Using Longitudinal Patient Encounter Data to Enhance Learning. Dr Simon Morgan Dr Parker Magin

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1 Using Longitudinal Patient Encounter Data to Enhance Learning Dr Simon Morgan Dr Parker Magin

2 Background - Clinical Encounters Clinical encounters are the core learning activity of GP training Ideally, clinical exposure should: cover common and significant conditions be similar to that of Australian VR GPs reflect the content of training curriculum and assessments

3 Background - Clinical Encounters BUT In real life, the curriculum walks through the door Exposure to different patient demographics and presentations is highly variable This variability has a significant impact on training The nature and content of clinical encounters in Australian GP training is not well known

4 Background GP Clinical Activity BEACH study Australian GP clinical activity Other international GP patient encounter studies VMA registrar study (2004) More new problems Less chronic disease More tiredness! BEACH sub-study (2007) UK trainee studies (1980s)

5 Background - Patient Logbooks Widely used in undergraduate setting for Reflective learning Curriculum coverage Program evaluation Used in other disciplines to record clinical and procedural encounters No requirement in Australian GP training

6 The Black Box of GP Training GP Trainer supervision Educational release workshops ECTVs External Clinical Teaching Visits Formative assessment tools? There is no mechanism to regularly audit the clinical exposure of GP registrars in their training

7 ReCEnT Study Aims The ReCEnT study aims to record and analyse the nature of the clinical and educational content of general practice registrar consultations over time

8 Cohort study Methods Registrar and Practice Characteristics Registrars in Terms 1, 2 and 3 to record 60 consecutive patient encounters Paper based data collection form Other terms (dermatology, Family Planning, community mental health) Coding using ICPC2-Plus Pilot October 2009

9 Registrar and Practice Characteristics Demographics Country of birth Country of training Previous health-related (or other) qualifications Years working in medicine Post-graduate qualifications Current term and FTE Practice details Access to educational resources

11 Patient Encounter Form - Demographics & Consultation Details DOB Sex Postcode Ethnicity Date Duration Continuity Medicare/billing

12 Patient Encounter Form - Clinical Aspects Reason for Encounter (RFE) Diagnosis/Problem Medications Procedures

13 Patient Encounter Form - Clinical Aspects Pathology Imaging Other tests Follow-up Plan

14 Patient Encounter Form - Educational and Other Aspects Learning goals Sources of Assistance Violence (Additional questions)

15 Potential Applications of Study Individual registrar education and training Regional Training Provider (RTP) program evaluation and quality improvement AGPT program evaluation Research opportunities

16 Individual Registrar Education and Training What presentations am I seeing? Formative assessment tool Reflective learning What presentations am I not seeing? Clinical gaps and learning needs Curriculum coverage Comparison with peers Learning plans and interventions

17 Individual Registrar Education and Training Am I practising good medicine? Comparison with indicators of best practice e.g. prescribing patterns Am I improving? Document change in practice over time e.g. numbers of patients, time per encounter, use of resources

18 RTP Program Evaluation and Quality Improvement Are we covering the curriculum? Curriculum review and development Is our training improving registrar practice? How do our practices compare? How do the particular training elements compare? e.g. Urban/Rural, Extended Skills Terms

19 AGPT Program Evaluation and Development How does registrar experience vary across Australia? How well do the particular training elements work? How can we improve what we do? Selection, Innovative models of training, remediation, assessment Is GP training effective?

20 Research Opportunities Platform for registrar research activities capacity building Predictors of clinical exposure and educational issues Validity of Teaching Visits (ECTVs) Correlation of clinical exposure and examination performance

21 What ReCEnT will add Open the black box of GP training - comprehensive information on clinical exposure of GP registrars Link clinical exposure to educational outcomes Provide novel information for evaluation of registrars, RTPs and AGPT Build GP registrar research capacity

Continuity of Care in General Practice Registrar Training: Results from the ReCEnT study

Continuity of Care in General Practice Registrar Training: Results from the ReCEnT study Mr James W Pearlman 1,2 Dr Parker Magin 1,2 Dr Simon Morgan 2 Dr Cathy Regan 2 Ms Kim Henderson 2 Ms Amanda Tapley