TRAINING UPDATE RHOE UPDATE
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Registrar Issue 28 | August 2018
Training Update
RHoE update
Fortunately, this year has not been one of extreme weather for the North Coast and so there hasn’t been
any natural disasters affecting our training in the region. I thank you again for diligently progressing through
your training and engaging with our program – we have again enjoyed excellent results in the FRACGP
exams with close to 95% pass rate in the recent OSCE.
As you will be aware, GP registrars require assessment during their GP placements – this is a college
requirement and of educational value to you as the registrar. I know from personal experience that I have
sometimes only picked up worrying signs in my registrar when I have sat in and observed them consulting
and identified deficiencies in their knowledge or consultation skills. Providing feedback has been gratefully
received by my registrars and averted many a disaster. Having this recorded on your portfolio in a formal
and comparative way by using an assessment tool is a valuable way to be able to assess at a point in time
and track progress over the term. It also allows you to have the conversation with your supervisor using a framework to guide feedback
on specific areas. It provides a way to identify GP registrars in need for whom we can then mobilise additional support early in training
rather than only realising towards the end of training when it is sometimes too late.
GP Synergy has developed a competency assessment tool that is our method of carrying out these mandatory formative
assessments. Supervisors are paid to complete these assessments and they have been refined and shortened considerably as a result
of feedback from registrars and supervisors.
We have had instances where GP registrars have run into trouble e.g. running out of training time or repeat exam failures and we have
had to approach the Department of Health to ask for extensions outside the normal policy guidelines. Sometimes they have asked
for the assessments of the registrars by the supervisors and it puts you in a very difficult position if they have not been completed. In
addition, they are a requirement of the RACGP to enable completion of training.
Supervisors are reminded when the assessments are due and we would be grateful if could remind them so they are completed in a
timely and appropriate fashion, with prior direct observation of you consulting to enable accurate assessment.
Remember that your Medical Educators are there to assist you during your training – we are all human and realise that ’things come
up’ that can affect your training – please do let us know as soon as practical so that we can mobilise assistance if required.
I look forward to seeing many of you at the upcoming educational workshops and am thrilled that we are able to provide a GPT3 and
beyond workshop day again to allow you to remain connected with us. And for those of you about to fellow , please do keep in touch –
we always welcome new CTV visitors , supervisors and mentors.
Dr Rashmi Sharma | Regional Head of Education North Coast
Check your inbox! Registrar national feedback survey now open
Each year, the Australian Government commissions an external research company to conduct
a survey of GP registrars to gauge the level of satisfaction with their training, regional training
organisations and career progression.
If you are a registrar that is or has been in a GP term (and you are not on extended leave) please
monitor your email for an invitation to complete the survey and we strongly encourage you to
participate. The survey will take approximately 10 minutes to complete and the results enable the
Department of Health to monitor the performance of the program and help bring emerging issues to
the attention of the Department and other GP training stakeholders.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Training Update | Registrar Issue 28 | August 2018 | pg1
To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-nd/4.0/.
Heading into a new practice this term?
Whether it’s your first GP term or your last GP term, if you are heading into a new practice there are a number of important activities
that you need to complete with your supervisor.
From Week 2-6: Discuss your learning plan needs and the supervision plan with your supervisor
Within the first four to six weeks of term your supervisor will spend time reviewing your learning needs to help you build your
learning plan.
Day 1: Practice orientation
When you start in a new practice, it is important you are properly orientated. To help practices orientate registrars to a practice,
we have developed some orientation resources which registrars can also access. Head to GPRime and look under ‘Forms,
Documents and Links’ – just search ‘orientation’.
Week 1-2: Direct observation
To help supervisors assess your competence and level of support required, we strongly recommend supervisors spend some
time observing your consultations in the first few weeks of term.
Supervision plan
As part of this process, your supervisor may complete a supervision plan and consider how to assess your current level of
competence, especially with regard to high risk or red flag areas. The aim of the plan is to identify areas requiring closer
supervision to optimise training and minimise the risk of adverse outcomes for patients and registrars. The supervision plan
covers a comprehensive range of presentations and procedures that are common to general practice.
Pre-GP Term Assessment Report (PTAR)
If you have already commenced in a GP term, your supervisor will have reviewed your Pre-Term Assessment Report (PTAR)
prior to you starting. The PTAR is a summary of your training. It includes your contact details, a history of your placements, and
all the competency assessments completed on you during GP community based terms, such Clinical Teaching Visits (CTVs) and
competency assessments completed by your other supervisors. You can access your PTAR at any time in GPRime – go to your
‘Trainee Portfolio’ and click on the ‘Summary tab’.
Competency assessment
Assessments of your progress during your term are very important for feedback and learning and are a mandatory part of
training. Make sure that your supervisor has directly observed a consultation and completed a competency assessment early
in the term. It’s due by week eight but can be done anytime from week two. Use this as a teaching session to see how you are
progressing through the term.
Training requirements – at a glance In-practice training requirements at a glance
Before first GP term
• Complete Pre-GP Term Assessment
(PGA)
Before every term
• Re-enrol through GPRime
• Term placement process (for GP terms)
Beginning of GP term
• Orientation to practice (first day)
• Discuss learning needs and learning
• Complete orientation module • Supervisor reviews Pre-Term plan with supervisor (supervisor
Assessment Report (PTAR) generates a supervision plan for the
• Submit relevant term specific term)
Stay on top of your training requirements by downloading the handy ‘In-practice training requirements at a
requirements (such as extended skills, • Supervisor directly observes registrar
academic terms, AST, ARST and other) seeing patients
Mandatory
ES-GP / GPT4 Elective /
Requirement GPT1/PRRT1 GPT2/PRRT2 GPT3/PRRT3*
PRRT4* Extension
Assessment
glance’ document.
80% onsite 50% onsite 25% onsite
Each week
Onsite supervision
20%phone 50% phone 75%phone
1h formal 1h formal
In practice teaching No formal requirement**
2h informal ½ h informal
Practice logs Every week
Clinical teaching visit (CTV) 2 per term 1 per term If required
Supervisor competency
3 per term 2 per term 1per term
assessment of the registrar
Each Term
Registrar’s assessment of the
2 per term 1 per term
placement
To access:
GP synergy workshops compulsory not compulsory
Training Advice (TA) with
1 per term
Medical Educator (ME)
ACCRM Complete and update ACRRM training plan and procedural logs
Term specific requirements Complete term specific assessments and requirements
During training
1. Login to GPRime2
Aboriginal and
Membership Emergency skills Torres Strait Research ReCEnT
Islander Health
Become and RACGP: ACRRM: Complete Complete online Participate in
maintain • CPR within 12m • Complete ACRRM Aboriginal Health research module GPT1/GPT2/GPT3
membership of prior to GPT1, emergency requirement (GPT1/2, PRRT 1/2) or PRRT1/PRRT2/
fellowship college and 12 months of course (GPT1/2, PRRT1/2) PRRT3*
Fellowship requirement
2. Go to ‘Forms, Documents and Links’ in the top toolbar
• ALS within 4
years of applying
for fellowship
*If Primary Rural and Remote Term (PRRT) is in general practice
**No formal weekly teaching however supervisors are encouraged to provide regular support as required.
3. Search ‘requirements’. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
License. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-nd/4.0/.
In-practice training requirements at a glance | Page 1
Training Update | Registrar Issue 28 | August 2018 | pg2
2019.1 Term placement dates now available
Key dates for 2019.1 term placement are now available. Detailed information about term placement will be circulated in the
coming weeks.
19 Sept: Deadline for applications for Training Location Obligations (TLO) exemptions. See below for details.
2-8 Oct: All registrars are required to re-enrol.
22 Oct: Registrars seeking GP terms in 2019.1 will be advised of their grouping allocation and will be able to apply for
placements on GPRime.
Important points about term placement:
• Practice logs: To be able to re-enrol for the 2019.1 term you must have completed all previous term practice logs and at
least the first week of practice logs in the current term.
• Training Location Obligation (TLO) exemptions: TLO exemption applications will be reviewed once per term,
immediately prior to enrolments opening. If you meet the eligibility requirements for a TLO exemption (TLO policy can
be found here) you must submit your application to your Education Coordinator (EC) by COB Wednesday September 19
for consideration for the 2019.1 term. Registrars are responsible for ensuring that they submit a completed application
with all necessary supporting documents by the above deadline. Late applications will not be considered. If you wish to
apply for a TLO exemption it is advised that you discuss your application with your medical educator and/or education
coordinator prior to submission to ensure you have a complete application.
Medicare provider Fellowship assessment
number reminder enrolment*
If you are a GP registrar going into a GP ACRRM fellowship assessments:
term in 2018.2 (Aug- Feb), make sure you • 2018.2: Assessment enrolment closed 13 Jul 2018
check the letter you have received from
Medicare advising of your provider number approval. For more information visit the ACRRM website.
Please ensure you have been issued with a provider RACGP fellowship assessments:
number with full billing rights before you commence billing • 2018.2 OSCE: Enrolments open 19 Mar – 7 Sep
patients. Registrars with refer and request rights will 2018
only be able to refer patients and request investigations
• 2019.1 AKT/KFP: Open 17 Sep – 16 Nov 2018
for them, until a provider number with full billing rights is
received. • 2019.2 OSCE: Open 17 Sep 2018 – 29 Mar 2019
For further information visit the RACGP website.
*Dates are subject to change. Always check the RACGP and ACRRM
websites for the most up-to-date information.
Moving to a new town this term?
Don’t forget there are dedicated Rural Support Officers (RSOs) to help you transition into a new town. GP Synergy also offers
relocation subsidies and other financial support for registrars training rurally. Find out more in the Registrar Support Guidelines
or contact your local RSO.
Kerry Robins Sue Hefren
New England/Northwest | North Coast
Murrumbidgee
| Hunter Manning & Central Coast
sue_hefren@gpsynergy.com.au
kerry_robins@gpsynergy.com.au
Maria Logan April McFadden
Western NSW South Eastern NSW
Maria_Logan@gpsynergy.com.au april_mcfadden@gpsynergy.com.au
Training Update | Registrar Issue 28 | August 2018 | pg3
ReCEnT (Registrar Clinical Encounters in Training)
The Registrar Clinical Encounters in Training (ReCEnT) project is a flagship general
practice education and training project.
The project is the first of its kind to document Australian general practitioner (GP)
registrars’ educational and clinical experience over time by measuring:
• what registrars do, the types of patients and conditions they see and the management they provide
• how registrars’ practice changes during their training.
ReCEnT is an important tool to aid reflection on practice and registrar’s reflection can be facilitated by comparing their data with that of
other registrars and established GPs, as well as with the registrar’s results in previous terms. Critical evaluation is encouraged:
• Was this a typical week?
• Are the results unexpected?
• Am I different from other registrars? If so, why might that be?
• Am I getting an adequate range of clinical presentations for optimal learning (and exam preparation)?
• Do I need to reconsider any aspect of my practice?
How does ReCEnT work?
The project requires GP registrars to:
• complete encounter forms, recording details of 60 consecutive consultations, in each of their three GP training terms (~1-2
minutes to complete per form)
• complete registrar and practice characteristic questionnaire (~5-10 minutes at a workshop)
• repeat the above process in each of their three GP training terms.
GP registrars are provided with a feedback report that compares their consultations to the larger group of registrars and, in some
cases, national GP data. Registrars are strongly advised to share this information with their supervisors and their medical educators. If
registrars provide consent, a copy of their report will be sent directly to supervisors. Feedback reports are accessible in GPRime2 by
medical educators and discussion of feedback reports is recommended.
When a training practice has had at least five registrar rounds of ReCEnT data, the supervisor and practice manager will receive an
annual practice report. This report enables them to see the registrar’s clinical exposure as well as aspects of their clinical and education
practice. It also provides comparisons with other training practices. At least five registrar rounds of data per practice report are used so
that individual registrars are not identifiable in the report and provides a more valid comparison with other practices.
Which subregions are participating in ReCEnT in 2018?
ReCEnT is being rolled out across all of GP Synergy’s training regions.
2018.2 ReCEnT timetable
HMCC NE/NW NWNS CESWS M/ACT* WNSW* SENSW* NC*
Term 1: 31 Aug 8 Aug 7 August 7 August 9 August 6 Aug 6 Aug 23 Oct
ReCEnT Orientation
GPT1/2 and PRRT1/2: 21 Sept 10 Sept 4 Sept 4 Sept 10 Sept 4 Sept 26 Sept GPT1 – 23 Oct
Distribute encounter (workshop) (mail) (workshop) (workshop) (mail) (workshop) (workshop) (workshop)
forms GPT2 –
18 Sept (mail)
GPT1/2 and PRRT1/2: 18 Oct 15 Oct 26 Oct 19 Oct 17 Oct 5 Oct (mail) 24 Oct GPT1 – 20 Nov
Collect encounter forms (workshop) (workshop) (workshop) (workshop) (workshop) (mail) (mail)
GPT2 – 23 Oct
(workshop)
GPT3 and PRRT3: 31 Aug 31 Aug 31 Aug 31 Aug N/A N/A N/A N/A
Distribute encounter (mail) (mail) (mail) (mail)
forms
GPT3 and PRRT3: 3 Oct (mail) 3 Oct (mail) 3 Oct (mail) 3 Oct (mail) N/A N/A N/A N/A
Collect encounter forms
*only GPT1 and GPT2s are participating
Assistance:
• questions about receiving or handing back your ReCEnT packs: Katie Mulquiney on 02 8321 4242 or
Katie_Mulquiney@gpsynergy.com.au
• overall project queries: Parker Magin on 02 8321 4540 or Parker_Magin@gpsynergy.com.au.
Training Update | Registrar Issue 28 | August 2018 | pg4In search of a smile – Meet Dr Hasan Sarwar
All GPs like to see their patients smile, for GP registrar Dr Hasan Sarwar it’s a mission that regularly takes him to Bangladesh as part of
a voluntary Australian medical team he co-founded with a colleague.
Training as a GP in Manilla might seem a world away from performing cleft lip palate and burn reconstructive surgery in the Pabna
district – about eight hours drive from the Bangladeshi capital of Dhaka.
“Surgery is my passion, but I have a strong interest in all medical fields from paediatrics to geriatrics.
“I’d like to be procedural GP in the future, a GP surgeon in a rural community.
“Being a GP I can help more people with my surgical skills in a rural and remote setting,” Dr Sarwar said.
As a founding member of the volunteer Aussi Bangla Smile team, a Rotary Australia World Community Services Project, the team has
been travelling to Bangladesh almost yearly since 2007 and have undertaken 775 operations.
“Before coming to Australia, I had done many cleft lip palate operations for underprivileged patients in Bangladesh, free of charge with
my voluntary medical team.
“In 2004 when I got a job as a plastic surgical registrar at Nepean Hospital, I shared my story with my operating theatre colleagues.
“With the help of my friend, registered theatre nurse, Barbara Mitchell OAM we met with colleagues and our local Rotary club.
“This year the Australian team included three doctors and eight nurses, the Bangladeshi team included four surgeons, anaesthetists,
local post graduate trainee doctors, interns and about 30 nurses.
“Working with a joint team from Bangladesh and Australia enables us to work together and train the local doctors and nurses,” Dr
Sarwar said.
The team has also established a women’s health surgical project focusing on vesico-vaginal fistula and uterine prolapse surgery and is
collaborating with the charity Days for Girls to distribute sustainable feminine hygiene kits in the world’s largest refugee camp.
“After our work in March 2018 I stayed in Bangladesh for another week to see the post-operation patients and to distribute reusable
sanitary kits for women and girls in the Cox’s Bazar refugee camp – home to nearly 600,000 Rohingya Muslim refugees.
“The Aussi Bangla smile team raised $10,000 to have 2000 kits made in a Bangladesh garments factory.
“With a Rohinghya interpreter service we held a training session for 10 Action Aid trainers and 50 Rohinghya women on basic female
physiology and how to use the kits.
“I do have a special interest in global health – all of my team members also feel that way.
“As Australians we’re in a such a good position, we can do something,” Dr Sarwar said.
Training Update | Registrar Issue 28 | August 2018 | pg5Clinical pearl: Wet combing for head lice
‘Wet combing’ can be used as an aid to diagnosis, management, and assessment of treatment outcome for
head lice infestations.
The technique for wet combing is described in detail at the RACGP Handbook of Non-Drug interventions
(HANDI) site: https://www.racgp.org.au/your-practice/guidelines/handi/interventions/children/wet-combing-for-head-lice/
Apply plenty of hair conditioner to wet hair; untangle the wet hair with a standard wide-toothed comb; divide the hair into ~4
cm sections; comb each section using a ‘nit comb’ available from pharmacies; ensure the teeth of the comb are lightly touching
the scalp, and draw the comb down to the ends of the hair with every stroke; wipe the comb and check for lice or nits after
each stroke; repeat the process for each section; rinse out the conditioner; repeat the whole process in the wet hair checking
for any lice missed the first time. Wash all combs in hot water post-combing.
This process can confirm a diagnosis of head louse when suspected.
It can also be used as a non-drug therapy, being especially useful for insecticide resistant infestations, in pregnant and breast-
feeding women, and in babies. Repeated treatments are needed, each day until no lice are seen with wet combing.
If topical pediculicide treatments (e.g. permethrin, maldison) are used, wet combing can confirm therapeutic success. Persisting
live lice indicate resistance to the pediculicide.
Regular post-treatment wet combing can also be used to detect recurrence of lice infestation.
Registrars do not commonly see head lice as a presentation in general practice (about 1 in 5000 GP Synergy ReCEnT
consultations) however, parents often ask GPs their opinion on head lice treatment as an aside to the consultation or more
commonly in the school playground!
ReCEnT project shows reduction
in GP registrars’ benzodiazepine Procedural/rural generalist
prescribing applications now open
Last month, GP Synergy’s ReCEnT team had a paper published in
the Journal of General Internal Medicine.
The team found that GP registrars’ benzodiazepine prescribing
decreased significantly during the period 2010-2015, on average
at a rate of 6% per year.
The reasons doctors prescribe benzodiazepines are complex,
multifactorial and may not be in the best interest of the
patient in the long term, so efforts to understand and reduce
benzodiazepine prescribing is critical.
Applications for procedural/rural generalist positions are
To further target this issue, GP Synergy is implementing a multi- now open and close 20 August from the HETI website.
component educational initiative aimed at GP registrars and their
supervisors during training. Registrars considering procedural/rural generalist skills
training are strongly encouraged to contact GP Synergy’s
The education initiative focuses on both providing GP registrars Special Programs and Education Manager, Felicity
with skills in non-pharmacological management of anxiety and Gemmell-Smith on felicity_gemmell-smith@gpsynergy.
insomnia, as well as providing supervisors with the skills to help com.au and your medical educator.
registrars implement this at the practice level.
For more information visit:
The findings highlight the importance of ReCEnT as a powerful tool
• GP Synergy website
for informing the design and delivery of GP training. The scientific
rigour in the design, collection and analysis of ReCEnT data provides • HETI website.
the best opportunity to understand whether an intervention is
necessary, and if so whether an intervention in education and
training makes a change and the nature of that change.
For more information visit: https://link.springer.com/ Developmental Disability
article/10.1007%2Fs11606-018-4577-5
Medicine Conference
1
Magin P, Tapley A, Dunlop A, Davey A, van Driel M, Holliday E, Morgan S, Henderson
K, Ball J, Catzikiris N, Mulquiney K, Spike N, Kerr R, Holliday S., Changes in early- Funded opportunity for a registrar to attend the AADDM
career general practitioners’ benzodiazepine prescribing: a longitudinal analysis.
Journal of General Internal Medicine. 2018https://doi.org/10.1007/s11606-018-4577-5 conference in Sydney 6-7 September. EOIs to Dr Small
jacqueline.small@health.nsw.gov.au by 20 August.
Training Update | Registrar Issue 28 | August 2018 | pg6Mileage rate increase Need some help?
The Australian Taxation Office has increased the mileage Education Coordinators
rate from .66c/km travelled to .68c/km travelled from 1
July 2018. Claims for travel undertaken after 1 July 2018 • Central, Eastern and South Western Sydney:
will be paid at the new rate for applicable travel as outlined Tia Dickson - 02 8321 4101
in the Registrar Support Guidelines. tia_dickson@gpsynergy.com.au
• Hunter, Manning and Central Coast:
Heidi Heinz - 02 8321 4238
heidi_heinz@gpsynergy.com.au
External activities of interest • Nepean, Western and Northern Sydney:
Kym Cashen - 02 8321 4112
• Western NSW PHN - Embedding Aboriginal & kym_cashen@gpsynergy.com.au
Torres Strait Islander Cultural Safety in Western • New England/Northwest:
NSW General Practice and Primary Health | Sally Lucas - 02 8321 4015
15 August 2018 | Bathurst | More information sally_lucas@gpsynergy.com.au
• Western NSW PHN - Embedding Aboriginal & • North Coast:
Torres Strait Islander Cultural Safety in Western Joanne Sayer - 02 8321 4128
NSW General Practice and Primary Health | joanne_sayer@gpsynergy.com.au
16 August 2018 | Orange| More information
• Western NSW:
• ACRRM - Ultrasound Workshop | Rachel Harris - 02 8321 4212
18 August | Mascot | More information rachel_harris@gpsynergy.com.au
• ACRRM Rural Emergency Skills Training (REST) | • Murrumbidgee and ACT:
1-2 September | Canberra | More information Catherine Daly - 02 8321 4149
• ACRRM Rural Emergency Skills Training | catherine_daly@gpsynergy.com.au
15-16 September | Mascot | More information • South Eastern NSW:
Amanda Piatek - 02 8321 4164
amanda_piatek@gpsynergy.com.au
Upcoming GP Synergy events Registrar Liaison Officers (RLO)
• Western NSW:
Registrars in their first or second GP term Currently vacant. Please contact another RLO.
workshops • Nepean, Western and Northern Sydney:
Dr Rajdeep Ubeja –
Foundation/Frameworks and Regional Workshop 1:
RLO_NESydney@gpsynergy.com.au
• Hunter New England Central Coast:
• Western NSW Node 1: 4-6 Sept, Dubbo
Bob Vickers - RLO_HNECC@gpsynergy.com.au
• Western NSW Node 2: 30-31 Aug, Wagga Wagga &
• Central, Eastern and South Western Sydney:
Collingullie
Rebecca Chan - RLO_LESydney@gpsynergy.com.au
• Western NSW Node 3: 20 or 21 Sept, Small
• South Eastern NSW:
groups, various locations
Jessica Swan -
• Lower Eastern NSW Node 1: 4-5 Sept, Liverpool RLO_SouthEastern@gpsynergy.com.au
• Lower Eastern NSW Node 2: 26-28 Sept, • North Coast:
Wollongong Currently vacant. Please contact another RLO.
• Lower Eastern NSW Node 3: 20 or 21 Sept, Small
• Murrumbidgee and ACT:
groups, various locations Jessica Tidemann -
• North Eastern NSW Node 1: 22-24 Oct, Coffs RLO_MurrumACT@gpsynergy.com.au
Harbour
• North Eastern NSW Node 2: 15-17 Oct, Armidale
Rural Support Officers (RSO)
• North Eastern NSW Node 3: 31 Aug, Newcastle • New England/Northwest | North Coast | Hunter
• North Eastern NSW Node 4: 4-5 Sept, Liverpool Manning & Central Coast:
Kerry Robins - kerry_robins@gpsynergy.com.au
Exam preparation workshops • Western NSW:
Maria Logan - maria_Logan@gpsynergy.com.au
• GP Synergy RACGP exam preparation workshops
• Murrumbidgee:
are now being planned for registrars sitting the
Sue Hefren - sue_hefren@gpsynergy.com.au
exams in 2018.2 only. Please email Nicole Tooma:
nicole_tooma@gpsynergy.com.au • South Eastern NSW:
April McFadden - april_mcfadden@gpsynergy.com.au
• GP Synergy ACRRM assessment preparation
workshops are currently being planned for
registrars sitting ACRRM assessments. Please
email Claire Doyle: claire_doyle@gpsynergy.com.au
Training Update | Registrar Issue 28 | August 2018 | pg7You can also read
