The end of a year is always a time for reflection. GPSA has continued to enhance our role in the General Practice training space. Our open access educational resources are used widely nationally and in attending WONCA in Seoul this October I was able to take them onto an International stage.
Our employment and practice support resources provide valuable advice to training practices and Supervisors. The NTCER will continue in its current form with Medicare indexed salary increases.
Australian General Practice is one of the best in the world. To maintain that, we need high quality training practices and Supervisors, that are well supported.
The Federal Government recognises this and funds GPSA to:
GPSA also represent and support you, our members :
2019-2021 will see more change in the General Practice training environment with the transition of control of training to the two Colleges. We will work closely with the Colleges, GPTAC, RTOs and GPRA to ensure the transition is as smooth as possible for our all training practices and supervisors.
It is with great pleasure that I welcome Dr Sarah Chalmers to the GPSA board. Sarah brings a wealth of experience as a remote GP, Senior lecturer in Remote medicine and SLO for NTGPE. Her knowledge will assist GPSA to play its part in encouraging more GPs to train and stay in rural and remote areas.
I would like to thank the GPSA Board, our CEO and staff for a year of hard work and achievement and to our members and all who read this newsletter for the support you give us.
I wish you all a happy festive season.
POLICY NEWS DECEMBER 2018
New Medical Board guidelines on sexual boundaries
The Medical Board of Australia has released new guidelines – Sexual boundaries in the doctor-patient relationship. These guidelines replace the previous Sexual Boundaries: Guidelines for Doctors.
The new guidelines came into force on 12 December 2018 and apply to all registered medical practitioners in Australia.
Read the Medical Board summary here:
And the guidelines and a video can be found here:
National Training Survey
The Medical Board of Australia will be running a National Training Survey to understand the quality of medical education in Australia.
The MBA want all doctors (including registrars and supervisors) to participate.
The Guiding Principles are quality improvement, safety and confidentiality, a focus on training, reflection and feedback, easy online access, transparency via publication of results and participation.
An external provider has been selected and via registration data, it has been determined that there are more than 28,000 doctors identified as ‘in-training’.
So expect a survey sometime in 2019!
Health Professional Online Services – implementation of recommendations
Following the Independent Review of Health Providers’ Access to Medicare Card Numbers, the recommendations continue to be implemented.
The key message: if you have an HPOS and you do not log in for 6 months, your account will be suspended. You’ll also need to update your delegated access every year. That’s as of September 2018 so if you haven’t logged in since then, you need to do so by March 2019.
Read the report and recommendations here: https://www.humanservices.gov.au/organisations/health-professionals/subjects/independent-review-health-providers-access-medicare-card-numbers
Research Roundup – DEC 2018
Finishing the year with a bang! In this month’s Research RoundUp we present the paper on the Supervisory Relationship Measure, let you know how mobile devices can best be used in clinical placements, provide the valuable tips on giving feedback to your peers, and finish with a dose of festive kindness!
Adapting the supervisory relationship measure for general medical practice
In last month’s Research Roundup, we put in a plug for the GP Supervisory Relationship Measures – one for Supervisors (GP-SRMS), one for Registrars (GP-SRMR).
We now have a published paper on the GP-SRMS.
You can read it here: https://rdcu.be/bb6rW
And the tools are here:
And the registrar version here, should your registrar wish to do likewise.
What works best for health professions students using mobile devices for educational support on clinical placement?
This wonderful guide by Maudsley et al will get all you tech-savvy supervisors excited about how best to use these beasties!
It’s a great paper that looks at all the evidence on how best to use mobile devices in clinical placements.
The findings cover the broad types of devices, use and functions including ‘just in time’ aspect.
The evidence is presented regarding:
They find that mobile devices have particular supported student assessment, communication, clinical decision making, logbook/notetaking, and access to information.
And the final recommendations regarding practice?
The authors also provide recommendations on further research that are well worth a read.
Read all about it here: https://doi.org/10.1080/0142159X.2018.1508829
Twelve tips for providing feedback to peers about their teaching
Now it’s well known that providing feedback to registrars is bread and butter work for supervisors.
Newman, Roberts and Frankl argue, however, that providing feedback to peers is a very different kettle of fish.
They note two models: expert-to-novice teaching (for evaluation purposes); and peer-to-peer (for formative, collaborative purposes).
They define peer observers as colleagues sharing the same goals of reflective practice, identifying best methods for teaching and solving problems through discussion of a teaching encounter.
They argue that peer observations can lead to a collective culture change.
So what are the tips?
Go forth and feed back!!!
Read all the detail here by cuttinng and pasting link in your browser: https://doi.org/10.1080/0142159X.2018.1521953
And to finish the year and in keeping with the festive season, here is a great paper that promotes kindness.
Show a little kindness
This reflection piece by Brewster and Waxman encourages all clinicians to just be a little kinder. They draw on the concept of the ISBAR for clinical handover (introduction, situation, background, assessment and recommendation) and suggest adding a little kindness to it to create the K-ISBAR.
They challenge all to use the K-ISBAR approach at clinical handover.
Worth reading? Worth doing! And couldn’t we all do with a little more kindness in our workplace?
That’s it from Research Roundup for 2018!
As the year races to an end, I am always impressed at how our large multinational service industries draw on big data to anticipate and deliver what they think we need… when, where and how we need it.
That is not to say that despite all of the data and responsiveness that they always get it right. Look at the plastic bags saga. Woolies spent no time in the spotlight and Coles quite a bit of negative attention based on their varying strategies around the same issue.
Learning how to deal with big data, consumer expectations and our evolving work environments is essential. The same is becoming true in healthcare and General Practice will be swept along with this trend whether we like it or not.
Your average consumer before smart devices was not tracking their food macros, sleep quality, or even as aware of how much more interesting other people’s lives appear on social media than their own… like everything, for better or worse this awareness is not likely to go away any time soon. So why not focus on using this information to inform better the service we provide to our internal and external stakeholders? What big data does your practice have access to? Are you using it for the asset that it is?
As we move into the new year, General Practice Supervisors Australia are looking at what resonated the most with the membership over the past three years to ensure we continue to deliver more of the support you need and less of the things that didn’t register.
One thing is clear, members, now more than ever, are seeking advice around performance management, business optimisation, employment contracts, NTCER, in practice teaching resources, and we’ve heard you loud and clear. It’s perhaps reflective of the cost of doing business when things don’t go well and the tighter fiscal and competitive environment we all operate within.
Whether it is a supervisor contracting services from the practice, a practice owner or a registrar learning their discipline, there is one thing that unites us all – we’re all service agents in a market which is driven by consumers.
Consumer demand will always be driven by needs. Have a look at the after hours services delivered over the past four years, whilst not reducing emergency presentations… if we as general practitioners don’t fill a need – there is always someone who will.
We cannot then be unhappy about someone else filling a need when we weren’t happy to fulfil the need ourselves.
As we move into the new year, may we all reflect on what things we do well, where the efficiencies are and where the industry is headed.
POLICY NEWS – NOVEMBER 2018
This month in Policy News we look to the areas where future policy will be needed, particularly around….you guessed it! artificial intelligence and all things robotic!
Rail as we might against change it’s always more effective with good policy
New Chair of the Medical Board of Australia announced
Following Joanna Flynn’s departure at the end of her tenure, a new Chair has been announced.
Emeritus Professor Anne Tonkin is a physician and clinical pharmacologist. She was also a previous chair of the SA Medical Board.
SA is becoming quite the place to be!
Changes to National Register
Links to public tribunal decisions when serious allegations have been proven will be published on the national register of practitioners in the interests of transparency for the public. This commenced for medical practitioners early in 2018 and will now be extended to all registered health practitioners.
By early 2019, all back decisions will be added with new decisions to be added as they occur.
Read about it on the AHPRA website:
Mandatory reporting laws
Much has been said and written about this issue, particularly whether practitioners treating other practitioners should be exempt from mandatory reporting requirements.
Apparently health ministers have listened and proposed amendments to the legislation will provide a balance between risk to the public and enabling practitioners to seek treatment without their treating practitioners necessarily having to make a mandatory notification.
The Tranche 1A amendments will be introduced into the Queensland parliament (where the National Law was originally legislated, with other jurisdictions then having mirror legislation). The National Law Regulation 2018 will apply to all jurisdictions, including WA, making it a truly National law.
Read the COAG communiqué here:
Snakes and Ladders – the journey to primary care integration
This report by Consumers Health Forum, UQ and The George Institute identifies 5 key themes and 10 priorities for the implementation and transformation required to have genuinely integrated primary care.
The 5 themes and 10 priorities are:
It comes with a five-year plan and an impressive list of participants in the roundtable discussion that helped inform the report.
Read the report here:
“Australian health system set to fail”
That’s the verdict of KPMG in a report just released about connecting people with progress.
For progress in relation to health care, think “a future where Australians have equal access to appropriate health and human services when and where they require the service, regardless of their geography and other demographic characteristics.”.
They identify 4 tactics to move healthcare into the future:
And yes! Many of these things are already happening!
It’s a fascinating report that takes a whole-of-society perspective.
View the whole report here:
The internet of medical things (IoMT)
You’ve heard of “the internet of things?” (IOT) – an information system infrastructure for implementing smart, connected objects Framling K, 2003).
Well this report is about the internet of medical things (IoMT).
What is the IoMT? A connected infrastructure of health systems and services, according to Deloitte.
This report claims that the global market for wearable devices and remote patient monitoring systems is expected to reach US$612 billion in 2022.
What does this market consist of? Check out this list:
The future is that we could all become cyborgs (hopefully not all like Arnie! Or that other nasty silvery guy…)
Read about it here:
Clinical supervision in Australia – challenges and opportunities
A paper by Martin et al in the MJA highlights the need to build clinical supervision capacity to support the rural medical workforce.
It provides an example using the Queensland Rural Generalist Program and the Central West Single Practice Service Model, which approaches managing the district’s workforce as one large practice rather than multiple small practices. The authors claim that this approach has more than doubled the medical workforce in Longreach.
They recommend for rural communities that:
Read the full article here:
Neuroticism and burnout
Ever wondered if that ever-so-slightly neurotic registrar might be a candidate for burnout? Turns out you’re probably right.
A study by Prins et al in Holland defined burnout as “a prolonged response to chronic emotional and interpersonal stressors on the job defined by three dimensions: emotional exhaustion, depersonalization and a low sense of personal accomplishment”.
Some have proposed that healthcare workers may have personality traits that make them more susceptible to burnout.
This study looked at associations between residents’ personality traits, specialty, and symptoms of burnout.
The results? Neuroticism had a strong association with burnout irrespective of specialty.
Neuroticism was significantly correlated with perception of higher workload, less autonomy, less peer support and less satisfaction with work/life balance.
Sound like anyone you know?
Read about it here:
Responding to microaggression and discrimination by patients
This is a great 12 tips paper that helps you to help your registrar deal with incidents of aggression by patients. It’s a bit hospital focused but a lot of the advice is translatable to the GP setting.
What is “microaggression?” I hear you ask? “Brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative slights and insults that potentially have harmful or unpleasant psychological impact on the target person or group” (Sue et al. 2007).
In brief, the tips are:
The tips are illustrated with some great scenarios and examples.
Read about it here:
Endemic unprofessional behavior in health care
A paper by Westbrook et al in the MJA outlines the recent history of surveys and reports of bullying, harassment and unprofessional behavior that have riven the sector in recent years. It also points to the limited evidence base when it comes to knowing what works in terms of effective interventions.
It also describes organizational professional accountability programs such as when staff can report negative or positive behavior anonymously online with the purpose being for designated peer review messengers to convey to the subject of the complaint the impact that their behavior is having on others with the intention being to encourage reflection and behavior change. This approach originated in the US but is apparently being used in some Australian hospitals, including the Royal Melbourne.
Another example described is the rollout of a program called “Ethos” in the St Vincent’s group, with the aim of redefining normal and tackling unprofessional behavior across all staffing groups and will be evaluated over a 4-year period.
The paper calls for a greater investment in research on behavior, teamwork and culture and unprofessional behaviour change in order to deal with the problem.
Read about it here:
GP supervisory relationship measures
GPSA’s contribution to this space is the development, in partnership with General Practice Training Tasmania (GPTT), GPEx and Monash University, a set of tools to measure the supervisory relationship. These tools – one for supervisors (GP-SRMS) and one for registrars (GP-SRMR) can be used by individuals for reflection. They have been validated for use in the AGPT program*. And they may also have wider uses yet to be identified and tried.
For now though, if you want to reflect on your supervisory relationship with your registrar, you can download the tool as a writeable PDF and keep the results entirely to yourself, purely for your own information and reflection. We’re working on delivering these tools to you as an app which will also shorten the number of questions.
You can find the GP-SRMS here:
And the registrar version here, should your registrar wish to do likewise.
We’d love to hear any feedback from you on how you find these tools.
You can email firstname.lastname@example.org or give me a call on 0472 520 611
*The GP-SRMS and GP-SRMR were developed as part of a research project supported by the Royal Australian College of General Practitioners with funding from the Australian Government under the Australian General Practice Training Program.
GPSA exists to support supervisors. We have had a request this month from a supervisor member for assistance in disseminating a survey as part of his PhD. Should you wish to support your fellow supervisor, you can find out more about the study here:
Atrial fibrillation (GPSAFER) study
|Atrial fibrillation and other arrhythmias are associated with higher morbidities and mortality. Should you screen asymptomatic patients? What is the role of mobile ECG devices? What is your need for ECG interpretation training? University of Sydney is conducting a 5-minute survey. Three $50-giftcards will be given away. Please click the following weblink to find out more about the GPSAFER study: https://redcap.sydney.edu.au/surveys/?s=RPH8AY9NNN
We have also had a request to assist with an evaluation of dementia GP support services. You can participate here:
Help improve dementia support services for GPs – survey
The Rosemary Bryant AO Research Centre at the University of South Australia is conducting an evaluation of the:
Doctors, nurses and allied health professionals who work with people living with dementia are invited to complete the anonymous survey at: https://www.surveymonkey.com/r/RRW6PBD
The survey closes on 30 November 2018.
AHPRA is currently consulting on amendments to the National Law in order to keep the Law up to date and fit for purpose. In particular, there are specific consultation questions relating to a number of issues including:
If you want to read the consultation paper or make a submission, you can find the links here:
Submissions close 31 October.
A potentially preventable hospitalization (PPH) indicator for general practice
Hot of the press, a consultation paper developed by the AIHW and RACGP was released by the Australian Government on 4 October.
The paper looks at the development of a potentially preventable hospitalization indicator for general practice.
Potentially preventable hospitalization indicators focus on conditions that may be prevented or managed best by general practice to minimise likelihood of hospital admission.
PPHs are used internationally and can be used to look at access to primary health care.
The RACGP’s aim is for a more clinically useful measure that may be better applied to education and performance assessment, targeted interventions for problem areas and performance monitoring.
A potentially preventable hospitalisation has been defined as:
Admission to hospital for a condition where the hospitalisation could have potentially been prevented through the provision of appropriate individualised preventative care and other health interventions delivered by general practice teams.
General practice teams are defined as:
The general practice team consists of all people who work or provide care within the practice. Practice teams are often multidisciplinary, made up of GP leaders, nurses and allied health professionals designed to service the unique requirements of each community.
There are a series of focused questions for feedback.
Find the paper here:
Submissions must be provided via email to the AIHW <PPH_feedback@aihw.gov.au> by 4 November, 2018.
New Medicare Schedule and other educational resource links
The Australian Department of Human Services has updated a number of its educational resources including the 1 July MBS Schedule.
Here are the most recent resource links:
You can find more here:
Department of Health is currently consulting on the Draft Charter of Aged Care Rights. The draft charter outlines these rights as follows:
| I have the right to:
a) receive safe and high quality care and services
b) be treated with dignity and respect and to have my individuality valued
c) have my identity, culture and diversity valued and supported
d) maintain my independence
e) live without abuse and neglect
f) be informed about my care in a way that meets my needs, have access to information about my rights, care, accommodation and anything else that relates to me personally, and get the information I need in a timely way
g) maintain control over, and continue to make decisions about, my care and personal and social life
h) be listened to and understood
i) choose to have another person speak on my behalf
j) complain, and to have my complaints dealt with fairly and promptly
k) exercise my rights without it adversely affecting the way I am treated
l) personal privacy and to have my personal information kept confidential
You can find the consultation paper, draft charter and online survey here:
With a Royal Commission into Aged Care Quality and Safety recently announced, consultations the Terms of Reference for the Royal Commission are currently being developed.
You can find out more here:
Colonoscopy clinical care standard
A colonoscopy clinical care standard was recently released by the Australian Commission on Safety and Quality in Health Care.
You can find the standard here:
The 70th anniversary of the much-maligned NHS was celebrated with a review!
The Lord Darzi Review of Health and Care has delivered a 10-point plan to reorient the NHS into the 2020s and a 10-point ‘offer to citizens’.
Here’s a teaser from the 10-point investment and reform plan:
And from the 10-point offer to citizens:
Read the summary here:
In this edition of Research Roundup we have a selection of 5 papers on some topics close to every GP’s heart!
Selection and recruitment, CPD, emotional intelligence, accreditation and continuity of care.
Feast your eyes on these!
Emotional intelligence – 12 tips
So all of you who have been following developments in GPSA research on the GP Supervisory Relationship Measure for Supervisors (GP-SRMS) and the newly minted partner tool, the GP-Supervisory Relationship Measure for Registrars (GP-SRMR) will have learned about the role that the registrar’s perception of the emotional intelligence of the supervisor plays in the educational alliance.
Beyond that, however, emotional intelligence is rapidly gaining currency for its potential contribution to the development of a culture of professionalism AND the good news is that some elements of it can be learned.
This 12 tips paper covers how to introduce EI into the curriculum.
This paper is well worth the read. My prediction? EI will be the next big thing.
Read all about it here:
2018 Ottowa Consensus Statement: selection and recruitment to the healthcare professions.
Everyone wants to recruit ‘the best’ people to healthcare, right? And we’ve been experimenting across the globe with all sorts of systems, processes and methods to select ‘the best’.
Well this paper is the update of the 2011 Ottowa consensus statement on selection.
It includes a terrific little summary of the evidence for selection methods including:
This paper goes to the nub of the issue: what outcomes are we trying to predict?
And if there is no generally agreed-upon gold standard that measures the performance of a practicing health professional, how can we choose a selection method that will predict that performance?
A bucket is tipped on some of the more recent trends in selection whilst others are supported.
The paper discusses the merits of these methods and makes 10 recommendations and calls for an expansion of methodological approaches.
Read all about it here:
Translating evidence into practice: lessons for CPD
We all love translational research, right? Getting that evidence into practice – nirvana!
So why does it so often go wrong with CPD?
Well this paper thinks it has the answers! And it involves 4 groups:
And there you have it! You don’t have to do a thing!
Read all about it here:
Is accreditation still relevant??
You bet! And for a couple of reasons.
This paper reflects on the role of accreditation as a driver for quality improvement and in particular, Australian Medical Council (AMC) accreditation of specialist training programs and compares accreditation systems internationally.
This paper notes that while the AMC’s objectives are similar to those of other accreditation bodies internationally, practices differ.
The paper goes on to suggest that the AMC could reorient its accreditation of specialist training programs from a focus on compliance and standards to one that emphasizes the colleges’ and facilities’ self-assessment and quality management processes and thus be more in line with international trends where the emphasis is on continuous quality improvement and self-evaluation.
The paper highlights that, in the Australian accreditation process, the colleges are entrusted with significant power and responsibility for training because the colleges set the curriculum and the standards for training and accredit the training sites themselves.
The authors also note that, by comparison with systems in Canada, the US, UK and the Netherlands; the AMC “is remote from the workplace” in terms of accreditation of training sites. They note that these other countries have accreditation processes that focus at a regional or training site level, not the national level as we do here in Australia via the colleges.
With the training program going back to the colleges, who knows what this may mean for accreditation???
Read it for yourself, here:
Continuity of care and mortality – is there a relationship?
As it turns out, yes, there is.
This paper is a systematic review of continuity of care and mortality and looks at the literature from 1996 to 2017 on continuity of care received by patients from any kind of doctor (i.e. generalist or specialist), in any setting, in any country and the measured mortality of the patients.
Continuity of care is defined here as “repeated contact between an individual patient and a doctor”.
The paper emphasizes the interpersonal aspects of care and challenges the notion that “non-personal care” (read ‘care by app’) should be the default option.
This (I think, scary) scenario was suggested in an opinion piece that describes some developments already happening driven by a business model that puts the face-to-face experience as a last resort option.
Although the evidence is lower quality (i.e. mostly observational) it does show that patients across all cultural boundaries appear to benefit from continuity of care with both generalist and specialist doctors and experience lower mortality rates.
Viva la face-to-face doctor visit!
Read the paper here:
And the scary opinion piece here: https://doi.org/10.1056/NEJMp1710735
You be the judge!
Become an ACRRM member today
The Australian College of Rural and Remote Medicine (ACRRM) is committed to making a positive difference to members through their exclusive member benefits. By becoming a member with ACRRM you’ll get:
As a member of ACRRM, you’ll play an integral role in shaping the future of rural medicine. Become an ACRRM member today!
There is great satisfaction in mentoring GP registrars in a rural practice, according to veteran South Australian GP supervisor Dr Martin Altmann.
These rewards range from helping registrars develop confidence and experience, teaching procedural skills needed in rural settings, to inspiring young doctors to immerse themselves in rural practice and lifestyle beyond fellowship.
Martin became the first GP supervisor at Bridge Clinic in Murray Bridge when he and GP wife Fiona Altmann joined the practice 26 years ago.
It was not long before his colleagues, Fiona included, followed suit: the practice now has a one-to-one supervisor-to-registrar ratio, with up to six supervisors each supporting a registrar at once.
Martin, a GP obstetrician, has supervised more than 30 GP registrars, and is enthusiastic about continuing his mentoring role.
“Because we are rural, we try to train registrars in procedural skills, such as obstetric, anaesthetic and emergency medicine,” he said.
“Our doctors at the clinic provide in-patient care, obstetrics, anaesthetics and emergency medicine care after hours.
“We try and get the registrars involved in community and sporting events. Patients love to see the doctors involved in their community.”
Martin credits great mentors throughout his own training, for his initial motivation to teach registrars.
The Altmanns settled in Murray Bridge in 1992 on the back of three years procedural training in Somerset, England.
“I worked half of the time in obstetrics at the hospital and half of the time as a rural GP. Fiona worked in anaesthetics and intensive care,” Martin said.
The pair’s commitment to medicine in rural Australia was recognised in 2013 when they were named joint winners of the Rural Doctors Association Australia Rural GP of the Year.
“We love the variety of work, the challenges and the rewards of cradle-to-grave care across many generations of local families,” Martin said.
In terms of his role as a supervisor, Martin said teaching – and learning from – registrars kept him young and up-to-date, and he credited patients’ receptiveness to care in a training practice as important to successful supervision.
He enjoys watching his registrars’ confidence and experience grow, and helping them understand their value in a rural practice’s workforce.
“Registrars are a great workforce contribution and are very valued by our practice and patients.
“It’s really rewarding to see them stay in our community or go to other rural communities where they are very valued.
“It’s always satisfying to hear they have progressed to supervision themselves.”
Martin’s advice to other supervisors is to touch base daily with their registrar and ensure they are coping.
“Through our experience we can help registrars problem solve, and teach them they don’t have to solve all problems on the same day; that often time, nature and common sense declare the problem.
“We can teach them to work through that uncertainty and not become overwhelmed by it.”