Provision of antenatal care is a rewarding aspect of general practice. However, GP registrars very often have limited clinical experience in this area, and can find antenatal care challenging. GP supervisors can support a systematic approach to looking after the pregnant woman, including screening and monitoring for potentially serious problems.
Genetic testing for human disease has never been more accessible, nor sought after by health consumers. Genetics counselling and testing is no longer solely the domain of specialist units, but increasingly becoming a routine element of Australian general practice. GPs can order a variety of different genetic tests, but direct-to-consumer marketing means that GPs are being asked to interpret complex tests that they may not have requested. There are a number of common genetic disorders e.g. hereditary haemochromatosis, thalassemia that registrars need to competently assess and manage. Furthermore, registrars increasingly need to consider a genetic contribution to a wide range of patient presentations, as well as develop a best practice approach to genetic counselling and test interpretation.
Health assessments/health checks are the second most frequent reason for encounter in Australian general practice (after prescription requests), occurring at a rate of 8.6 per 100 encounters. Health assessments, comprising preventive health activities and screening, are core elements of comprehensive general practice. They are particularly important in addressing the health disparities faced by disadvantaged population groups, like Aboriginal and Torres Strait Islander people. For many GP registrars, undertaking preventive health assessments and population screening will require the application of new knowledge and skills.
Immunisation has been a major factor in improving the health of communities over the past century, and general practice is the major location for vaccination in Australia. The safety and effectiveness of immunisation is well established. Despite this, a significant number of Australian adults remain unconvinced or fearful about immunisation. Registrars need to be up to date in relation to the ever-changing immunisation schedules, and be competent in dealing with reluctant parents.
The transition from prescribing in the hospital environment to the general practice setting is a challenging one for new GP registrars. The rules, regulations and restrictions of the PBS can be bewildering. This activity should be done at orientation, or very early in the term.
Polypharmacy is the concurrent use of multiple medications. This is an issue for all patients with comorbidities, although most prominent in the elderly, with a recent MJA study finding that 66% of people aged 75+ years taking five or more medications. Polypharmacy can be associated with multiple side effects, interactions and patient harm. De-prescribing is the process of withdrawal of an inappropriate or redundant medication with the goal of managing polypharmacy and improving outcomes. This tutorial is linked to the supervision activity of prescribing audit and feedback.
Professional and ethical practice is a fundamental component of quality general practice. Reflecting this, the professional and ethical role of the GP is identified as a core domain in the curricula of both the RACGP and ACRRM. The professional and ethical role embraces a wide range of areas: duty of care, boundaries, end-of-life care, professional standards, self-appraisal and self-care, teaching and mentorship, practicing within an ethical framework and life-long learning. Supervisors play an important role in instilling and nurturing professional and ethical values, attitudes and behaviours in their registrars. Fundamentally, these embrace the primacy of the duty of care to patients, the rights of patients to access competent, compassionate care, and the need to practice safely, effectively and ethically.
Medication use is the most common health-related action taken by Australians and, if used correctly, can significantly improve health outcomes. However, there are also potential harms and negative consequences related to medicines use. Rational prescribing (RP) is the judicious, appropriate, safe and efficacious use of medicines, and is known to be a challenging area for GP registrars. GP supervisors play a key role in influencing GP registrar prescribing. This tutorial is linked to the supervision activity of prescribing audit and feedback.
Critical use of investigations is one of the core skills of Australian general practice training and previous research has demonstrated that this is a challenging area for GP registrars. Inexperience and intolerance of uncertainty can lead to overtesting, with consequent risks of ‘investigation momentum’, false positives, ‘incidentalomas’ and patient harm. GP supervisors play a key role in influencing GP test ordering behaviour. This tutorial is linked to the supervision activity of TRAFk (test result audit and feedback – see GPSA Guide).
Although great progress has been made on reducing smoking rates over past decades, smoking remains one of the most important preventable causes of morbidity and mortality in the Australian population. There is good evidence that opportunistic intervention GPs can substantially increase abstinence rates and deliver significant public health benefits. However, there are a number of known barriers to initiating a discussion about smoking cessation. GP registrars need to develop an efficient and effective approach to this topic, including understanding the range of pharmacological interventions available.
Work related problems are an important and common aspect of Australian general practice, managed in 2.7% of all encounters. Most commonly, these comprise musculoskeletal disorders (mainly back), psychological problems, and skin conditions. The GPs role in managing work related problems is defined by worker’s compensation legislation, and there are certain obligations that must be met. The primary objective is to assist the patient’s recovery and early return to work. Worker’s compensation is a common source of anxiety for GP registrars, and it is therefore a critical area for GP supervisors to educate their GP registrars.