Appendix

Identify and reflect on the incidence of farm accidents, motor vehicle accidents, coronary artery disease and breast cancer health outcomes for rural Australia compared with urban Australia (the Australian Institute of Health and Welfare website will assist).

• Were you surprised by the differences?
• Why might there be such differences in health outcomes?
• What strategies could a rural GP use to reduce the incidence of these accidents and conditions?

Consider what procedural skills would be useful for a rural GP and do a self-assessment of your competencies:

• How comfortable are you using a dematoscope?
• Can you use a slit lamp?
• Are you able to manage simple fractures?
• Can you use the ECG machine in your practice?

Investigate and register for the rural procedural grants program the explore the CPD options that are available to you.

Discuss as a group or role-play talking to a patient about improvements they could make to their lifestyle and behaviour. Reflect on how you can prevent a patient from “sustain talk” or remaining ambivalent to change.

• Think about times when you were able to effectively tap into the patient’s motivations to change? Why did it work?
• What state of change do you find most difficult to support?
• Discuss the role of the GP as a health coach, and your experiences supporting patients who are experiencing multiple comorbid conditions.

GPs and other medical professionals are at higher risk of experiencing work-related vicarious trauma. Either on your own or as part of your practice team, consider:

• What are the symptoms that you or a colleague have experiencing vicarious trauma?
• How can you prevent vicarious trauma?
• How can your practice team / setting prevent vicarious trauma?
• What strategies could you use and how will you incorporate them into practice?

Discuss procedural skills for an individual with a suspected trauma history or cognitive impairment. Consider intra-aural or intranasal foreign body removal, laceration closure, catching urine, and examining ears and throat.

• What are the issues around consent for these procedures?
• What are the practical ways to conduct these procedures?
• Consider how you will accurately document these procedures in your notes, and when you will refer to a tertiary hospital for management.

Role-play a consultation with a new patient who has just left prison, having been discharged to your unfamiliar area as a condition of their parole. As a group, discuss potential issues a patient may face on returning to the community. Consider health, family and social networks, and social support needs. Consider the role of the GP in assisting this patient.

• What potential barriers and facilitators may people face on release from prison? What are potential barriers to healthcare? How might a GP work with the patient to increase the success of reintegration into the community? What might help improve healthcare access and engagement?
• What health problems should be anticipated and addressed?
• What are the challenges in rural and remote settings?

Consider the care that is required of you to manage common and acute and chronic conditions such as myocardial infarction, diabetes, alcohol and other drug use, asthma, chronic back pain, family and domestic violence, mental illness, chlamydia infection, rheumatoid arthritis, and obesity.

• What would be reasonable for you to take on as a rural GP, locum GP, GP with an extended skill, solo GP, or a GP working in hospital or residential aged care setting?
• What are your limits? What could you take on safely, and when / how would you use the expertise of others in your practice setting / local region / state-based support?
• What resources might be helpful for a solo, locum or rural GP before setting up your practice?

For the next five patients you see who are either children or young people, ask the parents for feedback on:

• How you handled the consultation overall?
• Did they feel like their ideas, concerns and expectations were acknowledged?
• Did you give them the information they needed to feel empowered / informed?
• Reflect on what this tells you about your strengths and areas for improvement?

As a practice explore the RACGP’s AOD GP Education Program’s Resource Library whole of practice resources.. Consider the de-escalating violence and withdrawal tools.

• What experiences have you had managing challenging behaviours?
• Do you know the difference between symptoms of intoxication or withdrawal?
• What behaviours are symptoms of a potential trauma history?

Review a recent “difficult” conversation with a patient that didn’t go well or as you expected. Maybe the patient withdrew into themselves, or became aggressive / agitated when you tried to help them?

• Why was the consultation difficult?
• What are common presentations for survivors of childhood trauma?
• Could childhood trauma or other trauma be a contributing factor as to why consultations with this patient are challenging?
• How do you feel at the end of these difficult conversations? How would you rate your current awareness and skills in trauma-informed care?
• What could you do to be more trauma informed?

Consider how you would conduct a HEEADSSS assessment (see learning resources section) for an adolescent who identifies as gender diverse is being bullied at school. 

• How would you build rapport?
• How do you make sure the patient is safe from harm?
• Consider the issues around consent and when you might have to break confidentiality.
• If the patient has suicidal ideations, how/when would you approach engagement of other services?

Reflect on the power and vulnerability that exists within the patient–doctor relationship. Identify a patient you have treated recently for a chronic condition who experiences socio-economic disadvantage and evaluate the following:

• How would you describe the doctor/patient relationship with this patient?
• Reflect on your personal response to supporting this patient. How does their life experience differ from your own? What was the patient’s health literacy?
• Evaluate the impact this may be having on how the patient perceives their care. Is this affecting their engagement with you and the way you discuss their goal setting?
• Evaluate the efficacy of your joint goal setting. Do they adhere to their treatment plans? Do they make progress as you might expect? Are they trying to please you?
• What might be required to promote better health outcomes for the patient?

Identify a patient who was vaccine-hesitant and where you discussed the risks and benefits of vaccination (for either COVID-19 boosters, influence, or childhood immunisation).

• What driving the patient’s hesitancy? How did you approach the discussion and address the patient’s concerns? Was it effective? What worked/didn’t work?
• Did you provide any educational resources to the patient?
• How did you discuss the information the patient may be exposed to from other sources?
• Review the patient’s biopsychosocial history and health literacy and evaluate if your approach was culturally informed and appropriate?
• Was your approach culturally informed? What is the patient’s health literacy levels?
• Review the patient’s biopsychosocial history and think about what other motivators you might be able to tap into to support a change in patient’s perceptions and behaviour.

Review a care plan completed for a chronic condition in an older child or adolescent with autism, developmental delay or cerebral palsy. Review the notes and check if the MBS requirements for formulating the care plan have been met.

• Consider what these requirements are and how you can reduce fragmentation of care in the management of chronic conditions in young patients.
• Consider the barriers that some patients may experience to safely access prescribed medication.
• Discuss when adolescents can make informed consent regarding contraception, immunisation, access to other care services.

Identify a family who were seeking your help for their child/young person’s behaviour, such as aggression, restrictive food behaviours, school refusal and sleep disturbances.

• How did you engage the patient? Do you have a complete biopsychosocial history?
• Did you screen for more serious underlying conditions? What investigations did you consider?
• What resources did you share with the family?
• How did you empower the parents?
• How did you ensure continuity of care and follow-up?

Use the opioid calculator to identify two patients with an Opioid prescription where the OMED dose is above 50mg, one patient being prescribed for an acute presentation, and the second for chronic non-cancer pain.

• What education was provided to the patient about the potential side-effects of this medication?
• Consider prescription of emergency naloxone and invite family members to the session to discuss its use.
• Review the treatment plan considering the patient’s biopsychosocial history. Is a planned tapering of the dose appropriate?
• How skilled are you at providing advice on pain, pain management, and the role of opioids?
• Are other non-pharmaceutical options suitable for the patient’s presenting pain problem?

Conduct a mini-audit of 20 patients above the age of 18. What proportion of patients that have completed information about their smoking, alcohol and drug use?

• How is information about substance use recorded in your practice? Where in the consultation is it recorded? How does your software ensure this information is recorded?
• Review the patient’s biopsychosocial history and previous discussions about substance use (if any).
• How skilled are you at delivering a brief intervention for smoking cessation or problematic alcohol use?
• Are there practice policies related to recall of patients with substance use disorder for routine follow-up?
• What systems are in place to achieve equity for Aboriginal and Torres Strait Islander substance-using patients in your practice?

Conduct a mini audit of up to 20 patients who are currently or were recently pregnant, and audit the notes to check for screening for abuse and violence.

• Have these patients been screened for exposure to abuse and violence?
• Do any of the patients have documented higher risk?
• For those who have disclosed abuse or violence, is there a safety assessment and safety plan documented?
• Can you sensitively present the results of this audit to your practice? What changes could you suggest to help ensure improved screening?

Identify 5 patients from your practice who have been in prison. Audit the content and quality of the health information that has been transferred between the prison health service and the practice and assess the patient’s needs when they presented to your practice.

• What health problems have been discussed and managed at your practice?
• Are these patients returning to your practice to access care?
• What have been some strengths in the way these patients were engaged with, and the quality of care provided?
• How could you improve your practice in this area?
• What different types of health and social support needs have you identified in these patients?

What practice-wide audits can be done to ensure practice population is up-do-date with age-appropriate and risk- appropriate screening?

• Inform patients at reception – normalise expectations that all GPs will be screening all patients.
• Discuss trends and potential patient barriers to care access.
• What role do individuals in the practice team have to support this activity?
• Utilisation of recall systems? How are patients contacted with reminders?
• How are results managed? What if the requesting doctor is away?

Research the health concerns in your local population or the health priorities for your practice. Identify number of patients with chronic disease conditions that are due for GP review and any population trends. Ask for patient reported feedback.

• Identify the barriers patients from areas of socio-economic disadvantage experience accessing your health care in your practice setting. Are specific priority populations adversely impacted?
• Consider out-of-pocket expenses, appointment availability and duration, opening hours, care experience through a trauma-informed and culturally safe lens.
• Consider the role of advocacy for patients who are experiencing barriers to multidisciplinary care access through your team-care arrangements.
• Implement changes and monitor their impact.