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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Managing the impact of the death of paediatric patients is a critical challenge for resident physicians and paediatricians&#44; who experience the emotional repercussions of the death of young patients and its impact on families&#46; Some of the possible strategies to address this challenge would be the delivery of structured comprehensive training in palliative care and bereavement management from the early stages of medical education&#44; pursuing an institutional culture that supports the emotional wellbeing of health care professionals&#44; promoting multidisciplinary collaboration in paediatric end-of-life care and fostering self-care and self-compassion in healthcare professionals&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Previous publications have proposed various structured interventions to facilitate the processing of loss and grief&#44; improve coping strategies and&#44; ultimately&#44; strengthen the emotional resilience of professionals working in clinical settings&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">&#8220;Death rounds&#44;&#8221; one of the tools available to healthcare professionals&#44; are based on established grief and bereavement counselling principles and provide a specific opportunity for participants to express&#44; share and process grief resulting from their clinical work&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> We developed an interventional study with the aim of exploring this tool for improvement of care delivery by paediatric professionals&#44; processing the impact and emotional repercussions of end-of-life experiences shared with children and their families and addressing challenges and deficits in managing these situations&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We conducted a qualitative interventional study in the department of paediatrics of a tertiary care hospital that includes a paediatric intensive care unit &#40;PICU&#41; and offers residency training&#46; With the collaboration of a mental health specialist with expertise on psychotherapy and grief&#44; we designed and held structured meetings for healthcare professionals to address end-of-life care for paediatric patients and bereavement care for families&#46; During these meetings&#44; which lasted approximately 2 hours&#44; attendees discussed aspects related to counselling and support skills using the same clinical scenario as a guiding thread for educational purposes&#44; a case narrative based on the death of a real patient from a subjective and emotional perspective&#46; The narrative&#44; written by the organisers&#44; highlighted essential aspects about the moment of death&#44; including the provision of support by health care professionals and their own self-care and management of emotions&#44; followed by a discussion in which participants shared their opinions and experiences&#46; We invited groups of 4&#8211;6 professionals to participate on a voluntary basis&#44; with different participants in each meeting&#44; and meetings were held monthly after being announced in the department&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">To assess the impact of these meetings&#44; we analysed the responses to two questionnaires&#46; The first one focused on the previous experience and knowledge of participants in relation to end-of-life care&#44; and the second evaluated the perceived knowledge and skills acquired through the meeting and their perceived usefulness in the participant&#8217;s practice&#46; The questionnaires were administered through the Google Forms platform&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">During the study period&#44; between 2018 and 2019&#44; a total of 50 physicians divided in groups participated in at least one of the nine meetings held&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the demographic and professional characteristics of the participants&#46; Eighty percent &#40;n &#61; 40&#41; reported having developed skills in end-of-life care through imitation of other professionals &#40;which was the sole means of training in 44&#37;&#41; and only a minority &#40;n &#61; 10&#41; reported learning through reading and studying&#46; In the questionnaire prior to training&#44; nearly all participants &#40;92&#37;&#41; expressed a need for specific training in grief&#47;bereavement&#44; ethics&#44; delivering bad news and the management of challenging situations&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Out of the 50 participants&#44; 80&#37; &#40;n &#61; 40&#41; evaluated the experience and the knowledge they had acquired in the training through a second questionnaire&#46; Of this subset&#44; 77&#37; &#40;31&#41; reported and demonstrated the acquisition of new knowledge and support skills and 88&#37; expressed increased confidence in facing the death of a patient&#46; When it came to self-care&#44; 95&#37; of professionals rated the received training as useful or very useful&#44; highlighting aspects like teamwork&#44; sharing feelings and experiences and introspection&#46; Most of them &#40;92&#37;&#41; considered the duration and number of participants adequate&#46; All participants that completed the post-intervention questionnaire agreed on attending additional sessions and establishing a continuing education programme on the subject&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">As a novel approach&#44; the strategy presented here was based on the use of the case narrative for medical education&#44; which&#44; combined with other training approaches&#44; proved more effective than any of them in isolation&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> underscoring the importance of the message and its alignment with the target audience and the objectives of the training&#46; During the intervention&#44; the physicians that participated requested further training on end-of-life care and related coping and bereavement management skills&#46; Death rounds emerged as a useful tool to address and process these aspects and were rated very positively by the same professionals that demanded training&#46; This and other strategies can help prepare them to face the emotional and professional challenges associated with death and contribute to reducing burnout among paediatricians and medical residents&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">Manuel Gij&#243;n Mediavilla receives funding for his research through a <span class="elsevierStyleGrantSponsor" id="gs0005">R&#237;o Hortega grant&#47;contract of the Instituto de Salud Carlos III</span>&#44; a public entity for health research promotion in Spain&#46;</p></span></span>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&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\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&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\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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Scientific Letter
Coping with death: bereavement support for paediatricians
Afrontando la muerte: reuniones de duelo para profesionales en el cuidado pediátrico
Manuel Gijón Mediavillaa,
Corresponding author
manugijonm@gmail.com

Corresponding author.
, Pablo Rojo Conejoa, Eduardo López Fernándezb, Sara Losantos Uchac, Sylvia Belda Hofheinzb
a Clinical Trials and Pediatric Research Unit, Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, Spain
b Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, Spain
c Área de Psicología de Duelo, Fundación Mario Losantos del Campo, Madrid, Spain
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    "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>"
    "titulo" => "Coping with death&#58; bereavement support for paediatricians"
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        "autoresLista" => "Manuel Gij&#243;n Mediavilla, Pablo Rojo Conejo, Eduardo L&#243;pez Fern&#225;ndez, Sara Losantos Ucha, Sylvia Belda Hofheinz"
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        "titulo" => "Afrontando la muerte&#58; reuniones de duelo para profesionales en el cuidado pedi&#225;trico"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Managing the impact of the death of paediatric patients is a critical challenge for resident physicians and paediatricians&#44; who experience the emotional repercussions of the death of young patients and its impact on families&#46; Some of the possible strategies to address this challenge would be the delivery of structured comprehensive training in palliative care and bereavement management from the early stages of medical education&#44; pursuing an institutional culture that supports the emotional wellbeing of health care professionals&#44; promoting multidisciplinary collaboration in paediatric end-of-life care and fostering self-care and self-compassion in healthcare professionals&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Previous publications have proposed various structured interventions to facilitate the processing of loss and grief&#44; improve coping strategies and&#44; ultimately&#44; strengthen the emotional resilience of professionals working in clinical settings&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">&#8220;Death rounds&#44;&#8221; one of the tools available to healthcare professionals&#44; are based on established grief and bereavement counselling principles and provide a specific opportunity for participants to express&#44; share and process grief resulting from their clinical work&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> We developed an interventional study with the aim of exploring this tool for improvement of care delivery by paediatric professionals&#44; processing the impact and emotional repercussions of end-of-life experiences shared with children and their families and addressing challenges and deficits in managing these situations&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We conducted a qualitative interventional study in the department of paediatrics of a tertiary care hospital that includes a paediatric intensive care unit &#40;PICU&#41; and offers residency training&#46; With the collaboration of a mental health specialist with expertise on psychotherapy and grief&#44; we designed and held structured meetings for healthcare professionals to address end-of-life care for paediatric patients and bereavement care for families&#46; During these meetings&#44; which lasted approximately 2 hours&#44; attendees discussed aspects related to counselling and support skills using the same clinical scenario as a guiding thread for educational purposes&#44; a case narrative based on the death of a real patient from a subjective and emotional perspective&#46; The narrative&#44; written by the organisers&#44; highlighted essential aspects about the moment of death&#44; including the provision of support by health care professionals and their own self-care and management of emotions&#44; followed by a discussion in which participants shared their opinions and experiences&#46; We invited groups of 4&#8211;6 professionals to participate on a voluntary basis&#44; with different participants in each meeting&#44; and meetings were held monthly after being announced in the department&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">To assess the impact of these meetings&#44; we analysed the responses to two questionnaires&#46; The first one focused on the previous experience and knowledge of participants in relation to end-of-life care&#44; and the second evaluated the perceived knowledge and skills acquired through the meeting and their perceived usefulness in the participant&#8217;s practice&#46; The questionnaires were administered through the Google Forms platform&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">During the study period&#44; between 2018 and 2019&#44; a total of 50 physicians divided in groups participated in at least one of the nine meetings held&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the demographic and professional characteristics of the participants&#46; Eighty percent &#40;n &#61; 40&#41; reported having developed skills in end-of-life care through imitation of other professionals &#40;which was the sole means of training in 44&#37;&#41; and only a minority &#40;n &#61; 10&#41; reported learning through reading and studying&#46; In the questionnaire prior to training&#44; nearly all participants &#40;92&#37;&#41; expressed a need for specific training in grief&#47;bereavement&#44; ethics&#44; delivering bad news and the management of challenging situations&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Out of the 50 participants&#44; 80&#37; &#40;n &#61; 40&#41; evaluated the experience and the knowledge they had acquired in the training through a second questionnaire&#46; Of this subset&#44; 77&#37; &#40;31&#41; reported and demonstrated the acquisition of new knowledge and support skills and 88&#37; expressed increased confidence in facing the death of a patient&#46; When it came to self-care&#44; 95&#37; of professionals rated the received training as useful or very useful&#44; highlighting aspects like teamwork&#44; sharing feelings and experiences and introspection&#46; Most of them &#40;92&#37;&#41; considered the duration and number of participants adequate&#46; All participants that completed the post-intervention questionnaire agreed on attending additional sessions and establishing a continuing education programme on the subject&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">As a novel approach&#44; the strategy presented here was based on the use of the case narrative for medical education&#44; which&#44; combined with other training approaches&#44; proved more effective than any of them in isolation&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> underscoring the importance of the message and its alignment with the target audience and the objectives of the training&#46; During the intervention&#44; the physicians that participated requested further training on end-of-life care and related coping and bereavement management skills&#46; Death rounds emerged as a useful tool to address and process these aspects and were rated very positively by the same professionals that demanded training&#46; This and other strategies can help prepare them to face the emotional and professional challenges associated with death and contribute to reducing burnout among paediatricians and medical residents&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">Manuel Gij&#243;n Mediavilla receives funding for his research through a <span class="elsevierStyleGrantSponsor" id="gs0005">R&#237;o Hortega grant&#47;contract of the Instituto de Salud Carlos III</span>&#44; a public entity for health research promotion in Spain&#46;</p></span></span>"
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    "fechaRecibido" => "2024-04-02"
    "fechaAceptado" => "2024-07-02"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sex &#40;male&#47;female&#41;&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">&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">12&#47;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><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
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                  \t\t\t\t">Age in years&#44; median &#40;IQR&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="left" valign="\n
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                  \t\t\t\t">25 &#40;23&#8211;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Professional category&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="left" valign="\n
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                  \t\t\t\t">Paediatrics resident&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">39&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">&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="left" valign="\n
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                  \t\t\t\t">Paediatrician&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="left" valign="\n
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                  \t\t\t\t">6&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">&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="left" valign="\n
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                  \t\t\t\t">Intensive care resident&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&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
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                  \t\t\t\t">&#60;5 years&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="left" valign="\n
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                  \t\t\t\t">48&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
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#62;5 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&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">No&#44; but had related training&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \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 ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">No&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">26&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">Type of training&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">Only imitation&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">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Imitation and study&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">7&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
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                  \t\t\t\t">&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">Imitation and specific training&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&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
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                  \t\t\t\t">&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Only study and specific training&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="left" 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></tr></tbody></table>
                  """
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Characteristics and previous experience of training participants&#46;</p>"
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        0 => array:2 [
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            0 => array:3 [
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                      "autores" => array:1 [
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                      "Revista" => array:7 [
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                        "link" => array:1 [
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                            "web" => "Medline"
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        "identificador" => "xack786465"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0050" class="elsevierStylePara elsevierViewall">We thank all the physicians that participated in the death rounds and contributed to this work with their responses regarding their personal experience and self-efficacy&#46;</p>"
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Article information
ISSN: 23412879
Original language: English
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