title: Test ordering by GP trainees: Effects of an educational intervention on attitudes and intended practice.
abstract: OBJECTIVE
  To assess the effectiveness of an educational intervention on test-ordering attitudes and intended practice of GP trainees, and any associations between changes in test ordering and trainee characteristics.
  
  
  METHODS
  Preworkshop and postworkshop survey of attitudes to test ordering, intended test-ordering practices for 3 clinical scenarios (fatigue, screening, and shoulder pain), and tolerance for uncertainty.
  
  
  METHODS
  Three Australian regional general practice training providers.
  
  
  METHODS
  General practice trainees (N = 167).
  
  
  METHODS
  A 2-hour workshop session and an online module.
  
  
  METHODS
  Proportion of trainees who agreed with attitudinal statements before and after the workshop; proportion of trainees who would order tests, mean number of tests ordered, and number of appropriate and inappropriate tests ordered for each scenario before and after the workshop.
  
  
  RESULTS
  Of 167 trainees, 132 (79.0%) completed both the preworkshop and postworkshop questionnaires. A total of 122 trainees attended the workshop. At baseline, 88.6% thought that tests can harm patients, 84.8% believed overtesting was a problem, 72.0% felt pressured by patients, 52.3% believed that tests would reassure patients, and 50.8% thought that they were less likely to be sued if they ordered tests. There were desirable changes in all attitudes after the workshop. Before the workshop, the mean number of tests that trainees would have ordered was 4.4, 4.8, and 1.5 for the fatigue, screening, and shoulder pain scenarios, respectively. After the workshop there were decreases in the mean number of both appropriate tests (decrease of 0.94) and inappropriate tests (decrease of 0.24) in the fatigue scenario; there was no change in the mean number of appropriate tests and a decrease in inappropriate tests (decrease of 0.76) in the screening scenario; and there was an increase in the proportion of trainees who would appropriately not order tests in the shoulder pain scenario. There were no significant associations between changes in test ordering and trainee demographic characteristics or tolerance for uncertainty subscale scores.
  
  
  CONCLUSIONS
  General practice trainees have conflicting attitudes to test ordering and demonstrate nonrational test ordering in 3 common scenarios. A workshop on rational test ordering led to desirable changes in attitudes and more rational intended test ordering. Our findings inform the development of appropriate educational interventions that address nonrational testing in family medicine.
authors.affiliation: GP and Medical Educator with General Practice Training Valley to Coast, practising in Newcastle, NSW, Australia. lochswilly@gmail.com.
authors.forename: Simon
authors.initials: S
authors.lastname: Morgan
authors.affiliation: Senior Medical Educator at Victorian Metropolitan Alliance and Senior Lecturer in the Department of General Practice at Monash University in Melbourne, Australia.
authors.forename: Andy
authors.initials: A
authors.lastname: Morgan
authors.affiliation: Senior Medical Educator with General Practice Training Tasmania and a GP at Claremont Village Medical Centre in Hobart, Australia.
authors.forename: Rohan
authors.initials: R
authors.lastname: Kerr
authors.affiliation: Research officer at General Practice Training Valley to Coast.
authors.forename: Amanda
authors.initials: A
authors.lastname: Tapley
authors.affiliation: GP and Medical Educator at General Practice Training Valley to Coast, and Conjoint Professor in the Discipline of General Practice at the University of Newcastle.
authors.forename: Parker
authors.initials: P
authors.lastname: Magin
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D005260:Female; D058005:General Practitioners / Q000193:education*; D006801:Humans; D008297:Male; D000069342:Medical Overuse / Q000517:prevention & control*; D010818:Practice Patterns, Physicians'; D015397:Program Evaluation / Q000592:standards*; D011795:Surveys and Questionnaires