Supervision requirements
Supervisor to registrar ratios
There is a risk to patient safety when a supervisor becomes responsible for too many doctors. Supervisors must not supervise more than three doctors. This is irrespective of:
- the doctor’s training fraction (for example, if you have a full-time registrar and a part-time registrar, this counts as two doctors being supervised)
- level of training (a GPT1 and an extended skills in general practice registrar are each counted as one doctor being supervised)
- the training program – doctors in RACGP AGPT, RACGP Fellowship Support Program (FSP), Practice Experience Program (PEP Specialist), Remote Vocational Training Scheme (RVTS), Australian College of Rural and Remote Medicine (ACRRM), More Doctors for Australian Program (MDRAP), Pre-Fellowship Program (PFP) and medical board programs all count towards the maximum of 3 doctors)
- the doctor being above the training cap (eg an ADF registrar)
TIP
The three supervised doctors to one supervisor ratio is consistent with the Medical Board of Australia’s policy for safe supervision.
Being accepted into the AGPT placement process does not permit a ratio exceeding 3:1. We do not have oversight of learners from other non-RACGP programs such as PFP, ACRRM, RVTS or medical board placements.
If your training site has multiple registrars, we may request you provide details of how teaching and supervision is managed in your training site. While group and multi-level teaching has some benefits, it is essential that adequate one-on-one teaching is provided to ensure your registrars have their individual learning needs met.
Day-to-day supervision requirements
The RACGP Standards for general practice training requires the level of supervision match the competency of the registrar. This ensures patient and registrar safety.
Four competency milestones have been identified in GP training and the expected timeline for a registrar to pass each milestone. The competency milestones are explained in the progressive capability profile of the general practitioner.
Four competency milestones (entry, foundation, consolidation, fellowship) have been identified in GP training and the expected timeline for a registrar to pass each milestone. The competency milestones are explained in the Progressive capability profile of the general practitioner and summarised in the following table. The milestones describe the expected path of improving competency for registrars in training sites and the matched supervision requirements.
Clinical supervision plans will help foster your relationship with your registrar and ensure safe supervision of your registrar’s patients. You are not currently required to submit supervision plans, but we may request to review them at any time or if there is a dispute about whether supervision is being adequately provided.
For registrars in GPT1, all consultations must be reviewed (at minimum by reviewing their notes) until you are confident they are safe to consult without this direct supervision. A supervisor can determine a registrar is ready to practice without review of every case any time during the first four weeks of training without requesting approval from a medical educator. Medical educator approval is required for any other transition of supervision requirements prior to the usual timeline.
In other words, a supervisor can determine when a registrar can transition from entry to foundation level supervision but other transitions outside of the usual timeframe require medical educator permission.
Table 1. A summary of the requirement for supervision by an accredited supervisor at the four milestones, when a specialist GP who is not an accredited supervisor can provide supervision, and the onsite requirements
|
Competency Milestone
|
Usual timeline
|
Supervision requirement
|
Accredited GP Supervisor requirement
|
Onsite supervision requirement
|
| Entry |
The first 4 weeks of community general practice placement |
Every case is reviewed by either sitting in, being called in, or reviewing (and where relevant discussing) the registrar’s notes |
An accredited GP supervisor is always available for the registrar1 |
100% of the time the registrar is consulting |
| Foundation |
From week 5 of GPT1 through to the end of GPT2 |
Cases are reviewed according to an agreed clinical supervision plan. The registrar’s designated supervisor regularly reviews the appropriateness of the plan based on their observations and assessments of the registrar. |
An accredited GP supervisor is always available for the registrar1 |
80% of the time the registrar is consulting3 |
| Consolidation |
From GPT3 through to completion of training |
Cases are reviewed according to an agreed clinical supervision plan. |
An accredited supervisor is available at least 80% of the time, with a specialist GP who is not an accredited supervisor permitted to supervise the remaining time2 |
50% of the time the registrar is consulting3 |
| Fellowship |
Completion of GP training |
Not required |
Not required |
Not required |
1. Available means the supervising GP is not overloaded with clinical or procedural work and is on-site. Offsite supervision is permitted after the entry milestone (as per the percentages above), but the supervisor must be easily contactable and able to immediately attend.
2. A non-accredited but specialist GP is a GP who holds FRACGP, FACRRM or specialist registration as a GP with Ahpra but has not yet completed GP supervisor training. It is never appropriate for a registrar to be supervised by a doctor who does not have specialist recognition as a GP.
3. The percentage requirements of on-site availability are per fortnight. If an accredited supervisor is away for more than a week during the consolidation milestone and a non-accredited specialist GP provides cover, notify the training coordinator. |
Supervisor Leave
Supervisors must plan leave with the consideration of the registrar’s needs and to ensure they meet the requirements for provision of supervision at different training milestones. Training sites with a limited supervisor pool, particularly single supervisor training sites, should have a contingency plan for unexpected leave. Further guidance is available in the AGPT Accredited Supervisor leave requirements and Emergency Leave Form.