Mandatory Hospital Term Requirements


Guidance document

1. Introduction

This document provides details of the hospital disciplines and competencies a doctor must achieve during their time in hospital training prior to commencing General Practice terms in the Australian General Practice Training (AGPT) program as detailed in the Vocational Training Pathway – Requirements for Fellowship Policy and the RACGP Standards for General Practice Training 3rd Edition (Standard 3.1, Outcome 3.1.2, Criterion 3.1.2.1).

2. Context

2.1 This guidance document replaces the previous Paediatric Term Requirements Guidance Document and will come into effect as of 11 October 2021.

2.2 General practice training involves a combination of hospital training and training in general practice and other community settings under supervision. Hospital training provides the foundation in a range of clinical disciplines relevant to general practice. This enables General Practitioners in Training (GPiT) to have a full understanding of the integration of primary and secondary levels of care.

2.3 Prior to entering into general practice terms GPiT must be able to demonstrate safe practice in some core areas relevant to general practice, including medicine, paediatrics, surgery and emergency medicine. The requirements to demonstrate safe practice are provided in the guidance below.

3. Guidance

3.1 The GPiT must undertake a range of clinical rotations relevant to general practice in accredited hospital posts in accord with criterion 1.3.1.1 of the RACGP Standards for General Practice Training 3rd Edition.

3.2 These rotations can be undertaken in an accredited hospital in Australia or New Zealand.

3.3 The GPiT must be able to provide either their hospital statement of service or end of term report containing evidence of a satisfactory level of performance for their supervisor to deem them competent in each rotation.

3.4 The GPiT must have adequate exposure in a hospital environment to demonstrate safe practice in the disciplines of:

  1. Medicine,
  2. Surgery,
  3. Emergency medicine, and
  4. Paediatrics

3.5 Safe practice includes the recognition and management of the seriously ill patient.

3.6 Competency in these four areas, as well as completion of 2 years of appropriate hospital terms within 5 years of commencing community GP training ensures a GPiT is safe to enter a GP term.

3.7 In exceptional circumstances where a GPiT has not achieved adequate recent hospital training in a specific discipline, the relevant Training Organisation may be able to apply alternative models to ensure adequate experience is obtained and to assess their competency.

4. Requirements specific to each discipline

The following requirements should be read in conjunction with the RACGP Curriculum Core Skills (CS16) for pre-general practice. GPiT should keep in mind the overall learning objectives of the Curriculum as they progress through training. It is important any alternative models developed to help satisfy the mandatory hospital terms requirements take into consideration the Australian Curriculum Framework for Junior Doctors as well as the RACGP Curriculum Core Skills (CS16).

4.1 Medicine

  1. To demonstrate safe practice in the discipline of medicine, a GPiT must provide documentary evidence of the completion of a full term (10-12 weeks) in general medicine, or equivalent, resulting in a satisfactory level of performance confirmed by the supervisor.
    1. Equivalent terms must offer a broad medical experience.
    2. Rotations may include, but are not limited to, cardiology, respiratory, gastroenterology, endocrinology, geriatrics, rheumatology and neurology.
  2. Work based opportunities specific to clinical experience in medical terms, should include managing inpatients with a range of medical conditions, including acute problems and chronic conditions, screening patients for common diseases and discussing healthcare behaviours with patients.
  3. Components of the Medicine term training equivalence includes, but is not limited to, competencies such as:
    1. Patient centred communication,
    2. Informed and shared decision making,
    3. Identifying and managing sick patients,
    4. Effective interactions with other health professionals to provide high quality care for patients,
    5. Effective communication in teams,
    6. Working with emergency and critical care teams, and
    7. Critical thinking and incident prevention.
  4. The diagnosis and management of a range of common acute and chronic diseases and presentations including, but not limited to:
    1. Bacterial infections, - Urinary tract infections, pneumonia, bacteraemia, sinusitis
    2. Viral infections – Upper respiratory tract infections, pneumonia
    3. Cardiovascular disease – ischaemic heart disease, acute coronary syndrome, heart failure
    4. Diabetes – type 2 diabetes, type 1 diabetes
    5. Aged care

4.2 Surgery

  1. To demonstrate safe practice in the discipline of surgery, a GPiT must provide documentary evidence of the completion of a full term (10-12 weeks) in a surgical discipline resulting in a satisfactory level of performance confirmed by the supervisors.
    1. Relevant rotations must offer a broad surgical experience.
    2. Rotations may include but are not limited to general surgery, orthopaedic, otolaryngology (ENT), and urology.
  2. Work based opportunities specific to clinical experience in surgical terms should include sterile techniques, management of intravenous fluids, perioperative care and exposure to common features of surgical illness including the metabolic response to trauma, shock, infection and neoplasia. This also includes experience in caring for patients with a broad range of acute and elective surgical conditions.
  3. Components of the Surgery term training equivalence includes, but is not limited to, competencies such as:
    1. Patient centred communication,
    2. Informed and shared decision making,
    3. Identifying and managing sick patients,
    4. Effective interactions with other health professionals to provide high quality care for patients,
    5. Effective communication in teams,
    6. Working with emergency and critical care teams
    7. Management of perioperative risks, and
    8. Critical thinking and incident prevention.
  4. The diagnosis and management of a range of common surgical conditions including, but not limited to:
    1. Post-surgical complications – infections, post-operative bleeding,
    2. Peri-operative blood management,
    3. Surgical prophylaxis,
    4. Acute surgical illness recognition and management including the deteriorating patient, and
    5. Common and important surgical conditions at all stages of life.

4.3 Emergency Medicine

  1. To demonstrate safe practice in the discipline of emergency medicine, a GPiT must provide documentary evidence of the completion of a full term (10-12 weeks) in Emergency Medicine within the last 5 years resulting in a satisfactory level of performance confirmed by the supervisor.
  2. Work based opportunities specific to clinical experience in emergency medicine terms should include common and important emergency presentations at all stages of life, the ability to apply relevant treatment guidelines and protocols to emergency patient care, and participation in resuscitation and trauma management.
  3. The Emergency Department must be operating 24 hours per day with onsite Emergency Physician available.
  4. Components of the Emergency Medicine term training includes, but is not limited to, competencies such as:
    1. Identifying and managing sick patients including patients with acute undifferentiated illness,
    2. Performing a range of procedural skills in an emergency setting,
    3. Develop and understanding of effective teamwork in emergency situations, and
    4. The diagnosis and management of a range of common and important emergency presentations.

4.4 Paediatrics

  1. GPiT require paediatric clinical experience to support the development of competence in the detection and management of serious or potentially serious illness through the full spectrum of the neonatal period, infancy, early and middle childhood and, where relevant, adolescence and young adulthood.
  2. Clinical paediatric experience must include the recognition, diagnosis, and management of the seriously ill child, should include a high proportion of paediatric emergency attendances and be appropriately supervised by a paediatrician and/or appropriately experienced general practitioner and/or emergency medicine physician.
  3. During their paediatric clinical experience training, GPiT must:
    1. see patients as the initial contact doctor,
    2. receive authentic, first point of contact clinical paediatric experience (‘hands on’ experience),
    3. follow up patients where practical, during admission and following discharge in order to develop an appreciation of the complete natural history of acute illnesses,
    4. be exposed to sufficient number and spectrum of acute paediatric presentations, and
    5. have direct supervision from accredited supervisors.
  4. Provided requirements 4.2 i-iii are met, to demonstrate adequate experience and safe practice in the discipline of paediatrics, a GPiT may provide documentary evidence of one of the following:
    1. the completion of a full (10–12 weeks) paediatric term in an accredited paediatric post,
    2. a half paediatric term (minimum 6 weeks in length) with an approved full (10–12 week) emergency department term (see glossary),
    3. two approved emergency department terms,
    4. completion of the coursework and exam for the Sydney Child Health Program at the Westmead Children's Hospital or another RACGP Council of Censors approved course, provided the GPiT has also had adequate clinical exposure to children, for example, an approved emergency department term or general practice hospital allocated rotation, or
    5. an approved emergency department term and a general practice hospital allocated rotation with appropriate supervision and education components
      1. A hospital allocated general practice rotation does not count as a stand-alone paediatric requirement.
  5. In addition to the evidence required as per 3.3 of this guidance document, for paediatric requirements met through approved emergency departments, GPiT must provide one of the following supporting documents:
    1. personal logbooks demonstrating cases signed off by supervisor,
    2. lists of individual cases managed (de-identified) with ages included from hospital administration,
    3. evidence of individual percentage of paediatric cases through hospital administration, or
    4. evidence of department percentage and confirmation the GPiT managed a representative caseload of paediatric presentations during their rotation.

5. Additional Guidance regarding Paediatric exposure

5.1 In routine general practice the majority of children are often able to be managed at home. This means that considerable responsibility rests upon parents and medical advisers to ensure children do not deteriorate to a point where significant morbidity or even mortality ensues.

5.2 In more severe presentations, these often require hospital admission after initial emergency management. Less severe cases following hospital assessment can be managed in an ambulatory setting after coordinated transfer from emergency departments or hospital to general practice and/or community services, when parents and carers take on a greater role.

5.3 Therefore, in addition to the specific skills needed to manage these presentations, some key generic patient management skills need to be developed including co-management with parents, carers and ancillary medical staff.

5.4 For these reasons, the GPiT must demonstrate exposure to and an understanding of the clinical situations listed below:

  1. Recognise and manage children with the following five acute clinical presentations which represent the most common undifferentiated acute health problems:
    1. the febrile child,
    2. the child with acute abdominal pain,
    3. the vomiting child,
    4. the child with breathing difficulties, and
    5. the dehydrated child.
  2. Recognise and initiate and/or continue the management of the following severe acute clinical presentations:
    1. the fitting child,
    2. the child with altered consciousness,
    3. the poisoned/bitten child,
    4. the child presenting with trauma and/or burns, and
    5. the child at risk of abuse.
  3. Registrars need to be able to:
    1. manage the sick child in conjunction with the family unit, carers and the extended health care team,
    2. develop effective and appropriate safety nets with parents and carers to enable them to detect and manage a deteriorating situation in such a way as to prevent any adverse outcomes, and
    3. communicate with children, young people and their families, as well as providing support, advice and follow-up.

In both hospital and general practice settings, all thirteen clinical scenarios listed in clause 5.4 of this guidance document can vary from mild to severe, with a diversity of symptom complexes and a highly variable threshold of recognition.

6. Glossary

Approved emergency department

In order to be approved for RACGP vocational training paediatrics clinical experience, emergency departments must have a significant paediatric component with a minimum of 20% paediatric presentations. The GPiT must demonstrate sufficient experience in assessing and managing paediatric cases and the training organisation needs to be satisfied that the GPiT has gained adequate skills.

7. References

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