Does a 3-day workshop for family medicine trainees improve preventive care? A randomized control trial.
OBJECTIVE
To evaluate the impact on clinical behavior of a 3-day workshop designed to increase trainees' rates of smoking cessation counseling and reminders about Pap smears in routine consultations.


METHODS
Randomized control trial.


METHODS
Accredited teaching practices of the Royal Australian College of General Practitioners' Training Program.


METHODS
Thirty-four trainees and 1,500 consecutive adult patients ages 16-65 years.


METHODS
Trainees randomly allocated to the experimental group participated in a 3-day interactive workshop on disease prevention during their 13-week family medicine term. Audiotapes of consultations with adults conducted by trainees at the beginning and end of the rotation were analyzed blind to compare assessment of patients' smoking status and, for women, date of last Pap smear. A questionnaire mailed to each patient after the consultation also allowed identification of smokers and women overdue for a smear. Consultations with these patients at risk were analyzed for preventive counseling. Inter- and intrarater reliability was calculated for audiotape analysis.


RESULTS
Preworkshop rates of questions about smoking were low, occurring in 22% of consultations. While trainees allocated to the experimental workshop 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 than one in five were advised to stop smoking. Reminders about Pap smears did not change as a result of training and remained low in fewer than 20% of consultations. kappa values demonstrated high reliability of audiotape analysis.


CONCLUSIONS
This direct measurement of clinical behavior revealed that low levels of preventive care provided by trainees are resistant to skills training without reinforcement in clinical practice. In view of the importance of prevention in routine consultations, we recommend continued evaluation of more intensive educational programs. Those withstanding rigorous evaluation could be considered for implementation in similar training contexts seeking to improve the frequency and quality of disease prevention in primary medical care.
Ward
J
J
School of Medical Education, University of New South Wales, Australia.
Sanson-Fisher
R
R
D000293:Adolescent; D000328:Adult; D001315:Australia; D016009:Chi-Square Distribution; D002983:Clinical Competence / Q000592:standards; D016001:Confidence Intervals; D005194:Family Practice / Q000193:education* / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007396:Internship and Residency / Q000379:methods / Q000592:standards*; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D019370:Observation; D065006:Papanicolaou Test; D010353:Patient Education as Topic / Q000592:standards; D010817:Physician-Patient Relations; D011315:Preventive Medicine / Q000193:education*; D000074606:Smoking Prevention; D014626:Vaginal Smears / Q000706:statistics & numerical data