GP First 2014 by GPRA Publications

GP First The essential guide for medical students and junior doctors

2014

About this guide The 2014 GP First guide is produced by the General Practice Students Network and the Going Places Network – initiatives of General Practice Registrars Australia. The GP First guide is designed to help medical students and junior doctors make informed decisions about their future training and career aspirations. GP First has been produced using sustainable environmentally friendly printing techniques and paper; an approach that reflects GPRA’s ethos of supporting tomorrow’s general practitioners, and their families, in their quest for sustainable careers in general practice. All information was correct at time of going to press.

Contents 1 Introduction 6 What is GPRA? 8 General Practice Students Network 10 Going Places Network 2 General practice – the first choice 14 16

10 great reasons to be a GP Dr Sarah Matenson

3 General practice career pathway 22 23 24 27 32 33 34 38 41 42 46 52 55 56 59 60 64 67 68 70 71 72 76 78

At medical school – clinical placement survival tips GPSN First Wave Scholarship program Alarna Boothroyd Keith Landale In the hospital – fast facts Making it work for you Dr Rabia Khan Tips for surviving your hospital internship The PGPPP Dr Iyngaranathan Selvaratnam The structure of GP training Dr Natalie Caristo How do I get into GP training? Dr Pavan Phanindra Selection day Dr Fiona Scoffell ACRRM Fellowship RACGP Fellowship RACGP Fellowship in Advanced Rural General Practice The RVTS Part-time training Dr Liz Bond The 10-year moratorium Dr Nici Williams

4 Regional training providers 83 Regional training providers in Australia 84 CoastCityCountry General Practice Training 2

On the cover Dr Sarah Matenson’s job as a city-based GP ticks all the boxes of what a great job should be. Read her story on page 16. 86 General Practice Training Valley to Coast 88 GP Synergy 90 North Coast GP Training 92 WentWest 94 Bogong Regional Training Network 96 Beyond Medical Education 98 Victorian Metropolitan Alliance 100 Southern GP Training 102 Adelaide to Outback GP Training Program 104 Sturt Fleurieu Education and Training Ltd 106 General Practice Training Queensland 108 Queensland Rural Medical Education 110 Tropical Medical Training 112 Western Australia General Practice Education and Training 114 General Practice Training Tasmania 116 Northern Territory General Practice Education 5 Money matters 120 What you can earn 121 Incentive payments 6 Survival tips 124 Looking after yourself – workplace issues 126 Looking after yourself – advice from a GP 128 Exam survivial 7 The networks 130 Going Places Network – ambassador contacts 132 General Practice Students Network – chair contacts 8 Info file 134 Jargon buster 137 GP resources

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GPRA would like to acknowledge the support of our patrons, professors John Murtagh and Michael Kidd. Professor John Murtagh AM is Emeritus Professor of General Practice at Monash University and Professorial Fellow in the Department of General Practice at the University of Melbourne. John is also the author of many internationally adopted textbooks, including the popular General Practice. Professor Michael Kidd AM 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 RACGP. GPRA is proud to have the support of two such distinguished figureheads of Australian general practice.

GPRA Editorial team General Manager: Sally Kincaid Editor: Denese Warmington Medical Editor: Dr Jane Maxwell

Writers: Nick Johns-Wickberg, Laura McGeoch, Jan Walker, Denese Warmington Graphic Designer: Peter Fitzgerald Manager GPSN and First Wave Scholarship: Alex de Vos Manager Going Places Network: Emily Fox

ÂŠ GPRA, 2014. 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 4, 517 Flinders Lane, Melbourne VIC 3001. ABN 60 108 076 704 ISSN 2203-143X GPRA wish to acknowledge the ongoing support of General Practice Education and Training Ltd Printed by Graphic Impressions

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

1 Introduction

About us What is GPRA? General Practice Registrars Australia (GPRA) is a not-for-profit organisation representing more than 21 000 medical students, junior 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, junior 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 healthcare 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 – that’s over 600 to date! The GPRA networks support:

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

• Junior 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.

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 healthcare among medical students and junior 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 • 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:

• social events • seminars and conferences • clinical skills sessions • networking opportunities • peer support. GPSN is available in all medical schools throughout Australia.

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1 Introduction

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

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.

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

GPRA networks

General Practice Students Network The General Practice Students Network (GPSN) has more than 11 000 members and is run by university club chairs – medical students who have a passion for general practice. They 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, national

events officer, internal communications officer, sponsorship officer, online officer, publications and promotions officer as well as a local events officer. GPSN provides a range of educational and professional resources of interest to all medical students including academic, professional and social events; guides, such as GP Companion – a handy pocket reference for general practice rotations; a GP-themed magazine, e-newsletters and website; and the First Wave Scholarship program.

Meet the national executive team National Chair – Joe Monteith Melbourne University, Victoria

What three words describe you? Passionate, organised, nerd. What I like about general practice is … the continuity of care for our patients. GPs are able to see their patients grow up over time, initiate treatment and then follow them through the good and the bad; GPs are the only true generalists, and can’t be pigeonholed within a particular type of medicine (unless we want to of course); and a career in general practice allows a fairly large degree of flexibility in terms of work-life balance, which frees up time to develop things within and outside of medicine. Who inspires you? Prof Lisa Nissen, Prof Steve Trumble, Group Captain Dr Stephen Davis and Prof Michael Kidd. These people go above and beyond all aspects of their careers and professional obligations whilst remaining grounded and true to themselves. They all excel as leaders and managers, clinicians and researchers, and I’m not 100 percent sure how they fit everything into their days! 8

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1 Introduction

National Vice Chair – Nicola Campbell Griffith University, Queensland

What three words describe you? Driven, pedantic (in a good way!), whimsical. What I like about general practice is … the diversity of work and never knowing what’s going to walk through the door next, the possibility of shaping my practice around my own interests, research and education opportunities, the flexible lifestyle and the continuity of care. Who inspires you? It’s far too hard to pick! I would broadly say people who channel their passion and enthusiasm into their work, and also use that to help engage those around them – be it their patients, students or colleagues. I love seeing people who are excited about what they do and find that it is positively infectious to be around them.

National Secretary – Danielle Todd Melbourne University, Victoria

What three words describe you? Enthusiastic, efficient, personable. What I like about general practice is … the variety of patients that walk through the door, and the opportunity to get to know them all. What is your most memorable GPSN moment? Attending my first October council meeting in 2012 and being inspired by the achievements of GPSN nationally.

Want to know more?

Every GPSN club has a university chair, vice chair and secretary. Some clubs have other members on their executive committee as well. See page 132 for a full list of how to contact your club chair. GP First – The essential guide for medical students and junior doctors

GPRA networks Going Places Network The Going Places Network is run by a team of GP ambassadors – junior doctors who have a real passion for general practice. Our GP ambassadors are dedicated to developing the Going Places Network in their hospital and are a point-of-contact for other junior doctors who want to know more about general practice. GP ambassadors run a series of networking and educational events around the country that provide junior doctors with the opportunity to network with peers, develop professional skills, have fun and meet with local GPs. Our ambassadors are on hand at hospitals or email to answer your questions about general practice. If there are any questions they can’t answer themselves, they’ll find the answers for you.

We have over 40 GP ambassadors throughout Australia, so go on, find out who your local GP ambassador is and drop them an email. Our GP ambassadors are there to help and look forward to meeting you! Going Places Network GP Ambassadors are listed on pages 130–131. In the meantime, meet two of our team.

Dr Ineke Woodhill

Barwon Health, Geelong, Victoria Contact Ineke at geelonggp@gpra.org.au As a GP, I’m looking forward to ... listening to people, always learning, and feeling like I have made a difference to the community at the end of a day’s work.

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1 Introduction

Why did you choose general practice? I see general practice as an interesting, diverse and flexible career path where I can get to know my patients. Who inspires you? Paul Farmer, physician and anthropologist, because of his commitment to primary healthcare in developing countries, and Atul Gawande, surgeon and author, because he takes the time to reflect honestly about what it means to be a medical practitioner.

Dr Helen Fraser

Townsville Hospital, Townsville, Queensland Contact Helen at townsvillegp@gpra.org.au As a GP, I’m looking forward to ... being able to have a balanced lifestyle of both work and play, and being able to move and create new and exciting opportunities in rural communities.

Why did you choose general practice? The lifestyle and scope of practice available in training, and, having a short attention span, I’m attracted to the many areas of interest and ability to sub-specialise within general practice. Who inspires you? Driven people, such as my grandmother, who fought against adversity; and philanthropists like the late Dame Elisabeth Murdoch who continuously kept giving back to society.

Want to know more? Contact your local GP ambassador, visit gpaustralia.org.au or look out for posters at your hospital to see what’s happening with the Going Places Network.

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

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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 GP 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 120.

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 121. The GP 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

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’.

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2 General practice – the first choice

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 GP training. For more information about the structure of the AGPT program, see pages 46–51.

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. For more information about training providers, see pages 83–117.

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 in 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 – gpet.com.au GPRA – gpra.org.au RACGP – racgp.org.au

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

City limits As a born and bred city girl, working flexible hours in a busy clinic in the heart of Melbourne is exactly where mum and GP Dr Sarah Matenson wants to be. If Dr Sarah Matenson’s job was advertised, it would tick all the boxes that a good job should. Flexible work hours. Tick. Ability to specialise. Tick. Autonomy and teamwork. Tick. Good local coffee. Tick! And the list would go on. It’s no surprise then, that after 11 years at Mid-Town Medical Clinic on Melbourne’s Collins Street, Sarah has no plans to leave any time soon. “I’m very privileged where I work,” says Sarah. “I even get to ride my bike to work – that’s part of the beauty of it.” Sarah dismisses the perception that a city GP’s patient list is full of grumpy office workers with coughs and colds. “I don’t tend to do a lot of that ‘non-interesting’ general practice here,” she says of Mid-Town, which has about 15 GPs. “It’s like a mini hospital. We have a sports clinic with a physiotherapist and allied health professionals attached to our centre, as well as orthopedic and skin specialists,” she explains. “There’s a real ‘team’ feel here. We ask each other questions and are very collaborative.” As part of her registrar training, Sarah did two city-based rotations, including one where she now works, and also spent six months in the picturesque town of Daylesford, northwest of Melbourne. “I enjoyed my country work, but there are two main reasons I prefer working in the city – one is 16

the lack of jobs for a GP’s partner, and the other is the lack of anonymity of working in a small town,” Sarah explains. “For example, I’ve had the lady working on the checkout at the supermarket discussing her Pap smear results with me!” On the downside, Sarah admits that city-based GPs practise less acute emergency medicine, which was an area she enjoyed during her internship in Bairnsdale in regional Victoria and at an outer suburban Melbourne hospital. Her introduction to the emergency department was a baptism of fire of sorts, but Sarah “loved” the work and met the challenge head on. “My first ever shift as a doctor lasted 30 hours and included running the emergency department overnight. That was a bit scary!” she recalls. But while she may not see as many acute injuries as her rural counterparts would, her patient list is still varied. “I remember, not long after I started, having a medical student sit in with me. I told them that some days can be quite routine, but then we immediately had a succession of really diverse medicine – there was one patient with breast cancer, we did an initial MS diagnosis and there was a case of appendicitis.” Sarah did her Diploma of Obstetrics during her registrar training and now provides ‘shared care’ for expectant mothers who want to split their appointments between their GP and hospital midwife or doctor. She says it’s a great option for women working in the city and suitable for low-risk pregnancies. “Most of the patients I see for shared care are already my patients to start with,” she says. “That’s the advantage – you already have a relationship with them.You get that continuity.” It was a combination of medical and personal elements that attracted Sarah to obstetrics and gynaecology. “On the whole, it’s a well and happy

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2 General practice – the first choice

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

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

medicine,” she says. “People aren’t usually coming to you with diseases or illness. I’ve been around my fair share of tricky labours, but mainly this work is fairly upbeat and happy.” “I like how defined ‘obs and gynae’ is,” she says. “Most of the time, it is anatomically straightforward medicine – a uterus and two ovaries. I don’t want to over-simplify it, but I see a beauty in that. There is a good sense of control,” she adds. The theme of stripping medicine back to basics first touched Sarah when she worked in a children’s hospital in Nepal as a medical student. “I just realised that the most life-saving kind of medicine that we could do for most people there was basic medicine and sanitation. We saw so many vaccine-preventable diseases that we just don’t see in Australia.” In terms of the local landscape, Sarah says Australians are becoming more informed about their health. “I’m seeing far less colds and trivial things,” she says. “People are better educated about their health. They come in for preventive screening now, which is unheard of in a lot of countries. “I also see more mental health issues now than when I first started. I don’t think that’s because there is more prevalence, I think people are just more comfortable to talk about it and to address it. They might have previously gone straight to a psychologist, but now they go to their GP first.” This trust and continuity of care that GPs develop with their patients is what appeals to Sarah. “It’s lovely when you start to establish that long-term relationship with patients … when they come back and see you, or send you a letter or a card to say ‘thank you’.” Sarah, who has two sons – Angus, seven and Tommy, four – lists the flexibility she enjoys in 18

her city clinic as another major benefit of general practice. “That’s why I love it,” she says. “I am working four days a week now, but whatever I want to do is fine (with the practice). Everyone here has a very balanced lifestyle. “I’m usually seeing my first patients by 9.30 am and on some days finish at 3 pm so I can manage the school and kinder runs a couple of times a week. “It can be really draining for a GP to work five-days a week – it’s a constant revolving door of people. So it’s important that you have time to try out other medical or personal interests.” And while she has a great team to support her, Sarah says she “loves” the autonomy of her role. “The thing about general practice is that I’m my own boss. Now and then there will be an emergency that will make me run late, but generally I can get out on time.” Although traditionally it has been women taking up part-time work, Sarah says male GPs are also now increasingly seeking to better balance their work and personal lives. “The new generation coming through is more into lifestyle and less into the management side and the stresses that come with it.Years ago, when I first started out, I might have said I want to run my own practice one day,” she says. “But it’s kind of hard to be the business person and the doctor as well.” So, where does Sarah see herself in 10 years time? Sarah’s reply confirms that her city job is the perfect fit for her. “Probably doing something very similar to what I am now!” she laughs. “Maybe I’ll do a little bit of teaching or simple surgical assisting. There are so many options.”

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

If you are interested in general practice, or just considering your options, GPSN is a great way to kick start your career.

•

Free networking events — meet others who share an interest in general practice.

• • • •

Free professional development events – attend student-focused general practice seminars, workshops and skills sessions Regular e-news and other resources providing all the latest on all things GP Free publications – GP First guide to general practice, GP Journey magazine and GP Companion – a handy pocket reference for GP rotations Opportunity to apply for a GPSN First Wave Scholarship and a chance to win some great prizes and places at conferences

Join online today – it’s free Contact your university GPSN chair (see page 132)

gpsn.org.au Online support for medical students interested in general practice

3 General practice career pathway

At medical school

Clinical placement survival tips Heading out of the classroom to do some ‘real-life doctoring’? Dr Patrick Tam shares some tips on getting more from your clinical placements. Before your placement

• Devise a plan – Think about what you expect to get out of the session and articulate some goals for the day. Some examples are to learn more about diabetes, focus on neurological examinations or find out how to take an appropriate drug history. The most important thing about your plan is to make it realistic and achievable.

• Organise how you’ll execute this plan – If your

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

• Collect your thoughts – Before you start, just

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

During your placement

• Be engaged – It’s easy to be a passive learner,

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

• Be open to failure – You’re not going

to know it all, nor will you get it all correct the

first time but don’t be afraid to put yourself out there. Give your answer and give it confidently. Medicine is never black and white and if you give a good justification for your response, even if it’s completely off the mark, you’ll learn from your mistake.

• Put yourself in your preceptor’s shoes – Think to

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

After your placement

• Invest in a logbook – Even if it’s not mandatory

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

• Nerd it up – Review what you saw during the

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

• Talk about your day – Talk to your friends,

housemates or whoever will listen to your boring medical chat, and trade what you all learnt. Learning something and then teaching it to someone else will solidify what you know – and you get to learn something from your colleagues in return. Just be sensitive about patient details and over-sharing.

Read Patrick’s tips for surviving your hospital internship on pages 38–40.

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3 General practice career pathway

The GPSN First Wave Scholarship program What is it?

What does it involve?

The GPSN First Wave Scholarship program provides positive, early, structured exposure to general practice in a range of settings including urban, outer metropolitan, Aboriginal medical services and academic.

The scholarship involves completing a series of supervised sessions in a clinical practice or doing a research project or other academic activity. Academic scholarship recipients also undertake some clinical sessions. Clinical sessions are generally scheduled during university summer holidays. Participants also attend an orientation workshop.

Who can apply? Any first, second, third or fourth year student studying at an Australian medical school.

How does it work? There are two streams: clinical and academic. Candidates apply via a formal process. Successful candidates are then matched with a GP who mentors them during their scholarship period.

When can I apply? Applications open 30 May 2014 and close 30 June 2014.

How do I apply? The GPSN First Wave Scholarship program is advertised at participating campuses through the 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 junior doctors

“There’s a real Embracing the possibilities ‘team’ feel here ... we are very collaborative.” to do her rotations in obstetrics and gynaecology,

Alarna Boothroyd, now a fifth year medical student at the University of Western Australia and recipient of a GPSN First Wave Indigenous Health Training Scholarship, is becoming more and more convinced that general practice is the career for her.

Alarna’s attitude throughout her studies has been to try to get as much experience as possible by never passing up an opportunity. Throughout high school she had wanted to be a vet, but in year 12 she started swaying towards medicine, and after studying law for a year made the transition. Since then she has fully embraced the opportunities medical training has to offer. During her first four years of study she spent two weeks every year experiencing general practice in the Victorian town of Mildura, and in December 2012 she spent a week working in an Aboriginal Medical Service in Bunbury as a recipient of a First Wave Indigenous Health Training scholarship. “I think it’s a good idea while you’re still a medical student, studying and learning little bits of everything, just to give everything possible a go because often you’ll be quite surprised about what you like and what you don’t like,” Alarna says. “I didn’t ever really consider rural medicine initially and now I’m doing all these things I’m loving.” Medical students at UWA have the option of spending their entire fifth year doing placements in a rural setting. Alarna, along with about 60 of her colleagues, chose to make the most of that option. At the start of 2013 she went to Albany in WA 24

paediatrics, general practice, surgery and general medicine. She has thoroughly enjoyed the experience, both in terms of career development and lifestyle. “I’ve done these other things that have made me quite like rural medicine, so I thought this was another option to get exposure,” she says. “Aside from that it’s just trying to get you to love the rural lifestyle as well, which I do. There’s so much hiking and canoeing and all those outdoor activities down here, which is really nice.” Alarna’s week of general practice experience in Bunbury through the First Wave Scholarship program was one of the reasons she has found herself becoming more interested in general practice and rural health. “That was also another rural experience I’ve had that I loved, which all kind of influenced me to spend this year down in Albany,” she says of the scholarship. “Going from someone who never really grew up in a rural area and hadn’t really been to a rural town at all and never really considered (working in a rural area), I’ve ended up doing all these things and I love it.” The scholarship, Alarna says, was well organised, interesting and financially supported; her transport, accommodation and training costs were all paid for. From a clinical perspective, it gave her the opportunity to take patient histories and do basic examinations under supervision. The written application required to answer fairly straightforward questions touching on why she was applying for the scholarship, what she expected to learn and why she was interested in Indigenous health. Although the questions were simple, Alarna’s answers were passionate and in-depth, earning her a spot in the program.

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3 General practice career pathway

“I think it’s a good idea while you’re still a medical student, studying and learning little bits of everything, just to give everything possible a go ...” GP First – The essential guide for medical students and junior doctors

It was clear that learning more about Indigenous health was one of Alarna’s primary motivators in going to Bunbury. She is passionate about health equality and wanted to learn more about the social determinants and other factors that contribute to the Indigenous health gap. For her, theoretical knowledge wasn’t enough – she needed a first-hand perspective. “That’s one of the main reasons I did it, because we didn’t really get any exposure to Aboriginal health up in Perth,” Alarna says. “You got taught about it a lot up in Perth at uni, in lectures and tutorials, but I don’t reckon that gives you any indication of what it’s really like until you get exposed to it in the clinical sense.You get to put all that theoretical knowledge into practice. “I really enjoyed hearing stories from Aboriginal people about their journey and life and where they’d come from,” she adds. “Sometimes we’d go on home visits as well, which was even more interesting because you could be introduced to their family and their home life in a much more comfortable and relaxed setting.” Witnessing first-hand the idiosyncrasies of an AMS was an interesting experience for Alarna. In Bunbury, the practice had certain days when no appointments were scheduled and patients could arrive at whatever time suited them. It was a system tailored to the needs of the community, for whom life is not always so heavily structured by time. “It was good being purely in an AMS rather than a general practice where you deal with both non-Aboriginal and Aboriginal patients, because it’s structured quite differently,” Alarna says. “It was quite interesting because some days they’d have booked appointments like a normal GP setting and then other times they would just have walk-in appointments. Sometimes we’d be sitting there 26

twiddling our thumbs for a few hours because no-one would come in, then all of a sudden a huge family would come in and you’d be busy for a few hours.” The thought of being a GP in the future is clearly growing on Alarna. There are many appeals – variety, building a connection with patients, continuing care and health co-ordination to name a few. “I really like being that primary care provider and seeing people for the first time.You have to know a bit of everything; working out the diagnosis and then referring on if you need to,” she says. “You’re the main person co-ordinating their entire care and you’ll see them from the beginning right until the end. I think that’s quite nice. So many of the GPs you talk to, they talk about how they saw this patient when they were a baby and now they’re treating their kids and then their kids even. I really like that aspect.” Alarna’s interests are influenced by the experiences she has had during her medical training so far, and will undoubtedly continue to be influenced by what she does in the coming years. The early and varied exposure she has had to rural general practice has shown her how rewarding a career as a GP can be. A future that she might not have considered otherwise is now well and truly on the radar. “I definitely would recommend other people to apply for things like the First Wave scholarship,” Alarna says. “In terms of general practice before all of this I was kind of on the fence; I wasn’t really sure if I liked it or if I didn’t like it. It was another one of the reasons why I applied, just to get some more experience and work out if it’s for me. The more and more I go along, I think the more and more it is for me.”

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3 General practice career pathway

Getting involved Being awarded the GPSN First Wave Clinical General Practice Scholarship was a landmark moment in Keith Landale’s medical training. It opened his eyes to how enjoyable rural general practice – and country life – could be. On his first morning in Narrandera, the small NSW town where he undertook his week-long ‘first wave’ experience, Keith introduced himself to the local newsagent and mentioned that he was a visiting medical student. By the time he returned to his lodgings at the Narrandera hospital it seemed the whole town knew who he was, and the next day his walk down the main street was met with friendly smiles and a “How do you do” from all and sundry. It was the kind of tight-knit community that Keith – born in Oman and raised in Sydney from the age of 11 – had not experienced before. “As I was walking down the two blocks that was the city of Narrandera, everybody knew who I was and was smiling,” Keith says of his second morning. It had a lasting effect. “When I came back to the city it was a bit awkward, because I started smiling at everybody because I’d just got used to it. The city people were looking at me with these awkward glances saying ‘Why is this guy smiling at me?’” Keith went to Narrandera in 2012, the second year of his medical degree. Two of his friends had been awarded the First Wave scholarship the year before and, having heard how much they’d enjoyed their experience, Keith was eager to apply. He was successful and, after a weekend induction in Sydney,

was destined for Narrandera, an hour west of Wagga Wagga. One of the aims of the scholarship is to give students a chance to practise basic clinical skills. Narrandera was the perfect place for that, as the local hospital is connected to the general practice, offering a wider range of training opportunities. While Keith only took a few histories during the week – the clinic was often busy and the supervising doctor was already very familiar with most of the patients – he got the chance to perform basic examinations, cannulate patients and even give his thoughts on some of the tougher cases. “The GP I was with was very encouraging. He would get me to examine the patient and then report my findings. I’d never talked to this patient and then I had to list all my findings and he would say whether I was right or wrong, then he would also get me involved in the management plan,” Keith says. “It was very involved. It wasn’t like I was sitting in a dark corner and just writing notes on my own. I was front and centre and very much a part of the conversation. “The clinical exposure being in a rural setting was a lot more hands-on than it would’ve been in a metro setting. That’s one of the main reasons I love being in the country,” he adds. “Country patients are so much more open to medical students just because they know the difficulties of getting medical care in those remote areas. They’re very outgoing, very friendly and very involving. “It’s very funny how I compare my GP experience there to the rotations I’ve had in the city as part of my medical degree. Here, the GPs always ask ‘I’ve got a medical student with me, is it okay if he sits

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

“It was very involved. It wasn’t like I was sitting in a dark corner and just writing notes on my own. I was front and centre and very much a part of the conversation.” 32

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3 General practice career pathway

in with us?’ A lot of patients in the city flat out deny me, whereas when I was in Narrandera I only had one patient tell me no.”

because it’s bad’. Well that’s not really a reason. Unless you’ve experienced it, you can’t say ‘I don’t want to do this area’.”

Another patient sticks out in Keith’s memory. He was a cancer survivor who had come out of chemotherapy with a resilient attitude and, while being prepped for a procedure, enjoyed a good chat with Keith. The patient’s veins had been affected by chemotherapy and Keith was unable to cannulate him, having to call on the supervising doctor for help. It was an experience that could have been disheartening for an aspiring doctor, but the very next day that patient returned to the clinic with his family just to say thanks. He told Keith how well he had done and expressed his gratitude for the care shown.

Is general practice the future for Keith? With two more years of his medical degree to go he’s keeping an open mind, but at this stage it appears the most likely pathway. Whatever specialisation he chooses though, Keith will always have a respect for the importance of general practice.

“In a city setting you usually won’t see your patient the next day and it was just nice to have that sort of follow-up,” Keith reflects. “Nice to see that circle complete itself.” If there’s one thing the First Wave scholarship has taught Keith, it’s that people should experience something first-hand before they judge it. He feels that many medical students have a negative perception of rural general practice because of what they have heard, rather than what they have seen. He would advise those people to give rural medicine a go before they come to that conclusion. “Remote areas get a lot of flak in the media – they don’t have any resources, they’re cut off from the world – but I just found that people are so genuine, they’re so friendly,” he says. “I find a lot of my colleagues saying ‘I don’t want to do this area

“I have seen the power a GP holds. The GP is the one that organises the patient’s care. The GP holds the power over who they send the patient to.Yes, specialists are quite powerful – but if the GP gets patients who have had bad results or bad patient encounters, they are the ones who can make or break your business,” he says. “In the future, the GP will still be where the power is no matter where you are in the world.” The effects of Keith’s week in Narrandera are plain to see. His interest in general practice and rural health can be traced back to that one experience, and it’s not about to stop there. In 2014, Keith will take his biggest step yet towards a future in rural general practice. “Presuming I pass my third-year exams, I’m actually doing my whole fourth year in Lithgow as a rural rotation. That was purely from being in Narrandera for a week. Doing that placement has really opened my eyes to the GP world and I’m strongly considering it for my specialisation,” Keith says. “Being so involved in somebody’s life is what medicine is. It is a privilege that a few of us get to experience and the GP setting is where you can do it.”

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

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

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

During your intern year you can apply for 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.

If you have completed some of the required hospital training as a junior 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 regional training provider (RTP) 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 – gpet.com.au • ACRRM – acrrm.org.au • RACGP – racgp.org.au

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Junior doctors – gpaustralia.org.au

3 General practice career pathway

Making it work for you Top tips Learn the art of referral As a junior doctor in hospital or Think about what information is pertinent on a a student preparing to graduate, referral letter sent with a patient to emergency. it’s easy to be occupied with the Discuss the referral process with consultants. usual duties of caring for too many What do they like in a referral? What tests should be ordered prior to referral? How urgently do they patients and constantly being paged. Often, there is little time left need to see particular cases? Be curious about to think about how your hospital management decisions experience can help you as a GP In addition to the acute management decisions you in the future. Here are our top will have made in the hospital setting, as a GP you tips to help you make the most will also be initiating and monitoring long-term management of chronic conditions. Talk to your 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 32. 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. During the prevocational years, doing a PGPPP term is a great insight.

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

Pick up useful procedural skills

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.

Do it now! 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 at 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 junior doctors

On the medical frontline Dr Rabia Khan came face-to-face with mass human suffering as a trainee army doctor in Pakistan. Now as a junior doctor and Going Places Network GP Ambassador in regional Victoria, she’s making a new life. The first thing that strikes you about Dr Rabia Khan is that she looks far too young to have done what she’s done and see what she’s seen. Who would guess this fresh-faced young doctor has already witnessed a miasma of mass human suffering? In displaced persons’ camps. In war zones. In the aftermath of some of the world’s worst floods and earthquakes. Working in such settings was part of her medical training and career as an army officer in her birthplace of Pakistan. Rabia served in the Pakistan Army as a Captain for almost six years after graduating from the army medical college and basic military training. She won an award for the most outstanding cadet in her year. “During this tenure I was exposed to the unique experience of dealing with war casualties, flood and earthquake victims in Pakistan,” Rabia says. “We were not only providing them with medical care but food, clothes and shelter.” When we asked her how she dealt with these confronting experiences, she was matter-of-fact. “My father was an officer in the Pakistan Army. Many members of my family have been in the

military and a number of them have been doctors. In Pakistan, the army is one of the most prestigious organisations and a very noble profession. “Being born into army life, these (working in war zones and humanitarian camps) were the sorts of things my father was involved with over the years so I had it in the back of my mind that I would be doing all this.” Even as a young child, Rabia knew she wanted to be a doctor. “It was always my father’s dream that all his daughters should be doctors. I’m the eldest of five sisters. But I didn’t feel pressured because it was my passion as well. Now all my younger sisters are either working as doctors or completing their training to be doctors back in Pakistan. “In my society, sons are traditionally more highly valued than daughters but my parents were determined that their daughters should be given the same opportunities as sons.” Rabia says that some people in Australia are surprised that women in Pakistan, a Muslim country, should be encouraged to pursue higher education and the professions. Rabia is quick to debunk this perception. “It’s not like that at all,” she says. “In Pakistan we have women in almost every profession.” So how did Rabia end up in Australia? “I came to Australia for my honeymoon in 2010,” she says. She and her husband, also an army officer, fell in love with Australia. “I met up with many friends who were working here, so I thought why not give it a go?” Now midway through completing her Australian general registration, Rabia is working as an admitting officer in the emergency department at

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3 General practice career pathway

“I was exposed to the unique experience of dealing with war casualties, flood and earthquake victims in Pakistan.” GP First – The essential guide for medical students and junior doctors

Goulburn Valley Health Hospital in Shepparton in regional Victoria. Rabia is also the GP Ambassador at the hospital for the Going Places Network, sharing her energetic enthusiasm for general practice with her peers. “I have big dreams for my future as a GP,” she says as she goes on to list the benefits of a career on the civilian medical frontline. The variety of work, being involved with the community and the ability to balance career and family all appeal to her. Rabia says everything is falling into place for her, including her personal life. With her husband, who is still working in the Pakistan Army, planning to soon join her in Australia permanently. Living alone while settling into a new job, new home and new country has been the most difficult part of being an international doctor in Australia, she says. But it has been made easier by her

supportive friends and hospital staff. And she keeps busy with many outside interests. “I love to read, I love to cook and I love photography. When my husband gets here I will be complete.” So what will she remember most about her formative years in the Pakistan Army and what impact did it have on her as a doctor? “There’s one incident I recall when I was working with war casualties at the Combined Military Hospital in Rawalpindi. This officer had lost both his legs just before he was about to get married. The wedding went ahead in the ward. It was an overwhelming experience I’ll never forget.” In the relief camps, Rabia says medical teams had to do the best they could with very limited resources. “I think it’s made me an adaptable doctor – and even more passionate about my work,” she concludes.

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Automatic cover for the treatment of public patients …you’re covered with MIGA

Sleeping easy is knowing you have the right cover in place. Medical indemnity policies for doctors aren’t the same and your current policy may not offer the cover you need. If you’re embarking on a GP placement call us today on 1800 777 156 or insure online at www.miga.com.au.

Call us on 1800 777 156 www.miga.com.au

Always on your side

Insurance policies available through MIGA are issued by Medical Insurance Australia Pty Ltd (AFSL 255906). MIGA has not taken into account your personal objectives or situation. Before you make any decisions about our policy, please read our Product Disclosure Statement and consider your own needs. Call MIGA for a copy or visit our website. © MIGA October 2012

Your hospital internship

Tips for survival and staying focused You’ve finished medical school and have earned the title of ‘Dr’ – well done! The hospital is your new domain, so what can you expect over the next two years? Dr Patrick Tam, a junior doctor in his second year at Alice Springs Hospital, shares his tips for surviving and getting the most out of your internship. What’s it like being called ‘doctor’ for the first time? I’m still getting used to it! I’m getting used to writing it on paper. Sometimes it feels a bit pretentious, but other times you need it to get things done. How did you end up in Alice Springs? I attended two medical conferences in Alice Springs as a medical student (Pat studied at the University of Wollongong). I only spent three or four days here each time, but I really enjoyed it. I was captivated by what I was told about working in Alice. It has an interesting population and interesting medicine.You have to think more clinically and go back to the basics because it is a smaller hospital and there is less equipment. What do you like about working there? On the medical side, I’m enjoying the challenges. It’s been interesting working with the Indigenous population who are primarily coming from ‘out bush’ into the community to see a doctor. Some patients present so late with conditions that it almost becomes extreme medicine. There are 38

also some cultural challenges and we have to incorporate this culture into the medicine. Is the hospital a big leap of responsibility compared to medical school? I think it’s a mentality thing. For me, it wasn’t that much of a big leap.Your mistakes now are your mistakes, but you still have a very supportive team and are still under the supervision of the hospital. I feel like I have autonomy, but also have support if I need it. I’ve never felt like I’ve been left floundering. Have you ever felt like you were thrown in at the deep end? Yes, a bit while being on nightshift over the weekend for the first time. On nights there is only one intern and one registrar for medical patients, and one intern and one registrar for surgical patients. I had a couple of sick patients present with really high fevers and worrying vitals suggestive of impending sepsis. I wasn’t quite sure what was wrong with them (one ended up having a urine infection and the other a septic joint). The nurses wanted to know what I wanted them to do right away. I guess it’s about thinking back to medical school, staying calm, thinking logically and starting with your medical ABCs.You might feel pressured to come up with a solution or diagnosis but really, if you’re stuck, just highlighting your main issues and then questioning it with a senior is sufficient at this stage in your training.You’ll feel more confident and comfortable the more times you get thrown into that deep end. What do you like about being in the hospital setting? When patients say ‘thank you’ for explaining things properly to them and tell you it’s the first time they’ve understood what’s happening to them.

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3 General practice career pathway

Patrick’s tips for surviving your internship Do ...

• Keep an open mind – Even if you don’t like

your particular rotation try and get the most out of it

• Challenge yourself – Put yourself in situations where you feel uncomfortable and learn from that

• Continue to learn – Keep yourself updated. You’re learning not only for yourself, but for your patients.

Don’t ...

• Be overwhelmed – It might seem like a

daunting task to come out as a doctor and you may feel like you need to do everything, but you are always supported and it’s a safe environment. As long as you are safe, there shouldn’t be an issue

• Offend people – It will always come back to you. This is especially true for nurses and allied health professionals

• Give up – Some days are hard and you might feel like an over qualified paper pusher monkey with minimal gratification, but keep in mind who you’re ultimately doing this for your patients.

“Your mistakes now are your mistakes, but you still have a very supportive team and are still under the supervision of the hospital.” GP First – The essential guide for medical students and junior doctors

Just talking to the patients – that’s more rewarding than taking bloods!

How do you deal with conflict with other hospital staff?

Is there a rotation that particularly stands out for you?

At the end of the day, you’ll always find conflict within the hospital. Hospitals are high stress areas and are often understaffed.

I’d have to say general medicine because the cases are quite complicated. It was also my first term as a If you have a problem, you’ve got to approach the doctor. There was more face-to-face time with the person diplomatically and if nothing changes then consultants too, which was good. go further up the chain. I had a problem with a senior staff member and took this course of action What sort of hours are you working? and things got better eventually. Anywhere from 38–60 hours per week. It depends on the rotation. I generally work 8 am to 4 pm, but If there is conflict, you have to resolve it. It might I end up staying until 5 pm or 7 pm on some days. be difficult in the short term, but it will be much better in the long term. During surgical rotations, I would get in more like 7 am. My longest shift was during this rotation and Do you have a good rapport with I worked 7 am to 11 pm. On the surgical team you the other interns? do a long day over the weekend and you get three There are 16 interns here and we all get along days off. really well. But during my orthopaedic rotation, I was doing 70 hours a week. It’s just what the specialty required and we were a bit short staffed. What’s your advice for managing a challenging day or long hours? I guess during the day it’s about trying to be aware of how you feel. It’s important to take a break if you need to. Even for just five minutes ... take a sip of water. I try and discuss any issues with colleagues or friends in a professional manner. Try to be healthy and go for a run or swim, or do something that you enjoy. I’m learning the ukulele!

I’m living with another intern and a pharmacist who I met in the nursing quarters when I first arrived. We have multi-disciplinary house meetings! We talk about the same patients from different angles. I can always learn something from them. What should be considered when choosing a hospital? Naturally people will choose hospitals where they may already know someone and hospitals that they are comfortable with. At the same time, it’s good to go somewhere where you don’t know anyone. It’s good to read up on the hospital and prepare yourself for what that hospital has to offer in terms of specialties, rotations and teaching. Also find out about the area that the hospital is in.

Medical students – gpsn.org.au

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3 General practice career pathway

Test drive general practice with the PGPPP Want to put yourself in the driver’s hospital terms. At the end of your term in general practice you simply rotate back to your hospital. seat beyond the hospital gates? Who is eligible? The Prevocational General Junior doctors, interns and international medical Practice Placements Program graduates employed by state government hospitals are all eligible. If you are an overseas-trained doctor (PGPPP) is a great way to have or former overseas medical student, you are your own patients while being eligible, provided you have no conditions on your registration. mentored by inspiring GPs. Will I be paid on the PGPPP?

What is the PGPPP? The PGPPP is a great opportunity to experience life as a GP during your hospital training years. Whether you are already set on general practice as a career, are seeking to get a broader understanding of primary care or to improve your clinical and consultation skills, the PGPPP will enhance your medical training.

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

How does it work? When you participate in the PGPPP you rotate out of your hospital into a general practice training post for a minimum of one and a maximum of two

Yes, you will continue to be paid by the hospital at an HMO rate while you are on your PGPPP rotation.

What are the benefits?

• A real-life experience in general practice over and above that of undergraduate training.

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

• Direct patient contact in primary care settings such as private general practice, Aboriginal Medical Services, drug and alcohol clinics and community-based facilities.

• A greater understanding of the integration of primary and secondary healthcare.

• Confidence and independence with medical and clinical skills, useful for future work.

• Great networking opportunities.

Want to know more? Ask the junior medical officer manager at your hospital about the PGPPP. To view personal stories from junior doctors who have done the PGPPP, visit gpaustralia.org.au or read Dr Iyngaranathan Selvaratnam’s story on pages 42–45. Information is also available at gpet.com.au

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

My PGPPP experience Dr Iyngaranathan Selvaratnam was looking to challenge himself both personally and professionally. He answers our questions about his PGPPP term on remote Elcho Island, an experience that gave him just what he was looking for and much more. You did your PGPPP on Elcho Island through Northern Territory General Practice Education. Why did you choose to go there? It was blind luck really, but in the end, I feel like it was fate that took me there. I had been in Alice Springs for 18 months and I wanted to get back up near the water. I also wanted to experience what it was like living in a remote Indigenous community and to challenge myself both personally and professionally. Elcho Island was a perfect fit. It is off the coast of northeast Arnhem Land and the main township, Galiwinku, has a population of 2500. Several smaller outstations are dotted along the Island, some of which I was fortunate enough to visit. With the PGPPP, you do have the opportunity to express preference over where you go, so I encourage prospective applicants to do their research. What did you learn from your supervisors? I had four supervisors out on Elcho because at the time the community didn’t have a permanent GP. They were all fantastic, each individual, but all very supportive, and they definitely always had your back. Each of them were remarkably skilled in general practice, but they equally knew their limits, which is one of the most important things to be aware of as a remote practitioner. 42

Tell us about some of the work you did in this unique part of the world. Working in a remote Indigenous health service exposed me to an incredible array of experiences ranging from trying to find runaway suicidal patients in the surrounding bush land with local police, going to the home of rheumatic heart disease patients to give them their monthly bicillin injections, and stitching up lacerations on people’s dogs! One day I went from managing a severe strongyloidiasis infection in a 3-year-old to driving the clinic’s troop carrier ambulance to emergency call-outs. I enjoyed my time out there so much I ended up taking annual leave and staying for an extra week for the Healthy Lifestyle Festival. It was an incredible experience to really become part of the community and to step away from medicine, which is only part of the comprehensive primary healthcare puzzle. It is this that I have a real passion for, and where inevitably the biggest gains in Indigenous health outside of the obvious social determinants will be made, particularly through health education. Did you get some ‘hands-on’ experience? As the only health provider for the township of Galiwinku, I saw a mix of general practice and emergency department presentations, and as there was no one else to compete with in the clinic, you could get your hands as dirty as you wanted to. Supervision by the senior doctor was never an issue and whenever you felt out of your depth, they were there by your side. Describe an average day during your PGPPP. It was such an incredible change from the shift work in the emergency department at Alice Springs Hospital that I had just finished.

Medical students – gpsn.org.au

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

Fantastic hours of 8 am to 4.30 pm with no after hours or weekends, although I did go in plenty of times in the evenings with the on-call nurse and when the doctor was called in, out of my own interest. This was when I saw some of the sickest and most difficult to manage patients. It amazes me how many acute mental health presentations, chest pains and septic patients we had to monitor for extended periods while awaiting the CareFlight plane for evacuation. I was fortunate to be able to split my time between the clinic and the chronic disease and mental health teams. All the programs are nurse, midwife and Aboriginal health practitioner led, and they make up the backbone of these remote clinics. They do such an incredible job. What are some of the important lessons you have learned about patient care? Indigenous health is such a challenging field. Just when you think you’ve got it all figured out, everything you know gets turned on its head. All you can do is continue to go in with an open heart and mind, be willing to learn, and be flexible and inventive.You need to take the time to listen and be yourself. When people realise that there’s no bullshit attached to you, they will warm to you and open up. General practice is often not about definitive solutions like surgery, but rather progressively working through problems and having a plan A, B and C for each time the patient comes to see you. What have you learned about general practice? My philosophy of what medicine is really about was reinforced on Elcho. To me, it is about understanding your patients in all their facets, sharing in their hopes and dreams and helping them to make them a reality. General practice

is the one specialty where I think you can truly practise medicine in this way. Did anything surprise you about the PGPPP experience? I was amazed at how welcomed and accepted I was by the staff at the clinic and the community itself. I was ‘adopted’ by one of the local families and was assigned a place within the complex kinship system. I also didn’t expect to make so many life-long friends out of the experience with reunions, birthdays and weddings invitations following my time there. What was the best part of the experience? Overall, I just had an amazing time, which was made possible by the incredible people I lived and worked with, the inspiring people that make up the community and blindingly beautiful place that Elcho Island is. I loved my work there, but I also loved being able to go out camping on the beaches, getting out on the water and catching a whole heap of fish. Attending events such as the school’s 30th anniversary celebrations, also made me feel very much apart of the community. What was the most challenging or difficult? Definitely stepping up and working more independently as a doctor. It’s easy as an intern/ RMO to become reliant on your superiors to make all the decisions. The PGPPP experience is a rewarding way to start being really pushed to further your knowledge and skills and to build your confidence. I never felt out of my depth though, due to my supportive supervisors. The remote nurses and Aboriginal health practitioners were also a wealth of knowledge and support.

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Would you recommend a PGPPP to others? For anyone thinking about general practice as career, or just looking to try something different, I wholeheartedly recommend you give a PGPPP term a go. In my opinion, every new doctor should try it whatever training pathway they choose, because it gives a better understanding of what happens out there in general practice and the challenges GPs face pre- and posthospital admission. Living in a rural, remote or Indigenous community also provides a much better understanding of the circumstances of many of your patients that end up in tertiary centres.

Iyngaranathan’s top three tips for those doing the PGPPP:

• Go in with an open mind and heart. • Embrace each and every experience

that your community has to offer. Good or bad, you will have something to talk about at the end of the day.

• This is an incredible opportunity to learn

about people and medicine, so offer to help out where you can, even after hours.

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

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

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

What are RTPs? GPET contracts with 17 regional training providers (RTPs) Australia-wide (see map on page 50). RTPs deliver the AGPT program in their designated region, enabling a targeted response to local workforce and population health needs. RTPs, together with the two GP colleges, accredit hospital posts, practices and other medical services to deliver the AGPT program. They are responsible for placing registrars in these facilities, delivering out-of-practice educational activities, and providing training materials to registrars.

Other ways to fellowship? There are other pathways to fellowship designed for experienced GPs. These pathways are not funded under the AGPT program and various fees are involved. For more information, visit the college websites racgp.org.au and acrrm.org.au 46

What is the RVTS? For those who wish to train in isolated remote locations, there is an alternative to the AGPT program – the Remote Vocational Training Scheme (RVTS), which involves distance education and remote supervision (see page 70).

What is the role of the two GP colleges? The RACGP and ACCRM establish training standards, set exams and assessments, accredit RTPs for the delivery of their college training programs, accredit training placements and practices together with the RTPs, and approve completion of training by registrars.

What are the endpoint qualifications? Attainment of a fellowship of the RACGP (FRACGP) and/or a fellowship of ACRRM (FACRRM) is necessary to achieve ‘specialist general practitioner registration’ with the Medical Board of Australia.

What is the difference between the two fellowships? ACRRM has specifically designed its curriculum to meet the needs of GPs practising in rural and remote settings. However, fellows of ACRRM may ultimately practise anywhere in Australia: rural, remote or urban. The RACGP curriculum is designed to prepare GPs for practice in any setting. Those who want to complement their FRACGP with more specialised rural and remote skills can do the RACGP Fellowship in Advanced Rural General Practice (FARGP) as an additional optional qualification (see page 68). You may wish to complete one, two or three qualifications (FRACGP, FARGP and FACRRM), and this can be integrated into your training course from the start.

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The AGPT landscape Australian Government

General Practice Education and Training Ltd

Australian General Practice Training

Prevocational General Practice Placements Program

Australian General Practice Training program

Training providers

Hospital/practices

Vocational training

Fellowship of the Australian College of Rural and Remote Medicine

Quality general practice experience

Fellowship of The Royal Australian College of General Practitioners

Specialist recognition

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

AGPT program endpoint qualifications and fellowships FRACGP qualiﬁcations (RACGP)

FACRRM qualiﬁcations (ACRRM)

Year one

Core clinical training time

Possible equivalence*

12 months

+ Year two

Primary rural and remote training 2 x 6 months

+ Joint training opportunities are available †

+ Year three

Primary rural and remote training 2 x 6 months

Year four

Advanced specialised training

GP terms

GPT1 – 6 months GPT2 – 6 months

+ Joint training opportunities are available †

+ Note: Fourth year is for FACRRM and FARGP candidates

Hospital training time

GPT3 – 6 months Extended skills – 6 months

FRACGP (VR) Possible equivalence*

12 months

Advanced skills training for FARGP (12 months)

FACRRM (VR) * Credit given for AGPT training already undertaken towards one fellowship, prior to undertaking a second or third fellowship † Can be achieved in dual-accredited practices or posts Note: Although this table is presented in a linear format, both colleges have flexible training options to enable registrars to plan their training around their own needs and interests. See the college websites for more information

Geographical classification

Statistics. This classifies all Australian towns and cities on a scale of 1–5, where 1 includes major Your training pathways and obligations are designed cities and 5 denotes the most remote areas. around the Australian Standard Geographical The General Practice Rural Incentives Program Classification-Remoteness Areas (ASGC-RA) (GPRIP) payments are also based on the system, developed by the Australian Bureau of ASGC-RA system. 48

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What are the training pathways and obligations?

• Six months in any two of the above areas (12 months total).

•

Six months in one of the above areas plus six Before starting training in the general practice months in an Aboriginal and Torres Strait setting, you need to complete mandatory hospital Islander health post at an Aboriginal Medical rotations determined by the colleges. If you have Service (12 months total). completed these before joining the AGPT program, you will need to apply for recognition of prior Rural pathway RA2-5 learning (RPL) in partnership with your RTP after Rural pathway registrars are required to undertake you have been accepted into the AGPT program. their training in rural locations RA2-5. You will complete your general practice training via Eligible registrars will benefit from the Australian either the general pathway or the rural pathway. Government’s General Practice Rural Incentives Fifty percent of AGPT program placements must Program, known as GPRIP. be in a rural pathway, which means RA2 and above. Rural generalist pathway A rural pathway is not a reflection on the nature of your training; it only relates to the location of The rural generalist pathway was pioneered in your training. Queensland as a Queensland Health initiative Doctors from overseas who are subject to the Section 19AB of the Health Insurance Act 1973 (the 10-year moratorium) are usually required to follow the rural pathway. General pathway RA1-5 Registrars in the general pathway of the AGPT program can train in RA1-5 locations. Training in the general pathway does not preclude a registrar later working in rural or remote areas. General pathway registrars are required to complete 12 months of their training outside the inner metropolitan area of a capital city, or alternatively six months of training outside the inner metropolitan area of a capital city and six months of training in an Aboriginal or Torres Strait Islander health training post. There is a range of flexible options to achieve this:

• 12 months in a rural location RA2-5. • 12 months in an outer metropolitan location. • 12 months in a non-capital city classified as RA1.

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

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

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

Regional training providers

Flexible aspects of training The AGPT program is known for its flexibility. Part-time training is a popular feature, especially for women who have children. Parental leave and other reasonable leave breaks may be negotiated. Transfers between RTPs may be possible to arrange

in extenuating circumstances. Applications for leave and transfers are assessed by GPET and the RTP on a case-by-case basis and cannot be guaranteed.

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

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registrars are paid while training. However, registrars are responsible for payment of their fellowship exams/assessment.

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

GPRA tip Recognition of prior learning (RPL) gained in hospital before entry into general practice training is possible, but requires good documentation. You need to apply for RPL in your first year in the AGPT program and have full documentary evidence of your relevant experiences to qualify. Talk to your RLO and RTP early for full details.

Who’s who? ACRRM Australian College of Rural and Remote Medicine

How GPRA helps

AGPT

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

FACRRM Fellowship of the Australian College of Rural and Remote Medicine

Want to know more?

Australian General Practice Training

FARGP Fellowship in Advanced Rural General Practice FRACGP Fellowship of The Royal Australian College of General Practitioners

For more information about the AGPT program, visit:

GPET

General Practice Education and Training Ltd

AGPT – gpet.com.au

GPRA

General Practice Registrars Australia

ACRRM – acrrm.org.au

RACGP the Royal Australian College of General Practitioners

RACGP – racgp.org.au Your RTP – gpra.org.au/links#RTPs GPRA – gpra.org.au

RLO

Registrar liaison officer

RTP

Regional training provider

You can also speak to your RLO.You can contact GPRA on 03 9629 8878 or email registrarenquiries@gpra.org.au

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

Practising the A-Z of medicine Sydney-based GP registrar Dr Natalie Caristo proves that you don’t need to go to far-flung places to practise the A-Z of medicine. “I’m definitely a city girl,” declares Dr Natalie Caristo. “I grew up in Sydney and went to the University of NSW. Most of my placements and practices, apart from two 10-week terms in Albury as an intern and resident, have been in Sydney,” she adds. Given this ultra-urban experience, Natalie is well-placed to respond to the stereotype that city-based GPs see a revolving door of ‘coughs and colds’ and ‘tears and smears’. “Not at all!” Natalie laughs at the suggestion. “When someone comes in with a cough or cold, it’s almost a sigh of relief because it means it’s a 10-minute consult and I get more time to catch up on things! “Often GPs are a person’s first point of contact,” she explains. “I’ve learned so many different things in the last six months that I would never have thought I would have.” Natalie is a GPT3 at a medical centre in Menai, a suburb about 45 minutes south of Sydney. She has also worked in Sydney’s northern and inner western suburbs. Natalie is enjoying working at the Menai Medical Centre, a small practice of four doctors. “The patients are lovely and the team is great,” she says. “My supervisor is very experienced and has a passion for teaching.” Having completed a special interest post in paediatrics and with an interest in women’s health,

Natalie is starting to “mould” her career in line with these areas. “That’s the great thing about general practice – you can focus on a particular area,” Natalie says. “My supervisor sends a lot of his female patients in to me. I have a little sign up on my door that says I specialise in women’s health,” she adds. Through family referrals, Natalie is also getting the chance to see the fuller picture of her patients’ lives. “I’ve had patients’ kids come in and they say ‘my mum said you were good’,” Natalie says. “So I see them now and can start to fit the pieces about the family together.” She says GPs have an opportunity to be a unique part of a person’s life. “We see so many different patients all day and find out not only about their medical problems, but also about their life,” she says. “GPs can be a very important part of a person’s life. If you want to be that person, you can. You’ll get as much out of general practice as you put into it.” Like many medical graduates, Natalie started her internship at St George Hospital unsure about what specialty to choose. “I knew I liked a bit of everything, but I was a bit scared to commit to general practice,” she admits. A negative general practice experience during university had made Natalie think twice about becoming a GP. “Exposure to general practice during university can either be really good or really terrible,” she believes. “I was placed with a doctor who worked on his own for long hours every day. I needed more variation than that.” Natalie opened herself up again to general practice during her internship by doing the PGPPP.

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“GPs can be a very important part of a person’s life. If you want to be that person, you can.”

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

“I’d been getting crossed messages about general practice from other people,” she says. “The PGPPP enabled me to make up my own mind.” It was a turning point. Her placement at Cremorne, in Sydney’s lower north shore, gave her a much more positive impression about life as a GP. “It was a group practice and everyone had their own side interests – one did travel medicine, another was a skin specialist and another wrote for the Medical Observer,” Natalie says. “All worked three or four days a week and did something else on the other day.” Natalie went on to be a GP Ambassador for the Going Places Network. She said the role gave her the chance to help junior doctors find out about the AGPT application process and about general practice careers. While the PGPPP confirmed her choice, Natalie’s first insight into a career as a GP was through her own family doctor. “I did work experience with him in year 10,” she recalls. “He was the one who inspired me to do medicine ... and has always been around to talk to about my career.” In a nice twist, she now runs into her GP at St George Hospital where they both teach. Natalie is fortunate to count her city-based supervisors among her GP role models. “My previous supervisor was someone who I really looked up to in terms of wanting to be in a similar position to her in 15 years time,” Natalie says. “She had a good balance between work and life outside work,” Natalie says. “She also dedicated her full attention to each patient and was happy seeing only three patients an hour so she could provide the best care. For her, it was all about quality not quantity and that gave her satisfaction in her job.”

The gratitude that patients feel when GPs provide quality care has not been lost on Natalie. “I recently received a bunch of flowers from a patient in her late 20s who had come in with bleeding during early pregnancy,” Natalie explains. “I referred her to hospital. She was told she was having a miscarriage and that everything would be okay and to just go back to her GP.” “But she continued to have bleeding and pain. We did more blood tests because it wasn’t following the usual pattern of a miscarriage. I put my foot down and made the hospital see her again and it was revealed she had an ectopic pregnancy and needed to be operated on immediately.” This reinforced to Natalie the significant responsibility GPs have for their patients. “Often I come home and think about my patients,” she says. “I ask myself, ‘Did I miss something? Will they follow my advice?’ It can be stressful.” But Natalie is learning to manage the uncertainty by listening to her supervisor’s advice. “He told me that you don’t want that worry to go away completely or you will become complacent.” It’s hard to imagine Natalie, who has such enthusiasm for her work, becoming complacent. She plans to one day work in a group practice and continue to teach, perhaps in a supervisor or medical educator role. Starting a family with her husband is also in the picture. And where will this picture be set? Sydney, of course. “My family and my husband’s family are here,” Natalie says. “Maybe 10 years down the track we might go for a sea change.” For now, the harbour-side city is where this urban GP wants to be.

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How do I get into general practice training? Applications to the AGPT program can be made as early as from your intern (PGY1) year. Applicants in later stages of training/employment may be eligible to apply for recognition of prior learning for their hospital based GP training component.

When can I apply?

To apply for the AGPT program you must meet certain eligibility requirements. To determine if you meet the AGPT eligibility requirements please visit the GPET website for detailed information. Information around eligibility may change â&#x20AC;&#x201C; please refer to the GPET website.

All applications to the general practice training program are to be made to Australian General Practice Training (AGPT). Applications are completed online at gpet.com.au

Applications into general practice training open in April each year and close in May.

How do I apply?

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

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

Improving regional healthcare for tomorrow From Karnataka’s most rural villages to Australia’s modern regional cities, GP registrar and international medical graduate Dr Pavan Phanindra is driven by a desire to improve his patients’ health for today and tomorrow.

also help run the World Health Organization’s polio immunisation campaign.

Dr Pavan Phanindra is about to start his registrar training in a clinic in Bathurst, a regional city of about 33 000 people in the New South Wales central tablelands. It’s a world away from where his first hands-on medical work took place.

He found a two-year Master’s degree through the University of Wollongong that incorporated both these areas. He secured a scholarship based on his excellent medical school results and arrived in Wollongong at the beginning of 2007.

Pavan is from Bangalore, a city in Karnataka with a population of over eight million. While India is famous for cities bursting at the seams, more than 70 percent of people live outside urban areas. During his medical degree, Pavan volunteered for an organisation called Social and Voluntary Empowerment Services (SAVE) that took him to Karnataka’s most rural areas where healthcare was non-existent or primitive at best.

“Wollongong University was exceptionally good at welcoming us,” he recalls. “There were a lot of activities for international students to help us to get used to living here. We had a buddy for the first six months who would teach some of the common Australian slang, which made a big difference!”

“I chose to go to really small areas where there is no community health centre,” Pavan says. “I offered to work there mostly to help the health of women of reproductive age and to provide antenatal care.” He tells of high infant mortality rates and women giving birth without the help of medical professionals. Visiting these areas, Pavan says, was an “eye opening” experience. “There is a huge gap in terms of rural and urban health.” Pavan continued to work with SAVE throughout his internship. During the week he worked in the hospital and on the weekend he visited small villages. There, he would screen for diabetes and tuberculosis and manage patients with leprosy, and 56

Following his internship, Pavan started to consider the next step in his medical career. “I realised it was important to gain some international experience and exposure,” he says. As well as clinical skills, Pavan wanted medical and study opportunities that would enable him to make a positive contribution to the bigger healthcare picture, be it in India or somewhere else.

It wasn’t long before Pavan got an insight into the diverse primary care that Australian GPs provide. “When I started my Masters degree I worked part-time as a medical receptionist at a local general practice,” Pavan explains. “It had four or five GPs and I had the opportunity to speak to them about the nature of the work they do. I was really fascinated about the diverse role that GPs play in Australia.” General practice had got Pavan’s attention, and he saw yet another dimension of the profession while working as a practice manager and on quality improvement in a drug and alcohol clinic. “It was there that I realised that general practice isn’t only about primary care and prevention, but also secondary prevention and harm minimisation.” Having now seen how GPs can contribute to the wider health landscape, Pavan decided to take the

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“You get to know a lot from your patients. They know that you are part of the community and make you feel welcome.” GP First – The essential guide for medical students and junior doctors

Australian Medical Council (AMC) exams and become a GP. While studying for the exams, Pavan embraced his “passion for teaching” and coordinated three university subjects – epidemiology, health promotion and public health, and communication skills. To complement his interest in public health, Pavan worked on a Wollongong City Council project that examined the social, economic and other indicators that impact the health and wellbeing of people aged between 12 and 24. Pavan passed his AMC exams and began his hands-on Australian medical experience as a resident medical officer in June 2010. His first “very memorable” term was a nine-month placement in the city of Nowra in the south coast region of NSW. While working at Shoalhaven Hospital, Pavan was mentored by a respiratory physician who made a lasting impression. “I got to work with one of the best medical consultants I could imagine, here or anywhere else in the world,” he says. “If he was on call, he used to come and see the patient and admit them himself. He would still be at the hospital at 8 pm seeing patients on ward rounds, putting in intravenous cannulas if the residents were busy ... always multi-tasking. “He could do the role of a doctor, a nurse ... anything!” Pavan emulated this approach during his emergency medicine term at Wollongong Hospital. “Every nurse used to be flat out, so I would take the urine samples, test them, start intravenous fluids and do the ECGs,” Pavan says. “I wanted to make sure that everything was organised for the patients.” As well as learning the art of multi-tasking, Pavan and his wife, who is also from India, enjoyed living in a regional city. “I really loved Shoalhaven,” he says. “It was smaller and more of a community.You get to know everyone by name, you get to know where to buy the best organic vegetables and go to the small festivals and fêtes around the corner on the weekend.” 58

“You get to know a lot from your patients,” he adds. “They know that you are part of the community and make you feel welcome.” Pavan went on to do six months of critical care work (anaesthetics and intensive care) and worked as an emergency department registrar for one year. “It was very important for me to understand these areas because I want to work in a small area and need to be able to function independently as a medical practitioner.” He is currently pursuing a certificate in women’s health and a diploma in children’s health. With all the building blocks to general practice in place, Pavan is ready to take the final steps. He was attracted to Bathurst after a thorough research project – which included several road trips to get a first-hand look at possible rural and regional locations. “Bathurst is one of the centre regions of Beyond Medical in NSW,” Pavan explains. “I will be closer to other GP registrars in the area and it will help me to attend workshops and study groups.” While Pavan has broadened his skills and found mentors in Australia, he still draws inspiration from his first medical influence – his grandfather. After retiring from primary school teaching at age 60, Pavan’s grandfather went on to enrol in medical school and start a second career in homeopathy in his late 60s. “I used to look up to him with everything he did,” Pavan says. “He used to help so many people and never charged anything. My grandfather told me: ‘I wanted to join the medical school and come out and serve the people’.” Pavan is driven by the same motive – to help others by improving the bigger health picture and bridging the gap between healthcare in rural and urban areas. “I want to improve patients’ wellbeing as well as provide acute clinical care,” he says. “For today, tomorrow and for the future.”

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What is selection day 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) as well as undertake Multiple Mini Interviews (MMIs). The method of delivering these two assessments is currently under review and may involve an online element for the 2015 AGPT program selection process. Keep an eye on the GPET website for detailed information about the process in late 2013/early 2014.

SJT and MMI preparation 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 will be shortlisted to their chosen RTP. The SJT and MMIs require applicants to draw upon their own experiences. It is recommended that applicants review the detailed criteria, which will be assessed outlined in the AGPT Applicant Guide. No other study materials can be provided, including previous test papers or topics covered.

Where can I find example questions? The practice questions in the 2015 AGPT Applicant Guide are supplied to ensure applicants understand the mechanics of the tests, not the topics covered.

Are there any preparation study courses? We are not aware of any appropriate study courses. However, you can prepare by:

• recalling good examples of patients you have dealt with which 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 NAC process. These are listed in the 2014 AGPT Applicant Guide.

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

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

Making the most from the hospital experience As she gets ready to start her AGPT program, Dr Fiona Scoffell says extra hospital experience has helped to prepare her for the “exciting” world of general practice. From practising diverse medicine to forming lifelong relationships with patients and their families, Dr Fiona Scoffell is looking forward to the unique benefits that a general practice career offers. She particularly likes how GPs get “the first bite” at diagnosing an illness. “By the time someone gets to the specialist, it’s all worked out already,” she says. “In other specialties, you don’t get that excitement of working out what’s wrong with someone. GPs can do that more than any other specialty.” Like many doctors, Fiona’s route to general practice has involved a few twists and turns. She initially studied radiography and also trained as a sonographer. But it was an experience back in high school that first sparked her interest in a medical career. “The Leukemia Foundation had units up the street from our boarding school house,” she explains. “We used to provide baby sitters to look after the well siblings of sick children.

she had the attributes needed to make a good GP. Over the next six weeks, he became a mentor to her and continues to follow her career. “He really opened my eyes to general practice and showed me how respected GPs can be,” Fiona recalls. “I was able to see first-hand all the good things about general practice that I’d heard people talk about.” During this placement, Fiona also saw the important counselling role that her mentor took on. “He made an incredible difference to so many people’s lives.” She notes that these differences may not have always been life saving, but depending on the patient, had the potential to be life changing. “I remember this young girl came in. She was in year 12 and her school formal was looming,” Fiona says. “She had an undiagnosed rash on her torso. My friend’s dad did dermatology and he knew exactly what it was – Christmas tree rash (Pityriasis rosea). It was so good to see the relief from this 17-yearold who was going to her formal and wanting to wear a strapless dress.” To help prepare her for the “huge portion” of counselling work that GPs do, Fiona is doing a diploma through the Australian Institute of Professional Counsellors.

“I just thought I’d like to be some help with these people. A lot of kids with leukaemia get better and I just thought it was amazing that people can help them like that.”

“I like to treat the person holistically,” she says. “A lot of mental health is linked to adverse physical health. I want to be able to offer my patients a comprehensive and holistic service.”

She got her first taste of general practice in her third year of medicine at University of Queensland. Her best friend’s father was a GP and he encouraged Fiona to do a placement with him believing that

Fiona is doing her GP training through the Central and Southern Queensland Training Consortium at Castle Hill Medical Centre in Murrumba Downs. Her acceptance to the AGPT program is all the more pleasing after she missed out on her first try.

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“The more hospital experience you can get, the better. See as many patients as you can, put yourself out there.”

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

Fiona had fallen ill (tests later confirmed influenza type A) right before the National Assessment Centre and she had struggled through these tests in an impeded state. Instead of re-sitting six months later, Fiona decided to take a full year to further boost her experience at Redcliffe Hospital. She’s notched up 29 weeks of emergency, a few weeks of radiology as well as surgery, paediatrics, mental health and obstetrics and gynaecology. All of which, she says, gave her the experience she needed to get accepted into the AGPT program. “There’s no real study you can do other than being the most diligent in hospital that you can be,” Fiona says. “The [assessment] questions are based on experience. They are looking for things like your situational judgement, logic ... they want someone who can apply common sense to a medical situation.

“The more hospital experience you can get, the better,” Fiona believes. “See as many patients as you can, put yourself out there.” And on the day of the assessments, Fiona advises that it’s important to “just be yourself ”. Varied and extensive hospital rotations, Fiona says, are great preparation for the range of medicine that GPs practise. “Every patient is completely different and this is why general practice stays exciting,” she says. “There is always someone different coming in the door. People come in because they think they have one thing, but actually they have something else.” Despite a wealth of experience from her time at Redcliffe Hospital, where she was a GP Ambassador for the Going Places Network, Fiona is looking forward to the 9 to 5 routine of working in a general practice clinic. “The schedule of a GP is very nice compared to the shift work of the hospital! You can do normal things like join sporting teams or go to a gym.” This balance is important to Fiona who lives with her “wonderful” husband Paul in the Moreton Bay area. “We have a lovely bit of water just between us and Brisbane,” she says. “We go paddle boarding and wakeboarding.” At the time of writing, Fiona was planning to get a taste of life as a GP through the PGPPP at Chermside Medical Centre in Brisbane’s northern suburbs. The placement will get her another step closer to putting her skills into practice and experiencing the unique relationships that GPs can develop with their patients. “I really look forward to one day having patients and also seeing generations of their whole family,” Fiona says. “It’s just such an honour the way GPs are let into a person’s life.”

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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.

Training time is reduced where a candidate is granted recognition of prior learning

• Training occurs on the job as a registrar in

a range of ACRRM-accredited teaching posts including general practices, hospitals, Aboriginal Medical Services and retrieval services.

Candidates wishing to achieve FACRRM can apply for one of three training pathways:

• the Vocational Preparation Pathway delivered by RTPs with funding from GPET

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

• general internal medicine • general surgery • paediatrics • 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. This training should provide you with sufficient clinical cases and opportunistic learning to form a good foundation to begin work in rural or remote practice.

• the Remote Vocational Training Scheme (RVTS)

Primary rural and remote training

• the Independent Pathway, administered by

24 months working in facilities accredited by ACRRM to build your clinical and procedural skills and your confidence to work in rural and remote contexts.

for doctors working in isolated rural communities who find it difficult to leave their community to participate in training

ACRRM, which is suitable for doctors with experience who prefer self-directed learning.

For more information on the pathway most suitable for you, contact the ACRRM vocational training team on 1800 223 226.

Vocational training towards FACRRM The ACRRM training program comprises of three stages of learning and experience. After completing 12 months core clinical training, a registrar may complete the remainder of the training requirements in any order. 64

These facilities can include general practices, hospitals, Aboriginal Medical Services and retrieval services.You may choose to complete your primary rural and remote training in one or several locations. Training in a single location will enable you to build a strong relationship with colleagues and your community. However, training in several locations may better equip you to expand your posting opportunities later in your career. While there is considerable flexibility, the experience must include a minimum of six months

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3 General practice career pathway

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 extends your broad generalist skills and capacity in at least one discipline. With these supplementary skills, your expanded professional scope can include valuable clinical privileging in hospitals, access to additional Medicare item numbers and contributing to the pool of medical skills in your district. Advanced specialised training requires a minimum of 12 months training in one of the 11 disciplines specified by the college:

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

Frequently asked questions Why would I consider training for FACRRM? Fellowship of ACRRM equips you to practise unsupervised anywhere in Australia. It does not restrict you to purely rural general practice. This gives you real freedom, independence and scope of practice throughout your career.Your broad general skill set – complemented by an advanced specialised skill set – provides the skills and confidence to practise in a broad range of geographic and clinical settings. This can vary from solo practice in small communities to leadership roles, roles in large hospitals, from retrieval and expeditionary medicine to Aboriginal Medical Services or urban general practice. Achieving FACRRM will verify that you are qualified to practise anywhere. There is no other general practice fellowship that covers this scope of practice. 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 enrol with ACRRM as soon as you enrol with an RTP. That way ACRRM 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 RTP about a program that complies with both colleges.

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

Do you have to undertake all training in rural or remote locations?

When do you undertake the assessments?

No. The flexibility of the program means that while most registrars will spend a significant amount of training in rural areas, and the focus is on gaining the skills and knowledge required in rural and remote settings, many of these skills 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 period of training, living and practising in a rural or remote setting, the minimum requirement is 12 months.

Once you have met the minimum eligibility of 24 months training, or equivalent RPL, you can commence assessment. However, it is important to note that the standard for all assessments is that of a doctor practising independently and safely at fellowship level, so it is important to be well prepared. While the order is not specified, it is strongly recommended that StAMPS is left until you have had experience across the broad range of learning experiences, including community primary, emergency and hospital care and rural or remote settings.

Can you train with ACRRM then later work in an urban setting?

What is available to help prepare for ACRRM assessments?

Yes. FACRRM qualifies you for specialist registration and approval to work in unrestricted general practice anywhere in Australia. Indeed the additional confidence and competence you will have developed through your training will enable you to more than adequately serve whatever community you choose.

New information is being developed all the time. Check the ACRRM website for sample questions and scenarios, plus recorded virtual classroom sessions and online modules on Rural and Remote Medical Education Online. StAMPS preparation workshops are offered face-to-face at least twice a year and study groups facilitated by a medical educator are run via virtual classroom leading up to each StAMPS assessment. For more information. visit acrrm.org.au Contributed by the Australian College of Rural and Remote Medicine

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2 General practice career – the first choice 3 pathway

The RACGP Fellowship What is the FRACGP? Fellowship of the RACGP (FRACGP) demonstrates to governments, the general practice community and the Australian community that a GP has met the required level of competence to deliver unsupervised general practice services in any general practice setting in Australia, 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 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 RTP 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 RTP accredited settings. Options include advanced rural skills, an overseas post, an academic post or extended procedural skills within a hospital or practice.

Fourth-year additional training (optional) Advanced skills:You may opt to undertake further training in a range of settings such as a hospital 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 have the option to complete an additional 12 months of advanced rural skills training (ARST). This can be undertaken as one of the requirements for the Fellowship of Advanced Rural General Practice (FARGP).

About the FRACGP exams 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 RTP 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/ becomingagp/students/vocational-training-pathway

• • • •

Contributed by The Royal Australian College of General Practitioners

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

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

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Get ready for the new year with resources from the RACGP developed especially for you Access an array of RACGP resources such as the check* Program, gplearning and the John Murtagh Library designed specifically to further your medical training and development.

Independent learning program for GPs

Unit 497 August 2013

Neurology

Do the GP pathway activity on gplearning – online educational platform developed for GPs by GPs.

Explore the popular check* Program showcasing case studies written by expert clinicians.

www.racgp.org.au/check

check_august_2013.indd 1

23/08/13 12:05 PM

Access DynaMed, an evidence based point of care tool or the John Murtagh Library’s online databases for research projects/assignment preparations.

Independent learning program for GPs

Visit us to further your medical training and learning www.racgp.org.au/yourracgp. *Available only for Resident/Interns.

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

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 the RACGP and ACRRM. 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

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3 General practice career pathway

Part-time training The part-time training options and parental leave available to registrars make general practice training flexible and family-friendly. 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

•

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 RTP.

You should apply for leave as early as possible.

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

All components of the training program, with the possible exception of hospital time, can be undertaken on a part-time basis.

• Once registered with an RTP, you need to

apply for part-time training with your RTP and have it approved before you begin working part-time. Contact your RTP 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.

Want to know more?

See the AGPT Full-time Equivalence Policy 2010 at gpet.com.au

GPRA tips

• If you want to apply for parental leave and

• 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 RTP.

• Most training usually occurs on weekdays.

•

enquire about part-time training opportunities, talk to your RTP and your practice well in advance of your baby’s arrival. To keep in touch, consider applying for an RLO position with your RTP. This offers a great opportunity to network and travel to meetings and education sessions.

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

A good balance Dr Liz Bond knows too well that life can change in an instant. After beating some incredible odds, this GP registrar is making the most out of her opportunity to be a good doctor and a good mum. GP registrar Dr Liz Bond paints a positive picture when describing how she balances raising two young daughters and doing her AGPT part-time. It seems like she’s in a good place, which makes it hard to imagine that her personal and professional dreams were almost shattered not so long ago. It was 2003 and Liz had completed just one of five exams of her first semester of medical school at the University of Melbourne. She was driving to her boyfriend (now husband) Stephen’s place one evening when a drunk driver, who was on parole, ploughed into her. Liz was in a coma for about two and a half weeks and in hospital for five months. She had horrific injuries. “I had three fractures in my pelvis,” she says. “I fractured all of my ribs and both my lungs were punctured. I also had serious internal abdominal injuries. “I was in ICU for almost four weeks. During this time I contracted bacterial meningitis, which left me with a permanent hearing impairment.” Through a combination of steely determination, excellent medical support – and a bit of luck – Liz was out of bed within three weeks of the accident. The long road to recovery had begun. Liz went back to university, repeated the semester, and successfully completed the remaining exams she had missed because of the accident.

While her injuries from the accident had healed, Liz’s hearing impairment posed a new challenge to her study. “Returning to medical school was hard because everything is taught verbally,” she says. “It certainly made it harder in the group work.” Prior to her accident and becoming a medical student, Liz had studied physiotherapy. It was during a physiotherapy locum in Canada that she first considered general practice. While working in Port Hardy, a town of 5000 people at the top end of Vancouver Island, Liz was impressed by the vast skill sets of the GPs she worked alongside and the interesting locations they could work. “There were no specialists in the area and the GPs basically did everything,” she says. “I was almost the musculoskeletal expert up there!” After returning from Canada, Liz enrolled in medical school and started to explore general practice through the John Flynn Placement Program. She had two placements in Elliott, a town of 550 people in the Northern Territory, where she got a “good taste of Indigenous culture and health”. Then she had her first daughter and a year off for maternity leave. She completed her last two John Flynn placements closer to home in the Victorian alpine town of Bright. The placements showed Liz how GPs can diversify their work through their special interests. Most of the six doctors in the clinic, including her supervisor, had diplomas in obstetrics or anaesthetics. Liz saw how these skills broadened the GPs’ work options, including being able to provide out-of-hours cover at the hospital. The GPs also staffed the nearby Mount Hotham Medical Centre, where Liz spent two days working during each placement. As well as giving Liz the novel chance to hit the slopes and go snowboarding, she also got to test out some of her practical medical skills by stitching up lacerations and tending to

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3 General practice career pathway

“I feel like it [working part-time] allows me to do my GP training well and to be a mum well ... to have a good balance.”

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

fractures and ligament injuries incurred by fellow skiers and snowboarders. “It was great to see the variety of things a GP can do,” Liz says. Liz finished her degree in 2009 and by this time was pregnant with her second child. As she prepared for her final exams, she was preparing for yet another challenge; 19 weeks into her pregnancy she and Stephen were told that their baby was not growing well and would be premature. Their daughter, Amy, arrived at 28 weeks – three weeks before Liz’s final exams. Taking it “one day at a time”, Liz, along with the support of the university administration and St Vincent’s Hospital (where she completed her clinical years) managed to successfully take her exams a few weeks after Amy was born. Another major milestone had been achieved. After a year off with her new baby, Liz started her internship at Western Health. She completed terms at Sunshine and Footscray hospitals in Melbourne’s western suburbs, where she is originally from. Liz was initially interested in endocrinology and considered physicians training, but general practice appealed from a personal and professional sense. “Having two children by that stage I realised that general practice was a better fit if I was to do both [motherhood and medicine] well,” she says. “I saw the registrars who were doing physicians training working long hours and then going home to study. “I also saw how I could still have an interest in endocrinology as a GP, and help manage conditions successfully to prevent complications and patients even needing to be admitted to hospital.” A successful PGPPP at Westcare Medical Centre in Melton, where Liz now works, confirmed that general practice was the right choice. As well as being able to practice a wide range of medicine, Liz says the quiet environment of a GP’s consulting 74

room means her hearing impairment has minimal affect on her work. “Because I am seeing patients one-on-one and there is no background noise, my work is not affected compared to how it would be in a noisy hospital setting,” she explains. She has also been the Going Places Network GP Ambassador for Western Health for the past 18 months, helping to host events at the hospital to provide information to junior doctors about general practice as a career, and the application process. Liz is starting to build up some regular patients and is enjoying seeing a range of patients and conditions. “I might see someone who is four weeks old – or 94 years old,” she says. “I’m seeing lots of interesting things, including musculoskeletal conditions. This is where my physiotherapy background is useful.” Now a GPT2, Liz works three days a week and estimates it will take her two and a half to three years to finish the AGPT program. Asking her practice for part-time work was straightforward; most of the 20 or so GPs who work there also work part-time. “They were quite happy with me with picking any hours,” Liz says. “I just had to fit in with other GPs as we share rooms. “I feel like it [working part-time] allows me to do my GP training well and to be a mum well ... to have a good balance,” Liz says. It also means that she can put her girls, now seven and four, to bed most nights and can also avoid studying most weekends and spend time with her family instead. It’s been a remarkable journey for Liz to reach the good place she is now in, where work or family are not compromised. Knowing how precious – and precarious – life can be, it’s a place that Liz is keen to stay.

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Understanding the 10-year moratorium Who does it apply to?

Have you come to Australia from overseas? Then there may be restrictions on where you can practise.

The moratorium applies to:

• OTDs 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 Doctors from overseas are being welcomed to or New Zealand under a temporary visa and help fill Australia’s GP shortage. However, to ensure subsequently obtained their primary qualification these doctors work in the geographic regions from an Australian or New Zealand university. that address workforce shortages, the Australian When does the moratorium start? Government has certain policies that apply to international medical graduates (IMGs), overseasThe period starts from the time a doctor is trained doctors (OTDs) and foreign graduates of registered as a medical practitioner in Australia. If an accredited medical school (FGAMS). a doctor has not obtained Australian permanent residency or citizenship by the end of the 10-year What is section 19AB/the moratorium, they will still need a section 19AB 10-year moratorium? exemption to continue accessing Medicare benefits. Section 19AB of the Health Insurance Act 1973, How long does it last? also known as the 10-year moratorium, states that OTDs and FGAMS will only be issued with a Originally, the geographic limitation on provider Medicare provider number if they work in areas numbers lasted for 10 years, which is why deemed by the government to be a district of the scheme became known as the 10-year workforce shortage. This usually means a rural, moratorium. However, there have been changes remote or outer metropolitan area. GP registrars that allow doctors to reduce the moratorium time under the moratorium do their vocational training by up to five years, depending on the remoteness in the rural pathway. area of the location where they practise.

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

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3 General practice career pathway

The Australian Standard Geographical Classification-Remoteness Area (ASGC-RA) system classifies locations from RA1 to RA5 according to their remoteness, with RA1 being the most urban and RA5 the most remote. The reduction in moratorium time is dependent on the remoteness of the area in which a doctor practises.

Want to know more? • Talk to the GP ambassador at your hospital, visit gpet.com.au or doctorconnect.org.au

• If you need detailed information about your

individual circumstances, contact the Department of Health and Ageing Workforce Regulation Section at 19AB@health.gov.au

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

An international registrar’s worldview With a background that traverses Africa, Scotland and Australia, Dr Nici Williams is one of the many international GP registrars subject to the 10-year moratorium now that they call Australia home. Dr Nici Williams wears her South African heritage close to her heart – literally. “‘Alles sal regkom’ is an Afrikaans expression my grandfather used to say, so I had it engraved on my stethoscope,” Nici explains. “The formal English translation is ‘everything will be all right’, but in my family we mean ‘it’s all for a good cause’.” It’s a soothing sentiment for Nici as an international doctor far away from the country of her childhood. Nici is one of around 25 percent of GP registrars who have an international background and therefore fall under the program known as the 10-year moratorium. “I’m now an Australian citizen, but I was a temporary resident when I started my medical degree in Sydney so the 10-year moratorium affects me,” Nici says. When international GP registrars are subject to the moratorium, it requires them to follow a rural pathway and prevents them from practising within the Medicare system in major metropolitan centres for up to 10 years. Instead, they are required to follow a rural pathway while training and practising in areas of medical workforce shortage. Typically this means rural, remote or sometimes outer metropolitan areas. 78

The moratorium concept was introduced as a smart way for Australia to provide doctors for the country’s most distant and difficult-to-staff dots on the map. But for registrars like Nici, life under the 10-year moratorium scheme can take some getting used to.

Travelling north When Nici and her husband Mathew moved from Sydney to Cairns at the beginning of 2013 so that Nici could begin her GP terms, they were reluctant to leave their home in Sydney. The couple had put down roots and built a life there over seven years, and the idea of packing boxes and quitting jobs was not entirely welcome. However, having made the move, they quickly fell in step with the relaxed rhythm of life in tropical North Queensland. “It’s been a dream come true so far,” Nici says. “I hadn’t even travelled to this area before we moved up here permanently. Who could bemoan living in a tropical paradise?” At the time of writing Nici was in her second GP term with Tropical Medical Training (TMT), working at Mount Sheridan Medical Practice just outside Cairns. “We are a general practice that services a huge area of Cairns, so we see a wide range of patients of all ages and from all backgrounds. It’s a beautifully designed, modern, purpose-built centre – fantastic really,” Nici says. Seeing patients at the clinic and a local aged care facility takes up 70 percent of Nici’s time. For the other 30 percent of her working week, she is a senior lecturer at James Cook University, teaching fourth-year medical students.

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“‘Alles sal regkom’ is an Afrikaans expression my grandfather used to say, so I had it engraved on my stethoscope.”

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

Mixing it up “The teaching is a great way to use another part of my brain and get back into study mode in preparation for my RACGP exams,” Nici says. “I also took up a position as a registrar director on the board of TMT. Getting involved in corporate governance is just another aspect of the multidimensional nature of medicine that I love.” By mixing up her weekly activities, Nici feels she has found a work style that suits her temperament. “Every day is different,” she says. The contentment and balance Nici now enjoys contrasts with her first GP term. “At the beginning of the year, it was full-time clinical practice and I found that too stressful. I’m much happier now with the diversity and flexibility, and the extra time to follow my other interests.” While some may consider general practice in a regional centre like Cairns to be rural medicine ‘lite’, Nici will immerse herself in Indigenous health during her next two terms with one term in the Aboriginal community at Yarrabah and a six-month posting on Thursday Island. She looks forward to the challenge. Being in more remote locations, these terms may also trim some time from the years of rural service she is obliged to do under the moratorium.

Humanitarian work Working with disadvantaged people in basic conditions is not a new experience for Nici. In an earlier chapter of her life, such an episode sparked her passion to study medicine. First, the backstory. “I grew up in South Africa, and after finishing school I travelled to Scotland

to study an MA (Hons) in international relations. Medicine was not my first degree or career choice. “Once I’d graduated I spent a year travelling in Africa where I met my now husband. We went back to Kenya and I volunteered in a refugee camp on the Sudanese border. That’s when I started meeting doctors who were truly inspirational, giving their all to help others.” Inspired to do further humanitarian work, Nici returned home and spent two and half years working as a program manager for a nongovernment organisation based in Johannesburg called Nurturing Orphans of AIDS for Humanity. “The founder of the NGO was a plastic surgeon who was volunteering his time for these communities. He could see that I was getting frustrated with paperwork and red tape, and inspired me to go back and study medicine to get more involved in the field in a hands-on capacity. That decision brought us to Sydney and I started my medical career,” Nici recalls.

The little things Almost eight years later, Nici is convinced she chose the right career path – especially on days when little things can mean a lot. “It was a particularly hectic day, when I was following up on a little five-year-old I had seen the day before with croup. She came back in with a beautiful card she had drawn, with a picture of me on the front. It said: ‘Dear Dr Nici. I do feel ok a bit.You are a nice lady. I love your hair the most. I hope you like my letter and my picture.’ It sits on my desk now and is a daily reminder to never forget the essence of why we do what we do.”

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4 Regional training providers

Regional training providers in Australia Regional training providers (RTPs) deliver the AGPT program to specific areas across Australia.

Check that your preferred RTP can provide training for the pathway, fellowships, training posts and special interests you want to pursue. The many and varied special interests covered by RTPs in Australia include:

There are currently 17 RTPs in Australia. Each RTP has a registrar liaison officer, who is often the first point-of-contact for your GP training questions.

• academic and research training posts • emergency medicine • anaesthetics • obstetrics • Aboriginal health • surgery • dermatology.

Your RTP will support your formal training with an individual learning plan, guidance and monitoring by medical education staff and GP supervisors in the practice environment. While each RTP provides training based on the same AGPT and college standards, each has its own characteristics, style and experiences to offer. For example, you may want to do your GP training in a rural area, or you may prefer to be city based or on the coast.

Check out the 17 RTPs featured on the following pages, visit their websites or visit all RTPs from one convenient source at gpra.org.au/links#RTPs

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

CoastCityCountry General Practice Training Hay and Hillston. The geographic diversity of CCCGPT provides an exceptional mix of training opportunities catering to each individual registrar’s needs and preferences.

Training opportunities

Location CoastCityCountry General Practice Training (CCCGPT) is the largest rural and regional training provider in NSW, delivering training to southeast NSW and the ACT. This area encompasses the regions of the Illawarra, Shoalhaven, Eurobodalla, Sapphire Coast, southern Highlands, Southern Tablelands, NSW Snowfields, Riverina, Murrumbidgee and the entire ACT.

Pathways available General and rural pathways; RACGP and ACRRM fellowship endpoints.

Geography and lifestyle The CCCGPT region boasts diverse landscapes, from the Illawarra, which fringes on southern Sydney spanning out towards the picturesque Southern Highlands and continuing down the spectacular southern coast of NSW to Pambula, the region crosses the Snowy Mountains and the Southern Tablelands. It continues westwards across the Riverina high country to Griffith, 84

As well as providing quality general practice placements throughout our region, our urban and large regional centres offer additional training opportunities in Aboriginal health, travel medicine, and refugee and prison health. Regional centres support advanced training, with procedural terms available in surgery, obstetrics, mental health, anaesthetics, emergency medicine and expedition medicine (based in the ski fields). Most of our rural practices provide opportunities to exercise VMO rights at the local hospital. Applicants for rural registrar positions can apply for the NSW Rural Generalist Program and will have the advantage of being able to lock in plans (including locations and posts) for the entirety of their training program. Academic research and teaching posts are also available through affiliations with the medical faculties of the University of New South Wales, the Australian National University and the University of Wollongong, which can be undertaken in urban and rural/regional settings.

Points to consider CCCGPT offers rural terms in each of its local training groups, but due to the extensive geographic area CCCGPT covers, registrars may have to relocate for the duration of the term.

The registrar experience CCCGPT understands that each registrar has his or her own unique set of circumstances and these will be taken into account during the application

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process. CCCGPT appreciates the difficulties that can be associated with juggling parenthood and educational requirements and aims to minimise these by providing registrars with accommodation and babysitting options at educational events. CCCGPT provides financial support to all registrars to assist with training costs. Registrars can choose their own practice placements throughout their training from a pool of long-standing and accredited teaching practices in the region. Your training experience is only limited by your imagination!

Contact Illawarra/Shoalhaven/Southern Highlands Dr Allison Miller P 02 4229 8675 ACT/southeast NSW Dr Karen Flegg P 02 6248 5010 Riverina/Murrumbidgee Dr Tim Caton P 02 6923 5405 2/21 Blake Street Wagga Wagga NSW 2650 P 02 6923 5400 F 02 6923 5430 W ccctraining.org

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

General Practice Training Valley to Coast From great surfing beaches, extensive national parks and world-renowned vineyards to the cultural and social attractions of Newcastle and Gosford, the region offers a range of choices to suit your lifestyle and professional needs. Sydney is still close enough to be able to make the trip easily, but you will rarely want to go!

Pathways available General and rural pathways; RACGP (including FARGP) and ACRRM fellowship endpoints.

Training opportunities Location General Practice Training Valley to Coast (GPTVTC) covers the Hunter, Manning and Central Coast regions of NSW. With both urban and rural practices you can undertake all your general practice terms within our region. The Hawkesbury River, just north of Sydney, forms our southern border and is where the NSW Central Coast begins, including Gosford and Wyong. Our border extends to the north, well past our office location in Newcastle, to Taree and the Manning Valley. The Newcastle region includes Lake Macquarie, Maitland and surrounding rural towns of the Hunter Valley such as Cessnock and Singleton. The glorious Manning Valley on the NSW mid north coast, and the rural towns of Taree and Wingham, are our northernmost posts. Gloucester is not far inland in the cool mountains of the Barrington Tops. Muswellbrook and Scone lie in the Upper Hunter Valley in the northwest of our region. 86

There are a huge range of hospital terms across two local health districts and nine hospitals, including John Hunter Hospital – one of the major tertiary training hospitals in Newcastle. For GP terms, GPTVTC has an extensive network of quality GP teaching practices from urban practices around Newcastle, Lake Macquarie and the Central Coast to both large and small rural towns, some with GP VMO hospitals. All supervisors are supportive and keen to teach. Special interest options are extensive for registrars who plan to work as GPs in a rural context as a GP proceduralist – for a comprehensive list please visit gptvtc.com.au NSW Rural Generalist Training Program posts are currently offered in anaesthetics and obstetrics. The NSW Procedural Training Program offers posts, primarily to fellowed GPs and also registrars in emergency medicine, anaesthetics, obstetrics, surgery and mental health. Research, academic and medical educations posts are also available.

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The Registrar Clinical Encounters in Training (ReCEnT) research program provides a unique view to registrars through individualised reports, mapping their experience compared to the rest of the cohort. Several registrar projects have been completed, and are underway, using ReCEnT data, while research links with other RTPs and a range of educational institutions are continuing to develop. GPTVTCâ&#x20AC;&#x2122;s training is practical, relevant, hands-on, challenging and well-supported. The region is small enough to allow registrars to attend workshops together, encouraging peer support and networking.

Contact Michael Geoghegan PO Box 573 Hunter Region Mail Centre NSW 2310 P 02 4968 6753 E gptraining@gptvtc.com.au W gptvtc.com.au

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GP Synergy GP Synergy registrars benefit from a rigorous and practical education program, including a comprehensive exam preparation program. As one of the largest training providers, registrars have access an extensive and diverse range of training opportunities, developing their skills under the guidance of dedicated and experienced GP supervisors and medical educators. Through GP Synergy’s innovative term placement system, registrars have unique flexibility and choice in determining their training placements.

Location GP Synergy offers rural pathway training in northwestern NSW and general pathway training in Sydney. The rural pathway training region includes the large regional centres of Tamworth, Armidale and Moree, as well as many other smaller rural communities. The general pathway training region extends across a large part of Sydney, stretching from Brooklyn in Sydney’s north, across northern, central, eastern, southern and southwestern Sydney, to Picton in the south.

Pathways available General and rural pathways; RACGP and ACRRM fellowship endpoints.

Training opportunities GP Synergy has a long-standing reputation for excellence in GP training demonstrated through high registrar satisfaction rates and fellowship exam results. 88

GP Synergy’s close ties with the numerous local hospitals and universities within its boundaries and expansive networks create further training and employment opportunities for registrars to pursue an extensive range of special interests during their GP training. Home to the first rural medical school at the University of New England in Armidale and the popular teaching hospital at Tamworth, rural pathway doctors training with GP Synergy undertake at least 18 months of their GP training in the New England/northwest region. The area is renowned for its IT and medical infrastructure development, as well as the quality training opportunities to develop procedural skills in areas such as anaesthesia and obstetrics, among others. General pathway doctors undertake their training across GP Synergy’s Sydney region in metropolitan and outer metropolitan locations, with rural training options available. Due to the expansive size of the Sydney training region and the number of accredited training facilities, doctors have access to a diverse and unique range of learning opportunities.

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Contact Paula Kunovsky Level 1, 36â&#x20AC;&#x201C;42 Chippen Street Chippendale NSW 2008 P 02 9818 4433 E applicant@gpsynergy.com.au W gpsynergy.com.au

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North Coast GP Training Training opportunities Training opportunities include: Advanced rural skills and procedural training in a range of disciplines, including mental health, surgery, emergency medicine, anaesthetics, and obstetrics and gynaecology Comprehensive rural orientation for all registrars with targeted emergency training skills for VMO registrars who are on-call and have admitting rights to small hospitals Academic and research posts Access to clinical training grants to participate in courses, such as EMST, advanced paediatric and obstetric life support, emergency, prehospital life support, sexual health and family planning NCGPT medical educators are renowned for their dedication, broad clinical experience and expertise in individual and small group work. The team is also recognised as a national leader in doctors’ wellbeing and the medical humanities.

• • • • Location North Coast GP Training (NCGPT) stretches from Port Macquarie in the south to the Queensland border in the north and west to the Great Dividing Range. The NCGPT head office is situated in Ballina, just south of Byron Bay.

Pathways available General and rural pathways; RACGP and ACRRM fellowship endpoints.

Geography and lifestyle The North Coast region is blessed with clean, white beaches and a stunning hinterland of pristine rainforests, waterfalls and mountain valleys. Many people move to this region for a more relaxed way of life that is still within a reasonable distance of Sydney, Brisbane and the Gold Coast.

•

Points to consider NCGPT employs a full-time registrar support officer who assists registrars with their special needs, including their move into general practice and the region. The NCGPT community has won a number of awards including the GPET 2011 Medical Educator of the Year, GPET 2011 RTP Innovation Award, the GPET 2010 Supervisor of the Year, the 2009 RACGP National Rural Registrar of the Year and the 2008 GPET/Medical Observer GP Registrar of the Year. NCGPT was also the inaugural winner of the GPET Training Provider of the Year Award.

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The registrar experience NCGPT holds regular regional educational and social events for registrars. All teaching is faceto-face in the three training nodes of Ballina, Coffs Harbour and Port Macquarie. This fosters friendships and teamwork while establishing a network of contacts and mentors. More than 75 percent of NCGPT registrars remain in the region after finishing their training. Contact NCGPT for an information kit or visit the website to view its electronic brochure and hear what registrars say about their NCGPT experience.

Contact Angelique Gellert E angeliqueg@ncgpt.org.au PO Box 1497 Ballina NSW 2478 P 02 6681 5711 F 02 6681 5722 E info@ncgpt.org.au W ncgpt.org.au

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

WentWest which may also be a permanent option after completing the RACGP fellowship.

Geography and lifestyle The region includes many contrasts from the urbanised plains of the Sydney basin to the scenic river gorges, hills and bushland of the Blue Mountains. The area is one of great demographic, cultural and socio-economic diversity, and offers world-class shopping facilities and restaurants and a wide range of recreational activities and venues.

Training opportunities Location The WentWest training region extends from Carlingford in the east to Mount Victoria in the west and from Merrylands in the south up to Wisemans Ferry and Colo Heights in the north. It includes a large outer metropolitan area, which extends from the north around to the west and into the Blue Mountains. Covering the full spectrum of general practice education and support, WentWest offers the AGPT program and PGPPP to registrars in the western Sydney region. WentWest is also a Tranche 1 Medicare Local, known as Western Sydney Medicare Local (WSML). WSML provides training, services and support to general practice and allied health professionals in the western Sydney and Hawkesbury-Hills areas.

Pathways available General and rural pathways; RACGP fellowship endpoint. Registrars in GPT3 can select a practice that best suits their interests and preferred style, 92

WentWest offers GP registrars a wealth of training resources including: a vibrant and culturally diverse community dedicated and caring GPs a wealth of resources for training and ongoing professional development as the WSML a long history of co-operative regionalised educational programs for all levels of training a high population-doctor ratio offering diverse clinical experience and adequate patient exposure opportunities to become involved in research and innovation.

• • • • • •

With the largest urban Aboriginal community in Australia living within the region, WentWest has collaborated with the Aboriginal Medical Service Western Sydney, located in Mount Druitt, to offer registrars the opportunity to work within an Aboriginal Community Controlled Health Service facility. In addition, WentWest is able to offer registrars the opportunity to train in an Aboriginal Community Controlled Health Service in a rural setting at Mamu Health Service in Far North Queensland.

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WentWest’s programs have been developed to work with leading teaching hospitals in areas such as Westmead, Blacktown, Nepean and Auburn hospitals. Registrars can also undertake an academic term at the University of Sydney Department of General Practice, Sydney Medical School – Western, with Professor Tim Usherwood. Registrars have the opportunity to undertake extended skills, allowing them to focus on a particular area of interest relevant to general practice. Registrars can choose from areas such as Aboriginal health, paediatrics and palliative care.

Contact Maggie Laycock E maggie.laycock@wentwest.com.au P 02 8811 7159 Level 1, 85 Flushcombe Road Blacktown NSW 2148 P 02 8811 7100 F 02 9622 3448 E wentwest@wentwest.com.au W wentwest.com.au

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

Bogong Regional Training Network including advanced rural skills and extended skills posts in: Aboriginal health academic posts alpine sports medicine anaesthetics emergency medicine mental health obstetrics remote medicine small town general practice.

• • • • • • • • •

Points to consider Location Bogong Regional Training Network incorporates the Goulburn Valley, northeast Victoria and the Albury Wodonga region.

Pathways available Rural pathway; RACGP and ACRRM fellowship endpoints.

Geography and lifestyle The Bogong region is family-friendly, with good schools, universities and TAFE colleges. Larger regional centres offer quality shopping, dining, cultural and professional services. The region is well known for its relaxed lifestyle and fresh, gourmet food. Fishing, camping, snow skiing, water sports and cycling are popular outdoor sports

Training opportunities

Registrars can complete their entire GP training, including hospital terms and advanced training within the Bogong region. The area is well served by major regional hospitals, small rural health services and an excellent cohort of committed and experienced GP supervisors. Bogong has a comprehensive practice matching process. Placements are based on interviews, the preferences of each registrar and the prospective practice.

The registrar experience Bogong GP registrars train as a peer group and attend education release sessions throughout training. These workshops are held at beautiful places across the Bogong region. Bogong regularly organises a family-friendly sponsored social event afterwards.

Bogong offers registrars a range of individualised, flexible training programs. Registrars can attain FRACGP, FACRRM and FARGP qualifications and extend training in areas of special interest, 94

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Contact Jo Hamilton E jhamilton@bogong.org.au 115 Hume Street Wodonga VIC 3690 PO Box 165 Wodonga VIC 3689 P 02 6057 8600 F 02 6024 7817 E bogong@bogong.org.au W bogong.org.au

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

Beyond Medical Education Geography and lifestyle BME delivers training over a large geographical region offering a broad range of clinical and lifestyle experiences. Training can be undertaken in a range of locations from remote areas such as Walgett and Broken Hill and lively country towns such as Mildura and Orange through to large regional centres such as Bendigo and Ballarat.You can choose a location that suits your lifestyle from vigorous outdoor activities through to fine dining.

Training opportunities

Location Beyond Medical Education (BME) offers rural and regional general practice training in western and central NSW and northwestern Victoria. Starting in Victoria, the region extends from the northwestern fringes of Melbourne along the Western Highway to the border with South Australia. The Hume Highway forms the eastern boundary and the northern limits include Echuca and Mildura. In NSW, the region extends from Bourke and Walgett in the north to Balranald in the south and from Lithgow in the east to Broken Hill in the west.

Pathways available General and rural pathways; RACGP and ACRRM fellowship endpoints.

Experience life as a GP in a vibrant regional city, an outback community or take to the skies with the Royal Flying Doctor Service. BME offers a range of experiences including: small practices in small country towns large practices in regional centres practices providing opportunities to care for patients in the local GP-managed hospital. Hospital training is available in Ballarat, Bendigo, Echuca, Mildura and Horsham in Victoria and Orange, Bathurst, Dubbo and Broken Hill base hospitals in NSW. Aboriginal health training posts are available in all areas of the BME region.

• • •

Points to consider As part of its commitment to improving access to primary healthcare across the region, BME requires all registrars to complete at least six months term in the defined zone 2 rural area of the BME region. Registrars are provided with financial support to undertake this term. The training available in these areas is challenging, high quality and a great learning opportunity.

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The registrar experience BME offers registrars a full range of services to support their training, including the ability to choose practice placements, financial support, educational releases and workshops. There is also an emphasis on self-care for registrars and social gatherings.

Contact 37 Rowan Street Bendigo VIC 3550 P 03 5441 9300 E info@beyondmedical.com.au W beyondmedical.com.au

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

Victorian Metropolitan Alliance variation in practice style and size is available to cater for the needs and preferences of registrars. VMA offers an innovative and dynamic educational program within a highly developed and extensive personal and resource support structure. With 140 GPT1, GPT2 and GPT3 practices, 11 Medicare Locals, 34 extended skills posts, 18 hospitals and many other organisations, training with VMA offers substantial networking, professional support and engagement opportunities.

Location Victorian Metropolitan Alliance (VMA) encompasses Melbourne, Greater Melbourne and the Bellarine and Mornington peninsulas.

Pathways available General and rural pathways; RACGP and ACRRM fellowship endpoints.

Geography and lifestyle VMA is positioned around Port Philip Bay, extending from the Bellarine Peninsula through the Melbourne metropolitan region to the Mornington Peninsula. Major centres include Melbourne, Frankston and Geelong. The range and depth of experience for registrars at practices within the VMA’s area of operations is one of several major attractions that are offered to existing and prospective registrars. Reflecting the spectrum of socio-economic and demographic factors in the VMA’s area of coverage, almost every

Registrars with an academic penchant are well catered for through educational partners, the University of Melbourne and Monash University.

Training opportunities VMA offers a wide range of training posts within its region to suit all needs. These posts are supported by skilled and knowledgeable supervisors and highly competent medical educator staff. Extended skills posts include: family planning, sexual health and HIV medicine palliative care addiction medicine forensic medicine dermatology sports medicine academic terms. There are multiple accredited placements available for registrars to undertake the DRANZCOG (Obstetrics and Gynaecology Diploma).

• • • • • • •

VMA also offers substantial subsidies to registrars who wish to obtain their Diploma of Child Health through Westmead Hospital.

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Education and training outside of practices is delivered at the office in Hawthorn. Fortnightly and monthly seminars are held for GPT1 and GPT2 registrars respectively, GPT3 and GPT4 registrars attend one professional development day per term. In addition, all registrars are required to attend four full days of weekend workshops.

Other benefits include sponsored conferences and social gatherings, professional development allowances, sponsored ALS and CPR courses, subsidised internet, a comprehensive library with paper, video and electronic resources and outstanding medical education and administrative support.

Points to consider

So why choose VMA? A key element of the VMA training experience is the engagement with professional medical educators, GP supervisors and mentors utilising a range of learning methodologies and approaches fully supported through strategic alliances with general practice organisations and rural consortia. These approaches, in the past, have consistently produced registrars who report an exceptional level of satisfaction with their training placements and educational outcomes, and achieve outstanding results.

In the general pathway, registrars are required to complete 12 months of their training’s ‘return of service obligation’ in outer metropolitan locations, rural locations, Aboriginal health services or a combination of these. Given VMA has a very large number of training posts able to facilitate this outcome, this has minimal impact on registrars’ training.

The registrar experience At VMA, registrars can expect a high quality and engaging program with the opportunity to select placements based on personal choice.

Contact Sharon Butler E sharon.buter@vma.com.au 15 Cato Street Hawthorn VIC 3122 P 03 9822 1100 F 03 9822 9011 W vma.com.au

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

Southern GP Training Pathways available General and rural (including rural generalist) pathways; FRACGP, FARGP and/or FACRRM endpoints.

Training opportunities SGPT provides innovative training opportunities with the flexibility to tailor individual programs to meet the identified learning needs and interests of each registrar. Registrars are provided with a range of opportunities to pursue areas of special interest. Many smaller town placements offer VMO opportunities in associated hospitals.

Location Southern GP Training (SGPT) rural pathway registrars can train in regional areas of southern Victoria and southeast South Australia. Rural training practices are available in a range of settings such as major regional towns, small farming communities and coastal villages. The rural pathway regions of SGPT are home to numerous iconic destinations including the 12 Apostles, Phillip Island, the Grampians and the Gippsland Lakes. General pathway registrars can train in practices on the Bellarine and Mornington peninsulas. These outer metropolitan areas including the cities of Geelong and Frankston, allow registrars to maintain a connection with Melbourne. The diversity of SGPT’s training footprint provides registrars with the opportunity to experience a range of general practice and hospital settings. Training practices offer unique opportunities to gain a broad range of skills with smaller towns often providing procedural medicine experiences. 100

SGPT offers training in the areas of Aboriginal health, academic research, adolescent health, anaesthetics, dermatology, emergency medicine, family planning, mental health, obstetrics, palliative care and paediatrics. Other posts can be developed; it’s all about registrar choice. SGPT offers quality training designed and delivered by dedicated supervisors and medical educators with registrar interests being the driving force. Registrar learning benefits from our hands-on approach, strong mentoring support and regular workshops. The informative and interactive workshops are highly valued by registrars. They provide a forum to address a wide range of issues in an environment where peer support and networking are encouraged. All SGPT services are supported by a professional and friendly administration team. Generous assistance is provided for educational opportunities and external courses.

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Contact Western region Jenny Smith P 03 5562 0051 E jenny.smith@sgpt.com.au Level 1, 49 Kepler Street Warrnambool VIC 3280 Eastern region Linda Kruger P 03 5132 3100 E linda.kruger@sgpt.com.au Suite B2, Monash 9N 50 Northways Road Churchill VIC 3842 W southerngptraining.com.au

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Adelaide to Outback GP Training Program Adelaide has recently been voted the world’s fifth Most Liveable City, reflecting it’s culture and lifestyle. The region offers beaches, seafood and cultural experiences, available centrally and in rural locations. The rural AOGP region follows Highway One North and West. It includes the Yorke Peninsula, Mid North, Flinders and Far North, Eyre Peninsula and the Adelaide Hills. The areas are diverse; ranging from small, rural locations to large regional centres. Maps illustrating AOGP’s region coverage are online at adelaidetooutback.com.au/training posts

Location The Adelaide to Outback GP Training Program (AOGP) maintains a large region, providing an extensive array of training opportunities: from remote practice in the north and west of the state, to a wide range of rural regions, through to outermetropolitan and urban general practice.

Pathways available General and rural pathways; RACGP and ACRRM fellowship endpoints.

Geography and lifestyle With a Mediterranean climate, affordable housing, sporting and cultural events, and excellent food and wine, the AOGP region covers a large proportion of metropolitan and rural South Australia. In metropolitan Adelaide, AOGP includes the area from the city north, east, west and inner south.

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Training opportunities AOGP strives to maintain an innovative, high quality yet adaptive general practice training program that reflects the needs of our registrars, supervisors/trainers and the regional community. At all times our aim is to provide the necessary educational expertise to ensure the program provides an exciting, diverse and inspiring education experience that creates confident and competent GPs who are a dynamic and passionate force in primary healthcare. AOGP’s scope of practice is diverse and includes sub-specialties in clinical and procedural medicine, opportunities for interdisciplinary team care, and working with specific demographic groups.

Points to consider AOGP requires registrars to be active partners throughout their training. AOGP will ensure registrars have the maximum opportunity to

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become the GP they aspire to be. All registrars in community placements are offered the opportunity to be involved in the allocation of practices and selection of areas they would like to work in.

The registrar experience AOGP offers a supported learning environment that includes a suite of training resources. Through registrar peer GP learning groups, in-practice training; and ‘core’ and ‘selected’ out-of-practice training, registrars have the opportunity to customise their training experience. AOGP offers a large component of education and self-directed learning through online learning and innovative use of technology.

Contact Michelle Pitot 183 Melbourne Street North Adelaide SA 5006 P 08 8366 3100 E info@adelaidetooutback.com.au W adelaidetooutback.com.au

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Sturt Fleurieu Education and Training Ltd Training opportunities Sturt Fleurieu – where innovation and the passion for practice of medicine come together to shape the modern GP. Our regional areas provide: high quality teaching practices access to dedicated, experienced practice supervisors and medical educators in-house educational programs for GPT1 and GPT2 registrars.

• • •

Location Sturt Fleurieu Education and Training Ltd covers Adelaide’s southern suburbs, the Adelaide Hills and extends into the Barossa Valley, the Murray Mallee, the Fleurieu Peninsula, the Riverland and the southeast of South Australia.

Pathways available General and rural pathways; RACGP and ACRRM fellowship endpoints.

Geography and lifestyle From the picturesque towns of the Adelaide Hills to the wine and food culture of the Barossa Valley, from the rolling farmlands of the Riverland and Murray Mallee to the pristine beaches of the Limestone Coast and Fleurieu Peninsula, Sturt Fleurieu can enrich your overall training experience.

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Our ever-evolving range of training modules gives registrars the opportunity to develop the strongest, broadest medical skills possible. Registrars can undertake a range of specialist medical skills in: anaesthetics dermatology emergency medicine sexual assault and domestic violence.

• • • •

There are opportunities for advanced rural skills training and academic research, as well as extended skills training in a range of areas.

Points to consider At Sturt Fleurieu, we are committed to excellence in medicine and general practice, and constantly look for new and innovative ways to train tomorrow’s GPs. We provide a wide range of opportunities for training in a program that combines innovative teaching and training methods, high standards of practice within a friendly, collegiate atmosphere. We offer the latest in technology-assisted learning, dedicated teaching times, and provide a supportive and well-structured program format and

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comprehensive RACGP and ACRRM exam preparation. Registrars experience basic and advanced life support training using computer simulation. gp-start is a structured learning package that links major clinical topics to key clinical activities. This educational product eases the transition from hospital to general practice, and focuses on the diagnosis and management of common clinical problems in patients, supported by the latest background readings on core topics. gp-advanced introduces registrars to the RACGP exam, addresses different clinical domains and guides registrars on how to develop their own questions and answers. This program is facilitated by case discussion sessions.

Our practices offer opportunities to explore a range of complex medical issues and their treatments. Registrars will work closely with expert practitioners. Throughout their completion of training, registrars are supported by our outstanding education and administrative team.

Contact Dr Peter Clements E peter.clements@sfet.com.au 132 Greenhill Road Unley SA 5061 P 08 8172 7600 E sturt.fleurieu@sfet.com.au W sfet.com.au

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General Practice Training Queensland

(formerly known as Central and Southern Queensland Training Consortium, CSQTC)

Pathways available General and rural pathways; ACRRM, RACGP and FARGP fellowship endpoints. Doctors who have commitments to the Queensland Health Rural Generalist Program or the Australian Defence Force, or who wish to train on a part-time basis are welcome and supported by GPTQ.

Training opportunities

Location General Practice Training Queensland (GPTQ) offers the full range of general practice training in the geographical areas located between Rockhampton and the New South Wales border (north to south) and between the coast and the South Australian border (east to west). GPTQ delivers the AGPT program across four decentralised districts, each with two medical education delivery nodes and each offering a range of training post locations. Two of our districts, Central Queensland and Fraser Coast and southwest Queensland, encompass solely rural and remote areas (ASGC-RA 2-5). Whilst the Metro North and Sunshine Coast district and the Metro South and Gold Coast district encompass a combination of rural, metropolitan (capital city and non-capital city ASGC-RA1) and outer metropolitan areas. We have offices located in Brisbane, Toowoomba and Rockhampton that provide localised education and responsive administrative support. 106

GPTQ offers registrars high quality training opportunities through: over 20 hospitals across the region with a variety of hospital, extended skills and advanced skills training posts experienced and committed accredited training practices for GP placements in remote, rural, metropolitan and outer metropolitan locations and in Aboriginal Medical Services a unique GP placement process that gives| registrars autonomy in choosing which GP term training practices they apply for while allowing practices to select registrars based on merit academic training posts and research opportunities through three universities access to our online learning platform, GPePortfolio, which promotes adult learning principles and allows registrars to track their own training progress access to web and video conferencing, to break down the tyranny of distance for our more remote registrars.

• • • • • • •

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While GPTQ offers the substantial benefits of being a large training provider, the education delivery is provided through a decentralised district/node structure which allows us to offer a personalised, registrar-focused program that is responsive to the local region and the changing needs of our registrars as individuals. We embrace the approach of small group learning which facilitates registrar interaction with their peers and expert presenters. Registrars will have access to exciting and relevant GP-focused education and training activities with GPTQ throughout all stages of their training, from when they are working in hospital-based

environments until they are preparing for college examinations and assessments. The GPTQ team will endeavour to ensure our registrars’ training experience is rewarding and hassle free, and will help guide and support all registrars towards achieving fellowship.

Contact

Julie Ball E gptq@gptq.qld.edu.au PO Box 1275 Stafford QLD 4053 P 07 3552 8100 E gptq@gptq.qld.edu.au

GPFirst First– The – Theessential essentialguide guideforformedical medicalstudents studentsand andjunior juniordoctors doctors GP

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Queensland Rural Medical Education Training opportunities We deliver the rural pathway of AGPT. Core/ hospital training can be completed anywhere in Australia and advanced skills training and extended skills terms can also be undertaken in rural or metro locations, depending on where the training is available. Advanced and extended skills should suit the rural community in which you will train and work. The popular and most needed in rural Queensland is skin cancer medicine, emergency medicine, obstetrics, anaesthetics, women’s health medical education.

Location Queensland Rural Medical Education (QRME) delivers as it is named: rural medical education in Queensland – to medical students, junior doctors and rural GP registrars in subtropical and northwest Queensland.

Pathways available For registrars, we train to the curricula of both ACRRM and the RACGP on the rural pathway. A large proportion of our registrars complete advanced and extended skills programs.

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Placements for general practice and rural medicine terms are in regional and rural practices and rural hospitals. Registrars are also supported for public health and tropical medicine placements in Pacific nations and southeast Asia. Many registrars become involved in teaching into our Rural Longlook Program for Medical Students.

Contact Joel Richters 190 Hume Street PO Box 2076 Toowoomba QLD 4350 P 07 4638 7999 E info@qrme.org.au W qrme.org.au

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Tropical Medical Training Cairns

• One of the most popular tourist destinations • Two World Heritage natural environments

– the Great Barrier Reef Marine Park and Wet Tropics ancient rainforests

• The Atherton Tablelands. Mackay

• Gateway to the Whitsundays • Relaxed, tropical lifestyle • Spectacular mountain regions. Location Tropical Medical Training (TMT) is North Queensland’s regional training provider for general practice. Covering two-thirds of Queensland, TMT encompasses enormous geographical and economically diverse areas. For those seeking a relaxed lifestyle in a beautiful part of Australia, the opportunities are endless. But be warned, those who venture north rarely leave! From the Torres Strait Islands to lush tropical rainforests and the magic of the outback, TMT covers it all. Townsville

• Australia’s largest tropical city • Major hospital • Beach within easy reach • Historic outback towns. 110

Mount Isa

• Progressive mining city • Lawn Hill Gorge • The Royal Flying Doctor Centre. Thursday Island

• Administrative heart of the Torres Strait • Diverse mix of cultures • Fishing and aquaculture. Pathways available General and rural pathways; RACGP and ACRRM fellowship endpoints.

Training opportunities TMT has a large number of procedural and practical-based skills training opportunities, enhanced training with extended skills posts and advanced rural skills posts in primary care, palliative care, oncology, anaesthetics and obstetrics.

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TMT has the largest number of Indigenous health training posts in Queensland. If you are seeking further adventure in your medicine, perhaps aviation or expedition medicine could be what you are looking for! TMT is heavily involved in the PGPPP.

Contact Maria-Theresa Lehmann PO Box 4056 Vincent QLD 4814 P 07 4729 5000 F 07 4729 5015 E enquiries@tmt.org.au W tmt.org.au

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Western Australian General Practice Education and Training medicine experience. Junior doctors can participate in a range of metropolitan and regional placements during one or more hospital rotations (10–11 weeks). Placements are available in general practice, palliative care or population health settings or as a composite post placement in general practice or Aboriginal health in conjunction with a hospital specialty. Some popular experiences are:

• general practice and rural acute medicine in Karratha

Location Western Australian General Practice Education and Training (WAGPET) is the sole GP training provider in Western Australia.

Pathways available General and rural pathways; RACGP and ACRRM fellowship endpoints.

Geography and lifestyle From awe-inspiring landscapes and unique communities in the north and east, to gentle forests and wine regions in the south; from the urban buzz of Perth and Fremantle to pristine beaches, coastal communities, mining towns and farming heartlands, Western Australia has something for everyone.

Training opportunities For junior doctors WAGPET’s prevocational programs provide a well-supervised and supported community 112

• Aboriginal health and paediatrics in Kalgoorlie • general practice and obstetrics in Perth. Year-long rural practice pathway placements are also available working in general practice or Aboriginal health and at the local regional hospital in specialty areas such as emergency, psychiatry and obstetrics. For GP registrars WAGPET offers a wide range of training opportunities for AGPT registrars throughout Western Australia.

• In metropolitan areas, registrars can experience consulting in a community practice setting

• In regional towns, registrars can provide care across the hospital and community setting

• In remote rural areas, registrars can work in a remote clinic setting.

Aboriginal health training opportunities are available in a range of metropolitan, regional and remote rural settings.

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WAGPET is committed to providing the highest quality of education for registrars. Education is provided locally in the training regions in addition to central full-day workshops held in Perth. Registrars also have access to virtual classroom education sessions and online learning resources. WAGPET offers comprehensive support while undertaking rural training, including relocation and accommodation allowances, procedural skills training opportunities and GP obstetrics or GP anaesthetics mentoring programs. Placements are based on preferences submitted by registrars during the annual placement process and for 2013 around 85 percent of registrars were allocated their first preference. Extended skills placements are varied and include academic research, obstetrics and gynaecology, drug and alcohol medicine, general practice, psychiatry and sports medicine.

Advanced rural skills training placements are possible in Aboriginal health, anaesthetics, emergency medicine, mental health, small town general practice, surgery and more. WAGPET offers a high quality service and can support registrars with specific training needs including Australian Defence Force, academic and part-time registrars.

Contact Georgina Ledwidge Suite 12, 16 Brooke Hail Drive Technology Park, Bentley WA 6102 P 08 9473 8200 F 08 9472 4686 E admin@wagpet.com.au W wagpet.com.au

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General Practice Training Tasmania Training opportunities GPTT delivers a broad, strong educational program and is known for the following areas of special educational interest and expertise:

• Expedition medicine: innovative and exciting

emergency training in wilderness locations in Tasmania combined with clinical training in emergency and travel medicine

• Integrated communication skills training:

communication, consulting and counselling skills training is a key feature of the program

• Practical skills workshops with an emphasis on Location General Practice Training Tasmania (GPTT) covers the entire state of Tasmania.

Pathways available General and rural pathways; RACGP and ACRRM fellowship endpoints.

Geography and lifestyle Just one hour from Melbourne by plane, Tasmania is a land apart, a place of wilderness and beautiful landscapes, pristine beaches and welcoming people. With a wonderful relaxed lifestyle in a temperate climate,Tasmania offers affordable housing along with a culture rich in the arts, music, theatre and sport. Relatively short distances between major centres mean that education, recreation, shopping and commercial services are all within easy reach.

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relevance to general practice: – STITCH – plastic surgery and trauma surgical skills in general practice – emergencies in general practice – ALS and emergency medicine training – musculoskeletal medicine – women’s health – teaching skills for GP registrars.

Research opportunities GPTT has strong links with the University of Tasmania and the Menzies Research Institute. We can provide a range of extended special skills posts and clinical attachments in:

• palliative care • remote medicine (Antarctica and Macquarie Island)

• population health • emergency medicine • drug and alcohol medicine • Aboriginal health.

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The registrar experience GPTT offers a supportive learning environment that includes monthly small group learning meetings, workshops held in beautiful locations around the state and various social opportunities. A scholarship fund is also paid quarterly, which helps registrars to broaden the range of their educational experiences and undertake research. There is also financial support for travel and accommodation for attending workshops and

contributions towards reimbursements for other training courses. A rental subsidy and rural relocation allowance is also available.

Contact Robyn Rose E robyn.rose@gptt.com.au RACT House Level 3, 179 Murray Street Hobart TAS 7000

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Northern Territory General Practice Education resources to make your journey safe, supported and exciting. NTGPE provides financial support to registrars who train in RA4-5 zones, including relocation costs, internet subsidy, rental assistance, educational allowances, professional development subsidies and grants on top of government rural incentives. Flexible, family-friendly training acknowledges registrars’ personal and family needs. Professional interests are catered for through extended skills and advanced skills training posts.

Why train in the Northern Territory? Northern Territory General Practice Education (NTGPE) is the innovative provider of quality general practice training and an active collaborator in the provision of general medical education in the Northern Territory. With the support of highly skilled medical educators and cultural educators we train:

• Develop clinical skills • Gain an understanding of the reasons for health disparities in Australia

• Give something back to the Australian

communities with the greatest health needs

• Challenge yourself • Develop skills in public health and primary

healthcare teams • GP registrars through the AGPT program • Develop excellent skills to work in volunteer aid • Prevocational doctors through the PGPPP work in the future • Overseas trained doctors through the Overseas • A choice of training sites matched to your level Trained Doctors Network (OTDNet) of skill and personal needs: • Medical students through the John Flynn – urban, regional and remote locations Placement Program.

– Top End or Central Australia

Pathways available

– GP terms, extended skills posts and advanced skills posts

General and rural pathways; RACGP and ACRRM fellowship endpoints.

Training opportunities NTGPE offers opportunities to all registrars in Australia and has the experience, focus and 116

– sites accredited by both ACRRM and RACGP

•

A range of primary healthcare models: Aboriginal Medical Services, fly-in-fly-out and remote hospital outreach

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• Full support from leaders in remote Aboriginal health education including NTGPE’s renowned cultural education team:

– an experienced and passionate team of health professionals, supervisors and educators – evolving new programs and developments designed to enhance your placement experience including extra training and family support – immersion in a precious and ancient living culture – flexible arrangements so your partner or family can accompany you to your post.

Contact Christine Heatherington-Tait P 08 8946 7079 E registrar@ntgpe.org Darwin office Level 3, Building 1,Yellow Precinct Charles Darwin University, Ellengowan Drive Casuarina NT 0810 Alice Springs office Centre for Remote Health – West Wing 5 Skinner Street Alice Springs NT 0871 PO Box U179 Charles Darwin University, NT 0815

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Q ue ast ensla GPTQ offers experiences in central and southern Queensland in nd & Fraser Co rural, remote and urban practices, Aboriginal Medical Services, special interest and procedural training posts and Australian Defence Force posts.

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Locally responsive education and support is delivered via GPTQ’s four decentralised training districts and their nodes, in rural towns offering the ultimate in small community based care, in large regional centres, coastal locations and fast paced capital city practices.

Choose your destination and begin your journey with GPTQ Formally Central & Southern Qld Training Consortium.

PREVOCATIONAL GENERAL PRACTICE PLACEMENTS Undertaking a prevocational general practice placement as one of your hospital rotations is a unique way to find out if general practice is the career for you. A number of GPTQ Training Practices host PGPPP rotations in rural and urban areas.

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Visit our website –Phone gpsn.org.au07

AUSTRALIAN GENERAL PRACTICE TRAINING If you’ve decided that general practice is the career for you, then you will discover that GPTQs experienced and committed team of supervisors, educators and support staff will provide you with a highly relevant and innovative educational and training program. Our diverse training locations will offer you opportunities to practice rewarding and challenging medicine.

3552 8100 Learn more www.gptq.qld.edu.au

5 Money matters

What you can earn 2103 training year minimum What do GP registrars and GPs earn? What are the hours? We give salaries plus 9.25% superannuation Annual Weekly you 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 can choose a set salary model or negotiate a percentage of income generated by the patients they see in the practice. In this case, remuneration is determined by how many patients are seen and whether there is bulk-billing or private billing.

Minimum terms and conditions During the first two general practice terms (or ACRRM equivalent), GP registrars are guaranteed minimum terms and conditions of employment according to the National Minimum Terms and Conditions (NMTC) document agreed by GPRA and the National General Practice Supervisorsâ&#x20AC;&#x2122; Association. Minimum salary rates are set out in the table, or alternatively the registrar is paid a minimum of 45 percent of gross billings, whichever is greater.

Calculate your income online 120

GP term 1 registrar

$72,760

$1,399

GP term 2 registrar

$87,476

$1,682

Note: The above salaries are a guide only, and from 2013. Salaries will change in 2014

Different remuneration systems On-call and hospital VMO work earn GP registrars a minimum of 55 percent of the hospital billings. In certain settings, registrars may work in salaried practice, especially ADF registrars, those working 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 NMTC document. For GP registrars and GPs practising in rural areas and identified areas of need, incentive payments are available on top of a regular salary.

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! Our online GP 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

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5 Money matters

Incentive payments As a GP registrar, you may be able to claim other financial incentives in addition to your salary. If you are working as a GP registrar, you may be eligible to receive a range of financial incentives and reimbursements on top of your regular salary. Most of these are offered by the Department of Health (DoH) to encourage more GPs to practise where they are most needed, such as in rural, remote and outer metropolitan areas.

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

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

GPRA tip RTPs can tell you more about the financial incentives you may be able to claim in addition to your salary, or visit gpra.org.au

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Is general practice the specialty you have been looking for?

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Join the Going Places Network today and find out more about general practice. • More than 3500 junior doctors have already joined us • Network with experienced GPs and meet other peers interested in becoming a GP

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• Attend free networking and educational lunches and dinners • Access free tools and resources • Get key information from your local GP ambassador in your hospital

gpaustralia.org.au Online support for junior doctors interested in general practice

6 Survival tips

Looking after yourself Workplace issues 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 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. 124

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

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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.

Source: Black Dog Institute

Workplace bullying means any behaviour that is repeated, systematic and directed towards an employee or group of employees that a reasonable person, having regard to the circumstances, would expect to victimise, humiliate, undermine or threaten and which creates a risk to health and safety. Section 55A (1) of the Occupational Health, Safety and Welfare Act 1986

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Looking after yourself Advice from a GP of one’s bank balance. As doctors, we will always Dr Hilton Koppe is a GP in be able to earn a comfortable living, and will usually Lennox Heads, NSW, and a medical be significantly better off than the majority of the educator with NCGPT. His own population. Many doctors I know seem to have health and personal care struggles lost sight of this fact. as a doctor led him to developing Resist the temptation to work too hard a checklist to help doctors to From my perspective, six or seven sessions per establish good habits early on week in general practice is full time work. I find the and have a successful and fulfilling work so intense that if I do more than this, then I am a pretty poor doctor to those unsuspecting career and life.

Be true to yourself in your work The myth of professional distance doesn’t ring true for me, especially in general practice. We spend so much of our time at work, it just does not make sense to try to be someone other than oneself during this time. The doctor-patient relationship is just that – a relationship. It relies on both parties being open and honest within the boundaries of the relationship. This means being clear about what I will do and what I won’t do. It means giving up trying to be all things to all people. It means being proud to work part-time in the practice, knowing that the other doctors are fully capable of attending to the patients when I am not there.

Get down, be silly and play with kids Even if you do not have children of your own, spending time playing with young people is one of the best ways I know to forget all the seriousness of our work, and to have a good laugh. And as we all know, ‘laughter is the best medicine’.

Resist the temptation to get rich True wealth comes from the quality of one’s relationships and life experiences, not from the size 126

patients who come in at the end of the week. I have only been able to achieve this goal by first resisting the temptation to get rich. It was an excellent decision.

Develop a regular practice of physical exercise I have found the benefits of exercise to be enormous. While it is easy to do 30 minutes of light exercise at least three times per week, unfortunately it is even easier not to do it! Like many of these things, it requires commitment.

Develop a regular practice of mental quiet time I find that I need at least 20 minutes per day of mental quiet time. It may involve sitting and focusing on my breath, or listening to music. It can be combined with physical exercise such as tai chi, or focusing on the breath while walking, swimming, showering or even doing the washing up.

Develop a regular practice of awareness of spirituality The word spirituality means different things to different people. I like the concept used in Alcoholics Anonymous of it meaning a force

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greater than ourselves influencing our lives. An awareness of spirituality helps to give greater meaning to life, with its consequent improvement in sense of wellbeing.

Develop a network of personal support Most of us spend all day supporting others in our lives, but fail to gain the same level of support for ourselves. We need to have the opportunity to debrief some of the difficult situations we face in our work, as well as to celebrate our successes. (The successes always outnumber the difficulties. It’s just that we are not very good at putting our attention on the successes, and we certainly were never taught to celebrate them!)

Develop your creativity Allow time, effort and energy for ‘right brain’ activities to help balance the intense ‘thinking’ nature of our work. My creative outlet is cooking (I’m a hopeless artist, and besides, you can’t eat a painting!).

Take a break, preferably a long one regularly I know many doctors who have not ever had more that one or two weeks off at a time. While frequent short holidays have their value, it’s just not long enough to get work right out of the system. In the 20 years since I graduated, I have had four long breaks away from work – one for nine months backpacking around Europe in my 20s, one for three months for my honeymoon, one for 12 months travelling around Australia, and most recently for six months when our second child was born. They were the most valuable times of my life. In summary, treat your wellbeing with at least as much respect as you treat others. This probably means enlisting the support of a medical colleague in deciding upon any medical treatments you may require. It may also mean making a commitment to some of the ideas outlined above. Read more of Hilton’s story online at gpra.org.au

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Exam survival For many students, exams are a time of increased caffeine intake, decreased sleep and copious amounts of procrastination. Claire Mohr, a junior doctor at Mater Hospital in Brisbane, shares her tips.

• Get started sooner rather than later – Learning

the entire semester’s content in the study week is simply not feasible. If you are able to embrace this study-as-you-go philosophy, your exams will be significantly less stressful.

• Listen for exam tips in the last week of classes

– Often lecturers will drop a few hints or go through past exam questions that will give you an indication of what might appear on the exam. This may mean dragging yourself back onto campus if your attendance has started to slip, or even just making sure you listen rather than going through the photos of that event you attended on the weekend.

• Minimise distractions – This may mean heading

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

• Get a study buddy – You can revise material

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

• Create a plan of attack – Draw up a schedule

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

• Alert your support network

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

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Going Places Network – ambassador contacts NSW and ACT

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

Mackay Base Hospital

mackaygp@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

Townsville Hospital

townsvillegp@gpra.org.au

SA and NT

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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

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7 The networks

SA and NT contintued 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

Southern Health

southernhealthgp@gpra.org.au

Western Health

westerngp@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

Fremantle Hospital

fremantlegp@gpra.org.au

Joondalup Health Campus

joondalupgp@gpra.org.au

Want to get involved? Going Places Ambassadors are junior doctors who have a real passion for general practice. To find out more about becoming a GP ambassador, email goingplaces@gpra.org.au GP First â&#x20AC;&#x201C; The essential guide for medical students and junior doctors

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General Practice Students Network – chair contacts NSW and ACT

Contact

University of New South Wales

unsw@student.gpra.org.au

University of Sydney

usyd@student.gpra.org.au

University of Western Sydney

westsyd@student.gpra.org.au

University of Notre Dame Sydney undsyd@student.gpra.org.au University of Wollongong

wollongong@student.gpra.org.au

University of Newcastle

newcastle@student.gpra.org.au

University of New England

newengland@student.gpra.org.au

Australian National University

anu@student.gpra.org.au

QLD University of Queensland

uq@student.gpra.org.au

Bond University

bond@student.gpra.org.au

Griffith University

griffith@student.gpra.org.au

James Cook University

jcu@student.gpra.org.au

SA and NT University of Adelaide

adelaide@student.gpra.org.au

Flinders University

flinders@student.gpra.org.au

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

umelb@student.gpra.org.au

Monash University

monash@student.gpra.org.au

Deakin University

deakin@student.gpra.org.au

TAS University of Tasmania

utas@student.gpra.org.au

WA University of Western Australia

uwa@student.gpra.org.au

University of Notre Dame Fremantle notredame@student.gpra.org.au

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Medical students – gpsn.org.au

Junior doctors – 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. See page 50 for map 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

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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

Medical students – gpsn.org.au

Junior doctors – gpaustralia.org.au

7 Info file

GPET – General Practice Education and Training Ltd A government limited company that funds and contracts RTPs to provide general practice education to registrars and junior doctors 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 RTP will give advice and guidance about your training miniCEX – Mini Clinical Evaluation Exercise A component of the ACRRM Fellowship exams and assessments 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

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PGPPP – Prevocational General Practice Placements Program 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)

RTP – Regional training provider RTPs are contracted by GPET to provide regionalised general practice training RVTS – Remote Vocational Training Scheme Provides distance vocational training to doctors already working in rural and remote locations where on-site supervision is not available SIP – Service Incentive Payment SLO – GP supervisor liaison officer Employed by an RTP to represent and advocate for GP supervisors

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

StAMPS – Structured Assessment using Multiple Patient Scenarios A component of the ACRRM Fellowship exams and assessments

RDAA – Rural Doctors Association Australia Has state branches. Represents rural doctor issues to government and other organisations

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

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

TGA – Therapeutic Goods Administration TMO – Trainee medical officer

RPBS – Repatriation Pharmaceutical Benefits Scheme

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

RPL – Recognition of prior learning

VMO – Visiting medical officer

RROC – Registrar representative on council A GP registrar who sits on the council of the RACGP to represent registrar concerns

VR – Vocational registration

RMO – Resident medical officer

RRADO – Registrar Research and Development Officer The RRADO is a registrar employed part-time by GPET to promote training in research and academic general practice 136

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

Medical students – gpsn.org.au

Junior doctors – gpaustralia.org.au

7 Info file

GP resources Textbooks and pocket guides Murtagh’s General Practice, Patient Education, Practice Tips Australian Medicines Handbook – (available online, CD, mobile, hard copy): shop.amh.net.au MIMS – (available online, mobile, hard copy): mims.com.au

Diabetes Management in General Practice – 17th edition, 2011/2012 Clinical Guidelines for Stroke and TIA Management: A quick guide for general practice Chronic Kidney Disease Management in General Practice – 2nd edition, 2012 Other important guidelines

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

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

Paediatric Pharmacopoeia – rch.org.au

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

Fitzpatrick’s Colour Atlas and Synopsis of Dermatology Reproductive and Sexual Health: An Australian clinical practice handbook – Family Planning NSW Contraception: An Australian clinical practice handbook – Sexual Health and Family Planning Australia Practical Fracture Treatment – McCrae and Esser Clinical Sports Medicine – Brukner and Khan Paediatric Handbook – from Royal Children’s Hospital or Westmead Oxford handbooks (Clinical Medicine, Clinical Specialties) The ECG Made Easy – Hampton, 7th edition Fast Facts series – fastfacts.com GP Companion – a handy reference of general practice clinical information available to GPRA members as an e-book: gpra.org.au/gp-companion See a recommended reading list from ACRRM: acrrm.org.au/assessment (scroll down and click on ‘Recommended reading list’)

Guidelines There are many guidelines available from the RACGP: racgp.org.au/guidelines Guidelines for preventive activities in general practice – (the ‘red book’) 7th edition Putting prevention into practice – (the ‘green book’) 2nd edition

Guide to Management of Hypertension (2008) updated 2010 – National Heart Foundation: heartfoundation.org.au Therapeutic Guidelines (TG or eTG, available online, CD, hard copy) – an invaluable resource: tg.org.au Australian Immunisation Handbook – (online or hard copy) health.gov.au/internet/immunise/publishing.nsf/ content/handbook-home Medical Observer has compiled an extensive list, which includes the RACGP guidelines: medicalobserver.com.au/about/guide-to-guidelines NHMRC guidelines have been developed and endorsed by the Australian Government National Health and Medical Research Council: nhmrc.gov.au/guidelines

Online learning and resources gplearning – RACGP: gplearning.com.au RRMEO (Rural and Remote Medical Education Online) – ACRRM: rrmeo.com PrimaryCare Sidebar – a resource that works alongside your clinical desktop from the RACGP: racgp.org.au/ehealth/primarycaresidebar ThinkGP – thinkgp.com.au

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Rural Health Education Foundation – rhef.com.au GP Psych Support – psychsupport.com.au A government-funded service that provides patient management advice to GPs from psychiatrists.You need to register before you can access this service

Courses ALSO (Advanced Life Support in Obstetrics) – also.net.au APLS (Advanced Paediatric Life Support) – apls.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

ARC (Australian Resuscitation Council, NSW branch) – arcnsw.org.au

Asthma – nationalasthma.org.au

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

COPD – copdx.org.au

DCH (Diploma in Child Health) – chw.edu.au

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

EMST (Early Management of Severe Trauma) – surgeons.org Sexual Health and Family Planning – shfpa.org.au

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

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Cardiology – heartfoundation.org.au Dermatology – dermnet.com; dermnetnz.org

Gastroenterology – gesa.org.au Haemochromatosis – Resources for GPs: haemochromatosis.org.au/GPResources.htm Immunisations – Australian Government Immunise Australia Program – 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 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

Medical students – gpsn.org.au

Junior doctors – gpaustralia.org.au

7 Info file

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

Organisations Department of Health – health.gov.au – the federal government’s health department website includes information on the latest public health campaigns, key policies, services, important forms and links to other relevant websites. See also your state or territory health department website Medicare – medicareaustralia.gov.au/provider; MBS Online: mbsonline.gov.au; PBS: pbs.gov.au Pharmaceutical Benefits Scheme (PBS) – health.gov.au/pbs NPS – the National Prescribing Service is an independent non-profit organisation that aims to provide accurate, balanced evidence-based information about medicines: nps.org.au Therapeutic Goods Administration (TGA) – the regulatory body for therapeutic goods in Australia: tga.gov.au

Journals, magazines and periodicals Most are available online and in print. Australian Doctor – especially its ‘How to Treat’ articles – australiandoctor.com.au Australian Family Physician – racgp.org.au/afp Australian Prescriber – australianprescriber.com and other NPS publications: nps.org.au Medical Observer – especially its ‘Clinical review’ feature: medicalobserver.com.au Medicine Today – medicinetoday.com.au Medical Journal of Australia (free with AMA membership) – mja.com.au Wonca (World Organization of National Colleges, Academies and Academic Associations of Family Physicians) – globalfamilydoctor.com check – an independent learning program for GPs (free with RACGP membership): racgp.org.au/ education/courses/check Rural Health Education Foundation – learning resources for GPs: rhef.com.au

GPRA – gpra.org.au

Medical apps for phone or iPad

Going Places Network – gpaustralia.org.au

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

GPSN – gpsn.org.au

Medical Observer – a useful calculator for a range of assessments: eg. Ottawa knee and ankle rules, Wells score

GPET – agpt.com.au RACGP – racgp.org.au ACRRM – acrrm.org.au AMA – ama.com.au Rural Health Workforce Australia (RHWA) – rhwa.org.au – a not-for-profit organisation dedicated to making primary healthcare more accessible for communities in rural and remote Australia

MBS Search – includes various item numbers, Medicare rebates and allows you to save your favourite item numbers Pedi Safe – a useful app that gives you normal values (HR, BP, RR, fluid resuscitation rates, values for sedation medication) based on weight iAnatomy – shows you CT scans and how to identify the structures in them. Includes a quiz mode

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Stethoscope – allows you to listen to real chest sounds including murmurs, lung sounds and bowel sounds, and gives you information about how to use a stethoscope. Good practise for OSCEs How to Treat from Australian Doctor – includes quizzes on various conditions to test your knowledge. Very useful for the AKT exams

Podcasts Available from iTunes store: Australian Family Physician The Health Report with Norman Swan Instant Anatomy Listen to the Lancet The Merck Manual of Patient Symptoms Other podcasts Annals of Internal Medicine

Patient information Better Health Channel – betterhealth.vic.gov.au – offers GPs consumer-based information that is checked on a regular basis. It has useful handouts for patients My Dr (MIMS Australia) – mydr.com.au – contains a range of consumer-friendly tools including quizzes, calculators, a medical dictionary and information on medications HealthInsite – healthinsite.gov.au – an Australian Government initiative that aims to provide patients with the latest information on health and wellbeing. It has links to health services across the states and territories Parent handouts – rch.org.au/kidsinfo/factsheets.cfm – a series of handouts for parents and patients from the Royal Children’s Hospital, Melbourne

Cochrane Library – cochrane.org/podcasts/

Patient pictures – patientpictures.com – a series of patient handouts with graphics to explain procedures and diseases

Drug Info – druginfo.adf.org.au

Access to resources

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

There are many resources available free online or from organisations. There may be some at your practice already. Some subscriptions, such as eTG, may be available through your RTP, practice or hospital. Some resources are free from the RACGP 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 RTP about nearby libraries that may hold relevant texts or DVDs

– annals.org/multimedia.aspx

Johns Hopkins Medicine News Roundup – hopkinsmedicine.org/news/audio/podcasts/ Podcasts.html Journal of American Medical Association Weekly – jama.jamanetwork.com/multimedia.aspx#Weekly New England Journal of Medicine Weekly Audio Summary – nejm.org

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Medical students – gpsn.org.au

Junior doctors – gpaustralia.org.au

A healing journey in general practice

Have you ever given thought to working as a GP registrar in an Aboriginal and Torres Strait Islander health training post? These posts can be undertaken as part of the Australian General Practice Training (AGPT) program. Talk to your regional training provider today for more information or go to gpet.com.au

With you on your journey students

junior doctors

registrars

General Practice Students Network gpsn.org.au

Going Places Network gpaustralia.org.au

General Practice Registrars Australia gpra.org.au

General Practice Registrars Australia Level 4, 517 Flinders Lane, Melbourne Victoria 3001 P 03 9629 8878 W gpra.org.au