Postgraduate General Practice Training Under Early Clinical Responsibility: A Narrative Review on System-Based Supervision and the Supportive Role of Artificial Intelligence

Abstract

BACKGROUND/OBJECTIVES: Primary care faces transformation due to workforce shortages and reform. Italy's Decree 77/2022 promotes Community Centers and extended care, while postgraduate training in general practice involves early clinical responsibility. In South Tyrol, trainees assume significant patient care duties early in a three-year program. This review examines traditional apprenticeship-based training and explores system-based supervision and AI as strategies for improving quality and safety. METHODS: A narrative review synthesized the literature and policy on postgraduate general practice education, supervised autonomy, and AI tools in primary care. Searches used the PubMed and Consensus platforms, focusing on Italian primary care reform and South Tyrol. Evidence was analyzed using SANRA guidance. RESULTS: Evidence consistently indicates that training quality depends less on individual supervisors and more on structured, system-based supervision frameworks, clear entrustment criteria, and supportive organizational contexts. Early supervised clinical autonomy in community-based primary care settings can accelerate competency development without compromising the quality of care when robust supervision and team structures are in place. AI-supported educational tools have the potential to augment feedback, assessment, and learning analytics, especially in settings with limited supervisory capacity; however, current evidence supports their use only as adjuncts to human supervision. CONCLUSIONS: Evidence supports system-based, competency-oriented supervision models over traditional apprenticeships in settings characterized by workforce constraints and distributed training sites. Integrated general-practitioner-led primary care settings offer favorable learning environments for postgraduate training, while service-oriented community hubs need careful governance as training sites. Though AI may support supervision, professional oversight remains essential for quality and safety.

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