There were several factors that led me to nominate for a position on the (National GP Supervisor Association) Board in 2012.
I was a solo rural procedural GP who had been “headhunted” by a Regional Training Provider (RTP) to train GP registrars a decade earlier.
At that time, I had been involved in undergraduate medical training and post-Fellowship medical education. I felt this to be a great opportunity to pass on some knowledge and skills in a supportive rural training environment. It did also cross my mind that that my 2000 patients may appreciate this opportunity to grow my practice.
I can say without reservation that all of my registrars have fitted in to our small practice extremely well and have been most appreciated by patients, staff and myself. That is not to say that there have not been challenges.
I found being an educational contractor to a RTP, an employer and a mentor to registrars and practice owner to be (at times) very difficult.
When suggesting that perhaps the RTP could look at employing the GP registrars, I was surprised to be told “we would have to have rocks in our head to do that”. This left me to ponder what exactly was happening in Supervisor heads generally.
I looked at the very variable terms of engagement that RTPs were placing upon supervisors, this included:
I say “placing upon” to illustrate the power imbalance that existed between very large, well resourced training organisations and many isolated (often small) practices. The “take it or leave it” method of negotiation often left supervisors and practices with very few options. The fear that a registrar may not be allocated has become a very significant factor in training practice engagement.
The consulting room that you have built and equipped, the staff you have employed, the patient numbers you have built up cannot be undone when a registrar is not “allocated”. It is not a tap that can be turned off and on at will.
Enhanced GP registrar employment conditions previously detailed in some RTP-training practice agreements may serve the purpose of attracting registrars but, if too one-sided, will risk the long-term viability of training practices.
With increasing practice costs and a relatively reducing practice income, a perfect storm was on the horizon to threaten GP training.
The NGPSA became GPSA (GP Supervisors Australia). Through the kindness of GPET, the Department and successive Ministers, our organisation has grown and the support for supervisors and training practices has exploded (in a good way).
Changes in Government direction led to RTPs reducing in number and becoming RTOs (Regional Training Organisations) and then an announcement by Health Minister Greg Hunt detailed GP Training was being handed over to the Colleges (ACRRM and RACGP).
GPSA has spent several years formulating a National Terms and Conditions for the Engagement of Supervisors (NTCES) and it now seems the time is right for a nationwide agreement to be set in place.
Further discussion will be taking place with ACRRM and RACGP as the organisations responsible for future GP training.
We currently have an agreed National Terms and Conditions for the Engagement of Registrars (NTCER) which is intended to establish a “fair and sustainable basis of employment between the employer and registrars in order to support an appropriate education and training environment, within the context of delivering safe and high quality services in a general practice setting. These terms and conditions represent what is perceived as acceptable by GPRA and GPSA and have been designed to provide a fair and reasonable financial return for all parties.”
Negotiations with GPRA are about to begin again and the GPSA position remains that while paying the agreed base salaries we should:
We call these the three pillars of sustainable training – bending any of these can lead to very adverse financial outcomes.
Feedback regarding any other issues to be considered in the NTCER (or NTCES) negotiation would be very appreciated.
No one wants to hop out of the GP training saucepan or “boil the frog” that may or may not be responsible for GP training.
(The boiling frog metaphor reminds us to be aware of even small adverse changes lest they suffer eventual undesirable consequences).
POLICY NEWS APRIL 2018
2018 is a re-negotiation year for the NTCER.
Thanks to all of those who responded to our quick survey on issues or changes they would like to the next NTCER.
GPSA provided the names of the GPSA Negotiating Team to GPRA and AMA in November 2017.
We are currently awaiting the names of the GPRA Negotiating Team and a log of claims.
We will keep you posted!
AGPT policy review – changes for 2019
The AGPT program reviews its policies annually. There are a number of changes to the policies that GP Supervisors should be aware of with the main ones affecting:
And of course, the addition of a Rural Generalist Policy for the first time.
Get all the details here – the overarching document it the best one to look at for a quick overview.
COAG – Mandatory reporting guidelines changes
No doubt in response to calls from the sector, Ministers agreed to change the legislation to enable practitioners to seek appropriate treatment without fear of their treating practitioners being required to make a notification.
The changes stop short of moving to the full WA model that has been in place since 2010 but is an improvement on the draft.
No doubt the devil will be in the detail! We’ll keep you posted!
Medical Board of Australia – consultation on divulging where you practice.
The MBA is currently consulting on a proposed guideline for informing them about where you practice.
The guideline would apply to practitioners who:
The consultation paper and a survey can be found at:
Survey closes 14 May 2018.
Written submissions close 25 May 2018.
Medical Board of Australia – recent research on older doctors supports Professional Performance Framework
The latest MBA newsletter cites recent research on older doctors (i.e. over 65 years) that indicates they are at higher risk of notifications.
This research is featured in this month’s Research Roundup – read all about it there!
RESEARCH ROUNDUP APRIL 2018
Research finds that older doctors have higher notification rates
You’re all aware of the findings of the Expert Advisory Group on Revalidation that reported on the risk of age (i.e. over 65 years) being a risk factor for notification?
Well here’s a paper that backs that up.
This paper examines whether ‘older doctors’ are at a higher risk of notification than those aged 36-60.
And the answer is: they are! 37% more! Mostly related to:
Read it for yourself here:
Last month you were promised coverage of any interesting papers on health professional education featured in MedEdPublish.
Here are 3 papers highly relevant to supervisors that just might float your boat!
Feedback – different sources, different uses – support for the apprenticeship model?
This interesting paper examines feedback given to medical students by junior doctors and compares it with that given by consultants.
Unsurprisingly perhaps, that given by junior doctors was useful regarding assessments; that given by clinicians was more geared toward clinical practice.
Perhaps what this paper really represents is support for the apprenticeship model.
Make up your own mind! Read it here:
“Recognition” (i.e. required training) for supervisors – the UK experience
So in our last Supervisor Survey, we asked you whether you thought there should be a mandatory qualification for supervisors.
The result was an overwhelming no, but with a lot of caveats related to protected time, who pays, grandfathering, the value of experience and so on.
Some thought it was an inevitable expectation particularly as a younger generation wash through the system.
Some said they would walk away from training.
Turns out your UK counterparts have a similar reaction!
However it’s now a requirement over there!
Here’s a take-home message for policy makers though:
“For some it has made them decide whether they wish to continue in a named supervisory role, resulting in some clinicians having to take on the responsibility of supervising additional trainees. This appears to be a risk of the process” (p19).
With the tsunami of medical students yet to fully hit, it’s a message that needs to be heard in Canberra…
Professionalism = courage, humility and mercy?
The literature and the sector have waxed and waned about professionalism since, well, time immemorial really.
Definitions are not necessarily easy to come by but everyone seems to recognize it, particularly the lack of it, when they see it.
At Michigan State University, they introduced a Virtuous Student Physician curriculum (great name!).
The attributes were:
So far so good!
However, students then began complaining that staff were not exhibiting these attributes themselves, thus promoting the oft-spoken of “hidden curriculum”!
In reviewing their program, what emerged was that these attributes were actually responsibilities and that possession of these attributes was a bare minimum.
Because they are aspirational and often difficult to achieve. But the pursuit of excellence should drive us all toward them.
So they boiled it all down and percolated it all up and what emerged was the attributes listed above as a minimum, but in the pursuit of excellence, these were encompassed by the virtues of courage, humility and mercy.
A really interesting approach to a complex topic that is still befuddling a lot of medical schools and colleges.
Be courageous, humble and merciful when you read all about it here:
POLICY NEWS – MARCH 2018
Rural Generalism: the Collingrove Agreement
Amazing what a meeting in a wine-growing region and a new face can do for a rift that’s been going on for years.
Rural Health Commissioner Emeritus Professor Paul Worley, ACRRM President Associate Professor Ruth Stewart and RACGP President Dr Bastian Seidel met and agreed on rural generalism.
Hurrah! In case you missed it, here it is:
The Collingrove Agreement (February 2018)
Representatives from the Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM) recently met with the National Rural Health Commissioner at Collingrove Homestead in the Barossa Valley, South Australia, to explore opportunities for collaboration.
The two Colleges are determined to secure a strong, sustainable and skilled national medical workforce to meet the needs of our rural and remote communities. The two Colleges have agreed to work together to lead the development of a national framework for Rural Generalism.
Consistent with the Cairns Consensus Statement on Rural Generalist Medicine and acknowledging the contextual position statements on Rural Generalism by ACRRM and the RACGP respectively, the two Colleges propose that a Rural Generalist (RG) is a medical practitioner who is trained to meet the specific current and future health care needs of Australian rural and remote communities, in a sustainable and cost-effective way, by providing both comprehensive general practice and emergency care, and required components of other medical specialist care in hospital and community settings as part of a rural healthcare team.
A Rural Generalist Pathway Taskforce is being formed, led by the National Rural Health Commissioner, which will ensure broad input from across the rural health sector into this Pathway. Further details of, and ways to contribute to, this historic work will be announced soon.
A significant first run on the board for the Professor Worley.
Watch this space for further developments!
Consultation on revised sexual boundaries guidelines
The Medical Board of Australia is conducting a consultation on revised changes to the sexual boundaries in the doctor-patient relationship guidelines. The revised guidelines take in the findings of the chaperone review.
Consultations are open till 29 March 2018.
Make a submission here:
National Health Genomics Policy Framework and Implementation Plan – information
Never hear of genomics? “You will young Skywalker, you will”. And how is it different to genetics?
The first National Health Genomics Policy Framework (and Implementation Plan) was quietly released in November 2017.
The focus is on genomic testing to prevent, diagnose, treat or monitor disease.
Sadly, there isn’t actually a definition of genomics in the entire document (although they do say that in this document, genomics refers to both the study of a single gene and the study of an individual’s entire genetic make up and how it interacts with environmental or non-genetic factors),
Here’s one from the WHO http://www.who.int/genomics/geneticsVSgenomics/en/ ):
“Genomics is defined as the study of genes and their functions, and related techniques. Genetics is the study of heredity.
The main difference between genomics and genetics is that genetics scrutinizes the functioning and composition of the single gene where as genomics addresses all genes and their inter relationships in order to identify their combined influence on the growth and development of the organism.”
The 5 Strategic Priority Areas are:
Find the policy framework here: (you’ll have to scroll down the list to find it! – it’s alpahabetical)
Find the implementation plan here:
Expect to hear a lot more on this topic in future. We’ll keep you posted!
Self-reflection and the law
There was a huge outcry over the treatment of Dr Bawa-Garba, when some of the UK paediatric registrar’s self-reflection statements were used against her in court.
Everyone is wondering what this means for them at a time when the Medical Board of Australia has launched its Professional Performance Framework, which encourages reflection.
Time will tell……
RESEARCH ROUNDUP – MARCH 2018
Have you come across MedEdPublish yet? It’s the European Association of Medical Educators’ (AMEE) open access journal. Edited by local Aussie med ed identity Professor Richard Hays, this journal enables post-publication peer review.
Next month’s theme is ‘the development of health professional educators’.
I’ll keep you posted on any interesting papers!
Twelve tips to promote a feedback culture
As you know – GPSA in collaboration with GPTT and Monash University received an Education Research Grant* to adapt and validate a tool for measuring the educational alliance – the GP Supervisory Relationship Measure (GP-SRM).
This paper by Ramani et al provides 12 tips to promote a feedback culture that swings the feedback pendulum from recipes to relationships.
And that’s what the GP-SRM does!
Tip 7 in this paper is “establish an educational alliance”. The GP-SRM measures the educational alliance from the supervisor’s perspective. It also promotes reflection.
GPSA will be launching the GP-SRM soon, including running workshops with Supervisor Liaison Officers and supervisors to get them using the tool.
Keep an eye on our e-news and website for more details!
The 12 tips in this paper are:
A terrific paper! Read it here:
* the GP-SRM project was supported by funding from the Australian Government under the Australian General Practice Training Program and support from the Royal Australian College of General Practitioners.
This fascinating paper by KPMG looks at the trends, predictions and actions that healthcare leaders can take.
Their snapshot of trends and predictions is:
Healthcare as a service (I thought it already was??)
Consumer held electronic medical record (ahem!)
IoT (that’s the Internet of Things) enabling outcome based care anywhere
Wearables, digestible and implantables
Precision medicine: genetics environment and lifestyle
Practice based evidence (using data analytics and quantum computing, wow!)
AR/VR (that’s augmented and virtual reality)
3D printed casts (no more plaster of Paris!), implants and organs
Human augmentation: rise of the cyborg (scary/amazing)
Treating and preventing diseases with gene therapy
Building a closer relationship between humans and AI (“Dave? Dave? I can’t let you do that Dave”)
Automation: rise of medical robots (yep, a robot that does brain surgery in 2.5 mins instead of 2 hrs – but it’s not like it’s brain surgery – oh, wait a minute, yes it is!)
Medical drones and autonomous vehicles (no, not your worst-ever lecturer, those little gizmos that fly around can deliver things to rural and remote Australia!)
Hospital design evolution (oops! Don’t mention that one around Adelaide!).
Read it here – It really is fascinating and easy to read:
Will robots really steal our jobs?
This report by PWC looks at how automation will roll out in different industry sectors, occupations and demographic groups across 29 OECD countries.
They predict that roll out up until 2030 will come in three waves:
Health and social work as well as education come in low on the list of those at risk – well, according to this report anyway.
It’s yet another interesting report on this issue which is already hitting us all but will only continue to do so.
Check it out here:
AHPRA Research Framework
AHPRA has released its first research framework for the National Scheme.
It consists of research priorities and research principles.
The priorities are:
Don’t know what it means for the future but I’m sure we’ll find out!
Check it out here:
Michael Polanyi, the philosopher, economist and physical chemist said, “I shall reconsider human knowledge by starting from the fact that we can know more than we can tell”. Michael is referring to tacit knowledge which he describes as the type of knowing that is difficult to transfer to another person by means of writing it down or verbalising it.
Dr Hubert van Doorn, Supervisor and Practice Medical Educator with NTGPE realised he was working in a GP supervisor setting that relied on tacit knowing and wanted to explore the influence of this type of knowledge when training GP registrars. “I realised after many years working in the same GP practice that I’d developed a form of knowing that operated without a lot of deliberate cognitive effort. This became more obvious when I needed to share the rationale behind making clinical decisions when consulting alongside GP registrars”.
Trying to find a way with language, to describe a phenomenon that is silent, has challenged Hubert enough to consult the academic community. This lead to developing a research proposal as a prospective master candidate at the Prideaux Centre in Flinders University. “Dr Julie Ash and Professor David Giles are educational academics from the university, and encouraged me to visit educational researchers in Canada to develop ideas and direction for my own research”.
In December 2017 Hubert travelled to Canada and with the help of Dr Warren Rubenstein and Professor Michael Kidd had meetings in Toronto relating to his research proposal. These were at the Department of Family Medicine, the Wilson Centre – which aims to advance healthcare education and practice through research, and the Mt Sinai Hospital in Toronto.
Before coming to Toronto Hubert met with three senior researchers at the Centre for Health Education Scholarship (CHES) at the University of British Colombia in Vancouver.
“These discussions validated the academic literature that expertise can be enacted in an unconsciously competent or tacit manner. The relevance to GP supervisors is to find a way of describing and sharing this important form of knowing, that isn’t expressed linguistically. The goal, perhaps put simply, is to find ways of sharing the experiential wisdom with our GP registrar colleagues.
Hubert returned to Australia encouraged from the people he met to formalise and refine a research question for his Master of Clinical Education on the nature of tacit knowing experienced by GP supervisors.
“The research methodology will be hermeneutic phenomenology, which sounds very complicated, but it is a method of collecting stories of experiences relevant to the research question and interpreting them. The plan is to enlist GP supervisors to share experiences of supervising GP registrars and knowing what is going on, but not being able to put this into words”.
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:
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.
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!
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.
There are some service indicators that will give your practice a good sense of performance.
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).
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.
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:
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.
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.
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.