Training organisation COVID-19 disruption alternative models of education and training delivery


There is a need to find flexible solutions to COVID-19 pandemic-related disruption of education, training and assessment, while also ensuring that training standards are met. The RACGP provides guidelines for RTOs and RVTS in developing alternative models of training delivery that comply with the Vocational Training standards during the COVID-19 disruption. The guidelines are relevant for RVTS GP trainees, AGPT rural and general pathway GP Trainees, as well as for those enrolled in FARGP. Guidelines 1 and 4 are applicable to the Practice Experience Program (PEP) participants.

COVID-19 alternative models

On this page, the RACGP provides guidelines for RTO and RVTS alternative models of training during the COVID-19 disruption. RACGP has developed a list of overarching principles to guide COVID-19 related RACGP education and training program decisions. These guidelines are framed by these principles.

The guidelines are detailed by areas of training that have been identified as requiring alternative models during this time. For each identified area of training, the intent of the standards for the area is detailed followed by guidelines on how the standards and their intent might be met. RTO alternative models that are that are consistent with these guidelines will be accepted by RACGP and prior approval is not required. However, documentation of alternative models of education and training instituted must be kept for accreditation and audit purposes. This documentation should detail how the intent of the standards are met. RTOs are also encouraged to share alternative models of training for broad use with contextual variations. RACGP acknowledges the work already done by RTOs in this area, and the existing models of remote supervision already in place for RVTS. Much of the guidelines listed below are based on work done by RTO staff.

If needed, RTOs and RVTS are welcome to discuss proposed COVID-19 related alternative models of training with the RACGP Principal Medical Education Advisor.

The guidelines on this page will be added to as the COVID-19 situation unfolds and as the need for alternative models of training become apparent. These guidelines may be modified over time. Alternative models instituted for dealing with the COVID-19 disruption are only approved for 2020 unless the disruption persists into 2021. If there is a desire to continue the alternative model of training beyond this time, the model will require approval through the normal route which requires written application to the relevant state Censor.


  1. RACGP will act in the best interests of patient care and the community.
  2. RACGP will act in the best interest of all stakeholders and the healthcare systems in which they work.
  3. RACGP will act consistently, transparently and fairly across all its educational programs.
  4. RACGP will at all times work to find flexible solutions while ensuring that standards are met.
  5. RACGP recognises that education and training will be significantly disrupted for an extended period.
  6. RACGP will extend the time in training programs to ensure requirements can be met, as required.
  7. RACGP will use this challenging period to drive innovation in its educational programs, content and services for GPs in training.


Intent of the standards:

Patient and AGPT/RVTS GP trainee safety are protected


Guidelines

Teleconsultations are patient consultation conducted by telephone or on a video-platform. Teleconsultations by GP trainees require supervision that is commensurate with normal supervision requirements as determined by the AGPT/RVTS GP trainee’s level of competence. For any teleconsultation, equivalence to onsite supervision of face-to-face consultations is the ability of the supervisor to be invited into the teleconsultation and for the supervisor to be available to the AGPT/RVTS GP trainee for this. The platform the AGPT/RVTS GP trainee uses for teleconsultations, including telephone consultations, should have the facility to invite the supervisor into teleconsultations as a third participant when needed. Smart phones and many commonly used platforms have this facility.

Calling the supervisor separately to a patient teleconference is equivalent the normal offsite supervision arrangement which is permissible for a proportion of clinical supervision for more advanced GP trainees.

GP trainee safety should be addressed including:

  • Ensuring a safe working environment
  • The means for debriefing
  • Respect for the AGPT/RVTS GP trainee choice in engaging with a new model of consulting and supervision

The usual requirements for teleconsultation should be in place including:

  • Access to patient clinical records
  • A structure for follow up clinical examinations if clinically indicated
  • A means for prescribing and enacting referrals and investigations
  • Protection of patient privacy


Intent of the standards

Supervision provides for patient and AGPT/RVTS GP trainee safety as the AGPT/RVTS GP trainee consults and for AGPT/RVTS GP trainee educational support.


Guidelines

The immediate need for supervision while the AGPT/RVTS GP trainee consults can be provided by a specialist GP without registration restrictions who is available and approachable. Educational support needs to be overseen by a suitably trained supervisor or educator.


Examples of acceptable alternatives

  • Clinical supervision is provided by a specialist GP who is committed to being available and approachable
  • Educational supervision is provided by an accredited educator or supervisor one on one or in small groups at a time when this is feasible but includes the facility for patient case debriefing at least weekly.


Intent of the standards

GP in Training performance in the workplace is evaluated for assessment and educational purposes.


Guidelines

There is substantial educational value in observation of the GP in Training working with patients followed by an immediate and interactive feedback exchange between the GP in Training and the educator.


Examples of acceptable alternatives

  • Remote real-time observation by the educator of the AGPT/RVTS GP trainee consulting with patients using a web-based video platform such as Zoom, Skype or Facetime. These real-time observations would not be recorded.
  • Joint observation of pre-recorded GP in Training consultations either with patients or with simulated patients. Pre-recorded patient consultations would need to be done in a way that complied with patient privacy and record requirements.
  • Simulated consultations role-played by the educator
  • Case analysis, discussion and feedback for AGPT/RVTS GP trainees who have previously demonstrated expected or above expected consultation skills.


Intent of the standards

Peer learning workshops provide for peer to peer networking and benchmarking, for role modelling by senior educators and for delivering educational content that might be missing within in-practice education.


Guidelines

Alternative models for Peer Learning workshops should provide the means of interaction between AGPT/RVTS GP trainees and educators. They should focus on content that is not covered well within in-practice education. A mix of modalities is preferred as no single remote modality can achieve the full intent of face to face workshops.


An acceptable alternative might include a mix of

  • Synchronous small group meetings on either video or audio platforms
  • Interactive large group tele/video conferences
  • Asynchronous discussion groups
  • On-line modules with feedback


Intent of the standards

AGPT/RVTS GP trainees require training time in the general practice setting to experience: the breadth of GP presentations; managing patients with the resources typical of GP settings; and, continuity of care.


Guidelines

  • This is agreed prospectively with the RTO or RVTS.
  • The non-GP clinic-based work should be relevant to general practice, with clarity on the GP related competencies that will be gained by undertaking the work.
  • Where clinically appropriate, the non-GP clinic-based work should be "bundled" in with GP clinic-based work, with the majority of training is still in an accredited GP practice. This forms a composite post (for example one day in a fever clinic with 3 days in general practice, or providing ED services on a roster in a rural town as part of the overall general practice service provision). Telehealth is considered to be part of general practice.
  • Supervision and teaching are provided that are matched to the AGPT/RVTS GP trainee’s level of competence (this could be a remote model). Supervision and teaching must meet usual requirements/standards.
  • The AGPT/RVTS GP trainee needs appropriate support and to feel confident that they can provide the any service outside of their normal training that they are being asked to deliver.

If the work is not suitable to be considered as a GP term, it may be recognised as an extended skills term. This is especially relevant to any non-clinical work which cannot be recognised as meeting GP term requirements. Flexibilities are available in the AGPT policies with regard to training time caps and extensions which can be used for leave of absence if the work is not suitable for training recognition.

Where there are concerns about the impact on training with regards to patient load and working hours being decreased then the following applies:

Meeting the part-time minimum requirement: There must be a minimum of 10.5 clinical consultation hours over a minimum of two days per week as well as active participation in educational activities relevant to the stage of training in order to be considered as meeting the part-time general practice experience requirement.

Meeting the full-time requirement: There must be a minimum of 27 clinical consultation hours over a minimum of four days, as well active participation in educational activities relevant to the stage of training in order to be considered as meeting the full time general practice experience requirement.