What should be in an Early Safety Assessment? Lessons from the experts and the RTO experience

In 2021, GPEx, in partnership with Flinders University, GP Synergy, General Practice Training Tasmania and General Practice Training Queensland, conducted research into Early Safety Assessments (ESAs) to understand the level of supervision required for early registrars (GPT1).

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

The aim was to find out what should be included in an ESA and in the process of early flagging of registrars in difficulty, and the acceptability and feasibility of the study’s recommendations. This involved a literature review, environmental scan, a review of documents and ESA data from participating Regional Training Organisations (RTOs), interviews with Directors of Training from participating RTOs, and a Delphi consensus.

The research found that:

  • ESAs vary immensely in those RTOs already using ESAs, both in content and timing.
  • The ESA should include a multiple-choice questionnaire (MCQ), a registrar self-assessment tool, an OSCE-style workshop (though this was not considered feasible), but not a multi-source feedback (MSF).
  • The registrar should be supernumerary for 1-4 weeks (every patient discussed with registrar), and the supervisor should directly observe the registrar consulting for the equivalent of at least one session before week 2.
  • The ESA should end when the registrar is either flagged or found to be ‘safe to practise with the supervisor available the majority of the time’.
  • Barriers include: supervisor engagement, lack of supervisor training, supervisor reluctance to make a judgement, lack of time, geography, IT issues, and bureaucracy.
  • Facilitators were: strong supervisor-registrar relationship, assessment information and training, stable technology, adequate funding for supervisors, flexibility, and a longer time to assess the registrar.

GPEx would like to acknowledge Steering Group members Dr Graham Emblen (GPTQ), Dr Kristen Fitzgerald (GPTT), Prof Parker Magin (GP Synergy), Dr Helen Mullner (GPEx) and Prof Lambert Schuwirth (Prideaux Centre, Flinders University) for their guidance and input into this research.

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