Utility of advanced training skills among GPs: a systematic review
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2025
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Mason, H.M.
Seidu, A.A.
Albert, F.A.
Anderson, E.
Alele, F.O.
McArthur, L.
Hollins, A.
Heggarty, P.
Gupta, T.S.
Hays, R.
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Rural and Remote Health, 2025; 25(1):9083-1-9083-10
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Hannah M. Mason, Abdul-Aziz Seidu, Francis A Albert, Emma Anderson, Faith O. Alele, Lawrie McArthur, Aaron Hollins, Paula Heggarty, Tarun Sen Gupta, Richard Hays, Bunmi S. Malau-Aduli
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Abstract
Introduction: Advanced Skills Training (AST) is designed toprovide GPs with an opportunity to enhance their clinical practicein a narrower speciality. This is valuable particularly for rural andremote communities that cannot justify narrower specialist servicesin the local community. ASTs require additional focused training,usually for 12 months, in a selected procedural or non-proceduralskill such as anaesthetics, obstetrics, surgery, emergency medicine,paediatrics, adult internal medicine, mental health, Indigenoushealth or palliative care. Ideally, several practitioners withcomplementary AST experiences work together to provide a widerrange of extended scope practice according to community need.However, experience so far suggests that this goal is notnecessarily achieved. Thus, this systematic review aimed to assessthe value and fitness for purpose of AST and ensure that it ismeeting the growing demand for coordinated care in ruralcommunities. This review addressed three questions: What is theeffectiveness of AST programs in improving GPs’ knowledge,attitudes and competence regarding rural clinical practice? How dostakeholders – including trainees, patients, management and thecommunity – perceive the impact (value and fitness for purpose) ofthe AST program in rural clinical practice? To what extent areadvanced skills training programs aligned with the needs of thecommunity served? Methods: This systematic review was conducted following thePreferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search strategy wasimplemented across six electronic databases (Medline Ovid,CINAHL, Emcare, Scopus, Web of Science and Informit) inDecember 2024. The quality of the studies was appraised using theQuality Assessment for Diverse Studies tool. Across all thereviewed articles, data on the effectiveness of AST, stakeholderperceptions of its value and extent of alignment of AST withcommunity needs in rural clinical practice were extracted andsynthesised using a data extraction template. Results : Sixteen peer-reviewed articles met the inclusion criteria.Of these, 11 employed qualitative study designs ( n=11, 68.8%) andfive were quantitative ( n=5, 31.3%). The majority were conductedin Canada ( n=5, 31.3%) and Australia ( n=5, 31.3%), followed by theUS ( n=4, 25.0%) and England ( n=2, 12.5%). The findings revealedthat the definition and scope of AST varied across the literature.Some defined it as advanced training that involves 12 months full-time equivalent in an accredited training post while others definedit as ‘tracks’, certificates, extended fellowships, residency programsor placements. Across the literature, participants notedimprovements in their knowledge, attitudes and competenceregarding their clinical practice. The value and fitness for purposeof the AST program was demonstrated by registrars’ continued useof skills after AST training, soft skills development and communityengagement opportunities, and rural workforce retention. Thechallenges reported for those undertaking AST programs werebarriers to inclusion on remote visits (eg transportation space,training space), time efficiency and management, workloadfluctuation, gaps between training and use of skills, peeracknowledgement, and differences between the hospital settingsin which training occurred and the rural contexts in which the skillswould be applied. Conclusion: Overall, this review provided evidence on the utility ofAST for GPs. Despite the value of AST in GP clinical practice, somebottlenecks may be limiting its effectiveness. Current ASTopportunities (both training and final practice location) and careerpathways are not always aligned, potentially limiting the success ofthe AST strategy in bridging the gap between urban and ruralhealth service status. Concerted efforts are required to improvealignment of career advice, community needs, training pathways,AST opportunities and final practice location in order to achievethe intended purpose. Further research is required on the impactof AST programs on community health outcomes.
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This work is licensed under a Creative Commons Attribution 4.0 International Licence