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A tailored educational intervention improves doctor's performance in managing depression: a randomized controlled trial

Authors

  • Mandana Shirazi PhD,

    Corresponding author
    1. Assistant Professor, Director of Educational development unit of Educational Development Centre, Tehran University of Medical Sciences (TUMS), Tehran, Iran, Affiliated Assistant Professor, Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden and Affiliated Assistant Professor of Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
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  • Kirsti Lonka PhD,

    1. Vice Dean and Professor, Faculty of Behavioural Sciences, University of Helsinki, Helsinki, Finland and Foreign Adjunct Professor, Department of LIME, Karolinska Institutet, Stockholm, Sweden
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  • Sagar V. Parikh MD,

    1. Professor of Psychiatry, University of Toronto, Toronto, ON, Canada
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  • Gunilla Ristner MS,

    1. Head of Klinicum, Department of Clinical Science and Education, Soder Hospital, Stockhol, Sweden
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  • Farshid Alaeddini PhD,

    1. Director of Health Research Institute, Tehran, Iran
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  • Majid Sadeghi MD,

    1. Professor, Department of Psychiatry, TUMS, Tehran, Iran
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  • Rolf Wahlstrom PhD

    1. Associate Professor, Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden and Affiliated Assistant Professor, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Prof Mandana Shirazi, Room number 303, 3rd floor, Tehran University of Medical Science building, Ghods ST, 19517 Tehran, Iran, E-mail: mandana.shirazi@ki.se

Abstract

Rational and objectives  To assess the effects of a tailored and activating educational intervention, based on a three-stage modified Prochaska model of readiness-to-change, on the performance of general physicians in primary care (GPs) regarding management of depressive disorders.

Methods  Parallel group, randomized control trial. Primary hypothesis was that performance would improve by 20 percentage units in the intervention arm. The setting was primary care in southern Tehran. The participants were 192 GPs stratified on stage of readiness-to-change, sex, age and work experience. The intervention was a 2-day interactive workshop for a small group of GPs' at a higher stage of readiness-to-change (‘intention’) and a 2-day interactive large group meeting for those with lower propensity to change (‘attitude’) at the pre-assessment. GPs in the control arm participated in a standard educational programme on the same topic. The main outcome measures were validated tools to assess GPs' performance by unannounced standardized patients, regarding diagnosis and treatment of depressive disorders. The assessments were made 2 months before and 2 months after the intervention.

Results  GPs in the intervention arm significantly improved their overall mean scores for performance regarding both diagnosis, with an intervention effect of 14 percentage units (P = 0.007), and treatment and referral, with an intervention effect of 20 percentage units (P < 0.0001). The largest improvement after the intervention appeared in the small group: 30 percentage units for diagnosis (P = 0.027) and 29 percentage units for treatment and referral (P < 0.0001).

Conclusions  Activating learning methods, tailored according to the participants' readiness to change, improved clinical performance of GPs in continuing medical education and can be recommended for continuing professional development.

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