To the Editor: Attachments to general practices offer medical students exposure to patients and to the prevention, diagnosis, treatment and palliation of the spectrum of illness in the community. However, medical schools face the challenge of retaining, recruiting, training and supporting teaching practices that can provide high-quality learning experiences for increasing numbers of medical students, and can keep student teaching manageable and rewarding for the general practitioners themselves.

We conducted semi-structured interviews with 55 of Brisbane’s practice-based GP teachers, to explore their views about teaching third-year University of Queensland medical students. Interviewees identified a number of rewards and challenges associated with supervising a medical student in the context of the “busyness” and business of everyday general practice (Box). Rewards included the intrinsic joy of teaching and mentoring; the satisfaction of a sense of obligation to teach; the opportunity to showcase high-quality general practice; the intellectual stimulation of having their practice observed and, at times, questioned; the exposure to current medical knowledge and young enthusiastic students; and an appreciation that patients themselves benefit from their participation in a teaching consultation. Other attractions identified were the availability of continuing medical education points, the federal government’s Practice Incentives Program payment of $100 per teaching session,1 and access to the University of Queensland library resources.

Challenges frequently cited included managing the extra time taken to teach without excessive delays for waiting patients; and the extra workload of addressing the students’ learning needs while ensuring that the patients’ needs are given priority. Other challenges included losing income from the reduction in patient load during teaching consultation sessions; anxiety about patient acceptance of active student participation in consultations; concerns about potential negative impacts on patients of inappropriate or inexpert student comments or skills (and possible medicolegal implications); and the extra demands of supervising a relatively weak or apparently unenthusiastic student. There were also problems related to practice infrastructure, with only a third of the GPs consistently having access to a room for student consultations and study.

We have identified a number of factors that motivate GPs to teach, and others that act as disincentives. The difficulties of recruitment and retention of high-quality teaching practices in the current climate of general practice workforce shortage and increased medical student numbers are likely to increase, unless practice-based teaching remains manageable and rewarding for GPs. Strategies to promote and enhance the rewards of practice-based teaching, and overcome perceived obstacles, will be needed.