title: Family medicine trainees' clinical experience of chronic disease during training: a cross-sectional analysis from the registrars' clinical encounters in training study.
abstract: BACKGROUND
  A broad case-mix in family physicians' (general practitioners', GPs') vocational trainee experience is deemed essential in producing competent independent practitioners. It is suggested that the patient-mix should include common and significant conditions and be similar to that of established GPs. But the content of contemporary GP trainees' clinical experience in training is not well-documented. In particular, how well trainees' experience reflects changing general practice demographics (with an increasing prevalence of chronic disease) is unknown. We aimed to establish levels of trainees' clinical exposure to chronic disease in training (and associations of this exposure) and to establish content differences in chronic disease consultations (compared to other consultations), and differences in trainees' actions arising from these consultations.
  
  
  METHODS
  A cross-sectional analysis from the Registrars' Clinical Encounters in Training (ReCEnT) study, a cohort study of GP registrars' (trainees') consultations in four Australian GP training organisations. Trainees record detailed data from 60 consecutive consultations per six-month training term. Diagnoses/problems encountered are coded using the International Classification of Primary Care-2 PLUS (ICPC-2 PLUS). A classification system derived from ICPC-2 PLUS was used to define diagnoses/problems as chronic/non-chronic disease. The outcome factor for analyses was trainees' consultations in which chronic disease was encountered. Independent variables were a range of patient, trainee, practice, consultation and educational factors.
  
  
  RESULTS
  Of 48,112 consultations (of 400 individual trainees), 29.5% included chronic disease problems/diagnoses. Associations of a consultation including chronic disease were the patient being older, male, and having consulted the trainee previously, and the practice routinely bulk-billing (not personally charging) patients. Consultations involving a chronic disease lasted longer, dealt with more problems/diagnoses, and were more likely to result in specialist referrals and trainees generating a personal learning goal. They were associated with less pathology tests being ordered.
  
  
  CONCLUSIONS
  Trainees saw chronic disease less frequently than have established GPs in comparable studies. The longer duration and more frequent generation of learning goals in chronic disease-containing consultations suggest trainees may find these consultations particularly challenging. Our findings may inform the design of measures aimed at increasing the chronic disease component of trainees' patient-mix.
authors.affiliation: Discipline of General Practice, the University of Newcastle, Callaghan, 2308, NSW, Australia. parker.magin@newcastle.edu.au.|General Practice Training Valley to Coast, Mayfield, Australia. parker.magin@newcastle.edu.au.
authors.forename: Parker
authors.initials: P
authors.lastname: Magin
authors.affiliation: General Practice Training Valley to Coast, Mayfield, Australia. simon.morgan@gptvtc.com.au.
authors.forename: Simon
authors.initials: S
authors.lastname: Morgan
authors.affiliation: General Practice Training Valley to Coast, Mayfield, Australia. kim.henderson@gptvtc.com.au.
authors.forename: Kim
authors.initials: K
authors.lastname: Henderson
authors.affiliation: General Practice Training Valley to Coast, Mayfield, Australia. amanda.tapley@gptvtc.com.au.
authors.forename: Amanda
authors.initials: A
authors.lastname: Tapley
authors.affiliation: School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia. Patrick.mcelduff@newcastle.edu.au.
authors.forename: Patrick
authors.initials: P
authors.lastname: McElduff
authors.affiliation: Discipline of General Practice, the University of Newcastle, Callaghan, 2308, NSW, Australia. jwpearlman@gmail.com.
authors.forename: James
authors.initials: J
authors.lastname: Pearlman
authors.affiliation: Hunter Translational Cancer Research Unit, School of Medicine and Public Health, the University of Newcastle, Callaghan, Australia. Susan.goode@newcastle.edu.au.
authors.forename: Susan
authors.initials: S
authors.lastname: Goode
authors.affiliation: General Practice Training Valley to Coast, Mayfield, Australia. Neil.spike@vma.com.au.|Victorian Metropolitan Alliance, Melbourne, Australia. Neil.spike@vma.com.au.
authors.forename: Neil
authors.initials: N
authors.lastname: Spike
authors.affiliation: Discipline of General Practice, The University of Adelaide, Adelaide, Australia. caroline.laurence@adelaide.edu.au.
authors.forename: Caroline
authors.initials: C
authors.lastname: Laurence
authors.affiliation: General Practice Training Valley to Coast, Mayfield, Australia. John.scott@gptvtc.com.au.
authors.forename: John
authors.initials: J
authors.lastname: Scott
authors.affiliation: Discipline of General Practice, the University of Newcastle, Callaghan, 2308, NSW, Australia. Allison.thomson@newcastle.edu.au.
authors.forename: Allison
authors.initials: A
authors.lastname: Thomson
authors.affiliation: Academic Discipline of General Practice, The University of Queensland, Brisbane, Australia. m.vandriel@uq.edu.au.
authors.forename: Mieke
authors.initials: M
authors.lastname: van Driel
mesh_terms: D000328:Adult; D001315:Australia; D002908:Chronic Disease; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004503:Education, Medical, Graduate; D005194:Family Practice / Q000193:education*; D005260:Female; D006801:Humans; D008297:Male; D012017:Referral and Consultation