GP First 2015 by GPRA Publications

GP First The essential guide for medical students and prevocational doctors

Inside Clinical placement tips Internship facts AGPT selection What you can earn Surviving it all

2015

Q: With over 40 in-house specialist medico-legal experts, who’s ready

Dr. Angie Di Re Avant member

Avant. Experience you can always count on. We’re Avant. We’re Australia’s largest MDO and we’ve got 120 years of experience defending doctors’ good names. With over 40 specialist medico-legal experts in-house ready to protect and defend you, we’re on-call 24/7. So whatever situation you find yourself in, we’re always available to give you personalised support and advice.

To find out more, call 1800 128 268 or visit avant.org.au

Not all doctors are the same. The same goes for MDOs. That’s why you need to choose one with more expertise and more experience. Avant is owned and run purely for the benefit of its doctor members. So if you’re looking for experience you can always count on, Avant is the answer.

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Your Advantage

* IMPORTANT: Professional indemnity insurance products 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, conditions, and exclusions that apply, please read and consider the policy wording and PDS, which is available at www.avant.org.au or by contacting us on 1800 128 268.

GP First 2015 GP First: The essential guide for medical students and prevocational doctors is produced by the General Practice Students Network and the Going Places Network â&#x20AC;&#x201C; initiatives of General Practice Registrars Australia Ltd.

The aim of GP First is to assist medical students and prevocational doctors make informed decisions about their future training and career aspirations. This 2015 edition includes information on clinical placements; hospital internship; general practice pathways, including information on the Australian General Practice Training program; how much you can earn as a registrar and general practitioner; and support, including exam survival tips and general practice resources.

GP First: The essential guide for medical students and prevocational doctors 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 general practitioners, and their families, in their quest for sustainable careers in general practice.

General Practice Registrars Australia Ltd is the voice and peak body for the next generation of general practitioners. We work to improve the health care of all Australians through excellence in education and training, and by promoting general practice as the medical specialty of choice.

GPRA would like to acknowledge the support of our patron, Professor Michael Kidd AM. Professor Kidd is Executive Dean of the Faculty of Health Sciences at Flinders University, President of the World Organization of Family Doctors and past president of The Royal Australian College of General Practitioners.

Editorial team CEO: Sally Kincaid Editor: Denese Warmington

Writers: Jan Walker, Denese Warmington Graphic Designer: Peter Fitzgerald General Manager Marketing and Communications: Wayne Bruton

© GPRA, 2015. All rights are reserved. All materials contained in this publication are protected by Australian copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior permission of General Practice Registrars Australia Ltd (GPRA) or in the case of third party material, the owner of that content. You may not alter or remove any trademark, copyright or other notice from copies of the publication. No part of this publication may be reproduced without prior permission and full acknowledgement of the source: GP First, a publication of General Practice Registrars Australia. All efforts have been made to ensure that material presented in this publication was correct at the time of printing and published in good faith. GPRA does not accept liability for the use of information within this publication. Due to the rapidly changing nature of the industry, GPRA does not make any warranty or guarantee concerning the accuracy or reliability of this content. Published by General Practice Registrars Australia Ltd. Level 1, 517 Flinders Lane, Melbourne VIC 3001. ABN 60 108 076 704 ISSN 2203-143X GPRA wish to acknowledge the ongoing support of the Australian Government Department of Health. Printed by Graphic Impressions

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Medical students – gpsn.org.au

Prevocational doctors – gpaustralia.org.au

Contents 1 About us 6 8 11 12 14

What is GPRA? General Practice Students Network GPSN Club Chairs Going Places Network GPN Ambassadors

2 General practice – the first choice 18 10 great reasons to be a GP 20 Dr Patrick McCarthy on the appeal of general practice 3 At medical school 25 27 28 30 32

Clinical placement survival tips John Murtagh First Wave Scholarship program Sandy Braiuka on her First Wave experience Your general practice questions answered GPSN working groups

4 In the hospital 34 Fast facts 35 Making it work for you 36 Dr Jen McAuliffe on being an intern

On the cover

Read GPSN National Chair Nicola Campbell’s clinical placement survival tips on page 25.

45 46 49 50 53 55 56 57 58

AGPT selection ACRRM Fellowship Remote Vocational Training Scheme Dr Sarah Farlow on being a rural generalist RACGP Fellowship RACGP Fellowship in Advanced Rural General Practice Part-time training The 10-year moratorium Dr Gihan Gunawardena’s journey to general practice

6 Money matters 62 What you can earn 63 Incentive payments 7 Survival tips 66 Looking after yourself 68 Dr Jon Priestley on support 71 Exam survival 8 Info file 75 Jargon buster 78 General practice resources

5 General practice pathways 41 Changes in the general practice landscape 43 How do I get into general practice training? 44 Training providers

GP First – The essential guide for medical students and prevocational doctors

Q:Who sets the standard in winning cases for its members?

Dr. Michael Nguyen Avant member

Avant. Experience when it matters most. You’ve worked hard to earn your reputation. We’ll work even harder to protect it. We’re Avant. And for over 120 years we’ve been defending doctors’ good names. We’re Australia’s largest MDO. We have over 40 specialist medico-legal experts in-house ready to defend you. We’re on-call 24/7 for the best advice and support whenever you need it. And you can be sure we’ll dedicate to you the same superior

To find out more, call 1800 128 268 or visit avant.org.au

defence that won many landmark cases such as Varipatis v Almario. Not all doctors are the same. The same goes for MDOs. That’s why you need to choose one with more expertise and more experience. Avant is owned and run purely for the benefit of its doctor members. So if you’re looking for an MDO that’s dedicated to defending your reputation, Avant is the answer.

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Your Advantage

1 About us

What is GPRA? General Practice Registrars Australia (GPRA) is a not-for-profit organisation representing more than 21 000 medical students, prevocational doctors and general practice registrars through targeted networks and activities. GPRA is the only organisation in Australia that has a cohesive, vertically integrated network which services medical students, prevocational doctors and GP registrars and provides the pipeline for transition into the Australian General Practice Training program. GPRA is the peak voice for the next generation of general practitioners. Its primary objectives are to improve the health care of all Australians through excellence in education and training, and to ensure that general practice is a medical specialty of choice.

GPRA networks GPRA has developed several general practice support networks for individuals with a common purpose and background. The networks are run by a number of highly committed volunteers, and provide members with opportunities for leadership and involvement in policy development. Since inception, these networks have produced over 120 potential GP leaders each year. The GPRA networks support:

• Medical students who wish to learn more about a career in general practice

• Prevocational doctors in hospitals who are interested in a career in general practice

• Registrars who are:

– undertaking general practice training – Aboriginal and/or Torres Strait Islander – interested in a career in medical education or general practice supervision.

Medical students – gpsn.org.au

GP First GP First is a program that has successfully ignited the conversation about general practice as a career specialty of choice in universities and hospitals around Australia. GP First was developed to increase the supply of doctors entering general practice and to enhance the understanding of the integration between primary and secondary health care among medical students and prevocational doctors. GP First delivers key programs aimed at increasing the profile of general practice among medical students and hospital-based doctors. The GP First program encompasses the:

• General Practice Students Network • John Murtagh First Wave Scholarship program • Going Places Network. General Practice Students Network

The General Practice Students Network (GPSN) is a national organisation run by medical students for medical students. It uses a peer-to-peer marketing model to encourage and assist students specialising in general practice. GPSN offers activities focused on exposing medical students to the diverse world of general practice including:

• career focused and social events • seminars and conferences • clinical skills sessions • networking opportunities • peer support.

GPSN has a presence in all medical schools throughout Australia. Prevocational doctors – gpaustralia.org.au

1 About us

John Murtagh First Wave Scholarship program GPSN is also responsible for administering the John Murtagh First Wave Scholarship program. This program gives selected applicants the opportunity to gain hands-on experience in general practice.

Going Places Network

during hospital training. It provides a single, clearly identifiable source of access, information and career advice about general practice for prevocational doctors. The network runs a series of events around the country and has a presence in 65 percent of all teaching hospitals throughout Australia.

The Going Places Network (GPN) is a prevocational doctor network that promotes exploration of the world of general practice

GP First â&#x20AC;&#x201C; The essential guide for medical students and prevocational doctors

GPRA networks

General Practice Students Network The General Practice Students Network has more than 11 000 members and is run by university club chairs – medical students with a passion for general practice. The club chairs promote GPSN at their university and are a point-of-contact for other medical students with general practice career questions. Overseeing the local clubs is a national executive team comprising a national chair, national vice chair, national secretary, working group officer,

Meet the team Nicola Campbell National Chair

Griffith University, Queensland What three words describe you? Driven, quirky, exuberant. What do you enjoy about general practice? I love every part of medicine I encounter. Send me to psychiatry and I will become fascinated by the mind, to surgery and I will fall in love with suturing, throw me on a medical ward and my eyes will light up when I get to use my stethoscope, allow me on a paediatric ward and I will attempt to make balloon animals after rounds. For me, general practice is the ultimate specialty.

national events officer, communications and online media officer, sponsorship officer, online officer, publications and promotions officer and a local events officer. GPSN provides a range of educational and professional resources to all medical students including academic, professional and social events; publications, such as GP Companion; e-newsletters and website; and the John Murtagh First Wave Scholarship program. Goals for 2015 I have so many goals for 2015 that I’m almost finding it hard to study for exams! Next year I would love to see us continuing to lay down groundwork for the local clubs to build on; to make sure each year is bigger and better than the last at every medical school around the country. I’d love to see us engaging even more with our members through social media and our website. The working groups have been going brilliantly and I want to make sure our executive supports them in continuing their work and projects.

Who inspires you? Throughout my university career and my time in GPSN I’ve come across a number of people who inspire me. Dr Liz Marles, Professor Michael Kidd, a huge list of my colleagues and my teachers over the past few years. I would broadly say that I’m inspired by people who channel their passion and enthusiasm into their work, and who use that to engage the people around them – be it their patients, students or colleagues. 8

Medical students – gpsn.org.au

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1 About us

Rajdeep Ubeja National Vice Chair

Emma Thompson National Secretary

University of Western Sydney

University of Notre Dame Sydney

What three words describe you? Driven, professional, cheeky.

What three words describe you? Compassionate, passionate, focused.

What do you enjoy about general practice? The community involvement, the flexibility and the constant requirement for problem solving.

What do you enjoy about general practice? General practice is the frontline of good patient care. Being part of a patientâ&#x20AC;&#x2122;s life through health and illness is an incredibly privileged position and has the potential for much change and benefit for the patient, and for the doctor.

Who inspires you? Anyone who ever had a goal, that for most would seem inconceivable, and followed through to succeed. Goals for 2015 To ensure our organisation not only continues to improve in 2015, but is supported to grow and flourish for years to come.

Goals for 2015 My goal is for a smooth transition from an exciting 2014 into 2015 as we head towards further growth of the organisation and through that, greater promotion of general practice.

GP First â&#x20AC;&#x201C; The essential guide for medical students and prevocational doctors

National Executive Team contacts Jaislie Anderson National Events Officer

Chair Nicola Campbell

University of Western Sydney

Vice Chair Rajdeep Ubeja

What aspects of general practice appeal to you? I love the prospect of having longevity of care with my patients and having the opportunity to build a lasting professional relationship. My aim is to become a rural GP and the lifestyle that general practice has to offer in a rural setting is what attracts me most to the specialty. What is your favourite GPSN memory/event? That would have to be the UWS Close the Gap Rural Night held in 2014. We set up a lovely picnic feast for people to dig into while they learnt more about the health disparity between metropolitan and rural/remote areas. What are your top three study tips? 1. Get organised early! 2. Try to keep up-to-date. There’s nothing worse than trying to fit a semester’s work into the one-week study vacation before the exam period.

chair@gpsn.org.au vc@gpsn.org.au

Secretary Emma Thompson

ns@gpsn.org.au

Local Events Officer Rebecca Calder

leo@gpsn.org.au

Events Officer Jaislie Anderson

Sponsorship Officer Anmol Khanna

neo@gpsn.org.au sponsorship@gpsn.org.au

Working Groups Officer Claire Chandler

wgo@gpsn.org.au

Publications and Promotions Officer Esther Zhou publications@gpsn.org.au Communications and Online Media Officer Jarrod Bradley como@gpsn.org.au

3. Find some motivation – whether this is creating a zen study cave and cramming by yourself or getting a group of driven friends together who will force you to do some work – find what motivates you and harness it!

Want to know more?

For more information about the General Practice Students Network, visit gpsn.org.au 10

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1 About us

General Practice Students Network Club chair contacts NSW and ACT

Contact

University of New South Wales

unsw@gpsn.org.au

University of Sydney

usyd@gpsn.org.au

University of Western Sydney

westsyd@gpsn.org.au

University of Notre Dame Sydney undsyd@gpsn.org.au University of Wollongong

wollongong@gpsn.org.au

University of Newcastle

newcastle@gpsn.org.au

University of New England

newengland@gpsn.org.au

Australian National University

anu@gpsn.org.au

QLD University of Queensland

uq@gpsn.org.au

Bond University

bond@gpsn.org.au

Griffith University

griffith@gpsn.org.au

James Cook University

jcu@gpsn.org.au

SA and NT University of Adelaide

adelaide@gpsn.org.au

Flinders University

flinders@gpsn.org.au

Northern Territory Medical Program ntmp@gpsn.org.au VIC University of Melbourne

umelb@gpsn.org.au

Monash University

monash@gpsn.org.au

Deakin University

deakin@gpsn.org.au

TAS University of Tasmania

utas@gpsn.org.au

WA University of Western Australia

uwa@gpsn.org.au

University of Notre Dame Fremantle notredame@gpsn.org.au

GP First â&#x20AC;&#x201C; The essential guide for medical students and prevocational doctors

GPRA networks Going Places Network The Going Places Network is run by a team of GP Ambassadors – prevocational doctors with a real passion for general practice. These Ambassadors are dedicated to developing the network in their hospital and are a point-of-contact for other prevocational doctors wanting to know more about general practice.

We have more than 40 GP Ambassadors in hospitals throughout Australia; they are there to help and look forward to meeting you. Contact your local Ambassador and find out what GPN can do for you. Our Ambassadors are listed on pages 14–15 of this guide. In the meantime, meet three of the team.

GPN offers special events and promotional activities that expose hospital doctors to the inspiring diversity of a career in general practice. Activities include information sessions, clinical skills For more information about the Going Places workshops, social events, seminars and conferences, Network, visit gpaustralia.org.au peer support and networking opportunities.

Want to know more?

Dr Rowland Oak

Modbury Hospital, South Australia modbury@gpra.org.au As a GP, I’m looking forward to... Having my own practice one day and being part of a community. Why did you choose general practice? Autonomy, lifestyle, to help families, and to be part of the continuance of care in a primary care setting. Who or what inspires you? My beautiful wife and children. What three words describe you? Resourceful, respectful, funny (well I think I am!). What three things would you take to a deserted island? Sat phone, GPS and drinking water!

10 12

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Prevocational Junior doctors doctors –– gpaustralia.org.au gpaustralia.org.au

1 About us

Dr Angela Smith

Dr Tim Mulherin

Redcliffe Hospital, Queensland redcliffegp@gpra.org.au

Western Health,Victoria westerngp@gpra.org.au

As a GP, I’m looking forward to... Continuity of care. Holistic approach to healthcare.

As a GP, I’m looking forward to... developing a broad range of skills by training in rural Victoria.

Why did you choose general practice? Lifestyle. Continuity of care.

Why did you choose general practice? I have a short attention span so I’m hoping that general practice will allow me to jump from one thing to the next. I also plan to work in a developing country in the future.

Who or what inspires you? Everybody around me and in my life for different reasons – mostly my friends and family. What three words describe you? Efficient, organised, compassionate. What three things would you take to a deserted island? Music, book and my bikini!

Who or what inspires you? Kiwoko Hospital: a Christian hospital in Uganda. It inspires me to give each of my patients the utmost respect and the best medical care possible, regardless of wealth, belief or social standing. What three words describe you? Committed, intuitive, practical. What three things would you take to a deserted island? My gorgeous wife, sushi and iced coffee!

GP First – The essential guide for medical students and junior doctors

Going Places Network GP Ambassador contacts NSW

Contact

John Hunter Hospital

johnhuntergp@gpra.org.au

Gosford Hospital

gosfordgp@gpra.org.au

Bankstown Hospital

bankstowngp@gpra.org.au

Royal North Shore Hospital

royalnorthshoregp@gpra.org.au

Westmead Hospital

westmeadgp@gpra.org.au

Royal Prince Alfred Hospital

royalprincealfredgp@gpra.org.au

St George Hospital

stgeorgegp@gpra.org.au

The Canberra Hospital

canberragp@gpra.org.au

Hornsby Hospital Network

hornsbygp@gpra.org.au

Tamworth Hospital

tamworthgp@gpra.org.au

Wollongong Hospital

wollongonggp@gpra.org.au

QLD

Cairns Base Hospital

cairnsgp@gpra.org.au

Gold Coast Hospital

goldcoastgp@gpra.org.au

Logan Hospital

logangp@gpra.org.au

Nambour Hospital

nambourgp@gpra.org.au

Princess Alexandra Hospital

princessalexandragp@gpra.org.au

Redcliffe Hospital

redcliffegp@gpra.org.au

Rockhampton Hospital

rockhamptongp@gpra.org.au

Toowoomba Hospital

toowoombagp@gpra.org.au

Prince Charles Hospital

princecharlesgp@gpra.org.au

Greenslopes Hospital

greenslopesgp@gpra.org.au

Royal Brisbane and Women’s Hospital

royalbrisbanegp@gpra.org.au

Mater Hospital

matergp@gpra.org.au

Medical students – gpsn.org.au

Prevocational doctors – gpaustralia.org.au

1 About us

SA and NT

Contact

Flinders Medical Centre

flindersgp@gpra.org.au

Lyell McEwin Hospital

lyellmcewingp@gpra.org.au

Modbury Hospital

modburygp@gpra.org.au

Royal Adelaide Hospital

royaladelaidegp@gpra.org.au

The Queen Elizabeth Hospital

queenelizabethgp@gpra.org.au

Royal Darwin Hospital

darwingp@gpra.org.au

VIC Eastern Health

boxhillgp@gpra.org.au

Shepparton Hospital

sheppartongp@gpra.org.au

St Vincentâ&#x20AC;&#x2122;s Hospital

stvincentsgp@gpra.org.au

Austin Hospital

austingp@gpra.org.au

Ballarat Hospital

ballaratgp@gpra.org.au

Geelong Hospital

geelonggp@gpra.org.au

Northern Hospital

northernhealth@gpra.org.au

Western Health

westerngp@gpra.org.au

Monash Health

monashhealthgp@gpra.org.au

Albury Wondonga Health

wodongagp@gpra.org.au

TAS Royal Hobart Hospital

royalhobartgp@gpra.org.au

Launceston Hospital

launcestongp@gpra.org.au

WA Royal Perth Hospital

royalperthgp@gpra.org.au

Sir Charles Gairdner Hospital

charlesgairdnergp@gpra.org.au

Fiona Stanley Hospital

fionastanleygp@gpra.org.au

Joondalup Health Campus

joondalupgp@gpra.org.au

GP First â&#x20AC;&#x201C; The essential guide for medical students and prevocational doctors

Melbourne Convention Centre

22–24 April 2015

#fgp15

The Future of General Practice 2015 conference will bring together medical students, prevocational doctors and general practice registrars from around Australia and deliver an educational program that focuses on leadership and innovation. Outstanding industry leaders will present their views and opinions of general practice and the direction it is taking. Student education days will be held on 22–24 April, while the prevocational doctor and general practice registrar combined education days will be held on 23–24 April. This exciting new program will provide attendees with many networking opportunities. The social highlight will be an imaginatively themed cocktail party – with a twist – a not to miss event on the Thursday evening. For more information

fgp.org.au

2 General practice â&#x20AC;&#x201C; the first choice

10 great reasons to be a GP Think general practice is all about coughs and colds? Think again! 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.

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. 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 to many lives through both preventive and acute care.

4. Special interest? Subspecialise! GP registrars can undertake special skills posts in paediatrics, anaesthesia, emergency medicine, academia, obstetrics, public health and many others. The general practice training program offers all GP registrars an opportunity to pursue a subspecialty of their choice.

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 savings or enjoy a 9-to-5 lifestyle.

6. Enjoy the rewards

GPs are well remunerated, usually without the extremely long working hours faced by other specialties. There are also generous 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 page 62.

7. Flexible and funded

The AGPT and RVTS programs are funded by the Federal Government and there are some generous financial incentives for rural GP trainees. Rural GP trainees can also get a HECS rebate. For more information about financial incentives, see page 63. The general practice training program is typically a three-year program, with the first year hospital-based. This means you can apply as early as your intern year, however you may also apply after several years of hospital-based training. If you

General practice is a specialty

General practice was recognised as a medical specialty in 2010 by the Medical Board of Australia. That means GPs are considered ‘general specialists’. 18

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2 General practice – the first choice

register during your intern or PGY2 year, you may be able to complete your first resident year and subsequent hospital years as part of your GP training. For more information about the structure of the AGPT program, visit agpt.com.au

8. Supportive training, supportive workplace

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 and interactive environment. During your GP training you are always supported by experienced GP supervisors and medical educators from your training provider.

9. Seeing the good with the bad 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.

10. Wherever you want to go, general practice can take you there

Winter as a ship’s doctor in Antarctica; treat the kids to summer on an island on the Great Barrier Reef; pursue a research interest; fly around Australia treating medical emergencies: wherever you want to go, whatever you want to do, general practice can take you there.

Want to know more? Check out these websites: Going Places Network – gpaustralia.org.au ACRRM – acrrm.org.au AGPT – agpt.com.au GPRA – gpra.org.au RACGP – racgp.org.au

GP First – The essential guide for medical students and prevocational doctors

A career of broad horizons Dr Patrick McCarthy is a GP registrar with a special interest in teaching the GPs of the future. He reflects on his own career odyssey from the Irish countryside to the Queensland tropics. Cairns-based GP registrar Dr Patrick McCarthy vividly remembers scanning the faces of the people in the room at his general practice teaching sessions. “To my left might be a mum working part-time in her training and to the other side I might have a defence registrar with the army,” he recalls. “To the back there might be someone doing anaesthetics at a hospital and to the front there might be someone doing obstetrics.” Those faces were a graphic reminder of the diverse and flexible career paths general practice can take. “General practice is just like a patchwork. That’s something that appealed to me. There are all these basic competencies and thereafter you can mould your career to suit you,” he observes. For Patrick, finding his piece of the patchwork meant travelling halfway across the world. Patrick grew up on a dairy farm in the Irish countryside with a father who was a farmer and a mother who was a nurse, which gave him early exposure to the possibilities of a career in medicine. After completing his medical degree and intern year in Cork, he was ready to satisfy his wanderlust and broaden his horizons. He says his backpack contained no firm ideas about his future medical specialty but “I always had general practice in the back of my mind”. 20

Medical students – gpsn.org.au

“It’s quite common for Irish doctors to come to Australia or New Zealand for a year before starting their training to have an insight into an alternative health care system. I went to Wellington in New Zealand for a year and I had a great time doing geriatrics and paediatrics.” Patrick’s gap year ended up blowing out to several. As his job in New Zealand drew to a close, he applied for an emergency position at Redcliffe Hospital in Brisbane. He remembers arriving in Queensland on the night of the State of Origin and, as a keen rugby fan, he was swept up in the tribal fervour. “I think I became a Queenslander by default that night,” he says with a laugh. Patrick went on to immerse himself in some quintessential Australian experiences. “I did some remote medicine in central west Queensland where you’re the only doctor in the town. That was a very significant experience for me.” He worked in Winton, renowned as the birthplace of Qantas and Waltzing Matilda, and the outback mining town of Mount Isa. “I distinctly remember one night we were swimming in the hospital pool and looking up at the stars and I thought how did I end up here in this very remote place in the Australian outback. It was a self-aware moment of realising it was very different from where I’d come from,” Patrick recounts. He made the decision to stay. “During that time I decided to apply for general practice training in Australia,” he says. Now in his third year of training and an Australian citizen, Patrick says he loves the scope general practice gives him to develop special interests while maintaining a healthy work-life balance. Prevocational doctors – gpaustralia.org.au

2 General practice – the first choice

“General practice is just like a patchwork. That’s something that appealed to me.” GP First – The essential guide for medical students and prevocational doctors

Medical education is one of Patrick’s enthusiasms. In 2013 he combined clinical work with an academic term working alongside the medical educators at Tropical Medical Training and teaching students at James Cook University in Townsville.

Recently Patrick has been working at Barrier Reef Medical Centre, a general practice in Cairns. “My supervisor is a very engaging senior doctor and he is quite expert with musculoskeletal medicine – not something that I’m amazing at.

He also completed a focus-group based research project about medical students’ perceptions of medical educators and how this affects their learning, and presented his findings at the RACGP and GPET conferences that year.

“So during this rotation I’m seeing a lot of patients with a bit of a musculoskeletal focus. I’m examining joints, doing injections of joints, a lot of sports injuries – so it’s useful to gain those skills.”

Patrick continues to develop his expertise with postgraduate studies in medical education online through the University of Dundee, Scotland.

While Patrick loves his job, he strongly believes in work-life balance. “I enjoy outdoor pursuits. I like squash and rugby and I’ll do a little bit of hiking and bushwalking when it’s not too hot.

“I would certainly like to continue my involvement in medical education in the future. It’s a very rewarding role,” he says.

“I think general practice can be busy if you allow it to be but the difference between general practice and other specialties is that you have control.”

Patrick’s passion for medical education also finds form in his position as Chair of the General Practice Registrar Medical Educator Network (GPRMEN) through GPRA. “It’s a role where you coordinate webinars online for people who are interested in medical education and you can share resources with other registrar medical educators around Australia,” he explains.

Does Patrick have any words of wisdom for medical students and prevocational doctors at their career crossroads?

Men’s health and Aboriginal health are further areas of interest for Patrick. Six months working at Wuchopperen Health Service, an Aboriginal Community-Controlled Health Organisation in Cairns, proved illuminating. “I learnt a lot about Aboriginal and Torres Strait Islander culture and the differences became more apparent to me. For example, some of the patients from the Torres Strait have English as perhaps their third language. And I enjoyed working with the Aboriginal health workers – that’s an extra dynamic.”

Medical students – gpsn.org.au

“Keep an open mind and expose yourself to a broad range of specialties,” he says. “Prioritise your natural aptitudes and think about where you see yourself in five years or 10 years time. “I have lots of friends who are doing surgery and can think of nothing better than to be awake at 3am removing an appendix, but if that’s not you then maybe you shouldn’t be a surgeon. “On the other hand, if you’re looking for a career that offers a patchwork of possibilities you can adapt to suit your interests and lifestyle, general practice is a great choice.” Written by Jan Walker

Prevocational doctors – gpaustralia.org.au

3 At medical school

Dr Jasmine Banner Darwin, NT

“ I am part of MDA National because … they offer grassroots support through training and advocacy of junior doctors. They supported many societies and organisations that I was involved in during medical school, and these play a valuable role in the development of junior doctors. As my career grows, MDA National’s training and advocacy programs provide ongoing educational opportunities...

See what our Members say.

mdanational.com.au

”

Friendly. Approachable. Personable.

The MDA National Group is made up of MDA National Limited ABN 67 055 801 771 and MDA National Insurance Pty Ltd (MDA National Insurance) ABN 56 058 271 417 AFS Licence No. 238073. Insurance products provided by the MDA National Group are underwritten by MDA National Insurance. Before making a decision to buy or hold any products issued by MDA National Insurance, please consider your personal circumstances, and read the relevant Product Disclosure Statement and Policy Wording and Supplementary Product Disclosure Statement and the Endorsement to Policy Wording available at mdanational.com.au. DIT152

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3 At medical school

Clinical placement survival tips Heading out of the classroom to do some ‘real-life’ doctoring? Nicola Campbell, GPSN National Chair and fourth-year medical student, shares her tips. Before your placement Introduce yourself and iron out the logistics There is nothing worse when rushed or anxious and heading out the door than realising you don’t know who to report to or where to park your car. Make sure you get in touch with your supervisors early. Ask them what you should wear, what to bring, where to go and when, and make sure you pack the night before. If, like me, you struggle to wake up in the morning, invest in a loud alarm clock! Find out if your supervisor has special interests If your supervisor has a special interest in an area of medicine, read up on it. A little bit of effort goes a long way and can open up learning opportunities. Read Catch up on the basics. Try and do some reading before you start your placement. This can help avoid awkward silences that can follow simple questions.

During your placement

Take an iPad or handbook WiFi may not be available so it’s a good idea to take a hard copy of your favourite resource. I almost always carry my copy of GP Companion. Be engaged Remember that your supervisor is giving up their time to teach you, so make sure that you learn all you can. Ask lots of questions, or summarise back the lessons that your supervisor gives you – it shows that you were listening and helps you to clarify your understanding.

Show your appreciation If you’ve had an awesome placement, let the practice know. Take in a cake or a card, and make sure you say thank you. This lets the practice know that they’re doing a great job teaching and reflects well on you, and medical students generally. Keep a log This is probably my nerdiest suggestion, but possibly the most useful! I always log in my placements. I find that it helps me to reflect and identify areas I need to study up on. Take photos Especially if your placement is out of town, make sure you take photos. They will be handy if you ever have to give presentations on your placement.

After your placement

Read up on the things you saw One of the most effective ways I learn on placements is reading up on things after I’ve seen them. No one expects you to know everything, but they do expect you to identify where you need to read up and to follow up on that. Keep in touch If you had a good placement, make sure you keep in touch with the practice and your supervisors. It can be great for future placements and references. Share the joy Telling friends about your experiences can often help other people learn too. I had a placement where I saw a lot of patients with malignant hyperthermia and shared this with my colleagues over coffee. When this came up in their placements, they were able to answer curly questions because they remembered our conversation. Enthusiasm is infectious, so share your stories!

GP First – The essential guide for medical students and prevocational doctors

â&#x20AC;&#x153;GP Companion was an invaluable tool as a student and has proven to be vital as a prevocational doctor.â&#x20AC;? Dr Joesph Monteith (past GPSN National Chair)

Buy your GP Companion online at the member discount price of

$19.95 RRP $34.95

Students visit

gpsn.org.au

Prevocational doctors visit

gpaustralia.org.au

3 At medical school

The John Murtagh First Wave Scholarship program What is the program?

How does it work?

Honouring the former GPRA Patron Professor John Murtagh, the John Murtagh First Wave Scholarship program (previously known as the First Wave Scholarship) provides positive, early and structured exposure to general practice in a range of settings including urban, outer metropolitan, rural and Aboriginal Medical Services.

Candidates apply via a formal online process. Successful candidates are then matched with a GP who mentors them during their scholarship period.

Who can apply? First and second year medical students studying at an Australian medical university.

What does it involve?

When can I apply?

The scholarship involves completing a series of supervised sessions in a clinical practice. Clinical sessions are generally scheduled during university summer holidays. Participants are also required to attend a fully funded two-day orientation workshop.

Applications open 29 May 2015 and close 3 July 2015.

How do I apply? The John Murtagh First Wave Scholarship program is advertised online and at participating university campuses through their local GPSN club. For more information, visit gpsn.org.au or email firstwave@gpra.org.au

GP First â&#x20AC;&#x201C; The essential guide for medical students and prevocational doctors

27 25

“There’s a real Hope inspired ‘team’ feel here ... we are very collaborative.” Sandy Braiuka, a fourth-year medical student from the University of Notre Dame Fremantle, tells us about her First Wave Scholarship program placement at an Aboriginal Medical Service in Western Australia.

Where did you do your placement? I was based at Bega Garnbarringu, the Aboriginal Medical Service in Kalgoorlie. ‘Bega’ as it is more affectionately known, is an Aboriginal-controlled, health service tasked with providing a holistic and culturally appropriate service to Aboriginal people in the Goldfields. Bega Garnbirringu means sickness gets better and it was easy to see that many members of this community have that faith in their centre. An important aspect of the care Bega is able to offer is that local Aboriginal people are encouraged and supported by training programs to become Aboriginal health workers (AHWs) and to play a role in promoting health in their community.

What was the highlight? One of the highlights was spending a morning with Tony Ugle, the highly respected driver of the Bega bus, who collects patients from outlying communities and brings them to Bega for their appointments. This gave me insight into the social situation of some of Bega’s patients and highlighted some of the challenges of giving and receiving care in Aboriginal communities. Also having the opportunity to work with extended families was a challenge, but great fun. What was it like working in an Aboriginal Medical Service? The holistic and comprehensive approach at Bega impressed me and I feel that many non-Aboriginal health centres could learn from this approach. So many health services are available under the one roof (or actually several roofs, but all in

What did you do while on your placement? My week comprised a variety of activities conducting point-of-care testing with the AHWs and RNs, sitting in with visiting specialists, conducting consultations with supervision from GPs, attending healthy cooking demonstrations, and spending time with the midwives in the New Directions (child/ maternal health) program.

Sandy with a ‘friend’ at a subsequent placement in Africa 28

Medical students – gpsn.org.au

Prevocational doctors – gpaustralia.org.au

3 At medical school

close proximity), including GPs and allied health professionals such as psychologists, counsellors, diabetes educators, speech therapists, audiologists and nutritionists. Bega also offers short-term housing for pregnant women in their last trimester coming in from the communities to have their baby. It was amazing to be part of a team offering such a comprehensive service. Did you get to spend much time in the community? Not as much as I might have liked. A week was so short! What was your GP supervisor like? I didnâ&#x20AC;&#x2122;t have one main supervisor but spent time instead with most of the team members. Natasha Bonney was the centre coordinator and provided my tour of Bega on arrival and ensured I was introduced to the very welcoming team of GPs,

AHWs, RNs, midwives and specialists. The GPs I sat in with were inspiring. Their approach was thorough and they took as much time as they needed with their clients/patients. Point-of-care testing conducted by AHWs and RNs allows up-to-date information on kidney function, blood sugar management and general health to be available when the client was seen by the GP. Retinal screening can also be done in-house. In the week I visited, appointments were also available with renal and diabetes specialists, a diabetes educator, childhood immunisation clinic and home visits were scheduled by one of the AHWs. The mobile clinic was being prepared for the trip to Esperance and communities in between, for the following week. What was the most important thing you learnt on your placement? Prior to my placement at Bega, I had certainly been aware of health inequities and outcomes for Aboriginal people but I had been filled with a sense of despair that, despite government and non-government initiatives, little seemed to have improved in the past 20 years or so in terms of mortality and morbidity statistics for Aboriginal people in Australia. What I saw and experienced at Bega inspired hope. While the model of care provided by Bega draws on a Western medical approach, it does so in a way that is more meaningful for Aboriginal people, relying heavily on input and involvement from the community. I feel blessed to have been witness to that and grateful for the opportunity to explore a new field of medicine for me, one which now holds tremendous appeal. I find myself intrigued by the complexities and inspired by the chance to make a difference.

GP First â&#x20AC;&#x201C; The essential guide for medical students and prevocational doctors

“There’s a real General practice? ‘team’ feel here ... Your questions answered we are very collaborative.” medical centres. Registrars also undertake an

Dr Jas Saini, GP registrar and GPRA Board Director, answers our medical students’ top five questions about general practice. What is general practice?

extended skills term and can pursue areas of special interest, such as procedural and academic general practice. More detailed information on the training program can be found in the 2016 AGPT Applicant Guide. Visit agpt.com.au

According to The Royal Australian College of General Practitioners (RACGP), general practice is a medical specialty that provides ‘person centred, comprehensive and coordinated whole-person health care to individuals and families in their communities’. A general practitioner is a doctor who treats acute and chronic diseases, which are often in their early stages of development and undifferentiated.

Is entry competitive? And what can I do to improve my chances?

For a more detailed definition of general practice and its principles, visit the RACGP website at racgp.org.au/becomingagp/what-is-a-gp/what-isgeneral-practice/

If you are interested in the AGPT program, you can check whether you are eligible using the Program Eligibility Guide in the 2016 AGPT handbook, which is accessible at agpt.com.au

How long is the general practice training program? The training program involves either a three or four-year full time commitment. Most registrars pursuing the RACGP Fellowship (FRACGP) are able to do so in three years. For those registrars interested in either Fellowship of the Australian College of Rural and Remote Medicine (FACRRM) or the Fellowship in Advanced Rural General Practice (FARGP), this is generally acquired over four years. General practice training is quite varied and registrars acquire experience in different training locations. These locations may include teaching hospitals, rural and urban practices and specialist

Medical students – gpsn.org.au

The Australian Government places a quota on the number of AGPT positions available, therefore entry into the program is competitive. The best way of improving your chance of entry into the program is to understand the requirements needed for entry and to speak to registrars currently in the program.

When can you start general practice training? You can apply to the training program as early as from your intern (PGY1) year. Applicants in later stages of training/employment might be eligible to apply for recognition of prior learning for their hospital-based general practice training component. What do I need to do during my intern and resident years to make me eligible for training? Great question. There are specific hospital rotations that are mandatory for entry into the AGPT program. These will differ between the two colleges (ACRRM and the RACGP). Prospective applicants should refer to the relevant college documents and discuss with their preferred training providers for more information. Prevocational doctors – gpaustralia.org.au

3 At medical school

Want to know more? ACRRM – Core Clinical Training Policy: acrrm.org.au/operational-policies

RACGP – General practice: Connecting the dots for students and junior doctors: racgp.org.au/becomingagp/students/

GP First – The essential guide for medical students and prevocational doctors

“There’s aworking real GPSN ‘team’ feel here ... we are very collaborative.”

groups

What are GPSN working groups?

Rural Working Group

The GPSN working groups were set up in April 2013 to develop national initiatives that tackle important issues facing medical students. The groups aim to provide experience and a pathway for students wishing to pursue further roles in policy making, research and public health as well as increasing the productivity of GPSN at a national level.

The Rural Working Group will tackle rural workforce distribution issues by developing new initiatives to promote rural general practice to medical students.

The groups work by responding to real needs in medical schools and the community with research and project development.

Close the Gap Working Group

The Close the Gap Working Group aims to encourage all medical students to make closing the gap and Indigenous health a priority in their future practice. The group will also develop programs to provide support to Aboriginal and Torres Strait Islander students during their time at medical school.

Medical students – gpsn.org.au

Policy Working Group

The Policy Working Group will develop new internal and external policy to ensure GPSN is able to support and advocate for medical students and future general practitioners.

Community Working Group

The Community Working Group will produce opportunities for medical students to volunteer in primary care and community care programs in the local community. If you would like to join a GPSN working group, contact the GSPN National Working Group Officer, Claire Chandler, at wgo@gpsn.org.au For more information about the working groups, visit gpsn.org.au

Prevocational doctors – gpaustralia.org.au

4 In the hospital

GP First â&#x20AC;&#x201C; The essential guide for medical students and junior doctors

In the hospital Fast facts When can I apply to the AGPT program?

How long do I have to spend in the hospital system?

During your intern year you can apply to the Australian General Practice Training (AGPT) program and undertake your second year (PGY2) as part of general practice training. There are hospital rotations that are compulsory in general practice training.

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. After being accepted into the training program, you apply for RPL.You must apply for RPL with your training provider within your first year in the program.

What rotations will I need to do?

Before leaving the hospital system the RACGP requires three relevant elective hospital rotations of your choice plus compulsory rotations in:

• general medicine • general surgery • emergency medicine • paediatrics.

ACRRM requires these four compulsory rotations plus obstetrics and gynaecology, and anaesthetics.

There are some restrictions for RPL, so look into it early and before choosing your rotations. For more information about compulsory hospital rotations for general practice training, visit:

• AGPT – agpt.com.au • ACRRM – acrrm.org.au • RACGP – racgp.org.au

gpsn.org.au Medical students – gpsn.org.au

Junior doctors Prevocational doctors –– gpaustralia.org.au gpaustralia.org.au

4 In the hospital

Making it work for you Top tips As a prevocational doctor in hospital or a student preparing to graduate, it’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 our top tips to help you make the most of your hospital experience. Choose your terms

Choose terms that will give you experience with common GP-managed conditions. Mandatory and other useful rotations are listed on page 34. 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. Mental health and women’s health are also big parts of general practice.

Fine-tune your practical skills

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

Pick up useful procedural skills

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.

Practise your writing

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.

Find out who’s who

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.

Join GPN

Join the Going Places Network at your hospital. It’s a fun way to learn more about general practice, and network with peers and mentors who also have an interest in the specialty. Join today: fill out the membership form at the back of this guide or visit gpaustralia.org.au

Learn procedural skills that may be useful in general practice: joint aspirations and injections, excision of cysts and skin lesions. GP First – The essential guide for medical students and prevocational doctors

“There’s a realthe “I’m just ‘team’ feel here ... we are very collaborative.”

intern...”

Dr Jen McAuliffe, a prevocational doctor at Mater Hospital in Brisbane, takes a light-hearted look at the life of an intern and passes on some sound advice.

Like most new medical graduates, the prospect of starting internship and officially being a doctor was a smidge intimidating. Although if you asked me at the time, I’m sure I would have given you some asinine comment about it mostly being paperwork, and that if those before me could, then so too could I ! Comically enough, this is the line I’ve stuck with when being questioned by the newest intake of medical students. To some extent though, it does hold true. There is a lot of paperwork. But there is also a whole lot more responsibility and there are times where the buck stops with you. Thankfully these times are (somewhat) rare, but they do exist. It’s as though graduation is the flicking of a switch and suddenly you now possess all the skills to identify and manage sick patients that you aren’t sure you really learned during medical school.Yay! However, since I’ve survived so far without a breakdown, I must be qualified to write this piece instructing you all on how to survive your internship (I feel like this is where a sensible disclaimer belongs!) and answer the questions the team at GPRA have given me. What’s it like being called ‘doctor’ for the first time? Most of us have probably been mistaken for a doctor or nurse at least once during our time in medical school. Post-medical school it seems patients have a harder time believing that you are the doctor than they did before you were the doctor! Suddenly you look too young to be a doctor. I’ve decided that with the addition of two letters in front of my name, I lost two years off my age… and I’m going with it! Seriously though, it’s kind of exhilarating. As long as your patient is well and happy, less great when your patient isn’t so well or happy. Frustratingly

Medical students – gpsn.org.au

Prevocational doctors – gpaustralia.org.au

4 In the hospital

and sometimes highly droll when as a first yearout rookie, your say-so (with your two days of experience on a neonatal/paediatric rotation) counts more to the parents of a newborn than the say-so of a midwife or nurse with 20+ years experience. Crazy right? What do you like about working at the Mater Hospital? I am really enjoying my time at Mater. It’s a tertiary hospital but is smaller by comparison to others in Brisbane. I’ve had a lot of hands-on opportunities that I perhaps wouldn’t have had in a larger hospital, which I’ve really appreciated. The Mater is well known for its O&G work, but it’s also a pretty good place to prepare for being a GP. Is the hospital a big leap in responsibility compared to medical school? In a word: ‘Yes’. The intern (on most rotations) knows the patients better than anyone else on the team.You know their history, their allergies, and when their condition deteriorates because you are the one on the ward with them every day. The hospital for the most part is a very supportive environment. But there are always times when your registrar is busy in clinic or theatre and your consultant is at another hospital or on a day off. Have you ever felt like you were thrown in the deep end? Yes. It’s just the way things are on some rotations. It’s important to know who to go to for help and at what point. What do you like about being in the hospital setting? The team. The best part of working in a hospital is that there is you, your team, the nursing/midwifery staff, allied health and more. The camaraderie is really what gets you through the tough days.

Is there a rotation that particularly stands out for you? Surgery. It was my first rotation of the year. I did heaps of primary assisting, did a minor procedure or two myself and was basically responsible for managing the medical issues of the surgical patients on the ward. It felt like I was being a ‘proper doctor’ and it was great. Scary at times, but great. What hours are you working? It really depends on your rotation. At the moment I’m on O&G doing an after-hours roster and about to start a run of 12-hour night shifts. Not super fun, but part of the job. There is some overtime, and it’s not all paid. Sometimes it’s about prioritising your work better and being more efficient, and other times the proverbial hits the fan and you have to stay and care for your patient. But it’s all part of the job and that’s why we do it. A 9-to-5 job would be way too boring for me! What’s your advice for managing a challenging day or long hours? Outside of work: rest when you can. Try not to skip exercise all together if possible. Eat healthy as often as you can. Eating junk food feels right at the time, but it only compounds the tiredness and exhaustion at the end of it all. At work: carry food and water with you, especially on days you know will be busy. Nuts, fruit, protein snacks, muesli bars, anything that will keep you from a hypo-anger rage. How do you deal with conflict with other hospital staff? Firstly, avoid it where possible. Nobody’s got time for that. But occasionally, conflict is inevitable. And it’s worth taking care in what you say to people and avoid gossip. In terms of dealing with conflict, it’s no different in a hospital setting to any other job. Be sensible, talk to the person, listen and find

GP First – The essential guide for medical students and prevocational doctors

a compromise or communicate effectively when a compromise (sometimes with a patient’s care) can’t be made. Above all, don’t burn any bridges. A hospital is a really small place and the world of medicine talks. Do you have a good rapport with the other interns? Of course! Well at least I like to think so and people are nice to my face... but... jokes aside, it’s really important to have good rapport with your colleagues. They are the ones who will help you with a cannula you just can’t get in, or take those bloods when you’re needed in theatre and on the ward at the same time and getting slammed by pages (that are probably about said bloods and theatre). Above all else, you’re at the bottom of the food chain together. You have to take care of each other. What should be considered when choosing a hospital? Some say it’s important to choose a hospital based on the specialty you want to pursue; others say tertiary above all else. It’s kind of the same argument as choosing a medical school. Just as medical school is what you make of it, so is internship. It really doesn’t matter where you end up, and we don’t all get to go where we want. Good learning experiences can be found anywhere if you are interested enough. Do your research: check on hours, teaching time, location and what the lifestyle is like if you need to relocate. All the sensible things adults are supposed to do. Okay, so that’s it! All else aside, don’t worry too much. The job really is just paperwork and administration. And if I can do it, so can you!

Medical students – gpsn.org.au

Jen’s top tips for surviving your internship

Do... •

Make friends with your colleagues, nursing staff and care staff. You will need help. A lot. It’s good to have people on your side when the going gets tough.

• Do as much of an intern’s job as possible during

medical school. Do the paperwork, request the CT, make the phone referral.You will thank yourself a million times over when in the first week these aren’t the things that are breaking you.

This can’t be stressed enough. It’s really important to know what is within your scope of practice as an intern on each of your rotations. What is okay for you to manage, what isn’t and when to ask for help if things start to go awry.

• Learn how to prioritise and ASK for help!

Don’t...

• Be afraid to make a MET call.There is a reason

•

for the ‘or if you are concerned about the patient’ qualifier. Use it. There will be more trouble if the patient deteriorates and you did nothing. It happens.

Call the anaesthetics registrar on call and ask for the cannulation service.You will have a bad day.

•

Think you have no time for food and water. You can’t function without food.You can’t take care of others if you don’t care for yourself. (Did you all just roll your eyes too?)

Prevocational doctors – gpaustralia.org.au

5 General practice pathways

GP First â&#x20AC;&#x201C; The essential guide for medical students and junior doctors

5 General practice pathways

Changes in the general practice landscape Changes to the general practice training program announced by the Federal Government in May 2014 have led to a major restructure of the administrative aspects of the program. With changes due to come into affect some time in 2015, GP First answers your key questions. How are the changes going to be articulated to current and future candidates?

during these administrative changes. If you need support or advice during your general practice training, contact the GPRA registrar services team at registrarenquiries@gpra.org.au When will new training providers and the regions they cover be announced? The new general practice training landscape should be confirmed by July 2015. When the changes are confirmed all information will be available on the GPN website at gpaustralia.org.au Members will be kept well informed and updated as information arises via regular e-blasts and our bi-monthly e-newsletter. Who will run the application and interview process?

Current and future candidates who are members of the Going Places Network will be kept informed about the changes via regular e-blasts. Updates will also be posted on the GPN website at gpaustralia.org.au

The two general practice medical colleges â&#x20AC;&#x201C; ACRRM and the RACGP â&#x20AC;&#x201C; will run the application and selection process that was previously administered by GPET. Visit gpaustralia.org.au for more information.

If you are a prevocational doctor and would like to be kept informed about the changes, visit gpaustralia.org.au and join today. Membership is free.

Will the level of experience candidates gain in general practice change?

How much notice will current registrars receive before these changes take place?

How will centralising administration and amalgamating training organisations be better?

Current registrars will be given ample notice of these changes and there should be no interruption to their training. However, in the event that their existing training provider faces difficulties, the Department of Health has a business continuity plan in place.

Refining and improving the current training model will streamline and improve the training and administrative processes.

How will the changes affect registrars currently on the program and starting general practice terms after December 2015? Registrars commencing training after December 2015 will be informed of all changes. The quality of general practice training will not be compromised

The general practice training model is of a high standard and that standard will be maintained.

Will the rural and general pathway streams still be available? General practice registrars can continue to elect the rural and general pathway streams. Will rural and remote training be impacted by reduced numbers of training providers? General practice training in rural and remote areas will not be affected by the changes.

GP First â&#x20AC;&#x201C; The essential guide for medical students and prevocational doctors

FRANKSTONÂMORNINGTON PENINSULA

Outer Metropolitan Relocation Incentive Grant Program â&#x20AC;&#x201D; OMRIG

Looking for a change of scenery? Or completing the General Pathway of the AGPT? This exciting opportunity for grants of up to $40,000 is available to eligible GP Registrars who are looking to work in outer metro areas. Working in an outer metro area can be a rewarding, challenging and fulfilling experience. Financial assistance is available to eligible practitioners. GP Registrars who are imminently to achieve fellowship may apply within 3 months of obtaining registration as a GP irrespective of their current practice location. To find out more about the program, please contact either of the numbers listed below. Bayside Medicare Local & Frankston Mornington Peninsula Medicare Locals Tracey Sultana t: 03 8514 1058 e: Tracey.Sultana@bml.org.au South Eastern Melbourne Medicare Local Rose Griffiths t: 03 8792 1911 e: R.Griffiths@semml.com.au

5 General practice pathways

How do I get into general practice training? Applications to the Australian General Practice Training (AGPT) program can be made as early as your intern (PGY1) year. Once you are enrolled in the AGPT program you are then eligible to apply for recognition of prior learning (RPL). Applications for RPL are made with your training provider to the relevant college, being ACRRM or the RACGP. It is the college that determines whether you receive RPL, or how much RPL. Applications for consideration of RPL is not possible prior to commencement of the AGPT program. To apply for the AGPT program you must meet certain eligibility requirements. To determine if you meet the AGPT eligibility requirements please visit the AGPT website at agpt.com.au or review the 2016 AGPT handbook.

When can I apply? Applications will open on 13 April 2015 and close on 8 May 2015 for the 2016 intake of the AGPT program. There are 1500 funded training places in the program and at least 50 percent of applicants must select the rural pathway for the location of their training.

How do I apply? Applications are completed online at agpt.com.au

Want to know more? For more information, visit agpt.com.au

Firstessential â&#x20AC;&#x201C; The essential for medical and junior doctors doctors GP FirstGP â&#x20AC;&#x201C; The guide forguide medical studentsstudents and prevocational

43 43

Training providers Feeling confused about the government changes to the delivery of general practice training? Read on… A network of 17 regional training providers currently deliver training of general practice registrars across the country. Changes to general practice training announced by the Federal Government in May 2014 have led to a major restructure of this network, with current training providers winding up by the end of 2015. At the time of going to print, the Federal Government had not made a final decision on just how this new network will look. However, what is clear, is that there will be significantly fewer training providers, leading to more streamlined administration and significant cost efficiencies. Until the end of 2014, the general practice training program was administered by a government agency, General Practice Education and Training (GPET). As part of the Federal Government’s reforms, this agency has been closed, with its administrative functions being taken over by the Australian Government Department of Health, along with the two general practice colleges, The Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM).

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In the past, prospective general practice trainees applied to be accepted into training with one of the 17 regional training providers and GP First provided significant information on each training provider to assist in that decision-making process. Unfortunately that information was not available when this edition of GP First went to print in December 2015. GPRA will be keeping all members and other prevocational doctors interested in general practice training informed of the changes as they are announced. If you are considering applying to general practice training, please check the Going Places Network website at gpaustralia.org.au for the most up-todate information. We will also be sending regular e-mail updates to our members. If you are not currently a member, join the General Practice Students Network at gpsn.org.au or the Going Places Network. at gpaustralia.org.au Alternatively, fill out the membership form at the back of this guide. Joining one of our networks will ensure you receive information on a range of educational, social and information events pertinent to general practice in your area, keeping you informed and in touch with other potential and future general practitioners. Membership of our networks is free… Why not join now?

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5 General practice pathways

What is AGPT selection and how does it work? Selection into the AGPT program is a merit-based, competitive and multi-staged process used to determine which applicants are best suited to general practice training. The process is carried out in accordance with the Australian Medical Council’s principles for selection into specialist training programs, against nationally consistent criteria. If eligible, you will be required to complete a Situational Judgement Test (SJT) online as well as undertake Multiple Mini Interviews (MMIs), which are conducted on a face-to-face basis. These two tests are conducted separately and form part of the national assessment process for the AGPT program and they will be held on different dates in different locations for the SJT and MMIs. Where possible, the AGPT national assessment tests are conducted in capital cities in all Australian states and territories. The standardised results of both the SJT and MMIs will determine each applicant’s total AGPT selection score. This score will determine whether or not an applicant is likely to be shortlisted to their preferred training provider. Applicants then have the ability to change their preferences for a training provider. Training providers may seek referee letters and conduct interviews if they believe appropriate.

How do I prepare? The SJT and MMIs require applicants to draw upon their own experiences, particularly any previous experiences with general practice. It is recommended that applicants review the detailed criteria that will be assessed, which is outlined in the 2016 AGPT Applicant Guide. No other study materials can be provided, including previous test papers or topics covered. You can prepare by:

• recalling good examples of patients you have

•

dealt with that illustrate your ability to deal with difficult situations.You are encouraged to think about a range of experiences that demonstrate your abilities

considering and understanding the assessment criteria used in the national assessment process. These are listed in the 2016 AGPT Applicant Guide.

Where can I find example questions?

The practice questions in the 2016 AGPT Applicant Guide are supplied to ensure applicants understand the mechanics of the tests, not the topics covered. For more information, visit agpt.com.au

GP First – The essential guide for medical students and prevocational doctors

The ACRRM Fellowship What is FACRRM? Fellowship of ACRRM (FACRRM) is an approved pathway to specialist registration as a general practitioner, access to A1 Medicare items and unrestricted general practice anywhere in Australia. It is a four-year integrated training program, and training occurs on the job as a registrar in a range of ACRRM accredited teaching posts. Training time is reduced where a candidate is granted recognition of prior learning.

• emergency medicine • obstetrics and gynaecology • anaesthetics.

Where completion of all terms is not possible, there are flexible options to build these skill sets as you progress through training.

Primary rural and remote training

24 months working in ACRRM accredited facilities to build your clinical and procedural skills and your Candidates wishing to achieve FACRRM can apply confidence to work in rural and remote contexts. for one of three training pathways: These facilities can include general practices, the Vocational Preparation Pathway delivered hospitals, Aboriginal Medical Services and retrieval by training providers services.You may choose to complete your the Remote Vocational Training Scheme (RVTS primary rural and remote training in one or several for doctors working in isolated rural communities locations. Training in a single location will enable who find it difficult to leave their community to you to build a strong relationship with colleagues participate in training and your community. However, training in several locations may better equip you to expand your the Independent Pathway, administered by posting opportunities later in your career. ACRRM, which is suitable for doctors with experience who prefer self-directed learning. While there is considerable flexibility, the

• • •

Vocational training towards FACRRM

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

Core clinical training

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

• general internal medicine • general surgery • paediatrics 46

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experience must include a minimum of six months in a community primary care setting, a minimum of six months in hospital and emergency care and a minimum of 12 months living and practising in a rural or remote setting.

Advanced specialised training

Advanced specialised training requires a minimum of 12 months training in one of the 11 disciplines specified by ACRRM:

• Aboriginal and Torres Strait Islander health • academic practice • adult internal medicine • anaesthetics

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5 General practice pathways

• emergency medicine • mental health • obstetrics and gynaecology • paediatrics • population health • remote medicine • surgery (2 years).

To achieve FACRRM, candidates must also successfully complete four ACRRM online education modules and at least two emergency skills courses approved by ACRRM (eg. REST/ EMST/ELS/APLS, ALSO). Emergency courses must be current at completion of training.

FAQs

How is FACRRM integrated into the AGPT program? Registrars enrolled in the AGPT program can elect to train for FACRRM. FACRRM training is open to both rural and general pathway registrars, provided they work in ACRRM accredited teaching posts. It is essential to enroll with ACRRM as soon as you enroll with a training provider. That way we can help to ensure your training occurs in accredited posts. Can candidates do both FACRRM and FRACGP qualifications at the same time? Yes, but requirements for placement, duration, completion of training and assessment are different between FACRRM and FRACGP. Registrars seeking both fellowships will need to talk to their training provider about a program that complies with both colleges.

Do you have to undertake all training in rural or remote locations? No. The flexibility of the program means that while most registrars will spend a significant amount of training in rural areas, gaining the skills and knowledge required can be developed in both urban and rural facilities. However, having a good understanding of the context of rural medicine is essential, therefore all registrars must spend a minimum of 12 months living and practising in a rural or remote setting. Can you train with ACRRM, then later work in an urban setting? Yes. FACRRM qualifies you for specialist 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 recognition of prior learning, 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. For more information, visit acrrm.org.au Contributed by the Australian College of Rural and Remote Medicine

GP First – The essential guide for medical students and prevocational doctors

Choose your own adventure

Open up your career options with a Fellowship of ACRRM, the only GP training program specifically designed to equip doctors to handle the challenges of rural and remote medicine.

Be a better doctor www.acrrm.org.au 1800 223 226 48

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5 General practice pathways

The RVTS

An alternative pathway to fellowship What is the RVTS?

Eligibility

The Remote Vocational Training Scheme (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.

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

Education is delivered via:

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.

• Teletutorials – weekly 90-minute education sessions via teleconference

• On-site teaching visits – An experienced

rural practitioner visits the registrar to observe consultations and provide feedback

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

• Remote supervision – Each registrar 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 RFD doctors, district medical officers, with Aboriginal Medical Services and in private practice. They serve a range of communities, from farming and mining towns through to remote Aboriginal and Torres Strait Islander communities. Many work in solo practice.

Applicants must provide continuing, whole-patient 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 ACRRM and the RACGP. Twelve-month training is available in advanced skills curricula, such as anaesthetics, obstetrics and emergency medicine. For more information, visit rvts.org.au Contributed by the Remote Vocational Training Scheme

GP First – The essential guide for medical students and prevocational doctors

The fruits of being a rural generalist As a GP registrar in the Queensland Rural Generalist Pathway, Dr Sarah Farlow is exploring the life of a multi-skilled rural doctor in one of Australia’s iconic outback communities. A ripe pawpaw jostles for space with a bundle of mail in Dr Sarah Farlow’s inbox at Mount Isa Hospital. The fruity paperweight may provoke a double take at some hospitals but at Mount Isa Hospital nobody bats an eyelid. “If one of my patients is successfully growing pawpaws, there’ll be a pawpaw in my inbox with my mail stuffed all around it,” Sarah says with a laugh. “Mount Isa is a great supportive little place.” Sharing home-grown produce is emblematic of the friendly, informal community feeling at the heart of rural medicine – something Sarah loves about her job. Sarah is a principal house officer in the emergency department of Mount Isa Hospital and a registrar in the Queensland Rural Generalist Pathway training to the Australian College of Rural and Remote Medicine (ACRRM) curriculum. This training program is specifically designed to meet the workforce needs of a vast state with many outback outposts remote from the consultants and infrastructure of a tertiary hospital. The idea is to produce multi-skilled, jack-of-all-trades doctors known as rural generalists who can deliver babies, deal with emergencies, give anaesthetics, perform basic surgery and make critical decisions across hospital and community-based practice.

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“My job at Mount Isa Hospital is completely unpredictable – no two days are the same,” Sarah says. “That’s part of the appeal for me. “In the last 24 hours, I’ve had two people requiring RFDS transfer – acute medical patients requiring tertiary intervention. We’ve had a motor vehicle accident, children with coughs and colds, an elderly person who’s had a fall – so we’ve had the management of all those different areas in the one day.” The diversity of the people is equally compelling for Sarah. “We have a very multi-cultural population with a high proportion of Aboriginal residents as well as a significant proportion of nomadic FIFO workers who come and go.” What drew Sarah to rural and remote medicine? Flashback to an elective Sarah did while at James Cook University. She found herself as a fifth-year medical student with scant clinical experience delivering babies in a Menang birthing centre in the remote highlands of Papua New Guinea. “It really ‘sold’ rural generalism to me,” she reflects. “People say in Mount Isa we have a lack of resources and access but seeing things from a third world perspective opened my mind to how lucky we really are. “I saw PNG-trained doctors who literally just had their hands and minds to get by and try to do the best for people. “I got to deliver babies and did twin deliveries, a breech birth and a vacuum extraction with an old foot pump vacuum extractor. I did all this as a medical student with a midwife in the middle of the night – things that perhaps a few obstetricians haven’t done.”

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5 General practice pathways

“My job at Mount Isa Hospital is completely unpredictable – no two days are the same.”

GP First – The essential guide for medical students and prevocational doctors

The experience strengthened Sarah’s resolve to become a rural generalist with advanced skills in obstetrics. “I knew I wanted to be a doctor and I never really imagined myself as a super specialist in an office in Brisbane. My father is a rural doctor so I had exposure to a rural GP’s life early on.”

Out of hours, Sarah is embracing the “wild west lifestyle”. “I’m getting into the things people do here like the local hospital touch football teams, the rodeos, race days, live local bands and I’m training for the annual Julia Creek Dirt and Dust Triathlon,” she says.

Looking ahead to the next stage of her training, Sarah is excited about developing her obstetrics skills – one of the mainstays of rural generalism. “Next I will be doing my advanced skills training working alongside two obstetrician consultants at Mount Isa Hospital,” she explains.

If Sarah’s schedule sounds exhausting, she is aware of the hazards of burnout. “You have to have your own personal fatigue alarm,” she observes.

For a coastal girl, Sarah’s move 1000 km west to Mount Isa was a deliberate shift out of her comfort zone. “I grew up on the coast around Proserpine, Airlie Beach and the Whitsundays but I’ve always wanted to do a stint out west. I went as far out west as I could. It was quite an adjustment but I really enjoy living here.” Sarah has grasped the opportunity with both hands, professionally and socially. She is determined to gain as much clinical experience as she can to “learn skills I can take to a community”, she sits on the committee of the Rural Doctors Association of Queensland and plays drums in the Rural Rednecks, a rock band of rural doctors who perform at medical conferences.

Taking regular breaks is a great way to dial down the stress, she says. Only by physically removing herself from the community and the constant connectivity of technology for a few days is she is able to really relax and recharge. “I book a few short breaks in advance – even if it’s just a weekend away with friends somewhere by the beach or in the city.” Future plans? “I want to get through my training and be able to contribute work in Papua New Guinea or somewhere in third world for maybe a quarter of my career if I can,” she says. In the meantime, Sarah is enjoying the life of a rural generalist trainee in Mount Isa. “I really feel that this job keeps you grounded, down to earth and in touch with the lives of your patients. They are your community, your neighbours, people who rely on you and you on them. “Every patient encounter is unique and rewarding in some way. Home-grown pawpaws are just one of the job’s added sweeteners.” Written by Jan Walker

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5 General practice pathways

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

Vocational training towards FRACGP

Fourth-year additional training (optional)

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

About the FRACGP exams

The essential components of vocational training towards FRACGP are:

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

• General practice placements (18 months): 18

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

• Extended skills (six months): Provides an

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

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

Eligibility to enrol for the exams

To be eligible to enrol in the RACGP Fellowship exams, you need to have completed the required training units for the exams you wish to enrol in. Unit completion will be checked with your training provider at the close of enrolments. For enrolment in the AKT only, you need to have completed six units by the AKT exam To enrol in all of the exams, you need to have completed eight units by the date of the OSCE. In addition, you must have: current Australian medical registration current financial membership of the RACGP.

• • • •

For more information, visit racgp.org.au Contributed by The Royal Australian College of General Practitioners

GP First – The essential guide for medical students and prevocational doctors

Healthy Profession. Healthy Australia.

Access a wide variety of exam support tools to help with your journey to Fellowship! Exam samples Gain insight into the questions in the Applied Knowledge Test (AKT) and Key feature Problems (KFP) exams.

Pre-exam workshops in your local area See what the exam is like, by enrolling in an RACGP workshop. Discounts available to RACGP members.

Interactive online modules Test your knowledge and gain practical experience through gplearning’s range of programs, including the Exam Support Online (ESO) program.

check case studies Prepare for the RACGP exam through a series of clinical cases followed by multiple choice questions.

2014 edition – pre-exam tutorial series on DVD RACGP members receive discounts off the 17-week tutorial series on DVD, ideal for those in rural areas who can’t make it to face-to-face workshops.

Visit www.racgp.org.au to become a member today! 54

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5 General practice pathways

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

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

• is based on contemporary adult learning,

reflective practice and self-determined learning

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

• builds on the specific knowledge and skills you

are developing as part of your training towards the FRACGP

• should be commenced early in your GP

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

Prerequisites for GP registrars:

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

FARGP requirements:

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

• 12 months of ARST in an accredited training post

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

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

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

• anaesthetics • obstetrics • surgery • emergency medicine • mental health • child and adolescent health • adult internal medicine • small town rural general practice • Aboriginal and Torres Strait Islander health.

Individually designed ARST (approval by the RACGP National Rural Faculty is required after consulting your medical educator). For more information, call the RACGP National Rural Faculty on 1800 636 764 or visit racgp.org.au/fargp Contributed by the RACGP National Rural Faculty

Firstessential – The essential for medical and junior doctors GP FirstGP – The guide forguide medical studentsstudents and prevocational

Part-time training 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 GP training program has the same flexibility, with parental leave and part-time training options available. 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 an RLO or an academic registrar.

Considerations

• All components of the training program, with

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

• Once registered with a training provider you

need to apply for part-time training with your

provider and have it approved before you begin working part-time. Contact your training provider and relevant college censor for further information.

• Registrars must work 3–8 sessions per week

to qualify as part-time and to remain within the AGPT program, registrars need to undertake a minimum of nine patient contact hours per week.

• You should negotiate the amount of practice based teaching during a term as a part-time registrar.

• You must attend educational activities that are required of you by your training provider.

• Most training usually occurs on weekdays.

The RACGP states that general practice experience gained while working part-time is valuable and likely to be worth more than an estimation of time alone would indicate. This is why acceleration of part-time training to ‘half-time’ training is available. It basically means that in order to have a 12-month term counted as the equivalent of six months full-time, you need to show that the number and range of patients seen are giving you adequate experience.

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.

• Registrar leave is managed by your training

provider. You should apply for leave as early as possible.

• Parental leave entitlements may vary by provider. Many offer up to 12 months parental leave.

Want to know more? For more information, visit agpt.com.au 56

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5 General practice pathways

Understanding the 10-year moratorium What is section 19AB/the 10-year moratorium?

When does the moratorium start?

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. This usually means a rural, remote or outer metropolitan area. GP registrars under the moratorium do their vocational training in the rural pathway.

Who does it apply to? The moratorium applies to:

• overseas-trained doctors who did not obtain their primary qualification in Australia or New Zealand

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.

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 changes that allow doctors to reduce the moratorium time by up to five years, depending on the remoteness area of the location where they practise.

• overseas doctors trained in Australia or New Want to know more?

Zealand who began studying in Australia For more information regarding the or New Zealand under a temporary visa and 10-year moratorium, visit agpt.com.au or subsequently obtained their primary qualification doctorconnect.org.au from an Australian or New Zealand university. If you require detailed information about your individual circumstances, contact the Department of Health and Ageing Workforce Regulation Section at 19AB@health.gov.au

Reduction in 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

GP First – The essential guide for medical students and prevocational doctors

An international doctor’s general practice journey The dusty outback of south-west Queensland is a world away from the lush green countryside of Sri Lanka, but that’s where Dr Gihan Gunawardena discovered his passion for general practice. Dr Gihan Gunawardena has just finished a 12-hour shift in obstetrics and gynaecology at Logan Hospital south of Brisbane when he finds a few spare moments to chat to GP First. But rather than sounding ready to collapse on the couch, Gihan is brimming with energy and enthusiasm for the multi-skilled GP career he has created since coming to Australia. Gihan recently completed his RACGP Fellowship. However, he continues to work diligently to acquire new skills – an advanced diploma in obstetrics and gynaecology followed by a qualification in anaesthetics. To this end, he is currently working in the hospital system while keeping his general practice skills honed by working part-time at a local family medicine clinic in Brisbane. “I’m quite a driven person. I always need something to keep me going. That’s why I thought I’d do the obstetrics and anaesthetics, so once I go rural again I’m pretty well skilled to manage anything,” Gihan explains. Gihan and his wife Kanchanamala – also a doctor – and their young daughter came to Australia in 2005 from Sri Lanka to undertake PhD studies at the University of Queensland. It was difficult to make ends meet in a two-student household so Gihan set aside his studies for full-time work. 58

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“I decided to apply for a job with Queensland Health as a junior doctor while my wife continued her PhD,” Gihan says. Back in Sri Lanka, Gihan had graduated in medicine from the University of Peradeniya and notched up three years of clinical work as a general practitioner as well as university lecturing positions. But like many international doctors, Gihan discovered he had to jump through many hoops to meet Australian registration standards. Cue the Australian Medical Council (AMC) exams – the most common pathway for international doctors seeking registration as a doctor in Australia. A suite of examinations that cover everything from clinical competency to English language proficiency. For Gihan, the trickiest part was not the clinical knowledge but getting to grips with a new system and culture. “You had to learn from scratch how things happen here as opposed to what we did back at home. It was getting used to the system, not the knowledge, that was most challenging,” he says. At times the local slang was a source of confusion and humour. Gihan recalls talking to an elderly lady who had fallen over and sustained a mild head injury. The lady was relating how her recovery had temporarily stalled and she had “hit a brick wall”. “I thought she meant she literally hit a brick wall when she fell, so I said how did you do that? I didn’t realise it was just an expression.” Gihan’s first job as a junior doctor in Australia was at Ipswich Hospital followed by two years at Bundaberg Hospital and three years at St George Hospital. As an international doctor, Gihan was Prevocational doctors – gpaustralia.org.au

5 General practice pathways

“It was getting used to the system, not the knowledge, that was most challenging.”

GP First – The essential guide for medical students and prevocational doctors

subject to the 10-year moratorium which means no Medicare billing rights are granted for up to 10 years except in areas of workforce shortage – usually rural, remote or outer metropolitan areas. The 10 years is measured from the date of registration, not vocational training. The length of time can be trimmed by working in more remote areas. Gihan recently concluded his moratorium obligations. Gihan explored many disciplines in the hospital system before entering the general practice training program. “I believe that taking this time has ultimately made me a better GP,” he says. Once accepted into the general practice training program, Gihan was posted to St George, a small outback town six hours west of Brisbane by road and a world away from the lush, green countryside of Sri Lanka. “I loved it,” Gihan says. He found an instant connection with rural general practice. Turnaround on blood tests can be up to three days and CT scans are 200 km away but the lack of resources didn’t faze him. “You often need to rely on your clinical skills rather than investigations to assess and manage patients. I compare it with rural practice in Sri Lanka. It felt like home, honestly,” he jokes. “Going to country Queensland was one of the best decisions I made. It’s just like a little village. Everyone knows everyone. I absolutely loved looking after a community,” he adds. The only downside was being temporarily separated from his family in Brisbane due to their school and work commitments. Gihan refers to his wife as “Supermum” for juggling her full-time job as a doctor and the care of their two children on her own while he was away from home. 60

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So did Gihan always want to study medicine? “That’s an interesting story,” Gihan says. “My dad was an electronics engineer and a very smart person. I couldn’t match him so I felt the only thing I could do was something quite different, so I chose medicine.” From an early age, Gihan showed an aptitude for science. It was through this talent that he met his wife Kanchanamala while still at secondary school at a camp for Sri Lanka’s most gifted science students. “We both ended up doing medicine at the same medical school, we started going out and then we decided we’d take it to the next level,” he says. Kanchanamala is currently a GP registrar working in emergency at Redland Hospital. Life is busy professionally and personally for the couple who spend much of their time outside work ferrying their school-age children to all kinds of extracurricular sports and musical activities. But Gihan has a dream of returning to rural general practice one day when the time is right for his family. “Hopefully with Kanchanamala’s emergency skills and my obstetrics and anaesthetics skills, if we go rural in a few years we should be able to run a rural hospital,” he says. Does Gihan have any advice for other international medical graduates? “Focus on your studies, get through the AMC exams and get your registration status in the quickest possible time. Then apply for the training program you are planning to do. “You can’t afford to take as long as I did because there are a lot more undergraduates in local medical schools now and the need for overseas doctors is reducing. So I would say get on with it.” Written by Jan Walker

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6 Money matters

What you can earn What do GP registrars and GPs earn? What are the hours? Check out the 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

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. Registrars usually receive a base wage and a percentage of income generated by the patients they see in the practice.

Terms and conditions of employment

During the first two general practice terms (or ACRRM equivalent), GP registrars are guaranteed basic terms and conditions of employment according to the Terms and Conditions document agreed by GPRA and the General Practice Supervisors’ Association (GPSA). Minimum salary rates are set out in the table, or alternatively the registrar is paid a minimum of 44.79% of gross billings, whichever is greater.

2013 training year minimum salaries plus 9.5% superannuation

Annual salary

Weekly

GP term 1 registrar $72,760

$1,399

GP term 2 registrar $87,476

$1,682

Different remuneration systems In certain settings, registrars may work in salaried practice, especially Australian Defence Force registrars, those in Aboriginal Medical Services and some rural and remote hospitals that also provide GP services to the community. 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 Terms and Conditions 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.

What established GPs earn

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.

Calculate your income online

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

The above salaries are a guide only from 2013–14 and will change in 2015.

Medical students – gpsn.org.au

Prevocational doctors – gpaustralia.org.au

2 Money Generalmatters practice â&#x20AC;&#x201C; the first choice 6

Incentive payments There is a range of financial incentive payments available to GP registrars. Check them out here. If you are working as a GP registrar, you may be eligible to receive a range of financial incentive payments and reimbursements in addition to your regular salary. Most of these are offered by the Department of Health (DoH) to encourage more GPs to practise where they are most needed, such as in rural, remote and outer metropolitan areas.

General Practice Rural Incentives Program

The General Practice Rural Incentives Program (GPRIP) is a DoH 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. For more information, visit doctorconnect.gov.au

Accommodation Each training provider has an individual policy regarding accommodation and relocation subsidies for GP registrars. This may include subsidised rental accommodation in rural areas.

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 RA2â&#x20AC;&#x201C;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. For more information, visit health.gov.au/hecs

More Doctors for Outer Metropolitan Areas Relocation Incentive Grant This is another DoH 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. For more information, visit health.gov.au/ outermetro

GP First tip

Visit gpra.org.au to find out more about the financial incentives you may be able to claim in addition to your salary.

GP First â&#x20AC;&#x201C; The essential guide for medical students and prevocational doctors

7 Survival tips

GP First â&#x20AC;&#x201C; The essential guide for medical students and junior doctors

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

Workplace bullying Workplace bullying is a serious concern. As a trainee, it can be difficult to know what to do if you are being bullied at work. Bullying behaviour can impact your health, self-esteem and your enjoyment of your career. So if you are being bullied, GPRA urges you to report the problem. 66

Medical students – gpsn.org.au

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

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

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

• Support the person who is being bullied.

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

• Report the bullying to someone in authority

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

• Make notes of what you have witnessed. Depression

Everybody feels down or sad at times. But it’s important to be able to recognise when depression has become more than a temporary Prevocational doctors – gpaustralia.org.au

7 Survival tips

thing, and when to seek help. As a general rule of thumb, if your feelings of depression persist for most of every day for two weeks or longer, and interfere with your ability to manage at home or outside the home, then you would benefit from assessment by a skilled professional. It’s also important to recognise that many of these features could be caused by or related to other things, such as a physical illness, the effects of medications or stress. A trained professional will help in assessing such things.

Allow yourself to seek help. Struggling on alone can prolong the depression. Useful resources include:

• Lifeline: 24 hour crisis support 13 11 14 • Suicide Call Back Service 1300 659 467 • Kids Help Line: counselling and support for

young people (to 24 years) who are feeling depressed, sad or need someone to talk to 1800 55 1800.

GP First – The essential guide for medical students and prevocational doctors

A fork in the road It took a case of burnout for former GP Ambassador, Dr Jon Priestley, to reassess where his career was headed – it was just what the doctor ordered. The journey to becoming a doctor can be a hard road, something Dr Jon Priestley knows all too well. Jon recently shared his experiences with GP First in the hope of highlighting the stresses placed on prevocational doctors and perhaps along the way, help prepare medical students for the road ahead. As Jon explains, the work and study load of prevocational doctors “is often underestimated” with the diversity of specialties covered – which in his case has been emergency, general surgery, general medicine, paediatrics, psychiatry, obstetrics and gynaecology – leaving many feeling stressed and overwhelmed. “To be honest it was difficult. I did 20 weeks of night shifts in one year, let alone all the evening and weekend cover, which is not unusual for prevocational medical staff.” But Jon is quick to point out that it’s not just the shift work and steep learning curve but the difficulty keeping connections with other prevocational doctors that makes hospital rotations tough going. “The difficult thing with three month rotations is that you are just getting comfortable understanding the new processes on the ward and building strong relationships with the doctors and nursing staff, and then you have to start the whole process again. “Changing jobs every few months can be so isolating. Relationships [with other prevocational doctors] can take time to develop. And because 68

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you don’t see many peers at the hospital, there is not a lot of opportunity to talk about the experience in any real depth.” Jon found the balance he needed, but it took a case of burnout before he re-assessed how he was approaching his career. Self awareness and acceptance of the situation you are in, he stresses, is key. “I got to the point where I was dreading going to work. I wasn’t sleeping well, not eating well and I started losing weight. I was not in a place I wanted to be. “When I admitted this to myself there came the realisation that I didn’t want to feel that way so I looked at ways to fix it. Talking with colleagues and family helped enormously,” Jon explains. “Finding [a way out of it] was a process of highlighting exactly what it was that was making me stressed.” Jon says he discovered that his main stress stemmed from a fear of forgetting something, such as following up of investigations and of being out of his depth. So to combat this he became more judiciously organised, something he says, is key for your intern year. “I had a daily planner rather than depending on memory alone. I also forced myself to exercise more, which was difficult initially but that brought on more sleep, which then made me hungrier. I became more open with colleagues about how I was feeling and came to realise that we are all in the same boat. So many of us are experiencing the same difficulties, but some cover up better than others. “A big one for me too, was that I sought feedback from senior doctors. I received good responses and realised I was being too self-critical.” The existing hospital culture where you must buck up and forge on regardless is known to put Prevocational doctors – gpaustralia.org.au

7 Survival tips

“I became more open with colleagues regarding how I was feeling and came to realise that we are all in the same boat.”

GP First – The essential guide for medical students and prevocational doctors

immense pressure on prevocational doctors, an experience that often makes them feel isolated and unsupported, and this, says Jon, was one of the reasons he became a GP Ambassador. “I wanted to get more involved and become more informed about general practice, as there are not a lot of opportunities to gain that knowledge when you’re in the hospital system.” Jon says that as a GP Ambassador he noticed first-hand his experience wasn’t the exception but the rule. And this, he says, is one of its greatest benefits as it highlights that others are having the same struggles and provides the opportunity to help. Jon says that at first, the bulk of questions he received as an ambassador were administrative in nature.

“You get mainly training queries.in terms of how it is set up, what rotations need to be done etcetera. The majority of questions tend to be about applying to the AGPT program,” Jon explains. But, he says, being an ambassador does inevitably turn into a support role. “Sometimes it’s about having someone to have a chat with, about the emotional support. I’d like to hope that people found me approachable.” Jon is now a GP Term 1 registrar based on Victoria’s Mornington Peninsula, and says the opportunity to engage in holistic care is high on his agenda. “I am looking forward to the outpatient environment. The one-on-one.You have more time to educate when people aren’t acutely unwell. I’m looking forward to building relationships with patients,” he says. Reflecting on his hospital rotation experiences, Jon says his choice to follow a career in general practice is confirmed. But while he acknowledges that a hospital career isn’t for him, the experience, he says, was essential to getting him where he is today. “The experience and the exposure have been invaluable. Now, a few years in I am not too concerned about the range of presentations I see and, because of the variety of rotations 1 did, I have a good grasp and understanding of different illnesses.” The road travelled so far has been a tough one, but Jon wouldn’t have it any other way.

Want to know more? “You get mainly training queries, in terms of how it 70

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Find out more about the Going Places Network at gpaustralia.org.au or turn to pages 14–15 to find the GP Ambassador at your hospital. Prevocational doctors – gpaustralia.org.au

7 Survival tips

Exam survival For many students exams are a time of increased caffeine intake, decreased sleep and copious amounts of procrastination. Emily Jenkins, an intern at the Royal Melbourne Hospital, provides some great tips to help you get through. Know how you learn best and use your time productively

– load your phone/laptop with medical apps, carry GP Companion in your pocket.

• Get on twitter and join the #FOAMed revolution.

Know what to study, make a plan

• Medicine is infinite: work out what you actually need to cover. Don’t forget case study based teaching – whenever there’s a weird left-field question on an exam/OSCE it’s inevitably pulled from a PBL.

chunks. Allocate one chunk of learning to each time spot so you know exactly what you need to do and when.

Know it inside out.

• Pharmacology can be daunting. Don’t learn

When you sit down to study, make sure you actually study. As hard as it can be sometimes, catch yourself when you’re losing focus and redirect your focus back to the task at hand. Reclaim transport time and other wasted time during your day – load important lectures or podcasts onto your iPod and listen to them when driving, or use time on public transport to read over your lecture notes.

•

• Have a pool of resources at your fingertips,

• Talley and O’Connor is your OSCE bible.

• Maintain self-control. This is the hardest part.

yourself to get to a lecture, are you really going to be able to motivate yourself to listen to eight hours of lectures at home when you’re surrounded by a myriad of distractions?

• Make a study plan. Break it down into bite-sized

•

to identify which ways you learn best to make the most of your time. If you’re a tactile learner, listening to lectures double-speed as you fall asleep may not be your best approach. Similarly, drawing elaborate colour-coded diagrams probably won’t suit auditory learners. Knowing how you learn best also means knowing where and when you are most productive. Some people work best with other people around they can bounce ideas off, others would just find this distracting. Tailor your study time around your best times.

• Everyone learns differently, so it’s important

• Be honest with yourself. If you can’t motivate

drug doses, but understand basic mechanisms of action, indications and any specific contraindications/side effects of common drugs and drug classes.

Read broadly, then deeply

• Have a comprehensive general overview of a topic before you start delving into detail about particular area.

•

Keep content fresh in your memory by regularly quizzing yourself on topics you have previously studied, and looking back over your old notes.

GP First – The essential guide for medical students and prevocational doctors

Be realistic

• Seize every opportunity to see patients and

• It’s absolutely essential to factor in breaks and

• Don’t overlook other allied health professionals.

• Avoid guilt. It’s unproductive and demotivating.

Didn’t study for a day? Didn’t study for a week? Didn’t study for a month? It’s not the end of the world! Adjust your plan and hit the books again.

practise procedures. Have the self-discipline to report back every patient you see to one of the doctors and constantly seek feedback on your performance.

Spend a day with the path nurses and never miss a vein again. Get the physios to help you perfect your musculoskeletal exams, or the social workers to talk you through the different support services or schemes your patients may be eligible for.

downtime. Burnout is a major issue and will hinder your exam performance much more than a few well-deserved regularly scheduled breaks.

Be kind to yourself

• I cannot stress enough how important it is to

maintain a balance between uni/study and life. Way too many medical students burn out or simply fall out of love with medicine.

• No one will judge you for asking for

help. Having the self-awareness of knowing when you are out of your comfort zone and asking for help is absolutely essential for safe practice as a doctor.

Practice makes perfect

• It’s never too early (or too late) to hit practice

questions or practice OSCEs.You will learn more from messing up an OSCE/getting practice questions wrong, than by skim reading page after page of a textbook.

• If you’re not in an OSCE study group – get in

one! There is no other way to do well in OSCEs than practise, practise and more practise.

• Remember that your faculty/supervisor/tutor is • Seize every and any opportunity to get there to support you. Don’t suffer in silence – resolve issues early.

We’re all in this together

• Succeeding in medicine is not about exam

results, but about patient outcomes. The people you are studying alongside are your future co-interns and the future specialists you refer your future patients to. Share resources, collaborate and support peers.

Make the most of ward time

• Never, ever miss a day on the wards.

You will learn more here than anywhere else.

Medical students – gpsn.org.au

feedback – whether from your peers or your superiors (and be prepared to offer constructive feedback in return).

• Put yourself out there – when your tutor asks for a volunteer, stick your hand in the air!

It’s never too late

• No matter how last minute things are, it is

always worth investing half an hour in making a solid plan.

• 80/20 rule: 80% of the answers lie in 20% of

the content. Accept that you are not going to cover everything and get smart with what you do focus on. Prevocational doctors – gpaustralia.org.au

8 Info file

Your network needs you

Make your voice count on shaping the future of general practice. Simply log in and update your details so your network can keep you informed. Students visit

gpsn.org.au

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gpaustralia.org.au

8 Info file

Jargon buster Acronyms and abbreviations abound in the language of general practice. Learn the lingo 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

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. AST – Advanced specialised training A 12-month training post required for ACRRM fellowship CMO – Career medical officer CPD – Continuing professional development DHAS – Doctors’ Health Advisory Service

AGPAL – Australian General Practice Accreditation Ltd This organisation completes accreditation of practices throughout Australia

DoH – Department of Health The federal government department responsible for health

AGPT – Australian General Practice Training The training program for GP registrars

EBM – Evidence-based medicine

AHPRA – Australian Health Practitioner Regulation Agency AIDA – Australian Indigenous Doctors’ Association AKT – Applied Knowledge Test A component of the RACGP Fellowship exam. A computer-based exam in multiple-choice format AMA – Australian Medical Association An independent organisation that represents the professional interests of all doctors, including political, legal and industrial AMLA – Australian Medicare Local Alliance A network funded by the federal government to manage national programs for Medicare Locals AMS – Aboriginal Medical Service

DVA – Department of Veterans’ Affairs 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

GP FirstGP – The guide forguide medical studentsstudents and prevocational Firstessential – The essential for medical and junior doctors

75 79

GPRA – General Practice Registrars Australia Ltd Represents GP registrar issues to GPET, RACGP, ACRRM, DoH and other bodies involved in training; promotes general practice as a medical specialty of choice to medical students and junior 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) 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 healthcare delivery, including general practice and allied health services. More than 60 have been established across Australia to date MBS – Medicare Benefits Schedule MCQ – Multiple choice question A component of the ACRRM Fellowship exams and assessments ME and TA – Medical educators and training advisors One of these people from your training provider will give advice and guidance about your training miniCEX – Mini Clinical Evaluation Exercise A component of the ACRRM Fellowship exams and assessments

Medical students – gpsn.org.au

NACCHO – National Aboriginal Community Controlled Health Organisation 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 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 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 PIP – Practice Incentives Program QI&CPD – 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)

Prevocational doctors – gpaustralia.org.au

8 Info file

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 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

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 Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians

RRADO – Registrar Research and Development Officer The RRADO is a registrar employed to promote training in research and academic general practice 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 SIP – Service Incentive Payment SLO – GP supervisor liaison officer Employed by a training provider to represent and advocate for GP supervisors StAMPS – Structured Assessment using Multiple Patient Scenarios A component of the ACRRM Fellowship exams and assessments

GP First – The essential guide for medical students and prevocational doctors

General practice resources Textbooks and pocket guides Australian Medicines Handbook – amh.net.au Contraception: An Australian clinical practice handbook – Sexual Health and Family Planning Australia Clinical Sports Medicine – Brukner and Khan Fast Facts series – fastfacts.com GP Companion – a handy reference of general practice clinical information: gpra.org.au John Murtagh’s General Practice, Patient Education, Practice Tips MIMS – mims.com.au Sara Bird’s Medico-Legal Handbook for General Practice – free for members of MDA National Oxford handbooks (Clinical Medicine, Clinical Specialties) Paediatric Handbook – Royal Children’s Hospital Melbourne – rch.org.au Paediatric Pharmacopoeia – rch.org.au Practical Fracture Treatment – McCrae and Esser

Clinical Guidelines for Stroke and TIA Management: A quick guide for general practice Chronic Kidney Disease Management in General Practice Other important guidelines Australian Immunisation Handbook – health.gov.au Asthma Management Handbook – nationalasthma.org.au Guidelines for the management of asymptomatic women with screen detected abnormalities – nhmrc.gov.au Guide to Management of Hypertension – National Heart Foundation: heartfoundation.org.au Medical Observer has compiled an extensive list, which includes the RACGP guidelines: medicalobserver.com.au/about/guide-to-guidelines NHMRC guidelines – nhmrc.gov.au/guidelines Therapeutic Guidelines (TG or eTG, available online, CD, hard copy) – an invaluable resource: tg.org.au

Fitzpatrick’s Colour Atlas and Synopsis of Dermatology

Online learning and resources

Reproductive and Sexual Health: An Australian clinical practice handbook – Family Planning NSW

gplearning – RACGP: gplearning.com.au

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

GP Psych Support – psychsupport.com.au A government-funded service that provides patient management advice to GPs from psychiatrists

Guidelines

There are many guidelines available from the RACGP – racgp.org.au/guidelines Diabetes Management in General Practice Guidelines for preventive activities in general practice – (the ‘red book’) Putting prevention into practice – (the ‘green book’)

GPRA – gpra.org.au

RRMEO (Rural and Remote Medical Education Online) – rrmeo.com Rural Health Education Foundation – rhef.com.au ThinkGP – thinkgp.com.au

Courses

Advanced Life Support in Obstetrics – also.net.au Advanced Paediatric Life Support – apls.org.au Australian Resuscitation Council – arcnsw.org.au

Medical students – gpsn.org.au

Prevocational doctors – gpaustralia.org.au

Clinical Emergency Management Program – racgp.org.au/cem

Haemochromatosis – haemochromatosis.org.au

Diploma in Child Health – chw.edu.au

Men’s health – Andrology Australia has great tools for prostate screening, male infertility assessment and more – andrologyaustralia.org

Sexual Health and Family Planning – shfpa.org.au

Evidence-based databases

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

Immunisation – immunise.health.gov.au

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

Bandolier – medicine.ox.ac.uk/bandolier – a UK-based independent journal of evidence-based healthcare

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

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

ACRRM – acrrm.org.au

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

Topic-based websites Anatomy – anatomyatlases.org

Arthritis – arthritisaustralia.com.au Asthma – nationalasthma.org.au Cardiology – heartfoundation.org.au COPD – copdx.org.au Dermatology – dermnet.com; 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

Organisations

AGPT – agpt.com.au AMA – ama.com.au Department of Health – health.gov.au GPRA – gpra.org.au Going Places Network – gpaustralia.org.au GPSN – gpsn.org.au Medicare – medicareaustralia.gov.au/provider; MBS Online: mbsonline.gov.au; PBS: pbs.gov.au National Prescribing Service – nps.org.au Pharmaceutical Benefits Scheme (PBS) – health.gov.au/pbs RACGP – racgp.org.au Rural Health Workforce Australia (RHWA) – rhwa.org.au – a not-for-profit organisation dedicated to making primary healthcare more accessible for communities in rural and remote Australia Therapeutic Goods Administration (TGA) – the regulatory body for therapeutic goods in Australia: tga.gov.au

Gastroenterology – gesa.org.au

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Visit our website – gpsn.org.au GP First – The essential guide for medical students and prevocational doctors

Journals, magazines and periodicals

Listen to the Lancet

Most are available online and in print.

The Merck Manual of Patient Symptom

Australian Doctor – especially its ‘How to Treat’ articles – australiandoctor.com.au

Other podcasts

Australian Family Physician – racgp.org.au/afp Australian Prescriber – australianprescriber.com and other NPS publications: nps.org.au check – an independent learning program for GPs (free with RACGP membership): racgp.org.au/ education/courses/check

The Health Report with Norman Swan

Annals of Internal Medicine – annals.org/multimedia.aspx Cochrane Library – cochrane.org/podcasts Drug Info – druginfo.adf.org.au Journal of American Medical Association Weekly – jama.jamanetwork.com/multimedia.aspx#Weekly

Medical Observer – especially its ‘Clinical review’ feature: medicalobserver.com.au

New England Journal of Medicine Weekly Audio Summary – nejm.org

Medicine Today – medicinetoday.com.au

NHMRC – nhmrc.gov.au/media/podcasts/index.htm

Medical Journal of Australia – mja.com.au Wonca – globalfamilydoctor.com

Medical apps for phone or iPad Drug Doses – useful in calculating paediatric doses for various medications iAnatomy – CT scans and how to identify the structures in them. How to Treat from Australian Doctor – includes quizzes on various conditions to test your knowledge. Very useful for the AKT Medical Observer – a useful calculator for a range of assessments: eg. Ottawa rules, Wells score MBS Search – includes various item numbers, Medicare rebates and allows you to save your favourite item numbers Pedi Safe – provides normal values (HR, BP, RR, fluid resuscitation rates, values for sedation medication) based on weight Stethoscope – allows you to listen to real chest sounds including murmurs, lung sounds and bowel sounds, and provides information about how to use a stethoscope. Good practice for OSCEs

Podcasts

Available from iTunes store: Australian Family Physician

Patient information

Better Health Channel – betterhealth.vic.gov.au – offers GPs consumer-based information and patient handouts My Dr (MIMS Australia) – mydr.com.au – a range of consumer-friendly tools including 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 with links to health services around Australia Parent handouts – rch.org.au/kidsinfo/factsheets.cfm – a series of handouts for parents and patients from the Royal Children’s Hospital Melbourne

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 training provider practice or hospital. Some resources are free from the RACGP as part of membership. 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 training provider about nearby libraries that may hold relevant texts or DVDs.

Instant Anatomy

Medical students – gpsn.org.au

Prevocational doctors – gpaustralia.org.au

GP Journey and GP First apps now available free from iTunes GP Journey GP Journey ISSUE 14 FREE

ISSUE 13 FREE

May – August 2014

Dr Mark Wenitong Leading by example

January – April 2014

Dr Jenny Wray Heart and soul medicine

Also in this issue:

Your career

GP profiles

Clinical cases

• Extended information • Interactive clinical cases • Animated images • Link to resources and further information on the web from within the apps

• Direct email capacity from within the apps • Free updates as information changes

concerning the general practice landscape.

Download free today App suitable for iPad only – search in iTunes Newsstand

Students visit

gpsn.org.au

Prevocational doctors visit

gpaustralia.org.au

With you on your journey As a GPSN or GPN member we support you on your journey toward general practice.

Students visit

gpsn.org.au

Prevocational doctors visit

gpaustralia.org.au