Older patients' consultations in an apprenticeship model‐based general practice training program: A cross‐sectional study

Bonney, Andrew D; Morgan, Simon; Tapley, Amanda; Henderson, Kim; Holliday, Elizabeth G.; Davey, Andrew K.; Driel, Mieke van; Spike, Neil; Regan, Cathy; Ball, Jean; Magin, Parker

doi:10.1111/ajag.12364

Cited by 10 publications

(12 citation statements)

References 19 publications

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“…Previous ReCEnT analyses suggest GP registrar experiences of interpersonal continuity of care might not be optimal, so regional and rural practice might be valuable in increasing registrars’ in‐training exposure to continuity. Similarly, our previous work has established that registrars have a relative deficit compared to established GPs in experience of older patient care, so our findings showing that registrars practising rurally see a greater proportion of older patients are again valuable in‐training exposure.…”

Section: Discussionsupporting

confidence: 76%

General practice training in regional and rural Australia: A cross‐sectional analysis of the Registrar Clinical Encounters in Training study

Tapley

Davey

Driel

et al. 2020

Australian J Rural Health

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Objective We aimed to investigate registrar, practice and consultation characteristics associated with varying degrees of GP registrars’ practice rurality. Design A cross‐sectional analysis of 12 rounds of data collection (2010‐2015) from the longitudinal Registrar Clinical Encounters in Training study, an ongoing, cohort study of Australian GP registrars. The principal analysis used was a generalised ordered logistic regression. Setting/Participants GP registrars in training practices within five of 17 GP regional training providers in five Australian states. Main outcome measure Degree of rurality of the practice in which the registrar undertook training terms was calculated from the practice postcode using the Australian Standard Classification‐Remoteness Area classification. Results A total of 1161 registrars contributed data for 166 998 patient consultations (response rate 95.5%). Of these, 56.9% were in major city practices (ASGC‐RA1), 25.7% were in inner‐regional practices (ASGC‐RA2) and 17.4% were in outer‐regional/rural practices (ASGC‐RA3‐5). Several statistically significant associations (P = < .001) were found within regional/rural practices (ASGC‐RA2‐5), when compared with major city practices (ASGC‐RA1). These included registrar characteristics such as being in Term 1, being medically trained overseas, and having worked at the practice previously; patient characteristics such as the patient being an existing patient, being older and being Aboriginal or Torres Strait Islander; and consultation characteristics such as performance of procedures. Conclusion Our findings suggest that registrars are undertaking rural practice early in their GP training and are being exposed to a rich and challenging mix of clinical and educational practice.

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Section: Discussionsupporting

confidence: 76%

General practice training in regional and rural Australia: A cross‐sectional analysis of the Registrar Clinical Encounters in Training study

Tapley

Davey

Driel

et al. 2020

Australian J Rural Health

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“…This level of registrar engagement has not always been evident in other ReCEnT analyses. Analyses of continuity of care in registrars’ consultations, and of consultations with older patients and patients with chronic disease, have suggested limited therapeutic engagement in these areas . This analysis’ finding of a non‐significant trend for older patient age being associated with less dietitian/nutritionist referral than middle‐aged patients (despite increasing diet‐related morbidity with age) may reflect a general lack of engagement with the management of older patients, being evident also in diet‐related aspects of health.…”

Section: Discussionmentioning

confidence: 89%

Referrals to dietitians/nutritionists: A cross‐sectional analysis of Australian GP registrars’ clinical practice

Mulquiney

Tapley

Driel

et al. 2017

Nutrition & Dietetics

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“…Despite the breadth of responsibility, several studies have identified GPs’ current dementia training as inadequate in preparing them for the timely diagnosis and ongoing management of dementia 5 11 17–19. While GP registrars are exposed to a wide range of patients in their training,20 they have limited exposure to those over 65 years of age and those they do see tend to have less complex medical conditions than those seen by more experienced GPs 21 22. Importantly, poor knowledge of dementia among GPs has been identified as one factor contributing to low rates of dementia diagnosis, delayed diagnoses and poor management outcomes 11.…”

Section: Introductionmentioning

confidence: 99%

Workshops on diagnosis and management of dementia for general practitioners: a pre–post intervention study of dementia knowledge

et al. 2019

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ObjectivesTo assess improvements in dementia knowledge among general practitioner (GP) registrars and supervisors following their participation in dementia workshops.DesignPre–post intervention study.SettingGeneral practice education in Australia.Participants296 GP registrars and 91 GP supervisors.InterventionsRegistrars participated in a 3-hour face-to-face workshop on diagnosing and managing dementia. Supervisors participated in a 2-hour modified version of the workshop designed to support them in teaching registrars.Main outcome measuresThe Dementia Knowledge Assessment Scale (DKAS) was used to assess overall dementia knowledge as well as knowledge on four subscales (causes and characteristics; communication and behaviour; care considerations; risks and health promotion). Changes in mean scores and the proportion of participants obtaining a threshold score (90th percentile score preworkshop) were used as measures of improvement.ResultsFew registrars and supervisors identified previous experience of formal dementia education. At baseline, mean dementia knowledge scores were 36 for registrars and 37 for supervisors of a total score of 50. Both groups had significantly improved overall dementia knowledge following the workshop with a mean score of 43. Improvements in knowledge were observed for all four DKAS subscales. Between preworkshop and postworkshop periods, there was an increase in the proportion of registrars and supervisors obtaining the threshold score for total DKAS as well as the four subscales. A significantly higher proportion of registrars compared with supervisors obtained the threshold score postworkshop in the areas of causes and characteristics and risks and health promotion.ConclusionsPrior to the workshop, no differences in overall dementia knowledge were observed between registrars and supervisors. While knowledge improved in all areas for both groups postworkshop, findings from this study suggest the need to include foundational content such as the causes and characteristics of dementia in educational workshops for both trainee and experienced GPs.

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Older patients' consultations in an apprenticeship model‐based general practice training program: A cross‐sectional study

Abstract: Our results suggest relatively limited GPR exposure to older patients coupled with less complex consultations than expected. Solutions will need to be carefully constructed not only to increase caseloads, but also to address training and supervision concerns.

Cited by 10 publications

References 19 publications

General practice training in regional and rural Australia: A cross‐sectional analysis of the Registrar Clinical Encounters in Training study

General practice training in regional and rural Australia: A cross‐sectional analysis of the Registrar Clinical Encounters in Training study

Referrals to dietitians/nutritionists: A cross‐sectional analysis of Australian GP registrars’ clinical practice

Workshops on diagnosis and management of dementia for general practitioners: a pre–post intervention study of dementia knowledge

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