The review assessed effectiveness of educational methods in teaching general practitioners psychiatric diagnostic skills and found no conclusive evidence for the effectiveness of an isolated method. The authors stated that combined methods appeared promising. The review had a number of methodological limitations, but overall presented a reasonable summary of a weak evidence base and drew appropriate conclusions.

To assess the effectiveness of different educational methods in teaching trainee general practitioners psychiatric diagnostic skills.

MEDLINE, EMBASE, PsycLIT and The Cochrane Library were searched (1995 to 2008) for studies published in English, French, German or Dutch. Search terms were reported. A number of Dutch Journals that related to general practice and medical education were searched. Bibliographies of included studies were scanned for additional publications.

Studies of educational methods for teaching psychiatric diagnostics to general practitioners and trainee general practitioners (RCTs, controlled before-and-after series or interrupted time series) and that included a change of behaviour as an outcome measure were eligible for inclusion. Studies that measured only change in knowledge and skills were excluded.

Included studies employed a wide variety of educational methods, most of which were poorly described by the primary studies. All except two of the included studies used a combination of educational methods. Educators who delivered interventions were varied and included psychiatrists, nurses and general practitioners. Duration of interventions varied widely, from single sessions (hours) to an extended education program over one year. It appeared that some studies that reported change in knowledge and skills outcomes were included. Twelve studies measured behavioural change using standardised patient measurements, video recordings or scored diagnoses. Seven studies measured patient outcome. Eight studies used self assessment.

Studies were independently screened for inclusion by two reviewers. Disagreements were resolved by the decision of a third reviewer.

The authors did not state that they assessed methodological quality. Some aspects of study quality (such as drop-out rate and selection bias) were reported in the results tables.

Data were extracted on details of the educational method, numbers of general practitioners included in each study and a narrative summary of the findings of each study.

The authors did not state how many reviewers performed data extraction.

Studies were summarised in a narrative synthesis.

Twenty-seven studies (eight RCTs, six controlled before-and-after studies and 13 interrupted time series) that included between 12 and 303 general practitioners (total unclear) were included in the review.

Three out of eight RCTs reported an improvement in competence in diagnosis of psychiatric disorders associated with the educational intervention; in one of these studies the improvement was short term only.

The 13 before-and-after studies and interrupted time series reported an improvement associated with the educational intervention.

No result could be explained by a single intervention.

No conclusive evidence was found for the effectiveness of an isolated educational method. The combination of methods seemed promising, but no specific mix of methods guaranteed success.

This review had a broad objective and inclusion criteria. A range of sources were searched for relevant studies. Searches were restricted to four European languages, which left open the possibility of language bias. Measures to minimise error and bias were applied throughout the review process. Use of a narrative synthesis was appropriate given the diversity of studies included. Included studies were described as being methodologically sound, but no formal assessment of methodological quality was described.

Overall, the review presents a reasonable summary of a diverse literature. The authors acknowledged the weakness of the evidence base and presented appropriate conclusions.

Practice: The authors stated that effective psychiatric diagnostic training should include practice-related combinations of methods with case studies, role-play, feedback, video and discussion. Education should take place in small groups and have a systemic interactive approach. Programmes should be flexible and based on individual needs and prioritised topics. Attention should be paid to the combination of knowledge skills and attitude. The authors noted that these recommendations were tentative and not based on convincing evidence.

Research: The authors stated that further research on attitudes of general practitioners was needed in order to determine which personal characteristics played a role in their behaviour in psychiatric diagnoses.

Not stated.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.