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Is there a role for GP registrars as teachers?

Benefits of GP registrars as teachers

Challenges of GP registrars as teachers

Mentoring a GP registrar as a teacher

Suggested further reading

Traditionally, junior doctors and medical students are supervised by senior residents or registrars and taught a wide range of skills within the public hospital training environment. The specialist consultant remains the overarching supervisor and team director; however, the day-to-day teaching and co-ordination is often undertaken by a more junior doctor with only a few years more experience than the learner. On the hospital wards, registrars take an important role in supervising or teaching medical students. Many GP registrars have, therefore, already had significant teaching roles in the hospital environment by the time they enter general practice.

The nature of the hospital environment is very different to private general practice in many regards. In general practice, patients have longitudinal relationships with the same GP, and they expect high quality care from the doctor of their choice, for which they are often paying a private fee. In this context, it can be challenging for GP registrars to supervise students. GP registrars are usually busy trying to establish and build their own patient base, whilst gaining their own confidence and clinical competence.

However, teaching can also contribute to confidence building for GP registrars, as they become more knowledgeable and able to clearly articulate their clinical decision-making processes and management planning to a student. Additionally, students can ask challenging questions.

Do GP registrars want to teach?

It seems that learners at all levels are keen to also be teachers. A survey of near-peer teaching of GP registrars in Australia explored learners’ willingness to teach.7 The study found generally high enthusiasm for taking a teaching role, with support from 72% of GP registrars, 68% of junior doctors, and 33% of medical students. In this study, three-quarters of GP supervisors allowed their learners to teach, with the most common form of teaching being medical students joining the GP registrar in a patient consultation. Registrars found that teaching improved their learning, and students found that near-peer teaching did not diminish the quality of teaching.

In contrast to medical students and junior doctors, who view the teaching received from GP registrars enthusiastically, GP supervisors have reservations about near-peer teaching because they questioned registrars’ skill and knowledge level, although they acknowledge some benefits, particularly in contribution to the teaching load.

The unique benefits of being a near-peer teacher are well recognised in the hospital sector. Registrar teaching is often considered to be more targeted and appropriate for junior leaners. For example, a registrar is more likely to undertake a full examination on a patient. This is helpful for medical students, who are more likely to be assessed on undertaking a complete physical examination rather than a targeted physical examination. Registrars are often clearer regarding the requirements and techniques for managing exams, and this leads to a more structured approach to teaching their students. Registrars who have previously attended the same medical school as a student can have important insight that guides students through educational activities that the registrar has previously undertaken. These benefits of GP registrar teaching are also relevant in the general practice setting.

Near-peer teaching

Junior learners describe enhanced social and cognitive congruence between themselves and near-peer teachers. Near-peer teachers are often more ‘in tune’ with the learning needs of junior colleagues and may provide more current information than teachers, who are significantly more advanced in their careers than the learner. They also often complemented the gender gap in the teachers, with many of the GP supervisors being male but GP registrar teachers often being female. Near-peer teaching is common in the hospital environment as registrars are commonly supervising junior doctors and students and this is often considered more acceptable to the learner because the near-peer is perceived as less judgemental.

Learning from teaching

Registrars report that teaching can increase their knowledge base, helping to validate their knowledge and increasing their own learning. Undertaking a role in teaching medical students can also help GP registrars to develop skills that can used in undertaking another key part of their role—patient education.

Contribution to the practice

Engaging GP registrars as teachers in the practice can reduce the time pressure on GP supervisors and help spread the load of teaching and benefit the practice financially by freeing up senior staff for patient appointments. It is also crucial in succession planning for the practice’s teaching team.

Personal enjoyment

Teaching can be an enjoyable activity that provides variety within a working day and contributes to a feeling of collegiality within the profession.GP supervisors often report that personal enjoyment is a primary motivation for teaching and for registrars it is likely to be the same as it can give them a sense of confidence and satisfaction.

Opportunity to teach

In contrast to the hospital, in which a teaching role is expected of a registrar, the GP registrar often faces a barrier of neither being expected to teach, nor provided with the opportunity to do so. In the hospital environment the consultant is generally not present on the ward for much of the day, and the registrar is the most accessible colleague to instruct and teach junior doctors and medical students. In contrast, the supervisors in a general practice environment are physically present throughout the session, and the teaching tends to default to senior clinicians.

Competency to teach

GP supervisors are often concerned about the competency of GP registrars to teach. There may be a perception that the GP registrar’s overall knowledge base is insufficient, given their relative inexperience. General practice covers a large range of clinical topics and it therefore takes time to establish high levels of clinical competency. In addition, GP registrars are usually highly focused on developing their own clinical competencies, such that development of teaching competencies may not be a priority. GP registrars require mentoring and support to undertake teaching. Encouraging registrars to attend training courses and gain skills in teaching and education enables them to develop confidence and motivation in their teaching role.

Remuneration and time

Teaching takes time. Experienced GPs report that consultations and tasks take longer when a medical student is present, which should always be considered when timetabling and booking patients. Registrars are at a stage of practice where the extra time that teaching requires will have a larger impact on their working schedule. However, many GP registrars have fixed work schedules over which they have limited control. This can make teaching responsibilities stressful for a GP registrar. Patients may also give less leeway to a registrar in terms of punctuality than they give to an experienced doctor they know well. Registrars are trying to build their own patient base—the registrar may not be enthusiastic to engage in parallel consulting with a medical student if they perceive the experience will impact negatively on their patients. However, patients who observe their doctor engaging in a responsible teaching role may build more trust and confidence in their doctor, which can assist the registrar to develop relationship with patients.

Remuneration for GP registrars who are teaching can also be an issue, particularly if they are paid per patient or on a percentage of billings. For salaried registrars this is less of an issue.

Enhancing Supervision Skills for Multi-Level Learning and the Resources section provide tips and resources that can be used to mentor and enhance the teaching skills of a GP registrar. Ask the GP registrar to read this page, and then discuss some further concepts about giving feedback to students. Ask the registrar to sit in and observe your teaching style with students, or observe the registrar’s teaching and give them some feedback. The key message a registrar needs from a supervisor is that they are trusted as teachers, and already have valuable wisdom to pass on to more junior learners. Regular opportunities to reflect on their teaching experiences and feeling that they are a valued member of the team are both important in the registrar’s development as a teacher.

Sometimes medical students are negative or dismissive towards more junior members of the GP team and may not recognise the skills and attributes of a GP registrar. Students who haven’t previously experienced the general practice setting can bring prejudiced preconceptions from the hospital environment that may be perceived as derogatory and patronising. This can be both deflating and difficult for a registrar who is keen to gain confidence. Negative student attitudes and interactions can reduce the registrar’s desire and motivation to teach. Some registrars need time to talk through these situations, so you can provide encouragement, reassurance and strategies for managing difficult circumstances as they arise.

Selberg P, Ahern C & van der Mortel T. Learners as teachers in general practice: stakeholder views of the benefits and issues. Educ Prim Care 2013; 24:410–417

This article provides a good overview of the various opinions in the Australian GP context of near peer teaching.

References for Registrars As Teachers