Utilisation of in-consultation supervisor assistance in general practice training and personal cost to trainees: a cross-sectional study
Nancy Sturman 1 , Amanda Tapley 2 3 , Elizabeth Holliday 2 , Alison Fielding 2 3 , Andrew Davey 2 3 , Mieke van Driel 1 , Jean Ball 4 , Kristen FitzGerald 5 6 , Neil Spike 7 8 9 , Parker Magin
2 3 *
1 General Practice Clinical Unit, Faculty of Medicine, University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women’s Hospital, Brisbane, Qld 4006, Australia.
2 School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia.
3 NSW and ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia.
4 Clinical Research Design and Statistical Support Unit, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia.
5 School of Medicine, University of Tasmania, Level 1, Medical Science 1, 17 Liverpool Street, Hobart, Tas. 7000, Australia.
6 General Practice Training Tasmania, Regional Training Organisation, Level 3, RACT House, 179 Murray Street, Hobart, Tas. 7000, Australia.
7 Department of General Practice and Primary Health Care, University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia.
8 School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Northways Road, Churchill, Vic. 3842, Australia.
9 Eastern Victoria General Practice Training, Regional Training Organisation, 15 Cato Street, Hawthorn, Vic. 3122, Australia.
Abstract
The aim of the study was to establish whether two previously described barriers to effective in-consultation assistance-seeking by general practice (GP) vocational specialist trainees (ie concern about patient impressions of their competence, and discomfort presenting to supervisors in front of patients) influenced the frequency of trainee in-consultation assistance-seeking from their supervisor.
This was a cross-sectional study nested in the Registrar Clinical Encounters in Clinical Training ongoing cohort study of Australian GP trainees. Trainee participants completed contemporaneous records of 60 consecutive patient consultations, including whether supervisory assistance was sought. Trainees also completed a cross-sectional survey including items eliciting their beliefs about patient impressions and their own discomfort in seeking in-consultation supervisory assistance. These were factors of interest in multivariable logistic regression analyses; the outcome factor in both regression models was the seeking of in-consultation supervisory assistance.
In 2018, 778 trainees (778/876, response rate 89%) completed the cross-sectional survey. No association was found between the odds of in-consultation help-seeking and perceived decrease in patient impressions of trainee competence (OR = 1.09; 95% CI: 0.91, 1.31; P = 0.36) or higher comfort presenting outside patients’ hearing (OR = 0.9; 95% CI: 0.77, 1.05; P = 0.19).
Contrary to expected utility models of help-seeking, trainees may not consider personal discomfort or impression management to be important enough, compared to patient safety and other considerations, to influence decisions regarding in-consultation help-seeking. Clinical supervisors should, nevertheless, consider the potential personal costs to trainees and maintain trainee self-esteem and confidence by providing in-consultation assistance in front of patients as comfortably and effectively as possible.
Keywords: education, family, family practice, general practice, graduate, medical, patient satisfaction, physician‐patient relations, physicians, preceptorship, professional role, ReCRnT.
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