Expectations of a training site and supervisor

Expectations of a Training Site and Supervisor

Please note that all training sites and supervisors accredited by the RACGP must comply with the following documents:

  • Accreditation Standards: Guide to implementation for training sites and supervisors
  • Codes and principles for training sites and supervisors- (provides detailed requirements and expectations).

The following information provides a brief overview of expectations, and more details can be found in the FSP Training site and supervisor handbook.

Employing a registrar

All FSP registrars must have a formal employment relationship with their training site.

General Practice Supervisors Australia (GPSA) provides resources and templates for practices and supervisors to assist with employment of registrars. If you would like further information, please visit their website.

Registrar employment hours

Full-time training in general practice is a minimum of 27 hrs face-to-face, rostered patient consultation time over a minimum of four days within a minimum 38-hour working week.

Part-time training is a minimum of 10.5 hours face-to-face, rostered patient consultation time over a minimum of two days within a minimum 14.5-hour working week.

Expected patient numbers, demographics and workload

The number of patients a registrar sees shouldn't exceed four patients per hour in a normal general practice setting.

Training sites are expected to provide a full range of patient presentations considered to be 'comprehensive general practice' (refer to the Comprehensive Australian General Practice Guidance Document). This will ensure registrars are exposed to comprehensive and experiential learning on common and significant conditions.

Managing fatigue must be considered in rostering registrars (including in-clinic consulting, on-call and after-hours shifts). Travel time and work undertaken external to the clinic such as local hospital cover and nursing home visits, also contribute to a registrar's overall workload. For more information you can read the RACGP policy position statement on stress and fatigue in general practice.

Anti-bullying

All training sites must comply with relevant work health and safety and fair work legislation, and training site staff and supervisors should be familiar with these, including having a zero-tolerance approach to bullying, harassment and discrimination.

Medicare provider numbers

FSP registrars in confirmed placements at accredited sites will be eligible to charge Medicare equivalent to a vocationally registered GP. We will prepare a Medicare provider number application for the registrar. The form must be signed by both the practice and registrar. The RACGP will endorse the signed application and submit it to Medicare.

It can take up to eight weeks once a completed form is submitted for the provider number to be mailed to the registrar, so please ensure that the necessary details are completed promptly – at least four weeks before the FSP term begins.

The role of the practice manager

Practice managers have valuable skills that can be of great benefit to registrars and the smooth running of a training placement. The practice manager is often the first person a registrar will contact with a range of queries.

Orientation and support for new practice managers will be provided by the local RACGP medical educator, training coordinator and a dedicated regional practice liaison officer.

Supervision

Onsite clinical supervision should always be readily available to all registrars while they are working, except in the case of pre-approved remote supervision. A supervisor's core tasks include:

  • orientating a registrar to the practice
  • supervising the registrar's intital consultations
  • developing and monitoring a clinical supervision plan
  • providing 'as needed' supervision
  • developing an in-practice teaching plan
  • providing regular uninterrupted teaching sessions
  • giving regular feedback
  • completing required assessments
  • coordinating the supervisory team (primary supervisor)
  • supporting and advocating for the registrar with the training site and the RACGP
  • evaluating the education and supervision provided.

Clinical supervision plan

As a requirement of accreditation, each training site must have a clinical supervision plan. The primary supervisor works with the broader supervisory team to develop a plan that details the roles and responsibilities of the team, documents how the registrar can access clinical supervision, and indicates who will provide onsite support when the registrar’s supervisor isn’t available.

The clinical supervision plan should consider:

  • supervision outside usual business hours
  • supervision during home visits
  • supervision whilst the registar is working as a visiting medical officer (VMO) or on-call at a hospital as part of the practice roster
  • supervisor leave (planned or unplanned)
  • the registrar's competence and level of training.

The supervision team

The supervision team includes the primary supervisor and any accredited secondary supervisors. Other members of the supervision team may include other GPs who are not accredited as supervisors, practice nurses, allied health professionals, Aboriginal Health Workers and non-clinical practice staff, all who have experience that can benefit a registrar.

An important requirement for a supervisor is enthusiasm for general practice and a commitment to providing a positive learning experience. It is important that training in general practice is seen as a team activity for the whole practice and not just the supervisor.

Supervisor professional development requirements

Professional development for accredited supervisors is required consistent with the National supervisor professional development program.

From 2023, GPs wishing to become supervisors will be required to complete the Foundations of GP supervision course to become an accredited supervisor.

The Foundations of supervision course consists of eight modules, delivered either as a blend of face-to-face workshops and online modules, or entirely online. The course will take one to two days to complete depending on which option you choose.

New primary supervisors must complete the first seven modules before their registrar commences. The final module is designed to reinforce the learning of earlier modules and is completed six to 12 months after the registrar commences.

New secondary supervisors will be required to complete three modules (modules 4, 6 and 7) prior to commencing their supervisory work, with the remaining five modules to be completed over a three-year period.

Continuing supervisor professional development is less prescriptive, and a range of activities is available.

Workshops, small-group learning and peer group learning will complement the initial online learning modules that will be available. GP supervisors may choose activities that interest them or are relevant to their practice.

Remote supervisors will need to complete the remote supervision online module.

Orientating the registrar

A well-planned, comprehensive orientation to the practice and the local environment is an essential task for the practice manager, supervisory team and other practice staff to undertake together. It helps ensure the safety (including cultural safety) of the registrar, the practice and the community. This is particularly important for registrars in their first general practice training term. The plan should include information about all aspects of the practice to enable the registrar to function effectively. A recommended orientation checklist is available to help guide your orientation activities.

Teaching

Learning plan

Registrars are responsible for planning their own learning. Supervisors help with this planning and review the plan regularly with the registrar.

Minimum hours of teaching time

The mandated teaching time for each level of registrar is:

  • Year 1 (GPT1 and 2) – minimum 1 hour per fortnight of scheduled and uninterrupted time
  • Year 2 (GPT3 and 4) – minimum 1 hour per month of scheduled and uninterrupted time.

For part-time registrars, the minimum teaching time is the same as for full-time registrars.

Each practice is required to develop an in-practice teaching plan that addresses the learning needs and is consistent with training program requirements.

Workplace-based assessments and feedback

Workplace-based assessment involves observation and assessment of a registrar’s practice in the workplace. It allows the registrar’s progress through training to be monitored, ensuring that the registrar receives appropriate support to gain the clinical competencies and skills relevant to their stage of training and to progress to Fellowship.

Workplace-based assessments may involve a range of people, including:

  • supervisor(s)
  • medical educator
  • external clinical teaching visitors (I.e., external assessors)
  • training coordinator.

After each assessment, feedback is given to the registrar to help them reflect on their progress and plan additional learning activities.

Supervisors are integral to workplace-based assessment, including direct observation of consultations and procedures, and participation in random case analysis and case-based discussions.

Supervisors provide assessments in the form of feedback reports, focusing on registrar’s competence and progression towards expected levels.

Registrars will also provide feedback on training sites and supervisors at the completion of their placement. This feedback is an opportunity for practices to continuously improve as they review their own progress as a learning environment.

External clinical teaching visits

External clinical teaching visits (ECTVs) are an educational tool involving an experienced GP observing a registrar’s consultations. These may be conducted face-to-face or virtually.

During the first two terms of training, two ECTVs are conducted; during Term 3 only one is conducted.

In addition to the teaching component, information gathered during these visits contributes to the RACGP site and supervisor reporting and monitoring that is linked to the maintenance of accreditation.

Practice reporting requirements

Throughout a registrar’s placement, reporting by the practice allows us to monitor the requirements of the practice and supervisors, as well as confirm that the registrar is achieving their training outcomes.

Any issues that are identified will be promptly managed by the local RACGP team. This may take the form of a discussion with the supervisor and/or practice manager or the provision of additional support or remediation. Any issues will be documented and, if necessary, escalated to the Regional Accreditation Panel.

Regular reporting through communications with the registrar and practice means that formal monthly reports, with their associated administrative burden, are not required.

Both colleges have agreed to share appropriate information on practice monitoring for dually accredited practices. Information is also shared between the AGPT program and the FSP.

Risk Management

As an employer, the training site, along with the supervisor, has the primary duty of care to ensure, as far as is reasonably practicable, the registrar’s health and safety during the placement.

Training sites must comply with work health and safety legislation applicable to their location and advise the training colleges of any safety concerns, risks, hazards or incident that may affect registrars.

Critical incident, adverse event and patient complaint management and reporting are an important part of training management, are a joint responsibility between all parties and a requirement of the Standards. The Critical incident and adverse event management and reporting guidance document defines what makes an adverse event a critical incident and details the reporting requirements.

Payments

Supervisors will be paid by the RACGP for educational supervision (ie in-practice education). In-practice teaching payments will be made monthly in arrears and will be validated by the RACGP to ensure the quality of teaching activity.

Failure to meet the requirements set out in the Codes and principles for training sites and supervisors may delay payment to supervisors.