Director of Supervisor Education update
My last DoSE update back in late March 2020 feels like a very long time ago. I don’t know about you but I have been listening to a lot more music compared to pre-COVID times and have quite a few ‘classics’ from my youth on my play lists. I keep coming back to David Bowie’s ‘Changes’ released in 1971:
“Ch-ch-changes, Turn and face the strange”.
There has been so much change in general practice this year. As GP supervisors we have progressed in our knowledge of COVID-19, learnt a lot about PPE, adapted to using telehealth consultations, come up with flexible solutions to undertake direct observation that incorporate COVID-safe practice, provided teaching and supervision when either supervisor or registrar or both may not be onsite to do face to face consultations, and ultimately continued to support our registrars in their training during a time of great uncertainty for doctors-in-training, especially around exams. Thank you for your ongoing involvement and commitment to registrar training despite the challenges of the last nine months.
We are here to support you. To discuss supervision related issues please get in touch with your PLSO, Regional Head of Education, myself, or the Director of Education and Training. Go to Need some help? to find contact details. If you are looking for information the GP Synergy COVID-19 FAQs and Resources page on GPRime is updated regularly.
Changes to programmatic assessment in 2020.2
I encourage you to review the updated programmatic assessment information on GPRime including the FAQs for supervisors which contains the interactive wheel to link to each component of assessment.
The Initial Observation Session (IOS) is now in GPRime under the assessment tab. The IOS remains the mainstay of early direct observation in the first four weeks of the first, second and third GP terms for RACGP and ACRRM registrars.
The new multisource feedback component for RACGP registrars in their first term has been deferred until 2021, except in the Western NSW subregion where a pilot program is underway for GPT1 and 2 registrars.
Take a look at the supervision requirements at a glance cheat sheet for all the updated details.
Changes to supervisor education in 2020.2
As you know all our planned face to face education sessions have been converted to an online format for the rest of this term. For details of upcoming events in your region go to the supervisor education calendar.
The regional workshops continue with the core topics presented on Zoom with breakout rooms for small group interaction.
The webinar program has an exam focus during September with a series of three bi-coastal webinars held in conjunction with WAGPET on assisting registrars to prepare for the exams (RACGP and ACRRM). On 22 October we will have the second part of our Dealing with Disruption to Supervision webinar meeting where we will also have the chance for interactive discussion in small groups following the presentation.
Bowie’s song ends with:
“Time may change me
But I can't trace time
I said that time may change me
But I can't trace time”
I have found music to be a place of calm and relaxation during COVID-19 – I hope you are all finding ways to support your wellbeing through this time of change.
Dr Sarah Gani | Director of Supervisor Education NSW & ACT
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.
September 10 is R U OK? Day
R U OK? Day is our national day of action to remind Australians that every day is the day to ask, “Are you OK?” if someone in your world is struggling with life’s ups and downs.
Remote CTV update
82% of the required remote CTVs for 2020.1 were completed by the end of August. While CTVs will be completed remotely until the end of 2020.2, we will be returning to the original scheduling model.
RACGP AGPT 2021 final intake
Do you know a doctor interested in GP training in 2021?
The final intake for training with RACGP through the AGPT program is open until 21 September.
2020 Rural video competition
Help inspire the next generation of rural GPs, and vie for one of the great prizes in our rural video competition!
We're extending the deadline for entries to 25 October!
Key dates for 2021.1 training placements
Mon 7 September to Tues 29 September 2020 – Update your 2021.1 training vacancies in GPRime2
Wed 14 October 2020 – Practice and supervisor caps advised
Mon 19 October 2020 – Registrars will be able to apply to practices within their assigned grouping
I’m writing this as I sit at home in my spare room which has now become my permanent home-based office when I’m not in clinical practice. I last wrote an article for this newsletter 12 months ago – and so much has changed!
What hasn’t changed is the need to ensure safety for our patients, our registrars, ourselves, and those that work around us. There are the obvious physical safety needs in this time of COVID-19 – for example the need to use PPE correctly and appropriately. And on a slightly flippant note the need to work out how to stop our glasses fogging up when we wear a mask. A small issue but important when doing a procedure!
From a supervisor perspective there is the need to ensure our registrars “only undertake procedures and management of high risk situations that they are competent to manage” (RACGP Standards for Training criteria 188.8.131.52). This is a great outcome to aim for but how do we try and ensure this happens and by doing so keep our patients and our registrars safe?
I would suggest that we start by doing early and ongoing direct observation when a new registrar starts in the practice and that we continue to do this as training progresses, even with registrars in their third GP term and extended skills terms. We don’t know what we can’t see. I believe it is also important that we are approachable – for the registrar to feel comfortable contacting us if they need to. Likewise, we need to be available or to organise appropriate cover if we can’t be there. This should be a practical reality. There is no point in saying “call me any time” if we are reluctant to answer that phone call.
There are tools available that can help us help our registrars to competently and safely manage their patients. The RACGP have a high risk list, found in the Standards for Training document, which is helpful in describing general areas where risk is greatest and where it is appropriate for the registrar to ask for help. One example found in the list is the diagnosis of malignancies. GP Synergy have also developed a red flag list which describes a number of situations where a registrar should call their supervisor for assistance.
A more specific and very helpful tool is described in an article published this year in AJGP by Ingham et al. They write about a qualitative study that resulted in the development of a 'Call for Help List' for registrars. Discussion of the research and the development of the list recently occurred in a General Practice Supervisor Association webinar and I would encourage you to watch this if you haven’t already seen it. It can be found on the GPSA website. The check list consists of issues that should trigger a registrar checking in with their supervisor to make sure they are safely dealing with a particular clinical problem. The list is owned by the registrar and one of the aims in developing it was to normalise the need to ask for help for the high risk areas described. Both the RACGP high risk list, the red flag list and the article about the call for help list are available on GPRime and can be accessed through the Supervisor Toolkit.
Early discussion with your registrar around how and when to contact you and the use of the tools discussed above, combined with regular direct observation, helps to set parameters and guidelines to keep both the patient and registrar safe. It also helps you to worry less about what is happening in the next consulting room. Really a win-win situation.
Keep safe. And thank you for continuing to support general practice training.
Dr Margaret Stellingwerff | Medical Educator with Supervisor Portfolio
Meet a registrar training in Aboriginal health
Previously based in Sydney, Dr Hugh Stump is training in Western NSW at an Aboriginal community controlled health service.
He chose to work there to further his experience in Aboriginal health and gain greater confidence in managing complex chronic health conditions. He is loving the complexity of the medicine, and how it pushes him to broaden his scope of practice in order to help provide a better service.
ReCEnT reflections – procedural skills insights
Part two of the COVID-19 ReCEnT reflections explores the changes in the number of procedures registrars were performing in 2020.1.
As exposure to many procedures has dropped, we have developed a handy resource available on GPRime for registrars and supervisors to learn these skills using online resources – visit Procedural skills log resources for COVID-19 support.
GP registrars’ management of urinary tract infection
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.
Symptomatic urinary tract infection (UTI) is a common general practice presentation.
Antibiotics are the standard of care for UTIs but, as with any antibiotic use, antimicrobial resistance is a concern. Appropriate antibiotic stewardship in this situation includes: courses of antibiotics for no longer than needed; avoiding antibiotics if there is no UTI (involving decisions regarding empirical treatment versus waiting for pathology confirmation), and “getting the antibiotic right” first time.
So, in an analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) project, we aimed to describe registrars’ management choices made in prescribing antibiotics for UTI.
In our analyses, 1,333 registrars diagnosed 2,850 new UTIs during 189 736 consultations (1.5% of consultations; 95% CI, 1.4-1.6). Antibiotics were prescribed at 86% (95% CI, 84.7-87.2) of these index consultations. Antibiotic choice in most cases followed Australian eTG recommendations. Urine microscopy and culture were requested at the index consultation less than recommended by guidelines in men, 69.2% (95% CI, 62.6-75.1), and children, 80.8% (95% CI, 76.4-84.6). Adults were significantly more likely to be treated with antibiotics at the index consultation than children under 16.
Our interpretation of these findings is that Australian GP registrars’ choice of antibiotic for UTIs is consistent with guideline recommendations. Interpretation of the findings regarding investigation in children and men, and antibiotic prescribing in children, is more complex. These findings may be influenced by the single-consultation ‘snapshot’ nature of ReCEnT data collection. It is plausible that they may reflect registrars’ diagnostic uncertainty in the often-difficult clinical scenarios of possible UTIs in men and children - with consequent appropriate attention to antibiotic stewardship by deferring antibiotic prescription. This requires more research, focused on registrars, UTIs, and patient demographics.
Davey A, Tapley A, Mulquiney K, van Driel M, Fielding A, Holliday E, Ball J, Spike N, FitzGerald K, Magin P. Management of Urinary Tract Infection by early-career general practitioners in Australia. Journal of Evaluation in Clinical Practice (published online 25/12/19) DOI: 10.1111/jep.13340
If you would like to discuss this analysis or the paper, 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.