DOES A 3-DAY WORKSHOP FOR FAMILY MEDICINE TRAINEES IMPROVE PREVENTIVECARE - A RANDOMIZED CONTROL TRIAL

Objective. To evaluate the impact on clinical behavior of a 3-day work shop designed to increase trainees' rates of smoking cessation counsel ing and reminders about Pap smears in routine consultations. Design. R andomized control trial. Setting. Accredited teaching practices of the Royal Australian College of General Practitioners' Training Program. Subjects. Thirty-four trainees and 1,500 consecutive adult patients ag es 16-65 years. Method. Trainees randomly allocated to the experimenta l group participated in a 3-day interactive workshop on disease preven tion during their 13-week family medicine term, Audiotapes of consulta tions with adults conducted by trainees at the beginning and end of th e rotation were analyzed blind to compare assessment of patients' smok ing status and, for women, date of last Pap smear. A questionnaire mai led to each patient after the consultation also allowed identification of smokers and women overdue for a smear, Consultations with these pa tients at risk were analyzed for preventive counseling. Inter- and int rarater reliability was calculated for audiotape analysis. Results. Pr eworkshop rates of questions about smoking were low, occurring in 22% of consultations. While trainees allocated to the experimental worksho p were more likely to ask a routine question about smoking at the end of the term than those in the control group (P = 0.01), two-thirds of smokers remained undetected irrespective of trainee group and fewer th an one in five were advised to stop smoking. Reminders about Pap smear s did not change as a result of training and remained low in fewer tha n 20% of consultations. kappa values demonstrated high reliability of audiotape analysis. Conclusion. This direct measurement of clinical be havior revealed that low levels of preventive care provided by trainee s are resistant to skills training without reinforcement in clinical p ractice. In view of the importance of prevention in routine consultati ons, we recommend continued evaluation of more intensive educational p rograms, Those withstanding rigorous evaluation could be considered fo r implementation in similar training contexts seeking to improve the f requency and quality of disease prevention in primary medical care. (C ) 1996 Academic Press, Inc.