Exploring how a patient encounter tracking and learning tool is used within general practice training: a qualitative study
Michael Bentley![https://orcid.org/0000-0003-3016-6194](/media/client/orcid_16x16.png)
![https://orcid.org/0000-0002-5075-6629](/media/client/orcid_16x16.png)
![https://orcid.org/0000-0001-5884-3068](/media/client/orcid_16x16.png)
![https://orcid.org/0000-0002-7547-779X](/media/client/orcid_16x16.png)
![https://orcid.org/0000-0002-2593-6038](/media/client/orcid_16x16.png)
![https://orcid.org/0000-0003-1711-9553](/media/client/orcid_16x16.png)
![https://orcid.org/0000-0001-8071-8749](/media/client/orcid_16x16.png)
![https://orcid.org/0000-0002-2063-1518](/media/client/orcid_16x16.png)
1
2
3
4
Abstract
In Australian general practitioner (GP) training, feedback and reflection on in-practice experience is central to developing GP registrars’ (trainees’) clinical competencies. Patient encounter tracking and learning tools (PETALs) that encompass an audit of consecutive patient consultations, feedback, and reflection are used to determine registrars’ in-practice exposure and have been suggested as a tool for learning within a programmatic assessment framework. However, there is limited qualitative literature on the utility of PETALs in GP training.
To provide greater understanding of how PETALs are used in GP training, using Registrars’ Clinical Encounters in Training (ReCEnT) as a case study.
Medical educators, supervisors, and registrars from two Australian regional GP training organisations participated in focus groups and interviews, designed to explore participants’ perceptions of ReCEnT’s utility. Data were analysed using reflexive thematic analysis.
Eight themes were identified that enhance our understanding of: how ReCEnT reports are used (reassuring registrars, facilitating self-reflection, identifying learning needs), what enables ReCEnT to reach its full potential (a culture of reflection, meaningful discussions with supervisors and medical educators, valuing objective data), and differences in understanding about ReCEnT’s role in a programmatic assessment framework (as a tool for learning, as ‘one piece of the puzzle’).
The findings were used to develop a Structure–Process–Outcomes model to demonstrate how ReCEnT is currently used and explores how it can be used for learning, rather than of learning, in a programmatic assessment framework for GP training. ReCEnT’s longitudinal format has potential for enhancing learning throughout training.
Keywords: clinical practice, general practice registrars, healthcare education, patient encounter data, performance and evaluation, primary healthcare, professional education, programmatic assessment, reflective practice.
References
1 Hays RB, Morgan S. Australian and overseas models of general practice training. Med J Aust 2011; 194(11): S63-S66.
| Crossref | Google Scholar | PubMed |
2 Royal Australian College of General Practitioners. The Clinical Competencies for the CCE. East Melbourne, Vic.: Royal Australian College of General Practitioners; 2021. Available at https://www.racgp.org.au/education/registrars/fracgp-exams/clinical-competency-exam/the-clinical-competencies-for-the-cce/the-clinical-competencies-for-the-cce [Accessed 21 December 2022].
3 Magin P, Morgan S, Henderson K, et al. The Registrars’ Clinical Encounters in Training (ReCEnT) project: educational and research aspects of documenting general practice trainees’ clinical experience. Aust Fam Physician 2015; 44(9): 681-684.
| Crossref | Google Scholar |
4 Morgan S, Henderson K, Tapley A, et al. How we use patient encounter data for reflective learning in family medicine training. Med Teach 2015; 37(10): 897-900.
| Crossref | Google Scholar | PubMed |
5 Wearne SM, Brown JB. General practice education: Context and trends. In: Nestel D, Reedy G, McKenna L, Gough S, editors. Clinical Education for the Health Professions: Theory and Practice. Springer; 2020. pp. 1–20. 10.1007/978-981-13-6106-7_6-1
6 GPEx. Workplace-Based Assessment Framework for General Practice Training and Education. Adelaide, SA: GPEx; 2019. Available at https://www.racgp.org.au/FSDEDEV/media/documents/Education/SGR007-GPEx-Final-WBA-Framework.pdf [Accessed 8 November 2023].
7 Schuwirth LW, van der Vleuten CPM. How ‘testing’ has become ‘programmatic assessment for learning’. Health Prof Educ 2019; 5(3): 177-184.
| Crossref | Google Scholar |
8 van der Vleuten CPM, Schuwirth LWT, Driessen EW, et al. A model for programmatic assessment fit for purpose. Med Teach 2012; 34(3): 205-214.
| Crossref | Google Scholar | PubMed |
9 Lockyer J, Carraccio C, Chan M-K, et al. Core principles of assessment in competency-based medical education. Med Teach 2017; 39(6): 609-616.
| Crossref | Google Scholar | PubMed |
10 Schut S, Maggio LA, Heeneman S, et al. Where the rubber meets the road—An integrative review of programmatic assessment in health care professions education. Perspect Med Educ 2021; 10(1): 6-13.
| Crossref | Google Scholar |
11 Heeneman S, de Jong LH, Dawson LJ, et al. Ottawa 2020 consensus statement for programmatic assessment–1. Agreement on the principles. Med Teach 2021; 43(10): 1139-1148.
| Crossref | Google Scholar | PubMed |
12 Roberts C, Khanna P, Bleasel J, et al. Student perspectives on programmatic assessment in a large medical programme: a critical realist analysis. Med Educ 2022; 56(9): 901-914.
| Crossref | Google Scholar | PubMed |
13 Van Der Vleuten CPM, Schuwirth LWT. Assessing professional competence: from methods to programmes. Med Educ 2005; 39(3): 309-317.
| Crossref | Google Scholar | PubMed |
14 Klein L, Bentley M, Moad D, et al. Perceptions of the effectiveness of using patient encounter data as an education and reflection tool in general practice training. J Prim Health Care Online Early 2023;
| Crossref | Google Scholar |
15 de Jong J, Visser M, Van Dijk N, et al. A systematic review of the relationship between patient mix and learning in work-based clinical settings. A BEME systematic review: BEME Guide No. 24. Med Teach 2013; 35(6): e1181-e1196.
| Crossref | Google Scholar | PubMed |
16 Ivers N, Jamtvedt G, Flottorp S, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database of Syst Rev 2012; 13(6): CD000259.
| Crossref | Google Scholar | PubMed |
17 van Braak M, Visser M, Holtrop M, et al. What motivates general practitioners to change practice behaviour? A qualitative study of audit and feedback group sessions in Dutch general practice. BMJ Open 2019; 9: e025286.
| Crossref | Google Scholar | PubMed |
18 Radloff A, Clarke L, Matthews D. Australian General Practice Training Program: National report on the 2019 National Registrar Survey. Melbourne: Australian Council for Educational Research; 2019. Available at https://www.health.gov.au/sites/default/files/documents/2020/04/agpt-program-national-report-on-the-2019-registrar-satisfaction-survey.pdf [Accessed 21 July 2023].
19 Britt H, Miller G. BEACH program update. Aust Fam Physician 2015; 44(6): 411-414 Available at https://www.racgp.org.au/getattachment/1197ed3f-7a67-48b7-a416-f3dd8fa52f69/BEACH-program-update.aspx.
| Google Scholar | PubMed |
20 Sargeant JM, Mann KV, van der Vleuten CP, et al. Reflection: a link between receiving and using assessment feedback. Adv Health Sci Educ Theory Pract 2009; 14(3): 399-410.
| Crossref | Google Scholar | PubMed |
21 Mann KV. Reflection’s role in learning: increasing engagement and deepening participation. Perspect Med Educ 2016; 5(5): 259-261.
| Crossref | Google Scholar | PubMed |
22 Pelgrim EA, Kramer AW, Mokkink HG, et al. The process of feedback in workplace‐based assessment: organisation, delivery, continuity. Med Educ 2012; 46(6): 604-612.
| Crossref | Google Scholar | PubMed |
23 Davey A, Tapley A, van Driel M, et al. The registrar clinical encounters in training (ReCEnT) cohort study: updated protocol. BMC Prim Care 2022; 23: 328.
| Crossref | Google Scholar | PubMed |
24 Crotty M. Foundations of social research: Meaning and perspective in the research process, 1st edn. London: Routledge; 1998. 10.4324/9781003115700
25 Braun V, Clarke V. One size fits all? What counts as quality practice in (reflexive) thematic analysis. Qual Res Psychol 2021; 18(3): 328-352.
| Crossref | Google Scholar |
26 Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19(6): 349-357.
| Crossref | Google Scholar | PubMed |
28 Donabedian A. Evaluating the quality of medical care. Milbank Q 2005; 83(4): 691-729.
| Crossref | Google Scholar | PubMed |
29 Metusela C, Cochrane N, Van Werven H, et al. Developing indicators and measures of high-quality for Australian general practice. Aust J Prim Health 2022; 28(3): 215-223.
| Crossref | Google Scholar | PubMed |
30 Hays R, Sen Gupta T. Developing a general practice workforce for the future. Aust J Gen Pract 2018; 47(8): 502-505.
| Crossref | Google Scholar | PubMed |
31 de Jong J, Visser MR, Mohrs J, et al. Opening the black box: the patient mix of GP trainees. Br J Gen Pract 2011; 61(591): e650-e657.
| Crossref | Google Scholar | PubMed |
32 Oerlemans M, Dielissen P, Timmerman A, et al. Should we assess clinical performance in single patient encounters or consistent behaviors of clinical performance over a series of encounters? A qualitative exploration of narrative trainee profiles. Med Teach 2017; 39(3): 300-307.
| Crossref | Google Scholar | PubMed |
33 Schellekens LH, Bok HGJ, de Jong LH, et al. A scoping review on the notions of Assessment as Learning (AaL), Assessment for Learning (AfL), and Assessment of Learning (AoL). Stud Educ Eval 2021; 71: 101094.
| Crossref | Google Scholar |
34 Dijksterhuis MG, Schuwirth LW, Braat DD, et al. A qualitative study on trainees’ and supervisors’ perceptions of assessment for learning in postgraduate medical education. Med Teach 2013; 35(8): e1396-e1402.
| Crossref | Google Scholar | PubMed |
35 Winkel AF, Yingling S, Jones A-A, et al. Reflection as a learning tool in graduate medical education: a systematic review. J Grad Med Educ 2017; 9(4): 430-439.
| Crossref | Google Scholar | PubMed |
36 Brehaut JC, Colquhoun HL, Eva KW, et al. Practice feedback interventions: 15 suggestions for optimizing effectiveness. Ann Intern Med 2016; 164(6): 435-441.
| Crossref | Google Scholar | PubMed |
37 Sargeant J, Lockyer J, Mann K, et al. Facilitated reflective performance feedback: developing an evidence-and theory-based model that builds relationship, explores reactions and content, and coaches for performance change (R2C2). Acad Med 2015; 90(12): 1698-1706.
| Crossref | Google Scholar | PubMed |
38 Curtis P, Taylor G, Riley R, et al. Written reflection in assessment and appraisal: GP and GP trainee views. Educ Prim Care 2017; 28(3): 141-149.
| Crossref | Google Scholar | PubMed |
39 de la Croix A, Veen M. The reflective zombie: problematizing the conceptual framework of reflection in medical education. Perspect Med Educ 2018; 7(6): 394-400.
| Crossref | Google Scholar | PubMed |
40 Torre DM, Schuwirth L, Van der Vleuten C. Theoretical considerations on programmatic assessment. Med Teach 2020; 42(2): 213-220.
| Crossref | Google Scholar | PubMed |
41 Bok HG, Teunissen PW, Favier RP, et al. Programmatic assessment of competency-based workplace learning: when theory meets practice. BMC Med Educ 2013; 13: 123.
| Crossref | Google Scholar | PubMed |
42 Taylor R, Clarke L, Radloff A. Australian General Practice Training Program: National report on the 2021 National Registrar Survey. Melbourne: Australian Council for Educational Research; 2021. Available at https://www.health.gov.au/sites/default/files/documents/2021/12/agpt-program-national-report-on-the-2021-national-registrar-survey.docx [Accessed 21 July 2023].
43 McKinn S, Bonner C, Jansen J, et al. Recruiting general practitioners as participants for qualitative and experimental primary care studies in Australia. Aust J Prim Health 2015; 21(3): 354-359.
| Crossref | Google Scholar | PubMed |