Additional Rural Skills Training

RACGP Rural Generalist Fellowship Training Handbook

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Last revised: 04 Aug 2023

Additional rural skills training

Completion of a minimum 52 weeks FTE of additional rural skills training (ARST) in an accredited training post is an essential component of training towards the Rural Generalist Fellowship.
This additional training is designed to enhance your rural general practice by providing an opportunity to develop additional skills and expertise in a particular area, increasing your capability to provide secondary-level care to the community.

Where possible, you should complete the training in a regional or rural location (MMM2-7); however, urban posts (MMM1) will be accepted depending on the availability of training posts for specific disciplines.

Where a genuine community need is identified, you may develop an ARST discipline outside the list of approved disciplines to meet this need. This must meet the required standard for an ARST and be approved by the RACGP Rural censor before you start training. Applications should first be discussed with your ME and assessed by the your RACGP rural training team prior to seeking approval from the Rural Censor .

You can select one of the following approved disciplines for your ARST training subject to funding and availability in your region. We recommend you consider both your own interests and the needs of your community when making your selection.

Aboriginal and Torres Strait Islander health
Academic post
Adult internal medicine
Anaesthesia
Child health
Emergency medicine
Mental health
Obstetrics
Palliative care
Small Town Rural General Practice
Surgery

Note that:

if you plan to do your ARST post in emergency medicine, you must complete the core EMT prior to the commencement of the ARST component.

Curricula

Each ARST curriculum sets out the competencies that need to be achieved. It also provides a framework for the teaching and learning of the critical knowledge, skills, and attitudes that rural GPs require to effectively deliver appropriate inpatient and outpatient care in rural and remote communities, where non-GP specialist support is often limited.

These curricula are effective for all AGPT and RVTS registrars who started training from 2022 onwards and for FSP registrars from 2023. Current registrars who have remained enrolled in FARGP prior to 2022 and are yet to transition to the RACGP-RG, and who have not yet commenced their ARST can choose to undertake these curricula or the pre-2022 curricula.
Additional rural skills training through other specialist colleges

Anaesthesia

RACGP registrars will complete the Rural Generalist Anaesthesia training (RGA) with the Australian and New Zealand College of Anaesthetists (ANZCA). In order for a registrar to be placed in an anaesthesia training post, the training site must be accredited with ANZCA and the RACGP.

Emergency medicine

The RACGP is working with the Australasian College of Emergency Medicine (ACEM) to implement the new ARST- emergency medicine curriculum for the RACGP Rural Generalist Fellowship. If you are commencing your emergency medicine ARST in 2024, you will still enrol in the existing ACEM Associateship in Advanced Emergency Medicine (AACEM). In order for a registrar to be placed in an emergency medicine training post, the training site must be accredited with ACEM and the RACGP.

Obstetrics

RACGP registrars will complete the RANZCOG Associate Training Program (Advanced Procedural) with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). In order for a registrar to be placed in an obstetrics training post, the training site must be accredited with RANZCOG and the RACGP.

Completing a second ARST post

You may apply to complete a second ARST after completing all the other training requirements of your FRACGP & FRACGP-RG, provided there is sufficient training time remaining. For AGPT registrars, the cost of a second ARST will not be subsidised by the training program. Approval to undertake a second ARST must be granted by the rural censor prospectively.

You will also need to discuss this with your RACGP rural training team to include in your training plan and liaise with local RGCU, where relevant, to identify available training posts, noting that priority will be given to those completing their first ARST.

You can apply to the rural censor by emailing your RACGP rural training team outlining which ARST you would like to complete and why (in particular, how it will benefit your community).

For practising GPs, if you complete a second ARST after previously completing the RG Fellowship, you will receive an additional certificate rather than an additional or amended RG Fellowship parchment. You can complete a second ARST or apply for RPLE via the usual RPLE process. Fees apply.

Training post and supervision requirements

For an overview of the training post and supervision requirements for each ARST discipline, please refer to the ARST training post requirements. More information can also be found in the rural generalist training placements section.

Blended Placements - Consolidation & Maintenance of Skills

To support an understanding of the context in which your additional rural skills training (ARST) will be applied, we recommend you undertake your ARST towards the end of your training, after completing the general practice terms, exams and Core EMT requirements.

However, the RACGP recognises that a registrar may be required or motivated to complete their ARST early, such as immediately after their hospital year. In these cases, the RACGP supports a more flexible approach to their GP training to ensure the registrar continues developing, consolidating, and maintaining the additional skills acquired as part of their RG training journey.

Whilst consolidation/maintenance of skills is not compulsory, it is encouraged particularly where registrars have completed a procedural ARST such as Anaesthetics, Obstetrics and Surgery to ensure they avoid the potential for deskilling and loss of competency in your chosen ARST discipline.

RGs who have undertaken an ARST early in their training, who wish to consolidate and/or maintain their skills in their chosen discipline may be eligible for a priority general practice placement match, to ensure placements are in the same community where they are using their additional rural skills.

In order to have time spent in consolidation and/or maintenance of additional skills recognised as training time, the registrar must work with their Rural Program team and have a targeted training plan developed and prospectively approved. Such a plan will need to include consideration of factors including:

the registrar is not working more than 38 hours per week in total.
the consolidation and maintenance posts are directly related to the registrar’s ARST discipline, as well as training and career in general practice.
The registrar will have ongoing support throughout their training from their supervisor(s).
where the ARST is practised outside of their community general practice, both training sites must be accredited and appropriate supervision provided.

Your rural generalist coordination unit (RGCU) may also have specific consolidation of skills programs that may provide funding. This will differ from State to State, but where an RGCU has a program in place to support consolidation of skills placements, this should be discussed with your Rural Programs Team and Medical Educator with approval granted by RACGP prospectively.

The following guidelines apply to those registrars who require consolidation and/or maintenance of skills support following completion of their ARST discipline during their general practice training:

Consolidation of skills (registrar may incur additional training time)	CoS is defined as the period when the RG has completed their ARST training requirements and is supported in the practice of their additional rural skills to increase confidence towards independent practice. RGs have the option of an additional extended skills training placement (EST). This time may be used for CoS, particularly for procedural ARST disciplines. Depending on the stage of training and other training placement requirements (teaching and admin time) up to 11 hours may count towards extended skills (CoS) training. This is reduced for GPT1 registrars as they have teaching time requirements of 3 hours per week which limits the time that may count towards extended skills training to no more than 8 hours per week. This will be recognised as a concurrent placement; a part time standard GP clinical placement and a part-time extended skills (Cos) placement, noting the CoS placement is not required to meet the minimum part-time training requirements (14.5 hrs/week). Rural Censor approval may be required.
Maintenance of skills (MoS)	Maintenance of Skills is defined as the continuing practice of additional rural skills as part of rural generalist practice where registrars have completed an ARST. RG placements may spend up to 20% of their training time practising their ARST discipline as part of rural general practice to maintain their skills. For a full-time registrar they may spend one day per week (up to 20% FTE) working in their ARST discipline and have this counted as part of their general practice training term (GPT). The MoS placement will be added as an ‘additional site’.
Blended placements	Blended rural placements are specific to the registrar and must be approved by the Rural Censor before commencement. For example, an RG working across a rural community general practice (0.5 FTE) and a rural hospital ED (0.5FTE) concurrently for 12 months, the time would meet the RG rural general practice time requirement provided the work is being completed in an MM3-7 location. The placement could be counted as: a part-time general practice training term completed over 12 months, and a part-time core emergency medicine training or extended skill term completed over 12 months.

The time working in the above activities is in addition to working in a comprehensive general practice.

Ultimately, the registrar must balance the consolidation (CoS) and maintenance (MoS) of ARST skills with all their other training requirements, including sufficient training in clinical general practice. This includes attending all scheduled workshops which take priority during the GP terms.

The RACGP will assess and approve training plans on a case-by-case basis and has discretion to grant further flexibilities in the registrar’s training, if required.

Workplace-based assessments

Satisfactory completion of RACGP ARSTs will be assessed by a suite of workplace-based assessments (WBA).

The WBA assessment tools and requirements for each ARST discipline are outlined below, and more information is available in the relevant curriculum.

For the ARST disciplines managed by external colleges – anaesthesia, emergency medicine and obstetrics – please refer to the relevant curriculum for the assessment requirements.

Names of WBAs

Mini – CEX – mini clinical evaluation exercise

CBD – case based discussion

RCA – random case analysis

DOPS – direct observation of procedural skills

Aboriginal and Torres Strait Islander health

Aboriginal and Torres Strait Islander health ARST curriculum

WBA templates

WBA Requirement	Assessor	Number of Assessments/activities	When assessment/activity should occur*
Mini-CEX	Supervisor	1 session with 3 observations	Completed during months 2-4
Mini-CEX	Independent assessor	1 session with 3 observations	Completed during months 7-8
CBD	Independent assessor	2 sessions, each with 2 case discussions	Completed during months 4-6 and 9-11
RCA	Supervisor	2 sessions, each with 3 case discussions	Completed during months 2-4 and 7-8
RCA	Medical educator or independent assessor	1 session with 3 case discussions	Completed during months 4-6
Logbook/cultural journal	Regular review by the supervisor and/or cultural mentor, and by the ME at each ME meeting	Refer to the ARST curriculum	Throughout training
Community Project	Regular review by the supervisor and/or cultural mentor, and by the ME at each ME meeting	Refer to the ARST curriculum	Throughout training
Supervisor Reports	Supervisor	1	Middle of training (eg at 6 months)
Supervisor Reports	Supervisor	1	End of training (eg at 12 months