Transitions in general practice training: quantifying epidemiological variation in trainees' experiences and clinical behaviours

Michael Tran; Susan Wearne; Amanda Tapley; Alison Fielding; Andrew Davey; Mieke van Driel; Elizabeth Holliday; Jean Ball; Kristen FitzGerald; Neil Spike; Parker Magin

doi:10.1186/s12909-022-03178-0

Transitions in general practice training: quantifying epidemiological variation in trainees' experiences and clinical behaviours

BMC Med Educ. 2022 Feb 23;22(1):124. doi: 10.1186/s12909-022-03178-0.

Authors

Michael Tran¹, Susan Wearne², Amanda Tapley^{3

4}, Alison Fielding^{3

4}, Andrew Davey^{3

4}, Mieke van Driel⁵, Elizabeth Holliday³, Jean Ball⁶, Kristen FitzGerald^{7

8}, Neil Spike^{9

10

11}, Parker Magin^{12

13}

Affiliations

¹ School of Medicine, Western Sydney University, Narellan Road & Gilchrist Drive, Campbelltown, NSW, 2560, Australia.
² Academic Unit of General Practice, Australian National University, The Canberra Hospital, Yamba Drive Garran, Canberra, ACT, 2605, Australia.
³ School of Medicine and Public Health, University of Newcastle, University Drive, NSW, 2308, Callaghan, Newcastle, Australia.
⁴ GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW, 2304, Australia.
⁵ Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Level 8, Health Sciences Building, Royal Brisbane & Women's Hospital, Brisbane, QLD, 4029, Australia.
⁶ Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia.
⁷ School of Medicine, University of Tasmania, 17 Liverpool Street, TAS, 7000, Hobart, Australia.
⁸ General Practice Training Tasmania (GPPT), Regional Training Organisation (RTO), Level 3, RACT House, 179 Murray Street, Hobart, TAS, 7000, Australia.
⁹ Department of General Practice and Primary Health Care, University of Melbourne, 200 Berkeley Street Carlton, Victoria, 3053, Australia.
¹⁰ Eastern Victoria General Practice Training (EVGPT), Regional Training Organisation (RTO), 15 Cato Street, Hawthorn, VIC, 3122, Australia.
¹¹ Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, Monash University, Northways Road, Churchill, VIC, 3842, Australia.
¹² School of Medicine and Public Health, University of Newcastle, University Drive, NSW, 2308, Callaghan, Newcastle, Australia. parker.magin@newcastle.edu.au.
¹³ GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW, 2304, Australia. parker.magin@newcastle.edu.au.

Abstract

Background: General 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.

Methods: A 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.

Results: Two 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.

Conclusion: Differences 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.

Keywords: Change management; Education, Medical, Graduate; Family practice; General practice; In-practice experience; Primary health care; Social theory.

MeSH terms

Australia / epidemiology
Cohort Studies
Cross-Sectional Studies
Family Practice / education
General Practice* / education
General Practitioners* / education
Humans