Effect of a short skills training course on competence and performance in general practice

Objectives Evaluation of the efficacy of a short course of technical clinic al skills to change performance in general practice. Design Subjects were self-selected general practitioners (n=59) who were un aware of the study design. They were assigned to the intervention group (n= 31) or control group (n=28) according to their preference for course date. The course covered four different technical clinical skills (shoulder injec tion technique, PAP-smear, laboratory examination of vaginal discharge, oph thalmoscopic control in diabetes mellitus). Main outcome measures used were pre- and post-training scores on a knowledge test of skills (60 multiple c hoice items), and pre- and post-training performance of procedures in pract ice using a log-diary covering 20 days. Setting University of Maastricht, The Netherlands. Subjects Self-selected general practitioners. Results Competence, as measured by the knowledge test of skills, improved s ignificantly as a result of the training and skills test scores were satisf actory after training. A significant effect on performance in practice was found for PAP-smear and shoulder injection technique, whereas no effect cou ld be demonstrated for examination of vaginal discharge and ophthalmoscopic control in diabetes mellitus. Conclusions A good degree of competence is a necessary but not always suffi cient condition for a physician to change his performance in practice. Whil e some skills training seems adequate to bring about desired changes, for o ther skills more complex interventions are probably needed.