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Background: Burnout and workforce shortages comprise a vicious cycle in medicine, particularly for Australian general practitioners (GPs). Professional diversification, whereby individuals work multiple roles across their week, may help address this problem, but this strategy is under-studied., Methods: We surveyed 1157 Australian GPs using qualitative and quantitative questions examining professional diversification, values, autonomy, and wellbeing. Quantitative data were analysed using inferential statistics, whilst qualitative data were analysed using inductive thematic analysis. We triangulated the data by using the qualitative findings to inform further quantitative testing., Results: Approximately 40% of the sample had diversified. Although diversifying was not significantly associated with wellbeing, the qualitative data indicated that diversification supported GPs' wellbeing by enhancing career sustainability, accomplished through various pathways (e.g. value fulfilment, autonomy, variety). Subsequent quantitative analyses provided evidence that these pathways mediated the relationship between diversification and wellbeing. To diversify, GPs needed particular personal qualities, external supports, flexibility, and serendipity. Barriers to diversifying mirrored these factors, spanning individual (e.g. skillset) and situational levels (e.g. autonomy, location)., Conclusions: Diversification can support GPs' wellbeing if it meets their needs. Organisations should focus on publicising opportunities and accommodating requests to diversify.

Background: Few general practitioners (GPs) pursue a career in Aboriginal and Torres Strait Islander health. This research examined factors motivating Australian General Practice Training Program (AGPT) graduates to remain in, or leave, Aboriginal Medical Services (AMSs)., Methods: AGPT graduates who remained (n =11) and left (n =9) AMSs after placements participated in semi-structured interviews across two studies. Thematic analysis informed by grounded theory was employed., Results: Both participant groups highlighted similar motivations for requesting an AMS placement, particularly their interest in Aboriginal health or culture. Participants enjoyed organisational structures and relationships, and faced similar barriers to working in AMSs. Those who left placed greater emphasis on the politics and bureaucracy, and unpredictability, and also faced the barrier of ties to their current practice. Those who remained in Aboriginal health more proactively addressed barriers and had a more external view of barriers., Conclusions: Factors influencing career decisions of GPs in Aboriginal health overlap with those for GPs in rural and other under-served areas. Training providers can better prepare (e.g. more comprehensive orientations) and support registrars during their placements (e.g. greater mentoring). Registrars' perceptions of, and reactions to, barriers may be pivotal in determining whether they remain in Aboriginal health. This article provides guidance for training providers to better support AMS registrars and encourage more GPs to work in this sector.

Objectives: Providing well-supported general practice (GP) training is fundamental to strengthen the primary health workforce. Research into the unique needs of GP registrars during disasters is limited. Registrar burnout and insufficient support have been associated with personal and professional detrimental effects. This study aims to explore the experiences of Australian GP registrars with learning, well-being and support from their training organisation during the COVID-19 pandemic, and to guide training organisation efforts to support registrars through future disasters., Setting: Interviews were conducted via Zoom., Participants: Fifteen GP registrars from South Australia, Victoria and New South Wales who had experienced community-based GP training in both 2019 (prepandemic) and 2020 (early pandemic)., Outcome Measures: Training, well-being and support experiences were explored. Interviews were recorded and transcribed and themes analysed., Results: Diverse experiences were reported: changes included telehealth, online tutorials, delayed examinations and social restrictions. Social and professional connections strongly influenced experiences. Personal and training factors were also important. Additional GP training organisation support was minimally needed when strong connections were in place., Conclusions: This study identifies aspects of support which shaped registrars' diverse experiences of COVID-19, particularly regarding professional and social connections. Findings illustrate the importance of broad principles around supporting registrar well-being. Particularly significant aspects of support include connection to educational mentors such as supervisors and medical educators; connection and culture within practices; opportunities to share clinical experiences; and connection to personal social supports. Participation in this global disaster contributed to registrars' developing professionalism. GP training organisations are positioned to implement monitoring and supports for registrars through disasters. Although registrars may not require significant GP training organisation intervention where powerful professional and personal connections exist, strong foundational GP training organisation supports can be established and augmented to support registrars in need before and during future disasters. These findings contribute to the global developing field of knowledge of registrar training and well-being needs during crises., Competing Interests: Competing interests: IW is currently an RACGP General Practice Registrar training with GPEx. She has won a grant through the RACGP to undertake this research project as part of her GP registrar training. RACGP and GPEx are not directly involved in conducting this research. No other member of the research team will benefit financially or otherwise from conducting this research. LW is the Director of the Adelaide Rural Clinical School and sits on ACRRM, Research and Assessment Committees, neither of which have involvement in GP registrar training. JB and TE are both staff members of GPEx. Neither participated directly in registrar interviews., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The relationship between general practice (GP) registrars and their supervisors underpins the training experience for the next generation of medical practitioners. Building on recent research into the development and validation of a measure of the relationship between registrars and supervisors from the perspective of the supervisor, the current study focuses on the educational alliance from the perspective of the registrar. This paper presents an adaptation and initial validation of the clinical psychology supervisory relationship measure for GP registrars in an Australian context. Following an Expert Group review and adaptation of the items, 238 GP registrars completed the adapted tool. Using exploratory factor analysis and Procrustes confirmatory rotation, an optimal four factor model of the supervisory relationship was identified, reflecting measures of Safe base ( α  =.93), Supervisor investment ( α  =.96), Registrar professionalism ( α  =.90), and Emotional intelligence ( α  =.87). The general practice supervisory relationship measure for registrars (GP-SRMR) demonstrated excellent model fit, high internal consistency, and was theoretically consistent with the original tool. Implications for clinical education and future research are presented.

Objectives Expanding learner cohorts of medical students and general practitioner (GP) vocational trainees and the impending retirement of the 'baby boomer' GP cohort threaten the teaching and supervisory capacity of the Australian GP workforce. Engaging newly qualified GPs is essential to sustaining this workforce training capacity. The aim of the present study was to establish the prevalence and associations of in-practice clinical teaching and supervision in early career GPs. Methods The present study was a cross-sectional questionnaire-based study of recent (within 5 years) alumni of three of Australia's 17 regional general practice training programs. The outcome factor was whether the alumnus taught or supervised medical students, GP registrars or other learners in their current practice. Logistic regression analysis was used to establish associations of teaching and supervision with independent variables comprising alumnus demographics, current practice characteristics and vocational training experiences. Results In all, 230 alumni returned questionnaires (response rate 37.4%). Of currently practising alumni, 52.4% (95% confidence interval (CI) 45.6-59.0%) reported current teaching or supervisory activities. Factors significantly (P<0.05) associated with alumni currently undertaking in-practice clinical teaching and supervision were: Australian medical graduation (odds ratio (OR) for international graduates 0.36; 95% CI 0.14-0.92), working in a regional or remote area (OR 2.75; 95% CI 1.24-6.11) and currently undertaking nursing home visits, home visits or after-hours work (OR 2.01; CI 1.02-3.94). Conclusions Rural-urban and country-of-graduation differences in the engagement of early career GPs in practice-based apprenticeship-like teaching or training should inform strategies to maintain workforce training capacity. What is known about the topic? Projected changes in the demand for and supply of clinical teaching and supervision within Australian general practice will require greater uptake of teaching and supervision by recently qualified GPs to ensure sustainability of this teaching model. Although interest in and undertaking of teaching roles have been documented for GP or family medicine trainees, studies investigating the engagement in these clinical roles by GPs during their early post-training period are lacking. What does this paper add? This paper is the first to document the prevalence of teaching and supervision undertaken by early career GPs as part of their regular clinical practice. We also demonstrate associations of practice rurality, country of medical graduation and undertaking non-practice-based clinical roles with GPs' engagement in teaching and supervisory roles. What are the implications for practitioners? Establishing current teaching patterns of GPs enables appropriate targeting of new strategies to sustain an effective teaching and supervisory capacity within general practice. The findings of the present study suggest that exploring focused strategies to facilitate and support international medical graduates to engage in teaching during their vocational training, aided by focused supervisor support, may be of particular value.

Background: Home visits (HVs) and nursing home visits (NHVs) are accepted as core elements of general practice. There is concern regarding declining rates of HVs and an increasing demand for NHVs together with a perceived decreased willingness of younger GPs to provide these services., Objectives: To establish the prevalence and associations of recently vocationally qualified GPs ('graduates') performing HVs and NHVs., Methods: A cross-sectional questionnaire-based study of recent (within 5 years) graduates of 3 of Australia's 17 regional general practice training programs. Outcome factors were performing, as part of current practice, HVs and NHVs. Factors associated with each outcome were assessed by logistic regression with graduate and current practice characteristics and vocational training experiences as independent variables., Results: Of 230 responding graduates, 48.1% performed HVs and 40.6% performed NHVs in their current clinical GP role. Factors associated with both HVs and NHVs were participating in in-practice clinical teaching/supervision [odds ratios (ORs) 2.65 and 2.66], conducting HVs/NHVs during training (ORs 5.05 and 10.8) and working full-time (ORs for part-time work 0.20 and 0.29). Further associations with performing HVs were older GP age (compared to <36 years: ORs 3.65 for 36-40 and 2.53 for 41+), smaller practice size (OR 0.53 for larger practices), Australian undergraduate education (OR 0.31 for non-Australian) and greater number of years in their current practice as a qualified GP (OR 1.25 per year)., Conclusions: Our findings of graduates' modest engagement with HVs and NHVs reinforce concerns regarding Australian general practice's capacity to accommodate the needs of an aging population., (© The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Resilience can be defined as the ability to rebound from adversity and overcome difficult circumstances. General Practice (GP) registrars face many challenges in transitioning into general practice, and additional stressors and pressures apply for those choosing a career in rural practice. At this time of international rural generalist medical workforce shortages, it is important to focus on the needs of rural GP registrars and how to support them to become resilient health care providers. This study sought to explore GP registrars' perceptions of their resilience and strategies they used to maintain resilience in rural general practice., Methods: In this qualitative interpretive research, semi-structured interviews were recorded, transcribed and analysed using an inductive approach. Initial coding resulted in a coding framework which was refined using constant comparison and negative case analysis. Authors developed consensus around the final conceptual model. Eighteen GP registrars from: Australian College of Rural and Remote Medicine Independent Pathway, and three GP regional training programs with rural training posts., Results: Six main themes emerged from the data. Firstly, rural GP registrars described four dichotomous tensions they faced: clinical caution versus clinical courage; flexibility versus persistence; reflective practice versus task-focused practice; and personal connections versus professional commitment. Further themes included: personal skills for balance which facilitated resilience including optimistic attitude, self-reflection and metacognition; and finally GP registrars recognised the role of their supervisors in supporting and stretching them to enhance their clinical resilience., Conclusion: Resilience is maintained as on a wobble board by balancing professional tensions within acceptable limits. These limits are unique to each individual, and may be expanded through personal growth and professional development as part of rural general practice training.

Introduction: In many parts of Australia where there is no access to local specialist services, procedural services are provided by local GPs. Within the range of procedural skills offered, a small group of GPs is able to provide surgery. Unlike other procedural areas, there remains no defined training or assessment pathway for GP surgeons. Support from specialist colleagues is variable and continuing education arbitrary. The result is a somewhat ill-defined group that is poorly understood by credentialing bodies, government, medical defence organisations and training colleges. This study aims to describe the scope of practice, initial training and ongoing support and education for GP surgeons currently practising in South Australia., Methods: Seventeen semistructured interviews were undertaken with self-identified GP surgeons (74% response rate). Areas explored included demographics, scope of practice, initial training and ongoing support and education. Content and thematic analysis was used to identify common responses and themes., Results: The amount of initial training varied among participants, with a mean duration of training of 20 months. Initial assessment of competency for the majority of participants was assessment by a supervisor (10/17). The most common procedures undertaken were caesarean sections (94% of participants) and grafts and flaps (94%). The most common continuing professional development was clinical attachments (27%) and assisting visiting specialists or colleagues (17%)., Conclusions: This study demonstrates a wide variation in training, scope of practice and continuing education for GPs performing surgery, highlighting the effects of a self-regulated system. There is a trend towards an increased level of training; however, engagement in continuing education remains low. Further work is needed to define this group, to enable successful planning of future training and education to support this group in rural areas.

Background: Research and critical thinking are essential skills for general practitioners. However, evidence indicates that GPs tend to lack confidence in their research ability. Regional training providers can address this by integrating primary care research education and skills development into their general practice training programs., Objective: The Adelaide to Outback GP Training Program developed a model that aims to overcome existing barriers to GP research and to promote a research culture across the organisation. It includes a research and critical thinking program for all registrars, a support structure for registrars wanting to extend their research expertise, and an organisational structure to promote and support research for registrars as well as throughout the organisation., Discussion: Since the implementation of the model there has been an increase in the frequency and quality of research outcomes at the Adelaide to Outback GP Training Program.

Value fulfillment has recently been proposed as fundamental to the development and prevention of burnout, although this remains untested. The present study distributed a survey to Australian General Practitioners (primary care physicians), yielding a sample of 1,157 individuals. Participants were asked about their burnout and wellbeing levels, autonomy, personal values and value fulfillment, and professional diversification. Value fulfillment was moderately, negatively correlated with burnout (r =.53), with post-hoc tests noting each level of wellbeing was associated with a higher degree of value fulfillment. A hierarchical regression showed that value fulfillment predicted a further 10% of variance in burnout levels after controlling for professional autonomy and satisfaction. These results suggest value fulfillment may represent an important avenue for further theoretical and interventional research to prevent burnout and promote wellbeing. The results support a holistic, rather than professionally-bound, conceptualization of burnout. [ABSTRACT FROM AUTHOR]

The article explores perspectives and experiences of burnout intervention among stakeholders involved in Australian general practice training. It is noted that key practice strategies fell under the umbrella theme of building a supportive environment, comprising four subthemes including supporting registrars' psychological wellbeing. Among the few maladaptive strategies identified for registrars was persisting or working harder and sacrificing sleep to keep pace with work demands.