Improving the psychiatric skills of the general practice trainee: an evaluation of a group training course

Fourteen general practice trainees took part in a course specifically designed to improve their psychiatric interviewing skills. The trainees were instructed in the problem-based model and were taught in a group setting with the use of videotape feedback. A significant improvement was demonstrated in the trainees' ability to identify psychiatric illness accurately, and there were significant changes in their interview behaviours after training. Those who were below average before training showed the greatest improvement. The implications of these findings are discussed. Group video feedback training is as effective as one-to-one video feedback training in improving the psychiatric interviewing skills of GP trainees, and could be more widely employed in general practice vocational training.     

Assessment of competence in technical clinical skills of general practitioners

Technical clinical procedures constitute an important part of the work of general practitioners. Assessment of competence in the relevant skills is important from the perspective of quality assurance. In this study, the psychometric characteristics of three different methods for assessment of competence in technical clinical skills in general practice were evaluated. A performance-based test (8 stations), a written knowledge test of skills (125 items) and a self-assessment questionnaire (41 items) on technical clinical skills were administered to 49 GPs and 47 trainees in general practice. The mean scores on the performance-based test and the written knowledge test of skills showed no substantial differences between GPs and trainees, whereas the GPs scored higher on the self-assessment questionnaire. While the correlation of the score on the knowledge test of skills with the score on the performance-based test was moderately high, the score on the self-assessment questionnaire showed a rather low correlation with the performance-based test. Although performance-based testing is obviously the best method to assess proficiency in hands-on skills, a written test can serve as a reasonable alternative, particularly for screening and research purposes.     

Teaching psychiatric interview skills to medical students

A teaching package is described for teaching interview skills to large blocks of medical students whilst on their psychiatric attachment. The aims of this package are to reduce students' concerns about interviewing psychiatric patients, to reinforce students' knowledge of basic interviewing skills and to introduce students to the particular skills required in taking a psychiatric history and mental state examination. The package emphasizes the following teaching methods: 'hands-on' experience of interviewing a patient in front of small groups of peers; peer feedback using check-lists which focus on three major aspects of interviewing; elicitation of facts, elicitation of feelings and control of the interview; facilitation of small-group discussions in the presence of senior psychiatrist. The active involvement of all students in interviewing psychiatric patients engages them in the learning process. Peer involvement increases motivation and was deemed by students as a supportive and constructive exercise. The presence of a senior psychiatrist ensures that discussion is focused on the process of interviewing rather than on patient pathology. Ideally this package would precede focused training throughout the subsequent psychiatric placement.     

Consulting skills training and medical students' interviewing efficiency

In more traditional medical education, medical students took a patient's medical history by asking a series of sequenced, routine questions, covering presenting medical problem(s); medical history; social and personal history; systems review; and physical examination. Following this process, the student then attempted to derive the patient's medical problems. This inductive problem-solving paradigm may not assist students to prepare for their future interviewing needs, given doctors use a hypothetico-deductive, problem-solving approach when interviewing patients and numerous researchers have developed specialized communication skills training programmes designed to enhance students' interviewing skills. Students given specific consulting skills training have tended to show significantly greater interpersonal effectiveness and improved interview behaviours compared with students who experience traditional patient clerking training. These improvements in interviewing tend to persist over the period of students' medical training. The aim of the present study was to determine whether specialized communication skills training helped students elicit greater quantity and quality of information from patients and if so, whether such information assisted students in improving their diagnostic skills. Videotaped history-taking interviews conducted by students trained in communication skills and untrained (control) students were rated for their interview efficiency. A comparison of ratings given by experimentally naive, independent observers revealed that trained students were more efficient, but took no longer than their control group counterparts to elicit fuller, more relevant information. However, the student groups did not differ in the accuracy or scope of their medical diagnoses. It is argued that students' lack of medical knowledge in this early phase of their clinical training militated against their being able to use their interviewing competence to derive more potentially accurate medical diagnoses.     

Improving the psychiatric skills of established general practitioners: evaluation of group teaching

Ten established general practitioners, eight of whom were also trainers, took part in a course designed to improve their psychiatric interviewing skills. Participants were instructed in the problem-based model with audiotape and videotape feedback of real consultations in a group setting. Although those attending were experienced practitioners with a particular interest in the management of psychological problems, evaluation demonstrated a significant improvement in their skills after training. It is suggested that trainers could be trained to provide a similar teaching experience for their own trainees.     

Medical student interviewing skills and mother-reported satisfaction and recall

BACKGROUND: Providing feedback to medical students about their interviewing skills is an important component of teaching programmes. There is very little information about mothers' views of medical student consultations in paediatrics, and in particular about what mothers consider to be the key elements of a successful consultation. Patient-centred interviewing is a model which emphasizes the active seeking of patient views. In association with appropriate clinical skills, it is reported to promote improved health outcomes. OBJECTIVES: To examine whether greater medical student clinical competence and more frequent use of patient-centred techniques is associated with higher maternal satisfaction, higher maternal rating of the medical student's interpersonal skills, and greater maternal recall of relevant diagnosis and treatment recommendations. METHOD: Two standardized 'medical student' videotaped interviews were created based on actual senior medical student consultations. Interview A demonstrated both higher student clinical competence and higher patient-centredness compared with interview B. Both videotaped interviews were viewed and then rated, using a questionnaire, by 11 mothers attending a teaching general practice. RESULTS: Significantly higher mean scores, indicating greater maternal satisfaction, were associated with interview A (P < 0.01 for all measures). Accurate recall for diagnosis and management was also significantly greater after interview A (mean diagnosis recall, interview A 35%, interview B 14%, P < 0.01; mean management recall, interview A 95%, interview B 57%, P < 0.01). CONCLUSIONS: Maternal satisfaction and recall were higher following a more clinically competent and patient-centred medical student interview. Maternal ratings of student interviews could be used as an additional method of assessment as well as providing feedback to medical students on their interview skills development.     

Improving the skills of established general practitioners: the long-term benefits of group teaching

This study set out to determine the long-term benefits of teaching psychiatric interview skills. Nine established general practitioners, eight of whom were also trainers, took part some 18 months after attending a problem-based interviewing course. Interview skills were assessed by rating behaviour during 10-minute videorecorded simulated consultations with role-players, recorded before and after training and at follow-up. The finding of an earlier study that, in terms of the course model, training successfully modified the doctor's behaviour, was largely replicated. In addition, not only were acquired skills maintained but further change took place during the follow-up period, change that can be seen as improvement in terms of the course model.     

Training general practitioners to teach psychiatric interviewing skills: an evaluation of group training

Group teaching in problem-based interviewing based on video and audiotape feedback of the doctor's own consultations significantly improved the ability of experienced general practitioners to teach psychiatric skills to their trainees. When the GPs were randomly allocated to one of three further training experiences--video feedback of their tutorial sessions, discussion about how to teach and no further teaching, there were very few differences between the groups. The greatest impact on improving teaching skills was brought about by watching their own consultations in a group feedback setting.     

Child and adolescent psychiatry placements in specialist psychiatric training: a regional study

Before beginning higher professional training in one of the subspecialties, all psychiatry trainees must complete a general professional psychiatric training. At this stage, some but not all will undertake a clinical placement in child and adolescent psychiatry. Fifty-seven trainees who had completed one of the 15 child and adolescent psychiatry placements in a Regional Health Authority, took part in a semi-structured telephone interview. The trainees were asked to compare the child and adolescent psychiatry placement with a general adult psychiatry placement with respect to the training received in a number of areas. These areas were considered to be important to psychiatrists of all future subspecialties and included: assessment, communication, psychological interventions and psychological theories. In addition, subjects were asked about their general professional training as a whole and the role that child and adolescent psychiatry placements should play. The interview included quantitative and qualitative components. The findings suggest that child and adolescent psychiatry placements can make a significant contribution to a number of important areas of general professional development and that there would be considerable support for strengthening the role of such placements in psychiatry training.     

A communication skills course for preclinical students: evaluation of general practice based teaching using group methods

Summary. Teaching preclinical medical students about doctor-patient communication gives them an opportunity to develop their interviewing skills prior to their having to elicit lists of symptoms in their clinical years. General practitioners should be among the more efficient interviewers in clinical medicine and therefore able to make important contributions to the teaching of interviewing skills. This paper describes the aims, objectives and methods of the preclinical communications skills course at St George's Hospital Medical School. The contribution of the Division of General Practice and Primary Care to the teaching of interviewing skills in the preclinical course has been evaluated using rapid group methods. Students were asked to identify examples of specific interviewing behaviours in videotaped general practice consultations, and to judge whether the behaviours were helpful or unhelpful in eliciting relevant information from the patient. Students who had been given experience in interviewing patients in small groups led by general practitioners identified significantly more helpful and unhelpful interviewing behaviours in the taped consultations than students who had not received the small-group teaching. Students rated the teaching as relevant and effective in terms of giving insights into the interviewing skills they needed to develop. Group methods of evaluation such as these might prove useful to other medical schools with class sizes of 150 students or more.     

Education in primary care psychiatry: research-based audit

This paper describes some of the difficulties faced by the KCGP Mental Health Education Fellows in designing an educational initiative to enhance the recognition and management of psychiatric illness in general practice. The initiative was evaluated using a consensus technique over six meetings which took place between 1993 and 1995. The results of the exercise illustrated the value of utilizing a validated instrument in identifying mental health problems, but when employed without support created disillusionment and a lack of confidence in the learner. However, when the instrument was applied as part of a wide educational process examining current practice, learners were stimulated to examine and change their behaviour by synthesizing newly acquired knowledge with their own previous clinical experience.     

Growth of Self-Perceived Clinical Competence in Postgraduate Training for General Practice and its Relation to Potentially Influencing Factors

Objective To examine the increase in self-perceived clinical competence during a three-year postgraduate training in general practice and to explore the relation between the growth of self-perceived competence and several background variables. Design Cohort, 1995–1998. Setting Three-year Postgraduate Training for General practice in the Netherlands Participants All Dutch trainees who followed postgraduate training from September 1995 to September 1998 (N=191). Intervention We asked the trainees at the start and at the end of their postgraduate training to complete a questionnaire, which assessed their self-perceived knowledge, clinical skills and consultations skills. We collected information about potentially influencing background variables. Amongst these were variables such as: age, gender, prior medical experience, the effort someone has spent upon her/his education, insight in weak and strong areas of clinical competence and knowledge and skills levels. Main outcome measure Self-perceived competence. Results A total of 127 trainees completed both questionnaires (190 at the first administration and 128 at the second one). We found statistically significant growth of self-perceived clinical competence. Self-perceived consultation skills increased more than self-perceived knowledge and clinical skills. The afore mentioned background variables did not relate in any way with the growth of self-perceived clinical competence. Conclusion This study shows that a 3-year postgraduate training in general practice enhances self-perceived clinical competence. However, we still do not know how to explain this improvement. Further study into the theoretical concept of self-assessment in medical education and into the factors contributing to the feeling of being competent, is required.     

Teaching medical students about neurosis

Practices used by medical schools in Great Britain and Ireland in the teaching of neurosis to medical students were assessed using postal questionnaires distributed to heads of departments, and to medical students at the end of their psychiatric attachments. In addition, medical students' factual knowledge about neurotic illnesses was measured using a brief multiple choice question (MCQ) test distributed with the questionnaire. There was considerable dissatisfaction among heads of departments with the way neurosis is taught, and there was general agreement that students see too many patients with psychotic illnesses and too few neurotics. Most neurotic patients are seen within departments of psychiatry and heads of department felt there was too little use of other settings such as general medical wards or general practice. Factual knowledge about neurosis as assessed by the MCQ was generally poor. Knowledge about neurotic illnesses relates most closely to the time devoted by departments to formal lectures on neurosis and is inversely related to the proportion of psychotic patients seen by students. Teaching of techniques of medical interviewing including the use of audio and video feedback of interviewing skills and behaviours is now widespread in British medical schools. There was no tendency for students receiving such teaching to display a better knowledge about neurosis.     

Management of somatic presentations of psychiatric illness in general medical settings: evaluation of a new training course for general practitioners

An improved teaching package is described which aims to help general practice trainees manage somatized presentations of psychological distress. The package comprises a training videotape in which a reattribution model is demonstrated, with material for role-play of new skills and small-group video feedback of consultations. Eighteen general practice trainees attending an 8-week course in psychiatry participated fully in the somatization management teaching programme. The teaching package was evaluated by blind rating of general interview skills and model specific skills demonstrated by trainees during 10 to 15-minute clinical interviews with professional role-players. Ratings were made on pre-training and post-training videotaped interviews. A significant improvement was demonstrated in general interview skills. Improvements were also noted in specific reattribution skills post-training. The evaluation revealed that skills in the model can be effectively learned, and that improvements in the package have resulted in its improved efficacy.     

A questionnaire examining learning in general practice

Vocational training is a key element of professional development in general practice. Learner-centred approaches to teaching bring a need for greater understanding of the individual learning styles and preferences of trainees. This paper reports the findings of a pilot study undertaken to determine factors that may influence learning among general practice trainees. A questionnaire survey of 261 trainees in six regions in the UK was carried out to explore attitudes to a series of themes identified in semi-structured interviews with trainees at the end of their training. Six distinct subscales were identified using principal components analysis. These are named 'Learning from Patients', 'Openness to Criticism', 'Negative Attitudes', 'Desire for Clear Guidelines', 'Peer Support', and 'Academic Approach'. Males scored significantly higher on 'Academic Approach' (   P < 0.05  ). Each of the subscales reflects themes that permeate the atmosphere of general pratice training. Further work is required to establish relationships between the subscales and the outcomes of learning and to explore the implications for continuing professional development. The questionnaire is an instrument that may prove useful in the future investigation of learning in general practice.     

Objectives for the undergraduate teaching of psychiatry: survey of doctors and students

OBJECTIVES: The principal aim was to assess the psychiatric topics that doctors and students considered most important for undergraduate teaching. Differences between doctors and students, men and women, physicians/students with or without an interest in psychiatry were examined. DESIGN: A mailed questionnaire was used concerning the knowledge and skills of psychological/psychiatric medi- cine considered to be needed in medical practice. SETTING: The Medical School of the University of Geneva. SUBJECTS: Doctors and undergraduate medical students in their last 2 years of medical training. RESULTS: Both doctors and students agreed on most topics, even though the students tended to give all items a higher rating. Both groups agreed on the importance of the following main topics: the doctor-patient relationship, identification and management of the principal psychiatric disorders and their associated risks and problems of a psychosocial nature. Those doctors showing an interest in psychiatry tended to accentuate the importance attached to interpersonal skills. The male and female doctors and students expressed very similar opinions. The female doctors, however, tended to attach greater importance to relational-emotional aspects and to disorders affecting children and adolescents than did their male colleagues, which is probably a reflection of the specific role that women still play within our society. When asked to assess the current teaching they received in medical school, the students considered that certain important aspects of psychiatry were insufficiently taught. CONCLUSION: These results confirm the importance of teaching psychiatry with an emphasis on problems encountered in general practice.     

The teaching of interviewing skills: comparison of experienced and novice trainers

During a clerkship in psychiatry thirty-six medical students were randomly allocated to one of three teachers who differed widely in their experience of teaching essential interviewing skills. Each teacher taught two groups of six medical students using videotape feedback and discussion of practice interviews. Independent raters who were blind to the teachers to whom the students had been assigned rated pre and post-training interviews. All three teachers proved effective in teaching interviewing skills and it is concluded that most teachers could probably be taught to carry out this training.     

Psychiatric training for family doctors: what do GP registrars want and can a brief course provide this?

CONTEXT: About 40% of British General Practitioners (GPs) train formally in a psychiatric post as part of their general practice training, but such training may not fully meet the needs of future GPs. A specific course in psychiatry for family doctors has run in Manchester for more than a decade. METHOD: Semi-structured interviews conducted with GP registrars before attending the Manchester course in psychiatry with questionnaire follow-up afterwards to ascertain (a) the training 'wants' of GP registrars and (b) whether the course was providing them. RESULTS: GP registrars most frequently wanted training in communication skills, how to access the resources that are available to GPs, the detection of psychiatric illness, drug treatment and the management of aggression. The course was successful in satisfying the first three but failed in the last two. There was trend for those who attended Manchester Medical School, which scored significantly higher on number of topics covered at undergraduate level, to perceive a greater need for training than those who attended other medical schools. However, there was no evidence to link self-perception of greater need with having already worked in general practice during postgraduate training. CONCLUSIONS: More attention needs to be paid to how to address the specific mental health skills training requirements of GP registrars both within the attachment in psychiatry and during the practice year. Preliminary research is required to devise teaching packages before they are entirely satisfactory for GP education.     

Communication skills and undergraduate medical education

This paper reports some aspects of teaching communication skills based on experience with over 100 pre-clinical students in each of two years. Students interviewed patients selected by general practitioner tutors from their practices and 214 interviews, recorded on videotape, were subsequently analysed. Without having been given detailed instruction, approximately two-thirds of each class of second year students (mean age 194 years) sustained a consultation for 5 minutes or more. Over one half of the students elicited the salient features of the patients' problems within this short time. Anxiety exhibited by the majority of students could be seen to influence the interviews in several ways. These manifestations and the ways in which the interview was affected are briefly described. When some of the patients were subsequently interviewed by postgraduate trainees in general practice, the consultations differed in a number of respects. These differences are described, and the possible significance of the observations is discussed in relation to medical education.     

卫生应急管理模块化培训远期效果评价

目的 评价卫生应急管理模块化培训的远期效果,为完善适宜的卫生应急管理培训模式提供依据.方法 通过问卷调查、学员个人访谈及小组座谈进行评价.结果 71.4％的学员认为本次培训内容很实用,85.7％的学员能将所学知识运用到工作中,81.0％的学员知识得到了显著提高,66.7％的学员工作技能得到了显著提高,61.9％的学员态度有了明显改善,95.2％的学员思维有了明显开阔,61.9％的学员行为得到了显著改善.结论 本次培训内容实用性好,大部分学员在知识、技能、态度、思维、行为方面有显著的提高和改善,且能将所学知识运用到工作中.