{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T10:26:51Z","timestamp":1784716011788,"version":"3.55.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"1184","license":[{"start":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T00:00:00Z","timestamp":1706659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100015539","name":"Australian Government","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015539","id-type":"DOI","asserted-by":"publisher"}]},{"name":"GP Synergy Regional Training Organisation"},{"name":"GP Synergy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>\u2018Low-value\u2019 clinical care and medical services are \u2018questionable\u2019 activities, being more likely to cause harm than good or with disproportionately low benefit relative to cost. This study examined the predictive ability of the QUestionable In Training Clinical Activities Index (QUIT-CAI) for general practice (GP) registrars\u2019 (trainees\u2019) performance in Australian GP Fellowship examinations (licensure\/certification examinations for independent GP).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The study was nested in ReCEnT, an ongoing cohort study in which Australian GP registrars document their in-consultation clinical practice. Outcome factors in analyses were individual registrars\u2019 scores on the three Fellowship examinations (\u2018AKT\u2019, \u2018KFP\u2019, and \u2018OSCE\u2019 examinations) and pass\/fail rates during 2012\u201321. Analyses used univariable and multivariable regression (linear or logistic, as appropriate). The study factor in each analysis was \u2018QUIT-CAI score percentage\u2019\u2014the percentage of times a registrar performed a QUIT-CAI clinical activity when \u2018at risk\u2019 (i.e. when managing a problem where performing a QUIT-CAI activity was a plausible option).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 1265, 1145, and 553 registrars sat Applied Knowledge Test, Key Features Problem, and Objective Structured Clinical Exam examinations, respectively. On multivariable analysis, higher QUIT-CAI score percentages (more questionable activities) were significantly associated with poorer Applied Knowledge Test scores (P\u2009=\u2009.001), poorer Key Features Problem scores (P\u2009=\u2009.003), and poorer Objective Structured Clinical Exam scores (P\u2009=\u2009.005). QUIT-CAI score percentages predicted Royal Australian College of General Practitioner exam failure [odds ratio 1.06 (95% CI 1.00, 1.12) per 1% increase in QUIT-CAI, P\u2009=\u2009.043].<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Performing questionable clinical activities predicted poorer performance in the summative Fellowship examinations, thereby validating these examinations as measures of actual clinical performance (by our measure of clinical performance, which is relevant for a licensure\/certification examination).<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/postmj\/qgad147","type":"journal-article","created":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T07:13:09Z","timestamp":1706771589000},"page":"382-390","source":"Crossref","is-referenced-by-count":3,"title":["Prediction of general practice licensure\/certification examination performance by a measure of \u2018questionable\u2019 activities in clinical practice: a retrospective cohort study"],"prefix":"10.1093","volume":"100","author":[{"given":"Parker","family":"Magin","sequence":"first","affiliation":[{"name":"School of Medicine and Public Health , College of Health, Medicine and Wellbeing, , University Drive, Callaghan, NSW 2308 , Australia"},{"name":"The University of Newcastle , College of Health, Medicine and Wellbeing, , University Drive, Callaghan, NSW 2308 , Australia"},{"name":"General Practice Training Research Department, Royal Australian College of General Practitioners , Level 1, 20 Mclntosh Drive, Mayfield West, Newcastle, NSW 2304 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Ralston","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health , College of Health, Medicine and Wellbeing, , University Drive, Callaghan, NSW 2308 , Australia"},{"name":"The University of Newcastle , College of Health, Medicine and Wellbeing, , University Drive, Callaghan, NSW 2308 , Australia"},{"name":"General Practice Training Research Department, Royal Australian College of General Practitioners , Level 1, 20 Mclntosh Drive, Mayfield West, Newcastle, NSW 2304 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Fielding","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health , College of Health, Medicine and Wellbeing, , University Drive, Callaghan, NSW 2308 , Australia"},{"name":"The University of Newcastle , College of Health, Medicine and Wellbeing, , University Drive, Callaghan, NSW 2308 , Australia"},{"name":"General Practice Training Research Department, Royal Australian College of General Practitioners , Level 1, 20 Mclntosh Drive, Mayfield West, Newcastle, NSW 2304 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Holliday","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health , College of Health, Medicine and Wellbeing, , University Drive, Callaghan, NSW 2308 , Australia"},{"name":"The University of Newcastle , College of Health, Medicine and Wellbeing, , University Drive, Callaghan, NSW 2308 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Tran","sequence":"additional","affiliation":[{"name":"School of Population Health , Faculty of Medicine and Health, , High Street and Botany Road, Kensington, Sydney, NSW 2052 , Australia"},{"name":"University of New South Wales , Faculty of Medicine and Health, , High Street and Botany Road, Kensington, Sydney, NSW 2052 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Tapley","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health , College of Health, Medicine and Wellbeing, , University Drive, Callaghan, NSW 2308 , Australia"},{"name":"The University of Newcastle , College of Health, Medicine and Wellbeing, , University Drive, Callaghan, NSW 2308 , Australia"},{"name":"General Practice Training Research Department, Royal Australian College of General Practitioners , Level 1, 20 Mclntosh Drive, Mayfield West, Newcastle, NSW 2304 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mieke","family":"van Driel","sequence":"additional","affiliation":[{"name":"General Practice Clinical Unit , Faculty of Medicine, , Herston, QLD 4029 , Australia"},{"name":"The University of Queensland, Royal Brisbane and Women\u2019s Hospital , Faculty of Medicine, , Herston, QLD 4029 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Ball","sequence":"additional","affiliation":[{"name":"Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI) , Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominica","family":"Moad","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health , College of Health, Medicine and Wellbeing, , University Drive, Callaghan, NSW 2308 , Australia"},{"name":"The University of Newcastle , College of Health, Medicine and Wellbeing, , University Drive, Callaghan, NSW 2308 , Australia"},{"name":"General Practice Training Research Department, Royal Australian College of General Practitioners , Level 1, 20 Mclntosh Drive, Mayfield West, Newcastle, NSW 2304 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Primary Care Clinical Unit , Faculty of Medicine, , 288 Herston Road, Herston, QLD 4006 , Australia"},{"name":"The University of Queensland , Faculty of Medicine, , 288 Herston Road, Herston, QLD 4006 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Fisher","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health , College of Health, Medicine and Wellbeing, , University Drive, Callaghan, NSW 2308 , Australia"},{"name":"The University of Newcastle , College of Health, Medicine and Wellbeing, , University Drive, Callaghan, NSW 2308 , Australia"},{"name":"General Practice Training Research Department, Royal Australian College of General Practitioners , Level 1, 20 Mclntosh Drive, Mayfield West, Newcastle, NSW 2304 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"FitzGerald","sequence":"additional","affiliation":[{"name":"General Practice Training Tasmania (GPTT) , Level 3, RACT House, 179 Murray Street, Hobart, TAS 7000 , Australia"},{"name":"School of Medicine, University of Tasmania , Level 1, Medical Science 1, 17 Liverpool Street, Hobart, TAS 7000 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Spike","sequence":"additional","affiliation":[{"name":"Eastern Victoria General Practice Training (EVGPT) , 15 Cato Street, Hawthorn, VIC 3122 , Australia"},{"name":"Department of General Practice and Primary Health Care, University of Melbourne , 200 Berkeley Street, Carlton, VIC 3053 , Australia"},{"name":"School of Rural Health, Monash University , Faculty of Medicine, Nursing and Health Sciences. Building 20\/26 Mercy Street, Bendigo, VIC 3550 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Turner","sequence":"additional","affiliation":[{"name":"General Practice Training Research Department, Royal Australian College of General Practitioners , Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Davey","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health , College of Health, Medicine and Wellbeing, , University Drive, Callaghan, NSW 2308 , Australia"},{"name":"The University of Newcastle , College of Health, Medicine and Wellbeing, , University Drive, Callaghan, NSW 2308 , Australia"},{"name":"General Practice Training Research Department, Royal Australian College of General Practitioners , Level 1, 20 Mclntosh Drive, Mayfield West, Newcastle, NSW 2304 , 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