Objective:To determine whether interns’ performances of technical, preventive, and communication ... more Objective:To determine whether interns’ performances of technical, preventive, and communication aspects of patient care improve during the intern year. Design:A descriptive study. At the beginning and end of the intern year, interns’ consultations with three simulated (standardized) patients were videotaped and scored according to explicit criteria set by an expert panel. Problems simulated were urinary tract infection, bronchitis, and tension headache. Setting:The casualty outpatient department in a general teaching hospital in New South Wales, Australia. Participants:Twenty-eight interns rotated to the casualty department. Results:Little improvement over the intern year in technical competence or preventive care was observed, even though initial levels of compliance with criteria were quite low for some items. Greater improvement was apparent in the area of communication skills. Conclusions:The results suggest that the internship should be restructured to more adequately teach the skills required for primary care.
Summary. Fifty-four interns agreed to a study in which their clinical performance in an outpatien... more Summary. Fifty-four interns agreed to a study in which their clinical performance in an outpatient unit with standardized patients was recorded on videotape. In order to examine whether they could distinguish standardized from real patients, the interns were asked to note any patients who they thought might be simulating their complaints and report these to the researchers at the end of each 2-day period of study. Thirty-two of the interns were assessed again at the end of their internship, using the same clinical problems presented by different simulators. The consultations took place in the casualty department of a large urban hospital. At the beginning of the year there were 152 consultations with standardized patients and 328 consultations with appropriate genuine patients. Standardized patients were identified definitely as ‘not genuine’ in only 12 of the 152 consultations (sensitivity 7.8%) whereas 320 of the 328 genuine consultations were accepted by the interns as genuine (specificity 97.8%). When the level of confidence required to distinguish the two groups was reduced from ‘definite’ to ‘probable’, the number of correctly identified simulator consultations increased to 36/152 (27%) but the rate of misclassification of genuine patients also increased from 8 to 37 out of 328 consultations (11%). At the end of the year there were 81 consultations with standardized patients and 149 consultations with genuine patients. Identification rates were only slightly changed. We conclude that simulator identification is not a problem in applying standardized patients to evaluate the quality of care provided in a hospital casualty.
To describe current mental health care practices of general practitioners and to identify their e... more To describe current mental health care practices of general practitioners and to identify their educational priorities and training preferences. Self-administered questionnaire to a stratified random sample of New South Wales general practitioners. 721 full-time general practitioners, of whom 534 (74%) responded. Mental health problems recognised by general practitioners at least once per week were psychosomatic (93%), emotional (89%), addiction (79%), social/economic (71%) and family (69%). At least two-thirds recognised sexual problems, sexual abuse and major psychiatric problems less frequently than once per week. Sixty-four per cent of general practitioners reported that patients felt uncomfortable about being referred to psychiatrists; 53% that referral service waiting lists were too long; 51% that there were insufficient local mental health services; and 25% that communication difficulties between referring general practitioners and mental health specialists obstructed optimal care. Educational priorities were diagnostic and counselling skills, with particular emphasis on crisis, family, individual and marital counselling and strategies to prevent general practitioner burn-out. General practitioners are interested in improving their mental health counselling and diagnostic skills but barriers remain. Both structural and educational initiatives are essential to enhance the quality of mental health care in general practice.
Objective:To determine whether interns’ performances of technical, preventive, and communication ... more Objective:To determine whether interns’ performances of technical, preventive, and communication aspects of patient care improve during the intern year. Design:A descriptive study. At the beginning and end of the intern year, interns’ consultations with three simulated (standardized) patients were videotaped and scored according to explicit criteria set by an expert panel. Problems simulated were urinary tract infection, bronchitis, and tension headache. Setting:The casualty outpatient department in a general teaching hospital in New South Wales, Australia. Participants:Twenty-eight interns rotated to the casualty department. Results:Little improvement over the intern year in technical competence or preventive care was observed, even though initial levels of compliance with criteria were quite low for some items. Greater improvement was apparent in the area of communication skills. Conclusions:The results suggest that the internship should be restructured to more adequately teach the skills required for primary care.
Summary. Fifty-four interns agreed to a study in which their clinical performance in an outpatien... more Summary. Fifty-four interns agreed to a study in which their clinical performance in an outpatient unit with standardized patients was recorded on videotape. In order to examine whether they could distinguish standardized from real patients, the interns were asked to note any patients who they thought might be simulating their complaints and report these to the researchers at the end of each 2-day period of study. Thirty-two of the interns were assessed again at the end of their internship, using the same clinical problems presented by different simulators. The consultations took place in the casualty department of a large urban hospital. At the beginning of the year there were 152 consultations with standardized patients and 328 consultations with appropriate genuine patients. Standardized patients were identified definitely as ‘not genuine’ in only 12 of the 152 consultations (sensitivity 7.8%) whereas 320 of the 328 genuine consultations were accepted by the interns as genuine (specificity 97.8%). When the level of confidence required to distinguish the two groups was reduced from ‘definite’ to ‘probable’, the number of correctly identified simulator consultations increased to 36/152 (27%) but the rate of misclassification of genuine patients also increased from 8 to 37 out of 328 consultations (11%). At the end of the year there were 81 consultations with standardized patients and 149 consultations with genuine patients. Identification rates were only slightly changed. We conclude that simulator identification is not a problem in applying standardized patients to evaluate the quality of care provided in a hospital casualty.
To describe current mental health care practices of general practitioners and to identify their e... more To describe current mental health care practices of general practitioners and to identify their educational priorities and training preferences. Self-administered questionnaire to a stratified random sample of New South Wales general practitioners. 721 full-time general practitioners, of whom 534 (74%) responded. Mental health problems recognised by general practitioners at least once per week were psychosomatic (93%), emotional (89%), addiction (79%), social/economic (71%) and family (69%). At least two-thirds recognised sexual problems, sexual abuse and major psychiatric problems less frequently than once per week. Sixty-four per cent of general practitioners reported that patients felt uncomfortable about being referred to psychiatrists; 53% that referral service waiting lists were too long; 51% that there were insufficient local mental health services; and 25% that communication difficulties between referring general practitioners and mental health specialists obstructed optimal care. Educational priorities were diagnostic and counselling skills, with particular emphasis on crisis, family, individual and marital counselling and strategies to prevent general practitioner burn-out. General practitioners are interested in improving their mental health counselling and diagnostic skills but barriers remain. Both structural and educational initiatives are essential to enhance the quality of mental health care in general practice.
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