RACGP Rural Generalist Fellowship Training Handbook

Training program requirements for the Rural Generalist Fellowship (FRACGP-RG)

Additional Rural Skills Training

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; however, urban posts 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 before emailing your request to the censor at rg@racgp.org.au.

You can select one of the following approved disciplines for your ARST training. 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
  • Surgery

Note that:

  • if you plan to do your ARST post in emergency medicine, you’ll need to complete your core emergency medicine training first.

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 started training before 2022 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 Diploma of Rural Generalist Anaesthesia (DRGA) 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 2023, you will still enrol in the existing ACEM Emergency Medicine Advanced Diploma (EMAD). 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 Advanced Diploma of RANZCOG 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 training program, 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 program team to include in your training plan and liaise with local rural generalist coordination units, where relevant, to identify available training posts, noting that priority will be given to those completing their first ARST.

You can apply to the censor by submitting a reflection outlining which ARST you would like to complete and why (in particular, how it will benefit your community) and emailing it to rg@racgp.org.au.

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.

Consolidation of ARST skills

To support an understanding of the context in which your additional rural skills will be applied, we recommend you undertake your ARST towards the end of your training, after completing your general practice terms. This also avoids the potential for deskilling and loss of competency in the discipline if you were to complete the ARST early in your training and not have the opportunity to use the skills until much later.

If you undertake ARST early in your training it is strongly recommended that you undertake your General Practice placements in a practice and community where you can use and consolidate your ARST skills, preferably with an experienced mentor in that discipline available to support you.

Your rural generalist coordination unit may have specific programs to help you consolidate your additional rural skills, so it is important that you check with both your program team and the RGCU.

RACGP Consolidation of Skills Policy Position

The RACGP recommends registrars undertake their ARST training towards the end of their Fellowship journey, after completion of their general practice terms. Registrars who undertake their ARST earlier in their training often do not revisit the additional clinical skills gained until after GPT3, through an extended skills post or other means. This extended gap of 1.5 years or more can lead to deskilling and potentially loss of competency in the additional skills. 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 and consolidating the additional skills learned.

Ultimately, the registrar must balance the consolidation of ARST skills with all the other training requirements, including sufficient training in clinical general practice.

The principles that the RACGP follows include:

  • Registrars complete no less than 27 hours per week face-to-face, rostered, patient consultation time undertaking general practice activities (as per the full time definition currently in place as per the training programs requirements policy. The rationale is that the RACGP does not recommend any further dilution of core general practice training time in the AGPT program.
  • Full-time training is defined as a minimum of 38 working hours per week. Outside of the 27 hours per week stated above, a registrar can allocate the remaining time to consolidation of additional skills. This equates to a maximum of 11 hours per week, which is approximately two standard sessions of 3.5–4 hours duration. Traditionally, these 11 hours are allocated to non-consulting activities in general practice (such as administrative time, teaching and release sessions).
  • The RACGP will still recognise registrars who meet the two abovementioned conditions as having worked full time in clinical general practice as per the AGPT program training requirements. If a registrar is undertaking part-time training, the amount of time spent in consolidating additional skills that the RACGP will accept as part of the registrar’s general practice training will be assessed pro rata against full time hours. For example, a registrar undertaking the AGPT program at 0.5 FTE (ie 19 hours per week) may spend up to 5.5 hours per week consolidating skills. The registrar may take on additional shifts for the purpose of consolidation, but the RACGP will not recognise this towards their general practice time.

In order to have time spent in consolidation of additional skills recognised as time spent in clinical general practice, the registrar must work with their training team and have a targeted training plan developed and prospectively approved by all parties. Such a plan will need to include consideration of factors including that:

  • the registrar is not working more than 38 hours per week in total
  • the consolidation posts are directly related to the registrar’s training and career in general practice

- the registrar will have ongoing support throughout their training from their supervisor(s) and program team.

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 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
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
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)
1 End of training (eg at 12 months

* Timing of when assessments occur is based on 12 months of FTE training


Adult internal medicine ARST curriculum

">WBA templates

WBA Requirement Assessor Number of Assessments/activities When assessment/activity should occur*
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
Independent assessor 1 session with 3 case discussions Completed during months 4-6
DOPS Supervisor 1 session with 3 case observations Completed during months 2-4
Independent assessor 1 session with 3 case observations Completed during months 7-8
Logbook 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)
1 End of training (eg at 12 months

* Timing of when assessments occur is based on 12 months of FTE training
 


Child 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
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
Independent assessor 1 session with 3 case discussions Completed during months 4-6
Logbook 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)
1 End of training (eg at 12 months

* Timing of when assessments occur is based on 12 months of FTE training


Mental 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
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
Independent assessor 1 session with 3 case discussions Completed during months 4-6
Logbook 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)
1 End of training (eg at 12 months

* Timing of when assessments occur is based on 12 months of FTE training


Palliative care 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
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
Independent assessor 1 session with 3 case discussions Completed during months 4-6
Logbook 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)
1 End of training (eg at 12 months

* Timing of when assessments occur is based on 12 months of FTE training


Surgery ARST curriculum

">WBA templates

WBA Requirement Assessor Number of Assessments/activities When assessment/activity should occur*
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
Independent assessor 1 session with 3 case discussions Completed during months 4-6
DOPS Supervisor 1 session with 3 case observations Completed during months 2-4
Independent assessor 1 session with 3 case observations Completed during months 7-8
Logbook 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)
1 End of training (eg at 12 months

* Timing of when assessments occur is based on 12 months of FTE training

 

Advertising