AGPT registrar training handbook

Training program requirements

Workplace-based assessment program

        1. Workplace-based assessment program

Last revised: 16 Feb 2024

Workplace-based assessment program

The workplace-based assessment program forms part of your AGPT program and involves observation and assessment of your practice in your own workplace via a range of formats. It allows us to track your progression through training, ensuring you receive the support that you need to gain the clinical competencies and skills relevant to your stage of training and to progress to Fellowship.

Several different people are involved in supporting your education and workplace-based assessment, including:

  • your supervisor(s)
  • your medical educator
  • external clinical teaching visitors
  • your training coordinator.

You’ll receive feedback following each of your assessments to allow you to reflect on your progress and plan additional learning opportunities with the support of your supervisor, ME or training coordinator.

It’s important that you schedule time for assessment, feedback and personal reflection.

The different assessment tools are outlined below.

Early assessment for safety and learning (EASL)

We understand that registrars enter their first general practice placement with varying levels of experience and clinical competency. Registrars come from diverse backgrounds, and some may be unfamiliar with working in Australian general practice.

An early assessment for safety and learning ensures that the supervision you receive is matched to your level of learning needs.

Information to guide your supervisor in making this assessment includes an online applied knowledge multiple-choice question assessment, regular case review and direct observations of your consultations. These assessments are generally done in the first few weeks of your first general practice placement (GPT1).

Clinical case analysis

Clinical case analysis (CCA) is a hybrid assessment format comprising review of clinical notes or case reports and oral questioning. CCA assessment tools include case-based discussions and random case analysis.

The CCA is designed to assess your clinical reasoning, management and decision-making skills using clinical cases that you’ve managed. Feedback is generally provided immediately after each session to support learning and reflection.

Your assessor will use a structured discussion format for the assessment. Targeted questions will allow you to demonstrate your competency across specified areas of the RACGP Curriculum and syllabus. The assessor will explore in detail any issues relating to the case to identify if you have any clinical knowledge gaps. Clinical case analysis is excellent preparation for both the written and clinical exams.

Case-based discussion

For case-based discussions (CBD), you’ll be asked to select a recent clinical case to present to the assessor, including providing clinical notes, relevant investigations or results, and details of referrals or preventive healthcare plans. You’ll present cases that you’ve been primarily responsible for and that represent a medium level of complexity, where clinical reasoning may be complicated by uncertainty and/or where decision-making requires consideration of multiple issues.

You might highlight aspects of the case for discussion, depending on your self-identified learning needs. Sometimes an assessor may request a case with a specific area of focus, particularly if it’s been identified that you need support in that area.

Random case analysis

In random case analysis (RCA), the assessor will randomly select a case from your consultation records to discuss. They’ll ask you to think about the case from different perspectives and discuss these through the lens of the RACGP Curriculum and syllabus, in particular, the five domains of general practice. The development of your clinical reasoning will be explored by considering how a case changes when one of four contextual influences changes – the doctor, the patient, the problem and the system.

RCA is helpful to ensure you explore cases you may not usually see in your day-to-day practice.

Multi-source feedback

Multi-source feedback (MSF) provides you with feedback from both patients and colleagues. When you receive your feedback report, you’ll be asked to complete a self-reflective exercise and to discuss the results with your ME.

Patients are surveyed using an interpersonal skills questionnaire. Data is collected from a minimum of 30 patients following their consultations with you. The survey explores patient perceptions about your behaviours, such as listening skills, clarity of explanations, respect for the patient and involvement of the patient in decision-making, as well as the patient’s confidence in your ability.

The colleague feedback evaluation focuses on your professionalism and workplace behaviours. Perceptions are collected about areas such as working relationships, competence and professional development.

You’ll generally only complete one MSF assessment during your general practice training. This process is managed externally and directly by the survey provider CFEP.

Mini-clinical evaluation exercise

A mini–CEX is an assessment that involves observation of you performing a consultation. This style of assessment can either focus on a particular competency area, such as professionalism, or specific clinical skills; it may be managed as a general observation. Once completed, your assessor can immediately discuss the consultation with you, providing feedback and ideas for further development, if necessary.

Clinical audit

A clinical audit is a systematic review of certain aspects of clinical performance. It is a valuable quality improvement activity designed to explore areas such as:

  • rational ordering of investigations (radiology/pathology):
    • review the frequency of tests ordered, for example, thyroid function test in patients on long-term thyroxine replacement
    • imaging in acute knee and ankle injuries, for example, what the indications are and what modalities could be used
  • management/prescribing:
    • how closely did you follow clinical guidelines in the management of (for example) lower back pain?
    • review your prescribing as compared to current best practice
  • preventive medicine activities:
    • review patient records for recording of smoking status and smoking cessation advice given
    • review patient records for recording of current alcohol use and alcohol cessation and reduction advice given.

After completing an audit, you should analyse the results and discuss the findings with your supervisor, who will give you feedback and help you plan further skills development in areas identified by the audit.

A clinical audit can be completed at any stage of training, but it is recommended that it be done in GPT3.

External clinical teaching visit

An external clinical teaching visit (ECTV) is conducted by a GP educator who observes your consultations during a session and gives you specific feedback after each consultation. They may use a variety of assessments such as mini–CEX, RCA and CBD during each visit.

You will have a minimum of five ECTVs throughout training. Two in GPT1, two in GPT2, and one during GPT3.

Mid and end-term appraisals

Mid and end-term appraisals are completed by your supervisor. These reports include detail about your competency at the current stage of training and enable tracking of your progression through training as well as providing an opportunity for you to talk with your supervisor about your learning.