In-consultation supervisory advice and assistance to general practitioner registrars: a cross-sectional study of inter-practice variability

In Australia's apprenticeship-style model of general practice training, experienced general practitioner supervisors oversee individual registrars' training in accredited training practices. In addition to providing formal in-practice education to registrars, supervisors have informal teaching and clinical support functions, including being called in by registrars seeking in-consultation advice/assistance. These ad hoc encounters are important learning opportunities but can be challenging to negotiate in the busy clinical environment and require registrars' assistance-seeking to be judiciously managed by supervisors. This study aimed to estimate variability between training practices in relation to registrars having recourse to supervisory in-consultation advice/assistance. The study used a cross-sectional analysis from the Registrar Clinical Encounters in Training project, an ongoing prospective cohort study of Australian registrars' in-consultation clinical and educational practise. Analyses used 2010 to 2021 data with outcome factor 'supervisor provided advice/assistance'. Inter-practice variability was estimated by intra-class correlation coefficients and median odds ratios within a Bayesian modelling framework. 4642 registrars contributed details of 1,026,330 problems/diagnoses 69,114 (6.73%; 95% confidence interval: 6.69-6.78%) involved in-consultation supervisory advice/assistance. On multivariable analysis, adjusting for confounding, the intra-class correlation coefficient for provision of supervisory advice/assistance was 0.043 (95% credible interval: 0.038-0.049), the median odds ratio was 1.523 (95% credible interval: 1.480-1.569). This analysis can be interpreted as a registrar randomly moving from one training practice to another will have a median of 52% increase in the odds of a registrar seeking (and a supervisor providing) in-consultation advice/assistance for a particular problem/diagnosis. These findings raise policy and practice questions about developing a consistent response to ad hoc supervisory encounters.