Does telehealth disrupt the trainee–supervisor learning environment in vocational general practice training? A qualitative study

Background: Used sparingly before 2020, telehealth was quickly adopted throughout Australia in response to COVID-19. This required general practitioner (GP) trainees (registrars) and their educators (supervisors and medical educators) to rapidly learn telehealth as a primary consultation method. As telehealth use continues within primary health care beyond the pandemic, greater insight into the impact on GP training is required. This is particularly relevant to general practice settings in countries that, like Australia, utilise an apprenticeship-style training model where the social space of in-consultation learning with supervisors is key to registrars achieving competence. We aimed to explore the impact of telehealth uptake on Australian GP vocational training, with particular focus on the in-consultation social space of registrars' learning. Methodology: Qualitative semi-structured individual interviews with 15 registrars, five supervisors and five medical educators were conducted and analyzed using reflexive thematic analysis. Wenger's community of practice theory provided a conceptual framework for analysis and interpretation. Findings: Three key themes were generated. (1) The social space of learning can be disrupted by telehealth. Registrars described how telehealth changed the options for help-seeking during consultations, delaying feedback for learning. Medical educators reported concerns about the delay of what should be immediate feedback for learning during consultations, whereas registrars and supervisors held mixed views on whether such delays impacted registrar learning. (2) Reduced in-person clinical exposure creates educational challenges. Telehealth consultations resulted in a loss of experiences and skill-development opportunities and reduced diversity of clinical practice. (3) Registrars and educators were managing and learning telehealth within a pandemic context. A lack of formal telehealth training to guide best practice required registrars and educators to learn how to utilise telehealth together. Conclusions: The rapid uptake of telehealth altered the in-practice social space of registrars' learning. As telehealth use continues, these findings highlight the need for telehealth-specific training to maximise registrar learning during consultations.