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RACGP Standards for general practice training (4th edition)

Introduction

Last revised: 10 Apr 2024

RACGP Standards for general practice training 

Introduction 


Please note that the fourth edition of the Standards will not come into effect until 2025. Until that time, the Standards for general practice training 3rd edition are still current throughout 2024.

The Standards for general practice training define the requirements for general practice training programs from selection and entry to the program, through to completion. Their purpose is to ensure that the delivery of training meets the needs of registrars to enable them to be fully prepared and competent to be admitted to Fellowship. 

Purpose

The purpose of the RACGP Standards for general practice training is to ensure high quality and safe general practice training that meets the needs of registrars, patients, the community, supervisors, medical educators, and regulators.  

The underlying principles of these training standards are to:  

  1. Maintain a focus on safety, including that of the patient and community, the registrar and those delivering training 
  2. Ensure training is fair, transparent, responsive, accountable and people focussed  
  3. Allow flexibility to cater for the impact of a variety of factors such as context, technology and the environment while maintaining quality 
  4. Ensure that Aboriginal and Torres Strait Islander health and cultural safety are embedded in the training program 
  5. Consider opportunities to address health inequity in the delivery of the training program 
  6. Promote quality improvement as well as quality assurance 

The RACGP educational framework conceptualises the RACGP’s approach to general practice education. It provides a foundation for ongoing high-quality education for GPs to enable them to deliver safe primary healthcare that meets the needs of people living in Australia. Central   to the framework are the guiding principles based on RACGP educational imperatives. The RACGP Standards for general practice training are one of the guiding instruments of the framework that provides direction for educational programs. The work of revising of the standards has been informed by the guiding principles of the Educational Framework. 

Purpose and principles of the Standards

Purpose and principles of the Standards



Key concepts

Standards describe the requirements of a training program to ensure the purpose of the program is met. Accreditation entails assessment of programs against standards to benefit stakeholders such as patients, learners or the public.1 Therefore, the standards are used in the accreditation process as they set the benchmarks for quality training programs.  

The National Health Practitioner Regulation National Law through the Medical Board of Australia (MBA) requires that the RACGP be accredited by meeting the standards of the Australian Medical Council (AMC) for all Fellowship pathways, educational and training programs and continuing professional development (CPD). As well as being a legislative requirement for the RACGP, having quality training standards are essential for the RACGP to meet its social responsibilities.

In summary, they assist the College to:
  1. Meet its responsibility to the community to ensure patient safety by training GPs to become competent to practice unsupervised anywhere in Australia and to address issues of health equity.   
  2. Meet obligations to the medical profession to ensure safety during training and competence of Fellows of a specialist college.   
  3. Fulfil its AMC requirements.  

Through the accreditation process, standards for accreditation can influence the institutional approach to education and the educational program.2 Further, postgraduate medical education is more variable and context driven when compared to undergraduate education and so can have some influence on patient and population health.3  The inclusion of trainee and program outcomes that reflect professional and ethical values and attitudes as well as core medical skills and knowledge ensures professionalism and ethics remain a focus during training.4 Such professional attitudes and values are important in the provision of quality health care and in health advocacy. Combined with consideration of contextual issues in the standards, they can contribute to addressing health inequity.    

Therefore, the standards should consider all aspects of quality care and through flexibility provide an opportunity for training programs to influence patient outcomes, population health and to reflect stakeholder and community needs.   

In addition, as well as focussing on outcomes in the maintenance of quality (Quality Assurance (QA) activities), training standards have the capacity to include a focus on program improvement (Quality Improvements (QI) activities).   

These standards apply to all RACGP training programs and organisations that deliver training on the RACGP’s behalf.   

In 2013, the RACGP introduced an outcomes-based approach to its training standards. Since then, there have been some minor updates, including a change of name to the RACGP Standards for general practice training.

The change in approach allowed a focus on the quality of the outcomes rather than the process of achieving the end point.  This approach allowed flexibility in delivery of training while achieving consistent outcomes. In accreditation, processes could still be monitored, and their effectiveness assessed without being prescriptive about what processes were required.  Some essential inputs however were maintained where that input was considered essential to maintaining the standard of training.
Previously, Regional Training Organisations (RTOs) were directly funded by the Australian Government to deliver the Australian general practice training program (AGPT) with the role of the RACGP to accredit the RTOs. The previous versions of the standards were written to apply to this model.

As of 2023, the model of delivery was changed by the Government and the AGPT program is now largely delivered by the RACGP. In addition, the evolution of the RACGP Practice Experience Program (PEP) - Standard Stream into the Fellowship Support Program (FSP) now requires accreditation of practices and supervisors. The Standards must apply to all programs delivering general practice training; this includes training in the Rural Generalist (RG) Fellowship. 

One remaining training organisation, namely the Remote Vocational Training Scheme (RVTS) continues to be accredited by the RACGP to deliver training. The training standards are also used in the accreditation of international colleges and programs by the RACGP.

Accreditation processes must ensure that all training programs meet or exceed these training standards. 

The 4th edition of the standards was developed through an extensive process of consultation and review with oversight by a general practice expert Steering Committee. A list of those involved in the development is available in the Acknowledgements. 

Development of the RACGP 4th edition Standards for general practice training (4th edition)

Development of the RACGP 4th edition Standards for general practice training (4th edition)

Stages of development 

Stage 1 

The review and renewal of the training standards was a collaborative process that included a working group in consultation with RACGP staff, faculties and committees. A desktop review was undertaken, which included the review of regulatory body requirements, national and international medical training standards and current literature in accreditation and standard setting best practice. Community and industry stakeholders provided input and feedback via an online survey and through individual submissions. 

Thematic analysis identified common important themes relating to training quality assurance. Different formatting styles across institutions made it evident that training standards are often presented in a process driven way, in that they focus on the aspects of delivery of the training program.   

The process of mapping the 3rd edition of the RACGP training standards to the AMC Standards for the Assessment and Accreditation of Specialist Medical Programs identified several gaps that needed to be addressed, including the need to develop standards relating to governance, conflicts of interest, reconsideration and appeals.    

Stage 2 

Nine focus groups were held with the purpose of gaining insight into industry and end-user needs. Participants were specifically asked to identify:  

  • The purpose of the standards 
  • How they currently use the Standards 
  • Issues and management strategies 

Focus group participants included representation from RACGP accreditation, policy and evaluation teams, regional training staff, censors, supervisors, registrars, practice managers and the RACGP training programs including representatives from Aboriginal and Torres Strait Islander health and rural health GP training teams.   Opportunity was provided to submit feedback for those who could not attend, or who did not wish to be recorded or for those who had further comments to add after attending a focus group.  

This process also served to inform the wider general practice education and training community of the development of new training standards and how they could provide input into the review process.   

Stage 3 

The working group developed an initial draft which included a definition of the purpose and underlying principles of the standards and created a new structure. Key concepts, including Aboriginal and Torres Strait Islander culture and health were embedded.   

Stage 4 

The steering committee reviewed the initial draft and provided general practice expertise and governance to the project. The committee included representation from the RACGP education and training business units, the GPs in Training faculty, Aboriginal and Torres Strait Islander health, the Rural faculty, GP supervisors, and the accreditation team. The initial draft was refined with input from the steering committee.  

Stage 5 

This stage of development involved a review period from a broad range of RACGP and external general practice stakeholders.   

Stage 6 

A final round of review involved key executive leaders from the Education and Training business units.   Feedback was incorporated at all stages of the review process.  

Stage 7 

The final version was presented to the RACGP Education and Workforce Committee and the RACGP Board for approval and endorsement in March 2024.

Stage 8 

Development of guidance and implementation documents.   

A new structure 

Although the outcomes-based focus of the 2013 standards has been maintained, the structure of the standards has changed from one based on the process of program delivery to the journey of the registrar from selection to completion of training and attainment of Fellowship. The aim is to reduce duplication where possible and maintain a focus on the purpose of the standards.       

New content 

This edition of the standards has eight standards, expanded from the previous three. Much of the content from the previous edition of the standards was reviewed and included with the addition of standards that addressed the gaps identified during the review and development process. Previous inputs and content relevant to the AGPT program alone have been removed to reflect the need for these standards to apply all training programs.   

A map of the changes from edition 3 to 4 is available here.

Earlier versions:  Standards-for-General-Practice-Training-Third-Edition 

  1. Akdemir N, Malik RF, Walters T, Taber S, Hamstra SJ, Philibert I, Scheele F. Using Gamification to Understand Accreditation in Postgraduate Medical Education. J Grad Med Educ 2019 Aug;11(4 Suppl):207-210. doi: 10.4300/JGME-D-19-00051.
  2. Orban J, Xue C, Raichur S, Misak M, Nobles A, Casimir J, Batra S. The Scope of Social Mission Content in Health Professions Education Accreditation Standards. Acad Med 2022 Jan 1;97(1):111-120. doi: 10.1097/ACM.0000000000004437.
  3. World Federation for Medical Education. WFME Global Standards for quality improvement of medical education–The 2023 Revision
  4. Chen AY, Kuper A, Whitehead CR. Competent to provide compassionate care? A critical discourse analysis of accreditation standards. Med Educ 2021 Apr;55(4):530-540. doi: 10.1111/medu.14428.
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