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

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. © 2022, The Author(s).

Keywords

Author Keywords

change management Family Practice General Practice primary health care in-practice experience Education, Medical, Graduate Social theory

Index Keywords

cross-sectional study human Cross-Sectional Studies Humans Australia education epidemiology general practice general practitioner General Practitioners cohort analysis Family Practice Cohort Studies

Author Affiliations

School of Medicine and Public Health, Callaghan, NSW, Australia, Regional Training Organisation, GP Synergy, Mayfield, NSW, Australia

School of Medicine, Western Sydney University, Penrith, NSW, Australia

Academic Unit of General Practice, The Australian National University, Canberra, ACT, Australia

School of Medicine and Public Health, Callaghan, NSW, Australia

Health Sciences Building, Faculty of Medicine, Brisbane, QLD, Australia

Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute, Australia, Newcastle, NSW, Australia

Tasmanian School of Medicine, Hobart, TS, Australia, Regional Training Organisation, General Practice Training Tasmania, New Town, TS, Australia

General Practice and Primary Health Care Academic Centre, University of Melbourne, Melbourne, VIC, Australia, Regional Training Organisation, Hawthorn, VIC, Australia, Nursing and Health Sciences, Federation University Australia, Ballarat, VIC, Australia

Funding & Acknowledgements

Australian Government

During the data collection period 2010 to 2015, funding of the ReCEnT study was by the participating educational organisations: General Practice Training Valley to Coast, the Victorian Metropolitan Alliance, General Practice Training Tasmania, Tropical Medicine Training, and Adelaide to Outback GP Training Program. These organisations were funded by the Australian Government. From 2016\u20132019, the ReCEnT study was funded by an Australian Government Department of Health Commissioned Research Grant, and supported by GP Synergy, the general practice Regional Training Organization for New South Wales and the Australian Capital Territory. GP Synergy is funded by the Australian Government.

Grant: 105904

During the data collection period 2010 to 2015, funding of the ReCEnT study was by the participating educational organisations: General Practice Training Valley to Coast, the Victorian Metropolitan Alliance, General Practice Training Tasmania, Tropical Medicine Training, and Adelaide to Outback GP Training Program. These organisations were funded by the Australian Government. From 2016\u20132019, the ReCEnT study was funded by an Australian Government Department of Health Commissioned Research Grant, and supported by GP Synergy, the general practice Regional Training Organization for New South Wales and the Australian Capital Territory. GP Synergy is funded by the Australian Government.

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

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