Learning to consult with computers S T Liaw & J J Marty Objective To develop and evaluate a strategy to teach skills and issues associated with computers in the consultation. Intervention An overview lecture plus a workshop before and a workshop after practice placements, dur- ing the 10-week general practice (GP) term in the 5th year of the University of Melbourne medical course. Design Pre- and post-intervention study using a mix of qualitative and quantitative methods within a strategic evaluation framework. Outcome measures Self-reported attitudes and skills with clinical applications before, during and after the inter- vention. Results Most students had signi®cant general computer experience but little in the medical area. They found the workshops relevant, interesting and easy to follow. The role-play approach facilitated students' learning of relevant communication and consulting skills and an appreciation of issues associated with using the infor- mation technology tools in simulated clinical situations to augment and complement their consulting skills. The workshops and exposure to GP systems were associated with an increase in the use of clinical soft- ware, more realistic expectations of existing clinical and medical record software and an understanding of the barriers to the use of computers in the consultation. Conclusions The educational intervention assisted stu- dents to develop and express an understanding of the importance of consulting and communication skills in teaching and learning about medical informatics tools, hardware and software design, workplace issues and the impact of clinical computer systems on the consultation and patient care. 1 Keywords Attitude to computers; Australia; computers; curriculum; education, medical, *methods; medical informations, computing; *physician±patient relations; professional competence. Medical Education 2001:35:645±651 Background and literature review In Australia 1 and internationally, 2±4 medical educators are becoming increasingly aware of the importance of improving pro®ciency and con®dence in information management and technology in medical graduates, in order to help them access the most recent and best evidence and use it critically to support decision-ma- king; 5 to learn; to do research; to keep up to date; to be a reliable information resource for their patients and communities, 6 and to provide optimal high quality patient care to individuals and their families. 7,8 Stu- dents should also be aware of the practical, 9 profes- sional, 10 social, ethical and legal issues associated with the use of information technology in health care. 11 The use of computer applications while consulting can improve aspects of clinical performance. 12±14 However, there is concern that computers may restrict the `art' of medicine and patient±doctor communica- tion by forcing the doctor to conform to the limitations of the software and hardware, thereby dehumanizing the consultation. 15 The conceptual framework of this study is based on an understanding of the patient± doctor±computer triadic relationship and interaction. 16 The use of computers may increase the length of the consultation and doctor-initiated medical content may be increased at the expense of patient-initiated social content. 14 The experienced user can save time per consultation, 17 but whether this is related to increased ef®ciency or less communication is unclear. When working with computers, doctors tend to shift from a `conversational' to a more `chunked' style where the consultation is divided into blocks punctuated by University of Melbourne Department of General Practice, Carlton, Victoria, Australia Correspondence: S T Liaw, The University of Melbourne Department of General Practice, 200 Berkeley Street, Carlton, Victoria 3053, Australia Research papers Ó Blackwell Science Ltd MEDICAL EDUCATION 2001;35:645±651 645