Supervisor Liaison Officer update
Does our training make better GPs and are we testing too much?
These two questions have been burning in my brain of late as our GP trainees pay out $5000 to sit their exams, which now include multiple choice, short answer, OSCEs and workplace assessments.
The perceived wisdom is that doing well in an exam equates to being a better doctor. Surely there must be evidence that all our educational assessments support this view? An extensive search, only revealed a few randomised controlled studies. One study showed that sending emails to medical students did help them retain knowledge (1). The second demonstrated that introducing competitive games to medical residents increased participation in online quality improvement programs (2). These studies demonstrated that it is possible to undertake randomised studies on educational interventions. Apart from this, most of our educational literature is philosophical discussions and reviews, or the interpretation of observational studies.
Prentice and Schuwirth (3) recently reviewed the examination process. Historically, postgraduate medical education was first tested with multiple choice, but this was found wanting and so short answer format was introduced. Recognising this was not ideal OSCE exams were then also introduced, but this too invited bias and inconsistency. So now 'Work-Based Assessment' is being promoted, with students or trainees being assessed at various intervals during their training. This is thought to give the best assessment as well as the opportunity for feedback and learning. However, approximately 40% of trainees and assessors believe that work-based assessments are of low value and may even detract from the quality of training (4).
So where does this leave us? There is little traditional research to guide us and exams have their problems. In the past the solution has been to just add another test. Added to this is society’s wish to verify that a trainee has met certain requirements and is ready to claim Medicare rebates. Possibly the answer is under our noses.
Some interesting research from Newcastle University suggests that a student’s HSC result can be predicted with 93% accuracy based on the Year 9 NAPLAN results (5). Similarly it is becoming apparent that a trainee’s success at passing the college exams can be predicted at the outset of their training. Perhaps then the trainer is the best person to judge the suitability of a trainee’s chance of becoming a good doctor. This would allow learning to be tailored to what is coming through the door or what excites the trainee’s interest.
Interestingly, this model of assessment is already used to determine the suitability of overseas doctors to practice in Australia. A one hour interview with an experienced Australian doctor will determine if a candidate is allowed to come and work in Australia. If this process is sufficient for overseas doctors then one would have thought a three-year traineeship, where every aspect of a trainee’s behaviour is observed, would be enough to not only turn out good doctors but save a lot of time preparing for exams.
As with any system of assessment, processes need to be in place to capture outliers that may need further instruction or redirection. Any trainee unhappy with their assessment should always have the option of a second opinion.
Lets face it, the trainees who come to us have proved their ability to pass exams many times over, what we need to know now is that they care about their patients.
Ian Charlton | Supervisor Liaison Officer
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.
There are a number of important activities that you need to complete with your registrar over the first four weeks of their placement, including an Initial Observation Session.
GP Synergy Strategic Plan 2020-2022
Over the past 12 months we have been developing our new strategic plan to guide the organisation from 2020 to 2022 and beyond.
The plan outlines how we can focus our energies and resources to reach our mission ‘to train highly skilled medical practitioners contributing to healthier communities’, and details how we will embrace opportunities and overcome challenges in the continued delivery of educational excellence to the benefit of communities within our training footprint.
What's new in Programmatic Assessment?
The impact of COVID-19 has meant that several components of programmatic assessment that were planned to begin in 2020 have needed to be deferred until 2021.
On Monday 20 July, the senior management team at GP Synergy, led by Georgina van de Water, presented the GP Synergy Strategic Plan 2020-2022.
I encourage you to look at the strategic plan and then keep revisiting it and embed a fundamental law of as much importance to education as E=mc2 is to physics.
L ≥ EC – learning must be greater than or at least equal to the rate of external change.
At the global level we have had more external change than we expected in 2020 – drought and fires and floods and now a pandemic. GP Synergy has managed these external changes, as well as significant but perhaps, in the scheme of things, lesser changes with the move to programmatic assessment and now the change to the colleges resuming control over general practice education from 2022.
In launching the strategic plan to staff our Director of Education, Vanessa Moran, presented on educational excellence and noted that this is our core business for registrars, supervisors, medical educators and for all staff.
From the viewpoint of the Medical Educator with Supervisor Portfolio (MESP) team, supervisor education is placed high in the strategic priorities list. Emphasis is placed on supporting the development of excellent supervisor education whilst also acknowledging that 95% of registrar education happens in practices and so our education goes a long way towards ensuring a quality practice and supervision experience for the doctors in training.
In the last few weeks GP Synergy was able to maintain its commitment to continuing medical education for staff by upskilling medical educators on the teleconferencing platform, Zoom. Presentations showcased the depth of education at all levels and from all regions across NSW and the ACT. As much as anything else this was an example of showcasing educational leadership which is another of the priorities outlined in the strategic plan.
GP Synergy is particularly fortunate that there has always been an emphasis on research, evaluation and also translation of this research. This is yet another priority in delivering best practice education as outlined in the strategic plan.
As we move through a time of rapid changes it is very well worthwhile reviewing the strategic plan and considering the need for learning to equal or exceed external change.
Excellence in education for supervisors is the priority for the MESP Team and we were pleased to see it highlighted in the strategic plan.
Dr Marjorie Cross OAM | Medical Educator with Supervisor Portfolio
2021 AGPT final intake
Do you know a doctor interested in undertaking GP training in 2021? Applications for a limited number of training places for the 2021 Australian General Practice Training (AGPT) program second intake with ACRRM is now open and RACGP applications will open shortly.
ReCEnT reflections - telehealth insights
Welcome to the first of our new 'ReCEnT Reflections' series. This month is the first of a four-part series sharing key insights from the 2020.1 term ReCEnT data.
GP Synergy Directors and team members are deeply saddened by the news of the passing of Dr Harry Nespolon. Harry had a long association with GP Synergy and GP training.
We are honoured to establish the Aunty Val Dahlstrom Award for Aboriginal Health Excellence to commemorate GP Synergy's late Aboriginal Liaison Officer, Val Dahlstrom. Nominations for the award are now open.
GP Synergy Annual Awards
Do you know a registrar, supervisor, practice manager or GP Synergy staff member that you'd like to recognise for their dedication and excellence in GP training?
Nominations for the GP Synergy annual awards close 6 September 2020.
Meet a general pathway registrar who has gone rural
As a general pathway registrar, Claire Monaghan wanted to get some rural experience early in her GP training. Based on a friend’s recommendation, she sought out the Murrumbidgee town of Temora.
Although COVID-19 hit within a month of her arrival, she has decided to extend her training in Temora by another six months. Claire tells us why.
Lights! Camera! Action!
All you need is a smartphone and a good idea to make a video that will help inspire the next generation of doctors to become rural GPs in NSW.
Entries open 17 August and close 6 October.
How often do registrars use dermoscopy for skin and pigmented lesion checks – and does it make a difference?
Evidence from the GP Synergy NSW & ACT Research and Evaluation Unit – each month we present findings from our work that may be of interest to registrars and their supervisors.
Dermoscopy has been demonstrated to improve accuracy of melanoma diagnosis by trained primary care physicians. And dermoscopy is a skill that GP registrars are expected to acquire by the end of general practice vocational training.
In a study led by academic registrar Georgie Whiting (1), and nested within the ReCEnT project, we aimed to establish prevalence of dermatoscope use by general practice registrars when performing skin and pigmented lesion checks, and to identify factors associated with dermatoscope use. We also sought to explore implications of dermatoscope use for registrars’ making skin lesion diagnoses and for their confidence in diagnosis.
During two six-monthly rounds of ReCEnT data collection we collected data on dermatoscope use by registrars during office-based consultations. Dermoscopy was used in 61% of consultations involving skin or pigmented lesion checks. Dermatoscope use changed provisional diagnosis in 22% of instances and increased diagnostic confidence in 55%. In examining the context for this use, we found 49% of registrars reported having dermoscopy training.
Dermatoscope use was more likely with the registrar being in terms 2 or 3 compared to term 1 and varied by region, but not by latitude.
We interpreted our findings as being that registrars perform dermoscopy in a modest proportion of skin and pigmented lesion checks (given that dermoscopy is considered best-practice in assessing skin lesions). We also concluded that dermoscopy is of utility, given that it influences registrars’ diagnoses and increases their confidence in their diagnoses.
(1) Whiting G, Stocks N, Tapley A, van Driel M, Holliday E, Morgan S, Henderson K, Ball J, Spike N, McArthur L, Davey A, Magin P. General practice trainees’ use of dermoscopy: prevalence, associations and influence on diagnosis and diagnostic confidence. 2019. Australian Journal of General Practice. 48(8). 547-553. doi: 10.31128/AJGP-11-18-4773
If you would like further information, please contact Parker Magin.
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.