Changes may be needed to facilitate GP registrars’ transition into general practice
Formal training for general practice in Australia began with Commonwealth funding of the Family Medicine Program in 1973.1 Future general practitioners worked in hospital specialties relevant to general practice, and then learned while working as GPs, under supervision, in accredited training practices. Since then, general practice and hospital medicine have changed significantly, but the GP colleges’ requirements for hospital experience ahead of GP training remain. Given the bottleneck in hospital junior doctor training positions, and junior doctors’ concerns that their stressful, demanding workloads are of questionable educational value, it is timely to reconsider the effectiveness of this preparation for general practice.
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- 1. Wilde S. 25 years under the microscope: a history of the RACGP training program 1973–1998. Melbourne: Royal Australian College of General Practitioners; 1998.
- 2. Ash JK, Walters LK, Prideaux DJ, Wilson IG. The context of clinical teaching and learning in Australia. Med J Aust 2012; 196: 475. <MJA full text>
- 3. Schumacher DJ, Slovin SR, Riebschleger MP, et al. Perspective: beyond counting hours: the importance of supervision, professionalism, transitions of care, and workload in residency training. Acad Med 2012; 87: 883-888.
- 4. Detsky AS, Berwick DM. Teaching physicians to care amid chaos. JAMA 2013; 309: 987-988.
- 5. Australian Institute of Health and Welfare. Australia’s hospitals 2014–15 at a glance. Canberra: AIHW; 2016. https://www.aihw.gov.au/reports/hospitals/australias-hospitals-2014-15-at-a-glance/contents/table-of-contents (viewed Dec 2017).
- 6. Morgan S, Henderson K, Tapley A, et al. Problems managed by Australian general practice trainees: results from the ReCenT (Registrar Clinical Encounters in Training) study. Educ Prim Care 2014; 25: 140-148.
- 7. Bowen JL. Educational strategies to promote clinical diagnostic reasoning. N Engl J Med 2006; 355: 2217-2225.
- 8. Trumble SC. The evolution of general practice training in Australia. Med J Aust 2011; 194: S59. <MJA full text>
- 9. Allen J, Gay B, Crebolder H, et al. The European definition of general practice/family medicine 2011. Barcelona: World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians; 2002. http://www.woncaeurope.org/sites/default/files/documents/Definition%203rd%20ed%202011%20with%20revised%20wonca%20tree.pdf (viewed Apr 2017).
- 10. Maarsingh OR, Henry Y, van de Ven PM, Deeg DJ. Continuity of care in primary care and association with survival in older people: a 17-year prospective cohort study. Br J Gen Pract 2016; 66: e531-e539.
- 11. Barker I, Steventon A, Deeny SR. Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data. BMJ 2017; 356: j84.
- 12. Britt HC, Harrison CM, Miller GC, Knox SA. Prevalence and patterns of multimorbidity in Australia. Med J Aust 2008; 189: 72-77. <MJA full text>
- 13. Britt H, Miller GC, Charles J, et al. General practice activity in Australia 2009–10. BEACH: Bettering the Evaluation and Care of Health. Canberra: Australian Institute of Health and Welfare; 2010. https://www.aihw.gov.au/getmedia/ab96aa0b-a070-4026-a57e-bc96d329aae5/12118.pdf.aspx?inline=true (viewed Dec 2017).
- 14. Aldrich R. The apprentice in history. In: Ainley P, Rainbird H, editors. Apprenticeship towards a new paradigm of learning. London: Kogan Page, 1999; pp. 14-25.
- 15. Ajjawi R, Thistlethwaite JE, Aslani P, Cooling NB. What are the perceived learning needs of Australian general practice registrars for quality prescribing? BMC Med Educ 2010; 10: 92.
- 16. Magin P, Morgan S, Wearne S, et al. GP trainees in-consultation information-seeking: associations with human, hard-copy and electronic sources. Fam Pract 2015; 32: 525-532.
- 17. Morgan S, Wearne S, Tapley A, et al. In-consultation information and advice seeking by Australian GP trainees from GP trainers — a cross sectional analysis. Educ Prim Care 2015; 26: 155-165.
- 18. Magin P, Tapley A, Davey A, et al. General practitioner trainees’ in-consultation generation of clinical questions for later answering: prevalence and associations. Fam Pract 2017; 34: 599-605.
- 19. Magin P, Morgan S, Henderson K, et al. Family medicine trainees’ clinical experience of chronic disease during training: a cross-sectional analysis from the registrars’ clinical encounters in training study. BMC Med Educ 2014; 14: 260.
- 20. Whiting G, Magin P, Morgan S, et al. General practice trainees’ clinical experience of dermatology indicates a need for improved education: a cross-sectional analysis from the Registrar Clinical Encounters in Training Study. Australas J Dermatol 2017; 58: e199-e206.
- 21. Morgan S, Tapley A, Henderson KM, et al. Australian general practice trainees’ exposure to ophthalmic problems and implications for training: a cross-sectional analysis. J Prim Health Care 2016; 8: 295-302.
- 22. Freed GL, Morgan S, Tapley A, et al. Referral rates of general practice registrars for behavioural or mental health conditions in children. Aust Fam Physician 2016; 45: 139-142.
- 23. Freed GL, Spike NA, Magin PJ, et al. The paediatric clinical experiences of general practice registrars. Aust Fam Physician 2012; 41: 529-533.
- 24. Royal Australian College of General Practitioners. RACGP 2018 AGPT selection guide. Melbourne: RACGP; 2017. https://www.racgp.org.au/Media-Assets/PDF/RACGP/AGPT/RACGP-2018-AGPT-selection-guide (viewed Jan 2018).
- 25. Department of Health. Rural Junior Doctor Training Innovation Fund [website]. Canberra: Commonwealth of Australia; 2018. http://www.health.gov.au/internet/main/publishing.nsf/content/work-rural-junior-dr-training-fund (viewed Jan 2018).
- 26. O’Dowd A. Significant changes to doctors’ training are needed for future-proof workforce, peers are told. BMJ 2016; 355: i6605.
- 27. Shaw E, Walsh AE, Saucier D, et al. The last C: centred in family medicine. Can Fam Physician 2012; 58: 346-348.
- 28. Family Medicine Maastricht. Basic information [website]. Maastricht: Maastricht University; 2017. http://www.familymedicinemaastricht.nl/what-we-do/specialty-training/basic-info (viewed Jan 2018).
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The ReCEnT study is funded by the Commonwealth Department of Health. We thank Bruce Willett and Nina Kilfoyle for their constructive comments on earlier drafts.
Susan Wearne is Senior Medical Adviser in the Health Workforce Division, Department of Health. Parker Magin is Director of Research and Evaluation for GP Synergy, the regional training organisation for New South Wales and the Australian Capital Territory. Neil Spike is Director of Training for Eastern Victoria GP Training. The views expressed in this article are the authors’ and not necessarily those of their employers.