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RACGP Standards for general practice training (4th edition)

Standard 4. Assessment

Last revised: 10 Apr 2024

Standard 4 | A program of assessment promotes, records and informs registrar performance

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A program of assessment refers to a series of progress assessment activities across the registrar’s journey. This program of assessment is for three purposes. These are:  

  1. to judge readiness for key training progress points 
  2. for early identification of progress issues and hence the need for educational interventions 
  3. to support learning.  

The key progress points are readiness:  

  • to enter general practice 
  • to train under indirect supervision in the general practice setting 
  • for sitting the RACGP Fellowship examinations  
  • for independent practice as a Fellow.   

Early identification of progress issues is important and front ending of assessments helps to achieve this. Early intervention is known to be much more effective than late intervention.1 Assessment supports learning in three ways. It provides feedback on performance, it provides direction for future learning, and it provides the means for reflection.   

The objectives of the program of assessment are to:

  • ensure that the registrar has the competencies required for the milestones of training 
  • monitor progress through the program from commencement to completion 
  • ensure that supervision is appropriately matched to the competency of the registrar 
  • provide guidance for learning and teaching 
  • identify performance concerns as early as possible to enable early interventions as needed 
  • promote the registrar’s ability to reflect on their performance and self-direct their learning  

No single assessment can adequately assess the multiple components of being a GP. Multiple assessments using multiple methods are required to credibly assess the range of knowledge, skills and attitudes required of registrars as they work towards becoming an independent GP. The Progressive capability profile of the general practitioner details the range of capabilities and competencies required of registrars as they progress through training. Context can influence the assessment as can the characteristics of the assessor. Therefore, for the program of assessment to achieve the objectives of being valid, fair and reliable, assessments must:  

  • Occur routinely, start early and involve a range of different tools suitable to the context. The frequency of assessment may depend on the stage of training and the competency and learning needs of the registrar.  
  • Support learning through the inclusion of quality feedback as a two-way conversation that includes the registrar’s own assessment of their performance and results in reflection and planning for further learning.  
  • Be delivered by a range of different assessors who are competent in performing the assessment and in delivering feedback. External visitors to the practices for example, medical educators as well as supervisors within the practice will be involved in assessments. It is important to provide training and tools such as assessment rubrics and feedback to assessors about their assessments to achieve validity and reliability. Training also increases engagement in the assessments and quality of the feedback. Benchmarking data helps assessors in their judgements and helps registrars to interpret feedback provided.3  
  • Be part of a well-documented program that is clearly communicated to registrars and assessors. This includes details of: 
    • The types of assessments, their purpose and requirements  
    • Timing of assessments within the program, and adequate notification of assessment dates 
    • The criteria of the assessment and the competencies to be achieved at the different stages of training. These are outlined in the RACGP curriculum and the Progressive capability profile of the general practitioner.    

This progressive program of assessment involves multiple measures over time to gauge a registrar’s knowledge, skills and attitudes. This requires efficient planning, clear processes and strong governance to ensure fairness in the making of higher stakes decisions. Those making high-stakes progress decisions should not be those performing the assessments. 

The primary method of assessment should be work-based assessment as this assesses the ability to perform in the workplace. Work-based assessment methods include consultation observation, multi-source feedback, clinical case analysis, clinical audit and supervisor reports.4 It is an opportunity to assess professional attributes as well as knowledge and skills. Issues of professionalism are a common cause of patient dissatisfaction, adverse outcomes, progression difficulties, involuntary withdrawal from training and Ahpra notifications so should form part of a program of assessment.  

To achieve the objective of providing guidance for individual learning, assessment needs to be combined with effective feedback conversations.5 Effective feedback is timely, regular, specific and constructive.5 It needs to engage the learner by addressing their perspective and identified needs. The credibility of the educator delivering the feedback is important. Supervisors who are judged to be credible as clinicians and educators and have a supportive relationship with their registrar are more able to engage in effective feedback interactions.   

Feedback helps to reinforce quality performance and address underperformance. It is essential for supporting registrars who require extra support to reach the expected standard. It is also important for high performers to receive quality feedback on a regular basis to achieve their full potential and to reinforce their performance. In addition, there are times when even those assessed as high performers will need assistance with their learning.7   

The RACGP summative Fellowship assessments are not delivered by the training program.  The program has a role however, in assisting registrars to complete these assessments by providing exam preparation support, including before the examinations or afterwards in the event of unsuccessful attempts. Registrars who face challenges with summative assessments may require additional support (see Standard 7). 

Inability to reach the expected level of performance can occur for many reasons. These may relate to the individual, the learning and clinical environments, or the program. In managing underperformance, patient, registrar and practice safety needs to be considered.8  

When there is an issue of unsatisfactorily progress, early identification and intervention is key to effectively addressing this and for reducing the risk of adverse outcomes.1 Learning intervention and remediation opportunities should be offered. There also needs to be accurate documentation of all issues identified, the interventions planned to address them, and any communication involved. Privacy needs to be protected in the way the documentation is stored and accessed. Throughout any remediation process, the wellbeing and health of the registrar must be supported. The program must have resources to support registrar wellbeing. These are discussed in Standard 6.    

Outcome 4.1 The approach to assessment is clearly defined 

Criteria 

4.1.1 Assessment policies and procedures are readily available  

4.1.2 Registrars are informed of the assessment and progression requirements of the program    

4.1.3 Assessors are competent in assessment   

4.1.4 Assessors identify and manage conflicts of interest 

Guidance 

The assessment program must be clearly defined and available to registrars and assessors. Details of the program include: 

  • The types of assessments that are required and who will be involved in each assessment  
  • How, and by whom, results and progress decisions are made 
  • What opportunities for feedback are provided 
  • How the outcomes of progress decisions are communicated to registrars, medical educators and supervisors involved in the registrar’s training program 
  • Opportunities for additional support or activities, if required  

Registrars must have access to assessment policies and procedures that are fair, equitable, accessible and transparent. This includes policies for special consideration, reconsiderations and appeals.   

Assessors also must be informed about how their assessment fits within the overall program and be trained in assessments relevant to their role.  They must be able to identify, mitigate and manage power imbalances and conflicts of interest that are present when assessing as well as being aware of potential biases that occur in assessment. 

Outcome 4.2 Assessment methods are fit for purpose 

Criteria  

4.2.1 The program of assessment is blueprinted to the RACGP curriculum and syllabus and the Progressive capability profile of the general practitioner  

4.2.2 The assessment methods are appropriate to the stage and context of the training  

4.2.3 Assessment must focus on performance in practice  

4.2.4 Criteria against which the registrar is assessed are clear, measurable, equitable and transparent 

4.2.5 The program is regularly reviewed

Guidance 

The assessment program needs to be robust and must demonstrate:  

  • How assessments are mapped relevant to the scope of general practice and the competencies expected of a GP registrar in a training program at various stages as defined in the Progressive capability profile of the general practitioner  
  • How the choice of methods used, and the criteria expected are developed and matched to the stage of training, the training context and the characteristics of the assessment. Where relevant, appropriate methods should be used for the setting of criteria and expectations. Observation must be included as part of the assessment of performance.9 
  • How the developed criteria and expectations of assessment are communicated to all involved, including registrars.  
  • How the assessment program is evaluated as an ongoing process to ensure that it remains robust and meets the objective of assisting registrars to achieve the competencies required at Fellowship.   

Outcome 4.3 The program of assessment is used to improve performance

Criteria 

4.3.1 The registrar’s progress is documented, monitored, regularly assessed and readily available to the registrar and the training program  

4.3.2 Self-reflection is promoted, and assessment of progress is used to plan the registrar’s ongoing training  

4.3.3 Registrars receive timely, constructive feedback which is used to improve performance  

4.3.4 The registrar has access to exam support

Guidance 

For registrars to improve, they need to know how their performance and progress matches the expectations at their stage of training. The program must provide evidence of how assessment is being used to improve performance.  This could be by demonstrating:  

  • How progress is monitored, benchmarked and used in registrar development  
  • Regular opportunities to provide feedback to registrars 
  • Training for assessors in delivering feedback  
  • How self-reflection is promoted  
  • Pre- and post-exam support that is provided and additional support for registrars with various needs. 

Outcome 4.4 Underperforming registrars are identified, supported, and managed 

Criteria 

4.4.1 Underperformance or other concerns are identified and managed early  

4.4.2 Processes are in place to support registrars in remediating underperformance  

4.4.3 Educational interventions to improve performance are clear   

4.4.4 The outcomes of educational interventions are reviewed regularly  

4.4.5 Relevant regulators, the RACGP and other relevant organisations and individuals are advised where safety is of concern

Guidance 

The program must have a documented approach to:  

  • Prevention and early identification of underperformance  
  • Management that includes remediation planning if necessary  

A plan for remediation includes documentation of the support and participation required, how progress will be monitored, and the potential outcomes and consequences of inadequate progress. In some cases where progress does not occur and further progression in the program is not possible, support to access vocational / career advice may be required and should be available.   

The plan requires agreement by all parties involved.  There must be a process to ensure documentation remains confidential and private. In some cases where registrar performance is a concern, measures to ensure patient safety must be considered. Where there are statutory responsibilities such as the notification to Ahpra of notifiable conduct, these must be met.   

 

Supporting documentation: 

  • Competencies/competency framework used to track progression  
  • Assessment activities, methods and timing  
  • Details of assessor training  
  • Processes for progression decision making  
  • Feedback processes and frequency  
  • Policies and processes for registrars in difficulty or who are underperforming.  
  • Plans to support identified registrars  
  • Monitoring processes  
  • Changes to the program based on assessment results  
  • Exam preparation support processes and activities  

This information is currently under development and will be made available for each training program ahead of implementation in 2025. 

  1. Zaharias G, Jones KM, Johnson C and Longman C. Health concerns, personal problems and underperformance in General Practice Registrars Med Ed Publish 2019; 8:162; [version 1].
  2. The Royal Australian College of General Practitioners. The four cornerstones. A guide to managing performance concerns in general practice registrars. 2023
  3. Prentice S, Benson J, Kirkpatrick E, Schuwirth L. Workplace-based assessments in postgraduate medical education: A hermeneutic review. Med Educ 2020; 54: 981-992.
  4. The Royal Australian College of General Practitioners. Workplace based assessment. Progressive assessment and workplace-based assessment program guide. 2023
  5. Norcini J, Burch V. Workplace-based assessment as an educational tool: AMEE Guide No. 31. Med Teach 2007; Nov;29(9):855-71. doi: 10.1080/01421590701775453.
  6. Telio S, Regehr G, Ajjawi R. Feedback and the educational alliance: examining credibility judgements and their consequences. Med Educ 2016; Sep;50(9):933-42. doi: 10.1111/medu.13063.
  7. Zaharias G. High-performing general practice registrars, the gifted and the talented: Helping them to reach their potential Med Ed Publish 2018; 7:93. doi:org/10.15694/mep.2018.0000093.1. [version 1].
  8. The Royal Australian College of General Practitioners. Performance management. A guide to managing performance concerns in general practice registrars. 2023. Available at;
  9. Magin PJ, Stewart R, Turnock A, Tapley A, Holliday EG, Cooling N. Early predictors of need for remediation in the Australian general practice training program: a retrospective cohort study. Advances in Health Sciences Education 2016; 22, 915 - 929. doi:10.1007/s10459-016-9722-5.
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