Identifying the at-risk General Practice trainee: a retrospective cohort meta-analysis of General Practice registrar flagging

Prentice, Shaun; Kirkpatrick, Emily; Schuwirth, Lambert; Benson, Jill

doi:10.1007/s10459-021-10031-4

Cited by 5 publications

(6 citation statements)

References 25 publications

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“…19,20 There remains an urgent need to destigmatise supportseeking in the medical profession through raising awareness of the effectiveness of psychological and (particularly for trainees) educational interventions. 30,31 The present findings must be considered in light of certain factors that may influence their transferability. First, participants were recruited from one RTO, potentially limiting the breadth of strategies suggested.…”

Section: Discussionmentioning

confidence: 89%

A qualitative exploration of burnout prevention and reduction strategies for general practice registrars

Prentice

Elliott²,

Dorstyn

et al. 2022

Aust J Gen Pract

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Background and objectiveBurnout interventions for trainee doctors have typically overlooked specialty-specific factors as well as presumed centralised training models. The aim of this study was to explore stakeholders' views of burnout interventions within Australian general practice training, where both factors are pertinent. MethodsForty-seven trainees, supervisors, medical educators and program coordinators from a regional training organisation participated in interviews and focus groups. Template analysis, informed by grounded theory, was used. ResultsStrategies were identified for registrars (eg prioritising replenishing activities), practices (eg providing psychological supports), training organisations (eg engaging with trainees) and the medical system (eg destigmatising poor wellbeing). Ineffective strategies (eg tokenistic interventions) were also highlighted, albeit to a lesser extent.

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Section: Discussionmentioning

confidence: 89%

A qualitative exploration of burnout prevention and reduction strategies for general practice registrars

Prentice

Elliott²,

Dorstyn

et al. 2022

Aust J Gen Pract

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“…Personal factors are more likely to require remediation when learners are older [ 102 , 117 , 118 ], had reported character failings [ 119 ], required remediation in the past [ 120 ], learners who required more time to complete medical school [ 121 ], had more re-examinations in the past [ 121 ] and previous lapses in professionalism in medical school [ 92 ].…”

Section: Resultsmentioning

confidence: 99%

“…Objective methods of identifying lapses in patient care and gaps in procedural skills include regular in-training assessments [ 64 , 65 , 95 , 110 , 115 , 128 , 130 , 133 , 135 , 136 ], simulations [ 18 , 78 ], OSCEs [ 70 , 96 , 137 , 138 ], failure to achieve EPAs [ 72 ]. These findings should be considered with supervisory or clinical evaluations [ 62 , 65 , 120 ], self-assessments [ 128 ], and activity logs [ 137 ]. Interpersonal and Communication Skills …”

Section: Resultsmentioning

confidence: 99%

“…The need for remediation in a physician’s interpersonal and communication skills may be identified through in-training evaluations [ 137 ], OSCEs or oral examinations [ 137 ], simulated patients (SP) interactions [ 74 , 84 ], team feedback and self-referrals [ 84 ]. Greater information may be accrued through supervisory or clinical evaluations [ 62 , 65 , 120 ], self-assessments [ 128 ], and activity logs [ 137 ]. Professionalism …”

Section: Resultsmentioning

confidence: 99%

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Post graduate remediation programs in medicine: a scoping review

et al. 2022

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Background Recognizing that physicians may struggle to achieve knowledge, skills, attitudes and or conduct at one or more stages during their training has highlighted the importance of the ‘deliberate practice of improving performance through practising beyond one’s comfort level under guidance’. However, variations in physician, program, contextual and healthcare and educational systems complicate efforts to create a consistent approach to remediation. Balancing the inevitable disparities in approaches and settings with the need for continuity and effective oversight of the remediation process, as well as the context and population specific nature of remediation, this review will scrutinise the remediation of physicians in training to better guide the design, structuring and oversight of new remediation programs. Methods Krishna’s Systematic Evidence Based Approach is adopted to guide this Systematic Scoping Review (SSR in SEBA) to enhance the transparency and reproducibility of this review. A structured search for articles on remediation programs for licenced physicians who have completed their pre-registration postings and who are in training positions published between 1st January 1990 and 31st December 2021 in PubMed, Scopus, ERIC, Google Scholar, PsycINFO, ASSIA, HMIC, DARE and Web of Science databases was carried out. The included articles were concurrently thematically and content analysed using SEBA’s Split Approach. Similarities in the identified themes and categories were combined in the Jigsaw Perspective and compared with the tabulated summaries of included articles in the Funnelling Process to create the domains that will guide discussions. Results The research team retrieved 5512 abstracts, reviewed 304 full-text articles and included 101 articles. The domains identified were characteristics, indications, frameworks, domains, enablers and barriers and unique features of remediation in licenced physicians in training programs. Conclusion Building upon our findings and guided by Hauer et al. approach to remediation and Taylor and Hamdy’s Multi-theories Model, we proffer a theoretically grounded 7-stage evidence-based remediation framework to enhance understanding of remediation in licenced physicians in training programs. We believe this framework can guide program design and reframe remediation’s role as an integral part of training programs and a source of support and professional, academic, research, interprofessional and personal development.

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“…An Early Safety Assessment (ESA) involves assessments undertaken by all General Practice (GP) registrars early in their training and involves assessing a registrar's competency, ensuring that they're practising safely, can self-assess their knowledge and practice limits, and seek help appropriately. It is important to identify registrars as at-risk, or ' agged', to allow for the provision of 'necessary supports or remediation in their development to becoming effective, safe, self-re ective and resilient doctors' (Prentice 2021). Early agging of registrars will identify those who need additional assistance before unsafe gaps or behaviours become embedded or cause harm.…”

Section: Introduction Backgroundmentioning

confidence: 99%

Recommendations for an Early Safety Assessment in General Practice Training

Woods¹,

Pitot²,

Elliot³

et al. 2023

Preprint

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Assessing the safety of new GP registrars is critical for the safety of patients, the registrar themselves and for their practice. The aim of an Early Safety Assessment (ESA) is to assess safety in independent practice, competency in self-assessment, appropriate help-seeking, knowledge and practice. The aim was to explore what should be included in an ESA, and the acceptability and feasibility of recommendations. A literature review, environmental scan, review of documents and ESA data from participating Australian GP Regional Training Organisations (RTOs), interviews with Directors of Training from participating RTOs, and a Delphi consensus were conducted. The study found that ESAs vary, both in content and timing. Recommendations were developed for their utility and feasibility. The ESA should end when the registrar is either flagged or found to be ‘safe to practice with the supervisor available most of the time’. There are barriers that can be addressed and facilitators to be encouraged so an ESA can be successfully implemented.

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Identifying the at-risk General Practice trainee: a retrospective cohort meta-analysis of General Practice registrar flagging

Cited by 5 publications

References 25 publications

A qualitative exploration of burnout prevention and reduction strategies for general practice registrars

A qualitative exploration of burnout prevention and reduction strategies for general practice registrars

Post graduate remediation programs in medicine: a scoping review

Recommendations for an Early Safety Assessment in General Practice Training

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