Exploring differences in patient mix in a cohort of GP trainees and their trainers

Abstract

BackgroundDuring specialty training for general practice, trainees acquire the required competencies through work-based learning. Previous small-scale and older studies suggest that the patient mix of general practitioner (GP) trainees differs from that of their trainers: trainees are exposed to more minor illnesses, and fewer chronic diseases and severe conditions, which may influence the development of their competency.Research questionWhat are the differences in the patient mix between trainees and trainers?Methods49 first- and 24 third-year trainees and their trainers (n=114) were included in the study. International Classification of Primary Care (ICPC) contact and diagnosis codes were extracted from electronic patient records over 6 months.ResultsTrainers had double the number of face-to-face consultations, and treble the number of telephone consultations compared with trainees. The trainees' patient mix consisted of significantly more patients with eye diseases, ear diseases, respiratory diseases, skin diseases and minor illnesses compared with their trainers. Trainers encountered significantly more patients with circulatory diseases, psychiatric diseases, metabolic diseases, male genital conditions, social problems, and chronic and oncological diseases. Female trainers and trainees encountered almost twice the number of female conditions compared with their male counterparts, while for male conditions, the opposite was found.DiscussionConsiderable differences between the patient mix of trainers and trainees were found. Specialty trainers and teachers must be aware of areas of low exposure. Trainers should ensure trainees handle more chronic, complex, psychosocial and circulatory conditions.

Investigating the contribution of physician assistants to primary care in England: a mixed-methods study

“…One thousand, one hundred and forty-seven Read code descriptors existed for the presenting problems of the 2086 patients at their index events. Nineteen per cent (n = 213) of these were listed by de Jong et al 96 in their classification of acute or minor problems. The largest grouping was the minor/symptoms category ( Table 18).…”

“…A categorisation of the presenting problems in the index consultation was also assigned to each patient record in order to examine the case mix of the consulting patients. This classification of acute, chronic, minor/symptoms, prevention and processes was an adaptation of that used by de Jong et al, 96 developed by the research team in which the GP in the research team (SdeL) made the final decisions on categorisation and assignment. The method of assignment of a condition category to each patient is presented in Appendix 6.…”

Testing and screening for chlamydia in general practice: a cross‐sectional analysis

“…13 Current Australian guidelines for chlamydia screening in general practice recommend annual testing of all sexually active people aged 15-29 and patients with a recent change in partner or reporting inconsistent condom use. 14 A study of Australian general practitioners (GPs) found that chlamydia testing was occurring in 0.32% of patient encounters overall; however, in an age group most relevant to screening (age [15][16][17][18][19][20][21][22][23][24], tests were being performed in 1.32% of encounters. 15 The same study found that…”

“…The Australian GP registrar cohort fits many of the predictors of greater likelihood of performing a chlamydia test: they are younger, more likely to be female, more likely to have graduated in Australia than overseas, 19 and are more likely to see patients who are new to the practice. 21 GP registrars have also been shown to see a higher proportion of younger patients 22 than their supervisors, and it is in younger patients that chlamydia screening is strongly advocated. It is, however, unknown if GP registrars actually perform regular chlamydia screening.…”

“…[7][8][9] Furthermore, there is evidence that young women are happy to be tested for chlamydia and support annual testing. 10 Australian research is under way to better assess the feasibility, acceptability, efficacy and cost-effectiveness of annual chlamydia testing among [16][17][18][19][20][21][22][23][24][25][26][27][28][29] year olds in the general practice setting. 11 General practice is the cornerstone of Australian primary care 12 and is the optimal setting for chlamydia screening.…”