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Learning by doing: a novel approach to improving general practitioners' diagnostic skills for common mental disorders

Der "learning by doing"-Ansatz zur Verbesserung der diagnostischen Kenntnisse von Allgemeinärzten für häufige psychiatrische Störungen

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Zusammenfassung

EINLEITUNG: Zur Verbesserung der Diagnoserate für psychische Störungen bei Patient/inn/en in der Allgemeinpraxis wurden zwei Wege vorgeschlagen: (1) Die Verwendung von Screening-Instrumenten und (2) eine eingehende psychiatrische Schulung von Allgemeinärzt/inn/en. Das von uns entwickelte Programm geht einen Mittelweg und verbindet eine zeit-ökonomische didaktische Intervention mit dem praktischen Einsatz eines didaktisch-diagnostischen Instruments. Die vorliegende Pilotstudie untersucht die Akzeptanz des Programms und evaluiert den Wissenszuwachs im Hinblick auf 12 psychiatrische (Depressions-, Angst- und Alkoholbezogene) ICD-10 Diagnosen. METHODIK: Die didaktische Intervention bestand aus zwei im Abstand von vier Wochen abgehaltenen, 3-stündigen interaktiven Fortbildungsveranstaltungen. Die teilnehmenden Allgemeinärzt/inn/en waren angehalten, das didaktisch-diagnostische Instrument, ein kurzes Interview namens TRIPS (Training für Interaktives Psychiatrisches Screening – eine gekürzte und adaptierte Fassung von PRIME-MD) zwischen den Sitzungen in ihrer klinischen Praxis einzusetzen. Fünf Wochen nach der zweiten Unterrichtseinheit wurde in einer dritten Sitzung festgestellt, ob der Lernerfolg erhalten geblieben war. Für die Erfassung des Wissenszuwachses wurde ein 15-Item-Fragebogen verwendet. Die Akzeptanz von TRIPS wurde mit einem eigenen Fragebogen erfasst. ERGEBNISSE: 26 der 31 Teilnehmer waren bei allen drei Sitzungen anwesend und wurden in die Auswertung einbezogen. Der Mittelwert richtig beantworteter Fragen wuchs von 5,5 bei der Ersterhebung auf 9,8 bei der zweiten Sitzung (p < 0,05), und auf 11,3 bei der Follow-up-Sitzung. Die Akzeptanz von TRIPS und die Einschätzung als praxisgerecht waren sehr hoch. SCHLUSSFOLGERUNGEN: Das Format der Fortbildungsveranstaltung und der "learning by doing"-Ansatz waren bezüglich der didaktischen Endpunkte erfolgreich. Die Teilnehmer/innen bewerteten TRIPS als geeignet für den Einsatz in der Allgemeinmedizin.

Summary

INTRODUCTION: Two strategies have been proposed to increase the rather low recognition rate of common mental disorders in primary care: (1) the use of screening instruments and (2) extensive psychiatric training for general practitioners. We have chosen a "middleof-the-road" approach to teach general practitioners by means of a time-saving psychiatric training programme how to make their own psychiatric diagnoses. This pilot study aimed at assessing the acceptance of this programme, its impact on general practitioners' knowledge of 12 ICD-10 disorders – depressive, anxiety and alcohol-related disorders – and the short-term persistence of the knowledge acquired. METHODS: The training programme consisted of two 3-hour sessions four weeks apart. An educational instrument, a short interview named TRIPS (Training for Interactive Psychiatric Screening), a shortened and adapted form of PRIME-MD, was used to train single-handed general practitioners in Vienna, Austria. TRIPS had to be used by the participants in daily practice in between sessions. Five weeks after the second training session a follow-up evaluation was held to assess the persistence of the knowledge acquired. The perceived usefulness of TRIPS was assessed by a short questionnaire. Knowledge was assessed by a separate 15-item questionnaire. RESULTS: Of the 31 participating general practitioners 26 attended all three sessions. There was a significant increase in the mean number of correctly answered questions between baseline (5.5 of 15) and session two (9.8; p < 0.0001), and a further increase between the second and the follow-up session (11.3; p < 0.05). Also, general practitioners rated TRIPS as a practical and useful tool for family practice and stated that its use met with patients' approval. CONCLUSION: The format chosen was successful in its intended educational endpoints. According to participants TRIPS is appropriate for the family practice situation and is accepted by patients.

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Authors and Affiliations

  1. Ludwig Boltzmann-Institute for Social Psychiatry, Vienna, Austria

    Wolfgang Spiegel, Michael Scherer & Heinz Katschnig

  2. Department of General Practice, Center for Public Health, Medical University of Vienna, Austria

    Wolfgang Spiegel & Hans Tönies

  3. Department of Psychiatry, Medical University of Vienna, Austria

    Heinz Katschnig

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  1. Wolfgang Spiegel
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  2. Hans Tönies
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  3. Michael Scherer
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  4. Heinz Katschnig
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Correspondence to Wolfgang Spiegel.

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Spiegel, W., Tönies, H., Scherer, M. et al. Learning by doing: a novel approach to improving general practitioners' diagnostic skills for common mental disorders. Wien Klin Wochenschr 119, 117–123 (2007). https://doi.org/10.1007/s00508-006-0702-2

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  • DOI: https://doi.org/10.1007/s00508-006-0702-2

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