The NSW Health Procedural Training program is administered under contract by CCCGPT in the same areas as we conduct our core business of GPR training. This means we cover three AHS, the SES/Illawarra and the Greater Southern Area Health Service and the Sydney South West Area Health Service.
The aim of the Procedural Training Program is mitigate the workforce issue in most parts of regional and rural NSW by training either existing GPs or GP Registrars in procedural skills. The areas in which training may be provided include:
- Obstetrics
- Anaesthetics
- Emergency Medicine
- Mental Health
- Surgery
Training may be for GPs already working in a centre which needs these skills or perhaps for GPs who would appreciate relocating for a rural/regional life style made richer by working as a procedural GP. Training can be offered on a full-time, part-time or flexible basis recognising individual circumstances and previous experience.
Training is offered at accredited training location, usually at regional/district hospitals where there are appropriate specialists supervisors. Regional Training Providers like CCCGPT ensure that training posts are accredited. To be accredited with the appropriate College, training posts must meet a number of requirements including a required volume and variety of cases as well as providing specialist supervision.
Background
The NSW Health Procedural Training Program has been developed to address the shortage of General Practitioners with procedural skills working in rural and regional NSW.
Through providing paid full-time part time or flexible training opportunities GPs already in practice or GP Registrars are encouraged to acquire procedural skills in the following areas:
- Anaesthetics
- Emergency Medicine
- Obstetrics
- Surgery
- Mental Health
Although Mental Health is not strictly a procedural specialty, it is recognised as an area of increasing prevalence where GPs have a significant service role and need for additional skills and qualifications.
A significant contribution is made by General Practitioners with procedural skills and qualifications to rural and regional health care in NSW. The value of expanding the current level of support for procedural training in rural NSW is considered an important facet of an overall strategy directed towards ensuring the availability of health care services.
The Rural NSW GP Procedural Training is the outcome of a joint proposal for the establishment of GP procedural training posts in NSW from Rural Doctors Association in NSW, NSW Rural Doctors Network, Royal Australian College of General Practitioners (RACGP) Rural Faculty and the Australian College of Rural and Remote Medicine (ACRRM).
The Program aims to enable up to 30 additional GP Procedural Training positions in rural NSW in the following specialties each year:
- Anaesthetics
- Emergency Medicine
- Obstetrics
- Surgery
- Mental Health
Positions are created on a full time, part time and flexible basis – dependent on the location and learning needs of the interested participants.
Guiding Principles
The guiding principles for the establishment of these GP procedural training posts in NSW include:
- Priority to be given to doctors seeking 6-12 month training terms
- Flexible and part time options to be available
- To be available to rural GPs or GPs seeking to take up rural practice
- To be available to permanent resident overseas trained doctors currently working in Area of Need positions in rural NSW
- To be consistent with the service needs of rural and remote communities
- To include formal recognition of training (eg links with CME programs, existing Diplomas etc)
- To link with existing accredited training providers
- To take into consideration recommendations from the NSW Rural Health Report
- Training to be offered in rural centres where possible but may be considered in a metropolitan environment. The trainee would then return to a rural location to work.
- Training posts to meet approved training standards determined by all relevant Colleges
- The procedural training process is to be endorsed by all of the relevant Colleges (ACRRM, RACGP and the other relevant learned medical Colleges).
In selecting participants for the Program, it is necessary to ensure that opportunities exist for the ongoing use of procedural skills. Doctors will be eligible to access training relevant to the service needs of the community in which they intend to practice. GP Registrars not in an established practice, or GPs intending to change the location of their practice, may be provided with assistance to identify practice locations or practice vacancies that would provide an opportunity for them to utilise their procedural training.
Eligibility Criteria
Doctors enrolling in the Program are targeted from the following groups:
a) Registrars enrolled in vocational General Practice training
The Program is flexible and available to all GP Registrars. It allows registrars different points of entry to enable them to access procedural skills training at any time during their overall general practice training.
Currently, GP registrars are required to complete 12 months of hospital training (PGY2 or above) and 2 years of general practice - the 2 years in general practice can include 6 months of special skills training. The Program can be incorporated into parts of the hospital training or the special skills requirement enabling maximum vertical integration. As part of the overall coordination of the Program, RTPs are able to integrate training with subsequent terms where the skills obtained can be utilised and further developed.
b) Rural General Practitioners.
This Program is available to all rural GPs wanting to acquire or maintain procedural skills. GPs who wish to undertake procedural training are likely to have established practices and therefore training is flexible to allow them to work part time in their practice. Training should be appropriate to the service needs of the community in which they intend to practice.
c) Metropolitan based Registrars / vocationally registered GPs proposing to take up rural practice.
Recruiting doctors from this group to the Program will assist in addressing rural General Practice workforce shortages.
d) Conditionally registered Overseas Trained Doctors currently working in Area of Need Positions.
This program is available to permanent resident overseas trained doctors who are currently working in an Area of Need position in NSW and have the support of their employer.
Those doctors who have previous experience in procedural medicine may particularly benefit from locally relevant training available through the Program.
To ensure that applications for training match the service needs of the community; a letter of support from the employer will be required to ensure eligibility for the Program. The Area of Need position will then need to be modified to incorporate the proposed training, and an application will need to be made to the NSW Medical Board to approve an extension of conditional registration to include the training position.
Permanent resident overseas trained doctors who have their FRACPG and are designated by the Medical Board of NSW "to work specifically as a specialist in general practice" may also be considered for entry into the Program.
The role of CoastCityCountry General Practice Training
Regional Training Providers (RTPs) are contracted to manage the administration of the Program in collaboration with the Area Health Services (AHS) and NSW Health (Department). CCCGPT liaises with the Greater Southern AHS and the SES/Illawarra AHS and the Divisions of General Practice to determine the current local service needs of the community as well as the availability or anticipated future availability of procedural positions.
Area Health Services have the ultimate responsibility for the selection and appointment of applicants into the training program based on standard employee appointment mechanisms. The RTP is responsible for the promotion and attraction of the trainees in the Program in close liaison with the local Division of General Practice and the AHS.
CCCGPT's administrative role includes marketing, accreditation of training posts, development of individual learning plans, facilitating the development of Learning Plans, provision of Bi-annual reports, arranging for program applicants to be recognised by NSW Health and co-ordinating the provision of Specialist Supervisors, Rural GP Supervisors and Medical Educators to support the trainee.
The Procedural Training Officer from CoastCityCountry General Practice Training is responsible for coordinating an analysis of the learning needs of the GP and taking into consideration the GP, Area Health Service and the community perspectives. This ensures that the training provided is consistent with the service needs of the community in which the GP intends to practice on completion of their training.
Learning Plan Development
Curriculum Based Learning Plans
- Training in the Program is based on an individual Learning Plan, which is developed by the GP and supervisor/s, and coordinated by the Medical Educator from the RTP.
- The Learning Plan reflects the training requirements of the trainee
- Identified service needs of the rural or remote community in which the doctor plans to practice) and is to be based on recognised curricula.
- Sources of curricula that are relevant to the Program are the Advanced Rural Skills Program (ARSP) curriculum (endorsed by the JCCs), the Graduate Diploma in Rural General Practice Curriculum (endorsed by the RACGP) and the list of skills and abilities endorsed by ACRRM in the ACRRM Primary Curriculum.
- Individual Learning Plans could include elements of any or all of these curricula, with the ability for trainees to draw from the curricula the objectives that match their learning requirements.
- Learning Plans are then submitted to the Learning Plan Review Committee (LPRC), which would approve the Plans or recommend modifications where appropriate.
- Where an existing curriculum in a specific procedural skill is not available, it is to be developed by this Committee in conjunction with the other relevant learned medical College and be endorsed by all three Colleges. Curriculum could then be “filed” and available to be incorporated in subsequent Learning Plans as required.
- RTPS are able to determine the key learning objectives able to be met at local training posts. RTPs can then work with each individual applicant to determine which elements of the curricula match their learning objectives and identify training posts where training in these learning objectives is available.
- The source curricula of the selected learning objectives is to be clearly specified in the Learning Plan to facilitate consideration for recognition of prior learning by the relevant JCC or College.
- Participants can add to their competencies over time and build up to fulfilling the number of learning objectives/elements of curriculum required to qualify for a higher degree (eg Diploma or ARSP Accreditation).
- Required number of training hours or required number of procedures performed needs to be specified in the Learning Plan, based on the requirements of the source curriculum (this may include a minimum number of hours/procedures required and a time limit on training).
- Educational tools such as RMMEO or GPEA Online could be utilised to assist in the development of Learning Plans.
- Ideally the training program and subsequent post would be a “package deal” to ensure sustainability; the aim of the marketing exercise for Tumut, Young and Moruya. Prior to commencing training, the GP would need to determine that their proposed future town and or practice has appropriate facilities, indemnity cover, and required number of clients per year to ensure sustainability. This process may be facilitated by CoastCityCountry General Practice Training.
Supervision
Accredited training posts provide supervision in procedural skills training at a level appropriate to the curriculum selected in the Learning Plan. Medical education supervision and support for each procedural trainee is provided by Specialist Supervisor, Medical Educator and a GP Proceduralists.
Recognition of Training
- The recognition of training in the Program is based on formal assessment processes and prospective approval.
- The level of assessment required is determined by the LPRC based on the requirements outlined in JCC curricula or in the Learning Plan
- The Program is linked to existing processes of recognition of GP training including the RACGP and ACRRM CME processes.
- Participants are able to apply for consideration for curriculum credit or recognition of prior learning toward other existing awards (eg Graduate Diploma of General Practice, ARSP accreditation, FACRRM)
Maintenance of Professional Standards
- The program is linked to existing structures to ensure the maintenance of professional standards
- Graduates of this Program may be Candidates or Fellows of either or both ACRRM and the RACGP. Both Colleges have professional development programs specifically aimed at GP Proceduralists, including a requirement that the Fellows demonstrate the maintenance of the skill set being used in practice.
- Procedural GPs wishing to maintain full accreditation with the JCC need to complete the JCC CPD pathway. However, a pathway via ACRRM / RACGP is available for those who do not require the full JCC accreditation in a particular specialty. This is to be based on a framework endorsed by the relevant other learned medical college and would be coordinated by the RACGP or ACRRM.
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