Assessment Of General Practitioners Research Articles

Needs assessment of general practitioners in Pakistan: A descriptive cross-sectional survey.

With the growing and complex nature of medicine, it is imperative for physicians to update their knowledge and skills to reflect current standards of care. In Pakistan, 71% of primary care needs are met by general practitioners (GPs). GPs are not required to complete structured training and no regulatory mandates exist for continuing medical education. We conducted a needs assessment to evaluate the readiness for competency-based updating of knowledge and skills, and the use of technology by practicing GPs in Pakistan. A cross-sectional survey inviting registered GPs across Pakistan was administered online and in-person. Questions pertained to physician demographics, practice characteristics, confidence in knowledge and skills, and preferred modes of updating knowledge and barriers. Descriptive analyses were performed for GPs and patient-related characteristics and bivariate analyses to evaluate the relationship between parameters of interest. Of the 459 GPs who responded, 35% were practicing for <5 years and 34% reported practicing for >10 years. Only 7% had a post-graduate qualification in family medicine. GPs reported needing practice in neonatal examination (52%), neurological exam (53%), depression screening (53%), growth charts (53%) and peak flow meter use (53%), interpretation of electrocardiograms (ECGs, 58%) and insulin dosing for diabetes (50%). High workload (44%) was the most common barrier to updating clinical knowledge. Sixty-two percent used the Internet on a regular basis. Most GPs have no structured training and encounter gaps in knowledge and skills in clinical practice. Flexible, hybrid, and competency-based continuing medical education programs can be used to update knowledge and skills.

How to learn skilled communication in primary care MUS consultations: a focus group study

Background Many general practitioners (GPs) experience communication problems in medically unexplained symptoms (MUS) consultations as they are insufficiently equipped with adequate communication skills or do not apply these in MUS consultations. Objective To define the most important learnable communication elements during MUS consultations according to MUS patients, GPs, MUS experts and teachers and to explore how these elements should be taught to GPs and GP trainees. Methods Five focus groups were conducted with homogeneous groups of MUS patients, GPs, MUS experts and teachers. MUS patients and GPs formulated a list of important communication elements. MUS experts identified from this list the most important communication elements. Teachers explored how these elements could be trained to GPs and GP trainees. Two researchers independently analysed the data applying the principles of constant comparative analysis. Results MUS patients and GPs identified a list of important communication elements. From this list, MUS experts selected five important communication elements: (1) thorough somatic and psychosocial exploration, (2) communication with empathy, (3) creating a shared understanding of the problem, (4) providing a tangible explanation and (5) taking control. Teachers described three teaching methods for these communication elements: (1) awareness and reflection of GPs about their feelings towards MUS patients, (2) assessment of GPs’ individual needs and (3) training and supervision in daily practice. Conclusion Teachers consider a focus on personal attitudes and needs, which should be guided by opportunities to practice and receive supervision, as the best method to teach GPs about communication in MUS consultations. KEY POINTS Many GPs experience difficulties in communication with patients with MUS. There is a need to equip GPs with communication skills to manage MUS consultations more adequately. Role-playing with simulation patients, reflection on video-consultations and joint consultations with the supervisor may increase the GPs’ awareness of their attitude towards MUS patients and may help GPs to identify their individual learning-points.

Risk literacy assessment of general practitioners and medical students using the Berlin Numeracy Test

BackgroundThe responsibility for helping patients understand potential health benefits and risks, especially regarding screening tests, falls largely to general practitioners (GPs). The Berlin Numeracy Test (BNT) specifically measures risk literacy (i.e., the ability to understand different aspects of statistical numeracy associated with accurate interpretation of information about risks). This study explored the association between risk literacy levels and clinical experience in GPs vs. medical students. Additionally, the effect of GP risk literacy on evaluation of the predictive value of screening tests was examined.MethodsThe participants were 84 GPs and 92 third-year medical students who completed the BNT (total score range 0–4 points). The GPs received an additional case scenario on mammography screening as a simple measure of performance in applying numeracy skills.ResultsDespite having an average of 25.9 years of clinical experience, GPs scored no better than medical students on risk literacy (GPs: 2.33 points, 95% confidence interval [CI] 2.08–2.59; students: 2.34, 95% CI 2.07–2.61; P = .983). Of all GPs, 71.6% (n = 58) greatly overestimated the real predictive value.ConclusionsIn this study, we found no difference in risk literacy between current students and current GPs. GPs lack risk literacy and consequently do not fully understand numeric estimates of probability in routine screening procedures.

Effects and Challenges Regarding Supervision in Palliative Care Teams: Results of a 5-Year Study in South Tyrol (Italy)

Objective: Evaluating a solution-oriented clinical supervision to improve the quality of care. Design: We performed a randomized, longitudinal controlled trial. A total of 32 health districts were involved in the study. For the evaluation of the intervention, the following dimensions were collected as indicators of the quality of supervision: Quality of life (FACT-G, SF12, POS), psychological stress, depression, burn-out (HADS, BDI-II, VAS scales, HPS), sense of coherence (SOC-13), satisfaction with care, communication and support from the patients and relatives (VAS scales) and working conditions (COPSOQ) from the nursing staff and family doctors. Results: Of the 85 subscales, the SOC Nursing Sum Score (p=0.017), the SF-12 Nursing Sum Scale (p=0.036), and the COPSOQ Scales of General Practitioners showed significant differences in developmental opportunities (p=0.020), leadership (p=0.003), social support (p=0.001) and community spirit (p=0.024). At the second point time of the study, significant differences were found in the subscales of the Palliative Care Outcome Scale (POS) and the subscale of the test instrument Functional Assessment of Cancer Therapy - General (FACT-G) FUNCTIONAL WELL-BEING of the patients. The satisfaction values of nurses and general practitioners with the supervision showed an extremely positive assessment of both nurses and general practitioners regarding supervision. Conclusions: Supervision affects positively the process of palliative home care. It seems important to adjust the number of supervision meetings according to the needs of the individual team in order to achieve an optimized team performance.

Impact of changing provider remuneration on NHS general dental practitioner services in Northern Ireland: a mixed-methods study

Background Policy-makers wanted to reform the NHS dental contract in Northern Ireland to contain costs, secure access and incentivise prevention and quality. A pilot project was undertaken to remunerate general dental practitioners using a capitation-based payment system rather than the existing fee-for-service system. Objective To investigate the impact of this change in remuneration. Design Mixed-methods design using a difference-in-difference evaluation of clinical activity levels, a questionnaire of patient-rated outcomes and qualitative assessment of general dental practitioners’ and patients’ views. Setting NHS dental practices in Northern Ireland. Participants General dental practitioners and patients in 11 intervention practices and 18 control practices. Interventions Change from fee for service to a capitation-based system for 1 year and then reversion back to fee for service. Main outcome measures Access to care, activity levels, service mix and financial impact, and patient-rated outcomes of care. Results The difference-in-difference analyses showed significant and rapid changes in the patterns of care provided by general dental practitioners to patients (compared with the control practices) when they moved from a fee-for-service system to a capitation-based remuneration system. The number of registered patients in the intervention practices compared with the control practices showed a small but statistically significant increase during the capitation period (p &lt; 0.01), but this difference was small. There were statistically significant reductions in the volume of activity across all treatments in the intervention practices during the capitation period, compared with the control practices. This produced a concomitant reduction in patient charge revenue of £2403 per practice per month (p &lt; 0.05). All outcome measures rapidly returned to baseline levels following reversion from the capitation-based system back to a fee-for-service system. The analysis of the questionnaires suggests that patients did not appear to notice very much change. Qualitative interviews showed variation in general dental practitioners’ behaviour in response to the intervention and how they managed the tension between professional ethics and maximising the profits of their business. Behaviours were also heavily influenced by local context. Practice principals preferred the capitation model as it freed up time and provided opportunities for private work, whereas capitation payments were seen by some principals as a ‘retainer fee’ for continuing to provide NHS care. Non-equity-owning associates perceived the capitation model as a financial risk. Limitations The active NHS pilot period was only 1 year, which may have limited the scope for meaningful change. The number of sites was restricted by the financial budget for the NHS pilot. Conclusions General dental practitioners respond rapidly and consistently to changes in remuneration, but differences were found in the extent of this change by practice and provider type. A move from a fee-for-service system to a capitation-based system had little impact on access but produced large reductions in clinical activity and patient charge income. Patients noticed little difference in the service that they received. Future work With changing population need and increasing financial pressure on the NHS, research is required on how to most efficiently meet the expectations of patients within an affordable cost envelope. Work is also needed to identify and evaluate interventions that can complement changes in remuneration to meet policy goals. Trial registration Current Controlled Trials ISRCTN29840057. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 6. See the NIHR Journals Library website for further project information.

Collaboration Between GPs and Psychologists: Dissatisfaction from the Psychologists' Perspective-A Cross-Sectional Study.

Collaborative mental health practices in primary care significantly enhances patients' health. Collaboration between general practitioners (GPs) and psychologists could improve non-drug mental care. Little is known of psychologists' perception of GPs and their collaboration. This study aimed to assess the quality of collaboration between GPs and psychologists from the psychologists' perspective and to identify factors associated with satisfactory collaboration. A questionnaire was sent by post to all private psychologists in a region of France in February, 2017. We carried out descriptive and multivariate analysis of factors associated with satisfactory collaboration. The response rate was 38% (n = 434 out of 1128). Collaboration between GPs and psychologists was considered unsatisfactory by 64% (n = 278) of psychologists. The main barriers reported were lack of time, lack of understanding and poor interactions/communication. Sixty-nine percent of psychologists felt that GPs knew little about their work. Psychologists had professional exchanges with an average of three local GPs and received referral information for 12% of new patients. Out of 10 new patients, 2 were referred by a GP.In a multivariate analysis, satisfactory collaboration was significantly associated with the number of GPs psychologists exchanged with (OR 1.29), receipt of referral information (OR 2.18) and a positive assessment of GPs' understanding of psychologists' activity (OR 3.35). Psychologists considered the collaboration between GPs and psychologists as substandard, as well as GPs' knowledge of psychologists' activity. More interactions and better understanding would improve their collaboration.

Cancer Control at the District Hospital Level in Sub-Saharan Africa: An Educational and Resource Needs Assessment of General Practitioners.

PURPOSEThe WHO framework for early cancer diagnosis highlights the need to improve health care capacity among primary care providers. In Rwanda, general practitioners (GPs) at district hospitals (DHs) play key roles in diagnosing, initiating management, and referring suspected patients with cancer. We sought to ascertain educational and resource needs of GPs to provide a blueprint that can inform future early cancer diagnosis capacity–building efforts.METHODSWe administered a cross-sectional survey study to GPs practicing in 42 Rwandan DHs to assess gaps in cancer-focused knowledge, skills, and resources, as well as delays in the referral process. Responses were aggregated and descriptive analysis was performed to identify trends.RESULTSSurvey response rate was 76% (73 of 96 GPs). Most responders were 25 to 29 years of age (n = 64 [88%]) and 100% had been practicing between 3 and 12 months. Significant gaps in cancer knowledge and physical exam skills were identified—88% of respondents were comfortable performing breast exams, but less than 10 (15%) GPs reported confidence in performing pelvic exams. The main educational resource requested by responders (n = 59 [81%]) was algorithms to guide clinical decision-making. Gaps in resource availability were identified, with only 39% of responders reporting breast ultrasound availability and 5.8% reporting core needle biopsy availability in DHs. Radiology and pathology resources were limited, with 52 (71%) reporting no availability of pathology services at the DH level.CONCLUSIONThe current study reveals significant basic oncologic educational and resource gaps in Rwanda, such as physical examination skills and diagnostic tools. Capacity building for GPs in low- and middle-income countries should be a core component of national cancer control plans to improve accurate and timely diagnosis of cancer. Continuing professional development activities should address and focus on context-specific educational gaps, resource availability, and referral practice guidelines.

Assessment of general practitioners' needs and barriers in primary health care delivery in Asia Pacific region.

Background:Primary health care is the key to achieve universal health coverage and health for all. The role of general practitioner is now more important than ever. Gaps exist between primary care doctors’ needs and available resources. Primary care professionals everywhere in the world are expected to provide basic standard of care and fulfill the unmet needs of the population. “Needs assessment” is essential in order to develop plans that reflect clinical priorities, educational needs, patient-centered care, and effective and efficient utilization of resources.Materials and Methods:A blend of qualitative (28 in-depth interviews) and quantitative (315 survey respondents) research helped to identify the educational gaps of general practitioners in the Asia Pacific (APAC) countries. Our in-depth methodology assessed perceived needs in order to inform educational tactics that will engage physicians and drive changes in clinical practice. Barriers to change and best practices were identified so that those barriers may be addressed by the educational strategy.Results:Key findings include a strong need for education for chronic conditions such as mental illness, skin problems, diabetes, hypertension, and others. The majority of physicians indicated that they prefer education in all aspects of the disease, from screening and diagnosis to maintenance or referral. Most clinicians prefer live presentations and small groups over Internet-based formats. Sub-analysis based on demographic factors showed little differences in the perceived needs, but significant differences in barriers to best practices.Conclusion:“Needs assessment” gives an insight into barriers, interest, and necessity related to education and skills in primary care and the best ways to deliver it.

Assessment of general practitioners’ interests in expediting wait lists for spine surgical consultation with use of allied health professionals—results of a pilot study

Background: General practitioners’ (GPs) opinions of non-physician clinician (NPC)-led triaging programs to expedite surgical consultation wait lists for patients presenting with non-urgent lower back pain (LBP) are not well described. Therefore, we targeted GPs practicing in Hamilton, Ontario and assessed their current experiences with referral to a single, large-scale spine surgery service as well as their feelings towards the implementation of triaging programs to improve the provision of health care. Methods: A 21-item cross-sectional web-based questionnaire was disseminated to 281 active GPs referring to a single high-volume academic spine surgery centre. Likert-style questions assessed respondents’ current non-urgent LBP referral practices and experiences, as well as their receptiveness to a NPC-led triaging program. Descriptive data, which comprised the entire data set, were reported as counts and percentages. Results: Among the 57 respondents (20% response rate; 57/281), there was an overwhelming dissatisfaction with current wait times for spine surgery consultation (91%; 52/57) despite referral practices being conservative with respect to the clinical indices that warrant diagnostic imaging and subsequent consultation. Ultimately, GPs strongly supported NPC-led LBP triage programs, feeling most comfortable with initiatives that are spearheaded by advance-practice physiotherapists (96%; 50/52). Finally, most respondents were interested in learning how to integrate triaging techniques into their own practice (81%; 42/52) to further expedite LBP patient assessments. Conclusions: GPs expressed a strong support for LBP triage programs run by NPCs. Future investigation is needed to assess the cost-effectiveness, feasibility, and patient satisfaction of such an initiative.

An Assessment of Private General Practitioners Contracting for Public Health Services Delivery in O.R. Tambo District, South Africa.

Low- and middle-income countries are striving towards universal health coverage in a variety of ways. Achieving this goal requires the participation of both public and the private sector providers. The study sought to assess existing capacity for independent general practitioner contracting in primary care, the reasons for the low uptake of government national contract and the expectations of general practitioners of such contractual arrangements. This was a case study conducted in a rural district of South Africa. The study employed both quantitative and qualitative data collection methods. Data were collected using a general practitioner and practice profiling tool, and a structured questionnaire. A total of 42 general practitioners were interviewed and their practices profiled. Contrary to observed low uptake of the national general practitioner contract, 90% of private doctors who had not yet subscribed to it were actually interested in it. Substantial evidence indicated that private doctors had the capacity to deliver quality care to public patients. However, low uptake of national contarct related mostly to lack of effective communication and consultation between them and national government which created mistrust and apprehension amongst local private doctors. Paradoxically, these general practitioners expressed satisfaction with other existing state contracts. An analysis of the national contract showed that there were likely to benefit more from it given the relatively higher payment rates and the guaranteed nature of this income. Proposed key requisites to enhanced uptake of the national contract related to the type of the contract, payment arrangements and flexibility of the work regime, and prospects for continuous training and clinical improvements. Low uptake of the national General Practitioner contract was due to variety of factors related to lack of understanding of contract details. Such misunderstandings between potential contracting parties created mistrust and apprehension, which are fundamental antitheses of any effective contractual arrangement. The idea of a one-size-fits-all contract was probably inappropriate.

A multifaceted intervention: no increase in general practitioners' competence to diagnose skin cancer (minSKIN) - randomized controlled trial.

General practitioners (GPs) play crucial roles in early detection of skin cancer. A pilot-study found a positive short-term effect of a 1-day dermatologic education programme on GPs' diagnostic competence. To determine effects of a multifaceted intervention, including technical equipment and continuing feedback by a dermatologist, on GPs' diagnostic skills regarding skin cancer. Randomized controlled trial with 78 GPs of the Canton of Zurich, Switzerland. GPs in intervention group received a 1-day training, a Lumio (magnifying glass with polarized light, 3Gen), a Nikon digital camera and - during 1 year - feedback on skin lesion pictures sent to the dermatologist. GPs in control group only received the 1-day training. structured assessment of GP's diagnostic skills in correctly diagnosing images of skin lesions regarding skin cancer. At baseline prior to intervention (T0), after the full-day training course in both groups (T1), and after 1 year of continuing feedback (T2) to the intervention group. Non-parametric unpaired (Wilcoxon-Mann-Whitney) tests were used to compare numbers of correctly classified skin lesions between both groups at T2 and for the change between T1 and T2. At T0, both groups classified a median of 23 skin lesions of the 36 images correctly. This value rose to 28 for both groups at T1 and fell to 24 for both groups at T2. No difference between control and intervention group at T2. Furthermore, we compared differences in the sum scores per GP between T1 and T2 for each group. Also in this comparison, no difference between control and intervention group was found. No long-term effect of the multifaceted intervention was found on the competence to diagnose skin cancer by GPs. The positive short-term effect of the 1-day dermatologic education programme did not persist over 12 months.

Insightful practice: a reliable measure for medical revalidation

BackgroundMedical revalidation decisions need to be reliable if they are to reassure on the quality and safety of professional practice. This study tested an innovative method in which general practitioners...

Training and Validation of Standardized Patients for Unannounced Assessment of Physicians' Management of Depression

Standardized patients (SPs) have been developed to measure practitioner performance in actual practice settings, but results have not been fully validated for psychiatric disorders. This study describes the process of creating reliable and valid SPs for unannounced assessment of general-practitioners' management of depression disorders in Iran. Ten psychology and nursing students (potential SPs) took part in a five-session course involving training in dialogue and body language. Five scenarios, along with corresponding checklists representing common presentations of mood disorders in primary-care settings, were developed by an expert group. The SPs' role-play performance of their respective scenario was videotaped and scored independently by three psychiatrists according to an observational rating scale to assess validity. The role-play was repeated after 1 week with the same scenario and the same doctor, to assess test-retest reliability. The reliability of each checklist to be used by the SPs was assessed by testing interrater reliability between groups of SPs. The cutoff score for the SPs' portrayal validity was 90% or above for all SPs. Mean interrater reliability for the checklists was acceptable for the SPs watching the same videos and filling in the checklists, while the mean kappa for assessing concurrent validity in filling in the checklists was lower. The test-retest performance for assessing reliability resulted in a mean kappa of 0.72. All SPs except one, who was not recruited, performed acceptably well. The authors have demonstrated a thorough validation of the technique of using standardized patients in the portrayal of depressive disorders in primary-care settings in Iran, which creates confidence in employing this technique to evaluate doctors' performance, for example, after an educational intervention. Similar methods of validation can be used for SPs' portrayal of other psychiatric disorders.

Sleep problems in general practice: a national survey of assessment and treatment routines of general practitioners in Norway

The aim of the current national survey of all general practitioners (GPs) practising in Norway was to explore assessment, treatment practice and perceived efficacy of treatment of sleep problems in general practice. A short questionnaire, including self-report measures of the frequency and routines of treatment and assessment of sleep problems, was sent to all 4049 GPs in Norway, of whom 1465 (36.7%) provided valid responses. The prevalence of sleep problems among patients in general practice was estimated to be 11.2%, of which almost two-thirds were believed to be caused by a medical condition. Anamnestic information and blood tests were the most common assessment of sleep problems, whereas GPs rarely referred patients to all-night polysomnographic recording. Sleep hygiene advices were the most commonly used treatment strategy, whereas hypnotics were believed to have the best short-term efficacy. Antidepressives were considered to be the best option for long-term management of sleep problems. About one-third of the patients were prescribed benzodiazepines or 'Z-drugs' for more than 6 months. This study demonstrates that sleep problems are recognized by GPs, but despite evidence that non-pharmacological treatment is superior in the long-term management of insomnia, the current study shows that hypnotics are still considered by GPs to be the most successful treatment.

Drug prescribing data used in the assessment of general practitioners’ treatment of asthma and urinary tract infection – Experience from the European Drug Education Project

ABSTRACTDescribing drug treatment given by general practitioners, and quantifying changes in their prescribingbehaviour due to educational intervention, were important parts of the method developed and appliedby the European Drug Education Project. Based on the physicians’ prescription data, individual patientswere defined as having either asthma or urinary tract infections. Prescribing indicators were establishedfor assessing the quality (acceptable or unacceptable) of the drug treatment. The diagnose definitionsand prescribing indicators are discussed in more detail in relation to feeding back individual prescribingdata to educational groups of physicians to improve the quality of their drug therapy.

Paid and unpaid carers: their role in and satisfaction with primary health care for people with learning disabilities

To a large extent the health care needs of people with learning disabilities living in the community have been neglected by policy makers, purchasers and providers. One result is that the role of carers, paid and unpaid, in monitoring and promoting health has been ignored. This article reports on interviews with carers and is drawn from a study which examined the delivery of primary health care to people with learning disabilities. A range of topics was covered during interview including: carers’ perceptions of their role, contact with and assessment of general practitioners’(GPs’) skills, difficulties experienced during consultations, views about medication, health promotion and health screening. Results indicated that insufficient attention is paid to the needs of people with learning disabilities in respect of health promotion, health screening and regular hearing and sight tests. Whilst generally satisfied with the care provided by GPs, carers made many suggestions about how to improve the standard of care offered. Suggestions for supporting paid and unpaid carers in order to fulfil their role are made. The need for joint strategies at the operational level and strategic level is also discussed.

Geography and credentialism: The assessment and accreditation of overseas-trained doctors

The traditional stronghold of medical dominance, and thus the construction of the medical labour market, has been challenged by a number of contemporary trends. While the social, economic and cultural trends driving this shift have been explored, the significance of geography as a key determinant in the construction of the medical labour market has yet to be addressed in detail. This paper examines how geographical arrangements have shaped the credentialist requirements for overseas-trained doctors and thus the nature and shape of the stratified medical labour market. The research traces the assessment and accreditation of overseas-trained general practitioners in NSW, focusing specifically on the registration process defining the last decade. Throughout this period the process has been significantly transformed: in the 1990s there was only one pathway to assessment, registration and subsequent entry to the labour market, there are now multiple pathways. An examination of this historical change illustrates how credentialist requirements are negotiated and renegotiated by the various stakeholders in light of shifting spatial demands.

Does computer-based testing (CBA) have a future in the assessment of general practitioners in the united kingdom?

Does computer-based testing (CBA) have a future in the assessment of general practitioners in the united kingdom?

Setting a standard for performance assessment of doctor-patient communication in general practice

Continuing professional development (CPD) of general practitioners. Criterion-referenced standards for assessing performance in the real practice of general practitioners (GPs) should be available to identify learning needs or poor performers for CPD. The applicability of common standard setting procedures in authentic assessment has not been investigated. To set a standard for assessment of GP-patient communication with video observation of daily practice, we investigated 2 well known examples of 2 different standard setting approaches. An Angoff procedure was applied to 8 written cases. A borderline regression method was applied to videotaped consultations of 88 GPs. The procedures and outcomes were evaluated by the applicability of the procedure, the reliability of the standards and the credibility as perceived by the stakeholders, namely, the GPs. Both methods are applicable and reliable; the obtained standards are credible according to the GPs. Both modified methods can be used to set a standard for assessment in daily practice. The context in which the standard will be used - i.e. the specific purpose of the standard, the moment the standard must be available or if specific feedback must be given - is important because methods differ in practical aspects.

Assessment of general practitioners by video observation of communicative and medical performance in daily practice: issues of validity, reliability and feasibility.

To develop a video assessment method for General Practitioners (GPs) by analysing issues of validity, reliability and feasibility of observation of videotaped regular consultations. In a cross-sectional study consultations of 93 GPs were video recorded in the practice during 1 week. The GPs registered consultation and patient data in a logbook; 16 consultations per GP were selected using preset criteria. The quality of communicative and medical performance of these consultations was assessed by GP observers with a validated instrument. The validity of the procedure was evaluated by checking the content of each GP's sample using specific sample criteria. Selection bias was estimated by multiple regression analysis, with sample characteristics as independent variables and scores on communication and medical performance as dependent variables. The influence of observation on GPs and patients was assessed by a questionnaire. Generalizability theory was used to estimate reliability. Feasibility was assessed by conducting a questionnaire, by keeping accounts, and by checking the technical quality of the videotaped consultations. Universities of Nijmegen and Maastricht, The Netherlands. General Practitioners (GPs). The domain of general practice was well covered in the samples; content validity was satisfactory. With regard to the sample characteristics, only the total duration of consultations appeared to correlate significantly with both the score on communication and the score on medical performance. A majority (71%) of GPs reported not being influenced by the observation, except in the first cases, and recognizing their usual daily performance in the videotaped consultations. An acceptable level of reliability was reached after 2.5 hours of observation, i.e. 12 cases by a single observer. The method was well accepted by both GPs and patients. The costs were pound250 per GP. Video assessment of GPs in daily practice according to the procedures described is a valid and reliable method, one which is useful for education and quality improvement. There is a trade-off between feasibility on one hand and validity, reliability and credibility on the other hand. Compared to investments in observation methods in standardized settings, the costs of video observation of GPs' actual performance are acceptable.