Historically ABS statistics show that Australian’s birth more frequently in March and you guessed it Spring, which means statistically speaking your registrar may be following this trend and have their own baby due soon or in about 9 months time.
As a rural GP Obstetrician, I have to balance my GP work and the needs of the pregnant patients I support. It is rewarding assisting patients with the births of their children. It’s understandable that as a profession we seek to support our GP colleagues through this process also.
GPSA are often asked what practices are required to pay registrars when they go on maternity or paternity leave. The answer is practices are not required to pay registrars beyond their usual NTCER entitlements during this exciting and costly time.
There is however the parental leave pay available to GP registrars, which is a direct relationship between the registrar and human services. You can assist your registrar by providing them with information about where they can find more information about the parental leave pay available from the Commonwealth Government, which we have provided for ease in this eNews.
Though it is rare that a registrar would work for one practice longer than a 12 month period. There are instances where this occurs and in these circumstances the parental leave pay may be paid directly to the employer and must then be passed onto the registrar. Under this scenario there is no out of pocket cost for the practice – it is a simple payroll transaction.
If this is likely to affect you and your practice in the next 9 months, have a look – it may save you some time.
The GPSA AGM is fast approaching. If you haven’t already considered working with a truly functional board, here is your opportunity. It is not a paid role, but the experience and collegiality among a truly exceptional board are priceless. Have a think about it.
Also of note is that the AGPT program will go to a second intake having not filled all training positions for 2018.
Take a look at the ethical dilemma cards in this edition and the best practice responses (cheat sheet for supervisors) created by MDA National. You can use these for in practice teaching.
Finally, we observed RUOK day last week. I hope someone asked if you were OK and that if you are not OK that you are able to reach out. Research shows doctors experience distress in the workplace at twice the rate of the national average for all work types. It’s a tough gig. Be kind to yourselves and those around you. We need each other.
Remember the RUOK Checklist:
Dr Steve Holmes
Results are currently being analysed but here’s some teasers for you:
Ethical Dilemma Scenarios – Best Practice Response
MDA National have provided best practice responses to each of the cases in the Ethical Dilemma Scenarios. They have also provided supporting documents and readings to assist you in working through each of the cases as part of your in-practice teaching with your GP Registrar. Click on each Case Study to view.
CLICK HERE to download a summary of Medical Ethical Principles.
Thank you MDA National for the Best Practice Responses.
A common enquiry to the GPSA office is, ‘how do I know if I need to pay parental leave?’
Under the NTCER, Clause 6.5 a registrar is entitled to unpaid parental leave. Parental leave pay is a Department of Human Services scheme for parents of newborn babies or recently adopted children. Though there is no provision for paid maternity or paternity leave under the NTCER your registrar may choose to avail of this commonwealth government support program.
The Department of Human Services website says;
As an employer, you must provide Parental Leave Pay to an eligible employee who:
If your registrar meets this criteria then they must apply to the scheme and be approved. Approved applications will result in the commonwealth’s minimum wage payment being received by the employer from human services and then paid to the employee.
If your registrar does not meet all of the criteria they can still contact Centerlink and may be eligible for assistance directly through Centrelink.
Other useful links for employees and employers;
Supervision seed planted early
GP supervisor Lisa Fraser says registrars should be inspired to build mentoring skills as a stepping stone to becoming supervisors.
Lisa Fraser realised early in her medical training that teaching and mentorship were implicit to the sustainability and enjoyment of the profession. And, so began her own journey into life-long learning and teaching, which Lisa says should go hand-in-hand with a GP career.
“I had great mentor experiences in my early training as a medical student,” Lisa, 39, said.
“It was very clear to me from those experiences that teaching was what made medicine sustainable, enjoyable and a great profession.
“After six years in the hospital and three years on the physician training program, I began to appreciate my interest in general practice.
“My initial career path was towards geriatrics, however I started to feel more confident about the diversity and complexity of general practice with more experience and the life stage of motherhood.
She fellowed with RACGP in 2016 and swiftly took on GP supervision at medium-sized practice Priority Health Medical Centre in outer Brisbane, where she works part-time.
While only newly fellowed, Lisa said the positive influence of her early mentors had set in motion the building blocks to becoming a GP supervisor so early in her career.
“There were opportunities to grow skills in teaching and supervision everywhere along the way,” Lisa said.
“At Priority Health, we have many different levels of training doctors in our practice, so it was very organic for me to start supervising registrars and medical students as we function with a high level of interaction.”
Lisa had previously built her experience and passion for training and mentorship through a variety of roles, including committee and medical educator positions with GPRA, GPME and GPTQ.
She believes early engagement with students on a pathway to general practice, is important to prepare them to consider – and be ready – to become supervisors early in their career: in turn, helping to “normalise” training and supervision as a culture of general practice.
“Supervision is part of all of our professional commitment to medicine, albeit is more challenging in the GP environment compared to the hospital,” Lisa said.
“We need to normalise training to improve quality, more young supervisors, more training practices, more patient acceptance and skills from administration staff.”
Lisa said “only about 30 per cent of practices are training practices,” and attributed this low percentage to “a product of time, and environment”.
She is passionate about encouraging a growing participation rate and would like to see 40 per cent of training practices in metropolitan areas by 2025.
“The seed for supervision needs to start in registrar years,” Lisa said.
“Historically there have been barriers to registrars and new fellows advancing their careers in medical education and supervision due to belief that juniority meant lack of competence.
“We are now progressing towards a competency-based model, with the recent change in RACGP criteria, which is more in line with current evidence.
“Some junior doctors have acquired extensive training in medical education and supervision before fellowship and some naturally have greater competencies in this area, so waiting five years before getting more involved in this field only serves to disengage fellows with the teaching culture and cause losses to the natural progression.”
Lisa believes junior supervisors and new fellows need to be represented in supervisor groups like RTOs and GPSA to reflect the profession’s commitment to diversity and inclusion.
She said new fellows had unique needs and characteristics which value-added to the supervision training group, such as their recent training and examination experience; cultural and generational diversity; and close connection to registrar perspective on studying and training towards fellowship at a young stage of life, often juggling children and parenting.
On the flipside, starting the supervision journey early, also added a unique value for the new fellow, Lisa said. “Starting your supervision journey young adds something different to your journey as a new fellow.”
Lisa said people should not be afraid to combine the steep learning curves of being a new fellow and GP supervisor in supportive practices with positive training cultures.
“It works well to do both in tandem. Having both journeys together marries well, and enhances your learning.”
POLICY NEWS September 2017
You are entering a policy news zone free of any references to marriage-equality or dual citizenship.
Instead this month’s Policy News looks at the outcomes from the Medicare Taskforce, strategies galore (digital health, drugs), an important report from AIDA and find out which skills you need to avoid being made redundant by robots!
Medicare taskforce outcomes
The Federal Government has responded to the Medicare Benefits Schedule Review Taskforce recommendations by accepting 45 recommendations in full and modifying some others.
The changes to the MBS include:
These changes will begin on 1 November 2017, with the exception of changes to colonoscopy, which will begin on 1 March 2018.
Get all the detail here:
Digital health strategy
Ouch! My finger hurts!
No! Not that kind of digital health!
Everything you always wanted to know about MyHealth Record and all other things related to the digital health strategy can be found here.
For instance, did you know that 84% of people go online first when seeking health information? There you go! So you need to go have a look at this, even if it’s just for the execsumm.
In case you don’t get that far, here are the 7 strategic priorities
National Drug Strategy 2017-2026
Harm minimization is still the driving philosophy in this latest iteration of the National Drug Strategy.
The priority actions are:
Priority substances are methamphetamines and other stimulants, alcohol, tobacco, cannabis, non medical use of pharmaceuticals, opioids and new psychoactive substances.
You can download it here:
AIDA report on bullying, racism and lateral violence in the workplace
The results of this survey have echoed around the system and make for disturbing reading. The survey was open only to AIDA members and received 53 responses.
The main findings were:
10% of Aboriginal and Torres Strait Islander survey respondents chose to largely conceal their identity in their workplaces for fear of bullying and racist stereotyping.
More than 48% of Aboriginal and Torres Strait Islander survey respondents had experienced either a few incidents per month, or daily incidents of bullying, racism and lateral violence in their workplaces. Only 43% of those who experienced these incidents reported them. A further 14% of respondents preferred not to say.
About half of Aboriginal and Torres Strait Islander survey respondents reported that colleagues had a negative reaction to their cultural identity, with misconceptions about perceived privileges and easier pathways into and through medicine for Indigenous Australians being the most commonly cited reaction.
Less than one in ten respondents believed that existing workplace policies and procedures offered accessible and adequate support – both for victims and for perpetrators.
Recommendations cover issues such as mandatory cultural safety training for all health professionals, independent complaints processes and increased support for Indigenous health staff at all levels.
You can read the full report here:
Will general practice still be around in 10 years?
So you will have read in previous editions of Policy News and Research Roundup about the future of work, the rise of the robots and so on.
This latest report analyses what skills will be needed in the next 10 years for the workplace. Ready?
So there you have it! How well-placed do you think being a GP makes you for the future????
Read the report here:
RESEARCH ROUNDUP – SEP 2017
Usage and impact of open access articles
So we all love the principal of open access (OA) but how effective is it in getting your message out there and is it accessed a little or a lot?
Open access of course is a disruptive technology but it has been around for a while and continues to upset the subscription model for medical education publishers.
The cost of subscription, however, is increasingly forcing university libraries to cancel their subscriptions.
Many granting bodies mandate that the results of research are provided in open access format.
This study by Piwowar et al looks at a mind-boggling 300,000 articles across three streams to answer the questions:
What percentage of scholarly literature is open access and how does this vary depending on publisher, discipline and year?
Are OA papers more highly-cited than their pay for access counterparts?
28% of all journal articles are freely available online.
OA articles receive 18% more citations than otherwise expected (lots of caveats there).
Read all about it here:
Find out more about legal, unpaid access to heaps of journals here:
And access the Directory of Open Access Journals here:
This fascinating paper by Henning et al is all about how students use social networking sites (SNS) and what can be done to assist them to think about the future and ensure that their online presence is in line with their professional aspirations.
Social media is great for communication but it also enables the blurring of personal and professional boundaries and that’s probably not a good thing.
Surprisingly, the millenials that took part in the study wanted guidance from those in authority (that’s you) to provide clarity about what were “the rules” of the profession.
They actually wanted formal teaching about this stuff, complimented by some peer discussion, practical demonstrations about how to manage and maximize their privacy settings and some scenario-based small group sessions.
Read all about it here:
Diagnosis and management of clinical reasoning difficulties Part 1 – supervision and diagnosis and Part 2 – management and remediation strategies
Ok. These two guides by Audetat et al are not exactly light reading but probably very worthwhile reading if you want to know more about how to help your registrar or student if they have clinical reasoning problems.
The table in part 2 is probably the most helpful information. It contains a list of key difficulties, main causes or enablers and examples of remediation strategies.
As an example:
Difficulty: building an overall picture of the clinical situation
Causes: lack of clinical experience and lack of appreciation of the importance of contextual factors, poor grasp of patient-centred care
Remediation: prompt the learner to think about the connections between different aspects of the clinical situation, encourage the learner to think about the patient with a longitudinal perspective, ask the learner to draw a concept map of the clinical situation and discuss with them.
Get all the details:
When I say clinical supervision….
The point of this little piece by Martin et al is to bring to your attention that there are differences between clinical supervision (supervision of colleagues) and educational supervision (supervision of registrars and students) and terms such as “intervision” and “guided supervision” not to mention “mentoring” and, as the authors suggest, we’re in a minefield!
Splitting hairs I reckon but see what you think yourself:
Masters degree for MEs
This paper by Tekian and Taylor heralds the setting of standards for master’s degrees in medical education and health professional education. The standards are in the format of the World Federation for Medical Education Standards (which guides the format of Australian Medical Council accreditation by the way).
The context is a bit different to Australia – the setting is where such courses are delivered to program directors who deliver medical education from universities and similar institutions.
But, there it is – a set of standards for delivering a masters program in medical and/or health professional education.
You read it here first:
Professional Development Opportunities at Rural Medicine Australia 2017 Conference
Rural Medicine Australia 2017 (RMA17) is the peak annual conference and medical science forum of the Australian College of Rural and Remote Medicine (the College) and the Rural Doctors Association of Australia (RDAA).
The conference will be held in the world’s most livable city, Melbourne, this October. It promises an exciting and engaging program of relevant and stimulating topics designed to educate, inform, and enlighten both new and practicing rural health professionals.
RMA17 provides opportunities for health professionals to network, access the latest research and development, and learn new and valuable skills in rural and remote medicine.
Professional development for delegates
Delegates who are registered to the Australian College of Rural and Remote Medicine’s (ACRRM) Professional Development Program (PDP) will receive 20 core points for attending RMA17.
Delegates are eligible for Procedural Grants to cover the equivalent of one day Emergency Medicine if the following sessions are attended:
Themes for this year will focus on:
This year’s program promises an exciting line up of workshops, events, and presentations focusing on relevant, innovative, and stimulating topics that will guarantee thought-provoking discussions, different skills, new knowledge, and inspiration for all health workers who attend.
Must see events, workshops and presentations for delegates include:
For more information on RMA17 or to register for the conference, please visit the RMA17 website.
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