How to thrive in general practice training: A practical guide

This article is part of a series of articles on doctors’ health and wellbeing.

Being a general practitioner (GP) and providing long term care in the community is a privilege. This journey starts with undertaking general practice training, a period with specific stressors and rewards.^1,2 Drawing upon the first two authors’ experience as medical educators in the Australian General Practice Training (AGPT) Program and the wider medical education literature, this article highlights key challenges in general practice training and how registrars can navigate these and make the most of their time in training to effectively prepare for independent practice. These issues are exemplified through case examples. The article concludes with an overview of the support mechanisms provided by The Royal Australian College of General Practitioners (RACGP) to registrars, as well as a list of resources to help registrars thrive during (and beyond) training. The article focuses on registrars in the AGPT setting, although many of the principles discussed have broader applicability.

Discovering what you do not know

As registrars progress from the beginning to the middle of training, the full scope of knowledge needed in general practice becomes apparent (Box 1). This shift towards awareness of one’s knowledge gaps is a recurring theme throughout any medical career,^3,4 but is perhaps most stark and overwhelming in the middle of general practice training. Such threats can contribute to imposter feelings. Knowing that imposterism is common among medical trainees⁵ can lead to a sense of relief when it is normalised. Other strategies for managing the discomfort from discovering all the things you need to learn include journaling (eg keeping a log of positive feedback and achievements), treating yourself with greater kindness (eg reminding yourself that no-one knows everything about medicine), and seeking mentoring to navigate these feelings.⁶

Although confronting, discovering knowledge gaps is a powerful motivator to guide your continued growth. Lifelong learning is essential for GPs, as there will always be presentations that baffle even the most experienced GP, and knowledge grows at breakneck speed.⁷ Viewing these knowledge gaps as opportunities, rather than threats, can help to focus on the action needed to address them.⁸ When encountering presentations that are unfamiliar, it is important to document these as learning points. Some problems will be amenable to solving quickly while consulting, whereas others might necessitate longer-term input from multiple sources, including supervisors or colleagues, and other resources to guide decisions and learning. Indeed, in 11.4% of consultations, registrars seek assistance from their supervisors. This assistance seeking decreases over time.⁹ Purposefully seeking and self-regulating your learning alongside dedicated external assessments is imperative for ongoing professional development during general practice training and beyond.¹⁰ 

Another helpful technique to consider using is discomfort logs. These allow you to consider clinical situations where you feel uncertain and then harness this uncertainty to identify professional development opportunities. Remove the pressure on yourself of expecting to have all the answers, because this is unrealistic in general practice. Instead, having ways to access knowledge ‘just in time’, either during or after a consult, is often necessary. Both AGPT registrars and supervisors have access to electronic Therapeutic Guidelines and the Australian Medicines Handbook through the Trainee Management System to allow for ease of access during the consult. Alternatively, sometimes deferring immediate diagnosis or treatment is necessary to allow time for more diagnostic information to surface.¹¹

Actively seeking knowledge gaps rather than waiting for them to arise in patient consults might also be helpful. Some mechanisms for this include external clinical teaching visits, video recordings of consults, and reviewing the curriculum and syllabus.

Exam preparation

As the end of training nears, registrars often experience exam stress.² This period requires gaining sufficient knowledge, skills and clinical competency, as well as an understanding of the exam structure. Consequently, registrars face the additional load of finding and prioritising the time and energy for exam preparation on top of work and personal commitments (Box 2).

During this period, registrars have very limited time and so must strategically allocate this precious resource. To manage the sheer breadth of topics that could be covered within the exams, you can focus on conditions that you have had little exposure to. Identification of these areas is facilitated by tools such as ReCEnT.¹² Further scaffolds for exam preparation include banks of standardised questions, as well as Medical Educator-led webinars, online modules and exam specific guides. Similarly, using high-quality, evidence-based resources like electronic Therapeutic Guidelines, Australian Journal of General Practice (AJGP), and RACGP-endorsed Australian guidelines¹³ ensures general practice trainees are guided by the best available clinical information. Using these tools and resources will help maximise your likelihood of success.

Just as important as what you study is how you study. Various effective study skills are available to support exam success. You might like to use the ‘snack study’ approach of having short, focused study sessions integrated into your consulting days. Differentiating quality study time from ‘fantasy study time’ (ie passively engaging in the materials without dedicated focus) ensures efficient learning. Diarising and protecting study time and removing distractions such as phones is essential. Physical activity, such as walking while studying, can improve cognitive function and retention of knowledge.¹⁴ Recording and listening to your own notes while being physically active combines active recall with movement, enhancing study.¹⁵ Learning from patient cases and engaging in case-based discussions can enhance clinical reasoning.¹⁶ An added advantage of learning from a patient presentation focus rather than a disease focus is that all cases in the exams are based around clinical vignettes. Study groups allow registrars to distribute the breadth of learning with a group of peers. Teaching peers can aid in knowledge retention, understanding and articulation, while small group learning fosters critical thinking and a deeper understanding of the content. Several exam performance strategies can be used, such as using narratives and audiovisual materials instead of passive reading to improve memory. These can be supported using a variety of revision techniques (eg mnemonics, imagery, spaced repetition and practice testing) rather than continually using the same techniques.^17–19 The RACGP offers a timeline to guide your exam preparation, starting at 12–18 months before the exam, available at (www.racgp.org.au).

Preparing for independent practice

Upon completion of the examinations and training time, registrars can apply for Fellowship. This will prompt many decisions, including choosing a practice to work in, defining your scope of practice, and setting your workload. The vast options available can be overwhelming. Using training as a period of exploration, though, can bring clarity when making these decisions.

A fundamental area of exploration is building awareness of one’s values – what are the things that are important to you? Understanding your values is essential to living in alignment with them, which facilitates a sustainable career. For instance, alignment between an individual’s and workplace’s values has been found to buffer against developing burnout.^20,21 General practice is a broad discipline, lending itself to a variety of positions beyond mainstream clinical work. Diversifying one’s working week to include other roles, such as subspecialty clinics, research, administration or medical education, can promote career sustainability.²² General practice training provides opportunities for exploring these avenues, particularly through extended skills posts (including academic posts) to try different types of work and see what is most fulfilling. Likewise, working in different practices across your training offers an opportunity to see what type of practice environment you are most suited to. Fellows often highlight that firsthand experience of a practice’s culture is critical in their decision- making about which practice they choose to work in after graduating.²³ Thus, although these decisions might seem overwhelming, approaching your training as an opportunity for exploration will yield experiences crucial in guiding your decision- making for the next chapter (Box 3).

Another critical strategy for navigating this aspect is connection with peers. Training represents a unique time for a GP to enjoy opportunities for regular connection with peers at a similar career level, and mentorship and guidance from more experienced GPs through supervisors and medical educators. As you progress to independent practice, having a similar network to provide expertise and alternative perspectives is invaluable. This is particularly true if you can find a mentor.^24,25 Training provides the structures to cultivate such a network, and continuing to invest in this network post-training will help ensure this network thrives and continues to support you throughout your career.

Supports during training 

For registrars who face challenges above and beyond the usual transitions, there are options for additional support through the RACGP training program. A focused learning intervention plan (FLI) enables further supports, such as extra supervisor teaching time or additional external clinical teaching visits tailored to the needs of the registrar (Box 4). If further support is required, a registrar might undertake a remediation term. In this situation, training time is paused, and more extensive supports are placed around the registrar while they continue to work, earn, learn and develop, without the expectation of progression in training before they are ready. These interventions include funding support, as required, and are not punitive in nature. Indeed, registrars who are flagged and given support early in training are more likely to pass their exams than registrars who are not flagged at all.²⁶ This shows that early supports are something to be embraced, representing opportunities to thrive in training.

Conclusion

General practice training is both a demanding and rewarding experience, shaped by a continuous cycle of learning, self-assessment and personal growth. Registrars must balance the pressure of acquiring medical knowledge and skills with the demands of patient care. The support systems provided by supervisors, medical educators and peers is vital in helping registrars build resilience and confidence, particularly through the challenging middle stages and the stress of exams. By prioritising your training, seeking out resources, and maintaining a commitment to professional development, you can navigate the complexities of the general practice pathway with success (Box 5). Ultimately, the transition to independent practice represents an exciting opportunity and a new set of challenges, as newly qualified GPs establish themselves in an ever-evolving healthcare landscape. Supervisors, medical educators and the broader RACGP general practice training team are there to support you in this journey to become the best GP you can be.