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Research Letter
In-consultation assistance-seeking by non-vocationally registered doctors pursuing general practice Fellowship
We report on findings from a study conducted with non-vocationally registered doctors pursuing Royal Australia College of General Practitioners (RACGP) Fellowship through the standard stream of the Practice Experience Program (PEP; www.racgp.org.au/education/imgs/fellowship-pathways/fellowship-programs-for-imgs/practice-experience-program). The PEP is an alternative, self-directed pathway for non-vocationally registered doctors, often from overseas countries, who can have had several years of experience in general practice.
The supervisory encounter is important for ensuring safe clinical practice and often takes place as an informal encounter during patient consultations.1 The study sought to establish how often PEP doctors access supervisory in-consultation assistance and compare PEP doctors’ assistance-seeking with that of Australian General Practice Training (AGPT) registrars. Unlike AGPT registrars, who have dedicated supervisors to call on for in-consultation assistance, PEP doctors are not required to have a direct general practitioner (GP) supervisor.2 Although PEP doctors can access informal ‘supervision’ – advice from an experienced GP in the practice – the lack of ‘formal’ supervision raises the question as to whether PEP doctors seek less in-consultation assistance than AGPT registrars.
We used a cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study.3 ReCEnT methodology was adapted to collect comparable PEP participant data. Univariable and multivariable logistic regression analyses were undertaken.
Participants (1013 AGPT registrars, 14 PEP doctors) contributed details of 125,228 problems/diagnoses of which 6.0% (n=7567) (95% confidence interval [CI]: 5.9–6.2%) involved seeking in-consultation supervisory assistance. PEP participants sought assistance in 9.3% (95%CI: 8.1–10.7%) of problems compared with AGPT registrars; Term 1 (9.4% [95%CI: 9.1–9.7%]), Term 2 (5.1% [95%CI: 4.9–5.4%]), Term 3 (2.9% [95%CI: 2.8–3.1%]). Differences in PEP participants’ and AGPT registrars’ in-consultation assistance-seeking were not statistically significant on multivariable analysis (P=0.54, 0.66, 0.24 for PEP compared with Term 1, 2 and 3, respectively).
PEP participants sought assistance at an absolute rate akin to Term 1 AGPT registrars. In-consultation assistance-seeking is more pronounced earlier in the AGPT registrar’s training,4 with a more collegial approach to assistance-seeking assistance as experience develops.5
Although the number of PEP participants in the study was low, the findings suggest that recognising PEP participant need and, hence, providing funded, tailored supervisory support might better prepare non-vocationally registered doctors pursuing RACGP Fellowship through other alternative pathways such as the Fellowship Support Program.
Authors
Michael Bentley BSc, MA, DrPH, Senior Research Assistant, GP Training Research, The Royal Australian College of General Practitioners, Hobart, Tas
Parker Magin PhD, FRACGP, Conjoint Professor, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW; Senior Manager, GP Training Research, The Royal Australian College of General Practitioners, Newcastle, NSW
Irena Patsan BND (Hons), MClinEpid, Conjoint Associate Lecturer, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW; Senior Research Assistant, GP Training Research, The Royal Australian College of General Practitioners, Darwin, NT
Amanda Tapley BBiomedSci (Hons), MMedStat, Conjoint Associate Lecturer, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW; Senior Research Officer and Statistician, GP Training Research, The Royal Australian College of General Practitioners, Newcastle, NSW
Annabelle Wood BN, MHEcon, MD, FRACGP, Medical Educator FSP, Medical Education, The Royal Australian College of General Practitioners, Dubbo, NSW
Mieke van Driel MD, MSc, PhD, FRACGP, Emeritus Professor of General Practice, The University of Queensland, Faculty of Medicine, General Practice Clinical Unit, Brisbane, Qld
Andrew Davey BSc, BE (Hons), DCH, BMed, MClinEpid, FRACGP, Conjoint Lecturer, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW; Senior GP Researcher, GP Training Research, The Royal Australian College of General Practitioners, Newcastle, NSW
Elizabeth G Holliday BSc (Hons), MSc, PhD, Professor of Biostatistics, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW
Jason Dizon BMath/BCompSc, MMedStats, Statistician, Hunter Medical Research Institute, Clinical Research Design and Statistical Support Unit, Newcastle, NSW
Ben Mundy BPsych (Hons), Research Assistant, GP Training Research, The Royal Australian College of General Practitioners, Newcastle, NSW
Alison Fielding BND (Hons), PhD, Conjoint Lecturer, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW; Research Manager, GP Training Research, The Royal Australian College of General Practitioners, Newcastle, NSW
Competing interests: None.
Funding: The study was supported by a 2021 RACGP Education Research Grant (ERG 2021-016; www.racgp.org.au/education/research-grants-and-programs/research-grants-and-programs/education-research-grants-1/education-research-grants-past-recipients).
The ReCEnT project was funded during the period of data collection reported here by GP Synergy, with assistance from Eastern Victoria GP Training and General Practice Training Tasmania. These Regional Training Organisations were funded by the Australian Government.
References
- Morrison J, Clement T, Nestel D, Brown J. Perceptions of ad hoc supervision encounters in general practice training: A qualitative interview-based study. Aust Fam Physician 2015;44(12):926–32.
- Ingham G, Johnson C. GP supervisors in Australia: A cornerstone in need of repair. Med J Aust 2022;216(4):178–81. doi: 10.5694/mja2.51411.
- Davey A, Tapley A, van Driel M, et al. The Registrar Clinical Encounters in Training (ReCEnT) cohort study: Updated protocol. BMC Prim Care 2022;23(1):328. doi: 10.1186/s12875-022-01920-7.
- Tran M, Wearne S, Tapley A, et al. Transitions in general practice training: Quantifying epidemiological variation in trainees’ experiences and clinical behaviours. BMC Med Educ 2022;22(1):124. doi: 10.1186/s12909-022-03178-0.
- Brown J, Nestel D, Clement T, Goldszmidt M. The supervisory encounter and the senior GP trainee: Managing for, through and with. Med Educ 2018;52(2):192–205. doi: 10.1111/medu.13468.