AUGUST 2013 - New Zealand Doctor

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RNZCGP Review of the delivery of general practice vocational training August 2013Training environment – roles of the teacher/supervisorReflectionAll medical vocational training in New Zealand, be it in primary or secondary care, occurs in unisonwith work place activities and is supervised by senior colleagues which allows for reflection onthe learning in practice. This reflective process often needs to be facilitated by peers or seniorcolleagues.Learning opportunitiesSupported on-the-job patient care provides valuable learning opportunities for developingcompetencies in general practice whilst ensuring patient safety. Whether it is through a formalisedlearning opportunity or simply from seeing a range of patients over a period of time, there is no doubtthat patients offer a unique view that can enhance the acquisition of skills, and change attitudes.Role modelling and peer supportRole modelling is a normal part of any vocational training and it is important that a variety ofexperiences and role models are seen. In Australia, UK and New Zealand registrars are allocated todifferent practices at times in their training which is a strength of these programmes. Peer supportduring training allows registrars to learn from others at the same level, provides support to thoseinvolved and also develops relationships that are long-lasting.AssessmentFormative assessment throughout training aids in the development of skills. Assessment needs tobe undertaken by those who are trained in this process. There needs to be a consistent approachas well as a formal process by whoever is assessing registrars for the development of these skills,knowledge and attitudes.Clinical Leader supportIn both GPEP Year 1 and GPEP Years 2 and 3 oversight of the programme is provided by ClinicalLeaders. The Clinical Leaders provide support to the registrars, teachers, MEs and administrationstaff as well as overseeing the strategic direction of the programme.MaterialsRegistrars require ready access to up-to-date material to aid their learning, but with the move to moreelectronic media there is requirement for educational resources to also be available online. Whilesome resources are available as documents on the learning platform, access to an electronic libraryis not, and is an option that needs to be explored.EducatorsThe education of educators is provided in a variety of ways including professional development days,conferences and the College’s Education Convention. Having trained teachers, facilitators, educatorsand/or supervisors is vital in supporting registrars and requires focused professional developmentplans for these individuals. It is also important for registrars to have opportunities to be educatorsthemselves. The Education Convention is well supported by educators across general practice and isself-funding.14
RNZCGP Review of the delivery of general practice vocational training August 2013GPEP Years 2 & 3The goal of GPEP Year 2 and 3, collectively known as GPEP2, is to assist senior registrars to furtherdevelop their skills and knowledge in general practice, building on the learning achieved in GPEP Year1, and culminating in assessment for Fellowship.Registrars are eligible to enter GPEP2 on completion of GPEP Year 1 or accepted equivalent. Seniorregistrars must be working at least four-tenths in a clinical area. While GPEP2 can be completedwithin two years, due to various factors the average completion time is 4.7 years. GPEP2 is based onregistrars completing two components: the education programme (annual activities) and clinical time.Completion of clinical time can extend beyond the period of the education programme.GPEP2 training delivery methodsPlacement supervisionUnlike GPEP Year 1 registrars, registrars in GPEP2 are responsible for finding a practice in whichto complete their required clinical hours. GPEP2 registrars are employed by their practice andsupervision of their practice work is as per standard employer/employee supervision and will bedifferent in each practice.While GPEP2 practices and the Fellows within them do not receive financial remuneration forteaching, teaching of GPEP2 registrars does occur in practice. This teaching is often informalopportunistic discussions or corridor teaching to respond to on-the-spot queries and concerns, butmore formal teaching and review may occur depending on the practice.Allocated MEEach registrar in GPEP2 is allocated an ME who facilitates the progress of registrars through theGPEP2 programme via regular contact with them. The ME is required to read and discuss with eachregistrar their Professional Development Plan and assist the registrar to identify their professionaldevelopment and learning needs.Learning groupsEach GPEP2 registrar is allocated to a learning group facilitated by an ME. Traditionally learninggroups have met physically, out of work hours, with groups structured around the geographic locationof registrars. The increasing use of Skype and other video conferencing tools has changed thisdynamic, with mixed and ‘Skype only’ groups being created in recent years. Traditional learninggroups consist of 6-12 registrars while Skype-based groups have 5-8. Learning groups meet everysix weeks (eight per year) for around two hours outside work hours.ME practice visitOnce a year, the allocated ME will visit each GPEP2 registrar at their practice. During the visit, whichusually takes four hours, the ME will:• observe a series of consultations;• assist in videoing consultations as appropriate;• view practice premises, resources and equipment;• review a selection of the registrar’s patient records;15
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AUGUST 2013 - New Zealand Doctor

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