General Practitioner post-graduate training uses an apprenticeship model combining hands-on practical work experience where registrars are exposed to different contexts and learn how to apply their clinical knowledge and skills to these situations while absorbing the art, craft, and ethics of their vocation.
Supervisors in general practice work with registrars to provide the foundation for broad and deep learning. Registrars learn best in practices with GPs overseeing patient safety while monitoring registrars. The key to absorbing the background knowledge essential to becoming a successful GP is combined with being a GP under supervision with practice in simulation centres.
Hands On GP Development
From a registrar perspective, the training they receive migrates them from ‘knowing that’ to ‘knowing how’. In addition to learning a broad base of primary care, which covers their patients’ life spans, registrars also need to evolve their own identities as GPs, by integrating professional norms with their personal values and characteristics.
In these environments, up-to-date medical knowledge is rounded out with knowledge relevant to primary care. The resulting model sees registrars combining traditional study with in-practice application of skills in different contexts and have up to date medical suction machine equipement on hand. Registrars also to learn how to balance patients’ needs, wishes, and culture with the patient’s medical needs.
How Do Registrars Learn?
General practice supervisors help registrars navigate the messy and uncertain challenges of real-world practice. They assist registrars with tasks of varying complexity, from simple process questions through to complex questions and providing care for patients whose symptoms do not fit a clear diagnosis.
Learning how to treat patients with deference to their social, psychological and cultural context is a challenge for traditional education methods. Supervisors, however, come to know their registrars and are better placed to discuss how their own backgrounds and assumptions transfer into their work in a way that influences registrar’ clinical decisions.
Communities Of Practice
While the supervisor–registrar alliance is foundational to training GPs, research on the educational aspects of learning at work confirmed the importance of an expert ‘community of practice’. Registrars, who learn in practices with non-hierarchical relationships between doctors and staff, which allows knowledge and experiences to be shared effectively, emerge better prepared for the realities of practice.
Observing Role Models At Work
Registrars learn from seeing experienced General Practitioners at work. This period of supervision is the last, most intensive, and most appropriate place to learn the ethics and attitudes of their chosen vocation.
How experienced GPs write notes, interact with staff, discuss patients, and behave day to day all provide learning opportunities. Registrars are learning via observation, and are likely to perpetuate the observed behavior through their careers.
Observing different consulting styles is standard practice in other countries and could be used more in Australia. In particular, international medical graduates new to Australian general practice environments will gain from observing experienced GPs’ scope of practice and skills.
Coaching and Reflection
Coaching is a specific process of direct instruction. Experienced GPs may need to consciously deconstruct and clearly articulate skills that have become automatic. Supervisors assist registrars in reflecting on their learning by discussing cases in structured teaching sessions and via ad hoc teaching between or during consultations.
Creating A Welcoming Learning Environment
A thorough orientation is a sound investment of time that kick-starts the educational alliance process. Providing registrars with additional time to learn the practice’s computer and local referral systems, practice protocols, and become familiar with local team members increases their confidence and boosts their productivity later on.
Orientation also allows the local GPs and their team to become familiar with the registrars, their backgrounds, experience, and learning requirements. This creates a tailored learning environment for registrars, who in turn contribute their skills to the practice.
Protecting registrars from the pressure of initially seeing too many patients is important for their confidence and education. Even relatively senior registrars need time to adapt to a new practice, especially if switching from or to an Aboriginal and Torres Strait Islander health service. Later on, increasing consultation rates provides valuable preparation for vocational examinations and clinical work post-qualification.
Accessible, Approachable Support
Registrars consistently report the importance of having accessible, approachable, and expert GPs as their supervisors. Registrars have to be confident their supervisors will welcome and respond to their questions. They frequently look for reassurance as they adapt to the isolation of general practice. Registrars also appreciate a safe, blame-free environment.