Steering the patient mix of GP trainees: results of a randomized controlled intervention.
BACKGROUND
In studies exploring the patient mixes of general practitioner (GP) trainees, gaps were repeatedly found, as there were disparities between the patient mixes of GP trainers and trainees. This reduces the opportunities of trainees to acquire enough competence.


OBJECTIVE
To investigate whether steering the patient mix can be effectuated by instructing medical receptionist, trainer and trainee, and to study the effects of this intervention on trainee's self-efficacy (SE) and knowledge.


METHODS
Randomized Controlled Trial (RCT). After a six-month basic registration period, 73 trainees were randomized. Patients with skin conditions and psychosocial conditions were actively assigned to trainees in the intervention group (n=35) during two successive periods of three months. The patient mix was measured by extracting data from electronic patient records. Learning outcomes were measured by SE questionnaires and by a knowledge test.


RESULTS
No increase was found in patient volume and diversity of the steered conditions in the intervention group as compared to the control group. However, the percentual increase of exposure to skin conditions was greater in the intervention group. No difference in skin SE and psychiatric knowledge was found. The increase of psychosocial SE was greater in the intervention group. In a regression analysis, patient volume was a significant predictor of both skin and psychosocial SE.


CONCLUSIONS
Despite the difficulty in implementing steering in daily practice, tailoring the patient mix to the individual learning needs of trainees could be considered.
Department of General Practice, University of Amsterdam, Amsterdam, The Netherlands. jipdejong@amc.uva.nl
Jip
J
de Jong
Mechteld R M
MR
Visser
Margreet
M
Wieringa-de Waard
D000328:Adult; D002982:Clinical Clerkship / Q000458:organization & administration*; D002983:Clinical Competence; D057286:Electronic Health Records; D005260:Female; D058006:General Practice / Q000193:education*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008496:Medical Receptionists; D001523:Mental Disorders / Q000175:diagnosis; D020377:Self Efficacy; D012871:Skin Diseases / Q000175:diagnosis