title: Mean clinical challenge rate and level of recognition of depression remain unchanged after two years of vocational training.
abstract: OBJECTIVE
  Our aim was to evaluate whether trainees encounter more difficult clinical situations (clinical challenge rate) and more patients with signs of depression in the last year of their training (T(1)) than in the first year (T(0)), and whether depression is recognized by trainees more frequently at T(1) than at T(0).
  
  
  METHODS
  An evaluation was undertaken of videotapes made by a random sample of 48 vocational trainees in general practice. Experienced staff members (GPs) assessed the clinical challenge rate of consultations at the two time points with the reliable and valid Amsterdam Clinical Challenge Scale (ACCS). They also rated the presence of signs of depression in the consultations (yes/no) and whether these were recognized by the trainee (yes/no).
  
  
  RESULTS
  Baseline and follow-up measurements (T(0) and (T(1))) were available for 45 trainees, from the original cohort of 48 at T(0), and for 527 consultations. Both at T(0) and at T(1), the mean ACCS score was 2.3 (T(0) SD = 0.95; n = 269) (T(1) SD = 0.92; n = 258). For each trainee, the mean difference in ACCS score between T(0) and T(1) was 0.01 [95% confidence interval (CI) -0.15 to 0.17]. According to staff-assessments, 66 patients had signs of depression (34 at T(0) and 32 at T(1)). Trainees recognized depression in 12 consultations (12/34 = 35%) at T(0) and in 11 consultations (11/32 = 34%) at T(1) (relative risk 1.0; 95% CI 0.4-2.9).
  
  
  CONCLUSIONS
  A focus on the challenge level of consultations, an individualized, integrated approach and the introduction of a new final consultation skills examination may be the way forward.
authors.affiliation: Department of General Practice, vrije Universiteit, Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: van Marwijk
authors.forename: A
authors.initials: A
authors.lastname: Gercama
authors.forename: H
authors.initials: H
authors.lastname: Adèr
authors.forename: M
authors.initials: M
authors.lastname: de Haan
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D003863:Depression / Q000175:diagnosis*; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D004503:Education, Medical, Graduate / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009426:Netherlands; D010821:Physicians, Family / Q000193:education* / Q000592:standards; D010822:Physicians, Women / Q000592:standards; D011897:Random Allocation; D015203:Reproducibility of Results