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Cserzo D, Bullock A. Longer in primary care: a mixed-methods study of the Welsh GP training model. BJGP Open 2024; 8:BJGPO.2023.0159. [PMID: 37884320 PMCID: PMC11169990 DOI: 10.3399/bjgpo.2023.0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/01/2023] [Accepted: 09/19/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND A new model of GP training was introduced in Wales, whereby trainees spend 1 year in hospital and 2 years in general practice (the 1+2 model), a change from the previous model of 18 months in each setting. AIM To evaluate the 1+2 model of GP training in Wales. DESIGN & SETTING Longitudinal mixed-methods evaluation via repeated surveys and focus groups with GP trainers and trainees across the Welsh training schemes. METHOD Yearly surveys and focus groups were undertaken between June 2020 and December 2022. Quantitative survey data were analysed in SPSS. Qualitative survey data and focus group transcripts were analysed thematically. RESULTS Spending more time in general practice was seen as a major benefit. The consensus was that general practice is the best place to learn essential consultation skills. Furthermore, general practice was viewed as a flexible educational setting where knowledge gaps can be addressed. The main concern about the 1+2 model was that trainees would miss experience of key specialties. However, as trainees progressed through the training programme, this concern diminished. All trainees and most trainers thought that the benefits of the 1+2 model outweighed drawbacks. CONCLUSION Spending more time in general practice during GP training appears to improve how prepared trainees felt for practice. Future changes should explore options to enhance hospital experience without reducing time spent in general practice.
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Affiliation(s)
- Dorottya Cserzo
- Children's Social Care Research and Development Centre, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Alison Bullock
- Cardiff Unit for Research and Evaluation in Medical and Dental Education, School of Social Sciences, Cardiff University, Cardiff, UK
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Russell DJ, Monani D, Martin P, Wakerman J. Addressing the GP vocational training crisis in remote Australia: Lessons from the Northern Territory. Aust J Rural Health 2023; 31:967-978. [PMID: 37607122 DOI: 10.1111/ajr.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/24/2023] [Accepted: 07/30/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE GP vocational training enrolments are declining Australia-wide and, in the Northern Territory (NT), considered by some as '…the litmus test for the national scene' the decline is precipitous. This research investigates the drivers of declining GP training uptake in the NT and identifies and ranks potential solutions. SETTING NT, Australia. PARTICIPANTS Ten senior medical students, 6 junior doctors, 11 GP registrars, 11 GP supervisors and 31 stakeholders. DESIGN Mixed methods: scoping review of Australian literature mapping key concepts to GP training pathway stages and marketing/communications; secondary data analyses; key informant interviews; and a stakeholder validation/prioritisation workshop. Interview data were thematically analysed. Workshop participants received summarised study findings and participated in structured discussions of potential solutions prior to nominating top five strategies in each of five categories. RESULTS Highly prioritised strategies included increasing prevocational training opportunities in primary care and selecting junior doctors interested in rural generalism and long-term NT practice. Also ranked highly were: [Medical School] ensuring adequate infrastructure; [Vocational Training] offering high quality, culturally sensitive, flexible professional and personal support; [General Practice] better remunerating GPs; and [Marketing] ensuring positive aspects such as diversity of experiences and expedited GP career opportunities were promoted. CONCLUSION Multifaceted strategies to increase GP training uptake are needed, which target different stages of GP training. Effective action is likely to require multiple strategies with coordinated action by different jurisdictional and national key stakeholder agencies. Foremost amongst the interventions required is the urgent need to expand primary care training opportunities in NT for prevocational doctors.
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Affiliation(s)
- Deborah Jane Russell
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - Devaki Monani
- Charles Darwin University, Darwin, Northern Territory, Australia
| | - Priya Martin
- Faculty of Medicine, Rural Clinical School, University of Queensland, Brisbane, Queensland, Australia
| | - John Wakerman
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
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Goldfeld S, Tapley A, O'Connor E, Spike N, Morgan S, Freed GL, Davey A, Holliday E, Ball J, Magin P. Prevalence and associated skills of Australian general practice registrars seeing children with functional bowel and bladder problems. J Paediatr Child Health 2023; 59:979-986. [PMID: 37231975 PMCID: PMC10946612 DOI: 10.1111/jpc.16444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/03/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
AIM Functional bowel (constipation and faecal incontinence) and bladder (urinary incontinence and enuresis) problems in children are often treated by paediatricians yet should mostly be managed by general practitioners (GPs). To understand whether the necessary skills and knowledge are being built in general practice, this study aimed to establish the prevalence and associated skills of Australian general practice registrars managing children with functional bowel and bladder problems. Together as paediatricians and GPs, we use these data to determine how best to ensure high quality, equitable care for children. METHODS We drew on 16 rounds of data collection from the Registrar Clinical Encounters in Training (ReCEnT) multi-site cohort study (2010-2017) of general practice registrars' in-consultation experience. It included a measure of paediatric consultations in which a functional bowel or bladder problem was managed, as well as demographic information. RESULTS Out of 62 721 problems/diagnoses for paediatric patients (0-17 years), 844 (1.4%) were coded as functional bowel (n = 709; 1.13% (95% confidence interval, CI: 1.05-1.22)) and/or bladder (n = 135; 0.22% (95% CI: 0.18-0.25)) presentations. Registrars were more likely to prescribe medication for bowel problems (odds ratio (OR) = 2.22 (95% CI: 1.86-2.64)) than for all other problems, but less likely to prescribe medication (OR = 0.31 (95% CI: 0.18-0.52)) for night-time wetting and more likely to make a specialist referral (OR = 1.99 (95% CI: 1.22-3.25)) compared to all other problems. CONCLUSIONS Only a small proportion of children with functional bowel and bladder problems were seen by registrars despite high prevalence in the community and amenability to management in the general practice setting (i.e. generally low morbidity and low complexity) versus need for specialists. Registrars appeared to be managing functional bowel and bladder problems according to evidence-based guidelines, but with relatively high levels of referral. Given the inequitable access to specialist care, paediatricians should support local general practice management of these problems. This might include (i) engaging with training programs to ensure appropriate education and (ii) liaising with individual registrars/practices to provide management advice for individual or example cases.
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Affiliation(s)
- Sharon Goldfeld
- Centre for Community Child Health, Murdoch Children's Research InstituteRoyal Children's HospitalMelbourneVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Amanda Tapley
- NSW and ACT Research and Evaluation UnitGP SynergyNewcastleNew South WalesAustralia
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Elodie O'Connor
- Centre for Community Child Health, Murdoch Children's Research InstituteRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Neil Spike
- Eastern Victoria General Practice TrainingMelbourneVictoriaAustralia
- Department of General PracticeUniversity of MelbourneMelbourneVictoriaAustralia
| | - Simon Morgan
- NSW and ACT Research and Evaluation UnitGP SynergyNewcastleNew South WalesAustralia
| | - Gary L Freed
- Child Health Evaluation and Research CenterUniversity of MichiganAnn ArborMichiganUSA
- Centre for Health Policy, Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Andrew Davey
- NSW and ACT Research and Evaluation UnitGP SynergyNewcastleNew South WalesAustralia
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Elizabeth Holliday
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS)Hunter Medical Research InstituteNewcastleNew South WalesAustralia
| | - Parker Magin
- NSW and ACT Research and Evaluation UnitGP SynergyNewcastleNew South WalesAustralia
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia
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Prentice S, Benson J, Dorstyn D, Elliott T. Promoting Wellbeing among Family Medicine Trainees: A Hermeneutic Review of Intervention Mechanisms of Change and their Delivery Methods. TEACHING AND LEARNING IN MEDICINE 2022:1-12. [PMID: 35465799 DOI: 10.1080/10401334.2022.2048833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
PHENOMENON Efforts to promote wellbeing and reduce burnout amongst postgraduate medical trainees have been hampered by little consideration of interventions' underlying mechanisms, as well as how interventions are delivered. The critical role of trainee specialty has also been overlooked, despite the unique personal and work-based stressors faced among subgroups - such as those completing Family Medicine/General Practice. A consolidation of intervention research can help to guide the design, implementation and evaluation of future targeted programs and potentially enhance their effectiveness. The present hermeneutic literature review addresses this gap. APPROACH The Embase, Ovid Medline, and Ovid PsycINFO databases were searched for articles exploring wellbeing and related concepts of burnout and stress amongst Family Medicine/General Practice trainees. Thirty-one studies were identified through seven iterative rounds, with articles that offered novel insights and/or addressed knowledge gaps identified in each round and analyzed, followed by refinement of the overarching coding structure. Thematic analysis was conducted by two researchers. FINDINGS Proposed and enacted wellbeing interventions typically involved a combination of individualistic (e.g., self-awareness), organizational (e.g., increasing policy flexibility), and cultural (e.g., leadership) strategies. Change mechanisms were interpersonal (e.g., comradery) and, to a greater extent, intrapersonal (e.g., normalizing and accepting feelings of insecurity). Key delivery methods included the need to ingrain trainee wellness into daily work life and the importance of contextualizing interventions to increase their relevance, acceptance, and effectiveness. INSIGHTS The present review identifies and consolidates key mechanisms of change intrinsic to wellbeing-promotion interventions, alongside delivery methods. These findings provide guidance for practice and research to identify these attributes of interventions in the design and evaluation stages. This, in turn, will enhance the clarity of what is being evaluated, facilitating more informed comparisons between evaluations.
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Affiliation(s)
- Shaun Prentice
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Jill Benson
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- GPEx Ltd, Adelaide, South Australia, Australia
| | - Diana Dorstyn
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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Moad D, Tapley A, Fielding A, van Driel ML, Holliday EG, Ball JI, Davey AR, FitzGerald K, Spike NA, Magin P. Socioeconomic status of practice location and Australian GP registrars' training: a cross-sectional analysis. BMC MEDICAL EDUCATION 2022; 22:285. [PMID: 35428305 PMCID: PMC9011937 DOI: 10.1186/s12909-022-03359-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Socioeconomic status (SES) is a major determinant of health. In Australia, areas of socioeconomic disadvantage are characterised by complex health needs and inequity in primary health care provision. General Practice (GP) registrars play an important role in addressing workforce needs, including equitable health care provision in areas of greater socioeconomic disadvantage. We aimed to characterize GP registrars' practice location by level of socioeconomic disadvantage, and establish associations (of registrar, practice, patient characteristics, and registrars' clinical behaviours) with GP registrars training being undertaken in areas of greater socioeconomic disadvantage. METHODS A cross-sectional analysis from the Registrars' Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing, multi-centre, cohort study that documents 60 consecutive consultations by each GP registrar once in each of their three six-monthly training terms. The outcome factor was the practice location's level of socioeconomic disadvantage, defined using the Index of Relative Socio-economic Disadvantage (SEIFA-IRSD). The odds of being in the lowest quintile was compared to the other four quintiles. Independent variables related to the registrar, patient, practice, and consultation. RESULTS A total of 1,736 registrars contributed 241,945 consultations. Significant associations of training being in areas of most disadvantage included: the registrar being full-time, being in training term 1, being in the rural training pathway; patients being Aboriginal or Torres Strait Islander, or from a non-English-speaking background; and measures of continuity of care. CONCLUSIONS Training in areas of greater social disadvantage, as well as addressing community need, may provide GP registrars with richer learning opportunities.
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Affiliation(s)
- Dominica Moad
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Newcastle, NSW Australia
| | - Amanda Tapley
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Newcastle, NSW Australia
| | - Alison Fielding
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Newcastle, NSW Australia
| | - Mieke L. van Driel
- The University of Queensland Faculty of Medicine, Primary Care Clinical Unit, Brisbane, QLD Australia
| | - Elizabeth G. Holliday
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW Australia
| | - Jean I. Ball
- Hunter Medical Research Institute, Clinical Research Design, IT and Statistical Support Unit (CReDITSS), New Lambton, NSW Australia
| | - Andrew R. Davey
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Newcastle, NSW Australia
| | - Kristen FitzGerald
- University of Tasmania, School of Medicine, Hobart, TAS Australia
- General Practice Training Tasmania (GPTT), Regional Training Organisation, Hobart, TAS Australia
| | - Neil A. Spike
- Eastern Victoria General Practice Training (EVGPT), 15 Cato Street, Hawthorn, VIC 3122 Australia
- Monash University, School of Rural Health, Churchill, VIC 3842 Australia
- Department of General Practice, The University of Melbourne, Carlton, VIC 3053 Australia
| | - Parker Magin
- The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW Australia
- GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Newcastle, NSW Australia
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW 2308 Australia
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6
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Ingham G, Johnson C. GP supervisors in Australia: a cornerstone in need of repair. Med J Aust 2022; 216:178-181. [DOI: 10.5694/mja2.51411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/28/2021] [Accepted: 08/04/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | - Caroline Johnson
- Eastern Victoria GP Training Melbourne VIC
- University of Melbourne Melbourne VIC
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7
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Tran M, Wearne S, Tapley A, Fielding A, Davey A, van Driel M, Holliday E, Ball J, FitzGerald K, Spike N, Magin P. Transitions in general practice training: quantifying epidemiological variation in trainees' experiences and clinical behaviours. BMC MEDICAL EDUCATION 2022; 22:124. [PMID: 35197039 PMCID: PMC8867826 DOI: 10.1186/s12909-022-03178-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
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.
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Affiliation(s)
- Michael Tran
- School of Medicine, Western Sydney University, Narellan Road & Gilchrist Drive, Campbelltown, NSW 2560 Australia
| | - Susan Wearne
- Academic Unit of General Practice, Australian National University, The Canberra Hospital, Yamba Drive Garran, Canberra, ACT 2605 Australia
| | - Amanda Tapley
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
| | - Alison Fielding
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
| | - Andrew Davey
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
| | - Mieke van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Level 8, Health Sciences Building, Royal Brisbane & Women’s Hospital, Brisbane, QLD 4029 Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Kristen FitzGerald
- School of Medicine, University of Tasmania, 17 Liverpool Street, TAS 7000 Hobart, Australia
- General Practice Training Tasmania (GPPT), Regional Training Organisation (RTO), Level 3, RACT House, 179 Murray Street, Hobart, TAS 7000 Australia
| | - Neil Spike
- Department of General Practice and Primary Health Care, University of Melbourne, 200 Berkeley Street Carlton, Victoria, 3053 Australia
- Eastern Victoria General Practice Training (EVGPT), Regional Training Organisation (RTO), 15 Cato Street, Hawthorn, VIC 3122 Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, Monash University, Northways Road, Churchill, VIC 3842 Australia
| | - Parker Magin
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
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8
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Magin PJ, Tng ETV. Specialists and generalists in skin disease management: educational, clinical and research imperatives. Br J Dermatol 2022; 186:1-2. [PMID: 34988983 DOI: 10.1111/bjd.20575] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- P J Magin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,NSW & ACT Research and Evaluation Unit, GP Synergy Regional Training Organisation, Mayfield West, NSW, Australia
| | - E T V Tng
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Department of Dermatology, John Hunter Hospital, New Lambton Heights, NSW, Australia
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Willems A, Tapley A, Fielding A, Tng ETV, Holliday EG, van Driel ML, Ball JI, Davey AR, Patsan I, FitzGerald K, Spike NA, Magin PJ. Prevalence and Associations of General Practice Registrars' Management of Atopic Dermatitis: A Cross-Sectional Analysis from the Registrar Clinical Encounters in Training Study. Dermatol Pract Concept 2021; 11:e2021128. [PMID: 34631271 DOI: 10.5826/dpc.1104a128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 10/31/2022] Open
Abstract
Introduction Atopic dermatitis (AD) is a chronic inflammatory condition which imposes substantial burden upon patients and their families. As a frequent primary care presentation, general practice (GP) trainees must develop adequate skills in AD diagnosis and management. Objectives We aimed to explore the prevalence and associations of GP registrars' management of patients with AD. Methods This study used data from the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing cohort study of the clinical and educational experience of Australian GP registrars. Registrar, patient, and consultation factors were independent variables in multivariable logistic regression with outcome factor 'diagnosis/problem being AD'. Results From 2010-2019, 2,783 registrars (96% response rate) provided data from 381,180 consultations. AD was encountered in 0.6% of consults. AD was more likely to be seen in patients aged 0-1 years and patients from a non-English speaking background. AD was less likely to be seen in Aboriginal or Torres Strait Islander patients. Learning goals were more likely to be generated for AD and these consultations were associated with registrars seeking information or assistance. AD was strongly associated with a medication being prescribed, of which the most prescribed medications were mild or moderate potency topical corticosteroids. Conclusions Our findings suggest that, similar to other dermatological presentations, registrars find AD challenging to manage. There may be some gaps in AD management knowledge and application.
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Affiliation(s)
- Anneliese Willems
- Eastern Victoria General Practice Training, Regional Training Organisation, Hawthorn, Victoria, Australia.,University of Melbourne, Department of General Practice and Primary Health Care, Berkeley Street, Carlton, Victoria, Australia
| | - Amanda Tapley
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 Mclntosh Drive, Mayfield West, NSW, Australia
| | - Alison Fielding
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 Mclntosh Drive, Mayfield West, NSW, Australia
| | - Er Tsing Vivian Tng
- Department of Dermatology, John Hunter Hospital, Newcastle, New Lambton Heights, NSW, Australia
| | - Elizabeth G Holliday
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, Australia
| | - Mieke L van Driel
- The University of Queensland Faculty of Medicine, Primary Care Clinical Unit, Faculty of Medicine, Level 8 Health Sciences Building, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Jean I Ball
- Hunter Medical Research Institute, Clinical Research Design, IT and Statistical Support Unit (CReDITSS), New Lambton, NSW, Australia
| | - Andrew R Davey
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 Mclntosh Drive, Mayfield West, NSW, Australia
| | - Irena Patsan
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 Mclntosh Drive, Mayfield West, NSW, Australia
| | - Kristen FitzGerald
- University of Tasmania Tasmanian School of Medicine, Hobart, TAS, Australia.,General Practice Training Tasmania, Regional Training Organisation, Hobart, TAS, Australia
| | - Neil A Spike
- Eastern Victoria General Practice Training, Regional Training Organisation, Hawthorn, Victoria, Australia.,University of Melbourne, Department of General Practice and Primary Health Care, Berkeley Street, Carlton, Victoria, Australia
| | - Parker J Magin
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 Mclntosh Drive, Mayfield West, NSW, Australia
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10
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Malau-Aduli BS, Alele FO, Heggarty P, Reeve C, Teague PA. Key elements of effective postgraduate GP educational environments: a mixed methods study. BMJ Open 2021; 11:e041110. [PMID: 33589449 PMCID: PMC7887342 DOI: 10.1136/bmjopen-2020-041110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Evidence in the literature suggests that satisfaction with postgraduate general practice (GP) training is associated with the quality of the educational environment. This study aimed to examine GP registrars' level of satisfaction with a distributed model of training in a regional educational environment and investigate the relationship between satisfaction and academic performance. STUDY DESIGN A longitudinal 3-year study was conducted among GP registrars at James Cook University using a sequential explanatory mixed methods research design. GP registrars' satisfaction was obtained using the scan of postgraduate educational environment domains tool. A focus group discussion was conducted to explore GP registrars' perceptions of satisfaction with the educational environment. SETTING James Cook University General Practice Training (JCU GPT) programme. PARTICIPANTS Six hundred and fifty one (651) GP registrars enrolled between 2016 and 2018 at JCU GPT programme. RESULTS 651 registrars completed the satisfaction survey between 2016 and 2018. Overall, 92% of the registrars were satisfied with the educational training environment. Registrars who had become fellows reported higher satisfaction levels compared with those who were still in training (mean=4.39 vs 4.20, p=0.001). However, academic performance had no impact on level of satisfaction with the educational environment. Similarly, practice location did not influence registrars' satisfaction rates. Four themes (rich rural/remote educational environment, supportive learning environment, readiness to continue with rural practice and practice culture) emerged from the thematic data analysis. CONCLUSION A clinical learning environment that focuses on and supports individual learning needs is vital for effective postgraduate medical training. This study suggests that JCU GPT programme's distributed model fostered a satisfying and supportive training environment with rich educational experiences that enhance retention of GP registrars in rural/remote North Queensland, Australia. The findings of this study may be applicable to other settings with similar training models.
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Affiliation(s)
- Bunmi S Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Faith O Alele
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Paula Heggarty
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Carole Reeve
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Peta-Ann Teague
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
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11
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McGrail MR, O'Sullivan BG, Russell DJ, Rahman M. Exploring preference for, and uptake of, rural medical internships, a key issue for supporting rural training pathways. BMC Health Serv Res 2020; 20:930. [PMID: 33032604 PMCID: PMC7543036 DOI: 10.1186/s12913-020-05779-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/30/2020] [Indexed: 11/12/2022] Open
Abstract
Background Improved medical care access for rural populations continues to be a major concern. There remains little published evidence about postgraduate rural pathways of junior doctors, which may have strong implications for a long-term skilled rural workforce. This exploratory study describes and compares preferences for, and uptake of, rural internships by new domestic and international graduates of Victorian medical schools during a period of rural internship position expansion. Methods We used administrative data of all new Victorian medical graduates’ location preference and accepted location of internship positions for 2013–16. Associations between preferred internship location and accepted internship position were explored including by rurality and year. Moreover, data were stratified between ‘domestic graduates’ (Australian and New Zealand citizens or permanent residents) and ‘international graduates’ (temporary residents who graduated from an Australian university). Results Across 2013–16, there were 4562 applicants who filled 3130 internship positions (46% oversubscribed). Domestic graduates filled most (69.7%, 457/656) rural internship positions, but significantly less than metropolitan positions (92.2%, p < 0.001). Only 20.1% (551/2737) included a rural location in their top five preferences, less than for international graduates (34.4%, p < 0.001). A greater proportion of rural compared with metropolitan interns accepted a position not in their top five preferences (36.1% versus 7.4%, p < 0.001). The proportion nominating a rural location in their preference list increased across 2013–2016. Conclusions The preferences for, and uptake of, rural internship positions by domestic graduates is sub-optimal for growing a rural workforce from local graduates. Current actions that have increased the number of rural positions are unlikely to be sufficient as a stand-alone intervention, thus regional areas must rely on international graduates. Strategies are needed to increase the attractiveness of rural internships for domestic students so that more graduates from rural undergraduate medical training are retained rurally. Further research could explore whether the uptake of rural internships is facilitated by aligning these positions with protected opportunities to continue vocational training in regionally-based or metropolitan fellowships. Increased understanding is needed of the factors impacting work location decisions of junior doctors, particularly those with some rural career intent.
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Affiliation(s)
- Matthew R McGrail
- Rural Clinical School, The University of Queensland, Cnr Cambridge & Canning Street, Rockhampton, Queensland, 4700, Australia.
| | - Belinda G O'Sullivan
- School of Rural Health, Monash University, PO BOX 666, Bendigo, Victoria, 3550, Australia.,Rural Clinical School, The University of Queensland, 152 West St, South Toowoomba, Queensland, 4350, Australia
| | - Deborah J Russell
- Menzies School of Health Research, PO BOX 4066, Alice Springs, Northern Territory, 0870, Australia
| | - Muntasirur Rahman
- Rural Clinical School, The University of Queensland, 152 West St, South Toowoomba, Queensland, 4350, Australia
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Ingham G, Plastow K, Kippen R, White N. Closer supervision in Australian general practice training: planning major system change. Aust J Prim Health 2020; 26:184-190. [PMID: 32050081 DOI: 10.1071/py19156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/23/2019] [Indexed: 11/23/2022]
Abstract
Major system change involving closer supervision of trainee GP registrars in Australia is warranted. Change management guidelines recommend involving stakeholders in developing change. The views of those involved in general practice training about current and potential supervisory practice were explored. Semi-structured interviews were conducted with a lead medical educator from nine Australian regions. Focus groups were conducted with GP supervisors and GP registrars. Transcripts from the interviews and focus groups were analysed using conventional content analysis, with themes emerging inductively from the data. The findings were that over 1-3 months, a registrar could progress from their supervisor observing all consultations through to the registrar only calling when they identify the need for help. There is strong support from registrars for this change to closer supervision, but less support from supervisors and educators. Barriers to the proposed change include high clinical demand competing with teaching capacity, inadequate payment for closer supervision and supervisors lacking skills or motivation to have a more active role in registrar supervision. If funding and logistic barriers to change are addressed, a change to a closer level of supervision is possible. A pilot study to further refine the change is indicated.
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Affiliation(s)
- Gerard Ingham
- Murray City Country Coast GP Training, Level 2, 369 Royal Parade, Parkville, Vic. 3052, Australia; and Corresponding author.
| | - Kayty Plastow
- Murray City Country Coast GP Training, Level 2, 369 Royal Parade, Parkville, Vic. 3052, Australia
| | - Rebecca Kippen
- Rural Health, Monash University, 26 Mercy Street, Bendigo, Vic. 3550, Australia
| | - Nicky White
- Murray City Country Coast GP Training, Level 2, 369 Royal Parade, Parkville, Vic. 3052, Australia
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13
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Magin P, Moad D, Tapley A, Holliday L, Davey A, Spike N, FitzGerald K, Kirby C, Bentley M, Turnock A, van Driel ML, Fielding A. New alumni EXperiences of Training and independent Unsupervised Practice (NEXT-UP): protocol for a cross-sectional study of early career general practitioners. BMJ Open 2019; 9:e029585. [PMID: 31152045 PMCID: PMC6549658 DOI: 10.1136/bmjopen-2019-029585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION General 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 of competent independent general practitioners (GPs) but also addresses these workforce issues. This study aims to establish the prevalence and associations of early career (within 2 years of completion of vocational training) GPs' practice characteristics; and also to establish their perceptions of utility of their training in preparing them for independent practice. METHODS AND ANALYSIS This will be a cross-sectional questionnaire study. Participants will be former registrars ('alumni') of three regional training organisations (RTOs) who achieved general practice Fellowship (qualifying them for independent practice) between January 2016 and July 2018 inclusive. The questionnaire data will be linked to data collected as part of the participants' educational programme with the RTOs. Outcomes will include alumni rurality of practice; socioeconomic status of practice; retention within their RTO's geographic footprint; workload; provision of nursing home care, after-hours care and home visits; and involvement in general practice teaching and supervision. Associations of these outcomes will be established with logistic regression. The utility of RTO-provided training versus in-practice training in preparing the early career GP for unsupervised post-Ffellowship practice in particular aspects of practice will be assessed with χ2 tests. ETHICS AND DISSEMINATION Ethics approval is by the University of Newcastle Human Research Ethics Committee, approval numbers H-2018-0333 and H-2009-0323. The findings of this study will be widely disseminated via conference presentations and publication in peer-reviewed journals, educational practice translational workshops and the GP Synergy Research subwebsite.
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Affiliation(s)
- Parker Magin
- Discipline of General Practice, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- NSW and ACT Research and Evaluation Unit, GP Synergy Ltd – Newcastle, Mayfield West, New South Wales, Australia
| | - Dominica Moad
- Discipline of General Practice, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- NSW and ACT Research and Evaluation Unit, GP Synergy Ltd – Newcastle, Mayfield West, New South Wales, Australia
| | - Amanda Tapley
- Discipline of General Practice, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- NSW and ACT Research and Evaluation Unit, GP Synergy Ltd – Newcastle, Mayfield West, New South Wales, Australia
| | - L Holliday
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Andrew Davey
- Discipline of General Practice, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- NSW and ACT Research and Evaluation Unit, GP Synergy Ltd – Newcastle, Mayfield West, New South Wales, Australia
| | - Neil Spike
- Eastern Victoria General Practice Training, Churchill, Victoria, Australia
- Department of General Practice, University of Melbourne, Parkville, Victoria, Australia
| | | | - Catherine Kirby
- Eastern Victoria General Practice Training, Churchill, Victoria, Australia
- School of Rural Health, Monash University, Clayton, Victoria, Australia
| | - Michael Bentley
- General Practice Training Tasmania, Hobart, Tasmania, Australia
| | - Allison Turnock
- Department of Health, Hobart, Tasmania, Australia
- Centre for Rural Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Alison Fielding
- Discipline of General Practice, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- NSW and ACT Research and Evaluation Unit, GP Synergy Ltd – Newcastle, Mayfield West, New South Wales, Australia
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Ingham G, Plastow K, Kippen R, White N. Tell me if there is a problem: safety in early general practice training. EDUCATION FOR PRIMARY CARE 2019; 30:1-8. [PMID: 31130089 DOI: 10.1080/14739879.2019.1610078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/15/2019] [Accepted: 03/27/2019] [Indexed: 10/26/2022]
Abstract
In contrast to other comparable countries, trainees commencing general practice in Australia can see patients without being required to contact their supervisor. To understand how patient safety in early training is managed a qualitative study design using semi-structured interviews was used. A lead medical educator from each of the nine Australian Regional Training Organisations (RTOs) was interviewed. Transcriptions of interviews were analysed to identify themes. RTOs do not mandate a period of direct observation of trainees and the use of safety checklists for supervision is variable and not monitored. The oversight of training practices by RTOs mirrors that of trainees by supervisors. The onus falls on those being supervised to identify the need for assistance. Despite this, lead medical educators still consider the commencement of general practice training to be safe. Other factors found potentially to impact on safety include the variability of training practices and supervision; the complex RTO-practice relationship; quota-driven selection of doctors into general practice; and the negative impact on education of the funding model. Patient safety may be improved by a period of direct observation of potential trainees prior to the commencement of general practice training and the use of checklists to encourage supervision of high risk activities.
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Affiliation(s)
- Gerard Ingham
- a Research , Murray City Country Coast GP Training , Melbourne , Australia
| | - Kayty Plastow
- a Research , Murray City Country Coast GP Training , Melbourne , Australia
| | | | - Nicky White
- a Research , Murray City Country Coast GP Training , Melbourne , Australia
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