title: Benefits and challenges of multi-level learner rural general practices--an interview study with learners, staff and patients.
abstract: BACKGROUND
  General practices vary in the provision of training and education. Some practices have training as a major focus with the presence of multi-level learners and others host single learner groups or none at all. This study investigates the educational benefits and challenges associated with 'multi-level learner' practices.
  
  
  METHODS
  This paper comprised three case studies of rural general practices with multiple levels of learners. Qualitative data were collected from 29 interviews with learners (n = 12), staff (n = 12) and patients (n = 5). Interviews were initially analyzed using open and axial coding and thematic analysis.
  
  
  RESULTS
  Thematic analysis showed 'multi-level learning' in general practices has benefits and challenges to learners and the practice. Learner benefits included knowledge exchange, the opportunity for vertical peer learning, a positive learning environment and the development of a supportive network. The presence of multi-level learners promoted sharing of knowledge with all staff, a sense of community, an increase in patient services and enthused supervisors. Challenges for learners included perception of decreased access to supervisors, anxiety with peer observation, reduced access to patient presentations and patient reluctance to be seen by a learner. Practice challenges were administration requirements, high learner turnover, infrastructure requirements and the requirement for supervisors to cater to a range of learner level needs.
  
  
  CONCLUSIONS
  The presence of medical students, interns and registrars in general practice has educational benefits to the learners extending to the other stakeholders (staff and patients). Multi-level learners present challenges to the learners and the practice by increasing pressures on resources, staff (administrative and supervisors) and infrastructure.
authors.affiliation: Victoria University, Osteopathic discipline, College of Health and Biomedicine, Melbourne, Victoria, Australia. tracy.morrison@vu.edu.au.
authors.forename: Tracy
authors.initials: T
authors.lastname: Morrison
authors.forename: James
authors.initials: J
authors.lastname: Brown
authors.forename: Melanie
authors.initials: M
authors.lastname: Bryant
authors.forename: Debra
authors.initials: D
authors.lastname: Nestel
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D005180:Faculty, Medical; D005260:Female; D058006:General Practice / Q000193:education*; D006801:Humans; D033183:Interdisciplinary Communication; D007396:Internship and Residency; D007407:Interviews as Topic; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D017145:Models, Educational; D010348:Patient Care Team; D017060:Patient Satisfaction; D010379:Peer Group; D012423:Rural Health / Q000193:education*; D014739:Victoria; D055815:Young Adult