Regional Head of Education update
Another year is drawing to a close. Is it just me, or does time actually accelerate as you get older? This year has rushed by, but I feel that we have achieved so much.
Our registrar education program is evolving. We take registrar feedback and use it to improve the delivery of the sessions every year. In 2019, we have used small group workshops as a vehicle to deliver teaching on several topics, including communication skills, paediatrics and chronic disease. In total, we deliver 18 days of education to the GPT1 and 2 Registrars, and one day to each of GPT3 and 4. However, the bulk of the teaching lies with supervisors, and I would like to thank you for all the hard work that you do at the practice level.
The local South Eastern NSW supervisor workshops this year were held in Wollongong, Bega, Goulburn and Batemans Bay. We will continue with these venues next year, and it is great to see the numbers of supervisors attending these workshops growing. If you haven’t managed to attend one yet, we would love to see you there.
GP training is basically an apprenticeship model. As supervisors, you are responsible for the daily teaching and mentoring of the registrar. There is a lot of time and effort that goes into moulding a hospital registrar into a fellowed GP, and I appreciate all of the work that you do. Please remember that there is support available.
No matter how experienced you are, sometimes there is just a tricky situation that you need help with! Dr Richard Griffiths and Dr James Best, our Medical Educators with a Supervisor Portfolio are great resources if there is a registrar in difficulty, or if you just have a situation that you want to discuss with someone. All registrars have an allocated Medical Educator who you can contact if you have a concern about your registrar’s progress. We would love to know about any concerns early. We can place a registrar on a Focused Learning Plan, and help can be provided for the registrar in all sorts of ways. Thank you for filling in the competency assessments, as this gives us valuable information.
As the year draws to a close, I would like to thank all the staff that have contributed to making the training program such a great success this year. I would like to thank the Medical Educators who have worked so hard this year. We have been very fortunate to have Cameron Warren, our Registrar Medical Educator, who has done some great work. Thank you to the Practice Liaison Support Officer, Education Coordinator, events team and all the other staff in the Wollongong Office.
Stay safe over the Christmas and New Year period, have a joyous festive season, and we will see you in 2020.
Dr Allison Miller | Regional Head of Education South Eastern NSW
Deadline for 2020.1 Medicare paperwork now 6 December:
The deadline to submit an application for Medicare provider numbers for the 2020.1 term is Friday 6 December not Friday 13 December as previously advised. Registrars are being advised to ensure they have submitted the signed AGPT paperwork for a placement to GP Synergy by 6 December 2019, and any Medicare initial provider number applications and other Medicare paperwork to Medicare by 6 December 2019 to avoid MPN processing delays.
Medicare provider number check:
If you are training a GP registrar in a GP term in 2020.1 (Feb-Aug), please ensure they check the letter from Medicare advising them of their provider number approval.
Registrars should confirm that they been issued with a provider number with full billing rights before they commence billing patients. Registrars with refer and request rights will only be able to refer patients and request investigations for them, until a provider number with full billing rights is received.
2020.1 term dates:
3 February 2020 – 2 August 2020
Annual supervisor and practice manager survey results
Thank you to all the supervisors and practice managers that provided feedback via our annual supervisor and practice manager surveys circulated earlier this year. The number of responses received increased again from last year, with 536 supervisor and 391 practice manager respondents.
Whilst the annual feedback surveys form an important part of our quality improvement process, they are only one of many ways we collect feedback. If you have any feedback you would like to share with us, at any time of the year, please don’t hesitate to let us know via your local Supervisor Liaison Officer (SLO), Practice Liaison and Support Officer (PLSO) or Medical Educator with a Supervisor Focus (MESP). You can also submit feedback on our website, via our complaints and compliments register, or via professional development evaluations.
Firstly, I’d like to introduce myself as I take up my new role as MESP for the Nepean, Western and Northern Sydney subregion of GP Synergy. I’m excited to be sharing this position with Sarah Gani.
I worked in general practice in Western Sydney for many years and have been a GP supervisor since 1990. I commenced work as a medical educator in 2013, initially with Wentwest and then in 2016 with GP Synergy. I am currently working in the Practice Experience Program (PEP) as well as ongoing work with AGPT.
At our recent medical educator meeting we were discussing the need for registrars to be on a quick learning curve in order to understand Medicare and the need for each individual doctor to be responsible for their own billings. I was reminded that under the NTCER agreement the registrar should have regular access to their billing sheet so that any inaccuracies can be corrected at the end of their working day. You will find further information about this in the Supervisor Toolkit under Contracts and Payments.
That link then takes you to the GPSA website where you will find the full NTCER document. You may also be interested in viewing the recent GPSA webinar about MBS billing.
I have recently been giving much thought to the topic of providing effective feedback during direct observation. Because of my work with registrars and PEP I spend a lot of my working hours giving feedback in one form or another and despite doing it regularly I still find it the most challenging part of my work. Feedback depends on the situation, the registrar, the type of patient and even the time of day, and can prove a daunting experience for both the giver and receiver. I find that I need to individualise and subtly change my feedback in every situation and tailor it to the context in which I am working.
Over the years I have used tried and true models such as Pendleton’s rules, but another model of feedback I quite like is ALOBA (Agenda Led Outcome Based Analysis). I can use this model when I am doing direct observation. I would initially discuss what the registrar wants help with (their agenda), then decide together with them how to reach their desired outcome or goal. I can then offer alternatives or make suggestions that I think are relevant to the subject or to what I have observed (my agenda). The registrar and I can then, together, fine tune the learning need, how it might be achieved and the final goal (shared agenda). I find this process creates an equal learning environment between the registrar, myself and even occasionally the patient contributing to the learning opportunity.
For those of you who would like more detail about ALOBA, it is more fully described in this article by Chowdhury and Kalu (2004).
Dr Margaret Stellingwerff | Senior Medical Educator
Supervisor Toolkit tip
Follow the link below to a great section on Assessment and Feedback in the supervisor toolkit. In the resources there is also a link to a GPSA Feedback Guide: 'Giving effective feedback in general practice'.
Where do registrars go for in-consultation information, advice and assistance?
Evidence for practice – findings from the GP Synergy Research and Evaluation Unit
Answering clinical questions arising from patient care improves care and increases patient safety. It is also a rich source of learning for registrars. Some questions need to be answered immediately – within the consultation that prompts the clinical question. Registrars seek in-consultation information and assistance in 21% of consultations, for 15% of all problems/diagnoses managed, and from multiple sources. The most common sources of information/assistance are the supervisor (or their delegate) in 45% of instances, and electronic sources (42%). Specialists (5.8%), other health professionals (3.9%) and hardcopy sources (9.7%) are much less common (note that more than one source can be used for a single question and more than one question can be generated per consultation).
Information is sought in 9.9% of instances for diagnosis, in 61.3% for management, and in 28.8% for both diagnosis and management. The most common systems for which information is sought are skin (16.0%), musculoskeletal (10.8%) and respiratory (10.7%).
The proportion of problems/diagnoses for which Term 1 registrars seek information or assistance is 21%; in Term 2 13%; in Term 3 11%; and in Term 4 8.6%.
Human information sources (rather than, mainly electronic, non-human sources) seem to be preferentially sought for more complex problems, even by these registrars who have trained in the ‘internet era’.
Magin P, Morgan S, Wearne S, Tapley A, Henderson K, Oldmeadow C, Ball J, Scott J, Spike N, McArthur L, van Driel M. General practitioners’ in-consultation information-seeking: associations with human, paper and electronic sources. 2015. Family Practice 32 (5): 525-532. doi:10.1093/fampra/cmv047.
For further information contact Professor Parker Magin, Director, NSW & ACT Research and Evaluation Unit: email@example.com
Launch of the Learning Activities Packages!
The Learning Activities Packages (LAPs) are a set of learning activities GP Synergy registrars complete to
- help prepare them for their first GP term
- progress through GP training in their subsequent GP terms.
These activities are accessible through the GPRime Quick Links and Subscriptions tab. Some learning activities are compulsory for registrars to complete, such as the Pre-GP Term Assessment and the Procedural Skills Log. Others are not but are highly recommended (e.g. PBS and Medicare online modules).
All RACGP and ACRRM registrars should review the LAPs as they will assist in addressing and identifying their learning needs as well as developing competency in clinical practice.
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 including RACGP point-of-care ultrasound workshops in Canberra and Sydney.
Need some help?
Find key GP Synergy contacts including Practice Liaison and Support Officers, Supervisor Liaison Officers and Medical Educators with a Supervisor Portfolio.