What lies beneath? The content of general practice registrars' consultations: the ReCEnT (registrar clinical encounters in training) study

Background: Patient encounters are the core learning activity of Australian general practice training. However, exposure to patient demographics and presentations is variable between registrars. This may affect quality and comprehensiveness of training. We aimed to identify the clinical and educational content of GP registrar consultations and compare this to national GP clinical activity data. Methods: This was a cross-sectional study (and pilot for a cohort study). Registrars from a single regional training provider (RTP) contemporaneously recorded (via a paper-based system) details of 60 consecutive consultations. Registrar and practice demographics were elicited by questionnaire. Problems managed were coded with the ICPC2-plus classification system. Results: Thrity-two of 33 eligible registrars participated and returned 1919 encounter forms. Patient mean age was 42.0 years (37.9 percent male). Mean consultation length was 16.95 minutes. Most common ICPC-2 disease chapters managed were respiratory (10.5 percent), musculoskeletal (9.3 percent ) and cardiovascular (8.5 percent ). Investigations were ordered at a rate of 77.4 (pathology) and 15.1 (imaging) per 100 consultations. There were 105.6 medications prescribed, 13.4 specialist referrals and 0.8 hospital referrals per 100 consultations. Supervisor advice was sought in 10.0 percent of consultations. Discussion: Registrars, compared to vocationally-registered GPs, saw a younger patient demographic, conducted longer consultations, ordered more tests, wrote more prescriptions and referred patients to specialists and hospital more frequently. Consultation data has utility for individual GP registrars as a formative assessment tool and for the training provider for program evaluation and quality assurance. The study also provides a ready platform for registrardriven and other research