Table 2 The consecutive steps of the ACA training programme (and the estimated time spent by participants on each step)

Step 1

Each participating GP or GP Trainee (GPT) had a videotaped physician-patient interview with a trained actor simulating a patient in an advanced stage of lung or colon cancer, according to a detailed script; immediately after the interview the participant received general feedback on communication style from the actor (30 minutes).

Step 2

Instructions on the ACA checklist, using oral presentations and written information (ACA booklet) in order to enhance the understanding of the participants of effective GP-patient communication in palliative care; each participant also received a plastic chart of the ACA checklist for use in daily practice (30 minutes).

Within two months after the start of the programma, outside the residential course:

Step 3

All participants received feedback according to the ACA checklist on their performance during the videotaped physician-patient interview in step 1. The GPs received individual written feedback from an experienced facilitator, the GPTs received oral feedback from their peers and facilitators in small groups (60 minutes).

Between the start of the programme and halfway through the programme, outside the residential course:

Step 4

The participants were asked to enhance their understanding of the ACA checklist and their insight into their own communication skills by studying the written information, discussing this material with their peers in small groups, and trying out newly acquired skills in their own general practice to identify problem areas from their own experience (60 minutes).

Before the residential course at halfway through the programme; outside the residential course:

Step 5

The participants were asked to formulate learning goals based on the individual shortcomings in their ACA communication skills identified at all previous steps (30 minutes).

Halfway through the programme; at the residential course:

Step 6

All participants were offered role-play exercises tailored to their individual learning goals. Hence, they could practise the desired behaviour in the safe environment of small groups and with the help of feedback on their performance from their peers and facilitators. GPs performed role-play with actors simulating a patient, GPTs performed role-play with other participants in the course, which had the additional advantage of enabling them to experience the position and emotions of the patient (60 minutes).

At the end of the ACA training programme; at the residential course:

Step 7

Each participant had a second videotaped interview with an actor simulating a patient; immediately after the interview the participant again received general feedback on communication style from the actor (30 minutes).

Step 8

All participants could use the second videotaped interview and the ACA checklist as tools for self-assessment of their communication skills, and they could then (off course) formulate new learning goals and start a new learning cycle (60 minutes).

The estimated total duration of all steps in the ACA training programme is six hours.