title: Effectiveness of simulated clinical teaching in general practice: randomised controlled trial.
abstract: BACKGROUND
  There are shortages in community-based general practice placements for medical students. Innovative ways to teach the skills required in general practice are needed.
  
  
  OBJECTIVE
  To assess the effectiveness of 'simulated' general practice clinics using actors, compared with standard community-based general practice attachments in medical undergraduate education.
  
  
  METHODS
  Randomised controlled trial involving medical students. Outcome measures included self-reported knowledge, clinical confidence, communication skills, and attitudes within general practice assessed at baseline and after one week. Intervention students participated in 24 simulated consultations with actor-patients over four days. Control students spent four days working with community-based general practitioners and real patients.
  
  
  RESULTS
  Of 138 eligible medical students in the first clinical year, 128 (93%) participated and 106/128 (82%) completed the study. Those participating in simulated clinics improved in confidence in history-taking (p=0.03), communication skills (p=0.04), and ability to detect depression (p<0.001) compared with those undertaking community attachments. Those in community-based attachments felt more confident in managing upper respiratory tract infections (p<0.001), giving injections (p<0.001), screening in general practice (p=0.03) and managing illness in the patient's home (p=0.04). There was no difference between the groups in other measures.
  
  
  CONCLUSIONS
  Simulated clinics may assist with development of communication skills within the general practice consultation and may also be used to supplement community-based attachment with real patients. Even so, confidence in the management of common conditions and procedures improves more with real patients.
authors.affiliation: Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand. c.elley@auckland.ac.nz
authors.forename: C Raina
authors.initials: CR
authors.lastname: Elley
authors.forename: Tara
authors.initials: T
authors.lastname: Clinick
authors.forename: Chris
authors.initials: C
authors.lastname: Wong
authors.forename: Bruce
authors.initials: B
authors.lastname: Arroll
authors.forename: John
authors.initials: J
authors.lastname: Kennelly
authors.forename: Henry
authors.initials: H
authors.lastname: Doerr
authors.forename: Fiona
authors.initials: F
authors.lastname: Moir
authors.forename: Tana
authors.initials: T
authors.lastname: Fishman
authors.forename: Simon A
authors.initials: SA
authors.lastname: Moyes
authors.forename: Ngaire
authors.initials: N
authors.lastname: Kerse
mesh_terms: D002983:Clinical Competence; D004504:Education, Medical, Undergraduate; D005260:Female; D058006:General Practice / Q000193:education*; D006801:Humans; D008297:Male; D016544:Patient Simulation; D011320:Primary Health Care; D015397:Program Evaluation