An exploration of the experiences of GP registrar supervisors in small rural communities: a qualitative study

Abstract

Background: In Australia registrar training to become a general practitioner (GP) involves three to four years of supervised learning with at least 50% of GP registrars training wholly in rural areas. In particular rural over regional GP placements are important for developing future GPs with broader skills because the rural scope of practice is wider. Having enough GP supervisors in smaller rural communities is essential such training. We aimed to explore what makes rural GPs' based outside of major regional centres, participate in supervising or not, their experiences of supervising, and impact of their practice context. Methods: Semi-structured interviews were undertaken with 25 GPs based in rural Tasmania (outside of major regions-Hobart and Launceston), in towns of < 25,000 population, to explore the GPs' professional backgrounds, their experiences of supervising GP registrars, their practice context and their decisions about supervising GP registrars or not. Thematic analysis was undertaken; key ideas, concepts and experiences were identified and then reviewed and further refined to core themes. Results: Supervising was perceived to positively impact on quality of clinical care, reduce busy-ness and improve patient access to primary care. It was energising for GPs working in rural contexts. Rural GPs noted business factors impacted the decision to participate in supervision and the experience of participating: including uncertainty and discontinuity of registrar supply (rotational training systems), registrar competence and generating income. Conclusions: Supervising is strongly positive for rural GPs and related to job satisfaction but increasing supervision capacity in rural areas may depend on better policies to assure continuity of rural registrars as well as policies and systems that enable viable supervision models tailored to the context.

‘The hardest job I’ve ever done’: a qualitative exploration of the factors affecting junior doctors’ mental health and well-being during medical training in Australia

“…There are many reasons for this, some of which were raised in the accounts, such as senior colleagues being time-poor, the structural power imbalance embedded in the training programs, JMOs hearing or observing instances where their peers are treated negatively when they raise mental health problems, and concerns around professional stigma towards mental illness [ 32 ], confidentiality and mandatory reporting. Additionally, senior clinicians are usually the gatekeepers of their future career, for example, in charge of decisions on entry to competitive fellowship programs, so it is not surprising that fear of ramifications for career progression is another barrier for JMOs to disclose mental health issues to their senior counterparts, as noted previously [ 12 , 33 ]. There needs to be systemic change in the medical culture and within training programs so that JMOs can speak openly to senior colleagues, can receive timely help and improve their well-being, without negative impacts on their future careers.…”

“…Previous qualitative studies have investigated the social dimensions of experiences of the workplace and professional practice for medical practitioners, highlighting the process of professional socialisation [ 10 ] and supervision and teamwork [ 11 , 12 ]. Qualitative studies with British and Australian junior doctors have revealed that much of the stress experienced as they transition from being a student to a working doctor is related to managing uncertainty [ 13 , 14 ], developing competence [ 15 ], fear of making mistakes [ 6 ], feeling unsupported by senior colleagues [ 16 ], bullying and traineeship demands of exams and study [ 9 ].…”

Retention of General Practitioners in remote areas of Canada and Australia: A meta‐aggregation of qualitative research

“…37 Becoming a mentor is also valued for its impact on quality of clinical care. 38 Peer support has been identified as a means of alleviating high levels of stress in remote doctors, 37 and GPs without collegiate support are more likely to report work-related distress and to seriously consider leaving rural and remote practice. 26,33 Providing access to continuing professional development addresses the desire of remote doctors to provide quality, up-to-date care for their communities.…”

“…The role of older, experienced colleagues is valuable to remote GPs for providing peer support and mentorship as well as role modelling options and opportunities for career progression 37 . Becoming a mentor is also valued for its impact on quality of clinical care 38 . Peer support has been identified as a means of alleviating high levels of stress in remote doctors, 37 and GPs without collegiate support are more likely to report work‐related distress and to seriously consider leaving rural and remote practice 26,33 .…”

A Framework to Guide the Implementation of Best Practice Clinical Learning Environments in Community General Practice: Australia

“…This gets busier as practices get smaller and community demand increases. In particular, in small rural areas, there are fewer doctors available to support distributed populations over large geographic catchments [ 6 ]. As such, resources for general practice learning need to be both relevant and efficient to use to avoid detracting from business and service demands.…”