General practice in the 21st century is an intellectual and clinical discipline which conscientiously, explicitly and judiciously integrates the best available evidence into decisions about the care of individual patients. All general practitioners (GPs) should aim to integrate current evidence into everything they do. GPs need to be research literate and research active, well informed and helpfully curious as they partner with patients to make the best possible healthcare decisions in the context of the whole person, including their values and social worlds. All GPs should also participate in regular clinical discussions with professional colleagues, during which clinical dilemmas are considered in the light of the best available research literature, clinical experience and local resources.
Research literacy encompasses a range of competencies, including the ability to critically interpret, and apply to one’s own practice, research from a range of methodological approaches. It also includes being able to communicate research findings clearly to patients to assist in informed decision making. Useful clinical evidence can stem from both quantitative and qualitative traditions.1 Research conducted in secondary and tertiary care settings may or may not be relevant to general practice patients; it is important, for example, to identify which patients were excluded from trials (perhaps due to advanced age or multimorbidity).2 Research literacy also includes the ability to reflect critically on one’s own clinical practice with a view to continuous improvement.
Research conducted in general practice settings, and by GPs, is crucial to building an evidence base which is relevant to optimising care for general practice patients and settings.3-6 Priorities for Australian general practice research include a diverse range of conditions and aspects of healthcare.6 The general practice context is different in many ways from secondary and tertiary hospital-based practice, with its broad scope of practice and prevalence of undifferentiated illness, medically unexplained symptoms, chronic, complex and multiple conditions and clinical uncertainty. Single disease research designs may have limited relevance. Symptoms which present in general practice often have a much lower pre-test probability of indicating serious illness than in typical hospital practice. General practice and primary healthcare also afford opportunities to prevent disease and interrupt disease progression, or further spread, by early detection and treatment. GPs are well positioned to avoid low value healthcare due to over-diagnosis, over-investigation and futile or otherwise inappropriate treatments.7 It is important to build the general practice evidence base in all these vital areas. GPs can contribute to this research by identifying important research questions, leading and/or supporting research projects and using research findings.
General practitioner researchers play a crucial role in conducting and disseminating high quality general practice research in a range of fields which include clinical research, health systems research and medical education research. General practice research may also emphasise the translation of research evidence and the co-design and implementation of interventions in particular communities. This helps in reducing research waste and ensures that research reaches those communities most in need.8
Academic general practice also plays a key role in promoting and advocating for the profession of general practice, by highlighting its research and conceptual underpinnings. GPs in training who are interested in further engagement and participation in general practice research are encouraged to consider clinician researcher academic pathways, including academic posts and higher research degrees.9 These involve additional training and participation in the design, delivery, analysis and dissemination of research, typically in collaboration with a broader research team. Nurturing the general practitioner academics and researchers of the future will stand the profession in good stead.