Appendix 1: RACGP Profile of the general practitioner

The Royal Australian College of General Practitioners (RACGP) published the ‘Competency profile of the Australian general practitioner at the point of Fellowship’ (the Competency Profile) in 2016. The Competency Profile articulates the required core competencies of a specialist general practitioner (GP) at the point of Fellowship, with a depiction of the context into which those competencies are applied. It represents the skill set that an Australian GP should possess for unsupervised specialist general practice in any Australian setting.

The structure of the Competency Profile complements that of the RACGP Curriculum for Australian General Practice (the Curriculum). It is structured around the same domains and same core skills that sit under those domains. It includes the competency outcome statements found in the Curriculum’s Core skills unit (CS16), and adds a further four from the Aboriginal and Torres Strait Islander health core skills unit (AH16). In addition, the Competency Profile includes two categories of statements under each domain. These are the:

• scope of general practice service to the Australian community
• competency indicators.

The Competency Profile is currently used as a reference point for:

• education providers delivering training programs for GPs on pathways to Fellowship
• GPs preparing for Fellowship
• Fellowship assessments.

In its current state, the Competency Profile applies to only a single point on the learning journey of a GP – at the point of being awarded Fellowship. It provides no view of the GP prior to Fellowship, nor the GP with an extended range of skills.

The structure and form of the Competency Profile can be challenging to grasp. The categories of ‘Scope of practice’, ‘Core skills’, ‘Competency outcomes’ and ‘Competency indicators’ are not well defined. Each of these categories contains a mix of statements that don’t clearly match the category. Many of the statements are what GPs do, described with increasing granularity across each category. There is also not a clear correlation of competency outcomes to competency indicators.

There is also a lost opportunity to use the Competency Profile as a descriptive picture of the career of a GP over time to inspire and attract the next generation of GPs. It does not provide a clear vision of the professional GP, and the positive impact and benefits GPs bring to a community.

As a guiding instrument within the RACGP educational framework, the Profile of the GP should be:

• an inspiration for those contemplating or engaging in a career as an Australian GP
• a public statement of the RACGP’s view on what an Australian GP is, and the essential contribution GPs make to Australian communities and society
• an expression of the values that the RACGP holds for the profession
• a guide for
  • all RACGP education activities, including learning, training, selection,
    assessment and remediation
  • GPs at all stages of educational life, including prevocational, vocational, continuing professional development, and those developing an extended range of skills or returning to practice
  • the RACGP Curriculum and RACGP education policies and standards.

In order to achieve these purposes, the Profile of the GP must align with the RACGP educational principles. It also needs to be:

• Broad in scope

Covering the:

• range of roles and activities undertaken by Australian GPs, both as individuals and collectively as a profession, including
  • clinical and non-clinical
  • advocacy and advisory
  • leadership and academic
• diverse contexts that the Australian GP works within, including
  • rural and remote settings
  • populations with diverse needs
  • local and national arenas
• different stages of the GP’s professional journey, particularly at entrance to a pathway to Fellowship, at Fellowship, and when extending expertise.

• Global in its representation of an Australian GP

Describing:

• the values that the Australian GP embraces
• the GP’s core and extended scope of practice
• the ethical conduct to which the Australian GP subscribes, aligning with the Medical Board of Australia (MBA) Code of Conduct

• Granular in its detail of the competencies of an Australian GP

Providing details to inform:

• selection
• learning
• training
• assessment
• remediation.

The Profile of the GP needs to align with current models of competency- and outcomes-based educational frameworks. These provide conceptual models of ‘knowing’ that reflect the nature of learning framed by its purpose in a way that can usefully guide education. These models focus on educational outcomes, being the subsequent performance of the learner and the impact of that performance.²⁸ Underpinning this is a concept of global capabilities enabled by the learner acquiring discrete competencies.^25,42 Educational focus is then on enabling the learner to achieve both the discrete competencies and global capability. Current international educational models also have taxonomies of knowledge that assist in educational design, as different types of learning are achieved and assessed in different ways. These taxonomies include categories such as knowledge, skills and attitudes, and codified and tacit knowledge. This is represented in Figure A1.1.

The Profile of the GP will provide detail on the competencies and capabilities of the Australian GP that can usefully inform the RACGP Curriculum, educational policies and standards, and educational programs.

The development of the RACGP Profile of the GP is a priority, given the current Competency Profile is limited to describing the profile of the Australian GP at the point of Fellowship. For the new Profile of the GP to take its place in the RACGP educational framework, considerable developmental work is required.

It is recommended that this development be undertaken as a substantial project with a project manager, a work group, an advisory group and a governance structure with reporting lines.

The work group requires significant medical education and clinical general practice expertise.

Development of the Profile of the GP must also align closely with development of the RACGP Curriculum. In particular, there must be alignment in layout and the way competencies, outcomes, outcome indicators and scope of practice are categorised.

There is a wide range of stakeholders to be considered and consulted, and important regulatory requirements with which to align. The first task is to identify these. A preliminary, but not exhaustive, list of significant stakeholders to be consulted includes:

• community representatives, including individuals from the rural and remote context
• Aboriginal and Torres Strait Islander peoples
• representatives from minority populations, including
  • culturally and linguistically diverse (CALD) communities
  • lesbian, gay, bisexual, transgender/gender diverse, intersex and queer (LGBTIQ+) communities
  • migrant and refugee groups
• RACGP Board, faculties, councils and committees
• general practice training organisations
• other education providers, in particular universities, to ensure
  • alignment with graduate outcomes
  • future academic extension and engagement by GPs
• GPs in training and post-Fellowship GPs
• GP advocacy groups, such as General Practice Registrars Australia and General Practice Supervisors Australia
• international medical graduates and Australian doctors changing career paths.

A preliminary, but not exhaustive, list of regulatory institutions, frameworks and documents that the Profile of the GP needs to align with includes:

• Australian Government health priorities⁵
• Department of Health General Practice Training Outcomes Framework
• Australian qualifications framework⁴³
• Australian curriculum framework for junior doctors 2012⁴⁴
• MBA Code of Conduct 2014¹⁰
• Australian Medical Council Standards for assessment and accreditation of specialist medical programs and professional development programs 2015⁴⁰
• MBA ‘Registration standard: Continuing professional development’³⁹
• Australian Health Practitioner Regulatory Agency³⁸
• relevant joint consultative committees
• RACGP strategic plan 2020–22.⁸