Publications (2)2.67 Total impact
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Article: Psychosexual problems in general practice: measuring consultation competence using two different measures.
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ABSTRACT: Psychosexual problems are a common presentation in general practice. Given that the cornerstone of assessment is excellent consultations skills, it may be assumed that general practitioners (GPs) will perform skilfully for such presentations. To determine if there is a significant difference in consultation skills assessed using a generic test of consultation performance compared to one which has been specifically developed for experts in psychosexual care, albeit modified for general practice consultations. Six GPs were video recorded consulting six standardised patients at their respective practices. Two assessors independently rated the consultation performance using the Leicester Assessment Package (LAP), a generic tool to assess GP consultation performance. Four sexologists, blind to the review by the LAP assessors, assessed the same consultations deploying the Permission, Limited Information, Specific Suggestion, Intensive Therapy (PLISSIT) framework. The PLISSIT is routinely used to teach health professionals communication skills when consulting people with psychosexual problems. Thirty-four consultations were successfully recorded. The mean duration of consultations was 12 minutes and 10 seconds (range 7 m. 54 s. to 16 m. 54 s.). Three GPs differed significantly in core competencies as measured by the LAP. Similarly, three GPs differed in competencies as measured by the PLISSIT. There were significant differences in mean LAP scores and PLISSIT scores observed for different doctors. Mean LAP scores varied by actor-scenario after adjusting for doctor clustering, whereas PLISSIT scoring did not vary significantly by actor-scenario in this small study with limited power. There was no evidence that mean LAP scores were associated with PLISSIT scores. Two measures of consultation competence revealed different outcomes when applied to the same consultations. We found evidence that general practitioners vary significantly on different measures of consultation competence when consulting patients with psychosexual problems in the context of a cancer diagnosis.Quality in primary care 01/2010; 18(4):243-50. -
Article: Investigating the impact of extraneous distractions on consultations in general practice: lessons learned.
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ABSTRACT: Extraneous distractions may influence the flow of general practice consultations. This study piloted a methodology to examine the impact of interrupting general practitioners (GPs) while consulting actor-patients. Six GPs were video recorded consulting six actor-patients each presenting a different clinical scenario in a simulated surgery. Five cases presented red flag cancer symptoms. Half the consultations were interrupted. Two independent assessors, blinded to the occurrence of interruptions, assessed consultation performance using the Leicester Assessment Package (LAP) for clinical competence. 24 of 36 consultations were video recorded with sufficient audio-visual clarity to allow scoring. The association between LAP score and three variables could be studied: a variety of interruptions, different GPs and various scenarios. Agreement between assessors on GP performance was poor and showed an increased bias with increasing LAP score. Despite this, the interruption did not significantly impact on assessor LAP scores (Mean difference: 0.22, P = 0.83) even after controlling for assessor, different GPs and scenarios. Extraneous distractions had no impact on GP performance in this underpowered pilot study, a conclusion which needs to be confirmed in a larger study. However several important lessons were learned. Recorded actor-patient clinical sessions are logistically challenging. GPs whose skills were not previously assessed were working in unfamiliar surroundings dealing with relatively straight forward diagnostic challenges and may have anticipated the interruptions. In a redesign of this experiment it may be possible to eliminate some of these limitations.BMC Medical Research Methodology 03/2009; 9:8. · 2.67 Impact Factor
