This research was conducted to investigate patterns of attendance at continuing education meetings and examine which factors encourage or inhibit attendance by comparing the characteristics of general practitioners who attend regularly with those who attend occasionally or not at all. The findings provide course organizers with a detailed insight into the attitudes and perceptions of frequent and infrequent attenders. The research identifies a need for greater personal contact in changing attitudes to continuing education and bringing about greater involvement. It is concluded that the role of general practitioner tutor should be enhanced to provide more direct contact and influence with small groups of doctors.
This study was based on the recording of psychotropic, drug prescribing over two weeks by 269 doctors using practice activity analysis (PAA) data sheets. The overall mean rates for patients receiving one or more psychotropic drugs were 17.5 per 1,000 list size and 130 per 1,000 consultations; and for prescriptions issued the rates were 20.6 per 1,000 list size and 153 per 1,000 consultations. Recorders were classified into five categories 'low' to 'high', by the volume of prescribing and this paper is concerned with the comparison between them. Between the high and low categories there was a twofold difference in the prescribing of new prescriptions, a fourfold difference for continuing prescriptions and a tenfold difference for repeat prescriptions; 51 per cent of all prescriptions were issued as 'repeats'. Other features of prescribing have been studied in each of the categories. Prescribing rates vary little with workload. Increasing trends are evident from the low to high categories for the use of polytherapy and for the proportion of elderly persons who received prescriptions; the proportion of male patients (28 per cent) was consistent in all categories. The relative proportion of prescriptions by drug group (tranquillizers, antidepressants and hypnotics) was reasonably uniform in all categories.
Patients attending their general practitioner were screened and a group with unrecognised major depressive disorder identified. This group was interviewed and the findings compared with those in a group of patients recognised correctly as depressed by their general practitioners. Half of the patients with severe depression screened in their doctors' waiting rooms went unrecognised, and they differed in few ways from those who were recognised. The differences found were that the patients with unrecognised depression were less obviously depressed and their illness had lasted longer. Physical illness was present in nearly 30% of patients in the unrecognised group, and the depression seemed related to it. Patients with unrecognised depression were more likely to have feelings other than those of normal sadness and more likely to respond with change of mood to intercurrent events. These data suggest that patients might benefit if general practitioners were better trained to recognise depression, although it is not known whether treatment would be effective.
In August/September 1984 a survey of the 267 course organizers in post in England and Wales was carried out. Eighty-two per cent replied to a questionnaire asking for details about their work and personal status. All 16 regions in England and Wales completed a questionnaire about levels of staffing and remuneration of those involved in general practice postgraduate education. The results show that there are considerable variations between regions in the role and responsibilities of course organizers, in their training, and in the facilities that are provided for them. The majority of course organizers reported a workload greater than the number of sessions for which they were remunerated. The effects of these factors on recruitment, tenure of post, and job satisfaction are discussed. Recommendations are made for improving the situation, including the removal of course organizer pay from the scale of trainers' pay, so that there can be flexibility in the number of sessions which can be held, improvement in training and certain facilities, and the implementation of national and local job descriptions.
This project was concerned with the clinical knowledge reported by general practitioners in relation to the diagnosis and management of seven common clinical conditions: acute otitis media, jaundice, iron-deficiency anaemia, transient cerebral vascular insufficiency, infectious mononucleosis, pulmonary infarction, and carcinoma of the prostate. Postal questionnaires were sent to three groups of doctors: a constant group of experienced general practitioners who were or had been trainers, randomly selected groups of 200 general practitioners, and small groups of consultants who were specialists in each condition. The last two groups were changed for each of the chosen clinical conditions; the constant group remained the same throughout. The study was not concerned with the attitudes and skills of general practitioners or consultants, and no attempt has been made to analyse the process of clinical problem-solving. The differences between the constant group and random group of general practitioners were minor. Consultants received questionnaires identical to those sent to general practitioners and were asked to answer them as they would expect a competent general practitioner to do; their answers suggested a more direct approach to the problem concerned than those given by general practitioners. The information obtained has implications for education for general practice and educational audit programmes. Areas for further research are suggested.
THE basic research strategy was to administer a comprehensive test battery to a sample of teachers and trainees using multiple choice questionnaires to measure knowledge, modified essay questions to measure problem-solving skills in patient management, and other methods of assessment to measure intelligence, ability, attitudes and personality. Questionnaires, interviews, and group discussions were also used to gather information on a wide range of variables including teaching resources and learning experience. The complete test battery was administered to the trainees at the beginning of the trainee year and a similar test battery at the end. The test battery was administered to the teachers at about the same time as it was first administered to the trainees, that is, at the beginning of the trainee year. The results showed that the difference between the trainees' pre-course and post-course MCQ scores was statistically significant (p < .0001). The teachers' scores were significantly greater than the pre-course scores of the trainees (p < .001), and subsequently the trainees' post-course scores slightly exceeded the scores of the teachers, although the difference between them was not statistically significant (p > .05). The difference between the trainees' pre-course and post-course MEQ scores was also statistically significant (p < .0001), and again the trainees' post-course scores tended to converge on the scores of their teachers. In the MEQ, however, the mean post-course score of the trainees fell short of the teachers' (76.191 compared with 79.066). As in earlier research, the MEQ increase was significantly greater than the MCQ increase-a finding which is in line with the goals of vocational training. Scattergrams were computed plotting the changes in the percentage MCQ scores of the trainees, pre-course to post-course, in relation to the MCQ scores of their teachers. The results were striking, the correlation R of .61837 being highly significant at the .00001 level. These findings show that there was a significant positive relationship between the scores of the teachers and the change in the trainees' scores between the beginning and the end of their course. The implication of these findings is of particular importance in vocational training since they emphasize the importance of the teachers' influence on the trainees' performance irrespective of the level of the trainees' scores on entry. Scattergrams plotting the changes in the percentage MEQ score of the trainees related to the MEQ scores of their teachers again showed striking results, the correlation R of .43076 being highly significant at the .00005 level. As in the case of the MCQ, there was a significant positive relationship between the scores of the teachers and the change in trainees' scores pre-course to post-course. Direct evidence is thus provided on a topic which has been the source of much debate in vocational training, since it demonstrates the importance of MCQ and MEQ scores in selecting teachers for vocational training. There were differences among the teachers on a number of variables in favour of those whose trainees showed greatest change between the beginning and end of their course. These included: experience of teaching, general educational activities, membership of professional and educational organizations, enthusiasm for teaching, and the organization of teaching. The results as a whole indicate that the teachers' clinical knowledge and problem-solving skills in patient management are major determinants in the trainees' learning and performance, irrespective of the trainees' scores on entry, and that compatibility of cognitive style and personality between teacher and trainee helps the learning process.
