Perceived preparedness for clinical decision-making in future general practitioners: a qualitative study informed by the CREATE project

In Australia, future general practitioners begin their medical careers as hospital-based junior doctors before continuing their training in the community. During their GP training, the development of clinical decision-making is a fundamental medical competency. However, hospital training is typically characterised by acute presentations and high levels of supervision, whereas general practice requires continuity, diagnostic reasoning, and ongoing management of undifferentiated problems. This contextual misalignment and a fragmented training structure may limit trainees’ preparedness as future GPs. This study examines the contextual factors influencing junior doctors’ perceived preparedness for clinical decision-making during hospital training. This qualitative study is part of work that explored strategies to improve the experience of hospital doctors seeking to pursue a career in general practice. Semi-structured interviews were conducted with 21 participants across Eastern Melbourne, including junior doctors interested in general practice, GP registrars, and other participants involved in the education of future GPs across hospital and community settings. Interviews explored experiences of hospital-based training and perspectives on educational innovations that could enhance preparedness for clinical decision-making during hospital training. Data were analysed thematically using deductive and inductive coding. Participants highlighted the differences between hospital-based training and the decision-making demands of future general practice. Two overarching themes were identified: i) Preparing for the world of general practice, which described gaps during hospital training such as limited continuity of care and misalignments between hospital and general practice settings; and ii) Innovations to strengthen decision-making, encompassing early exposure to general practice, targeted hospital rotations, structured mentorship and transitional supports, and greater visibility of GP role models within hospital education. Enhancing junior doctors’ preparedness for clinical decision-making extends beyond general practice training. Piloting the identified educational innovations may bridge hospital and community settings, strengthen primary care decision-making, and foster a more integrated Australian healthcare system.