A tailored educational intervention improves doctor’s performance in managing depression: a randomized controlled trial Mandana Shirazi PhD, 1 Kirsti Lonka PhD, 2 Sagar V. Parikh MD, 3 Gunilla Ristner MS, 4 Farshid Alaeddini PhD, 5 Majid Sadeghi MD 6 and Rolf Wahlstrom PhD 7 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 2 Vice Dean and Professor, Faculty of Behavioural Sciences, University of Helsinki, Helsinki, Finland and Foreign Adjunct Professor, Department of LIME, Karolinska Institutet, Stockholm, Sweden 3 Professor of Psychiatry, University of Toronto, Toronto, ON, Canada 4 Head of Klinicum, Department of Clinical Science and Education, Soder Hospital, Stockhol, Sweden 5 Director of Health Research Institute, Tehran, Iran 6 Professor, Department of Psychiatry, TUMS, Tehran, Iran 7 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 Keywords assessing performance, depression, randomized control trial and doctors, stages of change, unannounced standardized patient Correspondence 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 Accepted for publication: 28 June 2011 doi:10.1111/j.1365-2753.2011.01761.x 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 perfor- mance 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 interac- tive workshop for a small group of GPs’ at a higher stage of readiness-to-change (‘inten- tion’) 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 educa- tional 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. Introduction It is a worldwide concern that continuing medical education (CME)[1,2] and professional development (CPD) should improve professional performance and health outcomes [1]. Activating teaching and learning methods as well as multifaceted educational interventions have been shown to have the potential to improve skills and behaviour [1,3,4]. Additionally, adult learning theory Journal of Evaluation in Clinical Practice ISSN 1365-2753 © 2011 Blackwell Publishing Ltd, Journal of Evaluation in Clinical Practice 19 (2013) 16–24 16