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General practice Connecting the dots for students and junior doctors

DynaMed

Australia’s only peer reviewed, MEDLINE listed and SCIE indexed journal for general practitioners

ion 8th edit

Australian Family Physician

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Vol 42, No.12, December 2013

FOCUS

Juggling resources

Juggling resources

Volume 42, Number 12, December 2013

Resource allocation Multimorbidity Overdiagnosis

Pages 833–912

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www.racgp.org.au

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pathway

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15 options

22 RACGP

contacts

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You are faced with a variety of choices as you go through medical school. Ultimately, it comes down to what speciality strikes a chord with your interests and what lifestyle you prefer. This guide is designed to help clarify questions you may have about general practice as a speciality, and provide you with important information about what a career in general practice entails, the steps you need to take to become a general practitioner (GP) and what options are available throughout your career.

It’s your future


about

about

What is general practice? General practice provides person-centred, continuing, comprehensive and coordinated whole-person healthcare to individuals and families. As a sector, general practice, its practice teams and their primary healthcare relationships comprise the foundations of an effective healthcare system.

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As general practice is largely a relationship-based specialist medical discipline, GPs possess a unique combination of characteristics and skills, which are described below.

Person centredness

Whole-person care

GPs understand that health, illness and disease are ultimately personal experiences and their principal role is to relieve personal disease, in all its forms, in the manner best suited to each individual.

In caring for the medical needs of the whole person, the GP functions as a physician, counsellor, advocate and agent of change for individuals, families and communities.

Continuity of care GPs seek to build health, wellbeing and resilience through the continuing patient窶電octor relationship, application of best available evidence in the unique context of each consultation, and planned coordination of clinical teamwork, resources and services. One of the most rewarding aspects of general practice is the relationship GPs build with their patients; some GPs deliver the grandchildren of children they previously delivered.

Diagnostic & therapeutic skill GPs are skilled in managing uncertainty, undifferentiated illness and complexity. They are able to utilise best practice evidence in light of individual circumstances, and engage patients and families in understanding, planning and managing their health according to individual capacities. If you seek challenge, diversity and flexibility, general practice may be the vocation for you. It provides a lifelong career with a range of learning and employment opportunities.

Comprehensiveness General practice services and skills are not limited by age, gender, body system, disease process or service site. 3


pathway

pathway

In order to practise as a GP in Australia, all graduates need to undertake training and complete the assessment process at one of two colleges. The Royal Australian College of General Practitioners (RACGP) is the largest general practice organisation in Australia and is the national leader in setting and maintaining the standards for quality clinical practice, education and research. Here is an outline of the journey towards general practice for medical students and junior doctors in Australia, starting from your internship until you are a qualified GP (RACGP Fellow), and beyond. For further details about the RACGP, see page 22.

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The RACGP journey towards general practice (via the vocational training route)

Medical school (4-6 years)

Postgraduate resident years (PGY2) (this can be completed before or during general practice training)

Postgraduate year 1 (PGY1) Prevocational General Practice Placements Program (PGPPP) (optional) General practice training (3 years) Fellowship in Advanced Rural General Practice (FARGP) registrar pathway RACGP Fellowship examination

Successful completion of RACGP training and assessment

Advanced academic skills

RACGP Fellowship

Continuing professional development

FARGP Recognised prior learning (RPL) pathway for GPs working in rural and remote Australia

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pathway

Internship year

Postgraduate resident years

During your final year of university, you need to apply for your PGY1. PGY1 is primarily spent in public hospitals and/or community settings and consists of rotations that provide practical experience in each of the speciality areas of Australian medicine. Postgraduate Medical Councils (PMCs) in each state/territory are responsible for developing the education and training requirements for the internship year and can assist with the process of matching with and applying to hospitals in your state/territory.

While there is no requirement to complete hospital training (PGY2) prior to entry into general practice training, some junior doctors choose to undertake 1–2 years of hospital experience before committing to a specialist training program. If you do complete additional hospital experience after your internship, you may be eligible for RPL once you commence general practice training.

For more information, visit www.cpmec.org.au. If you decide a career in general practice is the one for you, you can submit an application during this year to commence training in the second year after graduation. If you are unsure whether you are suited to general practice, the PGPPP is a great way to get a real taste for the specialty. See page 7 for details.

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PGPPP The PGPPP is managed by General Practice Education and Training Limited (GPET) on behalf of the Australian Government. The PGPPP is facilitated through 17 regional training providers (RTP) and delivered by accredited practices and medical services throughout Australia. Postgraduate doctors who are engaged in the Australian healthcare system, and who hold a medical degree recognised by the Australian Medical Council and current registration with the Medical Board of Australia are eligible to apply to participate in the PGPPP.

The PGPPP involves working in an urban, regional, rural or remote general practice environment for an average placement of 12 weeks, allowing you to gain a sense of autonomy in your healthcare management skills. The program aims to build your confidence, experience and interest in general practice, increase your understanding of the vertical integration between primary and secondary healthcare, and encourage you to be better informed about general practice before deciding on your career path. For more information, visit www.gpet.com.au/Junior-doctors/ Prevocational-General-PracticePlacements-Program.

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pathway

General practice vocational training Vocational training towards RACGP Fellowship is three years’ full-time (or part-time equivalent), with an optional fourth year for additional skills and qualifications in rural general practice. There is flexibility regarding when and how the essential components of training can be completed, such as the ability to complete the training on a part-time basis and/or take up to three years of leave. The essential components of vocational training towards RACGP Fellowship are described below.

Hospital training (12 months) There are four compulsory hospital rotations for general practice training: general medicine; general surgery; emergency medicine; and paediatrics. To complement this you also need to undertake three hospital rotations of your choice, provided they are relevant to general practice.

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General practice placements (18 months) General practice placements need to be completed in RACGP-accredited teaching practices and include a compulsory term (minimum six months) in an outer-metropolitan or rural and remote area.

Extended skills (six months) The six months of extended skills training provides an opportunity to further develop your general practice skills and can be completed in a range of RACGP-accredited settings. Options include advanced rural skills, an overseas or academic post, or extended procedural skills within a hospital or practice.


Applying for vocational training General practice vocational training in Australia is managed and delivered by GPET and the Remote Vocational Training Scheme (RVTS). These organisations deliver the training according to the standards set by the RACGP. Once you have decided general practice is your desired career path, you will need to apply for training through GPET or RVTS. GPET is the largest general practice training organisation and offers general and rural streams of training. The RVTS delivers training only in remote and isolated communities to a smaller group of registrars.

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pathway

Australian General Practice Training (AGPT) program The AGPT program is managed and funded by GPET, a whollyowned Australian Government company. GPET was created in 2001 to establish and administer a regionalised approach to GP training. Applications for the AGPT program usually open in April and training commences the following calendar year. The AGPT program application and selection process is made up of three stages: • Stage 1 Application and eligibility check; apply online via www.gpet.com.au. • Stage 2 National assessment and ranking. • Stage 3 RTP selection and placement offers. For further details on the AGPT program, or to apply, visit www.gpet.com.au/Junior-doctors/ AGPT-program.

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RVTS The RVTS is an Australian Government-funded program that has been delivering general practice training for more than 10 years. Structured distance education includes weekly sessions via webinar, twice-yearly workshops, remote supervision, regular on-site teaching visits and individualised training advice. The program has two streams of trainees: • RVTS program for doctors working in rural and remote Australia, with 22 places available annually. • New RVTS extension providing support specifically for doctors in Aboriginal Community Controlled Health Services (ACCHS), with 10 places available annually. Enrolments for RVTS usually open in May and training commences the following calendar year. For further details on the RVTS program, including eligibility criteria, visit http://rvts.org.au/applicants.


fellowship

RACGP Fellowship (FRACGP) Fellowship of the RACGP demonstrates to governments, the general practice community and the Australian community that a GP has met the required level of competence to deliver unsupervised services in any general practice setting in Australia – urban, regional, rural or remote. It also confers the ability to access specialist medical registration and, consequently, A1 rebate rates under Medicare legislation. International acknowledgement of the RACGP Fellowship is expanding and it is now recognised in New Zealand, Ireland and Canada*. The RACGP also delivers the conjoint Fellowship examinations in Malaysia and Hong Kong. *Contact relevant college for full details.

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fellowship

The College Fellowship assessments (exams) Successful completion of the College Fellowship assessments is required for FRACGP. The Fellowship assessment for registrars comprises two online segments, the Applied Knowledge Test (AKT) and Key Feature Problems (KFP), and a clinical segment, the Objective Structured Clinical Examination (OSCE).

six active training units. Two of these units must be general practice term 1 (GPT1), also known as the basic term.

In order to allow for greater flexibility, each segment can be completed and paid for separately. All three segments need to be completed within three years of first passing one of the online segments.

• two basic units (GPT1)

To be eligible to sit the Fellowship assessments, all registrar candidates are required to have: • current Australian medical registration • current financial membership of the RACGP • completed the required vocational training.

General practice registrars enrolled with AGPT If the senior medical educator of the registrar’s regional training provider consents, the registrar will be eligible to enrol in the AKT after completing 12

With the authorised senior medical educator’s consent, all segments of the examination may be undertaken upon completion of eight active units of training, including:

• two advanced units (GPT2) • four other units. These can be hospital training, special skills, extended skills, subsequent time GPT3, optional elective, or mandatory elective. RPL may contribute up to four units.

General practice registrars enrolled with RVTS RVTS candidates are eligible to enrol in the FRACGP examination following satisfactory completion of 12 months in the RVTS, in addition to the standard RACGP eligibility criteria.


Fellowship in Advanced Rural General Practice (FARGP) If you are interested in working as a GP in rural or remote Australia, then the FARGP is the qualification for you. The FARGP is the highly sought-after qualification awarded by the RACGP beyond the vocational FRACGP. The FARGP recognises advanced rural skills training (ARST) that develops extended general practice skills and broadens options for safe, accessible and comprehensive care for Australia’s rural and remote and very remote communities. By completing ARST and other engaging and relevant activities you can work towards your second RACGP Fellowship.

General practice registrars can complete the FARGP requirements at any stage of their general practice training. An early start is highly recommended and means many of the requirements can be completed during general practice placements and before commencing exam preparations. The FARGP is also available to practising GPs who have at least three years’ (full-time) rural experience and who may apply for partial or full RPL.

GPs can undertake and complete the FARGP at any stage of their general practice journey. The requirements focus on what is relevant to the interests and skills of the individual GP, as well as the health needs of the communities in which they practice.

• Enrolled with an RTP or RVTS.

To be eligible to enrol in the FARGP, general practice registrars must meet the following prerequisites:

• Current financial membership of the RACGP. • Committed to working in rural and remote Australia. • Working towards or completed FRACGP.

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fellowship

FARGP requirements for general practice registrars include: 1. twelve months (or full-time equivalent) in rural or remote general practice (RA 2-5) 2. twelve months (or full-time equivalent) of ARST in an accredited training post; or the completion of the newly updated Small Town Rural General Practice curriculum 3. completion of a six-month community-based project for the ‘Working in rural general practice’ core unit 4. completion of two advanced emergency medicine courses (within the past three years) and a selection of emergency medicine activities. The FARGP cannot be awarded until the FRACGP requirements have been successfully met.

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options

General practice offers an array of diverse options. You can focus on your areas of interest or tailor your career to suit your work–life preference. The following are some opportunities you may choose to explore during your RACGP general practice training and possibly expand on later in your career.

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options

Areas of specific interest A career in general practice allows you to pursue other areas of specific interest. If you have a clinical interest in, for example, diabetes, Aboriginal and Torres Strait Islander health, paediatrics, anaesthetics or palliative care (just to name a few), you can choose to develop specific skills in that area after attaining FRACGP. If you wish to expand on these skills, there may be opportunities to undertake further formal studies. For example, you can complete the Diploma in Obstetrics via the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, or a Certificate of Primary Care Dermatology through the RACGP’s partnership with the Australasian College of Dermatologists.

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In order to help foster the specific interests held by GPs, the RACGP has established a National Faculty of Specific Interests (NFSI). This faculty provides you with the opportunity to share knowledge and develop materials with other members who have the same interests. For more information, visit www.racgp.org.au/nfsi or call 1800 090 588.


Research Getting involved in supervised research early in your career enables you to develop valuable skills to take into your clinical work and could act as a stepping stone towards an academic career. It is essential for GPs to understand how to access and apply research evidence to their clinical work. It is equally important that clinical questions arising from general practice be answered by research undertaken within the general practice setting. Research in general practice is essential for the improvement of patient healthcare outcomes. Evidence also shows that when those working in primary care are involved in research, there is an increase in the quality of care provided, as well as faster dissemination and adoption of research evidence. There is a range of opportunities to help you find the right level of research during your general practice training. You can become involved in a project by contacting your university or the RACGP Foundation, which offers research grants, awards and scholarships. You can also apply for an academic term under the RACGP pathway and work part-time in a university department. An academic

term can either be completed as an extended skills post or as optional additional training time and can occasionally count toward a higher degree (e.g. Master of Medicine or a PhD). Involvement in research will equip you with skills that you will be able to utilise throughout your medical career.

RACGP Foundation The RACGP Foundation provides opportunities for members to undertake medical research and projects by providing a suite of different research grants, awards and scholarships that contribute to the improvement in Australian primary healthcare. By supporting research in general practice through the attraction and dissemination of funding for key projects, the RACGP Foundation strengthens our profession’s commitment to continuous improvement.

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options

Indigenous Registrar Support program This project aims to increase the number of Aboriginal and Torres Strait Islander GPs by providing mentoring support for those registrars sitting their Fellowship exam. The Foundation is working closely with the National Faculty of Aboriginal and Torres Strait Islander Health to fund, promote and implement this project.

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Research grants and awards To apply for an RACGP research grant, award or scholarship*, or for further details, visit www.racgp.org.au/foundation, or contact the RACGP Foundation via email at research@racgp.org.au. *Grants, awards and scholarships are available to RACGP members only


Overseas posts If you are interested in gaining experience abroad, the RACGP’s training pathway can include completion of part of your general practice training overseas as an extended skills or advanced rural skills term. This is typically a 3–6 month full-time position, although an application for a part-time post can be made. It is also possible to undertake an elective post overseas. Please note there are restrictions regarding at which point in your training pathway the overseas training posts can be undertaken, and you need to obtain the prospective support of your RTP and prospective approval from the RACGP Censor in Chief.

Contact a regional training provider in your state, or visit www.racgp.org.au/gpet/resources for more details. If you are unable to undertake an overseas post during your vocational training you may choose to practise overseas for a period of time after completing your Fellowship. The portability of general practice as a medical speciality, combined with the international recognition of the FRACGP, makes this an exciting possibility.

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options

General practice in regional, rural and remote Australia Practising as a GP in regional, rural and remote Australia is a great career option. The unique geographical and demographic features of rural and remote Australia offer diversity in the range of complex health presentations and the variety of procedural and nonprocedural skills that can be utilised. These skills can include emergency medicine, obstetrics, anaesthetics, surgery, mental health, adult internal medicine, paediatrics, Aboriginal and Torres Strait Islander health and small town rural general practice. The extent to which you will utilise or engage in any of the above skills will depend entirely on the rural or remote context in which you choose to practice, or the range of general practice skills you wish to be involved in.

Going rural If you are considering ‘going rural’, there is a number of ways you can get a taste of general practice in rural and remote Australia: • Rural Health Career Check. These 20-minute sessions offered by the RACGP National Rural Faculty (NRF) provide students, registrars and GPs the opportunity to meet face-to-face with a respected rural GP and discuss any aspect of their future career in rural general practice. For more information, visit www.racgp.org.au/yourracgp/ faculties/rural/projects/ healthchecks/. • Rural general practice placements at university. Speak with your university coordinator about undertaking your mandatory general practice placement in a rural or remote practice. • PGPPP rural placements. If you are considering undertaking the PGPPP in your internship or postgraduate resident years, you can request a placement in a rural or remote practice (refer to page 7).

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The RACGP National Rural Faculty The RACGP NRF recognises the challenges specific to rural and remote areas and provides advocacy and support for GPs in these communities. The NRF currently has more than 9600 members, including more than 5100 GPs living and working in rural and remote Australia, making it one of the country’s largest representative bodies of rural GPs. The capacity of the healthcare system to respond to current and emerging pressures in rural and remote Australia is a key focus for the NRF. The NRF works hard to ensure future government reforms and programs are responsive to the unique challenges faced by GPs in supporting rural and remote communities. Close consultation with the profession means the NRF is well placed to provide valuable input to future healthcare initiatives.

Rural incentive programs The Commonwealth Government has developed a number of incentive programs to promote career options and encourage GPs to practise in regional, rural and remote communities: • Rural relocation grants. Payments for relocating from one area to another of greater remoteness. • Procedural training grants. Procedural and emergencymedicine GPs practising in rural and remote areas may be eligible to receive financial assistance for skills maintenance and development in their respective disciplines. • Rural retention payments. Regular payments that increase according to remoteness and length of service. For details about rural general practice, the NRF, rural incentive programs or the FARGP, visit www.racgp.org.au/rural or call 1800 636 764.

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RACGP

RACGP

The RACGP is Australia’s largest professional general practice organisation representing over 25,000 members with products and services to support GPs at every stage of their professional journey. The RACGP has been supporting GPs for more than 50 years and is the national leader in setting and maintaining the standards for quality clinical practice, education and research in Australian general practice. As an independent member-based organisation, the RACGP leads the way in advocating and facilitating continuous improvement through clinical, educational and e-health advances. The RACGP national office is located in Victoria, with faculties in every Australian state or territory. The RACGP also has a dedicated National Rural Faculty, National Faculty of Specific Interests and National Faculty of Aboriginal and Torres Strait Islander Health. Support is provided to RACGP members for the entire journey of general practice, starting from when you are a medical student, continuing through training and even into your retirement. Take up free Student online membership with the RACGP and access an array of member-only resources such as gplearning, DynaMed, Database resources, e-books and much more designed specifically to further your medical training and development. To find out more, visit www.racgp.org.au/student.

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Qualified GP and beyond Once you are qualified to practise as an unsupervised GP in Australia you need to continue to undertake professional development throughout your medical career in order to maintain your professional standing. The RACGP’s Quality Improvement and Continuing Professional Development (QI&CPD) Program enables vocationally-registered GPs to maintain their recognition status with Medicare Australia and allows all GPs to meet the registration requirements of the medical board of Australia.

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contacts

contacts

National Office 03 8699 0414

Membership 1800 331 626

RACGP Fellowship 1800 626 901

RACGP National Rural Faculty (NRF) 1800 636 764

RACGP National Faculty of Specific Interests (NFSI) 1800 090 588

RACGP National Faculty of Aboriginal and Torres Strait Islander Health (NFATSIH) 1800 000 251

RACGP Foundation 1800 331 626

General Practice Education and Training (GPET) 02 6263 6777

Remote Vocational Training Scheme (RVTS) 02 6057 3400 24


It’s your future Published November 2013 Updates available at www.racgp.org.au/gpcareer


www.racgp.org.au

Healthy Profession. Healthy Australia.

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