title: Using simulated patients to develop doctors' skills in facilitating behaviour change: addressing childhood obesity.
abstract: OBJECTIVE
  This study aimed to describe the application, feasibility and outcomes of using simulated patients (SPs) to increase the skills of general practitioners (GPs) delivering a behavioural intervention to reduce childhood overweight and mild obesity.
  
  
  METHODS
  Five female actors were trained as SPs. A total of 67 GPs from 46 general practices in Melbourne, Victoria, Australia, conducted two simulated consultation visits regarding healthy lifestyle family behaviour change, during which they practised their skills and received formative feedback. The GPs and SPs rated GP performance immediately after each consultation. Subsequently, 139 parents of overweight or obese 5-9-year-old children rated GP performance during real-life consultations. Other measures included child body mass index (BMI) Z-scores (at baseline and at a 9-month follow-up) and GP-reported levels of comfort and competence and the perceived value of SP visits.
  
  
  RESULTS
  Simulated patient ratings, but not GP self-ratings, of GP performance predicted both parent ratings of real-life consultations (Spearman's rho 0.39 for correlation with SP rating at Visit 1) and subsequent reductions in BMI Z-scores between baseline and follow-up (Visit 1, rho-0.45; Visit 2, rho-0.46). GP levels of comfort and competence were maintained during and after the SP visits. A total of 95% of GPs rated simulated consultations as useful, although only 18% said they would pay for them.
  
  
  CONCLUSIONS
  Simulated patient assessment may predict real patient feedback and clinical outcomes, helping to identify doctors who require further training in behaviour change techniques. Randomised controlled trials may establish whether SPs actually raise skills or improve outcomes.
authors.affiliation: Centre for Community Child Health, Royal Children's Hospital, and Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia. bibi.gerner@mcri.edu.au
authors.forename: Bibi
authors.initials: B
authors.lastname: Gerner
authors.forename: Lena
authors.initials: L
authors.lastname: Sanci
authors.forename: Helen
authors.initials: H
authors.lastname: Cahill
authors.forename: Obioha C
authors.initials: OC
authors.lastname: Ukoumunne
authors.forename: Lisa
authors.initials: L
authors.lastname: Gold
authors.forename: Lucy
authors.initials: L
authors.lastname: Rogers
authors.forename: Zoë
authors.initials: Z
authors.lastname: McCallum
authors.forename: Melissa
authors.initials: M
authors.lastname: Wake
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D032763:Behavior Control / Q000379:methods; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003258:Consumer Behavior; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care; D010290:Parents / Q000523:psychology; D010353:Patient Education as Topic / Q000379:methods*; D016544:Patient Simulation; D010821:Physicians, Family / Q000523:psychology; D011795:Surveys and Questionnaires; D014739:Victoria