Specificity of early-career general practitioners’ problem formulations in patients presenting with dizziness: a cross-sectional analysis

ObjectivesDizziness is a common and challenging clinical presentation in general practice. Failure to determine specific aetiologies can lead to significant morbidity and mortality. We aimed to establish frequency and associations of general practitioner (GP) trainees’ (registrars’) specific vertigo provisional diagnoses and their non-specific symptomatic problem formulations.DesignA cross-sectional analysis of Registrar Clinical Encounters in Training (ReCEnT) cohort study data between 2010 and 2018. ReCEnT is an ongoing, prospective cohort study of registrars in general practice training in Australia. Data collection occurs once every 6 months midtraining term (for three terms) and entails recording details of 60 consecutive clinical consultations on hardcopy case report forms. The outcome factor was whether dizziness-related or vertigo-related presentations resulted in a specific vertigo provisional diagnosis versus a non-specific symptomatic problem formulation. Associations with patient, practice, registrar and consultation independent variables were assessed by univariate and multivariable logistic regression.SettingAustralian general practice training programme. The training is regionalised and delivered by regional training providers (RTPs) (2010–2015) and regional training organisations (RTOs) (2016–2018) across Australia (from five states and one territory).ParticipantsAll general practice registrars enrolled with participating RTPs or RTOs undertaking GP training terms.Results2333 registrars (96% response rate) recorded 1734 new problems related to dizziness or vertigo. Of these, 546 (31.5%) involved a specific vertigo diagnosis and 1188 (68.5%) a non-specific symptom diagnosis. Variables associated with a non-specific symptom diagnosis on multivariable analysis were lower socioeconomic status of the practice location (OR 0.94 for each decile of disadvantage, 95% CIs 0.90 to 0.98) and longer consultation duration (OR 1.02, 95% CIs 1.00 to 1.04). A specific vertigo diagnosis was associated with performing a procedure (OR 0.52, 95% CIs 0.27 to 1.00), with some evidence for seeking information from a supervisor being associated with a non-specific symptom diagnosis (OR 1.39, 95% CIs 0.92 to 2.09; p=0.12).ConclusionsAustralian GP registrars see dizzy patients as frequently as established GPs. The frequency and associations of a non-specific diagnosis are consistent with the acknowledged difficulty of making diagnoses in vertigo/dizziness presentations. Continuing emphasis on this area in GP training and encouragement of supervisor involvement in registrars’ diagnostic processes is indicated.

Download Full-text

General practice training in regional and rural Australia: A cross‐sectional analysis of the Registrar Clinical Encounters in Training study

Australian Journal of Rural Health ◽

10.1111/ajr.12591 ◽

2020 ◽

Vol 28 (1) ◽

pp. 32-41

Author(s):

Amanda Tapley ◽

Andrew R. Davey ◽

Mieke L. Driel ◽

Elizabeth G. Holliday ◽

Simon Morgan ◽

...

Keyword(s):

General Practice ◽

Cross Sectional ◽

Training Study ◽

Cross Sectional Analysis ◽

Clinical Encounters ◽

Sectional Analysis ◽

Rural Australia ◽

General Practice Training

Download Full-text

General practice registrars’ clinical exposure to dermatological procedures during general practice training: a cross-sectional analysis

Education for Primary Care ◽

10.1080/14739879.2018.1520612 ◽

2018 ◽

Vol 29 (6) ◽

pp. 357-366 ◽

Cited By ~ 1

Author(s):

Er Tsing Vivian Tng ◽

Amanda Tapley ◽

Andrew Davey ◽

Sally De Zwaan ◽

Simon Morgan ◽

...

Keyword(s):

General Practice ◽

Cross Sectional ◽

Clinical Exposure ◽

Cross Sectional Analysis ◽

Sectional Analysis ◽

General Practice Training

Download Full-text

Emergency department referral patterns of Australian general practitioner registrars: a cross-sectional analysis of prevalence, nature and associations

Australian Health Review ◽

10.1071/ah17005 ◽

2019 ◽

Vol 43 (1) ◽

pp. 21 ◽

Cited By ~ 1

Author(s):

Nigel Catzikiris ◽

Amanda Tapley ◽

Simon Morgan ◽

Mieke van Driel ◽

Neil Spike ◽

...

Keyword(s):

Emergency Department ◽

General Practice ◽

Cohort Study ◽

Continuity Of Care ◽

Cross Sectional ◽

Referral Patterns ◽

International Evidence ◽

Cross Sectional Analysis ◽

Included Patient ◽

Sectional Analysis

Objective Limited international evidence suggests general practice registrars’ emergency department (ED) referral rates exceed those of established general practitioners (GPs). The aim of the present study was to fill an evidence gap by establishing the prevalence, nature and associations of Australian GP registrar ED referrals. Methods A cross-sectional analysis was performed of the Registrar Clinical Encounters in Training (ReCEnT) cohort study of GP registrars’ consultation experiences, between 2010 and 2015. The outcome factor in logistic regression analysis was referral to an ED. Independent variables included patient-level, registrar-level, practice-level and consultation-level factors. Results In all, 1161 GP registrars (response rate 95.5%) contributed data from 166966 consultations, comprising 258381 individual problems. Based on responses, 0.5% of problems resulted in ED referral, of which nearly 25% comprised chest pain, abdominal pain and fractures. Significant (P < 0.05) associations of ED referral included patient age <15 and >34 years, the patient being new to the registrar, one particular regional training provider (RTP), in-consultation information or assistance being sought and learning goals being generated. Outer regional-, remote- or very remote-based registrars made significantly fewer ED referrals than more urban registrars. Of the problems referred to the ED, 45.5% involved the seeking of in-consultation information or assistance, predominantly from supervisors. Conclusions Registrars’ ED referral rates are nearly twice those of established GPs. The findings of the present study suggest acute illnesses or injuries present registrars with clinical challenges and real learning opportunities, and highlight the importance of continuity of care, even for acute presentations. What is known about the topic? A GP’s decision concerning continued community- versus hospital-based management of acute presentations demands careful consideration of a suite of factors, including implications for patient care and resource expenditure. General practice vocational training is a critical period for the development of GP registrars’ long-term patterns of practice. Although limited international evidence suggests GP registrars and early career GPs refer patients to the ED at a higher rate than their more experienced peers, these studies involved small subject numbers and did not investigate associations of registrars making an ED referral. Relevant Australian studies focusing on GP registrars’ ED referral patterns are lacking. What does this paper add? The present ongoing cohort study is the first to establish the patterns of ED referrals made by Australian GP registrars, encompassing five general practice RTPs across five states, with participating registrars practising in urban, rural, remote and very remote practices. Several significant associations were found with GP registrars making ED referrals, including patient age, continuity of care, the registrar’s RTP, assistance sought by the registrar and rurality of the registrar’s practice. What are the implications for practitioners? The higher likelihood of GP registrars seeing acute presentations than their more established practice colleagues, coupled with a demonstrated association of registrars seeking in-consultation assistance for such presentations, highlights the importance of GP supervisor accessibility in facilitating ED referral appropriateness and in the development of registrars’ safe clinical practice.

Download Full-text