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

doi:10.1136/bmj.320.7229.224

BMJ 2000;320:224-230 ( 22 January )

General Practice

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 educationalintervention in adolescent health designed for general practitionersin accordance with evidence based practice in continuing medicaleducation.
Design: Randomised controlled trial with baselinetesting and follow up at seven and 13months.
Setting: Local communities in metropolitan Melbourne,Australia.
Participants: 108 self selected generalpractitioners.
Intervention: A multifaceted educational programme for 2.5hours a week over six weeks on the principles of adolescent healthcare followed six weeks later by a two hour session of case discussionanddebriefing.
Outcome measures: Objective ratings of consultations with standardisedadolescent patients recorded on videotape. Questionnaires completedby the general practitioners were used to measure their knowledge,skill, and self perceived competency, satisfaction with the programme,and self reported change inpractice.
Results: 103 of 108 (95%) doctors completed all phasesof the intervention and evaluation protocol. The interventiongroup showed significantly greater improvements in all outcomesthan the control group at the seven month follow up except forthe 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, theconfidentiality rating by the standardised patients decreasedslightly, and the objective assessment of competence further improved.106 (98%) participants reported a change in practice attributableto theintervention.
Conclusions: General practitioners were willing to completecontinuing medical education in adolescent health care and itsevaluation. The design of the intervention using evidence basededucational strategies proved an effective and quick way to achievesustainable and large improvements in knowledge, skill, and selfperceivedcompetency.

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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