Study protocol: the Registrar Clinical Encounters in Training (ReCEnT) study.

Simon Morgan,Susan M Goode,Mieke L Van Driel,Kevin P Sweeney,Catherine M Regan,Kim M Henderson,Steven J Bowe,Julian Jackel,Parker J Magin,John Scott

doi:10.1186/1471-2296-13-50

Abstract

BackgroundPatient encounters are the core learning activity of Australian general practice (family practice) training. Exposure to patient demographics and presentations may vary from one general practice registrar (vocational trainee) to another. This can affect comprehensiveness of training. Currently, there is no mechanism to systematically capture the content of GP registrar consultations. The aim of the Registrar Clinical Encounters in Training (ReCEnT) study is to document longitudinally the nature and associations of consultation-based clinical and educational experiences of general practice registrars.Methods/designThis is an ongoing prospective multi-site cohort study of general practice registrars’ consultations, entailing paper-based recording of consultation data. The study setting is general practices affiliated with three geographically-based Australian general practice regional training providers. Registrars record details of 60 consecutive consultations. Data collected includes registrar demographics, details of the consultation, patient demographics, reasons for encounter and problems managed. Problems managed are coded with the International Classification of Primary Care (second edition) classification system. Additionally, registrars record educational factors related to the encounter. The study will follow the clinical exposure of each registrar six-monthly over the 18 months to two years (full-time equivalent) of their general practice training program.ConclusionsThe study will provide data on a range of factors (patient, registrar and consultation factors). This data will be used to inform a range of educational decisions as well as being used to answer educational research questions. We plan to use ReCEnT as a formative assessment tool for registrars and help identify and address educational needs. The study will facilitate program evaluation by the participating training providers and thus improve articulation of educational programs with practice experience. From the research point of view it will address an evidence gap – the in-practice clinical and educational experience of general practice trainees, determinants of these experiences, and the determinants of registrars’ patterns of practice (for example, prescribing practice) over the course of their training.

Highlights

Patient encounters are the core learning activity of Australian general practice training
Registrars learn by the “apprenticeship model”, seeing patients in the general practice setting under the supervision of accredited general practitioner (GP) supervisors
In real life, the curriculum “walks through the door”, and anecdotally, the exposure to different patient demographics and presentations is highly variable between training practices and between one registrar and another

Summary

Introduction

Patient encounters are the core learning activity of Australian general practice (family practice) training. Exposure to patient demographics and presentations may vary from one general practice registrar (vocational trainee) to another Consulting with patients is the core learning activity of general practice (family practice) training in Australia. In real life, the curriculum “walks through the door”, and anecdotally, the exposure to different patient demographics and presentations is highly variable between training practices and between one registrar and another. This variability is likely to have an impact on the comprehensiveness and quality of training. Other Australian studies have looked at patient encounters in the Aboriginal Medical Service context [9,10,11] and between urban and rural settings [12]

Methods

Discussion

Conclusion