title: Early predictors of need for remediation in the Australian general practice training program: a retrospective cohort study.
abstract: Underperforming trainees requiring remediation may threaten patient safety and are challenging for vocational training programs. Decisions to institute remediation are high-stakes-remediation being resource-intensive and emotionally demanding on trainees. Detection of underperformance requiring remediation is particularly problematic in general (family) practice. We sought to establish early-training assessment instruments predictive of general practice (GP) trainees' subsequently requiring formal remediation. We conducted a retrospective cohort study of trainees from a large Australian regionally-based GP training organization. The outcome factor was requirement for formal remediation. Independent variables were demographic factors and a range of formative assessments conducted immediately prior to or during early-stage training. Analyses employed univariate and multivariate logistic regression of each predictor assessment modality with the outcome, adjusting for potential confounders. Of 248 trainees, 26 (10.5 %) required formal remediation. Performance on the Colleague Feedback Evaluation Tool (entailing feedback from a trainee's clinical colleagues on clinical performance, communication and probity) and External Clinical Teaching Visits (half-day sessions of the trainee's clinical consultations observed directly by an experienced GP), along with non-Australian primary medical qualification, were significantly associated with requiring remediation. There was a non-significant trend for association with performance on the Doctors Interpersonal Skills Questionnaire (patient feedback on interpersonal elements of the consultation). There were no significant associations with entry-selection scores or formative exam or assessment scores. Our finding that 'in vivo' assessments of complex behaviour, but not 'in vitro' knowledge-based assessments, predict need for remediation is consistent with theoretical understanding of the nature of remediation decision-making and should inform remediation practice in GP vocational training.
authors: School of Medicine and Public Health, University of Newcastle, Newbolds Building, University Drive, Callaghan, NSW, 2308, Australia. parker.magn@newcastle.edu.au.|General Practice Training Valley to Coast, Mayfield, NSW, Australia. parker.magn@newcastle.edu.au.
authors: Parker
authors: http://orcid.org/0000-0001-8071-8749
authors: P
authors: Magin
authors: Tropical Medical Training, Townsville, QLD, Australia.
authors: Rebecca
authors: R
authors: Stewart
authors: Tropical Medical Training, Townsville, QLD, Australia.|School of Medicine, University of Tasmania, Hobart, TAS, Australia.
authors: Allison
authors: A
authors: Turnock
authors: General Practice Training Valley to Coast, Mayfield, NSW, Australia.
authors: Amanda
authors: A
authors: Tapley
authors: School of Medicine and Public Health, University of Newcastle, Newbolds Building, University Drive, Callaghan, NSW, 2308, Australia.|Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, Newcastle, NSW, Australia.
authors: Elizabeth
authors: E
authors: Holliday
authors: School of Medicine, University of Tasmania, Hobart, TAS, Australia.
authors: Nick
authors: N
authors: Cooling
mesh_terms: D000328:Adult; D001315:Australia; D002983:Clinical Competence; D003142:Communication; D004503:Education, Medical, Graduate / Q000592:standards / Q000706:statistics & numerical data*; D004521:Educational Measurement; D005260:Female; D058006:General Practice / Q000193:education*; D006801:Humans; D008297:Male; D012073:Remedial Teaching / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012570:School Admission Criteria; D066107:Social Skills
keywords: Education, medical, graduate; Educational measurement; Family practice; General practice; Professional competence; Remedial teaching