Central and Southern Qld Training Consortium
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Practice based teaching

GP Trainers involved in vocational training of GP Registrars in their first year of General Practice must be available for weekly teaching, support and discussion (referred to as Practice-Based Teaching).

A  specified amount of formal, structured Practice-based teaching hours is required for the GP Registrar's first year of general practice placements (GPT 1/PRRT 1 and GPT 2/PRRT  2). During the later stages of general practice placements (GPT 3/PRRT 3 and Extended Skills/PRRT 4 if done in GP), Trainers are expected to provide teaching, supervision and support during these stages of training, particularly with a focus on preparation for the exam and broadening GP Registrars’ experiences in preparation for their post-training career in general practice.  Face to face teaching will take place on a more ad hoc basis, as it is required.  CSQTC is currently updating its guidelines for teaching requirements for GP Registrars in 2nd year GP Term placements.

1. Guidelines for teaching during the first year of general practice placements:
  • Under normal circumstances, all teaching must occur face to face.
  • For the first 6 months of General Practice training, the GP Trainer must be available for teaching, support and discussion for 3 hours per week.  1 hour per week must be must be a block of planned, protected, uninterrupted, contiguous time for face to face teaching and discussion with the GP Registrar, and must be consistent with the Registrar's Learning Plan.
  • For the second 6 months of General Practice training, the GP Trainer must be available for teaching, support and discussion for 1.5 hours per week.  1 hour per week must be must be a block of planned, protected, uninterrupted, contiguous time for face to face, one to one teaching and discussion with the GP Registrar, and must be consistent with the Registrar's Learning Plan.
  • CSQTC is flexible about the delivery of Practice-based teaching, focusing on achievement of the overall requirement for the placement, providing that a minimum of 1 hour per week of protected contiguous time for face to face teaching and discussion with the GP Registrar occurs:
    • For the first 6 months of General Practice training, an overall total of 72 hours of Practice-based teaching is required. As a full-time GP Registrar is entitled to 2 weeks of paid leave per 6 months (26 weeks), it is recommended that this 72 hours of teaching occurs over 24 weeks at an average rate of 3 hours per week.
    • For the second 6 months of General Practice training, an overall total of 36 hours of Practice-based teaching is required.  As a full-time GP Registrar is entitled to 2 weeks of paid leave per 6 months (26 weeks), it is recommended that this 36 hours of teaching occurs over 24 weeks at an average rate of 1.5 hours per week.
    • For part-time GP Registrars, the recommended weekly teaching arrangements may differ, and should be negotiated between the GP Registrar, GP Trainer and CSQTC.  As a rule, the RACGP states that for part-time placements, the minimum protected contiguous time for face to face teaching and discussion time must not be less than 30 minutes.
  • The planned weekly teaching session must be consistent with the GP Registrar’s learning plan and at an appropriate level considering the GP Registrar’s knowledge and experience. They may be prepared by the GP Registrar.  The timing of the planned education session should be arranged and negotiated between the GP Registrar and GP Trainer.
  • Where Practices have more than one GP Registrar, the potential for joint teaching can exist.  However, each Registrar must have individual, one on one teaching time which addresses their learning needs.  Individual teaching provided to the Registrar must be at least one third of the total teaching requirements for the Registrar.
For more detailed information on teaching requirements during first year placements, please read the following:
2. Guidelines for teaching during all stages of general practice placements:
  • The College curricula provide the framework for the education of GP Registrars.  Teaching should be based on the GP Registrar’s learning plan and other perceived needs that arise during training.  Teaching should include a range of methods such as direct observation, discussions on clinical problems and interesting cases, joint consultations, formal teaching on specific topics, review of taped consultations, demonstrations, participation in clinical procedures and selected or random case analysis.  Sometimes small group discussions with other members of the practice might be employed.
  • The GP Trainer must assist the GP Registrar in the development of a learning plan by week 4 of each 6 months of training – this will be submitted by the GP Registrar as part of the training portfolio for their completion of training.  The GP Registrar should submit a copy of their learning plan to CSQTC.
  • The GP Trainer must support access for a CSQTC Medical Educator to undertake direct observation sessions. 
  • The GP Trainer must assess the GP Registrar’s competence through consideration of training and experience or if necessary, by observation in areas that have an increased risk of adverse outcomes and litigation. 
  • For more information on standards and requirements for practice-based teaching, please refer to:

    RACGP
     
* Please note that specific details and guidelines of how the requirement for 1 hour of structured learning time is to be applied to Registrars undertaking GPT3 placements, as detailed in the above Standards and Companion documents, is currently being finalised by CSQTC.  CSQTC encourages GP Trainers of Registrars in second year placements onwards to actively engage in teaching with their Registrars.
ACRRM

3. Tips for practice-based teaching and support for Second Year Registrars (GPT 3 onwards and Extended Skills in General Practice)

The following information is for Trainers who are seeking guidance on how to provide appropriate practice-based teaching and support to GP Registrars during their second and subsequent years in general practice terms, when there is no formal requirement for a set amount of teaching hours. Two of our GP Trainers, Drs Gertrude Behan and Bruce Willett have kindly contributed the following article to talk about their experiences in supporting Registrars (proceeding to RACGP Fellowship) during the later stages of training.

"Registrars during their subsequent training time (2nd year GP Terms onwards) are colleagues who work in a supported general practice environment; an environment that we as Supervisors endeavour to create. This supportive environment encourages the free flow of information between people in the health care team. In this environment there is a nominated doctor or doctors whom the Registrar knows they can approach for knowledge or skill questions or pastoral issues. The environment is accommodative to the work/life choices of the Registrar.

Registrars in subsequent time are often either just about to sit the college exam or have just sat the exam. For those about to sit the exam, preparation for the exam is, of course, of paramount importance. Supervisors with experience as a college examiner will be in the best position to help Registrars to prepare for their exam. Trial exam questions with particular emphasis on adapting to the format of the exam is gratefully appreciated by Registrars.

Registrars in subsequent time are often close in age to the medical students sent to learn in a general practice environment and this connection coupled with the Registrar's focus on learning general practice and managing general practice challenges makes them ideal mentors and teachers of students. Teaching medical students increases the Registrar's self esteem and enhances their feeling of ownership of the practice as well as quickly revealing gaps in the Registrar's knowledge.

So the Registrar in subsequent time takes on the mantle of the profession by teaching others and starting the life of a GP after exams and facing the challenges of being a GP after  exams.  There are a number of challenges that face the GP after Fellowship, such as the appropriate setting of personal boundaries so that patients do not have unrealistic expectations of their doctor. There is the challenge of adopting work/life balances to avoid burnout. There is a challenge in how to view your future career and not feel that because there is no exam or hurdle ahead that there is emptiness ahead. There is the challenge on how to deal with guilt and anxiety following a mistake and there are challenges not unique to general practice such as time management.

These challenges can be well workshopped and addressed during subsequent time. We have recently begun to trial a Balint Group facilitated by a trained psychologist.

So in summary the training and support extended to a Registrar in subsequent time could encompass a supportive general practice, preparation for the college exam, a teaching role for the Registrar and a regular group debriefing."

Dr Gertrude Behan (GP Trainer) and
Dr Bruce Willett (SLO and GP Trainer)
slo@csqtc.qld.edu.au


Practice Subsidy and Teaching Allowance
Practices can claim Practice Subsidy and Teaching Allowance when they have GP Registrars in their first 12 months of GP Terms. In order to claim this, Practices must invoice CSQTC  and submit monthly  Monitoring Data and Teaching Log forms. Please refer to the web page on Payments for having GP Registrars in GP Terms.

Monitoring Data and Teaching Logs
Practice-based teaching and GP Registrars' patient consulting data for those in their first 12 months of GP Terms is to be recorded on the Monitoring Data and Teaching Log forms and must be lodged with CSQTC on a monthly basis. These forms require the signature of the GP Trainer and the GP Registrar before  submission to CSQTC.  Please refer to the web page on Monitoring Data and Teaching Logs.