Volume 52, Issue 5, May 2023

May 2023 correspondence

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In the article about direct observation of general practice registrars, Amarasekera et al1 add insights into this form of training, especially from the registrar perspective.

In addition to what direct observation they receive in their training practices, registrars in the Australian General Practice Training Program also undertake five external clinical teaching (ECT) visits. The visitor may be a medical educator or a general practitioner working casually as an ECT visitor and is often unknown to the registrar. Typically, the visits consist of three hours of observed consulting, with time in between consultations for discussion, as well as the visitor having a discussion with the supervisor and writing a report for the training organisation.

Although it is sometimes difficult to gauge how helpful these visits are, anecdotally, most registrars and visitors think that they are of enormous value. This paper paves the way for further research on their value in registrar learning.

In recent times, I have undertaken ECT visits with several excellent third-term registrars working in what appeared to be excellent teaching practices. They all considered that they derived great benefit from direct observation and expressed a desire for more of it. At a time in their training when mandated teaching time is diminishing, this may be difficult to achieve.

I believe that direct observation has a place in helping to evolve and refine registrars at all stages of training, and is not only useful in the early days to help develop consultation skills and answer the question, ‘are they safe in there?’


Murry Ludington MB, BS, FRACGP, MRCGP, DA(UK), DRCOG, External Clinical Teaching Visitor, The Royal Australian College of General Practitioners, East Melbourne, Vic

  1. Amarasekera N, Garth B, Trumble S. The only chance for a ‘bird’s-eye view’: General practice registrar experiences of direct observation. Aust J Gen Pract 2022;51(11):903–10. doi: 10.31128/AJGP-12-21-6271.


We would like to thank the reader for their response and insightful comments on general practice registrar perspectives on direct observation.

We agree with the reader that direct observation is helpful at all levels of training and not only in the early days. In the early part of training, it can be helpful in assessing safety and learning consultation and communication skills.1 In later stages of training, direct observation either by the supervisor or a visiting educator can be helpful in refining consultation skills.

Similarly, bidirectional observation (observing the supervisor) also can be useful.2

As most of the registrars in our study (n=5) were in their second training term in general practice, this possibly skewed the results, with a focus on the earlier terms than the latter terms.

In addition to the usefulness of direct observation for registrars in the latter part of training, direct observation can be helpful for qualified GPs as a part of continuing professional development (CPD). In the UK, for revalidation (similar to reaccreditation/continuing CPD), feedback from a college is required as a part of the Royal College of General Practitioners’ appraisal requirement, which is mostly conducted through direct observation.3

We thank reader for their comments, and acknowledge that we are in agreement with their statement about direct observation as a useful tool at all stages of training


Niroshe Amarasekera FRACGP, MBBS BSc(Med), MClin Ed, DRANZCOG, DCH, National Lead Medical Educator - Practice and Supervisor Accreditation, The Royal Australian College of General Practitioners, East Melbourne, Vic; General Practitioner, Carnegie Medical Centre, Carnegie, Vic

Belinda Garth PhD, BHSc(Hons), Research Fellow, Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Vic; Adjunct Senior Lecturer, School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Churchill, Vic

Stephen Trumble MBBS, MD, FRACGP, Head of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Vic

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  1. Ingham G, Plastow K, Kippen R, White N. Tell me if there is a problem: Safety in early general practice training. Educ Prim Care 2019:1-8. doi: 10.1080/14739879.2019.1610078. Search PubMed
  2. Longman C, Temple-Smith M. General practice registrar observation of their supervisors in consultation - What is the educational value? Aust Fam Physician 2013;42(6):418–21. Search PubMed
  3. Royal College of General Practitioners. Guide to your appraisal. 2022. Available at [Accessed 13 April 2023]. Search PubMed

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