The needs of General Practitioners in-training (GPiT) vary according to time, context and professional experience. This is the journey of how educators of a general practice (GP) training program devised new formative assessment tools to address GPiT-specific needs whilst meeting the expected standards of a changing program. Despite limited resources, ongoing changes to training, and the recent healthcare environment, the quality of the educational outcomes was maintained and enriched in the process.
This team of GP educators faced critical challenges in delivering formative assessments to a cohort of GPiT largely in rural and remote areas, consisting mostly of international medical graduates. Some of those challenges included: rapid growth of the number of GPiT in the program; an increase in the number of assessments required to successfully complete the program; and the isolation and disconnect from peers faced by this vulnerable GPiT cohort, made worse by COVID restrictions. It was also identified that clinical performance deficiencies common to GPiT of this program were only addressed opportunistically through the original iteration of assessment tools. Additionally, some GPiT of this program struggled to demonstrate their clinical skills when observed by assessors due to performance anxiety.
Through different iterations of learning activities and assessments, the program educators innovated group activities to address learning needs in a standardised fashion. Common learning needs identified included communication in difficult consultations; clinical reasoning; ethics and professionalism; fellowship examination preparation; and doctor wellbeing. Use of video platforms and online forums, and being responsive to feedback from evaluation surveys, helped to keep learning relevant and individualised. Group activities not only delivered the program more efficiently, but also improved GPiT satisfaction through peer-to-peer learning.
Willingness to engage in a process of innovation and proactive feedback, from both educators and GPiTs resulted in a more efficient and effective learning experience for all.

The key take away messages for my presentation are:
1. There is always opportunity for innovation and improvement in the face of change.
2. Formative assessment tools can be more effective by a process of listening to learners’ needs, being open to change and adaptation, and having the adequate evaluation processes to measure the learners’ satisfaction, engagement and performance.
3. Being open to innovating and working collaboratively as a team are keys to engaging learners in the learning process and staying relevant in our ever changing healthcare environment.

At the start of the pandemic GP Synergy was the Regional Training Organisation in NSW and the ACT providing training to GPs through both the Australian General Practice Training (AGPT) and Practice Experience Program (PEP). In-practice observation of consultations through AGPT Clinical Teaching Visits (CTVs) and PEP Direct Observations (DOs) was an integral part of these GP training pathways. CTVs and DOs provided educational support to general practitioners in training (GPiT), allowing real-time assessment and feedback as well as identifying GPiTs requiring additional assistance.

Pandemic-related disruption to GP training created an urgent need for flexible and sustainable approaches to CTVs and DOs. This presented a major educational, organisational and logistical challenge requiring extensive cross-team collaboration. In response we initiated innovative modes of CTV and DO delivery utilising a remote assessor and various educational strategies. An existing research project investigating perceived educational utility of CTVs and DOs presented a unique opportunity to compare remote direct observations to more traditional face-to-face observations. Remotely conducted CTVs and DOs were perceived as having high educational utility. Remote CTVs were rated similarly highly when compared with pre-pandemic face-to-face CTV utility data.

As the impact of a pandemic-induced altered learning environment for GPiT continued, our remote observations identified several issues potentially affecting the depth of clinical learning. The combination of increased telehealth consultations of shorter duration and lower complexity, and an overall reduction in the breadth of clinical exposure, highlighted the challenge of maintaining skill development e.g., physical examination skills.

Our experience has shown the effectiveness of remote observations in delivering education, assessment and feedback in GP training. It has also revealed the limitations of remote observation in an altered learning environment. Using a combination of face-to-face and remote observations during training can act to help mitigate issues of concern.

1.Analyse the impact of COVID-19 on direct observation of skill development in general practice training 2. Reflect on the role of cross-team collaboration to maintain high quality outcomes in direct observation by external assessors 3. Explore ways to incorporate the experience of pandemic-derived direct observation into future learning strategies.