CREATE protocol sets out a participatory redesign of GP training in Australia
Australia’s general practice workforce sits at the center of routine care, yet the pathway that prepares registrars for that role is often shaped by siloed systems rather than a shared design process. The Collaborative Registrar Education and Training Enhancement (CREATE) project is built to change that pattern. Its protocol describes a mixed-methods, participatory study that brings together hospital clinicians, primary care stakeholders and general practitioner training participants to co-design, implement and evaluate innovations intended to strengthen training quality and day-to-day learning.
The project is not built around a single intervention chosen in advance. Instead, it starts with the assumption that educational change is more likely to stick when the people who deliver, supervise and experience training help shape it from the outset. That logic is especially relevant in general practice, where registrars move between settings, encounter varied supervision models and depend on consistent educational structures to translate classroom learning into clinical judgment.
Over 80% of Australians visit a GP each year, and general practice accounts for more than 150 million consultations annually. In that setting, training quality is not an academic concern. It affects continuity, communication, prescribing, referral decisions and the confidence of the future workforce.
A three-part design to identify, test and embed change
The CREATE protocol uses three linked methods. First, a realist-informed scoping review will map what is already known about educational innovations relevant to GP training. That approach is useful because training systems are not simple cause-and-effect environments; what works in one site may depend on supervision culture, local clinical mix, registrar stage or staffing capacity. A realist lens is designed to ask not only whether an innovation works, but how, for whom and under what conditions.
Second, semi-structured interviews will gather views from stakeholders across the training ecosystem. These conversations are meant to surface practical barriers, local priorities and ideas that may never appear in routine performance metrics. They also create a structured way to compare perspectives between hospital-based educators, primary care clinicians and those directly involved in registrar education.
Third, consensus-seeking deliberative forums will be used to refine and prioritise the innovations that emerge from the earlier work. The protocol’s participatory structure matters because it shifts the project away from top-down reform and toward negotiated change. In training environments, implementation often fails when an innovation is technically sound but operationally mismatched to the realities of clinic flow, supervision time or institutional expectations.
One practical consequence follows from that design: the eventual intervention package will be selected because stakeholders judge it feasible, relevant and worth embedding, not because it looks elegant on paper.
Pilot implementation will occur inside one metropolitan health service
Once the educational innovations are prioritised, CREATE will pilot them within a single metropolitan health service. That decision creates a focused environment for implementation, but it also narrows the study’s reach. Findings from one service may not transfer cleanly to rural settings, smaller practices or training networks with different workforce pressures. The protocol acknowledges that limitation directly and builds the evaluation around it.
The pilot phase is where the project moves from design to lived practice. Innovations will be introduced into the local training environment, then assessed through an internal evaluation framework. Because the aim is not only to launch changes but to understand whether they become part of ordinary work, the evaluation is anchored in Normalisation Process Theory. That framework examines how a new model is understood, taken up and sustained by the people expected to use it.
This focus on normalization is clinically meaningful. Training interventions often fail not because participants dislike them, but because they never become routinized enough to survive scheduling pressure, staff turnover or competing institutional priorities. A model can be well received and still disappear if it does not fit the workflow of supervision, feedback and assessment.
Normalisation Process Theory places implementation at the center
Normalisation Process Theory is well suited to an initiative like CREATE because the study is concerned with social and organizational adoption, not just educational content. The framework can clarify whether stakeholders see the innovation as coherent, whether they invest effort in using it, and whether they perceive enough value to keep it going. Those questions are especially relevant in general practice training, where educational reform often depends on many people making small adjustments across different sites and roles.
This kind of evaluation also creates a bridge between design and sustainability. If the innovation can be shown to fit into the everyday logic of supervision and registrar support, the study may offer a model for other regions trying to improve training without adding unnecessary friction. If it does not fit, the evaluation should still be informative, because implementation failures in health professions education are often caused by weak integration rather than weak ideas.
The protocol’s strength lies in that realism. It does not assume that a new training model will spread simply because it is desirable. It treats adoption as a clinical and organizational process that must be studied in context.
Local gains may be clearer than immediate generalizability
Because the project is centered on one metropolitan health service, the most immediate value is likely to be local. The study can generate a practical blueprint for how educational innovation is selected, adapted and embedded within a real training network. It can also reveal where consensus is easy and where tension remains between hospital systems, primary care and registrar needs.
Those insights matter because training reform in general practice is often discussed in broad policy terms while the actual mechanics are left underexplored. A participatory protocol like CREATE moves the discussion toward specifics: who gets a voice, how priorities are decided, what gets piloted, and whether the resulting model becomes part of ordinary training rather than a short-lived project.
The protocol does not claim to solve all questions about GP training. It sets up a structured way to find out which innovations are worth carrying forward, how they are experienced in practice and whether they can be normalized within a busy health service. The final test will be whether the participatory process produces changes that educators and registrars can actually use, and whether those changes hold up beyond the confines of a single metropolitan setting.