RACGP Standards for general practice training (4th edition)

Standard 7. Pastoral support

RACGP Standards for general practice training (4th edition)
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Last revised: 10 Apr 2024

Standard 7 | The training program provides pastoral support

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Pastoral care is care that assists an individual in maintaining their intellectual, emotional, physical, social, and psychological well-being. Such care respects individuality, diversity and dignity. Supervisors are expected to provide pastoral care to registrars within the clinical environment (refer to Outcomes 2.2 and 2.3). Pastoral care is also the responsibility of the training program and be extended to all involved in the program including registrars, supervisors, medical educators, cultural mentors and administrative staff. Pastoral support refers to the institutional supports and services that are put in place to provide that care. 

Maintaining wellbeing is not the sole responsibility of the individual, and organisations need to acknowledge their responsibility in promoting wellbeing. Although stress management resources can be provided, there are further areas that can be provided, such as ensuring reasonable workloads, supportive organisational culture, flexibility, and resources and specific supports for individuals that assist in achieving work-life balance.1   

Registrars will need support and advice in navigating their program options based on preferences, previous experience and performance assessments. As well as program advice, career advice should also be accessible to registrars in relation to their future after completing training. Registrars should be supported in developing skills in career planning as a fellowed GP.  On occasions where a registrar is unable to complete the program satisfactorily, career advice about alternative options will be needed.   

Training arrangements need to be flexible to allow for individual circumstances. Some registrars will have specific needs for leave including sick leave and carer’s leave, parental leave and other types of leave, for example, Aboriginal and Torres Strait Islander additional cultural leave, or they may choose to work part-time. Allowances need to be made to reasonably accommodate these while also recognising the importance of continuity in training. 

It is important to support those involved in training disputes including reconsideration and appeals processes. Support is also required for those involved in an adverse event or a critical incident. Adverse events are defined as any disruptive event that causes, or risks causing, significant harm to patients, registrars, GP supervisors, training site staff or associated stakeholders.2 A critical incident is a serious adverse event in that it has resulted in serious negative outcomes. Adverse events and critical incidents may relate to clinical care or training issues, for example those related to supervision or training sites.  

Personal, social, health, financial or cultural factors can all impact well-being. At all stages in the GP journey, developing strategies for maintaining work-life balance, and for self-care is essential, as is being able to access additional support if necessary. Embedding wellbeing in the program can have a positive effect by encouraging registrars to engage with activities that promote their wellbeing.3,4 

Safe working environments free of discrimination (including racism), bullying and harassment must be provided (refer to Criteria 2.3.7 and 3.3.1). Where incidents occur, these are not always reported; the reasons for not reporting including fear of repercussions, concerns that reports will not be acted upon, and lack of processes, support or knowledge of how to report.5 Overall, reports of tolerance for bullying, harassment and/or discrimination are lower in general practice training than national averages as are reports of negative experiences in reporting incidents.5 Safe working environments must however remain a focus of the training program.  

Some registrars may face additional challenges and it is incumbent on the program to support them. This may include (but not be limited to) registrars from culturally and linguistically diverse backgrounds, Australian Defence Force (ADF) registrars, LGBTQI+ registrars, Aboriginal and Torres Strait Islander peoples, registrars at a socioeconomic disadvantage, those with disability, or neurodiversity, for example specific learning disorders, or those working in rural or remote areas. Support may be in terms of financial, psychological or physical supports, the provision of cultural educators and mentors or support with assessments and learning strategies.  

Support for Aboriginal and Torres strait Islander registrars is addressed in Outcome 6.2.  
 


International Medical Graduates (IMGs) come from a variety of backgrounds in terms of healthcare and previous training. As such, they bring varied experience in their communication and consulting skills, knowledge and attitudes. Some of the potential issues for which IMGs need extra support are:6 

  • Cultural differences including the different medical culture and the Australian health care system as well as language and communication barriers   
  • Clinical issues related to knowledge, managing a consultation and clinical reasoning as these reflect different cultural expectations of patients and different training and experiences 
  • Professional and medicolegal challenges 

Although individual support may be needed, there should be some focus on prevention by the provision of additional support before or at entry that includes such information as:7,8 


Registrars working in rural and remote areas can face challenges that include: 

  • The need for additional skills that may be required to work within a local community. 
  • Large geographical territories with limited infrastructure. 
  • Geographical isolation including isolation from their peers. 
  • Impact on family life.  
  • Increased workload with after-hours care provision. 
  • The need to maintain appropriate boundaries especially in small communities.9    

Whole-person care is particularly valuable for registrars working in rural and remote locations who face challenges not encountered by their colleagues in urban settings.10 Support may be in the form of financial help, assistance with relocation, the provision of medical educator and mentoring support or access to peer groups. Support may also be offered through case management to foster interest and capability to work in areas of workforce need.   


Australian Defence Force (ADF) registrars will have specific challenges relating to ADF requirements which may impact on their ability to complete the clinical training time. Tailored support from medical educators with specific knowledge in the ADF field is important. Medical educators may provide advice about and assistance with transfers between practices and regions, special training environments, deployments, leave, education requirements or extended skills training sites. 

As well as support for registrars, individuals who deliver the program need support in relation to: 

  • Their work role; they need clearly defined roles and responsibilities, the provision of adequate orientation and access to professional development relevant to their role 
  • Well-being support in relation to personal or workplace related issues 
  • The provision of safe working environments free of discrimination (including racism), bullying and harassment  

Robust policies and procedures need to be in place and to be clearly communicated to all individuals in the program. 

Outcome 7.1 The program supports the registrar and problems are effectively addressed 

Criteria 

7.1.1 The registrar is able to ask for and receive timely assistance about their training program  

7.1.2 Registrar concerns regarding their program are appropriately addressed  

7.1.3 There are documented dispute, reconsideration and appeals policies and processes in place that are transparent, accessible and follow best practice guidelines 

7.1.4 Discrimination (including racism), bullying and harassment is addressed in policies of the training program and within the training site with processes for reporting and addressing issues clearly available 

7.1.5 Registrars are treated equitably with policies and processes related to diversity, equity and inclusion 

7.1.6 Adverse events (including critical incidents) are appropriately managed and resolved  

7.1.7 Support is in place to ensure registrar wellbeing  

7.1.8 Registrars from vulnerable populations are supported  

7.1.9 Registrars are supported to access career advice    

7.1.10 The training program structure accommodates flexible working and study arrangements 

Guidance 

The program must have a well-documented approach to the support of registrars that includes policies and procedures and the provision of appropriate staff who can provide support. This must be clearly communicated to registrars, including at initial orientation, and relates specifically to:  

  • Advice about program and career options including information about recognition of prior learning and experience (RPLE), any hospital experience prior to commencing in general practice, practice options and extended skills opportunities where relevant. Registrars should be supported to access career advice and counselling.  
  • Support for and advice about flexible training arrangements for individual circumstances  
  • Clear procedures and support for registrars when concerns about training arise. Depending on the concern, external bodies such as General Practice Registrars Australia (GPRA) may be involved, or internal support such as provided by Registrar Liaison Officers (RLOs) or medical educators. Where decisions have been made that impact progression, avenues for reconsideration and appeals must be available. The reconsideration and appeals process must follow best practice and demonstrate an approach that is fair and consistent. 
  • Support in the event of an adverse event (including critical incidents). There must be a clear process for the prevention, reporting and management of adverse events and critical incidents:   
    • The triggers for potential events can be identified to allow early intervention. For registrars, these can be discussed at orientation and for supervisors, during supervisor professional development. Registrars and supervisors need to be aware of triggers for common problems and potential critical incidents to enable early intervention.  
    • If incidents occur, these must be addressed by involvement of all parties involved and notification as required. Review of management of the incident and its effectiveness is undertaken to evaluate processes.  
  • Well-being support. The program should include training to help registrars develop healthy self-care habits and work-life balance. Support and resources related to well-being must be available for registrars who experience issues in relation to their progress, performance, health or conduct.  
  • The provision of safe working environments free of discrimination, including racism, bullying and harassment (refer to Criteria 2.3.7 and 3.3.1). The program must have clear policies and procedures in the identification and management of issues that relate to discrimination (including racism), bullying and harassment and these must be clearly communicated to registrars, supervisors and practice staff.   
  • Specific supports for registrars who may need additional support as they face barriers in training. This may include (but not limited to) IMGs, ADF registrars, LGBTQI+ registrars, Aboriginal and Torres Strait Islander peoples, registrars at a socioeconomic disadvantage, those with disability or those working in rural or remote areas. Support may be in terms of financial, psychological or physical supports, the provision of cultural educators and mentors or support with assessments and learning strategies. 

Outcome 7.2 Staff delivering the program are supported

Criteria 

7.2.1 Cultural safety for staff is maintained  

7.2.2 There are transparent and documented policies and procedures to ensure a safe working environment   

7.2.3 Equity and access are embedded in policies and procedures  

7.2.4 Staff roles and responsibilities are clearly defined  

7.2.5 Staff receive induction  

7.2.6 Staff have access to professional development to support their role  

7.2.7 Support services are available for staff under stress 

Guidance 

The program must support the staff who deliver the program by providing a safe working environment. Support for supervisors and practices is included in Outcome 2.4. Other program staff can be supported through the provision of: 

  • Cultural safety training for all staff 
  • A clear approach, including policies that demonstrate zero tolerance for, discrimination (including racism), bullying, harassment.  
  • Procedures to manage conflicts of interest 
  • Safety for staff who report issues in the workplace (including Whistle-blower policies)   
  • Support for staff well-being  
  • Opportunities to provide feedback (see Outcome 5.4) 
  • Orientation for new staff which includes information about workplace health and safety  
  • A clear definition of staff roles and responsibilities  
  • Ongoing professional development and performance reviews which afford staff members with the opportunity to improve their skills and develop their careers. 
  • Registrar support processes including those identified at risk  
  • Critical incident reporting guidelines and processes  
  • Registrar and staff wellbeing guidelines and processes  
  • Support systems incorporating Aboriginal and Torres Strait Islander people 
  • Leave policies   
  • Dispute, reconsideration and appeals policies and processes 
  • Policies and processes related to diversity, equity and inclusion  
  • Approach to program and career advice  
  • Organisational approach to discrimination (including racism), bullying and harassment 
  • Position descriptions and professional development plans for individual staff members  
  • Conflict of interest policy and management procedures  
  • Credentials of those developing and delivering the educational program  
  • Examples of performance review and feedback for staff  
  • Professional development opportunities for staff  
  • Orientation processes for new staff  
  • Evidence of the completion of cultural safety training by staff 

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

  1. Shanafelt TD, Noseworthy JH. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clin Proc 2017; Jan;92(1):129-146. doi: 10.1016/j.mayocp.2016.10.004.
  2. The Royal Australian College of General Practitioners. Adverse Event (including critical incident) reporting. 2023. Available at:
  3. Merrick D, Mbaki Y, Pratten MK, Simpson TG. Exploring wellbeing in first year medical students amidst a curriculum change. BMC Med Educ 2021; May 1;21(1):252. doi: 10.1186/s12909-021-02678-9.
  4. The Royal Australian College of General Practitioners. Chapter 5: The future of the GP workforce - 5.2 Satisfaction and work–life balance. General Practice Health of the Nation Report 2021. Available at:
  5. Australian Health Practitioner Regulation Agency. Medical Training Survey 2023. Available at:
  6. General Practice Supervision Australia. Supervising the IMG GP Registrar Interactive Guide. 2023. Available at:
  7. Brown J, Kirby C, Wearne S, Snadden D. Remodelling general practice training: Tension and innovation. Aust J Gen Pract 2019; Nov;48(11):773-778. doi: 10.31128/AJGP-05-19-4929.
  8. The Royal Australian College of General Practitioners. Registrar Support and Remediation Policy. 2022. Available at:
  9. The Royal Australian College of General Practitioners. Rural Health. RACGP Curriculum and syllabus for Australian general practice. 2022. Available at:
  10. Wakerman J, Humphreys J, Russell D, Guthridge S, Bourke L, Dunbar T, Zhao Y, Ramjan M, Murakami-Gold L, Jones MP. Remote health workforce turnover and retention: what are the policy and practice priorities? Hum Resour Health 2019; Dec 16;17(1):99. doi: 10.1186/s12960-019-0432-y.
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