GPRA Statement on community-based training positions

GPRA Position Statement on community-based training positions

Position statement number: S01

1. PURPOSE

This document outlines the position of General Practice Registrars Australia on quality community-based training positions for vocational training in the specialty of general practice in Australia.

2. BACKGROUND

The RACGP defines general practice as “providing person centred, continuing, comprehensive and coordinated whole-person health care to individuals and families in their communities”(1). ACRRM states that “general practitioners can deliver services in the ambulatory care setting, the home, hospital, long-term residential care facilities or by electronic means—wherever and however services are needed by the patient”(2).

General practice training follows the curriculum and accreditation standards set by ACRRM and the RACGP, and involves gaining clinical experience hospital and community-based settings. General practice training employs an apprenticeship model whereby the trainee (Registrar) is involved in a broad range of patient care and clinical tasks under supervision from an experienced colleague. This practice-based learning is supplemented and consolidated through discussions and teaching from supervisors, teaching from medical educators, workshops and personal study.

3. SCOPE

This document applies to community-based general practice settings and other primary health care settings in which General Practice (GP) registrars (including independent pathway doctors and Australian Defence Force registrars) receive clinical training and all stakeholders involved in providing this training. This statement does not specifically apply to hospital and out-of-practice training environments, but the general principles described in this document may also be relevant to these settings.

4. GPRA POSITION

A high-quality community-based training position is in a training practice, such as a general practice or other primary health care facility, where: GP registrars are recognised as providing a valuable role in community-based patient care.

There is a demonstrated commitment and capacity to support the training of GP registrars. Most importantly, the consultant medical practitioners and other staff ensures that registrars are well supervised in their delivery of safe and effective health care, appropriate to the registrar’s competency and stage of training.

The apprenticeship model, which underpins GP training, is the cornerstone of the registrar’s experiences in the primary health care setting. Scheduled in-practice teaching, as well as access to ad hoc advice and guidance from the supervisor, is a vital component. The level of supervision should be matched to the registrars learning needs and level of clinical experience. Supervisor feedback and formative assessments promote the development of confidence and competence in the registrar. GP registrars are supported to acquire the necessary skills and experience through orientation, effective educational supervision, an appropriate workload, relevant learning opportunities, personal support and time to learn.

It is recognised that the GP registrar’s primary focus is education and obtaining clinical experience of providing high-quality patient care. This is not compromised by unreasonable clinical service demands, billing imperatives or other business issues related to practice management.

A safe environment is provided for the GP registrar as:

a clinician, in terms of potential aggressive behaviours from patients or other staff; and
a learner, in relation to a supportive, collegiate training environment where the registrar is considered to be an integral member of the practice’s clinical team and the power imbalance between supervisor/employer and registrar is appropriately addressed.

In this context, there is a zero-tolerance approach to matters of bullying, sexual harassment and discrimination.

The GP registrar has access to an appropriately configured consulting room, other clinical spaces and all relevant resources, IT support and necessary equipment and medications. (3)
The registrar is exposed to the broadest possible range of clinical conditions, but with due regard for the registrar’s competency and stage of training. The registrar has sufficient patient load to build clinical experience but their workload is no greater than any other doctor in the practice.

There are workplace policies in place to support the wellbeing and mental health of the GP registrar. This should include support for:

breastfeeding and other family/carer responsibilities.
parental leave
antidiscrimination and diversity.
fatigue management.

The GP practice is a formally accredited practice and approved for GP training (4,5).

5. RECOMMENDATIONS

The clinical responsibilities, related duties, working hours and supervision of GP registrars must be consistent with the delivery of high-quality, safe patient care.

The training practice should be committed to provide a good learning environment and engage in regular quality improvement activities, including regular review of patient management issues and audit.

Registrars are engaged as employees of the practice in which they are training under a written employment agreement negotiated, respectfully and in good faith, between the practice and registrar. The remuneration and employment terms and conditions of the registrar are based upon the minimum entitlements and obligations described in National Terms and Conditions for the Employment of Registrars (NTCER).

Supervisors are committed to continuing professional development in their role as educators and clinical supervisors.

The practice has policies and procedures in place to enable the registrar to raise concerns and address any grievances, as well as processes for resolving differences that maximise safety for all parties and address power differentials.

6. DEFINITIONS

ACCRM: Australian College of Rural and Remote Medicine

RACGP: Royal Australian College of General Practitioners In-practice teaching: is teaching and learning focused on, and usually directly involving, patients and their problems. Skills such as history taking, physical examination, patient communication and professionalism are best learnt in the clinical setting (6).

7. DATES AND NOTES

Originally approved by the GPRA Board: 12 May 2018
Current version number: 1
Next review year: 2021