%0 Journal Article
%T Investigating the impact of extraneous distractions on consultations in general practice: Lessons learned
%A Moyez Jiwa
%A Robert McKinley
%A Carolyn O'Shea
%A Hayley Arnet
%A Katrina Spilsbury
%A Marthe Smith
%J BMC Medical Research Methodology
%D 2009
%I BioMed Central
%R 10.1186/1471-2288-9-8
%X 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.In Australia, as in many other countries the general practitioner (GP) is usually the first medical practitioner to consult patients with any significant health care problem. The core activity which takes place in general practice is the consultation. The function of the consultation has remained essentially unchanged over many decades and the description by the British Royal College of General Practitioners in 1972 still has resonance today:"...the ideal consultation. The doctor's attention is devoted exclusively for a sho
%U http://www.biomedcentral.com/1471-2288/9/8