Taryn Elliott

When, what and how south australian pre-registration junior medical officers' career choices are made

Objectives  This study aimed to provide better understanding of how pre‐registration junior medical officers (PJMOs) make their career choices by investigating when decisions are made, what factors impact on choices, and the role of experience in this process.

Investigating naturalistic decision making in a simulated microworld: What questions should we ask?

Computer-simulated microworlds can provide a controlled method for investigating concepts related to naturalistic decision making (NDM). However, the extent to which these tools can be used to generate meaningful outcomes is unknown. The current study used a microworld called Networked Fire Chief (NFC) to explore the range of skills and knowledge acquired as participants gained practice on the program. The complexity of the NFC NDM environment was also explored. Twenty participants each completed 20 equivalent 5-min scenarios on NFC. Interview data, behavioral data and performance scores were collected across the trials. Results confirmed that NFC provides an environment that promotes appropriate perceptual—cognitive processing for NDM. However, performance improved to only a small extent across the 20 trials in four performance areas: speed, accuracy, efficiency and planning. In addition, the number of personal and situational factors to be considered when decision making on NFC was not comparable with real-world NDM environments. Overall, results indicated that the use of microworlds for research should be regulated by an understanding of the limitations of their applicability.

Exploring resilience in rural GP registrars - implications for training

BackgroundResilience 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.MethodsIn 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.ResultsSix 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.ConclusionResilience 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.

Home visits and nursing home visits by early-career GPs: a cross-sectional study

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.