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Changes in pathology test ordering by early career general practitioners: a longitudinal study

Parker J Magin, Amanda Tapley, Simon Morgan, Kim Henderson, Elizabeth G Holliday, Andrew R Davey, Jean Ball, Nigel F Catzikiris, Katie J Mulquiney and Mieke L van Driel
Med J Aust 2017; 207 (2): 70-74. || doi: 10.5694/mja16.01421

Abstract

Objective: To assess the number of pathology tests ordered by general practice registrars during their first 18–24 months of clinical general practice.

Design: Longitudinal analysis of ten rounds of data collection (2010–2014) for the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing, multicentre, cohort study of general practice registrars in Australia. The principal analysis employed negative binomial regression in a generalised estimating equations framework (to account for repeated measures on registrars).

Setting, participants: General practice registrars in training posts with five of 17 general practice regional training providers in five Australian states. The registrar participation rate was 96.4%.

Main outcome measure: Number of pathology tests requested per consultation. The time unit for analysis was the registrar training term (the 6-month full-time equivalent component of clinical training); registrars contributed data for up to four training terms.

Results: 876 registrars contributed data for 114 584 consultations. The number of pathology tests requested increased by 11% (95% CI, 8–15%; P < 0.001) per training term.

Conclusions: Contrary to expectations, pathology test ordering by general practice registrars increased significantly during their first 2 years of clinical practice. This causes concerns about overtesting. As established general practitioners order fewer tests than registrars, test ordering may peak during late vocational training and early career practice. Registrars need support during this difficult period in the development of their clinical practice patterns.

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  • Parker J Magin1,2
  • Amanda Tapley1,2
  • Simon Morgan3
  • Kim Henderson1,2
  • Elizabeth G Holliday1,4
  • Andrew R Davey1,2
  • Jean Ball4
  • Nigel F Catzikiris2
  • Katie J Mulquiney1,2
  • Mieke L van Driel5

  • 1 University of Newcastle, Newcastle, NSW
  • 2 GP Synergy, Sydney, NSW
  • 3 Elermore Vale General Practice, Newcastle, NSW
  • 4 Hunter Medical Research Institute, Newcastle, NSW
  • 5 University of Queensland, Brisbane, QLD


Acknowledgements: 

This work was supported by an Education Research Grant from the Australian Department of Health (grant number, D14/17024). The ReCEnT project was funded until 2015 by the participating educational organisations: General Practice Training Valley to Coast, the Victorian Metropolitan Alliance, General Practice Training Tasmania, Adelaide to Outback GP Training Program, and Tropical Medical Training, all of which were funded by the Australian Government. From 2016, ReCEnT is funded by an Australian Department of Health commissioned research grant and supported by the GP Synergy Regional Training Organisation. We acknowledge the general practice registrars, general practice supervisors and practices who have participated in the ReCEnT project, and Neil Spike and Rohan Kerr for their contributions to the wider ReCEnT project.

Competing interests:

No relevant disclosures.

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