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Rural and Remote Medical Education Online with ACRRM

The Australian College of Rural and Remote Medicine’s (ACRRM) Rural and Remote Medical Education Online (RRMEO) is an easy to use, whole-career support online learning platform free to all members. RRMEO allows members to up-skill and earn points towards individual professional development requirements for the triennium.

All learning modules on RRMEO are mapped to the ACRRM curriculum and are authored by experts in their field and ACRRM members. The majority of modules feature a case based approach to learning, reinforcing analytical and reflective skills through the use of real-life scenarios.

There are more than 100 online modules to choose from providing a wide variety of training opportunities for all stages in your career. See below for information on our most popular modules.

Rural Doctors Family and Domestic Violence Education Package

The module for Rural Doctors Family and Domestic Violence Education Package was developed to strengthen the rural general practitioners’ capacity to address family violence within their community.

This module is based on a series of clinically focused case-based discussions, with emphasis on providing best practice responses at both the individual and community level.

Reflecting the diversity of people who are affected by domestic violence in rural and remote communities, the module was developed by doctors across Australia, from locations such as Cooktown, Nhulunbuy, Alice Springs, Parkes, and Port Hedland.

The module is divided into six sections:

  1. Identifying Domestic Violence
  2. Understanding Domestic Violence
  3. Understanding the community – promotion, prevention and health education
  4. Managing Domestic Violence
  5. Demonstrating appropriate attitudes in practice – understanding the role and responsibilities of the GP in helping patients affected by Domestic Violence
  6. Self-reflection.

Members can receive 30 Practice Reflective Professional Development points towards their ACRRM Professional Development Program (PDP) when each section is completed.

Q Fever: Early Diagnosis and Vaccination

The Q fever: early diagnosis and vaccination module has been developed by the Communicable Diseases Branch, Health Protection New South Wales in collaboration with experts in clinical infectious diseases, veterinary microbiology, public health, and rural general practice.

This module has been developed to upskill GPs in Q fever prevention and the diagnosis and management of acute infections. The target audience are regional, rural, and remote general practitioners in line with the disease burden.

On completion of the module participants will:

This module takes approximately two hours to complete and has been accredited with ACRRM for two core Professional Development points.

150 Shades of Radiology

The 150 Shades of Radiology module features 150 radiology cases with a progressive series of online assessments. The content has been created and curated by A/Prof Tony Lamont, Associate Professor Clinical Education, James Cook University and previously Head of Radiology at Townsville Base Hospital.

Successful completion of 3 blocks of 10 cases and their associated assessments meet ACRRM’s requirements for Radiology MOPS for the current

For further information on RRMEO and the available online modules, you can visit the ACRRM website.

Practice performance monitoring

Do you track your practice’s service performance regularly, or is it one of those things you have a look at when you have a moment to spare and run a few reports? How do you manage this information and what story does it tell? If you’d like a helping hand with developing an easy to use tracking system that will give you real-time tangible information, read on!

Practice performance monitoring – take control!

In the busy-ness of day to day practice management, statistical data reporting is often relegated to the back seat and can be an ad-hoc activity if a streamlined and easy to use management system has not been developed.

Using practice performance data is crucial to maintain a sense of control of how your practice is performing at any point in time as well as telling the historical story of the business. Practices collect an overwhelming amount of data which needs some structure and manipulation to be able to make sense of it all. Whilst GP practices are becoming more skilled at analysing clinical data to assist with service planning – for example to plan chronic disease services, this feature focuses on the use of practice service data to give accurate and timely insight into financial and service performance.

Key Metrics

There are some service indicators that will give your practice a good sense of performance.

Monthly:

By summarising the above data for each Practitioner, you will be able to calculate monthly and cumulative results. This allows you to track individual Practitioner performance, average fees generated per patient, overall practice turn-over, year-to-date tracking and year-on-year performance (when using this consistently over a number of years).

What do I do with all that information?

The best way to manage large data sets is to use spreadsheets, including graphs. Visual representation is much easier to understand than raw data and numbers. By making this a regular monthly activity you will ensure that your statistical reporting is always up to date.

Once the information is updated, analyse the results for the purpose of deciding what action, if any, needs to be taken. These reports will be able to spot trends in activity that are tangible and on which you can confidently base your decision making.

These reports are, of course, important to share with your practice principals.

What kinds of trends can be identified?

Increase or decrease in;

In conjunction with debtor reports, the differential between billings and receipts (indicating possible issues with fee collection)

By comparing practitioners, identify:

PIP/SIP Data

By tracking quarterly PIP/SIP data, practices can gain a higher level of insight into performance than by only reviewing reports as they are issued.

WPE/SWPE numbers tell you about your practice patient population. The WPE – whole patient equivalent, is a measure of service provided to a patient over a 12 month period.

The SWPE – standardised whole patient equivalent, is a weighting applied to WPE to account for clinical complexity. This means that elderly, indigenous and patients with chronic conditions increase the SWPE and younger, healthier populations reduce the SWPE. The difference between WPE and SWPE is therefore a measure of clinical complexity of your patient base.

Further help is available

If you’d like to get started with tracking your practice performance data, a free template spreadsheet is available. Please visit www.medicalbusiness.services and lodge your request by contacting us.

Submitted by Riwka Hagen
Medical Business Services

 

Frank’s mission: “I want you to be a great GP”

Frank Jones is passionate about the profession of general practice, and instilling the same enthusiasm in the next generation of family doctors.

It’s impossible to quantify his influence, having supervised “at least 30-plus” registrars during his three-decade career in regional Western Australia.

“I like to leave them with the passion I have for general practice,” the immediate past president of RACGP said.

“It’s such an honour and privilege to be a doctor, and more specifically as a GP because you have this clinical continuity of care for patients.

“This honour and privilege fires me up every day: I look forward to going to work every day.”

Welsh-born Frank fellowed in the United Kingdom 35 years ago, before moving to Australia and initially working with the Royal Flying Doctor service. He has devoted most of his career to general practice in Mandurah, about an hour south of Perth.

The WA faculty of RACGP provost says registrars help keep him “grounded” – and vice versa.

“I learn a lot from registrars. It’s a two-way process: having a registrar keeps me grounded and up-to-date.”

Frank tells his registrars he wants them “to be good GPs”, but more so, he wants them “to be great GPs”.

So how does he go about teaching them to be “good” but strive for “great”?

“I try to teach them the three pillars of general practice: diagnosis and dealing with uncertainty; treatment in general practice (not just prescribing, but using allied health and getting a whole team base); and, the critical role of the opportunity for prevention in general practice.

“At the centre of that triangle is the golden gift of general practice, which is our continuity of care.

“I try and get registrars to understand the critical role GPs have in our health-care system.”

Frank advised supervisors to get to know their registrar early.

“It’s just like getting to know your patient. You need to get a picture in your mind who the person is because that gives you an idea of the educational relationship you will have.”

Frank stressed the importance of the registrar observing the supervisor’s consults during their first days in the practice, and then the supervisor observing the registrar’s consults during the early weeks.

“This will help you establish a baseline,” Frank said.

“I say to the registrar ‘If you are not knocking on my door in the first few weeks or months, then I am concerned, because in the early stages of your GP training you don’t know what you don’t know.’

Frank concedes supervision does bring its challenges, which can be managed.

“You need to have dedicated time put aside for the formal teaching because if you don’t do that, time management becomes an issue.

“You also need to have patience because each young doctor develops at their own pace and has their own individual learning needs.

“You have to be prepared to be interrupted in your clinical work, especially in the first few weeks or months.”

Frank, who in his spare time “still pulls on the shorts for golden oldies rugby”, encouraged any GP considering supervision to “just do it”, even early in their career.

“Within two to three years of fellowship you should consider if you are interested in becoming a GP supervisor, because it is a fantastic journey,” he said.

For Frank, the journey continues to reap rewards for the profession, community, and personally. His pride in their development indicates Frank’s enthusiasm for mentoring registrars is not likely to wane any time soon.

“My most recent registrar became not just a good GP, but a great GP, and it was wonderful to be a part of her journey and mentoring her.”

Frank has recently been recognised by GPSA, WAGPET and RACGP for in excess of 15 years service as a GP Supervisor, nurturing the next generation(s) of family practitioners.

 

 

In January 54 GP Supervisors were recognised for the service they have provided to their respective communities. Congratulations to;

John Hackett – Wonthaggi Medical Group
David Dalton – Sorell Family Practice
Alan Leeb – Illawarra Medical Centre
Alison Creagh – Womens Health and Family Services
Andrew Png – Kwinana Medical Centre
Barry Fatovich – Lockridge Medical Centre
Bernard Chapman – Moora Health Centre
Betty Lau – Prendiville Ave Medical Centre
Christopher Denz – Central City Medical Centre
Christopher Jacklyn – Beaumaris Family Practice
Darcy Smith – Hillside Family Practice
David Mildenhall – Southern Regional Medical Group
David Robinson – Duchess Medical Practice
David Tadj – Pioneer Health Albany
Edward Khinsoe – Ranford Medical Centre
Edward Pleydell-Bouverie – Woodbridge Medical Centre
Esther Tham – Woodvale Park Medical Centre
Evelynne Wong – Candlewood Medical Centre
Frank Jones – Murray Medical Centre
Gary Claydon – Seacrest Medical Centre
Gary Tapper – Busselton Medical Centre
Hamza Amira – Forest Lakes Medical Centre
Hany Ishak – Stirling Central Medical Group
Hugh Connolly – Peel Connolly Medical Centre
Ian Leggett – Southern Regional Medical Group
Ian Taylor – Panaceum Medical Group
Ivo Buters – Byford Medical Centre
Jack Christodulou – Belridge Medical Group
John McNeilly – Beaumaris Family Practice
Mark Zafir – The Surgery
Martin Gadd – Australind Medical Centre
Mary Cadden – Coolibah Medical Centre
Mary Cameron – Lindisfarne Medical Group
Michael Civil – Stirk Medical Group
Mostyn Hamdorf – Dunsborough Medical Centre
Moya Wood – Alexander Heights Family Practice
Murray James-Wallace – Panaceum Medical Group
Nadine Perlen – Lockridge Medical Centre
Neda Meshgin – Canning Vale Medical group
Nichola Wood – Woodbridge Family Practice and Women’s Clinic
Nicholas Forgione – Trigg Health Care Centre
Peter Maguire – Earl Street Surgery
Peter Wutchak – Collie River Valley Medical Centre
Robert Flynn – Woodvale Park Medical Centre
Rohan Gay – Walter Road East General Practitioners
Rosanna Capolingua – Floreat Medical Practice
Rupert Backhouse – Murray Medical Centre
Sean Stevens – Mead Medical Group – Kalamunda
Stephen Cohen – Duchess Medical Practice
Stephen Jarvis – Whitfords Avenue Medical Group – Kallaroo
Stuart Adamson – Midwest Aero Medical – Beresford
Stuart Burton – Kelvale Medical Group
Suzanne Bougher – Parkwood Medical Centre
Velupillay Kulaendra – Willetton Medical Centre


Congratulations and Thank You… YOU are valued!

54 GP Supervisors were recognised for the service they have provided to their respective communities on top of the three prestigious Australia Day awards bestowed on individuals from the GP supervisor community for Drs Marjorie Cross (OAM), Ian Fraser (OAM), and Morton Rawlin (AM). Dr Jack Maguire was also recognised as Townsville’s 2018 Citizen of the year.

Recognition for the work we do within our communities whether personal, professional, workplace or industry, while not essential, are signpost moments which cause pause and reflection on what is important. Indeed, many things we have reason to be proud of will never be formally recognised, but our contributions to our communities have a lasting benefit; a legacy effect.

For GP supervisors Recognition, Respect and Reward have been three key ingredients stakeholders have identified as being important. With so many of our community being recognised this year it is important to consider how we each recognise those in our own teams for the work that they do and the contributions they make to our communities and importantly as a team how we signpost to our own teams that they are valued.

As we progress through a busy February with a new cohort of registrars and training terms, you will be aware of how much of a team effort getting the next generation of family practitioners is.  Judging by the number of calls we receive at this time of year in preparation for end of term final payments and new contracts for the term about to commence in February, the constant cycle of renewal in our practices continues.

Not only do new GP trainees bring with them fresh ideas and the introduction of interesting new personalities to the practice they sometimes shine a light of workplace culture; positive or challenging.

GP Supervisors Australia recently met with Supervisors in Tasmania to look at developing intentional workplace cultures around performance management, and building social capital within their practices to support sometimes challenging conversations. What the conversation highlighted was that for the most part GP registrars are receptive to feedback and this is both acknowledged and respected by supervisors. Most supervisors had experience with a challenging learner at some stage throughout their careers. They were the exception, not the rule, but the impact of the experience was remarkable.

As practice leaders, now is the time that we set the scene for the very best outcomes in GP training, with appropriate employment agreements (available for download here), well structured orientation programs (available for download here) and investment in on-boarding the newest member of our teams.

For GPSA this year, there will be a focus on professionalism to mirror federal signals that this is indeed a priority area for the Australian Government and reflected in the communities expectation that The Australian GP Community deliver the very best in health care to our communities.

Based on meetings with the colleges, RTOs and Department of Health officials, the transition to a college lead GP training environment will also bring with it a focus on expanding AGPT supports for International Medical Graduates with supervision requirements throughout Australia. GP Supervisors are excited by the opportunity this presents to achieve even more with the comprehensive AGPT network and associated resources.

2018 will be a negotiation year for the National Terms and Conditions for the Employment of Registrars (NTCER). To this end we will be seeking your feedback on changes you would like to see made in the 2019-20 Agreement. Our door is always open to new ideas.

Finally, GPSA continue to recommend training practices avail of the risk management mechanisms included within the NTCER in its current format:

Remember the NTCER is agreed as fair and reasonable by both GPSA and GPRA and negotiations span almost a full year. The negotiation has therefore already been done by the time a registrar reaches your practice.

May your new training term progress smoothly.

Dr Steve Holmes

 

RESEARCH ROUNDUP – FEBRUARY 2018

This month’s Research Roundup looks at the relentless march of AI into the health professions, how to measure affect, whether University Departments of Rural Health are making a difference, resources for how to communicate with patients about risk and how teaching is embedded in clinical care.

Read on!

Artificial intelligence and the health professions

Continuing with a theme I’ve had running for a while now, this fascinating paper by Brian Hodges looks at the inroads AI is making into the health professions right here and now.

Prompted by the movie and book, Hidden Figures, which describes the role of 3 African American women as (literally) human computers during the early years of NASA; Hodges says that we are in just such a place in time right now. In Hidden Figures, one of the lead characters sussed out that the human computers would be replaced by the newly invented IBM and began surreptitiously teaching her colleagues how to program it. So when the IBM took over their roles as human computers, the female staff she had trained became computer programmers.

He reports on developments in his own hospital (in Canada) where already an AI system for planning radiation therapy treatment is taking 4 minutes to do what a physicist and an RT took 4 hours to do.

And also refers to drug-dispensing machines, integration of pathology and radiology departments (pattern recognition) as examples that are in evidence right now.

What do we do about it??

Setting aside for a moment the challenge of undergraduate selection, it is interesting that he encourages us all to look to CPD and future-proof that in preparation for the redeployment of health professionals that will inevitably come.

Hard to imagine, he muses, that affective computing will impact areas such as communication and empathy…which takes me to the next paper below!

A paper well worth the read for all you future-watchers like me!

http://doi.org/10.1111/medu.13350

The Griffith University Affective Learning Scale (GUELS)

This paper by Rogers et al tackles the hoary chestnut of assessment in the affective domain (read “professionalism”) and bemoans the dearth of validated instruments to measure it.

And lo and behold! Comes up with one that measures it! Reliably and validly!

But doesn’t include it in the paper (awww) because they wouldn’t want the students to get a hold of it and start writing to it (not much faith in their professionalism there!).

The instrument measures affective learning as demonstrated in undergraduate reflective journal portfolio entries.

Rogers et al call for it to be tried out in other settings such as clinical practice and invites anyone interested in giving it a hit-out to contact the authors directly.

Read about it here:

https://doi.org/10.15694/mep.2018.00002.

University Departments of Rural Health – are they making a difference?

This paper by John Humphreys and David Lyle evaluates the role and contribution of UDRHs to rural and remote Australia via teaching, research and health services.

As you know, the program was established in 1996 and there are 12 UDRHs across Australia with 3 new ones (or at least the funding for them) announced in 2017. Six are located in rural regions and 5 in remote regions (they don’t mention the 12th one).

The paper contains some interesting tables on numbers of student placements and program reach, peer-reviewed publications, and examples of projects.

They cite that the UDRH network as offered enhanced rural clinical placements to nearly one in five domestic students and that UDRHs have engaged with health services and communities across 40% of Australia. That’s impressive.

Research output has also been busy with over 40% of publications explicitly addressing a rural or remote health issue.

They stop short of answering the killer question: claiming lack of reliable and comprehensive data to indicate whether this all leads to retention of practitioners in rural or remote practice after graduation. More monitoring required.

Some interesting data for those with an interest:

https://www.rrh.org.au/journal/article/4315

This month’s FOAMEd tip

Communicating with patients about risk – open access module

Having difficulty communicating with your patients about risk? Or in guiding your registrar on this topic?

The Australian Commission on Safety and Quality in Health Care released an open access e-learning module to help in December 2017.

Access the module here:

http://contenttest.learningseat.com/safetyandquality/index.html

How physicians teach in the clinical setting – the embedded roles of teaching and clinical care

An interesting paper by Steinert, Basi and Nugus  from McGill University in Canada.

As many of you commented in last year’s National GP Supervisor Survey, being a doctor means being a teacher.

This was a focused ethnographic study that looked at 3 general internal medicine service teams for a total of 6 weeks in 3 tertiary hospitals

They found 3 major things:

That clinical work and teaching are interconnected

The boundaries between these two functions were blurred. They found that the attending physicians asked questions for various teaching, clinical and supervisory goals in order to obtain: factual information on a patient’s medical history; presenting problems or test results; to ascertain learners’ abilities; or to encourage collaborative problem solving as a team.

Scaffolding (guided supervision for graded responsibility) was also used frequently.

Teaching occurred along a spectrum of planned and opportunistic teaching and included both formal and informal learning.

A multiplicity of teachers

Teaching was diffused among different players and flowed in different directions – in other words, it was vertically integrated.

The influence of space and artifacts (no this isn’t about Indiana Jones meets Star Trek)

The physical space and artifacts embedded in it both enabled and constrained teaching – (artifacts is a fancy name for phones, pagers, patient charts, X-rays, whiteboards).

Interestingly, they found that whoever had the phone in their hand was an unspoken sign of power and who was ‘running the show’.

Enclosed spaces like seminar rooms and patient rooms facilitated confidential conversations and formal teaching. Sometimes patient rooms facilitated opportunistic bedside teaching.

Meeting spaces and ‘the back room’ where electronic patient files were updated, cases, reviewed, conversations with other clinicians took place, phone calls were made – facilitated problem solving.

The cafeteria facilitated informal interactions – no surprises there. Educational ‘war stories’ were exchanged, jokes shared, commentaries on current events swapped.

How the authors put all this together was thus:

The broad types of clinical teaching can be envisaged as occurring on two spectra: planned to opportunistic and formal to informal.

They propose that the framework of work-based learning, where work is a catalyst for learning and and includes observation, participation, and expert guidance in authentic environments.

The study showed how the work environment can provide opportunity and determine the types of educational strategies that can be used in particular circumstances.

Worth a read!

https://doi.org/10.1080/0142159X.2017.1360473

 

 

POLICY NEWS – FEBRUARY 2018

End of year is always a busy time for the government with lots of reports, consultations and issues on the boil.

Here is a summary of what has been happening and what’s currently under review in case you want to participate, make a submission or just get more information! Read on!

What consumers are being told about what to ask YOU!

If you’ve been asked any or all of the following questions, chances are your patient may have seen some of the Choosing Wisely consumer resources.

They’re great questions and ones to which both you and your registrar(s) should probably have the answer!

The website also has a list of recommendations from each of the participating colleges (including RACGP) on what tests, treatements and procedures providers and consumers ought to question, supported by relevant evidence. This in itself is a GREAT resource!

Check it out!

http://www.choosingwisely.org.au/recommendations

If you feel inspired by that, Choosing Wisely is currently seeking EOIs to be on the Choosing Wisely Australia Advisory Group for a 2 year term.

Find the application form here:

http://www.choosingwisely.org.au/news-and-media/media-centre/eois-to-join-advisory-group

Changes to codeine access for patients – be ready

Codeine will become a prescription only drug as of 1 February 2018.

Unsure of what to do? Why this is happening? How to explain it to your registrars or patients?

The decision is in line with 26 other countries which have taken similar action based on good scientific evidence.

Consult the Codeine information hub here:

https://www.tga.gov.au/codeine-info-hub

Closing the Gap Refresh – submissions open 

The 10th anniversary of the Close the Gap strategy sees only one of the targets met (Halve the gap for Indigenous Australians aged 20-24 in Year 12 or equivalent attainment by 2020) and only one of the remaining six targets on track and most not likely to be met.

The Commonwealth Government is consulting on the following questions to revise the strategy

To read the report or make a submission go here:

https://closingthegaprefresh.pmc.gov.au/about

National Alcohol Strategy 2018-2026 – submissions open

The report from the Department of Health has come under fire in some of the medical press.

The report covers national priority areas, collaboration and suggests a target of a 10% reduction in harmful alcohol consumption.

Judge for yourself. You may even want to make a submission by 11 February 2018.

Read the consultation draft here:

Consultation Draft National Alcohol Strategy 2018-2026 – PDF 1020 KB

To make a submission, email nationaldrugstrategy@health.gov.au.

 Private health insurance reform package October 2017- highlights

This package has a number of items of interest including changing coverage for some natural therapies, improving transparency of out-of-pocket costs to consumers and changes to private health insurers to cover travel and accommodation

Some of the work is just getting off the ground so here are some highlights.

Professor Brendan Murphy (Chief Medical Officer) has been given the unenviable task of leading the investigation into out-of-pocket costs and options to ensure consumers are better informed of fees BEFORE agreeing to treatment.

Unenviable because the recommendation from the Senate Committee is for a searchable website with practitioner fees listed. I feel an IT headache coming on!!

The committee has a raft of college and other stakeholder representatives on it but none from general practice.

The Advisory Committee is due to report in Oct-Dec 2018.

The private health insurance rebate for some natural therapies will no longer apply from 1 April 2019.

The list includes: Alexander technique, aromatherapy, Bowen therapy, Buteyko, Feldenkrais, herbalism, homeopathy, iridology, kinesiology, naturopathy, Pilates, reflexology, Rolfing, shiatsu, tai chi and yoga.

A victory for evidence-based medicine?

Some insurers currently offer travel and accommodation benefits only for medical treatment and only in top extras cover. This measure will enable insurers to offer travel and accommodation benefits under hospital cover as well.

A victory for regional and rural patients who currently don’t quite get the value out of their health insurance cover that urban consumers get due to lack of services?

Want further information on the package? You can access it here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/private-health-insurance-fact-sheets

 

 

 

 

ACRRM AGPT | Applications for 2019 opening soon

Applications for training with the Australian College of Rural and Remote Medicine (ACRRM) on the Australian General Practice Training (AGPT) Program open on Monday 26 March 2018.

The AGPT Program with ACRRM isn’t like any other. Choosing to study with ACRRM helps doctors to not only become better doctors, but leaders in rural and remote medicine. If you know someone who has the unique capabilities of practicing medicine in a rural and remote area, encourage them to join ACRRM on their training journey.

Why choose ACRRM?

Training through the AGPT Program towards Fellowship with ACRRM provides a broader set of skills and extended scope of practice for doctors to confidently manage the diverse range of health issues and challenges of rural and remote medicine. By choosing to train towards Fellowship with ACRRM, applicants receive greater choice, diversity, and flexibility throughout their career, a passport to work around the world, and the opportunity to choose from a wide variety of advanced specialized training options.

How to apply:

Step 1 – Eligibility Application

Step 2 – Written Submission

Step 3 – Application Fee

Step 4 – Multi Mini Interview

ACRRM is committed to supporting doctors in rural and remote communities, and offers a personalised service to assist during application. For further information you can visit the AGPT page on the ACRRM website, or contact us at agpt@acrrm.org.au or phone 1800 223 226.

Applications open Monday 26 March 2018.

Find out more at www.acrrm.org.au/agpt.

POLICY NEWS DEC 2017

As we wind down to the end of the year, we look at the latest items in terms of policy including revalidation, cloud-based medicine and patient experiences of general practice.

Read on!

Revalidation – a rose by any other name….

The Medical Board of Australia released its long-awaited response to the Expert Advisory Group on revalidation and their recommendations.

The result is…(drum roll) the Professional Performance Framework.

And all 18 of the recommendations of the Expert Advisory Group were either accepted or accepted in principle.

Not a UK style revalidation system (big breath of relief there). The report notes the progress already made in CPD by colleges and the consistency with the proposals in this framework.

But one not likely to endear itself to those aged 70 years or over who provide clinical care to patients.

That’s a step way back from the profile of those previously identified at risk of poor performance that included being male, over 35 years of age and having prior complaints.

The new system requires peer review and health checks for those aged 70 years and three-yearly subsequently.

It also identifies those at risk of professional isolation and requires them to undertake education on how to identify and manage this risk as well as increasing peer-based CPD.

The PPF also targets those who have had multiple substantiated complaints and will require them to participate in formal peer review.

For everyone else, it’s 50 hrs of CPD with a mix of performance review, outcome measurement and educational activities with CPD to be relevant to scope of practice, based on a personal professional development plan and parked with their “CPD home”. That bit’s new. You’ll need to find yourself a CPD provider (one of the colleges or an alternate provider) and participate in that provider’s program.

And self-directed CPD undertaken outside an accredited CPD program will not be recognized.

Reflective practice also features heavily.

And this will apply to ALL registered medical practitioners.

The other new bit that’s not about revalidation per se but is a welcome step in addressing an age-old problem is that of identifying and managing poor professional behavior in early career doctors. That one’s been hand-balled to the AMC.

None of this is going to happen quickly of course. There will be consultations all the way through to 2020. But some activity on issues such as establishing (or not!) the legal basis of peer review, health checks, data sharing and a revised registration standard will start to be tackled next year.

We will keep you posted!

Read all about it here:

http://www.medicalboard.gov.au/Registration/Professional-Performance-Framework.aspx

The first document is quite helpful and the one-page “pillars” document is very useful.

Cloud-based medicine

For those who were not at GP17, one of the opening plenary speakers was a very hip dude (hey, Jay Parkinson) who has founded a business called Sherpaa – “the world’s first primary care-in-the-cloud practice”.

This is a model of primary care that is…. Interesting. And caused quite a bit of buzz amongst the GPs who attended.

Who knows? It could be the future. Uber, AirBnB, Sherpaa  –  innovation through technology is taking hold in every sphere.

You be the judge: https://sherpaa.com/

You can also view Jay’s plenary address here: http://gp17.com.au/speakers/jay-parkinson

Ps no interest to declare!

Patient experiences in Australia, 2016-17

This is cause for celebration in GP world!

Scroll past the stuff on waiting times, barriers and after-hours care and reflect in the glow of these stats!

Of those who saw a GP in the last 12 months:

(Men reported slightly higher results on these three factors than women).

These figures were 79%, 82% and 80% respectively for medical specialists (which apparently doesn’t include you, or does it??).

But still, those are great stats!

Brought to you by the ABS who successfully carried out the Postal Survey on Marriage Equality!!!

http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4839.0Main+Features12016-17?OpenDocument

Marriage equality – now law

Unless you’ve been completely detached from the electronic world, marriage equality is now law in Australia.

And here is the official bill:

https://www.aph.gov.au/Parliamentary_Business/Bills_Legislation/Bills_Search_Results/Result?bId=s1099

That’s it for Policy News for 2017!

 

 

RESEARCH NEWS – DECEMBER 2017

In this month’s research news we focus in on power dynamics in supervision (“you don’t know the power of the dark side”…), conflict (queue light saber sound), uncertainty (I think) and on the very big difference you make on your patients’ BP.

Read on!

Power dynamics in clinical supervision

It’s often named as the reason why registrars don’t talk about what they perceive to be a poor experience of supervision and a whole range of other things.

The power differential in the supervisory relationship is undeniable but as these authors propose, it can be used positively or negatively.

So what are these aspects of power and from whence do they originate? This paper describes a study, again in clinical psychology, where 9 supervisees were interviewed in depth.

The results identified 5 categories.

An important source of power is the supervisor’s advanced knowledge and experience. This seems obvious and was agreed by all participants.

Unrecognised and unacknowledged supervisor errors erode the perception of expert power. These errors might be clinical, ethical or administrative.

Perceived misuses of power evoke self-preservation in supervisees. This is where the trainee can revert to turning off from the supervisory process in order to preserve their self-esteem or prevent further disappointment. So maybe that disengaged registrar’s behavior is trying to tell you something?

Power is shared when the supervisor demonstrates trust in the supervisee’s ability. This demonstration was often in the form of taking a more collaborative approach with the trainee.

Supervisor’s transparency and nurturance reduces the power differential. Ok so the language is a bit psychologically-oriented but the concept is the same. Roughly translated this seems to be getting at supervisors being able to share their own perceived weaknesses and uncertainty with their trainee.

Any of this ringing bells for you? If you’re interested you can read all about it here:

https://doi.org/10.1080.07325223.201.1295893

A framework for addressing supervisor-supervisee value conflict

Ever had a conflict with a registrar that was about values?

Well this paper from Clinical Supervisor proposes a framework that just might help.

The framework was developed in clinical psychology for managing value conflicts between psychologists and clients, but the framework itself has been adapted by the authors who think it may be useful in any discipline.

The framework is: Detect-Articulate-Respond (DAR).

Would it work in general practice? You be the judge! Tell us what you think. I’d love to know. Drop me an email!

Dunn R, Callahan JL. A proposed framework for addressing supervisee-supervisor value conflict. Clinical Supervisor, 2017:36(2).

Read all about it here:

https://doi.org/1080/07325223.2016.1246395

I’m not sure about this one…

Fascinating paper in Medical Education on the tolerance of uncertainty among GP registrars.

This is yet another paper emerging from the ReCEnT data collection (the study that keeps on giving!).

Seems there are different phenotypes for it! Wow! I didn’t even know there was a gene for it!! My genetics degree has seriously let me down here!

The two ‘phenotypes’ are those with a high affective response to uncertainty, and those reluctant to disclose uncertainty to patients.

The affective aspects of uncertainty were associated with being: female, less experience in hospital prior to commencing GP training and graduation overseas.

The maladaptive response to uncertainty (i.e. reluctance to disclose) was associated with urban practice, health qualifications prior to studying medicine, practice in an area of higher socio-economic status and being Australian-trained.

Read it hear, unless you’re unsure…

https://doi.org/10.1111/medu.13408

“About your blood pressure …”

Ever doubted that all that emphasis on communications skills in training is worth it?

Interesting paper in this month’s Medical Teacher encourages you to keep it up if you want to have a positive impact on hypertension outcomes.

This was a RCT conducted in Iran that showed that brief communications skills training for health providers seems to improve patient-provider communications skills AND improve hypertension outcomes in those with uncontrolled BP.

The intervention consisted of attendance at 3 focus group discussions and 2 training workshops. “Too much!” I hear you say but the results are quite impressive with SBP dropping by some 21 points and diastolic by 13.

Read all about it here:

https://doi.org/10.1080/0142159X.2017.1395002

And that’s it for 2017!

If you have any comments to make, suggestions, or even good articles you want to share with your colleagues please let me know at joan.burns@gpsupervisorsaustralia.org.au

Wishing you all season’s greetings and see you in 2018!