GP Training Research Articles

Evidence-Based Practice Approach on Clinical Empathy Skills Among Health Professionals: A Systematic Review Protocol

Introduction: Effective educational programs promote and strengthen nursing students’ empathetic skills, contributing to health professionals’ pleasure and emotions of personal accomplishment by offering a sense of excellent personal well-being, quality therapeutic management, and clinical expertise. Objectives: This review will synthesize the available evidence on the effectiveness of clinical empathy in general practice and clinical empathy skill training among health professionals. Review questions were structured using the PICOT framework. Inclusion criteria: We will include articles that detail original empirical studies and systematic reviews related to empathy skills among health professionals and the effect of empathy training on clinical empathy skills. Methods: The databases include the National Library of Medicine, SCOPUS, CENTRAL, MEDLINE, PubMed, EMBASE, and EBSCO. The key methods for facilitating the review will be print and electronic resources. Major medical subject heading (mesh) terms in titles and abstracts will be used in the search. To establish existing literature on the empathy training program, the search will contain the terms “empathy,” “clinical empathy,” and “empathy training” in all fields of the databases. The search strategy will commence from 2023 onward with no language restrictions. A team of independent reviewers will screen the retrieved titles, abstracts, and full-text reports and check the data quality using the John Hopkins EBP model and the literature will be systematically reviewed by following PRISMA Guidelines.

GP training in affluent practices in Scotland: the experiences of GP trainees and implications for their future practice

ABSTRACT UK general practice faces workforce challenges. The pandemic, and cost-of-living crisis are felt hardest by our most deprived communities. The Scottish Government is keen to tackle Scotland’s high drugs-related deaths. The perceptions and experiences of GP specialist trainees who have trained in deprived communities are already known. This qualitative study explored the perceptions and experiences of trainees from affluent practices and how this training may affect their future career. One-to-one in-depth interviews were conducted and analysed using grounded theory methods. Seven participants were interviewed. Five themes were constructed: training practice choices, perceptions of working in deprived areas, unmet learning needs for working in deprived areas, other sources of deprivation exposure and future working intentions. Most did not choose their training practice because of its affluence. They perceived that working in a deprived area would have challenges: less staff, higher rates of pathology, communication challenges, poorer patient health literacy. Addiction care was a significant unmet learning need. Most lacked confidence to work in deprived areas, and were likely to work in their training practice or similar, upon completion of training. This research has implications for ensuring equity of GP workforce provision and whether GP Specialty Training fulfils its intention of producing ‘a GP who is capable of working independently in a variety of primary care settings’. Those training in highly-affluent settings may not feel able to meet this aim. Training providers should consider this limited experience and whether rotations, involving affluent and deprived area practices, would prepare future GPs to work with a range of socioeconomic populations.

Medical certificates: More than just paperwork.

Medical certificates communicate the needs and conditions of a person to (often) non-medical entities or other stakeholders. Medical certificates can have a profound effect on patients' access to social and financial support, and therefore wellbeing. However, general practitioners (GPs) are not formally trained in effective completion of medical certificates, leaving opportunity for workforce development. This article discusses the significant role of medical certificates in patient care and the challenges GPs face in completing medical certificates. Medical certificates are often the only mode of communication between GPs and non-medical entities. The tone, comprehensiveness and content of medical certificates can influence the document's utility. There are limited guidelines and formal education for GPs on how to write an effective medical certificate. Designing and implementing guidelines along with appropriate training for GPs will likely result in better patient outcomes in line with their support needs.

General practitioner professional identity formation: Much needed, (still) oft forgotten.

Professional identity formation (PIF) as a general practitioner (GP) enhances the experience of meaning at work, reduces burnout, promotes patient-centred decision making and strengthens advocacy for the unique role of family medicine within the healthcare system. Unfortunately, there is insufficient emphasis on PIF in GP residency programs; it often remains a hidden curriculum. External factors limiting GP trainees' exposure to their own general practice community of practice further impede PIF. Thus, fostering general practice PIF requires deliberate, focused efforts; however, there is little empiric evidence on the GP professional identity or how to foster it. The aim of this paper is to discuss strategies for effective GP PIF in family medicine residency. The authors recommend explicit attention to PIF in three key areas: curriculum; teaching and learning; andfaculty development. Additionally, the authors encourage GPs tounite as a community to provide continuing and coordinated support for GP residents ontheir PIF journey.

What Interventions are Cost Effective in Reducing Violence Against Women? A Scoping Review.

To systematically summarise the recent literature on the cost and cost effectiveness of interventions implemented to reduce violence against women (VAW) and decision frameworks guiding resource allocation. A scoping review of scholarly and grey literature on the cost-effectiveness and/or resource allocation for interventions addressing intimate partner violence (IPV), dating violence and non-partner sexual violence perpetrated against women aged 15 years and over. All settings and contexts were eligible, with papers published in English between 2010 and March 2023 included. Nineteen papers fulfilled the inclusion criteria reporting the cost, cost savings and/or cost effectiveness of 24 interventions to prevent IPV and to a lesser extent, other forms of interpersonal violence. Among the 16 economic evaluation studies reviewed, four types of interventions were cost effective in multiple settings or studies, including community activism (Uganda, Ghana), gender transformative interventions with couples and individuals (Ethiopia, Rwanda), specific justice and law enforcement measures (USA) and a combined personnel training, support, and referral programme in General Practice in the UK. Other interventions were cost effective in a single study or had conflicting evidence. Three remaining papers conducted a partial evaluation or cost appraisal providing limited information on the cost or cost-savings of other implemented interventions. No frameworks on resource allocation for the prevention of VAW were identified. While there is some evidence of cost effectiveness emerging for interventions implemented in specific contexts, overall, we find the recent evidence on costs and cost effectiveness of interventions for the prevention of VAW to be limited. Embedding economic evaluation in future effectiveness trials will build critical evidence needed to inform policy and resource allocation decisions based on the value-for-money of interventions. Modelling the benefits and costs of interventions to better understand the societal impacts of programmes at scale is a further research opportunity.

Exploring the facilitators and barriers to addressing social media's impact on anxiety within primary care: a qualitative study.

Several researchers and policymakers have acknowledged the alarming association between social media (SM) usage and anxiety symptoms in young adults. While primary care holds a crucial role in the improvement of health outcomes for those presenting with anxiety, there has been no research on GPs' perceptions of the impact of SM on anxiety. Furthermore, there has been little discussion of SM as a risk factor in anxiety-related consultations. This study is the first to use empirical research to inform how primary care can adapt to address SM's impact on anxiety within young adults. To identify the facilitators and barriers within primary care to addressing SM's impact on anxiety among young adults. A qualitative study of GPs in the UK. Following an exploratory pilot interview, semi-structured interviews with GPs (n = 7) were transcribed and thematically analysed, following an inductive approach. The following six facilitators were identified: a framework to facilitate discussion; open GP attitudes; GP training; referral pathways; larger stakeholder influence; and young adult education of social media's impact on anxiety. The following three barriers were identified: a lack of GP awareness of SM's impact on anxiety; cautious GP attitudes; and increased pressure on the health service. This qualitative study revealed a diversity of perceptions, and these novel findings are instructive in the adaptation of primary care services to meet the current mental health needs of young adults, as well as better assisting GPs in engaging in these conversations, especially within university practice.

Communication training for general practitioners aimed at improving antibiotic prescribing: a controlled before-after study in multicultural Dutch cities.

IntroductionSuboptimal doctor-patient communication drives inappropriate prescribing of antibiotics. We evaluated a communication intervention for general practitioners (GPs) in multicultural Dutch cities to improve antibiotic prescribing for respiratory tract infections (RTI).MethodsThis was a non-randomized controlled before-after study. The study period was pre-intervention November 2019 – April 2020 and post-intervention November 2021 – April 2022. The intervention consisted of a live training (organized between September and November 2021), an E-learning, and patient material on antibiotics and antibiotic resistance in multiple languages. The primary outcome was the absolute number of prescribed antibiotic courses indicated for RTIs per GP; the secondary outcome was all prescribed antibiotics per GP. We compared the post-intervention differences in the mean number of prescribed antibiotics between the intervention (N = 25) and the control group (N = 110) by using an analysis of covariance (ANCOVA) test, while adjusting for the pre-intervention number of prescribed antibiotics. Additionally, intervention GPs rated the training and their knowledge and skills before the intervention and 3 months thereafter.ResultsThere was no statistically significant difference in the mean number of prescribed antibiotics for RTI between the intervention and the control group, nor for mean number of overall prescribed antibiotics. The intervention GPs rated the usefulness of the training for daily practice a 7.3 (on a scale from 1–10) and there was a statistically significant difference between pre- and post-intervention on four out of nine items related to knowledge and skills.DiscussionThere was no change in GPs prescription behavior between the intervention and control group. However, GPs found the intervention useful and showed some improvement on self-rated knowledge and communication skills.

Childhood obesity prevention in general practice: supporting implementation through co-ideation.

Childhood obesity is associated with physical and psychological complications thus the prevention of excess weight gain in childhood is an important health goal. Relevant to the prevention of childhood obesity, Australian general practice-specific, preventive care guidelines recommend General Practitioners (GPs) conduct growth monitoring and promote a number of healthy behaviours. However, challenges to providing preventive care in general practice may impact implementation. In October and November, 2022, a series of three workshops focusing on the prevention of childhood obesity were held with a group of Australian GPs and academics. The objective of the workshops was to determine practical ways that GPs can be supported to address barriers to the incorporation of obesity-related prevention activities into their clinical practice, for children with a healthy weight. This paper describes workshop proceedings, specifically the outcomes of co-ideation activities that included idea generation, expansion of the ideas to possible interventions, and the preliminary assessment of these concepts. The ecological levels of the individual, interpersonal, and organisation were considered. Possible opportunities to support childhood obesity prevention were identified at multiple ecological levels within the clinic. The preliminary list of proposed interventions to facilitate action included GP education and training, clinical audit facilitation, readily accessible clinical guidelines with linked resources, a repository of resources, and provision of adequate growth monitoring tools in general practice. Co-ideation with GPs resulted in a number of proposed interventions, informed by day-to-day practicalities, to support both guideline implementation and childhood obesity prevention in general practice.

New evidence on the validity of the selection methods for recruitment to general practice training: a cohort study.

Selection into UK-based GP training has used the Multi-Specialty Recruitment Assessment (MSRA) and a face-to-face selection centre (SC). The MSRA comprises of a situational judgement test and clinical problem-solving test. The SC was suspended during the COVID-19 pandemic. Evidence is needed to guide national and international selection policy. To evaluate the validity of GP training selection. A retrospective cohort study using data from UK-based national recruitment to GP training, from 2015-2021. Data were available for 32 215 GP training applicants. The ability of scores from the specialty selection process to predict subsequent performance in the Clinical Skills Assessment (CSA) of the Membership of the Royal College of General Practitioners examination was modelled using path analysis. The effect sizes for sex, professional family background, and world region of qualification were estimated. All component scores of the selection process demonstrated statistically significant independent relationships with CSA performance (P<0.001), thus establishing their predictive validity. All were sensitive to demographic factors. The SC scores had the weakest relationship with future CSA performance. However, for candidates with MSRA scores below the lowest quartile, the relative contribution of the SC scores to predicting CSA performance was similar to that observed for MSRA components. The MSRA has predictive validity in this context. Re-instituting an SC for those with relatively low MSRA scores should be considered. However, the relative costs and potential advantages and disadvantages should be carefully weighed.

GP perceptions of informal peer support in primary care: a qualitative study.

Burnout is on the rise among GPs in the UK. One approach to mitigating burnout in GPs is through informal peer support (IPS). This refers to GPs informally supporting each other on an informational (advice) and emotional (venting and reflection) basis. To explore GPs' perceptions of how IPS manifests in the primary care setting and what factors influence effective GP engagement with IPS. A qualitative study utilising semi-structured interviews to develop an in-depth understanding of GPs' perceptions of IPS, based on their experiences in practices across England. Fifteen GPs were purposively sampled to include the views of locum, salaried, and trainee GPs and GP partners. Semi-structured interviews were conducted, recorded, and transcribed verbatim. Transcripts were analysed using inductive thematic analysis. Four types of IPS were identified relating to emotional support, professional advice, sharing of workload, and mentorship, which reflect existing literature. The frequency and efficacy of IPS was found to be influenced by several factors categorised into individual traits, practice culture, and occupation. The results highlight where efforts should be directed to improve GP engagement with IPS. Specifically, GP leaders have an important role in shaping practice culture and fostering an environment for IPS to occur. Practices may also benefit from introducing professional development measures targeted at training GPs to better support each other based on their individual traits.

Knowing me, knowing you: evaluation of the impact of trainer involvement at an enhanced induction programme for International Medical Graduates (IMGs)

ABSTRACT Addressing differential attainment between International Medical Graduates (IMGs) and their peers who hold UK Primary Medical Qualifications remains one of the most significant challenges facing postgraduate General Practice (GP) training. Enhanced Induction programme, such as the Scottish Trainee Enhanced Programme (STEP), is one tool designed to try and facilitate transition into training and reduce this inequity. The STEP course is attended by both the trainee and their educational supervisor, and aims to lay the foundations of a successful and supportive supervisory relationship. Previous work has evaluated this programme from the perspective of the trainee. Through the use semi-structured interviews, we evaluated the impact and the benefits of the programme from the perspective of the educational supervisors, building on the literature on interventions to support inequity in medical education.

How to promote telemedicine in underdeveloped cities in central China? Qualitative interviews with medical personnel in tertiary A-level hospital of Xinyang City.

Telemedicine has emerged as a novel healthcare service model that plays a vital role in addressing the unequal distribution of medical resources. Telemedicine has recently gained significant traction in economically prosperous cities such as Beijing, Shanghai, and Guangzhou in China. However, Xinyang City in Henan Province is an economically less developed city, and telemedicine is still in its early stages. By exploring the views of medical staff and administrators at Xinyang City's tertiary A-level hospital on telemedicine, this study aims to determine the development status of telemedicine services in Xinyang City. The objective was to identify the challenges in the construction process and formulate corresponding strategies for advancing telemedicine in Xinyang City. Face-to-face personal interviews were conducted with 16 medical staff and administrators from a tertiary A-level hospital in Xinyang City, Henan Province, and the data were collected and analyzed using grounded theory. In the process of data analysis, NVivo12 software was used to encode and organize the data line by line. The development of telemedicine in Xinyang City has the potential to benefit residents, hospitals, and healthcare personnel despite several challenges, including the absence of laws and regulations, inadequate policy support, limited hospital cooperation, and low resident awareness, which must be addressed to unlock the full potential of telemedicine. The telemedicine system in Xinyang City is currently in a coordinated developmental phase, and several areas require further improvement. The development of standardized telemedicine in Xinyang City requires government support, better training for general practitioners, public awareness campaigns, and improved technology while ensuring reasonable work schedules and motivating medical personnel.

Health resource allocation within the close-knit medical consortium after the Luohu healthcare reform in China: efficiency, productivity, and influencing factors.

This study aims to assess the efficiency and productivity of the Luohu Hospital Group after the reform and to identify factors influencing the efficiency to support the future development of medical consortia. Data on health resources from Shenzhen and the Luohu Hospital Group for the years 2015 to 2021 were analyzed using the super-efficiency slack-based measure data envelopment analysis (SE-SBM-DEA) model, Malmquist productivity index (MPI), and Tobit regression to evaluate changes in efficiency and productivity and to identify determinants of efficiency post-reform. After the reform, the efficiency of health resource allocation within the Luohu Hospital Group improved by 33.87%. Community health centers (CHCs) within the group had an average efficiency score of 1.046. Moreover, the Luohu Hospital Group's average total factor productivity change (TFPCH) increased by 2.5%, primarily due to gains in technical efficiency change (EFFCH), which offset declines in technical progress change (TECHCH). The efficiency scores of CHCs were notably affected by the ratio of general practitioners (GPs) to health technicians and the availability of home hospital beds. The reform in the Luohu healthcare system has shown preliminary success, but continuous monitoring is necessary. Future strategies should focus on strengthening technological innovation, training GPs, and implementing the home hospital bed policy. These efforts will optimize the efficiency of health resource allocation and support the integration and development of resources within the medical consortium.

Comparison of vision screening results between trained teachers and general practitioners among elementary school students in rural Bali: A cross-sectional study

Context: Visual impairment is a major healthcare burden worldwide. The vision screening program was supposed to be conducted routinely; however, the shortage of healthcare personnel posed a significant challenge. Aims: This study was conducted to compare the visual acuity examination results of elementary school students when examined by trained teachers as lay screeners and general practitioners (GPs). Settings and Design: This was a cross-sectional study involving 2056 students from 19 elementary schools under one primary healthcare center in Gianyar. Materials and Methods: All students included in the study underwent a basic visual acuity test using the Snellen’s Chart at a distance of 6 m. The test was performed two times, once by teachers and once by GPs. Statistical Analysis Used: Data analysis was performed using Cohen’s Kappa interrater reliability. Results: The total number of study participants was 2056 students. The mean age of the screened students was 9.43 ± 1.69 years, and most of them were male (52.4%). The estimated number of children needing further eye examination and referred to the ophthalmologist was 253 (12.31%). The agreement between visual acuity examinations conducted by teachers and GP was found to be almost perfect, as indicated by Kappa values of 0.859 for the right eye, 0.856 for the left eye, and 0.878 for both eyes, and these were statistically significant (P &lt; 0.001). Conclusions: The high agreement value of visual acuity examination between teachers and GP shows the feasibility of involving teachers as lay vision screeners, which can elevate the number of children screened.

Video consulting for GP trainees

The COVID-19 pandemic prompted a dramatic shift towards remote and digital consulting in general practice. Supported by the wider political policy for ‘Digital-First’ primary care, many practices began offering a wider range of consultation modalities, including online, telephone and video options. Since the COVID-19 pandemic the proportion of appointments carried out remotely has slightly decreased, but still makes up a significant proportion of appointments. According to the latest data from NHS Digital, over a million video and online consultations took place in 2023 (the data does not differentiate between them). Video consulting is used more often in out-of-hours settings and for nursing home ward rounds. Remote consulting requires specific consultation skills, some interchangeable with other modes of consulting, and all important for future practice.

How to address the inverse care law and increase GP recruitment in areas of socioeconomic deprivation: a qualitative study of GP trainees' views and experiences in the UK.

The Deep End network in the North East and North Cumbria (NENC) was set up to tackle health inequalities in general practice. One aim is to address the inverse care law and improve recruitment of GPs, which is known to be especially challenging in areas of socioeconomic deprivation. To explore GP trainees' experiences and perceptions of working in Deep End or Deprived Area Practices (DE/DAPs) to identify how GP recruitment can be improved. Qualitative study recruiting 13 doctors training to be GPs from the Northumbria training programme. Audio-recorded, online, semi-structured interviews and discussion groups were undertaken, transcribed verbatim, and analysed with a grounded theory approach, using a process of thematic analysis. Overall, seven interviews and two discussion groups (13 participants in total) were conducted. Three themes were identified. The first theme was working in areas of socioeconomic deprivation is challenging but has many advantages. The challenges of working in DE/DAPs were not deterring factors for GP trainees wanting to work in areas of socioeconomic deprivation. The second theme was trainees are willing to work in areas of socioeconomic deprivation but clinical experience is important. Training in DE/DAPs gives trainees the confidence to work in areas of deprivation. Familiarity with a practice also makes them more likely to stay post-training. The third theme was financial incentives are not an important attracting factor but support and development opportunities are. Non-pecuniary measures, such as clinical support and protected time for continuing professional development (CPD), were found to be important. To improve recruitment to DE/DAPs, investments should be made to increase the opportunities to train in these environments. This can be achieved by supporting more DE/DAPs to become training practices, and providing clinical support and protected time for CPD.

The under-representation of racially minoritised doctors in academic general practice training: a retrospective analysis.

General practice has one of the most diverse medical training programmes in terms of sex and ethnic background. However, this diversity of race and ethnicity is not reflected in academic GP careers, with just 17% (n = 81/473) of academic GPs being from racially minoritised groups, according to the Medical Schools Council. To determine whether GP academic clinical fellow (ACF) trainees from racially minoritised backgrounds are proportionally represented, compared with the non-academic training programme, using the annual GP ACF conference as a proxy. A retrospective analysis of conference programmes from national academic GP training conferences from 2018-2023 and demographic data obtained from Health Education England (HEE). Using conference programmes and online searches, demographic information on conference speakers was obtained and a freedom of information request was made to HEE for the demographics of GP ACFs for corresponding years. This was compared with demographic data of GP trainees and academics. On average, there were 40 speakers each year at the conference. White females (average 20.2 speakers each year) were the most well represented group, followed by White males (average 12.5), Asian females (average 3.3), Asian males (average 1.8), Black males (average 0.7), and Black females (average 0.3). HEE data from 2022 revealed that 27 (71.1%) of the 38 (excluding five who did not state their ethnicity) ACFs were White British. GP academia should be more representative of the non-academic GP training scheme. Work needs to be done to understand and overcome the structural barriers to recruiting from racially minoritised groups.

Video versus telephone for telehealth delivery: a cross-sectional study of Australian general practice trainees.

Remunerated telehealth consultations were introduced in Australia in 2020 in response to the COVID-19 pandemic. Videoconferencing has advantages over telephone-consulting, including improved diagnostic and decision-making accuracy. However, videoconferencing uptake in Australia has been low. This study aimed to establish prevalence and associations of video versus telephone consultations in Australian general practice (GP) registrars' practice. A cross-sectional analysis of data from 2020 to 2021 (three 6-monthly data-collection rounds) from the Registrars Clinical Encounters in Training (ReCEnT) study. GP registrars record details of 60 consecutive consultations every 6-month term, for a total of 3 terms. Univariable and multivariable logistic regression were performed within the Generalized Estimating Equations framework with the outcome video versus telephone. 102,286 consultations were recorded by 1,168 registrars, with 21.4% of consultations performed via telehealth. Of these, telephone accounted for 96.6% (95% CI: 96.3-96.8%) and videoconferencing for 3.4% (95% CI: 3.2-3.7%). Statistically significant associations of using videoconferencing, compared to telephone, included longer consultation duration (OR 1.02, 95% CI: 1.01-1.03 per minute; and mean 14.9 versus 12.8 min), patients aged 0-14 years old (OR 1.29, 95% CI: 1.03-1.62, compared to age 15-34), patients new to the registrar (OR 1.19, 95% CI: 1.04-1.35), part-time registrars (OR 1.84, 95% CI: 1.08-3.15), and areas of less socioeconomic disadvantage (OR 1.27, 95% CI: 1.00-1.62 per decile). Registrars' telehealth consultations were mostly performed via telephone. Telephone use being associated with socioeconomic disadvantage has health equity implications. Future research should explore barriers to videoconferencing use and strategies to increase its uptake.

Cultural competency of GP trainees and GP trainers: a cross-sectional survey study

Objective To assess the cultural competence (CC) of GP trainees and GP trainers. Design and setting: A cross-sectional survey study was conducted at the GP Training Institute of Amsterdam UMC. Subjects We included 92 GP trainees and 186 GP trainers. Main outcome measures We measured the three domains of cultural competency: 1) knowledge, 2) culturally competent attitudes and 3) culturally competent skills. Regression models were used to identify factors associated with levels of CC. Participants rated their self-perceived CC at the beginning and end of the survey, and the correlation between self-perceived and measured CC was assessed. Results Approximately 94% of the GP trainees and 81% of the GP trainers scored low on knowledge; 45% and 42%, respectively, scored low on culturally competent attitudes. The level of culturally competent skills was moderate (54.3%) or low (48.4%) for most GP trainees and GP trainers. The year of residency and the GP training institute were significantly associated with one or more (sub-)domains of CC in GP trainees. Having >10% migrant patients and experience as a GP trainer were positively associated with one or more (sub-) domains of cultural competence in GP trainers. The correlation between measured and self-perceived CC was positive overall but very weak (Spearman correlation coefficient ranging from −0.1–0.3). Conclusion The level of cultural competence was low in both groups, especially in the knowledge scores. Cultural competence increased with experience and exposure to an ethnically diverse patient population. Our study highlights the need for cultural competence training in the GP training curricula.

Diagnosis and management of acute infections during telehealth consultations in Australian general practice: a qualitative study.

The use of telehealth has increased dramatically since the beginning of the COVID-19 pandemic. Little is known about how GPs manage acute infections during telehealth, and the potential impact on antimicrobial stewardship. To explore the experiences and perceptions of GP trainees' and supervisors' use of telehealth, and how it influences their management of acute infections. Australian GP registrars (trainees) and supervisors were recruited via email through their training organisations. Semi-structured interviews with 18 participants were conducted between July and August 2022. Interviews were transcribed verbatim and analysed using a reflexive thematic approach. We identified six overall themes. 1. Participants experienced impaired diagnostic capacity during telehealth consultations. 2. Attempts to improve diagnostic acuity included various methods, such as having patients self-examine. 3. The management of clinical uncertainty frequently entailed referring patients for in-person assessment, overinvestigating, or overtreating. 4. Antibiotic prescribing decisions during telehealth were informed by less information than were in-person consults, with varying impact. 5. Participants believed that other GPs improperly prescribed antibiotics during telehealth. 6. Supervisors believed that registrars hadn't developed the knowledge or skills to determine when conditions could be managed appropriately via telehealth. Telehealth has potential for reducing transmission of acute infections and increasing access to healthcare. However, the implications of GPs, especially less experienced GPs, making diagnoses with less certainty, and consequently compromising antimicrobial stewardship, are a concern. Patient self-assessment tools may improve outcomes of telehealth consultations for acute infections.