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.
RTO Guidelines for alternative AGPT and RVTS training models during the COVID-19 disruption
This document details RACGP guidelines for RTO alternative models of training during the COVID-19 disruption.
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 consistent with these guidelines will be accepted by RACGP and prior approval is not required. However, documentation of alternative models of 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. Much of the guidelines listed below are based on work done by RTO staff.
If needed, RTOs are welcome to discuss proposed COVID-19 related alternative models of training with the relevant Censor.
The guidelines on this page will be updated as the COVID-19 situation unfolds and as the need for alternative models of training becomes apparent. These guidelines may be modified over time. Alternative models instituted for dealing with the COVID-19 disruption are currently approved for 2020-2021.
Intent of the standards:
Patient and registrar safety are protected
Guidelines
Teleconsultations are patient consultation conducted by telephone or on a video-platform. Teleconsultations by GP registrars require supervision that is commensurate with normal supervision requirements as determined by the registrar’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 registrar for this. The platform the registrar uses for teleconsultations, including telephone consultations, should have the facility to invite the supervisor into teleconsultations as a third participant when needed.
A registrar calling a supervisor for advice for a teleconsultation without including the supervisor in the consultation is equivalent to the normal offsite supervision arrangement. This is permissible for a proportion of clinical supervision for more advanced registrars.
Registrar safety should be addressed including:
- Ensuring a safe working environment
- The means for debriefing
- Respect for the registrar 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 registrar safety as the registrar consults and for registrar educational support.
Guidelines
The immediate need for supervision while the registrar 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:
Registrar performance in the workplace is evaluated for assessment and educational purposes
Guidelines
There is substantial educational value in observation of the registrar working with patients followed by an immediate and interactive feedback exchange between the registrar and the educator.
Examples of acceptable alternatives:
- Remote real-time observation by the educator of the registrar 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 registrar 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 registrars 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 registrars 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 standard
To ensure registrars experience sufficient breadth of general practice. This means being engaged in a broad scope of primary care services which includes: a wide range of patients; involving continuity of care; and, not being limited to a specific speciality area.
Guidelines
- Teleconsultations remain part of the general practice landscape with on-going lockdowns and with this form of consultation becoming accepted for a range of presentations. The RACGP expects that trainees will continue to be engaged with teleconsultations. Respiratory clinics or Covid vaccination clinics have also become part of the scope of practice for some registrars. In order to ensure adequate exposure to comprehensive general practice, it is recommended that trainees limit their engagement in teleconsultations, respiratory clinics and vaccination clinics to a maximum of 20% of their GP time over the course of their training term. This is managed by the RTO with the needs of the individual registrar taken into consideration. The suggested 20% cap is a guideline only. It is the RTOs responsibility to support the registrar in gaining sufficient breadth of general practice experience.
- Where there is Public Health Orders requirement, then Teleconsultation is supported and on occasions may be completed from home when there can be adequate and reliable supervision. However, when there is no requirement via Public Health Orders it is expected that registrars work in their practice unless significant health issues prevent them from doing so.
Intent of the standard
Registrars are placed in practices where they will receive the required supervision, support and training, and experience a broad scope of GP presentations and management.
Acceptable alternatives
Practices that are already accredited
- Training organisations should follow appropriate state or regional restrictions regarding the ability to complete an on-site visit
- At RTO discretion, these practices can have their accreditation delayed for up to 6 months or have their site visit substituted with a remote accreditation visit. This should include a remote interview of the supervisor(s) and practice manager, a video link review of the registrar/s allocated room/s, and a video link review of relevant practice areas (entrance, parking, etc).
- Where concerns are raised that warrant an onsite visit and this is not available due to restrictions, these should be discussed with the appropriate Censor on a case-by-case basis
New Practice Accreditations
- Provisional accreditation can be offered to new practices following thorough desktop audit and a remote accreditation visit as described above. It is expected provisional accreditation will be for an initial six-month maximum period.
- A site visit is required to complete the requirement of initial full accreditation and should be arranged as soon as restrictions allow. This should be completed prior to the commencement of the registrar placement. If a registrar placement is required to commence in a new practice that has provisional accreditation this must first be discussed with the appropriate Censor.
Practices not accredited and are seeking urgent accreditation for urgent registrar placement
- These need to be addressed by the RTO on a case-by-case basis with final approval sought from the RACGP through the usual channels of approval of COVID-19 related alternative training models.
Further Considerations
- Due to COVID-19 restrictions, AGPAL / GPA may have extended / rescheduled planned accreditation visits with practices. This will need to be considered in any accreditation / reaccreditation as a training facility. Training Organisations are required to monitor RACGP Standards for General Practice accreditations and follow up to ensure General Practice certification for training practices is available as appropriate.
Intent of the standard
That a registrar at the point of Fellowship is competent to manage acute and life-threatening scenarios
Guidelines
In 2021 all ALS and BLS requirements for registrars on the AGPT need to be met unless there are compelling reasons not to do so. Face to face attendance is preferred with online option only acceptable in the case of prolonged or repeated periods of lockdown in a State or Territory. Where a registrar or specific cohort is unable to meet the ALS and BLS requirements in full, the situation needs to be discussed with the relevant Censor.