Evidence from the GP Synergy NSW & ACT Research and Evaluation Unit – each month we present findings from our work that may be of interest to registrars and their supervisors.
In our vocational specialist GP training program, education and teaching have multiple aims. We aim to influence registrars’ knowledge, skills, attitudes, professionalism, and their clinical practice (and, ultimately, patient well-being). Researching directly whether we affect patient well-being is exceedingly difficult. But we can evaluate and research outcomes of our education at these other levels.
Of these, establishing effects on actual clinical practice is the most challenging (and often the most important). Educational activities are often ‘complex interventions’. And clinical practice is complex and highly contextual. We have, however, attempted to assess the impact on clinical practice of a number of educational innovations in general practice vocational training.
An example is a program of work around rational prescribing of antibiotics for non-pneumonia respiratory tract infections – identified by the WHO as a major global health threat. Our initial work had identified a problem. From ReCEnT data we saw that registrars seemed to prescribe antibiotics somewhat less than established GPs, but still well in excess of international benchmarks. Qualitative work we did with a North Coast academic registrar gave us a great deal of insight into the context of this prescribing. Together with further examination of the ReCEnT data, review of the international literature in the area, and infectious disease content-expert input, we constructed an educational package including an online module, presentations to registrars and supervisors, and a structured outline for a one-on-one registrar-supervisor teaching session. We delivered this package in 2014 and 2015.
We evaluated this educational package with three modalities. We measured before-and-after questionnaire responses (in a study design without controls) to clinical ‘vignettes’ (i.e. ‘intended practice’, or knowledge and attitudes); we made comparisons including pre- and post-education ReCEnT data, and whether the registrars’ Regional Training Provider delivered the education or not (i.e. ‘actual clinical practice’); and conducted a post-education qualitative study of registrars and supervisors.
For ‘intended’ vignette-based prescribing we found statistically significant absolute reductions of 12-24% in registrars intended antibiotic prescribing for the sore throat, otitis media, and two of three acute bronchitis vignettes . For ‘actual prescribing’, there was a significant 16% absolute reduction in antibiotic prescribing for acute bronchitis . This reduction compares favourably with results from other educational interventions for antibiotic prescribing internationally. An important finding of the qualitative study was of an absence of registrar-supervisor conflicts concerning antibiotic prescribing, but most participants identified conflicts within the GP practice or with specialists .
Our conclusion was that RTPs’ (now RTOs) education can positively influence registrars’ clinical practice. We also feel that there is suggestive evidence that actively involving supervisors in this education is valuable. It also seems likely that, for many clinical behaviours, involvement of the whole teaching practice in the education is desirable.
- Magin P, Morgan S, Tapley A, Davis J, McArthur L, Henderson K, Mulquiney K, Dallas A, Davey A, Scott J, van Driel M. Reducing general practice trainees’ antibiotic prescribing for respiratory tract infections: an evaluation of a combined face-to-face workshop and on-line educational intervention. 2016. Education for Primary Care. 27(2):98-105
- Magin P, Tapley A, Morgan S, Davis J, McElduff P, Yardley L, Henderson K, Dallas A, McArthur L, Mulquiney K, Davey A, Little P, Spike N, van Driel M. Reducing early-career general practitioners’ antibiotic prescribing for respiratory tract infections: a pragmatic prospective non-randomised controlled trial. 2018. Family Practice. 35(1); 53-60.
- Deckx L, Anthierens S, Magin P, Morgan S, McArthur L, Yardley L, Dallas A, Mulquiney K, Little P, van Driel M. Focus on early-career GPs: qualitative evaluation of a multi-faceted educational intervention to improve antibiotic prescribing. 2018. Family Practice 35(1); 99-104.
If you would like further information, please contact Parker Magin.