Tim Usherwood

Validating the SF-36 health survey questionnaire: new outcome measure for primary care.

OBJECTIVES--To test the acceptability, validity, and reliability of the short form 36 health survey questionnaire (SF-36) and to compare it with the Nottingham health profile. DESIGN--Postal survey using a questionnaire booklet together with a letter from the general practitioner. Non-respondents received two reminders at two week intervals. The SF-36 questionnaire was retested on a subsample of respondents two weeks after the first mailing. SETTING--Two general practices in Sheffield. PATIENTS--1980 patients aged 16-74 years randomly selected from the two practice lists. MAIN OUTCOME MEASURES--Scores for each health dimension on the SF-36 questionnaire and the Nottingham health profile. Response to questions on recent use of health services and sociodemographic characteristics. RESULTS--The response rate for the SF-36 questionnaire was high (83%) and the rate of completion for each dimension was over 95%. Considerable evidence was found for the reliability of the SF-36 (Cronbachs alpha greater than 0.85, reliability coefficient greater than 0.75 for all dimensions except social functioning) and for construct validity in terms of distinguishing between groups with expected health differences. The SF-36 was able to detect low levels of ill health in patients who had scored 0 (good health) on the Nottingham health profile. CONCLUSIONS--The SF-36 is a promising new instrument for measuring health perception in a general population. It is easy to use, acceptable to patients, and fulfils stringent criteria of reliability and validity. Its use in other contexts and with different disease groups requires further research.

Subjective and behavioural evaluation of the teaching of patient interview skills

Summary. One aim of the course in general practice and public health medicine during the final year at the University of Sheffield is to help students to develop further their interpersonal communication skills with particular reference to their skills in interviewing patients. During the course students meet twice in small groups with a tutor in order to review audiotape recordings of interviews with patients seen during their general practice attachments. The main activity during these tutorials is group discussion of the interviewers behavioural options at significant points during the interview. Students also listen individually with a tutor to an interview that they have recorded, discuss this interview and assess it against a set of explicit criteria as part of their summative course assessment. In response to an anonymous end‐of‐course questionnaire, 85% of students felt that their interview skills had been improved by the teaching and 68% that listening to their own recordings had been the most helpful aspect. During interviews with simulated patients recorded at the end of the course, students asked more open questions, fewer questions referring to physical symptoms, more questions referring to feelings, beliefs or behaviour and fewer questions of a check‐list type than during interviews recorded at the start. A number of students also requested examples of specific events during the end‐of‐course interviews although none had done so at the beginning of the course. All of these changes were statistically significant and were in directions that were consistent with the teaching in the small‐group tutorials.

Student-directed problem-based learning in general practice and public health medicine

Summary. The development and implementation are described of a new 6‐week course in general practice and public health medicine for final‐year medical students. This course is based on the principles of student‐directed problem‐based learning in small groups and makes substantial use of student attachments to local general practices which act as learning resources. Student assessment is by profiles. Course evaluation is by qualitative feedback, and the results of this are presented. The course offers a flexible learning environment in which the aims of its designers and the goals of their students can be achieved.

The primary care organisation: team or hologram?

In 1986, Morgan suggested that in order to interact flexibly and responsively with its environment, to learn and to self-organise, an organisation must be characterised by the principles of requisite variety, redundancy of functions, minimum critical specification and learning-to-learn. In this article, each of the principles is discussed in the context of the primary care team, and the implications of adopting them on an explicit basis are considered.