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There is little doubt about the generosity of time, knowledge and spirit that GP supervisors show when teaching and mentoring the next generation of family doctors.

This publication is designed to provide best practice guidance to help ensure that GP supervisors’ work remains aligned with their positive intentions to nurture and teach the primary care givers of tomorrow.

Thank you to our supporters. General Practice Supervisors Australia (GPSA) received funding from the Australian Government under the Australian General Practice Training (AGPT) program.

Training Practices which implement zero tolerance policies for bullying and harassment are happy places to work. Despite workplace bullying, harassment and discrimination being unacceptable and illegal, it occurs in all sectors of the Australian workforce, including general practice.

The consequence of this behaviour can derail a victim’s professional and personal life, impact on their health, lead to legal action, and compromise patient safety.

We all, cleaner through to practice principal, have a responsibility to adopt a zero tolerance approach to bullying and harassment.

This guide explains how to recognise and manage this behaviour, fostering a healthy work culture which benefits staff and patient care.

Use this as a tearoom, team building and induction resource to complement your other educational activities. From our team to yours, we wish you well on your journey to zero tolerance and commend you on your commitment whether as the employer or the employee.

Thank you to our supporters. General Practice Supervisors Australia (GPSA) is supported by funding from the Australian Government under the Australian General Practice Training (AGPT) program.

One of the most important teaching behaviours in general practice training is giving feedback to registrars on their performance. Constructive feedback is designed to provide information and encourage reflection by the learner about current performance, with the aim of improvement in the future.

Feedback is fundamental to effective learning. Feedback has often been thought of as something that is done with, or given to, a learner. However, effective feedback is a ‘two-way’ dialogue that occurs between a supervisor and registrar, incorporating self-assessment, critique, reinforcement and planning.

We all have had our own experiences with feedback, and most of us (if not all) can easily recall feedback being delivered poorly. Poor delivery of feedback can be destructive to a registrar and significantly damage their self confidence. By contrast, the ability to effectively give constructive feedback is rewarding for both supervisor and registrar and can improve confidence, clarify learning needs and lead to improvements in practice.

Giving feedback effectively is a learnt skill. Your commitment to giving effective feedback will help build your registrar’s clinical skills, professionalism and self-esteem. Willingness to improve your feedback skills can have other flow-on effects within a general practice. Your feedback skills will be transferable to staff morale and motivation, as well as in clinical practice and improving rapport with patients.

This guide explains the importance of quality feedback and how to incorporate this into training your GP registrar. It is intended to help you implement strategies that will make providing feedback a meaningful and constructive experience for you both.

The progression for GP registrars from the highly structured and closely supervised environment of hospital based resident medical officer training to general practice represents the most significant change our junior colleagues may have faced since graduation.

The variety of patient presentations, challenges of a new workplace and employment structure, and relative isolation of the consulting room are just some of the aspects which experienced GP supervisors are completely comfortable with, but contribute to the complete paradigm shift our GP registrars encounter.

Added to this is our paramount concern for the safety of our patients, who must remain central in all our considerations.

While most GP registrars have the necessary knowledge, skills and attributes required for this adaptation, it is an essential component of proper supervision that they be monitored throughout their training, and that GP registrars in difficulty be identified early to allow appropriate intervention and support.

This guide aims to assist general practice GP supervisors to:

This guide is not intended to be used as a definitive reference but should be used in conjunction with the policies and guidelines of your own Regional Training Organisation (RTO), medical defence organisations and regulatory authorities.

 

 

GP supervisors make a vital contribution to the provision of quality training for the next generation of family doctors. They are the cornerstone of the ‘apprenticeship–style’ GP training program in Australia. Both the Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM) in their standards documents identify the importance of GP supervisor and team for the training of GPs.

The GP supervisor’s role is complex, diverse and can be challenging. It includes the roles of mentor, role model, clinical educator, assessor, pastoral carer, and also very often employer.1 One of their most important tasks is the early recognition of GP registrars in difficulty so that appropriate interventions and support can be put in place. But what about GP supervisors themselves? They too can find themselves in difficulty. How can this be identified early? What interventions and supports are there?

This guide aims to assist GP supervisors to:

This guide is not intended to be used as a definitive reference and should be used in conjunction with the policies and guidelines of your own Regional Training Organisation (RTO), medical defence organisations and regulatory authorities.

 

 

 

The transition from working in the hospital to the community setting is highly challenging for the new GP registrar. The general practice environment is characterised by a wide breadth of (often unfamiliar) clinical problems; complex and chronic disease management; relative independence of decision-making; time pressures; complex practice systems; and financial and billing issues.2 On top of all of this, GP registrars must also learn how to manage uncertainty, one of the defining features of general practice.

If there is one certainty in general practice, it is the inherent presence of uncertainty. Undifferentiated presentations are very common in primary care and a firm diagnosis is elusive in many encounters.3 Symptoms are often vague, examination findings unclear, investigation results conflicting, and response to treatment inconsistent. Guidelines may be irrelevant or non-existent. Clinical decision-making may be compromised for a myriad of reasons. As a result, uncertainty is intrinsic to the general practice encounter. Indeed, it has even been proposed that managing uncertainty is the ‘specialty’ of general practice.4

Not surprisingly, (in)tolerance of uncertainty varies from doctor to doctor. The ability to manage uncertainty has been found to influence a range of patterns of practice, including test-ordering behaviour.5,6 Most importantly, a lower tolerance of uncertainty has been identified as a cause of stress and burnout in GPs7, and GP registrars8.

Tolerating and managing uncertainty, while related to the individual doctor’s personality, is also a learned skill. Management of uncertainty is a core competency of both the RACGP Curriculum Core Skills Unit9 and the Australian College of Rural and Remote Medicine primary curriculum.10 As part of the apprenticeship model of Australian general practice training, you can therefore play a critical role in developing this skill in your registrars.

This GPSA guide aims to support GP supervisors to identify, assess, and facilitate development of, skills in managing uncertainty.

Thank you to our supporters. General Practice Supervisors Australia (GPSA) is supported by funding from the Australian Government under the Australian General Practice Training (AGPT) program.

GPSA produce a number of relevant guides for GP supervisors and practices, visit www.gpsupervisorsaustralia.org.au to view additional guides.

Thank you to Dr Simon Morgan and Dr Justin Coleman for their contributions in writing this GP supervisor guide.

 

 

 

References
2. Illing J, Taylor G, van Zwanenberg T. A qualitative study of preregistration house officers in general practice. Med Educ 1999; 33: 894-900.
3. McWhinney IR. A textbook of Family Medicine. 2nd edition London: Oxford University Press, 1997.
4. Pimlott N. Managing uncertainty. Can Fam Physician 2007; 53: 1000.
5. Geller G. Tolerance for ambiguity: An ethics-based criterion for medical student selection. Acad Med. 2013; 88: 581-4.
6. West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. JAMA. 2009: 302: 1294-1300.
7. Bachman KH, Freeborn DK: HMO physicians’ use of referrals. Soc Sci Med 1999; 48: 547-557.
8. Cooke G, Doust J, Steele M. A survey of resilience, burnout, and tolerance of uncertainty in Australian general practice registrars. BMC Med Educ 2013; 13: 2.
9. Royal Australian College of General Practitioners (RACGP) website. Core Skills Unit, Melbourne, 2016. Available at http://www.racgp.org.au/education/curriculum/2016-curriculum/ [accessed 10 September 2016].
10. Australian College of Rural and Remote Medicine (ACRRM). Primary Curriculum. Available at http://www.acrrm.org.au/ PrimaryCurriculum/Default.htm [accessed 28 March 2016].

 

In Australia, the acquisition of the knowledge and skills, both personal and professional, that lead to vocational registration as a quality general practitioner occurs within the apprenticeship model. Our GP registrars learn and grow in confidence through consulting with patients in our practices, though unlike the hospital setting, much of this is behind closed doors.

As clinicians, our fundamental responsibility is the safety of our patients. So, it is quite natural to feel a little anxious about what is happening between the GP registrar and their patient behind the consulting room door.

GP supervisors employ a range of support mechanisms to ensure both patients (and GP registrars!) remain safe. Case discussions form the basis of many GP supervisor/ GP registrar interactions. There are a number of case based discussion (CBD) tools that can be used to structure these discussions. This guide provides GP supervisors with an explanation of how to incorporate one such mechanism into their supervision toolkit; that of random case analysis (RCA).

In this guide, RCA has been applied to the Royal Australian College of General Practitioners (RACGP) domains, but the model may equally be applied to the Australian College of Rural and Remote Medicine (ACRRM) GP registrars. The use of RCA as a supervision method transcends individual curricula and sits squarely in the domain in which all GP supervisors are guided; that of keeping patients and colleagues safe.

RCA is relevant to GP registrars at all stages of their training and may be particularly useful for supervision of:

All GP registrars, whether ACRRM or RACGP, are required to receive three hours of formal teaching from you as their GP supervisor in their first general practice term. The use of RCA helps to identify and support what the GP registrar knows, and does not know, in a manner that is consistent and non-threatening. We hope you find this resource useful.

One of the most important teaching behaviours in general practice training is giving feedback to registrars on their performance. Constructive feedback is designed to provide information and encourage reflection by the learner about current performance, with the aim of improvement in the future. Feedback is fundamental to effective learning.

Feedback has often been thought of as something that is done with, or given to, a learner. However, effective feedback is a ‘two-way’ dialogue that occurs between a supervisor and registrar, incorporating self-assessment, critique, reinforcement and planning.

We all have had our own experiences with feedback, and most of us (if not all) can easily recall feedback being delivered poorly. Poor delivery of feedback can be destructive to a registrar and significantly damage their self confidence.

By contrast, the ability to effectively give constructive feedback is rewarding for both supervisor and registrar and can improve confidence, clarify learning needs and lead to improvements in practice.

Giving feedback effectively is a learnt skill. Your commitment to giving effective feedback will help build your registrar’s clinical skills, professionalism and self-esteem. Willingness to improve your feedback skills can have other flow-on effects within a general practice. Your feedback skills will be transferable to staff morale and motivation, as well as in clinical practice and improving rapport with patients.

This guide explains the importance of quality feedback and how to incorporate this into training your GP registrar. It is intended to help you implement strategies that will make providing feedback a meaningful and constructive experience for you both.

Thank you to Dr Simon Morgan and Dr Graham Emblen for their contributions in writing this GP supervisor guide. General Practice Supervisors Australia (GPSA) is supported by funding from the Australian Government under the Australian General Practice Training (AGPT) program. GP Supervisors Australia would also like to thank RACGP for supporting the development of this resource.

GPSA produce a number of relevant guides for GP supervisors and practices, visit www.gpsupervisorsaustralia.org.au to view additional guides.

Rational Prescribing Guide

Clinical reasoning has been defined as ‘the sum of thinking and decision-making processes associated with clinical practice … it enables practitioners to take … the best judged action in a specific context.’ Simply put, clinical reasoning is the process of making sense of the breadth of (often ambiguous and/or conflicting) clinical information regarding a patient’s presentation, in order to decide on the optimal plan of management. It is a core skill of the competent general practitioner and a fundamental learning objective of GP training.

Clinical reasoning encapsulates skills in:

Effective clinical reasoning requires a balance of the art and science of general practice. While development of clinical reasoning skills is based on accumulated experience, it is also a skill that can be taught. GP supervisors therefore play a key role in the development of clinical reasoning skills in their GP registrars, in particular how to ‘think like a general practitioner’.

This guide aims to support GP supervisors to assess, and facilitate development of, their GP registrar’s clinical reasoning skills in the general practice setting. In particular, this guide will focus on diagnostic clinical reasoning. Thank you to our supporters. General Practice Supervisors Australia (GPSA) is supported by funding from the Australian Government under the Australian General Practice Training (AGPT) program.

 

 

This guide aims to support supervisors to
identify, assess, and facilitate development of skills in
professional and ethical practice of their registrars. It
covers a range of practical strategies for supervisors
to use in teaching professionalism in the general practice setting.

Behind every general practice is a team working together to provide excellent clinical care to patients, to have a happy team and also to run a successful business.

The team refers to the GPs, GP supervisors, practice nurses, reception staff, practice managers and GPs at different stages of training, and can include allied health and other professionals from local health networks.

Each team member has a different personality, skill level and set of interests.

This guide provides practical tips and guidance to ensure you have an effective team with outcomes that benefit the clinical care of the patients, the staff and the business.