Configurations for obtaining in-consultation assistance from supervisors in general practice training, and patient-related barriers to trainee help-seeking: a survey study

BMC Medical Education

Neil A. Spike¹  Parker J. Magin²  Mieke L. van Driel³  Nancy J. Sturman³  Kristen FitzGerald⁴  Elizabeth G. Holliday⁵  Amanda Tapley⁶  Alison Fielding⁶  Andrew R. Davey⁶  Jean I. Ball⁷ 

[1] Eastern Victoria GP Training, General Practice Training Organisation, Melbourne, Australia;Department of General Practice Melbourne, The University of Melbourne, Melbourne, VIC, Australia;GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Newcastle, NSW, Australia;The University of Newcastle Hunter Medical Research Institute, Clinical Research Design and Statistical Support Unit (CReDITSS), New Lambton, NSW, Australia;Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, 8th Floor, Health Sciences Building, Royal Brisbane Hospital, Herston, 4006, Brisbane, Australia;School of Medicine, University of Tasmania, Hobart, TAS, Australia;General Practice Training Tasmania (GPTT), Regional Training Organisation, Hobart, TAS, Australia;School of Public Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia;School of Public Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia;GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Newcastle, NSW, Australia;The University of Newcastle Hunter Medical Research Institute, Clinical Research Design and Statistical Support Unit (CReDITSS), New Lambton, NSW, Australia;

关键词: Postgraduate training;    Primary care education;    Clinical supervision;    Help-seeking;    General practice training;   

DOI  :  10.1186/s12909-020-02291-2

来源: Springer

【 摘 要 】

BackgroundGeneral practice (GP) trainees may seek supervisor assistance to complete their patient consultations. This in-consultation assistance plays a key role in the supervisory oversight of trainees and in trainee learning. It may be obtained face-to-face, or using phone or messaging systems, and either in front of patients or outside their hearing. Trainee concerns about decreased patient impressions of their competence, and discomfort presenting patients within their hearing, act as barriers to seeking help during consultations. Little is known about the frequency and associations of trainee concerns about these patient-related barriers, or the various trainee-supervisor-patient configurations used to obtain in-consultation assistance.MethodsAustralian GP trainees rated their frequency of use of five specific configurations for obtaining in-consultation assistance, perceived change in patient impressions of their competence after this assistance, and relative trainee comfort presenting patients outside, compared to within, patients’ hearing. Statistical analyses included descriptive statistics and multivariable logistic regression.ResultsResponses were received from 778 Australian GP trainees (response rate 89%). Help-seeking configurations did not differ between trainees at different training stages, except for greater use of electronic messaging in later stages. In-consultation assistance was most commonly provided by phone between trainee and supervisor consulting rooms, or outside the trainee’s patient’s hearing. Supervisor assistance in the trainee’s room face-to-face with the patient was reported as either never or rarely obtained by 12% of respondents. More trainees (25%) perceived that patient impressions of their competence increased after help-seeking than perceived that these impressions decreased (19%). Most trainees (55%) preferred to present patients outside their hearing. Trainee age was the only variable associated with both patient-related barriers.ConclusionSupervisors appear to have considerable influence over trainee help-seeking, including which configurations are used and trainee perceptions of patient-related barriers. In-consultation supervision may actually increase trainee perceptions of patient impressions of their competence. Many supervisors and trainees may benefit from additional educational and workplace interventions to facilitate comfortable and effective trainee help-seeking in front of patients. More work is required to understand the clinical and educational implications of different help-seeking configurations when trainees require ‘just in time’ supervisor assistance.

【 授权许可】

CC BY