About the RACGP curriculum and syllabus


The Royal Australian College of General Practitioners (RACGP) Curriculum and Syllabus for Australian General Practice 2022 promotes, supports and maintains the high standard of general practice in Australia, setting the expectations for what all Australian general practitioners (GPs) should be able to do to achieve Fellowship and beyond, regardless of where they practice in Australia.

The RACGP has a history of developing peer-based, authentic and relevant curricula that have provided the foundation for Australian general practice training for many decades. This proud history has been built upon and consolidated in the 2022 curriculum with the welcome addition of a newly developed syllabus.

With the transition to profession-led training and the development of other Fellowship pathways, the ongoing renewal of the RACGP curriculum and the addition of the syllabus are essential to ensure that GP training remains relevant to the ever-changing medical landscape, ensuring our future practitioners meet the health needs of Australian society.

Becoming a GP is a most diverse and rewarding career. GPs are by far the most common first contact in matters of personal health for people of all ages, genders and backgrounds. With almost 85% of the population seeing a GP at least once each year,1 GPs take a leading, frontline role in the delivery of primary healthcare, and are central to supporting the long-term health of individuals, their families and communities. The 2022 curriculum and syllabus embraces this diversity that defines our specialty.

The professional life of a GP begins in medical school, where one’s identity as a doctor is first established. This identity is shaped along the path leading to Fellowship and in the years beyond. While knowledge and science provide the rational basis to care, the curriculum and syllabus also embodies core humanistic values and attitudes critical to providing holistic care to our patients. Providing quality patient care is why we do what we do and is the reason GPs dedicate themselves to rigorous specialty training.

A doctor’s care is founded on good communication, and the patient–doctor relationship is crucial to effective care. But the true measure of any society is how it treats its most vulnerable, and the role of the GP in supporting patients to access culturally safe, quality primary care can make an enormous difference. Patient-centred care is at the heart of this curriculum and syllabus, highlighting the role of the GP in managing uncertainty, supporting patients with multiple health conditions and advocating for access to appropriate care.

Written by GPs for GPs, this evidence-based curriculum and syllabus captures our unique perspective as practitioners from across Australia. Reflecting the diverse nature of Australian general practice and the communities in which we serve, countless hours of general practice experience will now inform and facilitate the transfer of wisdom from our most experienced GPs to future GP leaders.

We trust that this learning guide will provide a best practice foundation to support our profession’s commitment to high-quality GP teaching and learning.

Adj. Professor Karen Price
RACGP President

1. The Royal Australian College of General Practitioners. Health of the Nation. East Melbourne, Vic: RACGP, 2021.  [Accessed 4 February 2022].

Acknowledgement of Country

The Royal Australian College of General Practitioners acknowledges the Traditional Custodians of the land and sea on which we work and live, we recognise their continuing connection to land, sea and culture, and pay our respects to Elders, past, present and future.

Principles for training in Aboriginal and Torres Strait Islander health

The RACGP is committed to the health and wellbeing of all Australians by providing ongoing support to GPs, general practice registrars, and medical students. It is paramount to build rapport and develop great relationships with Aboriginal and Torres Strait Islander peoples, their families and their communities, helping overcome the current health gaps in Australian society, building understanding, respecting differences and finding what we have in common. 1


1. The Royal Australian College of General Practitioners. Relationships. East Melbourne: Vic: RACGP, 2021. [Accessed 4 February 2022]

Project team

  • Dr Nyoli Valentine, Clinical Lead
  • Nicole Quaife, Senior Education Advisor
  • Alanna Kirley, Program Lead
  • Maria Humphries, Editor
  • Lauren Peterson, Education Strategy and Development Lead
The project team gratefully acknowledges the following people, groups and committees that have contributed to the development and review of the curriculum and syllabus.
 

Principal medical education advisor
Assoc Prof James Brown

Medical educators
Dr Judith Culliver
Dr Deborah Hawthorne
Dr Ronald McCoy

Editing support
Alanna Burgess
Louise Kerr

Steering Committee and Reference Group
Mr Russell Baker
Dr Sama Balasubramanian
Dr Sean Black-Tiong
Assoc Prof James Brown
Ms Angela Burden
Dr Gary Butler
Ms Chris Cook
Dr Judith Culliver
Dr Sharmila Jayaram
Dr Karin Jodlowski-Tan
Dr Madan Mariappan
Dr Ronald McCoy
Dr Olivia O’Donoghue
Dr Catherine Pendrey
Dr Tanya Schramm
Dr Gillian Singleton
Dr Rebecca Stewart
Mr Alex Vaine
Dr Tess Van Duuren

Education Services Leadership Group
Assoc Prof James Brown
Ms Tess Joseph
Mr Rob LoPresti

Writers
Dr Penny Abbott
Dr Brooke Ah Shay
Dr Geordie Beath
Dr Penny Burns
Dr Cindy Clayton
Dr Dan Corkery
Dr Judith Culliver
Dr Mark Dalgleish
Dr Carolyn Ee
Dr Esther Gershenzon
Dr Kate Graham
Dr Miriam Grotowski
Dr Asma'a Gundru
Dr Abby Harwood
Dr Gerard Ingham
Dr Sugantha Jagadeesan
Dr Chaminda Jayaratne
Dr Ania Lucewicz
Dr Jane MacLeod
Dr Madan Mariappan
Dr Katrina McLean
Dr Lisa Mifsud
Dr Ben Mitchell
Dr Jenni Parsons
Dr Samantha Ranasinghe
Dr Tony Saltis
Dr Aajuli Shukla
Dr Gillian Singleton
Assoc Prof Nancy Sturman
Dr Georgina Taylor
Dr Alum Sheila Uyirwoth
Dr Alyssa Vass
 
Reviewers

RACGP Aboriginal and Torres Strait Islander Health Council
RACGP Aboriginal and Torres Strait Islander Health Education Committee
RACGP Specific Interests groups:

  • Abuse and Violence in Families
  • Addiction Medicine
  • Aged Care
  • Antenatal and Postnatal Care
  • Breast Medicine
  • Cancer and Palliative Care
  • Cardiology
  • Child and Young Person's Health
  • Climate and Environmental Medicine
  • Custodial Health
  • Dermatology
  • Diabetes
  • Disability
  • Disaster Management
  • Hospital Medicine
  • Integrative Medicine
  • Medical Education
  • Military Medicine and Veterans’ Health
  • Musculoskeletal Medicine
  • Pain Management
  • Psychological Medicine
  • Refugee Health
  • Respiratory Medicine
  • Sexual Health Medicine
  • Travel Medicine

RACGP National Faculty for GPs in Training
RACGP Council of Censors
RACGP Rural
Australian Defence Force
Department of Veterans' Affairs
Eastern Victoria GP Training
General Practice Medical Educators
General Practice Registrars Australia
General Practice Training Queensland
General Practice Training Tasmania
GP Synergy
GPEx
Indigenous General Practice Registrars Network
International Medical Graduate Committee
James Cook University GP Training
Lead Medical Educator Committee
Murray City Country Coast GP Training
National Cultural Mentor and Cultural Educator Network
Northern Territory General Practice Education
Regional Training Organisations Network
Remote Vocational Training Scheme
Western Australian General Practice Education and Training
Members of the Steering Committee and Reference Group

Dr Khayyam Altaf
Dr Cathy Andronis
Dr Kaye Atkinson
Dr Nicole Avard
Dr Rod Bain
Dr Trish Batchelor
Dr James Best
Dr Rachael Boland
Dr Joanna Bruce
Dr Kay Brumpton
Dr Danielle Carter
Dr Rachel Chen
Dr Erica Clarke
Dr Lisa Clarke
Dr Ty Clayworth
Dr Michael Clements
Dr Gill Cowen
Assoc Prof Bob Davis
Dr Gary Deed
Dr Stacey Deshong
Dr Paul Dilena
Dr Graham Emblen
Dr Sandy Eun
Dr Rebecca Farley
Dr Darran Foo
Dr Lisa Fraser
Dr Sarah Gani
Dr Pat Giddings
Dr Romey Giles
Dr Trina Gregory
Dr Owain Greville
Dr Ronda Gurney
Dr Josie Guyer
Dr Stephen Hampton
Dr Kerry Hancock
Dr Simon Hay
Dr Ashley Hayes
Ms Elisabeth Heenan
Dr Paula Heggarty
Ms Kathleen Hickey
Dr Libby Hindmarsh
Dr Aaron Hollins
Dr Sue Hookey
Dr Lorri Hopkins
Dr Jeremy Hudson
Dr Chris Hughes
Dr Nicholas Hummel
Dr Cynthia Jackson
Dr Danielle James
Dr Karin Jodlowski-Tan
Dr Bronwyn Jones
Dr Melissa Joseph
Dr Joanne Kaczmarek
Dr Alia Kaderbhai
Dr Konrad Kangru
Dr Margaret Kay
Dr Glynn Kelly
Dr Jessica Kneebone
Dr Vicki Kotsirilos
Dr John Kramer
Ms Crystal Laughlin
Dr Graham Lee
Dr Rebecca Lock
Dr Shani Macaulay
Prof Parker Magin

Dr Marisa Magiros
Dr Joshua Mann
Dr Jo-Anne Manski-Nankervis
Dr Bambi Markus
Dr Karyn Matterson
Assoc Prof Lawrie McArthur
Dr Jacqueline McDonnell
Dr Heather McGarry
Dr Allison Miller
Dr Beth Miller
Dr Chris Moller
Dr Vanessa Morgan
Dr Amy Moten
Ms Lavina Murray
Dr Tamara Nation
Dr Penny Need
Mr Henry Neill
Dr Karen Nicholls
Dr Sylvia Nicholls
Dr Natasha Nottingham
Dr Olivia O’Donoghue
Prof Edward Ogden
Dr Rodney Omond
Dr Carolyn O'Shea
Dr Catherine Pendrey
Dr Andrew Pennington
Assoc Prof Peter O'Mara
Dr Frances Poliniak
Dr Scott Preston
Dr Sarvin Randhawa
Dr Morton Rawlin
Dr Jenny Reith
Dr Joel Rhee
Dr Lara Roeske
Dr Anna Sallos
Dr Tim Senior
Dr Lizzi Shires
Dr Harsharan Singh
Dr Simon Slota-Kan
Ms Clara Smith
Prof Neil Spike
Dr Chris Starling
Dr Kerrie Stewart
Dr Rebecca Stewart
Dr Jen Taylor
Mr Peter Thomsen
Dr Wendy Thornthwaite
Dr Tom Turnbull
Dr Cristina Valero
Ms Georgina van de Water
Dr Edward Vergara
Dr Milana Votrubec
Dr Danielle Walker
Dr Kate Walker
Dr Kate Wallis
Dr Claire Walter
Dr Ken Wanguhu
Ms Xanthus Weber
Dr Neil Westphalen
Dr Hester Wilson
Dr Ross Wilson
Dr Kate Wylie
Dr Peter Zimmermann
Dr Nick Zwar

Additional support for the project was received from the following faculty team members:
Ms Leanne Bird
Ms Daniela Doblanovic
Ms Gillian Elliot
Ms Tori Lee
Ms Ada Parry
Ms Chantelle Vonarx.

The development of the syllabus component of the Curriculum and Syllabus for Australian General Practice 2022 was funded by the Australian Government Department of Health.

Fellowship of the Royal Australian College of General Practitioners (FRACGP) is a specialist general practice qualification accredited by the Australian Medical Council (AMC). General practice has its own curriculum, consultation style, skill set and holistic approach to diagnosis and management.1 As first point of contact for people seeking health advice and care, GPs see the widest range of conditions of any medical specialty, which has implications for a GP’s continuing medical education.2 The role of a GP is complex and includes responsibility to the individual and society, making decisions in ambiguous situations, dealing with uncertainty and developing personal attributes required across the continuum of training.3

The RACGP Curriculum and Syllabus for Australian General Practice 2022 (curriculum and syllabus) builds on the strengths of the previous RACGP curriculum and introduces a syllabus for general practice training.

The curriculum component describes the key competency and learning outcomes of GP education. These are detailed as the knowledge, skills, values and behaviours required to practise as a GP independently anywhere in Australia and to be recognised as a specialist in the field of general practice.

The syllabus component has been developed to support these high-order educational outcomes. It provides a framework for education, detailing the scope of educational content to be learnt across the domains of general practice, and suggesting learning modalities and educational resources to support learning.

Together, the curriculum and syllabus informs the development and delivery of educational programs and guides learners in working towards Fellowship. As a unified document and tool, it also serves as a guide to assist with remediation and for GPs returning to work after absence.

In revising the RACGP 2016 Curriculum and developing a syllabus, we have been guided by the imperatives and guiding principles of the RACGP educational framework. These guiding principles represent the values, educational philosophy and scope of learning that the RACGP considers necessary for quality general practice and best practice medical education of GPs in Australia.

A focus on competency at the point of Fellowship

The focus of the curriculum and syllabus is on describing the core competencies and outcomes for the GP at the point of Fellowship, unlike previous versions of the curriculum that also provided competencies and outcomes for GPs prior to entering training and after Fellowship. A new companion document, the RACGP Progressive Capability Profile of the General Practitioner, covers the professional training continuum.

The 13 core skills of the RACGP 2016 Curriculum (now termed ‘core competencies’)  have been reviewed and updated in the curriculum and syllabus, with the addition of two further competencies, making a total of 15 core competencies.

A new structure

Core and contextual units

The curriculum and syllabus consists of 42 units: seven core units and 35 contextual units.

Each of the five domains of general practice is presented as a standalone unit. Together with the Aboriginal and Torres Strait Islander health and rural health units, they make up the core units.

The contextual units included in the RACGP 2016 Curriculum have been rearranged and revised to reflect the current and evolving general practice environment. For example, the system-based topics previously covered by the adult medicine unit have been expanded into their own standalone units; for example, gastrointestinal health. In a similar way, the child and youth health unit now focuses on developmental and specific needs, while the system-based paediatric presentations are now included in the relevant system-focused units.

For further details, please refer to: 2016 to 2022 competency and content map.

Introduction of a syllabus

The inaugural RACGP syllabus provides detailed educational outcomes, content and processes for each unit. This is to support the educational work of educators, supervisors and learners. It is also a resource for other educational needs, such as for GPs returning to work, in cases of remediation and for post-Fellowship continuing professional development.

Each unit of the curriculum and syllabus has seven sections: rationale, competencies and learning outcomes, words of wisdom, case consultation example, learning strategies, guiding topics and content areas, and learning resources (Table 1).

‘The good physician treats the disease; the great physician treats the patient who has the disease.’

– William Osler

Core units

The curriculum and syllabus reflects the expectations, values and principles required of an Australian GP. It is framed by the five domains of general practice, and the Aboriginal and Torres Strait Islander health and rural health units. Together these make up the seven core units.

The five domains of general practice represent the critical areas of knowledge, skills and attitudes necessary for competent unsupervised general practice. They are relevant to every general practice patient consultation.

The five domains of general practice are:

The health of Aboriginal and Torres Strait Islander peoples is a national priority, and the ability of GPs to work effectively with Aboriginal and Torres Strait Islander peoples in improving their health is crucial if we are to close the gap in health outcomes. Therefore, all GPs are expected to achieve the outcomes in the Aboriginal and Torres Strait Islander health unit, whether or not they undertake a training experience or work in an Aboriginal and Torres Strait Islander health training post.

The health of rural and remote Australians is also a priority. In rural and remote Australia, geographical and demographic factors lead to great diversity in both the ranges of presentations a GP might encounter and the primary care facilities and infrastructure available. The GP at the point of Fellowship is expected to be able to demonstrate the rural-specific competency outcomes outlined in this curriculum and syllabus.

Contextual units

The 35 contextual units cover the patient populations, clinical presentations and areas of practice that make up Australian general practice. The contextual units detail how the core competencies are applied in everyday practice. The core units are integrated throughout the contextual units.

The 42 units of the curriculum and syllabus

Core units

The seven core units represent the essential knowledge, skills and attitudes expected of all Australian general practitioners. They include the five domains of general practice, together with the Aboriginal and Torres Strait Islander health and rural health units.

1. Communication and the patient–doctor relationship

2. Applied professional knowledge and skills

3. Population health and the context of general practice

4. Professional and ethical role

5. Organisational and legal dimensions

6. Aboriginal and Torres Strait Islander health

7. Rural health

Contextual units

The 35 contextual units cover the patient populations, clinical presentations and areas of practice that make up Australian general practice. The contextual units detail how the core competencies are applied in everyday practice.

8. Abuse and violence

9. Addiction medicine

10. Cardiovascular health

11. Child and youth health

12. Dermatological presentations

13. Disability care

14. Disaster health

15. Doctors’ health

16. Ear, nose, throat and oral health

17. Education in general practice

18. Emergency medicine

19. Endocrine and metabolic health

20. Eye presentations

21. Gastrointestinal health

22. Haematological presentations

23. Infectious diseases

24. Integrative medicine

25. Justice system health

26. Kidney and urinary health

27. Men's health

28. Mental health

29. Migrant, refugee and asylum seeker health

30. Military and veteran health 

31. Musculoskeletal presentations

32. Neurological presentations

33. Occupational and environmental medicine

34. Older persons' health

35. Pain management

36. Palliative care

37. Pregnancy and reproductive health

38. Research in general practice

39. Respiratory health

40. Sexual health and gender diversity

41. Travel medicine

42. Women's health

Competencies

The seven core units are the basis of the core competency framework (Figure 1). There are 15 core competencies (previously known as core skills) and 92 core competency outcomes that arise from these core competencies. Together they make up the core competency framework. The core competency framework is represented across the 35 contextual units. 
 

Figure 1

Figure 1

Competencies of the curriculum and syllabus.



Sections

Each of the 42 units follows a standard format, as shown in Table 1.


Table 1. Sections of the curriculum and syllabus.

Section Information
1. Rationale This section provides a summary of the area of practice for this unit and highlights the importance of this topic to general practice and the role of the GP.
2. Competencies and learning outcomes This section lists the knowledge, skills and attitudes that are expected of a GP.
Core units: Each core unit has a set of core competencies that are required of a GP across all clinical consultations, interactions and contexts. These core competencies are further detailed as measurable core competency outcomes.
Contextual units: Each contextual unit has a set of measurable learning outcomes that align to the core competency outcomes of the seven core units.
3. Words of wisdom Practical tips from experienced GPs covering a variety of competencies.
4. Case consultation example A common case demonstrating the application of the core competency framework to clinical practice. It contains questions ordered according to the RACGP clinical competency exam (CCE) assessment areas to prompt consideration about different aspects of the clinical case.
5. Learning strategies
 
Strategies to assist in building skills and knowledge, evaluation of learning and application of knowledge to clinical practice. These strategies cover all five domains and are organised as learning strategies to be done by learners on their own, with a supervisor, in a small group or with a family member or friend.
6. Guiding topics and content areas Examples of topic areas for each unit that can be used to guide learning.
7. Learning resources

GP, general practitioner.
A starting list of helpful resources for each unit covering all the five domains and Aboriginal and Torres Strait Islander Health and rural health.

 

 

The RACGP curriculum is accredited and monitored as part of the RACGP’s accreditation under the Health Practitioner Regulation National Law. Accreditation requirements for the AMC include regular curriculum review; this occurs every 3–5 years. The curriculum sits within the RACGP educational framework alongside the RACGP Standards for general practice training and the RACGP Progressive Capability Profile of the General Practitioner.

The review and revision of the curriculum was a collaborative process that included consultation and input from an expert advisory group, and RACGP faculties, groups and committees. A desktop review was undertaken, which included the review of regulatory body requirements, international medical curricula and medical literature. Other non-GP specialist medical colleges, schools and universities, regional training organisations and government and community organisations provided input, feedback and resources via an online survey and through individual submissions.

Development of key documentation and recommendations to enable ongoing revision and evaluation of the curriculum will assist in future review cycles.

 

The inaugural RACGP syllabus was developed collaboratively with GPs, supervisors, medical educators, cultural educators and GPs in training and new Fellows. Development occurred in stages in a cyclical, rather than a linear way (Figure 3).

The project’s Reference Group provided industry and community sector expertise and advice. The Reference Group comprised RACGP staff from the RACGP National Faculty for GPs in Training, the International Medical Graduate Committee, Assessment Development and Operations, RACGP Rural, RACGP Aboriginal and Torres Strait Islander Health, RACGP educational framework project team, RACGP curriculum review project team, and RACGP Education Strategy and Development. The Reference Group met bimonthly throughout the project to provide advice and feedback.

Two think tanks were held to help determine the aims of the syllabus and its alignment with other educational processes within the RACGP (Figure 2). Governance of the project was monitored by a steering committee and the RACGP Portfolio Management Office.

Figure 2

Figure 2

Aims and guiding principles of the RACGP syllabus

 


Stages of development

The stages of the syllabus development are illustrated in Figure 3.

Stage 1: Development of a shared vision and guiding principles

The aims and guiding principles of the syllabus were developed to ensure a shared vision between all stakeholders. These were informed by the guiding principles of the RACGP educational framework.

Stage 2: Draft template development

A draft template of the structure of the syllabus was developed using evidence-based principles. This was done to identify how the evidence-based principles, as well as the guiding principles, could be practically applied in a learning environment.

Stage 3: Stakeholder perspective and engagement

Thirteen focus groups were held with a total of 92 participants to better understand the perspectives of the stakeholders and end users of the syllabus. The participants were diverse (29 supervisors, 27 medical educators, eight RACGP council members from various RACGP councils and committees, four cultural educators or cultural mentors, and 23 doctors on their journey to RACGP Fellowship). There was representation from every state and territory across the 13 focus groups, from nine of the 10 regional training organisations and from each Australian Modified Monash Model location. Participants were presented with the draft template to stimulate discussion and provide a pragmatic perspective on what can be an abstract topic.

Following the focus groups, themes were summarised, and these perspectives were incorporated during further development of the template.

Stage 4: Finalising the syllabus template

An iterative process of development and review of the syllabus template occurred until agreement was reached. This process included the structure of the syllabus and the planned final presentation formats – online and PDF.

Stage 5: Combining the RACGP curriculum revision process with the writing of the syllabus

The curriculum and syllabus were brought together to ensure consistency between the two documents and improved usability for end users.

Stage 6: Writing of the curriculum and syllabus

Writers were engaged to write each of the seven core skills units and 35 contextual units of the curriculum and syllabus. Writers were chosen based on their educational and clinical expertise within a topic area. 

Stage 7: Review phase 1

The first draft of the curriculum and syllabus was edited by an RACGP editor and underwent a review by three medical educators to ensure that they were applicable to a GP at the point of Fellowship, academically sound, written to a high standard, and in accord with the template directions. Comments and feedback were provided to the writer and appropriate changes made. This process continued until the draft was ready for the next review phase.

Stage 8: Review phase 2

The curriculum and syllabus units were reviewed by content experts to ensure they accurately reflected the educational content for the area. The RACGP Specific Interests groups provided these reviews where possible. Where there was no appropriate special interest group, alternative expert reviewers were identified. The RACGP Aboriginal and Torres Strait Islander Health faculty and the RACGP Rural faculty were also involved in this phase, reviewing all units.

Feedback was collated and returned to the writers and appropriate changes made. An editor and medical educator then reviewed the updated drafts.

Stage 9: Review phase 3

Targeted internal and external stakeholders were invited to review the next draft of the curriculum and syllabus. Stakeholders were given the opportunity to review all seven core units and 35 contextual units. Feedback provided was collated and appropriate changes made.

Figure 3

Figure 3

RACGP syllabus development process.

A theoretical framework was used to ground the curriculum and syllabus template development. An understanding of the relevant theories is necessary to ensure the development of appropriate instructional strategies within the GP context and environment of learning.4

There is no single theory that explains how aspiring health professionals engage in learning.5 Each provides a different lens. The curriculum and syllabus draws from both humanistic and sociocultural learning theories. These include the humanistic theories of adult learning, transformative learning, experiential learning and reflective learning; and the sociocultural learning theories of communities of practice and work-based learning.

Promote self-motivation and self-directed learning

Humanistic learning theories pose that adults plan, manage, and assess their own learning to accomplish self-actualisation and self-fulfilment. They are self-motivated, driven by their own values and goals, and seek independence in their learning. The RACGP recognises that competent GPs are self-aware and can identify and address their learning development needs to ensure patient safety.6,7 Supervisors and medical educators are seen as facilitators of learning.5 Sociocultural theories support the role of supervisors, noting that learners develop their values, beliefs and problem-solving strategies through collaborative dialogue with a range of senior colleagues in the context of a working community.

Self-directed learning is a central theme of the RACGP curriculum and syllabus. Learners are diverse, with different experiences, understandings, strengths and weaknesses. A one-size-fits all approach will not suffice. The 42 units of the curriculum and syllabus enable learners to self-identify their priority areas of learning in accordance with their unique experiences, personal needs, and the needs of patients and the community that they work in. Supervisors support learners through facilitation, discussion and guidance.8

Support supervisors to provide scaffolding, enabling contextual and situational learning

In real-life medical practice, clinical situations are rarely neat, typical or standard. GPs are frequently faced with situations that are complex and poorly defined. Understanding and working within this ‘messiness’ of professional practice is at the heart of professional expertise.9 Being able to learn in this messy environment is crucial to being able to practise within it. 

Dornan et al. noted that clinical teaching for the 21st century is not about teaching, it is about supporting students to learn from real patients within clinical practice.10 Learning and knowledge construction are facilitated through interaction with an authentic environment.4 Situativity theory proposes that knowledge, thinking and learning are situated in experience.11

In line with sociocultural and work-based learning theories, general practice training provides opportunities for learners to learn from their clinical patients through a supported apprenticeship model. GP learners are ‘workers’ within a practice community. They are situated within the culture of their learning environment and need to construct meaning with other participants in the environment. Using real patients for learning allows learners to link prior learning to memorable patients to reinforce, consolidate and contextualise what has been learnt.10 Positioning learners as meaning makers and constructors of knowledge within their environment is central to promoting how learning through clinical practice might best progress.12

Development of expertise in clinical medicine requires more than a collection of knowledge and skills.13 It could be argued that a modern general practice expert is someone who knows how to access knowledge efficiently and can form conceptual links between seemingly unrelated areas. Learning how things are interconnected is often more useful than learning about the separate pieces. This expertise is best gained from experiencing the complex interplay between the physical and social contexts in the real-life clinical setting.14 Expert performance is a complex integration of knowledge and skills that are appropriate to the unique situation that learners face.13

The curriculum and syllabus uses common case scenarios and learning strategies to maximise contextual learning. Case scenarios focus on presentations, not diagnoses, and consider all aspects of general practice. In using case-based learning, the syllabus presents cases that are authentic (based on real patient stories), involve common scenarios, tell a story, are aligned with defined learning outcomes, have educational value, stimulate interest, create empathy with the characters, promote decision-making and have general applicability.15 The curriculum and syllabus also uses ‘what if the patient was x or y’ questions to prompt learners to consider the broader context in which the cases apply.

Contextually relevant learning for general practice cannot be achieved without learners crossing the ‘threshold’ of learning within the general practice environment, which is complex and often uncertain. As learners enter general practice, they might feel a sense of discomfort, as they do not understand the context of the new situation they find themselves in.16 To be able to enter this complex environment and develop new contextual knowledge requires scaffolding. Scaffolding refers to guiding learners through the volume and complexity of knowledge required.5 Supervisors are able to guide learners, introduce new ideas and language, and provide perspective to the context. The curriculum and syllabus supports supervisors by identifying learning outcomes and suggesting activities or questions to consider to assist with scaffolding. In this way, learners will be able to step over the ‘threshold’ into the new learning of the general practice environment and, with the help of supervisors, take their place in the community of practice.5

Promote a deeper approach to learning through reflection and development of evaluative judgement

General practice training provides repeated exposure to the complexities of clinical practice. However, experience alone is not sufficient for learning to occur. Formal theoretical knowledge and experiences must be critically applied, interpreted and integrated into existing knowledge structures to become new or expanded knowledge. Reflection and discussion are crucial for this active process of learning.17 Furthermore, reflecting on experiences of participation helps learners understand the scope and complexity of illness and disease and link theory with practice.10

Transformative learning theory explores how critical reflection can be used to challenge and change – or transform – a learner’s beliefs and assumptions through the process of problem-solving.5 It is proposed to have three stages: (1) reflecting on previous perspectives about a clinical issue or event, (2) engaging in critical evaluation and self-reflection on the experience, and (3) taking action about the issues, which leads to a transformation of meaning, context and longstanding propositions.4,5

Critical reflection is not necessarily a natural or intuitive ability; it needs to be developed.18 The curriculum and syllabus supports guided reflection to maximise the learning opportunities from this exposure through examining or auditing previous professional experiences to avoid repeating past errors, identification of learning needs or areas for improvement, identification of alternative methods of approaching complex situations, the use of small group and supervisor discussion and the collection of evidence of new learning.

Reflection can occur in response to new or complex problems; reflection can also be used when anticipating challenging situations.19 The curriculum and syllabus offers potential questions or challenging situations that learners might face in their clinical practice to encourage reflection on these situations, even prior to them occurring. Reflection is often not fully realised without the support of another person, either a supervisor, colleague or peer.17 Supervisors and peers play a role in helping learners make sense of their experience, through key counselling and mentoring skills, such as non-judgemental questioning and acceptance of differences.17 The curriculum and syllabus provides reflective questions that can help guide this interaction.

It is hoped that deeper learning and reflection can build evaluative judgement capability in learners. Evaluative judgement is the capability to make decisions about the quality of one’s work and that of others.20 Clinicians use evaluative judgement to determine what quality practice is, if their practice is at the necessary standard and whether they need to invest in further learning. It is a key part, therefore, of the self-monitoring required for working without supervision.21 Strategies that are considered to improve learners’ evaluative judgement include giving learners opportunities to discuss standards of care, the integration of peer feedback, how work does or does not meet standards of care, feedback on clinical skills, questions to guide reflection and the opportunity to witness exemplary behaviour.20 These strategies have been incorporated into the curriculum and syllabus.

Promote social learning from and within communities of practice

Humanistic learning theories focus on the individual, rather than the influence of culture and social structures on learning.5,22 The curriculum and syllabus supports independent self-directed learning; collaborative learning with supervisors, colleagues and peers; and sociocultural learning, with the learner becoming part of a community of practice.23

GPs and doctors on their journey to RACGP Fellowship work within communities of practice.11 In progressing to become a Fellow, doctors participate within communities of practice, undertaking the work of caring for patients. As they progress, they take on greater autonomy under the direction of one or more mentors or supervisors. Adopting a community identity in order to become a part of the community is an important step.11 The importance of belonging to this community of practice should not be underestimated,23 and the curriculum and syllabus supports the development of this social connectedness by encouraging learning with the support of supervisors, other practice staff and peers.

Promote all the expectations, values and principles required of an Australian GP

The RACGP has identified five domains of general practice that highlight the breadth of competencies required of a GP.6 To ensure that the curriculum and syllabus is comprehensive, all five domains of general practice have been integrated throughout. For example, effective communication is essential for improving patient health outcomes.24 Communication and the patient–doctor relationship is Domain 1 of the RACGP curriculum and syllabus. Strategies to support teaching and learning of communication skills have, therefore, been interwoven throughout the curriculum and syllabus. Similarly, ethical, professional and legal behaviours have also been integrated into the curriculum and syllabus. These competencies are best consolidated within the clinical environment, not separate to it. Asking trainees to record, role-play and discuss incidents that have ethical and professional implications is crucial to the development of this skill.5 This is reflected within the curriculum and syllabus.

Provide a framework to support coaching of learners

Supervisors and educators are a key part of general practice training. However, being a skilled clinician does not automatically make one a skilled educator. Supporting, guiding and teaching learners can be challenging, especially when this is competing with the demands of clinical practice. The curriculum and syllabus aims to support supervisors and educators in their teaching role.

Learners change their approach to learning as they develop expertise, shifting from expecting their teacher to provide information, to seeking support in translating knowledge into practice with an understanding of the context. This change in focus is important for developing confidence in coping with uncertainty.25 The syllabus uses guided questions, suggestions for feedback, words of wisdom and learning strategies that aim to use the supervisors’ expertise and understanding to help trainees apply their knowledge and deal with challenging and uncertain situations, rather than expecting supervisors to be the transmitters of knowledge.

The capacity to coach is now understood to be an essential skill of a teacher.26 Coaching is more than mentoring, in that it includes responsibility for the learner’s progression. This involves active feedback, both corrective and affirming, with the aim of enabling the learner to achieve their full potential.26 There is no one right way to coach a learner. It is both learner and coach dependant.27 The curriculum and syllabus supports this individual, tailored coaching, allowing the supervisor and educator to work with the learner to focus on the questions, strategies and areas that align with the learner’s learning needs.

Inform the assessment of learning

The curriculum and syllabus, along with the Progressive Capability Profile of the General Practitioner, provides the competencies and their indicators for blueprinting the RACGP assessments from entry to general practice Fellowship pathways, including selection, through progressive and workplace-based assessments, to Fellowship exams. The curriculum and syllabus provides comprehensive detail and rationale for the topic areas and content that will be assessed. It offers approaches to learning, and curated resources relevant to the content to assist learning. The case consultation examples within the curriculum and syllabus have been designed to demonstrate how the RACGP clinical exam assessment areas can be applied to a clinical scenario. The curriculum and syllabus has been developed and extensively reviewed by those involved across the full scope of Australian general practice, and is the basis for the development, writing and delivery of all RACGP assessments.

The core competency framework articulates the required core competencies of a specialist GP at the point of Fellowship. The framework seeks to clarify the nature of Australian general practice; to distinguish how this role is different from other disciplines within medicine; and to define the role of GP service delivery in the context of individual patients, their communities and the broader health system.

The seven core units are the basis of the core competency framework (Figure 1). There are 15 core competencies (previously known as core skills) and 92 core competency outcomes that arise from these core competencies. Together they make up the core competency framework (Table 3). The core competency framework is represented across the 35 contextual units.

A downloadable version of the core competency framework is available here.

A map of the changes to the core competency framework since 2016 is available here.


Table 3. Core competency framework

Domain 1. Communication and the patient–doctor relationship
Core competencies Core competency outcomes
  The GP is able to: 
  1. GPs communicate effectively and appropriately to provide quality care
  1. communicate with patients in a clear, respectful, empathic and appropriate manner
  2. communicate effectively in challenging situations
  3. use a clear and considerate approach when communicating with family, carers and others involved in the care of the patient
  4. communicate effectively and respectfully to address complaints and concerns
  5. communicate effectively and safely via electronic media
  6. use appropriate resources to communicate effectively where there is disability, impairment or language barriers

Rural health
  1. communicate effectively with other health professionals using available infrastructure
  1. GPs use effective health education strategies to promote health and wellbeing
  1. consider the patient’s level of health literacy, acknowledging that these factors can influence a patient’s experience of illness and health behaviours
  2. draw on a range of interview and counselling approaches to support patients to optimise health behaviours
  3. use planned and opportunistic approaches to provide screening, preventive care and health promotion activities
  1. GPs communicate in a way that is culturally safe and respectful
  1. communicate in a way that is respectful and responsive to the sociocultural context and beliefs of the patient
  2. incorporate sociocultural elements to tailor health education to the local context

Aboriginal and Torres Strait Islander health
  1. communicate with Aboriginal and Torres Strait Islander patients in a culturally safe and respectful manner
  1. GPs provide the primary contact for holistic and patient-centred care
  1. conduct a consultation that is aware and appropriate to the needs of the patient
  2. provide continuity of care through timely referral and follow up
  3. use a patient-centred approach to consultation, identifying and addressing the patient agenda to develop patient-centred management plans with the patient, their families or carers
  4. listen to and acknowledge the illness experience from the patient’s perspective
  5. understand different consultation models and identify the most appropriate for the situation

Aboriginal and Torres Strait Islander health
  1. establish an effective and culturally safe therapeutic relationship with Aboriginal and Torres Strait Islander patients
Rural health
  1. provide quality care in a rural and/or remote community
Domain 2: Applied knowledge and skills
Core competencies Core competency outcomes
  The GP is able to: 
  1. GPs diagnose and manage the full range of health conditions across the lifespan
  1. take a comprehensive and clearly documented history in a timely, ordered and respectful manner
  2. perform a relevant and respectful physical examination
  3. identify and manage significantly ill patients appropriately
  4. formulate a list of relevant differential diagnoses
  5. receive consent and undertake relevant procedures
  6. offer relevant screening and investigations
  7. interpret investigation results within the context of the patient’s life/situation
  8. demonstrate clinical reasoning in the diagnosis and management of the patient
  9. prescribe and monitor medication safely and appropriately
  10. acknowledge clinical uncertainty and respond appropriately to it

Aboriginal and Torres Strait Islander health
  1. undertake screening for early identification of health issues in Aboriginal and Torres Strait Islander communities
  2. manage health conditions in a timely manner, including responding effectively to the complex needs of patients with multi-morbidity
Rural health 
  1. develop knowledge and skills appropriate to the practice location
  1. GPs are innovative and informed by evidence
  1. identify and critically analyse quality evidence-based resources
  2. stay informed (and consider the use) of innovative approaches to chronic and complex health issues
  1. GPs collaborate and coordinate care
  1. ascertain the appropriate care model
  2. minimise fragmentation of care
  3. demonstrate leadership in emergency situations
  4. establish professional networks to maintain quality care

Aboriginal and Torres Strait Islander health
  1. ensure care is relevant to Aboriginal and Torres Strait Islander peoples’ social, cultural, economic and other unique needs
  2. work in respectful partnership with Aboriginal and Torres Strait Islander healthcare professionals
Rural health
  1. establish interprofessional networks to ensure quality local healthcare delivery
Domain 3. Population health and the context of general practice 
Core competencies Core competency outcomes
  The GP is able to: 
  1. GPs practise in a sustainable and accountable manner to support the environment, their community and the Australian healthcare system
  1. incorporate epidemiology into screening and management practices
  2. utilise shared resources in a sustainable manner (acknowledging that resources will always be finite)
  3. manage current and emerging public health risks effectively
  4. engage in public health and health promotion activities (to promote health in the local community)
  1. GPs advocate for the needs of their community
  1. describe the barriers to health equity in Australia (in the context of general practice)
  2. undertake the necessary action(s) to bring about positive change for patients (and community)
  3. explain how social and environmental determinants impact health (in their community)
  4. advocate to remove the health inequities that exist between various groups within the community

Aboriginal and Torres Strait Islander health
  1. identify and promote ways to achieve health equity for Aboriginal and Torres Strait Islander people
  2. identify and promote social, environmental and cultural determinants of health in the local community
Rural health
  1. advocate for equitable access to appropriate services for rural and remote communities
Domain 4. Professional and ethical role
Core competencies Core competency outcomes
  The GP is able to: 
  1. GPs are ethical and professional
  1. adhere to relevant codes and standards of ethical and professional behaviour
  2. maintain duty of care
  3. identify and manage critical incidents and potential critical incidents including appropriate use of open disclosure practices
  4. display a positive and professional demeanour
  5. recognise and preserve therapeutic boundaries in an ethical and professional manner
  1. GPs are self-aware
  1. identify and act on areas for professional development
  2. undertake regular self-reflective practice and appraisal
  3. demonstrate a positive personal health and wellbeing outlook
  4. show awareness of the influence that their values and behaviour have on others
  5. implement an ongoing plan to overcome professional isolation

Aboriginal and Torres Strait Islander health
  1. demonstrate awareness of their own cultural identity and the impact of this on clinical interactions and healthcare service delivery
  2. identify and actively seek to redress their own biases, judgements, assumptions and attitudes
  3. identify and promote strategies for responding to systemic racism in healthcare services
Rural health
  1. implement an ongoing plan to overcome professional geographical isolation
  2. be prepared, resourceful and adaptive to challenges that arise in geographic and professional isolation
  3. identify and acquire extended, or specific local knowledge to meet the healthcare needs of their community
  1. GPs mentor and teach
  1. share professional knowledge and experience with others
  2. utilise formal and opportunistic activities to engage in GP teaching and mentoring
  3. identify and ethically support colleagues and co-workers in difficulty

Aboriginal and Torres Strait Islander health 
  1. engage with and support Aboriginal and Torres Strait Islander cultural education
  2. promote the professional development and support of the Aboriginal and Torres Strait islander health workforce
  1. GPs participate in evaluation and research
  1. apply critical analysis skills to medical and grey literature
  2. participate in regular evaluations of clinical care, including appropriate clinical governance, incident review and clinical audits

Aboriginal and Torres Strait Islander health
  1. engage and support Aboriginal and Torres Strait Islander health research
  2. promote the use of Indigenous research methods and support for the AIATSIS Code of Ethics for Aboriginal and Torres Strait Islander Research
Domain 5. Organisational and legal dimensions  
Core competencies Core competency outcomes
  The GP is able to: 
  1. GPs use effective practice management processes and systems to continually improve quality and safety
  1. maintain and improve quality in clinical practice standards and infection control
  2. demonstrate effective leadership 
  3. manage time and priorities efficiently  

Aboriginal and Torres Strait Islander health
  1. identify and implement effective models of primary healthcare delivery which meets the needs of Aboriginal and Torres Strait Islander peoples
  2. implement systems to support identification of Aboriginal and Torres Strait Islander patients
  3. facilitate timely and appropriate use of relevant Indigenous-specific health measures and MBS/PBS items
Rural health
  1. manage time and priorities efficiently when undertaking on-call roles 
  1. GPs work within statutory and regulatory requirements and guidelines
  1. manage patient privacy and confidentiality appropriately according to the relevant jurisdiction(s) 
  2. explain and obtain informed consent in a manner of shared decision-making
  3. describe and integrate medico-legal requirements, including record keeping 
  4. conduct business ethically and legally
  5. provide a practice environment that is culturally safe for themselves, their staff, patients and their families  
  6. ensure a work environment that is safe and supported and free of bullying, harassment and discrimination

Aboriginal and Torres Strait Islander health
  1. identify and implement appropriate policies and initiatives regarding Aboriginal and Torres Strait Islander health to optimise outcomes

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Printed from the RACGP website at https://www.racgp.org.au/education/education-providers/curriculum/curriculum-and-syllabus/about-the-racgp-curriculum-and-syllabus 8/10/2022