Effectiveness of an Intervention Based on Communication Skills and Cognitive Distortions to Improve the Doctor–Patient Relationship

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It affects both patients (e.g., satisfaction, treatment adherence) and healthcare professionals (e.g., reduced conflict, improved well-being). Training in communication skills helps prevent conflicts, enhances quality of care, and protects professionals. Therefore, there is a need for training programs that strengthen the PPR, prevent difficulties in the therapeutic process, and improve well-being. Objective : To evaluate the effectiveness of a training program in communication and problem-solving skills aimed at medical staff. Method : The sample consisted of 147 professionals from the Public Health Service. Participants were divided into three groups of approximately 40–60 individuals each. Group allocation was non-random and based on medical specialty and professional setting. The intervention included content on cognitive restructuring, assertive communication, motivation, leadership, and conflict management. Sociodemographic variables, communication skills, cognitive distortions, and quality of life were assessed. Results : Following the intervention, significant changes were observed in the variables analyzed. Perceived quality of life increased among professionals, while dependency-related cognitive distortions decreased and perfectionism showed a slight increase. Communication skills scores decreased after the intervention. Sex-based differences were found in some variables, although not in the magnitude of pretest–posttest change. Significant associations among variables were also identified. Discussion : These findings provide evidence of the value of training professionals in skills that strengthen the PPR. Further research using more rigorous designs is needed to consolidate these results and advance the development of effective interventions. communication skills physicians intervention program cognitive distorsions Figures Figure 1 INTRODUCTION The doctor–patient relationship (DPR) plays a fundamental role in medical practice and constitutes one of the central elements of physicians’ professional activity (1–3). The DPR consists of an informational component (diagnosis, treatment, etc.) and an affective component (a respectful and trusting relationship), which develops within the clinical setting and may influence patients’ recovery and adherence to treatment (2, 4; 5). Factors such as professional interest, commitment to patient well-being, and honest and responsible behavior contribute to strengthening patients’ trust and satisfaction, facilitating information exchange and reducing interpersonal conflict during clinical encounters (1, 4, 6). Medical professionals are frequently exposed to high-demand clinical situations that may negatively affect their health and well-being due to the emotional and cognitive load involved (7,8). Professionals’ perceived ability to cope with conflictual situations, together with the thoughts they hold about these encounters, plays a key role in their psychological adjustment and occupational health (9). In this regard, distorted thinking patterns (such as excessive self-demand, perfectionism, or cognitive dependency) have been associated with poorer mental health outcomes, increased risk of burnout, and lower levels of communicative empathy (10,11). These cognitive patterns may interfere with emotional regulation and compromise the quality of interactions with patients, highlighting the importance of providing healthcare professionals with tools to manage complex communicative situations and protect their well-being (14–16). Professional quality of life (PQoL) is a key component of physicians’ occupational well-being and healthcare quality. The World Health Organization defines PQoL as individuals’ perceptions of their physical, psychological, and social well-being in the work context (17). In healthcare settings, higher PQoL has been associated with lower burnout, better communication with patients, and greater motivation, whereas low PQoL has been linked to reduced empathy, greater interpersonal conflict, and compromised patient safety (18–20). In this context, communication skills have been identified as a protective resource that supports resilience and the PPR, contributing to professionals’ overall quality of life (21,22). The quality of the physician–patient relationship (PPR) depends on multiple factors, including the individual characteristics of both physicians and patients, relational dynamics, and healthcare system policies (23). Physicians with strong active listening skills, empathy, and clear communication are less likely to receive complaints or legal claims (24). In contrast, unclear or condescending communication increases patient dissatisfaction and interpersonal conflict (24). Gender has been identified as a relevant factor influencing PPR. Previous research indicates that consultations conducted by female physicians tend to involve longer interactions, greater social exchange, and more effective communication strategies (25), and have been associated with better patient outcomes (26). Although communication training has been shown to be effective for both genders, persistent differences in baseline communication skills highlight the importance of incorporating a gender perspective into professional training programs (27). Targeted training in clinical communication has been shown to be effective in preventing conflicts, improving quality of care, and protecting healthcare professionals’ well-being (2,23,28). Existing programs typically combine theoretical instruction with experiential methodologies such as workshops, simulations, role-playing, reflective exercises, and audiovisual resources, which facilitate the acquisition and consolidation of communication skills in clinical practice (29–31). However, success in the PPR does not depend solely on the professional, as patient-related and healthcare system factors also play a role. Nevertheless, poor communication remains a primary risk factor for patient safety and treatment effectiveness (32). Despite growing interest in clinical communication, communication skills continue to receive insufficient emphasis within medical education (33). Many physicians report limited training in this area across undergraduate education and clinical practice, which is reflected in patients’ experiences of distant or insufficiently empathetic care (23,31,33–36). Although physicians play a central role in healthcare delivery, they often receive less formal training in communication skills than other healthcare professionals, such as nursing staff (37). To help address this gap, the present study proposes a training program aimed not only at strengthening the PPR, but also at providing practical tools to manage complex communicative situations commonly encountered in clinical practice. In an increasingly demanding, person-centered healthcare system, the implementation of this type of intervention is essential to improving both patient experience and professional well-being (35). The aim of the present study is to evaluate an intervention program designed to enhance communication and problem-solving skills among medical professionals. Specifically, the objectives are to: (a) analyze changes in communication skills before and after the intervention; (b) examine variations in quality of life and cognitive distortions; (c) explore the influence of gender on the effectiveness of the program; and (d) investigate the relationship between communication skills, quality of life, and distorted thinking patterns. The intervention is expected to improve communication skills, reduce cognitive distortions, and enhance physicians’ quality of life, with potential gender effects and associations with well-being. Methods Study design A single-group quasi-experimental pretest–posttest design was used, following the TREND Statement criteria for nonrandomized evaluations (38). No randomization or control group was included, as the intervention was implemented with all participants as an initial exploratory assessment of its effectiveness. Participants Eligibility criteria for participants A total of 300 medical professionals from the Murcia Health Service (MHS) were invited to participate. A convenience sampling method was used (39). The inclusion criteria for the study were: (a) being a member of the medical staff of the SMS; (b) actively working during the data collection and intervention period; and (c) voluntary participation in the study. Professionals unavailable during the intervention period were excluded. Group eligibility criteria Participants were divided into three groups of approximately 40–60 individuals each. Group allocation was non-random and based on medical specialty and professional setting (primary care or specialized care). This procedure was guided by organizational and feasibility considerations. All groups received the same intervention following a standardized protocol. Settings and locations for data collection The intervention and data collection were conducted in healthcare centers affiliated to the Murcia Health Service (MHS), including both primary and specialized care facilities. Assessments were administered digitally. Ethical principles of confidentiality, anonymity, and informed consent were observed. Accordingly, the study received approval from the Ethics Committee of the University of one of the authors (AUT.DCC.PLR.230719) Intervention The intervention was carried out between September and December 2023. The total training duration was 50 hours, divided into six sessions of four hours each. The format was blended, including 30 hours of online work. The intervention was delivered by an experienced multidisciplinary healthcare team (psychologists, doctors, etc.). Key topics addressed included factors influencing the doctor–patient relationship, communication and assertiveness skills, team conflict management, and communication in special clinical situations. The sessions combined theoretical presentations with practical workshops in which participants applied communication techniques through simulated scenarios and clinical cases. The intervention aimed to promote a human-centered approach and provide training in communication, motivation, leadership, and special clinical situations. Table 1 presents the general and specific contents of the program. Table 1 General and Specific Contents of the Program Sessions General content Specific content Session 1 Introduction and work proposal - Factors influencing the physician–patient relationship - The human being as a whole - What is evident versus what is subjective (pain vs. suffering) Human relationships. Communication - Unidirectional and bidirectional relationships - Key aspects of communication: assertiveness, boundaries, and empathy in relationships - The communication process - Verbal and nonverbal communication - Functional versus dysfunctional communication Session 2 Basic human needs - Patient reception and welcoming - Guidance and orientation The role of the physician - The physician’s role in the relationship with the patient. Characteristics of authority figures - The influence of authority in the physician–patient relationship. The role of the patient - Individual characteristics - Characteristics associated with the disease Session 3 Mental strategies - The concepts of logical thinking, lateral thinking, and emotional management of conflict. The mind in the face of novelty - How the mind approaches new ideas in problem-solving. Session 4 Cognitive restructuring - Transforming thoughts, emotions, and actions The power of mindset: growth vs. fixed - Fixed mindset versus growth mindset: “things are the way they are” or can they evolve? Session 5 Team creativity: integration, diversity, and collaboration - Team creativity: integrating individual differences (learning to work with diverse personal styles) and accepting others’ ideas Session 6 Conflict resolution - Most commonly used techniques for generating new ideas and approaches to conflict resolution. Practical module - Workshop on practical case resolution Outcome measures The assessment protocol included sociodemographic variables, communication skills, quality of life, and cognitive distortions. Communication skills The Health Professionals Communication Skills Scale (EHC-PS) was used (40). This instrument measures communicative competencies in healthcare settings, including both verbal and nonverbal skills. The scale consists of 18 items with a 6-point Likert response format (1 = strongly disagree to 6 = strongly agree). It assesses the following dimensions: a) Informative communication; b) active listening; c) empathy; d) respect; e) authenticity; and f) assertiveness. Previous studies have reported adequate psychometric properties, with reliability indices ranging from 0.65 to 0.78 (40). Similarly, in the present study, high internal consistency and reliability were obtained (α = .924). Quality of life The Professional Quality of Life Questionnaire (CVP-35); (41) is a psychometric instrument designed to assess professional quality of life in healthcare contexts. It consists of 35 items distributed across three factors: a) Management support, b) Workload y c) Intrinsic motivation. Items are rated on a 10-point Likert scale (1 = not at all to 10 = very much). The CVP-35 has shown good psychometric properties, with high internal consistency and reliability (α = .8–.7) (41), as well as adequate construct validity and sensitivity to change (42). In the present study, excellent reliability indices were found, with a Cronbach’s alpha of .952. Cognitive Distortions To assess cognitive distortions, the Dysfunctional Attitude Scale–Revised (DAS-R) was used (43). This is a revised and abbreviated version of the Dysfunctional Attitude Scale developed by Weissman and Beck (1978) (44). The instrument measures dysfunctional thought patterns, which are considered a risk factor for depression. The scale consists of 17 items distributed across two factors: a) Perfectionism/Performance evaluation and b) Dependency. Each item is rated on a 7-point Likert scale, where participants indicate their level of agreement with various statements. The DAS-R has demonstrated good internal consistency (α = .90), temporal stability, and convergent and discriminant validity (43). In the present study, a Cronbach’s alpha of .944 was obtained, indicating excellent internal consistency and reliability. Data analysis Statistical analyses were performed using JAMOVI software (version 2.3.28). The Jpower test was used to calculate the sample size. This analysis indicated that a sample size of 84 participants would be required to reliably detect an effect size of δ ≥ .4, with a statistical power exceeding .95, under a two-sided testing framework with a maximum Type I error rate of α = .05. Then, data distribution was examined using the Shapiro–Wilk test to assess the normality assumption of the variables of interest. Demographic data and other participant characteristics were described using descriptive statistics. Primary analyses were conducted using the intention-to-treat (ITT) approach (45). All participants who completed the baseline assessment and attended the first session were included in subsequent analyses, regardless of later participation or adherence to the intervention. Comparisons of categorical variables were conducted using the Chi-square test. Since the sample did not meet normality assumptions, comparisons of continuous variables were carried out using the Wilcoxon test, and repeated-measures ANOVA was used for variables measured at two time points (baseline and post-intervention). Additionally, data were analyzed using a linear mixed models (LMM; MIXED) procedure with maximum likelihood estimation and full information to assess relationships among model variables. The significance of these relationships was evaluated using Wilks’ lambda. Effect sizes were calculated using partial eta-squared (η²p) and interpreted according to Cohen’s criteria (46). RESULTS Of the 147 participants, 89 completed the pre-intervention assessment and 94 completed the post-intervention assessment, with a response rate of 62.2%. Figure 1 shows the flow diagram together with the corresponding results. Source. Adapted from CONSORT 2010 Sociodemographic Characteristics Participants’ ages ranged from 26 to 68 years (M = 45.1, SD = 12). The gender distribution was 31.5% men and 68.5% women. Regarding specialty, most participants belonged to Family and Community Medicine (56.2%). The sociodemographic data of the sample are summarized in Table 1 . Table 1 Sociodemographic and labor characteristics before the intervention Assessment Time n % Before the intervention 89 48.6 After the intervention 94 51.4 Age 18–29 14 15.7 30–39 16 18.0 40–49 24 27.0 50–59 26 29.2 > 60 9 10.1 Sex Man 28 31.5 Woman 61 68.5 Marital Status Married or Domestic Partnership 31 34.8 Single 44 49.4 Separated 1 1.1 Divorced 1 1.1 Missing 2 2.2 Type of Employment Contract Permanent 51 57.3 Temporary / Substitution 22 24.7 Resident 16 18.0 Interim 0 0.0 Long-term 0 0.0 Continuing Education Yes 89 100.0 No 0 0.0 Sick leave in the last 12 months Yes 19 21.3 No 70 78.7 Specialty Mental Health 5 5.6 Family and Community Medicine 50 56.2 Internal Medicine 2 2.2 Rehabilitation 1 1.1 Occupational Medicine 1 1.1 Pathological Anatomy 2 2.2 Intensive Care Medicine 1 1.1 Anesthesiology and Resuscitation 2 2.2 Hospital Pharmacy 0 0.0 Surgery 4 4.5 Specialist 7 7.9 Emergency Medicine 2 2.2 Radiology (Diagnostic Imaging) 3 3.4 Other 9 10.1 Years in Current Position 30 1 1.1 Years in the Profession 30 6 6.7 Missing 1 1.1 Communication Skills Table 2 presents the mean differences in communication skills. Significant differences were observed between pre- and post-intervention assessments. Scores decreased for Active Listening (p < .001), Informative Communication (p < .001), Empathy (p < .001), Respect and Authenticity (p < .001), and Assertiveness (p < .001). Quality of life On the other hand, Professional Quality of Life increased after the intervention (p < .001). Specifically, medical staff reported higher levels of Management Support (p < .001), Workload (p < .001), and Intrinsic Motivation (p < .001). Cognitive distortions Significant differences were found between pre-test and post-test measurements in cognitive distortions (p < .001). A reduction was observed in Dependency, whereas Perfectionism showed a slight increase (Table 2 ). Table 2 Mean differences before and after the intervention VARIABLES T1 T2 T1-T2 M (SD) M (SD) Statistical p Size Effect EHC 45.7 (16.9) 47.6 (22.2) 0.00 < .001*** -1.00 Active Listening 35.1 (4.55) 34.6 (4.91) 0.00 < .001*** -1.00 Informative Communication 63.7 (6.86) 60.9 (10.1) 0.00 < .001*** -1.00 Empathy 31.1 (5.71) 30.1 (6.47) 0.00 < .001*** -1.00 Respect and authenticity 32.0 (6.01) 30.9 (8.72) 0.00 < .001*** -1.00 Assertiveness 59.2 (7.06) 59.0 (7.61) 0.00 < .001*** -1.00 DAS-R 156 (18.9) 152 (28.6) 0.00 < .001*** -1.00 Perfectionism 26.7 (11) 28.7 (14.6) 0.00 < .001*** -1.00 Dependency 19 (7.17) 18.9 (8.64) 0.00 < .001*** -1.00 CVP 219 (50.3) 224 (57.4) 0.00 < .001*** -1.00 Management support 84.0 (19.7) 85.7 (23.0) 0.00 < .001*** -1.00 Workload 68.7 (17.2) 70.9 (18.1) 0.00 < .001*** -1.00 Intrinsic motivation 54.1 (17.2) 54.5 (15.1) 0.00 < .001*** -1.00 Quality of life 12.0 (4.43) 12.5 (4.62) 0.00 < .001*** -1.00 Note : EHC= Communication Skills Scale for Healthcare Professionals; DAS-R = Dysfunctional Attitude Scale-Revised; CVP = Professional Quality of Life Questionnaire; T1 = pre-test; T2 = post-test Gender differences Table 4 presents the descriptive analysis of the dependent variables by gender. The results indicate different trends according to gender: 1) Perfectionism was higher in women at the beginning; however, after the intervention, it increased notably more in men; 2) Dependency increased in men and decreased in women, 3) Communication skills were higher in women at baseline but became similar between genders after the intervention, 4) Men initially perceived greater Management Support and showed higher motivation than women; however, after the intervention, both variables increased notably among women, y 5) Quality of life was higher in men before the intervention, but by the end, it showed a greater increase in women. Table 4 Multivariate Analysis of Variance of the Evaluated Variables by Gender Men Women Pretest Post-test Pretest Post-test Perfectionism 25.21 (7.63) 32.00 (16.35) 27.27 (12.60) 27.6 (13.47) Dependency 18.29 (6.48) 19.69 (9.28) 20.12 (7.30) 18.93 (7.74) Active Listening 33.67 (5.96) 34.35 (5.43) 35.67 (3.71) 34.93 (4.42) Communication 61.83 (7.90) 60.77 (10.63) 64.22 (6.55) 60.87 (9.43) Empathy 29.67 (5.21) 28.73 (6.44) 32.27 (5.36) 30.22 (6.78) Respect 32.88 (5.40) 31.42 (8.31) 31.73 (5.06) 31.43 (8.19) Assertiveness 58.13 (6.97) 59.44 (7.73) 60.25 (6.55) 59.51 (6.67) Management support 88.29 (17.41) 89.19 (18.55) 83.59 (18.11) 87.48 (22.49) Workload 69.13 (14.17) 73.62 (16.11) 69.53 (17.24) 72.63 (16.99) Motivation 57.25 (12.12) 57.50 (12.05) 52.69 (12.45) 55.17 (14.77) Quality of life 13.04 (4.04) 13.27 (4.24) 11.63 (4.15) 12.21 (4.15) According to the results of the multivariate analysis of variance (MANOVA), the overall effect of Assessment Time on the dependent variables did not reach statistical significance (Wilks’ Λ = .978, F(2,177) = 2.03, p = .134, η²ₚ = .022). In contrast, a significant main effect of Sex was observed (Wilks’ Λ = .964, F(2,177) = 3.30, p < .05, η²ₚ = .036), indicating overall differences between men and women. However, the Assessment Time × Sex interaction was not significant (p = .660). No significant interactions were observed, suggesting that pre–post changes were consistent across men and women. Relationship between variables Table 5 presents the correlation analyses among the variables assessed. The correlational analysis revealed significant negative associations between Perfectionism-related cognitive distortions and all dimensions of communication skills, including Active Listening ( r = − .362, p < .001), Informative Communication ( r = − .348, p < .001), Empathy ( r = − .291, p < .001), Respect and Authenticity ( r = − .239, p < .001), and Assertiveness ( r = − .341, p < .001). In addition, a strong and significant positive correlation was found between Perfectionism and Dependency ( r = .777, p < .001), indicating that professionals with higher levels of self-demand tend to show a greater need for external validation. Similarly, Perfectionism-related cognitive distortions were negatively associated with perceived Managerial Support ( r = − .152, p < .05) and Professional Quality of Life ( r = − .147, p < .05). With regard to Dependency-related cognitive distortions, negative associations were observed with Informative Communication ( r = − .173, p < .05), Empathy ( r = − .168, p < .05), Respect and Authenticity ( r = − .164, p < .05), and Assertiveness ( r = − .279, p < .01). No significant associations were found between cognitive distortions and dimensions of professional quality of life. Regarding professional quality of life, strong positive associations were identified with organizational and motivational factors. Professional Quality of Life was significantly and positively correlated with Workload ( r = .587, p < .001), Managerial Support ( r = .736, p < .001), and Intrinsic Motivation ( r = .739, p < .001), although it was not correlated with communication skills. Likewise, Workload was positively associated with Managerial Support ( r = .829, p < .001) and Intrinsic Motivation ( r = .820, p < .001). Table 5 Correlation among outcome measures 1. Perfectionism 1 2 3 4 5 6 7 8 9 10 11 1 2. Dependency .777*** 1 3. Active Listening − .362*** − .235 1 4. Informative communication − .348*** − .173* .656*** 1 5. Empathy − .291*** − .168* .574*** .678*** 1 6. Respect and Authenticity − .239*** − .164* .491*** .613*** .706*** 1 7. Assertiveness − .341*** − .279*** .435*** .520*** .387*** .462*** 1 8. Management support − .152* − .09 .170* .116 .107 .128 .140 1 9. Workload − .074 − .08 .153* .036 .061 .054 .077 .829*** 1 10. Intrinsic Motivation − .116 − .074 .215** .135 .129 .160* .154* .899*** .820*** 1 11. Quality of Life -147* − .135 .133 .02 .055 .087 .164 .736*** .587*** .739*** 1 Note: *p<.05; **p < .01; ***p < .001 DISCUSSION The primary aim of the present study was to analyze the effectiveness of an intervention targeting medical professionals in improving communication skills, patient-related conflict resolution, and key aspects of assertive communication. Overall, the program produced mixed results across the evaluated variables. These outcomes render the findings unexpected and challenging to interpret. Although many intervention programs report positive effects, non-significant or unexpected findings remain underreported. This situation may contribute to publication bias, thereby distorting the evidence regarding intervention effectiveness (47,48). As discussed above, the effects of the program varied depending on the variable analyzed. Specifically, the program proved effective in certain aspects related to the physician–patient relationship. On the one hand, Professional Quality of Life (PQoL) increased following the intervention. Previous research has reported a positive association between communication skills and healthcare professionals’ well-being (21, 22). Quality of life improved but was not associated with communication skills. The absence of a significant association between quality of life and communication skills may be explained by the influence of organizational factors (e.g., managerial support or workload), which appear to mediate staff well-being more strongly than immediate interpersonal variables. This suggests that well-being improvements were not directly driven by communication skills. One plausible hypothesis is that the improvement in quality of life was related to the strengthening of organizational and motivational factors. Specifically, Professional Quality of Life showed robust positive correlations with Workload, Managerial Support, and Intrinsic Motivation. Therefore, the multicomponent program may have functioned as a job resource, increasing engagement and overall well-being among medical professionals (20). Significant differences were also observed between pre-test and post-test measurements in the Cognitive Distortions variable. Thoughts related to Dependency showed a reduction, which is consistent with previous evidence indicating an association between beliefs related to others’ influence and training in social and communication skills (49). In contrast, Perfectionism showed a slight increase following the intervention. This may reflect increased self-awareness following the intervention. The literature suggests that interventions targeting perfectionism require more specific and sustained approaches to achieve meaningful change (11). Moreover, some studies have reported a paradoxical worsening effect following interventions, which may be explained by increased awareness and sensitivity to personal difficulties. Accordingly, the observed increase may indicate that the intervention brought latent perfectionistic traits to the surface (50). With regard to communication skills, significant differences were found between pre- and post-intervention assessments. Counterintuitively, the results revealed a significant decrease in Active Listening, Communication, Empathy, Respect, Authenticity, and Assertiveness. This pattern raises important questions regarding both the effectiveness of the intervention and the interpretative validity of the measures used. his finding appears inconsistent with previous evidence on clinical communication training (51). These results may reflect measurement reactivity (52) or response shift (53). Previous studies indicate that following an intervention, individuals may change their evaluation criteria, leading to altered responses during assessment without reflecting a true decline in performance (54,55). Similarly, some interventions have been shown to produce changes in responses due to increased awareness and sensitivity rather than actual deterioration (56). Nevertheless, these findings should not be dismissed. The possibility that the intervention increased awareness of personal limitations and, consequently, self-criticism (56) does not exclude the likelihood that the program was insufficient in intensity, duration, or alignment with participants’ needs. Although the observed effect sizes were small, suggesting limited clinical change, the consistency of the decrease across all evaluated dimensions underscores the need for cautious interpretation and for considering alternative explanations beyond a mere sensitization effect. Specifically, regarding assertiveness, similar studies have reported mixed results in improving this skill among other healthcare professionals (57). Multimethod, face-to-face programs that include training in teamwork skills and communication techniques have been identified as particularly effective for enhancing assertiveness and communication skills (58). It should be noted that the present intervention also incorporated a blended-learning format, including 30 hours of online training. It can be speculated that this semi-face-to-face format, rather than a fully in-person approach, may have influenced the limited improvement in assertiveness. This skill may require greater direct interaction through simulations and role-playing activities (30, 31). The scientific literature indicates that mindfulness-based psychological interventions may contribute to increased empathy, improved well-being, and reduced burnout among physicians (59). However, research in this field remains limited, despite the fact that training in communication skills is essential for optimizing both diagnostic processes and therapeutic outcomes (30). Moreover, these competencies need to be reinforced on an ongoing basis to ensure sustained benefits (28)., In addition, it is important to consider the factors that influence the effectiveness of intervention programs. In the present study, the influence of sex was examined. Although the intervention did not show differences in effectiveness by sex, differences were observed in the evaluated variables before and after the intervention. Similarly, Driscoll et al. (2024) found no significant sex-based differences in the benefits derived from interventions, although differences in communication skills were evident (27). These differences may be more closely related to distinct coping styles and socialization patterns in men and women within emotionally demanding contexts, rather than to innate communicative abilities (60) In our case, and with regard to gender inequalities, one of the strengths of our findings is that the intervention appears to have contributed to reducing gender disparities in quality of life, managerial support, and motivation. This suggests the value of incorporating a gender perspective into future programs. Recent studies emphasize the importance of including a gender perspective in intervention programs, even when no significant overall effects are found, as this approach may enhance equity and differential impact across groups (61–63). Finally, the present study examined the relationship between communication skills, cognitive distortions, and quality of life. A significant association was found between cognitive distortions and communication skills, such that lower levels of perfectionism and dependency were associated with better communicative abilities. These findings are consistent with previous research indicating that perfectionism is associated with lower empathy and greater negative affect (13). Additionally, prior studies have shown that personality variables may influence the acquisition of communication skills (64). Thus, it may be hypothesized that perfectionism negatively affects improvements in communication skills. Furthermore, perfectionism-related cognitive distortions were negatively associated with perceived managerial support and professional quality of life. A recent systematic review has linked perfectionism to professional burnout, which is considered a primary indicator of low professional quality of life, highlighting the lack of managerial support as a key environmental factor (65). Likewise, research in healthcare professionals frequently draws on the Job Demands–Resources (JD–R) model, which explains how perfectionism interacts with environmental resources (66). With regard to professional quality of life, significant positive correlations were found with Workload, Managerial Support, and Intrinsic Motivation. However, professional quality of life was not correlated with communication skills. Previous evidence has reported an association between communication skills and quality of life, as well as a greater ability to cope with workload demands (21). Nevertheless, studies differ in their findings regarding the capacity of interventions to improve work motivation, with some reporting a decrease in positive work-related attitudes (22). These mixed results suggest the need for more in-depth research. Along these lines, prior scientific literature indicates a relationship between job demands, a lack of personal resources, and poorer health outcomes, highlighting that strengthening professionals’ job resources increases work engagement (20). In this context, physicians’ communication skills may play a fundamental role in both professional practice and occupational health. In conclusion, occupational health among medical professionals is a complex issue involving multiple interrelated variables that may influence both well-being and job performance. Therefore, studies such as the present one are necessary to identify which variables should be targeted in order to improve health and working conditions among medical professionals Limitations and Future Research Directions Despite the promising results of the study, it is not without limitations. First, a quasi-experimental design without a control group was employed. This limits the ability to control for potential confounding variables that may have influenced the observed outcomes. Therefore, future research using experimental designs that replicate interventions such as the one presented in this study is warranted. Despite these limitations, the present study provides empirical evidence regarding interventions aimed at improving communication skills and problem-solving abilities among medical professionals in their clinical practice. Enhancing the physician–patient relationship (PPR) is an area of particular relevance, not only for patient health and satisfaction, but also for the psychological well-being of healthcare professionals. Overall, the findings suggest that interventions based on cognitive restructuring and clinical communication may contribute to improved well-being and reduced cognitive distortions among medical staff. Future studies should explore the longitudinal impact of such interventions and their transfer to real-world clinical practice. It is important to note that the results did not consistently follow the expected direction across all analyzed variables. Transparent reporting of these findings contributes to a more balanced and realistic view of the effectiveness of intervention programs, which is sometimes obscured in the scientific literature. This transparency is precisely what motivates researchers to continue seeking effective strategies to achieve these goals. Accordingly, future research should emphasize the longitudinal impact of interventions and their translation into real clinical practice. In addition, it would be valuable to develop programs targeting different healthcare professionals, as communication skills with patients constitute a general and essential resource across all health disciplines. Finally, future studies are encouraged to consider differences related to sociodemographic and occupational variables, which appear to influence intervention effectiveness. In this regard, examining factors such as type of contract, years of professional experience, age, and related variables would provide a more nuanced understanding of intervention outcomes Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee of Miguel Hernández University (Reference number: AUT.DCC.PLR.230719). All participants provided informed consent prior to participation. The study followed the principles of the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors Author Contribution Author Contribution Statement (CRediT)RLL: Writing – Original Draft Preparation, Data Curation, Formal AnalysisACM: Data Curation, Formal Analysis. Writing – Original Draft PreparationDPL: Supervision. Visualization.EPL: Supervision.MRA: Investigation, Resources, Investigation (support in research execution).PLR: Conceptualization, Methodology, Funding Acquisition, Writing – Review & Editing. Data Availability The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. References Chandra S, Mohammadnezhad M, Ward P. Trust and communication in a doctor-patient relationship: A literature review. J Healthc Commun. 2018;3(36). Oh Nelson H. Doctor–Patient Relationship. In: Cockerham W, Ken PM, editors. The Wiley Blackwell Companion to Medical Sociology. Wiley-Blackwell; 2021. p. 495–515. Wu Q, Bachelor ZJ, Wang P. The relationship between the physician-patient relationship. J Gen Intern Med. 2021;37(6):1388–93. Guerrero-Vaca DJ, Guerrero-Vaca DI, Escobar-Zabala OD, Herrera-Abarca JM. La relación médico-paciente en la actualidad. Una revisión. Polo del Conocimiento. 2022;7(4):1038-56. Mahmoudian A, Zamani A, Tavakoli N, Farajzadegan Z, Fathollahi-Dehkordi F. Medication adherence in hypertensive patients: Does satisfaction with the doctor-patient relationship work? J Res Med Sci. 2017;22(1):48. Olaisen RH, Schluchter MD, Flocke SA, Smyth KA, Koroukian SM, Stange KC. Assessing the longitudinal impact of physician-patient relationship on functional health. Ann Fam Med. 2020;18:422-9. Cascales-Martínez A, López-Ros P, Pina D, Cánovas-Pallares JM, López López R, Puente-López E, et al. 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Front Public Health. 2021;9:810014. Esquivel Meno Y, Betancourt Plaza I, Carrera Gonzalez E, Lorenzo Ruiz A, Mezquia De Pedro N. Evaluación de competencias comunicativas a profesionales que laboran en unidades de atención al paciente grave. Rev Cubana Med Intensiva Emerg. 2024;22(3). Des Jarlais DC, Lyles C, Crepaz N, Trend Group. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: The TREND statement. Am J Public Health. 2004;94(3):361–6. Creswell JW. Educational research: Planning, conducting, and evaluating quantitative and qualitative research. 4th ed. Pearson; 2012. Leal-Costa C, Díaz-Agea JL, Tirado-González S, Rodríguez-Marín J, van-der Hofstadt-Román CJ. Psychometric properties of the Health Professionals Communication Skills Scale (HP-CSS). Int J Clin Health Psychol. 2016;16(1):76–86. Martín J, Cortés JA, Morente M, Caboblanco M, Garijo J, Rodríguez A. Características métricas del Cuestionario de Calidad de Vida Profesional (CVP-35). Gac Sanit. 2004;18(2):129–36. Martín-Fernández J, Gomez-Gascon T, Martinez Garcia-Olalla C, del Cura Gonzalez MI, Cabezas-Peña MC, García-Sánchez S. Measurement of the Evaluative Capacity of the Qpl-35 (Cvp-35) Questionnaire for Perceiving Quality of Professional Life. Atencion Primaria. 2008;40(7):327-36. Ruiz FJ, Suárez-Falcón JC, Odriozola-González P, Barbero-Rubio A, López-López JC, et al. Factor structure and psychometric properties of the Spanish version of the Dysfunctional Attitude Scale-Revised. Behav Psychol. 2015;23(2):287–303. Weissman AN, Beck AT. Development and validation of the Dysfunctional Attitude Scale: A preliminary investigation. Paper presented at: Annual Meeting of the Association for Advancement of Behavior Therapy; 1978 Nov; Chicago, IL. White IR, Carpenter J, Horton NJ. Including all enrolled participants in the completed analysis: Why and how to do it. BMJ. 2012;345:e4027. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Lawrence Erlbaum Associates; 1988. Hohlfeld A, Kredo T, Clarke M. A scoping review of activities intended to reduce publication bias in randomised trials. Syst Rev. 2024;13:310. Mohammadi M. Publication bias in prevalence studies should not be ignored. Syst Rev. 2025;14:85. Deng Y, Zhang J, Chen H, Tian S, Zhang Y, Hu X. Benefiting individuals high in both self-criticism and dependency through an online multi-component positive psychology intervention: Effects and mechanisms. J Happiness Stud. 2024;25:16. Axelsson E, Hedman-Lagerlöf E. Unwanted outcomes in cognitive behavior therapy for pathological health anxiety: a systematic review and a secondary original study of two randomized controlled trials. Expert Rev Pharmacoecon Outcomes Res. 2023;23(9):1001–15. Zota D, Diamantis DV, Katsas K, Karnaki P, Tsiampalis T, et al. Essential skills for health communication, barriers, facilitators and the need for training: Perceptions of healthcare professionals from seven European countries. Healthcare (Basel). 2023;11(14):2058. Ottenstein C, Hasselhorn K, Lischetzke T. Measurement reactivity in ambulatory assessment: Increase in emotional clarity over time independent of sampling frequency. Behav Res Methods. 2024;56:6150–64. Sawatzky R, Verdam MGE, Dubuy Y, Sajobi TT, Russell L, et al. Response shift results of quantitative research using patient-reported outcome measures: a meta-regression analysis. Qual Life Res. 2025;34:1393–406. Miles LM, Elbourne D, Farmer A, Gulliford M, Locock L, et al. Bias due to measurement reactions in health improvement trials (MERIT): research protocol to develop MRC guidance. Trials. 2018;19:653. Runhardt RW. Reactivity, validity, and measurement in the social sciences. Stud Hist Philos Sci. 2025;112:1–9. Ortega‑Gómez E, Vicente‑Galindo P, Martín‑Rodero H, Galindo‑Villardón P. Detection of response shift in health‑related quality of life studies: a systematic review. Health Qual Life Outcomes. 2022;20:20. Lee SE, Kim E, Lee JY, Morse BL. Assertiveness educational interventions for nursing students and nurses: A systematic review. Nurse Educ Today. 2023;120:105655. Omura M, Maguire J, Levett-Jones T, Stone TE. The effectiveness of assertiveness communication training programs for healthcare professionals and students: A systematic review. Int J Nurs Stud. 2017;76:120-8. Tement S, Ketiš ZK, Mirošević Š, Selič-Zupančič P. The impact of psychological interventions with elements of mindfulness (PIM) on empathy, well-being, and reduction of burnout in physicians: A systematic review. Int J Environ Res Public Health. 2021;18:11181. Tamres LK, Janicki D, Helgeson VS. Sex differences in coping behavior: A meta-analytic review and an examination of relative coping. Pers Soc Psychol Rev. 2002;6(1):2-30. Dorough RJM, Adamuti-Trache M, Sekar DR, Siropaides CH. Medical communication training: the effect of gender and experience and goals of care discussions. South Med J. 2024;117(12):725–9. Kayrouz R, Karin E, Staples L, Dear B, Nielssen O, Titov N. A review of the 257 meta-analyses of the differences between females and males in prevalence and risk, protective factors, and treatment outcomes for mental disorder. BMC Psychiatry. 2025;25(1):677. Otten D, Tibubos AN, Schomerus G, Brähler E, Binder H, et al. Similarities and differences of mental health in women and men: A systematic review of findings in three large German cohorts. Front Public Health. 2021;9:553071. Efrat A, Zait A. The effect of personality characteristics on the development of interpersonal communication skills through one-time training. Sci Ann Econ Bus. 2024;71(2):265–83. Hill PA, Curran T, Thomas KG, Smith MM. The costs of striving for excellence: A meta-analytic review of the relationship between perfectionism and burnout in clinical and nonclinical samples. Rev Gen Psychol. 2019;23(3):299–316. Bakker AB, Demerouti E. Multiple levels in job demands–resources theory: Implications for employee well-being and performance. In: Theorell TR, editor. Handbook of socio-cultural and professional aspects of health. Cham: Springer; 2018. p. 37–51. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 02 Apr, 2026 Editor assigned by journal 31 Mar, 2026 Editor invited by journal 05 Mar, 2026 Submission checks completed at journal 04 Mar, 2026 First submitted to journal 04 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8829287","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":617651328,"identity":"7f3d532a-2fab-4e5c-ba4b-55465bfb2553","order_by":0,"name":"Reyes López López¹","email":"","orcid":"","institution":"University of Murcia","correspondingAuthor":false,"prefix":"","firstName":"Reyes","middleName":"López","lastName":"López¹","suffix":""},{"id":617651329,"identity":"cae90740-a82f-47a4-b214-1785c95d49d1","order_by":1,"name":"Andrea Cascales Martínez","email":"","orcid":"","institution":"University of Murcia","correspondingAuthor":false,"prefix":"","firstName":"Andrea","middleName":"Cascales","lastName":"Martínez","suffix":""},{"id":617651330,"identity":"971b4ca2-630a-48ba-8aa2-353bbf26d442","order_by":2,"name":"David Pina","email":"","orcid":"","institution":"University of Murcia","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"","lastName":"Pina","suffix":""},{"id":617651331,"identity":"a96b3d13-2fb8-42e1-93c4-841270802756","order_by":3,"name":"Maribel Ruiz-Almarcha","email":"","orcid":"","institution":"University of Murcia","correspondingAuthor":false,"prefix":"","firstName":"Maribel","middleName":"","lastName":"Ruiz-Almarcha","suffix":""},{"id":617651333,"identity":"36c2324d-62db-4c51-b66f-bcac7f534f72","order_by":4,"name":"Esteban Puente López","email":"","orcid":"","institution":"University of Valladolid","correspondingAuthor":false,"prefix":"","firstName":"Esteban","middleName":"Puente","lastName":"López","suffix":""},{"id":617651334,"identity":"07530616-258a-4921-9d0d-0ec8e9e19fe0","order_by":5,"name":"Paloma López-Ros","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAoklEQVRIiWNgGAWjYDACdjBpw8AgQbQWZjCZRrqWwyRoMWdmPvbgw5/ziWtnNzA+/EGMFstmtnTDGTy3E7fdOcBszEOMFoPDPGbSPBJALTcS2KSJchhYyx+DcyAt7D+JchhYC0PCAbAtDEQ5DOyXngPJxttuJDZLE6XFnL352IMff+xkt91IPviROIcxMLBBmYwNxGhA0TIKRsEoGAWjAAcAAIkWMV5nIF9VAAAAAElFTkSuQmCC","orcid":"","institution":"Miguel Hernandez University","correspondingAuthor":true,"prefix":"","firstName":"Paloma","middleName":"","lastName":"López-Ros","suffix":""}],"badges":[],"createdAt":"2026-02-09 10:39:51","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8829287/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8829287/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106534619,"identity":"bb74f7b9-2b5a-4777-894c-081f579f6fa4","added_by":"auto","created_at":"2026-04-09 15:05:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":73803,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSource. Adapted from CONSORT 2010\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8829287/v1/ad782896129c52c997425e1e.png"},{"id":106726596,"identity":"f1dacb40-ae4b-4d43-b2ec-1a457e7a645e","added_by":"auto","created_at":"2026-04-12 18:36:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1396311,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8829287/v1/a7d94a7b-f22e-4bc4-81f8-a0e2726d437c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effectiveness of an Intervention Based on Communication Skills and Cognitive Distortions to Improve the Doctor–Patient Relationship","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe doctor\u0026ndash;patient relationship (DPR) plays a fundamental role in medical practice and constitutes one of the central elements of physicians\u0026rsquo; professional activity (1\u0026ndash;3). The DPR consists of an informational component (diagnosis, treatment, etc.) and an affective component (a respectful and trusting relationship), which develops within the clinical setting and may influence patients\u0026rsquo; recovery and adherence to treatment (2, 4; 5). Factors such as professional interest, commitment to patient well-being, and honest and responsible behavior contribute to strengthening patients\u0026rsquo; trust and satisfaction, facilitating information exchange and reducing interpersonal conflict during clinical encounters (1, 4, 6).\u003c/p\u003e \u003cp\u003eMedical professionals are frequently exposed to high-demand clinical situations that may negatively affect their health and well-being due to the emotional and cognitive load involved (7,8). Professionals\u0026rsquo; perceived ability to cope with conflictual situations, together with the thoughts they hold about these encounters, plays a key role in their psychological adjustment and occupational health (9). In this regard, distorted thinking patterns (such as excessive self-demand, perfectionism, or cognitive dependency) have been associated with poorer mental health outcomes, increased risk of burnout, and lower levels of communicative empathy (10,11). These cognitive patterns may interfere with emotional regulation and compromise the quality of interactions with patients, highlighting the importance of providing healthcare professionals with tools to manage complex communicative situations and protect their well-being (14\u0026ndash;16).\u003c/p\u003e \u003cp\u003eProfessional quality of life (PQoL) is a key component of physicians\u0026rsquo; occupational well-being and healthcare quality. The World Health Organization defines PQoL as individuals\u0026rsquo; perceptions of their physical, psychological, and social well-being in the work context (17). In healthcare settings, higher PQoL has been associated with lower burnout, better communication with patients, and greater motivation, whereas low PQoL has been linked to reduced empathy, greater interpersonal conflict, and compromised patient safety (18\u0026ndash;20). In this context, communication skills have been identified as a protective resource that supports resilience and the PPR, contributing to professionals\u0026rsquo; overall quality of life (21,22).\u003c/p\u003e \u003cp\u003eThe quality of the physician\u0026ndash;patient relationship (PPR) depends on multiple factors, including the individual characteristics of both physicians and patients, relational dynamics, and healthcare system policies (23). Physicians with strong active listening skills, empathy, and clear communication are less likely to receive complaints or legal claims (24). In contrast, unclear or condescending communication increases patient dissatisfaction and interpersonal conflict (24).\u003c/p\u003e \u003cp\u003eGender has been identified as a relevant factor influencing PPR. Previous research indicates that consultations conducted by female physicians tend to involve longer interactions, greater social exchange, and more effective communication strategies (25), and have been associated with better patient outcomes (26). Although communication training has been shown to be effective for both genders, persistent differences in baseline communication skills highlight the importance of incorporating a gender perspective into professional training programs (27).\u003c/p\u003e \u003cp\u003eTargeted training in clinical communication has been shown to be effective in preventing conflicts, improving quality of care, and protecting healthcare professionals\u0026rsquo; well-being (2,23,28). Existing programs typically combine theoretical instruction with experiential methodologies such as workshops, simulations, role-playing, reflective exercises, and audiovisual resources, which facilitate the acquisition and consolidation of communication skills in clinical practice (29\u0026ndash;31).\u003c/p\u003e \u003cp\u003eHowever, success in the PPR does not depend solely on the professional, as patient-related and healthcare system factors also play a role. Nevertheless, poor communication remains a primary risk factor for patient safety and treatment effectiveness (32).\u003c/p\u003e \u003cp\u003eDespite growing interest in clinical communication, communication skills continue to receive insufficient emphasis within medical education (33). Many physicians report limited training in this area across undergraduate education and clinical practice, which is reflected in patients\u0026rsquo; experiences of distant or insufficiently empathetic care (23,31,33\u0026ndash;36).\u003c/p\u003e \u003cp\u003eAlthough physicians play a central role in healthcare delivery, they often receive less formal training in communication skills than other healthcare professionals, such as nursing staff (37). To help address this gap, the present study proposes a training program aimed not only at strengthening the PPR, but also at providing practical tools to manage complex communicative situations commonly encountered in clinical practice. In an increasingly demanding, person-centered healthcare system, the implementation of this type of intervention is essential to improving both patient experience and professional well-being (35).\u003c/p\u003e \u003cp\u003eThe aim of the present study is to evaluate an intervention program designed to enhance communication and problem-solving skills among medical professionals. Specifically, the objectives are to: (a) analyze changes in communication skills before and after the intervention; (b) examine variations in quality of life and cognitive distortions; (c) explore the influence of gender on the effectiveness of the program; and (d) investigate the relationship between communication skills, quality of life, and distorted thinking patterns.\u003c/p\u003e \u003cp\u003eThe intervention is expected to improve communication skills, reduce cognitive distortions, and enhance physicians\u0026rsquo; quality of life, with potential gender effects and associations with well-being.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA single-group quasi-experimental pretest\u0026ndash;posttest design was used, following the TREND Statement criteria for nonrandomized evaluations (38). No randomization or control group was included, as the intervention was implemented with all participants as an initial exploratory assessment of its effectiveness.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eEligibility criteria for participants\u003c/h2\u003e \u003cp\u003e A total of 300 medical professionals from the Murcia Health Service (MHS) were invited to participate. A convenience sampling method was used (39).\u003c/p\u003e \u003cp\u003eThe inclusion criteria for the study were: (a) being a member of the medical staff of the SMS; (b) actively working during the data collection and intervention period; and (c) voluntary participation in the study. Professionals unavailable during the intervention period were excluded.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eGroup eligibility criteria\u003c/h3\u003e\n\u003cp\u003eParticipants were divided into three groups of approximately 40\u0026ndash;60 individuals each. Group allocation was non-random and based on medical specialty and professional setting (primary care or specialized care). This procedure was guided by organizational and feasibility considerations. All groups received the same intervention following a standardized protocol.\u003c/p\u003e\n\u003ch3\u003eSettings and locations for data collection\u003c/h3\u003e\n\u003cp\u003eThe intervention and data collection were conducted in healthcare centers affiliated to the Murcia Health Service (MHS), including both primary and specialized care facilities. Assessments were administered digitally. Ethical principles of confidentiality, anonymity, and informed consent were observed. Accordingly, the study received approval from the Ethics Committee of the University of one of the authors (AUT.DCC.PLR.230719)\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eIntervention\u003c/h2\u003e \u003cp\u003eThe intervention was carried out between September and December 2023. The total training duration was 50 hours, divided into six sessions of four hours each. The format was blended, including 30 hours of online work. The intervention was delivered by an experienced multidisciplinary healthcare team (psychologists, doctors, etc.).\u003c/p\u003e \u003cp\u003eKey topics addressed included factors influencing the doctor\u0026ndash;patient relationship, communication and assertiveness skills, team conflict management, and communication in special clinical situations. The sessions combined theoretical presentations with practical workshops in which participants applied communication techniques through simulated scenarios and clinical cases.\u003c/p\u003e \u003cp\u003eThe intervention aimed to promote a human-centered approach and provide training in communication, motivation, leadership, and special clinical situations. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the general and specific contents of the program.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral and Specific Contents of the Program\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSessions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral content\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpecific content\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSession 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntroduction and work proposal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Factors influencing the physician\u0026ndash;patient relationship\u003c/p\u003e \u003cp\u003e- The human being as a whole\u003c/p\u003e \u003cp\u003e- What is evident versus what is subjective (pain vs. suffering)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHuman relationships. Communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Unidirectional and bidirectional relationships\u003c/p\u003e \u003cp\u003e- Key aspects of communication: assertiveness, boundaries, and empathy in relationships\u003c/p\u003e \u003cp\u003e- The communication process\u003c/p\u003e \u003cp\u003e- Verbal and nonverbal communication\u003c/p\u003e \u003cp\u003e- Functional versus dysfunctional communication\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSession 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBasic human needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Patient reception and welcoming\u003c/p\u003e \u003cp\u003e- Guidance and orientation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe role of the physician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- The physician\u0026rsquo;s role in the relationship with the patient.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCharacteristics of authority figures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- The influence of authority in the physician\u0026ndash;patient relationship.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe role of the patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Individual characteristics\u003c/p\u003e \u003cp\u003e- Characteristics associated with the disease\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSession 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMental strategies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- The concepts of logical thinking, lateral thinking, and emotional management of conflict.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe mind in the face of novelty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- How the mind approaches new ideas in problem-solving.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSession 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCognitive restructuring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Transforming thoughts, emotions, and actions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe power of mindset: growth vs. fixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Fixed mindset versus growth mindset: \u0026ldquo;things are the way they are\u0026rdquo; or can they evolve?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSession 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeam creativity: integration, diversity, and collaboration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Team creativity: integrating individual differences (learning to work with diverse personal styles) and accepting others\u0026rsquo; ideas\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSession 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConflict resolution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Most commonly used techniques for generating new ideas and approaches to conflict resolution.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePractical module\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Workshop on practical case resolution\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eOutcome measures\u003c/h3\u003e\n\u003cp\u003eThe assessment protocol included sociodemographic variables, communication skills, quality of life, and cognitive distortions.\u003c/p\u003e\n\u003ch3\u003eCommunication skills\u003c/h3\u003e\n\u003cp\u003eThe \u003cem\u003eHealth Professionals Communication Skills Scale\u003c/em\u003e (EHC-PS) was used (40). This instrument measures communicative competencies in healthcare settings, including both verbal and nonverbal skills. The scale consists of 18 items with a 6-point Likert response format (1\u0026thinsp;=\u0026thinsp;strongly disagree to 6\u0026thinsp;=\u0026thinsp;strongly agree). It assesses the following dimensions: a) Informative communication; b) active listening; c) empathy; d) respect; e) authenticity; and f) assertiveness.\u003c/p\u003e \u003cp\u003ePrevious studies have reported adequate psychometric properties, with reliability indices ranging from 0.65 to 0.78 (40). Similarly, in the present study, high internal consistency and reliability were obtained (α\u0026thinsp;=\u0026thinsp;.924).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eQuality of life\u003c/h2\u003e \u003cp\u003eThe \u003cem\u003eProfessional Quality of Life Questionnaire\u003c/em\u003e (CVP-35); (41) is a psychometric instrument designed to assess professional quality of life in healthcare contexts. It consists of 35 items distributed across three factors: a) Management support, b) Workload y c) Intrinsic motivation. Items are rated on a 10-point Likert scale (1\u0026thinsp;=\u0026thinsp;not at all to 10\u0026thinsp;=\u0026thinsp;very much).\u003c/p\u003e \u003cp\u003eThe CVP-35 has shown good psychometric properties, with high internal consistency and reliability (α\u0026thinsp;=\u0026thinsp;.8\u0026ndash;.7) (41), as well as adequate construct validity and sensitivity to change (42). In the present study, excellent reliability indices were found, with a Cronbach\u0026rsquo;s alpha of .952.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCognitive Distortions\u003c/h2\u003e \u003cp\u003eTo assess cognitive distortions, the \u003cem\u003eDysfunctional Attitude Scale\u0026ndash;Revised\u003c/em\u003e (DAS-R) was used (43). This is a revised and abbreviated version of the \u003cem\u003eDysfunctional Attitude Scale\u003c/em\u003e developed by Weissman and Beck (1978) (44). The instrument measures dysfunctional thought patterns, which are considered a risk factor for depression. The scale consists of 17 items distributed across two factors: a) Perfectionism/Performance evaluation and b) Dependency. Each item is rated on a 7-point Likert scale, where participants indicate their level of agreement with various statements.\u003c/p\u003e \u003cp\u003eThe DAS-R has demonstrated good internal consistency (α\u0026thinsp;=\u0026thinsp;.90), temporal stability, and convergent and discriminant validity (43). In the present study, a Cronbach\u0026rsquo;s alpha of .944 was obtained, indicating excellent internal consistency and reliability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using JAMOVI software (version 2.3.28). The Jpower test was used to calculate the sample size. This analysis indicated that a sample size of 84 participants would be required to reliably detect an effect size of δ\u0026thinsp;\u0026ge;\u0026thinsp;.4, with a statistical power exceeding .95, under a two-sided testing framework with a maximum Type I error rate of α\u0026thinsp;=\u0026thinsp;.05. Then, data distribution was examined using the Shapiro\u0026ndash;Wilk test to assess the normality assumption of the variables of interest. Demographic data and other participant characteristics were described using descriptive statistics. Primary analyses were conducted using the intention-to-treat (ITT) approach (45). All participants who completed the baseline assessment and attended the first session were included in subsequent analyses, regardless of later participation or adherence to the intervention.\u003c/p\u003e \u003cp\u003eComparisons of categorical variables were conducted using the Chi-square test. Since the sample did not meet normality assumptions, comparisons of continuous variables were carried out using the Wilcoxon test, and repeated-measures ANOVA was used for variables measured at two time points (baseline and post-intervention).\u003c/p\u003e \u003cp\u003eAdditionally, data were analyzed using a linear mixed models (LMM; MIXED) procedure with maximum likelihood estimation and full information to assess relationships among model variables. The significance of these relationships was evaluated using Wilks\u0026rsquo; lambda. Effect sizes were calculated using partial eta-squared (η\u0026sup2;p) and interpreted according to Cohen\u0026rsquo;s criteria (46).\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eOf the 147 participants, 89 completed the pre-intervention assessment and 94 completed the post-intervention assessment, with a response rate of 62.2%. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the flow diagram together with the corresponding results.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSource. Adapted from CONSORT 2010\u003c/h2\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003eSociodemographic Characteristics\u003c/h2\u003e \u003cp\u003eParticipants\u0026rsquo; ages ranged from 26 to 68 years (M\u0026thinsp;=\u0026thinsp;45.1, SD\u0026thinsp;=\u0026thinsp;12). The gender distribution was 31.5% men and 68.5% women. Regarding specialty, most participants belonged to Family and Community Medicine (56.2%). The sociodemographic data of the sample are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic and labor characteristics before the intervention\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAssessment Time\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBefore the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfter the intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; 60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWoman\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried or Domestic Partnership\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeparated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of Employment Contract\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePermanent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTemporary / Substitution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLong-term\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContinuing Education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSick leave in the last 12 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSpecialty\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily and Community Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternal Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRehabilitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupational Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathological Anatomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntensive Care Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnesthesiology and Resuscitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital Pharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadiology (Diagnostic Imaging)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears in Current Position\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears in the Profession\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eCommunication Skills\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the mean differences in communication skills. Significant differences were observed between pre- and post-intervention assessments. Scores decreased for Active Listening (p \u0026lt; .001), Informative Communication (p \u0026lt; .001), Empathy (p \u0026lt; .001), Respect and Authenticity (p \u0026lt; .001), and Assertiveness (p \u0026lt; .001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eQuality of life\u003c/h2\u003e \u003cp\u003eOn the other hand, \u003cem\u003eProfessional Quality of Life\u003c/em\u003e increased after the intervention (p \u0026lt; .001). Specifically, medical staff reported higher levels of \u003cem\u003eManagement Support\u003c/em\u003e (p \u0026lt; .001), \u003cem\u003eWorkload\u003c/em\u003e (p \u0026lt; .001), and \u003cem\u003eIntrinsic Motivation\u003c/em\u003e (p \u0026lt; .001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eCognitive distortions\u003c/h2\u003e \u003cp\u003eSignificant differences were found between pre-test and post-test measurements in cognitive distortions (p \u0026lt; .001). A reduction was observed in Dependency, whereas Perfectionism showed a slight increase (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean differences before and after the intervention\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVARIABLES\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003eT1-T2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistical\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSize Effect\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEHC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45.7 (16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.6 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive Listening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35.1 (4.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.6 (4.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformative Communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63.7 (6.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60.9 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmpathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31.1 (5.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.1 (6.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespect and authenticity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32.0 (6.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.9 (8.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssertiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59.2 (7.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59.0 (7.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDAS-R\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e156 (18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e152 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerfectionism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.7 (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.7 (14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDependency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19 (7.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.9 (8.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCVP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e219 (50.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e224 (57.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManagement support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84.0 (19.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85.7 (23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorkload\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68.7 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70.9 (18.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntrinsic motivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54.1 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54.5 (15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuality of life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.0 (4.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.5 (4.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eNote\u003c/em\u003e: EHC= Communication Skills Scale for Healthcare Professionals; DAS-R\u0026thinsp;=\u0026thinsp;Dysfunctional Attitude Scale-Revised; CVP\u0026thinsp;=\u0026thinsp;Professional Quality of Life Questionnaire; T1\u0026thinsp;=\u0026thinsp;pre-test; T2\u0026thinsp;=\u0026thinsp;post-test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eGender differences\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the descriptive analysis of the dependent variables by gender. The results indicate different trends according to gender: 1) Perfectionism was higher in women at the beginning; however, after the intervention, it increased notably more in men; 2) Dependency increased in men and decreased in women, 3) Communication skills were higher in women at baseline but became similar between genders after the intervention, 4) Men initially perceived greater Management Support and showed higher motivation than women; however, after the intervention, both variables increased notably among women, y 5) Quality of life was higher in men before the intervention, but by the end, it showed a greater increase in women.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate Analysis of Variance of the Evaluated Variables by Gender\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePretest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePretest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePost-test\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerfectionism\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.21 (7.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.00 (16.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.27 (12.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e27.6 (13.47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDependency\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18.29 (6.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.69 (9.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.12 (7.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18.93 (7.74)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eActive Listening\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33.67 (5.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.35 (5.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.67 (3.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e34.93 (4.42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunication\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61.83 (7.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60.77 (10.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64.22 (6.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60.87 (9.43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmpathy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29.67 (5.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.73 (6.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.27 (5.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e30.22 (6.78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRespect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32.88 (5.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.42 (8.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.73 (5.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e31.43 (8.19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAssertiveness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58.13 (6.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59.44 (7.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60.25 (6.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e59.51 (6.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eManagement support\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88.29 (17.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89.19 (18.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e83.59 (18.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e87.48 (22.49)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWorkload\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69.13 (14.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73.62 (16.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69.53 (17.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e72.63 (16.99)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMotivation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57.25 (12.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.50 (12.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52.69 (12.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e55.17 (14.77)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQuality of life\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.04 (4.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.27 (4.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.63 (4.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.21 (4.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the results of the multivariate analysis of variance (MANOVA), the overall effect of Assessment Time on the dependent variables did not reach statistical significance (Wilks\u0026rsquo; Λ\u0026thinsp;=\u0026thinsp;.978, F(2,177)\u0026thinsp;=\u0026thinsp;2.03, p = .134, η\u0026sup2;ₚ = .022). In contrast, a significant main effect of Sex was observed (Wilks\u0026rsquo; Λ\u0026thinsp;=\u0026thinsp;.964, F(2,177)\u0026thinsp;=\u0026thinsp;3.30, p \u0026lt; .05, η\u0026sup2;ₚ = .036), indicating overall differences between men and women. However, the Assessment Time \u0026times; Sex interaction was not significant (p = .660). No significant interactions were observed, suggesting that pre\u0026ndash;post changes were consistent across men and women.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eRelationship between variables\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e presents the correlation analyses among the variables assessed. The correlational analysis revealed significant negative associations between Perfectionism-related cognitive distortions and all dimensions of communication skills, including Active Listening (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.362, p \u0026lt; .001), Informative Communication (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.348, p \u0026lt; .001), Empathy (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.291, p \u0026lt; .001), Respect and Authenticity (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.239, p \u0026lt; .001), and Assertiveness (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.341, p \u0026lt; .001). In addition, a strong and significant positive correlation was found between Perfectionism and Dependency (\u003cem\u003er\u003c/em\u003e = .777, p \u0026lt; .001), indicating that professionals with higher levels of self-demand tend to show a greater need for external validation. Similarly, Perfectionism-related cognitive distortions were negatively associated with perceived Managerial Support (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.152, p \u0026lt; .05) and Professional Quality of Life (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.147, p \u0026lt; .05).\u003c/p\u003e \u003cp\u003eWith regard to Dependency-related cognitive distortions, negative associations were observed with Informative Communication (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.173, p \u0026lt; .05), Empathy (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.168, p \u0026lt; .05), Respect and Authenticity (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.164, p \u0026lt; .05), and Assertiveness (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.279, p \u0026lt; .01). No significant associations were found between cognitive distortions and dimensions of professional quality of life.\u003c/p\u003e \u003cp\u003eRegarding professional quality of life, strong positive associations were identified with organizational and motivational factors. Professional Quality of Life was significantly and positively correlated with Workload (\u003cem\u003er\u003c/em\u003e = .587, p \u0026lt; .001), Managerial Support (\u003cem\u003er\u003c/em\u003e = .736, p \u0026lt; .001), and Intrinsic Motivation (\u003cem\u003er\u003c/em\u003e = .739, p \u0026lt; .001), although it was not correlated with communication skills. Likewise, Workload was positively associated with Managerial Support (\u003cem\u003er\u003c/em\u003e = .829, p \u0026lt; .001) and Intrinsic Motivation (\u003cem\u003er\u003c/em\u003e = .820, p \u0026lt; .001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation among outcome measures\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e1. Perfectionism\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2. Dependency\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e.777***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3. Active Listening\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.362***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4. Informative communication\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.348***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.173*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.656***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5. Empathy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.291***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.168*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.574***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.678***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6. Respect and Authenticity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.239***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.164*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.491***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.613***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.706***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7. Assertiveness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.341***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.279***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.435***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.520***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.387***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e.462***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e8. Management support\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;.152*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.170*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e9. Workload\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.153*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e.829***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e10. Intrinsic Motivation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e.215**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e.160*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.154*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e.899***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e.820***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e11. Quality of Life\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-147*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e.736***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e.587***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e.739***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003eNote: *p\u0026lt;.05; **p \u0026lt; .01; ***p \u0026lt; .001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe primary aim of the present study was to analyze the effectiveness of an intervention targeting medical professionals in improving communication skills, patient-related conflict resolution, and key aspects of assertive communication.\u003c/p\u003e \u003cp\u003eOverall, the program produced mixed results across the evaluated variables. These outcomes render the findings unexpected and challenging to interpret. Although many intervention programs report positive effects, non-significant or unexpected findings remain underreported. This situation may contribute to publication bias, thereby distorting the evidence regarding intervention effectiveness (47,48).\u003c/p\u003e \u003cp\u003eAs discussed above, the effects of the program varied depending on the variable analyzed. Specifically, the program proved effective in certain aspects related to the physician\u0026ndash;patient relationship. On the one hand, Professional Quality of Life (PQoL) increased following the intervention. Previous research has reported a positive association between communication skills and healthcare professionals\u0026rsquo; well-being (21, 22). Quality of life improved but was not associated with communication skills. The absence of a significant association between quality of life and communication skills may be explained by the influence of organizational factors (e.g., managerial support or workload), which appear to mediate staff well-being more strongly than immediate interpersonal variables. This suggests that well-being improvements were not directly driven by communication skills.\u003c/p\u003e \u003cp\u003eOne plausible hypothesis is that the improvement in quality of life was related to the strengthening of organizational and motivational factors. Specifically, Professional Quality of Life showed robust positive correlations with Workload, Managerial Support, and Intrinsic Motivation. Therefore, the multicomponent program may have functioned as a job resource, increasing engagement and overall well-being among medical professionals (20).\u003c/p\u003e \u003cp\u003eSignificant differences were also observed between pre-test and post-test measurements in the Cognitive Distortions variable. Thoughts related to Dependency showed a reduction, which is consistent with previous evidence indicating an association between beliefs related to others\u0026rsquo; influence and training in social and communication skills (49). In contrast, Perfectionism showed a slight increase following the intervention. This may reflect increased self-awareness following the intervention. The literature suggests that interventions targeting perfectionism require more specific and sustained approaches to achieve meaningful change (11). Moreover, some studies have reported a paradoxical worsening effect following interventions, which may be explained by increased awareness and sensitivity to personal difficulties. Accordingly, the observed increase may indicate that the intervention brought latent perfectionistic traits to the surface (50).\u003c/p\u003e \u003cp\u003eWith regard to communication skills, significant differences were found between pre- and post-intervention assessments. Counterintuitively, the results revealed a significant decrease in Active Listening, Communication, Empathy, Respect, Authenticity, and Assertiveness. This pattern raises important questions regarding both the effectiveness of the intervention and the interpretative validity of the measures used. his finding appears inconsistent with previous evidence on clinical communication training (51). These results may reflect measurement reactivity (52) or response shift (53). Previous studies indicate that following an intervention, individuals may change their evaluation criteria, leading to altered responses during assessment without reflecting a true decline in performance (54,55). Similarly, some interventions have been shown to produce changes in responses due to increased awareness and sensitivity rather than actual deterioration (56).\u003c/p\u003e \u003cp\u003eNevertheless, these findings should not be dismissed. The possibility that the intervention increased awareness of personal limitations and, consequently, self-criticism (56) does not exclude the likelihood that the program was insufficient in intensity, duration, or alignment with participants\u0026rsquo; needs. Although the observed effect sizes were small, suggesting limited clinical change, the consistency of the decrease across all evaluated dimensions underscores the need for cautious interpretation and for considering alternative explanations beyond a mere sensitization effect.\u003c/p\u003e \u003cp\u003eSpecifically, regarding assertiveness, similar studies have reported mixed results in improving this skill among other healthcare professionals (57). Multimethod, face-to-face programs that include training in teamwork skills and communication techniques have been identified as particularly effective for enhancing assertiveness and communication skills (58). It should be noted that the present intervention also incorporated a blended-learning format, including 30 hours of online training. It can be speculated that this semi-face-to-face format, rather than a fully in-person approach, may have influenced the limited improvement in assertiveness. This skill may require greater direct interaction through simulations and role-playing activities (30, 31).\u003c/p\u003e \u003cp\u003eThe scientific literature indicates that mindfulness-based psychological interventions may contribute to increased empathy, improved well-being, and reduced burnout among physicians (59). However, research in this field remains limited, despite the fact that training in communication skills is essential for optimizing both diagnostic processes and therapeutic outcomes (30). Moreover, these competencies need to be reinforced on an ongoing basis to ensure sustained benefits (28).,\u003c/p\u003e \u003cp\u003eIn addition, it is important to consider the factors that influence the effectiveness of intervention programs. In the present study, the influence of sex was examined. Although the intervention did not show differences in effectiveness by sex, differences were observed in the evaluated variables before and after the intervention. Similarly, Driscoll et al. (2024) found no significant sex-based differences in the benefits derived from interventions, although differences in communication skills were evident (27). These differences may be more closely related to distinct coping styles and socialization patterns in men and women within emotionally demanding contexts, rather than to innate communicative abilities (60)\u003c/p\u003e \u003cp\u003eIn our case, and with regard to gender inequalities, one of the strengths of our findings is that the intervention appears to have contributed to reducing gender disparities in quality of life, managerial support, and motivation. This suggests the value of incorporating a gender perspective into future programs. Recent studies emphasize the importance of including a gender perspective in intervention programs, even when no significant overall effects are found, as this approach may enhance equity and differential impact across groups (61\u0026ndash;63).\u003c/p\u003e \u003cp\u003eFinally, the present study examined the relationship between communication skills, cognitive distortions, and quality of life. A significant association was found between cognitive distortions and communication skills, such that lower levels of perfectionism and dependency were associated with better communicative abilities. These findings are consistent with previous research indicating that perfectionism is associated with lower empathy and greater negative affect (13). Additionally, prior studies have shown that personality variables may influence the acquisition of communication skills (64). Thus, it may be hypothesized that perfectionism negatively affects improvements in communication skills.\u003c/p\u003e \u003cp\u003eFurthermore, perfectionism-related cognitive distortions were negatively associated with perceived managerial support and professional quality of life. A recent systematic review has linked perfectionism to professional burnout, which is considered a primary indicator of low professional quality of life, highlighting the lack of managerial support as a key environmental factor (65). Likewise, research in healthcare professionals frequently draws on the Job Demands\u0026ndash;Resources (JD\u0026ndash;R) model, which explains how perfectionism interacts with environmental resources (66).\u003c/p\u003e \u003cp\u003eWith regard to professional quality of life, significant positive correlations were found with Workload, Managerial Support, and Intrinsic Motivation. However, professional quality of life was not correlated with communication skills. Previous evidence has reported an association between communication skills and quality of life, as well as a greater ability to cope with workload demands (21). Nevertheless, studies differ in their findings regarding the capacity of interventions to improve work motivation, with some reporting a decrease in positive work-related attitudes (22). These mixed results suggest the need for more in-depth research.\u003c/p\u003e \u003cp\u003eAlong these lines, prior scientific literature indicates a relationship between job demands, a lack of personal resources, and poorer health outcomes, highlighting that strengthening professionals\u0026rsquo; job resources increases work engagement (20). In this context, physicians\u0026rsquo; communication skills may play a fundamental role in both professional practice and occupational health.\u003c/p\u003e \u003cp\u003eIn conclusion, occupational health among medical professionals is a complex issue involving multiple interrelated variables that may influence both well-being and job performance. Therefore, studies such as the present one are necessary to identify which variables should be targeted in order to improve health and working conditions among medical professionals\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Future Research Directions\u003c/h2\u003e \u003cp\u003eDespite the promising results of the study, it is not without limitations. First, a quasi-experimental design without a control group was employed. This limits the ability to control for potential confounding variables that may have influenced the observed outcomes. Therefore, future research using experimental designs that replicate interventions such as the one presented in this study is warranted.\u003c/p\u003e \u003cp\u003eDespite these limitations, the present study provides empirical evidence regarding interventions aimed at improving communication skills and problem-solving abilities among medical professionals in their clinical practice. Enhancing the physician\u0026ndash;patient relationship (PPR) is an area of particular relevance, not only for patient health and satisfaction, but also for the psychological well-being of healthcare professionals. Overall, the findings suggest that interventions based on cognitive restructuring and clinical communication may contribute to improved well-being and reduced cognitive distortions among medical staff. Future studies should explore the longitudinal impact of such interventions and their transfer to real-world clinical practice.\u003c/p\u003e \u003cp\u003eIt is important to note that the results did not consistently follow the expected direction across all analyzed variables. Transparent reporting of these findings contributes to a more balanced and realistic view of the effectiveness of intervention programs, which is sometimes obscured in the scientific literature. This transparency is precisely what motivates researchers to continue seeking effective strategies to achieve these goals.\u003c/p\u003e \u003cp\u003eAccordingly, future research should emphasize the longitudinal impact of interventions and their translation into real clinical practice. In addition, it would be valuable to develop programs targeting different healthcare professionals, as communication skills with patients constitute a general and essential resource across all health disciplines.\u003c/p\u003e \u003cp\u003eFinally, future studies are encouraged to consider differences related to sociodemographic and occupational variables, which appear to influence intervention effectiveness. In this regard, examining factors such as type of contract, years of professional experience, age, and related variables would provide a more nuanced understanding of intervention outcomes\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003e The study was approved by the Ethics Committee of Miguel Hern\u0026aacute;ndez University (Reference number: AUT.DCC.PLR.230719). All participants provided informed consent prior to participation. The study followed the principles of the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor Contribution Statement (CRediT)RLL: Writing \u0026ndash; Original Draft Preparation, Data Curation, Formal AnalysisACM: Data Curation, Formal Analysis. Writing \u0026ndash; Original Draft PreparationDPL: Supervision. Visualization.EPL: Supervision.MRA: Investigation, Resources, Investigation (support in research execution).PLR: Conceptualization, Methodology, Funding Acquisition, Writing \u0026ndash; Review \u0026amp; Editing.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n\u003cli\u003eChandra S, Mohammadnezhad M, Ward P. Trust and communication in a doctor-patient relationship: A literature review. J Healthc Commun. 2018;3(36).\u003c/li\u003e\n\u003cli\u003eOh Nelson H. Doctor\u0026ndash;Patient Relationship. In: Cockerham W, Ken PM, editors. The Wiley Blackwell Companion to Medical Sociology. Wiley-Blackwell; 2021. p. 495\u0026ndash;515.\u003c/li\u003e\n\u003cli\u003eWu Q, Bachelor ZJ, Wang P. The relationship between the physician-patient relationship. 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Cham: Springer; 2018. p. 37\u0026ndash;51.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"communication skills, physicians, intervention, program, cognitive distorsions","lastPublishedDoi":"10.21203/rs.3.rs-8829287/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8829287/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: The physician–patient relationship (PPR) is a core element of clinical practice. It affects both patients (e.g., satisfaction, treatment adherence) and healthcare professionals (e.g., reduced conflict, improved well-being). Training in communication skills helps prevent conflicts, enhances quality of care, and protects professionals. Therefore, there is a need for training programs that strengthen the PPR, prevent difficulties in the therapeutic process, and improve well-being.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To evaluate the effectiveness of a training program in communication and problem-solving skills aimed at medical staff.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e: The sample consisted of 147 professionals from the Public Health Service. Participants were divided into three groups of approximately 40–60 individuals each. Group allocation was non-random and based on medical specialty and professional setting. The intervention included content on cognitive restructuring, assertive communication, motivation, leadership, and conflict management. Sociodemographic variables, communication skills, cognitive distortions, and quality of life were assessed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Following the intervention, significant changes were observed in the variables analyzed. Perceived quality of life increased among professionals, while dependency-related cognitive distortions decreased and perfectionism showed a slight increase. Communication skills scores decreased after the intervention. Sex-based differences were found in some variables, although not in the magnitude of pretest–posttest change. Significant associations among variables were also identified.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion\u003c/strong\u003e: These findings provide evidence of the value of training professionals in skills that strengthen the PPR. Further research using more rigorous designs is needed to consolidate these results and advance the development of effective interventions.\u003c/p\u003e","manuscriptTitle":"Effectiveness of an Intervention Based on Communication Skills and Cognitive Distortions to Improve the Doctor–Patient Relationship","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-09 15:05:30","doi":"10.21203/rs.3.rs-8829287/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-02T14:46:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-31T07:10:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-05T07:07:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-04T12:30:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-03-04T08:46:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"38d67864-cf26-457f-bcd4-99bfb6f9ef99","owner":[],"postedDate":"April 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-09T15:05:30+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-09 15:05:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8829287","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8829287","identity":"rs-8829287","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}