudiadas&#46; Se constataron la validez y la fiabilidad de las escalas de valoraci&#243;n utilizadas&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La metodolog&#237;a utilizada para implementar CoBaTrICE fue valorada positivamente por tutores y residentes&#46; Las escalas de valoraci&#243;n global utilizadas en la evaluaci&#243;n formativa demostraron ser v&#225;lidas&#44; fiables y reproducibles&#46;</p></span>"
        "secciones" => array:7 [
          0 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Objetivos"
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          1 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Dise&#241;o"
          ]
          2 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Participantes"
          ]
          3 => array:2 [
            "identificador" => "abst0055"
            "titulo" => "Intervenci&#243;n"
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          4 => array:2 [
            "identificador" => "abst0060"
            "titulo" => "M&#233;todos"
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          5 => array:2 [
            "identificador" => "abst0065"
            "titulo" => "Resultados"
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          6 => array:2 [
            "identificador" => "abst0070"
            "titulo" => "Conclusiones"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Castellanos-Ortega A&#44; Broch MJ&#44; Barrios M&#44; Fuentes-Dura MC&#44; Sancerni-Beitia MD&#44; Vicent C&#44; et al&#46; An&#225;lisis de la aceptaci&#243;n y validez de los m&#233;todos utilizados para la implementaci&#243;n de un programa de formaci&#243;n basado en competencias en un servicio de Medicina Intensiva de un hospital universitario de referencia&#46; Med Intensiva&#46; 2021&#59;45&#58;411&#8211;420&#46;</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">As&#58; asymmetry&#59; SD&#58; standard deviation&#59; Ku&#58; kurtosis&#59; <span class="elsevierStyleItalic">M</span>&#58; mean&#59; 1&#58; strongly disagree&#59; 2&#58; quite disagree&#59; 3&#58; neither agree nor disagree&#59; 4&#58; quite agree&#59; 5&#58; strongly agree&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" scope="col">Items&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Frequency responses by level</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Descriptors</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">M</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ku&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Methodology of the training evaluations</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The forms of the structured evaluations include the key competencies for professional practice&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#46;55&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>It is a good guide for allowing tutors to more objectively assess the performance of residents&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The evaluation forms incorporate tools that are useful for correctly addressing the clinical cases&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The evaluation forms are clearly worded&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#8211;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>It allows more complete evaluation than the traditional system&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#8211;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>It allows fairer evaluation than the traditional system&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#8211;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#8722;0&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tools are included that are very useful for evaluating training progression of the residents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#8211;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Promotion of learning self-regulation</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>It facilitates autonomous learning among the residents&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#8211;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#8722;0&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>It helps residents to recognize their strengths&#47;weaknesses in professional practice&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&#8211;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>It promotes more active learning&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">4&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>It helps residents to reflect upon the objectives and achievements reached in their training process&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#8211;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>It allows residents and tutors to reflect upon the areas of learning where further improvement is needed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#8211;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Quality of the feedback provided by tutors</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>It allows the feedback sessions with the tutors to be more productive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#8211;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>It allows communication to be more specific and centered on the needs of the residents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#8211;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The tutors are better able to adjust their behavior to the characteristics of each resident&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#8211;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tutor feedback is richer and adjusted to the performance level of the residents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#8211;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="11" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Usefulness of the electronic portfolio</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The material and technological support of the e-portfolio is very adequate&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Better documentation and organization of the evidences of training are allowed&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>It facilitates documentation of the training experiences and achievements of the residents&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>It affords a global view of the resident training process&#44; as well as of the strengths and weaknesses&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46; Requests and performs the necessary complementary diagnostic tests following a logical order of priorities&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46; Performs a complete differential diagnosis coherent with the clinical condition of the patient and the provisional results of the complementary tests&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;73&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#46; Performs frequent and structured re-evaluation&#44; insisting on the important findings of the previous explorations&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">8&#46; Correctly manages the steps in time&#44; particularly in situations where the outcome is time-dependent&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#46; Manages resources efficiently &#40;staff&#44; diagnostic tests and treatments&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">10&#46; Knows his or her limitations&#44; requesting help and advice from other specialists if needed&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">11&#46; Prioritizes actions based on their potential risks and benefits&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">12&#46; Generates confidence in the team&#44; the patients and their relatives&#46; Effective communication with the team&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">13&#46; Shows respect and empathy in communication with the patients and their relatives&#46; Explains the situation and the treatment plan to them in a clear and concise manner&#44; making sure that they have understood the information provided&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#8211;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;61&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">14&#46; Draft a complete&#44; structured and precise clinical report&#44; including the problems and the plan based on priorities&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;43&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#8211;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;77&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;86&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">15&#46; Performs an outcome estimate based on the use of prognostic indicators&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#8211;6&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Descriptive statistics &#40;mean &#91;<span class="elsevierStyleItalic">M</span>&#93;&#44; standard deviation &#91;SD&#93;&#44; range&#44; asymmetry and kurtosis&#41; and factor saturation of the items of the global assessment scale referred to management of the clinical cases&#46;</p>"
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                            0 => "L&#46;D&#46; Gruppen"
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