Guidance to RACGP Accreditation standards for training sites

Standard 1.1 – Supervision is matched to the individual registrar’s level of competence and learning needs in the context of their training site.

Outcome 1.1.1 – Competence is matched by appropriate supervision.

Criterion

Guidance/Requirements

• The supervisor conducts and records the assessment activities and other means of determining the registrar’s competencies during their placement.
• Supervisors assess the registrar's understanding of their level of competence and knowing when to call for assistance. This is undertaken at the commencement of GPT1 and is informed by early consultation observation and initial end-of-session joint review of clinical notes for each consultation. The early assessment of safety and learning (EASL) provides further information on registrar competence.
• The supervision team completes formal feedback to the RACGP as required.
• The supervisor has early discussions with the registrar around planning their learning.

• The supervisor develops a clinical supervision plan for each registrar.
• The supervisor and registrar discuss early assessment results and adjust the supervision plan as appropriate.
• Appropriate supervision is available to enable the registrar to train across the full scope of general practice.
• Supervision is tailored to the registrar’s needs and supervision level, as follows.

• The supervisor shares responsibility with the registrar for each individual patient. The supervisor must be physically present at the workplace at all times when the registrar is providing clinical care.
• The supervisor discusses and reviews the management of all patients attended by the registrar on the day of the consultation.

• The registrar takes primary responsibility for most patients. The supervisor must ensure that the level of responsibility that the registrar is allowed to take for different types of presentations is based on the supervisor’s assessment of the registrar’s capabilities. The supervisor must monitor the registrar’s practice.
• 3a The supervisor is available to attend in-person at all times, as required by the registrar.
• 3b The supervisor is available for advice by phone or videoconference at all times, as required by the registrar.

• The registrar takes full responsibility for each patient. The supervisor is available for consultation if the registrar requires. The supervisor oversees the registrar’s practice with regular formal review of their practice.
• Cultural safety and competencies are monitored as components of the registrar’s training. This will be in conjunction with a cultural educator or cultural mentor in Aboriginal and Torres Strait Islander health.

• Training is planned in conjunction with the supervisor, medical educator and registrar to match the registrar’s identified learning needs.
• The learning needs identified by the registrar are reviewed and learning activities are planned with the registrar within four weeks of commencement of the training term.
• A training plan, as represented in the clinical supervision plan and the in-practice teaching plan, that addresses the registrar’s learning needs, is developed, reviewed and amended in a timely manner.
• Ongoing supervisor review of the registrar’s learning progression is documented in the training management system as appropriate.
• The supervision plan is reviewed regularly and modified as required to align with the registrar’s competency and development.
• The supervisory team establishes a teaching plan in discussion with the registrar.
• The teaching plan is reviewed regularly by the registrar and their primary supervisor.
• The registrar reviews their training progress with their medical educators regularly to:
  • ensure that the registrar will complete their training requirements
  • address the registrar’s specific learning needs and training intentions.

• A training site’s expectations of a registrar (eg rostering and on call) are made available to the registrar.
• The training site has processes available to both the supervisor and registrar to address and manage problems (eg a grievance policy and process for resolution).
• The training site, supervisor and registrar identify and communicate difficulties that arise in training and supervision to the RACGP.
• Processes are in place to manage critical incidents, adverse events and patient complaints during and after the event. Practice staff, supervisors and registrars understand these processes.
• Critical incidents and adverse events are reported to the RACGP as per practice and supervisor agreements and the adverse events reporting guidelines.

Outcome 1.1.2 – Feedback mechanisms are in place and the feedback is used to improve the quality of training and supervision.

Criterion

Guidance/Requirements

• The supervisory team is headed by the primary supervisor and may include GPs, nurses, cultural mentors and other health workers who work within the training site. Responsibility for supervision lies primarily with the nominated primary supervisor, however it is the joint responsibility of the entire supervisory team to be alert to the registrar’s progress. The training site has a process in place for monitoring the progress of the registrar, and identifying and managing any problems.
• The registrar and supervisory team engage in regular and frequent scheduled and ad hoc two-way feedback exchanges. These include:
  • formal workplace-based assessment activities, including direct observation
  • bi-semester formal two-way feedback activities
  • feedback in the context of ongoing supervisory encounters and teaching sessions.
• Practices and supervisory teams foster a feedback culture that normalises the giving and receiving of feedback for all team members.

• The training site and supervisors enable registrars to provide feedback throughout the placement. Registrar feedback is obtained in a way that ensures the rights of all concerned are protected.
• The training site considers registrar feedback in quality improvement activities.

• The training site and supervisors evaluate their effectiveness in delivering training. This includes regular evaluation of:
  • the number and diversity of patients seen by the registrar
  • the clinical supervision plan and in-practice teaching plans
  • feedback from external clinical teaching visits with the registrar
  • educational outcomes of the teaching sessions with the registrar.
• Training sites evaluate their learning environment following each registrar placement to support continuous improvements to training.
• The training site and supervisors complete the reaccreditation process with the RACGP every three years.

Standard 1.2 – A model of supervision is developed in the context of the training post to ensure quality training for the registrar and safety for patients.

Outcome 1.2.1 – The supervision model ensures that all elements of supervision can be addressed within the context of the training post.

Criterion

Guidance/Requirements

• The clinical supervision plan is developed, reviewed and adjusted according to the needs of the registrar. The model of supervision will depend on many factors, including the stage of training of the registrar and their learning needs, the capability of the supervisor, the location of the training site and the demographics of the patients using the site.
• The supervision plan will include:
  • when the registrar needs to seek supervision
  • who is providing supervision
  • how supervision is accessed
  • a plan for escalating issues to an accredited GP supervisor if required
  • a risk management plan to address difficulty in accessing supervision
  • a statement of commitment by each supervisory team member to their contribution to supervision.
• The supervisory team meets regularly to discuss and review the supervision plan.
• Alternative models of supervision for specific sites are developed with and prospectively approved by the medical education team.
• Remote supervision sites must meet the requirements of the Remote Supervision Guidelines.

• Each general practice site will have a primary supervisor allocated to each registrar. The primary supervisor is responsible for ensuring the registrar receives the clinical and educational supervision required to meet the RACGP standards.
• Supervisor roles and responsibilities include:
  • registrar orientation to the practice
  • supervising the registrar's initial 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.
• A practice has enough accredited supervisors to ensure that there is always a GP supervisor available for escalation of time-critical registrar supervision needs.
• An accredited supervisor or experienced Fellowed GP who has accepted responsibility to provide clinical support is always available to the registrar.
• As the registrar progresses through a training term, competency assessments are undertaken by the supervision team and the supervision plan is adjusted as informed by these competency assessments.
• Supervisors are onsite during the registrar’s working hours as appropriate to the registrar’s level of training and competence. The supervision plan clearly documents how registrars can access their secondary supervisor, and who can provide onsite clinical support when their supervisor is not available.

• Patient and registrar safety are key considerations in the development of the clinical supervision plan.
• Critical incidents and adverse events are managed appropriately and reported to the RACGP.
• Processes are in place to ensure appropriate supervision is provided for high-risk procedures and situations.
• Processes are in place to monitor, identify and manage registrar stress and fatigue in general practice.
• Review of the supervision plan in conjunction with the registrar must include consideration of fatigue indicators.
• The model of supervision is regularly reviewed by the supervisory team to ensure that the model remains fit for purpose.
• The model of supervision is discussed with the local medical educator as part of ongoing local training program support of training sites.

Outcome 1.2.2 – The supervision team is skilled and able to deliver quality training and patient safety.

Criterion

Guidance/Requirements

• The clinical supervision plan outlines supervisor roles and responsibilities in relation to the registrar. The supervision team is able to match the level of supervision to the registrar’s needs.
• The supervisory team may include GPs, nurses, cultural mentors and other health professionals.
• A primary supervisor is appointed and has responsibility for ensuring the registrar’s supervisory and educational needs are met.
• Administrative responsibilities associated with the placement of the registrar are allocated to a nominated person or a team of people.
• The workforce needs of the training site are balanced with the registrar’s training needs.
• Administrative support is adequate to enable supervisors to fulfill their roles and responsibilities.
• The supervisory team meets regularly to review the supervision plan, roles and responsibilities.

• Supervisors have unrestricted medical registration with Australian Health Practitioner Regulation Agency (AHPRA).
• Supervisors must advise the RACGP of any changes to their AHPRA registration status or any investigations underway.
• FSP applicants with an AHPRA-approved supervisor and/or an AHPRA-approved practice location must match these for FSP purposes.
• Supervisors hold FRACGP or FACRRM (or equivalent) and are of good standing.
• The primary supervisor has relevant knowledge, skills and attitudes as a supervisor and clinician and is an experienced specialist GP.
• Supervisors must complete designated general practice supervisor initial training and professional development.
• A professional development plan for the supervision team is developed and reflects the development needs of the team, the needs of the supervisors within the team and the number and level of registrars placed at the site.
• The primary supervisor must ensure appropriate induction of new supervisors to their role within the supervision team.
• In extended skills and additional rural skills training (ARST), supervisors may be non-GP specialists and need to comply with their specialty continuing professional development requirements.

Standard 1.3 – The practice environment is safe and supports training.

Outcome 1.3.1 – The clinical and cultural safety of the patient, practice, supervisor, supervision team and registrar is protected.

Criterion

Guidance/Requirements

• General practice training sites:
  • offer continuity of care in comprehensive general practice
  • are not primarily referral based (e.g. hospital) or limited to a specialty or discipline (e.g. emergency departments)
  • provide medical care that is clinically managed by GPs
  • provide continuity of care through ongoing doctor–patient relationships
  • provide comprehensive care, including preventive, acute and chronic care
  • coordinate care according to patient, family and community needs
  • deliver patient-centred healthcare.
• The training sites are accredited by the RACGP and meet all ongoing requirements as a training site as detailed within the Accredited Training Site and Supervisor Agreement.
• Supervisor accreditation by the RACGP includes:
  • accreditation of primary supervisors, which includes an interview with the local medical educator and completion of initial professional development requirements with recognition of prior learning
  • accreditation of secondary supervisors, which includes completion of a core clinical supervision modules (unless recognition of prior learning is granted).
• The training site and supervisor will ensure that if the nominated supervisor is unable to continue in the role, the RACGP will be advised as soon as practicable.

• The training site must provide evidence of current practice accreditation according to the RACGP Standards for general practice by an approved accrediting agency.
• Evidence of equivalent accreditation is available as appropriate for extended skills and additional rural skills training sites.
• Hospital training units are required to be accredited through the postgraduate medical council of the relevant state or territory.
• The training site has a clinical risk management system in place to enhance the quality and safety of patient care, including a documented process for management of incidents, near misses and complaints.
• Patients are informed about the presence of the registrar as a GP in training in the practice and patient feedback is sought.

Outcome 1.3.2 – Learning opportunities and clinical experiences for the registrar meet patient safety requirements.

Criterion

Guidance/Requirements

• Supervisors maintain competency in emergency skills through regularly refreshing CPR skills.
• An early safety assessment of the registrar’s competence is undertaken by supervisors.
• The registrar is oriented to training site protocols, systems for acute and life-threatening scenarios, and use of available emergency equipment.

• High-risk procedures and situations are discussed with the registrar, including the registrar’s experience and training. The supervisor assesses the registrar’s ability to manage high-risk situations within the context of the training post, level of supervision and their current stage of training. This assessment may require direct observation.
• The supervisor assesses the registrar’s competency to contribute towards determining clinical privileges. The registrar is supported and supervised to gain competence in high-risk situations.
• Identified areas that pose high risk for patients and registrars include:
  • diagnosis and management of malignancies, serious medical and/or life-threatening problems, serious surgical problems
  • assessment of trauma
  • diagnosis and assessment of children
  • management of complex medication interactions and administration (to prevent prescribing error, inappropriate medication choice, drug administration error, adverse drug reaction)
  • managing patient privacy in line with National privacy principles
  • procedures such as intramuscular injections, venipuncture, ear syringing, minor surgery, cryotherapy and insertion of implants and intrauterine devices.
  • For a comprehensive list refer to Ingham et al. 2020.
• The supervision and teaching plans reflect learning needs and supervision requirements.
• The supervisory team structure supports supervisors in managing high-risk patients cared for by registrars.

• The clinical supervision plan details how to access clinical supervision for timely assistance. The primary supervisor discusses the process with the registrar.
• The clinical supervision plan includes:
  • how the provision of onsite supervision is appropriate to the registrar's level of supervision and training requirements
  • the process for the registrar to access supervision when the supervisor is offsite. When offsite, the supervisor is available by phone, other reliable electronic means, or has a plan for alternative support to be available to the registrar
  • the training site’s internal communication strategies.

Outcome 1.3.3 – Culturally safe care is delivered to Aboriginal and Torres Strait Islander peoples.

Criterion

Guidance/Requirements

• The training site has a plan to address cultural safety.

• The primary supervisor has attended cultural awareness and safety training.
• The supervision team’s professional development plan incorporates cultural safety.
• The registrar is able to access an Aboriginal and Torres Strait Islander cultural educator and/or mentor while working at the training site.

• As appropriate, cultural mentors are included in the supervision team and training plan for the training site.
• The registrar is encouraged to access an Aboriginal and Torres Strait Islander cultural educator and/or mentor as required while working at the training site.

Standard 2.1 – The registrar is selected and commences training.

Outcome 2.1.2 – The RACGP Curriculum and syllabus for Australian general practice is delivered.

Criterion

Guidance/Requirements

• The learning needs of the registrar are identified for the local context. The supervisor follows the RACGP curriculum and syllabus.
• The registrar must be involved in the development and review of the in-practice teaching plan.
• The teaching plan must be adaptable and reflect the registrar’s learning needs.

• The training site and supervisor support the registrar in attending and/or participating in all required RACGP educational program events.
• The supervisor is familiar with the RACGP educational program content and reinforces learning through in-practice teaching.

• The training site supports external clinical teaching visits, considers feedback and adapts the in-practice teaching plan as appropriate.

• The supervisor provides an accurate assessment of progress, in a structured way, to the registrar.
• Supervisors demonstrate appropriate skills, abilities and attitudes in the clinical environment that promote experiential learning through practical clinical experience.
• Supervisors support the registrar to develop self-directed, individualised and planned learning.
• Registrars receive at least 125 hours of peer/group learning delivered in the most appropriate way for the context.
• Registrars receive 1 hour of educational supervision/fortnight in Year 1 and 1 hour/month in Year 2. Mandatory small group learning 1-1.5 hours/month.

Standard 2.2 – Registrars learn in a structured way in posts that are accredited and engaged in the teaching and learning process.

Outcome 2.2.1 – Post-based learning activities are planned, structured, and referenced to the curriculum and syllabus, the learning needs of the registrar and the context of the post.

Criterion

Guidance/Requirements

• The in-practice teaching plan reflects the learning needs of the registrar in the context of the post and includes the learning activities to be undertaken.
• The supervisor assists the registrar to develop a plan for learning that is practical and relevant. Planning should be undertaken with the registrar by week four of the semester.
• The supervisor and registrar regularly review and, if necessary, modify the teaching plan to ensure that in-practice teaching and learning activities match the needs of the registrar and training context.
• A variety of teaching methods are used and detailed within the in-practice teaching plan. This may include direct observation, case-based teaching, patient scenario discussions, joint consultations, formal teaching on specific topics, review of taped or recorded consultations, demonstrations and participation in clinical procedures, random case analysis, small group discussions and cultural education.

• In-practice teaching time is allocated, protected (uninterrupted) and appropriate for the registrar’s stage of training and level of competence. In Year 1, after the first two orientation weeks, the minimum time allocation is one hour per fortnight. In Year 2, the time allocation is one hour per month.
• The in-practice teaching plan outlines when teaching will occur, and who will be providing the teaching and educational activities that will occur.
• The core of teaching activity is one-on-one clinical case discussion with the supervisor and professional mentoring related to the registrar’s daily case load.
• Learning activities are learner-centred, guided by the supervision team and supported by the RACGP curriculum and syllabus.
• Registrar feedback is sought regarding in-practice teaching. Feedback is used for quality improvement.

Outcome 2.2.2 – The registrar’s learning and development is well supported.

Criterion

Guidance/Requirements

• Registrar induction to the training site is completed using a structured documented orientation plan.
• The supervisor (or delegate) ensures orientation to the site includes:
  • registrar introduction to all members of staff, who also need information about the registrar’s stage of training and responsibilities
  • training in how to use practice systems where appropriate
  • the location of all relevant resources, including reference materials, medications and equipment
  • awareness of all relevant procedures in the practice, such as referral, admission to hospital, after-hours arrangements, follow-up of patients, sterilisation, S8 medications and disposal of waste.
• The physical environment provides the registrar with:
  • a quiet space with a computer and internet access for teaching, learning and study
  • a suitably equipped dedicated patient consultation room
• The registrar has access to educational references and patient information material, either online or via hard copy.

• The patient load is appropriate to the stage of training and competence of the registrar.
• The registrar sees no more than four patients per hour in the normal clinical setting. The registrar’s workload is monitored with consideration of stress and fatigue.
• The registrar’s roster should be comparable to other clinicians working at the training site. Structuring of on-call schedules will consider continuity of patient care and the educational needs of the registrar.
• The registrar’s and supervisor’s clinical load should provide adequate time for learning opportunities and support.
• The clinical load should enable the registrar to be occupied (patient contact, administration and education, in-practice teaching, clinical supervision) for most of the day. The registrar should see an average of two patients per hour, acknowledging administration and education time.
• The registrar’s patient case mix provides the full range of presentations.

Standard 2.3 – The development of each registrar is optimised.

Outcome 2.3.1 – The progress of the registrar throughout training is monitored and addressed.

Criterion

Guidance/Requirements

• The supervisor provides detailed constructive online feedback reports by due dates as requested.
• The supervisory team reviews information and documents updates in the training management system.

Outcome 2.3.2 – Registrars have the opportunity to address the depth and breadth of their training based on their performance.

Criterion

Guidance/Requirements

• The general practice offers a range of ongoing primary care services to a wide range of patients and is not primarily referral-based or limited to a specific specialty.
• The medical care in the facility is provided and clinically managed by GPs. The majority of the medical care is provided by GPs who work sufficient time to ensure continuity of care.
• The registrar should participate fully in the general practice, including after-hours and offsite care, although the greater proportion of workload should be in the clinic within usual clinic opening hours. It is recommended for registrars to have regular exposure to nursing home visits, home visits and hospital consultations where relevant and appropriate to the training post.
• The training site considers patient demographics and monitors appointments to ensure the registrar is exposed to a wide variety of patient presentations.

• The training site and supervisors provide opportunities for the registrar to experience all aspects of the practice.
• Additional rural skills training posts are discipline-based and offer a specific curriculum.
• FSP registrars who cannot meet the practice diversity requirements will be required to complete an alternative activity.

Outcome 2.3.3 – At-risk registrars are identified and appropriate remediation implemented.

Criterion

Guidance/Requirements

• Regular formative assessment is undertaken with constructive feedback to the registrar on their performance.
• The supervisor liaises with the medical education team to flag issues early.
• The registrar is informed of concerns as soon as they are identified.
• The supervisor supports learning interventions and works with the medical education team to provide additional support as required.

Standard 2.4 – The training provider delivers quality education and training.

Outcome 2.4.1 – The training provider has a documented educational plan that ensures the effective and transparent allocation of resources to education and training.

Criterion

Guidance/Requirements

• The supervisor understands the RACGP educational program and curriculum and syllabus.
• The supervisor provides constructive feedback on the educational plan as requested.

• The supervisor liaises with medical educators to review the educational plan and incorporate the local and regional context into their in-practice teaching.

Outcome 2.4.3 – Systems and processes support the educational program and the registrars.

Criterion

Guidance/Requirements

• The training site ensures secure access to training management and learning management systems is available for the supervisory team and registrar.
• The training site ensures that the practice and supervisory team are aware of and adhere to all system requirements.
• The supervisor ensures all practice, supervisor and registrar information is up to date in the RACGP training management system.

Outcome 2.4.4 – Communication between the training provider and the RACGP is effective.

Criterion

Guidance/Requirements

• The training site and supervisors liaise regularly with the local RACGP team.
• The training site and supervisor share information with the RACGP to increase collaboration and facilitate effective resolution of issues.
• The training site and supervisor advise the RACGP of any changes to the site or supervisory team in a timely manner.

Standard 3.1 – The registrar is competent to commence training.

Outcome 3.1.1 – The registrar is able to demonstrate achievement of agreed pre-entry competence.

Criterion

Guidance/Requirements

• The supervisory team supports registrar to complete mandatory requirements following RACGP assessment.

Outcome 3.1.2 – The registrar is able to demonstrate competence to work under supervision as a GP in Australia.

Criterion

Guidance/Requirements

• The supervisor participates in early safety processes to assess competence.
• The supervisor considers the registrar’s competence in the context of the training site and provides feedback to the registrar and RACGP.
• As appropriate, the supervisor completes any additional competency assessments of the registrar as requested by the RACGP to fulfil mandatory requirements (e.g., pediatric presentations).

• The supervisor and training site consider professionalism as a component of registrar competence. Professional attributes are assessed against the RACGP Progressive capability profile of the Australian general practitioner at the point of Fellowship.
• Professionalism is included in the registrar’s learning plan as appropriate.
• The training site supports the registrar in taking responsibility for their own learning.
• The supervisor supports the registrar’s development as a professional.

Standard 3.2 The competence of the registrar is articulated and benchmarked to inform progress throughout training.

Outcome 3.2.1 – There is a robust process of assessment.

Criterion

Guidance/Requirements

• The supervisor assesses the competence of the registrar in collaboration with the medical educator.
• The supervisor understands the expected level of achievement for the registrar’s stage of training.
• Early assessment will inform the registrar’s learning plan. The teaching and clinical supervision plans will support the competencies to be achieved during the placement, including defining competency requirements, monitoring progress and achievements, and steps the registrar needs to take to develop the competencies.

• The supervisor uses information on benchmarked registrar progress to plan training.
• Training site expectations are matched to the expected level of competence for the registrar, based on the RACGP Progressive capability profile of a general practitioner.
• The supervisor provides regular constructive feedback to the registrar on their performance.
• The assessment is relevant to the training post and considers feedback from the supervision team, external clinical teaching visitors and registrar self-assessments.

Outcome 3.2.2 – Assessment results are used to monitor and improve performance.

Criterion

Guidance/Requirements

• The supervisor provides feedback to the registrar on assessments and competence throughout their placement.
• The supervisor provides assessment reports to the RACGP by due dates.
• Registrars are supported to use assessments to improve clinical practice.
• The supervisor provides feedback to the registrar and RACGP early, where concerns regarding significant deficiencies in progress are identified.

Standard 3.3 –The registrar is competent to commence working as an unsupervised GP in Australia.

Outcome 3.3.1 – The registrar has met the RACGP’s requirements of Fellowship.

Criterion

Guidance/Requirements

• The training site and supervisory team aim to provide sufficient variety of experience in general practice.

• The training site and supervisory team support the registrar through their preparation for RACGP examinations.
• For registrars who are unsuccessful in RACGP summative assessments, the supervisor provides additional teaching and support through the remediation process as requested by the RACGP.

• The training site supports the registrar to participate in all out-of-practice RACGP training components.
• The supervisor completes and submits all required registrar assessment reports by due dates.