MEDIUM TERM FOLLOW UP OF THE WORKSHOP COMPONENT OF A GP TRAINING PROGRAM
Dr Anne Eastwood
Institute of General Practice Education (IGPE)
Aim:
To provide feedback to a GP education provider on part of a program.
Background:
IGPE provides training for registrars in south and Southwest Sydney. There is little published medium to long term evaluation of GP training in Australia or elsewhere.
Methods:
Key informant interviews, a study of the curriculum from a perspective of education theory and a literature review, were used to construct a questionnaire. Thirty-nine questionnaires were mailed to registrars in their final six months of the program and those who had completed the program since 2005. Responses were coded and analysed using descriptive statistics and grouping by themes.
Results:
Twelve completed questionnaires were returned (31%). Respondents appear to find knowledge and skill based workshop topics the most valuable. They supported a workshop on practice management near the end of training and the continued provision of hard copy resources.
Conclusions:
The poor response rate limits conclusions. This is a known problem with GP surveys. However, certain findings are suggestive. Information and skills based topics appear to be most valued and half the respondents rated social contact as the most important function of the workshops.
STRUCTURED BUT FLEXIBLE FRAMEWORKS FOR PRACTICE TEACHING
Dr Catherine Regan1 2
1General Practice Training - Valley to Coast, 2Faculty of Health, University of Newcastle
These were developed in response to expressed needs and ongoing feedback from supervisors and registrars. The objective was to provide a relevant framework for practice teaching which would be adaptable enough for use by supervisors and registrars with very different skills and needs and which would be flexible enough to respond to changing needs. It would provide resources and also incorporate and encourage our formative assessment program.
Although some supervisors requested help with “what to teach” and some registrars noted lack of structured teaching, others had well structured programs which had stood the test of time. We needed a framework on which branches could be grafted.
The term 1 framework has six modules on basic topics and the term 2 framework has six modules on aged care presentations. The latter emerged from an email-delivered aged care module aimed at greater integration between workshop and practice learning. Modules contain suggestions for teaching, relevant articles and registrar activities (without overloading), with no compulsion to complete each one for every registrar. However, there is a teaching checklist and registrars are expected to have covered the topic areas in some way.
In addition to the modules, the framework encompasses orientation and observation sessions, reviews of progress and activities planned jointly for the individual registrar.
Feedback so far has been positive and constructive. The frameworks have been implemented in flexible and customized ways. It will be straightforward to update, add or delete modules as appropriate in the future.
BEST PRACTICE: CONSULTATION PERFORMANCE FEEDBACK
Dr Myra Dunn
GPlogic General Practice Training
This poster presentation describes a method of providing feedback to registrars who have completed a role play consultation which poses a possible cross-cultural problem. The registrars complete this role play under exam conditions. The role play is assessed, using specific criteria, by a medical educator and a cultural safety expert. The presentation will demonstrate:
(1) The presentation of role play situations. This consists of a description of a farmer from an isolated rural area, recently widowed, seeking treatment for chest pains. Another scenario also used concerns a Roman Catholic couple who have six children. The wife is pregnant again and Down’s Syndrome appears likely. They present for discussion about their alternatives for action.
(2) The assessment procedures, including the criteria used. The medical educator and the cultural safety expert rate the role play performance according to a number of criteria.
(3) The method of providing feedback to registrars. Each registrar is given an evaluation of his/her role play performance as rated against the criteria. Suggestions for improvement are made and support provided for those who need further assistance.
Evaluation of this performance is part of a number of assessments GPlogic conducts concerning cultural safety skills and communication skills. As a result of these assessments registrars may be required to do GPlogic’s online Cultural Safety Program.
DIRECT OBSERVATION TEACHING SESSIONS BY SUPERVISORS. AN AVENUE OF FORMATIVE ASSESSMENT
Dr George Kostalas
Institute of General Practice Education Inc. (IGPE)
A formal system of direct observation was commenced at IGPE in 2007. Supervisors were required to complete three assessments based on three patients per term for each basic GP registrar.
Positive evaluations were received by both supervisors and registrars. The assessments were used to triangulate registrar progress.
CULTURAL ISSUES IN GENERAL PRACTICE VOCATIONAL TRAINING
Mr Hadia Haikal-Mukhtar1 2, Dr Christos Papachristos1
1Victorian Metropolitan Alliance, 2University of Melbourne
Cultural issues influence the doctor/ patient relationship as well as interactions between health professionals. Acquiring knowledge and skills to manage cultural issues in general practice is a requirement of the RACGP curriculum. It is also a key contributor to an appropriate and forward - looking training in general practice, which aims to cater for a culturally and linguistically diverse society and medical workforce.
The structure of the workshop consists of an introduction to the topic by the speaker, followed by participants breaking - up into small group to discuss clinical case scenarios and share experiences related to the topic. This is followed by a presentation on cultural theories and a role - play which illustrates these theories. The workshop concludes with strategies which supervisors and educators can adopt in their general practice and when coaching GP registrars
The content covers relevant statistics on culturally and linguistically diverse communities in Australia, theories of culture, the opportunity to discuss clinical case scenarios and similar personal experiences in general practice, as well as strategies/practical tips to manage cultural issues in general practice.
The learning objectives are:
A FOCUSSED COMMUNICATION TRAINING TOOLBOX FOR CLINICIANS SUPERVISING INTERNATIONAL MEDICAL GRADUATES
Ms Jane Anderson-Wurf, Prof Louis Pilotto, Dr Geraldine Duncan
University of New South Wales Rural Clinical School
A change in the Australian medical workforce over the last 10 years has seen an increasing number of international medical graduates (IMGs) being recruited into general practice positions, particularly in rural Australia. This increase has also been reflected in general practice training where in 2006, 33% of places in postgraduate training programmes were overseas trained doctors with permanent resident visas who had completed their AMC examinations.
GP supervisors of IMGs need culturally appropriate tools and resources to address underlying communication issues for use in teaching sessions with registrars. A toolbox consisting of six parts has been developed for use by supervisors in their teaching sessions. The toolbox includes sections on:
(1) Orientation to Medical Practice in Australia
(2) Structure of the Consultation
(3) Challenging Consultations
(4) Language Competency
(5) Teaching, Learning and Supervision
(6) Written Communication Skills.
The poster will present an overview of the practical resources focusing on the readings and worksheets specifically developed to explore and reflect upon values, attitudes and communication skills in these areas. Participants will have an opportunity to view the teaching materials and consider their application to their particular teaching situation.
GP TRAINERS’ PROFESSIONAL DEVELOPMENT AND TRAINING CAPACITY IN NTGPE GP TRAINING PROGRAM
Dr Nigel Gray, Dr Ameeta Patel, Dr Hung The Nguyen
Northern Territory General Practice Education (NTGPE)
Context
NTGPE GP training program is delivered to a geographically vast area. The program offers challenging and rewarding placements in urban, rural and remote training posts. Significant emphasis is placed upon Indigenous health and cultural training as well and rural and remote general practice. Due to the vast distances and harsh terrains, GP trainers (GPTs) may sometimes find attending NTGPE organised conference and meetings a challenge to them and their families. Time away from work and family, cost in salary and enduring long journeys are some key hardships for GPTs when trying to particpate in NTGPE PD activities.
Objectives:
The poster will:
Key messages
GPTs in the Northern Territory are extremely dedicated and enthusiatic in training future general practitioners. They are distant and isolated from each other and NTGPE. Much more work and resources are required to overcoming these barriers.
Key principles in engaging GPTs in continual professional development in teaching and learning in the NT are: to provide multiple opportunities to participate; different access to scheduled events; innovative use of IT resources; and appropriate level of financial support. The benefits are an engaged, connected, supported and organisationally aware group of dispersed but dedicated GP trainers.
Conclusion
NTGPE recognises the essential role of GPTs in GP training and are continually defining locally appropriate and relevant professional development for GP trainers.
COMMUNITY RESIDENCIES, CREATING COMMUNITY FOCUSSED JOBS FOR PREVOCATIONAL DOCTORS USING GENERAL PRACTICE EXPERIENCE IN WESTERN AUSTRALIA
Ms Maryanne Coombs, Ms Stephanie Hoad
Western Australian General Practice Education and Training (WAGPET)
The Community Residency Program has been developed in response to the increasing number of medical graduates requiring high quality prevocational placement and training. The Community Residency Program aims to give junior doctors a community medicine experience through integrated hospital and general practice placements. Training posts for the program have been developed in the regional areas of Bunbury, Geraldton, Kalgoorlie and Karratha, and in outer metropolitan areas of Armadale, Joondalup and Rockingham-Kwinana. Placements involve general practice experience combined with any of the following disciplines: Emergency Medicine, Homeless & Youth Medicine, Palliative Care, Obstetrics and Paediatrics.
The Project, initiated in February 2006 by the Organisational Development Division of the Department of Health Western Australia, was piloted in 2007 and expanded in 2008 following an evaluation of the pilot. The in response to the increasing number of medical graduates requiring high quality prevocational placement and training. WAGPET has been contracted to provide this program.
Objectives
To demonstrate that providing prevocational doctors with a working experience across disciplines in community and hospital medicine, provides junior doctors with an improved understanding of continuity of care and the relationship between primary and secondary care.
Key Messages
Conclusion
It is anticipated that these community residency positions will provide an improved interface between hospital and community medicine and that junior doctors will gain a greater understanding of the place of general practice in patient care. It is further anticipated that the program will help junior doctors make an informed decision about their futures and encourage them to engage in general practice as a medical career.
PREVOCATIONAL GENERAL PRACTICE PLACEMENTS PROGRAM
Ms Olga Makripoulias1, Ms Leanne Renfree2, Dr Morton Rawlin1
1Royal Australian College of General Practitioners (RACGP), 2Australian college of Rural and Remote Medicine (ACRRM)
A combined presentation from the managing organisations: RACGP and ACRRM.
The Pre-vocational General Practice Placements Program (PGPPP), funded under a grant from the Commonwealth Department of Health and Ageing provides up to 280 training placements per year, for junior doctors to undertake supervised 10-13 week general practice placements as part of their hospital training.
As at the start of 2008, there were a combined total of (ACRRM = 42 + RACGP=) practices participating in the program with (ACRRM = 33 = RACGP=) hospitals and (ACRRM=17 + RACGP=) fundholders involved in the program. To date, there have been (ACRRM=372+RACGP=) junior doctors placed in practices throughout Australia
The recently conducted National Internal Evaluation indicates the program has a positive affect on junior doctor’s clinical experience, as well as their attitude towards general practice training and lifestyle. The data demonstrates that the PGPPP is an important transitional education program that assists participants in better evaluating their long-term career prospects.
The PGPPP is a valuable program that is increasing in popularity amongst junior doctors and the general practice community. The evaluation data provides a basis for program improvements around such aspects as capacity, supervision and educational activity.
Chart: not included on webpage
“I KEEP THINGS CONFIDENTIAL AND THEN THE WHOLE OF THE COMMUNITY STAYS WELL": CONFIDENTIALITY AND GENERAL PRACTITIONER TRAINING IN AN ABORIGINAL MEDICAL SERVICE
Dr Jenny James1, Ms. Sonya Cameron1, Professor Tim Usherwood2
1Aboriginal Medical Service (AMS), Western Sydney, 2Department of General Practice, University of Sydney at Westmead Hospital
The medical ethic of confidentiality matters enormously to the Western Sydney Aboriginal community. The doctor-patient relationship will be enhanced if GPs can have some understanding of how local culture and community values influence this. AMS Western Sydney is a training post for GP registrars. Cultural mentoring from our health workers is a central part of the teaching programme. This qualitative research study aims to enhance this method of teaching, by incorporating Western Sydney Aboriginal community views into understandings of a topic that is usually examined through Western philosophical systems of ethics. The study has been a collaborative effort between the GP investigator and an Aboriginal cultural mentor. In depth interviews on the topic of confidentiality have been conducted with Aboriginal Health Workers, non-Aboriginal workers at the AMS, GP registrars, and Aboriginal clients of the service. These were recorded and transcribed, and are being analysed for themes emergent from the data. Key findings will be presented. The research is being conducted in accordance with the Aboriginal Health and Medical Research Council's Guidelines for Research into Aboriginal Health.
GP CARE FOLLOWING HOSPITALIZATION IN COMPLEX MEDICAL PATIENTS
Dr Shu Ching Yang1, Prof Nicholas Zwar2, Dr Sanjyot Vagholkar1, Dr Sarah Dennis3, Dr Helen Redmond 4
1General Practice Unit, Sydney South West Health Area, 2School of Public health and Community Medicine, University of New South Wales (UNSW), 3UNSW Centre for Primary Health Care and Equity, 4Rehabilitation Medicine, Sydney South West Health Area
Patients with complex medical problems often have unmet information needs, and are at risk of adverse health outcomes following hospital discharge. General practitioners are able to offer these patients continuity of care, and provide information to meet the patient’s needs. However, there is currently a lack of information about the benefits of primary care follow up and barriers to accessing such care.
Aims
To describe GP care of complex medical patients after hospital discharge. The effect of GP follow up on a patient's management and their satisfaction with their health care and understanding of their condition and management will be assessed. Utilisation of other health services or professionals post-discharge and barriers to follow up with GP will also be examined.
Methods
Participants recruited from a district hospital with complex medical conditions will be interviewed by phone 2 weeks post discharge using the study questionnaire. The phone interview will then be thematically analysed.
Results
Data on patients’ understanding of their hospital admission, management, discharge plans and changes instituted at follow up as well as patients’ level of satisfaction with follow up will be presented. Attendance at follow up, utilisation of health services and barriers to follow up will also be described.
Conclusion
The outcome of the research is expected to provide information on general practice follow up in medical patients with complex problems. We also hope to identify barriers preventing access to primary health care which may lead to further research to explore ways to optimize general practice follow up.
FUTURE STANDARDS FOR AUSTRALIAN GENERAL PRACTICE VOCATIONAL TRAINING
Dr Morton Rawlin, BMed, MMed Sci, Dip Prac Derm, Dip FP, Dip Bus Admin, FRACGP, FACRRM, Dr Frank Meumann, B Med Sc (Hons), MBBS, DRCOG, DCH, FRACGP, PAC Psych Med, FAICD, Grad Cert Clin Ed, Mr Roald Versteeg, BBus, Mr Greg Dalton, BHSc, Dip Voc Trng
Royal Australian College of General Practitioners (RACGP)
Introduction
The Royal Australian College of General Practitioners (RACGP) sets the standards for the delivery of Australian general practice vocational training. The standards are currently being reviewed to ensure that vocational training continues to reflect current and emerging challenges in general practice.
Methods
To progress the development of the standards for general practice vocational training the RACGP has:
Results
Postgraduate medical vocational training both nationally and internationally varies significantly. This includes duration of training, required experience, level of supervision, and assessment during training.
Consultation with stakeholders indicated vocational training standards should be flexible, intuitive, outcome focussed and achievable.
Discussion and conclusions
Reviewing current literature and early consultation with key stakeholders are fundamental to the development of the Australian general practice vocational training standards, including the development of the underpinning principles, the conceptual framework, structure, and draft standards.
Following a brief presentation of the development of the standards to date, the RACGP will seek stakeholder and international perspectives in this session regarding the:
Findings concerning international literature trends in this area will be presented, including lessons learned throughout the development process.
SKIN CANCER WORKSHOPS FOR RURAL AND REMOTE GENERAL PRACTITIONERS
Ms Sarah Constantine, Ms Kylie Willett, Mr Col White
Health Workforce Queensland
Background:
Many experienced rural GPs are treating skin disorders; it comprises a significant part of their practice. Australia leads the world in the incidence of skin cancer and over 80% of treated skin cancers are managed by GPs.
Issue:
For patients living and working in a rural and remote Queensland, access to specialists is limited. Making a trip to a specialist for skin cancer surgery is expensive and time consuming.
Skin Cancer Workshop Objective:
To provide comprehensive training in the diagnosis and management of skin cancer medicine in the primary care setting to ensure that GPs can safely and effectively diagnose and manage the large majority of patients with skin cancer and associated conditions in their own practice.
Five, 5-day workshops have been held in since 2003. 101 Rural GPs have completed the course.
Results:
When asked how these new skills would help them in their current practice, the majority of participants discussed greater confidence in patient diagnosis and management of skin conditions. Also discussed was the ability to treat the conditions themselves rather than referring them on, better patient outcomes, and being able to offer more advanced procedures to patients. Delegate’s comments include;
Conclusion
It is important that rural doctors have access to quality skin cancer surgery training in order to deliver the best outcomes for their patients both in cost and effectiveness of treatment.
A PILOT PROJECT DEVELOPING A SPECIAL SKILLS POST IN PSYCHIATRY TO ENHANCE GENERAL PRACTICE PSYCHIATRY EDUCATION AND HEALTH CARE OF PSYCHIATRY PATIENTS
Dr James Best1, Ms Natalie Taig2, Dr Kathryn Roberts1
1Sydney Institute of General Practice and Training Ltd (SIGPET), 2NSW Institute of Psychiatry
Rationale
Undergraduate and post-graduate clinical psychiatric training of GP candidates is often limited, especially in non acute mental health, which forms the majority of clinical interactions in general practice.
In addition, general medical care of patients with mental health problems is often poor, to both patients in the community, and in psychiatric hospitals and institutions.
Program/ Model
A new psychiatric clinical placement with a formal educational component, designed for GPs and GP registrars, is currently being trialled. The placement includes clinical work in an outpatient psychiatry setting under psychiatrist supervision, learning clinical psychiatry skills. It also includes clinical work attending to general medical needs of patients in a psychiatric hospital. Formal educational training is run in parallel with the clinical placements in a pilot Mental Health Education Program developed by the NSW Institute of Psychiatry (NSWIoP). The placement is also approved as a Special Skills Post.
Subjective Outcome
Assessment of the placement has been done by interview with relevant parties, including the GP registrar involved in the placement, administrators, clinical supervisors, Nursing Unit Managers and also patients. This will be performed using a subjective scored questionnaire on either the value to patient care, or the value to the GP registrar’s educational needs, or both, depending on the role of the interviewee.
Future Direction
It is hoped that this model can be used by other institutions, in co-operation with other GPET regional training providers and the NSWIoP. If expanded to other institutions, a more formal analysis of outcomes would be desirable.
INDIGENOUS CONSULTATIONS IN GENERAL PRACTICE
Dr Hung Nguyen, Mr Kevin Parriman, Ms Ada Parry
Northern Territory General Practice Education (NTGPE)
Context
There is a lack of quality video consultations involving Indigenous patients in general practice. Although, live simulated patient sessions offer potential benefits in education and training of learners in Indigenous health there are significant barriers and limitations both logistically and from a cultural safety perspective.
NTGPE with funding from ACRRM, have produced a DVD of Indigenous consultations in general practice with an accompanying booklet. These resources can be used in a number of ways, by employing multiple educational methodology that best fit local and educational objectives.
Objectives
Key messages
Potential use of this resource is in the appraisal of skills, knowledge and attitudes of learners, communication issues in an Indigenous context and as a springboard for discussion of common Indigenous health topics.
Conclusions
This resource is a valuable in addition to training providers’ current list of resources in Indigenous health education and training.
IMGES: INTERNATIONAL MEDICAL GRADUATE EDUCATION AND SUPPORT PROGRAM AT NTGPE
Dr Hung Nguyen, Ms Helen McHugh
Northern Territory General Practice Education (NTGPE)
Context
International medical graduates (IMGs) have been a significant workforce for rural and remote general practice. It is unusual that NTGPE has comparative very low number of IMGs in it GP training program. The NT has a relatively large pool of IMGs who are arguable poorly supported in general practice and in the public hospital system. This fact alone can explain why IMGs, when they have a chance, leave the NT to other states for further training and employment. NTGPE is building on its success after the introduction to the NT of the Clinical Bridging Course which is unique in its approach of combining cultural competence training with clinical training. We have created a new program to support IMGs who are in general practice (and who are not in the GP training program) and those who are interested in the general practice career pathway.
Objectives
Key messages
(1) The development of the IMGES program is based on extensive consultations with GPRs, GPT, MEs, ACE and IMGs themselves.
(2) The choice of educational methods are balanced between participants’ needs, available resources in the NT, evidence of successful methodology in teaching IMGs and integration with existing programs (such as the GP training program and Aboriginal cultural orientation program).
(3) Support for IMGs in rural and remote context is paramount for a healthy GP workforce in the NT, assistance for GP Trainers, patient safety and satisfaction and future GP training program recruitment.
(4) IMGs value support but above all, a sense that their contribution to general practice is recognised and welcomed.
Conclusions
RTPs has a significant role to play in support IMG collegues in general practice and can be achieved with local resources.
A PILOT STUDY TO MEASURE THE PREVALENCE OF SYMPTOMS OF OBSTRUCTIVE SLEEP APNEA IN PRIMARY CARE PRACTICE IN AUSTRALIA
Dr Soheyl Aran
Institute of General Practice Education Inc (IGPE)
Ostructive sleep apnea is a common medical condition with significant morbidities.OSA remains under diagnosed in primary care in Australia .In Australia the only method to diagnose OSA is by doing the sleep study. In this study we used the Berlin questionnaire which is a validated instrument to identify individuals who are at risk for OSA. The present study undertaken to find out the prevalence of symptoms of obstructive sleep apnea in one of primary care practice in western suburbs of Sydney and to gain an awareness of the potential size of the burden of OSA.
HEADSPACE - A MODEL OF GENERAL PRACTICE FOR THE FUTURE
Mrs Neroli Stayt
Australian General Practice Network
Headspace, which is the new National Youth Mental Health Foundation, provides an interesting model of primary health care delivery and multidisciplinary teamwork in partnership with community-based service providers. General practice is central to this approach and as such headspace provides an interesting model for discussion in regard to the way of the future for general practice.
FINDINGS FROM THE "45 YEAR-OLD" HEALTH CHECK IN GENERAL PRACTICE
Ms Rachel Boak, Dr Eldon Lyon, Prof James Dunbar, Prof Prasuna Reddy, Dr Margaret Garde
Aims & Background:
In November 2006 a new Medicare Benefits Schedule (MBS), the “45 year old health check” (item 717), was introduced. This project was designed to investigate implementation of Item 717 in Rural and Regional Victorian and South Australian General Practices, specifically to;
• Develop a systematic approach to undertaking the health check;
• Collect data relevant to chronic disease risk factors; and
• Investigate different patient recruitment methods
Methods:
A systematic approach to performing health checks was developed. Registrars and supervisors collected data on numbers of patients attending, methods of recruitment, and several chronic disease risk factors. A focus group was held to understand registrars’ experiences of patient recruitment.
Findings:
Ten registrars and GPs from eight different practices recruited 157 eligible patients to undergo health checks during a five month period. The majority of patients were recruited to health checks opportunistically. Telephone and letter invitations were also used by some GPs.
A standard template ‘checklist’ prompt for performing health checks was developed, based on the RACGP recommended checklist. This template was made available on practice software. Several chronic disease risk factor results were recorded by registrars. For example, BMI, blood pressure, lipid profile, fasting glucose.
Conclusion:
The distribution of several chronic disease risk factors for a population presenting for health checks in General Practice was determined. The distribution of risk factors in this group was compared with State and regionally representative data for the same age group.
CONSIDERATIONS IN UNDERTAKING FURTURE GENERAL PRACTICE REGISTRAR RESEARCH
Dr Eldon Lyon, Ms Rrachel Boak, Dr Margaret Garde Prof James Dunbar, Prof Prasuna Reddy
Enablers
Registrar
- Start later in the year
- Research mentor to each registrar
- Educate supervisors to better support the project