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Family Practice Vol. 18, No. 6, 590-591
© Oxford University Press 2001

Original Paper

Mean clinical challenge rate and level of recognition of depression remain unchanged after two years of vocational training

Harm van Marwijk, Ale Gercama, Herman Adèr and Marten de Haan

Department of General Practice, vrije Universiteit, Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.

Objectives. Our aim was to evaluate whether trainees encounter more difficult clinical situations (clinical challenge rate) and more patients with signs of depression in the last year of their training (T1) than in the first year (T0), and whether depression is recognized by trainees more frequently at T1 than at T0.

Methods. An evaluation was undertaken of videotapes made by a random sample of 48 vocational trainees in general practice. Experienced staff members (GPs) assessed the clinical challenge rate of consultations at the two time points with the reliable and valid Amsterdam Clinical Challenge Scale (ACCS). They also rated the presence of signs of depression in the consultations (yes/no) and whether these were recognized by the trainee (yes/no).

Results. Baseline and follow-up measurements (T0 and T1) were available for 45 trainees, from the original cohort of 48 at T0, and for 527 consultations. Both at T0 and at T1, the mean ACCS score was 2.3 (T0 SD = 0.95; n = 269) (T1 SD = 0.92; n = 258). For each trainee, the mean difference in ACCS score between T0 and T1 was 0.01 [95% confidence interval (CI) –0.15 to 0.17]. According to staff-assessments, 66 patients had signs of depression (34 at T0 and 32 at T1). Trainees recognized depression in 12 consultations (12/34 = 35%) at T0 and in 11 consultations (11/32 = 34%) at T1 (relative risk 1.0; 95% CI 0.4–2.9).

Conclusion. A focus on the challenge level of consultations, an individualized, integrated approach and the introduction of a new final consultation skills examination may be the way forward.

Keywords. Clinical challenge rate, depression, general practice, postgraduate training.


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