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2014

GP Registrar The essential guide for general practice registrars


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About this guide The 2014 GP Registrar guide is produced by the GPRA Registrar Network – an initiative of General Practice Registrars Australia. The aim of the GP Registrar guide is to help registrars navigate their way through the maze of general practice training. The guide has been prepared by registrars for registrars. GP Registrar has been produced using sustainable environmentally friendly printing techniques and paper; an approach that reflects GPRA’s ethos of supporting tomorrow’s general practitioners, and their families, in their quest for sustainable careers in general practice. All information was correct at time of going to press.


Contents On the cover Dr Georgie Whiting, a GP registrar working in an Aboriginal Medical Service in Port Augusta, is enjoying the challenges and advantages of a career in general practice. Read her story on page 50.

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1 GPRA and what we do 6

Introducing General Practice Registrars Australia 8 Influencing the profession 10 Dr David Chessor 16 GPRA subcommittees 18 Dr Belinda Allan 20 Membership of GPRA 22 Dr Vivienne Sharma 26 The Indigenous General Practice Registrars Network 28 Dr Aleeta Fejo 32 Teach while you learn 34 Dr Stuart Glastonbury 2 Employment as a registrar 40 41 42 46 47 48 50

3 Support

Message from the Chair

Employment terms and conditions Schemes and incentives Dr Renee Cremen Terms and conditions GPT1/2 registrars Terms and conditions GPT3 and beyond Creating your employment agreement Dr Georgie Whiting

54 56 60 62 64 66

4 GP training resources 69 70 74 75 77 78 82 83

Visit our website – gpra.org.au

AGPT program ACRRM Fellowship RACGP Fellowship RACGP Fellowship in Advanced Rural General Practice Registrar liaison officers Dr Marion Davies Useful resources Regional training providers

5 Exam survival 84 How GPRA can help 87 Passing the colleges’ exams

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First day survival tips Dr Georga Cooke When things go wrong Transferring to another training provider Looking after yourself Wellbeing tips


GPRA would like to acknowledge the support of our patron, Professor John Murtagh AM. Professor Murtagh is Emeritus Professor of General Practice at Monash University and Professorial Fellow in the Department of General Practice at the University of Melbourne. John is also the author of many internationally adopted textbooks, including the popular General Practice. GPRA is proud to have the support of such a distinguished figurehead of Australian general practice.

GPRA Editorial team General Manager: Sally Kincaid Editor: Denese Warmington Medical Editor: Dr Belinda Allan

Writers: Nick Johns-Wickberg, Laura McGeoch, Jan Walker, Denese Warmington Graphic Designer: Peter Fitzgerald Registrar Services Coordinators: Dr Cameron Adams, Nicole Bonne

Š GPRA, 2014. All rights are reserved. All materials contained in this publication are protected by Australian copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior permission of General Practice Registrars Australia Ltd (GPRA) or in the case of third party material, the owner of that content. You may not alter or remove any trademark, copyright or other notice from copies of the publication. No part of this publication may be reproduced without prior permission and full acknowledgement of the source: GP Registrar, a publication of General Practice Registrars Australia. All efforts have been made to ensure that material presented in this publication was correct at the time of printing and published in good faith. GPRA does not accept liability for the use of information within this publication. Due to the rapidly changing nature of the industry, GPRA does not make any warranty or guarantee concerning the accuracy or reliability of this content. Published by General Practice Registrars Australia Ltd, Level 4, 517 Flinders Lane, Melbourne VIC 3001. ABN 60 108 076 704 ISSN 2203-1448 GPRA wish to acknowledge the ongoing support of the Australian Government Department of Health. Printed by Graphic Impressions

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Message from the Chair ‘It cannot be too often or too forcibly brought home to us that the hope of the profession is with the men (and women!) who do its daily work in general practice.’ Sir William Osler On behalf of General Practice Registrars Australia (GPRA), I am delighted to release the 2014 GP Registrar guide – the ultimate guide for registrars in general practice training. GP Registrar provides tips, resources and stories that will help you during your time in training and beyond. GP Registrar (previously known as ‘Explorer’) has been written by a number of key people, including GP registrars and GPRA staff, who specialise in dealing with general practice training issues. They have put their thoughts and knowledge into a resource that will be extremely useful when you are first starting out in general practice. It took me some time to discover this guide when I first became a GP registrar. It answered so many of my questions about training and exams that I wished I’d read it sooner, so peruse to your heart’s content.

GPRA is the voice of the next generation of general practitioners, from medical students to newly qualified GPs. GPRA’s key aims include:

• representing the interests of GP registrars and

supporting them through the training program

• advocating on key issues affecting GP registrars • providing resources for exam preparation • providing support to registrars to help maintain resilience

• preparation for life and practice beyond the training program.

Inside GP Registrar you will read about different options for training pathways, crucial information on your employment conditions, and some fantastic exam preparation resources. For those with a passion for more, the guide explains how you can become involved in a GPRA subcommittee. GPRA subcommittees focus on a wide array of areas relevant to GP registrars, including Indigenous health, medical education and even the governance of GPRA. We urge you to jump in, get involved and to remain informed as we work towards the best possible future for general practice training. General practice is a wonderfully rewarding specialty. During the course of your training you will become an expert in the continuity of care. You will gain unique skills in undifferentiated illness, and acquire preventive care knowledge to guide your patients through a healthy and happy life. Beyond that, the world is your oyster. The flexibility and variety that is possible in general practice is one of its greatest attributes. Congratulations on a fine choice of specialty, and welcome to general practice! Dr David Chessor GPRA Chair

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1 GPRA and what we do


Introducing General Practice Registrars Australia What is GPRA? General Practice Registrars Australia (GPRA) is the peak national representative body for general practice registrars in Australia. One of our most important functions is to provide a range of resources that support you, as a GP registrar, throughout your training and to represent your interests.

What we do As a GP registrar, GRPA can support you by:

• negotiating the National Minimum Terms and

Conditions of Employment for GPT1 and GPT2

• providing a wealth of resources to support

you throughout your training, such as exam and business skills webinars and other professional development activities

• fighting for your interests and providing a direct channel for you to raise any issues

• representing your views to the Minister for

Health, Department of Health, General Practice Education and Training Ltd (GPET), regional training providers (RTPs), professional colleges and other stakeholders

• directing individual support to registrars going through any appeals process as part of their training

• providing information and direction about your training

• offering peer-to-peer support and reporting on

any issues that require improvement to registrar liaison officers (RLOs), who are the link between RTPs and GPRA.

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In addition to representing GP registrars, we promote general practice as a medical specialty of choice to:

• medical students – through the General

Practice Students Network and the First Wave Scholarship program

• junior doctors in the hospital setting – through the Going Places Network.

Shaping the future of general practice We provide critical feedback to stakeholder organisations and the government to help shape the direction of general practice training in Australia. At a time when general practice is undergoing a generational shift, GPRA represents the emerging new generation of GPs as the voice of the future. We have strong links with other key organisations involved in general practice education and training, so we can work together for the common purpose of advancing the profession and the healthcare of all Australians.

GPRA’s structure GPRA has a Board of Directors who is elected from its membership. Given GPRA’s expanding role, this includes board positions for a junior doctor or a medical student, and co-opted directors, each selected for the special skills they bring to the role. The Board is responsible for corporate governance, our financial sustainability, and for advancing GP registrar issues with appropriate organisations.


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The Board relies on the GPRA Advisory Council to provide feedback and information on registrar policy issues. From this input, the Board can develop policy to improve general practice training. The Advisory Council is made up of RLOs from every RTP in addition to national registrar representatives from industry stakeholders and the Chair of the Indigenous General Practice Registrars Network. The Advisory Council is in communication

all-year-round, forming an Australia-wide network to provide solutions to both local and national training issues. Your RLO, the Advisory Council, GPRA Board and management team all play an important role in your future career. Find out how you too can get involved: email the Registrar Services Team at registrarenquiries@gpra.org.au or phone 03 9629 8878.

GPRA Board (back row from left) Dr Piotr (Peter) Swierkowski, Dr Edward Vergara (Immediate Past Chair), Dave Townsend, Dr Gerry Considine (Vice Chair) (front row from left) Ingrid Williams, Dr David Chessor (Chair), Dr Deepthi Iyer

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Want to influence the profession? Here’s how As a GP registrar, you are in a position to improve your training program, and the profession of general practice as a whole. Here’s how. When you become a GP registrar, you enter a world of community medicine, complex training requirements and competing interests. It is a fascinating, ever-changing environment, where people just like you continue to make changes to improve general practice training and the profession as a whole. By seeking employment as an RLO, by joining one of GPRA’s subcommittees, or by simply sharing your ideas, you can play an active role in the delivery of the general practice training program. You don’t have to be knowledgeable about all the issues or excessively opinionated. If you are keen to contribute to better training, support current and future registrars, and learn more about the bigger picture, consider getting involved. It’s a great way to broaden your skill set, networks and impact your training – and it can be very satisfying. It’s also the perfect way to kick start a career in advocacy.

Become an RLO Every RTP in Australia employs one or more RLO to provide pastoral care, information and support to GP registrars. RLOs are registrars themselves, and their RLO work can sometimes be counted

towards training in a special skill. Each RLO is a member of the GPRA Advisory Council, which meets four times a year. Attending meetings may involve paid travel – a great fringe benefit!

Join a subcommittee This is a great option for people short on time, or for those with a specific area of interest. Small groups of people meet, usually via web-conference, to work on solutions to a particular issue. For example, a subcommittee concerned about the quality and quantity of in-practice teaching to registrars authored the In-practice teaching resource.

Be more vocal with your opinions Just make sure you tell someone who cares, and who can do something about your concerns. Look out for emails from your RLO that may alert you to current issues and request your feedback. If you have an issue, concern or idea, don’t hesitate to raise it with your RLO or with GPRA. The progress of our profession relies on people raising issues and suggesting solutions.

Share your story A story about your GP training experience, an inspirational GP supervisor, your experience at an Aboriginal Medical Service, or even a great book or app you’ve read can be shared with other GP registrars and used to inspire junior doctors and medical students to look at general practice as a specialty choice. It can provide them with knowledge and insight from someone who has been there.

Right: The Breathing New Life into General Practice conference, Canberra, March 2013 8

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1 GPRA and what we do

Share your exam experience GPRA provides exam support to its members with the help of registrars and new fellows who have survived – and passed – RACGP and/or ACRRM exams. Sharing your exam experience can be as simple as sending in your tips via

email or by writing a case to present on a webinar. Payment may be available. Contact the GPRA Registrar Services team at registrarenquiries@gpra.org.au or phone 03 9629 8878.

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Preaching from the converted Once sceptical about the clinical fulfilment that general practice could offer him, GP registrar Dr David Chessor – 2013 GPET Registrar of the Year, RACGP National Rural Faculty Rural Registrar of the Year and GPRA Chair – is now thriving in the specialty. Dr David Chessor’s decision to do general practice was made during a “soul searching” trekking trip through the Nepalese mountains. He and his wife Suzanne, also a doctor, had quit their hospital jobs and taken six months off to consider what they wanted from their careers – and from life. The newlyweds were facing long periods apart during their PGY2 at Nambour Hospital in Queensland. David was scheduled to do a rural relieving term 1000 km from Nambour, during which time Suzanne would be doing nightshift. The pair proposed alternatives to the hospital administration but were given no other options. “We realised that specialty training was going to be like that for the next five or six years,” David says. “We didn’t want to ruin our lifestyle or to live apart.” David thought that perhaps general practice could work for them from a lifestyle perspective. “I thought that if general practice was half as good or three-quarters as good as any other specialty, then that would be okay as the other areas of my life would be better.”

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They posted their GP training application forms from Kathmandu and returned to finish their internships. Little did David know that a life working in general practice could actually be “awesome”. “I was a bit worried about the lack of procedural stuff ... having no idea of all the opportunities and fantastic variety available to me [as a GP]. I was about two weeks in before I realised: ‘Oh my god. This is awesome!’” David’s first general practice university experience was an “overwhelmingly positive” John Flynn Scholarship Program placement at Bamaga, a rural community at the tip of Cape York. “The community has a pretty even mix of Aboriginal and Torres Strait Islander residents,” David says. “I went for a month initially, and went back every year during medical school.” David embarked on another cultural and professional “learning curve” during a rotation in another Indigenous community on Thursday Island. “The breadth and the range and also the severity of illness that you see are good for someone who is looking to learn and up-skill. “To be welcomed and invited into a community that is predominantly Indigenous and having the opportunity to learn ... it gives you a really different look at life.” However, a subsequent general practice rotation in Rockhampton almost overshadowed David’s wonderful rural experiences. “I often tell people I hated general practice during university,” he says. “I sat in the corner of the room for eight weeks and found it really hard to engage with my supervisor. Somehow I managed to dissociate my opinion on general practice from the fantastic remote experience I’d had.


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“Every now and then I find myself doing something that’s not work and realising that often I enjoy my work as much as I do my leisure time.” GP Registrar – The essential guide for general practice registrars

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“I didn’t think very critically about it ... and this was almost a disaster to me. It was really serendipitous that I ended up here.” And “here” is at the Durri Aboriginal Corporation Medical Service in Kempsey, a regional town on the NSW mid-north coast. In the language of the local Dunghutti people, ‘Durri’ translates as ‘to grow in good health’. David, who lives in Port Macquarie, started at Durri in early 2012. More than half of the 50 or so Durri team members are from the Aboriginal community. “We have a really team-based approach to care here ... the way to treat patients is about building trust and having partnerships with people,” David says. “Real shared decision making.” Being “respectful of a person’s own understanding of their health and their priorities”, David says, is important. “Sometimes your priorities for what

Check out David’s blog ‘Not just a GP’ (notjustagp.com) or follow him on twitter @dchessor 12

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you want to get done in a consult will be different to what your patient wants.” The team try to take away that “power differential” by asking patients for their opinion about their health. “It’s a really simple question to ask people: ‘What do you think is making you sick? What do you want to do about it?’” David says. “You notice that someone has never really been asked what their opinion is.” David is passionate about Aboriginal and Torres Strait Islander health and has chaired the GPRA Close the Gap Subcommittee. When asked about progress in this area, David is divided. “I think the answer to that question is always ‘yes’ and ‘no’. I think we did well initially when the Council of Australian Governments (COAG) reforms started in 2007... there was a demonstrable gain, but then it slowed down.”


1 GPRA and what we do

On a positive note, David says that attitudes – from both Indigenous and non-Indigenous Australians – are changing, and this is providing better opportunities for doctors to build the trust with their Indigenous patients. David is doing the Fellowship in Advanced Rural General Practice (FARGP) in Aboriginal health. He is in his second year of training with North Coast General Practice Training (NCGPT). He is doing his training part time, which is an option he “thoroughly recommends” and notes that GPs can make enough money to do so. “Whatever you do in that extra time, even if it’s lying in a hammock and reading Voltaire ... to have that flexibility in work is one of the strengths of general practice.” he says. “It makes me a better doctor.”

David’s study tips

• Try and make sure you are actively learning during the whole time of your GP training.

• Start studying for exams about six months out so you don’t have to cram.

• Think about the GP you want to be for the rest of your life and start to acquire the knowledge you need to be that GP. This approach gives a purpose to the study.

Working three days a week means that David can more easily fit in his public health Master’s degree and teaching at the University of NSW. “Despite years of swearing to my two teacher parents that I would never be a teacher, I’ve found that I love teaching with an equal passion to clinical work.” He is determined to give his students a positive general practice experience. “No one is allowed to sit in the corner and do nothing in my room!” Part-time training has also allowed David to become involved with GPRA. This variation of clinical, teaching and advocacy work helps him keep motivated. “I love my job,” David says. “Every now and then I find myself doing something that’s not work and realising that often I enjoy my work as much as I do my leisure time.” From once viewing general practice as his least favoured specialty, David is now relishing the opportunity it is giving him to carve out the career and lifestyle he wants. “I know that I’m never going to get sick of general practice because it can just be a million different things depending on what is important to you.”

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David and GPRA When did you hear about GPRA? Only when I became an RLO with NCGPT. I did an RLO workshop with GPRA in Canberra in March 2012. It was really hard not to be enthusiastic and excited after that. How did you first become involved? I signed up for the subcommittees and chaired the Close the Gap Committee. I now sit on all six GPRA subcommittees. How does GPRA benefit you? It’s like the world’s biggest secret! To be an RLO and to network and make friends from all over Australia ... I feel really lucky to sit in

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the room with so many bright and inspiring people. As a result of that interaction I feel like I’m going to be a better doctor. I don’t understand why someone isn’t fighting me for the job! How can other registrars become involved? They can inquire about being a RLO or become a member of a subcommittee. Come along to a meeting! We have a lot via webinars so it’s easy to sit in and watch. Do subcommittee members have to be an RLO? No. We are always extremely excited when someone who is not an RLO wants to sit on a subcommittee. It’s great to get a new perspective and fresh ideas.


GPRA subcommittees Your opportunity to influence the general practice training sector. The subcommittees GPRA subcommittees were formed to progress an issue or idea of importance to GPRA members and the wider profession, and are one of the primary drivers of GPRA policy development. These subcommittees cover a range of issues, and are an opportunity to get to know and support registrars, brainstorm, find solutions and improve the future of general practice in Australia. GPRA advocates on behalf of GP registrars via the activities of its Registrar Services team, Advisory Council, sub-committees and Board. Many issues are first raised within the Advisory Council, based on discussions and reports from the subcommittees. GPRA facilitates policy development through working closely with GPRA subcommittees, the GPRA Chair and CEO to author discussion papers and submissions. Key policy and advocacy areas GPRA will be working on in 2014 include rural and international medical graduate issues, support for Aboriginal and Torres Strait Islander registrars, terms and conditions of employment, assessment and standards, and furthering the recognition and support for registrar medical educators and emerging supervisors.

How GPRA policy is created In the first instance, issues are generally raised with the Advisory Council. Subsequently, the relevant subcommittee investigates change and develops potential solutions. This often includes working with external stakeholders to develop industry-wide policy statements. An example of this is the recently released statement of principles and 16

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discussion paper, Fatigue management in vocational general practice training.

How the subcommittees work GPRA subcommittees are working parties of the Advisory Council. Not only do they promote discussion and provide support, they produce outcomes and work with industry bodies to make sure these outcomes are embraced and implemented. The work of many of our subcommittees to improve the training program has been integrated into the various standards and policies that govern the program, and subcommittees have even authored some of our publications. Subcommittees and networks are a great way to gain experience in governance and advocacy, and to broaden one’s knowledge of the wider industry of general practice. GPRA currently has subcommittees working on the following areas:

• Assessment and standards • Closing the Gap • International medical graduates • Rural issues • Terms and conditions • Wellbeing. Any GPRA Registrar member or Alumni member can join a subcommittee. It’s a great way to be involved, get your ideas heard and make a difference. Meetings are usually held via a web-based conferencing platform. If you are interested in joining one of GPRA’s subcommittees, or would like to know more, email us at registrarenquiries@gpra.org.au


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The value of connection Dr Belinda Allan, GP registrar, GPRA Wellbeing Subcommittee Secretary and medical editor of this issue of GP Registrar, gives us a very personal account of GPET Conference 2013 and the GPRA Advisory Council meeting. Community, Strength, Healing Staring across the room at my first GPRA Advisory Council meeting these three words burned into my mind. It was my first glimpse of the Indigenous General Practice Registrars Network (IGPRN) banner, and it caught me totally by surprise. I thought I was here for business! Reflecting back on the previous two days of forums, keynotes, papers, symposiums and workshops, I realised that the GPET Conference 2013, and now the GPRA Advisory Council, was so much more than an opportunity for intellectual banter and stakeholder politics. I was overwhelmed by the passion and collegiality around me. When Professor Fiona Wood AM took to the podium and urged us to wake up every day with a dream, to dare to be extraordinary, I was inspired to believe. As I listened to this incredible woman, doctor, Australian, I realised that it was her dayto-day grit that saw her achieve the impossible – spray on skin! Innovation came out of a drive for excellence, denial of unfounded opposition, and a willingness to consider an ‘Italian breath freshener’ as her answer. How else would you spray newly formed skins cells in the operating theatre? I laughed, imagining her and her research colleague trawling through pharmacies and supermarkets looking for the ideal atomiser to apply their 18

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precious product ... a product she would nurture and harvest in her lab at 4 am ready for her 8 am operating list. Dedication seemed only part; passion was everything. After such tales of achievement, I wandered into the ‘Making work in an Aboriginal Medical Service irresistible’ workshop feeling pretty average. I couldn’t help thinking, “I should get on and find something valuable to do with my life”. Sitting down with a table of fellow registrars, GP supervisors and educators, I found myself drawn into the task of brainstorming what a registrar would need to make working in Indigenous health sustainable. Before long the passionate cross-fertilisation of thoughts erupted onto the butcher’s paper as a list of practical, achievable and community focused ideas. As we listened to each others ideas, it was clear that every stakeholder – be it community members, Aboriginal Medical Services, CEOs, registrars, supervisors and RTPs – all had strikingly similar motivations and objectives. I couldn’t believe that within 30 minutes we had generated manageable solutions – we were not so average. As I listened to ‘A day in the life …’ speakers, it was clear that there was no such thing as a typical registrar’s day. Tales of research, the challenges of transition and the joys of educating all painted a fascinating picture of my colleagues’ journey to becoming a GP. I am not ashamed to admit that I actually had a cry! Yes, I cried as I sat in the middle of a room full of people listening to Emma Kozianski share her journey to Indigenous health. An incredibly raw and insightful reflection on the shame and uselessness that overwhelmed her as ‘a white middle class girl’ looking at the injustice, pain and inequity that faces anyone working in Indigenous health. Her humility and intimate reflection moved me – I understood.


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I knew that feeling. Shame. Anyone who strives to close the gap, and take action in our own backyard, knows the feeling of inadequacy she so eloquently described. Emma shared the moment that changed everything for her: when her cultural mentor, an Aboriginal Elder, took her little white face in both her hands and said, “We need you.You are just a drop, but together we are an ocean.� What was all this? I was coming to a conference to hear about education, to get tips for training and maybe add something to my CV. I came wanting to know about the latest hot topics in research, and hear about the latest application of e-training, e-health and social media. I did indeed get those things, but it was the connection that surprised me. Sitting across the room, staring at the IGPRN banner, I realised the inherent value of coming

Dr Belinda Allan (right) at the GPET conference 2013

together. Meeting face-to-face gives us the big picture. We may be sitting on our own in our small consulting rooms outback, or down town, or in suburbia, but we are still a community. No one should be in this profession alone. Our burdens are too great, the job too big and the need relentless. Distance, language, culture and different learning needs potentially isolate many registrars. I realised in participating in the GPRA Advisory Council, and brainstorming in its subcommittees, that GPRA provides a vital pathway for advocacy and community. I came away from Perth with a renewed sense that the experience, strength and hope that we provide to each other, as colleagues, mentors, educators and students, empowers us to live our profession. The profession of healing.

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Membership of GPRA Your GP registrar community Being a member of GPRA provides many professional and personal benefits. Registrar membership Registrar membership is open to all GP registrars from acceptance into general practice training through to two years post-fellowship. Membership is free of charge. As a Registrar member you receive:

• Advice on the National Minimum Terms and

Conditions for employment and what it means for you

• Personalised one-on-one advocacy, support and assistance with any issues or disputes related to your training

• Professional exam preparation and clinical webinars at special member rates

Online exam resources, such as case studies, specifically developed for registrars by registrars

Alumni membership Alumni membership is open to GPs postfellowship who want to stay abreast of general practice issues, resources and activities, or who wish to contribute further to supporting those who are yet to attain their fellowship. Opportunities exist for membership of subcommittees, board appointments, and for providing education through webinars, case studies and articles. As an Alumni member you receive:

• E-newsletters and mail-outs to keep you up-to-date with activities

• Professional development and networking

opportunities through GPRA subcommittees

• Access to professional development workshops at special member rates.

3 easy ways to become a member

• Online at gpra.org.au • Regular e-newsletters that keep you up-to-date Email registrarenquiries@gpra.org.au • • Member discounts on some conference • Phone 03 9629 8878 registrations, products and services • Competitions and other opportunities • Professional development opportunities via involvement in GPRA subcommittees

• The opportunity to vote for new GPRA

Board members who determine future policy for registrars.

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Just what the doctor ordered A career in metropolitan general practice gives Dr Vivienne Sharma – a Sydney-based mother of three – the flexibility to find a fulfilling work-life balance. Becoming a doctor was, for Vivienne, the realisation of a lifelong dream. She had begun a sensible and lucrative career in engineering, but it lacked a certain challenge and satisfaction that only medicine could provide. In 2003, Vivienne made the leap of faith and enrolled in a medical degree. She doesn’t regret her decision for a second. “I actually gave up a very good career for medicine,” she says. “It was where I always imagined myself to be. When I was a kid I wanted to be a doctor my entire life.” Vivienne has long known the importance of juggling work and study with her duties as a mother. When she started her medical studies, her first son was one year old. Parenthood was an added responsibility that meant she “had to study smarter rather than harder”. “I had to be an efficient studier, otherwise you waste time. If I went to a class and I felt it was a waste of my time, I didn’t go again,” she says. However, she notes that study was the easy part; moving into the workforce as a young mother and junior doctor was the real challenge. “It was actually easier being a student with kids than working full-time with kids. As a student you get

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more time off and if you don’t want to go in and go to lectures, it’s not the end of the world.” By the time Vivienne had started full-time work she had three children and knew that a further six years of study to become a specialist was off the cards. With the possibilities of general practice becoming apparent, however, that wasn’t a problem. “Once I did my medical internship, I was open to other possibilities , and not doing general practice, but I got bored ’ Vivienne says, explaining that her 10-week specialist rotations were interesting for the first few weeks but soon started to feel a bit repetitive. “In the two years I’ve done general practice now … I can’t say a single day has been boring. There’s always that one patient of the day where you just go ‘What?’ “There’s also the lifestyle factor; if I want to do shift work it’s my choice, but I don’t have to,” she adds. “It gave me the most control over where I wanted to be and wanted to do.” Vivienne enjoys working in a metropolitan setting. While she hasn’t really experienced rural medicine – her rural GP placement was only about 20 minutes drive from her house in outer-suburban Sydney – Vivienne expects the added stress of being on-call in a small community would be difficult for a mother of three. That’s why metropolitan practice is ideal for her and her family. “Being in metropolitan Sydney and not having to do on-call and after-hours at all is a big choice for me,” she says. “I have three small kids ranging from


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“I think everyone should become a member. And if not actively involved, at least understand what [GPRA] can do for them in case they do have any issues.” GP Registrar – The essential guide for general practice registrars

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11 years old to two years old, so I don’t really want to have to give up my spare time!” Vivienne’s job allows her to dedicate some time to WentWest, the RTP in Sydney’s western suburbs, where she has been an RLO since June 2013. The role has given her an understanding of the issues faced by many GP registrars around Australia and shown her how fortunate she has been during her training. “By getting involved as the RLO, my eyes have been opened to the fact that I’ve had a really good dream run,” she says. “I suppose that’s when I became more informed about what GPRA does for its members and for all GP registrars.” Vivienne has become aware of GPRA’s important work in advocating for the rights of GP registrars and collaborating with other general practice organisations such as GPET and the colleges. She also believes the resources, webinars and advice GPRA provides can be very helpful for registrars, especially when it comes to contract discussions. “When you come out as a GP, you effectively have to make a lot of financial decisions, especially

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if you’re going to be a contractor or if you’re in practice,” she says. “[GPRA] can definitely help with discussing employment negotiation for your training posts in regards to hours and what your entitlements are.” Vivienne became a member of GPRA towards the end of her medical degree, and while she considers herself lucky to have not faced any major issues during her training, she says “it’s nice when you come out from the hospital system and you know that you’ve got support”. “I think everyone should become a member. And if not actively involved, at least understand what [GPRA] can do for them in case they do have any issues. Even if they’re lucky like me and they have a dream run, it’s nice to know that you’ve got back-up,” Vivienne adds. “It’s a good networking opportunity. It’s good to sit down with like-minded colleagues who want to go into general practice and ask them how their experience is going and know that you’re not alone.” Sometimes, being able to share your highs and lows with those who understand best can make all the difference.


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Registrar –The essential guide for general practice registrars

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The Indigenous General Practice Registrars Network The Indigenous General Practice Registrars Network (IGPRN) provides a forum for Aboriginal and/or Torres Strait Islander registrars to provide professional and cultural support to one another.

Network Chair

About IGPRN

How to join IGPRN

In 2008, and with the assistance of GPET, IGPRN was established by a group of Aboriginal and Torres Strait Islander GP registrars. In 2012, GPRA agreed to manage the co-ordination of the network, with the objective of providing more targeted assistance to its members. The aim of the network is to assist all Indigenous GP registrars through to fellowship by providing support throughout their training and assessment. The network is there for when times are challenging, and also to celebrate achievements. IGPRN undertakes exam preparation and peer debriefing via online study groups, discussion forums and two face-to-face workshops each year.

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Visit Visit our our website website –– gpra.org.au gpra.org.au

Dr Aleeta Fejo is IGPRN’s current Chair and spokesperson. Dr Fejo is a Larrakia/Warramunga Territorian and a recently fellowed GP based in Katherine in the Northern Territory. Dr Fejo’s objectives include helping all Indigenous GP registrars seeking fellowship by providing direct support, and by working with GPRA, training providers, GPET, the Australian Indigenous Doctors’ Association (AIDA) and other stakeholders. If you are an Aboriginal and/or Torres Strait Islander GP registrar, or you have up to two years post-fellowship, we welcome your involvement in the network. To discover how to become a member, email igprnenquiries@gpra.org.au We look forward to hearing from you and we wish you all the very best in your training. For further information, please contact: Dr Aleeta Fejo Chair IGPRN E aleeta.fejo@gpra.org.au P 03 9629 8878 Stephanie May IGPRN Coordinator E stephanie.may@gpra.org.au


1 GPRA and what we do

Left: Dr Aleeta Fejo (Chair IGPRN) and Dr Angela Forrest (Immediate Past Chair IGPRN) GP Registrar – The essential guide for general practice registrars

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Aboriginal doctor for everyone Dr Aleeta Fejo experienced many struggles on her long journey to become a GP but was determined to see it through. All this makes her uniquely qualified to help a new generation of Indigenous trainee doctors. Dr Aleeta Fejo is not one who seeks the spotlight. But when the cameras flashed at the 2013 GPRA – Breathing New Life into General Practice conference as Aleeta took centre stage to accept a special award, she paused to reflect on just how far she had come. “I never expected to win an award for something I had been doing for so long anyway, but it’s nice to be recognised,” she says of the inaugural Wakapi Anyiku Doctor Oomparani (Aboriginal Doctor for Everybody) Award received in recognition of her passionate advocacy for Aboriginal health and her work in assisting Indigenous registrars. Aleeta believes it’s crucial to support the surge of Indigenous doctors coming through. Indigenous medical students now represent 2.5 percent of medical students, roughly in proportion to Australia’s Aboriginal and Torres Strait Islander population for the first time in history. “But we must support them through to completion. We can’t afford to lose even one,” Aleeta says. Completing a fellowship is a marathon rather than a sprint for any medical student. For aspiring Indigenous doctors it can be an ultra-marathon, with several fiendishly gruelling obstacle courses thrown in. 28

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“These registrars often come from big families and poor families,” Aleeta says. “They are often older, with extended family responsibilities, other community responsibilities – so many issues that a lot of non-Aboriginal doctors don’t have.” Aleeta’s own pathway to general practice is an inspiring one involving decades of study, false starts, new starts and dogged determination to make a difference. “It’s taken me more than 20 years to finish all my medical training and GP fellowship, but there are many reasons for that,” she says. As a mature-age student, mother – and, for a time, single mother – Aleeta had to fit study and work around her family. “But I never once thought of giving up,” she says. “I thought my story started when I was 28 years of age, but actually it started before I was born. I am a Larrakia traditional owner, inherited from my father, and I am a Warramunga woman from my mother.” Growing up on her father’s tribal land in Darwin, Aleeta left high school in 1979 as one of only 30 Indigenous students who had ever matriculated in the Northern Territory. She got a job at the Department of Social Security and stayed for seven years, but became disillusioned with a system she believed was keeping Aboriginal people in poverty. Her next job was at the Menzies School of Health Research analysing statistics on low birth weight Aboriginal babies. It was a revelation. “We found out these babies were so small because the mothers were starving.


1 GPRA and what we do

“Aleeta’s own pathway to general practice is an inspiring one involving decades of study, false starts, new starts and dogged determination to make a difference.” GP Registrar – The essential guide for general practice registrars

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When I was able to see the statistics I understood why I had to go to so many funerals,” Aleeta says. “My father said to me if you don’t like the way things are done, go and do it yourself. That’s when I decided I’d be a doctor and try to help my people.” At 28 Aleeta moved to Melbourne, with her young family in tow, to undertake a three-year science bridging course at Monash University. On finishing that, she started medicine at Melbourne University in 1992 and became the first Indigenous Territorian to study medicine. But she struggled as she tried to balance family and study. In 1993 she gave birth to her third child. She transferred to science, moved back to Darwin – now a divorced mother of three – and completed her first degree. She worked three jobs to save up the money to study medicine again, then packed up her kids and moved to Adelaide for a fresh start at Flinders University. “I was raising my kids as a single mum, studying medicine, working part-time and volunteering at the local Aboriginal health service. It was hard, but I got through.” Aleeta relocated to Darwin for the last two years of her medical degree and remarried. She finally graduated in 2004. “I was so happy, and then I was scared. I worked every extra shift to gain experience, knowledge and confidence,” she recalls.

football team I had a uniform with a big ‘Doctor’ written on the back. I used to walk up and down in front of the grandstand so that people could see that I was a doctor. I thought it might plant the seed that they could be a doctor too.” Aleeta now lives in Katherine and drives or flies 300 km each week to work at the remote Ngukurr Aboriginal community near the Gulf of Carpentaria. So with a job she loves, a supportive husband, grown-up children and an empty nest, is it time to take things a little easier? Not at all! Aleeta has just taken on the role of Chair of the Indigenous General Practice Registrar Network, supporting 40 Indigenous GP registrars as they work towards their fellowship. She was instrumental in founding the network, which provides peer group support, advocacy and professional development for all Indigenous GP registrars. In this capacity she is also a member of the GPRA Advisory Council and the Closing the Cap Subcommittee. As if this isn’t enough, Aleeta is also planning to do a PhD. “It’s going to be on the topic closest to my heart and that is helping Indigenous registrars. Aboriginal people like to have Aboriginal doctors, and Aboriginal doctors need support.”

After joining the general practice training program she took a job in Katherine, driving 300 km home to Darwin to see her family every weekend. She completed her fellowship last year. Aleeta is acutely aware of being a community role model. “When I was the doctor for my son’s 30

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Dr Aaron Davis with Dr Aleeta Fejo


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Teach while you learn

Become a registrar medical educator There is an old adage that teaching someone something is one of the best ways to learn about it yourself. So why not consider becoming a registrar medical educator?

• Networking within the education team and

A registrar medical educator (RME), or junior medical educator (JME), is both an educator and a learner. If you become a medical educator, you are supported to acquire the knowledge, skills and competencies required for medical education.

There are about 20 RMEs currently in Australia, and the number will increase as more RTPs invest in the ‘vertical integration’ model of medical education. The workload generally ranges from 1–5 sessions a week, with 3–9 sessions of clinical practice to complete the working week.

RMEs are the future of medical education, and GPRA is committed and passionate about supporting and nurturing this group. To support this, GPRA runs the General Practice Registrar Medical Educators Network (GPRMEN) and the General Practice Registrar Emerging Supervisor Network (GPRESN). The aim of GPRMEN is to provide a professional network for registrar medical educators and to advocate for the role to exist in a quality framework. The network provides peer support for RMEs around the country via online discussion forums and web conferencing. GPRESN is a complementary network with a focus on registrars who have an interest in becoming the supervisors of the future.

What does an RME do? The RME role includes:

• Teaching to a number of different levels, including registrar, junior doctors and medical students

• Delivering lectures, workshops, small group

tutorials, problem based learning, and clinical skills tutorials

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with other stakeholders

• Working with their RTP to plan and deliver education, including policy, curriculum and resource development

• Undergoing professional development to further enhance skills.

Workload and endpoints

RMEs may work towards qualifications such as a Graduate Certificate in Education or Master of Public Health. There are also annual conferences for medical educators, including the Australian Medical Educators Network workshop held by GPET, where RMEs are always welcome. Peer support is also available through GPRMEN.

Considering a career as a medical educator? The ability to educate others is a crucial role in general practice – for patients, fellow health professionals and junior colleagues. Medical education is the basis of a sustainable, quality medical workforce, and being an educator helps you to be a well-informed and inspired GP. Becoming an RME is a useful and supported way to test the waters when considering a career in medical education. For more information about joining GPRMEN or GPRESN email the GPRA Registrar Services Team at registrarenquiries@gpra.org.au or phone 03 9629 8878.


1 GPRA and what we do

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From film and TV to rural GP Dr Stuart Glastonbury explored a number of occupational directions before studying medicine. Now synergies are emerging between his eclectic past and his medical career.

tweet and email questions and comments while watching the presentation live online.

Dr Stuart Glastonbury was once a budding filmmaker at the Australian Film Television and Radio School in Sydney.

“One of the objectives was to really support registrars who work out in the rural and remote locations on how to manage complex presentations when you don’t have a CT scanner or a paediatrician just up the road,” he says.

What does that have to do with his current role as a GP registrar? Quite a bit, as it turns out. His old film and TV skills have been dusted off, digitised and pressed into service to educate the rural GPs of the future. Two days a week, Stuart works as a medical educator with his regional training provider, Queensland Rural Medical Education (QRME), and he uses a local university TV studio to present an online, interactive education event called Rural Medicine Grand Rounds.

Grand rounds go rural “In the hospital, the concept of grand rounds has a long history as an education event, where there’s a case presentation and a discussion by specialists, registrars, students and allied health.You get all the different levels of experience there in one room,” Stuart explains. “When I got out of the hospital I kind of missed that a little bit. So as a medical educator I developed this online Rural Medicine Grand Rounds series focusing on rural health issues.” The QRME program presents case studies and the expertise of guest specialists and allied health practitioners in the style of hospital grand rounds, but with the spotlight on rural general practice. Participants can be part of the live audience or can 34

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The program is designed to assist registrars with exam preparation, strengthen their ability to work in a multidisciplinary team and build networks among future rural primary care doctors in southeast Queensland.

As a medical educator, Stuart works with new general practice registrars as well as junior hospital doctors doing the Prevocational General Practice Placements Program. In addition to producing Rural Medicine Grand Rounds, he delivers workshops, writes educational modules and advises GPs-in-training, all of which Stuart says is immensely satisfying.

The value of a chat Clinical practice makes up the remainder of Stuart’s workload. Three days a week, he drives from his home in Toowoomba to see patients in Clifton, a small rural farming community in southeast Queensland. Stuart says many of his patients are older, lonely and often just want a chat. “I kind of really like that. There are a lot of mental health problems – unfortunately that’s very prevalent in rural areas because of stressors such as drought, floods and financial uncertainty.” Stuart also sees numerous cases of metabolic syndrome and type 2 diabetes, and skin is another important concern. “Farmers, being out in the sun all the time, have a lot of problems with skin damage and cancers so you get to do a reasonable amount of procedural work removing lesions,” he says.


1 GPRA and what we do

“I realised it’s not just being able to regurgitate a textbook that makes you a good doctor.” GP Registrar – The essential guide for general practice registrars

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Stuart enjoys the hospital side of rural medicine. “The hospital at Clifton links up with the GP clinic so I get to do some hospital work, which is really nice. It’s actually a cooperative hospital owned by the Clifton community. I get to do a lot of geriatrics and some acute medicine as well,” he says.

Australia, the Australasian Integrative Medicine Association, the Australian College of Nutritional and Environmental Medicine and Doctors for the Environment Australia.

Eclectic interests

Paediatrics and integrative medicine

After growing up and finishing school in Wagga Wagga, Stuart tried his hand at an eclectic array of careers and passions before studying medicine.

At the opposite end of the age spectrum, paediatrics is a clinical passion for Stuart. He has a Diploma in Child Health through Sydney University and the Children’s Hospital at Westmead.

He played drums in a rock band in Melbourne. He travelled the world making documentary films. He studied at the Australian Film Television and Radio School in Sydney. He worked in the film industry. He spent a year in India studying classical Indian percussion. He studied naturopathy, and this ultimately led Stuart on to medicine.

Stuart recently passed his RACGP exams and at the time of writing had only a few months to go before achieving his fellowship. His studies will continue however as a PhD candidate with the School of Medicine at the University of New England where he is researching the cooperative model of primary care health service delivery. Next year, Stuart, his partner Jess and their two children Jarrah and Layla plan to move to the major regional centre of Newcastle to be closer to family. He says he will probably return to rural medicine when the time is right and he believes that his rural training has imparted some lasting lessons. “I worked with a lot of Aboriginal and Torres Strait Islander people in rural areas and it helped me to see that often ill-health or health is a very complex dynamic involving not only medicine but social issues, psychological issues, economic issues and political issues – all of those things. “I realised it’s not just being able to regurgitate a textbook that makes you a good doctor.” This holistic view is in harmony with Stuart’s experience in naturopathy which he studied before entering medical school. He has a keen interest in integrative medicine. He is a member of the National Herbalists Association of 36

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“My mum is a biologist and basically I had always been interested in science. I had been studying naturopathy for about a year when I realised it wasn’t going to give me the level of science and critical thinking I wanted so I applied for a medical science degree at the University of Technology, Sydney. I did naturopathic medicine and a medical science degree concurrently, majoring in immunology and biochemistry. “I was getting quite good marks and I sort of joked with my partner that I’d sit the exam to get into medicine. I ended up getting into med school at the University of Queensland. “We were pregnant with our first child Jarrah and he was actually born within the first couple of months of me starting med school.” That’s when Stuart’s life changed dramatically on all fronts – domestic and career. “It started me on a new trajectory in my life that’s fantastic,” he says. For more information about participating in Rural Medicine Grand Rounds, visit qrme.org.au


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Your registrar services team are here to help.

• Have you got questions about your employment terms and conditions? • Want access to exam preparation resources and study support? • Need help in understanding the training process? • Want advice on workplace concerns and opportunities? Contact us for support and information P 03 9629 8878 E registrarenquiries@gpra.org.au W gpra.org.au GPRA280213388 R


2 Employment as a registrar


Employment terms and conditions There are terms and conditions from the Fair Work Act and Australian Taxation Office that apply to all GP registrars. It’s important that you check these items are included in your employment agreement. GP registrars must be employees According to the Australian Taxation Office, the Fair Work Act and the National Employment Standards, as a GP registrar you are an employee for work purposes. Typically, registrars have limited scope in determining their working conditions and adjusting their work environment. This is driven in part, by the fact that while you are a registrar you are essentially an apprentice acting under supervision and can never act as a truly independent contractor while in training.

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Other parts of the tax law also have an impact on the employment status of a registrar and any breaches (ie. working as a contractor) can involve heavy penalties both for the practice as well as the registrar. GPRA highly recommends that registrars have a clear written employment contract in place before commencing work. Some broad obligations that employers must meet in having a registrar in their practice include:

• payroll tax • superannuation payments • occupational health and safety requirements • leave entitlements including sick leave, annual leave, carers leave.

Details on employer obligations and employee entitlements are available via Fair Work Australia (fairwork.gov.au) and the Australian Taxation Office (ato.gov.au), or call GPRA on 03 9629 8878.


2 Employment as a registrar

Schemes and incentives General Practice Rural Various incentive schemes are available to encourage GP registrars Incentives Program The General Practice Rural Incentives Program to work or train in Australian (GPRIP) commenced on 1 July 2010. GPRIP was regional, rural and remote funded in the 2009–10 budget as part of the Rural Health Workforce Strategy. The program aims to communities. HECS Reimbursement Scheme The HECS Reimbursement Scheme reimburses a proportion of a medical student’s standard Commonwealth Supported HECS-HELP debt for every year they provide medical services or train in eligible rural and remote communities. If you work in an Australian Standard Geographical Classification Remoteness Area (ASGC-RA) 2+, you are probably eligible for this scheme. These areas are classified as:

• RA2 – inner regional Australia • RA3 – outer regional Australia • RA4 – remote Australia • RA5 – very remote Australia.

encourage medical practitioners to practise in rural and remote communities and promote careers in rural medicine. It combines two previously separate retention incentive programs available to GPs and registrars, and provides a relocation grant. The GPRIP payment is based on your ASGC-RA classification and length of service. For more information on these schemes and ASGC areas, visit:

• ruralhealthaustralia.gov.au • health.gov.au/internet/otd/Publishing.nsf/ Content/RA-intro

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The best of both worlds Dr Renee Cremen wanted a job that would give her the broad medical experience required for ACRRM training while also allowing her to raise a family. In the Queensland town of Babinda she found her perfect match.

“I cover everything from antenatal and children’s health all the way through to palliative care, including emergency,” Renee says. “I really enjoy having that wide breadth of medicine, which is why I’m doing the ACRRM pathway for my fellowship.”

As an employee of Queensland Health working in a hospital-based clinic, Renee is entitled to annual, sick, bereavement, maternal and professional development leave. With two young children, Ethan and Sienna, having the flexibility of paid leave in her contract was important to her.

“I think it has been excellent for my ACRRM training seeing that the ACRRM pathway covers all of those areas. We need to have a good breadth of knowledge of all of those areas, including emergency medicine,” she adds. “This is an ideal job to aid my study.”

“I’ve just turned 30 this year and I’ve got two children, and I had hoped that I would’ve had or nearly completed my family by the age of 30. That was always important for me along with having a medical career,” Renee says. She advises all registrars to think about what is most important to them – both professionally and in terms of lifestyle – before signing a contract.

While Babinda isn’t technically remote – it’s about an hour from Cairns by road – Renee’s GP supervisor is off-site. However, she is very used to getting advice and second opinions over the phone and meets face-to-face with her supervisor every month or so to make sure all is going well. Renee’s training is provided through the Remote Vocational Training Scheme, where she is now also a RLO.

“They need to consider ‘what works best for me’. I wanted to be a mum. I wanted to have children while I was young; I didn’t want to be finishing my specialty and be 36 and then go ‘Right, I’m going to have children’,” she says. “That led me to finding Babinda as an appropriate place for my training that was suitable for my family and lifestyle.” Renee couldn’t do it on her own; her husband Nathan looks after the kids full-time and is “very supportive”. In a town with a population of just over 1000 where she has, at times, been the only doctor, that personal support is vital. But despite the heavy workload, getting broad experience in all areas of medicine has been fantastic for Renee’s training. 42

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Babinda Hospital is set up as a multi-purpose health service, with an emergency ward, aged-care beds, acute and long-stay beds and a palliative care bed as well as the GP clinic. Renee gets experience in all of those areas, which she values greatly.

Renee has lived and worked in Babinda since April 2011 and has no plans to relocate anytime soon and, if some of her more dedicated patients are to be believed, she wouldn’t be able to leave even if she wanted to! “The patients here at Babinda really enjoy having me here as their permanent doctor so much so that they are willing to rip up the highway north and south of this town to keep me here,” Renee says. “I love working here so I took that in the good sense, not the bad sense!” For a small-town Aussie doctor, there’s surely no higher praise.


2 Employment as a registrar

“This is an ideal job to aid my study.”

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Terms and conditions GPT1/2 registrars The National Minimum Terms and Conditions (NMTC) is the guide for GPT1 and GPT2 registrar salaries and terms and conditions of employment. What is the National Minimum Terms and Conditions? The NMTC are negotiated every two years by GPRA and the General Practice Supervisors’ Association (GPSA). Once negotiations are complete, the NMTC acts as a guide to minimum GP registrar salaries, terms and employment conditions. Currently the NMTC applies only to GPT1 and GPT2 registrars in private practice. The NMTC is completely reviewed every two years, and annually indexed to the Medicare Benefits Scheme. The NMTC document is available on the GPRA website at gpra.org.au

NMTC compliance All RTPs within the AGPT program are contractually obliged to comply with the NMTC. RTPs usually ensure that training practices in their region are complying with the NMTC and employing registrars based on the terms and conditions stipulated. Training establishments that refuse to comply with NMTC should not be accredited to train GPT1 and GPT2 registrars. Please note that registrars not in private practice, such as Australian Defence Force registrars and those employed by an Aboriginal Medical Service or general practices attached to community health centres, are not covered by the NMTC document, as these workplaces are significantly different to private practice.

All registrars must be employees As a GP registrar, you are a trainee. As such, in the eyes of the Australian Taxation Office your relationship with your practice is one of employer-employee, regardless of any agreement you sign. Therefore, the Fair Work Act applies to all registrars, guaranteeing you the same basic conditions as any other employee, such as paid annual and personal leave, and employer superannuation guarantee contributions.

Want to know more? Contact:

GPRA P 03 9629 8878 E registrarenquiries@gpra.org.au W gpra.org.au Your RLO Australian Taxation Office – ato.gov.au Fair Work Australia – fairwork.gov.au 46

Visit our website – gpra.org.au


2 Employment as a registrar

Terms and conditions GPT3 and beyond For registrars in GPT3 and beyond, the NMTC can be used as a baseline to negotiate their own terms and conditions at market rates. When negotiating their terms and conditions of employment, we recommend that registrars start with the terms and conditions within the NMTC as a baseline. In GPT3 and beyond, registrars should be negotiating market rates and are typically paid via a percentage of billings at a similar or better percentage than the GPT2 rate. Remember, GP registrars are viewed as employees by the Australian Taxation Office, please refer to page 46 for more information.

member feedback indicating that a majority of registrars in or entering these terms would welcome the benefits of a NMTC that covers their employment. As more registrars enter the training program and demand for GPT3 and GPT4 training places begins to approach supply, the importance of protecting the conditions of these registrars grows. If you are interested in joining the Terms and Conditions Subcommittee to work on the new NMTC, please refer to page 16.

Need help?

Phone GPRA on 03 9629 8878 or email the Registrar Services Team at registrarenquiries@gpra.org.au to discuss your employment.

How GPRA can assist GPRA has a negotiation guide, an employment agreement template and a terms and conditions benchmarking survey that will assist registrars in finalising a win-win employment agreement. These documents are available at gpra.org.au

GPRA Terms and Conditions Subcommittee Our Terms and Conditions Subcommittee is currently working to develop a NMTC for GPT3 and GPT4 registrars. There has been significant

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Creating your employment agreement It’s an exciting time when you are offered your general practice placement. It’s important that you understand your employment agreement and ensure it meets the minimum requirements. Be aware of what you are entitled to Regardless of your training term, read the National Minimum Terms and Conditions document. At a minimum, your employment agreement should meet the NMTC. For those in terms GPT3+ you can negotiate conditions higher than the minimum. Use the GPRA Terms and Conditions Benchmarking Survey for information about what registrars earn around the country.

Talk to the practice Discussions about your employment may occur with the GP supervisor, practice manager or another person within the practice. Don’t be afraid to ask questions and have a positive attitude during this time. GPRA members can access personalised advice on the terms and conditions and how they apply to their situation by either emailing or calling the GPRA enquiries line.

Use a template to create your employment agreement Use the GPRA Employment Agreement Template or your RTP employment agreement template. The GPRA Employment Agreement Template can be downloaded from gpra.org.au

Understand what you are signing Read your agreement and understand each clause. Speak to the practice, your RLO or phone GPRA 48

Visit our website – gpra.org.au

if you would like to discuss any parts of your agreement you are unclear about.

Ensure both parties are happy You can negotiate with your employer for conditions and benefits that are greater than the NMTC. Be prepared for a bit of give and take, it needs to be a win-win situation. Remember that no clauses or conditions can be removed. Refer to GPRA’s:

• More than Money: A negotiation guide for GP registrars

• Terms and Conditions Benchmarking Survey. Further discussions during the term

Things change during the year so it is important that any changes to your terms and conditions are captured in an amendment to your original agreement. GPRA recommends that:

• you sign an employment agreement before you start work at the practice

• a new employment agreement be drawn up

each term, even if you are completing another term at the same practice

• if you make any changes to your agreement,

ensure you have the changes in writing or that your agreement is amended.

Need advice? GPRA members can access personalised advice about their employment. Contact the Registrar Services Team at registrarenquiries@gpra.org.au or phone 03 9629 8878.


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The perfect balance A fixed salary, good hours and more time to spend with patients are just a few of the advantages of working in an Aboriginal Medical Service, according to GP registrar Dr Georgie Whiting. Having graduated from medicine at Adelaide University in 2010, Georgie focused on women’s health throughout her early medical training. A career in obstetrics and gynaecology looked likely, but two PGPPP placements and a general practice rotation opened her eyes to a new set of possibilities. “I figured out pretty quickly that I missed a lot of the other aspects of medicine, like paediatrics and geriatrics and general medicine,” Georgie says, reflecting on a stint at Melbourne’s Royal Women’s Hospital that was enjoyable but lacked the variety she had enjoyed in general practice. “You can never be bored as a GP,” she adds. “Everything changes so quickly.” One of Georgie’s PGPPP placements was a threemonth stint in Alice Springs, her first experience working in Indigenous health. It left a profound impression upon her. “[Indigenous health] is something I hadn’t really thought about doing prior to that, but after that experience I think I left knowing that I would be doing more of it,” Georgie reflects. “There are lots of reasons why I like it. I suppose one of the most obvious reasons is the wide range of presenting complaints. Sadly there is a huge burden of disease in the Aboriginal community, so I do see a lot of

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interesting pathology that I most likely wouldn’t get the opportunity to see in normal, mainstream practice.” Georgie was right to assume she would continue in Indigenous health. Now, about a year later, Georgie is working for an Aboriginal Medical Service in the rural South Australian town of Port Augusta. The connection she and her colleagues share in providing team-based care to patients is something she particularly enjoys. “Working in an Aboriginal Community Controlled Health Service, it’s not like your mainstream practice where there are a few doctors working independently, then your admin staff and possibly a nurse,” Georgie says. “We’ve just got the most amazing access to allied health staff and different programs, and there is the feeling that you all are working together. “We’ll pass each other in the corridors and have a chat about a patient we’ve got to know and how we can work together to improve outcomes,” she adds. Employment contracts vary significantly between GPs and practices and Georgie says it’s important for registrars to identify what matters most to them. “Leave entitlements, flexibility of hours and the freedom to take time off for study or training are elements of an employment contract that should be considered,” she says. She considers herself lucky in that the contract she was offered at the Port Augusta AMS was very reasonable and suited her needs well. “One of the other benefits of working in an AMS is that I’m on a salary, so I don’t have to worry about billing and I know how much I’m going to get each week. My contract involves really good


2 Employment as a registrar

“Communication is the key and I think most supervisors accept registrars because they’ve got an interest in teaching.”

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hours so I don’t do on-call, I don’t do weekends. It takes a lot of that added stress away from work so I can really just focus on the patients,” Georgie explains. “Working in an AMS, my consults are a bit longer than they were in mainstream practice, so I do have longer to talk to patients and hear their stories. I really love that,” she adds. As a young doctor who is constantly learning, having the time to get to the bottom of issues and really get to know her patients is great for her development. Georgie has negotiated a contract previously, and while it’s not something she has ever had to think too much about, she’s learnt that up-front communication is the best way to find a happy medium. “Communication is the key and I think most supervisors accept registrars because they’ve got an interest in teaching. They’re not there to make

life hard, so if you communicate then you can try to come to the best agreement for both of you,” she says. On top of her own practice work, Georgie works as an RLO with Adelaide to Outback GP Training. It’s a leadership role that gives Georgie a broader perspective on health issues and introduces her to some great people. “It is an extra commitment, but my hours at the moment are quite flexible and I’m lucky that I’m able to fit that in. I enjoy my work as an RLO. Basically, I get to know my registrars quite well and I’m also really lucky that it allows me to meet other registrars from across Australia,” she says. “There are a lot of really motivated registrars out there and it’s uplifting to be able to work with them and hear about their ideas, but also about their challenges.” Georgie has also been fortunate enough to be able to keep up her interest in obstetrics and gynaecology; she works one day a week at a recently opened women’s health centre in Port Augusta. There’s one particular patient whose story sticks with Georgie and exemplifies why women’s health is important to her. “A bit of a sad story that ended in a good story was a patient I saw early on in my first term. The reason she came to me initially was because she’d had difficulties conceiving, which I had to manage,” she recalls. “But in my last week of that GP term she came to me because she was pregnant, so being able to diagnose that pregnancy and start the process was a really special thing for me to be able to do.” For Georgie, an exciting and diverse career in general practice surely lies ahead.

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3 Support


First day survival tips Starting at a new practice? Common sense tips can help you make it through those first consultations with ease.

• Put resource books in your room if available. • Locate Therapeutic Guidelines, either print copies

In your room

• Ensure your practice firewalls allow you access.

• Open all the cupboards in your room to find where everything is.

• Locate where all the prescription, pathology and

radiology forms are kept, and check with reception staff where the extra or infrequently used referrals and forms are kept.

• Work out which way the paper faces in the computer printer.

• Work out how the phone works and put labels against internal numbers if not already done.

or on the desktop of your computer.

• Add useful and recommended websites to your favourites or bookmarks list on your browser. Log on before your first consult.

• Play with software. Use a fake patient to manage a condition. Every practice will have one of these on their system for you to experiment on.

• Locate where information leaflets are on the toolbar (especially with Medical Director).

• Start collecting resources that will be useful during your consultations, such as guidelines for bowel screening and a flowchart for investigating breast lumps. Keep them in an accessible place (such as a folder or concertina file) in your room.

• Check if there is an emergency alert button,

In the practice

• Investigate common equipment:

• Check out the treatment room, especially where

and how to use it and turn it off.

– what type of sphygmomanometer is used – which way the BP cuff faces and where the large cuff is kept

• Check how to fill up and use liquid nitrogen

– what type of thermometer is used

• Find out where the resuscitation kit and oxygen

– where the otoscope with different sized specula for ears and noses is kept – what type of specula and which sizes are kept, in addition to other Pap smear equipment – what and where the different types of swabs (MCS, PCR) and specimen jars are kept.

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dressings, vaccines and needles are kept. Does the practice nurse administer vaccines?

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for cryotherapy.

are kept. Ensure you know what is in the kit and how to use it. Find out if you have access to oxygen saturation monitors and an ECG.

• Make friends with practice staff, they can make

your life much easier. Be friendly and polite and make an effort to learn their names. Offer to make coffee and bring treats for morning tea from time-to time. The practice manager is a key ally and can help smooth your way into your new environment.


3 Support

• Have a say in setting up your bookings.You will

almost certainly need extra time until you find your feet, so book accordingly (ideally two patients per hour when you first start, moving to three or four when you feel comfortable). Let the practice staff know the common procedures you may routinely need extra time for (eg. Pap smears, psychological intervention and care plans, skin excisions).

With your supervisor

• • Ask about the practice policy on checking and

Check the practice booking and billing system.

follow-up of results and patient recalls, including who follows up your patients’ results after you leave the practice.

• Establish their preferred method of being

contacted for questions during consultations (eg. phone, knock on the door, internal messaging system) and after hours. If you’re doing after-hours cover, make sure that a senior has been designated to back you up and that you have their contact numbers.

• Ask for a list of local services, including contact

details (ie. phone numbers/addresses) from your supervisor. Many practices will have a list on their practice software: – pathology/radiology – allied health – specialists – the capabilities and specialist coverage of the local hospital

• Talk about your teaching requirements. Make sure you have sufficient designated teaching time and discuss how you would like to use this.

During consultations

• Take a deep breath, count to 10 and then call your first patient in.

• Start with open-ended questions. • Try to get the full list of the patient’s complaints and needs early in the consult. Then you can prioritise and, if required, book a second appointment to cover the list in full.

• Try to do all the work for each consult

(investigation requests, prescriptions, referrals and notes) during the consultation to avoid having to hang around after hours when everyone else has gone home and when you are more likely to forget the details.

• Have a system for keeping track of clinical

questions that arise during consults (eg. notebook on your desk, manila folder with patient consult summary printed) to ask your supervisor or look up.

GPRA tip Once you have survived your first day, enjoy your term! Ask lots of questions, look after yourself and leave work at work. Debrief with other registrars at block releases and teaching sessions. Have fun, and if you are not enjoying work talk to someone at your RTP about it early on in your term.

– community or domiciliary nursing services – local audiometrists and optometrists. GP Registrar – The essential guide for general practice registrars

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Support that makes a difference The potential for stress and burnout among young doctors is becoming more widely recognised. Queensland-based Dr Georga Cooke has begun researching how her fellow GP registrars might be affected. After training stints at several general practices and some part-time academic work, Georga now works as a medical administration registrar in Brisbane and is a teaching fellow and researcher at Bond University on the Gold Coast. Having explored psychiatry and geriatrics during her junior years, she had a strong interest in wellness models and was interested in looking into burnout and stress with a particular focus on GP registrars. “In looking for a research project to take on, I thought there’s not been a lot done in GP trainees in particular. There were studies done across the junior doctor population, but nothing that really focused in on people who are training in the community, which is a really different model; you’ve got a much closer relationship with your supervisor on a day-to-day basis,” Georga says. “I actually found the process of doing the research really interesting because I could distribute my survey to registrars and it kicked off a couple of interesting conversations around wellbeing and expectations and work-life balance.” Georga was somewhat surprised at the results of her survey. She found that GP registrars are, by and large, less affected by stress than previous research would indicate. As far as Georga is aware, hers is the only study in Australia to focus 56

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exclusively on resilience and burnout in general practice training, suggesting that GP registrars are coping better than many other young doctors. Her research is yet to be replicated by other studies, but she suspects the results might be explained by the closeness of supervision in general practice and the excellent peer support among GP registrars. “I get the sense that we’re a very passionate bunch of doctors and there’s a level of camaraderie that you come into when you start as a GP registrar that perhaps isn’t there in a hospital as a junior doctor,” Georga says. “I think there’s a support network that is possible to access that people haven’t felt before.” Potentially, one of the most stressful times in a GP registrar’s career is their first training term (GPT1), when they might have difficulty adjusting to the workload and demands of general practice. However, Georga points out that the thrill of starting something new and the anticipation of a future in general practice can be an effective counterbalance to stress during GPT1. “That’s not to say people don’t struggle, because they do, and I think it’s important to keep the options multiple and flexible for people who do have issues during training or who find it stressful,” she explains. “But having spoken to quite a few registrars, it’s a pretty professionally exciting time when we start as a GP registrar.” Georga hopes to continue and expand her research and would also be happy to see others follow up in the area. Further studies that monitor results over a longer period of time or a larger population group could add depth to her original findings and help explain them.


3 Support

“GPRA offers something that’s slightly different in that it’s a peer network, and that peer-support, often in combination with other supports, is what can really make the difference.”

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“Certainly it hasn’t been repeated by anyone, so I think it would be interesting to see if someone else found the same thing, or if longitudinally things change as people go through their training and into their professional lives,” she says.

can have something to look forward to if things get tough. “A lot of people keep their leave up their sleeve,” she says, but taking the step to arrange time off and having a trip to get excited about can be psychologically beneficial.

During the process, Georga has learnt a lot about the way stress affects young doctors and how best to cope when things get difficult. From the conversations she’s had with registrars, as well as her own experience, she knows the importance of seeking support from the right people.

When things do get hard to manage, support is available in many forms, both unofficial and official. One of the most valuable resources for GP registrars, Georga says, is GPRA, which can provide a sense of peer-to-peer understanding that can’t quite be replicated by talking to senior doctors.

“Spending time with your supervisor and talking to them about their own experience starting out as a GP and seeking mentorship from some of the other GPs at your practice can be really helpful,” Georga says. Thinking back to her first term as a GP registrar, she recalls the support offered to her by not just a sole supervisor but all the GPs at the clinic, each of whom were happy to help her out in their own way.

“There are a number of different supports available to GP registrars, whether that’s from their own RTP or the college support programs that exist,” she says. “But I suppose GPRA offers something that’s slightly different from either of those in that it’s a peer network, and that peer-support, often in combination with other supports, is what can really make the difference.

“It was a practice that had four or five GPs and each of them offered me something different,” she says. “I found talking with all of them – we had more of a group supervision model rather than a primary supervisor – about understanding the multiple ways to look at a problem was very helpful. That’s why I think seeking help and some other perspectives is probably the first thing to do if you notice you’re having problems.” One of Georga’s other tips for GP registrars is to make sure they plan holidays in advance so they

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“The staff have a lot of experience in problems that are common during training and so I think both the registrars and the staff at GPRA offer something different from the other supports that are available,” she adds. “[GP training] is an exciting time, but it’s also a time where problems or stresses may come up. When you are so focused on caring for others and learning a new craft, it can be difficult to remember to care for yourself.” It can sometimes feel like hard work, but maintaining a strong support network and approaching training with a positive outlook can do wonders for the development of young GPs.


When things go wrong What to do Occasionally during your GP training, things may not go exactly as planned. If you find yourself in difficulty, remember that GPRA can provide support and assistance. Occasionally, registrars find themselves in situations where they are unhappy about some aspect of their training. This may include practice placement, relocation, educational issues, interpersonal problems or financial disputes. If you find yourself in this type of situation, don’t worry, you are not alone. There are many people involved in GP training who are specifically employed

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to assist you with these difficulties. If you are in a fix, the best advice we can give you is to let someone know – and let them know as soon as possible.

Talk to someone The most appropriate person to talk to depends on what the problem is and how you want to go about dealing with it.Your RLO is always there in the front line to support and advise you no matter what the problem. RLOs are registrars too, and it is a part of their job to provide peer support to you. In some circumstances, the RLO can act on behalf of a registrar if the registrar feels that they are unable to confront the issue themselves. In general, most problems will be resolved locally with the practice or RTP.


3 Support

Your RTP will also have a staff member as a point-ofcontact for registrars. GPRA has a dedicated registrar services team you can contact if you are not comfortable talking to your RLO or RTP for any reason. They can double-check that the information you have been given is correct, provide suggestions on how to approach a difficult situation or help solve larger problems. We help by discussing matters thoroughly with the registrar, can speak directly with the RTP to straighten out any misunderstandings, and provide representation and assistance with appeals. The first thing we will advise you to do in the event of a dispute is document relevant events. Make a note of times and dates, make notes of any verbal advice you are given, retain copies of correspondence and try to stick to factual occurrences. Always be civil and professional in your dealings, as this will go a long way in supporting your case if a formal dispute arises.

Take it further? If your issue does not seem to be resolved to your satisfaction, you may wish to escalate the matter further. Every RTP has an appeals process, and should that not resolve the issue, there is a further appeal process that involves GPET. GPRA offers valuable assistance and advice during these processes. We have been involved in registrar appeals of all types, so don’t hesitate to talk to us if you find yourself in this situation. Often early intervention and discussion results in better outcomes for all parties. Contact us as soon as you realise you may need outside help in a situation.

Sometimes issues arise that indicate the possibility of a systemic problem, for example, a policy or situation that is disadvantaging a particular group of registrars. GPRA can act to collaborate with or lobby the relevant stakeholders to review and change their policies. Once again, GPRA has been involved in and advocated on many issues within the AGPT program that have resulted in positive change for all registrars.

Dispute resolution guidelines, policies and appeals If a dispute arises, you need to be aware of relevant policies. Many RTPs have dispute resolution policies available on their websites. If you cannot find yours, contact your RLO. GPET also has policies, which are available on their website. GPET appeals are initiated when a registrar wishes to appeal a decision made by their RTP. These appeals are a last resort when all else has failed. Remember, all employees are covered by national and state legislation relating to employment including maternity leave, discrimination, sexual harassment and bullying.

GPRA Registrar Services Team GPRA staff are always available for you to talk about any problems or difficulties you may encounter with your training. Our Registrar Services Team can be contacted by email at registrarenquiries@gpra.org.au or by phoning 03 9629 8878. All matters are treated as confidential. We are an independent body run by registrars, for the benefit of all registrars.

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Transferring to another training provider Transferring to another training provider is an extraordinary process. Transferring disrupts training and often prolongs time required in the training program. We understand that there are sometimes genuine circumstances where a transfer is essential, and there are clear policies to support this process. GP registrars are asked to nominate their preferred RTPs at the time of application into the AGPT program. Transferring from your allocated training provider after you have accepted a training position can cause logistical and planning issues for all concerned and often results in prolonging the training time for the registrar, and additional costs to the training program. This process is usually unavailable in GPT1, and beyond this a registrar must prove genuine reasons for wanting to transfer. AGPT and training provider transfer policies outline the conditions under which transfers can be made. These conditions usually relate to extenuating or unforeseen circumstances that result in a registrar having to relocate. Transfer

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requests must be made in writing, and must be approved by GPET and the two relevant RTPs. Requests must clearly demonstrate the reasons and circumstance behind the transfer. There are five broad categories of transfers and it is important you understand how the relevant transfer policies apply to your situation.

• Category 1 – Transfers between RTPs within six months of commencing training

• Category 2 – Transfers between RTPs • Category 3 – Transfers from the general pathway to the rural pathway

• Category 4 – Transfers from the rural pathway to the general pathway

• Category 5 – ADF registrar transfers. Refer to the AGPT and RTP specific policies on RTP transfers. GPRA can assist and guide you during this process, and ensure that you submit a transfer request that complies with the relevant transfer policies. More information can be found at gpet.com.au or contact the GPRA Registrar Services Team: phone 03 9629 8878 or email registrarenquiries@gpra.org.au


“Test, Check, Save and Go” Test yourself Check the answer, explanation and link Save the references to read later “I’m happy with All while on the GO the app. It’s easy to Available on Android & Apple

Practise, practise, practise is the best way to prepare for the fellowship written examination. Dr. MCQ is a medical multiple choice questions (MCQ) app developed by Sturt Fleurieu. With 120 MCQs written and extensively

navigate and it’s a great way to make good use of short snippets of study time. The questions are challenging, which motivates me to study certain topics further.” Dr. M

reviewed by a group of Australian general “Dr. MCQ is an practitioners and medical educators, it is a reliable excellent study tool for resource for examination preparation. Its mobile format both GP trainees but also for enables you to make the most of your precious time any medical based person wherever you may be. At any stage, Dr. MCQ is a great wanting to extend their knowledge. study motivator. It may be used for self-review or in a I believe the app is an invaluable study group. Dr.MCQ is useful whether you are just study tool and would recommend starting your studies or even when the examination date it to anyone, but especially those wanting to pass the GP written is looming. examinations...buy it now to see During the very early part of what all the fuss is about!” your preparation, Dr.MCQ “I like the Dr. C gives an indication of question convenience of being structure and allows you to able to quiz myself whenever develop an effective approach to I am bored or in the mood to test MCQs. Whilst in the midst of preparations, Dr.MCQ can my medical knowledge whether supplement your studies with its explanations I am in a cafe or at home. The and live links to a range of general practice references. questions are relevant to current practice and the links to some of The readings can even be saved, emailed or printed for the answers provide a very review later. Closer to the examination date, Dr.MCQ can good source of reference.” be used to gauge your level of learning. The categorised Dr. Q results helps you make sure you have covered all of the important topics.

www.sfet.com.au/drmcq

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Looking Number one after priority yourself Workplace – looking after issues yourself Fatigue in doctors Fatigue is a huge problem for doctors at all levels of their career. If you have suffered from fatigue, you will have experienced an acute, ongoing state of tiredness. It can lead to mental or physical exhaustion and prevent you from functioning within normal boundaries. Why is fatigue in doctors such a concern? Fatigue is a hazard that can affect all health professionals. It can compromise both the safe provision of high quality care to patients, and also the health and wellbeing of the doctor. Fatigue management in doctors is the responsibility of the individual practitioner and the system they work in. GPRA fatigue management discussion paper Fatigue and sleep deprivation are recognised workplace hazards. A GPRA subcommittee worked in conjunction with stakeholders to examine the problem of fatigue in doctors. They used their findings to produce a statement of principles and discussion paper. This paper draws on a number of sources to suggest methods of addressing fatigue within general practice. You can view the Fatigue management in vocational general practice training: Statement of principles and discussion paper at gpra.org.au

Workplace bullying Workplace bullying is a serious concern. As a trainee, it can be difficult to know what to do if you are being bullied at work. Bullying behaviour can impact your health, self-esteem and your enjoyment of your career. If you are being bullied,

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GPRA urges you to report the problem. This usually means reporting it to your GP supervisor and/or director of training. If in doubt, please call GPRA for a confidential discussion on 03 9629 8878. Some types of workplace bullying are criminal offences. If you have experienced violence, assault or stalking for example, these matters should be reported to the police. Supportive bystanders People respect those who stand up for others. But being a supportive bystander can be tough. Sometimes it’s not easy to work out how to safely assist because bullying occurs in many ways. There is no ‘one size fits all’ approach to being a supportive bystander. The following suggestions may assist supportive bystanders in taking safe and effective action:

• If you witness bullying, consider standing close to the person who is being bullied

• Make it clear that you won’t be involved in bullying behaviour

• Support the person who is being bullied.

Suggest they ask for help: for example, go with them to a place they can get help or provide them with information about where to go for help (such as GPRA)

• Report the bullying to someone in authority or someone you trust at work. If the bullying is serious, report it to the police; if the bullying occurs on social media, report it

• Make notes of what you have witnessed.


3 Support

.

Workplace bullying means any behaviour that is repeated, systematic and directed towards an employee or group of employees that a reasonable person, having regard to the circumstances, would expect to victimise, humiliate, undermine or threaten and which creates a risk to health and safety. Section 55A (1) of the Occupational Health, Safety and Welfare Act 1986

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Wellbeing tips Maintaining sanity during your training is vital. Dr Belinda Allan shares her wellbeing tips.

• Have another registrar or friend that you can debrief with at the end of a tough day.

• Always have a holiday or long weekend in the pipeline to look forward to.

• Do something on a Friday night for pleasure to mark the end of your working week (even if you have to work weekends).

• Always have one activity a week, booked into

your diary which you do not cancel, that is just for enjoyment, such as yoga, sport, music, art or a hobby.

• Make exercise a part of your working week. • Learn relaxation techniques and use them

before sleep, depending on your beliefs this may include breathing techniques, mindfulness, meditation or prayer.

• Learn to leave work at work, debriefing can help with this.

Learn to turn off your analytical brain, consider doing something creative or pleasurable instead such as listening to or making music, art, or playing with children.

Have a wind-down ritual, such as getting out of work clothes, having a shower, eating a nutritious meal, doing exercise, having time alone or with loved ones.

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• Recognise your signs of stress: – psychological – ruminating about work, inability to unwind, waking up anxious, low mood, general anxiety, perfectionism, irritability or mood swings, pessimism, feeling overwhelmed or inadequate, reduced concentration, difficulty making decisions – physical – fatigue, headaches, muscular aches, insomnia, gastrointestinal upsets, palpitations, and dermatological disorders – lifestyle – problems in your relationships, increased use of alcohol or drugs, lower tolerance of life stressors, social isolation, decrease in performance at work, increased number of sick days, loss of hobbies or outside interests.

• Have your own GP (don’t laugh – this is

essential!) – make an appointment at least once every 12 months (and include a mental health check-up).

• Be honest – have someone in your life that you trust and can confide in about stress.

• Speak up early! Contact your RLO, GPRA or

someone you trust about issues in your practice with your supervisor or RTP that are affecting your stress levels.

• Ask your fellow registrars how they are going – you’d be surprised how many of us are going through a similar experience.

GPRA has a dedicated self-care section on their website, including support programs, advice from GPs and more. Visit gpra.org.au/self-care or phone the GPRA Registrar Services Team on 03 9629 8878.


4 GP training resources


GPRA is the peak national body for GP registrars. Run by registrars, for registrars. Our publications contain registrars’ collected experience and wisdom on the training program, exams and employment. Our registrar services team is here to answer your questions.

Terms and conditions benchmarking survey 2012

GP Registrar The essential guide for registrars. Benchmarking survey Power up your negotiations! Find out what other registrars earn. In-practice teaching resource Maximise your in-practice teaching experience.

In-practice teaching resource

More than Money A negotiation guide for GP registrars

More than Money A negotiation guide for registrars in training and post fellowship who are negotiating a contract. Exams Tips, case studies and webinars; we have you covered. National Minimum Terms and Conditions Your GPT1/2 terms and conditions have already been negotiated. GPRA website The latest news and information for registrars; keeping you informed during your training.

Need help? Talk to us. P 03 9629 8878 E registrarenquiries@gpra.org.au W gpra.org.au

Secure your win-win employment agreement

General Practice Training Program National Minimum Terms and Conditions for GPT1 and GPT2 2013 GP training year


AGPT program Endpoint qualifications and fellowships FRACGP qualifications (RACGP)

FACRRM qualifications (ACRRM)

Year one

Core clinical training time

Possible equivalence*

12 months

12 months

+ Year two

Primary rural and remote training 2 x 6 months

+ Joint training opportunities are available †

+ Year three

Primary rural and remote training 2 x 6 months

Year four

Advanced specialised training 12 months

GP terms

GPT1 – 6 months GPT2 – 6 months

+ Joint training opportunities are available †

+ Note: Fourth year is for FACRRM and FARGP candidates

Hospital training time

GPT3 – 6 months Extended skills – 6 months

FRACGP (VR) Possible equivalence*

Advanced skills training for FARGP (12 months)

FACRRM (VR) * Credit given for AGPT training already undertaken towards one fellowship, prior to undertaking a second or third fellowship † Can be achieved in dual-accredited practices or posts Note: Although this table is presented in a linear format, both colleges have flexible training options to enable registrars to plan their training around their own needs and interests. See the college websites for more information

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The ACRRM Fellowship What is FACRRM?

• Fellowship of ACRRM (FACRRM) is an approved pathway to specialist registration as a general practitioner, access to A1 Medicare items and unrestricted general practice anywhere in Australia

• It is a four-year integrated training program.

Training time is reduced where a candidate is granted recognition of prior learning

• Training occurs on the job as a registrar in

a range of ACRRM-accredited teaching posts including general practices, hospitals, Aboriginal Medical Services and retrieval services.

Candidates wishing to achieve FACRRM can apply for one of three training pathways:

• the Vocational Preparation Pathway delivered by RTPs with funding from GPET

Core clinical training 12 months working in an accredited hospital, where ideally you complete terms in:

• general internal medicine • general surgery • paediatrics • emergency medicine • obstetrics and gynaecology • anaesthetics. Where completion of all terms is not possible, there are flexible options to build these skill sets as you progress through training. This training should provide you with sufficient clinical cases and opportunistic learning to form a good foundation to begin work in rural or remote practice.

• the Remote Vocational Training Scheme (RVTS)

Primary rural and remote training

• the Independent Pathway, administered by

24 months working in facilities accredited by ACRRM to build your clinical and procedural skills and your confidence to work in rural and remote contexts.

for doctors working in isolated rural communities who find it difficult to leave their community to participate in training

ACRRM, which is suitable for doctors with experience who prefer self-directed learning.

For more information on the pathway most suitable for you, contact the ACRRM vocational training team on 1800 223 226.

Vocational training towards FACRRM The ACRRM training program comprises of three stages of learning and experience. After completing 12 months core clinical training, a registrar may complete the remainder of the training requirements in any order. 70

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These facilities can include general practices, hospitals, Aboriginal Medical Services and retrieval services.You may choose to complete your primary rural and remote training in one or several locations. Training in a single location will enable you to build a strong relationship with colleagues and your community. However, training in several locations may better equip you to expand your posting opportunities later in your career. While there is considerable flexibility, the experience must include a minimum of six months in a community primary care setting, a minimum


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of six months in hospital and emergency care and a minimum of 12 months living and practising in a rural or remote setting.

Advanced specialised training Advanced specialised training extends your broad generalist skills and capacity in at least one discipline. With these supplementary skills, your expanded professional scope can include valuable clinical privileging in hospitals, access to additional Medicare item numbers and contributing to the pool of medical skills in your district. Advanced specialised training requires a minimum of 12 months training in one of the 11 disciplines specified by the college:

• Aboriginal and Torres Strait Islander health • academic practice • adult internal medicine • anaesthetics • emergency medicine • mental health • obstetrics and gynaecology • paediatrics • population health • remote medicine • surgery (2 years). To achieve FACRRM, candidates must also successfully complete four ACRRM online education modules and at least two emergency skills courses approved by ACRRM (eg. REST/ EMST/ELS/APLS, ALSO). Emergency courses must be current at completion of training.

Frequently asked questions Why would I consider training for FACRRM? Fellowship of ACRRM equips you to practise unsupervised anywhere in Australia. It does not restrict you to purely rural general practice. This gives you real freedom, independence and scope of practice throughout your career.Your broad general skill set – complemented by an advanced specialised skill set – provides the skills and confidence to practise in a broad range of geographic and clinical settings. This can vary from solo practice in small communities to leadership roles, roles in large hospitals, from retrieval and expeditionary medicine to Aboriginal Medical Services or urban general practice. Achieving FACRRM will verify that you are qualified to practise anywhere. There is no other general practice fellowship that covers this scope of practice. How is FACRRM integrated into the AGPT program? Registrars enrolled in the AGPT program can elect to train for FACRRM. FACRRM training is open to both rural and general pathway registrars, provided they work in ACRRM-accredited teaching posts. It is essential to enrol with ACRRM as soon as you enrol with an RTP. That way ACRRM can help to ensure your training occurs in accredited posts. Can candidates do both FACRRM and FRACGP qualifications at the same time? Yes, but requirements for placement, duration, completion of training and assessment are different between FACRRM and FRACGP. Registrars seeking both fellowships will need to talk to their RTP about a program that complies with both colleges.

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Do you have to undertake all training in rural or remote locations?

When do you undertake the assessments?

No. The flexibility of the program means that while most registrars will spend a significant amount of training in rural areas, and the focus is on gaining the skills and knowledge required in rural and remote settings, many of these skills can be developed in both urban and rural facilities. However, having a good understanding of the context of rural medicine is essential, therefore all registrars must spend a period of training, living and practising in a rural or remote setting, the minimum requirement is 12 months.

Once you have met the minimum eligibility of 24 months training, or equivalent RPL, you can commence assessment. However, it is important to note that the standard for all assessments is that of a doctor practising independently and safely at fellowship level, so it is important to be well prepared. While the order is not specified, it is strongly recommended that StAMPS is left until you have had experience across the broad range of learning experiences, including community primary, emergency and hospital care and rural or remote settings.

Can you train with ACRRM then later work in an urban setting?

What is available to help prepare for ACRRM assessments?

Yes. FACRRM qualifies you for specialist registration and approval to work in unrestricted general practice anywhere in Australia. Indeed the additional confidence and competence you will have developed through your training will enable you to more than adequately serve whatever community you choose.

New information is being developed all the time. Check the ACRRM website for sample questions and scenarios, plus recorded virtual classroom sessions and online modules on Rural and Remote Medical Education Online. StAMPS preparation workshops are offered face-to-face at least twice a year and study groups facilitated by a medical educator are run via virtual classroom leading up to each StAMPS assessment. For more information, visit acrrm.org.au Contributed by the Australian College of Rural and Remote Medicine

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The RACGP Fellowship What is the FRACGP? Fellowship of the RACGP (FRACGP) demonstrates to governments, the general practice community and the Australian community that a GP has met the required level of competence to deliver unsupervised general practice services in any general practice setting in Australia, whether it be urban, regional, rural or remote. It also confers the ability to access specialist medical registration and consequently A1 rebate rates under Medicare legislation. The FRACGP is recognised in New Zealand, Ireland and Canada. The RACGP also delivers conjoint fellowship exams in Malaysia and Hong Kong.

Vocational training towards FRACGP The essential components of vocational training towards FRACGP are:

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

• General practice placements (18 months): 18

months of general practice placements need to be completed in RTP accredited training posts, and include a compulsory term (minimum of six months) in an outer metropolitan area or a rural or remote area

• Extended skills (six months): Provides an

opportunity to develop your general practice skills further and can be completed in a range of RTP accredited settings. Options include advanced rural skills, an overseas post, an academic post or extended procedural skills within a hospital or practice.

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Fourth-year additional training (optional) Advanced skills:You may opt to undertake further training in a range of settings such as a hospital with an approved learning plan addressing such skills as obstetrics, acute medicine, emergency medicine, paediatrics, surgery or anaesthetics. If you have a strong interest in rural general practice and want to take your training and education further, you have the option to complete an additional 12 months of advanced rural skills training (ARST). This can be undertaken as one of the requirements for the Fellowship of Advanced Rural General Practice (FARGP).

About the FRACGP exams The fellowship exams for registrars comprise two online segments: the Applied Knowledge Test (AKT) and Key Feature Problems (KFP), and a clinical segment – the Objective Structured Clinical Examination (OSCE). All three segments need to be completed within a three-year period of first passing one of the online segments.

Eligibility to enrol for the exams To be eligible to enrol in the RACGP Fellowship exams, you need to have completed the required training units for the exams you wish to enrol in. Unit completion will be checked with your RTP at the close of enrolments.

• For enrolment in the AKT only, you need to have completed six units by the AKT exam

• To enrol in all of the exams, you need to have

completed eight units by the date of the OSCE.

In addition, you must have:

• current Australian medical registration • current financial membership of the RACGP.

For more information, visit racgp.org.au/ becomingagp/students/vocational-training-pathway

Contributed by the Royal Australian College of General Practitioners


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RACGP Fellowship in Advanced Rural General Practice • 12 months of ARST in an accredited

What is the FARGP? The FARGP is the qualification awarded by the RACGP beyond vocational fellowship (FRACGP). The FARGP recognises advanced rural skills training that develops extended general practice skills and broadens options for safe, accessible and comprehensive care for Australia’s rural, remote and very remote communities. The FARGP:

• enables you to develop skills, competencies and confidence to work in rural Australia

• is based on contemporary adult learning,

reflective practice and self-determined learning

• gives you access to an online learning platform that enables you to complete the program on the go

• builds on the specific knowledge and skills you

are developing as part of your training towards the FRACGP

• should be commenced early in your GP

training to enable you to get the most of your experience.

Prerequisites for GP registrars:

• financial membership of the RACGP • working towards FRACGP • commitment to working in rural general practice.

FARGP requirements:

• completion of a learning plan and reflection • 12 months in rural general practice

training post

• completion of a six-month ‘working in rural general practice’ community-based project

• completion of two advanced emergency skills courses and a series of emergency medicine activities.

Advanced rural skills training An important component of the FARGP is 12 months of ARST. Each ARST has its own curriculum guidelines and assessment process. Registrars may choose to complete a 12-month or two six-month ARST accredited posts in a procedural or non-procedural area of interest or of value to a rural community. Training can be undertaken in the following areas:

• anaesthetics • obstetrics • surgery • emergency medicine • mental health • child and adolescent health • adult internal medicine • small town rural general practice • Aboriginal and Torres Strait Islander health. Individually designed ARST (approval by the RACGP National Rural Faculty is required after consulting your medical educator). For more information, call the RACGP National Rural Faculty on 1800 636 764 or visit racgp.org.au/fargp Contributed by the RACGP National Rural Faculty

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Get ready for the new year with resources from the RACGP developed especially for you Access an array of RACGP resources such as the check* Program, gplearning and the John Murtagh Library designed specifically to further your medical training and development.

Independent learning program for GPs

Independent learning program for GPs

Unit 497 August 2013

Neurology

Do the GP pathway activity on gplearning – online educational platform developed for GPs by GPs.

Explore the popular check* Program showcasing case studies written by expert clinicians.

www.racgp.org.au/check

check_august_2013.indd 1

23/08/13 12:05 PM

Independent learning program for GPs

Independent learning program for GPs

Visit us to further your medical training and learning www.racgp.org.au/yourracgp. *Available only for Resident/Interns.

Access DynaMed, an evidence based point of care tool or the John Murtagh Library’s online databases for research projects/assignment preparations.


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Registrar liaison officers Your local peer support Registrar liaison officers are GP registrars employed by RTPs to provide pastoral care, information and support to registrars. All RLOs automatically become members of the GPRA Advisory Council. The core objectives of the RLO position are to:

• act as a liaison between GP registrars in their region and the RTP

• advocate and represent registrar interests at several levels

• help support GP registrars in their region. Advocacy and representation

While undertaking the AGPT program, you can contact your RLO confidentially to discuss any aspect of your training and employment.Your RLO may refer you to the appropriate person or group to resolve a particular problem, assist in mediating a dispute, or may just hear you out. RLOs will often be able to answer a question on the spot.

board’ and support person for the registrar. They may listen to the complaint, direct the registrar to further support, or may assist with anonymous or identified enquiries with the RTP. RLOs are also available to provide emotional support to registrars experiencing personal difficulties. RLOs can facilitate social or group events that may help registrars debrief and support each other, particularly in isolated areas. If you find yourself in a position where you are struggling or feeling isolated, your RLO can provide support via phone calls, emails, and may also be helpful with putting you in touch with other doctors in the area or with social networks. Contact your RTP to find out who your local RLOs are, or refer to the GPRA RLO directory at gpra.org.au

RLOs also represent registrar concerns and opinions at the RTP level and nationally via the GPRA Advisory Council.

Pastoral care Pastoral care is an important part of the RLO position. RLOs can refer GP registrars to a GP or other appropriate health professional. It is inappropriate for the RLO to enter into a patient-doctor type relationship with any of their registrars. When a placement is not going well for a registrar, or if there is a dispute with the RTP or practice, the RLO may have a role as a ‘sounding GP Registrar – The essential guide for general practice registrars

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A strong foundation Dr Marion Davies’ training has taught her all about remote medicine, but she never expected to have to apply her skills in the most isolated place imaginable: an aeroplane at 20 000 feet. Marion was on a flight from Melbourne to Perth when a member of the cabin crew, having seen the ‘Dr’ title on her boarding pass, tapped her on the shoulder and asked if she knew how to deliver a baby. “I was presented with one of my fellow passengers down the back in the galley – she was 30 weeks pregnant with her first baby and was having abdominal pains. The concern was that she was going into premature labour 20 000 feet up, which is the most remote location I’ve ever been in!” Marion recalls. “I thought ‘Crikey, this is going to get me into a bit of strife’. But I said yes because I can, because I had just done my AST (advanced skills training) in obstetrics.” The WA-based GP registrar was understandably nervous knowing that she didn’t have any medical back-up and wouldn’t be able to “phone a friend” for support. But after those initial jittery moments, her training kicked in and she realised she would be able to handle the stressful situation. “It was a bit of a revelation in that moment for me because I realised that I didn’t need all those things. Whilst they’re nice to have, I did actually have the skills and the knowledge to be able to handle that situation. Fortunately I didn’t need to use all those

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skills and she didn’t deliver on the plane,” Marion says. “But it was just really good to know that my training is paying off and I am useful to a lot of people.” Marion, who is Registrar Director at the Australian College of Rural and Remote Medicine (ACRRM) and sits on the GPRA Advisory Council, is passionate about GP training. She has chosen the ACRRM rural generalist pathway, which she believes will provide the best foundation for her career, and is three years into her five-year fellowship. Marion completed ASTs in obstetrics and anaesthetics early on in her training so she could practise those skills and be as well-rounded as possible from the outset. It reflects her belief that registrars should be proactive about their training and make sure they build the skills that will serve them best in their future. “As trainees, we need to seek the training to get the skills we think we will need to best serve our communities,” Marion says. “Probably the best way to do that is to set clear goals for each term of training. Set goals for your training overall and talk to your supervisor early on about the best ways of achieving them. “It’s also important to always say ‘yes’,” she adds. “It’s normal to feel underprepared and unsure the first few times you do a procedure or do a consultation on your own, but your training time is your chance to have the opportunity to practise those skills in a safe and supervised environment. Say yes all the time, because one day you’ll be on your own and you won’t have someone watching you and backing you up, so you’ve got to take all the opportunities while you’re a trainee.”


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“Say yes all the time, because one day you’ll be on your own and you won’t have someone watching you and backing you up.” GP Registrar – The essential guide for general practice registrars

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One of the great advantages of general practice is its variety, both within practices and across Australia. The skills required in the heart of a capital city are very different to those required in a remote outback town, and those needs vary again between communities and regions. She advises registrars to keep an open mind about their training and realise what other possibilities might be available to them. “There’s a lot more flexibility in training than many trainees know of or understand. I think many would be surprised by the possibilities and the flexibility both in the time and scope of training,” Marion says. “Consider doing an AST early on during your training because you can carry those skills through the rest of your training. Often people think ASTs come at the end, but they can

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be done in the first couple of years. I’ve done that and I’ve found that useful.” Marion’s passion for general practice is clear and she plans to use the skills she has learnt to improve the health of people in rural communities. “I believe rural practice offers the most interesting, challenging and rewarding career in general practice. It also appeals to my sense of social justice and responsibility: currently there’s an unacceptable gap in health status between urban and rural Australians,” she notes. “I think all Australians deserve access to best practice healthcare, but currently Australia’s sickest people have the least access. I have the skills and training that can help to bridge that gap, so why wouldn’t I get out there and try to do my bit?”


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Useful resources There are many free resources available online to assist you throughout your training, and some may already be available at your practice, hospital or through your RTP. Many health and training organisations provide online learning resources and other information. ACRRM and the RACGP provide free resources as part of their memberships. Online resources

• Blogs written by GPs and registrars can be

useful during training. For a list of reviewed blogs, podcasts, books and other resources, visit gpra.org.au/blogs

• The RACGP John Murtagh Library lends to its

members. This is a great service with books delivered to your door. Visit racgp.org.au/library

• Some subscriptions, such as eTG, may be

available through your RTP. Also ask your RTP about nearby libraries that may hold relevant texts or DVDs. For a list of RTPs visit, gpra.org.au

Organisations Australian College of Rural and Remote Medicine (ACRRM): acrrm.org.au Australian General Practice Training (AGPT): agpt.com.au Australian Medical Association (AMA): ama.com.au 82

Visit our website – gpra.org.au

Department of Health (DoH) – the Federal Government’s health department website includes information on the latest public health campaigns, key policies, services, important forms and links to other relevant websites. See also your state or territory health department website: health.gov.au gplearning – the RACGP online learning tool: gplearning.com.au Medicare Australia: medicareaustralia.gov.au/provider MBS online: mbsonline.gov.au National Prescribing Service (NPS): nps.org.au Pharmaceutical Benefits Scheme (PBS): pbs.gov.au Royal Australian College of General Practitioners (RACGP): racgp.org.au Rural and Remote Medical Education Online (RRMEO): acrrm.org.au Rural Health Education Foundation (RHEF): rhef.com.au Rural Health Workforce Australia (RHWA) – a not-for-profit organisation dedicated to making primary healthcare more accessible for communities in rural and remote Australia: rhwa.org.au Therapeutic Goods Administration (TGA) – the regulatory body for therapeutic goods in Australia: tga.gov.au


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Regional training providers Your RTP is an invaluable source for ongoing support and guidance, and for information and useful resources. Visit gpet.com.au

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Take the guesswork out of monitoring wheeze A recent survey shows that two thirds of Australians with asthma do not monitor their condition. This can make it difficult to manage asthma effectively. AirSonea is the world’s first handheld device that turns a patient’s smartphone into a portable wheeze monitor. The presence of wheezing is a sign that airways are inflamed and the asthma is not well controlled. Home monitoring of wheeze can help patients become more aware of this symptom and adhere to their treatment plans. When combined with the AsthmaSense smartphone app, AirSonea provides patients with a comprehensive monitoring system to record and track wheeze, other symptoms, events, and medication usage. With regular use, AirSonea gives you an accurate picture of recent asthma events to review at their next visit. AirSonea is listed on the Australian Register of Therapeutic Goods.

Find out how you and your patients can better monitor wheeze.

airsonea.com.au or iSoneaMed.com

ISO0017GPRA


5 Exam survival


Studying for your exams? How GPRA can help We understand how hard it is for GP registrars to study for their RACGP and ACRRM exams while working in a busy general practice. To make things a little easier, we have compiled a range of tools and resources to help give you every advantage with your fellowship exams. These resources have been designed by registrars, for registrars. Find a study partner GPRA members can use our website to advertise for a study partner or group. Ads are kept online for eight weeks, or until you let us know you have successfully found a study partner. Take advantage of this service, which is only available to members, and get access to other registrars around Australia. Visit gpra.org.au/study-partners or email registrarenquiries@gpra.org.au to find out more.

Webinars GPRA offer webinars where attendees can listen to the experiences of other registrars who have recently successfully completed their exams. During these webinars, you can ask questions about the exams, have a go at some questions, and have the opportunity to role-play an OSCE situation. “I would really like to thank you for organising these webinars. I am quite impressed given the fact that this

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was the first webinar of this kind. It was quite informative and I really appreciate the fact that we could participate in the discussions from home. Looking forward to more of these.” Priya, GP registrar, WA Visit gpra.org.au/webinars or email webinars@gpra.org.au for more information about upcoming webinars.

Case studies GPRA has developed downloadable clinical case studies to assist candidates with exam preparation. These cases are based on the RACGP Clinical Case Proforma, available to RACGP members on their website. The content is based on the clinical experiences of registrars, and has been written by your peers. It does not aim to reflect past exam content. Members can also access a range of case studies authored by Professor John Murtagh. These case studies provide engaging, authentic examples from clinical practice, and highlight some of the common mistakes and difficulties that practising GPs often encounter. We are always keen to talk to registrars interested in writing case studies for us. If this is you then visit gpra.org.au/case-studies or email registrarenquiries@gpra.org.au for more information. For information about exam preparation and workshops refer to the relevant colleges: ACRRM – acrrm.org.au 1800 223 226 RACGP– racgp.org.au 1800 331 626.


5 Exam survival

ACRRM and RACGP fellowship exams: Top tips for passing Medical exams are tough; you don’t need us to tell you that! As a GP registrar it would be prudent to seek out all the help and guidance you need to pass your ACRRM or RACGP exams. Don’t forget, you can only sit the exams a limited number of times, and they are costly. Make sure that you are properly prepared and ready to sit each exam, and allow yourself at least 6–12 months of study time. If you are not sure if you are ready to pass the exam yet, talk to your medical educator. Read the colleges’ websites Take advantage of the information the websites provide. They have important exam advice, resources and policies.

Study with others Consider forming a study group, either online or in-person. Technology such as Skype and Google mean that you can effectively study with someone across the other side of the country.You will be studying for several months, and working with a small group enables you to support and motivate each other, pool resources, and share strengths. It is a good idea to begin meeting at least a year before your exams and increase the frequency

of meetings closer to the exam date. GPRA members can place a free advertisement for a study partner or group on our website.

Avoid sticking to topics you enjoy We all have areas that we enjoy studying more than others, and it is easy to focus on those topics at the expense of the rest of your studies. Identify your learning gaps as soon as you can to make sure that you don’t make this mistake.

Make a realistic plan Make a study plan and spread out your study evenly. It is equally important to schedule some time off away from the books to unwind.You don’t want to find yourself spending weeks on some areas of study, with barely any time left for others.

Keep your resources at hand Make sure you keep all the resources you will need close by. The resources you use in your day-to-day practice are also the most useful for your exams. For written exams, Murtagh’s textbooks, Therapeutic Guidelines and RACGP guidelines such as the ‘red book’ are essential. Also, ensure that you are familiar with the National Immunisation Program schedule.

Practise written questions Before you begin your studies, gather together as many relevant practice questions as you can. Ask other registrars and recent fellows if they have any, search the colleges’ websites, and even write your own. Time yourself on each practice session. When you are working with your study group, use practice questions as a guide.You could read topics

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together out loud, go through practice questions, quiz each other on guidelines, and write and share your own practice questions. Don’t forget to encourage your study group to share practice questions via email.

Use OSCE/StAMPs cases Many people are tempted to just read through the cases, but it is more effective to practise them under timed exam conditions. When you are working with your study group, give each other feedback on the skills that you can’t learn from a book such as communication, use of non-medical language and analysis of research articles.

Attend pre-exam courses Both colleges and your RTP may run courses that will help you to prepare for the exam. Attending some of these courses will be invaluable to your preparation as they enable you to:

• become familiar with the structure of the exam • devise a study plan • gauge the level of difficulty • identify learning gaps • practise your techniques.

GPRA webinars GPRA run webinars on a wide range of subjects throughout the year including preparing for exams, clinical subjects or how to effectively manage your finances.

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A healing journey in general practice

Have you ever given thought to working as a GP registrar in an Aboriginal and Torres Strait Islander health training post? These posts can be undertaken as part of the Australian General Practice Training (AGPT) program. Talk to your regional training provider today for more information or go to gpet.com.au


With you on your journey students

junior doctors

registrars

General Practice Students Network gpsn.org.au

Going Places Network gpaustralia.org.au

General Practice Registrars Australia gpra.org.au

General Practice Registrars Australia Level 4, 517 Flinders Lane, Melbourne Victoria 3001 P 03 9629 8878 W gpra.org.au


GP Registrar 2014