Fielding incognito standardised patients as 'known' patients in a controlled trial in general practice.

BACKGROUND: Incognito standardised patients (SPs) have only been used to represent new patients so far. The few trials with incognito SPs provide little detail on the method used for fielding them. OBJECTIVE: To establish the feasibility of introducing SPs as 'known' patients (i.e. patients who have previously visited the practice) into practices, to indicate the required practice preparations, and to describe the various aspects of using SPs in a pretest/post-test design. METHODS: We used incognito SPs as known patients in a controlled trial to assess the practice behaviour of 49 trainees. The SPs received a 2-day training in role playing and completing checklists. We compiled comprehensive practice information folders of each practice to be visited. Real personal data and faked medical data of SPs were inserted in the filing system of each practice to be visited. Apart from SP roles with slightly different reasons-for-encounter and different SPs, the same training protocol, checklists and practice information folders were used in the post-test. RESULTS: The SPs carried out 287 visits in 50 practices. All practices prepared the patient records for the SP visits in a fairly authentic practice style. Trainees detected the SP in 74 visits. The main reasons for detection were imperfections in patient records and aspects of SP roles or role playing. CONCLUSION: Fielding incognito SP visits as known patients was feasible but labour-intensive. Preparing the SP patient records and familiarising SPs with the interior of practices represented new elements in the use of SPs. The pretest/post-test format made their use more efficient instead of complicating it.

GPs' needs for practice-oriented nutrition education; a Delphi study among Dutch GPs.

BACKGROUND: Published guidelines and lists of topics in nutrition education for GPs are affected by practical drawbacks, which prevent them from being easily implemented in vocational training curricula. OBJECTIVE: Our aim was to draw up a concise priority list of disease-related nutrition topics reflecting the needs among Dutch GPs for nutrition education geared to everyday practice, which can be used to decide on the main topics and educational content of computer-based instruction. METHODS: This was a two-round Delphi study, using pilot-tested questionnaires carried out among 41 GPs who attended a national CME meeting on nutrition in The Netherlands. Sum scores of, and summarized comments on nutrition topics and their frequencies in top-10 lists drawn up by respondents were the main outcome measures. RESULTS: The response in both Delphi rounds was high (93 and 95%). Analysis of questionnaires in both rounds yielded a priority list of disease-related nutrition topics, with the 14 highest ranking topics identical in both rounds. A fifteenth topic, only found in the second questionnaire, completed the priority list. A group of experts assessed this list as fully acceptable. CONCLUSION: It was possible to compile a priority list of disease-related nutrition topics reflecting the needs of GPs for nutrition education. Based on the results of the Delphi study, we generated the following list of five priority topics: weight problems; diabetes mellitus; hypercholesterolaemia; intestinal complaints; and hypertension. This list of five and the summarized comments of respondents will determine the main topics and educational content of a computer-based instruction we are currently developing.

Controlled trial of effect of computer-based nutrition course on knowledge and practice of general practitioner trainees.

BACKGROUND: Nutrition education is not an integral part of either undergraduate or postgraduate medical education. Computer-based instruction on nutrition might be an attractive and appropriate tool to fill this gap. OBJECTIVE: The study objective was to assess the degree to which computer-based instruction on nutrition improves factual knowledge and practice behavior of general practitioner (GP) trainees. DESIGN: We carried out a controlled experimental study, using a 79-item knowledge test and 3 incognito standardized patients' visits in a pre- and posttest design with 49 first-year GP trainees. The experimental group (n = 25) received an average of 6 h of a newly developed computer-based instruction on nutrition. The control subjects (n = 24) took the standard vocational training program. RESULTS: The percentage of correct answers on the knowledge test increased from 30% at pretest to 42% at posttest in the experimental group, and from 36% to 37% in the control group. Analysis of covariance, with the pretest scores as covariate, showed a significant experimental versus control group difference at posttest: 9.2% (P = 0.002). The mean percentage of correctly performed items during the 3 standardized patients' visits (assessed by checklists) showed an increase in the experimental group from 20% at pretest to 36% at posttest, whereas the control group changed from 20% to 22%. Analysis of covariance, with the pretest scores as covariate, revealed a significant group difference at posttest: 13.7% (P < 0.001). CONCLUSION: The computer-based instruction proved its effectiveness, both by increasing factual knowledge and by substantially enhancing GP trainees' practice behavior on the subject of nutrition.