Teaching capacity in general practice: results from a survey of practices and supervisors in South Australia

The increase in the number of medical graduates in Australia has been well reported.1 This will place pressures on medical schools, teaching hospitals and vocational training programs to accommodate an increased teaching load, and more community-based teaching may be one solution. However, there are few data about current teaching loads of community general practices in Australia or their ability to expand their teaching within or across training levels.2

We conducted a survey to describe the teaching load of practices involved in undergraduate, prevocational medical training and vocational general practitioner training; the ability of practices to expand their teaching; and the type of supports required to achieve this.

We conducted a questionnaire-based survey of GPs who taught medical students, junior doctors (postgraduate years 1–3) and GP registrars within the region covered by the Adelaide to Outback GP Training Program3 or the Discipline of General Practice at the University of Adelaide, South Australia.

The questionnaire was developed in consultation with a steering group consisting of GP supervisors, universities and support organisations. It covered four areas: attitudes to teaching; current teaching load; capacity to expand; and activities associated with teaching. The questionnaire had two parts: Part 1 sought information about the practice as a teaching environment and Part 2 focused on individual teaching delivered by each GP.

The questionnaire was piloted (six GPs from three practices participated) and revised before formal dispatch, between July and October 2007, to the relevant practices and GPs. Part 1 was sent to the main GP supervisor in each practice and Part 2 to all GPs who taught in the practice. To maximise response rates, two reminders were sent to practices and GPs following the first mail-out.

Ethics approval was provided by the University of Adelaide Human Research Ethics Committee.

Descriptive analysis of the survey results was undertaken using SPSS, version 15.0 (SPSS Inc, Chicago, Ill, USA).

A total of 325 questionnaires were disseminated to GPs in 102 practices in urban, rural and remote SA. Responses were received from 60% of GPs (194/325) and 75% of practices (76/102). The characteristics of participating practices are summarised in Box 1.

Our findings on the reasons GPs teach concur with those of other research where GPs stated that teaching added variety to their week4,5 and was enjoyable,6 although in our study respondents placed greater importance on the exposure of students and junior doctors to general practice.

We also identified the level of teaching occurring in the general practice environment across the medical training continuum, from medical students to GP registrars. Forty-three per cent of the practices surveyed were involved in two or more levels of teaching.

The support provided for practices to undertake teaching was frequently seen as inadequate for medical students and GP training. The payments for junior doctor training were most often rated as adequate (the PGPPP Practice and Teaching support package).

Findings from other research suggest that innovative ways of organising the teaching at medical student level can increase the numbers taught without necessarily requiring additional space.7 It is clear from this study that, within the teaching practices surveyed, there is a capacity to increase the volume of teaching in the short and long term, but with the caveat of additional resource support.

There is a link between teaching level and the measure of capacity to accommodate more teaching. The largest increase in teaching can occur at the medical student level, as the length of placements is usually 1–5 weeks. On the other hand, GP registrars are placed with a practice for 6–12 months. Even so, half of the practices involved in GP training could take on at least another registrar in the short and long term.

The capacity of practices to increase their teaching load is linked to the provision of adequate resources. Differences existed in the priority given to some resources between GPs who could expand their teaching within 6–12 months versus those who could do so in the longer term. However, increased teaching subsidies, more in-practice teaching GPs and extra space or rooms are the top three.

This study shows a high percentage of practices are involved in multiple levels of teaching. Various models of vertical integration of teaching may have the potential to reduce demand on resources. However, more research on the costs and benefits of current and potential teaching models is required.

This study had several limitations. It focused on practices and supervisors already involved in teaching and assessed their capacity to increase teaching. It did not target practices uninvolved in teaching nor investigate what types of support would enable non-teaching practices to change their status. This is worth investigation. The study also represents the views of supervisors in one training region in SA. However, the region included urban, rural and remote teaching practices and also all levels of teaching, so it is likely that similar results would be found elsewhere. Information about training of junior doctors is limited because the opportunity for teaching practices to be involved in this level of teaching is contained by the number of places funded nationally.

The GP response rate for our questionnaire was 60%, which might limit the study’s generalisability. The rate may have been improved by the use of incentives and telephone follow-up. However, it was higher than that found in other recent postal surveys of GPs in Australia.8-11

To our knowledge, this is the first attempt to quantify the types of teaching being undertaken in Australian general practices and the capacity of these practices to increase their teaching load. Scope exists to increase current teaching within general practice, in both the short and long term, but the volume varies depending on which of the training levels the practice is engaged in. Targeted teaching support seems essential if practices are to expand their teaching.