Adelaide to Outback GP Training Program, South Australia.
BMC Med Educ. 2011 Jul 12;11:45. doi: 10.1186/1472-6920-11-45.
In Australia, training for general practice (GP) occurs within private practices and their involvement in teaching can have significant financial costs. At the same time there are growing demands for clinical places for all disciplines and for GP there is concern that there are insufficient teaching practices to meet the demand at the medical student, prevocational and vocational training levels. One option to address this may be to change how teaching occurs in the practice. A question that arises in posing such an option is whether different models of teaching change the costs for a teaching practice. The aim of this study is to determine the net financial outcome of teaching models in private GP.
Modelling the financial implications for a range of teaching options using a costing framework developed from a survey of teaching practices in South Australia. Each option was compared with the traditional model of teaching where one GP supervisor is singularly responsible for one learner. The main outcome measure was net financial outcome per week. Decisions on the model cost parameters were made by the study's Steering Group which comprised of experienced GP supervisors. Four teaching models are presented. Model 1 investigates the gains from teaching multiple same level learners, Models 2 and 3, the benefits of vertically integrated teaching using different permutations, and Model 4 the concept of a GP teacher who undertakes all the teaching.
There was a significant increase in net benefits of Aus$547 per week (95% confidence intervals $459, $668) to the practice when a GP taught two same level learners (Model 1) and when a senior registrar participated in teaching a prevocational doctor (Model 3, Aus$263, 95% confidence intervals $80, $570). For Model 2, a practice could significantly reduce the loss if a registrar was involved in vertically integrated teaching which included the training of a medical student (Aus$551, 95% confidence intervals $419, $718). The GP teacher model resulted in a net remuneration of Aus$207,335 per year, sourced predominantly from the GP teacher activities, with no loss to the practice.
Our study costed teaching options that can maximise the financial outcomes from teaching. The inclusion of GP registrars in the teaching model or the supervisor teaching more than one same level learner results in a greater financial benefit. This gain was achieved through a reduction in supervisor teaching time and the sharing of administrative and teaching activities with GP registrars. We also show that a GP teacher who carries a minimal patient load can be a sustainable option for a practice. Further, the costing framework used for the teaching models presented in this study has the ability to be applied to any number of teaching model permutations.
在澳大利亚，全科医学（GP）培训是在私人诊所进行的，他们参与教学可能会产生重大的财务成本。与此同时，各学科对临床实习岗位的需求也在不断增长，而全科医学领域则担心教学实践的数量不足以满足医学生、预备实习医生和职业培训医生的需求。解决这个问题的一个选择可能是改变实践中的教学方式。在提出这样一个选择时，一个出现的问题是，不同的教学模式是否会改变教学实践的成本。本研究的目的是确定私人 GP 中各种教学模式的净财务结果。
使用从南澳大利亚教学实践调查中开发的成本框架，对一系列教学选择的财务影响进行建模。每种选择都与传统的教学模式进行了比较，在传统模式中，只有一名全科医生导师负责一名学习者。主要的结果衡量标准是每周的净财务结果。研究指导小组对模型成本参数做出了决定，该小组由经验丰富的全科医生导师组成。提出了四种教学模式。模型 1 研究了教授多个同级别学习者的收益，模型 2 和 3 研究了使用不同排列方式进行垂直综合教学的好处，模型 4 研究了承担所有教学任务的全科医生导师的概念。
当一名全科医生教授两名同级别学习者（模型 1）和一名高级住院医师参与教授预备实习医生（模型 3）时，实践中的净收益显著增加了每周 547 澳元（95%置信区间 459 澳元，668 澳元）。对于模型 2，如果注册医师参与包括培训医学生在内的垂直综合教学，实践中可以显著减少损失（551 澳元，95%置信区间 419 澳元，718 澳元）。GP 导师模式的年收入为 207335 澳元，主要来源于 GP 导师活动的报酬，对实践没有损失。
我们的研究成本核算了可以最大化教学收益的教学选择。在教学模式中纳入全科医生注册医师或让导师教授多名同级别学习者，可以带来更大的经济利益。这种收益是通过减少导师的教学时间和与全科医生注册医师共享行政和教学活动来实现的。我们还表明，一位承担最小患者负担的全科医生导师对于实践来说是一个可持续的选择。此外，本研究中用于呈现教学模型的成本框架具有适用于任何数量的教学模型排列的能力。
