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Turnock A, Fielding A, Moad D, Blowes A, Tapley A, Davey A, Holliday E, Ball J, Bentley M, FitzGerald K, Kirby C, Spike N, van Driel ML, Magin P. Prevalence and associations of provision of nursing home visits and home visits by early-career specialist general practitioners. Aust J Rural Health 2024. [PMID: 38511481 DOI: 10.1111/ajr.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 02/18/2024] [Accepted: 03/10/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE To establish prevalence and associations of provision of nursing home visits (NHV) and home visits (HV) by early-career specialist GPs. Of particular interest were associations of rurality with performing NHVs and HVs. METHODS A cross-sectional study. DESIGN A questionnaire-based study. SETTING Australian general practice. PARTICIPANTS Early-career specialist GPs, practising in Australia, who attained Fellowship between January 2016 and July 2018, inclusive, having completed GP training in NSW, the ACT, Eastern Victoria or Tasmania. MAIN OUTCOME MEASURES Current provision of NHV and HV. RESULTS NHV were provided by 34% of participants (59% in rural areas) and HV by 41% of participants (60% in rural areas). Remote, rural or regional practice location, as compared to major-city practice, was strongly associated with performing NHV as an early-career specialist GP; multivariable OR 5.87 (95% CI: 2.73, 12.6), p < 0.001, and with the provision of HV; multivariable OR 3.64 (95% CI: 1.63, 8.11), p = 0.002. Rurality of GP training (prior to attaining Fellowship) was significantly univariably associated with providing NHV and with providing HV as an early-career specialist GP. On multivariable analyses, these were no longer statistically significant. CONCLUSION Early-career specialist GPs located in regional/remote areas are more likely than their urban colleagues to provide NHV and HV.
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Affiliation(s)
- Allison Turnock
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Australian Government, Department of Health, Hobart, Tasmania, Australia
| | - Alison Fielding
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- NSW & ACT Research and Evaluation Unit, GP Synergy, Mayfield West, New South Wales, Australia
| | - Dominica Moad
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- NSW & ACT Research and Evaluation Unit, GP Synergy, Mayfield West, New South Wales, Australia
| | - Ashley Blowes
- NSW & ACT Research and Evaluation Unit, GP Synergy, Mayfield West, New South Wales, Australia
| | - Amanda Tapley
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- NSW & ACT Research and Evaluation Unit, GP Synergy, Mayfield West, New South Wales, Australia
| | - Andrew Davey
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- NSW & ACT Research and Evaluation Unit, GP Synergy, Mayfield West, New South Wales, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI), New Lambton Heights, New South Wales, Australia
| | - Michael Bentley
- General Practice Training Tasmania (GPTT), Australian General Practice Training, Hobart, Tasmania, Australia
| | - Kristen FitzGerald
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
- General Practice Training Tasmania (GPTT), Australian General Practice Training, Hobart, Tasmania, Australia
| | - Catherine Kirby
- Eastern Victoria General Practice Training (EVGPT), Australian General Practice Training, Hawthorn, Victoria, Australia
| | - Neil Spike
- Eastern Victoria General Practice Training (EVGPT), Australian General Practice Training, Hawthorn, Victoria, Australia
- School of Rural Health, Monash University, Churchill, Victoria, Australia
- Department of General Practice and Primary Health Care, University of Melbourne, Carlton, Victoria, Australia
| | - Mieke L van Driel
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Parker Magin
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- NSW & ACT Research and Evaluation Unit, GP Synergy, Mayfield West, New South Wales, Australia
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Turnock A, Fielding A, Moad D, Tapley A, Davey A, Holliday E, Ball J, Bentley M, FitzGerald K, Kirby C, Spike N, van Driel ML, Magin P. The prevalence and associations of Australian early-career general practitioners' provision of after-hours care. Aust J Rural Health 2023; 31:906-913. [PMID: 37488936 DOI: 10.1111/ajr.13022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Access to after-hours care (AHC) is an important aspect of general practice service provision. OBJECTIVE To establish the prevalence and associations of early-career GPs' provision of AHC. DESIGN An analysis of data from the New alumni Experiences of Training and independent Unsupervised Practice (NEXT-UP) cross-sectional questionnaire-based study. Participants were early-career GPs (6-month to 2-year post-Fellowship) following the completion of GP vocational training in NSW, the ACT, Victoria or Tasmania. The outcome factor was 'current provision of after-hours care'. Associations of the outcome were established using multivariable logistic regression. FINDINGS Three hundred and fifty-four early-career GPs participated (response rate 28%). Of these, 322 had responses available for analysis of currently performing AHC. Of these observations, 128 (40%) reported current provision of AHC (55% of rural participants and 32% of urban participants). On multivariable analysis, participants who provided any AHC during training were more likely to be providing AHC (odds ratio (OR) 5.51, [95% confidence interval (CI) 2.80-10.80], p < 0.001). Current rural location and in-training rural experience were strongly associated with currently providing AHC in univariable but not multivariable analysis. DISCUSSION Early-career GPs who provided AHC during training, compared with those who did not, were more than five times more likely to provide after-hours care in their first 2 years after gaining Fellowship, suggesting participation in AHC during training may have a role in preparing registrars to provide AHC as independent practitioners. CONCLUSION These findings may inform future GP vocational training policy and practice concerning registrars' provision of AHC during training.
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Affiliation(s)
- Allison Turnock
- University of Tasmania, School of Medicine, Hobart, Tasmania, Australia
- Department of Health, Hobart, Tasmania, Australia
| | - Alison Fielding
- GP Synergy, NSW & ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
- The University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, New South Wales, Australia
| | - Dominica Moad
- GP Synergy, NSW & ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
- The University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, New South Wales, Australia
| | - Amanda Tapley
- GP Synergy, NSW & ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
- The University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, New South Wales, Australia
| | - Andrew Davey
- GP Synergy, NSW & ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
- The University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, New South Wales, Australia
| | - Elizabeth Holliday
- The University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, New South Wales, Australia
| | - Jean Ball
- Hunter Medical Research Institute (HMRI), Clinical Research Design and Statistical Support Unit (CReDITSS), New Lambton Heights, New South Wales, Australia
| | - Michael Bentley
- General Practice Training Tasmania (GPTT), Hobart, Tasmania, Australia
| | - Kristen FitzGerald
- University of Tasmania, School of Medicine, Hobart, Tasmania, Australia
- General Practice Training Tasmania (GPTT), Hobart, Tasmania, Australia
| | - Catherine Kirby
- Eastern Victoria General Practice Training (EVGPT), Hawthorn, Victoria, Australia
| | - Neil Spike
- Eastern Victoria General Practice Training (EVGPT), Hawthorn, Victoria, Australia
- Monash University, School of Rural Health, Churchill, Victoria, Australia
- Department of General Practice and Primary Health Care, University of Melbourne, Carlton, Victoria, Australia
| | - Mieke L van Driel
- Faculty of Medicine, General Practice Clinical Unit, The University of Queensland, Brisbane, Queensland, Australia
| | - Parker Magin
- GP Synergy, NSW & ACT Research and Evaluation Unit, Mayfield West, New South Wales, Australia
- The University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, New South Wales, Australia
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Bentley M, FitzGerald K, Fielding A, Moad D, Tapley A, Davey A, Holliday E, Ball J, Kirby C, Turnock A, Spike N, van Driel M, Magin P. Provision of other medical work by Australian early-career general practitioners: a cross-sectional study. J Prim Health Care 2022; 14:333-337. [PMID: 36592773 DOI: 10.1071/hc22066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/23/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction There is a trend towards GPs diversifying their role by working in health areas beyond general practice. However, little is known about whether this trend is apparent among early-career GPs once they make the transition from training to independent practice. Aim To describe the prevalence of and characteristics associated with early-career GPs providing other medical work. Methods A cross-sectional questionnaire-based study of GPs ('alumni') who had fellowed within the past 2 years from three of Australia's nine regional training programs. The outcome factor was provision of medical work in addition to clinical general practice. Associations of independent variables (encompassing alumni demographics, current practice characteristics and vocational training experience) with the outcome were estimated using univariate and multivariable logistic regression. Results Of 339 responding alumni, 111 (33%) undertook other regular medical work. Sixty-five (59%) of these were in medical education. In multivariable analysis, factors associated with providing other medical work were having a spouse/partner not in the workforce (odds ratio (OR) 5.13), having done any training part-time (OR 2.67), providing two or more of home visits, nursing home visits and after-hours care (OR 2.20), working fewer sessions per week (OR 0.74), and currently working in an area of lower socio-economic status (OR 0.84). Having dependent children (OR 0.27), and being female (OR 0.43) were associated with not providing other medical work. Discussion In this study, many early-career GPs are providing other medical work, particularly medical education. Acknowledging this is important to general practice workforce planning and education policy.
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Affiliation(s)
- Michael Bentley
- General Practice Training Tasmania (GPTT), Level 3, RACT House, 179 Murray Street, Hobart, Tas. 7000, Australia
| | - Kristen FitzGerald
- General Practice Training Tasmania (GPTT), Level 3, RACT House, 179 Murray Street, Hobart, Tas. 7000, Australia; and School of Medicine, University of Tasmania, Level 1, Medical Science 1, 17 Liverpool Street, Hobart, Tas. 7000, Australia
| | - Alison Fielding
- Discipline of General Practice, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; and NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Dominica Moad
- Discipline of General Practice, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; and NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Amanda Tapley
- Discipline of General Practice, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; and NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Andrew Davey
- Discipline of General Practice, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; and NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
| | - Elizabeth Holliday
- Discipline of General Practice, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Catherine Kirby
- Eastern Victoria General Practice Training (EVGPT), 15 Cato Street, Hawthorn, Vic. 3122, Australia
| | - Allison Turnock
- School of Medicine, University of Tasmania, Level 1, Medical Science 1, 17 Liverpool Street, Hobart, Tas. 7000, Australia; and Department of Health Tasmania, GPO Box 125 Hobart, Tasmania 7000, Australia
| | - Neil Spike
- Eastern Victoria General Practice Training (EVGPT), 15 Cato Street, Hawthorn, Vic. 3122, Australia; and School of Rural Health, Monash University, Churchill, Vic. 3842, Australia; and Department of General Practice and Primary Health Care, University of Melbourne, 200 Berkeley Street Carlton, Vic. 3053, Australia
| | - Mieke van Driel
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, 288 Herston Road, Brisbane, Qld 4006, Australia
| | - Parker Magin
- Discipline of General Practice, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; and NSW & ACT Research and Evaluation Unit, GP Synergy, Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia
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Burnout in French General Practitioners: A Nationwide Prospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212044. [PMID: 34831796 PMCID: PMC8624683 DOI: 10.3390/ijerph182212044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 01/04/2023]
Abstract
Background: We aimed to evaluate the prevalence of burnout among French general practitioners in private practice and to study the risk and protective factors of burnout. Methods: A nationwide cross-sectional study was conducted with French GPs working in a private practice in France who were asked to fulfil an internet questionnaire. We used the secure internet application REDCap®. Exclusion criteria were only working in a hospital, substitute doctors, and internship students. There was a putative sample size of 88,886 GPs. We retrieved the Maslach Burnout Inventory (MBI), occupational characteristics (type of installation, emergency regulated shifts, night shifts, university supervisor, weekly hours worked, seniority), and personal characteristics such as age, gender, marital status, and number of children. Results: We included 1926 GPs among the 2602 retrieved questionnaires. A total of 44.8% of French liberal GPs were experiencing burnout, with 4.8% (95%CI 3.9–5.9%) experiencing severe burnout. The risk factors of severe burnout were male gender (RR = 1.91, 95%CI 1.15–3.16), working in a suburban area (5.23, 2.18–12.58), and having more than 28 appointments per day (1.95, 1.19–3.19). Working more than 50 h weekly showed a tendency to increase the risk of severe burnout (1.55, 0.93–2.59, p = 0.095), with a significant increase in the risk of low and moderate burnout (1.31, 1.02–1.67 and 1.86, 1.34–2.57, respectively). Protective factors were mainly resident training, which decreased the risk of both low, moderate, and severe burnout (0.65, 0.51–0.83; 0.66, 0.48–0.92; and 0.42, 95%CI 0.23–0.76, respectively). Performing home visits decreased the risk of severe burnout (0.25, 0.13–0.47), as did group practice for intermediate level of burnout (0.71, 0.51–0.96). Conclusion: GPs are at a high risk of burnout, with nearly half of them in burnout, with burnout predominantly affecting males and those between the ages of 50 and 60 years old. The main risk factors were a high workload with more than 28 appointments per day or 50 h of work per week, and the main protective factors were related to social cohesion such having a teaching role and working in a group practice with back-office support.
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Pearson R, Mullan J, Dijkmans-Hadley B, Halcomb E, Bonney A. Medical care in Australian residential aged care: Perspectives of residents, family, nurses and general practitioners. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:e279-e287. [PMID: 33761182 DOI: 10.1111/hsc.13352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/13/2020] [Accepted: 02/11/2021] [Indexed: 06/12/2023]
Abstract
The importance of residential aged care facility (RACF)'s medical care is growing, driven by world-wide demographic trends in ageing populations. Despite this, there is a paucity of research into this care delivery from the perspective of those most involved. This study aimed to identify the enablers of and barriers to satisfactory RACF medical care by focusing on the general practitioner (GP) visit in the experience of residents, their family, registered nurses (RNs) and GPs. A multi-site case study was conducted at four purposively chosen RACFs in rural and regional New South Wales, Australia. Data derived from semi-structured interviews with 35 randomly selected aforementioned stakeholders and conducted in 2017 were evaluated using thematic, specifically framework analysis. The study's first key finding was related to the care team and to care recipients. It was evident that the quality of the RN-GP interprofessional collaboration was important for satisfactory care delivery. However, the care team was observed to additionally include RACF care staff and family members. Families were also in need of care. The study's second key finding was related to continuity of care. The interpersonal continuity of care provided by the existing GP continuing a new resident's care was beneficial. Informational continuity of care was found to be important but often disrupted by patient's information being initially unavailable, then fragmented and stored in different places. Medication management systems when accessed were poorly organised, time consuming and complex. This research suggests two useful new paradigms for residential aged care. The first is a re-envisaging of the resident care team to include the RN, GP, family and care staff, and those needing care to include residents and family. Secondly, care teams informed by interpersonal and informational continuity of care, and satisfactory resident care appears inextricably and positively linked.
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Affiliation(s)
- Russell Pearson
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- Illawarra and Southern Practice Based Research Network (ISPRN), University of Wollongong, Wollongong, NSW, Australia
| | - Judy Mullan
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- Illawarra and Southern Practice Based Research Network (ISPRN), University of Wollongong, Wollongong, NSW, Australia
| | - Bridget Dijkmans-Hadley
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Elizabeth Halcomb
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Andrew Bonney
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- Illawarra and Southern Practice Based Research Network (ISPRN), University of Wollongong, Wollongong, NSW, Australia
- Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, Australia
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Wilson M, Tran Y, Wilson I, Kurrle SE. Cross-sectional study of Australian medical student attitudes towards older people confirms a four-factor structure and psychometric properties of the Australian Ageing Semantic Differential. BMJ Open 2020; 10:e036108. [PMID: 32801196 PMCID: PMC7430444 DOI: 10.1136/bmjopen-2019-036108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES The Australian Ageing Semantic Differential (AASD) survey was developed to quantify medical student attitudes towards older people. The purpose of this study is to examine psychometric properties of the survey and confirm its factor structure of four composites. DESIGN A cross-sectional study. SETTING Three medical schools in three Australian states: Victoria, Western Australia and South Australia. PARTICIPANTS Third-year or fourth-year medical students (n=188, response rate=79%). OUTCOME MEASURES In the previous AASD study, exploratory factor analysis supported a four-factor model consisting of 'Instrumentality' (I), 'Personal Appeal' (PA), 'Experience' (E) and 'Sociability' (S). Congeneric one-factor confirmatory factor analysis (CFA) were used to examine model fit for factors using a new student sample (n=188).Psychometric properties of survey items and factors.Post-hoc analysis of pooled data from this study and earlier AASD study (n=509). RESULTS Indices of fit (Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), root mean square error of approximation (RMSEA), standardised root mean square residual (SRMR)) for data to the factor model were: PA adequate fit (CFI=0.94, TLI=0.89, RMSEA=0.11 and SRMR=0.05), I good fit (CFI=0.99, TLI=0.99, RMSEA=0.04 and SRMR=0.03), S good fit (CFI=0.98, TLI=0.95, RMSEA=0.06 and SRMR=0.03) and E excellent fit (CFI=1.0, TLI=1.0, RMSEA=0.00 and SRMR=0.01).The AASD was internally consistent (Cronbach's alpha=0.84), without difference in mean student scores by institution. Mean AASD score was positive for medical students outside New South Wales (73.2/114).Mean I score for all Australian students was negative, with female respondents' mean E score significantly higher than their counterparts. A positive correlation between student age and I score was noted. CONCLUSIONS The AASD is internally consistent and generalisable within Australia, with acceptable structural validity for measuring medical student attitudes towards older people within a four-factor model. Student attitudes were positive globally and within all factors except I. Female students rated older persons E more positively. Older students recorded more positive attitudes towards I of older people.
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Affiliation(s)
- Mark Wilson
- Graduate Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- PhD Candidate, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ian Wilson
- Graduate Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Susan E Kurrle
- Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Health Service, Sydney, New South Wales, Australia
- Department of Health Care of Older People, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Balmer D, Frey R, Gott M, Robinson J, Boyd M. Provision of palliative and end-of-life care in New Zealand residential aged care facilities: general practitioners' perspectives. Aust J Prim Health 2020; 26:124-131. [DOI: 10.1071/py19081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/15/2019] [Indexed: 11/23/2022]
Abstract
This exploratory study examined general practitioners’ (GPs) perspectives on delivering end-of-life care in the New Zealand residential aged care context. A general inductive approach to the data collected from semi-structured interviews with 17 GPs from 15 different New Zealand general practices was taken. Findings examine: (1) GPs’ life experience; (2) the GP relationship with the facilities and provision of end-of-life care; (3) the GP interaction with families of dying residents; and (4) GP relationship with hospice. The nature of the GP relationship with the facility influenced GP involvement in end-of-life care in aged care facilities, with GPs not always able to direct a facility’s end-of-life care decisions for specific residents. GP participation in end-of-life care was constrained by GP time availability and the costs to the facilities for that time. GPs reported seldom using hospice services for residents, but did use the reputation (cachet) associated with hospice practices to provide an authoritative buffer for their end-of-life clinical decisions when talking with families and residents. GP training in end-of-life care, especially for those with dementia, was reported as ad hoc and done through informal mentoring between GPs.
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Catzikiris N, Tapley A, Morgan S, Holliday EG, Ball J, Henderson K, Elliott T, Spike N, Regan C, Magin P. Maintaining capacity for in-practice teaching and supervision of students and general practice trainees: a cross-sectional study of early career general practitioners. AUST HEALTH REV 2019; 42:643-649. [PMID: 28793952 DOI: 10.1071/ah16285] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/18/2017] [Indexed: 11/23/2022]
Abstract
Objectives Expanding learner cohorts of medical students and general practitioner (GP) vocational trainees and the impending retirement of the 'baby boomer' GP cohort threaten the teaching and supervisory capacity of the Australian GP workforce. Engaging newly qualified GPs is essential to sustaining this workforce training capacity. The aim of the present study was to establish the prevalence and associations of in-practice clinical teaching and supervision in early career GPs. Methods The present study was a cross-sectional questionnaire-based study of recent (within 5 years) alumni of three of Australia's 17 regional general practice training programs. The outcome factor was whether the alumnus taught or supervised medical students, GP registrars or other learners in their current practice. Logistic regression analysis was used to establish associations of teaching and supervision with independent variables comprising alumnus demographics, current practice characteristics and vocational training experiences. Results In all, 230 alumni returned questionnaires (response rate 37.4%). Of currently practising alumni, 52.4% (95% confidence interval (CI) 45.6-59.0%) reported current teaching or supervisory activities. Factors significantly (P<0.05) associated with alumni currently undertaking in-practice clinical teaching and supervision were: Australian medical graduation (odds ratio (OR) for international graduates 0.36; 95% CI 0.14-0.92), working in a regional or remote area (OR 2.75; 95% CI 1.24-6.11) and currently undertaking nursing home visits, home visits or after-hours work (OR 2.01; CI 1.02-3.94). Conclusions Rural-urban and country-of-graduation differences in the engagement of early career GPs in practice-based apprenticeship-like teaching or training should inform strategies to maintain workforce training capacity. What is known about the topic? Projected changes in the demand for and supply of clinical teaching and supervision within Australian general practice will require greater uptake of teaching and supervision by recently qualified GPs to ensure sustainability of this teaching model. Although interest in and undertaking of teaching roles have been documented for GP or family medicine trainees, studies investigating the engagement in these clinical roles by GPs during their early post-training period are lacking. What does this paper add? This paper is the first to document the prevalence of teaching and supervision undertaken by early career GPs as part of their regular clinical practice. We also demonstrate associations of practice rurality, country of medical graduation and undertaking non-practice-based clinical roles with GPs' engagement in teaching and supervisory roles. What are the implications for practitioners? Establishing current teaching patterns of GPs enables appropriate targeting of new strategies to sustain an effective teaching and supervisory capacity within general practice. The findings of the present study suggest that exploring focused strategies to facilitate and support international medical graduates to engage in teaching during their vocational training, aided by focused supervisor support, may be of particular value.
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Affiliation(s)
- Nigel Catzikiris
- GP Synergy NSW and ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia. ;
| | - Amanda Tapley
- GP Synergy NSW and ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia. ;
| | - Simon Morgan
- GP Synergy NSW and ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia. ;
| | - Elizabeth G Holliday
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. Email
| | - Jean Ball
- Public Health Research Program, Hunter Medical Research Institute, Locked Bag 1000, New Lambton, NSW 2305, Australia.
| | - Kim Henderson
- GP Synergy NSW and ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia. ;
| | - Taryn Elliott
- Discipline of General Practice, University of Adelaide, 183 Melbourne Street, North Adelaide, SA 5006, Australia. Email
| | - Neil Spike
- Eastern Victoria GP Training, 15 Cato Street, Hawthorn, Vic. 3122, Australia. Email
| | - Cathy Regan
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. Email
| | - Parker Magin
- GP Synergy NSW and ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia. ;
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Magin P, Moad D, Tapley A, Holliday L, Davey A, Spike N, FitzGerald K, Kirby C, Bentley M, Turnock A, van Driel ML, Fielding A. New alumni EXperiences of Training and independent Unsupervised Practice (NEXT-UP): protocol for a cross-sectional study of early career general practitioners. BMJ Open 2019; 9:e029585. [PMID: 31152045 PMCID: PMC6549658 DOI: 10.1136/bmjopen-2019-029585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION General practice in Australia, as in many countries, faces challenges in the areas of workforce capacity and workforce distribution. General practice vocational training in Australia not only addresses the training of competent independent general practitioners (GPs) but also addresses these workforce issues. This study aims to establish the prevalence and associations of early career (within 2 years of completion of vocational training) GPs' practice characteristics; and also to establish their perceptions of utility of their training in preparing them for independent practice. METHODS AND ANALYSIS This will be a cross-sectional questionnaire study. Participants will be former registrars ('alumni') of three regional training organisations (RTOs) who achieved general practice Fellowship (qualifying them for independent practice) between January 2016 and July 2018 inclusive. The questionnaire data will be linked to data collected as part of the participants' educational programme with the RTOs. Outcomes will include alumni rurality of practice; socioeconomic status of practice; retention within their RTO's geographic footprint; workload; provision of nursing home care, after-hours care and home visits; and involvement in general practice teaching and supervision. Associations of these outcomes will be established with logistic regression. The utility of RTO-provided training versus in-practice training in preparing the early career GP for unsupervised post-Ffellowship practice in particular aspects of practice will be assessed with χ2 tests. ETHICS AND DISSEMINATION Ethics approval is by the University of Newcastle Human Research Ethics Committee, approval numbers H-2018-0333 and H-2009-0323. The findings of this study will be widely disseminated via conference presentations and publication in peer-reviewed journals, educational practice translational workshops and the GP Synergy Research subwebsite.
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Affiliation(s)
- Parker Magin
- Discipline of General Practice, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- NSW and ACT Research and Evaluation Unit, GP Synergy Ltd – Newcastle, Mayfield West, New South Wales, Australia
| | - Dominica Moad
- Discipline of General Practice, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- NSW and ACT Research and Evaluation Unit, GP Synergy Ltd – Newcastle, Mayfield West, New South Wales, Australia
| | - Amanda Tapley
- Discipline of General Practice, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- NSW and ACT Research and Evaluation Unit, GP Synergy Ltd – Newcastle, Mayfield West, New South Wales, Australia
| | - L Holliday
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Andrew Davey
- Discipline of General Practice, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- NSW and ACT Research and Evaluation Unit, GP Synergy Ltd – Newcastle, Mayfield West, New South Wales, Australia
| | - Neil Spike
- Eastern Victoria General Practice Training, Churchill, Victoria, Australia
- Department of General Practice, University of Melbourne, Parkville, Victoria, Australia
| | | | - Catherine Kirby
- Eastern Victoria General Practice Training, Churchill, Victoria, Australia
- School of Rural Health, Monash University, Clayton, Victoria, Australia
| | - Michael Bentley
- General Practice Training Tasmania, Hobart, Tasmania, Australia
| | - Allison Turnock
- Department of Health, Hobart, Tasmania, Australia
- Centre for Rural Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Alison Fielding
- Discipline of General Practice, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- NSW and ACT Research and Evaluation Unit, GP Synergy Ltd – Newcastle, Mayfield West, New South Wales, Australia
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