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Rural supervision valued and rewarding

There is great satisfaction in mentoring GP registrars in a rural practice, according to veteran South Australian GP supervisor Dr Martin Altmann.

Doctors Martin and Fiona Altmann enjoy inspiring young doctors to pursue medical careers in rural regions.

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.”

Ewen’s mission to train and retain rural doctors

It is difficult to quantify the number of doctors veteran GP supervisor Dr Ewen McPhee has mentored in an official and unofficial capacity since his early career in rural medicine.

Rural GP obstetrician Doctor Ewen McPhee has supervised between 60 to 80 young doctors since his early career in the country.

That’s because the GP Supervisors Australia Recognition of Service Award (30-plus years) recipient has supported young doctors since his first country post as a second-year doctor in Charleville, rural Queensland.

The long-time Emerald, Central Queensland GP obstetrician, estimates he has since supervised between 60 to 80 young doctors as GPs or rural generalists.

“It’s a unique environment in the country, which is something you have to teach clinicians when they move from the city,” Ewen said.

“For this reason, I have been supervising and supporting young doctors in the country since early in my career.”

The practice principal of Emerald Medical Group is among three supervisors and two medical educators at the clinic.

He is passionate about rural and remote primary care, and wears his heart on his sleeve about training, and retaining great doctors with a connection to rural areas.

Ewen is particularly excited by the success in the last four years of shifting primary care in Emerald from a locum-based model to a local GP model.

During this four-year period, he has supervised 17 registrars and along with his peer supervisors, is enthused by the new model’s high retention rate of young doctors in Emerald beyond fellowship.

He is also excited about the Queensland Rural Generalist Program.

“It’s about picking the right people and giving them the right training, and you need good supervisors in the country to teach them to be great doctors and to thrive and survive in the country.

“We need supervisors to talk about the positives of being out here, and we have been rewarded with that in the last four years with the high retention rate of getting young doctors to stay in our patch, Emerald.

“We are seeing good young doctors who have moved to the community and establishing themselves in general practice and the lifestyle here.

“It’s indicative of supervising in the country that we can role model the great benefits and rewards of rural practice and living in a rural community.”

Ewen credited training organisations and colleges for excellent preparation and providing registrars interested in rural medicine, and with a connection to country lifestyle and communities.

Ewen’s passion for country medicine and training doctors who will build their lives long-term in the bush, is evident in the numerous hats he wears.

Among his many commitments is a role as a senior academic clinician at the University of Queensland Regional Training Hub; board member of Australian College of Rural and Remote Medicine (ACCRM); and as a member of the World Organisation of National Colleges and Academies (WONCA) – Rural Working Party.

He hosts international doctors and speaks overseas about the evolving role of rural generalists and the international implications of the Australian methods of training our next generation of family doctors.

“Australia is an exemplar of how we train rural doctors,” Ewen said.

He encouraged other rural GP supervisors to “go with the flow”, understanding that every registrar is unique in their needs, career experience and goals.

He encouraged supervisors to link themselves with peer supervisors; work with their local Regional Training Organisation (RTO) to find the right candidates for rural practice; and to value the opportunity of supervision.

“Don’t look at registrars just as a workforce solution: it’s an absolute pleasure to teach them. They are there to learn; so to step back and teach, and be available to them, is really rewarding.”

With Dementia Awareness Month now upon us, we are inviting health professionals to take part in the free Dementia Care Training and Education Program (DCTEP) which has been developed by General Practice Training Tasmania to assist in recognising, diagnosing, managing and supporting dementia patients in their care.

This innovative Australian-first dementia care resource was launched in Hobart in March 2018 by Federal Aged Care Minister Ken Wyatt AM MP.

The free interactive program was developed with the entire practice in mind. The informative modules can be completed by all practice staff to improve the overall level of service and care provided to dementia patients and their loved ones, from making an appointment through to management of the condition.

With aged care services around the country stretched to their limit, the care and management of dementia patients often falls to GPs and Practice Nurses. The DCTEP gives health professionals and their support teams the tools and knowledge to confidently take on this responsibility and provide enhanced support to patients and their carers and loved ones.

The program only takes three hours to complete and can be completed in entirety or progressively to fit in with busy schedules.

Already, the evaluation of this program has demonstrated some early changes in health professionals’ clinical behaviour, resulting from improved awareness, knowledge and confidence in managing and supporting dementia patients in general practice.

To access the program please visit https://gptt.com.au/training/dementia-care-education-training-program/

Chair’s Report – August 2018

We see this week what disunity and discord represents to the people of Australia – self-interest, futility and almost certain demise. Yet within the context of organisations, atmospherics can emerge and prevail from a raft of actions, feelings, internal and external factors.

It is clear in recent times that the world views of registrars and supervisors can be different. Is this a bad thing or is it to be expected? Are they really that different? We will all have a different perspective on these questions and that is part of the rich tapestry of general practice. In some ways it reflects the general practice team nationally. But do we work as a team?

Nothing could be more certain than if we do not collaborate and participate in the discussions about the future of general practice training as a team, then decisions about all of our futures will be made without us. Our internal and external orientation in general practice needs to be unity in order to survive.

From this perspective, discussions around the NTCER and pay for registrars should not occur without understanding that everyone in general practice is under pressure and financial strain. The challenge for us all is to grow the pie, not argue over our share of the crumbs.

Supervisors should be the very best friends of registrars, the colleges, the Department of Health and relevant Ministers. So, at a time of many uncertainties, it’s disconcerting to see some focus on immediate financial return without acknowledgment of the balance needed to support ongoing  quality training.

So where is GPSA influencing the evolution of general practice? GPSA has provided feedback to the Rural Health Commissioner around the rural generalist pathway being developed, we have provided feedback to the Department of Health around the risk associated with supervision in after hours environments. We have pointed out to Ministers and government that a number of the key workforce initiatives specifically funded in the 2018 federal budget all hinge upon supervision. We need to enable the changes and additional activity and recognise the challenges associated with each for our GP supervisors.

July saw the indexation of MBS item 23 at 1.5% and this automatically triggers an increase in the NTCER base rates.  Since the last increase was 5 years ago, it is perhaps reasonable that we are all unused to this mechanism within the NTCER and so GPSA have focussed on advising and supporting practices to implement the new base rate. Publication of our newest guide on teaching professionalism was also published in July. It’s part of a suite of guides scheduled for the second half of 2018 including this month the supervisor guide on Supervising in after-hours environments and in September a guide on performance management within general practice.

Sincerely,

Steve Holmes

ACRRM launches new online learning system  

The Australian College of Rural and Remote Medicine (ACRRM) have launched their brand-new online education platform, ACRRM Online Learning. The new platform replaces the existing RRMEO system with state-of-the-art, industry-leading software, making it easier for you to access our wide range of education resources.

ACRRM Online Learning provides whole-of-career support for Australian medical practitioners. The system is easy to use, continually being reviewed and revised, and will help you to keep up with the demands of the medical profession.

Key features of the new system

Search all available courses on the ACRRM website.

Registrar performance awareness

Training practices are boosting patient care and registrar development with the help of GP-designed software package Doctors Control Panel (DCP).

Belgrave Medical Clinic practice principal and GP supervisor Dr Dennis Gration likens DCP to “a personal assistant that thinks like a GP”.

“It’s a fantastic tool: it’s probably better than a stethoscope,” Dr Gration said of the package used in his Victorian clinic for six years.

Dr Gration, who is also an RACGP examiner and training supervisor for Eastern Victoria GP Training, said DCP was “the future of viable general practice operating at the standard we endeavour to teach our registrars.”

Queensland’s Victoria Point Surgery practice principal, GP Supervisor and GPSA immediate past chair Dr Bruce Willett said his practice had benefitted from DCP’s multi-faceted functions for about 10 years.

Dr Willett said the program’s dual ability to analyse data and flag immediate action during a patient consult; auditing tools; guidance for assessment tools, care plans and billing was very useful.

He said the program enhanced practice quality, optimised patient health, and taught good habits to GP registrars.

DCP links with the two major software programs used throughout Australia  – Best Practice, and Medical Director – and their associated appointment and billing software.

Developed by practising Melbourne GP Anton Knieriemen, DCP has multi-faceted uses specific to best practice and administrative requirements of general practice.

Among these is the program’s ability to help supervisors and registrars ensure recommendations of routine care are attended to before a patient leaves a consultation.

A glance at the program’s colour-coded control panel enables the doctor to access the patient’s preventative care status, and therefore promote interventions.

A green indicator shows recommended guidelines have been met; orange indicates what is due; and red indicates overdue.

“It drills into a patient history and pulls out all that summary information in a format that makes sense of the whole history,” Dr Gration said.

“It doesn’t intrude into the consultation process. It just helps facilitate it.”

Health on Central practice owner and GPSA board member Dr Nicole Higgins introduced DCP to her clinic in Mackay, Queensland, when it opened, and has used the full version of the program for the last 15 months.

First introduced to Dr Higgins by a fellow supervisor, she describes DCP as a “a safety net and a quality improvement tool,” and “a small investment that pays back many times over”.

“As a new practice embedding new staff, it was a check and balance to ensure demographics were correctly entered,” Dr Higgins said.

“As a practice owner I find the performance charts and business intelligence invaluable. Each individual contractor and registrar can track their clinical data and billing trends.

“The performance charts give me an insight into how the practice and individual doctors are going with information needed for accreditation, such as recording of allergies, smoking, alcohol etc.

“If there is any data missing it is quickly identified and remedied through the software. It gets me a quick overview of the practice’s billings, billings/hr, percentage of bulk-billed consultations, etc.”

Dr Higgins said patients, registrars and supervisors all benefitted from the DCP software program.

She said it provided patients a safety net; supervisors an excellent tool for chart review with patients; and prompts which ensured registrars met all the preventative activities of the RACGP red book.

For more information about Doctors Control Panel and subscription costs, visit www.doctorscontrolpanel.com.au

 

 

Teaching is at heart of clinic’s mission

Moving to a purpose-built GP teaching clinic in regional Victoria has brought career growth and lifestyle rewards for United Kingdom-trained doctor Robert Campbell and his peers.

Empty nesters Robert and his GP wife Dr Elizabeth Kennedy embraced the unique opportunity to move Down Under in 2013 to practice and become GP supervisors alongside their medical school friends at the innovative University of Melbourne Shepparton Medical Centre.

Their UK friends  ̶  doctors Derek Wooff and Jane Gall  ̶  had taken up posts at the teaching clinic when it opened in 2010, and enthused Robert and Elizabeth to join them on their supervision journeys.

The University of Melbourne Shepparton Medical Centre was the first purpose-built teaching clinic in Australia, designed to provide primary (GP) and secondary (specialist) medical and allied health ambulatory care in a parallel consulting model for medical and allied health students.

Teaching and learning is at the heart of the clinic’s mission, and the message greets guests at the reception counter with signage announcing, “Students are our future.”

GP supervision is a rewarding journey says Shepparton Medical Centre medical director Robert Campbell, pictured with the purpose-built teaching clinic’s operations manager Joanne Kinder.

The clinic’s large student learning hub doubles as the practice tearoom, meaning registrars and medical students have constant access to peers, GPs, practice nurses, and visiting specialists in their collaborative learning environment.

It’s clear from the outset, this is a contemporary and vibrant medical clinic providing best-practice patient care and an all-inclusive, proactive learning space for young, and senior doctors alike.

“The attraction to come out from the UK was teaching,” Robert, the clinic’s medical director, said.

As a full-time GP in the UK, Robert had enjoyed some limited teaching experience in public health, as well as at Scotland’s Dundee and St Andrews universities, but has honed his skills as an experienced supervisor in Shepparton.

The modern, light-filled clinic is on the University of Melbourne Department of Rural Health Shepparton campus, opposite the Goulburn Valley Base Hospital, and is a collaborative teaching environment which has also attracted other overseas and interstate doctors.

“The University of Melbourne embed a core of students here in Shepparton who do the bulk of their learning in a general practice setting, which is quite unusual,” Robert said.

“We are the first in Australia which was built with this model in mind to try and overcome the shortage of doctors in rural places; that is, if you actually expose students to life in a regional centre, they may well see the attraction.”

Robert said the eight-year-old clinic had a proud culture of vertical integrated learning which involved everyone from administration staff through to visiting specialists.

“All four senior doctors are approved GP supervisors; but even within that structure, we involve GP registrars in supervising or helping peer support for their juniors.

“We are all involved with the undergraduate teaching we do with the University of Melbourne. That is, all the medical staff, whether they are GP registrars or fully fellowed.

“What we hope to do is instil into them an interest, or a passion for teaching because we are passionate about what we do.”

Robert and his colleagues hope this teaching ethos will in turn be paid forward by registrars and medical students throughout their careers.

He said registrars enjoyed the clinic’s vertical integrated learning structure, and giving these learners the opportunity to also teach others was ideal exam preparation.

“It’s really good revision for the GP registrars getting near exam times because they are having to think about what they are doing.

“A lot of it is attitudinal, so it’s teasing out ‘What is the thought process behind my decision making?’ and that is what the KFP (Key Feature Problems) is looking at.”

Robert said “wholistic wrap-around medicine” and teaching registrars how to work in partnership with patients was another element of the Shepparton Medical Centre’s teaching ethos.

“In teaching wholistic wrap-around medicine, it means we are not just interested in the symptoms put in front of us: you might come in for a prescription, or a referral, or because you have got a pain; but we are interested in who you are, who is at home with you, what’s your social background, what’s your academic attainment, at what level in terms of your health literacy do we need to pitch what we are doing for you and with you?

“It’s very much a partnership, and I think that’s what the patients here appreciate.

Shepparton Medical Centre’s student hub doubles as a tearoom, and with an all-practice morning tea break, provides learners with continuous interaction with professional mentors.

“The partnership is not just telling them what to do: it’s trying to help the patient understand what they need to do to optimise their health, minimise illness, and come to terms with things for which there is no cure; and that can be the hardest part.

“It’s an important thing to teach our registrars: there isn’t always an answer, there isn’t always a clear solution.”

With regular visits to their family in the UK, Robert and Elizabeth remain committed to their GP supervising journey in Shepparton.

Centrally located, two hours’ drive from Melbourne and close to wine, river, high and snow countries, Robert said the multicultural region was suited to any GP’s lifestyle.

“The area is suited to families, couples, sports enthusiasts and lovers of food, wine and art,” he said.

Currently seeking a GP supervisor (new or experienced) to join the clinic, practice operations manager Joanne Kinder echoed Robert’s enthusiasm for regional living.

“Shepparton is a thriving and vibrant region that is experiencing significant change and growth, in particular with recent budget announcements; we believe it is an attractive place to set up your family and embed yourself in the community,” Joanne said.

 

Dedicated GP supervisor Dr Aline Smith is equally committed to supporting her peer supervisors in their teaching journeys.

Peer support key to Aline’s supervision

Long-time GP supervisor Dr Aline Smith is not only passionate about educating the next generation of family doctors, but also supporting her peer supervisors in their mentoring role.Having supervised more than 50 registrars in a GP career spanning 30-plus years, Aline is well placed to advise peers on effective and rewarding supervision.

The principal doctor at The Village Medical Practice in Summer Hill, NSW, first started supervising in inner-west Sydney in 1992.
Aline, who has this year also taken on an academic position at Fairfield GP unit, encourages an all-rounded approach to supporting GP supervisors at The Village Medical Practice.

This support includes: a succession of GP supervisors, which ensures ongoing shared supervision; developing processes which streamline the practicalities of supervision; and in-practice continued professional development (CPD) for doctors at all stages of their career.

At any given time, the responsibility of supervision is shared between two and four doctors at The Village clinic.

“All GPs who come to us have some interest in teaching, which is a very strong focus in the practice,” Aline said.
“When people leave, we replenish and credential supervisors.”

Aline is not resting on the laurels of her well-honed teaching skills; advancing her own learning to help others teach the learner.

“I am completing a Masters in Health Professional Education and part of that learning is to develop supervision programs for the registrar and practice as a whole, to make sure in-practice teaching is being done well,” Aline said.

“We have built an in-house CPD program which helps bring registrars into the learning, while supervisors are also learning within the same learning and teaching opportunities.”
Aline said The Village’s learning program was successful because it complied with college standards and provided learning opportunities which modelled adult-learning principles.
“We encourage the registrars to have a learning plan and bring that to their supervisor,” Aline said.

“Supervisors will often have their favourite topics they want to impart on the registrars, but our learning plan is about the conversation between supervisor and registrar on what topics to schedule in to protected learning time.”

Planned learning is key to effective learning, according to Aline, which is why she is so committed to the practice’s in-house CPD program, and the collaboration of tailored learning plans between registrars and their supervisors.

“Unless it’s planned, it’s not going to happen well: one of my biggest tips for other supervisors is to plan your teaching and learning activity before it happens.

“It is important to know what your registrar’s gaps are by getting them to reflect; and supervisors need to look at the assessment report from the RTO to see where the gaps are to pre-plan before the registrar comes.”

Whether the registrar is a GPT1 or GPT3, Aline stressed the necessity of a comprehensive orientation to a new practice.

“As a supervisor we need to appreciate how stressful it is for a GP registrar to come into a practice.

“When they come, we set up observational times and orientate them into the way the practice works, such as processes for appointments, billings, practice communication etc.”

While supervisors may believe more time was needed to orientate a GPT1 coming straight from the hospital system to practise independently, Aline said it was equally important to familiarise more experienced registrars with the uniqueness of their new clinic.

“It’s important not to assume a GPT3 will be able to practise independently because not all practices are the same,” she said. “For example, there are different demographics, and systems for doing things; some practices do nursing home visits; and not all practices are fully computerised.”

Aline said her clinic’s collaborative learning-teaching culture between supervisors, registrars and other practice staff also included registrar-run teaching sessions.

“Everyone contributes to learning, whether they are a supervisor or not. Some registrars are very up-to-date on certain topics: for example, we had a registrar run a learning session with other registrars and doctors on sexual health.

“We find out what skills we all have and share them in the practice,” she said.

Grateful for lessons and values shared by her early mentors, Aline encouraged supervisors to embrace teaching registrars how to deal with the uncertainties of general practice.

“We need to teach them how to communicate, and how uncertainty shouldn’t be stressful. General practice is an honour: it’s a vocation, not just a job.”

Dear fellow teachers of perspective,

2018 is a re-negotiation year for the NTCER and as many of you have noted, the NTCER negotiations highlight just how tough general practice is for everyone.

When it comes to decision making around earning potential and which medical specialty one will choose one thing is clear: no-one chooses general practice for earning potential. This is true for supervisors, practice principals and registrars alike.

The most recent words, the media releases and the strategy around registrar claims have disappointed some in the sector.

Some might wonder why GPSA are not responding to every media release published by the registrar organisation. In short, continuing down this divisive path is to the detriment of the GP community.

The simple fact is: it is financially tough to be a GP registrar, GP supervisor, and GP practice principal. This appears to be corroborated by the volume of journalists writing on the topic of GP remuneration.

The NTCER allows business decisions to be made where it is viable to do so, while protecting the earnings of registrars with a base salary and affording registrars the opportunity to earn far greater income than the base as they become more competent.

The first meeting of the negotiations took place with GPRA on 7 July 2018 with the AMA providing impartial chairing of the meeting.

The claims addressed by the registrars at the negotiation meeting held recently identified a number of items largely outside the control of the NTCER and those negotiating it.

More than ever, through this negotiation GPSA’s aim is to provide certainty and stability for all stakeholders as we move into the period of transition of training to the colleges.

This will be achieved with the cooperation, good will and common intent of all the parties to provide certainty to registrars, practices, RTOs and other key stakeholders in the general practice arena.

Good progress was made at the recent meeting – we will keep you updated.

The aim is still to have an NTCER by September/October 2018 in order for practices and RTOs to have certainty with placements for the first term of 2019.

This fortnight I encourage all of you to have a conversation with your registrars about the business costs of general practice. Nurturing your registrar’s perspectives on employment conditions with a view from the employers end will likely support a more balanced view of the context in which they are training.

Yours in GP Training,

Dr Steve Holmes
Chair, GPSA

RMA18 full program announced

Rural Medicine Australia 2018 (RMA18) is the peak national event for rural and remote doctors of Australia, presented by the Australian College of Rural and Remote Medicine (ACRRM) and the Rural Doctors Association of Australia (RDAA).  RMA18 will be held at the Darwin Convention Centre from Thursday 25 – Saturday 27 October 2018 and we’re thrilled to reveal the RMA18 program, which is available online.

With a packed program full of innovative and informative presentations, interactive workshops and social events, along with a heap of exhibitors, you’re not going to want to miss out. This first release is just the beginning – we’ve got even more to add in the coming weeks!
Register now for RMA18 and view the full program.

This year we have dedicated streams for our registrars and students that specifically relate to where they’re at in their training and studies. We’re bringing back the ever popular Suturing Workshop for students, and a session on planning and completing your Advanced Specialist Training (AST) for registrars. We also have dedicated themes for this year’s conference, two of which are Research in Policy and Practice, and Women in Health.

Notable highlights in the program stemming from these themes include ‘Codeine Rescheduling – evaluation of impacts and future implications for rural and remote practitioners and communities’ and, ‘Gender Bias in Rural Healthcare, Planning for Women’.