Director of Supervisor Education update
As I write this update I am acutely aware of the major impact GP supervisors are facing across NSW and the ACT related to the COVID-19 pandemic and the delta strain. The impact of restrictions and lockdown, variations in vaccine roll out and risk of COVID-19 exposure are just a few of the additional stressors in our GP lives. It is worth taking a moment to reflect on the incredible effort supervisors, practices and registrars have made to provide high quality care to patients over many months and in challenging times.
Role modelling the GP problem-solving approach and displaying the flexibility of thinking inherent to quality primary care makes for some powerful learning for all of us. Thank you for continuing that essential teaching and mentoring role for registrars getting a training experience that might be a little different to their expectations when they began GP training.
The final element of the GP Synergy programmatic approach to assessment, multisource feedback (MSF) for RACGP GPT1 registrars, was introduced throughout NSW and the ACT in the 2021.1 term. This new process involves obtaining patient and practice staff feedback, providing reports based on that feedback, and the subsequent reflective discussions between supervisor and registrar. We know that doing this during the GPT1 term gives the chance for early identification of any issues of concern in relational empathy, professionalism and teamwork.
In 2021.1 331 GPT1 registrars across 283 practices were asked to participate in MSF, with an opt out option taking into account events impacting at the time. Despite COVID-19 effects and floods we got a great response with 255 registrars in 218 practices participating. We received completed patient feedback (CARE) for 74% of registrars and practice staff feedback for 63% of registrars. Given all the contributing factors this is a great outcome. Thank you to everyone involved at the practice level for taking the time to make this happen.
We will maintain the MSF component of training for RACGP GPT1 registrars in 2021.2 with the opt out process in place again as we acknowledge the unique stressors impacting general practice at this time. More information on how to opt out will be sent to supervisors and practice managers in a coming weeks.
We have had positive feedback from supervisors about the value added by the MSF reports and associated reflective discussions. One of our newer supervisors recently told me:
“The MSF was a welcome opportunity to discuss other aspects of general practice with a registrar beyond just the clinical knowledge: team-work with other doctors, reception staff and nurses, and communication with patients and their families. In my experience it allowed the registrar to get feedback from patients that they probably wouldn't have otherwise. It can give GPT1 registrars some confidence to know they're heading in the right direction as they continue their training”.
We continue to evaluate components of the programmatic approach to assessment and a supervisor survey will be sent to those supervisors involved later this term. Some preliminary data from the annual practice managers survey indicates that following involvement in the MSF process in 2021.1, 84% of those surveyed reported that providing feedback from practice managers and nurses adds value to the registrars’ education.
Your ongoing support for registrars in training is fantastic – thank you all. Please get in touch with me or your regional member of the MESP team if we can provide educational support.
Dr Sarah Gani | Director of Supervisor Education
We continue to circulate information concerning the impact of COVID-19 on the training program, including the ongoing COVID-19 situation. This includes FAQs and changes to our face-to-face education program.
2022.1 term placement process
- Between 6-28 September 2021: Update your 2022.1 training vacancies in GPRime.
- Wed 13 October 2021: Practice and supervisors advised of practice and supervisor caps.
- Mon 18 October 2021: Registrars will be able to apply to practices within their assigned grouping.
We will also be hosting a term placement webinar for practices and supervisors new to term placement:
- Wednesday 15 September 2021.
Congratulations on RCE results!
Congratulations to the GP Synergy registrars who sat the Remote Clinical Exam (RCE) in 2021.1. Overall they achieved a 97% pass rate!
The national pass rate was 85%.
R U OK? Day is 9 September
2021 has been a challenging year for everyone and circumstances have made it even more important for us all to stay connected and, for those who are able, be willing to support those around us.
R U OK? Day is a national day of action to remind us that every day is the day to ask, “Are you OK?”.
Medical Educator Supervisor Portfolio (MESP) update
As NSW and ACT faces an ongoing COVID-19 outbreak, we have all had to make many changes to our practice and life, often at short notice. These changes may have had an impact on your supervisor role. You or your registrar may at times need to work from home, or perhaps you are both physically present at work, but mostly providing telehealth, and trying to physically distance as much as possible between staff who are present.
All these factors create new supervision challenges: How can I mentor my registrar when we are working in separate locations and not having the usual tea room chats? How do I complete the direct observation competency assessments under these circumstances? How can I meet my teaching requirements? GP Synergy has developed a number of helpful resources, such as the GP supervisor guide to assessing competency using direct observation during the COVID-19 pandemic. This resource can be found on the COVID 19 FAQ page on GPRime, along with a number of other helpful links and resources.
However, the MESP team is also here to provide support and advice if needed on how to support you to meet your supervisor requirements under changing circumstances. Please get in touch with your local MESP via your PLSO or find our contact details on the Support Team tile on your GPRime homepage.
Dr Skye Boughen | Senior Medical Educator
Supervisor Toolkit hot tip
Changing COVID restrictions have also led to a number of changes to the registrar education calendar. The link to education calendar can be found in the Supervisor Toolkit under ‘Registrar Placements’ or it can be found at our website under Calendar.
The importance of looking after ourselves
Dr Marjorie Cross, Medical Educator with Supervisor Portfolio for our Murrumbidgee and ACT subregion, discusses the importance of looking after ourselves particularly during the pandemic.
Meet one of our alumni working in Aboriginal health
Dr Ezekiel Raju undertook an Aboriginal health training post during his GP training, now fellowed he is working in an Aboriginal community controlled health service and enjoys the holistic care model that the services are known for.
Immediate and delayed antibiotic prescribing strategies used by Australian GP registrars
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.
GP Synergy Research and Evaluation Unit staff, together with colleagues from NSW, interstate, and overseas, recently designed and delivered educational sessions and resources for GP Synergy registrars and supervisors on the topic of antibiotic use, antibiotic resistance, and antibiotic stewardship, focussing on non-pneumonia acute respiratory tract infections (ARTIs). Antibiotic resistance and rational antibiotic use are national health priorities in Australia, but antibiotics remain overused for ARTIs.
Antibiotics are mostly not indicated in treating ARTIs. Doctors’ use of antibiotics can be classified as: 'no prescribing', 'delayed prescribing', and 'immediate prescribing'. 'Delayed prescribing' is where the intention is to not use antibiotics unless certain criteria are met (for example, a deterioration in condition). 'Delayed prescribing' significantly reduces consumption of inappropriate antibiotics for ARTIs compared to 'immediate prescribing', with no difference in patient satisfaction.
The segments of our educational sessions and resources devoted to delayed prescribing were informed, in part, by our own research into delayed prescribing by Australian GP registrars. Findings from this research will soon be published in the British Journal of General Practice.1 We found that for all presentations of ARTIs, no antibiotics were prescribed in 68%, antibiotics were prescribed for immediate use in 23%, and delayed antibiotics were prescribed in 9%. 'Delayed prescribing' was used in 22% of otitis media, 16% of sinusitis, 13% of sore throat, 11% of acute bronchitis/bronchiolitis, and 5% of upper respiratory tract infection (URTI).
'Delayed prescribing' was used for 29% of all prescriptions written. 'Delayed prescribing' and 'immediate prescribing' were both associated with markers of registrars’ clinical concern. 'Delayed prescribing' was associated with longer duration of consultation and with fewer other diagnoses/problems dealt with in the consultation.
These results suggest that our registrars prescribe antibiotics for ARTIs substantially less frequently than established Australian GPs (a pleasing finding for our supervisors and education teams), but still prescribe antibiotics in excess of validated benchmarks (except for the case of URTIs, where our other work suggests there has been a decline in prescribing during the first decade of the ReCEnT project). There is limited other evidence for ‘real world’ prevalence of delayed prescribing, but our findings suggest registrars use delayed prescribing more often than European GPs.
Taking our findings together with our earlier qualitative research in this area,2,3 we feel registrars may use delayed prescribing to manage diagnostic uncertainty and, possibly, conflicting influences on prescribing behaviour. Delayed prescribing may be particularly useful for early-career GPs, especially registrars.
The use of delayed prescribing may enable a transition to a future environment of more rational antibiotic prescribing for ARTIs.
If you would like to read the whole paper, a preliminary version can be accessed at British Journal of General Practice.
If you have any questions about the analyses or the study, please contact Parker Magin.
1. Davey A, Tapley A, Mulquiney K, van Driel M, Fielding A, Holliday E, Davis J, Glasziou P, Dallas A, Ball J, Spike N, FitzGerald K, Magin P. Immediate and delayed antibiotic prescribing used by Australian early-career general practitioners. British Journal of General Practice. doi.org/10.3399/BJGP.2021.0026
2. Dallas A, Davey A, Mulquiney K, Davis J, Glasziou P, van Driel M, Magin P. Delayed prescribing of antibiotics for acute respiratory infections by GP registrars: a qualitative study. 2020. Family Practice. 37(3). 406–411 doi 10.1093/fampra/cmz079
3. Dallas A, van Driel M, van der Mortel T, Magin P. Antibiotic prescribing for the future – exploring the attitudes of trainees in general practice. 2014. British Journal of General Practice. 64:e561-e567
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