Research Projects

Few general practitioners (GPs) pursue a creer in Aboriginal and Torres Strait Islander health. This research examined factors motivating Australian General Practice Training Program (AGPT) graduates to remain in, or leave, Aboriginal Medical Services (AMSs).

AGPT graduates who remained and left AMSs after placements participated in semi-structured interviews across two studies.

The research concluded that factors influencing career decisions of GPs in Aboriginal health overlap those for GPs in rural and under-served areas. It also highlighted the critical role of training in building a sustainable GP workforce to meet the needs of Indigenous Australian communities.

The research was published by the Australian Journal of Primary Health and the full text may be viewed here.

Burnout and poor wellbeing are at epidemic proportions in the medical profession. Research has focused in particular on the high rates of burnout amongst trainees, with clear evidence that faculty, educators and supervisors have a strong impact on trainees’ wellbeing. However, to date there has been minimal research examining the wellbeing of supervisors. Along with the inherent benefits to supervisors themselves, supporting wellbeing in this group may bolster the wellbeing of successive cohorts of trainees, improve educational outcomes, and enhance the sustainability of the supervisor workforce within the Australian General Practice Training program.

This project, run in partnership with General Practice Training Queensland and the University of Queensland, seeks to remedy this gap in the research by exploring how GP Supervisors understand wellbeing and burnout, what factors affect these, and what individual and organisational strategies might enhance and protect GP supervisors’ wellbeing.

Interviews will be conducted with GP supervisors across two GP training sites. Additionally, focus groups will be conducted with training organisation staff and GP supervisor representatives. These data will help generate conceptual models of GP supervisor burnout and wellbeing, categories of factors that may threaten or support supervisors’ wellbeing, and suggestions for wellbeing strategies for this group.

If you would like more information on this research study, please contact GPEx.

This research project is supported by The Royal Australian College of General Practitioners with funding from the Australian General Practice Training Program: An Australian Government initiative.

Healthy General Practitioners (GPs) are likely to be more sustainable and offer better patient care. However, GP wellbeing continues to raise concerns. GP wellbeing is an RACGP priority. Dr Harry Nespolon flagged GP wellbeing as “a key area of focus” in the RACGP Health of the Nation report (2019). A key strategy in the RACGP Vision for General Practice and a Sustainable Health Care System, launched by Dr Harry Nespolon in 2019 is “improving the work life of health providers”, including a focus on “implementation of systems to address burnout and increase role satisfaction”. This report emphasizes that “Improved satisfaction of GPs will also increase the attractiveness of general practice as a profession, helping to grow and sustain the future general practice workforce.” In 2020 the ‘Every Doctor Every Setting Framework’ brought doctor self-care to the forefront, and all disciplines have been encouraged to implement these recommendations.

There is evidence that if doctors invest time in professionally meaningful work there is an associated decreased risk of burnout. Recent GPEx research found that GP registrars, supervisors and other stakeholders believed that work diversification was associated with burnout prevention. There is little research into what GPs might do in their professional life, and how often, in order to increase their wellbeing. Because GPs are usually time-poor, practical and straightforward strategies to improve well-being are needed that can be implemented across the wide variety of contexts in which GPs practise, in line with the values and interests that motivate doctors to choose to be GPs. Encouraging GPs, for instance, into sub-specialties, FIFO rural and remote work, and working with vulnerable populations is likely to add variety and meaning without risk to continuity of care or workforce pressures.

This project focuses on one practical solution to decreasing burnout in GPs by identifying the relationship between career diversity and wellbeing. We will also explore the extent, the timing, and the enablers and barriers faced by GPs with respect to work diversification. An online survey will be distributed to GPs around Australia with results analysed to understand trends, associations and themes emerging from the data. The results will be shared by with the RACGP community, with practical strategies to improve wellbeing. These results will be important to inform future GP registrar training and GP wellbeing support and career counselling, as well as implications for GP related policy, GP workforce planning and modelling.

The researchers gratefully acknowledge the RACGP Foundation for their support of this project.

View our Building Career Sustainability Through Diversification flyer here.

Primary and secondary prevention models in medicine are population or individual-based interventions to prevent disease with the aim of minimising morbidity and mortality. Secondary prevention involves the screening and detection of early signs of an illness, which, if left unmanaged, would become worse. Screening and early detection is of limited value if abnormalities cannot be promptly and effectively remedied in a cost-efficient manner.

In medical education, early assessment of the registrar is analogous to this secondary prevention model. Safety for the registrar, the patient and the practice, as well as the registrar’s personal well-being and future retention in the work-force are all at stake. Findings form the 2018-198 GPEx led workplace-based assessment (WBA) education research grant indicate that screening for registrars who are in difficulty and early detection of issues that need to be addressed will increase the likelihood of passing exams, but also of ongoing safety and professionalism.

In light of recommendations from the WBA ERG, other regional training organisations (RTOs), including GPEx, have now developed an early safety assessment (ESA) to be undertaken by all GP registrars early in their training. However these have been developed in isolation.

Each RTO however, has developed their ESA in isolation. There is no current audit available describing the content, structure, outcomes, feasibility or acceptability of ESAs within RTOs. There is also no current evidence of what should be included in an ESA or what flagging criteria should be used, important gaps in the evidence. This information is needed to inform the ongoing review and development of ESA content and processes across RTOs, leading to an evidence based, feasible and acceptable system.

Funded by the Australian Government and supported by the Royal Australian College of General Practitioners, this research study aims to improve existing Early Safety Assessment (ESA) content, structure, and flagging procedures. This will be achieved through a mixed methods approach involving a Delphi consensus, interviews with RTO Directors of Training and data analysis of RTO ESA structure, content and flagging protocols as well as flagging prevalence.

GPEx is proud to be partnering with Flinders University, GP Synergy, General Practice Training Tasmania and General Practice Training Queensland in undertaking this research study.

• View the Executive Summary here
• View the Research Report here

Teaching practices and supervisors are critical in the delivery of general practice training in Australia, which is based on an apprenticeship-style model. Recent data from the2019 GPSA National Supervisor Survey indicates that 83% of supervisors are looking for recognition and greater remuneration for supervision in general practice.

The 20% of supervisors who indicated that they were planning to retire in the next five years, cited reasons including frustration with the administrative arrangements and poor financial return, particularly those in smaller practices; suggesting that this may impact the sustainability of our supervisors. In order to address the financial viability of supervision, we must gather evidence to indicate the activities and costs associated with teaching and supervision in general practice.

However, we are also currently in an environment where there are many upcoming changes to the general practice training landscape, which may impact on the requirements placed on practices. With supervisor and practice sustainability already being questioned, it is important for funders to consider how a future model for teaching and supervision in general practice can be developed which is financially viable, and acceptable to registrars, supervisors and practices.

In partnership with the University of Adelaide and GP Supervisors Australia, this project aims to better understand the sustainability of general practitioner supervision in general practice by determining the financial costs and revenue associated with teaching and supervision in general practice.

To address these aims the study will use a quantitative design with three interrelated parts:

• Stakeholder interviews
• Survey of Supervisors
• Cost revenue analysis.

Findings will be triangulated and will inform recommendations.

This research project is supported by The Royal Australian College of General Practitioners with funding from the Australian General Practice Training Program: An Australian Government initiative.

For more information please contact us.

• View the Executive Summary here
• View the Research Report here
• View the Cost of Teaching checklist

GPEx, in association with the Rural Doctors Workforce Agency and with support from General Practice Registrars Australia, is undertaking a study to fill a current gap in the evidence regarding employment disparity for doctors choosing to enter and complete GP training.

General Practitioners (GPs) play a critical role in the accessibility and delivery of health care to the Australian community and are usually the first point of contact within the health care system. As such, Australians rely on the supply of well-trained GPs providing high quality services in their communities. However, there has been a recent decline in the number of pre-vocational doctors applying for a training position under the Australian General Practice Training Program.

One of the reasons regularly cited as contributing to this decline is the employment arrangements that exist for GP Registrars. Junior doctors on commencing GP training lose accrued leave entitlements from their time in the public hospital system and access to parental leave provisions. There are also concerns about major reductions in income during their first year as a GP registrar.

In order to address this, stakeholders have been advocating for the introduction of a ‘single employer model’ for all GP training. It is thought that such a model would improve the attractiveness of General Practice as a career pathway by bringing remuneration and entitlement arrangements more in line with hospital-based Registrars.

While single-employer model pilot programs are already underway, and consultation is progressing to reform GP Training employment arrangements, one of the current barriers is the lack of underpinning evidence. In particular within South Australia, while anecdotally the pay disparity between hospital work and beginning general practice is often cited as a barrier to choosing GP as a specialty, the size of the problem is not quantified. Through a mixed-methods approach including an environmental scan and stakeholder surveys this project aims to fill this gap.

To achieve this goal the project has four aims:

• To better understand and quantify the difference in employment arrangements for registrars who have left the hospital setting and begun in a general practice training setting within South Australia.
• To provide guidance on how long registrars are disadvantaged and by how much.
• To explore and describe the variation in income, benefits and entitlements of registrars in training, and how this differs across settings and stages of training.
• To compare models of salary, benefits and entitlements within GP training with what registrars would commonly be accessing when they leave the hospital system to commence GP training.

View the Executive Summary here

GPEx are supporting Dr Paul Dilena to complete an exploratory research project which seeks to identify the features of high quality general practice learning environments. Results from this qualitative project will be used to inform GPEx programs and feed into the development of a GPEx Practice Quality Framework.

In order to be lifelong learners, it is important that GP registrars identify their learning goals and can track their learning to allow for adequate reflection.

This qualitative study aims to better understand:

• The acceptability, feasibility and utility of a learning checklist tool for registrars;
• How Australian general practice registrars learn within the consultation; and
• How real-time mapping of their learning concerns allows for a more accurate reflection of their educational needs.

Building on existing research around learning plans and their current low utility, the project aims to answer the following research questions through a series of registrar interviews:

• Does tracking learning needs within general practice registrar consultations adequately encourage self-reflection and capture learning gaps?
• Is the concept of real-time electronic tracking of learning feasible and acceptable to registrars, and how easy is it to involve supervisors and medical educators in this process?
• Can electronic learning logs sufficiently identify and monitor learning needs and what is the overall educational impact of such tools?

In 2020, GPEx has been awarded an Education Research Grant by the Royal Australian College of General Practitioners to investigate the acceptability, utility and feasibility of a Patient Encounter Tracking And Learning (PETAL) tool. This project aims to understand:

• How PETAL tools stimulate reflection;
• How useful PETAL tools are for practising GPs; and
• How a PETAL tool can be implemented across different training contexts.

Using GP Explore as the PETAL tool, we will be using a mixed-methods design to address the research aims, sourcing data through interviews and surveys with stakeholders, and analysing registrars’ reflective assessments. The findings of this research may help to improve the quality of PETAL tools for a variety of uses and provide information regarding their implementation and value for other training contexts.

View PETAL summary report here.

This project has drawn together findings from a contextual analysis, focus groups and a survey to better understand the perceptions of rural general practice and general practice in comparison to other specialties, and the factors that influence specialty decision-making for medical students, junior doctors and specialists in training. Triangulation of results across the project showed strong agreement, which assists to strengthen the overall key messages and combat the limitations of individual study parts. The final model of specialty decision-making highlights the important contextual information, experiences and messaging, perceptions and decision-making criteria being used to inform specialty choice. This information can be used to understand why applications to the rural pathway, and general practice training more broadly, are decreasing. Finally, the opportunities presented should be used to generate discussion and inform future strategy.

• View MSDM summary report here
• View MSDM full final report here

GPEx and the University of Adelaide undertook a research project to understand the regional distribution of GPEx graduates within SA. It incorporated the personal and professional factors that may influence a graduate’s future practice location.

View SA Graduate Tracking Study infographic here

GPEx has worked in partnership with WAGPET to drive the replication of this project across a number of RTOs Australia wide, investigating the impact of AGPT on regional GP workforce outcomes.

View combined Graduate Tracking Study infographic here

Aboriginal and Torres Strait Islander peoples face considerable discrepancies in their health and wellbeing compared to non-Indigenous populations. A key strategy for addressing these discrepancies is ensuring a strong healthcare workforce is in place. Despite offering placements in Aboriginal Health Services (AHSs) in the AGPT program to GP registrars, there remains a shortage of GPs in this sector. Understanding the factors that have motivated AGPT graduates to pursue a career in Aboriginal health will help improve recruitment to, and retention of, GPs in AHSs.

This project used qualitative interviews to better understand the experiences of GP registrars who have completed AHS placements. Understanding these experiences provides critical information for developing strategies to promote AHS placements and improve future registrars’ experiences in AHSs.

View summary report here

Since 2018 GPEx have been supporting our Research Support Officer, Shaun Prentice, to complete research into the important area of GP registrar burnout. Shaun is completing a series of interrelated research projects that aim to develop a clearer understanding of the nature of burnout for GP trainees and to determine prevention strategies.

This includes a systematic review and meta-analysis of the international literature examining burnout levels and patterns in postgraduate medical trainees, a hermeneutic literature review examining GP trainees’ wellbeing, interviews and focus groups with registrars, supervisors, medical educators and PTAs to contextualise findings, and surveys examining how burnout relates to occupational resilience.

These projects will help to inform future directions for us to support our registrars’ wellbeing. This work is being completed in partnership with The University of Adelaide. Short reports and links to published articles for completed projects are available below.

• View Burnout Levels and Patterns summary report here
• View Correlates of Burnout summary report here
• View Burnout Levels and Patterns report here (Academic Medicine Journal 2020)
• View Wellbeing Conceptualizations in Family Medicine Trainees: A Hermeneutic Review here
• View A Hermeneutic Literature Review of Family Medicine/General Practice Trainee Wellbeing and Burnout: Summary report here
• View Promoting Wellbeing among Family Medicine Trainees: A Hermeneutic Review of Intervention Mechanisms of Change and their Delivery Methods article here
• View Burnout, wellbeing and how they relate: A qualitative study in general practice trainees article here

Please contact Shaun Prentice for further details about the research and publication.

shaun.prentice@adelaide.edu.au

In late 2018, GPEx was awarded a special Education Research Grant by the Royal Australian College of General Practitioners (RACGP) to design a Workplace-based Assessment (WBA) Framework for use within Australian General Practice Training (AGPT). This Framework was completed in collaboration with, Flinders University, EVGPT, GP Synergy, GPTQ, GPTT, MCCC, NTGPE, RVTS and WAGPET. To inform Framework development a literature review; environmental scan; audit of WBAs used within Australian Regional Training Organisations (RTOs) and the Remote Vocational Training Scheme (RVTS); and a series of mixed method research projects were completed.

The findings from this comprehensive project were used to inform the development of an evidence-based, practical and contextualised WBA Framework, which has been delivered to the RACGP. The four essential elements that together make up the Framework are: WBA tools, the assessor, the trainee and the context.

The Framework provides information that can inform the local planning, delivery and review of effective and efficient workplace-based assessment systems.

• View WBA Framework report here
• View WBA Framework flyer here
• View ‘Identifying the at-risk General Practice trainee: a retrospective cohort meta-analysis of General Practice registrar flagging’ article here
• View Workplace-based assessments in postgraduate medical education: A hermeneutic review here
• Workplace based assessments in postgraduate medical education: A hermeneutic review – Interview with Shaun Prentice and Lambert Schuwirth. Listen here

In 2018 GPEx were awarded Education Research Grant by the Royal Australian College of General Practitioners (RACGP) to develop and validate a tool to measure the strength of the educational alliance between the GP registrar and GP supervisor from the registrar perspective. This project was completed in collaboration with General Practice Supervisors Association, General Practice Training Tasmania and Monash University. The educational alliance can significantly impact on outcomes for registrars, supervisors, practices, Regional Training Organisations, the Colleges and our community.

This research has validated a tool within the Australian GP context to measure the strength of the educational alliance from the registrar perspective (GP-SRMR). The GP-SRMR is complementary to the previously validated tool to measure from the supervisor perspective (GP-SRMS). This project found that both tools can be delivered more efficiently using computer adaptive testing. The GP-SRMR and the GP-SRMS are both available for access online:

• View GP-SRMR here
• View GP-SRMS here
• View Educational Alliance short report here
• View Educational Alliance long report here
• View ‘Adaptation and initial examination of the psychometric properties of the Short Supervisory Relationship Questionnaire (SSRQ) for use with general practice registrars’ article here