Using simulated patients to develop doctors' skills in facilitating behaviour change: addressing childhood obesity.
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.
Gerner
Bibi
B
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
Sanci
Lena
L
Cahill
Helen
H
Ukoumunne
Obioha C
OC
Gold
Lisa
L
Rogers
Lucy
L
McCallum
Zoë
Z
Wake
Melissa
M
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