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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]

Over-prescription of antibiotics for non-pneumonia respiratory tract infections (RTIs) is a major concern in general practice. Australian general practice registrars (trainees) have inappropriately high rates of prescription of antibiotics for RTIs. The 'apprenticeship' educational model and the trainee-trainer relationship are drivers of this inappropriate prescribing. We aimed to reduce registrars' non-pneumonia RTI antibiotic prescribing via an educational intervention (a 90-min face-to-face workshop supported by online modules), complemented by delivery of the same intervention, separately, to their trainers. We conducted a pre-and post-intervention comparison of the registrars' intention to prescribe antibiotics for common RTIs using McNemar's test. We similarly tested changes in supervisors' intended prescribing. Prescribing intentions were elicited by responses to six written clinical vignettes (upper respiratory tract infection, otitis media, sore throat and three acute bronchitis vignettes). We found that, for registrars, there were statistically significant reductions in antibiotic prescribing for the sore throat (24.0% absolute reduction), otitis media (17.5% absolute reduction) and two of the three acute bronchitis (12.0% and 18.0% absolute reduction) vignettes. There were significant reductions in supervisors' antibiotic prescribing intentions for the same four vignettes. We conclude that our intervention produced a significant change in registrars' intention to prescribe antibiotics for non-pneumonia RTIs. [ABSTRACT FROM AUTHOR]

Introduction: Atopic dermatitis (AD) is a chronic inflammatory condition which imposes substantial burden upon patients and their families. As a frequent primary care presentation, general practice (GP) trainees must develop adequate skills in AD diagnosis and management., Objectives: We aimed to explore the prevalence and associations of GP registrars' management of patients with AD., Methods: This study used data from the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing cohort study of the clinical and educational experience of Australian GP registrars. Registrar, patient, and consultation factors were independent variables in multivariable logistic regression with outcome factor 'diagnosis/problem being AD'., Results: From 2010-2019, 2,783 registrars (96% response rate) provided data from 381,180 consultations. AD was encountered in 0.6% of consults. AD was more likely to be seen in patients aged 0-1 years and patients from a non-English speaking background. AD was less likely to be seen in Aboriginal or Torres Strait Islander patients. Learning goals were more likely to be generated for AD and these consultations were associated with registrars seeking information or assistance. AD was strongly associated with a medication being prescribed, of which the most prescribed medications were mild or moderate potency topical corticosteroids., Conclusions: Our findings suggest that, similar to other dermatological presentations, registrars find AD challenging to manage. There may be some gaps in AD management knowledge and application., Competing Interests: Competing interests: The authors report no conflict of interest., (©2021 Willems et al.)

Background: The management of psoriasis by general practitioners (GPs) is vital, given its prevalence, chronicity, and associated physical and psychosocial co-morbidities. However, there is little information on how GPs (including early-career GPs) manage psoriasis., Objectives: This study assessed the frequency with which Australian specialist GP vocational trainees ('registrars') provide psoriasis care and the associations of that clinical experience., Methods: A cross-sectional analysis was done of data from the ReCEnT study, an ongoing multi-site cohort study of Australian GP registrars' experiences during vocational training. In ReCEnT, 60 consecutive consultations are recorded 3 times (6-monthly) during each registrar's training. The outcome factor for this analysis was a problem/diagnosis being psoriasis, and independent variables were related to registrar, patient, practice and consultation factors. This study analysed 17 rounds of data collection (2010-2017) using univariate and multivariable regression., Results: Data from 1,741 registrars regarding 241,888 consultations and 377,980 problems/diagnoses were analysed. Psoriasis comprised 0.15% (n=550) of all problems/diagnoses (95% CI, 0.13-0.16). Significant patient multivariable associations of a problem/diagnosis being psoriasis included age, gender, being new to a practice or a registrar, and psoriasis being an existing problem rather than a new diagnosis. Significant registrar associations included seeking in-consultation information/assistance, not scheduling a follow-up appointment, prescribing medication, and generating learning goals., Conclusions: Australian registrars have modest training exposure to psoriasis and may find psoriasis management challenging. Furthermore, continuity of care (essential for optimal chronic disease management) was modest. The findings have implications for GPs' approaches to the management of psoriasis more widely as well for general practice education and training policies., Competing Interests: Competing interests: The authors have no conflicts of interest to disclose., (©2021 Nawaz et al.)

Background: Atopic dermatitis (AD) is a common presentation in the general practice (GP) setting. Implementation of appropriate referral pathways is instrumental for best patient care and is an essential skill for Australian GP registrars., Objectives: We aimed to explore the prevalence and associations of GP registrar referrals to specialists for AD management., Methods: A cross-sectional analysis utilizing data from the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing cohort study that documents in-consultation clinical and educational experience of Australian GP registrars. Registrar, patient, and consultation factors associated with referrals for AD were established using logistic regression., Results: A total of 2,783 registrars (96% response rate) provided data from 381,180 consultations from 2010 to 2019. A total of 3,285 (0.55%) of 595,412 diagnoses managed were AD, of which 222 (6.8%) resulted in referral. Of these referrals, 70% were to dermatologists, 17% to allergists/immunologists, and 10% to pediatricians. Associations of referral included registrar female gender, patient age, longer consultation duration; an established (rather than new) AD diagnosis; supervisor advice being sought; and learning goals being generated., Conclusions: Both registrar and patient factors influence AD referral patterns. Registrars referred established rather than newly diagnosed AD, suggesting a level of comfort in initial management. Referral was associated with longer consultations, seeking supervisor advice, and generation of learning goals-suggesting these are more complex presentations and, possibly, registrar learning opportunities. A significant proportion of referrals were to non-dermatologist specialists. The implication of this for optimal patient care is a subject for further study., Competing Interests: Competing interests: The authors have no conflicts of interest to disclose., (©2021 Willems et al.)

Background and Objectives: Dermoscopy increases accuracy for melanoma diagnosis by trained primary care physicians. We aimed to establish prevalence of dermatoscope use by general practice registrars, and identify factors associated with dermatoscope use and the implications of dermatoscope use for diagnosis and confidence in diagnosis., Method: This was a cross-sectional study nested within the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing multi-site cohort study of general practice registrars' consultations. The study was conducted during two six-monthly rounds of ReCEnT data collection in four regional training providers in 2014., Results: Forty-nine per cent of registrars reported having dermoscopy training. Dermoscopy was used in 61% of consultations involving skin or pigmented lesion checks. Dermatoscope use changed provisional diagnosis in 22% of instances and increased diagnostic confidence in 55%., Discussion: Dermoscopy is performed by general practice registrars in a modest proportion of skin and pigmented lesion checks. Its use influences registrars' diagnoses and increases their confidence in their diagnoses.