Effect of a short skills training course on competence and performance in general practice

Authors:
  • RGR P Grol
    R P Grol
  • VVVan Der Vleuten
    Van Der Vleuten
  • ASA J Scherpbier
    A J Scherpbier
  • HCH F Crebolder
    H F Crebolder
  • JRJ J Rethans
    J J Rethans
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Abstract
Objectives: Evaluation of the efficacy of a short course of technical clinical skills to change performance in general practice. Design: Subjects were self‐selected general practitioners ( n =59) who were unaware of the study design. They were assigned to the intervention group ( n =31) or control group ( n =28) according to their preference for course date. The course covered four different technical clinical skills (shoulder injection technique, PAP‐smear, laboratory examination of vaginal discharge, ophthalmoscopic control in diabetes mellitus). Main outcome measures used were pre‐ and post‐training scores on a knowledge test of skills (60 multiple choice items), and pre‐ and post‐training performance of procedures in practice using a log‐diary covering 20 days. Setting: University of Maastricht, The Netherlands. Subjects: Self‐selected general practitioners. Results: Competence, as measured by the knowledge test of skills, improved significantly as a result of the training and skills test scores were satisfactory after training. A significant effect on performance in practice was found for PAP‐smear and shoulder injection technique, whereas no effect could be demonstrated for examination of vaginal discharge and ophthalmoscopic control in diabetes mellitus. Conclusions: A good degree of competence is a necessary but not always sufficient condition for a physician to change his performance in practice. While some skills training seems adequate to bring about desired changes, for other skills more complex interventions are probably needed.

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