AUGUST 2013 - New Zealand Doctor

RNZCGP Review of the delivery of general practice vocational training August 2013Option 5: Immersion teaching and supervisionPoints for consultation1. The College should explore models of both clustered and vertically integrated practices and create amore formalised process for these forms of education delivery.2. The College continues to support practices unable to accommodate multiple registrars and exploresways of making this model of delivery more cost effective or finds alternative funding methods.3. The feasibility of the training models should be tested to determine whether trainees and practiceswould agree to the conditions of the model and/or whether these models warrant an increase infunding to compensate for training provided outside the scope of current training provision contracts.In any professional vocational training programme, on-the-job training is the key learningenvironment and ongoing supervision throughout all years of training is essential whether it is in asecondary care, general practice or community-based setting.At present, the College uses immersion training which is on-the-job supervised training in generalpractices. This is a common and thoroughly proven model for educating postgraduate trainees inmany professions, including all vocational scopes of medicine.For GPEP Year 1, a registrar is placed in a practice with an assigned GP teacher/supervisor, who iscontracted to supply the formal and informal teaching of that registrar while they are in the practicefor a limited number of hours. At present teachers are contracted to provide 1½ hours of teachingand supervision per week. Other educational delivery, including significant informal learning, alsooccurs through interaction with other members of staff and the practice team. In GPEP Years 2and 3, the registrar has no formal directed teaching from the Fellows in their practice, although theCollege is aware that informal teaching and mentoring occurs.In the DHB setting formal teaching from senior colleagues occurs throughout the years of training.The senior colleagues are paid to deliver this learning as part of their remuneration and it is notfunded separately as it is in general practice.In general practice currently, there are many trainees of a variety of disciplines alongside GPregistrars, medical students and PGY2/3. Moving to a group teaching model within practices couldcreate issues around capacity and funding as medical students, PGY2/3 and GPEP registrars are allfunded from different sourcesOption 5.1: In-practice supervisionThe one teacher to one registrar training model is currently used to train GPEP Year 1 registrars inthe practice setting. The current model allows a practice to have multiple registrars, but there mustbe an equal number of teachers to registrars, a level of supervision that meets the MCNZ supervisionrequirements.In many practices, both rural and urban, there are insufficient consultation rooms, resources and/orpatients to have more than one registrar, and therefore a 1:1 ratio is the only option.As senior registrars progress through training in other vocational scopes they gather a broader setof skills, but there is often more individual time spent with their senior colleagues as these skills arefine-tuned.32