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Rural Healthcare

Advancing rural skills

Author: Paul Hayes

The RACGP’s Fellowship in Advanced Rural General Practice offers GPs in rural and remote Australia the opportunity to reflect on their abilities and develop further skills to help their communities.

 ‘If you’ve seen one country town, you’ve seen one country town’

Context matters regardless of where a GP plies his or her healthcare trade. One practice will never be exactly the same as another.

In the case of GPs who work in rural and remote Australia, the scope of patient populations often takes in entire communities and the differences between locations can be stark.

Rural GPs thus require advanced abilities that can easily be adapted to different settings.

‘Rural general practice has its differences – not good or bad – from other general practice for which you need a certain level of skill,’ Dr Ken Wanguhu, an experienced rural GP, told Good Practice. ‘As you grow in rural general practice you get to appreciate just how much the community that you are working in actually shapes your practice.

‘I you go into a small community and they need obstetric services, for example, then that sort of procedural stuff is important as a GP. Or if it’s an older population, then skills in internal medicine, geriatrics, palliative care, etc become a really big part of it.’

The RACGP’s Fellowship in Advanced Rural General Practice (FARGP) qualification, which is available to general practice registrars as well as experienced GPs, aims to develop advanced rural skills and increase options for safe, accessible and comprehensive care in rural, remote and very remote communities throughout Australia.

‘If you want to work in rural and remote areas and have that credibility as a GP, then you need to show a lifelong commitment to enhancing your skills and your qualifications. The FARGP is a great way to do that,’ Assoc Prof Brad Murphy, an experienced rural GP who recently completed the FARGP, told Good Practice.

‘The wonderful thing about the FARGP is that it has so many opportunities – you’re not necessarily committed to obstetrics, anaesthetics, surgery, or anything else. There is acknowledgement that there is a whole range of other areas of special interest.

‘The FARGP identifies that and gives you an opportunity to be formally recognised for your expertise and qualifications.’

Never stop learning

Many practising GPs undertake the FARGP throughout their careers, and Assoc Prof Murphy and Dr Wanguhu represent a significant level of experience in a wide range of areas within general practice.

Assoc Prof Murphy, a long-time GP throughout Queensland, has held roles such as Chair of RACGP Aboriginal and Torres Strait Islander Health and Services Director – Clinical/Medical at the Indigenous Wellbeing Centre in Bundaberg. He is also on the RACGP Council and a founding member of the Jimmy Little Foundation.

Dr Wanguhu, who was born in Kenya and worked as a doctor in Kenya, Somalia and South Africa before coming to Australia in 2001, has practised in the South Australian Riverland town of Waikerie for more than a decade. He is also RACGP Rural Censor and received the faculty’s Brian Williams Award in 2015.

Regardless of their experience, both doctors are aware of the value in continuing their learning. One of the most valuable opportunities the FARGP offers experienced GPs is the chance to take a closer look at their careers and, as such, their abilities.

‘It’s nice to step back on reflect on your skills,’ Dr Wanguhu, who recently completed the FARGP, said. ‘That is what the FARGP gives you a chance to do; to reflect and ask, “What else do I need? What else does my community need?”

‘The FARGP then gives you an opportunity to address any of the areas that you identify.’

Given their extensive backgrounds in general practice, Assoc Prof Murphy and Dr Wanguhu were eligible for the FARGP’s recognition of prior learning (RPL). This pathway recognises the experience, skills and qualifications of experienced rural GPs, offering the opportunity to submit evidence that demonstrates how they meet the specific criteria of the FARGP.

‘Even with the RPL process, there is still a chance to reflect,’ Assoc Murphy said. ‘I found that really useful because I had to go back through a whole lot of stuff that I had done in the past in order to be able to justify to those who were doing the assessment that I had actually met the necessary criteria.

‘It was a useful journey for me to have a look at the things I had completed, both in my medical career at the coalface and in terms of what I had been involved in at a national level. For example, setting up RACGP Aboriginal and Torres Strait Islander Health.

‘That journey can blur over time … so the FARGP gave me a chance to reflect upon that and what I have been able to achieve.’

Advancing skills

When Dr Wanguhu took a step back and looked at his existing practice and abilities, he was struck by a specific area in which he had definite room for improvement.

‘I found there was one thing I hadn’t done much in my community … and that was men’s health,’ he said. ‘And rural men often have bad health – they smoke, they have a high suicide rate. They don’t do as much with their health.

‘I thought we were doing better, but when a patient pointed it out I realised it was perfect for me within the FARGP.

‘I was able to develop a learning plan and do some education. From that I developed a series of talks for men in my community.’

The FARGP provided Assoc Prof Murphy the chance to examine his abilities in Aboriginal and Torres Strait Islander health – a prominent area of his career – and develop more advanced non-clinical skills.

‘I think it’s an understanding of some of the differences that can often be associated with Aboriginal and Torres Strait Islander health,’ he said. ‘The interpersonal skills, the relationships you have with the patient and the wider family and community are often so important.

‘Aboriginal and Torres Strait Islander people – as a gross generalisation – tend to be very family-oriented, so it’s really important to collaborate with communities, and with individuals and families in order to get the right outcomes.

‘Because if you have the relationship with the community then the person with the problem, who you may never see because they would never walk through your door, will be brought to you by the community if they know you are trustworthy, reliable and competent.

‘That is just imperative, otherwise these people won’t even come to you. They will stay away and suffer in silence.

‘Understanding the resources that are available to you [is also vital]. Being up to date with what’s available and collaborating with the RACGP, being involved in the [Aboriginal and Torres Strait Islander Health] faculty and those sorts of things so that you get that information on a regular basis can be really important.’

Confident in practice

While the ability for individuals to independently provide competent primary healthcare lies as the foundation of high-quality general practice, a greater level of isolation means that independence is inevitably heightened for GPs in rural and remote areas of Australia.

‘[Rural healthcare] uses all of the skills you get as an urban GP, but it is quite challenging because the referral opportunities you have in the more urban areas aren’t always available to you,’ Assoc Prof Murphy said.

‘You are much more reliant on the use of technology, such as emails, photos, the internet and the phone. But you really need to develop the confidence to be able to practise in those areas.

‘You also need to acknowledge your own skills and be comfortable with your own skills so you can practise [remote medicine] with some confidence. It takes a lot of confidence to be able to look after someone with major chest trauma from a road accident at two o’clock in the morning when you only do it once every two years.

‘That is a different sort of medicine. The journey you undertake through the FARGP … is about acknowledging those differences and that we can always work towards improving and enhancing. That we maintain that qualification, that skill, to be the very best for the patients we look after.’

Following his many years in rural general practice, both with patients and other healthcare professionals, Dr Wanguhu appreciates the fact the FARGP offers a certain level of appreciation for the work that is required.

‘We know so much and we are so experienced at general practice that we can be on auto-pilot. We are unconsciously competent: we don’t think, we just do,’ he said. ‘We work in rural general practice but don’t always get that recognition, so it’s actually nice to have a qualification that recognises what you have done for your community and what you do every day.’

Regardless of their considerable service to rural general practice, each GP found undertaking the FARGP to be an especially beneficial journey, both for their own practice and in terms of what they can pass on to other GPs and registrars.

‘It’s certainly an advertisement to registrars who might want to go and undertake their training,’ Assoc Prof Murphy said. ‘They can say, “This guy has obviously ticked the boxes and sees this journey as being important enough for him”.’