Pathology test-ordering behaviour of Australian general practice trainees: a cross-sectional analysis

Objective: In the context of increasing over-testing and the implications for patient safety, to establish the prevalence and nature of pathology test-ordering of GP trainees, and to describe the associations of this test-ordering. Design: A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) cohort study. Setting: Five of Australia's 17 general practice regional training providers, encompassing urban-tovery remote practices. Participants: GP trainees. Main Outcome Measure(s): The number of pathology tests ordered per problem/diagnosis managed. Results: A total of 856 individual trainees (response rate 95.2%) contributed data from 1832 traineeterms, 108 759 encounters and 169 304 problems. Pathology test-ordering prevalence was 79.3 tests (95% CI: 78.8-79.8) per 100 encounters, 50.9 (95% CI: 50.6-51.3) per 100 problems, and at least 1 test was requested in 22.4% of consultations. Most commonly ordered was full blood count (6.1 per 100 problems). The commonest problem prompting test-ordering was 'check-up' (18.6%). Test-ordering was significantly associated, on multivariable analysis, with the trainee having worked at the practice previously; the patient being adult, male and new to both trainee and practice; the practice being urban; the problem/diagnosis being new; imaging being ordered; referral being made and followup being arranged. Trainees were significantly less likely to order tests for problems/diagnoses for which they had sought in-consultation information or advice. Conclusions: Compared with the established GPs, trainees order more pathology tests per consultation and per problem managed, and in a higher proportion of consultations. Our findings will inform educational policy to enhance quality and safety in general practice training.