To do or not to do: Teaching the skill of deciding what to do in the face of uncertainty.

Background: The management of uncertainty is a core general practice skill best learnt in clinical practice.

Objective: This article outlines strategies a general practice supervisor can implement to help registrars acquire the skills of managing and coping with uncertainty.

Discussion: The medical education literature recommends supervisors being explicit about the different paradigm operating in primary care and normalising the existence and tolerance of uncertainty.

Finding and addressing weaknesses in GP supervisor professional development.

Background: The Royal Australian College of General Practitioners' Standards for general practice training require supervisor continuing professional development (PD) to meet the needs of the individual supervisors and develop the supervisory team.

Objective: The aim of this article is to explore current supervisor PD and consider how it might better meet the outcomes described in the standards.

Discussion: General practitioner supervisor PD delivered by regional training organisations (RTOs) continues to operate without a national curriculum.

Should I stay or should I go? Observation post-vaccination during the COVID-19 pandemic and the law of unintended consequences.

Background: Standard practice after all vaccinations in Australia is to observe patients for 15min. During the coronavirus disease 2019 (COVID-19) pandemic, could the risk of contracting and dying from COVID-19 acquired in the waiting room be greater than the risk of dying from post-vaccine anaphylaxis when leaving immediately?

Methods: The risks are modelled for a patient aged 70+years attending for annual influenza vaccination in a typical Australian general practice clinic. The risk of death from anaphylaxis is estimated based on known rates of anaphylaxis shortly after influenza vaccination.

Using organisational role theory and job analysis to identify and define the roles of an effective Australian general practice supervisor.

General practice (GP) supervisors - the key resource for training the future GP workforce - are often described as 'occupying a role' or enacting a series of roles. However, as much of the discourse uses a lay understanding of role, or merely hints at theory, a significant body of theoretical literature is underutilised. We reasoned that a more rigorous application of role theory might provide a conceptually clearer account of the GP-supervisor's job.

Random case analysis in general practice clinical team meetings.

Background: The Medical Board of Australia intends to mandate that at least 25% of continuing professional development (CPD) is focused on performance review.

Objective: The aim of this article is to describe how random case analysis (RCA) can be used for performance review in general practice clinical team meetings, and outline its benefits and challenges.

Discussion: RCA is a powerful learning method for CPD.

Flags for seeking help: making supervisor expectations of general practice trainee help-seeking explicit.

Timely supervisor input into patient care plays a key role in ensuring the safety of patients under the care of general practice trainees. Current models of clinical supervision for trainees in both hospital and general practice training have, however, been criticised for placing too much onus on the trainee to request assistance, despite the many known barriers for trainees to do so. An important barrier to general practice trainee help-seeking is trainee uncertainty about when and how their clinical supervisor expects them to seek this assistance.

Getting good help: a guide for reflection, debriefing and feedback conversations about in-consultation supervision.

Timely supervisor input to the care of their trainees' patients plays a key role in ensuring the safety of patients under the care of general practice trainees. Supervisor responses to trainee calls for assistance are also important for trainee learning and professional identity formation. The in-consultation supervisory encounter in general practice training is, however, a complex social space with multiple trainee, supervisor and patient agendas.

Good help: a model for providing in-consultation supervision of general practice trainees.

Timely clinical supervision of trainee consultations plays a key role in ensuring the safety of patients under the care of general practice trainees, and in trainee learning and professional development. Trainee requests for assistance during their consultations present supervisors with a number of challenges, however, and a number of factors act as barriers to, or reduce the utility of, this in-consultation assistance from the trainee's perspective. Face-to-face supervision in the presence of the patient presents particular challenges and opportunities.

A 'call for help' list for Australian general practice registrars.

Background And Objectives: Currently when undergoing Australian general practice training, a registrar must determine when clinical supervision is needed. The aim of this study was to identify situations in early Australian general practice training requiring closer supervision and consider how this can be achieved.

Method: The study used a qualitative approach involving 75 registrars, supervisors and medical educators from seven focus groups in Victoria and Tasmania.

Closer supervision in Australian general practice training: planning major system change.

Major system change involving closer supervision of trainee GP registrars in Australia is warranted. Change management guidelines recommend involving stakeholders in developing change. The views of those involved in general practice training about current and potential supervisory practice were explored.

Tell me if there is a problem: safety in early general practice training.

In contrast to other comparable countries, trainees commencing general practice in Australia can see patients without being required to contact their supervisor. To understand how patient safety in early training is managed a qualitative study design using semi-structured interviews was used. A lead medical educator from each of the nine Australian Regional Training Organisations (RTOs) was interviewed.

Adding random case analysis to direct observation (ARCADO) - Updating the external clinical teaching visit to improve general practice registrar assessments.

Background: In response to the advent of competency-based training and the increase in the number of general practice registrars, the Australian general practice education community is seeking valid, reliable, time-efficient and cost-efficient tools to assess registrars. Despite the central role of the external clinical teaching visit (ECTV) in formative assessment of general practice registrars, the ECTV has been an infrequent subject of research or evaluation.

Objective: The objective of this article is to report on the development of a new approach to ECTV that adds random case analysis to direct observation of consultations - ARCADO ECTV.

A blended supervision model in Australian general practice training.

Background: The Royal Australian College of General Practitioners' Standards for general practice training allow different models of registrar supervision, provided these models achieve the outcomes of facilitating registrars' learning and ensuring patient safety.

Objective: In this article, we describe a model of supervision called 'blended supervision', and its initial implementation and evaluation.

Discussion: The blended supervision model integrates offsite supervision with available local supervision resources.

ARCADO - Adding random case analysis to direct observation in workplace-based formative assessment of general practice registrars.

Background: Workplace-based formative assessments using consultation observation are currently conducted during the Australian general practice training program. Assessment reliability is improved by using multiple assessment methods. The aim of this study was to explore experiences of general practice medical educator assessors and registrars (trainees) when adding random case analysis to direct observation (ARCADO) during formative workplace-based assessments.

Towards an educational continuing professional development (EdCPD) curriculum for Australian general practice supervisors.

Background: Within the apprenticeship model of general practice training, the majority of teaching and learning occurs in the practice under the guidance of the general practice supervisor. One of the foundations of a high-quality general practice training program is the delivery of relevant, evidence-based educational continuing professional development (EdCPD) for general practice supervisors. Despite The Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM) standards requiring EdCPD, there is currently no standardised educational curriculum for Australian general practice supervisors.

Why and how do general practitioners teach? An exploration of the motivations and experiences of rural Australian general practitioner supervisors.

Background: In medical education, a learner-centred approach is recommended. There is also a trend towards workplace-based learning outside of the hospital setting. In Australia, this has resulted in an increased need for General Practitioner (GP) supervisors who are receptive to using adult learning principles in their teaching.

Are GP supervisors confident they can assess registrar competence and safety, and what methods do they use?

Background: The new Royal Australian College of General Practitioners' vocational training standards emphasise patient safety and matching the level of supervision to registrar competence.

Methods: All supervisors attending a regional training provider's annual education workshop were surveyed about their overall confidence in assessing the safety of their registrars' patients, their registrars' competence across the five RACGP domains of general practice and supervision methods used.

Results: Of 84 supervisors, 92.

GP supervisors--an investigation into their motivations and teaching activities.

Background: There is little empirical information on how general practitioner (GP) supervisors teach and the reasons for the variation in their teaching methods. Could the variation be due to differing motivations to teach?

Methods: Supervisors from one regional training provider who attended educational workshops in 2013 were surveyed, seeking infor-mation on their motivation to become and remain a supervisor, and the frequency of use of selected teaching activities.

Results: The majority of respondents cited intrinsic motivators, including enjoying teaching (84%), contribution to the profession and community (82%), adding variety (78%) and workforce/succession planning (69%), as reasons for becoming GP supervisors.

Random case analysis - a new framework for Australian general practice training.

Background: Random case analysis is a powerful tool for clinical supervision, teaching and assessment. It can identify gaps in knowledge, assess clinical reasoning skills and allow provision of critical and timely feedback.

Objective: In this article, we propose a new framework for random case analysis based on The Royal Australian College of General Practitioners curriculum.

Avoiding 'consultation interruptus' - a model for the daily supervision and teaching of general practice registrars.

Background: In general practice placements, much of the teaching occurs when the supervisor is called into the consulting room by the registrar while the patient is still present. How should this unique learning environment affect on teaching strategies?

Objective: This article analyses the nature of general practice teaching and proposes a different model of teaching in a 'patient-present' environment.

Discussion: General practice registrars are advanced learners who benefit from exploration of clinical reasoning in patient encounters.