The challenges of teaching in a general practice setting

Rod Pearce, Caroline O Laurence, Linda E Black and Nigel Stocks
Med J Aust 2007; 187 (2): 129-132. || doi: 10.5694/j.1326-5377.2007.tb01161.x
Published online: 16 July 2007

Medical education in Australia is facing a crisis. It is estimated that the number of domestic graduates will increase by 81% between 2005 and 2012, and, with the inclusion of international students, Australia will be producing more than 3000 medical graduates annually in 5 years.1

The quality of the teaching experience provided in general practice,2 and the success of programs such as the Prevocational General Practice Placement Program (PGPPP), make community general practice an attractive solution for the education of the increased number of medical students and junior doctors.3

There is no coordinated system for collecting data on general practice teaching in Australia, but Box 1 shows our estimate of the number of teaching practices involved in medical education in 2006 at various training levels; many practices are involved at more than one level, but the degree of overlap cannot be determined. With an estimated total of 3000 medical students, 900 interns and 600-plus registrars requiring placement in general practice by 2012, the numbers seem well short of meeting the requirement, unless more sites are recruited, or larger numbers are trained per site.

Before practices consider undertaking training, they need to be aware of the challenges of community-based teaching.2,7-9 Teaching impacts not only on the trainers, but also on other practice staff, patients and the students, junior doctors and registrars themselves. Summarised below and in Box 2 are the issues that general practitioners in the community face when they undertake to teach, and a range of evidence and solutions that should be considered.

Patient perspective

Patients’ willingness to participate in medical education is vital for the sustainability of community-based teaching.11 Patients overall were found to enjoy their involvement in teaching, as it provided the opportunity for longer consultations and to learn more about their conditions, and improved their view of their illness.8,23 But teaching can also impact on patients’ relationships with their GPs, and patients must clearly be able to choose when they want to be involved in teaching.12,24


To resolve these issues, community general practice must be more innovative in how it organises and provides teaching. Research in other countries and in Australia suggests a number of solutions. With medical students, registrars and now junior doctors being taught in general practice, it is an opportune time to explore the benefits of vertical integration.14 Evidence from other countries and the hospital setting provides a model where more senior doctors teach junior doctors. Models that work well under vertical integration include DeWitt’s service–learning model, which allows productivity while teaching;15 and the “hub and spoke” model of teaching practices, where a main practice provides core teaching, with linked practices undertaking an ancillary role.26 This allows the involvement of practices that might otherwise have had no role because of lack of teachers, space or patient load. For vertical integration to be effective, key organisations must work together, pool resources, support existing teaching practices and encourage new practices to be involved in teaching.

Another approach is to make better use of other practice staff and health services. Rotations through public health organisations, and sessions with private specialists, pharmacists or nurse-led diabetes or asthma clinics during general practice placements could provide GP trainers with a break from teaching. Other practice staff could also be utilised in teaching. Administrative staff might coordinate “volunteer” patients whose medical problems could be reviewed by students.

These models require practices and associated organisations to think more laterally. However, for these solutions to be effective, practices must have the space to accommodate more than one level of student or postgraduate doctor.

A popular solution to resolving some of the issues outlined above is financial. However, missing from the debate is evidence on the direct and indirect costs of teaching at all levels of training. Existing research has focused on particular programs.18,27 Further research is required to determine what support is appropriate, particularly support for infrastructure.


Teaching in the general practice setting will play an increasingly important role in the training of medical practitioners.3 The increased teaching requirement for general practice provides challenges, but is an opportunity to expose more medical students, junior doctors and registrars to the specialty of general practice. General practice has the potential to provide a greater breadth of exposure to health conditions and unique settings, and to allow the acquisition of new skills.

To allow general practice to maintain current teaching levels and to respond to the increasing load, practices and trainers require support in a number of areas, particularly remuneration of direct and indirect teaching costs. While research on viable models for general practice exist,28 the costs and benefits associated with teaching have not been included in the modelling. Research is needed on models that will increase teaching efficiency. In addition, we need to accurately calculate the level of support required across the teaching continuum in both urban and rural environments. This research would inform the debate and provide evidence for appropriate strategies to accommodate the increased teaching load.

2 Challenges for teaching in general practice and possible solutions

Perspective and challenges

Possible solutions

General practitioner




Medical education provider

  • Rod Pearce1
  • Caroline O Laurence2
  • Linda E Black1
  • Nigel Stocks2

  • 1 Adelaide to Outback GP Training Program, Adelaide, SA.
  • 2 Discipline of General Practice, University of Adelaide, Adelaide, SA.

Competing interests:

None identified.

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