Evidence based management of acute bronchitis; sustained competence of enhanced communication skills acquisition in general practice Jochen W.L. Cals a, * , Nicole A.M. Scheppers a , Rogier M. Hopstaken a,b , Kerenza Hood c , Geert-Jan Dinant a , Henk Goettsch a , Christopher C. Butler d a Department of General Practice, Care and Public Health Research Institute (CAPHRI), Maastricht University, The Netherlands b Institution of Health Care Centres, Eindhoven, The Netherlands c South East Wales Trials Unit, School of Medicine, Cardiff University, Wales, United Kingdom d Department of Primary Care and Public Health, Centre for Health Sciences Research, Cardiff University, Wales, United Kingdom Received 21 January 2007; received in revised form 13 June 2007; accepted 23 June 2007 Abstract Objective: To determine if a communication skills training program for general practitioners involving context-rich learning experiences and ‘peer review’ of consultation transcripts results in communication skills acquisition and maintenance, while preserving time-efficiency in consultations. Methods: A pre-test–post-test evaluation of training 20 general practitioners (GPs) in enhanced communication skills. Audio taped consultations with simulated patients in routine practice conducted before, within 2 weeks and again 6 months after communication skills training were analysed and consultation length measured. Transcripts were scored for specific skills to determine differences in short and longer-term competence of GPs for the communication skills. Results: There was good evidence that GPs acquired key communication skills after training and that these were maintained over 6 months. Consultations remained within normal consultation length in primary care. Conclusion: Specific communication skills for acute bronchitis can be successfully acquired by GPs through context-rich communication training with peer review of transcripts with simulated patients, without making consultation length unfeasible. Practice Implications: This approach to skill acquisition is useful for enhancing communication skills competence in general medical practice. # 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Respiratory tract infections; Acute bronchitis; Communication; Simulated patients; Transcripts; Antibiotics; Primary care 1. Introduction Unnecessary antibiotic prescribing in primary care remains an important public health threat in an era of increasing antimicrobial resistance [1]. It is particularly common in lower respiratory tract infections (LRTI) where approximately 80% of patients receive a prescription for antibiotics despite evidence for little or no benefit [2–5]. LRTI is one of the most common reasons for people to consult general practitioners (GPs), and use of broad-spectrum antibiotics is increasing for this indication [6–8]. General practitioners are aware that they over prescribe antibiotics for LRTI [3,4,9]. Diagnostic uncertainty and non- clinical factors, such as time-pressure, perceived patients’ expectations and the desire to maintain good relationships play an important role in the decision to prescribe antibiotics [10–15]. However, patient satisfaction is influenced more by the quality of information provision and physical examination than by whether or not an antibiotic is prescribed [9,15,16]. Moreover, diagnostic uncertainty needs to be minimised through appropriate clinical assessment and additional testing to exclude pneumonia, rather than through prescribing antibiotics to cover the eventuality of a bacterial aetiology [11,17]. The quality of communication between physicians and patients is a critical factor for optimal medical care generally. In www.elsevier.com/locate/pateducou Patient Education and Counseling 68 (2007) 270–278 * Corresponding author at: Department of General Practice, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. Tel.: +31 433882441; fax: +31 433619344. E-mail address: j.cals@hag.unimaas.nl (J.W.L. Cals). 0738-3991/$ – see front matter # 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2007.06.014