The pandemic's telehealth surge dramatically reshaped GP training, but at what cost to our future doctors?
In a seismic shift for Australian healthcare, the COVID-19 pandemic catapulted telehealth into the mainstream. Within mere months, an astounding 90% of general practices had embraced this new way of delivering care. This wasn't just a minor adjustment; it fundamentally altered the landscape of medical consultations. During the 2020-21 period alone, telehealth accounted for a significant 21% of all GP registrar consultations, with a notable preference for telephone over video calls.
Naturally, this rapid transformation had a profound impact on the education of General Practice registrars – the doctors in training. A groundbreaking study, meticulously conducted by the RACGP’s GP Training Research team and recently published in the esteemed journal Medical Education, offers a deep dive into these effects and the invaluable lessons learned.
But here's where it gets controversial... The research, which involved in-depth interviews with 15 registrars, five supervisors, and five medical educators, revealed that telehealth significantly disrupted the traditional learning interactions. Registrars found it challenging to seamlessly involve their supervisors during live telehealth consultations. It seems both the trainees and their educators were in a steep learning curve, figuring out the intricacies of telehealth simultaneously amidst a health crisis.
Irena Patsan, the study's lead author and a Senior Research Assistant at the RACGP, shared, "We found that telehealth altered the usual learning environment for supervisors and registrars in training practices." She elaborated, "Rather than seeking supervisory assistance while in-consultation using telehealth, registrars sought supervisory advice post-consultation." This delay, as educators rightly pointed out, meant fewer opportunities for immediate, real-time feedback, a crucial element in skill development.
And this is the part most people miss... The study also highlighted a reduction in opportunities for hands-on, in-person clinical education. Consultations increasingly focused on simpler matters like repeat prescriptions, medical certificates, and routine follow-ups, leaving less room for complex diagnostic scenarios or hands-on physical examinations. Co-author Parker Magin noted that these findings align with previous research, such as the ReCEnT project, which also observed shorter consultation durations, less frequent in-consultation supervisor input, and fewer physical examinations.
Ms. Patsan emphasized the global relevance of these findings, stating, "The rapid uptake of telehealth altered the in-practice social space of registrars’ learning." The study authors concluded that as telehealth continues to be a part of healthcare, there's a clear need for telehealth-specific training to truly maximize learning for registrars during their consultations.
Dr. Linda Klein, the study's senior author and manager of RACGP’s GP Training Research team, who began investigating this issue in 2022, offered a balanced perspective. "Telehealth is a great thing," she told newsGP. "It opens up options for practices and patients, but it has to be thought through judiciously, especially when you’re training registrars." She even suggested that for first-year registrars, telehealth might not be the ideal starting point, proposing it could be introduced later when they possess more confidence and require less immediate supervision.
Associate Professor James Brown, RACGP’s Director of Medical Education, praised the project for demonstrating the vital role of practice-focused research during times of upheaval. He remarked, "It has provided the insights required to enable effective training to be maintained in the context of a major change to the training environment." The fact that this research has been published in a leading medical education journal underscores its significance and quality.
What do you think? Is the shift towards telehealth a net positive for medical education, or are we sacrificing crucial hands-on learning experiences for the sake of convenience? Share your thoughts in the comments below – we'd love to hear your perspective!
