Trainees gain reasonably broad exposure overall in terms of patient demographics and problems managed. In comparison to established GPs, trainees managed the same mean number of problems, but the nature of problems managed was different, with more new patients, more new problems and less chronic disease. Our findings have significant implications for GP training in Australia.

Continuity of care is a defining characteristic of general practice. Practice structures may limit continuity of care experience for general practice registrars (trainees). This study sought to establish prevalence and associations of registrars' continuity of care. We performed an analysis of an ongoing cohort study of Australian registrars' clinical consultations. Primary outcome factors were 'Upstream' continuity (having seen the patient prior to the index consultation) and 'Downstream' continuity (follow-up organised post-index consultation). Independent variables were registrar, practice, patient, consultation and educational factors. 400 registrars recorded 48,114 consultations. 43% of patients had seen the registrar pre-index consultation, and 49% had follow-up organised. 'Upstream' continuity associations included registrar seniority, Australian medical qualification, practice billing policy, smaller practice size, registrar's previous training in the practice, chronic disease and older, female patients (but not registrar full-time/part-time status). Associations of 'Downstream' continuity included non-Australian qualification, billing, chronic disease and the patient having seen the registrar previously. Consultations prompting follow-up were more complex: longer duration, involving more problems and generating more learning goals. There was, however, evidence for limited educational utility of this 'continuity'. In our study, continuity of care in Australian registrars' training experience is modest. Associations are complex, but may inform initiatives to increase in-training continuity.

BackgroundA broad case-mix in family physicians’ (general practitioners’, GPs’) vocational trainee experience is deemed essential in producing competent independent practitioners. It is suggested that the patient-mix should include common and significant conditions and be similar to that of established GPs. But the content of contemporary GP trainees’ clinical experience in training is not well-documented. In particular, how well trainees’ experience reflects changing general practice demographics (with an increasing prevalence of chronic disease) is unknown. We aimed to establish levels of trainees’ clinical exposure to chronic disease in training (and associations of this exposure) and to establish content differences in chronic disease consultations (compared to other consultations), and differences in trainees’ actions arising from these consultations.MethodsA cross-sectional analysis from the Registrars’ Clinical Encounters in Training (ReCEnT) study, a cohort study of GP registrars’ (trainees’) consultations in four Australian GP training organisations. Trainees record detailed data from 60 consecutive consultations per six-month training term. Diagnoses/problems encountered are coded using the International Classification of Primary Care-2 PLUS (ICPC-2 PLUS). A classification system derived from ICPC-2 PLUS was used to define diagnoses/problems as chronic/non-chronic disease. The outcome factor for analyses was trainees’ consultations in which chronic disease was encountered. Independent variables were a range of patient, trainee, practice, consultation and educational factors.ResultsOf 48,112 consultations (of 400 individual trainees), 29.5% included chronic disease problems/diagnoses. Associations of a consultation including chronic disease were the patient being older, male, and having consulted the trainee previously, and the practice routinely bulk-billing (not personally charging) patients. Consultations involving a chronic disease lasted longer, dealt with more problems/diagnoses, and were more likely to result in specialist referrals and trainees generating a personal learning goal. They were associated with less pathology tests being ordered.ConclusionsTrainees saw chronic disease less frequently than have established GPs in comparable studies. The longer duration and more frequent generation of learning goals in chronic disease-containing consultations suggest trainees may find these consultations particularly challenging. Our findings may inform the design of measures aimed at increasing the chronic disease component of trainees’ patient-mix.

In this first report of associations of vitamin D testing in the GP setting, we found that non-targeted vitamin D testing (testing inconsistent with current guidelines) is widespread in GP trainees' practice. Adoption of more rational testing approaches is needed.

The ReCEnT patient encounter program provides a rich platform for reflective learning for vocational trainees and supports development of skills in lifelong learning.