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Rationale, aims, and objectives: Urinary tract infection (UTI) is a common presentation to general practitioners (GPs). There is increasing antimicrobial resistance in urinary pathogens in many healthcare systems. Adherence to principles of antimicrobial stewardship is important to combat this problem. Our aim was to describe the prevalence of presentations of clinically diagnosed new UTI to early‐career GPs, to describe management choices made, and to identify associations of prescribing antibiotics at the index consultation for UTI. Method: This is a cross‐sectional analysis of the Registrar Clinical Encounters in Training cohort study. Early‐career GPs from five Australian states (urban to very remote practices) collected data on 60 consecutive patient encounters during each of three 6‐month training terms. Proportions of problems being new UTIs, antibiotics prescribed, urine microscopy and culture ordered were calculated. Univariate and multivariable logistic regressions established associations of patient, registrar, and practice factors with prescribing antibiotics for a new UTI. Results: One thousand three hundred thirty‐three early‐career GPs diagnosed 2850 new UTIs from 189 736 consultations (1.5%; 95% CI, 1.4‐1.6). Antibiotics were prescribed at 86% (95% CI, 84.7‐87.2) of these index consultations. Antibiotic choice followed Australian therapeutic guideline recommendations. Urine microscopy and culture were requested at the index consultation less than recommended by guidelines in men, 69.2% (95% CI, 62.6‐75.1), and children, 80.8% (95% CI, 76.4‐84.6). Adults were significantly more likely to be treated with antibiotics at the index consultation than children under 16. Conclusions: A new UTI is a common presentation to Australian early‐career GPs. There is general adherence to guidelines for antibiotic choice in UTIs. Further research is needed, however, to understand some decisions made when managing UTI in children and men. This may reflect diagnostic uncertainty with consequent attention to antibiotic stewardship by deferring antibiotic prescription. [ABSTRACT FROM AUTHOR]

Background: General practitioners play an important role in diagnosis and ongoing management of pregnancies. Some GP registrars entering GP training may have had no post‐graduate experience in obstetrics and gynaecology. GP registrars' involvement in antenatal care is under‐researched. Aims: This study aimed to determine the prevalence and associations of Australian GP registrars' clinical consultations involving antenatal care. Materials and Methods: A cross‐sectional analysis from the Registrar Clinical Encounters in Training (ReCEnT) cohort study. GP registrars record details of 60 consecutive consultations during each of three six‐month training terms. Associations of managing pregnancy‐related problems (compared to all other problems) were analysed using univariate and multivariable logistic regression. Independent variables included registrar, practice, patient, consultation and educational factors. Results: Antenatal care comprised 3277 (1.1%) of registrar problems/diagnoses. Consultations involving pregnancy‐related problems were significantly associated with registrars being female, in term three, younger, and having post‐graduate qualifications in obstetrics/gynaecology. Patients were significantly more likely to be from a non‐English speaking background. Pregnancy‐related problems/diagnoses were more likely to be seen in lower socioeconomic areas. Consultation factors significantly associated with a pregnancy‐related problem/diagnosis included ordering imaging, ordering pathology, arranging referrals, and a longer duration of consultation. Registrars were less likely to prescribe medication or generate learning goals. Conclusions: GP registrars see fewer antenatal problems compared to established GPs. Male registrars, especially, have significantly less exposure to antenatal care, suggesting potential limitation of opportunity to gain skills and experience in antenatal care. [ABSTRACT FROM AUTHOR]

Introduction: Relatively few general practice (GP) workplace-based assessment instruments have been psychometrically evaluated. This study aims to establish the content validity and internal consistency of the General Practice Registrar Competency Assessment Grid (GPR-CAG). Methods: The GPR-CAG was constructed as a formative assessment instrument for Australian GP registrars (trainees). GPR-CAG items were determined by an iterative literature review, expert opinion and pilot-testing process. Validation data were collected, between 2014 and 2016, during routine clinical teaching visits within registrars' first two general practice training terms (GPT1 and GPT2) for registrars across New South Wales and the Australian Capital Territory. Factor analysis and expert consensus were used to refine items and establish GPR-CAG's internal structure. GPT1 and GPT2 competencies were analysed separately. Results: Data of 555 registrars undertaking GPT1 and 537 registrars undertaking GPT2 were included in analyses. A four-factor, 16-item solution was identified for GPT1 competencies (Cronbach's alpha range: 0.71–0.83) and a seven-factor 27-item solution for GPT2 competencies (Cronbach's alpha: 0.63–0.84). The emergent factor structures were clinically characterisable and resonant with existing medical education competency frameworks. Discussion: This study establishes initial evidence for the content validity and internal consistency of GPR-CAG. GPR-CAG appears to have utility as a formative GP training WBA instrument. [ABSTRACT FROM AUTHOR]

Patients with mental health conditions commonly present in General Practice. Mental health curricula are broad. We do not know that trainees are exposed to the learning they require. This study aimed to establish the prevalence, characteristics and associations of GP trainees' management of mental health problems. This paper presents a cross-sectional analysis of the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing multisite cohort study of Australian GP trainees (registrars) documenting their clinical experiences over 60 consecutive consultations. Univariate and multivariable logistic regression analyses were conducted with outcome of the problem/diagnosis being a mental health condition. 1659 trainees provided data on 218,325 consultations and 340,453 problems/diagnoses. Mental health conditions were associated with patients being male, of Aboriginal or Torres Strait Islander or English-speaking background. Trainee characteristics were being more senior and having trained in Australia. Practice characteristics included being in low socioeconomic areas. Trainees sought less help for mental health concerns than they did for other problems. While early-career GPs see a broad range of mental health conditions, they may benefit from training to manage patients from cross-cultural contexts. They may also need support to generate appropriate learning goals and seek assistance if they are to continue to deepen competence. [ABSTRACT FROM AUTHOR]

Background and objectives Gender differences may exist in the performance of women's reproductive procedures. The aim of this study was to investigate the prevalence and association of general practice registrars' performance of women's procedures with trainees' gender, rurality of practice and in-consultation seeking of information or assistance. Method This was a cross-sectional analysis of a cohort study of registrars' consultations in 2010-17. Registrars recorded 60 consecutive consultations during each six-month training term. The outcome was performance of a procedure related to women's reproductve health. Results Of 24,333 procedures performed in 332,700 encounters, 15,634 were on female patients and 6025 of those included procedures relating to women's reproductive health; 5002 were Pap smears (20.6%). Only 235 (4.7%) Pap smears were performed by male trainees. Performing women's procedures was significantly associated with trainees' gender, with an adjusted odds ratio of 4.80 (95% confidence interval: 4.10, 5.61). Discussion Our findings suggest that a gender difference exists in general practice trainees' frequency of performing women's procedures. Male trainees require more opportunities and support from their preceptors, clinical settings and training programs to perform these procedures. [ABSTRACT FROM AUTHOR]

Background Transient ischemic attack incurs a risk of recurrent stroke that can be dramatically reduced by urgent guideline-recommended management at the point of first medical contact. Aims This study describes the prevalence and associations of new transient ischemic attack presentations to general practice registrars and the management undertaken. Methods A cross-sectional analysis of the Registrar Clinical Encounters in Training cohort study. General practice registrars from five Australian states (urban to very remote practices) collected data on 60 consecutive patient encounters during each of their three six-month training terms. The proportion of problems managed being new transient ischemic attacks and proportion of transient ischemic attacks with guideline-recommended management were calculated. Univariate and multivariable logistic regression established associations of patient, registrar, and practice factors with a problem being a new transient ischemic attack. Results A total 1331 general practice registrars contributed data (response rate 95.8%). Of the 250,625 problems, there were 65 new transient ischemic attacks diagnosed (0.03% [95% confidence interval: 0.02–0.03%]). General practice registrars were more likely to seek help, generate learning goals, and spend more time for a new transient ischemic attack compared to other problems. Compliance with management guidelines was modest: 15.4% ordered brain and arterial imaging, 36.9% prescribed antiplatelet medication, and 3.1% prescribed antihypertensive medication. Conclusions Transient ischemic attack is a very infrequent presentation for general practice registrars, giving little clinical opportunity to reinforce training program education regarding guideline-recommended management. General practice registrars found transient ischemic attacks challenging and management was not ideal. Since most transient ischemic attacks first present to general practice and urgent management is essential, an enhanced model of care utilizing rapid access to specialist transient ischemic attack support and follow-up could improve guideline compliance. [ABSTRACT FROM AUTHOR]

Background: Inappropriate antibiotic prescription and consequent antibacterial resistance is a major threat to healthcare.Objectives: To evaluate the efficacy of a multifaceted intervention in reducing early career general practitioners' (GPs') antibiotic prescribing for upper respiratory tract infections (URTIs) and acute bronchitis/bronchiolitis.Methods: A pragmatic non-randomized trial employing a non-equivalent control group design nested within an existing cohort study of GP registrars' (trainees') clinical practice. The intervention included access to online modules (covering the rationale of current clinical guidelines recommending non-prescription of antibiotics for URTI and bronchitis/bronchiolitis, and communication skills in management of acute bronchitis) followed by a face-to-face educational session. The intervention was delivered to registrars (and their supervisors) in two of Australia's seventeen regional GP training providers (RTPs). Three other RTPs were the control group. Outcomes were proportion of registrars' URTI consultations and bronchitis/bronchiolitis consultations prescribed antibiotics. Intention-to-treat analyses employed logistic regression within a Generalised Estimating Equation framework, adjusted for relevant independent variables. The predictors of interest were time; treatment group; and an interaction term for time-by-treatment group. The P value associated with an interaction term determined statistically significant differences in antibiotic prescribing.Results: Analyses include data of 217 intervention RTPs' and 311 control RTPs' registrars. There was no significant reduction in antibiotic prescribing for URTIs. For bronchitis/bronchiolitis, a significant reduction (interaction P value = 0.024) remained true for analysis adjusted for independent variables (P value = 0.040). The adjusted absolute reduction in prescribing was 15.8% (95% CI: 4.2%-27.5%).Conclusions: A multifaceted intervention reduced antibiotic prescribing for bronchitis/bronchiolitis but not URTIs. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]