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GP Research Webinar Series - Academic Registrar Showcase 2022

Welcome everyone to tonight’s webinar.  I am really delighted to be here with you for the Annual Academic Registrar Showcase 2022.  My name is Liz Sturgiss, I am a clinical GP in Canberra and I work as a researcher at Monash University in Melbourne.  Before we start, I would like to acknowledge the traditional owners of the lands from which each of us is joining this webinar tonight and acknowledge that I am meeting you from the lands of the Ngunnawal and Nambri people and I wish to pay my respects to their Elders past, present and emerging.
Before we get started today, we have got three fabulous speakers lined up, it’s really exciting to see the fantastic work that’s gone on with the academic registrars this last year.  We are here on Zoom together, I actually do live a lot of my life on Zoom now, but for those that are unfamiliar with Zoom, when you look at your screen and hover down the bottom, there is a control panel and that’s where you can ask questions, so you will see the Q&A box there.  Be aware that when you write in the Q&A box that can be visible to all participants here in the webinar and the panels.  So don’t pop any personal information in there, but if you need help just raise your hand and one of the admin people will come and give you a hand.  Everyone is muted tonight because it is a webinar style and you can’t see the other people who are here with you, but I promise you there’s lots of other people online with you tonight if you are here in live with us.  After each of our presenters, we will have all time for questions.  So, pop your questions in that Q&A box and if you like someone else’s question there is an option to upvote it and we will take the most popular questions after each presentation and we will also have time for a panel with all of the presenters at the end.  So, tonight, I would like to say Dr Brent Venning is unwell and can’t join us tonight, so I hope he gets well soon, but we do have three fabulous presenters with us tonight.  I am going to introduce each one as we go in turn, and we are going start tonight with Dr Darran Foo.  So, Darran is a soon-to-be fellow GP.  He is pursuing a blended career in Clinical General Practice, Primary Care Research and Digital Health.  As part of his training, Darran undertook his academic _____ at the University of Wollongong, conducting research in the differences in help-seeking behaviours between rural and urban cancer patients.  Darran is now working at Macquarie University to deliver an integrated care service within NQ Health.  He is also lecturing within Macquarie University’s Global MD Program.  Darran is passionate about advocating his fellow registrars through his roles as a registrar liaison officer with GP Synergy and a registrar advisor for GPRA.  A big welcome Darran, I am really looking forward to your presentation.
5:06
Thanks, Liz.  I will just get my slides up.  Alright.  So, thanks everyone for coming, my name is Darran, I will be talking to you a little bit about my project that I did as an academic registrar last year at the  University of Wollongong together with my supervisor A/Prof Joel Ree, at the time who was at University of Wollongong, but has also moved on to a position at UNSW now.  The title of my project is Factors Influencing Early Presentation to GPs for non-screen detected breast cancer, and it was a qualitative comparison study.  So, the background of it is, you know, I was practising on the South Coast in New South Wales and the statistics show that women living rurally have worse survival rates for breast cancer.  I really wanted to identify some factors within the primary care space that could contribute to delayed presentation, and in turn could help reduce this disparity.  So, the aim of our project really was to identify and explore the differences in help-seeking behaviours between rural and urban women with non-screen detected breast cancer, and you could think of help-seeking behaviours as kind of what influences someone's decision to seek help for a particular symptom, and in this case in relation to breast symptoms or breast cancer symptoms.  So, what we did was a qualitative study of 20 semi-structured interviews of women across rural and urban New South Wales, who had a diagnosis of non-screen detected breast cancer in the last five years.  So, we identified six key themes, you can see on this figure here.  And really this encapsulates the key themes and how to interact with each other and really encapsulates how complex the decision-making process is for someone once they have discovered the symptom, and so the themes included symptom appraisal and symptom monitoring, emotions and attitudes towards those symptoms, their social interactions, and that process was an iterative process, not linear, so someone could have, for example, found a breast lump and then decide that it was not severe enough for them to go and see a GP for whatever reason and they monitor it for a while and then go back to appraising again, for example, if something changed, like it got bigger or it started getting painful.  And, that will be an iterative process and finally they would make a decision to go and see their GP and accessing GP services on its own was a key theme as well.  And this all occurred within their own personal environment, so any person or environmental factors would have an overarching factor on the decision-making process.  So, for example, social interactions here would refer to things like having a discussion with their friends or family who may have encouraged them to go and see their GP, and emotions and attitudes include things like rural stoicism, so the main differences we found between rural and urban women were mainly in the themes of emotions and attitudes in accessing GP services, and we found that the presence of stoicism was quite unique to rural women, so they had a very very very high threshold of what constitutes a symptom that was serious enough for them to go and seek help from their GP.  And there was also a lot of differences that we found in terms of accessing GP services.  So, we found that rural women face quite significant barriers regarding accessing GP services and this was pertaining to things like availability, costs, and distance to accessing their GP.  So, what we found was that GPs play a critical role in facilitating earlier presentation and more research into this theme of rural stoicism and the quintessential rural Australian character and how that affects, more broader healthcare decision-making is required as well, it would be an interesting topic, and clearly continuing investment into our rural primary care workforce would be key to improving access issues.  Yep.
10:16
Thanks very much Darran.  Thanks so much for sharing, that’s fantastic.  I will take the chair and ask a question there of you.  The stoicism… can you tell me a little bit more about how you saw that in your data, it sounds like a really interesting thing there.
10:37
So, it is through analysis of the interviews and the quotes and we found this recurring theme in rural women, who just said things like, it’ll be okay, oh it will be alright, sure it’ll be alright, I don’t really have to go to look at it, or you know things like, well, I have got to tough it out because I live in a property where it’s just me, or something like that, and I don’t have time due to this, or this is not a priority for me in my kind of environment, and the stoicism really came across as having a much higher threshold what they would constitute as something that was serious.  And we didn’t think it was related to, for example health literacy or education, but more related to their reality.  Yep.
11:49
Yeah.  And there’s a related question there from the audience, from Sonya, what is known previously about the concept of rural stoicism, and are you aware of any other literature on it?
11:58
Yes, it is quite interesting, there has been studies across WA and also in South Australia about help-seeking behaviours in other types of cancers, like colorectal cancers amongst others, and I can’t remember which one was which, but one showed similar results to ours, and one showed that it was kind of similar across the board.  So, it is not a lot of research done specifically as to how stoicism affects how people make their health care decisions, and it is clear that we don’t really have a lot of data on it per se, and those studies were looking at broader subjects as well, not specifically at stoicism and rural stoicism.  Yep.
12:50
And you mentioned you worked in the South Coast, was that part of your training or…?
12:57
Yes, I trained all in the South Coast in Milton and Mollymook, and in the later stage of my training was up in Kiama.
13:06
Beautiful part of the world.  And the research you have done, has that changed your way you think clinically at all, or how’s that?
13:13
Yeah, I mean it really changes to where you think about how… it really hones in on that holistic care model, that you really want to assess your patients with, and so how you perceive their symptoms, they may not think it is such a priority in their world, and it just kind of bolsters that notion of holistic care and taking the whole patient into account and not just narrowing on the particular symptom or taking that into account of their whole person and their life and everything that’s around them.
13:55
Fantastic.  There’s one from the audience there, from ____, what was the age group that you worked with?
14:06
This was anyone aged 18 to 75 essentially.  I mean, as with breast cancer we have had majority of the participants from 45 and above.  Yep.
14:19
Fantastic.  Thank you Darran.
14:21
Cool.
14:23
We will bring you back at the end for the panel if that’s okay.
14:24
No worries.
14:26
Thank you very much for that presentation.
14:27
Thank you.
14:28
We are going to move now to Dr Katie Fisher.  Katie is a 2021 GP academic registrar at the University of Newcastle.  I did my first degree at Newcastle, my Med degree there Katie, so we can talk all about Newcastle.  Katie was a recipient of the 2021 GP Synergy New South Wales ACT Dr Charlotte Hespe Research Award.  Congratulations!  And the 2021 RACGP Charles Bridges-Webb Memorial Award.  Katie is working with GP Synergy Research and Evaluation Unit to analyse GP registrars’ telehealth use during the COVID-19 pandemic.  Katie also works as a part-time GP registrar in Newcastle and is currently undertaking a Masters in Clinical Epidemiology at the University of Newcastle.  Welcome Katie, I am really looking forward to hearing this.
15:20
Thanks Liz.  I will just get my slides up.  (Pause).  Alright.  So, my research project during my academic post was looking at telehealth consultations in GP registrars’ practice, and I was really fortunate that I got to work not only with the University of Newcastle for my post, but also with the research and evaluation unit at GP's Synergy and I would like to extend a big thank you to all of the authors listed on the slide, who have helped me immensely over the last 12 months and I have also attached my email if anyone wants to get in contact with me after the webinar.  So, the background for my research project was that in 2020 we had an introduction of telehealth consultation item numbers in response to the COVID-19 pandemic, which saw a rapid uptake of telehealth in Australian primary care and while there has been published literature looking at established GP’s use of telehealth and their experience with this, there is currently no available literature looking at Australian GP registrars, and we felt that GP registrars were a really important clinician group, not only because they make up 11% of Australian GPs by head count, but being so early in their careers they will taking these technological changes into their future practice.  So, the objective was to assess the prevalence and the associations of using telehealth vs face-to-face amongst our Australian GP registrar cohort.  So, the method for this project was utilising data from the recent study, which is a multisite cohort study that currently operates across three regional training organisations that includes registrars from New South Wales, the ACT, Tasmania and Victoria.  And for those who are not familiar with recent GP registrars from those RTOs record the clinical and educational details of 60 consecutive consultations every six month term for a total of three terms.  So, we performed a cross-sectional analysis of data from 2020.1 to 2021.1, so an 18 month period during the pandemic and we used univariate and multivariable logistic regression to compare telehealth to face-to-face.  So, over that time period we had 746 registrars record just over a 100,000 consultations and 21.4% or just over a fifth were telehealth and you can see there that the overwhelming majority of those were performed via telephone with a small percentage via videoconference.  There were several significant associations of using telehealth compared to face-to-face.  For telehealth consultations, we found that they were more likely to be associated with female patients compared to males and also those aged 35 to 65 compared to other age groups.  We also found that telehealth consultations were shorter in duration by almost 6 minutes on average compared to face-to-face and they addressed fewer problems per consultation.  A follow-up consultation was also more likely to be arranged after a telehealth consult and registrars were less likely to seek help from their supervisors during telehealth consults as well.  So, this was quite a large sample size of registrars across Australia going from urban right through to rural and very remote regions, so there was good generalisability for the Australian registrar cohort and there may even be some generalisability to the broader GP population in Australia, particularly those GPs that have recently fellowed.  However, because it is a cross-sectional study, we are unable to establish causality for these findings and because the telehealth item numbers are still relatively new there may have been scope for registrars to enter these incorrectly during the data collection stage.  So, because telehealth tended to be shorter on average, address fewer problems and be more likely to have a follow-up appointment arranged, we feel that careful use of telehealth is needed and practices may benefit from a triage system to avoid double-handling of issues.  And given that registrars were less likely to seek supervisor assistance for telehealth compared to face-to-face, there may be some implications for training and education and additional supervision plans may be needed for telehealth consultations.  So, that was my 12 months condensed into 5 minutes (laughter).
20:11
Well done Katie, it’s always really funny, the research has taken you so much time, the condensed or short presentation, you did a beautiful job, very clearly presented there.  I’d love to hear more about the triage, what do you mean when you are talking about practice triage there?
20:28
Yeah.  So, one thing we noticed, not just in our study, but also in the literature, was this idea that there was double handling of problems, so patients were booking a telehealth consult and then it needed to be seen face-to-face and so there was a second appointment, it was kind of, I suppose increasing GP workloads and GP shortages.  So, the triage system that we had in mind was sort of, for when patients are booking appointments, having the practices be able to triage whether or not it was appropriate for telehealth, to kind of I guess increase service availability and reduce that double handling.
21:04
Really good.   And one from the audience, from Sonya, do you have any data on types of presentations that tended to correlate more with the telehealth.
21:18
We do have that data, I just don’t have it with me at the moment for this particular presentation today unfortunately, but I can get any details, if anyone wants to email me, I can definitely get that information to you.
21:31
Fantastic.  And Katie, is your email there on the first slide, maybe I don’t know if you want to flip back to that because that person might want to contact you there.  The other question I was really curious about the supervision, so …in telehealth, would a supervisor join the registrar on the call or how would that work or does it work?
21:54
Yeah, I guess that probably is potentially one of the reasons why maybe registrars were less likely to seek their supervisors, I think I guess it’s bit more difficult to get your supervisor to come in and join a phone call than it is to get them to come into the room when the patient is in front of you.  I can only speak I guess anecdotally from my experience, but I note like you can do three-way telephone calls or get the supervisor to come in and just let the patient know that they are on the phone call as well, but I think it definitely is still a bit clunky and not quite as convenient as having them come into the room with the patient there in front of you.
22:32
Yeah.  And is telehealth something you have always been interesting in or is this is the new thing with the pandemic or where did this question come from for you?
22:39
It’s a new thing with the pandemic.  Initially actually I started off thinking about a research question around billing practices with GP registrars because I was kind of interested to know who is private billing, who is bulk billing, who is more likely to do which, and so I started looking at the billing item numbers in the recent database and then it kind of pivoted to telehealth because we realised that by looking at the different types of item numbers we could actually compare that to face-to-face, so it did pivot towards telehealth as the pandemic sort of reared it’s head.
23:11
That’s great.  It is good to be adaptable as the researcher, very impressive.  And the recent database, it is a pretty impressive database that one, isn’t it?
23:20
Yeah, it is fairly impressive, the recent studies have been going for over 10 years now, so there’s a lot of data there, which was great, so there’s lots of potential little side projects that can happen with the research which is really exciting.
23:22
Fantastic.  Thank you very much for that Katie.  I just might actually ask these questions now that have come in.  From Sonya, why do you think women are more likely to use telehealth?
23:48
Yeah.  Obviously we can’t kind of establish causality, but from looking at the literature we propose that it could be because that women in general are more likely to seek health services and to see a GP compared to male patients, so we postulated that it might be to do with that, the fact that women do present more often to see a GP.
24:11
And from Manil, so if I have said that wrong Manil, does the experience of the person during a triage have any influence on the type of these consultation?
24:33
I suppose that was outside of the scope of what we were looking at with this particular research question and the recent database, but it would definitely be…. I imagine it would be variable depending on whether it is a nurse or a receptionist or even a doctor triaging to telehealth vs face-to-face, so I am sure it would be very variable, but I think if the practice can come up with a system that works I think it would definitely reduce that double-handling and make things a bit smoother for everyone.
24:50
One last quick one.  Do you have any comparative data about the outcome of the consultations?  Anything about whether management was generally better with the face-to-face versus telehealth?
25:07
We don’t have that data available to us in terms of the outcome of the consultation.  We do collect data on different variables like whether or not medication was prescribed, whether or not imaging or pathology was ordered, and from that side of things we did find that there was sort of less prescribing and less imaging being ordered by telehealth compared to face-to-face, but not on the actual sort of outcome in terms of clinical outcomes and patient satisfaction that kind of thing.
25:36
Yep.  It’s great when you research opens up lots of new questions and interests, thats fantastic. Thank you very much Katie for that presentation and we will bring you back after this next one for the panel as well.  Thank you.  Our final presenter for tonight is Dr Seren Ovington, who is an RACGP academic post registrar in Canberra.  I have said your last name wrong, I am sorry Seren, I even practiced, is it Ovington.
26:00
(Laugher).  It’s impressive because Seren is normally the one that tricks people.
26:04
Ovington?
26:03
Yep.
26:06
Great.  So, she is completing her academic post at the ANU, The Australian National University, and has undertaken a qualitative research project exploring the experience of Australian GPs working during the COVID pandemic.  ANU is also where I did my registrar academic process and I feel well connected there.  Being previously inexperienced with research, Seren has enjoyed the challenge of developing and conducting her own research project.  She has also enjoyed the various teaching and learning opportunities that academic work offers.  In addition to the academic post, Seren works in clinical practice and is passionate about holistic, preventative and patient-centered care.  We are looking forward to hearing more about GP experiences and COVID.  Thanks Seren.
26:47
Thanks Liz.  I will just pull up my screen.  Okay.  Hi everyone, yeah… so, my name is Seren and I have just completed my academic post with the Australian National University here in Canberra and as Liz said, I undertook a qualitative study exploring the experiences of Australian GPs working during COVID.  I did this with the help of my supervisor, Associate Professor Katrina Anderson and a couple of other colleagues from ANU.  So, I did not really go into the post with a burning research question or an area of interest and it just so happened that as I was applying for the post and thinking about it, that’s when sort of COVID hit Australia and I thought, oh my gosh, this is something massive.  I personally experienced massive impacts on how I was working as a GP registrar at the time, I saw it amongst my GP colleagues and I thought this is going to be something very interesting and myself and my supervisor we were particularly interested in sort of the various different ways the pandemic was influencing GPs both professionally and personally, so as Katie noted, there was the big pivot to telehealth in clinical practice, but I was also interested in things like, well, how is this impacting the patient-doctor relationship and the relationship between GP colleagues and about GPs attitudes towards their work.  So, to sort of try to come up with some answers to these questions, I recruited, invited Australian GPs to participate in my study via sending out some emails and posting on GP social media and then selected 15 willing participants and was fortunate to get a reasonable spread of participants from across four different states and territories in Australia, as well as a nice mix of male, female GPs, some more junior GPs, more experienced GPs, urban, rural as well as some practice owners and some contractors, and then I ran 15 semi-structured individual interviews over Zoom and phone, and then went through the interview transcripts and undertook a thematic analysis of the transcripts with the help of the NVivo 12 software.  From the analysis of the results and the interviews with my 15 participants, there were sort of five main themes that stood out to me the most.  The first, and probably not surprising to anyone was the fear of infection.  So, my GP participants were afraid not only of themselves contracting COVID-19, but of potentially transmitting it then to their families, friends and their patients.  The second main theme was one of uncertainty and information overload.  So, particularly at the start of the pandemic the participants described this feeling of immense uncertainty.  They did not know about COVID-19, they did not know how to respond to keep themselves and their patients safe.  Then as the pandemic went on and we got a little bit more information, that actually became problematic because there was information coming from multiple different sources all at once, was often conflicting or changed rapidly, which actually exacerbated the uncertainty.  The third theme was the impact on the GP-government relationship and unfortunately it was a bit of a negative impact with the GP participants feeling that the government communication to GPs was pretty poor and that the government had sort of sidelined and undervalued the role of GPs in the pandemic response.  The fourth theme was the impact on the patient-doctor relationship and this had both positive and negative impacts.  So, in terms of the negative impacts there were certain tensions that emerged in the relationship, particularly around GPs feeling frustrated when patients were not taking the pandemic seriously, or were doing things that placed themselves and their practice at risk, and this was even before all the issues with mask and vaccine exemptions. But on the other hand a lot of participants felt that their relationship with their patients was strengthened during the pandemic and the pandemic sort of acted as a shared bonding experience.  The fifth theme that I sort of identified was that there was a sort of increase in teamwork during the pandemic and that was both within practices and that would be all the practice staff from the doctors, the nurses, to the front receptionist staff, and the practice managers, and there was also an increase in teamwork within GPs, within a practice, within local communities and amongst the broader GP community as a whole, which was a really nice finding.  So, I found that listening to the participants’ stories really fascinating and I do think I was able to generate some sort of novel insights into these sort of more deeper and richer experiences of the pandemic that had not been described elsewhere, and my hope is that by documenting it and contributing to what is known about the GP experience, that will just help us think of ways to support GPs in the ongoing pandemic and potential future pandemics or future disasters.  I have got my email there, so I am more than happy if anyone wants to shoot me an email with any questions about my research or the academic post.
32:31
Thank you so much Seren.  It’s good to be prepared for those future disasters and pandemics.  Not nice to think about but you are absolute right.  Super interesting findings, it sounds like really deep work there.  In terms of the patient-doctor relationship, did you have any ideas around like new patients, did anyone talk about having new patients?
32:46
That would be… you know, it certainly would not have been a significant trend, but that was my impression from what the participants were telling me was, it was sort of their existing long-term patients that was who the relationship was strengthened with, and it was more the sort of intermittent one-off patients who there was that bit of conflict with, and I think it was in the media a little bit last year, particularly in Melbourne, anxious parents were getting frustrated and angry that GPs wouldn’t see their kids with respiratory symptoms face-to-face and then, so it was bit of a bidirectional frustration.
33:26
And the teamwork, were all the GP participants from different practices or ..?
33:37
Yeah, so, I didn’t have anyone from the same practice, but a few of them talked about setting up in their sort of local areas, sort of weekly or monthly Zoom groups where they could chat amongst the different practices about, hey, what are you guys struggling with, how are you managing this, and also a lot of them talked about GP social media and I guess both the pros and cons of that and many of them found that a really helpful resource to help them get through the pandemic.
34:09
And lastly, you may have said and I may have missed, but were they from all over Australia or were they…?
34:16
Unfortunately I would have loved to get someone from every state, but I think in the end I had GPs from ACT, New South Wales , Victoria and South Australia.
34:26
Great.  That’s wonderful, you have got a really nice spread there.  And has this research impacted you as a clinician at all or how has that been for you?
34:36
I mean I guess it wasn’t really clinically focused, but one nice thing was it reinforced to me that I do really love general practice and it was really nice, all the participants they were just so lovely and just so interesting and it was fantastic talking with them and actually most of them said that despite the pandemic being a very stressful time it sort of reinvigorated their love of general practice, so that sort of made me think that I am in the right area.  And I guess I should say too that the academic post in itself, more so the teaching side of things I found that very helpful for my clinical practice, because I was doing the post with all the teaching at the same time as studying for my RACGP exams and that was so helpful keeping me fresh and up-to-date.
35:30
Fantastic.  Definitely we should touch on that in the panel at the end about the academic post in a bit of detail because there are probably people watching tonight or watching the recording who are thinking about doing the post themselves.  Thank you very much for sharing that research Seren.  We might bring everyone back now for the panel at the end.  Thank you for three fabulous presentations, I can see you are all getting a lot of practice with your presentation skills during your posts, they were really clear and interesting presentations.  One thing I was wondering and is for each of you, what’ happening with that research that you have completed now, is it ongoing or you are writing it up or where is it going for you.  Maybe Seren, do you want to start?
36:14
Yeah.  So, I have written it and that was really hard actually the write-up phase, but I have written it and I have just submitted it to the Australian Journal of General practice, so I am eagerly and nervously awaiting the editor’s response.
36:33
Good on you Seren, that is amazing to get a paper submitted so quickly.  Congratulations, and I will have everything crossed for you.  How about you Darran?
36:52
Reviewer #2 Seren, watch for reviewer #2 (laughter).  Yeah, so, mine has been written up and submitted to the AJGP back in November and have heard good news that it has been accepted.
37:02
Oh congratulations Darran!
37:05
Yeah, so… who knows when it will come into print (laughter).
37:05
Yes.  That’s the next step.  Academia is a lot about waiting, isn’t it?
37:11
It is a lot of doing and then waiting.
37:14
That’s right.  And is it leading onto any more research with all that interesting stuff about stoicism or…?
37:21
We did add in a quantitative component where we formulated a survey based on the themes that we found and from the qualitative study.  And that’s finished and now I have to find the time to write that up, but I have also started a new role and really focusing in on integrated care and digital health tools, so it will be a challenge, time management challenge (laughter).  Yes.
37:55
Good to hear that there’s more coming, that’s great.  And Katie, how about you, what’s happening with your research.
38:00
I am still in the write-up phase and still waiting for my final results to come in, so hopefully writing up the publication later this month or early next month and then in terms of sort of future research, we did want to then kind of look directly at telephone vs video and get a bit more granular and then I will probably return to my original kind of thinking about billing amongst a few registrars as well.  So, a few little projects planned with GP Synergy.
38:38
Oh fantastic Katie, that’s wonderful!  There is a question from the audience, it is probably mostly for Seren and Katie I think with the COVID theme, but what would increase confidence in general practices to do more face-to-face consultations in regards to infective illness, and would placements and communication with hospital emergency departments help?  Katie, do you want to think about that one first?
38:57
Yeah, it might be a little bit outside the scope of my project.  I suppose what will increase confidence, I suppose having access to timely and available PPE will increase confidence in doing face-to-face, certainly I know that’s been a problem particularly for primary care getting access to good quality PPE.  Placements and communication with hospital emergency departments, I suppose definitely having that communication from the emergency departments and that kind of collaborative teamwork approach I think would definitely help things.  I am not sure if I can expand much more on that.
39:36
Yeah, that’s a great answer Katie.  And Seren, anything from your qualitative data around confidence in doing face-to-face care?
39:45
Yeah well my data sort of echos what Katie said, in that PPE was particularly, the lack of PPE worsened my participants’ fear of seeing patients face-to-face, but then conversely having the PPE made them feel a bit safer … and the interesting thing is the relationship between general practice and hospitals and certainly I think there is inevitably some tension and frustrations between GPs and EDs, so anything that can improve that relationship I think would go a long way.
40:28
And, I am really curious about why each of you chose to do an academic post as part of your GP training.  I guess for people that might not know, when you do your GP training that is an opportunity to apply to do an academic registrar post and most people are in a university-type setting for about half the week for a whole year.  Darran, what drew you to want to do a post?
40:55
I think it was just interest in primary care research and realising how much … or not much, how little (laugher)… how little the amount of primary care research is being done by GPs, and just wanting to get involved in that and moving from there.  Also, you know, the academic post gives you a lot of flexibility in terms of setting your work days and your work hours and it was really great as Seren has said, because I think all three of us were kind of sitting exams at the same time.  So, it gave you that flexibility where you are not stuck in your clinical hours, and yeah, it is a lot of very independent kind of run…. like, you have to run your own schedule and meet your deadlines, but other than that you kind of run your own schedule and you have that flexibility, which was great.
41:53
So, it sounds like you were really drawn to the research aspect and maybe some flexibility there as well.
42:00
Yep.
42:01
Seren, what made you want to apply for a post.
42:03
I signed up on a bit of a whim actually, it certainly wasn’t anything that I had planned on doing, but I didn’t really have any other ideas for my extended skills term as part of GP training and actually just at the practice I was at a GP T1, there was a recently fellowed GP who had done the academic post and just spoke so highly of it and pretty much convinced me to apply.  The selling factors for me, actually to be honest not so much research, that’s never anything I had really see myself doing, but I enjoyed it a surprising amount, but I was particularly drawn to the opportunity to get involved in with teaching at the university and as Darran mentioned the sort of flexibility and variability it gives you in the week.
42:53
Do you want to talk a little bit more about the teaching opportunities you had Seren?  Because I think lots of people are drawn to the post for that.
42:59
And, having spoken with the different ____ I think it does vary based on the university you are at, and also it probably varies based on how interested you are in it, because I think there is a huge flexibility there, but I was pretty lucky because ANU is a relatively small medical school that I could get quite heavily involved, so, mainly I was involved in teaching the third-year medical students who were doing their GP terms, and running weekly tutorials, I got to develop a seminar and present a seminar, get involved with the exam process, both in writing exams and marking exams and sort of supervising a couple of students though.  Yeah, it was really fantastic.
43:41
That was at the medical school level?
43:44
Yeah.  Oh, yes, sorry, in medical school, yep.
43:48
Yep.  And are they postgraduate?
43:50
Yep, it’s a postgrad program.
43:53
Fantastic.  And Katie what drew you to an academic post?
43:57
Probably a lot of the things that Seren and Darran have already said, and similar to Seren I also had a former academic registrar really upsell the program and she had a lot of really nice things to say about it, but I was kind of interested in both the research and the teaching components and I saw it as a good opportunity to really refine my research skills and perhaps make a start as an early career researcher and I think after GP training finishes there is not necessarily a lot of obvious opportunities to get involved in GP research, particularly once you are a really busy clinicians.  So, I saw it is a really good opportunity to network a little bit, refine my research skills and start that research career.
44:40
Fantastic.  And did you come with research skills Katie?
44:42
I had done a bit of research at university, I did like an independent learning project, which is a 12 months’ learning project in third year, so that was my little bit of research experience, but other than that not a great deal prior to the post, but I think you learn so much during the post that you don’t necessarily need to have any prior experience before applying.
45:07
Fantastic.  And we have got a question from Oliver in the audience.  Oliver said thanks for the presentations, they were I agree very good.  Can you talk about managing your time during each week?  So, it sounds like Oliver is quite interested perhaps in a post, and also during the length of your research projects, how do you get the length of the research project right in order to get it all done…so, time management.  Darran, do you want to try first?
45:35
Yeah, sure.  So, managing your time, it is very self-directed …so, when you come up with your research proposal for the post, if you are seriously considering applying for it, there is a section where you have to kind of come up with a rough timeline, but those are just like your major milestones, but day to day you kind of have to be self-directed in terms of how you meet those milestones, three months down the track or six months down the track, and adjust and adapt along the way when you run into little roadblocks here and there, which you always run into in research, and it is really done in discussion with your supervisor that that you will be talking to a lot when you discuss your research proposal.  And so, you will have to learn to have good time management skills, and I think they have got rid of the requirement where you have to be doing part-time clinical work now, I am not sure, but we all had to do half-and-half, kind of half academic post half clinical work.  Duration of the research is tricky and I think the main person to talk to would be your supervisor and discuss it and they will be very good at offering you advice on telling you this is going to take way longer than 12 months, so try and narrow your focus down, is what they will probably say (laughter).
47:08
It’s always good to dream big isn’t it Darran, but sometimes we need people to help us pack that down a little bit.
47:15
Or you can have three or four publications from your one big idea then.
47:16
Yeah, this is true.  It’s a really good point you brought up, so, there’s a new college kind of change in policy, which is very very welcome, so, it used to be that you had to sort to bear full-time worker because you had to do part-time 50% university 50% clinical, but there is much more flexibility in that policy now, which is really fantastic for people to have all kinds of reasons why they are not working full-time.  Seren, what would you say about work balance and workload and time.
47:52
Well, Darran is obviously more of the expert because he has got his favour in, but, yeah, look in terms of timing your research, I think that is such a difficult thing and yeah, really speaking to your colleagues at your university and getting guidance from them, you know.. what is a feasible project, because you really don’t have that much time, it is 12 months, but it is part-time and so that was something you know … you do want to do something achievable, but you don’t want to just do a token little project just for the sake of it, so, you know, I don’t have an answer for that.  And then in terms of just for me personally, I split my week, I had two sort of long days in clinical practice, I think you have to do 19 hours of each, so I just did two Mondays and Thursdays, long days in clinical practice and then I did two-and-a-half days at Uni to do my project.  Within that time that was then split between research and teaching.
48:56
It is a very busy year…
49:01
And it was one of the biggest things I guess to get your head around because it is quite different in academia vs clinical practice, you are stuck to your…. well, you are loosely stuck… I am often running late … you get stuck to your appointment, there is a new problem coming in every 15 minutes and you check it off, boom boom boom boom boom, maybe have a few jobs at the end of the day, but the academic post you have just got this big looming project hanging over your head and at times I felt like I had a big school assignment due and it was hanging over my head on the weekend.  So, that took a little bit of time getting used to and just sort of trying to be disciplined in myself and sort of break it down into more achievable goals.
49:43
Great, great tips there Seren.  And Katie, what would you say?
49:45
Yeah, I was similar to Seren in that I split mine, I had too long… sort of 10-hour clinical days and then the sort of two-and-a-half days at the Uni with a split of research and teaching.  I think in terms of time management, one of the good aspects about the teaching is that the university does have that kind of cyclical nature with the quiet periods over the uni breaks and so you can kind of catch up a little bit on your research work during the uni breaks and then when the teaching is heavy you kind of back off on the research a little bit.  So, I think there is some flexibility to it and that does make it a little bit easier, but I suppose that it would be important to consider when your exams are going to be.  I think all of us were quite fortunate that our written exams were out of the way at the beginning of the post and then we just had the RCE in the middle of the year, but the teaching with the medical students as well kind of reinforces knowledge for the exam, so that part of it was quite good, and likes Seren said I think the clinical days are very busy and you have got back-to-back patients.  The research days, even though you have got this big project that is looming, you have kind of got a lot of time to really chip away at it over the year and you can be really flexible with those hours.
50:57
That’s fantastic.  Another question from the audience so David.  In terms of the research question that you came up with, so what was your process for coming up with that question.  Is there flexibility in regards to coming up with it or does it have to mesh with other bits of research coming out of the university you are interested in.  And there might be people in the audience who are like, oh my goodness, how I find a supervisor and any tips for finding a supervisor and a research question.  Katie, did you want to start there?
51:29
Yeah, sure.  So, I think there is scope to kind of do both of those, I think either you can come into it with a really unique research question that you are really interested in, or you can pick up a project that is also being worked on with your university, so I think the choice is yours.  I went into the post interested about the registrar billing practices and then telehealth kind of morphed from that, and I was really fortunate that my supervisor Parker McGinn does run the research and evaluation unit at GP Synergy, so he was connected to _____ and he was able to link me in with that, but I think just reaching out to your university and finding out who are the available supervisors and then you can kind of have a meeting with them and find out what research projects are they working on, does that mesh with what you are interested in or can they support you coming up with a completely new and unique study, and I think there is a lot of flexibility in doing that depending on who you reach out to.
52:25
And did you just email Parker or did you already know Parker?
52:28
Yeah, I emailed Parker.  I think when the academic post applications were open, I think Parker was the contact person for GP Synergy, so I reached out to him and that kind of started that conversation.
52:42
Fantastic.  So, there will be people in your kind of clinical sphere that you can reach out to to get help from.  That’s great.  Darran, how did you come up with your question and supervisor?
52:55
Yeah, so, my research question is completely 180 degrees different (laughter) to the question and research idea that I went into the academic post with.  Hence, my comment on adapting and adaptability and adjusting.  Well, my initial research idea was really to do with big data and data linkage, looking at kind of breast cancer outcomes between rural and urban populations, but there was a lot of delays in getting the data set from the external providers and that wouldn’t have fit in in a 12-month timeline, so we had to change project a bit, but just to answer the participant's questions, so, GP Synergy…I think where I was, they had a presentation from my supervisor Joel, he came to do a presentation on the opportunities of academic posts at Wollongong Uni, and so really that peaked my interest and I just basically… when we were still doing I think the last face-to-face kind of workshop for the next three or two and a half years, so I spoke to him a little bit after the presentation and that is where we got things going.  You could really go either way, you could reach out to any of your supervisors or potential supervisors at your university about your own research idea that you are interested in and passionate about, which is probably great, because then that will carry you through the 12 months.  Or if you have some broad ideas then maybe you can ask them what they are working on and where the opportunities are for you to do a 12-month academic post.  Yep.
54:29
Great.  So, you contacted Joel, who came and ….
54:33
So, Joel came to give a presentation and basically I spoke to him after his talk and then that’s where we kind of got things going.  Yep.
54:42
Fantastic.  And Seren, how did it work for you?
54:44
Yeah, so, I … well, I am fortunate in that I went to ANU Medical School, which would be my university for the post and I just remembered A/Prof Katrina Anderson for being one of my favourite educators in med school, so I just approached her and said, hey I am thinking about doing the post, have you got any research you are already involved in that I could get a part of, or could we brainstorm a new project.  And fortunately she said yep and then we sort of as I mentioned before, COVID was this new exciting phenomenon, so we thought, oh, that’ll be interesting and sort of just came up with the project on the fly.
55:30
Fantastic.  So, if you are looking for a supervisor or a question, you can definitely cold email GP researchers or researchers working in an area you are interested in.  Most GP academic posts are based in like a general practice department or primary care area, so you have that kind of experience working with GP researchers, but as academics, we are very used to getting emails out of the blue from all kinds of people, and you know, we are often sitting at a desk searching and things all day, so friendly emails from GP colleagues are always very welcome.  If you are having trouble finding either a topic or a supervisor, probably your first point of contact would be your medical educator and your RTO and sort of training pathway, but there’s also people at the RACGP that can help you.  So, Georgia Franklin is a contact at the RACGP, look up on the website, the academic post and they are an extremely friendly bunch and very experienced and can point you in the right direction.  We have another question from the floor about the new flexible options with full-time work and clinical work from Sonya.  Sonya, I would really recommend you have a look online on the RACGP website and the policies now there, and if you can’t find it, again shoot Georgia and the RACGP team an email and they will be able to point you in the right direction.  And one from Rene that has just come through about any prerequisites for the academic post.  My understanding is, no, there is no prerequisites.  Does anyone think there is?
57:08
(Overlapping conversation). I think you have to complete a GPT1 or something before you can apply, I think.
57:17
I think you are right there Darran.  So, complete a GPT1, but again all of those details will be on the RACGP website.  We are drawing to the end there, that went so fast, it was very fun.  I think for the last thing I would really love to hear what would be your hot tip for someone who is in the audience thinking about applying, going to apply, what would be your tip for an academic post Seren?
57:46
Yeah, my tip would be, if you are contemplating it just go for it, because I sort of wasn’t sure about it, and as I mentioned, signed up on a whim and I am so so happy I did it, it was a fantastic year, so, yeah, my hot tip is go for it.
58:01
Go for it.  That’s a good tip.  Darran, what would you say?
58:06
Same.  Go for it.  I think if you are on the fence, this will be a good time to try it out because you know you it will count to training, you get a good opportunity to really expose yourself to what the experience would be like working as an academic GP, doing research, teaching, balancing clinical work if you are working full-time, and you know you don’t go on in your later career wondering or trying to think whether you should have done it.  And if you find that it is not for you then it is not for you, great, and then you would probably still make good networks and learn really useful skills along the way.  And if you find that it is for you then you have really set a good foundation for yourself to launch your academic career.
58:55
Fantastic.  And Katie?
59:00
My hot tip would be, if you are thinking about it, I think get in touch with a potential supervisor really early on and start the application process, because the application can take quite a bit of time to put together, so the sooner you start that I think the easier that whole process is and it also means you can start brainstorming your research idea and really get that kind of solidified before you start your post.
59:25
That’s a really great tip Katie.  Do you know which bit of the year they are due in at the moment?  Is that around the middle of the year?
59:33
From memory, I think it was ….(overlapping conversation)
59:34
It’s like a lot earlier than expected.
59:40
I can’t be certain, but I think it is mid-year, yeah.
59:42
Mid year.  Fantastic.  So, probably if… if there is something kind of brewing in your mind, jump on the website and have a look at the details there about how to apply.  I totally agree Katie, to go early.  So, Georgia has jumped in there, she is in behind the scenes here.  So, the applications open in April or May and close around July to August, but the firm dates are to be confirmed.  They are not open online yet, but that doesn’t mean you can’t sort of start thinking about it, contacting a supervisor and getting things going.  That’s a great tip.  Thank you all for joining us tonight.  You were wonderful volunteers, fantastic presentations, I really enjoyed hearing about your research and your experience.  I think a number of years ago, I think it was _____ when he was President, talked about our profession being an academic profession, really based on sound research, and when you see all of these fantastic new, up and coming researchers, you really know that the profession is in great hands and we really will go to looking at the how and why of the art of general practice.  So, thank you very much for joining us.  For everyone who is listening live or on the recording, this has been part of the GP research webinar series and that will be continuing through 2022, which is fantastic.  So, keep looking at the website for the next topics and we look forward to seeing you at the next webinar.  Thanks very much.

Other RACGP online events

Originally recorded:

15 February 2022

Have you considered applying for the RACGP Academic Post Program? This webinar will showcase GP research undertaken by participants of the Program, presented by the researchers. Each presenter will provide a brief overview of their project and the highlights and challenges of conducting it. The presenting researchers will also participate in a Q&A session with the audience. Those interested in engaging in GP research and curious others are invited to attend.

If you are potentially interested in an Academic Post, this webinar will provide inspiration for possible projects.

Learning outcomes

  1. To showcase the research done by participants in the RACGP Academic Post Program to raise the profile of GP research
  2. To raise awareness among GP registrars and interested others of the purpose of the RACGP Academic Post Program and the possibilities for research projects
  3. To raise awareness of research undertaken by participants of the RACGP Academic Post Program
  4. To raise awareness of how a careeer in GP research can enhance the career of interested GPs
This event attracts 2 CPD points

This event attracts 2 CPD points

This event is part of GP research webinar series 2020-2022. Events in this series are:

Host

Dr Liz Sturgiss

Dr Liz Sturgiss is a clinical general practitioner and primary care researcher at Monash University, Melbourne. Liz leads an emerging research program on the management of complex and stigmatised health issues in primary care, focusing on translating guidelines into real-world practice. Her clinical practice focuses on caring for people with substance dependence and complex multi-morbidity. One of the things Liz enjoys most about academic practice is engaging with people from diverse backgrounds, discussing exciting new ideas, and being involved in research that changes clinical practice. She has representative roles with the Royal Australian College of General Practitioners, the Australasian Association for Academic Primary Care, and on the International Committee of the North American Primary Care Research Group.

Presenters

Dr Darran Foo

Darran is a GP registrar pursuing a blended career in clinical general practice, primary care research and digital health. As part of his training, Darran undertook his Academic Post term at the University of Wollongong conducting research on the differences in help-seeking behaviours between rural and urban cancer patients. He is also passionate about advocating for his fellow registrars through his roles as a registrar liaison officer with GP Synergy and a registrar advisor for GPRA

Dr Katie Fisher

Dr Katie Fisher is a 2021 GP Academic Registrar at the University of Newcastle. Katie is the recipient of the 2021 GP Synergy NSW/ACT Dr Charlotte Hespe Research Award and the 2021 RACGP Charles Bridges-Webb Memorial Award. Katie is working with the GP Synergy Research & Evaluation Unit to analyse GP registrars' telehealth use during the COVID-19 pandemic. Katie also works part-time as a GP registrar in Newcastle NSW and is currently undertaking a Masters in Clinical Epidemiology at the University of Newcastle.

Dr Seren Ovington

Dr Seren Ovington is an RACGP Academic Post Registrar from Canberra. She is completing her academic post at the Australian National University and has undertaken a qualitative research project exploring the experiences of Australian GPs working during the COVID-19 pandemic. Being previously inexperienced with research, Seren has enjoyed the challenge of developing and conducting her own research project. She has also enjoyed the various teaching and learning opportunities the academic post offers. In addition to the academic post, Seren works in clinical practice and is passionate about holistic, preventative and patient-centered care.

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