General Practice Clinical Unit, Faculty of Medicine, University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women's Hospital, Brisbane, Qld 4006, Australia.
School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; and NSW and ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia.
J Prim Health Care. 2024 Mar;16(1):4-11. doi: 10.1071/HC23044.
Aim The aim of the study was to establish whether two previously described barriers to effective in-consultation assistance-seeking by general practice (GP) vocational specialist trainees (ie concern about patient impressions of their competence, and discomfort presenting to supervisors in front of patients) influenced the frequency of trainee in-consultation assistance-seeking from their supervisor. Methods This was a cross-sectional study nested in the Registrar Clinical Encounters in Clinical Training ongoing cohort study of Australian GP trainees. Trainee participants completed contemporaneous records of 60 consecutive patient consultations, including whether supervisory assistance was sought. Trainees also completed a cross-sectional survey including items eliciting their beliefs about patient impressions and their own discomfort in seeking in-consultation supervisory assistance. These were factors of interest in multivariable logistic regression analyses; the outcome factor in both regression models was the seeking of in-consultation supervisory assistance. Results In 2018, 778 trainees (778/876, response rate 89%) completed the cross-sectional survey. No association was found between the odds of in-consultation help-seeking and perceived decrease in patient impressions of trainee competence (OR = 1.09; 95% CI: 0.91, 1.31; P = 0.36) or higher comfort presenting outside patients' hearing (OR = 0.9; 95% CI: 0.77, 1.05; P = 0.19). Discussion Contrary to expected utility models of help-seeking, trainees may not consider personal discomfort or impression management to be important enough, compared to patient safety and other considerations, to influence decisions regarding in-consultation help-seeking. Clinical supervisors should, nevertheless, consider the potential personal costs to trainees and maintain trainee self-esteem and confidence by providing in-consultation assistance in front of patients as comfortably and effectively as possible.
目的 本研究旨在确定之前描述的两种阻碍全科医学职业专家培训生（GP）有效咨询协助的障碍（即担心患者对其能力的印象，以及在患者面前向主管陈述时感到不适）是否会影响培训生向主管寻求咨询协助的频率。 方法 这是一项横断面研究，嵌套在澳大利亚 GP 培训生正在进行的登记员临床培训中的注册临床遭遇研究中。培训生参与者同时记录了 60 次连续患者咨询，包括是否寻求监督协助。培训生还完成了一项横断面调查，其中包括询问他们对患者印象和寻求咨询监督协助时自身不适的看法的项目。这些是多变量逻辑回归分析中的感兴趣因素；两个回归模型中的结果因素都是寻求咨询监督协助。 结果 2018 年，778 名培训生（876 名中的 778 名，应答率为 89%）完成了横断面调查。在咨询中寻求帮助的可能性与患者对培训生能力印象下降的可能性之间没有关联（OR=1.09；95%CI：0.91，1.31；P=0.36）或更高的舒适度（OR=0.9；95%CI：0.77，1.05；P=0.19）。 讨论 与寻求帮助的预期效用模型相反，与患者安全和其他考虑因素相比，培训生可能认为个人不适或印象管理的重要性不够，不足以影响咨询中寻求帮助的决策。然而，临床主管应考虑到培训生可能面临的个人成本，并通过尽可能舒适有效地在患者面前提供咨询协助来维持培训生的自尊心和信心。
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