Effectiveness of simulated clinical teaching in general practice: randomised controlled trial

Abstract

INTRODUCTION: There are shortages in community-based general practice placements for medical students. Innovative ways to teach the skills required in general practice are needed. AIM: 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), 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. DISCUSSION: 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. KEYWORDS: Medical education; patient simulation; primary health care; randomised controlled trial