Aspire Guide 2013 by GPRA Publications

2012

Going Places 2013 Aspire Prevocational doctors

guide to GP training

General Practice Students Network guide

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About this guide The 2013 Aspire guide is produced by the General Practice Students Network, an initiative of General Practice Registrars Australia (GPRA).

The name Aspire reflects the aim of this guide: to help medical undergraduates make informed decisions about their future training and career aspirations. It is set out in colour-coded sections for easy navigation. This guide has been produced using sustainable, environmentally friendly printing techniques and paper; an approach that reflects GPRAâ&#x20AC;&#x2122;s ethos of supporting tomorrowâ&#x20AC;&#x2122;s GPs, and their families, in their quest for sustainable careers in general practice.

Produced with funding support from

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Contents Gosin A pigrPela2012 On the cover 2c0e13s

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GPSN Vice-chair Jen McAuliffe. Read her report on the BNL conference on page 34 and her article on being busy without going crazy on page 50.

Ge Level neral Pra 4, 51 cti 7 Flin ce Re ders gistra Phon Lane, rs Austr e: 03 Melbo alia (GPR 9629 urne 8878 Victor A) ia 30 01

1 About this guide 4 Welcome 5 A message from the GPSN Chair

1/ Aspiring to general practice 8 10 12 14 16

Network with GPSN 10 great reasons to be a GP Why I choose general practice GP myths exposed General practice timeline

2/ General practice at medical school 20 Four ways to experience general practice as a medical student 22 The GPSN dream team 24 Meet your GPSN Student Ambassador 30 A year in the life of GPSN 34 Name-dropping at BNL 38 Apply for the GPSN First Wave Scholarship 40 My hands-on First Wave adventure 44 My extraordinary experience

Visit our website — gpsn.org.au

46 48 50 53

Two patients and their GP lessons Supercharge your clinical time Being busy without going crazy Exam survival guide

3/ After medical school, what next? 56 58 62 64

Four ways to continue experiencing general practice when you graduate GP focus in hospital Test-drive general practice with the PGPPP The PGPPP and me

4/ About general practice training 68 74 77 80 84 88 90 92

The structure of GP training The RACGP Fellowship RACGP Fellowship in Advanced Rural General Practice The ACRRM Fellowship RVTS — An alternative pathway to fellowship Joining forces with the ADF Joel Hissink — serving on land and on sea Understanding the moratorium

GPRA and GPSN would like to acknowledge the support of our patron, Professor Michael Kidd AM.

5/ Design your own GP career 96 The many faces of general practice 102 Part-time training options 106 Travel while you train

6/ Money matters 108 What you can earn 110 Incentive payments

7/ Info file 114 Jargon buster 119 GP resources directory 124 GPSN calendar 2013

Professor Kidd is Executive Dean of the Faculty of Health Sciences at Flinders University and a past president of the RACGP. His research interests include general practice, medical informatics, health policy, medical education, safety and quality in primary care and the primary care management of HIV and hepatitis C. GPSN is proud to have the support of Professor Kidd as a distinguished figurehead of Australian general practice.

GPRA Editorial team General Manager: Sally Kincaid Editor: Jan Walker Graphic Design: Peter Fitzgerald Business Development Manager: Kate Marie ÂŠ2013 GPRA. 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: Going Places, 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. Printed by Graphic Impressions

GPSN â&#x20AC;&#x201D; Breathing new life into general practice

Welcome Welcome to the 2013 issue of Aspire — a guide to all things general practice.

Hello medical students all across the country! My name is Claire Mohr and I am a fourth-year medical student at the University of Queensland. I am also the Medical Editor for this 2013 issue of Aspire. I have spent the past two years getting elbowdeep in GPSN. For those of you who don’t know, that’s the General Practice Students Network. I have loved every event-organising, emailing, conferencing and phone-calling minute of it!

“This issue of Aspire contains an absolutely mammoth amount of information on everything general practice.” 4 Visit our website — gpsn.org.au

GPSN has really opened my eyes to the variety that general practice can embrace. It’s definitely not just coughs and colds — and honestly after a long day of clinic I’m almost praying for a simple cough or cold! This issue of Aspire contains an absolutely mammoth amount of information on everything general practice, from why you should choose it in the first place to what salary you might expect. There are also stories from other medical students who have taken up scholarship opportunities such as the GPSN First Wave Scholarship and the John Flynn Placement Program. These placements have given many medical students an early, and often unique, look into the world of general practice. Another way to get involved is with the local GPSN team. Head to pages 24 – 29 to find your university’s GPSN Student Ambassador. I hope you enjoy reading this guide as much as I have enjoyed compiling it! Claire Mohr Medical Editor Aspire 2013

A message from the GPSN Chair

Over the past six years, GPSN has grown from the seed of an idea by a medical student into a thriving national network of student clubs that run exceptional events at every medical school across Australia. Can you believe that GPSN now has more than 8,800 student members and in 2012 we ran more than 90 events promoting general practice? Clubs held career events such as general practice information nights featuring countless inspiring GPs, as well as leading national figures such as professors John Murtagh and Michael Kidd. The clubs also staged a range of clinical events where students could learn practical skills such as suturing, plastering, injections and cannulation. And let’s not forget the wide array of social events so everyone could let off some steam! This year we will continue to run a stimulating program of events at each university as well as our much-loved First Wave Scholarship Program.

We will also be developing new programs to increase GPSN’s community involvement at a local and national level, and starting new programs to build international ties with GP student clubs overseas. Most importantly, we are planning new and exciting ways for our members to have their say and contribute to the future direction of GPSN. 2013 will be a big year for GPSN, so make sure you are a part of it. Sign up as a member, go to your local club events, enter our competitions, apply for the First Wave Scholarship Program — and grow with us! David Townsend GPSN Chair

“2013 will be a big year for GPSN, so make sure you are a part of it.”

GPSN — Breathing new life into general practice

Aspiring to general practice

Network General Practice Students Network GPSN is the student arm of General Practice Registrars Australia (GPRA). GPSN has a presence in medical universities all over Australia. By joining GPSN you can have fun, make friends and establish valuable networking contacts while you learn hands-on professional skills for your future. Whether you have your sights on a career in general practice or you have an open mind, joining GPSN is one of the best things you can do at medical school — professionally and personally.

What is GPSN? GPSN is the only national student organisation with a focus on general practice. There are active GPSN clubs at every medical university in Australia. Since the establishment of GPSN in 2007, membership has risen to more than 8,800 and growing.

GPSN free membership! 8

Visit our website — gpsn.org.au

with GPSN

GPSN’s aims • We empower medical students to make

informed decisions in choosing their future vocation.

• We seek to correct misconceptions about

general practice.

• We promote the benefits of general

practice as a career.

• We champion the importance of general

practice in the medical landscape.

What does GPSN do? GPSN provides a range of general practicerelated educational and professional resources of interest to all medical students including:

• academic events • professional development events • social events • an e-newsletter and website • a scholarship • GP Companion — handy pocket reference

for general practice rotations.

Explore the world of general practice, meet like-minded medical students and have fun. Visit gpsn.org.au

Who supports GPSN? GPSN is administered by GPRA and financially supported by General Practice Education and Training (GPET). The idea came from medical student and general practice enthusiast Joe Rotella, who was GPSN’s founding chair.

Who is GPRA? GPRA is the peak national representative body for general practice registrars in Australia. One of GPRA’s most important functions is to provide resources to support GP registrars during their training and represent their interests. In addition, GPRA promotes general practice as a specialty of choice to medical students through GPSN, and to junior doctors in the hospital environment through the Going Places Network.

Dr Tom Rolley

registrar rave

1 Aspiring to general practice

My training provider is North Coast GP Training.

My current post is at Mullumbimby Medical Centre, Mullumbimby, NSW. A typical workday for me is four hours of consulting, a luxurious hour and a half for lunch — if I’m on time — and the afternoon session till five. Then I drive home through the hills of the Byron hinterland. I enjoy the great family feeling in the practice and strong back-up to help with clinical decisions.

After hours I like to spend time with my wonderful family, go surfing, play guitar, cook and practise qi gong. My vision for the future is integrating general practice with traditional Chinese medicine to provide holistic primary care for my patients.

GPSN — Breathing new life into general practice

great reasons to be a GP

Want the fast facts on general practice? Here are 10 compelling reasons to be a GP.

1. Every day is different

Ask any GP registrar if general practice is all coughs and colds or tears and smears, and they’ll probably laugh and say, ‘If only!’ The diversity of patients and medical presentations is one of the most enjoyable aspects of general practice for many GPs, who thrive on the variety and thrill of not knowing what will come through the door next.

2. Intellectually stimulating

One of the most challenging, but also the most rewarding and satisfying, roles of a GP is diagnosing medical presentations. Every day as a GP you will use all the knowledge you learnt at medical school, not just a small part of it. It’s a daily brainteaser that doesn’t allow for boredom.

3. Treat the patient,

not just the illness

Unlike many other specialties, GPs can offer holistic continuity of care to their patients, building long-term relationships as they treat patients and their families over their lifespan. As a GP you have the power to make a real difference not only in one life, but in many.

Visit our website — gpsn.org.au

Special interest? Subspecialise! At any one time there are numerous GP registrars in special skills posts pursuing their interest in paediatrics, anaesthesia, emergency medicine, academia and many others. The GP training program offers all GP registrars an opportunity to pursue a subspecialty of their choice. For more information about career options, see pages 96 –105.

5. The choice is yours

As a GP you decide where you work and what hours, tailoring your workload to suit your stage of life and career. This flexibility creates opportunities to pursue other career interests, have a family, travel, build up your savings or enjoy a nine-to-five lifestyle.

6. Reap the rewards

GPs are well remunerated, usually without the extremely long working hours faced by other specialties. You’ll also find that there are some lucrative financial incentives for GPs to work in areas where there is a shortage of doctors — typically rural areas. Even if you decide to be metro-based, you can be assured you’ll be well rewarded. For more information about how much you could earn as a GP, see pages 107 – 109.

7. Fast, flexible and funded

Not only funded, but fast! The AGPT and RVTS programs are funded by the federal

1 Aspiring to general practice

government and there are some lucrative financial incentives for rural GP trainees. Rural GP trainees can also get a HECS rebate. For more information about financial incentives, see pages 110 – 111. The GP training program is typically a threeyear program, with the first year hospital-based. This means you can apply as early as your intern year, and you may be able to complete your first resident year as part of your GP training. For more information about the structure of the AGPT program, see pages 68 – 71.

8. Supportive training,

10. Wherever you want to

go, general practice can take you there

Fancy spending the winter as a ship’s doctor in Antarctica or treating the kids to summer on an island in the Great Barrier Reef? Do you want to pursue a research interest at the same time as providing primary care? Or would you like to try something different like flying around Australia treating medical emergencies? Wherever you want to go, whatever you want to do, this is just a taste of where a career in general practice can take you.

supportive workplace

General practice is a specialty

Solo GPs are becoming a thing of the past, with many practices employing several doctors as well as practice managers and practice nurses, allowing you to do what you do best in a supportive, interactive environment. During your GP training you are always supported by experienced GP supervisors and medical educators from your training provider.

It’s official. General practice was recognised as a medical specialty in 2010 by the Medical Board of Australia. That means GPs are considered ‘general specialists’

Being a GP you get the highs with the lows, treating not just sick patients but managing patients during positive times in their lives such as pregnancy and for preventive health programs.

For more information, check out these websites: GPSN — gpsn.org.au AGPT — agpt.com.au GPRA — gpra.org.au RACGP — racgp.org.au ACRRM — acrrm.org.au

9. Seeing the good with the bad

Do it now

GPSN — Breathing new life into general practice

Why

I choose general practice

Melbourne-based GP and former GPRA Chair, Dr Rachael Sutherland, answers our questions about that one big question on the minds of junior doctors and medical students: ‘What kind of doctor do I want to be?’

Did you originally choose general practice as a career pathway? I think I entered medicine with general practice as my view for my future. My experience of doctors as a patient was fortunately limited, however my mum worked in a general practice and the local GPs were the most I knew of medicine.

How did you decide that general practice was to be Choosing your specialty can be your future career? daunting. What’s your advice? Failing the ability and inclination to narrow Consider your personality as well as your professional interests and strengths. Speak to many people but make your decision your own.

my focus to one field of medicine, I chose to keep my options open and pursue a more generalist path.

Tell us what it was like for you. What general practice My medical school and resident experiences experiences have you had and presented two or three medical specialties what are you doing now? that interested me. However, haematology, nephrology and gastroenterology could not lure me away from general practice, nor into ongoing shiftwork in the public hospital system.

“I chose to keep my options open and pursue a more generalist path.” 12

Visit our website — gpsn.org.au

I began my life in general practice as a registrar in rural Victoria. After two years completing my practice-based registrar training I returned to Melbourne where my partner, now husband, was based. I have been in urban general practice ever since, maintaining my ties with rural Victoria via a role in medical education with Beyond Medical Education.

Any inspirational people or role models along the way? So, so many. The most wonderful thing is the ongoing inspiration that can be found all

1 Aspiring to general practice

around the country among registrars, GPs and GP leaders.

to maximise the potential of this relationship with supportive health systems and policy.

Why should a junior doctor seriously consider general practice?

The scope for work-life balance is attractive. What are your interests outside work?

General practice gives you enormous scope. The potential knowledge base is infinite but the even greater challenge, and reward, is the development of practical wisdom and instinct. You will amaze yourself.

What do you enjoy most about it? I often marvel at the honest, open, and often vulnerable, thoughts and feelings patients disclose to their GP. They will make you laugh, they will make you cry — and they will certainly make you wonder.

What special interests has it allowed you to explore?

My two small children destroy any notion of balance in my life. However, I am very grateful that I have been able, with the support of my parents, to organise my professional life to cater to the needs of my family more than other specialties would have permitted. Working in our garden and looking forward to a holiday after months of winter ills keep me going.

In summary, why did you — and do you — continue to choose general practice? To make a small difference every day.

I have discovered a personal interest in health policy. We owe it to patients, and to the highly skilled and committed GPs providing their care, GPSN — Breathing new life into general practice

GP myths exposed Boring? Badly paid? A second-rate specialty? Myth 3 We object! Our GPs and GP registrars debunk some GPs don’t earn of those nasty myths about much money. Reality general practice. “I remember one of my

Myth 1

It’s all about coughs, colds and referrals to specialists. Reality “It’s simply untrue. We do a lot of diagnosis. I see a lot of undifferentiated illness, I do caesarean sections, and I do a lot of hands-on work.” Dr Andrew Pennington GP, Wallan,VIC

Myth 2

General practice is boring. Reality “It is by far and away the career that you can be most creative with and the career in which you can enjoy huge variety and flexibility — you can really find your niche. You can work anywhere in Australia and many countries overseas.” Dr Anne Kleinitz GP registrar, Darwin, NT 14

Visit our website — gpsn.org.au

bosses said to me, ‘Concentrate on the medicine. The money will follow.’ And it has. I am very well remunerated for my work.” Dr Glenn Pereira GP, Forbes, NSW

Myth 4

General practice is an easy job. Reality “This is the hardest job I’ve ever done because you are expected to know everything about everything. With O&G, you focus on mainly the pelvis. With ear, nose and throat, it’s the head area. But with general practice, it’s the whole body and also lifestyle.” Dr Danni Gitsham GP registrar, Gladstone, QLD

1 Aspiring to general practice

GPSN â&#x20AC;&#x201D; Breathing new life into General Practice

General practice

timeline Experience general practice from medical school to fellowship.

University

There are many ways to experience general practice as you move from your student years through to your prevocational hospital years and beyond. Here’s an at-a-glance guide.

Join the General Practice Students Network (GPSN)* See pages 8 – 9

* These experiences are optional but recommended on the path to a general practice career †Most GPSN First Wave Scholarships are open to medical students in years one and two. However, at certain universities it is possible to do the GPSN First Wave Scholarship Program during the third and fourth years. For more information, visit gpsn.org.au

Visit our website — gpsn.org.au

GPSN First Wave Scholarship program*† See pages 38 – 42 John Flynn Placement* Program (JFPP) See page 45 General Practice Rotations See pages 58 – 60

1 Aspiring to general practice

Hospital training

GP registrar vocational training

Join the Going Places Network* See page 59

Australian General Practice Training program (AGPT) See pages 68 – 73 or Remote Vocational Training Scheme (RVTS) See pages 84 – 85

Prevocational General Practice Placements Program (PGPPP)* See pages 62–63

Join General Practice Registrars Australia (GPRA)* Visit gpra.org.au

GPSN — Breathing new life into general practice

If you are interested in general practice, or just considering your options, the General Practice Students Network (GPSN) is a great way to kick start your career. Gosin A pigrPela2012 2c0e13s

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• Free networking events — meet others who share an interest in

general practice.

general practice seminars, workshops and skills sessions.

all things GP.

GP Companion — a handy pocket reference for GP rotations.

and win places at conferences.

• Free professional development events — attend student-focused • Regular e-news and other resources providing all the latest on • Free publications — Aspire guide to general practice and

• Opportunity to apply to the GPSN First Wave Scholarship program Join today – it’s free Visit gpsn.org.au Contact your GPSN Student Ambassador (see pages 24 – 29)

General practice at medical school

Four ways to experience general practice as a medical student Curious about general practice as a career? Or perhaps you have already decided that being a ‘general specialist’ is your calling. Here are some simple things you can do right now to get a taste of general practice and help your career, whichever way it goes.

Visit our website — gpsn.org.au

1. Join GPSN

Become a member of the General Practice Students Network (GPSN) at your university. It’s a fun way to find out about careers in general practice and network with others who share your interest while developing your clinical knowledge and credentials. See pages 8 and 18. Visit gpsn.org.au

2. Apply for the GPSN First Wave Scholarship program

Embark on an experience of general practice that is positive and inspiring with a dedicated GP supervisor. The GPSN First Wave Scholarship offers a unique learning experience for GPSN members. See pages 38 – 42.

Dr Steve Grillett

registrar rave

2 General practice at medical school

My training provider is Beyond Medical Education.

3. Apply for the John Flynn

My current post is at Maari Ma Aboriginal Health Service in Broken Hill, NSW. I work with other GPs, visiting specialists, nursing staff, a midwife, a psychologist and Aboriginal health workers.

The John Flynn Placement Program (JFPP) places medical students with a rural doctor for two weeks a year, normally over a four-year period. Students work closely with their rural mentor in a wide variety of health settings and experience one-on-one support. See pages 44 – 45.

A typical workday for me varies. I work three days in Broken Hill, the other two days I attend outreach community clinics in Wilcannia and Menindee. It’s 8.30 am till 5 pm, no overtime, on-call or weekends, which makes me smile.

Placement Program

4. Make the most of your general practice rotations

Approach your general practice clinical rotations in a positive manner and seek to take advantage of all the learning opportunities offered. See pages 58 – 60.

I enjoy seeing the great variety of clinical cases from which to learn. Also, there are many challenges in Aboriginal health, and I enjoy a challenge.

A quirky fact about me is that I was once an avid pigeon racer, which has been rudely interrupted by my studies.

GPSN — Breathing new life into general practice

The GPSN dream team

Joining the General Practice Students Network will inspire you in medicine and life. Behind the scenes is a hardworking team from around Australia. The chair and national office bearers, pictured here, make up the National Executive who organise GPSN at a national level. The local teams of executive officers and secretaries, plus the General Practice Student Ambassadors (GPSAs), pictured on the following pages, organise GPSN at each university club. GPRA’s office in Melbourne provides administrative support. Get to know the team now!

GPSN Chair David Townsend

National Vice-chair Jen McAuliffe

University of New England chair@student.gpra.org.au

Griffith University vc@student.gpra.org.au

Three words that describe me. Optimistic, enthusiastic, shameless!

Three words that describe me. Busy (but wonderfully so), passionate, inquisitive.

What I like about general practice. The broad spectrum of opportunities and challenges, the lifestyle and, most importantly, the connection with patients.

What I like about general practice. Living a ‘thank God you’re here’ life. Absolutely anything can come walking through the door.

Visit our website — gpsn.org.au

2 General practice at medical school

National Secretary Stephanie Munari Deakin University ns@student.gpra.org.au Who inspires me. People who find a way to balance their work and home life. Most memorable GP moment. Being elected as secretary for the National Executive. What an honour!

Publications Officer Rebecca Wood University of Western Australia publications@student.gpra.org.au Three words that describe me. Geeky, compassionate, welcoming. Who inspires me. My mother, gynaecologist Dr Jen Gunter (USA), Professor Christobel Saunders (UWA), and Professor Michael Kidd (Flinders University).

IT Officer Anmol Khanna University of Notre Dame Fremantle itofficer@student.gpra.org.au What I like about general practice. I like the idea of a flexible work environment and the opportunity to shape your career around different areas of interest. Who inspires me. Thomas Edison, for his work ethic. GPSN â&#x20AC;&#x201D; Breathing new life into general practice

Meet

your GPSN Student Ambassador The General Practice Student Ambassador (GPSA) at your university is like a human GPS who can point you in the direction of your ideal medical career. Whether you want to find out about GPSN’s amazing events or you have a specific question about a career in general practice, see your GPSA and ask away!

Australian National University Sia Yang Tan — anu@student.gpra.org.au Three words that describe me. Spontaneous, fun, competitive.

Bond University Joon Sung — bond@student.gpra.org.au Three words that describe me. Kind-hearted, happy, eat a lot. (I know, that’s more than three words!) Best GPSN event in 2012. The GP4ME Tri-Uni Symposium featuring Professor John Murtagh.

Deakin University

Hamish Beeston — deakin@student.gpra.org.au Three words that describe me. Inquisitive, hindmost, ritzy. Club ethos. To project the image of general practice in a stronger light. What’s in store for 2013? A mixture of socialising, networking, academia and practicality.

Flinders University

Scott McGilvray — flinders@student.gpra.org.au Three words that describe me. Enthusiastic, grounded, involved. Best GPSN event in 2012. An evening with Professor John Murtagh and Professor Michael Kidd. 24

Visit our website — gpsn.org.au

2 General practice at medical school

Griffith University Lauren Mann — griffith@student.gpra.org.au Three words that describe me. Passionate, reliable, dedicated. Club ethos. To be a relevant and positive component of medical school whilst fostering interest in general practice. Best GPSN event in 2012. The GP4ME Tri-Uni Symposium featuring the renowned Professor John Murtagh and the inspiring Professor Michael Kidd; two fantastic nights for all involved.

James Cook University Caitlin Rushby — jcu@student.gpra.org.au Three words that describe me. Outgoing, passionate, vivacious. Club ethos. Don’t wait until graduation to begin the career of a lifetime. What’s in store for 2013? Awesome prizes, heaps of fun and some learning along the way.

Monash University Jessica Deitch — monash@student.gpra.org.au Three words that describe me. Enthusiastic, reliable, fun. Club ethos. Expose students to, and foster an interest in, general practice while having fun! Best GPSN event in 2012. Careers night. What’s in store for 2013? Careers night, mock OSCE sessions. GPSN — Breathing new life into general practice

Northern Territory (Flinders University and James Cook University) Tessa Finney-Brown — ntmp@student.gpra.org.au Three words that describe me. Curious, nerdy, yogini. Club ethos. We aim to be inclusive, inspire students about life in general practice and provide enjoyable, beneficial events.

University of Adelaide Kristen Tee and Anni Chen — adelaide@student.gpra.org.au Three words that describe us. Laughing, creative, meerkat (Kristen). Fun, hardworking, smiley (Anni). Club ethos. We help medical students gain an insight into a general practice career through our Adelaide GP networks.

University of Melbourne Position available — umelb@student.gpra.org.au At the time of going to press, this GPSA position was unconfirmed. Visit gpsn.org.au for updates.

University of New England Mark Papageorge — newengland@student.gpra.org.au Three words that describe me. Fun, enthusiastic, easygoing. Club ethos. To enhance relationships between students, staff and GPs. What’s in store for 2013? Great opportunities for students to mingle with staff, GPs and other students.

Visit our website — gpsn.org.au

2 General practice at medical school

University of New South Wales Jessica Xiong — unsw@student.gpra.org.au Three words that describe me. Loud, fun, crazy. Club ethos. Our club is all about inspiring students and providing as many opportunities as possible to network with GPs.

University of Newcastle Position available — newcastle@student.gpra.org.au At the time of going to press, this GPSA position was unconfirmed. Visit gpsn.org.au for updates.

University of Notre Dame Fremantle Kate McCabe — notredame@student.gpra.org.au Three words that describe me. Friendly, organised, a runner. Club ethos. Exploring our career options while enjoying inspirational speakers and learning skills in good company with great prizes. Best GPSN event in 2012. A clinical skills night that involved suturing pigs’ trotters and strapping each other’s knees and feet.

University of Notre Dame Sydney Mark Aicken — undsyd@student.gpra.org.au Three words that describe me. Conscientious, diligent, consistent. Club ethos. A passion for general practice, community, student involvement and healthy living. Best GPSN event in 2012. The ‘I heart my GP’ City2Surf fun run. GPSN — Breathing new life into general practice

University of Queensland Patrina Liu and Rozanne Visvalingam — uq@student.gpra.org.au Three words that describe us. Fun, friendly, livewires. What’s in store for 2013? Clinical skills workshops, career evenings and more symposia events.

University of Sydney Yvonne Nguyen — usyd@student.gpra.org.au Three words that describe me. Approachable, open, enthusiastic. Best GPSN event in 2012. The Breathing New Life into General Practice Conference in Canberra. It was wonderful to listen to inspirational people talk about their careers and lives.

University of Tasmania Imal Hemachandra — utas@student.gpra.org.au Three words that describe me. Thoughtful, calm, determined. Club ethos. To inspire a new generation of GPs. What’s in store for 2013? Awesome events and resources for students from all three campuses.

University of Western Australia Danielle Lam — uwa@student.gpra.org.au Three words that describe me. Friendly, fun, motivated. Club ethos. I think that GPSN-UWA is an amazing initiative that is heaps of fun and plays an integral role in informing students about the different aspects of general practice, as well as breaking down the preconceptions that follow ‘GP-land’. 28

Visit our website — gpsn.org.au

University of Western Sydney Likhitha Sudini — westsyd@student.gpra.org.au Three words that describe me. Curious, approachable, keen. Best GPSN event in 2012. Our inaugural GP dinner. What a wonderful night of mingling and learning with fantastic speakers and food!

What’s in store for 2013? Novel freebies to draw out meddies from their study caves.

University of Wollongong Position available — undsyd@student.gpra.org.au At the time of going to press, this GPSA position was unconfirmed. Visit gpsn.org.au for updates.

Join GPSN now Free membership

For more information, see pages 8 – 9 or visit gpsn.org.au

Have you meet your GPSA yet? Contact your GPSA today and open the door to cool events and even cooler connections with like-minded medical students, junior doctors and GPs. You can also find out answers to all your general practice career questions. GPSN — Breathing new life into general practice 29

A year

in the life of GPSN

In 2012, GPSN members had fun, and networked with other medical students at their university and across the country, while learning about general practice. GP4ME Tri-Uni Symposia series Brisbane, July and August 2012 The University of Queensland, Bond University and Griffith University came together to provide their student members with an opportunity to hear from the professionâ&#x20AC;&#x2122;s quintessential practitioners. The clubs hosted two seminars featuring keynote presentations by Professor John Murtagh and Professor Michael Kidd. More than 400 students from the universities attended as well as staff and sponsors.

First Wave Scholarship orientation workshop Perth and Sydney, August and September 2012 A total of 120 GPSN First Wave Scholarship recipients travelled to Perth and Sydney for the annual orientation workshops featuring presentations from inspirational GPs. The First Wave Scholarship program gives medical students the opportunity to explore general practice under the guidance of a dedicated general practice supervisor.

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City2Surf event Sydney, August 2012 An idea conceived by GP Student Ambassador Andrew Flint (Notre Dame University Sydney), and supported by Chris Timms (GPSN Chair 2012), GPSN and the Going Places Network, became a reality on 12 August. The wind blew, the temperature plunged, but nothing could dampen the spirits of the ‘I heart my GP’ City2Surf runners. Afterwards, it was off to the Bondi Bowling Club for a barbecue. Speakers Dr Ginni Mansfield and Dr Guy Davies gave presentations on exercise and fitness in general practice.

GPSN Council meeting Melbourne, October 2012 Representatives from all 21 GPSN clubs attended the GPSN Council meeting in Melbourne on 20 –21 October. Over the course of the weekend, delegates celebrated their achievements, planned for 2013 and elected their new National Executive team: Chair, David Townsend; Vice-chair, Jen McAuliffe; and Secretary, Stephanie Munari.

GPSN — Breathing new life into general practice 31

Melbourne, October 2012 At the GPSN Council meeting in Melbourne, clubs were recognised for organising and hosting outstanding events. In 2012, there were three categories: Best Clinical Skills Event, Best Careers Event and Best Social/New Event. Best Clinical Skills Event Joint GPSN/NOMAD OSCE Clinical Skills Weekend Deakin University — Stephanie Munari Best Careers Event GP4ME Tri-Uni Symposia Series University of Queensland — Claire Mohr Griffith University — Jen McAuliffe Bond University — Amani Savy Best Social/New Event (Joint winners) 2012 Flu Vaccination Day University of Notre Dame Sydney — Kirby White Beyond Borders Pan Society Event Flinders University — Andrew Hughes

Dr Casey Maddren My training provider is WentWest.

registrar rave

GPSN club awards

My current post is working as an academic registrar at the University of Sydney, Westmead. My research topic is GP registrars’ experience of death and bereavement care. I’m also GPET’s Registrar Research and Development Officer (RRADO) and doing some clinical work. A typical workday for me I don’t have one! My work is varied and geographically diverse. I regularly travel to Canberra as the RRADO and work in two different areas of Sydney. The last book I read was The Help — an absolute delight with so many messages about friendship, sisterhood, equality, integrity, steadfastness and joy.

Life is … such a gift. Being in general practice reinforces how blessed I am and how our time on this earth is limited.

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GPSN â&#x20AC;&#x201D; Breathing new life into General Practice

Name-dropping BNL Conference personal story

at BNL

a national level at the Breathing New Life into The Breathing New Life General Practice Conference, known in the biz into General Practice as ‘BNL’. Conference (BNL) is a In the hot seat highlight of the GPSN Students, registrars, trainees and qualified calendar and a chance to doctors from all over Australia descended upon mingle with the ‘celebrities’ our nation’s capital for a three-day veritable smorgasbord of general practice issues, including of Australian general current issues, successes, moves for the future practice. GPSN Student and, well, just some plain old fun. Ambassador Jen McAuliffe theme of the 2012 conference was ‘GP reports on the 2012 event. The in the Hot Seat’, a topic that is very relevant I love conferences! There is nothing more motivating and re-invigorating than being surrounded by some of the most outstanding and innovative people in medicine. In March 2012, Benignus Logan (Executive Officer) and I represented GPSN Griffith on

“Students, registrars, trainees and qualified doctors from all over Australia descended upon our nation’s capital for a three-day veritable smorgasbord of general practice.” 34

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to general practice today, particularly as we enter a time when primary care is becoming the primary solution to supporting an overburdened health system.

National GPSN Council We spent two days attending the national GPSN Council along with representatives from the other 20 GPSN clubs around the country.

Health Minister Tanya Plibersek spoke at the conference

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Here we discussed the ‘big issues’ — training places for new graduates interested in general practice and improving student access to rural and regional general practice exposures — and we helped to formulate six priorities for inclusion in national policy. We heard from fantastic speakers such as Professor Michael Kidd and GPRA Chair, Dr Edward Vergara, who spoke about their passion for general practice. We also used our time to talk about how best to serve you as our members and what we can do maximise your opportunities at a local and national level.

Influential people Our last day was spent in the Great Hall at Parliament House listening to, and rubbing shoulders with, some of the most influential and highly regarded members of the general practice community: the incredible Professor John Murtagh; the amazing Professor Michael Kidd; the outstanding Professor Claire Jackson (immediate past president of the RACGP) — can I possibly fit more adjectives in this

sentence? Federal Minister for Health Tanya Plibersek and Shadow Health Minister Peter Dutton also dropped by. During the afternoon we had the opportunity to interact, problem-solve and dream big with the registrars and guests. A list of hot topics challenged us to come up with solutions that were achievable and some that were dreaming big. If our table is any indication, the future could be an e-health care system that utilises toilets capable of sampling and investigating

About the BNL conference The Breathing New Life into General Practice Conference, or BNL, is an annual event held in Canberra. A joint initiative between GPRA, the Going Places Network and GPSN, it brings together registrars, students, educators, supervisors, politicians and medical community leaders from across the country to address the issues facing general practice. Two representatives from each GPSN club are funded to attend and enjoy an introduction to a career in general practice while rubbing shoulders with leaders in Australian health care. The 2013 BNL Conference is scheduled for 16–19 March.

Participants were enthralled by the conference

GPSN — Breathing new life into general practice

FOBT and urinalysis, not to mention fridges that, when hugged, could take AP chest X-rays in the home. Of course, all results would be electronically reported directly back to the patient’s GP!

The social side

The workshops at BNL were very popular and covered a wide range of topics

Jen McAuliffe (third from right) pictured with John Murtagh and other conference attendees

The cocktail party on the shores of Lake Burley Griffen was a great opportunity to socialise and network

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As with any event that allows students and doctors to escape the working week and study desk, there was a fun social component. One of the main themes of the event was to help integrate practising GPs and registrars with students. What better place to do that than overlooking the beautiful Lake Burley Griffin for a classy evening soiree? Here I met and bantered with Professor John Murtagh; AMSA President, James Churchill; QRME medical educator and Griffith Rural Clinical Lead; Professor Scott Kitchener; National Rural Health Students’ Network representative Francesca Garnett and many more. Not that I’m dropping names or anything. All in all, my experience was informative, inspiring and spurring. I feel that there are many ways in which we can improve the world of general practice, and it starts right here with us in medical school. I came back feeling super-ready to sink my teeth into the role of GP Student Ambassador. Because whether you are keen on being a GP or not, no matter what specialty you ultimately choose, it will be vital to understand the role of the GP.

Apply

for the GPSN First Wave Scholarship

The GPSN First Wave Scholarship program provides first, second, third or fourth year medical students real-life exposure to general practice. Are you in the first, second, third or fourth year of your medical degree? Would you like to experience what it’s really like to work in general practice while establishing professional relationships with dedicated doctors? Then consider applying for a GPSN First Wave Scholarship. The experience will be invaluable (and will certainly enhance your CV!). The First Wave Scholarship program was initiated by GPSN to provide positive, early, structured exposure to general practice in a range of settings including urban, outer metropolitan, Aboriginal Medical Services and academic. There were 120 scholarship offered for the 2012–2013 program across all medical schools in the country.

The program was initiated by GPSN to provide positive, early, structured exposure to general practice in a range of settings including urban, outer metropolitan, Aboriginal Medical Services and academic.

Do it now The GPSN First Wave Scholarship program will be advertised at participating campuses through the local GPSN club Applications for the First Wave Scholarship program open 27 May 2013 and close 31 June 2013 For more information, visit gpsn.org.au Email firstwave@gpra.org.au or telephone 1300 131 198

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Fact file What is it: GPSN First Wave Scholarship program — GP exposure opportunities at participating Australian universities. Why it began: There was previously a lack of opportunities for medical students to gain real-life exposure to general practice in a variety of settings. There was also a desire by GPSN to raise awareness of general practice and its role in the health care of all Australians. Who’s behind it: Regional training providers (RTPs), General Practice Education and Training (GPET), participating Australian medical schools and participating general practices. How it works: There are two streams — Clinical and Academic. Candidates apply via a formal process. Scholarship recipients are matched with a GP who mentors them. The scholarship involves completing a series of supervised sessions in a clinical practice or doing a research project or other academic activity. Academic scholarship winners also undertake some clinical sessions. Clinical sessions are generally scheduled during the post-Christmas summer holidays. Participants also attend an orientation workshop in Melbourne or Perth. Who can apply: First, second, third or fourth year students studying at Australian medical schools.

Dr Danielle Arabena

registrar rave

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My training provider is Central and Southern Queensland Training Consortium.

My current post is at the Majellan Medical Centre in Scarborough near Brisbane, a private practice that is Indigenous-friendly. As a Torres Strait Islander GP registrar, I love seeing my Indigenous patients every day. A typical workday for me involves laughing, engaging, advocating and sometimes a little cry with a patient.

I am inspired by members of the Australian Indigenous Doctors’ Association and the GPRA Indigenous General Practice Registrars Network, by my mob’s journey into medicine and by the resilience that we as Indigenous medical students and doctors have — all with a desire to help our community. My biggest challenge was finishing my medical degree while being a mother. I would have to get up at 4 am to study before everyone else woke up. GPSN — Breathing new life into general practice

GPSN First Wave Scholarship personal story

My hands-on First Wave Ros Forward, a first-year medical student from Notre Dame University in Fremantle, dived head first into hands-on work in a rural operating theatre during her First Wave Scholarship placement. I was thrilled when I received my offer of a GPSN First Wave Scholarship. I’ve always wanted to be a country doctor, but I didn’t know if general practice would be able to keep me interested.

I’m going to Collie? Great! During the induction workshop we lined up to be told, one-by-one, where we had been placed. I heard the people in front of me get Dunsborough, Busselton, Esperance, Albany and Broome — all desirable destinations with lots to see and do. Finally, it was my turn. I was going to Collie — and my heart sank. I had done a placement in Collie as an occupational therapy student some 10 years earlier. The thought of the creepy, draughty old 40-room nurses’ quarters where I stayed made me cringe.

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“I was really challenged to put the little I had learnt from one year of study into practice.”

2 General practice at medical school

Collie is a coal mining town of about 10,000 people, 200 km south of Perth, and is renowned for being populated by hairy miners with hardcore tattoos. It sits on the top of the Darling Scarp, approximately 200 m above sea level. People who live in the southwest joke that Collie is the only place you go up a hill to get into a hole. When my friends heard I was going to Collie, they told me it was going to be great, but with a fake smile that meant they felt sorry for me.

My theatrical role I made the trip down and when I arrived in town, Collie didn’t look as rough or grotty as I remembered. I drove past the motel WAGPET had booked, and it looked nice. I found the general practice and introduced myself, only to find out that my GP mentor wasn’t there. It turned out he was in theatre and I was pointed in the direction of the hospital. I was greeted by a nurse who directed me to the change-rooms and instructed me to get changed. I didn’t know what was going on — this was a general practice placement and I had never been into a theatre before. I was going into theatre as a first-year medical student!

The best anatomy lesson ever My mentor doctor was a GP anaesthetist and it was scope day. I saw endoscopies, colonoscopies, biopsies and haemorrhoids. All those anatomy lessons and hours of looking at cadavers were paying off! My GP mentor encouraged me to have a go and taught me skills like how to cannulate, how to anaesthetise a patient and how to chart the unconscious patient, which I did under his careful instruction. Over the next few days I removed warts and skin cancers, gave immunisations and sutured a toe after a woman cut herself with an axe while chopping wood — in thongs! I was really challenged to put the little I had learnt from one year of study into practice. Back in the hospital for a general surgery day I was put to work doing pre-operative briefs, medications and final checks as well as cannulations. One of the highlights was when the town’s GP surgeon said to the nurses he needed some extra hands. My GP mentor said: “Here, have my medical student.” I was told to scrub in. Very sheepishly I told them I didn’t know how

GPSN — Breathing new life into general practice

to scrub. A nurse took me aside and taught me to scrub and got me dressed.

An awesome procedural experience

While in surgery, the GP surgeon had me doing all types of things — prepping the patient, creating a sterile field, holding equipment and even doing some of the cutting (with very close guidance). It was cut here, sew here, staple this. This was the best anatomy lesson ever!

I also did two sessions with allied health, one with the lab and the other with the pharmacy. I now better understand how doctors work with other members of a health team. One important take-away was the implications of a doctor’s messy writing!

From varicose veins to circumcisions Overall, I saw and helped with varicose vein removal, a repeat vasectomy with a hydrocele, circumcision, emergency appendectomy and tonsillectomy. The GP anaesthetist let me insert airways (LMAs, guedels). For the tonsillectomy on an 11-year-old girl I got to help with the intubation by providing cricoid pressure. I had no idea what I was doing but I watched, listened and learnt.

Do it now The GPSN First Wave Scholarship Program will be advertised at participating campuses through the local GPSN club or for more information visit gpsn.org.au Applications open on 27 May 2013 and close on 31 June 2013. Refer to the GPSN website for further application details

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In the lab I learnt to take blood, run tests and interpret the results. In the pharmacy I finally managed to learn more about some of the drugs I had been struggling with all year: how they are dispensed, side effects and correct use. I also got to fill Webster-paks and prepare medications for dispensing. The only thing I didn’t get to do in Collie was help deliver a baby — but some things just can’t be neatly scheduled. While I still don’t know if general practice is for me, my GPSN First Wave experience as a GP proceduralist was awesome.

My extraordi nary experience John Flynn Placement Program personal story

procedures. I was sometimes able to assist the When Rebecca Li did Later on in my placements, I was the John Flynn Placement anaesthetist. mentored by a GP anaesthetist, who taught me Program, she stayed at the basics of anaesthesia. the home of one of her I was paired with a GP who worked in the mentors and they ate hospital’s ED, where I encountered many breakfast together in their industrial injuries. This partnership allowed me improve my skills with intubation, assist in pyjamas. Total immersion tocaesarean sections and utilise my DRABCDEs in the rural GP life with — all while then, only in my second year of inspiring GPs is what makes medical school! the JFPP such a formative A day in the life … experience, as final-year I would wake up in the guest bedroom of my medical student Rebecca GP mentor’s house. I would help myself to some breakfast and sit at the dining table next reports. to my GP mentor, who would be wearing her I was placed in Gladstone, Queensland — an industrial and mining town of 60,000 people that’s a world away from my usual place of medical schooling in Tasmania.

PJs. We would finish getting ready and she would drive us to the practice.

Individual mentoring

I would see patients with a range of presentations: from baby checks to depression; anaemia to the common cold; eczema to syncope; gastroenteritis to pneumonia; fractures to Pap smears.

The John Flynn Placement Program, known as the ‘JFPP’, is a unique experience, particularly as we are paired with a mentor who works with us individually. My main supervisor was a GP who part-owned her multidisciplinary clinic and also worked at the private hospital in obstetrics and gynaecology.

I would sometimes also get called out to the room of the GP who specialised in skin cancer to assist with removing a suspicious lesion, or the GP who did vasectomies to help with his procedures. The nurse might then call me to help immunise a six-month-old baby, perform an ECG or take blood from a febrile patient.

This allowed me to spend one day a week at the private hospital, watching or assisting in caesarean sections and gynaecological

Lunch would be followed by seeing more patients until around 5 pm. My GP mentor would then drive us back home, and we would

Over my final four years of medical school I grew to know and love this close-knit community.

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communicating to the public health team in Brisbane, seeing patients exposed to the confirmed cases and giving out prophylactic medication. This experience highlighted the problems with medicine in rural and remote areas. A few days into the outbreak, we almost ran out of rifampicin (the prophylactic medication), and were desperately waiting for further supplies from Brisbane.

enjoy a lovely home-cooked meal with some lively discussion and debrief of the day’s interesting cases.

Swimming, Friday drinks and dancing to ABBA Students are also teamed up with a community person to help them get oriented to the town and encourage community bonding. Mine was a Rotary Club member who invited me to lunch at his farm, gave me a driving tour of the town, a swimming excursion to the nearby beach and a drinks get-together with club members. He also took me to the harbourside festival to watch the local talent quest. I was able to bond and socialise with the other doctors in the general practice during their regular Friday drinks, dinner outings and even a house party with dancing to ABBA!

An interesting case In my most recent placement, I spent a week at the hospital’s ED, where I experienced firsthand an outbreak of meningococcal disease in the town. I helped out with

It has been an amazing, eye-opening and thoroughly rewarding experience for me on my JFPP placements. It has allowed me to not only experience extraordinary medicine but to meet some remarkable people. Just apply and see for yourself!

About the John Flynn Placement Program The John Flynn Placement Program, named after the founder of the Royal Flying Doctor Service, is funded by the Department of Health and Ageing as a strategy to attract more GPs to rural and remote practice. Students spend eight weeks in the same rural community over a number of years with a GP mentor or mentors, usually two weeks a year over a four-year period. It is administered by the Australian College of Rural and Remote Medicine. For further information and details on how to apply, visit acrrm.org.au, contact the JFPP Support Officer at ACRRM on 1800 231 231 or email jfpp@acrrm.org.au

GPSN — Breathing new life into general practice

Twoand their patients GP lessons There’s a popular saying that a GP never knows what’s going to walk through the door. As a final-year medical student, Dr Sophie GascoigneCohen discovered two essential truths about general practice through two memorable patients. “Take your next patient to the second room on the right,” my GP supervisor told me. It was Monday morning and the first day of my general practice rotation. I had picked a regional town in Victoria based on a burgeoning interest in rural general practice. Despite being a final-year medical student, it was still with some trepidation that I greeted patients in the waiting room and walked them down to the consulting room.

“I had barely finished introducing myself as a student doctor when her lip quivered.”

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Patient 1

General practice gets emotional This particular morning it was a slim and elegantly dressed woman who I brought down the corridor. “Hmm … she doesn’t look unwell,” I thought. Once inside, I had barely finished introducing myself as a student doctor when her lip quivered and she uttered a few incomprehensible words before a flood of tears ensued. I stood there in silence, surprised that someone who had never met me before and who knew

2 General practice at medical school

nothing about my level of empathy could cry so openly in front of me. After dabbing her eyes with the tissues I’d thankfully managed to locate, the patient started to explain what prompted such an outpouring of grief. I gathered it was the result of a CT brain scan, and that the somewhat sinister result explained her ongoing debilitating neck pain. I called in my supervisor to provide the explanation of her CTB. Being a student, I could not offer a thorough interpretation of her imaging nor advise her on follow-up. What my supervisor highlighted afterwards was that members of the health care professions, especially general practice, offer patients a confidential emotional outlet. Medical students and junior doctors are usually not trained counsellors but the act of listening is part of the therapeutic relationship.

Patient 2

General practice means serious emergencies The unexpected clinical scenario is a common theme in general practice and you need to be prepared to treat emergency cases. One afternoon a woman brought in her 12-year-old daughter who had needed the past few days off school as she had been feeling lethargic with a headache after a recent flu-like illness.

A review of her vital signs showed her to be febrile and tachycardic and she looked very unwell with an extensive erythematous rash across her trunk. Noting that she felt dizzy on standing up and preferred to lie still on the examination couch, I called in the supervising GP immediately. The GP, a former paediatrician, listened to the history, examined the patient and then swiftly requested blood cultures before we gave a dose of antibiotics. I called the base hospital ED to advise them of the transfer and the patient was sent off with a suspected diagnosis of bacteraemia. On follow up, we found she had Staphylococcus aureus septicaemia. She recovered after some days on the paediatric ward. To have such a patient sitting in the general practice waiting room was a valuable lesson to always be on guard for the most sinister diagnoses. General practice rotations are invaluable for what they offer — the unexpected, the confronting emotions, the emergencies, and the lasting lessons we only learn by seeing patients.

GPSN — Breathing new life into general practice

Supercharge your clinical time Clinical rotations

Heading out of the classroom to do some ‘real-life doctoring’? Northern Territory intern Dr Patrick Tam shares some tips on getting more from your clinical placements. Okay, so here’s the scene … You’re finally out of the classroom from those life-changing, awe-inspiring lectures on the citric acid cycle or the coagulation cascade. You’re dressed up in your fancy clinical clothes, stethoscope awkwardly half-swung across your shoulders, projecting importance — but not too much importance leading people to mistake you for a real doctor. You’re outside the hospital or your general practice, eyeing up that seemingly harmless-looking building. You take a deep breath and think, ‘I’m in over my head’. Maybe this little scene I’ve set isn’t you. If so, then great! But if you’re like I was and anything but confident as an L-plate doctor, here are a few things I’ve learnt as a student about making the most of your clinical placements.

Before your placement • Devise a plan — Think about what you

expect to get out of the session and articulate some goals for the day. Some examples are to learn more about diabetes, focus on 48

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neurological examinations or find out how to take an appropriate drug history. The most important thing about your plan is to make it realistic and achievable.

• Organise how you’ll execute this plan —

If your goal is to perfect your neuro exam then think about how you will accomplish this. Ask your preceptor about whether you could demonstrate the exam for them with a suitable patient, or ask your preceptor to talk to you about diabetes.

• Collect your thoughts — Before you start,

just take it easy. It’s common to get a bit stressed out or anxious, particularly during your early clinical days when you get asked questions and you draw a blank.

During your placement

• Be engaged — It’s easy to be a passive

learner, particularly if your clinical placement is mostly shadowing your preceptor early on. Get active, ask questions, listen to the patient’s story and pay attention to what’s going on around you.

“You take a deep breath and think, ‘I’m in over my head’.”

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a logbook of the patients you see. Reflect on who you saw, what struck you about that patient, the reason they came in and the condition they had. It will help you to remember diseases and management practices better when you can put a face to it.

• Nerd it up — Review what you saw during

the day, then fill in the gaps in your knowledge with the answers that you couldn’t produce during the day. Next time you get asked about it, you can whip out those 12 cranial nerve names or other random facts without even thinking about it.

• Talk about your day • Open yourself up, to failure — You’re not

going to know it all, nor will you get it all correct the first time but don’t be afraid to put yourself out there. Give your answer and give it confidently. Medicine is never black and white and if you give a good justification for your response, even though it’s completely off the mark, you’ll learn from your mistake.

• Put yourself in your preceptor’s shoes —

Think to yourself, given this constellation of symptoms and signs, what do I think the diagnosis could be?

After your placement • Invest in a logbook — Even if it’s not

— Talk to your friends, housemates or whoever will listen to your boring medical chat, and trade what you all learnt. Learning something and then teaching it to someone else will solidify what you know — and you get to learn something from your colleagues in return. Just be sensitive about patient details and over-sharing. Armed with your new tactics, we’ll flashforward to that scene of you standing out the front of your clinical placement. Your stethoscope might still be awkwardly placed, your shirt not quite tucked in and a coffee stain has now appeared on your trousers but hey, at least you’re ready to take on this clinical placement and make the most of it.

mandatory at your school, think of keeping GPSN — Breathing new life into general practice

Being busy without going crazy Stress management for med students

Jen McAuliffe is a medical student and GP Student Ambassador at Griffith University — and she loves to say yes to all life has to offer. But achieving work-life balance without going crazy is a challenge when you are crazy-busy. At the start of 2012 I made a promise to myself and my boyfriend. I promised that I would make 2012 my year of work-life balance. I was looking forward to a quieter year with more time for love, life and study. I kind of sucked at it. I only lasted until March when I attended the Breathing New Life into General Practice Conference (BNL). BNL was so inspiring it was literally intoxicating. I returned home after my trip to Canberra like a woman on a mission and in my crazy enthusiasm more like a woman high on some restricted substance.

Saying yes In no small part was this due to the advice of Michael Kidd. I was so stirred by his presentation and his lasting message to us: “Just say yes, in the first instance always say yes.” I have lived

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the last seven months according to this ethos and it has been hugely rewarding. There is one small issue though. Saying yes to everything has meant that I have become rather run off my feet. So I am speaking from experience when I offer the following advice about how to manage your stress.

“Relaxation and revitalisation are not passive activities. You have to make time to do things that you enjoy.” Time management I am of the school of thinking that says: a) You don’t know how much you can do until you do it, and b) You don’t have good time management until you’re busy. You would be surprised by how much you can fit into a day when you really have to. And no, I don’t mean using those sleeping hours for something else! Sleep is one of the most important things to help you reduce stress and avoid burnout. I’d like to think that I have not yet gone insane. As such, I feel like I have probably managed to balance at least some of my life to do that … but how?

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Jen’s top 10 stress tips

Have a good GP — Listen to your body and seek help if you need it.

Schedule exercise — Diarise it for three times a week, and actually do it!

Eat well — If you are busy mid-week, have a cooking session on a less busy night and freeze the meals for later.

Sleep well — I average six hours. Some of my friends get by on three. It’s not sustainable.

Stay inspired — Go to conferences and events because they keep you motivated.

Remind yourself why — Write down three reasons you went to med school on a sticky note somewhere visible. It’s easy to forget.

Make family or partner time sacred. Guilt is not allowed here.

Study smart — There are plenty of ‘Google-able’ resources to help you study smarter.

Read the paper or a book — Take an interest in current affairs beyond your professional field, or simply immerse yourself in a good novel.

— You can only do what you can do.

2 3 4

Fitting in the important things Be proactive! Relaxation and revitalisation are not passive activities. You have to make time to do things that you enjoy. Schedule it in and fit study around it. I believe that if you are going to do something extra, do something you are passionate about. Luckily for me, I am passionate about life as a med student. Here’s an important one — have a good break. I don’t believe in using your holidays to get a head start on study. And don’t feel guilty about taking them! You are going to be a doctor and advocate for the health and wellbeing of your patients. If you can’t manage to be healthy and well yourself, how can you ask it of others? Finally, see your significant other, family and friends. Life is so much more.

5 6

7 Wall off family or partner time — 8 9

10 Don’t be too hard on yourself

GPSN — Breathing new life into general practice

A secure space for Australian doctors to: ● share ideas ● learn from each other ● talk with peers

It’s where Australian doctors connect

or scan here

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Exam survival guide Stress management for med students

For many students, exams are a time of increased caffeine intake, decreased sleep and copious amounts of procrastination. Claire Mohr, a fourth-year medical student at the University of Queensland, medical editor of this issue of Aspire and Red Bull addict, shares her tips.

With the bulk of my degree under my belt, I realise I must have done something right when it comes to studying — or I’ve just had very understanding examiners! What follows are some tips and tricks I have picked up over my years in medical school. I hope they might also help you to get through this challenging degree we have all so foolishly taken on. First things first: medicine is different to many other university degrees. Learning the entire semester’s content in the study week is simply not feasible so I definitely suggest getting started sooner rather than later. If you are able to embrace this study-as-you-go philosophy your exams will be significantly less stressful.

• Listen for exam tips in the last week of

classes — Often lecturers will drop a few hints or go through past exam questions that will give you an indication of what might appear on the exam. This may mean dragging yourself back onto campus if your attendance

has started to slip, or even just making sure you listen rather than going through the photos of that event you attended on the weekend.

• Alert your support network — It’s invaluable

to have housemates who will cook for you, family who will help you with washing your clothes or buying groceries. Just make sure to thank them later!

• Minimise distractions — This may mean

heading into the library to get away from the TV, video games and refrigerator, or recognising your addiction to Facebook. Admitting you have a problem is the first step towards recovery!

• Get a study buddy — You can revise material

and read through lectures as much as you like, but testing whether you know something is often better elicited with someone quizzing you. Keep in mind that a good study partner is not always synonymous with a good friend who may just distract you from your study sessions.

• Create a plan of attack — Draw up a

schedule of the topics you need to cover, along with the number of hours you think will be required to cover them. Ensure you allow an extra day or two — this gives you a bit of wriggle room. Crossing off milestones on your schedule is extremely satisfying.

GPSN — Breathing new life into general practice

After medical school, what next?

Four ways to continue experiencing general practice when you graduate

1 Join the Going Starting to plan for your Places Network intern year and beyond? The Going Places Network is a peer group It’s easy to get swept up club for prevocational doctors and is the in the ‘hospital specialties’ hospital equivalent of the General Practice during your hospital training, Students Network (GPSN). Look out for Going Places networking and educational but remember you can events at your hospital or a hospital near you. gain valuable experience See the GP Ambassador at your hospital or in general practice while visit gpaustralia.org.au doing hospital training. Make sure you keep in mind the following tips when you start your intern year. Even if you are undecided about your future career direction, these tips will help your career in general practice or any other specialty.

2 Choose GP-friendly hospital rotations

Choosing the right hospital and rotations as an intern and beyond can help ease the way to a career in general practice (see pages 58 – 60).

3 Test-drive general practice

with the PGPPP

The Prevocational General Practice Placements Program (PGPPP) enables you to work in a community general practice as part of your hospital training (see pages 62 – 63).

4 Attend a general practice

careers night at your hospital Going along to a general practice careers night at your hospital is a great way to find out more about a general practice career and what the training involves.

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GP focus in hospital Choose your terms There are ways to keep focused on general practice Choose terms that will give you experience common GP-managed conditions. during your hospital terms. with Mandatory and other useful rotations are listed When you graduate and enter your hospital training, itâ&#x20AC;&#x2122;s easy to be occupied with the usual duties of caring for too many patients and constantly being paged. Often, there is little time left to think about how your hospital experience can help you as a GP in the future. Here are a few points that will help you make the most of your hospital experience.

Learn procedural skills that may be useful in general practice: joint aspirations and injections, excision of cysts and skin lesions.

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on page 60. General terms, such as general medicine and general surgery, may be more relevant than super-specialised placements. Accident and emergency terms are always a great opportunity to experience a wide range of presentations and to learn acute care skills, timely management and referral. Any experience with skin, ears and eyes will stand you in good stead. During the prevocational years, doing a PGPPP term is a great asset.

3 After medical school, what next?

Fine-tune your practical skills

Practise your writing

Ask nurses to teach you skills, such as giving vaccinations (especially to children) and dressing wounds. Ensure you can place common types of plaster casts with confidence.

Take particular notice of writing comprehensive and prompt discharge summaries, and don’t be afraid to call GPs to tell them that their patients are coming home.

Pick up useful procedural skills Find out who’s who Learn procedural skills that may be useful in general practice: joint aspirations and injections, excision of cysts and skin lesions.

Learn the art of referral Think about what information is pertinent on a referral letter sent with a patient to emergency. Discuss the referral process with consultants. What do they like in a referral? What tests should be ordered prior to referral? How urgently do they need to see particular cases?

Be curious about management decisions In addition to the acute management decisions you will have made in the hospital setting, as a GP you will also be initiating and monitoring long-term management of chronic conditions. Talk to your consultants and registrars about up-to-date guidelines and approaches to chronic disease management.

Identify people who may be good sources of information when you are working in the community, such as hospital registrars, consultants and clinical nurse consultants. Contributed by Dr Kate Beardmore, Dr Kate Kelso and Dr Kirsten Patterson

GPSN tip After you graduate from med school, join the Going Places Network — GPSN’s sister club for prevocational doctors — at your hospital. It’s a fun way to continue to learn more about general practice and network with peers and mentors who also have an interest in the specialty. Visit gpaustralia.org.au

GPSN — Breathing new life into general practice

Dr Sara Tarafi Making hospital a general practice launch pad Dr Sara Tarafi’s number one tip for future GPs in hospital? Be open about your career aspirations. That way, your colleagues can help you find the general practice gold in the hospital wards. “As I approach each new rotation I discuss with my registrar my plans to be a general practice and we talk about what parts of the specialty are important for me to focus on for general practice,” Sara says. “Every specialty will have aspects relevant to general practice because it’s the one specialty that requires basic knowledge about all specialties.” Having worked in emergency as an intern, Sara has added other rotations with a link to general practice. “So far I have chosen obstetrics and gynaecology, paediatrics, psychiatry and geriatrics,” she says. Sara is currently working with Southern Health in Melbourne, which includes various hospitals and medical centres. She has a keen interest in women’s health and paediatrics. “Paediatrics in hospital has given me a great base for treating families,” she says. 60

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Choose the right hospital and rotations There are hospital experiences that are compulsory in general practice training. The RACGP requires three relevant hospital rotations of your choice plus compulsory rotations in: general medicine general surgery emergency medicine paediatrics.

• • • •

ACRRM requires the four compulsory rotations above plus: obstetrics and gynaecology anaesthetics.

• •

If you have completed some of the required hospital training as a prevocational doctor, you may qualify for recognition of prior learning (RPL) so you can either reduce your training time or substitute terms that develop existing or new skills. You must apply for RPL with your regional training provider in your first year of GP training. For more information about compulsory hospital rotations for general practice training, visit agpt.com.au, racgp.org.au and acrrm.org.au,or see pages 74 – 76 (RACGP) and pages 80 – 82 (ACRRM).

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Test-drive general practice with the PGPPP

Want to put yourself in the driverâ&#x20AC;&#x2122;s seat beyond the hospital gates? The Prevocational General Practice Placements Program (PGPPP) is a great way to see your own patients while being mentored by inspiring GPs. What is the PGPPP? The PGPPP is a great opportunity to experience life as a GP during your hospital training years. Whether you are already set on general practice as a career, you are seeking to get a broader understanding of primary care or to improve your clinical and consultative skills, the PGPPP will enhance your medical training.

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What is the PGPPP experience like? Your placement will expose you to a real-life experience in the general practice world. You will have management of your own patients and be involved in varied areas of health care, such as aged care, sexual health, drug and alcohol, paediatrics, acute and chronic disease management, and home visits. Throughout your placement you will be well supervised by experienced GPs who also teach GP registrars. Your supervisor will help you gain independence and a sense of autonomy in your clinical management of cases and help you to develop your communication skills and medical professionalism.

Your supervisor will help you gain independence and a sense of autonomy in your clinical management of cases.

3 After medical school, what next?

How does it work? When you participate in the program you rotate out of your hospital into a general practice training post for a minimum of one and a maximum of two hospital terms. At the end of your term in general practice you simply rotate back to your hospital. While undertaking the PGPPP you remain employed by your tertiary hospital and continue to be paid by the hospital and accrue leave entitlements. Your medical indemnity also continues to be met by your hospital.

Who is eligible? Prevocational doctors, interns and international medical graduates (IMGs) employed by state government hospitals are all eligible. If you are an overseas-trained doctor (OTD) or former overseas medical student, you are eligible, provided you are unconditionally registered.

Will I be paid while on the PGPPP? Yes, you will continue to be paid while you are on your PGPPP rotation.

What will I gain on the PGPPP? • A real-life experience in general practice over and above that of undergraduate training.

• An opportunity to work in urban, regional and remote areas.

• Direct patient contact in primary

care settings, such as private general practice, Aboriginal Medical Services, drug and alcohol clinics and community-based facilities.

• A greater understanding of how

primary and secondary health care settings work together.

• Confidence and independence to take into future training and work environments.

• Personal mentoring by respected GPs. • Great networking opportunities.

Find out more To view a range of personal stories from junior doctors who have done the PGPPP, visit gpaustralia.org.au Information is also available at agpt.com.au GPSN — Breathing new life into general practice

The pgppp and me PGPPP personal story

Dr Danielle McMullen, a junior doctor at St Vincent’s Hospital in Sydney, took a walk on the wild side to local general practice, Kings Cross Clinic for her PGPPP. She answers our questions about her general practice experience in the heart of one of Australia’s most eclectic urban villages. Tell us about doing your PGPPP in Kings Cross. It has quite a reputation. It sure does! Kings Cross Clinic is located right in the heart of the Cross, so even the walk to work was full of colourful characters. But during the day there are enough tempting cafès and pâtisseries that you can almost forget about the suburb’s seedier side after dark.

from the eccentric cafè owner to a homeless lady to a very well-dressed elderly woman out for a stroll. He made sure I knew everyone’s interesting stories.

“Even the walk to work was full of colourful characters.”

What was your supervisor like? Describe an average day during your PGPPP. Dr Raymond Seidler is definitely a character. He’s been working in the same practice for over 30 years so he really is part of the community. It was incredible to walk down the street with him as he says hello to everyone — 64

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Ah, the luxury of general practice! Compared to a busy day up the road at St Vincent’s, general practice was soothing for the soul. I started at 8 am but no patients until 9 am

3 After medical school, what next?

(an hour for study, teaching and catching up on results). An hour for lunch and always home on time at 6 pm. Oh, and did I mention it’s a four-day week? Yes, Fridays off!

and even a few celebrities. We were also a referral general practice for a number of airlines and local backpacker hostels, so I saw patients from all over the world.

How independent or closely supervised were you?

Is there one patient you remember more than others?

At the start of the term I sat in with Dr Seidler, then saw patients first before having them reviewed by him. By about halfway through the term I was seeing my own patients, but he was always around for advice. Most days also involved a walk down to the local nursing home and a retirement village for home visits.

I really got an insight into the challenges of homeless health. One man who’d been sleeping rough for years came to see me about a chest infection. As well as sorting that out I managed to get podiatry and dental appointments for him, but unfortunately he was often too drug-affected to remember and failed to attend both. Even after an altercation when he was hanging out and requesting meds, he kept coming back to see me. He has the dental information written down and I hope one day he uses it.

“Compared to a busy day up the road at St Vincent’s, general practice was soothing for the soul.” What kind of case mix did you see? We had a huge spectrum of patients — many with drug and alcohol or mental health problems, but also a lot of geriatric medicine

Were any of the patients aggressive? The practice is very strict on behaviour and treatment of staff. A couple of times patients got aggressive at reception and they were kicked out, and often not allowed back. I learned some good techniques to refuse patients requesting medications and thankfully managed to get through the term without many aggressive patients. That’s not to say they weren’t colourful!

GPSN — Breathing new life into general practice

How did your general practice placement compare with hospital work? The work-life balance was incredible. Working four days a week left me feeling much more rejuvenated at the end of the weekend. PGPPP is more independent than hospital work in one way, but you have a closer relationship with your supervisor than in many hospital terms.

Has anything surprised you about the experience? I didn’t expect so much teamwork. It was great having a few GPs, a nurse and mental health nurse as well as great reception staff. It made Kings Cross a really pleasant place to work and not as isolated as I thought general practice might be.

Would you recommend a PGPPP to other junior doctors? Definitely! Whether or not you’re interested in general practice, the PGPPP is a very worthwhile term. Most medicine happens in the outside world so it’s important to have a working understanding of how community health care operates.

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Dr Ashe Nicholas

registrar rave

“The PGPPP is a very worthwhile term.”

My training provider is Tropical Medical Training.

My current post is GPT3, for which I’m doing a rural term in Charters Towers in north Queensland. Before that I did an extended skills post as a registrar medical educator. A typical workday for me starts with an emergency clinic, then later I see booked patients. I still work as a registrar medical educator so I often come home and do some preparation for a talk or educational program. I enjoy my current post because I see a lot of acute medicine and pathology you would not see in a larger town.

An ‘aha’ moment for me was when I was accepted into general practice training — a wonderful feeling.

My favourite technical gizmo is the forehead thermometer because it’s much easier to use with kids.

About general practice training

The structure of A brief overview of the who, what and how of general practice training. What is the AGPT program? The Australian General Practice Training (AGPT) program is the vocational training program for GP registrars.

What is GPET? General Practice Education and Training Ltd (GPET) is a government-owned company established in 2001 by the Australian Government to fund and oversee general practice vocational training in Australia

What are RTPs? GPET contracts with 17 regional training providers (RTPs) Australia-wide. RTPs deliver the AGPT program in their designated region, enabling a targeted response to local workforce and population health needs. The RTP is responsible for administering the training program, training GP supervisors and delivering educational activities and training material to registrars.

What is RVTS? For those who wish to train in isolated remote locations, there is an alternative to the AGPT program — the Remote Vocational Training Scheme (RVTS), which involves distance education and remote supervision (see pages 84 – 85).

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What is the role of the two colleges of general practice? The RACGP and ACRRM establish training standards, set exams and assessments, accredit training placements and approve completion of training by registrars.

What are the endpoint qualifications? Attainment of a fellowship of the RACGP (FRACGP) or a fellowship of ACRRM (FACRRM) is necessary to become vocationally recognised for independent general practice in Australia under the Medicare system.

What is the difference between the two GP fellowships? ACRRM has specifically designed its curriculum to meet the needs of GPs practising in rural and remote settings. However, fellows of ACRRM may ultimately practise anywhere in Australia — rural, remote or urban. The RACGP curriculum is designed to prepare GPs for practice in any setting. Those who want to complement their FRACGP with more specialised rural and remote skills can do the RACGP Fellowship in Advanced Rural General Practice (FARGP) as an additional optional qualification (see pages 77– 78).

Other ways to fellowship There are other pathways to fellowship designed for experienced practitioners. These pathways are not funded under the AGPT program and various fees are involved.

4 About general practice training

The AGPT landscape Australian Government

General Practice Education and Training Ltd

Australian General Practice Training

Prevocational General Practice Placements Program

Australian General Practice Training program

Training providers

Hospital/practices

Vocational training

Fellowship of the Australian College of Rural and Remote Medicine

Quality general practice experience

Fellowship of The Royal Australian College of General Practitioners

Specialist recognition

GPSN â&#x20AC;&#x201D; Breathing new life into general practice

AGPT program endpoint qualification and fellowships

FRACGP qualiﬁcations (RACGP)

FACRRM qualiﬁcations (ACRRM)

Year one

Core clinical training time

Possible equivalence*

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.

You may wish to complete one, two or three qualifications (FRACGP, FARGP and FACRRM), and this can be integrated into your training course from the start.

Geographical classification Your training pathways and obligations are designed around the Australian Standard 70

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Geographical Classification-Remoteness Areas (ASGC-RA) system, developed by the Australian Bureau of Statistics. This classifies all Australian towns and cities on a scale of 1–5, where 1 includes major cities and 5 denotes the most remote areas. The General Practice Rural Incentives Program (GPRIP) payments are also based on the ASGC-RA system

4 About general practice training

What are the training pathways and obligations? Before starting training in the general practice setting, you need to complete mandatory hospital rotations determined by the colleges. If you have completed these before joining the AGPT program, you will need to apply for recognition of prior learning (RPL) in partnership with your RTP after you have been accepted into the AGPT program. You can complete the rest of your general practice training via either the general pathway or the rural pathway. Fifty per cent of AGPT program placements must be in a rural pathway, which means RA2 and above. A rural pathway is not a reflection on the nature of your training; it only relates to the location of your training. Doctors from overseas who are subject to the 10-year moratorium are usually required to follow the rural pathway.

General pathway RA1–5 Registrars in the general pathway of the AGPT program can train in RA1–5 locations. Training in the general pathway does not preclude a registrar later working in rural or remote areas. General pathway registrars are required to complete 12 months of their training outside the inner metropolitan area of a capital city, or alternatively six months of training outside the inner metropolitan area of a capital city and six months of training in an Aboriginal or Torres Strait Islander health training post.

There is a range of flexible options to achieve this: 1. 12 months in a rural location RA2–5. 2. 12 months in an outer metropolitan location. 3. 12 months in a non-capital city classified as RA1. 4. Six months in any two of the above areas (12 months total). 5. Six months in one of the above areas plus six months in an Aboriginal and Torres Strait Islander health post at an Aboriginal Medical Service (12 months total).

Rural pathway RA2–5 Rural pathway registrars are required to undertake their training in rural locations RA2–5. Eligible registrars will benefit from the Australian Government’s General Practice Rural Incentives Program, known as GPRIP (see page 110).

Rural generalist pathway The rural generalist pathway was pioneered in Queensland as a Queensland Health initiative to provide a fully supported, incentive-based career pathway for junior doctors wishing to pursue a career in rural generalist medicine, combining hospital procedural work with general practice. Rural generalist programs aim to offer opportunities for procedural skills training early in the training pathway. New rural generalist training programs are being developed all over Australia. For more information, talk to your state government health department. GPRIP incentive payments will apply to eligible registrars.

GPSN — Breathing new life into general practice

Map of RTPs

Northern Territory GP Education

Tropical Medical Training

WAGPET Adelaide to Outback GP Training

Queensland Rural Medical Education PLUS Central and Southern Qld Training Consortium

Central and Southern Qld Training Consortium North Coast GP Training GP Synergy New England/Northwest

Beyond Medical Education

GP Training Valley to Coast GP Synergy - Sydney Central and South/Southwest

WAGPET Sturt Fleurieu GP Education and Training

WentWest

Bogong

CoastCityCountry General Practice Training

GP Training Tasmania

Shared zone: Sturt Fleurieu and Southern GP Training

Shared/transitional zone

Southern GP Training

Victorian Metropolitan Alliance Shared zone: Southern GP Training and Victorian Metropolitan Alliance

Personalised learning

Flexible aspects of training

The AGPT program is personalised to meet each registrarâ&#x20AC;&#x2122;s individual goals and career aspirations and is a composite of in-practice learning and external education and training arranged by your RTP. Your medical educators, supervisors and mentors will help guide your learning to shape your future career.

The AGPT program is known for its flexibility. Part-time training is a popular feature, especially for women with children. Parental leave and other reasonable leave breaks may be negotiated. Transfers between RTPs may be possible to arrange if the registrar has a strong case.

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4 About general practice training

Is training funded? Training places under the AGPT program and RVTS are fully funded by the government and registrars are paid while training.

Can I be enrolled in another specialty program while doing the AGPT program? Yes, this is possible. It must be approved in advance by your RTP, be supported by your medical educator and be incorporated in your learning plan. However, you may not be enrolled in another program during your first six months of the AGPT program. Following this initial six months, you can do another specialty program part-time. See the Training Outside of AGPT Policy 2010 online at agpt.com.au

How GPRA helps

Whoâ&#x20AC;&#x2122;s who ACRRM Australian College of Rural and Remote Medicine

With so many different entities involved, each with a slightly different focus, GPRA plays an important unifying role with its focus on the interests of the registrar.

AGPT Australian General Practice Training program

Do it now

FARGP Fellowship in Advanced Rural General Practice

For more information about the Australian General Practice Training program, visit: GPSN gpsn.org.au AGPT agpt.com.au RACGP racgp.org.au ACRRM acrrm.org.au You can also speak to your GPSN Student Ambassador

FACRRM Fellowship of the Australian College of Rural and Remote Medicine

FRACGP Fellowship of The Royal Australian College of General Practitioners GPET

General Practice Education and Training Ltd

GPRA General Practice Registrars Australia RACGP The Royal Australian College of General Practitioners RTP

Regional training provider

GPSN â&#x20AC;&#x201D; Breathing new life into general practice

Fellowship The RACGP

Fellowship of The Royal Australian College of General Practitioners (FRACGP) is held in high esteem around the world and certifies competence to practise unsupervised in any general practice setting in Australia.

an optional fourth year for additional skills and qualifications in rural general practice. There is flexibility in regard to when and how the essential components of training can be completed, such as the ability to complete the training on a part-time basis and/or take up to three years of leave.

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 — urban, regional, rural or remote. It also confers the ability to access specialist medical registration and consequently A1 rebate rates under Medicare legislation. International recognition of the FRACGP is expanding and is now recognised in New Zealand, Ireland and Canada. The RACGP also delivers conjoint fellowship exams in Malaysia and Hong Kong.

Vocational training towards FRACGP Vocational training towards FRACGP is three years full-time (or part-time equivalent), with

74 Visit our website — gpsn.org.au

The essential components of vocational training towards FRACGP are: training (12 months) — Four • Hospital 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.

practice placements (18 months) • General — 18 months of general practice placements

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

skills (six months) — Provides • Extended an opportunity to develop your general

practice skills further and can be completed in a range of RACGP-accredited settings. Options include advanced rural skills, an overseas post, an academic post, or extended procedural skills within a hospital or practice.

4 About general practice training

Fourth-year additional training (optional)

rural skills — If you decide that • Advanced you want to become a rural GP or have a

strong interest in rural general practice and For more information about exam preparation, want to take your training and education see page 53. further, you have the option to complete an additional 12 months of advanced rural Eligibility to enrol for the exam skills training (ARST). To be eligible to sit the fellowship assessments, all registrar candidates are required to have: Advanced academic skills — You can also apply for an academic term under the current Australian medical registration RACGP pathway and work part-time in a current financial membership of the RACGP university department and part-time in confirmation from your RTP that you have clinical general practice. completed the required vocational training.

•

To allow for greater flexibility, each segment can be completed and paid for separately. All three segments need to be completed within a three-year period of first passing one of the online segments.

• • •

About the FRACGP exam

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

Do it now Find out more

Contributed by The Royal Australian College of General Practitioners

For more information about the FRACGP exam, visit: racgp.org.au/assessment/examination racgp.org.au/assessment racgp.org.au/assessment/faqs

or for specific questions, email fellowshipservices@racgp.org.au

GPSN — Breathing new life into general practice

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

Medical school (4 â&#x20AC;&#x201C; 6 years)

Internship year (PGY1)

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

General practice training (3 years)

RACGP Fellowship exam

Prevocational General Practice Placements Program (optional)

Fourth year additional training in advanced rural skills or advanced academic skills (optional)

Successful completion of RACGP training and assessment

RACGP Fellowship

Continuing professional development

Visit our website â&#x20AC;&#x201D; gpsn.org.au

Fellowship in Advanced Rural General Practice (FARGP) (optional)

RACGP

4 About general practice training

Fellowship in Advanced Rural General Practice How far can you go as a • works best if you start early and go rural GP? If you are interested in living and working in regional, rural or remote Australia, then the Fellowship in Advanced Rural General Practice (FARGP) is for you. The FARGP is the qualification awarded by the RACGP beyond the vocational fellowship. 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. In 2011, the FARGP was extensively reviewed for the first time since its inception in 2006. Advice was sought from RTP staff, medical educators, key stakeholders and candidates (past and present). Based on the findings and current research, the new FARGP was developed and launched in April 2012.The FARGP e-learning platform was launched in October 2012. The new FARGP:

• is based on contemporary thinking in adult

learning, reflective practice, self-determined learning and places the learner at the centre of the process

meet the needs of their local community

• focuses on building the specific knowledge and skill sets required by individual GPs to

rural so you can complete more of the requirements before heading into the FRACGP exams.

Speak to your RTP, medical educator, visit racgp.org.au/fargp or call the RACGP National Rural Faculty on 1800 636 764 for more information on how the RACGP can meet your needs.

Pre-requisites for general practice registrars:

• membership of the RACGP • working towards FRACGP • committed to working in rural

general practice.

FARGP requirements:

• completion of a learning plan and reflection • 12 months in rural general practice • 12 months of advanced rural skills training in an accredited training post • completion of a six-month ‘working

in rural general practice’ communitybased project

of two advanced emergency • completion skills courses and a series of emergency

medicine activities.

GPSN — Breathing new life into general practice

Advanced rural skills training An important component of the FARGP is advanced rural skills training (ARST). Each ARST has its own curriculum guidelines and assessment process. Registrars may choose to complete an ARST post in an area of interest or of value to a rural community including: 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).

• • • • • • • • • •

Contributed by the RACGP National Rural Faculty

Do it now Contact the RACGP National Rural Faculty on 1800 636 764 or visit racgp.org.au/fargp

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Building your RACGP membership value

The Royal Australian College of General Practitioners (RACGP) is Australia’s largest professional general practice organisation and represents urban and rural GPs. The RACGP offers support to over 21 500 members during their entire journey of general practice – from when you’re a medical student, throughout your training, and even in your retirement. If you are embarking on a career in general practice or still thinking about which path you would like to take, as a medical student you are invited to take up RACGP Student membership. The RACGP membership package for Student members now offers even more in value and savings. You can access hundreds of clinical general practice case studies as well as a range of online tools and resources to support your assignment/examination preparation and in keeping your clinical knowledge up-to-date.

Join the RACGP or renew and upgrade your RACGP Student membership today. www.racgp.org.au/student or freecall 1800 331 626

Fellowship The ACRRM

or the Independent Pathway, administered The Australian College of by ACRRM, which is suitable for doctors Rural and Remote Medicine with experience who prefer self-directed (ACRRM) has designed its learning. general practice training For more information on the pathway most program to meet the scope suitable for you, contact the ACRRM vocational training team. of clinical skills, knowledge and values required by the Vocational training rural and remote practitioner. towards FACRRM

The ACRRM training program comprises three stages of learning and experience. After first completing Core Clinical Training, a registrar Fellowship of ACRRM (FACRRM) is an approved pathway to vocational registration may complete the remainder of the training and unrestricted general practice anywhere requirements in any order. in Australia. Core Clinical Training — 12 months It is a four-year integrated training program. working in an accredited hospital, where you Training time is reduced where a candidate complete terms in: – general internal medicine is granted recognition of prior learning. – general surgery Training occurs on the job as a registrar – paediatrics in a range of ACRRM-accredited teaching – emergency medicine posts including general practices, hospitals, – obstetrics and gynaecology Aboriginal Medical Services and the Royal – anaesthetics. Flying Doctor Service. Gaps in terms may be filled during subsequent Candidates wishing to achieve the stages of training. FACRRM can apply for one of three This training should provide you with sufficient training pathways: the Vocational clinical cases and opportunistic learning to form Preparation Pathway delivered by RTPs a good foundation to begin work in rural or with funding from GPET; the Remote remote practice. Vocational Training Scheme (RVTS) for doctors working in isolated rural Primary Rural and Remote Training communities who find it difficult to leave — 24 months working in facilities accredited by their community to participate in training; ACRRM, to build your clinical and procedural

What is FACRRM?

•

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4 About general practice training

skills and your confidence to work in rural and remote contexts. These facilities can include general practices, hospitals, Aboriginal Medical Services or the Royal Flying Doctor Service. 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 and a minimum of six months living and practising in a rural or remote setting.

•

Advanced Specialised Training — Broadens your skills and capacity beyond the standard scope of general practice training. With these supplementary procedural skills, your expanded professional scope can include 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 10 disciplines specified by the college:

– Aboriginal and Torres Strait Islander health – adult internal medicine – anaesthetics – emergency medicine

– mental health – obstetrics and gynaecology – paediatrics – population health – remote medicine – surgery.

To achieve FACRRM, candidates must also successfully complete four ACRRM online education modules and at least two emergency skills courses approved by ACRRM (eg. EMST/ELS/PHTLS or equivalent, APLS, ALSO).

Frequently asked questions Why would I consider training for FACRRM? Fellowship of ACRRM equips you to practise unsupervised anywhere in Australia. This gives you real freedom, independence and scope of practice throughout your career. Your general practice qualification — complemented by Advanced Specialised Training — provides the skills and confidence to practise in a broad range of geographic and clinical settings. From solo practice in small communities to leadership roles in larger hospitals, from retrieval and expeditionary medicine to Aboriginal Medical Services or urban general practice. Achieving a FACRRM will verify that you are qualified to practise anywhere. How is FACRRM integrated into the AGPT program? Registrars enrolled in the AGPT program can elect to train to either or both FACRRM and FRACGP. FACRRM training is open to both rural and general pathway registrars, provided they work in ACRRM-accredited training posts. GPSN — Breathing new life into general practice

What is the difference between ACRRM and RACGP training pathways? The ACRRM program is an integrated program that usually takes four years post-internship. However, there can be the opportunity for some of a registrarâ&#x20AC;&#x2122;s PGY2 or 3 training to be assessed for RPL. ACRRM has a unique curriculum and set of assessments that reflect the broad and deep requirements of the rural and remote context. Candidates must train in posts accredited by ACRRM. Can candidates do both qualifications at the same time? Yes, but requirements for placement, duration and completion of training 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. It is essential to enrol with ACRRM as soon as you enrol with an RTP. Do you have to undertake all training in rural or remote locations? No, while most registrars will spend a significant amount of training in rural areas, the focus is on gaining the skills and knowledge required in rural and remote settings. Many of these skills can be developed in urban or rural facilities. However, having a good understanding of the context of rural medicine is also essential, therefore all registrars must spend a period of training living and practising in a rural or remote setting.

Do it now Find out more 82

Can you train with ACRRM then later work in an urban setting? Yes, FACRRM qualifies you for vocational registration and approval to work in unrestricted general practice anywhere in Australia. When do you undertake the assessments? 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. What is available to help in preparing for ACRRM assessments? 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 (RRMEO). StAMPS preparation workshops are now offered via live virtual classroom or face-to-face at least three times a year. Contributed by the Australian College of Rural and Remote Medicine

For more information, visit acrrm.org.au, telephone ACRRM on 1800 223 226 or contact ACRRM Vocational Training at training@acrrm.org.au

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4 Money matters

GPSN â&#x20AC;&#x201D; Breathing new life into General Practice

RVTS

An alternative pathway to fellowship

RVTS trains GP registrars working in rural and remote locations, where accessing mainstream training is impractical or impossible.

The Remote Vocational Training Scheme (RVTS) offers GP registrars working in rural or remote locations a unique remote training experience and an alternative pathway to fellowship.

Remote training and supervision RVTS trains its registrars via distance education and provides remote supervision. No location is too remote and the program is structured to meet the needs of solo practitioners.

RVTS registrars enjoy the same level of support as their big city counterparts, no matter how remote they are. 84

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Education is delivered via:

Teletutorials — Weekly 90-minute • education sessions via teleconference. teaching visits — An experienced • On-site rural practitioner visits the registrar to

observe consultations and provide feedback.

workshops — Registrars • Face-to-face meet for five days of practical training twice a year.

supervision — Each registrar • Remote is allocated a supervisor who acts as a

mentor and provides clinical and educational advice.

RVTS registrars enjoy the same level of support as their big city counterparts, no matter how remote they are. They can be found practising as RFDS doctors, district medical officers, with Aboriginal Medical Services and in private practice. They serve a variety of communities, from farming and mining towns through to remote Aboriginal and Torres Strait Islander communities. Many work in solo practice.

Eligibility RVTS is an independent Australian Governmentfunded program with its own application process and annual intake of 22 registrars. Applications open in May each year for training starting the following February.

4 About general practice training

Geographic location is the key eligibility requirement. To apply, applicants must be working in an eligible location, or have arrangements in place to be in an eligible location at the start of training. Applicants must provide continuing, wholepatient care. Preference is given to doctors working in solo practice and those who cannot access the AGPT program. Once accepted, the registrar remains in the same location throughout their training. Check the RVTS website for complete eligibility criteria.

The endpoint This 3 – 4 year program meets the requirements for fellowship with both the RACGP and ACRRM. Twelve-month training is available in advanced skills curricula, such as anaesthetics, obstetrics and emergency medicine. Contributed by the Remote Vocational Training Scheme

Do it now For more information, telephone RVTS on 02 6057 3400 or visit rvts.org.au

Dr Catherine Gargan

RVTS registrar Dr Catherine Gargan enjoys the stimulation of splitting her time between Darwin and remote Indigenous communities. Mondays and Tuesdays Catherine travels to the community of Maningrida in Western Arnhem Land, population 3,200. Her focus is child health, performing well kids’ checks to identify children at risk and managing chronic diseases in children. Wednesday it’s back to Darwin to tidy up loose ends and provide support to the community from a distance. On Thursdays she travels to the Nauiyu community in the Daly River region south of Darwin, where she mainly sees adults with chronic disease, usually diabetes and renal diseases. Friday is dedicated to meetings and following up outstanding issues. Catherine graduated in 2008 and spent a year in Bendigo, Victoria, before moving north in 2010. She joined the RVTS program in 2012, a move that means she can train for fellowship in the remote locations she prefers. “There’s plenty of assistance when I need it, which allows me to practise in a challenging and rewarding environment,” Catherine says.

GPSN — Breathing new life into general practice

Joining forces with the ADF

between RTPs and modified requirements Around 2.5 per cent of regarding work in outer metropolitan and GPs train in the Australian rural areas. Defence Force (ADF). It’s an opportunity to develop Civilian and military posts practice terms are undertaken through leadership skills and specific General a combination of civilian and military posts, medical skills in a challenging known as ‘composite terms’. The unique environment. demographic of the military necessitates Training as a GP registrar in the ADF offers opportunities and challenges.

concurrent exposure to the broader Australian community to ensure experience in areas such as paediatrics and geriatrics.

ADF GP registrars must meet the same educational requirements but there are some specific policies that relate to ADF GP registrars. These include leave provisions, transfer

Generally, composite terms are accredited only after an initial full-time civilian term, usually a three-month rural term.

Most ADF MOs are recruited as medical students, some from universities and others from within the services. A small number join as direct entry medical practitioners. 88

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While most ADF GP registrars will select the general pathway, exposure to rural general practice provides valuable experience in the decision-making, leadership, teamwork and clinical skills that can be utilised for ADF clinical practice in Australia and when deployed. Deployments may be prospectively accredited for training. Initially, medical officers (MOs) in the ADF are encouraged to specialise in primary care. This is important because whether in Australia or deployed, ADF personnel need access to high quality primary health care. There are also opportunities to specialise in public health, medical administration, occupational medicine and sports medicine, known as the ‘force protection’ specialties. In addition, there are

4 About general practice training

limited opportunities to specialise after initial service as an MO in certain procedural specialties (surgery, anaesthetics, orthopaedics) required for providing higher level care on deployment.

ADF medical officer recruitment Most ADF MOs are recruited as medical students, some from universities and others from within the services. A small number join as direct entry qualified medical practitioners. Medical students and trainees serve as ADF members and attract a salary and ADF benefits such as superannuation, allowances, medical and dental care, and accommodation options while training. The MO’s primary duty is to train at medical school, then complete PGY1 and 2 prior to their first full-time posting to an ADF unit. At the unit, the MO receives further training, in parallel with the AGPT program, including officer training, early management of severe trauma (EMST) and specialist courses such as aviation medicine or underwater medicine. At the same time, the MO gets acquainted with the military health system.

Competency levels Clinical employment is based on progression through clinical competency levels designated as ‘medical levels’ (ML). Beginning at ML1, MOs who have completed initial courses and a period of supervised primary care are recognised as ML2. MOs at ML2 have basic skills and are considered

suitable for remote supervision in a deployed environment. Those who have achieved FRACGP or FACRRM progress to ML3.

Remuneration In return for supporting the initial medical training, the ADF requires a Return of Service Obligation (ROSO) or Initial Minimum Period of Service (IMPS). During internship and residency, The ADF continues to pay the MO a salary, while wages earned from the hospital or other employers are paid to Defence. If hospital pay exceeds military pay, the difference is paid to the MO periodically. MOs at CL2 and above are reimbursed a further $10,000 annually for continuing medical education expenses. Contributed by Dr Geoff Menzies

Do it now GP registrars and fellows wanting to explore a career as an ADF medical officer may find it helpful to speak with a current ADF registrar. You can speak to a member of the ADF Joint Health Command who can direct your query to the relevant person. Contact Bronwyn Ferrier Staff Officer, Medical Officers Telephone: 02 6266 4176 Email: bronwyn.ferrier@defence.gov.au For more information or to apply, telephone 13 19 01 or visit defencejobs.gov.au

GPSN — Breathing new life into general practice

Dr Joel Hissink Lieutenant Commander Joel Hissink is currently posted to the HMAS Penguin Navy establishment in Mosman, NSW. The Sydney Harbour setting is idyllic — Joel can paddle his kayak to work from his nearby home. This is the site of the Navy’s submarine and underwater medicine unit and Joel is in charge. His work centres on occupational health — keeping assorted Navy crew medically shipshape. Duties range from conducting medicals on Navy divers to formulating diving policy across Navy, Army and Air Force.

A recently fellowed military doctor finds satisfaction serving on land and at sea. known as ‘the bends’. Joel is also involved in research projects in collaboration with naval and civilian diving organisations around the world. One day a week he practises at a civilian general practice in Dee Why, an activity endorsed by the Navy as part of his continuing professional development. However, as a Navy medical officer he could be deployed to an operation at any time. One such deployment remains vivid in Joel’s memory. He was a member of an ADF medical taskforce that delivered emergency relief to thousands of displaced people after the Pakistan floods of 2010, one of the world’s worst natural disasters.

“Humanitarian work is one reason why many doctors are The unit oversees a hyperbaric attracted to chamber that treats divers — both Navy and civilian — the military.” for decompression sickness,

“People were coming in from a nearby displaced persons’ camp and were also travelling from further afield — up to 220 km — to reach our centre,” he says. The team treated some 215 patients a day for 53 days for malaria, cholera, tuberculosis, malnutrition, skin and eye infections and diarrhoeal illnesses. “It was an amazing opportunity. Humanitarian work is one reason why many doctors are attracted to the military,” Joel reflects. Joel originally joined the Navy in a different capacity and decided to retrain as a doctor under a generous postgraduate training scheme sponsored by the ADF. . 90

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4 About general practice training

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*IMPORTANT: Professional indemnity insurance products available from Avant Mutual Group Limited ABN 58 123 154 898 are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. The information provided here is general advice only. You should consider the appropriateness of the advice having regard to your own objectives, financial situation and needs before deciding to purchase or continuing to hold a policy with us. For full details including the terms and conditions (and exclusions) that apply, please read and consider the policy wording GPSN new life General128 Practice and PDS, which is available at www.avant.org.au orâ&#x20AC;&#x201D;byBreathing contacting us into on 1800 268.93

Understanding the moratorium Have you come to Australia from overseas? Then there may be restrictions on where you can practise. Doctors from overseas are being welcomed to help fill Australia’s GP shortage. However, to ensure these doctors work in the geographic regions that address workforce shortages, the Australian Government has certain policies that apply to international medical graduates (IMGs), overseas-trained doctors (OTDs) and foreign graduates of an accredited medical school (FGAMS).

area. GP registrars under the moratorium do their vocational training in the rural pathway.

Who is under the moratorium? The moratorium applies to: overseas-trained doctors who did not obtain their primary qualification in Australia or New Zealand

•

doctors trained in Australia or • overseas New Zealand who began studying in

Australia or New Zealand under a temporary visa and subsequently obtained their primary qualification from an Australian or New Zealand university.

When does the moratorium start?

What is section 19AB/the 10-year moratorium? Section 19AB of the Health Insurance Act 1973, also known as the 10-year moratorium, states that OTDs and FGAMS will only be issued with a Medicare provider number if they work in areas deemed by the government to be a district of workforce shortage (DWS). This usually means a rural, remote or outer metropolitan

The period starts from the time a doctor is registered as a medical practitioner in Australia. If a doctor has not obtained Australian permanent residency or citizenship by the end of the 10-year moratorium, they will still need a section 19AB exemption to continue accessing Medicare benefits.

Reduction of moratorium time RA classification

RA category

Scaling % discount Restriction period reduced to:

RA1

Major cities

Nil

10 years

RA2

Inner regional

10%

9 years

RA3

Outer regional

30%

7 years

RA4

Remote

40%

6 years

RA5

Very remote

50%

5 years

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4 About general practice training

Fact file What are IMGs, OTDs and FGAMS?

How long does it last? Originally, the geographic limitation on provider numbers lasted for 10 years, which is why the scheme became known as the 10-year moratorium. However, there have been recent changes that allow doctors to reduce the moratorium time by up to five years, depending on the remoteness area (RA) of the location where they practise. The Australian Standard Geographical Classification-Remoteness Areas (ASGC-RA) system classifies locations from RA1 to RA5 according to their remoteness, with RA1 being the most urban and RA5 the most remote. The reduction in moratorium time is dependent on the remoteness of the area in which a doctor practises (see table on previous page).

IMG — International medical graduate A graduate who received their primary medical degree from a medical school outside of Australia or New Zealand. OTD — Overseas-trained doctor A doctor who received their primary medical degree from a medical school outside of Australia or New Zealand, who has also undertaken at least a portion of further training outside of Australia or New Zealand. FGAMS — Foreign graduate of an accredited medical school A doctor who received their primary medical degree from an Australian or New Zealand university, but who was a temporary resident when first enrolled in that degree. For the purposes of the AGPT program, the terms IMG and OTD are often used interchangeably.

What resources are available? DoctorConnect website

Do it now •

•

Talk to your RTP, visit agpt.com.au or doctorconnect.org.au If you need detailed information about your individual circumstances, contact the Department of Health and Ageing Workforce Regulation Section

This has some very useful information including a map showing various RA categories and district of workforce sihortage locations. Medical Observer IMG Survival Guide Published annually, this is essential reading for international doctors. Additional material contributed by Dr Zeshan Shaikh

GPSN — Breathing new life into general practice

GPs are vital to the cancer journey ...

Research

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We have the resources to support you NSW CERVICAL SCREENING PROGRAM

www.cancerinstitute.org.au/direct

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Design your own GP career

Subspecialise

faces

The many of general practice

General practice is the Rural-remote most flexible of medical Dr Gerry Considine careers — you can shape RTP: Adelaide to Outback GP it to suit your own interests. Training Program Many GPs are going places Location: Wudinna, SA Dr Gerry Considine is a pilot, blogger in their careers by taking plays in a rock band. Since moving to up subspecialties, multiple and Wudinna, he also plays on the wing for roles and following their the Wudinna B-grade footy team — and own individual passions. somehow finds time to train as a rural GP registrar. GP registrars give you a glimpse at the scope of this “During my medical training, I had two very positive experiences in rural general practice. all-embracing profession These cemented my plans not only to do GP by describing some of training but to head bush with it. I enjoy being their diverse training posts. part of the community and

improving the health of people I see in the supermarket or at the football.”

Dr Gerr

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5 Design your own GP career

Aboriginal and Torres Strait Islander health Dr Deepthi Iyer RTP: Victorian Metropolitan Alliance Location: Melbourne,VIC Dr Deepthi Iyer did a post at the Victorian Aboriginal Health Service in Fitzroy. It opened her eyes to a holistic approach where doctors work closely with Aboriginal health workers, nurses and other staff, and time is taken to understand the social background of patients. “I had half an hour to see my patients and could have a long chat with them as well as take a detailed history and examination. Patients were warm and welcoming, and brought in food and cakes to be shared with all the staff and other patients. The community has a big heart.”

Academic

Dr Andy

Hume

Dr Andy Hume RTP: Northern Territory General Practice Education Location: Darwin, NT Dr Andy Hume was curious to find out whether food gardens in remote Aboriginal communities could change diets and reduce disease rates. He initiated a research project with the Menzies School of Health Research in Darwin to investigate. “Academic general practice offers the chance to investigate and possibly alter the factors that mediate disease. I see academic work underpinning general practice and vice-versa. Sitting under a tree in a remote community talking with a manager or a gardener about what they do, I have to remind myself that this is a job.”

r pthi Iye

Dr Dee

GPSN — Breathing new life into general practice

IPN: Experience the benefits of a community IPN is the largest operator of medical centres within Australia. With over ten years of experience in general practice management, you can be confident in establishing your career with us. We offer a supportive network you can rely on, within a community you can trust. For more information, visit our website at www.ipn.com.au. We look forward to working with you.

Supporting Better Medicine www.ipn.com.au

5 Design your own GP career

Paediatrics and adolescent mental health Dr Rebecca Jacobs RTP: Beyond Medical Education Location: Orange, NSW Dr Rebecca Jacobs boosted her paediatric confidence in this award-winning post. Registrars see newborns to adolescents, with time divided between the child and adolescent mental health team and the paediatric unit at Orange Base Hospital. “I found the variety in this post exceptional. It could be an emotional rollercoaster as you never quite know what is going to occur when you are on-call, or when you are called to attend a birth, or the challenges adolescents will throw at you or the thanks you will get from a family.”

eran

achend

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ath Dr John

Anaesthetics Dr Jonathan Ramachenderan RTP: Western Australian General Practice Education and Training Location: Perth, WA Dr Jonathan Ramachenderan did a 12-month stint as a GP anaesthetic registrar at Joondalup Health Campus in Perth to prepare for the cases he would later encounter as a rural GP. He has since moved with his family to Albany on WA’s south coast.

cobs

ecca Ja

Dr Reb

“The procedural and dynamic nature of manipulating acute physiology attracted me. I love placing IV cannulas, central lines, being involved in airway management and resuscitating sick patients. I see myself as a rural critical care doctor, having done further training in emergency and critical care.”

GPSN — Breathing new life into general practice

Sexual and reproductive health Dr Vanessa Huang RTP: Southern GP Training Location: Melbourne,VIC Dr Vanessa Huang spent a term working with Family Planning Victoria at Box Hill and Action Centre for under-25s in the Melbourne CBD. Her objective was to fine-tune her knowledge of sexual health issues. Dr Rhia

nnon Sm

ith

Obstetrics and gynaecology Dr Rhiannon Smith RTP: Sturt Fleurieu General Practice Education and Training Location: Murray Bridge, SA

“I was seeing clients wanting contraception advice, doing up to five Implanon insertions a day, STI check-ups and treatment, sex worker check-ups and unplanned pregnancy counselling. I am now a lot more confident and competent dealing with sexual health issues.”

Dr Rhiannon Smith originally had a dilemma choosing between general practice and O&G. Doing her DRANZCOG (Advanced) through the Bridge Clinic and Murray Bridge Hospital allowed her to combine two careers in one. “It has been fantastic seeing a patient through her entire pregnancy, managing her labour, then seeing the baby for follow-up. My supervisor and other GP obstetricians were always available for support, even in the early hours of the morning. I now have a gallery of baby photos on my fridge!” Dr Vane

ssa Hu

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5 Design your own GP career

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Special interest options General practice is the most flexible of medical careers — you can shape it to suit your own interests. Design your own general practice career based around an almost unlimited list of special interests including: Aboriginal and Torres Strait Islander health academic medicine and research alpine sports medicine anaesthetics

• • • •

Dr Mike Cross-Pitcher , GP Ambassador at Nambour Hospital, undertakes a short course in expedition medicine

• aviation medicine • dermatology • drug and alcohol medicine • emergency medicine • family planning and sexual health • forensic medicine • geriatrics • HIV medicine • men’s health • mental health • musculoskeletal medicine • obstetrics • occupational medicine • palliative care • paediatrics • population health • refugee health • remote medicine • Royal Flying Doctor Service • rural generalist surgery • small town rural general practice • sports medicine • surgery • travel medicine • tropical medicine • women’s health. …plus many more!

Do it now For more information about the almost unlimited possibilities of a general practice career, talk to the GPSN Student Ambassador at your university or visit gpsn.org.au

102

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5 Design your own GP career

diversity, opportunity GPSNchallenge, â&#x20AC;&#x201D; Breathing adventure, new life into General Practice 99

Part-time training options Flexible work options

The part-time training options and parental leave available to GP registrars make general practice training very flexible. The flexibility of general practice when it comes to working hours is one of the reasons many people choose it as their career path. The training program has the same flexibility, with parental leave and part-time training an attractive offering. Of course, part-time training is especially attractive for those registrars having babies and raising young children. However, the part-time option can also give other registrars the freedom to take up opportunities, such as becoming a registrar liaison officer (RLO) or an academic registrar. When thinking about part-time training, consider the following:

• all components of the training program, with

the possible exception of hospital time, can be undertaken on a part-time basis

• full-time is considered to be 38 hours

104

a week, which includes all consultation time. Part-time training is anything less than 38 hours

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• to remain in the AGPT program, you need

to undertake a minimum of nine patient contact hours per week.

Taking parental leave

• All parental leave is unpaid by employers

in the AGPT program but you may be eligible for paid parental leave from the Australian Government.

• The primary caregiver is eligible for leave of

up to 12 months following the live birth, adoption or assumption of guardianship of the child or children.

5 Design your own GP career

Dr Cass Wys As a new parent able to pursue her chosen career part-time, Dr Cass Wys enjoys a balanced blend of motherhood and medicine.

“Being a parent is a full-time job in itself,” declares Dr Cass Wys, a Cairns-based GP registrar who had her first baby a couple of years ago with partner Matt Cooper. She knows all too well the intricate, sleepdeprived juggle of the working mother but says the flexibility of general practice eases the way.

“The flexibility of part-time work and training in general practice means you can maintain a healthy balance,” she says. Cass left work to have Alyssa towards the end of her first GPT1 and returned to complete the post when her baby was just under five months old.

“The flexibility of part-time work and training in general practice means you can maintain a healthy balance.” “My supervisors and the staff at the practice were exceptional,” she says, as she tells of the understanding she received if the baby was sick or she came to work bleary-eyed after a night of broken sleep. Now that the baby is older, Cass works two and a half days a week in general practice. She is also able to pursue her special interest in sports and acute injury management by working in a new post especially created for her at an acute orthopaedic injury clinic with an orthopaedic surgeon. In addition, she spends four hours a week as an RLO for her regional training provider Tropical Medical Training, a post that underscores another of her interests, medical education and training. “I absolutely love Alyssa, but I also enjoy my career, and I am so lucky that I can have the best of both worlds,” she says. GPSN — Breathing new life into general practice

105

Travel while you train

ADVERTORIAL

Tra vel

Strap on your backpack and make the world your consulting room while you train. It’s all possible in general practice. If you enjoy travelling and are keen to gain clinical experience in another country, both the RACGP and ACRRM offer exciting opportunities to complete part of your general practice training overseas. Typically these are six-month full-time positions, although in some cases part-time may be possible.

Dr Kelly Seach Irish Exchange Program “I worked in general practice in the town of Ballybofey in County Donegal, Ireland. I learned how to pronounce Irish names, appreciate potatoes five ways and work in a different health system. In all, I loved my Irish exchange.”

The overseas training terms are appropriate for registrars who have already undertaken some training. Overseas terms can include the United Kingdom, Ireland, USA, New Zealand, China, Malaysia and the Middle East (Australian Defence Force posts). Overseas terms are a fantastic opportunity to broaden your horizons while completing your general practice training. However, you should be aware that it takes a lot of forward planning to organise an appropriate post and ensure it meets college requirements. You are therefore advised to talk to your RTP early if you are considering a training experience overseas.

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Do it now For further information regarding overseas training posts, visit the college websites racgp.org.au or acrrm.org.au Southern GP Training (SGPT) in Victoria and South Australia has an Irish exchange program. Visit their website at southerngptraining.com.au.

Money matters

What you can earn What do GP registrars and GPs earn? What are the hours? Here are some financial facts and figures. The earning power of GP registrars and GPs is excellent when you consider the flexibility and work-life balance of the profession.

GP registrar salaries

the table, or alternatively the registrar is paid a minimum of 45% of gross billings, whichever is greater. 2013 training year minimum salaries plus 9% superannuation

Annual salary Weekly GP term 1 registrar $72,760

$1,399.23

GP term 2 registrar $87,476

$1,682.23

Full-time GP registrars work a minimum of 38 hours a week. This includes education time and administration time. The actual hours of consulting (seeing patients) are usually between 27 and 33 hours a week. This can vary, especially in rural areas.

Different remuneration systems

Registrars can choose a set salary model or negotiate a percentage of income generated by the patients they see in the practice. In this case, remuneration is determined by how many patients are seen and whether there is bulk-billing or private billing.

In certain settings, registrars may work in salaried practice, especially ADF registrars, those in Aboriginal Medical Services and some rural and remote hospitals that also provide GP services to the community.

Minimum terms and conditions During the first two general practice terms (or ACRRM equivalent), GP registrars are guaranteed minimum terms and conditions of employment according to the National Minimum Terms and Conditions (NMTC) document agreed by GPRA and the National General Practice Supervisorsâ&#x20AC;&#x2122; Association (NGPSA). Minimum salary rates are set out in 108

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On-call and hospital VMO work earn GP registrars a minimum of 55% of the hospital billings.

It is important to note that working in rural areas, doing procedural work and working as a hospital VMO tend to attract significantly higher incomes. However, even in urban areas, GP registrars often earn more than what is stipulated in the NMTC document. For GP registrars and GPs practising in rural areas and identified areas of need, incentive payments are available on top of a regular salary. (For more information, see pages 110 â&#x20AC;&#x201C; 111.)

6 Money matters

What established GPs earn

Calculate your

income online

Established GPs can earn good money, with the actual amount dependent on the nature of the practice and hours worked. In addition, there is the opportunity to run your own medical practice if you choose. All this with flexible hours and choice of practice style!

gpaustralia.org.au/earnings-calculator Our online GP earnings calculator allows you to estimate your individual earning potential based on the kind of GP you want to be

Contributed by Dr Siew-Lee Thoo, Dr Naomi Harris and Dr Jason Ong

Training stage Location Practice style On-call Average Weekly* % of billings patient ($) paid consultations (hours/week)

Annual* ($)

GP term 1 Any 45% N/A (or equivalent)

4 patients per $2,307 hour — 28 hrs per week

$120,000

GP term 2 Remote Salaried (or equivalent) hospital-based medical officer procedural work (anaesthetics)

1 in 2 – 3 days

60 hrs

$3,007

$160,000

GP term 3 Rural 50% mix (or equivalent) billing, hospital admitting rights, procedural work (anaesthetics)

1 in 6

28 – 30 hrs

$2,788

$145,000

Locum Rural (newly fellowed GP)

60% mix hospital admitting rights

N/A

38 – 40 hrs

$3,600

$187,200

Established Urban (busy practice)

65% private billing, hospital admitting rights

N/A

45 hrs

$5,175

$269,100

* Salary includes billings paid and has been calculated using the Earning Calculator. It is intended as an estimate only. Refer to the NMTC at gpra.org.au/national-minimum-terms-conditions

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Incentive payments In addition to your salary, GP registrars.This may include subsidised rental you may be able to claim accommodation in rural areas. General Practice Rural other financial incentive payments as a GP registrar. Incentives Program If you are working as a GP registrar, you may be eligible to receive a range of financial incentives and reimbursements on top of your regular salary. Most of these are offered by the Department of Health and Ageing (DoHA) to encourage more GPs to practise where they are most needed, such as in rural, remote and outer metropolitan areas.

Accommodation Each RTP has an individual policy regarding accommodation and relocation subsidies for

The General Practice Rural Incentives Program (GPRIP) is a DoHA scheme that applies to registrars and GPs (both locally and overseas-trained) working in rural and remote areas. Payments are on a sliding scale calculated using the Australian Bureau of Statistics Australian Standard Geographical Classification-Remoteness Areas (ASGC-RA) system. The more remote the area and the longer a doctor stays there, the higher the rewards (see Table 1).

For more information, visit doctorconnect.gov.au

Table 1 – General Practice Rural Incentives Program Practice time (years) in a rural and remote location RA location

0.5

RA2 (inner regional)

3–4

$2,500

$4,500

$7,500

$12,000

RA3 (outer regional)

$4,000

$6,000

$8,000

$13,000

$18,000

RA4 (remote)

$5,500

$8,000

$13,000

$18,000

$27,000

RA5 (very remote)

$8,000

$13,000

$18,000

$27,000

$47,000

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6 Money matters

Table 2 – HECS Reimbursement Scheme ASGC-RA classification

No. of years to receive full reimbursement 5 years

HELP/HECS Reimbursement Scheme The HECS Reimbursement Scheme applies to Australian graduates who completed their medical degree in the year 2000 or later. Participants in the scheme have a proportion of their HECS fees reimbursed for each full-time year of medical training undertaken or service provided in areas designated as Australian Standard Geographical Classification RA2–5. These reimbursements are scaled to reward doctors working in the most remote areas who receive a higher level of reimbursement and recover their fee payments over a shorter period of time (see Table 2).

4 years

3 years

2 years

More Doctors for Outer Metropolitan Areas Relocation Incentive Grant This is another DoHA scheme for GP registrars on the general pathway who have completed their training and are prepared to work in an outer metropolitan area for two years. Newly fellowed GPs must apply within three months of receiving their fellowship and are eligible for a total payment of up to $30,000, paid in three instalments of 40 per cent, 40 per cent and 20 per cent. For those who further commit to outer metropolitan areas by setting up their own practice and staying for three years, there is a total of $40,000 available. For more information, visit health.gov.au/outermetro

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Info file

Jargon buster

Acronyms and abbreviations abound in the language of general practice training. Crack the code here!

AAPM — Australian Association of Practice Managers ACCHO — Aboriginal Community Controlled Health Organisation ACCHS — Aboriginal Community Controlled Health Service ACIR — Australian Childhood Immunisation Register ACRRM — Australian College of Rural and Remote Medicine One of two general practice colleges. ACRRM has a curriculum of educational objectives for rural GPs and a fellowship process for vocational registration AGPAL — Australian General Practice Accreditation Ltd This organisation completes accreditation of practices throughout Australia AGPT — Australian General Practice Training The training program for GP registrars

AMA — Australian Medical Association An independent organisation that represents the professional interests of all doctors, including political, legal and industrial AMG — Australian medical graduate AMLA — Australian Medicare Local Alliance A network funded by the federal government to manage national programs for Medicare Locals AMS — Aboriginal Medical Service AMSA — Australian Medical Students’ Association ARST — Advanced rural skills training ASGC-RA — Australian Standard Geographical Classification-Remoteness Areas The Australian Bureau of Statistics model by which all cities and towns in Australia are assigned a number between RA1–5. This is used to calculate incentive payments to doctors outside metropolitan areas RA1 — major cities

AHPRA — Australian Health Practitioner Regulation Agency

RA2 — inner regional

AIDA — Australian Indigenous Doctors’ Association

RA4 — remote

AKT — Applied Knowledge Test A component of the RACGP Fellowship exam. A computer-based exam in multiple-choice format ALMA — Australian Lesbian Medical Association 114

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RA3 — outer regional RA5 — very remote A map of Australia showing these classifications is available at doctorconnect.gov.au AST — Advanced specialised training A 12-month training post required for ACRRM fellowship

7 Info file

CMO — Career medical officer CPD — Continuing professional development DHAS — Doctors’ Health Advisory Service DoHA — Department of Health and Ageing The federal government department responsible for health and ageing DVA — Department of Veterans’ Affairs EBM — Evidence-based medicine ECT — External clinical teacher ESP — Extended skills post A component of AGPT comprising a six-month training post in either general practice or an area of relevant skills; eg. obstetrics and gynaecology, accident and emergency FACRRM — Fellowship of the Australian College of Rural and Remote Medicine FARGP — Fellowship in Advanced Rural General Practice FGAMS — Foreign graduate of an accredited medical school May be subject to the 10-year moratorium (see also IMG and OTD) FRACGP — Fellowship of The Royal Australian College of General Practitioners GPET — General Practice Education and Training Ltd

specialty of choice to medical students and prevocational doctors; provides support to GP registrars. Membership is free GPRIP — General Practice Rural Incentives Program GPRMEN — General Practice Registrar Medical Educator Network GPSN — General Practice Students Network GPT1, GPT2, GPT3 — General practice terms 1, 2 and 3 Part of the RACGP curriculum HMO — Hospital medical officer IGPRN — Indigenous General Practice Registrars Network IMG — International medical graduate May be subject to the 10-year moratorium (see also FGAMS and OTD) JAC — Joint Advisory Committee JCC — Joint Consultative Committee KFP — Key Feature Problems A component of the RACGP Fellowship exam. A computer-based exam in short and long answer Medicare Locals Organisations established to coordinate primary health care delivery, including general practice and allied health services. More than 60 have been established across Australia to date

A government limited company that funds and contracts RTPs to provide general practice education to registrars and prevocational doctors MBS — Medicare Benefits Schedule GPR — General practice registrar, GP registrar MCQ — Multiple choice question A component of the ACRRM Fellowship GPRA — General Practice Registrars exams and assessments Australia Ltd Represents GP registrar issues to GPET, RACGP, ACRRM, DoHA and other bodies involved in training; promotes general practice as the medical

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ME and TA — Medical educators and training advisors One of these people from your RTP will give advice and guidance about your training miniCEX — Mini Clinical Evaluation Exercise A component of the ACRRM Fellowship exams and assessments

OTD — Overseas-trained doctor May be subject to the 10-year moratorium (see also FGAMS and IMG) PBS — Pharmaceutical Benefits Scheme/ Pharmaceutical Benefits Schedule PCEHR — Personally Controlled Electronic Health Record

NACCHO — National Aboriginal Community Controlled Health Organisation

PGPPP — Prevocational General Practice Placements Program

NGPSA — National General Practice Supervisors’ Association Not to be confused with the SLON (Supervisor Liaison Officer Network), although they are essentially the same people. NGSPA is the GPRA equivalent for supervisors. It undertakes an advocacy role for supervisors, particularly in terms and conditions negotiations

PIP — Practice Incentives Program

NMTC — National minimum terms and conditions A document prepared for GP registrars in their first and second general practice terms that outlines the requirements of employment contracts between registrars and practices NPS — National Prescribing Service A federal government-funded organisation that provides independent information on the prescription and use of various medications. Lots of resources and case studies for GP registrars can be found at nps.org.au OSCE — Objective Structured Clinical Examination A component of the RACGP Fellowship exams comprising multiple stations similar to an MSAT or viva voce exam OTC — Over-the-counter

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QICPD — Quality improvement and continuing professional development RACGP — The Royal Australian College of General Practitioners The largest of the of two general practice colleges. Has a fellowship process for vocational registration. The RACGP also offers a fellowship in Advanced Rural General Practice (FARGP) RACGP state censor A fellow of the RACGP in each state who checks that the GP registrar has completed the training requirements for fellowship of the RACGP RDAA — Rural Doctors Association Australia Has state branches. Represents rural doctor issues to government and other organisations RDL — Registrar-directed learning RDNA — Rural Doctors Network Australia RFDS — Royal Flying Doctor Service RLO — Registrar liaison officer A registrar employed by an RTP to represent and advocate for GP registrars and liaise with GPRA RMO — Resident medical officer

7 Info file

RPBS — Repatriation Pharmaceutical Benefits Scheme RPL — Recognition of prior learning RROC — Registrar representative on council A GP registrar who sits on the council of the RACGP to represent registrar concerns. RROB — Registrar Representative on Board GPET Board representative RRADO — Registrar Research and Development Officer The RRADO is a registrar employed part-time by GPET to promote training in research and academic general practice RRF — Registrar Research Fund A pool of funding maintained by GPET to fund GP registrar research projects RTP — Regional training provider RTPs are contracted by GPET to provide regionalised general practice training RVTS — Remote Vocational Training Scheme Provides distance vocational training to doctors already working in rural and remote locations where on-site supervision is not available

10-year moratorium The 10-year moratorium requires some doctors originally from overseas (see FGAMS, IMGs and OTDs) to train and practise in districts of workforce shortage such as rural and outer metropolitan areas for up to 10 years, although it is now possible to reduce this time by practising in more remote areas TGA — Therapeutic Goods Administration TMO — Trainee medical officer UGPA — United General Practice Australia A group of six key medical groups who work together on key health policy areas: RACGP, ACRRM, AMA, GPRA, AGPN and RDAA VMO — Visiting medical officer VR — Vocational registration WONCA — World Organisation of National Colleges, Academies and Academic Associations of General Practitioners /Family Physicians Contributed by Dr Siew-Lee Thoo, Dr Naomi Harris, Dr Kate Kelso and Dr Kirsten Patterson

SIP — Service Incentive Payment SLO — GP supervisor liaison officer Employed by an RTP to represent and advocate for GP supervisors StAMPS — Structured Assessment using Multiple Patient Scenarios A component of the ACRRM Fellowship exams and assessments

GPSN — Breathing new life into general practice

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gpra.org.au gpsn.org.au Your one-stop shop jam packed with all the latest happenings within for GPSN Your online resource and essential resources to everything you need to help out ifyour general help youyou getfind through practice the career training andisnegotiate your for you.contract. firstchoice employment Exam resources webinars, Local GPSN— clubs — lateststudy newstips, and case eventsstudies

• local GPSN Ambassador • Meet your Publications — GP Companion, Calculate how much you can earn as a GP • than More Money: A Negotiation Guide GPSN First Wave Scholarship program — find out how you can apply • registrars, for GP Explorer guide • GP training — get a quick overview of the who, what and oney an M e th Mor RS

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Professional development — finance, medico-legal, contracts

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Blogs — follow our regular blogs ‘Confessions of a Medical Student’ and ‘GP Bytes’ National Minimum Terms and Conditions — policy document, get your burning questions answered. • Forum —assistance interpretations,

Go stay connected Goonline onlineand to keep up to datewith withGPSN how GPRA is working for you.

resources directory

Some handy GP resources and how to get them.

Textbooks and pocket guides Murtagh’s General Practice, Patient Education, Practice Tips

GP Companion — a handy reference of general practice clinical information available to GPRA members as an e-book: gpra.org.au/gp-companion

Australian Medicines Handbook — (available online, CD, mobile, hard copy): shop.amh.net.au

See a recommended reading list from ACRRM: acrrm.org.au/assessment (scroll down and click on ‘Recommended reading list’).

MIMS — (available online, mobile, hard copy): mims.com.au

Guidelines

Sara Bird’s Medico-Legal Handbook for General Practice — free for members of MDA National

There are many guidelines available from the RACGP: racgp.org.au/guidelines. Some important ones are:

Paediatric Pharmacopoeia — rch.org.au Fitzpatrick’s Colour Atlas and Synopsis of Dermatology Reproductive and Sexual Health: An Australian clinical practice handbook — Family Planning NSW Contraception: An Australian clinical practice handbook — Sexual Health and Family Planning Australia

Guidelines for preventive activities in general practice — (the ‘red book’) 7th edition, and Putting prevention into practice — (the ‘green book’) 2nd edition Diabetes Management in General Practice — 17th edition, 2011/2012 Clinical Guidelines for Stroke and TIA Management: A quick guide for general practice

Practical Fracture Treatment — McCrae and Esser

Chronic Kidney Disease Management in General Practice — 2nd edition, 2012

Clinical Sports Medicine — Brukner and Khan

Other important guidelines:

Paediatric Handbook — from Royal Children’s Hospital or Westmead

Asthma Management Handbook — (2006): nationalasthma.org.au

Oxford handbooks (Clinical Medicine, Clinical Specialties)

Screening to prevent cervical cancer: Guidelines for the management of asymptomatic women with screen detected abnormalities — nhmrc.gov.au

The ECG Made Easy — Hampton, 7th edition Fast Facts series — fastfacts.com

Guide to Management of Hypertension (2008) updated 2010 — National Heart Foundation: heartfoundation.org.au

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Therapeutic Guidelines (TG or eTG, available online, CD, hard copy) — an invaluable resource: tg.org.au Australian Immunisation Handbook — (online or hard copy) health.gov.au/internet/immunise/ publishing.nsf/content/handbook-home You can find more lists of guidelines at: Medical Observer has compiled an extensive list, which includes the RACGP guidelines: medicalobserver.com.au/about/guide-toguidelines

Courses ALSO (Advanced Life Support in Obstetrics) — also.net.au APLS (Advanced Paediatric Life Support) — apls.org.au ARC (Australian Resuscitation Council, NSW branch) — arcnsw.org.au Clinical Emergency Management Program — racgp.org.au/cem DCH (Diploma in Child Health) — chw.edu.au

NHMRC guidelines have been developed and endorsed by the Australian Government National Health and Medical Research Council: nhmrc.gov. au/guidelines

EMST (Early Management of Severe Trauma) — surgeons.org

Online learning and resources

Reference and evidence-based medicine databases

gplearning — RACGP: gplearning.com.au RRMEO (Rural and Remote Medical Education Online) — ACRRM: rrmeo.com PrimaryCare Sidebar — a resource that works alongside your clinical desktop from the RACGP: racgp.org.au/ehealth/primarycaresidebar ThinkGP— thinkgp.com.au Rural Health Education Foundation — rhef.com.au GP Psych Support — psychsupport.com.au A government-funded service that provides patient management advice to GPs from psychiatrists.You need to register before you can access this service

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Sexual Health and Family Planning — shfpa.org.au

PubMed — US National Library of Medicine — pubmed.gov — a database of journal articles including MEDLINE The Cochrane Library — cochrane.org.au — a database of clinical reviews. The international site (cochrane.org) has top links for GPs and podcasts on reviews for your commute to work Bandolier — medicine.ox.ac.uk/bandolier — a UK-based independent journal of evidencebased health care UpToDate — uptodate.com — a US-based website that contains peer-reviewed and regularly updated review articles on an extensive range of clinical topics. It has a subscription fee

7 Info file

RCPA Manual — the Royal College of Pathologists of Australasia. Outlines appropriate tests for a clinical problem, interpretation of test results and more, rcpamanual.edu.au

assessment and more: andrologyaustralia.org Mental health — beyondblue: beyondblue.org.au; Black Dog Institute, blackdoginstitute.org.au Paediatrics — Children’s Hospital Westmead: — chw.edu.au; Royal Children’s Hospital Melbourne: rch.org.au

GPnotebook — gpnotebook.co.uk — an encyclopaedia of medicine updated on a continual basis. Has a subscription fee

Sexual health — Australasian Society for HIV Medicine: ashm.org.au; Melbourne Sexual Health Centre: mshc.org.au

Topic-based websites Anatomy — anatomyatlases.org

Women’s health — including unplanned pregnancy counselling, termination, contraception: mariestopes.org.au; childrenbychoice.org.au

Arthritis — arthritisaustralia.com.au Asthma — nationalasthma.org.au Cardiology — The Heart Foundation, heartfoundation.org.au

Organisations

COPD — copdx.org.au Dermatology — There are two Dermnets and both are useful, dermnet.com and dermnetnz.org Drug and alcohol — Australian Drug Foundation adf.org.au Conducts research and education on illicit drugs and alcohol. Their website: druginfo.adf.org.au has information for health professionals, courses and podcasts

Department of Health and Ageing (DoHA) — health.gov.au — 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 Medicare — medicareaustralia.gov.au/provider; MBS Online: mbsonline.gov.au; PBS: pbs.gov.au

Gastroenterology — Gastroenterological Society of Australia: gesa.org.au

Pharmaceutical Benefits Scheme (PBS) — health.gov.au/pbs

Haemochromatosis — Resources for GPs: haemochromatosis.org.au/GPResources.htm

NPS — the National Prescribing Service is an independent non-profit organisation that aims to provide accurate, balanced evidence-based information about medicines: nps.org.au

Immunisations — Australian Government Immunise Australia Program — immunise.health.gov.au Men’s health — Andrology Australia has great tools for prostate screening, male infertility

Therapeutic Goods Administration (TGA) — the regulatory body for therapeutic goods in Australia: tga.gov.au GPRA: gpra.org.au GPSN — Breathing new life into general practice

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Going Places Network: gpaustralia.org.au GPSN: gpsn.org.au

Rural Health Education Foundation — learning resources for GPs: rhef.com.au

GPET: agpt.com.au

Medical apps for phone or iPad

RACGP: racgp.org.au

Drug Doses — very useful in calculating paediatric doses for various medications

ACRRM: acrrm.org.au AMA: ama.com.au Rural Health Workforce Australia (RHWA): rhwa.org.au — a not-for-profit organisation dedicated to making primary health care more accessible for communities in rural and remote Australia

Journals, magazines and periodicals Most are available online and in print. Australian Doctor — especially its ‘How to Treat’ articles: australiandoctor.com.au Australian Family Physician — (free with RACGP membership) — racgp.org.au/afp Australian Prescriber — australianprescriber.com and other NPS publications: nps.org.au Medical Observer — especially its ‘Clinical review’ feature: medicalobserver.com.au Medicine Today — medicinetoday.com.au Medical Journal of Australia (free with AMA membership) — mja.com.au

Medical Observer — a useful calculator for a range of assessments: eg. Ottawa knee and ankle rules, Wells score MBS Search — includes various item numbers, Medicare rebates and allows you to save your favourite item numbers Pedi Safe — a useful app that gives you normal values (HR, BP, RR, fluid resuscitation rates, values for sedation medication) based on weight iAnatomy — shows you CT scans and how to identify the structures in them. Includes a quiz mode Stethoscope — allows you to listen to real chest sounds including murmurs, lung sounds and bowel sounds, and gives you information about how to use a stethoscope. Good practise for OSCEs How to Treat from Australian Doctor — includes quizzes on various conditions to test your knowledge. Very useful for the AKT exams

Podcasts

Wonca (World Organisation of National Colleges, Academies and Academic Associations of Family Physicians) — globalfamilydoctor.com

Available from iTunes store:

check — an independent learning program for GPs (free with RACGP membership): racgp.org. au/education/courses/check

The Health Report with Norman Swan

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Australian Family Physician

Instant Anatomy

7 Info file

Listen to the Lancet

Patient information

The Merck Manual of Patient Symptoms

Better Health Channel — betterhealth.vic.gov.au — offers GPs consumer-based information that is checked on a regular basis. It has useful handouts for patients

MedPod101 — entertaining, but some reviewers have reported it to be offensive

Podcasts Available from iTunes store: Australian Family Physician The Health Report with Norman Swan Instant Anatomy Listen to the Lancet The Merck Manual of Patient Symptoms MedPod101 — entertaining, but some reviewers have reported it to be offensive Other podcasts Annals of Internal Medicine — annals.org/multimedia.aspx Cochrane Library — cochrane.org/podcasts/ Drug Info — druginfo.adf.org.au NHMRC — nhmrc.gov.au/media/podcasts/index.htm Johns Hopkins Medicine News Roundup — hopkinsmedicine.org/news/audio/podcasts/ Podcasts.html Journal of American Medical Association Weekly — jama.jamanetwork.com/multimedia. aspx#Weekly New England Journal of Medicine Weekly Audio Summary — nejm.org

My Dr (MIMS Australia) — mydr.com.au — contains a range of consumer-friendly tools including quizzes, calculators, a medical dictionary and information on medications HealthInsite — healthinsite.gov.au — an Australian Government initiative that aims to provide patients with the latest information on health and wellbeing. It has links to health services across the states and territories. Parent handouts — rch.org.au/kidsinfo/factsheets. cfm — a series of handouts for parents and patients from the Royal Children’s Hospital, Melbourne Patient pictures — patientpictures.com — a series of patient handouts with graphics to explain procedures and diseases

Access to resources There are many resources available free online or from organisations. There may be some at your practice already. Some subscriptions, such as eTG, may be available through your RTP, practice or hospital. Some resources are free from the RACGP with membership. In the past, free resources have included Murtagh’s texts and subscriptions to AMH or eTG. The RACGP John Murtagh Library lends to all members. This is a great service with the books posted to your door, racgp.org.au/library. Ask your RTP about nearby libraries that may hold relevant texts or DVDs Contributed by Dr Christine Willis

GPSN — Breathing new life into general practice

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GPSNcalendar 2013 National and international key dates GPSN Council Meeting, Canberra

18–20 March (Mon–Wed)

Breathing New Life into General Practice Conference, Canberra 19 March (Tue) GPSN First Wave Scholarship

Applications open 27 May, close 31 June

GPSN First Wave Scholarship Orientation Workshop, Perth

17–18 August (Sat–Sun)

GPSN First Wave Scholarship Orientation Workshop, Sydney

31 August–1 September (Sat–Sun)

GPSN National Council Meeting

19–20 October (Sat–Sun)

Local dates Check with your local GPSN club and GP Student Ambassador for dates and details of events at your university or a university near you — icebreakers, social networking events, clinical skills workshops, career planning events and more!

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