Abstract
BackgroundGeneral Practice training in Australia is delivered through the apprenticeship model. General Practice supervisors support trainees transitioning from hospital-based work towards competent independent community-based practice. The timing and manner in which support should be provided is still not well understood. This study aimed to establish the variation in clinical and educational experiences and behaviours, and location, of general practice trainees’ consultations by stage of their vocational training. It was hypothesised that change is greater in earlier stages of training.MethodsA cross-sectional analysis of data (2010–2018) from the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing cohort study of Australian GP registrars’ in-consultation clinical and educational experience and behaviours. Multinomial logistic regression assessed the association of demographic, educational, and clinical factors in different stages of training. The outcome factor was the training term.ResultsTwo thousand four hundred sixteen registrars contributed data for 321,414 patient consultations. For several important variables (seeing patients with chronic disease; new patients; seeking in-consultation information or assistance; ordering pathology and imaging; and working in a small or regional practice), odds ratios were considerably greater for comparisons of Term 1 and 3, relative to comparisons of Term 2 and 3.ConclusionDifferences experienced in demographic, clinical and educational factors are significantly more pronounced earlier in registrars’ training. This finding has educational and training implications with respect to resource allocation, trainee supervision and curriculum design. Sociocultural learning theory enables an understanding of the impact of transitions on, and how to support, general practice trainees and supervisors.
Highlights
General Practice training in Australia is delivered through the apprenticeship model
After graduating from medical school, general practitioner (GP) registrars will complete a minimum of 24 months of hospital-based training, 18 months of general practice placements and 6 further months of extended skills training
Given previous individual findings using training term as an independent factor, that changes in demographic, clinical and educational variables would be greatest earlier in training. This analysis was conducted within the Registrar Clinical Encounters in Training (ReCEnT) project
Summary
General Practice training in Australia is delivered through the apprenticeship model. Tran et al BMC Medical Education (2022) 22:124 programs exist to prepare trainees for the change from hospital-based work to general practice work and learning [3]. Navigating this change is important to reduce negative consequences including burnout and intolerance of clinical uncertainty [4]. Australian general practice specialist vocational training (hereafter, ‘GP training’), like many medical vocational training programs, is based on the clinical apprenticeship-like model. Registrars (trainees) work independently alongside experienced general practitioner (GP) supervisors [5] This model provides exposure to a wide-ranging set of patient demographics and clinical presentations. There are shared experiences between Australian GP training and post-graduate medical specialist training programs internationally [6]
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