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 counted as two doctors being supervised)
- the training program – doctors in RACGP AGPT, RACGP FSP, ACRRM training programs and medical board programs all count towards the maximum of 3 doctors)
TIP
The three supervised doctors to one supervisor ratio is consistent with the Medical Board of Australia’s policy for safe supervision.
Acceptance into the AGPT placement process does not mean approval of a great than 3:1 ratio. We have no awareness or oversight of learners from other non-RACGP programs such as MDRAP, ACRRM, RVTS or medical student placements.
If your practice has multiple registrars, we may request you to provide details of how teaching and supervision is managed in your practice. 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 GP training require the level of supervision matches 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.
The milestones describe the expected path of improving competency for registrars in community training posts 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’re not required to submit supervision plans, but we may request to review them during reaccreditation or if there is a dispute about whether supervision is being adequately provided.
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.
The table below summarises the requirement for supervision by an accredited supervisor at the four milestones and when a specialist GP who is not an accredited supervisor can provide supervision.
|
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 consulting2 |
| 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 to supervise the remaining 20%3 |
50% of the time the registrar is consulting2 |
| Fellowship |
Completion of GP training |
No supervision is required |
No requirement |
Nil |
1. Available means the supervising GP is not overloaded with clinical or procedural work and is on-site, or if off-site is easily contactable and able to attend.
2. The percentage requirements are per term, but periods of more than a week's absence of an on-site accredited supervisor resulting in coverage by a specialist GP who is not an accredited supervisor should be notified to a medical educator.
3. A non-accredited but specialist GP is a GP with FRACGP or FACRRM or has 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. |
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. Practices with a limited supervisor pool, particularly single supervisor practices, should have a contingency plan for unexpected leave.