Early-career General Practitioners Research Articles

Evaluation of the first 5 years of the Next Generation GP leadership programme: balancing autonomy and accountability

BackgroundIn 2017, a group of trainee general practitioners (GPs) came together to design and deliver a six-session leadership development programme for their peer trainee and early career GPs: the Next...

Early-career general practitioners’ career intentions in Estonia: A qualitative study

Background The shortage of general practitioners (GPs) is a worsening problem in many countries and poses a threat to the services provided by primary care and by extension for the entire healthcare system. Issues with GP workforce recruitment and retention can be reasons for this shortage. Objectives To describe GP trainees and newly qualified GPs experiences and perceptions on how their training and early experiences of work influence their career intentions in primary care in Estonia. Methods A qualitative study with GP trainees (n = 12) and newly qualified GPs (n = 13) using semi-structured group interviews (n = 6) was conducted. Interviews were conducted from October until November 2020. Data were analysed using thematic analysis with NVivo Software. Results Although early-career GPs in Estonia envision their future roles as GP practice owners with patient list, this is often postponed due to various reasons. Early-career GPs expressed a sense of unpreparedness to fill all the roles of GPs’ and found the process of establishing a GP practice and taking on a patient lists very complicated. They value work-life balance and prefer workplaces, which offer flexible working conditions. Conclusion Potential strategies were identified to enhance the willingness of early-career GPs to continue their career as GP practice owners with patient list: improving the GP training program by placing more emphasis on managing skills and making the process of establishing GP practice and taking on a patient list less bureaucratic and more accessible.

Absolute cardiovascular risk assessment by Australian early-career general practitioners: a cross-sectional study

ObjectiveTo determine the prevalence and associations of general practice registrars’ performing absolute cardio-vascular risk (ACVR) assessment (ACVRa).DesignA cross-sectional study employing data (2017–2018) from the Registrar Clinical Encounters in Training project,...

The prevalence and associations of Australian early-career general practitioners' provision of after-hours care.

Access to after-hours care (AHC) is an important aspect of general practice service provision. To establish the prevalence and associations of early-career GPs' provision of AHC. An analysis of data from the New alumni Experiences of Training and independent Unsupervised Practice (NEXT-UP) cross-sectional questionnaire-based study. Participants were early-career GPs (6-month to 2-year post-Fellowship) following the completion of GP vocational training in NSW, the ACT, Victoria or Tasmania. The outcome factor was 'current provision of after-hours care'. Associations of the outcome were established using multivariable logistic regression. Three hundred and fifty-four early-career GPs participated (response rate 28%). Of these, 322 had responses available for analysis of currently performing AHC. Of these observations, 128 (40%) reported current provision of AHC (55% of rural participants and 32% of urban participants). On multivariable analysis, participants who provided any AHC during training were more likely to be providing AHC (odds ratio (OR) 5.51, [95% confidence interval (CI) 2.80-10.80], p < 0.001). Current rural location and in-training rural experience were strongly associated with currently providing AHC in univariable but not multivariable analysis. Early-career GPs who provided AHC during training, compared with those who did not, were more than five times more likely to provide after-hours care in their first 2 years after gaining Fellowship, suggesting participation in AHC during training may have a role in preparing registrars to provide AHC as independent practitioners. These findings may inform future GP vocational training policy and practice concerning registrars' provision of AHC during training.

What competencies do European general practice trainees value the most? A prioritisation exercise using a Delphi-informed approach

ABSTRACT General Practice has changed over the past decade. Expansion of clinicians’ roles may create uncertainty, stress, and overload – particular for those at the start of their career. The WONCA Europe network for medical education, EURACT, has published competency-based aims and requirements for speciality training in general practice. Greater understanding of the trainee perspective would support planning and delivery of postgraduate training curricula. This two-step study aims to provide a competency priority list, created by European early career general practitioners, to highlight skills that this generation considers highly essential in future speciality training. A competency list was drafted with trainee- and early career general practitioners from across Europe at the Vasco da Gama Movement Forum (Edinburgh, January 2022). Participants identified competencies that they regarded as most relevant for future speciality training in their respective national contexts. Competencies were coded into categories and ranked in two consecutive rounds, the first taking place online and the second at WONCA Europe (London, June 2022). After two rounds, a consensual list of three main competencies for each category was drafted. The top three competencies for each category remained the same throughout both rounds and may be considered competencies that early career general practitioners in Europe consider important for training. Prioritisation of these competencies by institutions and educators within general practice training programmes may support trainees’ satisfaction and perceived preparedness for practice.

Early-career general practitioners’ perceptions of the utility of vocational training for subsequent independent practice

ABSTRACT Purpose To evaluate Australian early-career general practitioners’ perceptions of the utility of their prior vocational training in preparing them for independent specialist practice. We hypothesised that in-practice teaching would be perceived as more useful than formal education delivered by Regional Training Organisations (RTOs). Methods and materials A cross-sectional questionnaire-based study of early-career general practitioners (RTO ‘alumni’). The outcomes were Likert scale ratings of alumni’s perceived impact of RTO education versus in-practice training on their preparedness for independent practice. Ratings were compared using Wilcoxon signed-rank tests. Multivariable linear regression was used to establish alumni characteristics associated with perceptions of utility of in-practice versus RTO-delivered education. Results Three hundred and fifty-four alumni responded (response rate 28%). In-practice training was rated statistically significantly higher than RTO education for minor procedural skills, teaching skills, professional responsibilities, tolerating clinical uncertainty, and preparing for managing child and adolescent health, aged care, chronic disease, multi-morbidity and mental health. RTO education rated higher than in-practice training for practising evidence-based medicine and Aboriginal and Torres Strait Islander health. For a number of further areas, there was no statistically significant difference in alumni ratings of utility. Conclusions In-practice or RTO-led teaching was perceived as more useful for some components of independent practice, whilst for others there was no significant difference. The findings support recognition of the individual educational components of a blended education/training structure.

Cross-sectional analysis of the clinical work hours of early-career general practitioners.

The clinical working hours of early-career general practitioners (GPs) are an important factor in Australian GP workforce planning. This study aimed to establish the prevalence and associations of early-career GPs working full time (nine or more sessions per week) inclinical practice. This was a cross-sectional questionnaire-based study ofalumni (from six months to two years post-Fellowship) from three regional training organisations. Multivariable logistic regression was used to establish factors associated with alumni working full time. Of 356 currently practising early-career alumni participants, 30% worked full time. Factors associated with working full time included spouse/partner employment and family structure and any examination failure. Factors associated with working less than full time included female gender, being an Australian medical graduate, provision of other medical work and having taken additional leave during training. A high proportion of early-career GPs working part time in clinical general practice has implications for workplace planning, as GPs seek workload diversity and flexibility across their career stages.

Prevalence and associations of rural practice location in early-career general practitioners in Australia: a cross-sectional analysis.

ObjectivesTo: (1) establish the prevalence of urban, regional, rural and remote practice location of early-career general practitioners (GPs); and (2) examine demographic and training-related characteristics associated with working in regional, rural or remote areas post attainment of vocational general practice qualifications.DesignCross-sectional, questionnaire-based study, combined with contemporaneously collected data from participants’ prior vocational training.SettingAustralian general practice.ParticipantsNewly vocationally qualified GPs (ie, within 6 months–2 years post fellowship) who had completed vocational training with regional training organisations in New South Wales, Australian Capital Territory, eastern Victoria, and Tasmania between January 2016 and July 2018.Primary outcome measureRurality of post-fellowship practice location, as defined by Modified Monash Model (MMM) geographical classifications, based on current practice postcode. Prevalence of regional/rural/remote (‘rural’) practice was described using frequencies, and associations of rural practice were established using multivariable logistic regression, considering a range of demographic factors and training characteristics as independent variables.ResultsA total of 354 participants completed the questionnaire (response rate 28%) with 319 providing information for their current practice location. Of these, 100 (31.4%) reported currently practising in a rural area (MMM2-7). Factors most strongly associated with practising in a rural area included having undertaken vocational GP training in a rural location OR 16.0 (95% CI 6.79 to 37.9); p<0.001; and undertaking schooling in rural area prior to university OR 4.21 (1.98, 8.94); p<0.001.ConclusionsThe findings suggest that vocational training experience may have a role in rural general practice location post fellowship, attenuating the previously demonstrated ‘leakage’ from the rural practice pipeline.

Provision of other medical work by Australian early-career general practitioners: a cross-sectional study.

Introduction There is a trend towards GPs diversifying their role by working in health areas beyond general practice. However, little is known about whether this trend is apparent among early-career GPs once they make the transition from training to independent practice. Aim To describe the prevalence of and characteristics associated with early-career GPs providing other medical work. Methods A cross-sectional questionnaire-based study of GPs ('alumni') who had fellowed within the past 2 years from three of Australia's nine regional training programs. The outcome factor was provision of medical work in addition to clinical general practice. Associations of independent variables (encompassing alumni demographics, current practice characteristics and vocational training experience) with the outcome were estimated using univariate and multivariable logistic regression. Results Of 339 responding alumni, 111 (33%) undertook other regular medical work. Sixty-five (59%) of these were in medical education. In multivariable analysis, factors associated with providing other medical work were having a spouse/partner not in the workforce (odds ratio (OR) 5.13), having done any training part-time (OR 2.67), providing two or more of home visits, nursing home visits and after-hours care (OR 2.20), working fewer sessions per week (OR 0.74), and currently working in an area of lower socio-economic status (OR 0.84). Having dependent children (OR 0.27), and being female (OR 0.43) were associated with not providing other medical work. Discussion In this study, many early-career GPs are providing other medical work, particularly medical education. Acknowledging this is important to general practice workforce planning and education policy.

Specificity of early-career general practitioners’ problem formulations in patients presenting with dizziness: a cross-sectional analysis

ObjectivesDizziness is a common and challenging clinical presentation in general practice. Failure to determine specific aetiologies can lead to significant morbidity and mortality. We aimed to establish frequency and associations...

Deprescribing in older patients by early-career general practitioners: Prevalence and associations.

Deprescribing is the health-professional-supervised process of withdrawal of an inappropriate medication to manage polypharmacy and improve patient outcomes. Given the harms of polypharmacy and associated inappropriate medicines, practitioners, especially general practitioners (GPs), are encouraged to take a proactive role in deprescribing in older patients. While trial evidence for benefits of deprescribing is accumulating, there is currently little epidemiologic evidence of clinicians' (including GPs') deprescribing behaviours. We aimed to establish the prevalence and explore associations of deprescribing of inappropriate medicines by early-career GPs. A cross-sectional analysis of the ReCEnT study of GP registrars' in-consultation experience, 2016-18. Participants recorded 60 consecutive consultations, three times at 6-month intervals, including medicines ceased (our measure of deprescribing). The outcome was deprescribing of an inappropriate medicine (defined by a synthesis of three accepted classification systems) in patients 65years or older. Logistic regression determined the associations of deprescribing inappropriate medicines. One thousand one hundred and thirteen registrars reported 19581 consultations with patients 65years and older. Inappropriate medicines were deprescribed in 2.6% (95% CIs 2.4%-2.9%) of consultations. Of deprescribed medicines, 43% had been prescribed for three months or longer. Most commonly deprescribed were opioids (19%), proton pump inhibitors (9.2%), anti-inflammatory drugs (9.0%), statins (7.8%), and antidepressants (6.6%). The most common reason for deprescribing was: "no longer indicated" (38%). Significant adjusted associations of deprescribing included patients identifying as Aboriginal or Torres Strait Islander (OR 2.86); continuity-of-care (ORs 0.71 and 0.20 for the patient being new to practice and to the registrar, respectively); inner-regional compared to major-city location (OR 1.33); the problem/diagnosis being chronic (OR 1.90); and longer consultations (OR 1.03 per minute increase in duration). These findings will have important implications for the education of GPs in deprescribing as a clinical skill.

Management of a Chronic Skin Disease in Primary Care: An Analysis of Early-Career General Practitioners' Consultations Involving Psoriasis.

The management of psoriasis by general practitioners (GPs) is vital, given its prevalence, chronicity, and associated physical and psychosocial co-morbidities. However, there is little information on how GPs (including early-career GPs) manage psoriasis. This study assessed the frequency with which Australian specialist GP vocational trainees ('registrars') provide psoriasis care and the associations of that clinical experience. A cross-sectional analysis was done of data from the ReCEnT study, an ongoing multi-site cohort study of Australian GP registrars' experiences during vocational training. In ReCEnT, 60 consecutive consultations are recorded 3 times (6-monthly) during each registrar's training. The outcome factor for this analysis was a problem/diagnosis being psoriasis, and independent variables were related to registrar, patient, practice and consultation factors. This study analysed 17 rounds of data collection (2010-2017) using univariate and multivariable regression. Data from 1,741 registrars regarding 241,888 consultations and 377,980 problems/diagnoses were analysed. Psoriasis comprised 0.15% (n=550) of all problems/diagnoses (95% CI, 0.13-0.16). Significant patient multivariable associations of a problem/diagnosis being psoriasis included age, gender, being new to a practice or a registrar, and psoriasis being an existing problem rather than a new diagnosis. Significant registrar associations included seeking in-consultation information/assistance, not scheduling a follow-up appointment, prescribing medication, and generating learning goals. Australian registrars have modest training exposure to psoriasis and may find psoriasis management challenging. Furthermore, continuity of care (essential for optimal chronic disease management) was modest. The findings have implications for GPs' approaches to the management of psoriasis more widely as well for general practice education and training policies.

Role legitimacy, comfort and confidence providing tobacco, alcohol and other drug care: a cross-sectional study of Australian early-career general practitioners

ABSTRACT Australian general practitioners (GPs) see most Australians each year and, as tobacco, alcohol and other drug use (substance use) are common, GPs often see problematic, risky or dependent substance use. This study aimed to explore early-career GPs’ role legitimacy, comfort and confidence managing patients with problematic use of tobacco, alcohol, psychoactive pharmaceutical or illicit substances. Using the ‘5A’s framework: Ask, Assess, Advise, Assist and Arrange, we surveyed 251 early-career GPs (GP registrars) on role legitimacy, confidence managing patient substance use, and sources of clinical information, advice and support. There was strong agreement that managing substance use is a GP’s role, with high levels of confidence ‘Asking’ (screening) about tobacco and alcohol use, which decreased across other substance classes. Early-career GPs reported lower levels of confidence ‘Assessing’ and ‘Advising’ (brief interventions); and much lower levels of confidence ‘Assisting’ (treating) and ‘Arranging’ (follow up and/or referral) for patients with substance issues across all substances, including tobacco. Participants were most likely to seek advice from senior colleagues in their practice. Early-career GPs reported lower than optimal levels of confidence for all substances. Our findings have important implications for educators globally. Education that improves confidence across all 5As for high-prevalence substances (tobacco and alcohol) while focusing on increasing comfort screening and improving understanding of referral pathway options for low-prevalence substances may improve early-career GPs’ confidence. This could increase engagement in managing substance use issues potentially leading to better health and wellbeing outcomes for patients.

Prevalence and associations of prescribing of long-acting reversible contraception by general practitioner registrars: a secondary analysis of ReCEnT data

ObjectiveLong-acting reversible contraception (LARC) is the most effective form of contraception but use in Australia is low. Uptake of LARC prescribing by early-career general practitioners (GPs) has important implications for...

Acne in primary care: A cross-sectional analysis.

Acne is a common chronic condition. The aim of this study was to establish the frequency and associations of consultations for acne by early-career general practitioners (general practice registrars). The study was a cross-sectional analysis of data from the Registrar Clinical Encounters in Training study. During 2010-18, 2234 registrars contributed data for 289,594 consultations and 453,344 problems/diagnoses. Acne comprised 0.38% (95% confidence interval [CI]: 0.36, 0.40) of all problems/diagnoses. Nine per cent of patients were new to the practice (odds ratio [OR] 1.82; 95% CI: 1.62, 2.05) and 61% were existing patients of the practice but new to the registrar (OR 1.78; 95% CI: 1.46, 2.18). There was a lower frequency of acne presentations by Aboriginal and Torres Strait Islander patients (OR 0.29; 95% CI: 0.14, 0.58) and by patients in regional/remote/very remote areas (OR 0.75; 95% CI: 0.58, 0.95). The majority of the patients had an existing diagnosis of acne. That Aboriginal and Torres Strait Islander patients and patients in rural/remote areas present less frequently with acne requires further study.

Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP’s management of impetigo

ObjectiveTo establish the prevalence and associations of systemic antibiotic prescription for impetigo by early-career general practitioners (GPs) (GP registrars in their first 18 months in general practice).DesignA cross-sectional analysis of...

New alumni EXperiences of Training and independent Unsupervised Practice (NEXT-UP): protocol for a cross-sectional study of early career general practitioners

IntroductionGeneral practice in Australia, as in many countries, faces challenges in the areas of workforce capacity and workforce distribution. General practice vocational training in Australia not only addresses the training...

Mentored Training Positions for Early-Career General Practitioners.

Novel early-career general practitioner jobs were introduced in NHS Tayside, Scotland with 2 purposes: first, to develop the skills and confidence of recently qualified general practitioners (GPs), and second, to address well-known issues of recruitment and retention in general practice.1 In this

Improving care for people with asthma: building capacity across a European network of primary care organisations – the IPCRG’s Teach the Teacher Programme

# Background The International Primary Care Respiratory Group (IPCRG) is a global network of organisations committed to improving assessment/treatment of chronic respiratory disease (CRD) in primary care. As a charity IPCRG supports improvements in health systems within member countries by disseminating research evidence and offering evidence-based resources, such as the U-BIOPRED (Unbiased BIOmarkers in PREDiction of respiratory disease outcomes) research into different phenotypes of asthma and IPCRGs desktop helper - which is short practical guidance distilled from the evidence on structured asthma review -- termed SIMPLES. # Methods We ran a pilot educational programme -- called Teach the Teacher: Difficult to Manage Asthma designed to build capacity for teaching knowledge and skills in asthma management to primary healthcare workers in eight member countries. We used a cascade approach, which allowed for adaptation to local contexts to address local challenges, overcome barriers and optimise facilitators within various political, financial and healthcare systems. We explored impact using an educational evaluation framework. # Results Seven in-country programmes were delivered within project timescales March - December 2015. An important feature of the programme level evaluation shows considerable variation in the design and focus of in-country events. Over 230 health professionals participated in these educational events in seven countries, including specialist nurses, physiotherapists, general practitioners (GP), early career GPs, and GPs with a special interest in respiratory disease. Findings from a survey of in-country leads showed the importance of local needs assessment to ensure it was responsive to local social and healthcare context and allowed local variation and needs to be highlighted. Needs assessment also engaged the potential audience and ensured their buy-in to the programme at an early stage. Evidence based resources were adapted to different contexts which allowed them to be integrated to the routine training of primary care clinicians thus ensuring sustainability. # Conclusions Variation in the design and focus of in-country events was crucial to local implementation. Teams encountered, and found local solutions for, challenges in assessing learning needs, setting up education programmes and in supporting clinical practice change. Project funding enabled national programmes, but sustainability will require additional resource and a longer-term strategy.

Capsule Commentary on Magin et al., Changes in Australian Early-Career General Practitioners' Benzodiazepine Prescribing: a Longitudinal Analysis.

Capsule Commentary on Magin et al., Changes in Australian Early-Career General Practitioners' Benzodiazepine Prescribing: a Longitudinal Analysis.