Rural general practice training in the Victorian Metropolitan Alliance
- Overview of rural general practice in the Victorian Metropolitan Alliance (VMA)
- The key features of rural general practice
- Comparison with metropolitan general practice
- Rural general practice – the 'soft sell'
- RACGP definition of rural general practice
- ACRRM definition of Rural and Remote Medicine
- The key features of training in rural general practice in VMA
- GP Registrars
- Training posts
- VMA personnel for rural training
- Teaching and learning for rural general practice in VMA
- Overview of the rural context in Australian General Practice Training (AGPT)
- Where AGPT 'fits' in rural training
- Choice of pathway
- Choice of curriculum
- The 3-year program
- The 4-year program
- The 'non rural' rural pathway GPR and the 'rural' general pathway GPR
- Other options for GP training
- Terminologies – RACGP and ACRRM
- RACGP domains
- ACRRM domains
- Comparison of FRACGP (+/-FARGP) and FACRRM
- Comparison of location requirements for the rural and general pathways
- Training to FRACGP (+/- FARGP) and to FACRRM
- Common features
- Differences
- Requirements for the award of:
- FARGP
- FACRRM
- Costs to GPR
- Training support for rural GPRs – outline
- Structure of training meeting
- Rural training resources
- FARGP and FACRRM information, documents and forms
- Web resources
- Recommended texts
1. Overview of rural general practice training in VMA
Rural general practice training in the Victorian Metropolitan Alliance (VMA)?
The terms 'rural' and 'metropolitan' present a contradiction. However, these terms are compatible within the VMA training framework. VMA provides training posts and teaching which span the geography and the scope of rural general practice.
VMA provides training for rural pathway GP Registrars to the RoyalAustralianCollege of General Practitioners (RACGP) curriculum. VMA also provides training to the RACGP National Rural Faculty (NRF) Fellowship in Advanced Rural General Practice curriculum. Rural pathway GP Registrars exit the VMA training program with the Fellowship of the Royal Australian College of General Practitioners (FRACGP) and, optionally, with the Fellowship in Advanced Rural General Practice (FARGP).
General pathway GP Registrars may also enrol in FARGP.
VMA is developing a plan to introduce a program for training GP Registrars to the Australian College of Rural and Remote Medicine (ACRRM) curriculum. These GP Registrars will exit the VMA training program with the Fellowship of the AustralianCollege of Rural and Remote Medicine (FACRRM). The program for training to the ACRRM curriculum and the program for training to the RACGP and FARGP curricula will provide an 'integrated rural training framework' (IRTF) for VMA.
Practising rural medicine requires knowledge, skills and attitudes that address location, role in the community, communication, healthcare systems, clinical responsibility and scope of practice (including procedural practice, hospital care and extended skills).
There are differences between RACGP and ACRRM in terminology, curricula, training, assessment and accreditation. However, the differences are in approach and emphasis rather than in concepts. Training to FRACGP and FARGP and training to FACRRM are compatible within an IRTF. In future, GP Registrars may choose to complete 'all three' fellowships during their Australian General Practice Training (AGPT) program in VMA.
2. The key features of rural general practice
2.1. Comparison with metropolitan general practice
Compared to metropolitan general practice, rural general practice involves:
- a broader scope of practice
- greater clinical responsibility
- requirements and/or opportunities for procedural work and/or hospital work (eg emergency medicine, obstetrics, anaesthetics, surgery, medicine, paediatrics)
- greater workload (including after-hours and on-call commitments)
- cultural diversity
- extended role within the community
2.2. Rural general practice – the 'soft sell'
What is rural?
One-third of the Australian population live outside urban areas. Compared to urban populations, rural populations have:
- Lower:
- Levels of health, education and income
- Access to health services and to healthcare providers
- Higher:
- Mortality and morbidity (particularly for Aboriginal and Torres Strait Islander people)
- Rates of cancer, cardiovascular disease, diabetes, mental illness, infectious disease and trauma
- Prevalence of risk factors for disease
The Australian Standard Geographical Classification (ASGC) categorises rural locations in to 'remoteness areas' (RAs) according to distance from the nearest urban centre. This classification does not consider size of community, healthcare services or healthcare providers.
Rurality is diverse. Australia's rural areas include the coast, the mountains, the desert, the 'bush' and the 'outback'. Rural populations are culturally diverse including Aboriginal people. Rural industries include farming, fishing, mining, manufacturing, tourism and service industries.
What is rural medicine?
Rural medicine is a diverse specialty. The required knowledge, skills and scope of practice are determined by location, community size and demographic factors. Wherever rural medicine is practised there are challenges and rewards - and a non-urban lifestyle.
The RACGP and ACRRM have defined rural general practice and rural and remote medicine respectively (see below).
The terms 'rural general practice', 'rural and remote medicine' and 'rural medicine' tend to be used synonymously and interchangeably – although they do reflect subtly different concepts as defined by RACGP and ACRRM. VMA uses the terms synonymously.
Rural medicine provides and requires a broad scope of practice. It presents a clinical environment in which GPs can practice a wide range of skills with a high level of clinical responsibility. It enables some clinical autonomy and clinical independence.
GP consultations are more complex across many domains (acute care, continuing care, chronic disease and prevention). There are opportunities or requirements for procedural practice (surgery, obstetrics and anaesthetics), emergency management and hospital-based care.
Rural medicine presents a wider spectrum of disease and later presentations of disease compared to urban-based general practice. Continuity of care can be facilitated as rural GPs can, for example, provide care for a patient through emergency presentation, hospital management and care in the community. Continuity of care is multidimensional – across families, across generations and over time. Compared to urban GPs who may be working in larger and less connected communities, rural GPs are able to 'get to know' their patients very well – rural GPs can develop knowledge and understanding of patients, families, relationships and communities which can enhance the 'doctor-patient relationship', improve care and improve 'job satisfaction'.
Rural GPs typically provide care for patients in the local hospital, managing emergencies, acute medical problems, surgery (emergency and elective) and obstetrics. Rural GPs have extended roles as generalists providing care that might otherwise be provided by specialists in urban areas (for example – palliative medicine, oncology (chemotherapy) and public health).
Advantages of rural general practice
As described above, rural general practice provides a broad scope of practice that is challenging, complex and rewarding, with opportunities for procedural work and hospital work and opportunities to use a wide range of clinical skills. Most regard these as very positive aspects of rural general practice.
Rural GPs are likely to be valued and respected as doctors and as members of their communities. In general, rural communities tend to be welcoming and friendly. Compared to urban areas there are less likely to be noise, crowds, traffic and pollution (and possibly less crime too).
There are lifestyle advantages to living in rural areas – these depend on the individual's preferences and on the location (eg coastal, mountains, 'bush').
Rural GPs are likely to have higher incomes than urban GPs – this reflects a broader scope of practice, procedural work, hospital work, longer working hours (including 'after-hours') and rural incentive payments.
The skills acquired and required in rural general practice are also appropriate for working in Aboriginal health and for practising medicine in rural areas overseas and in the developing world.
Disadvantages of rural general practice
Work that is challenging and complex, high levels of clinical responsibility and clinical autonomy, procedural work, hospital work and long working hours may be regarded by some as negative aspects of general practice.
The disadvantages of rural general practice include perceived isolation (personal, professional and geographical), family concerns (partner's wishes, values and opportunities (employment, social)), children's education), and workload (long hours, after-hours, on-call, complex problems, emergencies).
Rural GPs may find it difficult to take time-off and to take holidays – they may perceive that they cannot 'let down' their communities by being unavailable or by taking leave.
Rural GPs and their families may perceive a lack of privacy and excessive community demands. Rural GPs and their families are likely to be well recognised and well-known in their communities – and although the positive aspects of this are friendliness and respect – the negative aspects are intrusion, gossip and unrealistic expectations.
Managing some of the disadvantages of rural general practice
Rural GPs can develop networks for professional and personal support via peers, colleagues and divisions of general practice. The Rural Medical Family Network (RMFN) provides strong support for rural GPs' families.
Rural GPs are strongly encouraged to practise self-care and this includes planning time-off, study leave and holidays. There are supports via rural workforce agencies, divisions and other agencies for providing skilled locums for rural GPs. Rural GPs can develop strategies to 'protect' their time and their privacy.
Education in schools in rural areas can be as good as and better than education in schools in urban areas.
There are many models for working in rural medicine – eg part-time work, special interests, teaching, no hospital work, no procedural work – rural GPs do not have to subscribe to the so-called 'superdoc' phenomenon of '24/7 full featured rural medicine' - including family medicine, hospital work, procedural work and on-call.
Summary
Rural medicine provides fantastic opportunities in professional experience and lifestyle. It is challenging and rewarding. However, rural medicine is not for everyone - for any number of personal, family and professional reasons. GPs who do not wish to pursue a career in rural medicine may wish to consider a rural attachment or rural locum work to experience some of the many wonderful opportunities of rural medicine – without committing to a long-term position as a rural GP.
2.3. RACGP definition of 'rural general practice':
"Rural general practice provides its own diversity of contexts and characteristics. In rural and remote Australia, geographical and demographic features lead to great diversity in both the ranges of presentations a general practitioner may encounter and the facilities that may be available to them to administer primary care. Research has shown that rural general practitioners are more likely to be able to provide in-hospital care as well as private consulting room care, to provide after hours services, to engage in public health roles expected of them by discrete communities in which there are few doctors to choose from, to engage in clinical procedures, to engage in emergency care, to encounter a higher burden of complex or chronic health presentations, and to encounter larger proportions of Aboriginal or Torres Strait Islander patients in their overall patient load.
The extent to which the GP will engage in any of these activities and roles, however, will depend entirely on the rural or remote context in which they choose to practice, or the range of general practice skills in which they wish to involve themselves. Some rural doctors in smaller rural towns, for instance, are based primarily at the local hospital, but the practice they conduct is still predominantly primary medical care, even though some secondary and, in cases, tertiary care is also possible due to the hospital facilities. Whilst their practice thus conforms to the core curriculum set for its Fellowship by the Royal Australian College of General Practitioners, it will also involve specific skills sets appropriate to the rural and/or remote health context in which they find themselves. These skills sets may be practiced at an extended or advanced level, depending on patient requirements. These characteristics and practices are supported by the RACGP Standards of Practice and a curriculum developed and maintained by the College and reflected in the Fellowship in Advanced Rural General Practice."
(This definition supplements the RACGP's definition of 'general practice' - a copy of this definition is available in 'resources')
2.4. ACRRM definition of Rural and Remote Medicine:
"Rural and Remote Medicine is typically delivered through private community based practice facilities and hospitals, however, it can also occur on roadsides, in remote clinics, jails, Aboriginal medical services or via telephone or e-health systems. It is one of the hallmarks of a rural and remote practitioner that they have highly developed clinical judgment and extended skill sets which allow them to safely care for patients in a variety of ways that would not be typical of general practitioners in more urban settings. This includes providing certain specialised areas of care such as surgery or obstetrics, and admitting and caring for adults and children in hospital (secondary) care settings.
The clinical scope, practices and values that characterise Rural and Remote Medicine within the medical specialty of general practice are outlined in the curricula and professional standards that are set and maintained by ACRRM.
General practitioners who achieve these standards are recognised through the award of Fellowship of ACRRM. Fellows of ACRRM receive full vocational recognition and are able to practise in any location throughout Australia."
3. The key features of training in rural general practice in VMA
3.1. GP Registrars
GP Registrars can train in rural general practice posts irrespective of pathway or curriculum.
Rural pathway GP Registrars must complete all of their general practice term training (or primary rural and remote training) in posts that are in 'Remoteness Areas 2 to 5 (inner regional, outer regional, remote or very remote)' (RA2-5) – that is not in RA1 (major cities).
Although strongly encouraged to do so, rural pathway GP Registrars do not need to complete a fourth year in the AGPT program in advanced training and they do not need to train to FARGP and/or FACRRM. Rural pathway registrars can exit the AGPT program after three years with FRACGP and vocational registration (although any moratorium restrictions will apply).
General pathway registrars can choose to complete a fourth year in the AGPT program in advanced training posts and train to FARGP (provided that they have completed at least 12 months general practice training in a rural area) and/or to FACRRM (provided that they meet ACRRM's requirements for training and assessment).
GP Registrars are encouraged to contact the rural coordinator to discuss their options and applications for posts in rural general practice and advanced training.
3.2. Training posts
VMA has eight RACGP accredited rural training posts for GP terms at general practices in the following locations:
- Whittlesea
- Warburton
- Yarra Glen
- Koo Wee Rup
- Bannockburn
- Point Lonsdale
- Drysdale
- Aireys Inlet
These posts are all in 'Remoteness Area category 2' (RA2).
Currently, VMA does not have any posts that are ACRRM accredited for primary rural and remote training.
GP Registrars who wish to do some or all of their training in non-VMA rural general practices should contact the relevant Regional Training Provider (RTP) or Regional Training Network (RTN) to request information about available posts and to submit applications.
A GP Registrar who has accepted a position in a non-VMA rural general practice is required to 'transfer' to the relevant RTP or RTN – either temporarily (for the duration of the position) or permanently.
An 'Application for Registrar Transfer' form must be completed. The transfer needs to be approved by the CEO of VMA, by the CEO of the other RTP or RTN, and by GPET. Transfers are governed by the AGPT 'Transfer Policy'.
A transferred GP Registrar follows the relevant RTP or RTN's training program (including external clinical teaching visits (ECTVs) and workshops). A transferred GP Registrar is not required to participate in any VMA training activities (eg teaching visits, workshops and Weekend Educational Series sessions (WESs)) for the duration of the transfer.
VMA has access to Victorian Department of Health funded posts for advanced rural skills training (ARST) and advanced specialised training (AST) in obstetrics, anaesthetics and emergency medicine. Posts available in Melbourne and Geelong are listed below. (There are many other posts available in regional areas of Victoria – VMA has a database of these posts and VMA can access these posts for GP registrars).
GP Registrars should apply directly to the relevant hospital or health service. GP Registrars should advise VMA of their applications and of the post once this has been accepted.
GP Registrars may apply for other posts that are eligible for ARST or AST. GP Registrars should advise VMA of their applications and of the post once this has been accepted.
- Obstetrics
- AnglissHospital
- Box Hill Hospital (Eastern Health)
- DandenongHospital
- GeelongHospital
- Monash Medical Centre
- Mercy Hospital
- Moorabbin
- MorningtonPeninsula (Frankston)
- Northern Hospital
- Royal Women's Hospital
- SandringhamHospital
- WesternHospital Sunshine
- Angliss, Dandenong and Western Hospitals are accredited for DRANZCOG advanced training.
- Anaesthetics
- GeelongHospital
- Northern Hospital
- Western Health Service
- Emergency medicine
- AnglissHospital
- WerribeeMercyHospital
Through networks and collaborations with rurally based Regional Training Providers and Rural Training Networks, VMA provides access to a range of general practice posts and hospital based posts in rural areas.
VMA has a database of all ACRRM accredited Advanced Specialised Training posts and Primary Rural and Remote Training posts. VMA can facilitate a GP registrar's application for one of these posts. Currently, VMA will not be able to provide training to ACRRM in one of these posts – however, VMA will provide training to FRACGP and FARGP in these posts (except for posts that are not co-accredited by RACGP) or VMA can help to organise a transfer to another Regional Training Provider.
To provide more training opportunities for rural general practice, VMA is developing alliances with the following:
- The Kimberley Aboriginal Medical Services Council - to provide training posts in Aboriginal health for GP terms, primary rural and remote training, advanced specialised training and advanced rural skills training.
- The Victorian Palliative Medicine Training Program – to provide six-month diploma positions in rural and regional areas for advanced rural skills training.
3.3. VMA personnel for rural training
Andrew Baird (rural coordinator) is the medical educator with responsibility for rural training in VMA.
VMA is developing a 'rural portfolio' for a GP Registrar Liaison Officer (RLO).
VMA will train a VMA administrator for the role of 'Administrator (rural training)' as the VMA's 'point of contact' for rural GP Registrars and for enquiries about rural issues.
3.4. Teaching and learning for rural general practice in VMA
Compared to the Curriculum for Australian General Practice, most of the additional components for training and assessment for FARGP and FACRRM are practice-based and related to clinical experience. GP Registrars, GP Supervisors and Medical Educators need to be familiar with the relevant curricula to ensure that learning objectives are met through experience and through teaching in their rural training posts.
Peer Learning Workshops (PLWs), Weekend Educational Series sessions (WESs) and Catch-up Program modules (CUPs) incorporate a rural perspective on topics where relevant.
One WES session may be developed exclusively for rural GP Registrars using an online learning environment as this is convenient and efficient and it models an appropriate mode of learning for GPs practising in rural or remote areas. The content of a rural WES session may include emergency management, hospital-based management, clinical networking, tele-health (and other communication relevant to rural practice), role in the community and issues in self-care, family, and work-life balance.
VMA will fund rural GP Registrars to attend one or more procedural medicine programs/emergency skills courses delivered by external education providers. For example:
- Rural Emergency Skills Training (REST - ACRRM – 2 day course)
- Advanced Life Support (ALS – ACRRM – 1 day course)
- Emergency Life Support (ELS – 2 day course)
- Combined (intermediate and advanced) Clinical Emergency Management Program (CEMP – RACGP – 1 day (intermediate) + 2 day (advanced) courses)
- Early Management of Severe Trauma (EMST – 3 day course)
- Advanced Paediatric Life Support (APLS – 3 day course)
- Advanced Life Support in Obstetrics (ALSO – 2 day course).
4. Overview of the rural context in Australian General Practice Training (AGPT)
4.1. Where AGPT 'fits' in rural training
Irrespective of pathway, curriculum and program duration, successful completion of AGPT certifies competence for unsupervised unrestricted general practice throughout Australia. This includes practice in metropolitan, regional, rural and remote areas.
Many general practitioners who practise in non-metropolitan areas will complete further training to develop skills that are relevant to the scope of rural medicine. To complete training posts for the full range of skills for rural medicine would take at least eight years – for example 12 months of emergency medicine, 12 months of obstetrics, 12 months of anaesthetics, 24 months of general surgery, 12 months of adult medicine, 12 months of paediatric medicine and 12 months in 'special interest' areas (eg Aboriginal health, mental health, remote medicine or palliative medicine).
However, most general practitioners will complete further training in perhaps two or three of these areas during their careers. General practitioners will also acquire skills in many of these areas in the course of their experience in rural medicine – without completing formal training posts in those areas.
The AGPT program enables GP Registrars to complete 12 months of training as the 'fourth year' of AGPT in posts that are relevant to rural medicine. This training is described by ACRRM as 'advanced specialised training' and by RACGP as 'advanced rural skills training'.
After completing AGPT and obtaining fellowship, general practitioners may choose to complete further training in posts that are relevant to rural medicine. These posts are arranged directly by general practitioners who apply for relevant posts in hospitals or health services.
There are programs to support general practitioners who wish to train in procedural medicine – principally, the General Practitioner Procedural Training Support Program (GPPTSP) which provides a subsidy of $40,000 for general practitioners who wish to train in anaesthetics (in an AST or ARST post) or in obstetrics (to DRANZCOG 'advanced' level). GP Registrars may be eligible to apply for a subsidy in the GPPTSP.
The Rural Procedural Grants Program (RPGP) provides funding for educational activities and clinical attachments for rural proceduralists to maintain or upgrade their skills (in anaesthetics, obstetrics, surgery or emergency medicine). The RPGP does not provide funding for initial training in procedural medicine.
4.2. Choice of pathway
Medical practitioners can choose to apply for vocational training in general practice via the general pathway or the rural pathway provided that they satisfy both of the following conditions:
- basic (primary) medical training completed at an Australian medical school
- Australian citizen or Australian permanent resident when started basic (primary) medical training
Other medical practitioners (overseas trained or trained in Australia as an international student) are restricted to vocational training in general practice via the rural pathway and the 10-year moratorium applies. The 'clock' for the 10 year moratorium starts when the medical practitioner first obtained, or first obtains, registration with the Medical Board of Australia (or with a State or Territory Medical Board prior to 1 July 2010). There are exceptions to the moratorium eg, medical practitioners who obtained full registration with an Australian Medical Board before 1997 are not subject to the moratorium.
4.3. Choice of curriculum
GP Registrars can choose to train to either the ACRRM curriculum or to the RACGP curriculum or to both curricula (irrespective of pathway). GP Registrars must train in posts that are accredited by the relevant colleges. Currently, VMA does not provide training to the ACRRM curriculum.
Both FRACGP and FACRRM certify competence for unsupervised general practice throughout Australia – including metropolitan and rural settings.
4.4. The 3-year training program
GP Registrars can exit from either pathway with FRACGP and vocational registration after three years of training (or less with 'recognition of prior learning' (RPL)).
It is possible for rural pathway GP Registrars to exit from AGPT after three years with FRACGP and vocational registration. However, any moratorium restrictions still apply, and all general practice training must be completed in RA2-RA5.
4.5. The 4-year training program
GP Registrars who have trained to the RACGP curriculum can do a further 12 months of training in advanced rural skills posts, complete four years of training (or less with RPL) and complete the FARGP.
GP Registrars who are training to the ACRRM curriculum must complete four years of training (or less with RPL) and complete FACRRM in order to exit the AGPT with vocational registration.
The 4 year training program is for GP Registrars who are training to FRACGP+FARGP, or FACRRM, or FRACGP+FARGP and FACRRM – irrespective of their training pathway (ie general or rural).
4.6. The 'non rural' rural pathway GP Registrar and the 'rural' general pathway GP Registrar
It is acknowledged that a GP Registrar may choose to train in the rural pathway or be required to train in the rural pathway - without intending to practise in rural medicine beyond completion of the AGPT program or beyond any moratorium requirements. Such GP Registrars may elect to exit AGPT with FRACGP after 3 years of training. Although such GP Registrars are following the 'rural pathway' for AGPT, their attitudes and intentions may not have a rural focus. They will be encouraged and supported to pursue a career in rural medicine.
Conversely, a GP Registrar may choose to train in the general pathway with the intention of maintaining an option to practice in rural medicine after completing the AGPT program. In VMA, such GP Registrars will be encouraged to consider training to FARGP (and/or to FACRRM when training for this can be provided in VMA).
4.7. Other options for GP training
AGPT is not the only option for GP training. Medical practitioners can also train in general practice via the Remote Vocational Training Scheme (RVTS), via the specialist training pathway and by independent practice-based assessment.
5. Terminologies – 'near equivalents' for ACRRM and RACGP
|
ACRRM |
RACGP |
|
Rural and Remote Medicine |
Rural general practice |
|
Rural Medical Generalist (RMG) |
Rural general practitioner (Rural GP) |
|
Core Clinical Training (CCT) |
Hospital Term training (HTT) |
|
Primary Rural & Remote Training (PRRT) |
General Practice Term (GPT) training |
|
Advanced Specialised Training (AST) |
Advanced Rural Skills Training (ARST) |
|
Primary Curriculum (CCT+PRRT) |
Curriculum for Australian General Practice |
|
Advanced Curricula (AST) |
i) Advanced Rural Skills Training Curricula ii) FARGP Curriculum |
|
MiniCEX (Mini Clinical Evaluation Exercises) |
ECTV |
|
StAMPS (Structured assessment using multiple patient scenarios) |
OSCE |
|
7 domains* |
5 domains |
5.1. RACGP domains:
- Communication skills and the patient-doctor relationship
- Applied professional knowledge and skills
- Population health and the context of general practice
- Professional and ethical role
- Organisational and legal dimensions
5.2. ACRRM domains:
- Core clinical knowledge and skills
- Extended clinical practice
- Emergency care in generalist practice
- Population health
- Aboriginal and Torres Strait Islander (ATSI) health in generalist practice
- Professional, legal and ethical practice
- Rural and remote context
* Compared to the RACGP domains, ACRRM adds 'extended clinical practice', 'emergency care in generalist practice', 'ATSI in general practice' and 'Rural and remote context'. ACRRM does not include 'communication' as a separate domain
6. Comparison of FRACGP(+/-FARGP) and FACRRM
Training for FRACGP (+/- FARGP) requires a minimum of 12 months of hospital term training (HTT). This can be started at any time after completing the intern year. There are no geographical requirements for HTT. HTT must be completed before starting general practice terms. The intern year plus HTT must cover a minimum of seven rotations in disciplines related to general practice of which general surgery, general medicine, emergency medicine and paediatrics are mandatory. These rotations must have been in Australian Postgraduate Medical Council accredited posts.
Training for FACRRM requires a minimum of 12 months of core clinical training (CCT). This can be started at any time after completing the intern year. There are no geographical requirements for CCT (although the hospital must be accredited by ACRRM. ACRRM accepts Postgraduate Medical Council (PMC) accreditation as a proxy for ACRRM accreditation). CCT must be completed before starting primary rural and remote training. The intern year plus CCT must cover rotations in general medicine, general surgery, emergency, paediatrics, obstetrics and anaesthetics. These rotations must have been in Australian Postgraduate Medical Council accredited posts. Note that obstetrics and anaesthetics are not required for training for FRACGP.
A rotation is usually 13 weeks – but as little as 10 weeks is acceptable. 'Rotation' and 'term' are synonymous.
Once HTT or CCT has been completed, a GPR progresses in AGPT as follows:
RACGP:
- 4 x 6 month GP Terms (Terms 1,2,3 and 4 (extended skills)) +/- 12 months advanced academic term or 12 months advanced rural skills training (ARST).
- Advanced rural skills training (ARST) posts can be completed before, during or after GPT1-4. ARST posts are available in anaesthetics, obstetrics, emergency medicine, surgery, Aboriginal health, mental health, paediatrics, adult medicine, small town general practice and others with the approval of the RTP and the RACGP's National Rural Faculty (NRF) - eg palliative medicine, sports medicine, drug and alcohol medicine.
ACRRM:
- 24 months 'Primary rural and remote training' (PRRT) + 12 months advanced specialised training (AST)
- Advanced specialised training (AST) posts can be completed before, during or after PRRT. AST posts are available in anaesthetics, obstetrics and gynaecology, emergency medicine, surgery, remote medicine, adult medicine, paediatric medicine, mental health, indigenous health and population health. (Note: Palliative medicine is not eligible for AST)
7. Comparison of location requirements for the general pathway and the rural pathway
General pathway GPRs must complete either 12 months of general practice training in a rural area (RA2-RA5) or an outer metropolitan area or 6 months of general practice training in a rural area (RA2-RA5) and 6 months of general practice training in an outer metropolitan area.
For rural pathway GPRs, all general practice training (GPT1-4 (RACGP) or PRRT (ACRRM)) must be completed in posts located in RA2-RA5.
For PRRT, GPRs may work in ACRRM accredited general practices, hospitals, Aboriginal Community Controlled Health Services, or RFDS posts – that is, not just 'general practice'. For PRRT, ACRRM accredits posts, not facilities (eg a 'post' could include working at a private general practice and at an associated hospital)
8. Training to FRACGP + FARGP and training to FACRRM:
8.1. Common features
- In-practice training – teaching and supervised practice in accredited posts with accredited supervisors (or trainers)
- Supervision requirements (teaching, Supervisor on-site)
- Peer learning workshops
- GP registrar learning plan
8.2. Differences
- Accreditation standards for posts and trainers
- For RACGP, accreditation of a rural general practice for GP Terms is based on location only (RA 2-5). (However, for an ARST post in small town general practice, location must be RA 3-5 and there are requirements for scope of practice).
- For ACRRM, accreditation of a post for PRRT is based on location (RA 2-5) AND scope of practice (to include: hospital work, emergency work, after-hours work)
- Structured learning activities in practice for GP terms/PRRT
- 1 hour per week for FRACGP
- 3 hours per week (first 6 months), 1.5 hours per week (second 6 months) for FACRRM
- Supervisor accreditation for FACRRM: Non-FACRRM supervisors need to satisfy eligibility criteria on a points system (16 points – based on qualifications and experience (rural practice, clinical work and teaching)).
- Requirement to use the 'teaching plan template' (an enhanced 'practice profile') for training to FACRRM– see Appendix 3, ACRRM Guide for Supervisors
9. Requirements for the award of:
9.1. FARGP
- Hold FRACGP
- Completed a minimum of 12 months training in accredited rural general practice
- Completed 12 months of advanced rural skills training (including 360 hours of educational activities)
- Completed the LEAP (learning and educational assessment portfolio)
- Completed two core modules ('working in rural general practice' and 'emergency medicine')
- Completed 160 hours of self-directed educational activities (which could include PLWs, online learning etc)
9.2. FACRRM
- Completed training requirements
- Completed assessment (five components: Multi-source feedback (MSF) (colleagues, patients, self), MiniCEX (9 consultations), MCQ (3 hour, 125 questions, online), StAMPS (8 x 10mins, videoconference), procedural skills logbook)
- Completed four online learning modules on RRMEO (Rural and Remote Medical Education Online)
- Completed at least two ACRRM accredited emergency skills courses
- Maintained procedural skills logbook
10. Costs to GPR
RACGP
Membership
- $310 per annum (Registrar)
- $995 per annum (full-time, post Fellowship)
FRACGP exam is $6265
FARGP fee is nil to GPRs who are enrolled in AGPT.
ACRRM
Membership:
- $235 per annum (Registrar)
- $975 per annum (full-time, post Fellowship)
PRRT (MSF, miniCEX, StAMPS, MCQ) $3585
AST (project, miniCEX or StAMPS) approx $1200 per AST (excluding anaesthetics and obstetrics)
DRANZCOG (advanced – training and exam) is $1705
Joint Consultative Committee on Anaesthetics (JCCA) – no fees
Cost to GPR
|
ITEM |
RACGP |
ACRRM |
|
Membership (Registrar) p.a. |
$310 |
$235 |
|
Membership (Fellow) p.a. |
$995 |
$975 |
|
PRRT exam |
- |
$3585 |
|
AST (per AST, excl obs/ana) |
- |
$1200 |
|
FRACGP |
$6265 |
- |
|
FARGP (RTP pays $250) |
$0 |
- |
|
+/- JCCA (anaesthetics) |
$0 |
$0 |
|
+/- DRANZCOG advanced |
$1705 |
$1705 |
11. Training support for rural GPRs - outline
GP Registrars who are training in a rural post (irrespective of pathway and curriculum) will meet with the rural coordinator every three months. The initial visit in each GP term and ARST post will be 'face-to-face on-site' at the GP Registrar's practice or hospital. Other visits (including hospital terms) may be by phone or videoconference. All visits will be structured and documented
12. Structure of training meeting.
Organisational
- Requirements for training program.
- Requirements for assessment.
- Incentives
- General Practice Rural Incentive Program (GPRIP)
- General Practitioner Procedural Training Support Program (GPPTSP) – GPRs who have been accepted for an AST/ARST post in anaesthetics or obstetrics may be eligible to apply for a subsidy of $40,000 per post
- Accommodation (VMA subsidy)
- Other
Professional training
- Learning plan – as far as possible integrate FARGP and FACRRM planners with VMA planner
- Assessment
- Enrol in either FARGP or FACRRM or both
- GPRs must join ACRRM before starting training to ACRRM curriculum
- GPRs can train to RACGP curriculum without joining RACGP – but GPRs must become members of RACGP to enrol in FARGP and must maintain RACGP membership during FARGP training
- Career development
- Applications for GP training posts
- Applications for ARST/AST posts
- Training and experience after FARGP/FACRRM
Personal support.
- Role of rural doctor
- Relocation and accommodation
- Family
- Networking
- Support available via VMA, RACGP, Rural Medical Family Network (RMFN), Victorian Doctors Health Program (VDHP), AMA.
- Career development (eg Rural Workforce Agency Victoria (RWAV))
13. Rural training resources
13.1. AGPT, FARGP and FACRRM information, documents and forms (all are also freely available from websites (www.racgp.org.au, www.acrrm.org.au, www.agpt.com.au, www.doctorconnect.gov.au )).
- General
- FARGP
-
RACGP definition of general practice -
RACGP curriculum for rural general practice -
FARGP curriculum guidelines -
FARGP overview for GP Registrars -
FARGP frequently
asked questions -
FARGP enrolment form - FARGP advanced rural skills training curriculum statements
-
- FACRRM
-
ACRRM training flowchart -
FACRRM vocational training brochure -
FACRRM vocational training handbook -
Frequently asked questions for vocational training for FACRRM -
GPR application form to enrol in ACRRM -
ACRRM primary curriculum -
Recommended reading list for primary curriculum -
Assessment
for FACRRM -
ACRRM
assessment handbook -
ACCRM procedural skills logbook -
Policy on enrolment and participation in ACRRM -
Policy on core
clinical training -
Policy on
primary rural and remote training -
Policy on advanced
specialised training -
Accredited
emergency medicine courses - Advanced specialised training curricula
-
13.2. Web resources
Australian College or Rural and Remote Medicine (ACRRM)
www.acrrm.org.au
ACRRM membership brochure
https://www.acrrm.org.au/files/uploads/pdf/membership/megazine.swf
ACRRM 'Country Watch' newsletters
https://www.acrrm.org.au/country-watch-newsletter
Royal Australian College of General Practitioners, National Rural Faculty
www.racgp.org.au/rural
RACGP, NRF, 'Bush Alert' newsletters
http://www.racgp.org.au/bushalert
The Rural and Remote Health Journal
www.rrh.org.au
The Australian Journal of Rural Health
www.nrha.ruralhealth.org.au/ajrh
'PracticalProf': Teaching tools for rural GPs (Canada).
http://www.practicalprof.ab.ca/
RuralMed electronic mailing list (Canada)
http://www.srpc.ca/ruralmed_sign-up.html
The Rural Medical Family Network (RMFN) provides information, support and networks
for rural doctors and their families.
www.rmfn-vic.com
The Victorian Doctors Health Program (VDHP) is a confidential service for doctors
who have health concerns. The service includes a rural outreach program. Telephone:
9495 6011.
www.vdhp.org.au
The Rural Workforce Agency (Victoria) (RWAV) does not have funding or programs
for GP registrars. However, RWAV can provide support for GPs who have completed
training and who intend to work in rural medicine. As such, RWAV can help with linkages
between training and a career in rural medicine.
www.rwav.com.au
The DoctorConnect website is a production of the Department of Health and Ageing
that aims to provide a range of information to doctors about incentives available
to work in regional, rural and remote Australia. It also provides a starting point
for overseas trained doctors and potential employers.
http://www.doctorconnect.gov.au
The 'GP Australia' website has been developed to help junior doctors explore
the world of general practice. It is an essential tool for any junior doctor considering
a career in general practice.
http://www.gpaustralia.org.au/home
13.3. Recommended texts
Wilkinson D, Hays R, Strasser R, Worley P, Handbook of Rural Medicine in Australia, 2004
Liaw S-T, Kilpatrick S. A textbook of Australian rural health. Canberra: Australian Rural Health Education Network; 2008
Hutten-Czapski P, Magee G, Wootton J, Society of Rural Physicians of Canada. Manual of rural practice. Shawville, Québec: Society of Rural Physicians of Canada; 2006