Medicine

Revitalising Australia’s Apprenticeship Learning Model For GP Registrars

While the emerging promise of the Healthcare Internet of Things (IoT) has been dazzling venture capitalists, care providers, and Healthcare administrators, the General Practitioner (GP) remains the bedrock of Australia’s healthcare system.

Recently, a team of researchers comprising of Susan M Wearne (BM, PhD, MMedSc, a Senior Medical Adviser, with the Department of Health, and the Central Clinic in Alice Springs), Louise Butler (BMedSc, MBBS (Hons), the Central Clinic in Alice Springs’ General Practice Supervisor) and Jeremy A Jones (BEng (Software)(Hons), a General Practice Registrar, at the Central Clinic in Alice Springs) revisited Australia’s General Practitioner post-graduate training to assess how relevant Australia’s apprenticeship model was in today’s GP environment.

The research team discovered that the traditional registrars training model combining hands-on practical work experience in different contexts continued to provide high-quality training, particularly in regional Australia. Regional GP registrars were typically called on to apply their clinical knowledge and skills to a host of different situations while absorbing the finer art, craft skills, and ethical frameworks of their profession.

Rural and Remote GP Practices

While emerging medical technology is evolving rapidly and promises major changes in the way extended care is delivered, the focus for primary care in regional and remote areas remains largely unchanged in terms of its diversity and demands on flexibility, self-sufficiency, and wide general knowledge.

In rural areas, general practice frequently involves on-call availability for hospital duties and emergency care. Supervisory issues can be problematic where registrars are fully qualified in their procedural skills but require supervision for office-based duties. The research team found that supervisory expectations in situations where registrars are on call, often require careful management given the typical disconnect between employing registrars as part of the workforce and giving registrars learning opportunities.

One major finding was the psychosocial and cultural challenges faced by registrars working in remote practice. Here, registrars have to adjust to living and working in isolated environments, where they may not understand or share their patient’s cultural attitudes to healthcare.

Subsequently, the team found having cultural mentors provide support was crucial for registrars working in remote Aboriginal and Torres Strait Islander communities and the team strongly recommended all registrars entering those environments be encouraged to promote a culturally observant practice.

Hands On GP Development

Based on extensive interviews with registrars, the research found from a registrar’s perspective, that the hands-on training they receive migrated them from a ‘knowing that’ phase to a ‘knowing how’ state. In addition to learning a broad base of primary care skills, registrars also pointed out the need to evolve their own identities as GPs, by integrating professional norms with their personal beliefs and value systems.

In these care environments, contemporary medical knowledge is rounded out with contextual knowledge to their role in delivering primary care. The resulting model sees registrars combining traditional education with the application of their skills in disparate practice-based contexts. Registrars also pointed to learning how to juggle their patient’s needs, wishes, and cultural beliefs with the patient’s medical needs as one of the major advantages of Australia’s apprenticeship model for GP registrars.

How Do Registrars Learn?

The research team highlighted the GP supervisor’s ability to help registrars steer between the messy and uncertain challenges of real-world practice as being one of the key determinants of registrar learning. Supervisors routinely assist registrars with a spectrum of tasks of diverse complexity, ranging from simple process issues to complex cases, through to providing care for patients whose symptoms defy a clear diagnosis.

Learning how to treat patients with deference to their social, cultural and psychological context is often cited as a challenge for traditional education methods. Supervisors, however, overcome many of these formal limitations through the opportunity to become personally acquainted with their registrars and as the study found, are better placed to discuss how their own cultural framework informs their work in a way that influences a registrar’s clinical decisions.

Summary

The study conclusively found that Australia’s apprenticeship-style learning model for prospective GPs is fundamental to creating the next generation of GPs. Five key learning’s from the paper are:

  1. One-on-one coaching is highly effective as a means of transferring knowledge and experience to aspiring GPs
  2. Hands-on learning is essential for young GP registrars with GP supervisors providing a patient safety net
  3. A 360 degrees community of practice coaching model provided by the GP team is core to bringing GP registrars up to speed on non-medical practice-related issues
  4. All GP staff should feel comfortable in influencing registrars to develop good practice
  5. Cultural understanding and affinity are a key part of being a successful GP in rural and remote areas
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