Provide in-practice teaching
General practice training in Australia follows an apprenticeship model with a registrar learning ‘on the job’. In this context, a supervisor’s prime teaching role is to enhance and deepen the learning that occurs through clinical work.
The teaching you provide will be mainly directed by the individual learning needs of your registrar.
Registrars are responsible for planning their own learning. This involves identifying what they need to learn, how they are going to learn it, and knowing when they have learnt it.
Supervisors are involved in planning a registrar’s learning at every stage by helping to identify, clarify and prioritise learning needs; assisting in addressing these needs; and providing feedback on whether the learning has occurred. The following teaching methods are used to enhance workplace-based learning.
There is no better way for you to assess your registrar’s consultation and communication skills than by directly observing their interactions with patients. Direct observation, or ‘sitting in’, is known to be acceptable to the patient, as well as highly regarded as a learning experience by learners. Sitting in on consultations early and often in the training term is strongly encouraged.
Problem case discussion
In problem case discussion, as the name suggests, a registrar brings a ‘problem case’ to discuss with you. This teaching method tends to be the predominant method used early in general practice training. In addition to teaching core knowledge, discussion of problem cases can be used to improve clinical reasoning skills and management of uncertainty.
Random case analysis
In random case analysis (RCA), a supervisor selects a recent registrar record for discussion. Unlike problem case discussion, where the registrar chooses a patient to discuss, a ‘random’ selection method allows identification and exploration of areas in which the registrar either doesn’t recognise they have a clinical knowledge gap (‘unconscious incompetence’) or doesn’t wish to reveal (‘conscious incompetence’) they have a knowledge gap. As a result, RCA has educational utility for all stages of learners, and across all levels of competence. Although RCA can be used to explore all domains of general practice, it is a particularly effective method for exploring a registrar’s clinical reasoning and record-keeping skills.
Reviewing test results by going through a registrar’s email inbox is an effective way of monitoring rational test ordering and provides a lead-in to a broader case discussion. Inbox review is valuable for exploring how a registrar is managing uncertainty and their understanding of the appropriate use of screening tests.
There is no requirement to provide specific topic tutorials as part of in-practice teaching. However, if it meets the registrar’s learning needs, discussion of a topic may be appropriate. There are many helpful resources for teaching a topic, including:
- the 2022 RACGP curriculum and syllabus for Australian General Practice that is designed for use by registrars and educators and can be a useful resource for a supervisor’s teaching. It supports your role as a ‘meaning maker’ – helping with the application of knowledge rather than being a transmitter of knowledge. There are 42 units covering important general practice clinical presentations and patient populations. Each one includes learning strategies that are specifically designed for use with supervisors. None of these are mandatory to use in practice but may complement the registrar’s work-based learning.
- GPSA has teaching plans that cover a wide range of clinical presentations.
Registrars are also provided with out-of-practice educational activities during their training. Being aware of the content of these activities may help inform the in-practice teaching plan. Supervisor professional development frequently focuses on teaching methods, including those listed above and others, such as topic teaching, teaching a procedure, role play, and critical incident review.
Training for general practice largely takes place in the practice setting, which is where registrars should also prepare for exams. Fellowship exams don’t just assess knowledge from books; they aim to assess how knowledge is applied to everyday situations in Australian general practice. The actual processes of patient care and a doctor’s attitudes are also important. During the FSP, assistance with exam preparation will be coordinated by RACGP medical educators.