Advances in Health Sciences Education

, Volume 22, Issue 4, pp 915–929 | Cite as

Early predictors of need for remediation in the Australian general practice training program: a retrospective cohort study

  • Parker Magin
  • Rebecca Stewart
  • Allison Turnock
  • Amanda Tapley
  • Elizabeth Holliday
  • Nick Cooling


Underperforming trainees requiring remediation may threaten patient safety and are challenging for vocational training programs. Decisions to institute remediation are high-stakes—remediation being resource-intensive and emotionally demanding on trainees. Detection of underperformance requiring remediation is particularly problematic in general (family) practice. We sought to establish early-training assessment instruments predictive of general practice (GP) trainees’ subsequently requiring formal remediation. We conducted a retrospective cohort study of trainees from a large Australian regionally-based GP training organization. The outcome factor was requirement for formal remediation. Independent variables were demographic factors and a range of formative assessments conducted immediately prior to or during early-stage training. Analyses employed univariate and multivariate logistic regression of each predictor assessment modality with the outcome, adjusting for potential confounders. Of 248 trainees, 26 (10.5 %) required formal remediation. Performance on the Colleague Feedback Evaluation Tool (entailing feedback from a trainee’s clinical colleagues on clinical performance, communication and probity) and External Clinical Teaching Visits (half-day sessions of the trainee’s clinical consultations observed directly by an experienced GP), along with non-Australian primary medical qualification, were significantly associated with requiring remediation. There was a non-significant trend for association with performance on the Doctors Interpersonal Skills Questionnaire (patient feedback on interpersonal elements of the consultation). There were no significant associations with entry-selection scores or formative exam or assessment scores. Our finding that ‘in vivo’ assessments of complex behaviour, but not ‘in vitro’ knowledge-based assessments, predict need for remediation is consistent with theoretical understanding of the nature of remediation decision-making and should inform remediation practice in GP vocational training.


Family practice General practice Education, medical, graduate Professional competence Remedial teaching Educational measurement 



This project was funded by an Education Research Grant, 2015, Australian Government Department of Health.


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Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  1. 1.School of Medicine and Public HealthUniversity of NewcastleCallaghanAustralia
  2. 2.General Practice Training Valley to CoastMayfieldAustralia
  3. 3.Tropical Medical TrainingTownsvilleAustralia
  4. 4.School of MedicineUniversity of TasmaniaHobartAustralia
  5. 5.Clinical Research Design, IT and Statistical Support UnitHunter Medical Research InstituteNewcastleAustralia

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