Welcome to the latest CT visitor training update
As I write this update we are moving into the 2020.2 term and I’m reflecting on the last time we transitioned into a new term, what a lifetime ago that seems!
While I have missed seeing friends, family and colleagues face to face for much of this time the advancements made in general practice and GP education and training are nothing short of miraculous. It’s been a challenging but also a very rewarding time.
As you are all well aware, one of the greatest changes has been the transition to remote clinical teaching visits from the traditional face to face. Dr Sarah Gani, Dr Rula Ali and the CTV medical educator champions did an outstanding job pulling this all together, and while in many ways it seemed like it took a long time to get going, with the complexities of what happened in the background to ensure security, privacy, legal requirements and college approval it was truly amazing what was achieved in such a short period of time. To put it into context, GP Synergy had been working on trialing remote CTVs for more than two years with not much headway due to the digital restraints in place at the time. The COVID-19 pandemic meant that lots of systems had to change and we were able to take advantage of that.
When we stopped our face to face CTVs we had over 1,000 CTVs outstanding across NSW and ACT, a figure that made us shudder at the time. However, as I write this we already have more than 600 of those completed remotely, another 200 or so scheduled to happen in the next few weeks and we can see the light at the end of the tunnel!
This is a fabulous achievement and I would like to thank all of you for the role you have played in that. Even just one CTV makes a difference.
Our registrars really value your feedback. A recent registrar focus group revealed that registrars wanted even more feedback about their clinical practice, even if the feedback they have received so far has been positive. There has been significant disruption to training and many registrars have had multiple stressors, many registrars may need extra reassurance. It’s great to be able to offer this feedback using the remote CTV and I’m very glad to have this option.
As we move through this 'new normal' we will continue to review the situation. We hope to return to face to face CTVs one day. In the meantime, we have all been pleasantly surprised at just how well a remote CTV can work and while not the same, will certainly prove to be a useful tool well into the future which provides registrars the feedback they desire and need.
Dr Vanessa Moran | Director of Education and Training NSW and ACT
Remote CTVs update
Last year, when I asked to incorporate oversight of CTVs into the supervisor education portfolio I was not expecting to be involved in a project to convert face to face CTVs into remote CTVs in the context of a global pandemic. How quickly things can change!
Even though I found having a CTV as a registrar very stressful, I have always enjoyed doing CTVs as the CT visitor since my first experiences as a CT visitor in 2002. I have reflected back on those experiences quite frequently over the last few months as we have moved to the remote model for CTVs during COVID-19. Back in 2002 I was learning to be a medical educator and the buddy system of new CT visitor training was in operation. I recall being schooled by Dr Andrew Knight in the best ways to stay quiet, observe and give feedback both kindly and effectively. With remote CTVs the principles remain the same even as the technology and logistics have morphed dramatically. It’s easier to stay quiet too with the microphone muted.
Whether it is the patient observation based (video/phone) remote CTV or the case submission based remote CTVs (RCA or CBD remote CTV) I have been impressed by the willingness of registrars, supervisors and practices to embrace remote CTVs, despite a few challenges along the way. My heartfelt thanks to all our CT visitors, and for your patience as we roll out various elements and make enhancements in future. The commitment, flexibility and availability of CT visitors has meant registrars continue to receive valuable input from experienced external GPs.
It is truly remarkable that by the end of August the majority of CTVs from the 2020.1 training term will have been completed.
At this stage, to provide certainty around the planning of CTVs in the changing COVID-19 landscape, GP Synergy has made the decision for all CTVs to be done remotely until the end of the 2020.2 training term.
We strongly believe that face to face CTVs provide the most well rounded educational experience for the registrar and enable a holistic view of the registrar working in their practice. We recognise that continuing with remote CTVs is not ideal, however, in this current environment, it is important we provide safe and effective education through the remote model.
If at any stage following a remote CTV, you believe a registrar should have a further educational review, please do not hesitate to let us know at firstname.lastname@example.org. Our medical education team will review alternate additional options to provide feedback and support to that registrar.
In conjunction with Dr Rula Ali and the CTV medical educator champions from each subregion of GP Synergy it has been a challenging and thought provoking process to develop and implement the remote CTV model. We have all been on a steep learning curve trying to navigate to the broad range of factors requiring consideration. Thank you to Rula and all the CTV medical educator champions for their tireless work. Throughout GP Synergy members of the Events, Admin, Business Systems and Medical Education teams have played a big role in the process too – thank you to all.
Please get in touch if we can help:
- For questions about allocations contact email@example.com
- For assistance with scheduling a specific remote CTV contact firstname.lastname@example.org
- To provide feedback to the CTV medical education team contact email@example.com.
In this newsletter we have included reflections on the remote CTV experience from CT visitors, medical educators and registrars. I hope you enjoy reading about those experiences.
Dr Sarah Gani | Director of Supervisor Education NSW and ACT, Clinical Lead for Remote CTVs
What’s new in GPRime for remote CTVs?
CT visitors can go to the remote CTV landing page on GPRime to access a range of resources relevant to each different type of remote CTV. Please refer to the information sheets about each individual type of remote CTV to ensure you are familiar with the specific requirements, such as case submission requirements for RCA or CBD remote CTVs or consent issues for the video/phone remote CTVs. Please note, if patients do not consent to observation the registrar is advised to log out of the Zoom room and log back in once the patient has left the consultation.
Further enhancements have been made to the CTV assessment in GPRime for remote CTVs where patients are not directly observed. For RCA or CBD CTVs from the end of July some of the slider bars for individual competencies have been pre-selected as ‘not assessed’ to reflect that a number of competencies are not easy to assess using these types of remote CTVs. You will see the following message on GPRime as a reminder of what to do if you feel you can assess one of these individual competencies.
The landing page has recently been updated and now includes links to additional resources for Random Case Analysis (RCA) and Case Based Discussion (CBD) remote CTVs. The CBD tab was added into the CTV assessment in late June and a number of CBD remote CTVs have been undertaken. This type of remote CTV will have additional relevance in future with the remote clinical exam (RCE) for RACGP and is already an embedded format for ACRRM registrar exams and assessments.
The resources for RCA have been updated with an ACRRM windmill of domains to explore with 'what if?' questions. You can also access this directly when you are in the RCA tab of the CTV assessment – you can toggle between the RACGP star and the ACRRM windmill as you need to during the CTV.
See our hints and tips later in this update.
Perspectives on remote CTVs
Dr Zenith Lal - CTV ME
In early June I managed to complete my first remote CTV, it was great to see how this process played out after being behind the scenes to help put the process together and also very rewarding to hear that the registrar found it a beneficial teaching process given the COVID-19 restrictions.
Ongoing improvements to remote CTVs
We continue to work through the process of quality improvement for all aspects of remote CTVs.
In response to feedback from CT visitors we have enabled the share screen option on the CTV Zoom room links. This allows the CT visitor to easily review the clinical records with the registrar when the desktop computer is being used by the registrar for the remote CTV. Please note it is of critical importance that no screen shots are taken of this confidential information during the remote CTV.
The modified processes used for scheduling remote CTVs is currently under review going into the 2020.2 training term. We anticipate returning to the previous process where CT visitors scheduled CT visits into GPRime themselves. We will keep you informed once this is finalised.
The survey about your availability for CTVs due in the 2020.2 training term will be sent out in the second week of August and CTVs for 2020.2 will commence from 31 August 2020.
Contribute to the future of CTVs in GP training
With every challenge comes opportunity. The implementation of remote CTV delivery methods in response to COVID-19 provides us with a unique, once-only opportunity to examine the content, educational usefulness, benefits and limitations of different types of CTVs. This will provide much-needed evidence to guide not only how GP Synergy can best deliver CTVs into the future, but also how CTVs may optimally function within the colleges' programmatic assessment framework.
GP Synergy’s Research and Evaluation Unit are currently undertaking a research project to assess and compare the educational usefulness of different CTV delivery methods. This is your chance to directly contribute to the future of CTVs in GP training.
Please look out for the invitation to complete a questionnaire after you conduct CTVs over the coming months. This includes all types of CTVs (including those done via Zoom, telephone, Random Case Analysis and case-based discussions).
If you would like further information about this research project, please contact Alison Fielding.
Behind the scenes
When the COVID-19 pandemic happened earlier this year, the existing process of the CT visits had to stop abruptly due to the potential health risks for all involved in the CT visit, from the CT visitor, registrar, supervisor to the patient.
Our Business Analyst in the Business System team, Divya Balakrishnan, was responsible for collating the requirements to make the changes required to the existing CTV process. This included:
- updating the CTV scheduling process
- modification of the existing CTV report to support the transition from a face-to-face CT visit to remote visits done via Zoom
- inclusion of the RCA and CBD tabs as part of the CTV report
The initial work to update the CTV started in early April and after rounds of rigorous testing by the Business Systems team (as well as involvement from the Medical Education team) over the following months, a majority of the changes to CTV module to support the implementation of the remote visits was completed by the end of June. The Business Systems team will continue to work with the CTV Medical Education group to implement any changes or improvements taking into account feedback from all CT visitors.
Shan Chow | Application Support Analyst
Hints and tips when completing the CTV report in GPRime
Preparation is the key, ensure prior to starting on your report, you have checked the following:
- Access to desktop or laptop – tablets such as iPad or Galaxy smart tablet will work, but we recommend the report to be done on a desktop or laptop where possible.
- Ensure there is reliable and stable internet or wi-fi connection to your device.
- Google Chrome is the recommended browser for GPRime – browsers such as Microsoft Edge, Firefox and Safari are also supported but not Internet Explorer.
- Ensure only one browser tab is open for GPRime when completing your CTV report – you can still have multiple tabs opened for other resources in the same browser, but we recommend that only one browser tab is opened for GPRime for the CTV report to ensure the data is saved accordingly when Save as Draft or autosave is triggered.
- Save regularly as draft to ensure your progress is saved – there is also an autosave function which will automatically save any changes made to the report with the timer duration of 15 minutes. If no changes have been made within the 15-minute period, the autosave will not be triggered and the timer will reset again. If you are unsure at any stage whether your progress has been saved, click on the Save as Draft button to save your progress – there should be a message to confirm if it has been saved successfully.
- Ensure all mandatory fields are completed prior to submitting your CT visit report – the progress bar will not be showing as 100% and on clicking Submit a banner to alert you of any incomplete information will be displayed at the top of the page.
- If you are experiencing any issues with your CTV report, please contact firstname.lastname@example.org for assistance.
Need some help?
There is a team of local GP Synergy staff to help you every step of the way.