How did the rise of telehealth impact GP registrars?

It was one of the most profound changes to healthcare delivery in Australia in years.
 
With COVID-19 prompting the widespread use of telehealth, more than 90% of general practices had adopted it within months of the pandemic’s arrival.
 
It was estimated that during 2020-21, telehealth accounted for 21% of GP registrar consultations with a majority of these carried out by telephone versus video.
 
Inevitably, there was an impact on the education of GPs in training at the time. A new study by the RACGP’s GP Training Research team offers a clearer insight into what those effects were, and lessons learned.
 
Recently published in Medical Education, the research was based on interviews with 15 registrars, five supervisors and five medical educators.
 
It found telehealth disrupted learning interactions, with registrars finding it difficult to involve supervisors during consultations, and that both registrars and educators were learning how to navigate the challenges of telehealth simultaneously at a time of crisis.
 
‘We found that telehealth altered the usual learning environment for supervisors and registrars in training practices,’ Irena Patsan, the study’s first author and a Senior Research Assistant at the RACGP, told newsGP.
 
‘Rather than seeking supervisory assistance while in-consultation using telehealth, registrars sought supervisory advice post-consultation.’
 
The study found educators were concerned this delay cut the opportunities for immediate feedback.
 
It also found reduced opportunities for in-person clinical education as consultations shifted to simple issues such as repeat prescriptions, certificates and follow-up discussions.
 
Co-author Parker Magin said these are consistent with findings from the ReCEnT project, which showed shorter consultation duration, less frequent recourse to in-consultation supervisory advice or assistance, fewer problems addressed per consultation, and infrequent physical examinations.
 
Ms Patsan added that the lessons are relevant not just in Australia but also in other countries that have rapidly increased their use of telehealth.

‘The rapid uptake of telehealth altered the in-practice social space of registrars’ learning,’ the study authors found.
 
‘As telehealth use continues, these findings highlight the need for telehealth-specific training to maximise registrar learning during consultations.’
 
The study’s senior author, Dr Linda Klein, manager of RACGP’s GP Training Research team, started investigating the issue in 2022 while working with the GP Synergy Research team, the former GP regional training organisation for NSW and ACT.
 
‘Telehealth is a great thing,’ she told newsGP. ‘It opens up options for practices and patients, but it has to be thought through judiciously, especially when you’re training registrars.’
 
She suggested, for example, that for first-year registrars, telehealth ‘may not be the best thing’ and that it could be introduced ‘when they’re more confident and not needing as much in-practice supervision’.
 
Meanwhile, Associate Professor James Brown, RACGP’s Director of Medical Education, said the project ‘demonstrates the importance of practice-focused research during times of disruption’.
 
‘It has provided the insights required to enable effective training to be maintained in the context of a major change to the training environment,’ he told newsGP.
 
‘The fact that it has been published in one of the pre-eminent medical education journals is testament to the importance and quality of this work.’
 
For more information, or to access the full-text article, contact the RACGP GP Training team.
 
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