With a ‘tsunami' of medical students and a rapidly growing demand on health, involvement of the medical student as an active GP team member in patient care can help workforce shortages, encourage multidisciplinary training, and provide practical hands-on skills training. A new model of teaching and upskilling medical students has been very successful using local practices and Joondalup Health Campus to provide teaching of the traditional hospital-based disciplines, Medicine and Psychiatry, but with a community focus.

Medical student numbers in WA have tripled in the last three years. UWA have doubled their intake, in addition to its new graduate entry program, and next year the first intake of the University of Notre Dame (UNDA) will finish. When I completed my degree at UWA in 1984, there were 104 graduates and 20 years later in 2004 there were still 104 graduates. In 2009 there will be nearly 330 graduates needing intern places!

The undergraduate focus on GP teaching has improved the exposure and experience of medical students. At UWA there is now GP teaching in every year of the six year course and the focus of UNDA is GP training. Currently about 1 in 7 GPs are teaching medical students, and if undergraduate GP teaching is to remain robust, then almost 1 in 3 GPs will need to be involved in teaching within the next two or three years.

General practice is mostly a small private business. There are not explicit funds nor specific facilities for teaching as in public teaching hospitals. PIP payments provide recognition for teaching but are inadequate to cover opportunity losses and many, mostly female, GPs get no or only part PIP payment. Manpower is also a problem. It is an expectation of hospital registrars that they teach junior doctors and medical students. A recent survey showed that over 90% of hospital registrars teach but only 10% of GP registrars are teaching medical students.

Research shows that GPs find teaching medical students fun and intrinsically rewarding, and importantly, that patients like students and teaching in general practice. There are two main reasons GPs give for not teaching: confidence and time. Good teaching requires time and energy and it has previously been seen by some to be uneconomic when running a small business.

UWA and WAGPET have developed training programs to help GPs feel more confident teaching. In particular, programs such as Fiona Lake's Teaching on the Run have been popular and effective.

At UWA's Outerurban Clinical School (OCS) Joondalup, we have started to look at innovative models of teaching, endeavouring to decrease the economic burden on practices and also to improve the efficiency of teaching. The training module "Efficient Teaching" has helped GPs to adopt economically efficient and educationally vigorous practices.

The active involvement of the medical student as a GP ‘assistant' in a general practice can provide an opportunity for increased efficiencies as well as good teaching. A good general practice business delivers high quality health care in a supportive environment, efficiently and productively.

Can we develop models to ensure good teaching and good business?

There are real possibilities!