2017
The essential guide for medical students and junior doctors
Inside general practice pathways clinical placement tips internship facts what you can earn surviving it all
Healthy Profession. Healthy Australia.
I’m an RACGP registrar because... ‘It is a well-established specialist qualification that is recognised both nationally and overseas. The flexibility in the training program also appealed to me in that it encouraged practising in multiple areas, both rural and metropolitan. I also like the support and advocacy it provides for its registrars and Fellows.’ Dr Scott Allison, RACGP member since 2015
RACGP Fellowship (FRACGP): Supporting you on your general practice journey Fellowship of the RACGP demonstrates to governments, the general practice community and the wider community that a general practitioner has been assessed as competent across the core skills of general practice, enabling him or her to work safely and unsupervised anywhere in Australia.
To find out more about RACGP Fellowship visit racgp.org.au
Join Australia’s vibrant general practice community – become an RACGP member online at racgp.org.au/membership
The essential guide for medical students and junior doctors
2017
GP First: The essential guide for medical students and junior doctors is proudly produced and funded by General Practice Registrars Australia Ltd. GP First is intended for medical students and junior doctors thinking about a career in general practice. It combines two General Practice Registrars Australia networks: the General Practice Students Network for medical students, and the Going Places Network for junior doctors. General Practice Registrars Australia 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. We 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 (WONCA) and past president of The Royal Australian College of General Practitioners.
GP First: The essential guide for medical students and junior doctors Published by General Practice Registrars Australia Ltd Level 1, 517 Flinders Lane Melbourne VIC 3001 P 03 9629 8878 E enquiries@gpra.org.au W gpra.org.au ABN 60 108 076 704 ISSN 2203-143X Editorial team Editor Denese Warmington Writer Denese Warmington GPRA staff General Manager – Marketing and Communications Wayne Bruton wayne.bruton@gpra.org.au Membership Services Manager Faye Simpson faye.simpson@gpra.org.au Š 2017 GPRA. All rights are reserved. All materials contained in this publication are protected by Australian copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior permission of General Practice Registrars Australia Ltd (GPRA) or in the case of third party material, the owner of that content. You may not alter or remove any trademark, copyright or other notice from copies of the publication. No part of this publication may be reproduced without prior permission and full acknowledgement of the source: 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. Image p.29 copyright Denese Warmington Printed by Finsbury Green
Contents On the cover Members of the General Practice Students Network National Executive for 2017. From left: Arianne Kollosche, Cassie Williams, Jayden Murphy, Megan Bleeze, Terence Luo. Meet the rest of the team on page 46.
1. About GPRA What is GPRA? GPRA membership
5 6 8
2. General practice – the first choice 9 The most diverse specialty 10 Flexible training 12 Extended skills posts 13 3. General practice pathways General practice training Regional training organisations The 10 year moratorium Endpoint qualifications and fellowships About the fellowships
15 16 17 19 20 21
4. Money matters What you can earn Incentive payments
23 24 25
5. Survival tips Looking after yourself Exam survival The life of an intern
27 28 31 33
6. Resources for junior doctors Training program fast facts Going Places Network Going Places Network Ambassadors Hospital rotation tips
37 38 39 40 42
7. Resources for medical students 43 General Practice Students Network 45 General Practice Students Network National Executive 46 General Practice Students Network University Club Chairs 47 General Practice Students Network Working Groups 48 John Murtagh First Wave Scholarship program 49 General practice questions answered 50 Clinical placement tips 51 8. General practice resources Guidelines, apps and more Jargon buster
53 55 59
Remote Health The time is now
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About GPRA
What is GPRA? General Practice Registrars Australia (GPRA) is a not-for-profit organisation representing over 25,000 medical students, junior doctors and general practice registrars through targeted networks and activities.
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.
GPRA’s Board is responsible for corporate governance, our financial sustainability, and for advancing registrar issues to stakeholders.
The GPRA networks support:
We are informed by an Advisory Council, which consists of Registrar Liaison Officers from every training organisation and national registrar representatives from various stakeholders. The Council is in communication all-year-round, forming an Australia-wide network providing and sharing solutions to both local and national training issues. GPRA also promotes general practice as the medical specialty of choice to medical students and junior doctors. We do this via the General Practice Students Network for university students, and the Going Places Network for junior doctors.
The future of general practice Medical students, junior doctors and general practice registrars are the future of general practice. GPRA provides critical feedback to stakeholders and the government in order to improve general practice training in Australia. At a time when general practice is undergoing a substantial reshaping, we are the voice of the future. We work hard together with other stakeholders for the common purpose of advancing the profession and the health care of all Australians.
GPRA networks GPRA has developed several general practice support networks for individuals with a
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• Medical students who wish to learn more about a career in general practice • Junior doctors in the hospital setting who are interested in a career in general practice • General practice registrars undertaking general practice training. GPRA’s networks deliver key programs aimed at increasing the profile of general practice among medical students and hospital-based doctors. Our student and junior doctor networks encompass 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 run by students interested in general practice as a specialty. There are active GPSN clubs in medical schools at all 21 university campuses across Australia. GPSN offers programs focused on exposing medical students to the inspiring diversity of a career in general practice. Activities include clinical skill sessions, social events, seminars and conferences, peer support and networking opportunities. GPSN is administered by GPRA and is supported by a funding grant from General Practice Education and Training.
Medical students – gpsn.org.au
1 About GPRA
John Murtagh First Wave Scholarship program
General Practice Registrar Medical Educators Network
The John Murtagh First Wave Scholarship program offers medical students early realworld exposure to general practice, coupling scholars with mentors that often produce relationships that endure for many years.
The General Practice Registrar Medical Educators Network (GPRMEN) was formed to provide a professional network for general practice registrar medical educators (RMEs) and to advocate for the role to exist in a quality framework. The network provides peer support for RMEs around the country via online discussion forums and web-based conferencing.
Going Places Network The Going Places Network (GPN) is a junior doctor network that promotes exploration of the world of general practice during hospital training. It provides a single, clearly identifiable source of access, information and career advice about general practice for junior doctors. The network runs a series of networking and educational events around the country, and has a presence in 65 percent of all teaching hospitals throughout Australia.
General Practice Registrar Emerging Supervisor Network Many supervisors begin their career in mentoring the next generation of GPs without much formal training in supervision. In order to provide peer-to-peer networking and guidance to potential supervisors, GPRA formed the General Practice Registrar Emerging Supervisor Network (GPRESN).
Indigenous General Practice Registrars Network The aim of the Indigenous General Practice Registrars Network (IGPRN) is to assist all Aboriginal and Torres Strait Islander general practice registrars through to fellowship by providing support throughout their training and assessment. The network is there for when times are challenging, and also to celebrate achievements.
For more information about GPRA, visit gpra.org.au Â
IGPRN undertakes exam preparation and peer debriefing via online study groups, discussion forums, and two face-to-face workshops each year.
Junior doctors – gpaustralia.org.au
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GPRA membership
Your peer support community Being a member of GPRA provides many professional and personal benefits – and it’s free!
Three easy ways to become a member
Junior doctors
1. Junior doctors go to gpaustralia.org.au
Associate membership of GPRA is available to junior doctors through the Going Places Network. By joining GPN you gain access to:
2. Medical students go to gpsn.org.au
• general practice focused networking and educational events • free and discounted publications and guides • online and member-only access to general practice resources • bi-monthly e-newsletters that provide the latest on all things general practice • peer support.
3. Phone 03 9629 8878. By becoming a member of the Going Places Network or the General Practice Students Network you will also become an Associate Member of General Practice Registrars Australia (GPRA).
To find out more, visit gpra.org.au
Medical students Associate membership of GPRA is available to medical students through the General Practice Students Network. By joining GPSN you can meet like-minded students at a range of social and networking events and gain access to:
• the John Murtagh First Wave Scholarship program • general practice seminars and skill sessions • free and discounted publications and guides • online and member-only access to general practice resources • bi-monthly e-newsletters that provide the latest on all things general practice • peer support and access to your university club chair and national executive team to help answer all your general practice related questions.
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Medical students – gpsn.org.au
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General practice – the first choice
General practice
The most diverse specialty Did you think general practice is all about coughs and colds? Well think again, and check out our top 10 reasons why you should choose general practice as your specialty.
1. Every day is different Ask any general practice 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.
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’.
4. Special interest? Subspecialise! GP registrars can undertake extended 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 24.
7. Flexible and funded The Australian General Practice Training (AGPT) program and the Remote Vocational Training Scheme (RVTS) are funded by the Australian Federal Government, and there are some generous financial incentives for rural and remote based general practice trainees. For more information about financial incentives, see page 25. The training program is typically a three-year program, with the first year hospital-based.
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Medical students – gpsn.org.au
2 General practice – the first choice
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 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 general practice training. For more information about training options, see page 12 or visit gpaustralia.org.au
89 percent of the “ Australian population visit their GP annually: the clinical activity we see is unique with a massive variability. The skills required are complex, but include the ability to assess and manage multiple undifferentiated presentations and consequent clinical uncertainty, having the knowledge base for therapeutic options (not just pharmacotherapy) and the ability to provide quality continuity of care.
”
Associate Professor Frank R Jones Immediate Past President, The Royal Australian College of General Practitioners
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 general practice training you are always supported by experienced GP supervisors and medical educators from your training organisation.
9. S eeing the good with the bad Being a GP you get the highs with the lows, treating not just sick patients but managing patients during the 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 GPRA – gpra.org.au AGPT – agpt.com.au ACRRM – acrrm.org.au RACGP – racgp.org.au RVTS – rvts.org.au
Junior doctors – gpaustralia.org.au
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Flexible training Flexible career
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 general practice training program has the same flexibility, with parental leave and part-time training options available. Part-time training is especially attractive for those registrars having babies and raising young children. However, the part-time option can also give other registrars the freedom to take up opportunities, such as becoming a Registrar Liaison Officer (RLO) or an academic registrar.
Considerations • All components of the training program, with the possible exception of hospital time, can be undertaken on a part-time basis. • Once you are registered with a regional training organisation (RTO) you need to apply for part-time training and have it approved before you begin working part-time. Contact your RTO 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 training program registrars need to undertake a minimum of nine patient contact hours per week. • You should negotiate the amount of practicebased teaching during a term as a part-time registrar. • You must attend educational activities that are required of you by your RTO. • Most training usually occurs on weekdays. The RACGP states that general practice experience gained while working part-time is
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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 fulltime, you need to show that the number and range of patients seen are providing you with 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 RTO. You should apply for leave as early as possible. • Parental leave entitlements may vary between RTOs. Many offer up to 12 months parental leave.
Want to know more? Visit: gpsn.org.au gpaustralia.org.au
Medical students – gpsn.org.au
2 General practice – the first choice
Extended skills posts
Follow your special interests There is a range of extended skills posts available as part of the training program and each RTO offers different options. Here are just a few of the exciting extended skills posts you can experience as part of your general practice training:
• • • • • • • • • • • • • • • • • • • • • • • • • • • •
Aboriginal health Academic/research Aged care Alpine sports medicine Anaesthetics Aviation medicine Child and adolescent health Chronic disease management Critical care Custodial medicine Dermatology Disability medicine Drug and alcohol medicine Emergency medicine Family planning Forensic medicine Geriatrics Health policy Hospital in the Home Medical education Mental health Obstetrics and gynaecology Paediatrics Palliative care Psychiatry Sexual health and HIV medicine Sports medicine Women’s health.
Junior doctors – gpaustralia.org.au
For more information, contact your RTO or visit gpra.org.au
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Western Australia offers a rich and unique environment for training as a specialist general practitioner. With 15 years’ experience in providing GP training and education, we excel at preparing doctors for a rewarding career, where no two days are the same. Your training opportunities There are choices in where and how you would like to train. Placement opportunities are available throughout the entire state, from up north in the Kimberley to the southern most points in the Great Southern region. You can extend your skills with training placements in Aboriginal health, anaesthetics, emergency medicine, mental health, small town general practice, surgery, obstetrics and gynaecology, drug and alcohol medicine, psychiatry and sports medicine. There is support available if you choose to train rurally, including procedural skills training opportunities and mentoring programs.
Education program We offer you an interactive, self-directed education program that combines structured online learning with modules that draw from your patient caseload in addition to your in-practice teaching and supervision. Case discussions, consultation observations and assessments provide you with an opportunity for constructive feedback and self-reflective learning. You will be supported by our experienced, passionate supervisors, training facilities, regional medical educators and dedicated program staff as you train to become a qualified specialist in general practice.
Training pathways With WA General Practice Education and Training (WAGPET), you are able to train towards a Fellowship with the Australian College of Rural and Remote Medicine (ACRRM) and/or a Fellowship with the Royal Australian College of General Practice (RACGP) and Fellowship in Advanced Rural General Practice (FARGP). We also support registrars with specific training needs, including the Australian Defence Force and academic registrars.
Find out how to start your journey in a general practice career at wagpet.com.au or call us on (08) 9473 8200
3
General practice pathways
How do I get into general practice training? Australian general practice training is managed by the Australian Government Department of Health. Delivery of the training program is made by regional training organisations (RTOs) throughout Australia. Applications to the training program can be made as early as your intern (PGY1) year. Once you are enrolled in the program you are then eligible to apply for recognition of prior learning (RPL). Applications for RPL are made with your RTO to the relevant college, being the Australian College of Rural and Remote Medicine (ACRRM) or The Royal Australian College of General Practitioners (RACGP). It is the relevant college that determines whether
you receive RPL, or how much RPL. Application for consideration of RPL is not possible prior to commencement of the training program. To apply for the general practice program you must meet certain eligibility requirements. To determine if you meet the eligibility requirements, visit agpt.com.au
How do I apply? There are 1500 funded training places in the training program and at least 50 percent of applicants must select the rural pathway for their training. Applications are completed online at agpt.com.au
Do you want to
Be a better doctor? 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. $30 for student membership (life of your medical degree)* $60 for Intern/Resident (annual)* * Membership benefits and fees may be subject to change without notice
Be a better doctor™
www.acrrm.org.au 1800 223 226
3 General practice pathways
Regional training organisations Delivering the training program The general practice training program is delivered by a national network of training organisations dedicated to supporting general practice registrars as they embark on a career in general practice.
standards, each has its own characteristics, style and experiences to offer. Check that your preferred RTO can provide training for the pathway, fellowships, training posts and special interests you want to pursue.
Your RTO will support your formal training with an individual learning plan, guidance and monitoring by medical education staff and GP supervisors in the practice environment.
The endpoints of the training program are Fellowships of ACRRM and/or the RACGP. For more information, including a breakdown of the training boundaries, visit agpt.com.au
While each RTO provides training based on the same general practice training and college
Training organisations
Junior doctors – gpaustralia.org.au
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Eastern Victoria GP Training Eastern Victoria (EV) GP Training delivers training throughout eastern, south-eastern and north-eastern metropolitan Melbourne, Mornington Peninsula and Gippsland. EV’s quality program offers:
• Both general and rural training pathways • FRACGP, FACRRM and FARGP endpoints • A wide variety of experienced and accredited supervisors, training practices, community health centres and Aboriginal Medical Services • The chance for registrars to meet personal learning needs and interests through our diverse training practices and supervisors • Full-time and part-time training
EV provides opportuni�es for registrars to extend their skills during training including:
Academic research, adolescent health, anaesthetics, custodial medicine, dermatology, emergency
medicine, family planning, forensic medicine, HIV medicine, medical education, mental health, obstetrics, palliative care, paediatrics, sexual health, sports medicine and more.
There are lots of good reasons to choose EV:
• Our people - experienced, passionate and dedicated GP supervisors and medical educators place registrar interests at the forefront • Program delivery - a range of learning approaches are used including hands-on workshops, small group learning and an engaging and innovative online learning program as well as individual in-practice teaching opportunities • Great support - registrars are well supported by our outstanding and experienced staff
P: 1300 851 753 E: enquiry@evgptraining.com.au 15 Cato Street Suite B2, 50 Northways Road Hawthorn Vic 3122 Churchill Vic 3842
Find out more about our quality program on our website www.evgptraining.com.au
3 General practice pathways
Understanding the 10 year moratorium What is Section 19AB/the 10 year moratorium? Section 19AB of the Health Insurance Act 1973, also known as the 10 year moratorium, states that overseas trained doctors (OTDs) and foreign graduates of an accredited medical school (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 • overseas doctors trained in Australia or New Zealand who began studying in Australia or New Zealand under a temporary visa and subsequently obtained their primary qualification from an Australian or New Zealand university.
When does the moratorium start? 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. Areas are rated for remoteness and town size according to the Modified Monash Model.
Want to know more? For more information regarding the 10 year moratorium, visit doctorconnect.org.au 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 RA1 RA2 RA3 RA4 RA5
RA category Major cities Inner regional Outer regional Remote Very remote
Junior doctors – gpaustralia.org.au
Scaling discount Nil 10% 30% 40% 50%
Restriction period reduced to: 10 years 9 years 7 years 6 years 5 years
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General practice training program Endpoint qualifications and fellowships FRACGP qualifications (RACGP)
FACRRM qualifications (ACRRM)
Year one
Core clinical training time
Possible equivalence*
Hospital training time
12 months
12 months
++ Year two
Primary rural and remote training 2 x 6 months
Joint training opportunities are available†
GP terms GPT1 – 6 months GPT2 – 6 months
++ Year three
Primary rural and remote training 2 x 6 months
Joint training opportunities are available†
GPT3 – 6 months Extended skills – 6 months
+ Year four Note: Fourth year is for FACRRM and FARGP candidates
Advanced specialised training
FRACGP (VR) Possible equivalence*
Advanced rural skills training for FARGP (12 months)
12 months
FACRRM (VR) * Credit given for AGPT training already undertaken towards one fellowship, prior to undertaking a second or third fellowship † Can be achieved in dual-accredited practices or posts Note: Although this table is presented in a linear format, both colleges have flexible training options to enable registrars to plan their training around their own needs and interests. See the college websites for more information. Registrars can undertake dual fellowships with both the RACGP and ACRRM and the training must be concurrent.
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3 General practice pathways
About the fellowships What is FACRRM?
What is the FARGP?
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.
The FARGP is the qualification awarded by the RACGP beyond vocational fellowship (FRACGP). The FARGP recognises advanced rural skills training (ARST) that develops extended general practice skills and broadens options for safe, accessible and comprehensive care for Australia’s rural, remote and very remote communities.
For more information visit acrrm.org.au
What is 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.
For more information visit racgp.org.au
An important component of the FARGP is 12 months of ARST. Each ARST has its own curriculum guidelines and assessment process and individually designed ARST is available (with approval by the RACGP National Rural Faculty after consulting your medical educator).
For more information visit racgp.org.au/fargp
What is the RVTS? 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.
For more information visit rvts.org.au
Junior doctors – gpaustralia.org.au
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Delivering better health for rural, remote and regional communities through excellent General Practice training.
CRICOS Provider Number: 00117J
Train with GMT, visit www.gmt.edu.au
www.gmt.edu.au
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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
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
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 percent of gross billings or receipts, whichever is greater.
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.
2016–17 training year minimum salaries (plus 9.5% superannuation)
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Annual
Weekly
GP term 1
$74,215
$1427
GP term 2
$89,226
$1716
GP term 3 and above
$95,295
$1833
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
Medical students – gpsn.org.au
4 Money matters
Incentive payments If you are working as a GP registrar, you may be eligible to receive 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.
more effectively target financial incentives to doctors working in areas that experience greater difficulty attracting and retaining general practitioners. Eligible locations under the new GPRIP arrangements are classified as MMM 3–7. The GPRIP payment is based on your eligible location and length of service. The following table outlines payments for each location and year of service.
General Practice Rural Incentives Program
Accommodation
The General Practice Rural Incentives Program (GPRIP) commenced in July 2010. The program aims to encourage medical practitioners, including registrars, to practise in rural and remote communities and promote careers in rural medicine.
Each training organisation has an individual policy regarding accommodation and relocation subsidies for GP registrars. This may include subsidised rental accommodation in rural areas.
Since 1 July 2015, GPRIP has run under a new classification system, the Modified Monash Model (MMM), to determine eligible locations for the incentive payments.
Want to know more? Visit gpra.org.au to find out more about the financial incentives you may be able to claim in addition to your salary.
The MMM classification system categorises metropolitan, regional, rural and remote areas according to both geographical remoteness and population size and was developed to
Modified Monash 1 Category 0 2 0 3 0 4 0 5 $16,000 6 $25,000 7
Year level service 3
2
4
5 plus
0
0
0
0
$4500
$7500
$7500
$12,000
$8000
$13,000
$13,000
$18,000
$12,000
$17,000
$17,000
$23,000
$16,000
$25,000
$25,000
$35,000
$25,000
$35,000
$35,000
$60,000
Source: ruralhealthaustralia.gov.au
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“I liked the idea of looking after ‘the whole’ patient rather than specialise in a single field. General practice offers a broad scope of practice, as well as being a flexible career with a wide range of working opportunities.” Dr Toby Jackson GP Synergy GP Registrar
Thinking GP? Think GP Synergy The leading provider of GP training in NSW/ACT Western NSW | North Eastern NSW | Lower Eastern NSW
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Survival tips
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 junior 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 28
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. 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. Medical students – gpsn.org.au
5 Survival tips
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 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
Junior doctors – gpaustralia.org.au
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 • Lifeline: 24 hour crisis support 13 11 14 • Australasian Doctors’ Health Service: an independent confidential support service run by doctors in all states and territories: visit dhas.org.au for a full list of contacts around Australia • Suicide Call Back Service 1300 659 467 • Kids Help Line: counselling and support for young people (to 24 years) 1800 55 1800.
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5 Survival tips
Exams
Tips to get you through For many students, exams are a time of increased caffeine intake, decreased sleep and copious amounts of procrastination. Dr Emily Jenkins, past GPSN Online Officer and current junior doctor, provides some great tips to help get you through.
Know how you learn best and use your time productively • Everyone learns differently, so it’s important 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. • Maintain self-control. This is the hardest part. 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. • Be honest with yourself. If you can’t motivate 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? • Have a pool of resources at your fingertips, – load your phone/laptop with medical apps, carry GP Companion in your pocket. Junior doctors – gpaustralia.org.au
• Get on Twitter and join the FOAM4GP revolution at #foamgp.
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. • Make a study plan. Break it down into bitesized chunks. Allocate one chunk of learning to each time spot so you know exactly what you need to do and when. • Talley and O’Connor is your OSCE bible. Know it inside out. Ditto, GPRA’s The general practice exam book and The general practice clinical cases. • Pharmacology can be daunting. Don’t learn drug doses, but understand basic mechanisms of action, indications and any specific contraindications 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 a particular area. GP First 2017
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• Keep content fresh in your memory by regularly quizzing yourself on topics you have previously studied, and looking back over your old notes.
Be realistic • 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. • It’s absolutely essential to factor in breaks and 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. • Remember that your faculty/supervisor/tutor is 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. 32
• Seize every opportunity to see patients and 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. • Don’t overlook other allied health professionals. 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.
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 practice, practice and more practice. • Seize every and any opportunity to get 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 percent of the answers lie in 20 percent of the content. Accept that you are not going to cover everything and get smart with what you do focus on.
Medical students – gpsn.org.au
5 Survival tips
“I’m just the intern...” Dr Jen McAuliffe, a junior doctor based 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. At 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 Junior doctors – gpaustralia.org.au
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. It’s frustratingly and sometimes highly droll when as a first year-out 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?
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 GP First 2017
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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.
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, 34
talk to the person, listen and find 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 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
5 Survival tips
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. • Learn how to prioritise and ASK for help! 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.
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?)
Remote Health The time is now
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Resources for junior doctors
The training program Fast facts
When can I apply?
What rotations will I need to do?
During your intern year you can apply to the 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.
Before leaving the hospital system the RACGP requires three relevant elective hospital rotations of your choice, plus compulsory rotations in:
How long do I have to spend in the hospital system? If you have completed some of the required hospital training as a junior doctor, you may qualify for recognition of prior learning so you can either reduce your training time or substitute rotations that develop existing or new skills. After being accepted into the training program, you apply for RPL. You must apply for RPL with your RTO within your first year in the program. There are some restrictions for RPL, so look into it early and before choosing your rotations.
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• • • •
general medicine general surgery emergency medicine paediatrics.
ACRRM prefers registrars to have these four rotations plus obstetrics and gynaecology, and anaesthetics. However, if registrars have had difficulty getting any of these terms, flexible opportunities exist to make up this learning during registrar training.
For more information about compulsory hospital rotations, visit: • AGPT – agpt.com.au • ACRRM – acrrm.org.au • RACGP – racgp.org.au
Medical students – gpsn.org.au
6 Resources for junior doctors
Going Places Network Your community What is the Going Places Network?
How can I contact my GP Ambassador?
The Going Places Network is for junior doctors interested in the most challenging and versatile medical career of all – general practice. Joining GPN gives you access to national general practice focused events, publications, online resources and more.
Visit gpaustralia.org.au/gp-toolkit/ ambassador-directory/ for a state-by-state listing of our GP Ambassadors, or turn to pages 40 and 41 for details.
What is a GP Ambassador? GP Ambassadors play a pivotal role in the Going Places Network. As the champions of general practice in their hospital, they have a strong dedication to developing and promoting GPN while being the primary point of contact for other junior doctors wanting to find out more about general practice. GP Ambassadors also help us run our GPN events, from hospital-based coffee mornings and educational workshops to larger networking events, such as winery tours and barefoot bowls.
“
General practice plays an important role in preventive health. I believe that by delivering effective health education in the community we can prevent a majority of presentations to tertiary hospitals.
”
Dr Shiran Xiao GP Ambassador Fiona Stanley Hospital, WA
How can a GP Ambassador help me? GP Ambassadors are always willing to give honest and useful advice. Whether you have a question about a career in general practice and the training program, or just simply want to chat, your local GP Ambassador will make time for you and offer you the support you need.
What are you waiting for? Explore the specialty of general practice while you complete your hospital training and embark on the journey of a lifetime. Join the Going Places Network at gpaustralia.org.au
Junior doctors – gpaustralia.org.au
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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
Contact
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
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6 Resources for junior doctors
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
Contact
Eastern Health
boxhillgp@gpra.org.au
Shepparton Hospital
sheppartongp@gpra.org.au
St Vincent’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
Contact
Royal Hobart Hospital
royalhobartgp@gpra.org.au
Launceston Hospital
launcestongp@gpra.org.au
WA
Contact
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
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Hospital rotations
Top tips for a good experience As a junior doctor in the hospital setting 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 rotations Choose rotations that will give you experience with common GP-managed conditions. Compulsory and other useful rotations are listed on page 38. General rotations, such as general medicine and general surgery, may be more relevant than super-specialised placements. Accident and emergency rotations 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 procedural skills that may be useful in general practice: joint aspirations and injections, excision of cysts and skin lesions.
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 upto-date guidelines and approaches to chronic disease management.
Hone your writing skills 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 the Going Places Network 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: visit gpaustralia.org.au
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 42
Medical students – gpsn.org.au
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Resources for medical students
7 Resources for medical students
General Practice Students Network
Your student community The General Practice Students Network is a national network of university clubs based at every medical school in Australia, supported by a national executive committee. Club chairs promote GPSN at their university and are a point-of-contact for medical students with general practice career questions. GPSN clubs host a range of educational and career-focused events across Australia and provide professional resources to medical students. GPSN is funded by the Department of Health and overseen by GPRA. Being part of GPSN is being part of a community of more than 25,000 medical students, junior doctors and general practice registrars.
Connect with us There are many ways to get involved in GPSN. At the university level, members have access to events run just for them by their university GPSN club, or become part of the club executive, where they can continue their passion for general practice through advocacy and events.
As a GPSN member, you also become an Associate Member of GPRA. Both GPSN and the Going Places Network, which is for junior doctors, are represented on the GPRA Board and on various external organisations. The GPSN National Executive and Council work to ensure you have the right support to assist you on your journey through medical school, your transition into the hospital system and onto general practice.
National Council The GPSN National Council comprises the local university club chairs and the national executive. The national executive meets frequently throughout the year to discuss, debate and share ideas, and to further develop the network. For a full list of university club chairs around Australia and to meet the 2017 GPSN National Executive, turn to pages 46 and 47.
At a national level, members can become involved with GPSN working groups, attend the GPSN national conference or become part of the GPSN National Executive team.
Why join? As a GPSN member, there are many benefits available to you, including access to free events, discounts and free resources as well as national representation on external committees. We are constantly working on new benefits, based on member feedback. Visit gpsn.org.au to learn more. Junior doctors – gpaustralia.org.au
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2017 GPSN National Executive Meet the team
National Chair
National Vice Chair
National Secretary
Jayden Murphy University of Wollongong chair@gpsn.org.au
Cassie Williams University of Melbourne vc@gpsn.org.au
Megan Bleeze University of Notre Dame Fremantle ns@gpsn.org.au
National Working Group Officer
National Events and Projects Officer
Local Events Officer
Arianne Kollosche Griffith University wgo@gpsn.org.au
Vinay Murthy University of Western Sydney neo@gpsn.org.au
Terence Luo University of New South Wales leo@gpsn.org.au
Promotions and Publications Officer Jaffly Chen University of New England publications@gpsn.org.au 46
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7 Resources for medical students
General Practice Students Network University 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
Contact
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
Contact
University of Adelaide
adelaide@gpsn.org.au
Flinders University
flinders@gpsn.org.au
Northern Territory Medical Program
ntmp@gpsn.org.au
VIC
Contact
University of Melbourne
umelb@gpsn.org.au
Monash University
monash@gpsn.org.au
Deakin University
deakin@gpsn.org.au
TAS
Contact
University of Tasmania
utas@gpsn.org.au
WA
Contact
University of Western Australia
uwa@gpsn.org.au
University of Notre Dame Fremantle
notredame@gpsn.org.au
Junior doctors – gpaustralia.org.au
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GPSN working groups What are GPSN working groups?
Rural Working Group
The GPSN working groups were set up 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.
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, Arianne Kollosche, at wgo@gpsn.org.au For more information about the working groups, visit gpsn.org.au
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7 Resources for medical students
The John Murtagh First Wave Scholarship program What is the program? 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.
What does it involve? 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.
How does it work? Candidates apply via a formal online process. Successful candidates are then matched with a GP supervisor who mentors them during their scholarship period.
Who can apply? First and second year medical students studying at an Australian medical university.
When can I apply? Applications open in May 2017 and close early July 2017.
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
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General practice?
Your questions answered Dr Jas Saini, a GP and GPRA Board Director, answers our medical students’ top five questions about general practice.
1. What is general practice? According to the 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.
2. 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 ACRRM Fellowship (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 centres. Registrars also undertake an extended skills term and can pursue areas of special interest, such as procedural and academic general practice.
The best way of improving your chances of entry into the program is to understand the requirements needed for entry and to speak to registrars currently in the program. If you are interested in the training program, visit gpsn.org.au
4. When can you start general practice training? You can apply to the training program as early as from your intern year (PGY1). Applicants in later stages of training may be eligible to apply for recognition of prior learning for their hospitalbased general practice training component.
5. 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 training 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 RTO for more information.
Want to know more? visit gpsn.org.au
3. Is entry competitive? And what can I do to improve my chances? The Australian government places a quota on the number of training positions available, therefore entry into the program is competitive. 50
Medical students – gpsn.org.au
7 Resources for medical students
Clinical placements
Tips for before, during and after Heading out of the classroom to do some ‘reallife’ doctoring? Dr Nicola Campbell, past GPSN National Chair and current junior doctor, shares her tips for a successful clinical placement.
Before your placement Iron out the logistics early 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!
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.
Junior doctors – gpaustralia.org.au
Keep a log This is probably my nerdiest – but possibly the most useful – suggestion! I always log in my placements. I find that it helps me to reflect and identify areas I need to study up on.
After your placement Read up on the things you observed 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!
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8
General practice resources
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8 General practice resources
Guidelines, apps and more Textbooks and pocket guides Australian Medicines Handbook – amh.net.au Contraception: An Australian clinical practice handbook – Sexual Health and Family Planning Australia
Clinical Guidelines for Stroke and TIA Management: A quick guide for general practice Chronic Kidney Disease Management in General Practice
Fast Facts series – fastfacts.com
Other important guidelines Australian Immunisation Handbook – health. gov.au
GP Companion – a handy reference of general practice clinical information: gpra.org.au
Asthma Management Handbook – nationalasthma.org.au
John Murtagh’s General Practice, Patient Education, Practice Tips MIMS – mims.com.au
Guidelines for the management of asymptomatic women with screen detected abnormalities – nhmrc.gov.au
Sara Bird’s Medico-Legal Handbook for General Practice – free for members of MDA National
Guide to Management of Hypertension – National Heart Foundation: heartfoundation.org.au
Oxford handbooks (Clinical Medicine, Clinical Specialties)
Medical Observer has compiled an extensive list, which includes the RACGP guidelines: medicalobserver.com.au/about/guide-to-guidelines
Clinical Sports Medicine – Brukner and Khan
Paediatric Handbook – Royal Children’s Hospital Melbourne – rch.org.au Paediatric Pharmacopoeia – rch.org.au Practical Fracture Treatment – McCrae and Esser Fitzpatrick’s Colour Atlas and Synopsis of Dermatology
NHMRC guidelines – nhmrc.gov.au/guidelines Therapeutic Guidelines (TG or eTG, available online, CD, hard copy) – an invaluable resource: tg.org.au
Online learning and resources
Reproductive and Sexual Health: An Australian clinical practice handbook – Family Planning NSW
gplearning – gplearning.com.au
Recommended reading list from ACRRM – acrrm.org.au/assessment (scroll down and click on ‘Recommended reading list’)
RRMEO (Rural and Remote Medical Education Online) – rrmeo.com
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’) Junior doctors – gpaustralia.org.au
GPRA – gpra.org.au
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
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Clinical Emergency Management Program – racgp.org.au/cem Diploma in Child Health – chw.edu.au Sexual Health and Family Planning – shfpa.org.au
Evidence-based databases
Immunisation – immunise.health.gov.au Men’s health – Andrology Australia has great tools for prostate screening, male infertility assessment and more: andrologyaustralia.org Mental health – beyondblue: beyondblue.org.au Black Dog Institute: blackdoginstitute.org.au
PubMed – US National Library of Medicine – a database of journal articles including MEDLINE: pubmed.gov
Paediatrics – Children’s Hospital Westmead: chw.edu.au Royal Children’s Hospital Melbourne: rch.org.au
The Cochrane Library – a database of clinical reviews This international site (cochrane.org) has links for GPs and podcasts: cochrane.org.au
Sexual health – Australasian Society for HIV Medicine: ashm.org.au Melbourne Sexual Health Centre: mshc.org.au
Bandolier – a UK-based independent journal of evidence-based health care: medicine.ox.ac.uk/ bandolier UpToDate – 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: uptodate.com 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 – an encyclopaedia of medicine updated on a continual basis. Has a subscription fee: gpnotebook.co.uk
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
Women’s health – including unplanned pregnancy counselling, termination, contraception: mariestopes.org.au; childrenbychoice.org.au
Organisations ACRRM – acrrm.org.au 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) – a not-for-profit organisation dedicated to making primary health care more accessible for communities in rural and remote Australia: rhwa.org.au
Drug and alcohol – Australian Drug Foundation conducts research and education on illicit drugs and alcohol: druginfo.adf.org.au has information for health professionals, courses and podcasts: adf.org.au
Therapeutic Goods Administration (TGA) – the regulatory body for therapeutic goods in Australia: tga.gov.au
Gastroenterology – gesa.org.au
Australian Doctor – especially its ‘How to Treat’ articles: australiandoctor.com.au
Haemochromatosis – haemochromatosis.org.au 56
Journals, magazines and periodicals Most are available online and in print.
Medical students – gpsn.org.au
8 General practice resources
Australian Family Physician – racgp.org.au/afp Australian Prescriber – australianprescriber.com and other NPS publications: nps.org.au
Other podcasts Annals of Internal Medicine – annals.org/multimedia.aspx
check – an independent learning program for GPs (free with RACGP membership): racgp.org.au/ education/courses/check
Cochrane Library – cochrane.org/podcasts
Medical Observer – especially its ‘Clinical review’ feature: medicalobserver.com.au
Journal of American Medical Association Weekly – jama.jamanetwork.com/multimedia.aspx#Weekly
Medicine Today – medicinetoday.com.au Medical Journal of Australia – mja.com.au
New England Journal of Medicine Weekly Audio Summary – nejm.org
WONCA – globalfamilydoctor.com
NHMRC – nhmrc.gov.au/media/podcasts/index.htm
Medical apps for phone or iPad
Patient information
Drug Doses – useful in calculating paediatric doses for various medications
Better Health Channel – offers GPs consumerbased information and patient handouts: betterhealth.vic.gov.au
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 Instant Anatomy Listen to the Lancet The Health Report with Norman Swan The Merck Manual of Patient Symptom Junior doctors – gpaustralia.org.au
Drug Info – druginfo.adf.org.au
My Dr (MIMS Australia) – a range of consumerfriendly tools including a medical dictionary and information on medications: mydr.com.au HealthInsite – an Australian Government initiative that aims to provide patients with the latest information on health and wellbeing with links to health services around Australia: healthinsite.gov.au Parent handouts – a series of handouts for parents and patients from the Royal Children’s Hospital Melbourne: rch.org.au/kidsinfo/factsheets.cfm
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 organisation 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 organisation about libraries that may hold relevant texts or DVDs. GP First 2017
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“Filled with practical advice, the GP Companion will add to the richness of your experiences during your clinical rotations in general practice.” Professor Michael Kidd – GPRA Patron
Are you a GPRA member? Get your copy of GP Companion for the special member price of
$19.95 RRP $34.95
Students visit
gpsn.org.au Junior doctors visit
gpaustralia.org.au
8 General practice resources
Jargon buster What does that mean? 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
FACRRM – Fellowship of the Australian College of Rural and Remote Medicine FARGP – Fellowship in Advanced Rural General Practice FRACGP – Fellowship of The Royal Australian College of General Practitioners GPET – General Practice Education Training GPN – Going Places Network
GPRA – General Practice Registrars Australia Ltd
ACRRM – Australian College of Rural and Remote Medicine
GPRMEN – General Practice Registrar Emerging Supervisor Network
AGPAL – Australian General Practice Accreditation Ltd
GPRMEN – General Practice Registrar Medical Educators Network
AGPT – Australian General Practice Training
GPSN – General Practice Students Network
AHPRA – Australian Health Practitioner Regulation Agency AIDA – Australian Indigenous Doctors’ Association
GPT1, GPT2, GPT3 – General practice terms 1, 2 and 3
AKT – Applied knowledge test
GRIP – General Practice Rural Incentives Program
AMA – Australian Medical Association
HMO – Hospital medical officer
AMS – Aboriginal Medical Service
IMG – International medical graduate
AMSA – Australian Medical Students’ Association ARST – Advanced rural skills training ASGC-RA – Australian Standard Geographical Classification-Remoteness Areas AST – Advanced specialised training CPD – Continuing professional development DHAS – Doctors’ Health Advisory Service DoH – Australian Government Department of Health DVA – Department of Veterans’ Affairs EBM – Evidence-based medicine ESP – Extended skills post Junior doctors – gpaustralia.org.au
IGPRN – Indigenous General Practice Registrars Network KFP – Key feature problem MBS – Medicare Benefits Schedule MCQ – Multiple choice question miniCEX – Mini clinical evaluation exercise MMM – Modified Monash Model NACCHO – National Aboriginal Community Controlled Health Organisation NGPSA – National General Practice Supervisors Association
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NTCER – National Terms and Conditions for the Employment of Registrars NPS – National Prescribing Service OSCE – Objective Structured Clinical Examination OTD – Overseas trained doctor PBS – Pharmaceutical Benefits Scheme PCEHR – Personally Controlled Electronic Health Record
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
PIP – Practice Incentives Program QI&CPD – Quality improvement and continuing professional development RACGP – The Royal Australian College of General Practitioners RDAA – Rural Doctors Association Australia RDNA – Rural Doctors Network Australia RFDS – Royal Flying Doctor Service RLO – Registrar liaison officer RMO – Resident medical officer
RPBS – Repatriation Pharmaceutical Benefits Scheme RPL – Recognition of prior learning RRADO – Registrar Research and Development Officer RTO – Regional training organisation RVTS – Remote Vocational Training Scheme SIP – Service Incentive Payment StAMPS – Structured Assessment using Multiple Patient Scenarios TGA – Therapeutic Goods Administration TMO – Trainee medical officer
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Medical students – gpsn.org.au
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The Future of General Practice Medical students – Junior doctors – GP registrars The Future of General Practice
The The Future FutureofofGeneral GeneralPractice Practice Medical doctors – GP registrars Medicalstudents students– –Junior Junior doctors – GP registrars
Medical students – Junior doctors – GP registrars
Save the date –
April 2017 #fgp17 1 2Save the date 2017 #fgp17 1 2 April
What does the future hold for general practice? There’s only one way to find out – come to #fgp17
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What doesRydges the future holdSquare for general practice? World There’s only to find out –NSW come to #fgp17 389 one Pittway Street Sydney
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With you on your journey GPRA – proudly supporting medical students and junior doctors on their journey to general practice.
Students visit
gpsn.org.au Junior doctors visit
gpaustralia.org.au