• Lucie Walters, David Prideaux, Paul Worley, Jennene Greenhill, and Heidi Rolfe.
• Flinders University, Rural Clinical School, Flinders University, South Australia, Australia. lucie.walters@flinders.edu.au
• Med Educ. 2009 Mar 1;43(3):268-73.

ObjectivesThe practice of having medical students see patients in a general practice setting, in their own consulting rooms, prior to the GP preceptor joining the consultation does not increase general practitioner (GP) consultation time. How do GPs meet the needs of both patient and student without extending consultation time? This study sought to quantify and compare GP consultation activities with and without students.MethodsThis was a prospective cohort study of 523 videotaped consultations. Consultations were analysed in 15-second intervals using a modified Davis observation code to define GP activity. Estimated marginal means were calculated using mixed model analysis accounting for confounding factors.ResultsIn comparison with consulting alone, GPs precepting a student spent 37 seconds less time examining patients (P = 0.001), 41 seconds less on patient management, and 1 minute, 31 seconds less on clerical and other activities (P < 0.001). This created time for GPs to take a history from both the student and patient (39 seconds longer; P = 0.002) and to teach students (1 minute, 10 seconds; P < 0.001).DiscussionGeneral practitioner activity in the consultation changes significantly when precepting a student; GPs spend longer exploring the history in order to unpack the student's clinical reasoning, verify the patient's story and resynthesise the information. They spend less time on examination, management and clerical activities and presumably delegate or defer these activities. Conclusions This organising of clinical activities in order to meet the needs of both patient and student is likely to require different processing skills to solo consulting.

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