Teaching practical procedures in general practice: A primer for supervisors of medical students and registrars

Abstract

Practical skills are needed in general practice to provide comprehensive care to patients. General practitioners find this work rewarding, particularly in rural areas where procedural medicine is an important part of job satisfaction. A sustainable Australian general practice workforce requires practical skills to be taught to registrars and medical students aspiring to become GPs. General practitioner supervisors act as important role models and mentors to this group; part of their role is to plan teaching to facilitate skills acquisition and opportunities for ongoing practice of these skills under supervision. Rural GPs perform procedures with safety in small Australian communities. A major initiative in training has been to require all registrars to experience rural general practice motivating some to train specifically for procedural practice. At the same time, the work environment of rural general practice is changing; fewer GPs are involved in procedural medicine. Part of the challenge for supervisors is to promote the professional rewards of procedural medicine to registrars. Appropriate initial training is central to developing psychomotor skills, however, confidence to continue to practise skills are also related to caseload and the attitudes of peers and patients.5 Several developments have decreased the amount of practical skills teaching in general practice including medicolegal issues, concerns about higher complication rates with novice practitioners, limited time, and the fact that some important procedures occur rarely, limiting teaching opportunities. Undergraduates and junior medical officers complain about a lack of opportunities to learn skills during their prevocational training. This has placed a greater reliance on GP supervisors to teach registrars during their postgraduate training. The philosophy of 'see one, do one, teach one' as the most effective means of skills training is changing. Work based training linking skills training to assessment of competence is needed. This article develops a framework for teaching and assessing procedural skills and their assessment in general practice.