General practice placements for pre-registration junior doctors: adding value to intern education and training

Anne A Martin, Caroline O Laurence, Linda E Black and Bruce V Mugford
Med J Aust 2007; 186 (7): 346-349. || doi: 10.5694/j.1326-5377.2007.tb00934.x
Published online: 2 April 2007

The Prevocational General Practice Placements Program (PGPPP), initiated by the Australian Government in 2003,1 provides junior doctors with an opportunity to work in general practice (GP) or community settings as part of their training (Box 1). In South Australia, most placements have been at the pre-registration, PGY1 level (intern).

During the first 2 years after graduation, medical graduates gain knowledge, attitudes and skills that will equip them for further training.4 Research in the United Kingdom (where GP posts at the pre-registration level have been available since the early 1980s) indicates that completing a GP term adds value to junior doctors’ training years.5-11 Benefits gained include: appreciation of psychological factors in illness;7,8 experience of a wider variety of problems and procedural skills;11,12 greater responsibility in managing patients;9,13 improved communication skills;9,10 and exposure to the interface between primary and tertiary care.9,11,12

In Australia, GP terms at the intern level of training have been rare, but in SA the success of a previous demonstration rural GP term for interns12 led to an expansion of such placements under the PGPPP. In 2005, eight GP-term placements were made available to interns in SA: six rural and two in outer metropolitan areas of workforce shortage. This provided an opportunity for a detailed evaluation, particularly of the educational value of these posts.

Here, we examine interns’ perceptions of how a GP term contributes to their training.


Semi-structured interviews were undertaken between May and December 2005 by two of us (C O L and A A M). As we are each linked to a different one of the two regional training providers managing the PGPPP for interns in SA, we each conducted interviews with interns associated with the other regional training provider. The interviews followed a predetermined script (Box 2), which was designed to reduce bias and elicit similarities and differences between rotations, rather than their negative or positive aspects. The questions were asked in a systematic and consistent way by both interviewers.

Interns were asked to compare their educational experiences in their GP and TH terms, with particular emphasis on the domains of junior medical officer education as listed by the Postgraduate Medical Council of SA.4 Interviews typically lasted between 30 minutes and 1 hour and were audiorecorded and later transcribed. Transcripts were provided to the participants for confirmation of accuracy before analysis.

Concepts and themes were identified by open coding14 independently by two of us (C O L and A A M) using qualitative data analysis software (NVivo, version 2.0, QSR International, Melbourne, Vic). Agreement on interpretation and inferences was reached through ongoing discussions, with subsequent adjustment of the coding system.


Interns described the contribution of the GP term to their training program in two ways. Firstly, they described it as part of a general experiential learning and professional development process across all terms throughout the year; for example, development of an understanding of ethical and legal issues was seen to occur across all training terms with no issues specific to GP or TH terms. Secondly, they described particular contributions which were characteristic of the GP term and which complemented those of the TH terms. The themes reflecting these particular contributions are described here.

What interns actually did

While formal teaching sessions occurred in both environments, interns also described the work done as an important aspect of the learning environment. The descriptions of what the interns actually did showed marked differences between the GP and TH terms (Box 4).

Personal and professional development

Our study has highlighted the contribution of a GP term to the intern training year. A GP term offered the opportunity for interns to broaden their knowledge and skills as doctors, particularly the skills required to manage undifferentiated patient presentations, and encouraged expansion of their knowledge of health care beyond that offered in tertiary care THs.

While the apprenticeship model of learning “by doing” and through “master as role model”15 is used in both the TH and GP environments, the application is different. In the TH, interns learnt to perform basic tasks while they observed higher-level activities being performed by seniors; in GP terms, they had the opportunity to practise the higher cognitive functions of initial diagnosis and management of their own patients, as modelled by their GP supervisors. Similar comparisons between TH and GP terms have been drawn by others.9

The interns in our study described the wide range of patient presentations as an important aspect of the learning environment in the GP term. In contrast, they described some TH terms, particularly those in specialist units such as cardiology or colorectal surgery, as having a narrow range of patient presentations, although the placements were labelled “general medicine” or “general surgery”. The skills interns acquired in these TH terms were low-level and generic “intern skills”, such as inserting intravenous cannulas, and writing up drug charts; a general medicine intern did much the same things as a general surgery intern.

On the other hand, interns found their skill base was broadened by their GP-term experiences. They practised not only a range of different procedural, communication and counselling skills, but also had the opportunity to assess undiagnosed patients, exercise their own clinical judgement, perform one-on-one consulting, and draw up management plans. Other authors have described similar experiences for interns in GP terms but not TH terms.8,9

The fragmentation of modern medicine in THs into many subspecialties, with short patient stays, means that “patients tend to either be having things done to them or to be at home”.16

The GP term gave the interns an opportunity to experience and practise a model of medical care requiring a different range of skills undertaken in a different context. They learnt about the roles of general practitioners and the importance of good communication between the different levels of care, findings also reported by others.9

The connection of the interviewers (A A M and C O L) with the regional training providers managing the PGPPP intern program could have reduced the validity of the data, but this potential limitation of our study was avoided, as described in the Methods.

The Postgraduate Medical Council of SA states that “the principal objective of early postgraduate education is to provide all medical graduates . . . with the knowledge, attitudes and skills that will equip them to proceed to specialist vocational training and general practice”, and notes that interns in SA are placed in a “hyperacute setting” in THs, giving them “unprecedented access to a wide range of learning opportunities”.4 The interns in our study described a wider range of learning opportunities when a GP term was included in their program.

Our study confirms the key role of the TH-term experience for interns, but, in contrast to GP terms, identifies a paucity of opportunity for them to initiate the diagnostic process. Medical problems seen in GP as “common” can only be defined as such, and managed appropriately, after a diagnosis has been made. Interns have recognised their role in the diagnostic process as a key feature of their GP terms.

The SA experience provides evidence of the valuable contribution of GP terms to intern training, complementing the TH component of learning. GP terms should be considered for inclusion in intern training programs across Australia.

Received 24 August 2006, accepted 12 December 2006

  • Anne A Martin1,3
  • Caroline O Laurence2,4
  • Linda E Black2
  • Bruce V Mugford1

  • 1 Sturt Fleurieu, Strathalbyn, SA.
  • 2 Adelaide to Outback GP Training Program, Adelaide, SA.
  • 3 Department of Medical Education, Flinders University, Adelaide, SA.
  • 4 Discipline of General Practice, University of Adelaide, Adelaide, SA.



We would like to thank Professor Richard Ruffin and Ms Karen Grace of the Postgraduate Medical Council of South Australia (PMCSA) for their support of this study, and advice in preparing the manuscript. The PMCSA provided funding for interviewee participation and transcribing of interviews.

Competing interests:

None identified.

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