Appendix 1: Guideline development
The Australian Department of Health and Aged Care funded two projects to develop, pilot and refine the remote supervision guidelines in 2021–23:
- Remote Supervision for Rural and Remote Practices project (2021–22)
- Remote Supervision pilot project (2022–23)
Remote supervision for rural and remote practices project
The purpose of the Remote Supervision for Rural and Remote Practices project was to develop a model for GP registrars working at sites where remote supervision is needed in order to ensure safe and effective training, education and support.
Although funded and developed within the RACGP, the Guidelines for safe and effective general practice training utilising remote supervision have been written to be applicable beyond the Australian General Practice Training (AGPT) program, and are relevant to all doctors training in general practice and working in locations needing remote supervision, regardless of the training program.
A remote supervision expert advisory group (EAG) with a diverse range of remote supervision experiences was formed. This group included academics, previously remotely supervised registrars, remote supervisors and key stakeholders. Their advice was sought at both formal meetings and on an ad hoc basis.
An extensive review was undertaken, exploring both national and international literature on remote supervision for doctors, as well as for other health professionals. Some of the authors of seminal articles were contacted in order to access older articles, for advice about other literature related to the topic and to take part in the interviews. Recommendations of articles also came from the interview participants.
A document review and environmental scan explored documents from regional training organisations (RTOs) and other organisations, and included:
- past evaluations of remote supervision models
- templates for use in remote supervision
- outlines of models
- guidelines for remote supervision
- conference presentations
- newsletter articles.
Further grey literature was discovered from searches, as well as being submitted by interviewees.
Semistructured interviews were conducted with over 50 relevant stakeholders. Initially this was strategic, with known experts, those recommended by the EAG, RTOs, other key stakeholder organisations and authors of relevant literature. This then proceeded into an iterative snowballing process, where interviewees recommended others to be interviewed, contributed documents and suggested peer-reviewed literature.
The final interview list included:
- academics
- authors of relevant literature
- current and past remotely supervised GP registrars
- current and past remote supervisors
- current and past RTO directors of training and education
- medical educators
- administrators of remote supervision models
- CEOs of relevant organisations (eg General Practice Supervisors Australia, Remote Vocational Training Scheme)
- developers of remote supervision models for other health professions
- experts in Aboriginal and Torres Strait Islander health
- health professionals administering other models (eg Practice Experience Program, More Doctors for Rural Australia Program)
- medico-legal experts
- representatives from the RACGP, Australian College of Rural and Remote Medicine and the Australian Medical Council, regarding administration, new models, evaluation, financing, medico-legal issues and internal political issues.
Questions were asked about the interviewees’ particular area of expertise, then more generally about remote supervision, including:
- models of remote supervision that have been tried or are currently in use
- the strengths and weaknesses of these models
- the potential for adding medical graduates to areas of workforce need
- risks in remote supervision and ways to mitigate potential risks
- the acceptance of remote supervision by rural and remote communities.
The transcripts from the interviews, peer-reviewed literature, grey literature and relevant documents were triangulated using NVivo to develop an approach to the remote supervision guidelines.
Eighteen themes were identified from the 130 documents analysed. These were then discussed within the project team and with the EAG. The rich data that ensued from this process informed the development of such novel procedures as the contextualised remote supervision placement process (CRSPP), the models of supervision, the risk management matrix and the remote assessment options. The final document has undergone several rounds of review by the EAG and other key stakeholders.
A formative evaluation approach was embedded throughout the initial development of the remote supervision guidelines. The scope of this evaluation focused on formative considerations to assess project planning, progress, operational processes and short-term outcomes.
Remote supervision pilot project
The remote supervision pilot project implemented and evaluated the remote supervision guidelines, as well as the associated documents and processes, to refine the guidelines prior to wider implementation.
After the implementation and evaluation of the remote supervision in the two pilot training sites (Norfolk Island and in the Aboriginal Medical Service in the rural New South Wales town of Walgett), the registrars have chosen to continue working in both these locations as Fellowed GPs after completion of all their training requirements. Both locations were considered areas of workforce need, and without remote supervision would not have been able to have a registrar work in their health service. To have the GPs continue to work in these sites is testimony to the success of the supervision, support and processes implemented through the remote supervision guidelines.
The pilot project aimed to evaluate the various processes, including:
- training site accreditation with remote supervision risk assessment
- registrar and remote supervisor eligibility and selection requirements
- establishing an onsite supervisory team
- remote supervision orientation period
- remote supervision throughout the placement.
Interviews were undertaken with the registrars, supervisors and representatives from the training sites at three points in time: before the placement commenced, after orientation and in the final weeks of training. The operational staff involved in the placements were also interviewed about whether the documents and procedures were practical, timely and facilitated streamlined processes throughout the pilot. All participants were asked whether they would recommend any changes or do anything differently in future remotely supervised placements.
The evaluation was overwhelmingly positive, with very few changes recommended, and most of these minor. As well as the registrars continuing on in the locations in which they trained, they both said that remote supervision was ‘better than any face-to-face supervision’ they had ever had. The three supervisors are also very keen to continue to remotely supervise GP registrars, and the training sites would like remotely supervised registrars again in the future. Findings from the evaluation have been used to revise the guidelines and associated documentation and processes.