SIMULATED PATIENTS IN ASSESSING CONSULTATION SKILLS OF TRAINEES IN GENERAL-PRACTICE VOCATIONAL-TRAINING - A VALIDITY STUDY

Although simulated patients are increasingly used in medical education , little research has been carried out on their validity. Validity in this case defines the relationship between performance with a simulate d patient and performance with a real patient. One of the objectives o f this study was to determine the validity of the use of simulated pat ients in assessing the consultation skills of trainees in vocational t raining at die Department of General Practice, University of Utrecht, The Netherlands. A check-list with a rating scale was used to assess t he consultation skills of trainees at the department with simulated pa tients as well as in their training practices with real patients. The simulated and the selected practice cases were patients with complex m ulti-conditional problems like low back pain, headache and chest pain. The consultation skills were subdivided into four groups: the patient -centred approach, the non-somatic approach, communication skills and interpersonal skills. The measurement of skills, in particular of cons ultation skills, is very difficult. A description is given of the way the research group solved this problem. The analysis was performed by determining the sensitivity and predictive value of the assessment of a simulated encounter with a routine practice encounter. A difference existed in the assessed level of consultation skills in the simulated encounter compared to the level in the training practice. In simulatio n the level of consultation skills was higher than in day-to-day pract ice. This difference can reflect the difference between competence and performance. Competence is defined as what a doctor is capable of doi ng and performance as what a doctor actually does in day-to-day practi ce. The assessment of behaviour in simulation reflected well those tra inees who also performed inadequately with practice cases. The predict ive value of inadequate performance in simulation is high. For feedbac k purposes this is an important issue. Because of the difference betwe en competence (simulation) and performance (real practice), the predic tive value of the behaviour rated adequate in simulation is not so hig h. Considering the difference between competence and performance, acto r simulation is a valid method to assess consultation skills of traine es.