Use of videotaped consultations in summative assessment of trainees in general practice.

BACKGROUND: There are many different methods by which trainees may be assessed summatively. AIM: The objective of the study was to determine if videotaped consultations could be used to identify reliably those general practitioner trainees who have not yet reached acceptable levels of competence. METHOD: Videotapes of 10 trainees carrying out normal consultations were assessed by 20 assessors for acceptable competence using a rating scale specifically developed for the purpose. RESULTS: A principal components analysis showed a strong correlation among the items in the rating scale used, indicating that a single underlying factor accounted for 76% of the overall scores. Agreement between assessors on the scoring of individual consultations was limited. There was much greater consistency with regard to the decision on overall competence, examined for the first consultation. A non-competent trainee would have a 95% probability of being identified by the process as described using two assessors for each videotape. The assessors had reached firm judgements on each trainee by the time four consultations had been viewed. CONCLUSION: The workload involved in producing and analysing the tapes is discussed. Considerations of patient consent are addressed. It is concluded that the use of videotaped consultations appears to offer a feasible and reliable method of summative assessment of general practitioner trainees.     

An audit of ENT referrals assessing training needs for general practice trainees

Over 500 ENT diagnoses made by general practitioners when referring patients to one ENT department were examined and compared with the diagnoses by the specialist department. A broad grouping of the categories of referral was made and topics highlighted which seemed particularly appropriate for further postgraduate training for general practitioners.

We believe the amount of postgraduate training in ENT currently available to trainees in the UK may be too low and ought to be increased and that this approach offers a logical starting point for constructing educational objectives for such training.

     

Antibiotic prescribing for the future: exploring the attitudes of trainees in general practice

Background

Antibiotic resistance is a public health concern worldwide. A high proportion of antibiotics are prescribed in primary care, often for conditions where there is no evidence of benefit. Without a change in these prescribing patterns, resistance will persist as a significant problem in the future. Little is known about how trainees in general practice perceive and develop their prescribing.

Aim

To explore the attitudes of trainees in general practice towards antibiotic use and resistance, and the perceived influences on their prescribing.

Design and setting

A qualitative study of 17 vocational trainees in general practice (GP registrars) in both rural and urban areas in Australia employing semi-structured interviews and a focus group.

Method

Maximum variation purposive sampling of GP registrars from diverse backgrounds and training stages continued until thematic saturation was achieved. Topics of discussion included awareness of antibiotic resistance, use of evidence-based guidelines, and perceived influences on prescribing. Transcribed interviews were coded independently by two researchers. Data collection and analysis were concurrent and cumulative, using a process of iterative thematic analysis.

Results

Registrars were aware of the importance of evidence-based antibiotic prescribing and the impact of their decisions on resistance. Many expressed a sense of dissonance between their knowledge and behaviours. Contextual influences on their decisions included patient and system factors, diagnostic uncertainty, transitioning from hospital medicine, and the habits of, and relationship with, their supervisor.

Conclusion

Understanding how trainees in general practice perceive and develop antibiotic prescribing habits will enable targeted educational interventions to be designed and implemented at a crucial stage in training, working towards ensuring appropriate antibiotic prescribing in the future.     

A new look at learning needs in general practice

Over a period of 18 months, trainees in the West Midlands were given a multiple choice questionnaire at the start of the general practice year to assess their factual knowledge in 14 areas of medicine and were given the opportunity to take the same test six months later. Sixty-five trainees who completed the test twice are the basis of the study, and their results are compared with 99 trainers who completed the paper once. In the pre-training test, the trainees' scores were significantly lower than their trainers' in total and in most individual subjects. In the mid-training test, the trainees' knowledge of most subjects had improved significantly over the six months. These results indicate that the teaching and assessment of factual knowledge should not be dismissed as unimportant in general practice training.     

Experience of using rating scales for the assessment of vocational trainees in general practice.

For two years trainers in the northern half of the south western region have been asked to assess their trainees with a condensed version of the new Manchester rating scales for vocational training in general practice and to send copies to the regional adviser. The condensed version retains the 23 scales but does not include the subscales. Trainers' workshops and comments from individuals suggested that no radical improvements to the scales were required and that they were an adequate statement of what was required from trainees. The response rate of 89% for returning at least one assessment and 38% for returning all three suggested that use of this condensed version would be more feasible than using the full version of the scales. Analysis of 86 first assessments and 48 sets of three assessments showed a range of variation both in trainee ratings and use of individual scales that was consistent with expectations. A lack of significant rank correlations between the scales indicated that each of the scales measured a different characteristic of behaviour. We suggest that the most useful way to achieve systematic assessment of vocational trainees is by the use of the 23 main rating scales, with regional variations where appropriate.     

The identification of children with learning problems in general practice

Twenty-four childen who were patients in a large general practice in Southern England were seen in a learning problem clinic in the practice during a 14-month period. The method of assessment used took an hour per child but several examples show that it was both practical and effective.     

Use of the objective structured clinical examination for assessment of vocational trainees for general practice

General practice training schemes currently have no structured methods of assessment and most rely on a variety of subjective ratings of performance. In West Cumbria the `objective structured clinical examination' has been used to assess training performance in areas covered by small group teaching during the preceding terms. Consultation skills, interpretation of clinical data and a number of aspects of practice management were tested. The examination was conducted in the local postgraduate centre and assessed 20 trainees. Each trainee received feedback of his performance on each problem set and also an overall comparison with his peers.

This method of assessment appeared to be well received by trainees and was practicable within the limited resources available. In addition, the variety of problems set allowed for a broad range of trainees' performances to be assessed.

     

Continuing education for general practice: a learning system

A learning system for continuing education for general practitioners is described and illustrated by examples from educational programmes held in Doncaster. The work that needs to be done by organizers in planning, organizing, implementing, and evaluating educational programmes is outlined. I hope that this will help other organizers of continuing education.