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Achtergrond. Training in evidence-based medicine (EBM) is een belangrijk onderdeel van de huisartsopleiding. Onderzoek laat zien dat in de klinische praktijk geïntegreerd EBM-onderwijs betere resultaten geeft dan opzichzelfstaande (stand-alone) theoretische modules. Echter, deze onderzoeken werden niet uitgevoerd binnen de huisartsgeneeskunde en keken niet naar effecten op EBM-gedrag in de praktijk na de opleiding. Wij onderzochten de effecten van geïntegreerd versus het gebruikelijke stand-alone EBM-onderwijs op EBM-gedrag, -attitude en -kennis bij huisartsen bij afronding van de opleiding en een jaar daarna.Methoden. In een pragmatische, cluster-gerandomiseerde trial werden zes groepen derdejaars aios huisartsgeneeskunde van het UMC Utrecht verdeeld over geïntegreerd of gangbaar EBM-onderwijs. Voor EBM-gedrag keken we naar het handelen volgens NHG-richtlijnen, het hebben van klinische dilemma’s en het zoeken naar antwoorden. Aios hielden consultlogboeken bij. EBM-attitude en -kennis werden gemeten met behulp van gevalideerde vragenlijsten. Data werden verzameld aan het begin (T0) en einde (T1) van het derde jaar, en een jaar na afronding van de opleiding (T2). Multilevel-analyses werden uitgevoerd op basis van intention-to-treat.Resultaten. Van 82 aios in 6 groepen deden er 79 mee (96%); 39 in de interventiegroep, 40 in de controlegroep. Van 76 (96%) hiervan waren logboekdata op baseline (T0) beschikbaar, van 60 (76%) op T1 en van 53 (67%) op T2. We vonden geen significante verschillen tussen de groepen in EBM-gedrag, -kennis en attitude.Conclusie. Meer in de praktijk geïntegreerd EBM-onderwijs heeft, vergeleken met het gebruikelijke, stand-alone, onderwijs, geen effect op EBM-toepassing, -attitude of -kennis van (toekomstige) huisartsen.

Item does not contain fulltext PURPOSE: To examine the validity of a written knowledge test of skills for performance on an OSCE in postgraduate training for general practice. METHODS: A randomly-selected sample of 47 trainees in general practice took a knowledge test of skills, a general knowledge test and an OSCE. The OSCE included technical stations and stations including complete patient encounters. Each station was checklist rated and global rated. RESULTS: The knowledge test of skills was better correlated to the OSCE than the general knowledge test. Technical stations were better correlated to the knowledge test of skills than stations including complete patient encounters. For the technical stations the rating system had no influence on the correlation. For the stations including complete patient encounters the checklist rating correlated better to the knowledge test of skills than the global rating. CONCLUSION: The results of this study support the predictive validity of the knowledge test of skills. In postgraduate training for general practice a written knowledge test of skills can be used as an instrument to estimate the level of clinical skills, especially for group evaluation, such as in studies examining the efficacy of a training programme or as a screening instrument for deciding about courses to be offered. This estimation is more accurate when the content of the test matches the skills under study. However, written testing of skills cannot replace direct observation of performance of skills.

Objective To evaluate the effects of insulin 30/70 twice daily or bedtime isophane (NPH) insulin plus continued sulfonylurea and metformin in patients with type 2 diabetes in primary care. Study Design Open-label, randomized trial. Population Persons younger than 76 years with type 2 diabetes whose disease had not been controlled with oral hypoglycemic agents alone. A total of 64 insulin-naive patients treated with maximal feasible dosages of sulfonylurea and metformin (baseline glycosylated hemoglobin [HbA(1c)]=8.5%) were randomly assigned to insulin monotherapy (IM group; n=31) or insulin in addition to unchanged oral hypoglycemic medication (IC group; n=33) for 12 months. Insulin doses were adjusted to obtain fasting glucose Outcomes Measured Outcome measures included HbA(1c), treatment failure, weight, hypoglycemic events and symptoms, satisfaction with treatment, general well-being, and fear of injecting insulin and testing. Results HbA(1c) improved from 8.3% to 7.6% in the IC group, and from 8.8% to 7.6% in the IM group (P=NS). The IC group had 24% treatment failures, compared with 2% in the IM group (P=.09). Patients in the IC group had less weight gain than those in the IM group (1.3 vs 4.2 kg; P=.01), and they reported fewer hypoglycemic events (2.7 vs 4.3; P=.02). Increased satisfaction with treatment was equal in the 2 groups, and general well-being improved by 3.0 points more in the IC group (P=.05). Fear of self-injecting and self-testing did not differ. Conclusions Bedtime NPH insulin added to maximal therapy with sulfonylurea and metformin is an effective, simple, well-tolerated approach for patients with uncontrolled type 2 diabetes.