Experiences of GP trainees in undertaking telephone consultations: a mixed-methods study

Abstract

BackgroundPrimary care telephone consultations are increasingly used for patient triage, reviews, and providing clinical information. They are also a key postgraduate training component yet little is known about GP trainees’ preparation for, or experiences and perceptions of, them.AimTo understand the experiences, perceptions, and training of GP trainees in conducting telephone consultations.Design & settingA mixed-methods study was undertaken of North Central and East London (NCEL) GP trainees.MethodA cross-sectional electronic survey of trainees was performed with subsequent semi-structured interviews. Survey data were analysed using descriptive statistics, and qualitative data using thematic analysis.ResultsThe survey response was 16% (n = 100/618), and 10 participated in semi-structured interviews. Trainees felt least confident with complicated telephone consulting, and there was a strong positive correlation between the percentage reporting having received training and their confidence (R2 = 0.71, P<0.0001). Positive experiences included managing workload and convenience. Negative experiences included complex encounters, communication barriers, and absence of examination. Trainees reported that training for telephone consultations needed strengthening, and that recently introduced audio-clinical observation tools (COTs) were useful. Positive correlations were found between the length of out-of-hours (OOH) but not in-hours training and the level of supervision or feedback received for telephone consultations.ConclusionThis project sheds light on GP trainees’ current experiences of telephone consultations and the need to enhance future training. The findings will inform a wider debate among stakeholders and postgraduate learners regarding training for telephone consultations, and potentially for other remote technologies.

Remote Musculoskeletal Consultations: A Survey of General Practitioner Registrars’ Level of Confidence, Acceptability, and Management

“…As the COVID-19 pandemic has continued to spread and expand, clinicians have been doing significantly more remote consultations, and reports have emerged indicating a lack of clinician confidence [ 21 ]. A recent mixed-methods study evaluated the experiences of GP registrars when undertaking telephone consultations and found that "complex encounters" and the "absence of examination" were reported as key drawbacks in remote assessments [ 22 ]. The study concluded that GP registrars required further guidance and training to better prepare them for remote telephone consultations.…”

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“…By constructing the checklists according to the RICE criteria, evidence from the literature supports the validity of teaching this concept [ 9 ]. Research by Eppich et al as well as Chaudhry et al supports the effectiveness of simulation in teaching telephone consultation [ 14 ], [ 16 ].…”

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Gut feeling is changing in the post-coronavirus world

“…Before the pandemic, GP trainees felt there was insufficient training for telephone consultations. 6 While consultation modalities change, telephone consulting training should be fully integrated into in-hours GP rotations rather than be left to out-of-hours training. MRCGP curriculum and assessment changes must occur to assess other consultation modalities, such as audio consultation observation tools (COTs).…”