What factors influence Global Assessments of general practice registrars?
This very question is being researched by GP Training Queensland (GPTQ), which researchers hope will enhance the validity and reliability of this increasingly important selection and assessment tool.
Medical Educators and GP Supervisors from the Regional Training Organisations and the Remote Vocational Training Scheme are invited to participate in this important research. Participation involves completion of up to six questionnaires over a six-month period, each questionnaire taking approximately 15-30 minutes to complete. All data will be de-identified.
If you are interested in participating, please review the Participant Information and Consent Form, available via the following link (GATE Consent form) which is followed by the initial questionnaire.
This research project is supported by the Royal Australian College of General Practitioners with funding from the Australian Government under the Australian General Practice Training Program.
High survey response rates often indicate something is amiss. It’s similar to the old chestnut:
“An unhappy person will tell 11 people, a happy person will tell none”
In general practice we are surveyed ad nauseum. Which is why when we send out a survey and there are low response rates we understand. In fact, we have to be a little bit happy about this reality, because it is a proxy measure for happiness or contentment – to a degree.
We know that GP’s tend not to be shrinking violets when we have an opinion about something that is not quite right, so it is nice to see a drop off in people beating down our door to tell us about their discontent with GP training.
We are pleased to see that many of the issues raised by stakeholders in last year’s supervisor satisfaction survey have been acted upon by the relevant RTO.
Consider the statistics:
1. For every customer complaint there are 26 other unhappy customers who have remained silent –Lee Resource.
2. 96% of unhappy customers don’t complain, however 91% of those will simply leave and never come back – Financial Training services.
3. A dissatisfied customer will tell between 9-15 people about their experience. Around 13% of dissatisfied customers tell more than 20 people. – White House Office of Consumer Affairs.
4. Happy customers who get their issue resolved tell about 4-6 people about their experience. – White House Office of Consumer Affair.
5. 70% of buying experiences are based on how the customer feels they are being treated – McKinsey.
6. 55% of customers would pay extra to guarantee a better service – Defaqto research.
7. Customers who rate you 5 on a scale from 1 to 5 are six times more likely to buy from you again, compared to ‘only’ giving you a score of 4.8. – TeleFaction data research.
8. It takes 12 positive experiences to make up for one unresolved negative experience – “Understanding Customers” by Ruby Newell-Legner.
9. A 5% reduction in the customer defection rate can increase profits by 5 – 95% – Bain & Company.
10. It costs 6–7 times more to acquire a new customer than retain an existing one – Bain & Company.
11. eCommerce spending for new customers is on average $24.50, compared to $52.50 for repeat customers – McKinsey.
As a GP Supervisor you are a customer or consumer; so too is your registrar. Your feedback isn’t just collected to tick a box or sit in a dust cupboard. When GPSA ask you what you think, we feed the deidentified trends back to RTOs and the Department of Health. If you have not yet shared your thoughts, that’s great, we take it as a given that you are happy and time poor or perhaps you just have survey fatigue. Not you? Complete the survey now.
Our rural GP Supervisors are the happiest of all!
Not you? Complete the survey now.
OK, so we might be getting a little cheeky there, but frankly if you don’t complete the survey, your voice gets lost and all sorts of substitute claims can be made. We’d love you to share your thoughts… the survey takes just 10 minutes.
Employment Contract and NTCER Hotline
As we progress into a new training term we are receiving a lot of phone calls for support with contracts, leave payout calculations and percentage questions. Keep them coming. We are here to support you. If you need to clarify something it is vastly easier to do it at the start of a term than at the end for you and your registrar. You can email your query through to email@example.com or call the office on 03 5440 9077.
Yours in GP training,
Dr Steve Holmes
RESEARCH ROUNDUP – August 2017
This month’s Research Roundup features our GPSA Chair, Steve Holmes and the MJA musing on pathology test ordering rates; the highs and lows of antibiotic prescribing and all you ever wanted to know about competency-based medical education. And old William Horman of Eton may well have nailed it when he said that “manners maketh the man (or woman)”…..
Changes in pathology test ordering by early career GPs
This paper appears in July’s MJA and concludes that test ordering by GP registrars increased by 11% per training term over the course of vocational training.
The only problem is that the actual data presented doesn’t support this conclusion. In fact quite the opposite.
Based on the data presented GP registrars actually order less tests over time – an average of 26% less over the course of training rather than the 11% per term more that the study suggests.
The drop off in protected teaching time as registrars progress from term 2 to term 3 might be reflected in the increase in test ordering that happens at this point
In any event, the paper does support a number of points that GPSA has been calling out over the years, including
Read the paper here:
And Steve Holmes’ response here:
MJA feature a paper by McCulloch et al that examines antibiotic prescribing rates for acute respiratory infections and finds………(drumroll)…….that the rates are way above guideline recommendations. In fact, anywhere between 4 and 9 times the recommended rate. Ouch!!
So of course, there’s an editorial (Gulliford and Ashworth) that asks the question: can it be reduced?
The answer? Yes! Results from the UK (this is an international problem of course) indicate that a deferred prescribing strategy can work but a no-prescribing strategy is preferable and still acceptable to patients.
The NHS has introduced a contractual financial incentive for meeting targets. Hmm. Another SIP perhaps?
Best of all, something as simple as a personalized letter from the Chief Medical Officer resulted in a 3% reduction in antibiotic dispensing!!!
So expect your personalised letter from John Horvath soon!
Read the paper here:
And the editorial here:
Everything you ever wanted to know about competency-based medical education but were afraid to ask
A whole journal edition devoted purely to CBME! Wow!
If you want to know anything about this topic, look no further and read the whole June edition of Medical Teacher cover to cover.
But for a surprisingly balanced read, look no further than Holmboe et al’s call to action on the topic in the first few pages.
The authors cite the continued global growth in CBME as being indicative of the effectiveness of an outcomes-based approach to the primary mission of medical education i.e. to meet the needs of those they serve.
And well-known ME radical, Jason Frank (aka father of CanMEDS), reckons the end of time-based training is nigh!
Do yourself a favour, keep yourself up to date and grab a copy of this one.
Miss Manners says….
Ever thought there’s a problem with your millennial registrars and their manners? Well, they might think the same about you!
This report looks at social etiquette in Australia and modern manners – I kid you not!
But the results are fascinating and instructive!
If you think everyone is more rude and impatient these days compared to 20 years ago, you’re right!! (at least seniors think so).
And the worst public faux pas?
Both groups agreed that remembering your “please”, “thank you” and “excuse me” was important but interestingly, millenials thought that avoiding making racist or classist comments was even more important. Food for thought.
Everyone agreed that burping, farting and swearing in public were right out!
Want to really make a millennial uncomfortable? Get into their personal space. Bothers ‘em twice as much as seniors.
But which is the best city in the social etiquette stakes?
And the worst?
You guessed it, Sydney!
Here’s an important point of difference on social media.
So there you have it! But lots of little gems in this report.
Put on your hard hat and go mining here:
This month’s Policy News has a focus on rural health policy and research, cost-effectiveness of clinical trials and everyday heroes (that’s you).
Integrated care consultation
For those interested in the current consultation on the new integrated care packages, the Department are currently consulting until 21 August.
Consultation questions include:
Make a submission and/or read the discussion paper here:
Where to next for rural general practice policy and research in Australia?
Former ACRRM President, Lucie Walters et al reflect on 20 years of policy, advocacy and research in rural general practice and highlight 4 key policy areas where most of the activity has occurred: education and training, regulatory strategies, financial incentives and support for general practice.
They conclude that whilst there has been considerable national policy investment with limited accompanying evidence, these provide an important context for current rural GP workforce reforms.
Their conclusion? Despite much rapid and ongoing policy implementation in rural general practice, there is little evidence of its effectiveness extending to smaller remote communities.
They advocate for a national research program that includes vocational rural generalist training, advanced skills practice, migration, sustainable practice models and specific targeted interventions to underpin policy.
Read all about it:
Health priorities for people living in the bush – what they say
A report by RFDS and the NFF outlining results of a survey of people living in in remote and rural regions on health care access, mental health and preventive health.
Almost one third (32.5%)identified general health access as a priority. This was broken down into access to:
The second and third priorities were mental health (12.2%) and drug and alcohol (4.1%).
The report didn’t find anything that government policy wasn’t already trying to address but concluded that more effort and resources were required to address them.
Read the report here:
Economic evaluation of investigator initiated clinical trials conducted by networks
Ever wondered whether they’re cost-effective?
If the results of the trials were implemented in 65% of the eligible Australian populations for one year:
So answer to that question? A $2b yes.
The 3 networks in the study were the Australasian Stroke Trials Network, the interdisciplinary Maternal Perinatal Australasian Collaborative Trials Network and the Australian and New Zealand Intensive Care Society Clinial Trials Group.
And if you’ve ever taken part in one of those trials, the results are in the paper.
The suggested next steps are interesting too. Big emphasis on translational research of course but also on reducing the reliance on in-kind support.
Read the full report here:
An interesting opinion piece by Lesley Russell that essentially outlines the difference between ‘heroic medicine’ (read, surgery) versus ‘incremental care’ (read, general practice).
It is a call to treat general practice as a specialty, think the controversial “I’m not just a GP, I’m your specialist in life” campaign and to reward ‘the quiet heroism of incremental care’.
Singing to the choir!
Read it here: http://insidestory.org.au/everyday-heroes
Practice manager Riwka Hagen ensures GP registrars have a comprehensive orientation at the start of their term, setting up a rewarding and happy learning experience.
After 25 years in practice management, Riwka Hagen has a well-established routine in helping registrars reap the rewards of their term in general practice.
Her well-honed processes and skilled interactions with trainees also ensures a happy and successful experience in the apprenticeship training model for GPs.
“I first and foremost remember that the registrar is there in a training capacity – the primary objective is their need to learn,” Riwka, 50, said.
Next on her list is a comprehensive and friendly orientation, which starts from the moment a registrar first walks in the door at Gisborne Medical Centre, Victoria.
“I make a segregated time to have a really detailed conversation with them about how the practice operates,” Riwka said.
“It’s about relationship building; making sure the registrar understands while day-to-day they may not see much of the practice manager, I let them know I am there as their agent. You are there to facilitate what their needs may be.”
The meeting with Riwka, closely followed with scheduled orientations with other team members, sets the foundation for ongoing positive interactions for registrars taking the leap from hospital training to general practice.
Riwka spends an uninterrupted hour with the registrar early in their two-day orientation, which works through a detailed checklist with the team, including nurses, senior administration and GP supervisor.
As well as detailing practice processes, Riwka explains to the registrar that they are not seen as a guest, but as an “integral part of the team”. She encourages them to ask questions and seek help as soon as an issue arises.
Riwka, also likes to prepare young doctors for the inevitability – and importance – of feedback, building their ability for a positive response and averting a “meltdown”. She explains her role is to provide feedback from doctors, staff and patients.
“I explain that getting critical feedback is not uncommon. It’s not disciplinary in its nature; it’s part of the industry and it’s very much a part of learning.
In the event of a complaint, the registrar is informed about what to expect. “I will explain to them what comes to me and they will have an opportunity to explain what happened.”
Furthermore, Riwka also debunks the mystery of whose role it is to inform any would-be complainants of outcomes, explaining it is her role to speak to patients about resolutions.
Whether such issues are reasonable or not, the situation is then reviewed as a learning opportunity. And again, the registrar is prepped to embrace this scenario.
Adverse events, including resolutions and any resulting changes to practice processes, are discussed during the practice’s regular clinical meetings.
The cultural practice of positive transparency and a collaborative learning environment gives registrars the opportunity – and confidence – to “put their hand up when something goes wrong” and to “learn from mistakes”, Riwka said.
“Our feedback mechanisms are about not having secrets, so there are no surprises when the registrar gets to the end of their term.
“Part of the success of their placement here is that we have well-developed systems in place and a clarity about our processes.”
Registrars are further supported by well-planned rosters and collaborative scheduling of appointments, which increases alongside the registrar’s growing confidence.
“Patient scheduling should not undermine their confidence. They start slow and we make adjustments along the way, taking cues from the registrar,” Riwka said.
Reflecting on her own career in supporting possibly more than 50 registrars at various workplaces, Riwka is enthusiastic.
“I have enjoyed teaching, training, mentoring, supporting and watching registrars develop from being shy and uncomfortable to becoming really capable GPs.”
Applications for ACRRM Independent Pathway open 21 August 2017
The Australian College of Rural and Remote Medicine’s (ACRRM) Independent Pathway is an accredited training pathway to become a general practitioner in Australia. Successful completion of this program will result in being awarded Fellowship of the College, or FACRRM.
The Independent Pathway has been developed by rural practitioners for rural practitioners and is administered entirely by the College. This pathway is suited to experienced doctors who respond well to self-directed learning, flexibility, and keen to make a positive difference in rural and remote medicine.
If you’re supervising a junior doctor who is looking for a diverse and dynamic career, ACRRM’s Independent Pathway is the perfect solution. Prior experience is often recognised and can cut-down on the length of training.
The four year program consists of:
There are also opportunities to select one area of Advanced Specialised Training.
RPL applications close 7 August, IP applications open 21 August
The College has two openings each year to apply for the Independent Pathway, with training typically commencing in February or July. Applications for Recognition of Prior Learning and will close 7 August, with pathway applications open 21 August – 4 September.
If you know a junior doctor who is interested in a challenging and rewarding career, encourage them to read the How to Apply Guide and apply today.
POLICY NEWS – JUNE 2017
This month’s Policy News has a focus on social media, preventive health and climate change.
MBS Taskforce consultation
The MBS Taskforce is seeking comments on after-hours MBS items.
Consultations close 21 July.
You can access the online survey here: http://www.mbsreview.com.au/after-hours.html
Sensis Social Media Report 2017
For those with an interest in social media, this report makes great reading.
Some highlights include:
So there you have it! All that latest stats on social media usage.
For more, find the report here: https://www.sensis.com.au/
#StatusOfMind – the effects of social media on young people
A report entitled #StatusOfMind reported the results of a survey in the UK that looked at the positive and negative effects of social media on young people.
The survey asked 1,500 youths to rate each platform on a set of 14 health and well-being related issues as follows:
The platforms came out as follows:
If you suffer from FoMO, read the full report here:
GP bread and butter – preventive health
A recent report shows that Australia compares very poorly with OECD countries like Canada, NZ and the UK regarding health spend on prevention.
The numbers say it all: the annual cost of treating chronic disease in Australia is around $27b and yet we spend just over $2b a year on prevention.
More numbers? Chronic disease accounts for 66% of the burden of disease and 83% of all premature deaths. Half the population suffers from a chronic disease.
The report argues for more spending on preventive health based on cost-effectiveness and notes that the choice of funding mechanism for preventive health activities seems to be based on history rather than efficacy.
Was there ever a better case for evidence-based policy than preventive health?
Singing to the choir here but if you’re interested and want to read more, the report can be found here:
National Strategy on Climate, Health and Well-Being for Australia
This framework was the result of a long process of consultation with key Australian health stakeholders.
The outcome is support for the Commonwealth Government to protect the health and well-being of Australian communities from the effects of climate change.
The framework recognizes that many of the determinants of health and well-being lie outside the health portfolio.
The vision is one of “ a fair and environmentally sustainable national policy framework that recognizes, manages and addresses the health risks of climate change and promotes health through climate change action” (p6).
The findings of the consultation were grouped under 4 themes:
The framework cites some startling stats including:
The framework outlines 7 areas of policy action including:
Key policy recommendations include:
We’ll follow this one but read the strategy and related documents here:
RESEARCH ROUNDUP – June 2017
This month’s Research Roundup looks at articles on cultural safety, feedback-seeking, teaching communication skills, social media and a piece on whether or not the millennial GPs are shying away from full-time work!
Plus the BEST social media policy I’ve ever seen!
Students’ motivation toward feedback-seeking in the clinical workplace
Are your registrars just shy? Or are they not motivated to seek feedback?
This paper by de Jong et al looks at self-determination theory to explore the reasons why learners seek feedback (or not!).
They found that high performing students are higher self-determined than low performing students and that this leads to greater persistence, more positive self-perception and better quality engagements.
Low performing students seek feedback because it meets external demands (such as assessment requirements) and leads to rewards. And why? Because high-performing students experience higher benefits in seeking feedback than low performing students. They learn from it.
Read all about it here: http://dx.doi.org/10.1080/0142159X.2017.1324948
Embedding cultural safety in Australia’s main health care standards
In an article from this month’s MJA (coinciding with NAIDOC week) that is devoted to Indigenous health, Martin Laverty, Dennis McDermott and Tom Calma claim that the existing health safety and quality standards are insufficient to ensure culturally safe care for Indigenous patients.
They call for the embedding of cultural safety into professional standards as well as accreditation processes.
Read this special edition of the MJA here:
Are millennial GPs shunning full time work?
Apparently the CEO managing the organisation tasked with training the NHS’s workforce put it out there that millennial GPs (born between the late 1980’s and the early 2000’s) were unwilling to work full time!!
The author of this piece puts it all down to changes in the way workforce data were collected from one year to the next and claims that roughly the same proportion of the workforce worked full time in 2015 and 2016.
This article talks about GPs having a ‘portfolio career’, where their reduced time in face-to-face patient hours is taken up with other roles including clinical commissioning groups (read PHN for the Australian context), management tasks, other clinical work (e.g. pain clinics our out-of-hours work) and roles in ….medical education and academia!
So here’s to all you GPs out there with fulfilling portfolio careers!
Read all about it here:
12 tips for just-in-time teaching of communication skills for difficult conversations in the clinical setting
This paper by Hinkle et al tackles the thorny old issue of breaking bad news. So here are the 12 tips:
Read all about it here:
A day in the life: social media for clinical practice and clinical education
A great little paper by Victoria Brazil and Casey Parker that refers to social media-based education as individualized, democratized medical education. Viva!
Some really useful hints and tips including one for all of us to remember (courtesy of the Mayo Clinic’s 12-word social media policy):
“don’t lie, don’t pry, don’t cheat, can’t delete, don’t steal, don’t reveal”
Access the article here:
Rural Medicine Australia is coming to Melbourne 19-21 October 2017
The Australian College of Rural and Remote Medicine (ACRRM) and the Rural Doctors Association of Australia (RDAA) have partnered to bring the very best of rural and remote medicine to Melbourne. ACRRM and RDAA invite all rural and remote medical practitioners and allied health professionals to the Rural Medicine Australia (RMA17) Conference, 19-21 October in Melbourne. Early bird sale is on now.
Call for Abstracts extended to 16 July 2017
RMA17 will be held in Melbourne from 19 – 21 October 2017 and will be focusing on the themes of sports medicine, research in policy and practice and climate change and health. We encourage you to submit an abstract that explores the wider issues associated with these themes, as we are looking for a variety of topics and presentation styles.
As an example, you might present about a case of a retired athlete you treat for their lingering sports injuries or skin cancers resulting from years of training in the sun. Or consider the ways that climate change can impact mental and physical health of rural and remote communities.
Worried your abstract idea doesn’t fit our themes? You can still submit for review. During the application process, simply select “Unsure” on the Themes page of the application form.
Responses to abstract submissions will be finalised by mid to late August 2017.
Start planning your presentation in line with our three themes now, and submit all presentations for review during our online Call for Abstracts, open until 16 July 2017.
Keynote Speakers confirmed
This year’s themes are Sports Medicine, Research in policy and practice, and Climate Change and health. We have an exciting line up of keynotes ready to present their thoughts and research, including Dr Bob Brown (Bob Brown Foundation), Dr David Hughes (Chief Medical Officer; Australian Institute of Sport) and Mr Tim Kelsey (Chief Executive, Australian Digital Health Agency).
Dr David Hughes oversees the day-to-day functioning of the Department of Sports Medicine at the Australian Institute of Sport, and was Medical Director for the Australian Olympic Team in Rio in 2016. Dr Hughes will discuss sports-related concussion injuries on Thursday 19 October.
Tim Kelsey is Chief Executive of the Australian Digital Health Agency, and was formerly National Director for Patients and Information for the National Health Service and National Information Director for Health and Care in England. Mr Kelsey will discuss the current status of the My Health record, and digital health strategies in Australia on Friday 20 October.
Dr Bob Brown has remained a high-profile advocate for environmental issues since his first speech in the Senate in 1996. After resigning from Senate in 2012 he organised the Bob Brown Foundation to help fight damage to Australia’s natural environment. Dr Brown will discuss climate change and rural health on Saturday 21 October.
RMA regularly attracts over 550 healthcare professionals. Don’t miss the perfect opportunity to catch up with colleagues and discover the latest innovations in rural and remote medicine – secure your tickets today.
To find out more about RMA17, please visit the website or contact ACRRM on 1800 223 226.
The Teaching Course Melbourne 2017
31 Aug – 3 September 2017
Citadines on Bourke, Melbourne
After one of our most successful events in history, The Teaching Course is coming back to Melbourne in 2017!
This 3-day course has been designed especially for medical educators seeking to enhance their skills as a teacher and who want to make a real difference in medical education.
Our passionate, all-star cast of local and international educators, will inspire and help you to truly rejuvenate your teaching.
Sessions will include:
And if you are truly serious about upping your presentation game, don’t miss the opportunity to participate in the Pcubed Workshop, hosted by the phenomenal Dr Ross Fisher.
Further information and registration The Teaching Course Melbourne