Comparing physical examination in face-to-face and remote External Clinical Teaching Visits in general practice vocational training

External Clinical Teaching Visits (ECTVs) are formative workplace-based assessments involving experienced general practitioners (GPs), acting as external clinical teaching visitors (ECT visitors), observing trainees ('registrars') in practice. ECTVs are a core element of Australian GP vocational training. Remote modalities of ECTVs, introduced in response to the COVID-19 pandemic, have continued alongside face-to-face ECTVs post-pandemic.

This study aimed to explore the characteristics and associations of ECTV content delivered by these different modalities.

From 2020 to 2021, GP registrars of three geographically defined regional training organisations were invited to complete a questionnaire after completing ECTVs. Outcomes included: (1) the frequency registrars were observed performing physical examination by an ECT visitor and (2) the frequency a physical examination was observed and discussed by the ECT visitor. Analyses employed univariable and multivariable logistic regressions.

A total of 1394 questionnaires (for 44% of eligible ECTVs) were completed by 729 (58% of eligible) registrars. After exclusions, 1106 questionnaires were analysed. Eighty-two percent of visits were conducted by video. Overall, 87% of visits involved a registrar being observed performing a physical examination at least once, and 42% involved both observation and discussion of physical examination. On multivariable analysis, the odds of observation of physical examination were significantly less with video-conducted visits (OR: 0.16, 95% CI: 0.05-0.49, P = 0.001).

Remote ECTVs are an attractive option to reduce resource usage and logistical burden. However, key differences in the content of ECTVs delivered by remote modalities compared to those conducted face-to-face were found. A hybrid model ECTV program may be appropriate to ensure the educational integrity of ECTVs is maintained.