Improving psychiatric interview skills of established GPs: evaluation of a group training course in Italy

BACKGROUND: A number of studies have shown that the communication style of GPs has a significant impact on their ability to recognize and manage psychiatric disorders. Italian training programmes do exist, but none have been evaluated for effectiveness. METHODS: Nine established GPs participated in a training programme consisting of twelve 3-h education sessions. Each session consisted of group discussion of videotaped patient interviews selected by GPs. Case discussion followed Lesser's "problem-based approach" criteria. Efficacy of training was assessed by measuring the pre-post change in accuracy in detecting psychiatric illness and changes in the interview skills of the GPs. RESULTS: Accuracy in detection of psychiatric illness increased significantly after training. Changes were seen in the interview style after training, such as use of open-ended questions and appropriate counselling in relation to problems presented by the patient. Physicians also improved their management skills by using a more negotiatory style and providing patients with supportive feedback. The way in which physicians gave advice and information to the patients improved significantly despite the fact that GPs were not instructed about how to give information to their patients. CONCLUSIONS: Group training in problem-based interviewing utilizing video feedback is a robust, culturally transferrable model for improving the skills of established physicians. Our results suggest that training produces indirect effects that are the result of the teaching method rather than of explicit instructions. Further research is required to assess how to optimize the effect of educational interventions to ensure sustainability and maximal impact on measurable outcomes of care.