BMJ 2000;320:224-230 ( 22 January )

General Practice

Evaluation of the effectiveness of an educational intervention for general practitioners in adolescent health care: randomised controlled trial

L A Sanci, fellow in adolescent health, ^a C M M Coffey, epidemiologist, ^a F C M Veit, adolescent physician, ^a M Carr-Gregg, director of training and education, ^a G C Patton, director, ^a N Day, principal research fellow, ^b G Bowes, professorial fellow. ^a

^a Centre for Adolescent Health, Department of Paediatrics, University of Melbourne, Parkville, Victoria 3052, Australia, ^b Centre for Health Program Evaluation, Faculty of Business Economics, Monash University, Clayton, Victoria 3168, Australia

Correspondence to: L A Sanci sancil{at}cryptic.rch.unimelb.edu.au

Objective: To evaluate the effectiveness of an educational intervention in adolescent health designed for general practitioners in accordance with evidence based practice in continuing medical education.
Design: Randomised controlled trial with baseline testing and follow up at seven and 13 months.
Setting: Local communities in metropolitan Melbourne, Australia.
Participants: 108 self selected general practitioners.
Intervention: A multifaceted educational programme for 2.5 hours a week over six weeks on the principles of adolescent health care followed six weeks later by a two hour session of case discussion and debriefing.
Outcome measures: Objective ratings of consultations with standardised adolescent patients recorded on videotape. Questionnaires completed by the general practitioners were used to measure their knowledge, skill, and self perceived competency, satisfaction with the programme, and self reported change in practice.
Results: 103 of 108 (95%) doctors completed all phases of the intervention and evaluation protocol. The intervention group showed significantly greater improvements in all outcomes than the control group at the seven month follow up except for the rapport and satisfaction rating by the standardised patients. 104 (96%) participants found the programme appropriate and relevant. At the 13 month follow up most improvements were sustained, the confidentiality rating by the standardised patients decreased slightly, and the objective assessment of competence further improved. 106 (98%) participants reported a change in practice attributable to the intervention.
Conclusions: General practitioners were willing to complete continuing medical education in adolescent health care and its evaluation. The design of the intervention using evidence based educational strategies proved an effective and quick way to achieve sustainable and large improvements in knowledge, skill, and self perceived competency.

Key messages Firm evidence shows that the confidence, knowledge, and skills of doctors in adolescent health contribute to barriers in delivering health care to youth Evidence based strategies in continuing medical education were used in the design of a training programme to address the needs of doctors and youth The programme covered adolescent development, consultation and communication skills, health risk screening, health promotion, risk assessment of depression and suicide, and issues in management of psychosocial health risk including interdisciplinary approaches to care Most interested doctors attended and completed the 15 hour training programme over six weeks and the evaluation protocol covering 13 months Doctors completing the training had substantial gains in knowledge, clinical skills, and self perceived competency than the controls; these gains were sustained at 12 months and were further improved in the objective measure of clinical competence in conducting a psychosocial interview

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