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

There are shortages in community-based general practice placements for medical students. Innovative ways to teach the skills required in general practice are needed.

To assess the effectiveness of 'simulated' general practice clinics using actors, compared with standard community-based general practice attachments in medical undergraduate education.

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.

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), giving injections (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.

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.