Supervisor Liaison Officer update
Given the current COVID-19 situation, it is understandable that concerns are arising in practices. There is a need for practices to consider those concerns, and be proactive in managing them. I hope this short quiz and prompts will help you talk to your registrar about any concerns they may have.
Quiz – Dreamworld Theme Park vs GP training practices April 2020
- What is a common feature between the two S _ _ _ _ _ O _ _ _ _ _ _ _ _ _ _ ?
- What is a non-common feature between the two B _ _ _ _ _ C_ _ _ _ _ _ _ _ _ _ ?
Safety obligations as a training practice
For our practices to become accredited for training, we have agreed to meet and follow the criteria as specified in the RACGP standards for GP training:
- RACGP Standards of GP Training Standard 1.3 – The practice environment is safe and supports training.
- Outcome 1.3.1 – The clinical and cultural safety of the patient, practice, supervisor, supervision team and registrars is protected.
Safety obligations as an employer – NTCER
The National Terms and Conditions for the Employment of Registrars (NTCER), clause 4 (Nature of employment ) and clause 5 ( Statutory Obligations) confirm that a registrar is engaged as an employee and therefore covered by the National Employment Standards (NES), regardless of the awards and term of contracts.
The NTCER, clause 16.3 (Health &Safety) recognises that the personal safety of a registrar is an issue to be addressed.
Safety obligations as a community-based health service – NSW Health COVID-19 advice
NSW Health in its COVID-19 advice for health professionals provides comprehensive guidance in the article Infection Prevention and Control-Novel Coronavirus 2019 - Primary and Community Care.
Diligence – a virtue of a leader
Our registrars will be well aware of their rights to a safe workplace. Naturally, they rely on their supervisors for their safety at work. In our current situation of rapid changes to address responses to the pandemic, as supervisors, we are experienced enough to know that a small failure of safety might cause grave consequences to the welfare of our registrars and their families.
Taking a pro-active approach (informing registrars about your policies and procedures and asking for the registrar’s feedback) will also reduce the risks.
The coronial inquest into the Dreamworld accident found that four deaths could have been prevented if safety obligations were adhered to in a more stringent manner.
Best wishes for good health and self-care!
Dr Cecile Dinh | Supervisor Liaison Officer Nepean, Western and Northern Sydney
- common feature = safety obligations
- non-common feature = before coronavirus (the accident at Dreamworld occurred in 2016)
We have been circulating information concerning the impact of COVID-19 on the training program. This includes FAQs and changes to our face-to-face education program.
GP Synergy supports registrars who wish to work in alternative clinical placements during the COVID-19 pandemic and there are several opportunities for registrars seeking alternate forms of employment.
GP Synergy has developed a number of remote alternatives to clinical teaching visits for registrars, these will be prioritised and rolled out over the coming months. We will be in contact with registrars and practices with updates in the coming weeks.
The Department of Health has released the Management Plan for Aboriginal and Torres Strait Islander Populations to guide the COVID-19 response focusing on Aboriginal and Torres Strait Islander people.
Term placement key dates
Registrar re-enrolment has now closed and if you are seeking a registrar in the second half of 2020 (2020.2 term), key dates are as follows:
- 15 April – practices reminded of 2020.2 training capacity caps
- 16 April – registrars going into a GP term in 2020.2 notified of grouping allocation
- 20 April – 2020.2 term placement lists open for application.
As a result of RACGP's update of Standards for Accreditation and Research, your practice must have its own insurance that covers research. If your practice insurance is with Avant, your practice’s participation in ReCEnT will only be covered once you have disclosed this to Avant.
The aim of general practice training is to allow registrars to work unsupervised anywhere in this great country. As we know, there are many and varied challenges for all doctors working in rural, remote and metropolitan areas. This year we have all faced additional challenges from the drought, fire, flood and now a 1 in a 100 year worldwide pandemic. As we know – there is no cure for the pandemic – the only weapon in our arsenal is social distancing. Who would have predicted this?
How can we help our registrars in this new disconnected, remote world? Well, we know us GPs have always been resourceful and quick to change and take on new technologies. The current situation means we shall be doing more and more telehealth consultations with our patients, either by telephone or video. The use of these mediums involves the very art of being a GP – listening to the patient, which as Osler told us leads to 90% of all diagnoses. We use our active listening skills to pick up on subtle cues in speech such as hesitations, changes in pitch, tempo and tone of voice. Moreover, these remote consultations rely on the true art of being a GP – dealing with uncertainty, adequate safety netting and using time as both a therapeutic and diagnostic tool. This can be easier for experienced GPs who know their patients well, but how can we aid and prepare our registrars for telehealth consultations?
Don’t forget GP training is based on the master/apprentice model – the registrar is our pupil – they learn from how we react and what we say to both patients, admin and nursing staff during this difficult time. This is the power of mirroring – our registrars learn a lot from watching and listening to us.
Having our registrars observe and listen to how we consult via telehealth shows them how we deal with these challenges. We often use set piece consultation structure or phrases to address patient concerns in telehealth consultations. Registrars also learn from observing our organisational skills, our computer skills, short cuts and autofill’s, and of course our staff management and delegation skills.
Why not set time aside for your registrar to observe you conducting a series of non-face to face consultations? In turn you could switch roles and observe the registrar and give feedback. This could be done as part of a formal teaching session and your observations can contribute to an upcoming competency assessment for the registrar (for more information go to GP supervisor guide to competency assessments during the COVID-19 pandemic). Furthermore, asking your registrar to feedback on our performance helps breed a culture of learning and feedback in the practice.
We live in unprecedented times but using our own experience and training we shall help build the GPs of tomorrow to deal with whatever challenges they face. Take care of yourselves.
Dr Richard Griffiths | Senior Medical Educator
Useful GPRime links for supervisors
RACGP Foundation Grants
The RACGP offers a number of competitive grants for general practice innovation or research. The closing dates for 2020 RACGP Foundation grants have been extended.
General Practice Registrar Competency Assessment Grid (GPR-CAG) – how did we get here & what further can we do?
Evidence for practice – findings from the GP Synergy Research and Evaluation Unit
GP Synergy research shows that the Competency Assessment Grid has high validity and can now be used for further assessment of registrar progress in training.
Clinical Teaching Visits (CTVs) are a major component of RTOs’ (including GP Synergy’s) Workplace Based Assessment (WBA) programs to support and formatively assess registrars’ clinical and educational progress.
Relatively few general practice WBA instruments have been psychometrically evaluated (i.e. have had their validity and reliability formally assessed). The GP Synergy Research and Evaluation Unit was tasked with evaluating the GP Registrar Competency Assessment Grid (GPR-CAG). The GPR-CAG was constructed as a CTV formative assessment instrument in 2012-2013 by a team of GP Synergy Medical Educators (via an iterative literature review, expert opinion, and pilot-testing process).
Using CTV data collected from 2014 to 2016 in GPT1 and GPT2 CTVs, we employed factor analysis and expert consensus (experienced Medical Educators) to refine the included ‘competencies’ (items that CTV visitors record regarding registrars’ performance) and to establish GPR-CAG’s internal structure.
The result was a reduction in the total number of competencies from 25 to 16 for GPT1, and from 57 to 29 for GPT2. Using factor analysis to ‘group’ individual competencies into ‘factors’, a four-factor, 16-item solution was identified for GPT1 competencies and a seven-factor 27-item solution for GPT2 competencies.
The factor structures were clinically characterisable and resonant with existing medical education competency frameworks. For example, the four factors for GPT1 could be characterized as ‘Attention to basic-level clinical professional responsibilities’; ‘Consultation techniques subserving patient-centered ‘Caring’’; ‘Proficiency in physical examination skills’; and ‘Skills in formulating and articulating coherent hypotheses and management plans’.*
We have just concluded a confirmatory factor analysis (not yet published) which has strongly supported the robust original findings.
How do we use these findings? The original GPR-CAG refinement process reduced the number of competencies considerably (and thus, decreased the burden on CTV visitors and increased comprehensibility for MEs). Having done a great deal of work establishing the GPR-CAG factor structure and its validity we can now be confident in testing potential uses – e.g. in giving focused CTV feedback to registrars, MEs and supervisors, and in providing early prediction of Fellowship exam performance – that can inform individual registrar educational strategies and learning plans. Watch this space!
*Fielding A, Canalese R, Tapley A, Mulquiney K, Klein L, Holliday E, Ball J, Magin P. A general practice workplace-based assessment instrument: Content and construct validity. 2020. Medical Teacher, 42(2): 204-212.
Special interest training
One of the great things about GP training is the ability for registrars to pursue a special interest during training. The areas of subspecialty are broad and depend on the fellowship pathway.
- During training, registrars following the RACGP Fellowship pathway undertake a six month extended skills term. This term can be undertaken in a variety of settings.
- Registrars training under the ACRRM fellowship pathway are required to complete a minimum 12 month Advanced Specialised Training (AST) term.
Meet three registrars with diverse interests
GP Synergy PD calendar
Make sure you don't miss an event or webinar by accessing the supervisor professional development calendar on our website.
External activity noticeboard
Explore a list of activities and online modules. This includes modules on children's health, dermatology, mental health, prescribing and more!
Need some help?
Find key GP Synergy contacts including Practice Liaison and Support Officers, Supervisor Liaison Officers and Medical Educators with a Supervisor Portfolio.