Article 2014

We live in testing times: Teaching rational test ordering in general practice

Australian Family Physician
Journal · Vol. 43 · Issue 5 · pp. 273-276
Abstract

Background: Pathology, imaging and other tests have an essential role in the diagnosis and screening for disease in medical practice. However, over-testing has recently emerged as a significant issue and has implications for the patient, doctor and health system. Vocational training is arguably the most critical period in the development of future patterns of clinical practice for the GP. This includes the development of test ordering behaviour. The general practitioner (GP) supervisor, therefore, has a key role to play in educating registrars to avoid over-testing. Objective: In this article, we discuss general approaches and practical strategies for GP supervisors to teach their registrars rational test ordering. Discussion: Teaching should take a patient-centred focus and an emphasis on fostering a greater tolerance of uncertainty. Role modelling and demonstrated use of relevant clinical guidelines is a strong influence on registrar behaviour. Specific strategies for teaching rational test ordering include random case analysis, investigation audit, topic tutorials and use of targeted resources.

Keywords

Author Keywords

education, medical Pathology Diagnostic imaging Evidence-based medicine Vocational education/graduate education

Index Keywords

Teaching human male medical education Humans Internship and Residency Article Australia education general practice clinical practice middle aged patient care methodology case report Patient-Centered Care diagnostic procedure Diagnostic Techniques and Procedures unnecessary procedure Physician's Practice Patterns Unnecessary Procedures
Author Affiliations
General Practice Training Tasmania, New Town, TS, Australia
Inala Indigenous Health Service, Brisbane, QL, Australia, Griffith University, Brisbane, QLD, Australia
Funding & Acknowledgements
No funding information
References 10 References
1 Greystone, (2012)
2 Knock Ou Le Triomphe De La Medecine, (1924)
3 undefined
4 Verstappen, Wim H.J.M., Variation in test ordering behaviour of GPs: Professional or context-relateed factors?, Family Practice, 21, 4, pp. 387-395, (2004)
5 Evidence Practice Gap in GP Pathology Test Ordering A Comparison of Beach Pathology Data and Recommended Testing, (2009)
6 McGregor, Margaret J., Testing 1, 2, 3: Is overtesting undermining patient and system health?, Canadian Family Physician, 58, 11, pp. 1191-e617, (2012)
7 Moynihan, Ray N., Preventing overdiagnosis: How to stop harming the healthy, BMJ (Online), 344, 7859, (2012)
8 Enhancing the Quality Use of Pathology for GP Registrars and International Medical Graduates Assessing the Need, (2008)
9 Lilford, Richard J., What is the best strategy for investigating abnormal liver function tests in primary care? Implications from a prospective study, BMJ Open, 3, 6, (2013)
10 Willis, Cameron David, Vitamin b12 and folate tests: The ongoing need to determine appropriate use and public funding, Medical Journal of Australia, 198, 11, pp. 586-588, (2013)
Quick Actions
Citation Metrics
26
Times Cited (Scopus)

References 10
Document Identifiers
  • EID 2-s2.0-84900466668
  • PubMed 24791766
  • Language English