What is the aim of the pilot?
The service is currently staffed by a male GP for two sessions per week. This model would see this experience GP supervisor work in the capacity of the primary supervisor with assistance and cultural support from staff already employed at Winda Mara.
What need does it address?
The blended supervision model addresses the need to provide an alternative method of remote supervision by placing a registrar in a remote community health facility to support an Aboriginal Medical Service. The registrar would have the ability to improve access to clinical care for indigenous people in the Heywood area, which has the fifth largest Aboriginal population in Victoria. The model will assist in promoting a safe and supported environment for the registrar and improve their ability to provide culturally safe health care.
The supervisor will interview registrars who express an interest in working at the post. Registrars are assessed for all training posts in accordance with established criteria and procedures. Their motives, background experience and suitability with respect to communication skills, a desire to learn more about cultural matters and cultural safety will be assessed. The supervisor themselves has over 15 years’ experience working in Aboriginal health settings and communities.
How will it work?
The parent practice (Active Health) will delegate a nominated primary remote supervisor who has extensive experience in Aboriginal Health. The remote supervisor will be working at the parent practice and be available by phone while the registrar is working at Winda Mara. A protocol will be in place that describes how the registrar is to contact the remote supervisor if necessary. Winda Mara will provide an orientation for the registrar to inform them of the services offered and the personnel responsible.
The orientation will also outline the critical incident plan, similar to the one in place at the parent practice, which the registrar will have access to. Roles and responsibilities will be clearly articulated in writing in the training agreement between Winda Mara and SGPT. The registrar will have one hour of protected teaching time with the remote supervisor on the morning following the session worked at Winda Mara. A learning plan specific to this post will be developed and reviewed formally monthly or more often if required. An ECTV will be conducted during each term worked at the Aboriginal Medical Service.
What are the risks?
There are a number of factors which could pose as challenges in implementing this process. The risks identified are:
- The inability of the remote supervisor and registrar to meet weekly for case review.
- Inability of the registrar to be able to contact the primary remote supervisor or the secondary supervisor.
- Ensuring appropriate cultural awareness and safety training have been accessed.
- Compromised registrar welfare.
- Failure of the registrar to access supervision when necessary (the registrar may be “unconsciously incompetent” and may not seek assistance when it is required).
How will the risks be managed?
If the weekly meeting between the remote supervisor and registrar is not able to take place, a secondary meeting which could take place the following week will be arranged. The registrar must keep a record of all patients seen so that it can be reviewed by the supervisor. Alternatively the registrar may meet with the secondary supervisor instead in order to review the session content.
In terms of the registrar not being able to contact the remote or secondary supervisor, there will be a protocol to follow. The protocol includes calling the remote supervisor at the parent practice (Active Health) via front desk. Should the receptionist be unable to access the supervisor, the registrar is to call the supervisor’s mobile phone number. If the registrar is unsuccessful in reaching the supervisor, there will be at least one secondary supervisor on whom they can call using the same protocol.
For addressing risks in cultural awareness and safety training, SGPT will employ practice based cultural mentors who works on site at Winda Mara. This mentor will not be a GPs but an experienced Aboriginal Health Worker, in addition a Practice Manager employed by Winda Mara who has an understanding of registrar training and will be able to address all of the registrar’s non-clinical questions. The registrar will also be expected to attend events run by Winda Mara and will also be supported to attend all cultural safety activities run by SGPT.
Ways to mitigate risks which may compromise the registrar’ welfare include:
- providing the registrar with at least two mentors on site to assist in improving the sense of professional isolation
- provide the registrar with the ability to de-brief on a weekly basis to the remote supervisor in a face-to-face session.
Winda Mara is a health service with many supports available to provide care in a multi-disciplinary team. The registrar is also able to access the SGPT cultural mentor at any time on an informal basis in order to access further support.
An assessment of the registrar is undertaken, taking into consideration viewing tapes of consultations, record and referral reviews to see if the registrar is suitable to practice in a remote location. In addition, cases are reviewed the day following the session worked, so that feedback can be given in a timely manner. This will assist in identifying when to seek assistance from the supervision.