Acquisition of clinical skills in postgraduate training for general practice.

BACKGROUND Postgraduate training in general practice aims to develop clinical competence. However, little is known about its effect on trainees' development of clinical skills. AIM To assess the acquisition of clinical skills during a 3-year training programme and to evaluate whether a satisfactory level is achieved towards the end of training. DESIGN OF STUDY Cross-sectional design. SETTING Dutch postgraduate training in general practice from 1995 to 1998. METHOD Clinical skills were assessed using a written knowledge test of skills and by an Objective Structured Clinical Examination (OSCE). The written test was administered to trainees in all 3 years. Trainees at completion of their training took the OSCE. The results of both tests were compared with a standard of adequacy and to a reference group of general practitioner (GP) trainers. RESULTS An increase in the level of clinical skills and pass rate was found throughout the training, being most prominent during the first 6 months. At completion of their training, trainees scored higher than the GPs on the written test (48% versus 39%) and on the OSCE (69% versus 63%). Eighty-eight per cent of the trainees would have passed the written test against 70% of the GPs and 94% would have passed the OSCE against 80% of the GPs. CONCLUSION A 3-year postgraduate training period in general practice contributes to a satisfactory acquisition of clinical skills. Further research into when and where acquisition takes place, and the role of the GP trainer, is needed.