This is a live document which contains hyperlinks to websites, documents, policies and email contacts. Please always refer to this electronic version on the MCCC website.

Date of effect: 26th July 2021

Introduction

Murray City Country Coast GP Training (MCCC) is committed to enhancing community health and well-being through leadership in general practice education, training research and workforce development for GP registrars training with MCCC on the Australian General Practice Training (AGPT) Program.

This policy handbook sets out the requirements for GP registrars training with MCCC on the AGPT program, practices and posts that employ registrars to undertake their training within their facilities and GP supervisors that oversee the registrars training.

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Acronyms and definitions

The following acronyms and definitions are used frequently within the policies in this handbook. Please familiarise yourself prior to reading the policies or refer back as required.

Selection Procedure

Last updated: July 2021

Relevant resources

MCCC website – Where you can train

RACGP information

ACRRM information

1. Purpose

Entry into the Australian General Practice Training (AGPT) program is a competitive, multi-phased, transparent and merit-based selection process.

Murray City Country Coast GP Training (MCCC) ensures the selection process stands up to the scrutiny of external regulators in respect of human rights and anti-discrimination. Specifically, the process is:

• Procedurally fair.
• Free of bias.
• Non-discriminatory.
• Transparent and defensible.

The Selection process for the AGPT program consists of three stages:

Stage 1: Application and eligibility.

Stage 2: College assessment.

Stage 3: Regional Training Organisation (RTO) and training region placement.

Further information about the selection process can be found in the AGPT Applicant Guide.

2. Scope

This procedure applies to all RACGP applicants for selection into the AGPT program with MCCC, as ACRRM administer their own interview process with support from MCCC interviewers. Details of ACRRM’s process and timeline are available on their website and are not detailed in this procedure.

RACGP’s website and selection documentation describes the first two stages of selection of Candidates.

This procedure refers only to Stage 3: RTO and training region placement.

3. Procedure

Stage 3: RTO Selection and placement offers

1. MCCC coordinates the interview process on behalf of the RACGP. MCCC provides information about the Selection process via the MCCC website.
2. RACGP inform MCCC of the names of candidates at a designated time. Candidates who have been shortlisted for interview will receive an email requesting the following:
   • booking their interview time: this will be on a first in basis. A booking confirmation email will be generated automatically to the candidate.
   • completion of an Application to Train with MCCC via a Survey Monkey.
   • a request to complete the Hospital Experience Assessment via MCCC’s online portal.
   • If interviews are being held virtually, a confidentiality form
3. There are designated day/s available for interview and all candidates must be available during these date/s. The numbers of days available may change depending on the format of the interview. If a candidate cannot attend, they will need to re-apply to the AGPT program the following year.
4. The interviews for RACGP can be Multiple Mini Interviews (MMI) or Panel interviews. The format of interviews will be determined each intake.
5. Interviews may be offered in person or virtually which will be determined and specified each intake.
6. MCCC will select and offer candidates a training place in the AGPT program on the basis of the following in descending order:
   • Their interview score
   • Interviewers’ feedback.
   • The CAAKT score (if available).
   • Rural intent (if a rural placement and other criteria have not differentiated the candidates).

AGPT Matched Shortlist Places will be offered to Aboriginal and Torres Strait Islander candidates who have requested priority shortlisting. As with rural Australian Defence Force (ADF) candidates, these candidates will be automatically shortlisted to their preferred region.

Being accepted into the AGPT program does not automatically guarantee a GP term placement.

Candidates who successfully obtain a place with MCCC in the second AGPT intake (give interview date) will undertake hospital term for their first year of training.  To avoid disappointment of being unable to secure a placement, those registrars are strongly encouraged to obtain a hospital placement for 2022.

By exception, there are limited Practice vacancies in 2022 in the North East Region only for second AGPT intake.

Placement into North East Region Practice vacancies will be subject to candidates:

• securing a Practice Placement in the North East Region before 15 December 2021 and submitting to MCCC any Medicare Provider Number information required within required timelines; and
• not having received an offer of employment with a hospital; and
• submitting and meeting Hospital Experience Assessment requirements within MCCC timelines

Further detail regarding timelines and requirements will be provided to candidates seeking a North East Region Practice Placement closer to the time.

Region distribution process

Additional information will be sought via the Application to Train with MCCC to assist MCCC distribute successful candidates to regions

1. Shortlisted candidates will be asked to preference their desired training locations, through the MCCC Application to Train
   • Rural pathway candidates, this will be in one of following regions: North East, North West or South West.
   • General pathway candidates, this will be in either the Metro West (Western side of Melbourne) or South West (Geelong only) regions.

2. A list of available training locations can be found on MCCC’s website, under the Registrars tab in ‘Where you can train’.
3. If successful following the interview stage, MCCC will take the candidates’ preferences into consideration when undertaking the process to allocate each candidate to a region.
4. The allocations will be based upon the interview score, their genuine commitment to the region and the number of places available in each region, until a region is full.
5. Registrars are placed in their region of preference utilising the following Criteria:
   • Interview scoe
   • Rural intent
   • Their links with the region of preference

The number able to be given their first preference will depend upon:

• • the number of registrars requesting that region
  • the number of places available in the region

MCCC will endeavour to fill the placements in each region with those who candidates who chose it as their first choice, where possible

Hospital Experience Assessment

1. All candidates should obtain from their Hospital/s or Workforce Manager Statement of Service they will be asked to provide. This information is needed for one of three reasons
   • To assess if you are considered “practice ready to commence in General Practice.
   • To assess registrars undertaking Extended or Advanced Skills as they need to be practice ready to do so.
   • To provide registrars continuing in the hospital setting the following year, with an outline of future requirements to ensure they are practice ready by either the second semester or first semester the following year.
2. The required information is to be entered and uploaded into the MCCC Hospital Experience Assessment portal located on the MCCC website. Ensure you have your Statements of Service, as detailed below before beginning the online process.

All candidates should obtain from their Hospital/s or Workforce Manager Statement of Service. Request these as early as possible as they can take up to 8 weeks to obtain.

3. Statements of service – these are letters from the hospital providing dates, duration and disciplines completed.

• • The statement will need to cover all the required core rotations and breadth of experience requirement for RACGP. ACRRM candidates will be asked to provide their details via a separate format.
  • Candidates requiring more hospital training may require one statement showing rotations you have completed and another indicating rotations you are yet to undertake but are rostered to complete prior to commencing training.
  • Australian trained candidates will require evidence of 52 weeks (full time equivalent) of hospital time since full general registration and overseas trained candidates must have two years of Australian/New Zealand hospital training.

Offers of Training

1. Once the preferences are allocated, offers of training will then be sent out to all candidates.
2. The offer will indicate the region the candidate has been allocated to. If a candidate does not wish to accept the offer for the particular region, the candidate can decline the offer of training. Any candidate grievances regarding their region allocated will be reviewed by the MCCC CEO (or their delegate), however the principles outlined in this policy continue to apply in that review. In the event the candidate does not with to accept the offer the candidate will need to contact the relevant College/s, with a view to participating in any further intakes.
3. Should a candidate not be successful and does not receive an offer of training, subject to college requirements they may be invited by MCCC to participate in any subsequent intakes or interview rounds for any unfilled positions. This will initially require the candidate to contact the College to confirm eligibility prior to any participation in subsequent invites.
4. Should a candidate decline an offer of training, they may be eligible to reapply to another pathway with MCCC. This will initially require the candidate to contact the College to confirm eligibility prior to any change of pathway.

MCCC works in partnership with hospitals and expects registrars, who have accepted a hospital position for the following year, will honour that commitment. MCCC will not support registrars reneging on their hospital placement to commence their training in general practice unless there is agreement from the hospital to release the registrar. Evidence must be provided by the registrar from their employer that identifies in writing their agreement to release the registrar.

4. Document history

Version	Summary of changes
1.0	First version
2.0	2018 updates
3.0	Third version
4.0	Amended to changes to Selection in 2020
5.0	2021 updates

Hospital Experience Assessment Policy & Procedure

Last updated: September 2020

Relevant resources

ED 003 Recognition of Prior Learning for RACGP Registrars Policy

AGPT Selection Guide for entry

RACGP CPR Qualification

RACGP Paediatric Term Requirements

RACGP Recognition of Prior Learning

RACGP Basic Life Support and Advanced Life Support Guidance Document

RACGP Vocational Training Pathway Requirements for Fellowship

RACGP – COVID-19 information for GP’s in training (Refer section 15 GP Term Readiness)

Medical Board AHPRA Registration Standard: Recency of Practice

ACRRM Fellowship Training handbook

ACRRM Training Eligibility Policy

ACCRM Training Program Requirements

1. Purpose

To outline the mandatory requirements for AGPT registrars and provide guidance on what will be assessed in determining general practice term readiness.

2. Scope

This policy and procedure applies to all AGPT registrars enrolled in the Australian General Practice Training (AGPT) Program where Murray City Country Coast GP Training (MCCC) is the host registered Regional Training Organisation (RTO).

3. Policy

1. Registrars who are undertaking the AGPT program must hold General Medical Registration at the commencement of their AGPT training.
2. Murray City Country Coast GP Training (MCCC) assesses all registrars’ prior learning to determine their potential readiness to commence training and to enter the general practice training term component of their training program.
3. The “hospital experience assessment” determines the practice readiness of a Registrar and is not an application or approval for recognition of prior learning (RPL). Registrars who have completed PGY2 and above and wanting to commence their training in general practice terms should refer to ED 003 Recognition of Prior Learning for RACGP Registrars and/or ED 002 Recognition of Prior Learning for ACRRM Registrars

Requirements to commence in a General Practice Term for RACGP registrars

1. Registrars must meet the 12-month (FTE) mandatory Postgraduate PGY1 or Intern year hospital requirements as detailed in the key requirements below. This can be done as a 12-month AGPT hospital year or where eligible, they can apply for 12 months of Recognition of Prior Learning.
2. A Basic Life Support (BLS) course completed within the 12 months prior to commencing General Practice term. For RACGP registrars this must meets the requirements detailed in RACGP’s Basic Life Support and Advanced Life Support Guidance Document.   

Exemptions may apply in exceptional circumstances e.g. COVID-19 in accordance with exemptions specified by RACGP – refer COVID-19 information for GP’s in training.

Key requirements

The following requirements apply to all MCCC registrars. RACGP and ACRRM registrars who do not meet these requirements will be required to have further discussions with their RHE or Rural Portfolio Lead ME prior to being able to commence in practice.

A minimum of one FTE year of hospital rotations post intern year (PGY1) must be completed. If the intern year was completed overseas, then two FTE years must be undertaken in an accredited hospital in Aus/NZ.

The hospital rotations (in combination with PGY1) must:

• • Provide the Registrar with adequate exposure to a range of clinical rotations relevant to the discipline of general practice that provide the opportunity to develop the breadth of skills
  • Be sufficient to demonstrate an understanding of safe practice, including the recognition and management of the seriously ill patient, prior to commencing general practice terms. This must include adequate exposure to the disciplines of medicine, surgery, emergency medicine and paediatrics in an Australian or New Zealand hospital.
  • Registrars who have undertaken their internship overseas can apply for terms to be recognised by the RACGP using the “RACGP case studies demonstrating the mandatory term competencies” and “Mandatory term competency requirements – reporting tool for RTO’s”. These forms are available from the REAPS.
  • Be undertaken in an accredited hospital in Australia or New Zealand.

1. If a rotation was undertaken more than five years prior to the start of a general practice term, evidence of competency maintenance is required.
2. Required mandatory hospital rotations (Medicine, Surgery, Emergency and Paediatrics) do not have to be completed before application and entry into the AGPT program however they must be completed prior to commencing general practice terms.
3. If applicants request Recognition of Prior learning in lieu of completing a hospital year within the program, refer to the related RPL policy and procedure

Mandatory Hospital Rotations 

Certain hospital training experience is considered mandatory preparation for the AGPT Program and must be satisfactorily completed before commencing in any GP placements and be undertaken in an accredited Australian and/or New Zealand hospital.

1. General medicine: Preferably general medicine, or, if unavailable, a rotation that offers broad medical experience.
2. General surgery: Preferably general surgery, or, if unavailable, a surgical rotation that covers the principles of basic surgical care.
3. Emergency: A term in an Emergency Department (ED).
4. Paediatrics: Paediatric experience must be adequate to ensure safe practice in this area and for RACGP registrars, this is outlined in the RACGP Paediatric Term Guidance Document. ACRRM registrars must discuss this requirement with the Rural Lead ME or their RHE.

Practice Readiness: Breadth of Experience

In addition to these rotations, GP registrars must obtain hospital disciplines in a variety of other areas to demonstrate a breadth of experience. It is an MCCC requirement that you have at least three (3) other disciplines, to provide the variety of skills relevant to general practice, e.g. obstetrics and gynaecology (O&G), psychiatry, aged care or rehabilitation.  There may be acceptable variations to this which will need to be approved by a Regional Head of Education (RHE).

This experience needs to be adequate in exposure, and recently practised in generalist terms in an Australian or New Zealand hospital. An applicant who has come from specialist training would need to demonstrate updated general experience within the past two to three (2-3) years. Applicants are also expected to meet recency of practice requirements.

An applicant who is not practice-ready can still apply to the AGPT program but will need to complete additional hospital rotations on the program prior to commencement in a general practice.

AGPT Hospital Year  

It is the responsibility of each applicant to secure his or her own hospital rotations if required to undertake further hospital training in the program.

Recognition of Prior Learning 

Please note: The HEA process is not the RPL process.

• HEA is providing information relating to mandatory requirements to be considered practice ready.
• RPL is providing proof of 1 year of Hospital time, there is a separate College application process undertaking on commencement in training.

For RACGP registrars to be eligible for any RPL, they must have completed either a minimum of one year of hospital post General Registration OR a minimum of two years in total of Australian or New Zealand accredited hospitals by the start of GPT1 . These time periods are full time (part time work is calculated pro rata). ACRRM registrars will need to discuss RPL eligibility with their RHE and/or Rural Portfolio Lead ME.

Recognition of prior learning (RPL) may be claimed to a maximum of 52 weeks to reduce a registrar’s overall time in the AGPT program.

RPL is not automatically granted, as MCCC and the relevant College censor need to be satisfied that the registrar has the skills and knowledge to justify shortening training time. There are certain criteria for RPL and it is suggested that this be discussed with MCCC staff.

Applicants and registrars are asked to keep copies of their hospital term performance and assessment reports, as they will be required for RPL applications.

Requirements to commence in a General Practice Term for ACRRM registrars

ACRRM policies do not reference “Hospital Experience Assessment”

This reflects the recognition that some of the registrar’s learning journey can take place in a setting working in a regional or small rural hospital. It is noted that apart from a policy on eligibility for training (see below), the emphasis is on “output” at COT time rather than “input” prior to training commencing, allowing flexibility around the means the registrar gains competence rather than the site in which this is gained.

The ACRRM training requirements are contained in the ACRRM Training Eligibility, and Training Program Requirements documents referenced at the bottom of this policy.

The main differences in approach with assessing terms for Core Generalist Training are-

1. Limited registration (not necessarily general registration) is permitted “providing they can demonstrate their ability to fully participate in and meet training program requirements”
2. Disciplines are not mandated within a single year (the “hospital year” in RACGP terminology) but can be gained progressively through Core Generalist Training time (up to 3 years)

The Fellowship Training Handbook provides a range of options to meet these requirements. This lists a range of “curriculum remediation” means to cover “curriculum gaps” within practice. Experience that is required for fellowship is outlined in the ACRRM Training Program Requirements Policy.

The REAPS process document TO 001 can be used to guide the HEA process.

REAPS will conduct an HEA assessment for terms done by ACRRM registrars prior to entry into Community terms.

There will be a discussion between REAPS and RHEs.

It is anticipated there will be several outcomes of this discussion-

1. Registrars clearly ready to start in Community terms (meeting the RACGP requirements above)
2. Registrars who may not meet all of the RACGP requirements above but for whom the RHE and REAPS feel are ready to commence practice. If desired Lead Rural ME is available to support the decision.
3. Registrars who want the start Community terms but where the REAPS/RHE are unsure about the decision. In this case Rural Lead ME and/or DMET can be involved.

A Training Plan discussion will be scheduled between RHE or ACRRM Training Advisor after the HEA process has been completed and before commencement in Community terms.

4. Procedure

For RACGP registrars

When an applicant is sent an offer to train with MCCC, s/he will be asked to complete a Hospital Experience Assessment via a portal on the MCCC website. The assessment will request details of hospital experience to meet the Mandatory rotations and breadth.

Applicants who are making enquiries prior to applying for the AGPT program may also complete the assessment to obtain more specific guidance on whether they are likely to be able to commence directly into general practice and claim RPL.

Statements of Service (in the form of a letter from the hospital – available from Medical workforce) detailing each discipline undertaken, the start and end date of the rotation, and any leave taken are required as evidence from each relevant hospital. Statements should cover all the rotations to be considered, including those pertaining to breadth of experience.

Applicants may need to provide statements for upcoming rotations for MCCC to assess breath of experience and RPL eligibility. It is essential that MCCC be notified immediately of any changes to future rotations.

MCCC will assess this information and email back a letter to the registrar advising of the outcome of their practice readiness assessment. The process is completed in a timely manner to enable assessment prior to participation in the Registrar Placement process if eligible.

Intern (PGY1) applicants also complete the assessment and will be provided with a letter detailing what required rotations will need to be completed during their “hospital” year on the program.

Basic Life Support

MCCC will send an email to registrars commencing in General practice requesting evidence of completion of a Basic Life Support course within 12 months of the practice commencement date. These are due December 1^st for registrars commencing in February and June 1^st for registrars commencing in August.

For ACRRM registrars

The process will be the same as above. If there are “gaps” (eg in paediatric experience) the options for ACRRM registrars are

1. Spend an extra year in a hospital to gain extra skills (RG Skills Year)
2. Commence in a community term with aims to “remediate” curriculum gaps as per ACRRM Training Program Handbook
3. If interns, PGY2 year may offer experience to fill in “gaps”

These plans are required to be noted in an “ACRRM Training Plan”.  (see guidelines)

The plan can be pre-populated by REAPS with information from the HEA form. The plan is then finalised at meeting between the registrar and the RHE and/or Training Advisor. The Training Plan is a dynamic document that is revisited at each TARM throughout training.

It is a requirement that all ACRRM registrars attend 2 emergency courses throughout training. REST is one of these.

RPL is available for ACRRM registrars. RPL is capped at a maximum of 2 years in Core Generalist Training. Details are noted in Fellowship Training Handbook.

5. Document history

Version	Summary of changes
1.0	First version
2.0	Revision   –   additional information about O&G and Anaesthetics
	–    removed membership evidence requirement
3.0	Revision – alignment with most recent ACRRM and RACGP requirements

Orientation of Registrars in Training Facilities Policy

Last Updated: March 2017

Relevant Resources

Orientation for Registrars

ACRRM Primary Rural and Remote Training Standards for Supervisors and Teaching Posts

National Terms and Conditions for the Employment of Registrars

RACGP Standards for General Practice Training

1. Purpose

To ensure that the process of orientation of registrars commencing in a training post complies with The Standards of the Royal Australian College of General Practitioners (RACGP) and/or the Australian College of Rural and Remote Medicine (ACRRM), Murray City Country Coast GP Training (MCCC) requirements, and the current edition of the National Terms and Conditions for Employment of Registrars (NCTER)

2. Scope

This document applies to all supervisors, registrars and MCCC staff involved in accreditation of MCCC training posts.

3. Policy

1. RACGP and ACRRM standards require that registrars receive a structured orientation at the commencement in a training post that they have not worked at previously. This applies to all levels of training including: GPT 1/PRRT 1, GPT2/PRRT 2, GPT3, PRRT3, GPT 4/PRRT 4 and ESP.

4. Procedure

1. All training posts will conduct a structured registrar orientation in compliance with The Standards of the applicable College.
2. The orientation will be conducted on the first day of the new training term or, where a registrar commences during a term, on the first day of employment in the post during the registrar’s usual rostered work hours.
3. Orientation must not be conducted prior to the commencement of the term, whether in or out of working hours or while the registrar is still in the employment of another post.
4. A registrar may wish to make an informal visit to the practice prior to commencement of employment, but this does not form part of the formal orientation.
5. In the unlikely event that it is deemed necessary to complete orientation outside the above process, prior approval must be sought from the Regional Head of Education (RHE) in the relevant region.

5. Document history

Version	Summary of changes
1.0	First version
2.0	Second version
3.0	Third version

Supply of equipment in training practices

Last updated: May 2021

1. Purpose

To ensure that registrars and supervisors are aware of the equipment to be supplied and made available in training practices, for the use of the registrar.

2. Scope

This procedure is applicable to MCCC training practices, their supervisors and registrars.

3. Statement

Registrars and supervisors in training practices require clarity about what equipment will be available in training practices and any items that registrars need to provide themselves.

4. List

Equipment to be supplied by registrar

1. Stethoscope

Basic essential equipment is to be available in the registrar consulting room

1. Electronic blood pressure machine or sphygmomanometer
2. Digital thermometer
3. Torch
4. Tongue depressors
5. Aurioscope with adult and paediatric ear pieces
6. Visual acuity chart
7. Weight Scales
8. Height measurement
9. Measuring tape
10. Tendon Hammer
11. Tuning Fork
12. Pap smear equipment
13. Urinalysis
14. Pregnancy test kits
15. Gloves – disposable
16. Sharps disposal container
17. Biohazard waste container

Routine equipment which all registrars should have access to within the clinic

1. PPE
2. Glucometer
3. Pulse oximeter
4. Dermatoscope
5. Blood pressure cuffs – large and paediatric
6. Peak Flow meter
7. Ophthalmoscope
8. Ear Syringe
9. Liquid Nitrogen
10. Dressings
11. Suture kits
12. Sterile Gloves
13. Eye examination kit

Emergency Equipment to be available in treatment/resus room

1. Bag and mask ventilation equipment
2. ECG
3. AED
4. IV access equipment
5. Emergency drugs e.g adrenaline/epipen, ventolin
6. Oxygen

5. Document history

Version	Summary of changes
1.0	First version
2.0	Second version

Recognition of Prior Learning for ACRRM and RACGP

Last updated: November 2018

AGPT Training Obligations Policy 2019 (p.7-8)

RACGP Recognition of Prior Learning Policy Guidance Document

RACGP Applying for Recognition of Prior Learning Q&A

ACCRM Recognition of Prior Learning Policy

1. Purpose

To inform registrars of the requirements and guidelines for the application and assessment of Recognition of Prior Learning (RPL) by the Royal Australian College of General Practitioners (RACGP), the Australian College of Rural and Remote Medicine (ACRRM) and Murray City Country Coast GP Training (MCCC).

2. Scope

This policy and procedure applies to all registrars enrolled in Australian General Practice Training (AGPT) program.

3. Policy

Recognition of Prior Learning (RPL) is the acknowledgement of experience, training and assessment that applicants have already undertaken, which may provide exemptions from training time, assessment or other training components as required by the RACGP or ACRRM colleges. This policy informs registrars of the requirements and guidelines for the application and assessment of RPL.

ACRRM 

1. MCCC believes that learning in general practice requires continuous, comprehensive and compassionate contact with a variety of people including patients, supervisors, practice staff, administrative staff and medical educators. To this end, the ACRRM pathway and the MCCC training program are learner focussed and longitudinal, covering many rural sites over 12 months. Registrars will learn together in a cohort that will be relatively stable over a year.
2. In order to assist registrars to gain the most from the MCCC training program, and consistent with the aim above, all ACRRM registrars are required to complete at least twelve (12) months in PRRT 1-2 in a post that fulfils primary/community and hospital/emergency care as listed in the ACRRM Fellowship Training Handbook.
3. Registrars may be granted up to two (2) years’ RPL from the ACRRM Censor. Thus within MCCC a maximum of twenty-four (24) months of RPL will be permitted from within the three components, i.e.
   • Twelve (12) months Core (hospital) and/or
   • Twelve (12) months PRRT 3-4 or
   • Twelve (12) months Advanced Specialised Training (AST).
4. If special circumstances apply, a special consideration application must be sent to ACRRM.
5. If twelve (12) months of RPL under the PRRT component has been granted by the ACRRM censor, e.g. in the Emergency medicine component, then it is MCCC policy that twelve (12) months of PRRT 1 and 2 be completed in an ACRRM-accredited post that provides community general practice, preferably also with hospital and emergency care to that community.
6. RPL for CCT time is not required if registrars joined MCCC at this training stage from 2016 onward.
7. Registrars should become familiar with ACRRM Fellowship Training Handbook documentation.
8. A Training Plan will need to be supplied in conjunction with MCCC to ACRRM as part of the RPL application process.

RACGP 

1. Eligibility requirements: Registrars must have completed either a minimum of twelve months of hospital post General Registration OR a minimum of two years in total of Australian or New Zealand accredited hospital by the start of GPT1 in order to be eligible to apply for RPL.
2. Registrars yet to undertake a post-graduate year (PGY) term (hospital units) in their first year on the AGPT program will not need to apply for RPL. All other registrars need to ascertain what type of RPL they require, e.g. for hospital time, extended skills or advanced training.
3. RPL will only be approved for a total of fifty-two (52) weeks.
4. Should the RPL application once submitted not be granted for the full 52 weeks (ie. insufficient evidence is provided) up to three months of the hospital year can be undertaken in general practice posts, at the discretion of the RACGP Censor. Although RACGP’s policy indicates these posts can be undertaken at any stage of training, MCCC has the authority to nominate the timing of this additional training time. MCCC has mandated this time must be added to the end of the registrars core training time.
5. Once submitted, RPL outcomes may not be amended, augmented or revoked.

4. Procedure

ACRRM

1. RPL can be a lengthy and complex process. The initial meeting between the ACRRM registrar and a Medical Educator (ME) will attempt to create a learning plan that will identify learning goals throughout training time, consideration of an AST discipline and potential curriculum gaps (especially in other disciplines not covered in AST). This will inform an RPL application depending on the registrar’s stage of training and whether the registrar enrolled in ACRRM prior to core clinical training (CCT).
2. RPL requires an assessment and recommendation by MCCC and approval by the ACRRM Censor. Registrars are advised to submit their completed applications within the recommended time lines.
3. Application forms are available on the MCCC website. Applications must be made on the ACRRM Recognition of Prior Learning (RPL) Application form.
4. An application must be submitted to the regional Registrar Education and Practice Support Coordinator (REAPS) within the first two (2) months of commencement of training. It should be completed as early as possible as the outcome will inform a registrar’s training plan.
5. The registrar must return the completed application pack electronically to their regional REAPS Coordinator.
6. On receipt of the application, the REAPS Coordinator will check the documentation is complete and request additional information from the registrar if required.
7. The Regional Head of Education (RHE) or delegated ME will assess the registrar’s application. The application will be assessed in light of the applicant’s knowledge, skills, experience, and training requirements.
8. The completed application, with MCCC’s recommendation, will be forwarded to the Censor.
9. Once ACRRM receives the application, the Censor will conduct a final assessment and make a decision. The Censor will confirm this decision in writing to MCCC, which will inform the registrar of the outcome.
10. If a registrar disagrees with the decision regarding RPL, he or she can discuss their concerns with their RHE.
11. If a registrar wishes to appeal a decision, he or she can lodge an application for a review of their RPL with ACRRM.

RACGP

1. The RPL can be a lengthy and complex process and requires MCCC’s Senior Medical Educators and Director of Medical Education to assess and make their recommendation prior to being sent to the college Censor.
2. Applications must be submitted within the first two (2) months of commencement of training in general practice. It should be completed as early as possible as the outcome will inform a registrar’s training planning.
3. This timeframe is needed to ensure that RPL applications are submitted to the RACGP as mandated by the end of GPT1.
4. Guidelines for RPL are available on the MCCC website. An application for the hospital-based year of training must be made via the online RPL portal located on the MCCC website.
5. There is a declaration form that, which is required to be downloaded, signed by the registrar and a witness and re-uploaded to this portal. The application form must be completed in full and all required documents uploaded.
6. Upon receipt of the fully completed application, the Training Support Officer and REAPS will check the documentation is complete and forward it to the Regional Head of Education (RHE) for approval.
7. The RHE, or their delegate, will assess the RPL application. Applications will be assessed considering the applicant’s knowledge, skills, and experience and training requirements.
8. The assessed application requires final sign off by MCCC’s Director of Medical Education and Training (DMET).
9. The completed application, including MCCC’s recommendation, will be forwarded to the RACGP Censor. The application will outline which posts and how many weeks are recommended for RPL. This may be part, or all, of the time initially requested by the registrar.
10. Once the RACGP receives the application, the Censor will conduct a final assessment and make a decision. The Censor will confirm the decision in writing to MCCC who will inform the registrar of the outcome.
11. If a registrar disagrees with the decision regarding RPL, he or she can discuss their concerns with their RHE.  If a registrar wishes to appeal a decision, he or she can lodge an application for a review of their RPL with the RACGP.

5. Document history

The policy above is a combination of ED 002 and ED 003:

ED 002 Recognition of Prior Learning for ACRRM Registrars

Version	Summary of changes
1.0	First version
2.0	Removal of “unrestricted” post
3.0	Edited points 1 and 2 policy section to reflect ACRRM requirement of 12 months PRRT

ED 003 Recognition of Prior Learning for RACGP Registrars

Version	Summary of changes
1.0	First version
2.0	Change approval responsibilities
3.0	Reflect RACGP Policy update
4.0	Reflect RACGP Policy update
5.0	Reflect RACGP Policy update
6.0	Reflect change to when Additional Training time is to be taken
7.0	Minor changes

Training Obligations Policy and Procedure

Last updated: June 2021

Relevant resources

ED 008 Registrar Wellbeing Policy

TR 002 Diversity of Training Experience Policy and Procedure

TR 006 Transfer Between Training Pathways Procedure

TR 012 Metro West Outer Metro training requirements and restrictions Policy

TRF 017 Variation and Verification to Training Time Application

ACRRM Fellowship Training Handbook

AGPT Training Obligation Policy

National Terms and Conditions for the Employment of Registrars (NTCER)

RACGP Standards for General Practice Training

1. Purpose

To outline the training obligations for registrars who are undertaking the Australian General Practice Training (AGPT) program.

2. Scope

Registrars are required to train in accordance with the policies and procedures of Murray City Country Coast GP Training (MCCC) and the Department of Health (the Department) and the standards of the Royal Australian College of General Practitioners (RACGP) and Australian College of Rural and Remote Medicine (ACRRM).

This policy applies to all registrars enrolled in the AGPT program and seeking endpoint to one of the following: Fellowship of the RACGP (FRACGP), Fellowship of ACRRM (FACRRM) or Fellowship in Advanced Rural General Practice (FARGP).

This document should be read in conjunction with the current AGPT Training Obligations Policy.

3. Policy

Training location obligations

General pathway requirements

Please refer to current AGPT Training Obligations Policy and TR 012 Metro West Outer Metro training requirements and restrictions Policy  for further details.

Rural pathway requirements

1. The rural pathway training location requirements do not apply to the hospital/core clinical training year.
2. Registrars who are subject to Section 19AB of the Health Insurance Act 1973 (the ten-year moratorium) must undertake all of their training, including required skills training, under the rural pathway at facilities located in MMM 2-7 locations.
   • These registrars are not eligible to apply to transfer from the rural pathway to the general pathway unless they are first granted a Section 19AB exemption by the Department.
3. A Section 19AB exemption allows the registrar to apply to transfer from the rural pathway to the general pathway. A Section 19AB exemption does not guarantee MCCC or the Department will approve the application to transfer the registrar to the general pathway.
   • a) MCCC will only consider transfers to the general pathway subject to the conditions as set out in TR 006 Transfer between Training Pathways Procedure, and subject to training post availability.
   • b) Registrars not subject to Section 19AB and training on the rural pathway must also undertake all of their training in facilities located in MMM2-7 locations. However, the TR 006 Transfer between Training Pathways Procedure allows MCCC and the Department to consider pathway transfer applications from registrars so that these registrars may train in an MMM 1 location. These registrars do not require a Section 19AB exemption to support their application.
   • For the purposes of Clauses, a and b above:
4. MCCC may allow registrars to undertake Extended Skills (excluding extended skills in General Practice), Advanced Specialised Training (AST) and/or Advanced Rural Skills Training (ARST) temporarily in MMM1 locations, subject to the following conditions being met:
   • MCCC must document that all reasonable options for rural placements within their training region have been exhausted.
   • Upon completion of this term, the registrar must return to MMM 2-7 training locations.
5. Specific location preference is subject to the following conditions:
   • Registrars on the rural pathway must meet the RACGP Diversity of Training Requirement during Core Vocational Training.
6. With consideration to fatigue management and registrar well-being, registrars on the rural pathway are expected to reside within sixty (60) minutes’ travel time from the practice in which they are placed. Attempting to reside further away than this while training in the rural pathway is detrimental to training and potentially hazardous.
7. Exceptions to training location obligations are set out in the current AGPT Training Obligations Policy.

Training time obligations

1. Registrars should refer to the current National Terms and Conditions for the Employment of Registrars (NTCER) for more information about training time. Note that the NTCER refers to industrial arrangements regarding employment and not training requirements.
2. All registrars commence vocational training at 1.0 FTE (38 hours per week full time equivalent) and are supported to undertake full-time training to obtain College Fellowship (FRACGP, FACRRM or FARGP).
3. MCCC will endeavour to provide access to training at less than 1.0 FTE for those registrars who require this flexibility.
4. Registrars wishing to train at less than full time must apply to their RHE as outlined in 4.4.
5. Training at less than 1.0 FTE can only commence with the prior written approval of the RHE.
6. Registrars will be expected to train at the FTE negotiated during the registrar placement process.
7. Any arrangement for variation of training at less than 1.0 FTE or negotiated during the practice placement process is subject to negotiation between the registrar, the training practice and MCCC outlined in 4.4.
8. Only one application will be considered in any given semester unless there are unforeseen and extenuating circumstances.
9. MCCC advocates that registrars wishing to train less than full time should train to a minimum of 0.5 FTE. Training less than 0.5 FTE may adversely impact on exam readiness. However, minimum training time will be based on the NTCER in line with the College’s
10. Only training activities that have been approved by MCCC will be counted towards a registrar’s FTE.
11. Registrars may work more than 38 hours per week, but this will not accelerate their progress towards Fellowship.
12. Registrars who work for more than 38 hours per week must refer to the following prior to doing so:
    • ED 008 Registrar Wellbeing Policy and other related Policies/Guidelines
    • The NTCER.
    • The relevant Occupational Health and Safety legislation.
    • The Fair Work legislation.
13. Part-time registrars are expected to meet and schedule their out-of-practice educational attendance in their first year of training as if they were training full-time (unless otherwise approved). Part-time attendance at workshops compromises the continuity and educational value of the workshops.

Training time definitions

1. MCCC uses scheduled patient consulting time in a non-workshop week as a measure of FTE. This is because the time released for educational activity and in-practice teaching time varies throughout training.
2. Except in exceptional circumstances (e.g. COVID) full-time general practice experience comprises a 38 hour minimum working week (averaged over four weeks), over a minimum of four days per week, inclusive of:
   • A minimum of 27 hours (averaged over four weeks) rostered face-to-face general practice consultation time (in general practice activities)
   • Admin time (1/2 hour per working day)
   • In-practice teaching time
   • MCCC workshops and webinars (practices release full-time registrars for all workshops and webinars).

   Hours worked beyond the above definition of full-time will not be considered.  Any exceptional circumstances must be discussed on a case by case basis with the RHE.

   Part-time general practice experience is considered pro rata against the definition of full-time general practice experience. Part-time general practice must comprise a 14.5-hour minimum working week, over a minimum of two days per week, inclusive of:

   • A minimum of 10.5 hours (averaged over four weeks) rostered, face-to-face consultation time (in general practice activities)
   • Admin time (approximately 1/2 hour per working day)
   • In-practice teaching time (TT1/2 minimum 1 hour teaching regardless of FTE)
   • Workshop and webinar commitments vary from month to month across the year, but average at approximately 3.5 hours per week. Part-time registrars are expected to attend all MCCC workshops and webinars with their cohort.

   Any exceptional circumstances must be discussed on a case by case basis with the RHE.

   Those seeking Fellowship of the RACGP cannot train at less than 0.3 FTE (14.5 hours over 2 days) as per the college requirements. Those seeking Fellowship of ACRRM cannot train at less than 0.5 FTE as per the college requirements.

Variation to training time procedure

1. Registrars wishing to train at less than 1.0 FTE must then apply to their RHE by submitting a Variation and Verification of Training Time Application Part A at least twenty (20) business days prior to the requested commencement date of the revised FTE.
2. The registrar will be contacted by the RHE and/or REAPS to understand the reasoning for the change and to ensure the registrars wellbeing.
3. If approved, the training time will need to be verified by the practice and the registrar using the Variation and Verification to Training Time Application Part B. This is submitted to the regional REAPS and approved by the RHE.

4. Document history

Version	Summary of changes
1.0	First version
2.0	Updated Policies: Change RSCA to MMM, updated procedure to apply for a variation of training time
3.0	Third version

On-Call Guidelines and Procedure for Registrars and Supervisors

Last updated: January 2019

1. Purpose

Some MCCC accredited training practices require their registrars to participate in an after-hours on-call roster. While on-call, these registrars must be appropriately supervised by a RACGP/ACRRM accredited supervisor who is able to attend the patient, should the registrar require this.

2. Procedure

Where a registrar is on-call or will be rostered on-call during the training term, the following guidelines are applicable:

1. Registrars must have received a thorough orientation to their on-call responsibilities and to the equipment and staff at the Urgent Care Centre.
2. GPT1 registrars should not, unless unforeseen circumstance prevail (such as illness or incapacity of other GPs on the on-call roster), be rostered on-call for at least the first six weeks of the term.
3. The hours a registrar is rostered on-call should not be more onerous than those of other GPs in the practice participating in the on-call roster.
4. Training practices must confirm that all registrars have completed or are scheduled to complete either the REST course or ALS training, whichever is applicable, which is provided to all registrars working in rural areas.
5. Registrars working on-call must be supervised by an accredited MCCC supervisor at all times. Where such a supervisor is working in a different practice to that of the registrar, an introductory meeting between the registrar and the supervisor is advisable prior to the registrar’s first on-call shift.
6. If required, the supervisor should be available to attend on-site to assist the registrar if necessary, within the practice/hospitals usual agreed acceptable on-call distance/time delay. A delay of greater than thirty minutes is not considered appropriate for the safety of patients or registrars.
7. Where on-call arrangements for an area are shared among a number of practices, the registrar, if practically possible, should only see patients of their own practice or another MCCC accredited practice. Supervision arrangements for the registrar should be as above (see 5). Ideally there should be access to medical records after hours from the Urgent Care Centre.
8. The registrar’s usual supervisor should discuss physical safety arrangements with the registrar prior to commencing on-call work e.g. travelling alone at night, emergency contact numbers such as police. Where a registrar is responsible for hospital in-patients (which may occur while a registrar is on-call for the Urgent Care Centre), the supervisor needs to ensure that the details of registrar supervision and indemnity arrangements are clearly outlined in the contract with the hospital. Registrars are advised to view a copy of this contract for inpatient work. The registrar still requires supervision by an MCCC supervisor when on-call for in-patients.
9. On-call rosters need to give consideration of the potential for registrar fatigue. On-call for registrars should not be scheduled overnight prior to a MCCC workshop so as to ensure the registrar is safe to drive and fit to participate in the workshop.
10. Practices need to give consideration to management of practice bookings and workload following an overnight on-call which has been particularly demanding or busy. These strategies should be discussed with the registrar as part of the orientation to the practice and there should agreement from all parties on how these arrangements will be implemented.
11. Registrar on call time spent attending to patients can be counted towards training time and
    recorded as such on recipient created tax invoices (RCTIs). By contrast, on-call time with no direct patient contact cannot count toward training time. The RACGP requires that time spent attending to patients after hours is documented and substantiated.

Additional time spent on-call, when not physically conducting a consultation with a patient, is not included. When practices are calculating this time, the practice software can extract the relevant billing codes and/or billing charges.

Appendix

The applicable after-hours items numbers are:

• After hours home visits: 5003, 5023, 5043, 5063
• After hours RACF visits: 5010, 5028, 5049, 5067 (nursing homes)
• After hours urgent consults at clinic: 585, 591, 594, 599, 600
• Prolonged professional attendance – patient in imminent danger of death 160, 161, 162, 163, 164

Practices could check this in several ways:

• Run an Item or Transaction report for the registrar for the month and then just check how many of these items showed up.
• Do a search for these items or
• Check with the registrar/reception if any after-hours billings took place. This should be noted either in an after-hours log or within the appointment screen

3. Document history

Version	Summary of changes
1.0	First version

Leave from the Program 

Please refer to AGPT’s leave policy here.

Return to training following absence

Last updated: June 2021

Relevant resources

ED 005 Registrar in Difficulty Procedure

ACCRM Fellowship Handbook

Australian Medical Board “Information on Returning to Practice” Factsheet

Australian Medical Board Registration Standard: “Recency of Practice”

1. Purpose

MCCC GP Training recognises that registrars who have had extended periods of absence from general practice training, may require additional support to facilitate their return to clinical practice and fulfil training requirements. This procedure outlines a standardised approach to the assessment and planning for additional support where required. For the purposes of this procedure, extended leave is defined as a period of time of twelve months or longer from clinical general practice. Extended leave also includes time taken to do Advanced skills or Advanced Rural Skills Training.

2. Scope

This procedure is applicable to all registrars enrolled in the Australian General Practice Training (AGPT) RACGP and ACRRM programs, Regional Heads of Education (RHEs), relevant administrative support officers and the portfolio leads for Registrar Monitoring, Assessment and Progression and Pastoral and Learning Support (PALS).

3. Policy

MCCC GP Training recognises that registrars may take leave or not work in clinical general practice for a variety of reasons, and that there are a number of factors that may affect their ability to transition back into clinical work and training commitments. These include but are not limited to:

• How long the GPR has been away
• Reasons for absence, and potential for this to impact on their return to training
• Were there any concerns about the GPR before they went on leave?
• Has the registrar undertaken any study or otherwise made attempts at maintain knowledge and skills whilst absent?
• Do any workplace modifications or accommodations have to be made?

In order to successfully support safe return to training, MCCC GP Training advocates an early assessment, with subsequent development of an individualized Focused Learning Intervention (FLI) where appropriate, recognising the specific needs of each registrar.

4. Procedure

1. Registrars who have been absent from clinical general practice training for longer than twelve months are identified by relevant administration staff and notified to the RHE. This initiates a process for assessment of the registrar as per Level 2 of the PALS pathway.
2. The RHE (or delegate) will arrange a meeting with the registrar to discuss their return to training and identify any significant issues that may need to be considered.
3. Where the registrar has already matched with a practice, the practice should be advised that the registrar has had an extended period of leave and informed of the assessment procedure. If the registrar has not secured a position, the RTO should assist in facilitating this.
4. The registrar will undergo an assessment, depending on their stage of training:
   • Registrars returning at the start of Training Term 1 (TT1) will undergo Initial Assessment (IA) with the rest of the TT1 cohort.
   • Registrars returning part of the way through TT1 will sit the IA MCQ prior to their return, and have an ECTV, Practice Manager report and Supervisor report in the first two to six weeks of practice.
   • Registrars returning at the start of Training Term 2 (TT2), will sit the Further Assessment (FA) MCQ and clinical reasoning questions (CRQs) prior to their return and have an ECTV, complete a Self- reflection tool (SRT) and Practice Feedback tool (PFT) and Supervisor report in the first two to six weeks of practice.
   • Registrars returning part of the way through TT2 level, will sit the FA MCQ and CRQs prior to their return and have an ECTV, SRT and PFT and Supervisor report in the first two to six weeks of practice.
   • Registrars returning at the start of Training Term 3 (TT3), will sit the Term 3 Assessment (T3A) prior to their return and have an ECTV and Supervisor report in the first two to six weeks of practice.
   • Registrars returning part of the way through TT3 level and beyond, who have NOT passed their relevant college Fellowship exams, will sit the T3A prior to their return and have an ECTV, and Supervisor report in the first two to six weeks of practice.
   • Registrars who return to TT3 and beyond and have passed their relevant college Fellowship exams will require an early supervisor report in the first two to six weeks of practice. They may also require an early ECTV depending on the report.
   • The SRT and PFT can be used as part of the assessment for registrars returning to practice in TT3 and beyond if requested by the RHE.
5. The RHE (or delegate) will review the assessment results and provide information to the allocated Training Advisor to facilitate feedback to the registrar.
6. Early allocation of a Training Advisor is recommended to provide a point of contact and support for the registrar.
7. Registrars returning at the start of TT1 will have a Training Advisor Review Meeting (TARM) in line with the standard IA procedure.
8. For all other registrars, the first TARM will ideally occur in the sixth-seventh week after the registrar re-commences to discuss feedback from the assessment process and review their learning plan and/or FLI where applicable. Additional TARMs may be held as needed.
9. The RHE will involve the local PALS ME if any issues have been identified during the assessment process. Additional assessment may be needed as per the PALS procedure Level 2, to provide clarification of these issues.
10. Where a registrar is identified as requiring additional support, the procedure for PALS Level 3 or 4 should be followed, depending on the additional resources and needs identified.

5. Document history

Version	Summary of changes
1.0	First version
2.0   3.0	Change to GPT and PRRT to Training Term.  Changed leave to from “more than 12 months” to “12 months or longer” Updated formatting Self -reflection tool and practice feedback tool for FA and beyond added. Timeline changed 2-6 weeks from 2-4 weeks for all assessments.

Extension of Training Time

Please refer to AGPT’s Extension of Training Time policy here.

Registrar Learning Needs and Learning Plan Policy

Last updated April 2021

Relevant resources

RACGP Standards for General Practice Training

ACRRM Fellowship Training Handbook

1. Purpose

To describe the requirements for identifying and recording registrar learning needs and suggested methods by which registrars can maintain learning plans.

2. Scope

This policy applies to all Murray City Country Coast GP Training (MCCC) registrars, supervisors and medical educators.

3. Policy

1. A competent general practitioner recognizes that learning and professional development is a dynamic and lifelong process and that learning needs continue to present and evolve throughout a medical career.
2. Planned and proactive self-directed learning is an essential skill all GPs must acquire and maintain. Use of an effective tool to manage learning needs such as a learning plan is highly recommended.

4. Procedure

Maintenance of a Learning Plan

1. All MCCC registrars are required to keep an up-to-date learning plan. It is recommended that the learning plan be maintained on at least a monthly basis. The following information should be recorded in the plan:
   • Identified learning needs: May be required knowledge, skill or experience; should be finite in nature, e.g. “management of melanoma”, not “dermatology”.
   • Proposed learning activity: Description of the activity, e.g. “attend education symposium” or “read relevant journal article”.
   • Record of the activity undertaken: Specific nature of activity undertaken, e.g. “attended GP Dermatology Course” or “Australian Family Physician Article: Chaos and Clues”.
   • Outcome of learning activity: Description of learning achieved, e.g. “understanding of principles of melanoma management in general practice including biopsy techniques, excision margins and referral processes”.
2. The learning plan must be maintained in an electronic format of the registrar’s choosing, e.g. on a spreadsheet, Word document, or within Pivotal. Dates for each entry must be recorded.
3. A minimum of two (2) learning needs and activities must be recorded each month.
4. The registrar is not required to upload the learning plan on to Pivotal. The learning plan does, however, need to be viewed when discussed with supervisors, medical educators and training advisors.

Identifying Learning Needs

1. Registrars identify learning needs as either gaps in knowledge, the need to acquire or hone a skill, or embellish experience. It is recommended that when a learning need is recognized, it is recorded in a notebook or device at the time and then added to the learning plan and addressed when appropriate/convenient. Learning needs can be identified in response to the following:
   • Patient presentations.
   • Assessments/training requirements.
   • Personal interest in a topic.
   • Conscious incompetence.
   • Receipt of reading material.
   • Peer discussion.
   • Supervisor feedback/teaching sessions.
   • Workshops

Meeting Learning Needs

1. It is encouraged that registrars use varied methods for meeting their learning needs. Choice of learning activity should appropriately reflect the required learning outcome. Methods include use of:
   • Medical texts.
   • Medical literature, e.g. Australian Family Physician, How to Treat, Check, Medicine Today.
   • Attendance at educational seminars and symposia.
   • On-line resources, e.g. Dynamed, UpToDate, eTG.
   • One-on-one education with colleagues, e.g. supervisors, allied health practitioners, practice managers, practice nurses.

Recording Learning Outcomes

1. Registrars must record a synopsis of the learning outcomes achieved as a result of participating in the learning activity.

Reviewing the Learning Plan

1. Registrars’ learning plans are reviewed via the following procedures:
   • At each External Clinical Teaching Visit (ECTV) by the visiting medical educator, with the review recorded in the ECTV report.
   • By training advisors at the training advisor review meeting, with the review recorded in the Training Advisor Review Meeting Report.
   • By supervisors throughout the term, with the review recorded in the Supervisor Report twice a term.
2. When the learning plan is reviewed, the educator and registrar discuss the registrar’s choice of learning activity in meeting particular learning needs, and whether learning outcomes were achieved.

Concerns about a Registrar’s Learning Plan

1. It is expected that registrars will:
   • Enter at least two (2) learning needs in to their learning plan per month.
   • Record learning needs that are finite, specific and achievable in nature.
   • Involve activities that are educationally valuable.
   • In instances in which registrars do not maintain a learning plan adequately, the medical educator will give that registrar a period of two (2) months in which to bring the plan up to date. The medical educator will contact the registrar at the conclusion of the two-month period to request the updated document be submitted for review.
2. If the registrar fails to produce a remedied plan, the registrar will be referred to their Regional Head of Education (RHE). The registrar’s progression through, and completion of training may be suspended by their RHE until a valid learning planner is produced.

5. Document history

Version	Summary of changes
1.0	First version

Metro West Outer Metro Training Requirements and Restrictions Policy

Last updated: March 2019

Relevant resources

AGPT Training Obligations Policy

DoctorConnect

RACGP Requirements for Fellowship Policy

1. Purpose

To outline Murray City Country Coast GP Training’s (MCCC) position on outer metropolitan (outer metro) training placements.

2. Scope

This policy applies all MCCC registrars who are enrolled in the general training pathway of Australian General Practice Training (AGPT) program with the Royal Australian College of General Practitioners (RACGP).

3. Policy

1. The AGPT Training Obligations Policy requires all general pathway registrars to undertake twelve (12) calendar months of training in a prescribed outer metropolitan location, regardless of whether they are full time or part-time. Registrars in MCCC’s Metro West region may undertake this time in an accredited outer metro Melbourne practice, the boundaries of which are defined by the Department of Health (via the Doctor Connect website). Variations of this requirement are possible and specified by AGPT in the AGPT Training Obligations Policy
2. The RACGP Requirements for Fellowship Policy requires registrars to train in at least two different general practices during their general practice based training.
3. In order for MCCC to assist its registrars in meeting both the above requirements, registrars will not be allowed to train for more than twelve (12) calendar months in outer metro training practices (e.g. registrars cannot spend 12 months in one outer metro practice and then move to another outer metro practice). This will make available more outer metro posts and encourage registrars to experience a diverse range of practices.
4. Any variation to this policy will require approval from both the outer metro practice and the Metro West Regional Head of Education (RHE) and the Director of Medical Education and Training (DMET).

4. Document history

Version	Summary of changes
1.0	First version
2.0	Amendment to section 4.3 to clarify outer metro training placements 12 months only
3.0	Slight amendment to wording in policy section

Registrar Placement Policy

Last update: September 2021

Relevant resources

Registrar Placement Guide

TR 002 Diversity and Training experience

TR 026 Boundaries in Therapeutic and Professional Relationships Guidelines

ED 022 Training Post Supervisor Accreditation Procedure: new training post

AGPT Obligation policy

AGPT Rural Generalist Policy 2020

ACRRM Fellowship Training

National Terms and Conditions for the Employment of Registrars (NTCER)

1. Purpose

To facilitate the placement of registrars to practices, in a transparent and equitable way. Whilst addressing community need and considering the registrars’ career goals and training requirements.

2. Scope

This policy applies to registrars enrolled in the Australian General Practice Training (APGT) program with Murray City County Coast GP Training (MCCC).

Nothing in this policy negates any other obligations placed on a registrar, specific requirements of the Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM) or requirements of the AGPT Rural Generalist Policy.

Registrars and practices must participate in the process for a placement to be approved by MCCC.

3. Policy

Placement is a process that must consider the needs and requirements of communities, practices, supervisors and registrars training needs. As well as obligations and requirements of the AGPT program, the Department of Health (the Department), RACGP and ACRRM.

Placing registrars in practices is intended to:

1. assist in building a sustainable primary healthcare team within the MCCC footprint especially in areas of higher workforce need
2. encourage registrars to take advantage of the experience offered by more rural and remote practices
3. support each registrar’s identified training needs e.g. Rural Generalist (RG Pathways), RG Consolidation of Skills, College requirements and general pathway obligations
4. ensure equitable distribution of registrars to training practices
5. ensure transparency of process, and,
6. expose registrars to a variety of practices

Registrars are required by AGPT to train full time unless otherwise pre-approved a minimum of 20 days prior to placement.

MCCC will implement strategies to ensure that registrars with specific needs and requiring particular opportunities are placed accordingly.

MCCC will take into consideration the Registrar’s college/s requirements when approving the practices registrars may apply to.

4. Pathway specific requirements

RACGP General Pathway registrars

General Pathway registrars are predominately placed in MMM1 locations being Melbourne or Geelong CBD but also have access to MMM2 – 7 training placements.

General Pathway registrars have an outer-metro or rural obligation.

Outer Metro – Due to the number of outer-metro practices available, Metro West registrars are required to train a maximum of 12 calendar months in outer-metro

Rural locations – General Pathway registrars may however undertake all or some of their training in MMM2 – 7 locations.

Due to the availability of practices within the Metro West region, MCCC recommends Metro West registrars undertake two six-month placements.

RACGP Rural Pathway registrars

RACGP Rural Pathway registrars must be placed in practices in MMM2 – 7 locations or Priority Distribution Areas.

With consideration to fatigue management and registrar well-being, registrars on the rural pathway are expected to reside within 60 minutes’ travel time from the practice in which they are being matched to. Attempting to reside further away than this while training in the rural pathway is detrimental to training and registrar well-being.

It is a requirement that registrars will live and work in the area where placed. RACGP registrars are required to undertake the diversity requirement set by the College.

ACRRM registrars

ACRRM registrars are to apply to practices that will provide them with the environment and training best suited to this pathway.

ACCRM registrars are considered Rural Generalists (RG) and are therefore eligible to apply through the RG placement process, to a defined pathway.

Alternatively, ACRRM registrars are recommended to participate in the Priority Placement process, which provides preferential access to practices that provide the rural and remote context experience as specified by the College.

MCCC strongly advocate for ACRRM registrars to undertake their Community Primary Care in an MMM4 and above locations.

RACGP Rural Generalists (RG)

RACGP Rural Generalist registrars will have a separate placement process where they can apply to defined RG pathways or be placed in practices that offer Rural Generalist-Consolidation of their Advanced Skill.

RACGP Rural Generalist registrars are to complete training plans with defined pathways that are advertised and obtained. The registrar is required to train in the post and practices detailed within their designated pathway.

Should a Rural Generalists registrar not be successful in obtaining an advertised training pathway, they may participate in the Priority or Competitive Placement process. These practices are in MMM3 and above locations.

5. Prior to Allocation Process

Important Information for Registrars

All intakes

MCCC works in partnership with hospitals and expects registrars, who have accepted a hospital position for the following year, to honour that commitment.  MCCC will not support registrars reneging on an accepted hospital placement to commence their training in general practice unless there is agreement from the hospital to release the registrar.  Evidence must be provided by the registrar from their employer that identifies in writing their agreement to release the registrar.

AGPT Second Intake

Most candidates who successfully obtain a place with MCCC in the second AGPT intake, will undertake hospital term for their first year of training.  To avoid disappointment of being unable to secure a placement, those GP trainees are strongly encouraged to obtain a hospital placement.

Typically, only limited practice placement vacancies are available for second intake and MCCC’s GP Trainee Placement Handbook provides information on possible vacancies at the time of second intake.

Placement into Practice vacancies in second intake will be subject to candidates:

• Securing a Practice Placement in the vacancies available before and submitting to MCCC any Medicare Provider Number information required within required timelines; and
• Not having accepted an offer of employment with a hospital; and
• Submitting and meeting Hospital Experience Assessment requirements within MCCC timelines

6. Allocation Process

Registrars with identified training requirements will be placed in practices that can provide this training e.g. Consolidation of Skills training, Rural Generalist training and identified training support. Community need will also be given precedence. This regulation supersedes all other placement regulations.

There is a restriction on the number of highly desirable (HD) ratings a registrar and practice can be allocated:

Registrars:

• 1 x HD rating (per placement)
• No limit on Desirable (D) ratings

Practices:

• 1 x HD rating per training level for TT1-2 and/or TT3-4* for 12 months (two registrars in total)
• Practices placements for single-semesters (6 months) can preference 1 x HD registrar per term (two registrars for the year)

*Allocations of TT 3-4 registrars will be reviewed by MCCC based on factors such as practice accreditation and availability of registrars.

Practices should remain open to receive applications during the entire initial application period. Registrars are aware they have this nominated time period to apply so closing applications early may disadvantage registrars.

Practices must provide one full time equivalent (FTE) supervisor for every two registrars to adequately support the teaching and learning requirements. MCCC will not support placement of registrars above this ratio, without exceptional circumstances and pre-approval.

Practices hoping for multiple registrars are better to indicate this capacity with additional TT 1-2 registrars, rather than have an expectation of a TT 3-4 registrar, as the number available can be limited.

Allocations will prioritise community need and training requirements e.g. RG-Consolidation of Skills placements.

Following this, HD Practice to HD Registrars matches and subsequent desirable matches will be allocated.

Allocations are made in the following order:

1. Community or training need
2. HD Practice to HD Registrar
3. HD Practice to D Registrars
4. D Practice to D Registrar.

MCCC will endeavour to match a minimum of one GP Trainee for each suitable practice, until all vacancies are filled.

MCCC is unable to guarantee that this minimum number will be achieved for every practice as factors such as number of GP Trainees, practice and registrar preferences, training requirements and practice restrictions must be considered by MCCC when determining allocation. For equity purposes, once all practices that received a preference are filled with at least one registrar, additional allocations may then be made dependent on registrar numbers and suitability of the practice.

It is expected that all practices accredited for TT1 registrars are able to receive at least one TT1 for a minimum of 12 months over a three-year period (this can be 2 x six-month placements).

MCCC is responsible for ensuring GP trainees are placed in a suitable training practice

7. Conditions Pertaining to the Registrar Placement Process

1. Under this policy direct approaches or agreements cannot be made between a registrar and practice. Registrars and practices should not attempt to make private arrangements or for a placement as MCCC will not approve these agreements.
2. Registrars and practices must not discuss how they intend to preference each other. Registrars and practices not abiding by this condition are at danger of being withdrawn from the placement process.
3. MCCC require registrars and practices to be considerate of their peers and other training practices and to follow these regulations during the placement process.
4. Registrars must advise the practice of the time fraction they intend to work and any upcoming leave at the time of interview.
5. Both registrar and practice should discuss the requirements of the position e.g. after-hours work, on-call, anticipated leave etc.
6. The final placement is the decision of MCCC with consideration given to both parties’ preferences and any other factors that are relevant to the placement. Placements in the Competitive Placement phase will not be allocated until the end of the placement period regardless of when the submission comes in.
7. Once the placement has closed and MCCC emails out the placement outcome, the placement is considered binding. This is not reliant on a contract between the registrar and practice being in place.

Additional Practice Obligations

1. A practice must be able to provide enough supervision for the number of registrars in training. The ratio being two registrars for every one accredited supervisor.
2. Through the accreditation and/or re-accreditation process practices will be informed of the level/s of registrar/s suitable to train in their practice
3. In some circumstances due to limited supervision or location restrictions, some practices are accredited to receive only higher level registrars. In these circumstances placements will be distributed to also factor in these requirements.
4. Supervisors must inform registrars of any upcoming leave and/or changes to supervision at the time of interview.

Additional Registrar obligations

1. Registrars must complete all scheduled interviews before submitting their preferences. Failing to attend scheduled interviews is unprofessional and will limit registrars’ chances of being allocated to a practice.
2. Registrars must interview with practices in order to preference them.
3. Registrars must inform practices of any upcoming leave and/or changes to hours, or any other employment changes that may impact on registrar training at the time of interview.
4. Registrars must preference a minimum of three genuine practice options for their application to be considered.

8. Withdrawals 

During the placement process

A registrar or practice may withdraw during the placement process however they must inform MCCC and the other involved parties immediately.

1. The registrar must advise all practices they have interviewed or have booked to interview at, and MCCC of their intended withdrawal.
2. The practice must advise all registrars they have interviewed or have booked to interview and MCCC of their intended withdrawal.

After the placement process

Once the placement has closed and MCCC emails out the placement outcome, the placement is considered binding. This is not reliant on a contract between registrar and practice being in place.

If for any reason a registrar or practice wishes not to continue with the placement, they have been allocated by MCCC, the withdrawing party may not receive a placement by MCCC for that same term or advertised vacancy.

9. Procedure

Please refer to the MCCC GP Trainee Placement Handbook for the details of the Placement Process, including key dates and actions required.

Practices and registrars will also be provided with information at relevant points via email.

1. Practices will utilise the MCCC practice portal to communicate shortlisted registrars and final preferences.
2. Registrars will be emailed a link to enter their preferences at the appropriate time.

10. Document history

Version	Summary of changes
1.0	First version – list major key changes with each version change
2.0	Second version
3.0	Third version
4.0	Fourth version
5.0	Fifth version
6.0	Sixth version
7.0	Seventh version
8.0	Eighth version

Diversity of Training Experience Policy and Procedure

Last update: August 2020

Relevant resources

TRF 002a Alternative Option to Practice Site Diversity Application

TRF 002b Exemption to Practice Site Diversity Application

AGPT Training Region Obligations Policy

RACGP Standards for General Practice Training A Guide to Managing Practice Diversity

Vocational Training Pathway – Requirements for Fellowship Policy

1. Purpose

To guide registrars training towards Fellowship of the Royal Australian College of General Practitioners (RACGP) in meeting the RACGP’s diversity of training experience requirement. This document should be read in conjunction with the RACGP’s “Vocational Training Pathway – Requirements for Fellowship Policy” and the associated “A Guide to Managing Practice Diversity”.

2. Scope

This document outlines the procedure by which registrars, enrolled in the RACGP training pathway, can meet their diversity requirement with MCCC.

3. Policy

The RACGP Diversity policy requires registrars to have exposure to at least two different supervisors and two different practice management systems. In addition to this there is a requirement to be exposed to diverse patient populations.

MCCC and the RACGP emphasise that the best way to meet this requirement is to have experience across different practices.

Diversity cannot be met by working in a branch practice associated with the registrar’s main practice. A definition of a branch practice is available in the document “A guide to Managing Practice Diversity”.

It is acknowledged that there are circumstances where a registrar may consider that moving practices will pose undue hardship. In this case a registrar may request an exemption. Exemption requests will be considered on a case by case basis.

Pressure should not be applied to registrars to remain in one practice (or a group of similar practices) if they wish to move between training terms.

MCCC will assist registrars in meeting their diversity requirements. The requirements can be met in several ways¹.

1. Working in at least two practices during their GPT 1-4 terms.
2. Utilising the alternative options to diversity training available to MCCC registrars
3. Request an exemption to moving practice TRF 002 Exemption to Practice Site Diversity Application and meet the RACGP requirements by other means.

4. Procedure

1.Working in at least two practices 

Placements are made via the Registrar Placement process.

¹MW (Metro West) region registrars are expected to move practices in their GPT 1, GPT 2 and GPT 3 terms. Registrars in the MW region who wish to stay in a practice for greater than a training term are required to discuss and request prospective approval from the MW RHE and the DMET.

2. Alternative options

 Alternative options include either a composite post or attendance at an alternative practice for a shorter duration of time. These are explained below:

1. Composite
   • A composite post is achieved by working a minimum of fourteen and a half (14.5) hours per week over two (2) days for a minimum of twenty-six (26) weeks in an Aboriginal Health Post, while continuing to work a minimum of fourteen and a half (14.5) hours per week over two (2) days in the current practice.
2. Attendance at an alternate practice for a specified number of sessions per week over a specified period.
   • Registrars must work at an alternative practice for a minimum of fourteen and a half (14.5) hours per week over two (2) days as a minimum in any one position. A total of twenty-six (26) working days must be achieved under this arrangement, which can be done as a continuous six-week block or part time for three (3) sessions a week across fourteen (14) weeks. If more sessions are undertaken per week, the duration will be reduced pro rata.
   • The alternative practice must be an RACGP-accredited practice, situated in the same region as the registrar, and able to provide appropriate supervision in accordance with the registrar’s level of The practice must not be a branch practice, as defined by the RACGP.
3. The registrar must notify their REAPS of their intention to utilise one of the alternative options to meet their diversity This should be done at least 3 months prior to the practice match so that there is adequate time for the request to be addressed and provider number applications processed.
4. The REAPS will then notify the RHE. If both the registrar and RHE agree to the proposed option, a confirmatory email will be sent to the registrar by the RHE.
5. Once details of the placement are finalised, the registrar must complete TRF 002a Alternative Option to Practice Site Diversity Application and send it to the REAPS. This must be submitted at least 2 months prior to the placement commencement.
6. It is the responsibility of the registrar to arrange their diversity placement, complete the relevant paperwork in the stated timeframe and undertake the proposed The registrar will not be eligible for fellowship until the diversity placement is completed.

3. Exemption to Practice Site Diversity

 In certain circumstances, and only in discussion with the RHE, DMET and training practice, a registrar may remain in a single practice for the entirety of their training. For example, if a registrar has moved their family to a rural community and considers that leaving the community would be detrimental to the registrar, their family, the practice and the community, an exemption would be considered.

1. For an exemption to be considered, the registrar must discuss their situation with their regional RHE as early in their training as possible
2. If the RHE agrees that the registrar’s situation meets the requirements of an exemption, then the matter is discussed with the DMET
3. If both the DMET and the RHE agree that an exemption is reasonable, the registrar will be required to complete and submit Section A of the TRF 002b Exemption to Practice Site Diversity Application form within 4 weeks of being notified by MCCC.
4. Information that is to be provided in Section A includes:
   • The names of two MCCC accredited supervisors who actively undertake your clinical supervision in your current practice
   • Details of how the registrar plans to meet the practice management
     • PRACTICE MANAGEMENT REQUIREMENTS

It is expected that the registrar will read through the following three of the modules in the General Practice Management Toolkit of the RACGP

• • • 1. Business Structure
      2. Practice Teams and
      3. Leadership Clinical Governance

The registrar will then arrange a visit to another general practice and write a comparative essay (600 -1000 words) between the two practice management systems under the three headings above, focusing on:

1. 1. • 1. Benefits and Risks of the two business models identified
        2. Attributes of effective working groups
        3. Risk assessment of the clinical governance across the two practices.
      • Alternatively, the registrar can submit a detailed plan of how they wish to meet the Practice Management Requirements. This option will need to be to be discussed with and approved by the RHE and the DMET.

• • Evidence of “Scope of Practice” the registrar plans to provide to show the comprehensiveness of practice, as outlined in the RACGP definition of general practice.

COMPREHENSIVENESS OF PRACTICE

“General practitioners are not limited by age, gender, body system, disease process or service site. The scope of clinical practice is challenging, spanning prevention, health promotion, early intervention for those at risk, and the management of acute, chronic and complex conditions within the practice population whether in the home, practice, health service, outreach clinic, hospital or community.”

This could be demonstrated using the following alternatives:

1. 1. 1. 1. Logbook of 100 consecutive patients providing details such as age, gender, presenting complaint/s, acute vs chronic, use of health promotion/preventative health practices.
         2. Audit of the last 100 patients seen outlining the same as above.
         3. Report of the patients seen over the last month detailing scope of practice, as outlined above, using a data extraction tool (eg. PEN CAT Tool).
         4. An alternative different from above. This option will need to be discussed with and approved by the RHE and the DMET.
         5. A combination of any of the above alternatives. This option will need to be discussed with and approved by the RHE and the DMET.

5. If approved, the registrar will be notified in

1. • The registrar will then complete the activities as outlined in their application within the first three semesters of training
   • The registrar will then submit Section B of TRF 002b Exemption to Practice Site Application form by the proposed date (stated in Section A). Note: The date must be at least six months prior to the registrar’s anticipated completion of training

6. If the submission does not meet the requirements as outlined in sections 3.4.2 and 4.3.4.3 above, the registrar will be asked to resubmit. The registrar will not be eligible for fellowship until the activities planned to meet diversity requirements are completed to a satisfactory standard.

5. Document history

Version	Summary of changes
1.0	First version
2.0	Second version
3.0	Amendments made throughout document
4.0	Amended sections 4.2 and 4.3

Transfers between Training Pathways Procedures

Last update: January 2019

Relevant resources

TR 007 Registrar Placement Policy and Procedure

TR 013 Change of MCCC Region Policy

AGPT Application – Pathway Transfer

AGPT Application – Transfer Between RTOs or Training Region

1. Purpose

To ensure that applications to transfer between pathways are dealt with in a fair and transparent manner and in accordance with the AGPT Transfer Policy.

2. Scope

This procedure applies to formal applications received from registrars enrolled in the Australian General Practice Training (AGPT) program wishing to transfer between pathways.

3. Definitions

The following definitions apply to this procedure:

MMM 3. Geographical Remoteness Classification

The Modified Monash Model is a geographic classification system: The Modified Monash Model is a geographical classification system which uses up-to-date population data which can be used to better address the maldistribution of medical services across developed by eminent rural academics at Monash University that allows quantitative comparisons between city and country Australia. The Modified Monash (MM) categories (once called Remoteness Areas RAs) are defined as follows:

MM 1: All major cities of Australia.

MM 2: Inner and outer regional Australia that in terms of remoteness: the physical distance of a location from the nearest urban centre based on population size. There are in, or within 20 kilometres road distance, of a town with a population >50,000.

MM 3: Inner and outer regional Australia not included in MM 2 and are in, or within, 15 kilometres road distance of a town with a population between 15,000 and 50,000.

MM 4: Inner and outer regional Australia not included in MM 2 or MM 3 and are in, or within, 10 kilometres road distance of a town with a population between 5,000 and 15,000.

MM 5: All other inner and outer regional Australia.

MM 6: All areas categorised as remote Australia that are not on a populated island that is separated from the Australian mainland in the Australian Bureau of Statistics geography and is more than 5 kilometres offshore.

MM 7: All other areas – that being all areas categorised as very remote Australia and areas on a populated island that is separated from the Australian mainland in the Australian Bureau of Statistics geography and is more than 5 kilometres offshore.

Category 2 (transfer): One of the three seven MM categories:

MM1:	Major Cities (formerly RA1)
MM2:	Large Regional areas – areas formerly categorised RA2 and RA3 that are in, or within 20km road distance of a town with population less than 50,000.
MM3:	Medium Large Regional – areas formerly categorised RA2 and RA3 that are not in MM2 and are in, or within 15km road distance, of a town with population between 15,000 and 50,000.
MM4:	Medium Regional – areas formerly categorised RA2 and RA3 that are not in MM2 or MM3 and are in, or within 10 km road distance of a town with population between 5,000 and 15,000.
MM5:	Small Regional – All other areas in RA2 and RA3.
MM6:	Remote – All areas categorised RA4 that are not on a populated island that is separated from the mainland in the ABS geography and is more than 5km offshore.
MM7:	Very Remote – All other areas, that being RA5 and areas on a populated island that is separated from the mainland in the ABS geography and is more than 5km offshore.

4. Policy

1. Registrars training on the general pathway do not require an AGPT approved transfer in order to train in a Modified Monash Model MM1-MM7 location. The general pathway includes MM1-7 locations.
2. However, registrars should note that MCCC has a policy regarding the placement of general pathway registrars in MM2-7 locations. Registrars should read this procedure in conjunction with TR 007 Registrar Placement Policy and Procedure.
3. Where registrars need to undertake Extended Skills, Advanced Specialised Training and/or Advanced Rural Skills Training terms, MCCC may approve rural pathway registrars temporarily training in an MM1 location. Upon completion of the training term, rural pathway registrars are expected to return to their MM2-7 placements. A transfer from the rural pathway to the general pathway is not required in this instance.
4. For registrars subject to section 19AB of the Health Insurance Act 1973 (the ten-year moratorium), successful application for exemption from the moratorium is a prerequisite to an application for transfer from rural pathway to general pathway training. The granting of an exemption to the 19AB moratorium is not a guarantee that an application for transfer will be granted.
5. Registrars wishing to request a pathway change that may also require a change of MCCC region must also read TR 013 Change of MCCC Region Policy.

5. Procedure

1. Before formally applying for a transfer between pathways, a registrar is encouraged to discuss the anticipated application with his or her GP supervisor, Training Advisor (TA), Regional Head of Education (RHE) and/or Registrar Education and Practice Support (REAPS) Coordinator.
2. A registrar initiates the formal application to transfer between pathways by completing the AGPT Application – Pathway Transfer in addition to the TRF 0013 Change of MCCC Region form. This is sent to their REAPS Coordinator via email, together with supporting documents.
3. The REAPS will check that the application is complete and forward it to MCCC’s Training Operations Team Leader (TOTL), acting as the Chief Executive Officer’s (CEO) delegate.
4. The TOTL will take the application to a committee comprised of the CEO and Director of Medical Education & Training (DMET) and discuss with the registrars Regional Head of Education, which will consider whether:
   • The request is for a skills training term, rather than a general practice term.
   • All options for rural placements within MCCC’s training footprint have been exhausted.
   • Applicable requirements under Section 19AB of the Health Insurance Act 1973 have been met.
   • The registrar has any identified career and/or education and training requirements.
   • The registrar, or an immediate family member, has had extenuating and unforeseen changes to their personal circumstances.

The committee will support or decline the request and, if supported, the TOTL will send the AGPT Application – Pathway Transfer to the Department of Health.  It is noted that MCCC does not have the authority to approve an application to transfer from rural to general pathway.

5. The Department will notify MCCC of the outcome within twenty (20) business days of receipt of the completed and supported application.
6. The TOTL will notify the registrar of the Department’s decision.

6. Document history

Version	Summary of changes
1.0	First version
2.0	Second version
3.0	Amendment to definitions section to include MMM classification definitions Third version – change from ASGC-RA to Modified Monash Model (MM1-MM7)

Dual Practice Part Time Training Placements

Last update: January 2019

Relevant resources

TRF 017a Variation of Training Time Application

TR 022 MCCC Professional Behaviours Policy

MCCC Registrar Agreement (Provided to each Registrar)

AGPT Training Obligations Policy

Doctor Connect www.doctorconnect.gov.au

RACGP Vocational Training Pathway – Requirements for Fellowship Policy – November 2018

Legislation

Fair Work Australia

Requests for flexible working arrangements

1. Purpose

This is a guidance document for registrars wishing to undertake training in two practices concurrently. Its purpose is to ensure that both registrars and training posts undertaking such arrangements can anticipate and address in advance any potential issues which may arise.

This document is applicable to all MCCC regions, however it has particular implications for AGPT General Pathway where registrars are required to comply with the AGPT Training Outer Metro Obligations Policy.

2. Scope

This policy is applicable to registrars and supervisors in MCCC training practices. Registrars, supervisors and medical educators should ensure that they are familiar with the MCCC Professional Behaviours Policy (TR 022) and comply with Fair Work legislation when considering dual practice placements.

3. Definitions

The following definitions apply to this document:

Outer metropolitan practice: A practice located in an outer metropolitan area as defined by Department of Health (www.doctorconnect.gov.au).

Inner metropolitan practice: A practice which does not comply with the definition of an outer metropolitan practice as above.

4. Policy

All part time placements must comply with the RACGP Vocational Training Pathway – Requirements for Fellowship Policy (November 2018) which defines the minimum number of hours a registrar must work to be eligible for Fellowship. This stipulates part time training as a minimum 10.5 hrs face to face, rostered, patient consultation time undertaken over a minimum of two days within a 14.5hr working week.

For ACCRM registrars –part time training must be based on an agreed minimum proportion of the equivalent full-time training position. Part time training which is less than 50% of full time is not encouraged.

5. Procedure

Where a registrar wishes to work part time concurrently in two practices:

1. In general, MCCC will only permit registrars at GPT/PRRT – 3/4 level to work part time concurrently in two practices.
2. Registrars who sign a contract to work full time in a practice and subsequently wish to change to part time need to inform the practice of their request and receive MCCC approval from the RHE twenty (20) business days prior to commencement of the placement, unless urgent circumstances intervene. The practice has a right to decline the request on grounds of workforce requirements and in compliance with Fairwork Australia (https://www.fairwork.gov.au/how-we-will-help/templates-and-guides/fact-sheets/minimum-workplace-entitlements/requests-for-flexible-working-arrangements)
3. Registrars who wish to change from full time to part time hours need to have extenuating circumstances for this to be approved (e.g. health issues, childcare arrangements, family issues or other unforeseen matters – these should be discussed with the RHE).
4. Where a registrar reduces from full time to part time work, the part time hours to be worked must be mutually agreeable to all parties. If a registrar then wishes to return to full-time work hours, where applicable, this should be with the original practice in which the registrar was placed.
5. If a registrar has commenced contracted full-time work and subsequently reduces to part time work and then wishes to undertake work concurrently at another practice, approval must be obtained from both practices and the MCCC RHE twenty (20) business days before this can proceed.
6. It is advisable that registrars making applications for more than one part time position disclose to both practices of their intention to seek part time training positions concurrently. This is to ensure that arrangements are in place to facilitate the registrar’s day to day transition and working hours between the two practices.
7. Where a registrar proceeds with a change in training hours/arrangements as outlined above, the employment contract must reflect this.
8. Registrars who change work hours must submit to MCCC TRF 0017A Variation of Training Time Application twenty (20) business days prior to the anticipated commencement of the placement.
9. Except in extenuating circumstances, only one change of registrar working arrangements is permitted per training term.

Where a registrar is already working in an approved part time arrangement concurrently in two practices:

1. Registrars should generally work full days in each practice and not split the day working across both practices. Split days may carry implications for patient care with unforeseen issues arising in either practice affecting the registrar’s work in the other practice.
2. Registrars cannot expect to change working hours in either practice where this may affect the hours in the second practice, without clear agreement from all parties.
3. Registrars need to take into consideration that it may not be possible to take leave from both practices at the same time or to make demands about weekend work hours because of this arrangement.
4. Where a registrar is working part time in two practices and needs to return to full time employment, this must be undertaken in their original practice where the registrar was placed in the first instance, where applicable. If this is not possible, this return to full time work can be undertaken in another practice. The registrar must submit to MCCC TRF 0017A Variation of Training Time Application twenty (20) business days prior to the anticipated commencement of the placement.

Guidance for training practices:

1. Training practices offering full time positions only, need to inform registrars of this at interview and state in their contract that a change to part time is not possible because of practice work force demands.
2. Full time training positions advertised on the practice website should be clear that the position is full time only and not available to applicants seeking part time work, unless the practice has the capacity to accommodate this.

Teaching Requirements:

GPT3/PRRT3 registrars require at least 45 minutes of protected face to face teaching per week. registrars and practices undertaking dual practice arrangements need to ensure that this requirement is met. Agreed teaching arrangements should be clearly documented in employment contracts prior to commencement. In general, registrars and practices undertaking a 50/50 split dual practice placement will alternate their teaching weeks. Variations to dual practice placement fractions and teaching arrangements should be discussed with the RHE and agreed to by all parties prior to approval of placements.

Please refer to the MCCC Registrar Agreement for teaching payment information.

6. Document history

Version	Summary of changes
1.0	First version

Boundaries in Therapeutic and Professional Relationships Guidelines

Last update: November 2020

Relevant resources

AHPRA: Good medical practice: a code of conduct for doctors in Australia

RACGP: Keeping the Doctor Alive

AMA: Victorian Doctors Health Program and AMA Peer Support Service

1. Purpose

Clearly define boundaries associated with therapeutic relationships and employment relationships or arrangements, that may impact on the registrar’s capacity to train successfully.

2. Scope

Applies to all medical practitioners either employed by MCCC or involved in the AGPT program with MCCC, such as General Practice Supervisors and GP Trainees, including doctors involved in PEP (Practice Experience Program).

3. Definitions

Therapeutic relationship:  A professional doctor-patient relationship.

Close personal relationships (previously known as pre-existing relationships):

The relationship between a registrar and their own or their supervisor’s:

• Spouse
• Partner
• Parent or parent-in-law
• Sibling
• Child
• Close friend (as defined by the registrar)

Practice Ownership: the registrar being an owner (full or part) or shareholder in the training practice in which they wish to train.

GPS: General Practice Supervisor

GP Trainee: GP Registrar

4. Policy

1. In the event of a medical emergency, care of the patient is the priority regardless of any existing relationship between a medical practitioner and a patient.
2. Close personal relationships blur professional boundaries making it difficult to maintain objective therapeutic relationships. These issues are compounded for GP registrars who require supervisor advice and support. To avoid potential conflicts of interest and protect registrars and close personal relationships and therapeutic relationships should be kept separate.
3. It is recognised that circumstances may exist in rural practice which can make applicability of these guidelines difficult. Any such circumstances should be referred to the DMET.

Therapeutic relationships

1. MCCC strongly supports the position of AHPRA (1), the RACGP (6.2), ACCRM and the AMA (6.3) that all medical practitioners should have their own general practitioner and only access medical care and prescriptions from that GP in an established therapeutic relationship.
2. Medical practitioners may at times need to treat colleagues, family members or friends either as the doctor or patient, for reasons such as an emergency or in the circumstances of rural practice. Where this is necessary, adequate documentation and an awareness of any potential or personal conflict is vital. This documentation should be subsequently forward to the patient’s usual GP.

The following scenarios are strongly discouraged by MCCC as they can blur boundaries and may put the registrar, the patient and the training practice at risk.

While employed as a Registrar within an accredited MCCC Training Post:

1. GP Supervisors and Registrars should not enter formal therapeutic relationships with each other while the Registrar is undertaking a training term or is allocated to complete a future training term within the practice of that GP Supervisor.
2. GP Supervisors and Registrars should not provide informal treatment or prescriptions of medication to each other at any time, nor pressure each other to provide prescriptions for themselves, family members or friends.
3. Training post staff, including other general practitioners within the practice, should not seek informal medical care or prescriptions for themselves or other persons from Registrars.
4. Registrars should not enter therapeutic relationships with staff members in their training practice, including other general practitioners or their families. If such an arrangement is unavoidable, disclosure must be made to the training post, and activities undertaken only in the context of an appropriate medical consultation. In these circumstances the following are required:
   • The Registrar must be able to contact their supervisor for advice if required and the patient should be aware this may be necessary.
   • Appropriate documentation should occur as with any patient consultation.
   • The registrar maintains confidentiality as with any patient consultation; this is discussed along with caveats to confidentiality at the beginning of the consultation.
   • The GP Supervisor should be advised of the consultation and should carefully consider the circumstances of the consultation if it pertains to a Work Cover or TAC related matter.

This also applies within MCCC. Medically qualified staff employed by MCCC should not enter formal or informal therapeutic relationships with other MCCC medical or non-medical staff or staff in partner practices. In circumstances where this is unavoidable this must be referred to the DMET as soon as practicable.

Close Personal Relationships and/or Practice Ownership

1. Where there is a close personal relationship between a GP supervisor and a registrar, the registrar is strongly advised not to train at that practice. Conflicts can arise in these settings and it is in the registrar’s best interest to not work in a practice where they have such a close personal relationship.
2. Registrars are not permitted to train in a practice where they are full or part practice owners due to the ongoing conflict of interest this poses.
3. Training placements where there is a pre-existing personal relationship MAY be considered for Term 3/ Term 4 (ESP) providing:
   • There is an independent on-site supervisor approved by relevant RHE and an appropriate plan for alternative supervision for supervisor planned or unplanned leave or if they cease to work in the practice.
   • A written employment contract is in place that is equivalent to other registrar contracts
   • The registrar does not have a pre-existing close personal relationship with a full or part owner of the post.

5. Procedure

Close Personal Relationships

1. If there is any type of close personal relationship between a registrar and a practice at which they wish to train, the registrar and the practice must disclose this to the relevant RHE. This must be done in writing at least 4 weeks prior to the start of the practice match process.
2. The RHE will discuss the pre-existing relationship with the DMET, based on the principles outlined above.
3. The registrar and the practice will be notified by the RHE of the outcome of the discussion, at least one week prior to the practice placement process.
4. These guidelines are applicable even when the registrar considers the above principles have been met for employment in a prospective training post. The application for consideration must address the issues described above in detail and is applicable to all levels of registrar training.
5. Where there is a close personal relationship between non-medical members of the supervision team (registered nurse, allied health or practice manager), or non-supervising GPs in the practice, the registrar should declare this to the RHE prior to seeking placement at that practice as outlined above.

Therapeutic relationships

1. In the event of an emergency requiring a GPR, GPS or ME to provide treatment for each other, the incident should be disclosed to the Director of Medical Education and Training (DMET) who will review the episode, provide support and debriefing if required and consider other issues regarding the GPR placement.
2. Where a medically qualified staff member has a pre-existing therapeutic relationship with another MCCC staff member, MCCC registrar or GP Supervisor in a partner practice, the potential working relationship between these two persons should be reviewed and discussed with the DMET where a decision will be made after considering the individual circumstances involved.

6. Document history

Version	Summary of changes
1.0	First version

Rural Relocation Reimbursement to Priority Placement Practices

Last update: March 2020

Relevant resources

2020 MCCC Registrar Placement Guide

FNF 005 Rural Relocation Reimbursement to Priority Placements Claim Form

1. Purpose

MCCC provides rural relocation support to registrars if they satisfy the requirements outlined in this policy.  The purpose of this document is to provide guidance on eligibility and the procedure for the application process.

2. Scope

This policy and procedure are applicable to all registrars in their core training terms, where Murray City Country Coast GP Training (MCCC) is the host Regional Training Organisation (RTO).

This policy supersedes all previous policies and is applicable to Priority Practice Placements commencing 2020 onward.

3. Policy

MCCC provides a once-only relocation support payment of up to $1,000 to registrars relocating to commence training in an identified rural Priority Placement practice that was matched during the Placement process.

Eligibility:

1. Rural relocation support is available to MCCC registrars training in their core GP terms, in identified rural Priority Placement practices.
2. The reimbursement is only available when a registrar is matched and commences work in one of the priority practices advertised in the year the placement process pertained to.
3. Claims will only be considered if lodged by 31st October in the year the expense is incurred.
4. No items being claimed have previously been claimed by another registrar. Eg. registrar’s partner.

Reimbursement criteria:

Registrars who are eligible may claim the following (up to the funding cap):

1. Travel and accommodation to source permanent accommodation to undertake the approved Priority Placement.
2. Airfares or mileage for up to two return trips to the Priority Placement destination and from the originating destination (airfares to alternate destinations are not supported). Mileage at the Australian Taxation Office (ATO) cents per kilometre rate as published at the time incurred.
3. Removalist fees.
4. Trailer or self-move vehicle hire fees.
5. Disconnection and reconnection fees for utilities (electricity, gas, landline, internet).

Exclusions:

MCCC does not support the following:

1. relocation that was not necessitated by the Registrar Placement process.
2. costs within or into a General Pathway region.
3. items that would be reasonably deemed a ‘cost of living’ e.g. rent, mortgage payments, weekly internet or phone payments, utility bill, etc.
4. items that are considered an asset, i.e. furniture, trailers, kitchen appliances or other portable items.

4. Procedure

1. Registrars must complete the appropriate Registrar Claim form – Rural Relocation to Priority Placements and forward to their Registrar Education and Practice Support Co-ordinator (REAPS) for approval.
2. All relevant receipts/tax invoices should accompany the claim form. Registrars may be required to provide additional information to substantiate the claim, if the expenditure is unclear.
3. Claims will only be processed following the commencement of the applicable term and upon receipt of a completed claim form, supporting evidence and, where required, evidence of prior approval.
4. Claims are to be submitted as soon as possible after the expense is incurred and no later than 31^st October in the year the expense is incurred.

5. Document history

Version	Summary of changes
1.0	First version
2.0	Amalgamated Registrar Educational Support and Relocation Reimbursement Payments Policies/Procedures
3.0	Moved education financial support information to a new policy (ED 011)
4.0	Funding changed to only apply to Priority Placement practices.

Registrar Extended Skills Post Application Policy and Procedure

Last updated: August 2018

Relevant resources

EDF 004 Registrar Extended Skills Post Application

TRF 018 Appeals Form

TR 001 Complaints Policy and Procedure

TR 018 Appeals Policy and Procedure

RACGP Accreditation of overseas posts

1. Purpose

This procedure provides information and guidance on the application process to undertake an Extended Skills Post (ESP) (not including GPT4 terms) with Murray City Country Coast GP Training (MCCC).

General practice vocational training with the Royal Australian College of General Practitioners (RACGP) is currently a three-year program consisting of twelve months in hospital posts, eighteen months in general practice and six months in an ESP. The six months of extended skills can be spent in (a) a general practice or (b) a post shown to be relevant to general practice, which improves skills and is of demonstrable or potential benefit to patients. The ESP must be accredited and have a nominated supervisor and a documented teaching and learning plan.

MCCC registrars are required to complete twelve months in general practice prior to commencing an ESP.

Exceptions to this may include applications for hospital-based ESPs, which will be considered on a case-by-case basis and only in circumstances where the experience and educational opportunities offered are consistent with the registrar’s learning needs such as the Diploma of Obstetrics and Gynaecology (DRANZCOG) and Diploma of Palliative Care. Posts that would not be consistent with this are those where the registrar has already developed a skill set, e.g. a registrar that has spent a number of hospital terms in a particular discipline e.g. emergency medicine and then wishes to complete another term in emergency medicine.  Hospital terms must be completed either prior to commencing in a general practice term or at the completion of 12 months in general practice.

Only in extenuating circumstances can an ESP be done following the completion of 6 months in general practice as this will have a significant impact on participation and completion of the mandatory out of practice education provided by MCCC.

All applications must be prospectively approved by the Regional Head of Education (RHE) and the Director of Medical Education and Training (DMET). Applications for ES posts must be lodged at least three months prior to commencement of the placement. Recognition of prior learning will not be given for these posts except in exceptional circumstances (Please see below).

2. Scope

This document applies to Australia General Practice Training program (AGPT) registrars on the RACGP Fellowship Pathway with MCCC. It is not applicable to registrars wishing to apply for Advanced Rural Skills Training (ARST) or Advanced Skills Training (AST) posts.

3. Procedure

Extended Skills Posts (Excluding GPT4 terms)

1. Prior to accepting an ES position, the registrar must ensure the post is RACGP training post accredited through written contact with the regional Registrar Education and Practice Support (REAPS) Coordinator, or designated person, a minimum of three months prior to the commencement of the term. It is recommended that registrars commence the process well before this minimum time if possible. (Refer Appendix A.)
2. Note that approval to work in an ESP is not automatic, even if the post is accredited. The applicant must demonstrate the objectives, including personal learning needs, of undertaking a particular post at a particular time in training, in the learning plan.

For an Extended Skills Post already accredited:

1. Once notified that a post is accredited, the ESP application form, learning plan, and a copy of the position description must be lodged with the regional REAPS Coordinator. The ESP application form is available on the MCCC website.
2. The registrar will be notified in writing by the REAPS Coordinator of the final decision within twelve working days of receipt of the application. Reasons for the decision will be documented in the notification and in the registrar’s folder in Pivotal.

For an Extended Skills Post not already accredited:

1. Approval of the registrar’s learning objectives by the RHE will be required prior to the post being accredited. The REAPS Coordinator will notify the registrar in writing of the decision within twelve working days of receipt of this information. Reasons for the decision will be documented in the notification and in the registrar Pivotal folder.
2. The REAPS Coordinator (or delegate) will also notify the registrar in writing of the accreditation status of the post. If the post is not accredited, an accreditation application form will be forwarded to the training post by the REAPS Coordinator.
3. Following approval of the learning objectives, the registrar will need to submit the ESP application form with a position description and learning plan pro forma to the RHE for approval prior to accreditation of the post.
4. Once the registrar’s ESP application and supporting position description and learning plan is approved, the post and prospective supervisor must complete the MCCC accreditation forms and return to the REAPS Coordinator within two weeks.
5. The training post will be subsequently contacted within two working days of receipt of the application to arrange an accreditation visit if this is required.

5. MCCC’s regional accreditation panel will review the training post accreditation report written by the ME who performed the visit, and, if RACGP Standards and MCCC requirements are met, recommendation will be made to the RACGP regarding accreditation of the post.
6. The applicant and the post will be notified by email within one working day of MCCC’s decision. A formal letter will be sent the following week.
7. This process should be completed four weeks of the commencement at the placement.

 

Recognition of Prior Learning for an Extended Skills Post

1. Recognition of prior learning will not be given for these posts except in exceptional circumstances and only for the Diploma of Obstetrics and Gynaecology and the Diploma of Palliative Care.
2. Approval is not automatic, and the applicant must demonstrate the objectives, including personal learning needs, of undertaking the post at a particular time in training, in the learning plan.
3. The ESP application form, learning plan, and a copy of the position description must be lodged with the regional REAPS Coordinator. The ESP application form is available on the MCCC website.
4. The REAPS Coordinator (or delegate) will also notify the registrar in writing of the accreditation status of the post.
5. If the post is an accredited post, the registrar will be notified in writing by the REAPS Coordinator of the final decision within twelve working days of receipt of the application. Reasons for the decision will be documented in the notification and in the registrar’s folder in Pivotal.
6. If the post is not accredited, an accreditation application form will be forwarded to the training post by the REAPS Coordinator. The post and prospective supervisor must complete the MCCC accreditation forms and return to the REAPS Coordinator within two weeks.
7. The training post will be subsequently contacted within two working days of receipt of the application to arrange an accreditation visit if this is required.
8. MCCC’s regional accreditation panel will review the training post accreditation application, and, if RACGP Standards and MCCC requirements are met, recommendation will be made to the RACGP regarding accreditation of the post.
9. The applicant and the post will be notified by email within one working day of MCCC’s decision. A formal letter will be sent the following week.

Overseas Extended Skills Posts:

Registrars seeking to undertake ESPs or optional Advanced Rural Skills Training posts in an overseas setting must complete an application form, available from the RACGP. All overseas posts must be prospectively approved by the RACGP Censor in Chief and then sent to the DMET for approval. Registrars should be aware that this may be a lengthy process.

Appeals Process: 

Where a registrar disagrees with the decision regarding an ESP, it can be appealed through MCCC’s   TR 001 Complaints Policy and Procedure. If the registrar is unsatisfied with the result, an appeal can be lodged via an application TRF 128 Appeals form. Further to this through the RACGP state censor.

Doctors in Secondary Schools Program

Last updated: September 2018

Relevant resources

ED 022 Training Post and Supervisor Accreditation Procedure: New Training Post (including Extended Skills Posts)

1. Purpose

To ensure ongoing quality of training, physical and emotional safety and appropriate supervisor support for all registrars participating in the program, and optimum outcomes for the student patients.

2. Scope

This procedure document applies to all accredited supervisors and training posts and their registrars, and all MCCC staff involved in the Doctors in Secondary Schools Program.

3. Procedure

1. The school consulting room is not regarded as a branch practice so is not required to be accredited against RACGP/ACRRM Standards.
2. Registrars participating in this program must be at level GPT3/4 or have significant experience with adolescent mental health (as deemed and approved by the designated RHE).
3. The participation of the registrar in the program is completely voluntary and he/she may decline to undertake this work at any time prior to or during the term without any pressure or penalty from the practice.
4. The GP supervisor must be very familiar with the program and the clinical scenarios that the registrar is likely to encounter at the school where they will work.
5. The GP supervisor will provide a thorough orientation to the role of a Doctor in Secondary Schools Program at the commencement of the term and an on-site orientation at the school when the registrar commences treating student patients.
6. The school will provide a room suitable for medical consultations. As there will not be on-site supervision, the registrar needs to have telephone access and the supervisor must be able to be contacted whenever the registrar is working in a school clinic. If necessary, the supervisor may need to attend the clinic to assist the registrar if needed.
7. Where the GP supervisor is on leave, an accredited additional supervisor must be available to provide supervision for the registrar as outlined above.
8. Student patient booking numbers must comply with RACGP Standards for Training.
9. The supervisor needs to ensure the school has a registrar safety plan and the physical and emotional safety of the registrar is prioritised.

Other requirements

All participating registrars must have a “Working with Children Check.”

4. History document

Version	Summary of changes
1.0	First version

Registrar Extended Skills Post (ESP) Expression of Interest Policy and Procedure

Last updated: August 2021

Relevant resources

EDF 004 Extended Skills Post Expression of Interest

TRF 018 Appeals Form

TR 001 Complaints Policy and Procedure

TR 018 Appeals Policy and Procedure

RACGP approval of overseas extended skills training posts for GP Registrars in the ADF

RACGP approval of overseas extended skills training posts for GP Registrars in the ADF

RACGP Accreditation of overseas posts

1. Purpose

This procedure provides information and guidance on the application process to undertake an Extended Skills Post (ESP) (not including GPT4 terms) with Murray City Country Coast GP Training (MCCC).

2. Scope

This document applies to Australia General Practice Training program (AGPT) registrars on the Royal Australian College of General Practitioners (RACGP) Fellowship Pathway with MCCC. It is not applicable to registrars wishing to apply for Advanced Rural Skills Training (ARST) or Advanced Skills Training (AST) posts.

3. Policy

General practice vocational training with the RACGP is currently a three-year program consisting of twelve months in hospital posts, eighteen months in general practice and six months in an ESP.

The six months of extended skills can be spent in (a) a general practice or (b) a post shown to be relevant to general practice, which improves skills and is of demonstrable or potential benefit to patients.

The ESP must be accredited and have a nominated supervisor and a documented teaching and learning plan.

MCCC registrars are advised, that in many cases, it is recommended that they complete twelve months in general practice prior to commencing an ESP. This will depend on the post and can be discussed prior to submitting an expression of interest.

Only in extenuating circumstances can an ESP be done following the completion of 6 months in general practice as this will have a significant impact on participation and completion of the mandatory out of practice education provided by MCCC.

Registrars can apply for recognition of prior learning of an ESP in line with RACGP Policy. Please note that no more than 12 months of RPL can be applied for. The ESP must be in line with the registrars learning needs and will only be approved in exceptional circumstances. *

Extended skills training may be made up of a single post or a combination of posts and there are minimum weekly working hours for extended skills terms.  Please refer to the RACGP policy for further information. **

All applications must be prospectively approved by the Regional Head of Education (RHE) or their delegate, and where necessary, the Director of Medical Education and Training (DMET).

Expressions of interest must be lodged in a timely manner so that preapproval and post accreditation, where necessary, can be completed prior to the relevant placement process.

Note that approval to work in an ESP is not automatic, even if the post is accredited. The applicant must demonstrate the objectives, including personal learning needs, of undertaking a particular post at a particular time in training, in the learning plan.

4. Procedure

Registrars Interested in an Extended Skills Post

Registrars interested in ESP’s should refer to the ESP page on the MCCC website. All posts on the MCCC website are typically approved, accredited posts. However, it is prudent to check the accreditation status of the post with your regional Registrar Education and Practice Support (REAPS) Coordinator prior to sending in an Expression of Interest form.

If you wish to discuss the post prior to placing an Expression of Interest, then please contact your regional REAPS Coordinator and/or Regional Head of Education (RHE).

All applications must be prospectively approved by the RHE and, where necessary, the Director of Medical Education and Training (DMET). This is to occur prior to applying for any position as approval to work in an ESP is not automatic, even if the post is accredited.

Expression of Interest: Extended Skills Posts accredited by MCCC.

The registrar will contact any potentially suitable post opportunities directly to determine suitability, confirm availability and obtain a copy of the position description.

The registrar completes an Expression of Interest (EDF 004), which includes the learning plan, to undertake an ES post and submits this to the REAPS Coordinator, along with a position description. The REAPS will in turn seek necessary approvals from the RHE, or their delegate, for approval.

Expressions of interest must be lodged at least two months prior to the interview process for that post.

The REAPS Coordinator confirms the post remains accredited and will notify the registrar if there are any issues with the accreditation status.

The REAPS Coordinator will liaise with the RHE, or their delegate, to confirm approval of the registrars learning objectives for the ESP.

The registrar will be notified by the REAPS Coordinator in writing within 12 working days of submitting their application of whether their expression of interest has been approved. Reasons for the decision will be documented in the notification and in the registrar’s folder.

The registrar will then be eligible to apply for the post.

Upon receipt of an offer for the post and prior to acceptance the registrar will notify the REAPS Coordinator in writing. This may be via email.

Expressions of Interest: Extended Skills Post not accredited by MCCC:

There may be occasions when a registrar becomes aware of a post, that would meet their educational and learning needs and also would meet the needs of the community they work in, which is not accredited by MCCC.

The registrar may wish to discuss this post with the RHE prior to submitting an expression of interest application.

The registrar will contact any potentially suitable post opportunities directly to determine suitability, confirm availability and obtain a copy of the position description.

The registrar completes an Expression of Interest (EDF 004), which includes the learning plan, to undertake an ESP and submits this to the REAPS Coordinator, along with a position description to the RHE for approval.

Expressions of interest must be lodged at least three months prior to commencement of the interview for placement process to ensure that accreditation requirements can be met.

If the RHE, or delegate, approves the expression of interest, then the training post will be contacted within five working days of the approval of the expression of interest and the accreditation application will be sent.

The post is expected to return the completed paperwork within 15 working days of the receipt so accreditation visit, either face to face or virtual can be arranged by the ME delegated to complete the report.

The MCCC accreditation panel will review the training post application and the MCCC accreditation ME report. If RACGP Standards and MCCC requirements are met, the post will be accredited.

The registrar and post will be notified in writing by the REAPS Coordinator of whether the ESP is approved. Reasons for the decision will be documented in the notification and in the registrar’s folder.

The registrar will then be eligible to apply for the post.

Upon receipt of an offer for the post and prior to acceptance the registrar will notify the REAPS Coordinator in writing. This may be via email.

*Recognition of Prior Learning for an Extended Skills Post:

Recognition of prior learning will not be given for these posts except in exceptional circumstances and generally only for the Diploma of Obstetrics and Gynaecology and the Diploma of Palliative Care.

Approval is not automatic, and the applicant must demonstrate the objectives, including personal learning needs, of undertaking the post at a particular time in training, in the learning plan.

The Expression of Interest (EDF 004) form, which includes the learning plan, and a copy of the position description must be lodged with the regional REAPS Coordinator.

The REAPS Coordinator will liaise with the RHE, or their delegate, to confirm approval of the registrars learning objectives for the ESP.

The registrar will be notified by the REAPS Coordinator in writing within 12 working days of submitting their application of whether the ESP is approved. Reasons for the decision will be documented in the notification and in the registrar’s folder.

The Registrar will need to apply for Recognised Prior Learning (RPL) as outlined in the RACGP RPL policy. Approval of RPL is not automatic and is decided by the RACGP State Censor.

The Registrar will be notified once advice from the RACGP has been received.

**Combined Posts:

This is especially relevant in posts such as Rural Generalist Consolidation posts (also known as Consolidation of Skills) relevant to Fellowship in Advanced Rural General Practice (FARGP) registrars and MCCC’s Registrar Liaison Officer and Registrar Medical Educator positions. For further advice on these posts please contact the relevant regional REAPS/RHE.

Overseas Extended Skills Posts:

These are only available for Australian Defence Force (ADF) registrars and only after prior approval by the RACGP. Please contact the relevant regional REAPS/RHE for further advice.

5. Document history

Version	Summary of changes
1.0	First version
2.0	Second version
3.0	RPL section
4.0	Express of interest

Out of Practice Education Attendance Policy

Last Updated: January 2020 

Relevant resources

ED 013 Financial Support and Safety for Out-of-Practice Events (Registrars and Supervisors)

ACRRM training requirements

RACGP training standards

1. Purpose

All components of the out-of-practice education program are compulsory.

The out-of-practice education program at MCCC GP training comprises:

• face to face learning (workshops);
• synchronous online learning (webinars); and
• asynchronous online learning (core eLearning activities, done in the registrar’s own time).

This policy outlines the principles supporting this and the procedure to be followed when a registrar is unable to meet the requirement.

2. Scope

This policy is applicable to all registrars in their GP training terms 1-3, with Murray City Country Coast GP Training (MCCC).

3. Policy

Attendance at all scheduled MCCC workshops and webinars, as well as the completion of all core eLearning activities, is a mandatory educational requirement and a pre-requisite for eligibility to sit college exams.

MCCC runs an intensive 12-month out of practice education program and all registrars are required to complete the program during the first 12 months of their training (this includes registrars whose practice hours are on a part time basis).

1. The components of the MCCC’s out-of-practice education program are explicitly linked, and together they create each learning program. Workshops, webinars and the core eLearning activities together, provide a meaningful and relevant learning narrative.
2. The design of the out-of-practice education program ensures that face to face learning activities (both at workshops and at webinars):
   • address topics not easily taught in a general practice setting’;
   • allow registrars to practice specific procedural skills in a safe environment;
   • deliver information on priority health areas and other relevant clinical and non-clinical topics; provide the opportunity for registrars to learn with peers at the same stage of training; and provide an opportunity for peer-to-peer teaching.
3. The dates of the mandatory education program are available to all required registrars on MeL via their login. They are also emailed to each registrar and practice managers.

It is essential that registrars diarise these dates to ensure their availability and plan their annual leave and other commitments around these activities.

4. Workshops and webinars are held during in working hours.
5. Registrars are to be released from their practices to attend all workshops and webinars.
6. Non-compulsory workshops such as pre-exam workshops, are to be undertaken in the registrar’s own time. Release from the practice will need to be negotiated. This may mean the use of annual leave or leave without pay, if allowed by the practice.

4. Procedure

1. Registrars who are unable to attend a workshop or webinar, due to unforeseen and extenuating circumstances* must notify their regional Education and Program Support Officer (EPSO) as far in advance of the event as possible.
2. Registrars must also provide appropriate certification/documentation for non-attendance to the Regional Head of Education (RHE) in their region. These must be provided within a week of the missed workshop or webinar.
3. Registrars may be responsible for unrecoverable costs related to their non-attendance, e.g. accommodation expenses.
4. The registrar must then contact the RHE of their region within fourteen (14) days to discuss follow up education activities.
5. The RHE or delegate will identify appropriate alternative activities for the missed workshop/webinar.
6. The alternative activities will be completed by the registrar within the identified time frame, in the registrar’s own time.
7. If the alternative activity requires attendance at a workshop or webinar facilitated in a following 12-month period, registrars will need to negotiate directly with their practice regarding release.
8. Evidence of satisfactory completion of these alternative activities must be submitted to the RHE or delegate for recording in the appropriate data base.
9. Failure to complete mandatory education activities or appropriate alternatives may result in an inability to sit the exam.

*Unforeseen or extenuating circumstances: In this instance, this refers to personal or sick leave, carers leave, or bereavement leave.

The following are alternate activities that may be undertaken following discussion with your RHE.

Please note these are examples only.

 

Emergency Skills requirement

Registrars providing services to small rural hospitals, are required to undertake a REST course in GPT1/PRRT1, these are offered in various regions. For emergency skills the only the only alternatives are:

• A REST course in another region, if available

or

• A course run not through MCCC, in this instance the related cost would be the responsibility of the registrar.

All other registrars are required to undertake a one-day ALS course in their own time. This alternative should be undertaken in GPT1/PRRT1. MW will now run 2 ALS days per year, registrars can attend the second ALS session in the second half of the year.

 

Aboriginal and Torres Strait Islander health

The alternative activity must meet the RACGP/ACRRM requirements. To meet these requirements the registrar must either:

1. Attend an MCCC Aboriginal and Torres Strait Islander Health workshop on another date.
2. Undertake an alternative activity approved by the Aboriginal Health Manager/Cultural Educator, the lead Aboriginal and Torres Strait Islander portfolio Medical Educator (ME), and the RHE.

 

For other workshops and webinars, alternative activities may include any combination of:

1. Undertaking an appropriate online activity on MeL.
2. Undertaking another appropriate online activity.
3. Attendance at another MCCC workshop or webinar.
4. Undertaking appropriate research and presenting to peers
5. An individual learning projects.

5. Document history

Version	Summary of changes
1.0	First version
2.0 3.0	Changes to emergency skills alternatives Reference to 12-month education program

Registrar wellbeing policy

Last updated: July 2018

Relevant resources

ED 005 Registrar in Difficulty Procedure

TR 001 Complaint Policy and Procedure

Clode, D. and Boldero, J. (2005) Keeping the doctor alive: A self-care guidebook for medical practitioners. Royal Australian College of General Practitioners, South Melbourne.

MCCC Remediation Agreement

Registrar Assistance Support Framework

Pastoral and Learning Support Flowchart

MCCC Focused Learning Intervention Agreement

MCCC Grievance Procedure

MCCC Registrar in Difficulty Procedure

Medical Board of Australia (not dated) Good medical Practice: A code of conduct for Doctors in Australia.

Registrar agreement

Registrar Handbook

Rowe, L., Morris-Donovan, B. and Watts, I. (2009) General practice – a safe place: tips and tools. Royal Australian College of General Practitioners, South Melbourne.

1. Purpose

This policy is to assist Registrars with any issue, problem or concern that may hinder their progression towards Fellowship of ACRRM and/or the RACGP. This policy aimed at ensuring the safety and wellbeing of registrars and identifying registrars who may be “in difficulty” and who may benefit from additional resources, focussed intervention and/or other forms of support.This Policy sits alongside the Pastoral and Learning Support (PALS) Policies and Procedures.

2. Scope

Registrar wellbeing is an intersection of the responsibilities of MCCC, accredited training posts, and the individual registrar. As employers of registrars, training posts have occupational health and safety obligations that are governed by Federal and State legislation. Both ACRRM and the RACGP set standards to ensure the occupational health and safety of a practice team. Specific sections of The National Terms and Conditions for the Employment of Registrars (NTCER) similarly addresses issues related to the health and safety of registrars. The Policy applies to all Registrars enrolled in the MCCC training program and comes into effect from 1 January 2016.

This policy and procedure applies to the Registrar, Director of Medical Education and Training (DMET), PALS, TAs, Regional Heads of Education (RHE), Registrar Education and Practice Support (REAPS) Coordinators, Training Support Officers (TSO), Medical Educators (ME), Registrar Liaison Officers (RLO)s.

3. Policy

Although registrars are not employed by MCCC, the organisation has a responsibility to ensure their safety and wellbeing is promoted and risk factors are minimised as far as practicable. MCCC’s Registrar Agreement details particular responsibilities for both the organisation and registrars enrolled with MCCC.

All registrars are required to undertake a comprehensive MCCC orientation program aimed at preparing them for the transition to general practice.  This is undertaken prior to commencing or in the first week of the first general practice placement.  Included in the program is information on wellbeing and self-care, the importance of having a GP, the potential stressors of general practice training and information on the range of internal and external support mechanisms available to registrars and the process by which these can be accessed.

At the commencement of their training, all registrars are allocated a Training Advisor (TA) who will provide ongoing support, including pastoral care.

The Registrar Pastoral and Learning Support Policy builds upon information gathered in the formative assessment and monitoring processes outlined in ME 001 (initial assessment procedure) and ME 002 (further assessment procedure) and ME 006 and ME 007- assessment over training maps for RACGP and ACRRM.

Once the areas of need are identified, MCCC develops support programs that are unique to each registrar and their situation as outlined in the MCCC Registrar in Difficulty procedure.

4. Procedure

1. All registrars are allocated to a Training Advisor (TA) for their training period. However they are also in contact with a number of other MCCC employees and support persons, these include, but are not restricted to, REAPS, TSOs, MEs (especially at workshops and ECTVs), RLOs, RHEs, PALS MEs and the DMET. If a registrar is experiencing difficulty then they should approach the person they feel will most readily address their issue.
2. If the person being approached feels that the issue is beyond their remit then, with the registrar’s permission they should notify, the Regional Head of Education in their region and/or the PALS ME.
3. If the issue is of a training or educational concern then the PALS team in that region will follow the Registrar in Difficulty procedure.
4. If the issue is one of supervision or in-practice education then the Accreditation ME should be notified along with the REAPS Coordinator in that region. The Practice with Issues policy will then be followed.
5. If there are health issues, including psychological issues, the registrar will be referred to their own General Practitioner. Assistance can be provided on sourcing a GP if the Registrar requires this support.
6. If the Registrar would prefer to directly access the support of a psychologist, MCCC supports the following:
   • Attendance at five consultations with a cap per consultation of $250 which covers either a psychiatrist or registered psychologist.
   • The Registrar can choose their own psychologist and notify the Education Portfolio Manager- Pastoral and Learning Support, of their intention to see that psychologist and then request that a de-identified invoice be sent by the psychologist directory to the Education Portfolio Manager, who will forward the invoice to the Finance Department for payment.
7. Ongoing support will be followed up by the PALS team.

5. Document History

Version	Summary of changes
1.0	First version
2.0	Second version
3.0	Amended wording in 6b

Fatigue Management Guidelines

Last updated: January 2019
Relevant resources

MCCC Registrar Handbook 2019

TR 003 Training Obligations Policy and Procedure

TR 007 Registrar Placement Policy and Procedure

AGPT Training Obligations Policy 2019

Good Medical Practice: Code of Conduct for Doctors in Australia 2014

1. Preface

Fatigue management is an integral component of ensuring the safety and psychological wellbeing of MCCC registrars as they progress through the training program. The Australian General Practice Training Obligations Policy for 2019 states “the management of fatigue is the responsibility of registrar, Regional Training Organisations, General Practice Supervisors and Training Facilities”. Therefore, it is essential MCCC as a Regional Training Organisation (RTO) details the responsibilities of all parties including the RTO, registrars, practices and supervisors in addressing fatigue management and list appropriate steps to ensure the registrar has safe conditions for optimal clinical decision-making and personal welfare.

2. MCCC Recommendations and Responsibilities

MCCC staff, including the education team, all have a role in supporting registrars who feel unable to cope with clinical workload and/or training requirements.

Below is a list of registrar responsibilities around the management of fatigue, and a joint approach to this topic should be discussed with the Training Facility during the practice interview process and again during orientation to a new practice. While different policies may be in place amongst training facilities, MCCC acknowledges the need for a discussion and an approach towards ensuring safe conditions for registrars. MCCC may be involved in optimising registrar conditions if no agreement between the training facility and registrar can be met during interview or orientation at clinic level.

3. General Training Facility Responsibilities

1. All training facilities (practices) must have an approach to fatigue management and actively engage in conversation with registrars and supervisors about this subject.
2. Training facilities (practices) should have an awareness of registrar training requirements and travel times to workshops along with study requirements for college examinations.
3. Measures to enhance registrar wellbeing by reducing excess fatigue should be regularly reviewed by the training facility (practice). This should include review of the registrars in-clinic consulting hours, on-call and after-hours shifts, travel time and work undertaken external to the clinic such as local hospital cover and nursing home visits.
4. Appropriate supervision, which is in keeping with the registrar’s level of capacity and confidence, must be available for on-call/after-hours work undertaken by the registrar. Therefore, supervisor fatigue management should also be reviewed by the training facility (practice).
5. The workload of after-hours weekend and on-call shifts should be shared between registrars and other available GPs at the training facility (practice).
6. If a training facility (practice) holds concern over the registrar’s capacity to maintain optimal clinical decision-making or personal wellbeing due to excess fatigue, this should be raised with the registrar and MCCC via the registrar’s Training Advisor or relevant Regional Head of Education.

4. General Registrar Responsibilities

1. Registrars have an individual responsibility to be aware of personal fatigue levels and to actively undertake measures to maintain safe working conditions.
2. As mentioned in the Code of Conduct for Doctors in Australia (2014), registrars hold a responsibility to ensure optimal performance in judgment and decision-making during all clinical encounters.
3. Registrars are encouraged to discuss on-call and after-hours workload with the training facility (practice) during orientation and throughout the training term.
4. If a registrar feels the workload and associated fatigue is excessive this should first be discussed with the relevant supervisor and training facility (practice) manager. If there is not a resolution, then the registrar should then discuss with MCCC via their Training Advisor or Regional Head of Education.
5. Registrars must hold an awareness of self-limitations when committing to workload undertakings, and factor in training requirements such as MCCC workshops, travel time and study for college examinations.
6. If a registrar feels they are unable to cope with training requirements, study and the workload undertaken within a training facility (practice)/clinic/local hospital they are encouraged to actively pursue measures to enhance personal wellbeing via MCCC supports (Training Advisors, Registrar Liaison Officers) and accessing appropriate MCCC funded psychological services.

5. Recommendations for Training Facilities for registrars undertaking on-call/after-hours work

For registrars rostered for an overnight on-call shift prior to a usual in-clinic day the following options may be utilised:

1. The following clinic day bookings for the morning session may be listed as “on the day appointments only” giving the registrar the opportunity to start later in the day if they were required to undertake on-call duties overnight.
2. Alternatively, the following day’s afternoon session bookings may be listed for “on the day appointments only” giving the registrar opportunity to finish consulting after the morning session if they were required to undertake on-call duties overnight.
3. If a registrar is rostered to undertake the weekend on-call coverage for the clinic or local hospital/nursing home, then a day off in lieu may be offered during the following week. The timing of this day off in lieu should be negotiated in advance by the registrar and practice manager, and should factor registrar wellbeing and preference, and attempt to ensure minimal disruption to clinic bookings. This option should also be available to supervisors who were required to assist registrars during on-call work over the weekend, as negotiated with the practice.

6. Recommendations for registrars towards reducing excess fatigue

1. MCCC strongly encourage registrars to reside within reasonable travelling distance to the primary location of work during the GP term (as defined within MCCC’s Training Requirements Policy TR 003 – Training Obligations Policy and Procedure and TR 007 – Registrar Placement Policy and Procedure).
2. Registrars are encouraged to reduce external factors impacting on fatigue including avoiding additional employment outside of the training program.
3. Registrars are encouraged to hold an awareness of fatigue caused by recreational undertakings when required to undertake on-call/after-hours work.
4. Registrars should maintain a log-book of hours worked throughout the week, including on-call and after-hours work and should ensure these details are entered onto the Recipient Created Tax Invoice (RCTI) submission to MCCC.

7. Document history

Version	Summary of changes
1.0	First version

Registrars in Difficulty

Last updated : December 2019

Relevant resources

ED 028 Adverse Event, Critical Incident, Serious Issue and Near Miss Procedure

ED 008 Registrar Wellbeing Policy

Focused Learning Intervention Plan template

Registrar Assistance Support Framework

Remediation Agreement (including draft remediation contract and budget pro forma)

TR 001 Complaint Policy and Procedure

AGPT Training Obligations Policy

RACGP A guide to Registrar Remediation

ACRRM Remediation Policy

AGPT Withdrawal Policy

1. Purpose

To ensure that a registrar who has been identified as failing to progress to an expected level of training or who is experiencing personal difficulty is provided with resources and support to progress towards independent practice in a fair, transparent and defensible manner. This additionally ensures that:

1. The safety of patients and registrars is protected
2. Evidence about registrars’ support is documented.

2. Scope

This procedure is applicable to all registrars enrolled in the Australian General Practice Training (AGPT) program.

3. Procedure

1. MCCC has a process for monitoring registrar progress through the training program. This process identifies registrars whose performance raises concerns, and those who have issues that may potentially impact on their performance. (Refer Appendix A.)
2. Where further information is required to make a judgement about a possible or potential performance concern, additional information will be obtained via methods targeted to the specific case. Available methods are listed in the Registrar Assistance Support Framework, which will be used to summarise and collate evidence. Documentation at this level will be on as spreadsheet held on the Z drive. The registrar should be informed if there is any level of assessment other than routine progression. (Refer Appendix A.)
3. When a registrar is identified as being in difficulty, a meeting to discuss the issue/s will be convened between the registrar, the local PALS ME and/or the Regional Head of Education(RHE), and any of the following as appropriate: the registrar’s primary supervisor, MCCC’s CEO, the DMET, and a Registrar Liaison Officer (RLO).
4. The precise nature of the performance concern should be defined using evidence-based tools where possible.
5. Once the performance issues are defined, they will fall into one or more of the domains outlined in the Registrar Assistance Support Framework. The framework supports the development of an intervention plan by listing appropriate tools to help address each issue. The support program developed will be unique to the registrar’s needs. The implementation options will be context specific, and may be significantly different for registrars in hospital posts compared with those completing core general practice terms.
6. The levels at which these issues will be addressed will also be determined. These may include a Focused Learning Intervention (FLI) plan or escalation to remediation with suspension from training time (remediation) as per AGPT policy. (Refer Appendix A.)
7. FLI and remediation documents will be held on the Z drive and recorded on Pivotal or within the registrar’s record as appropriate.
8. The PALS panel will meet quarterly to review registrars on remediation and FLIs. Immediate approval of proposed interventions may be given between meetings by the lead PALS ME (or delegate) where necessary in order to avoid any delay in facilitating timely intervention.
9. Costing for any resources required to support additional assessments or interventions will be forwarded to the MCCC finance department for verification and action.
10. Where a difficulty may be better addressed via another procedure, the registrar may be additionally or alternatively directed to any of the other relevant registrar support documents, e.g. MCCC’s TR 001 Complaint and Appeals Procedure, ED 008 Registrar Wellbeing Policy, or ED 028 Adverse Event, Critical Incident, Serious Issue and Near Miss Procedure.
11. Whist formal channels should be used where possible for the giving and receiving of feedback where difficulties are encountered by a registrar, there may be instances where registrars seek advice or input from a member of their medical education team without needing a formal intervention. In these instances, the principles of giving secure feedback should be adhered to, and communication should be handled with respect for all parties. The registrar should be advised that, whilst confidentiality will be maintained, if potentially serious issues are raised that may have significant impact on either the registrar or another party, these will need to be addressed formally and appropriately documented.

Focused Learning Intervention

1. The learning plan will have clearly delineated learning needs and learning activities, reportable learning outcomes and a clear time-line.
2. The registrar will be supported in achieving the goals of the FLI plan with additional resources when indicated or as necessary.
3. At the end of the FLI period, a decision will be made by the PALS lead ME as to whether sufficient progress has been made.
4. If the PALS lead ME decides that the issue/s remain unresolved, the registrar will be considered for Remediation with Suspension from Training Time under the current AGPT Remediation Policy.

Remediation with Suspension from Training Time

1. Remediation is enacted when it is expected that the identified issue will require further training time and will require significant additional educational resources to address the issue. This process requires consultation with the relevant college.
2. The process is instituted when major concerns are identified in the registrar’s progress and the identified issues are deemed to warrant halting progress through training but do not warrant withdrawal of the registrar from the AGPT program.
3. Remediation is based on a specifically constructed remediation contract.
4. Where a registrar’s training term is defined by a remediation contract, time worked does not count towards training time.
5. The remediation contract is established between the registrar, the supervisor and MCCC.
6. Remediation contracts require approval by the relevant College prior to commencement.
7. The contract is based on clearly delineated learning needs and learning activities, reportable learning outcomes and a clear time-line.
8. Remediation terms usually require significant additional resources, for which additional funding will normally be sought from the relevant College. In applying for remediation funding MCCC will provide the College with the following documents:
   • A completed application form as supplied by the relevant College.
   • A remediation contract that has been agreed to and signed by the registrar.
   • A detailed budget to support the remediation.
   • A proposed timetable for progress reports to the relevant College.
   • The timeframe for the completion of the remediation.
9. If the registrar is deemed as having successfully completed Formal Remediation as defined by the contract, the registrar will recommence normal training.
10. If the registrar is deemed as having unsuccessfully completed Formal Remediation as defined by the contract, a further and final remediation contract may be developed or the registrar may be excluded from training.
11. Where a registrar refuses to or fails to participate in an approved remediation plan, the registrar will be required to show cause to the RHE as to why this should not result in withdrawal from the AGPT program.

Withdrawal of the registrar from the AGPT program

1. Failure to progress through the process of remediation may result in the registrar’s withdrawal from the AGPT training program.

4. Document history

1.0	First version
2.0	Changes made to reflect that responsibility for remediation with suspension from training has transferred to the RACGP and ACRRM

Critical Incident, Adverse Event or Serious Issue, Policy and Procedure

Last update: July 2021

Relevant resources

ACRRM Training Organisations Standards 2.3.3

ACRRM College’s Serious issues reporting form (internal use only)

RACGP Training Organisations Critical Incident Reporting Guideline

RACGP RTO Critical Incident / Adverse Event Report form (for internal use only)

EDF 028 Adverse event, critical incident, and serious issue reporting form

MCCC General Practice Registrar Agreement

TR001 Complaints Policy and Procedure

ED 008 Registrar Wellbeing Policy and Procedure

ED 005 Registrar in Difficulty Procedure

1. Purpose

• Provide definitions of critical incidents, adverse events, and serious issues in accordance with relevant College obligations and any other applicable obligations
• Ensure that there is an investigation procedure for critical incidents, adverse events, and serious issues and all reporting obligations are met.
• To provide guidance on the reporting of critical incidents, adverse events, and serious issue to in line with College requirements.

2. Scope

This policy applies to registrars enrolled in the Australian General Practice Training Program (AGPT) and the RACGP’s Practice Experience Program (PEP) with MCCC; members of training posts’ supervisory teams who are responsible for supervision of registrars; and MCCC as an accredited training organisation.

3. Definitions

For the purpose of this document the definitions are as outlined in the relevant College’s Standards/Guidelines:

• ACRRM Training Organisations Standards 2.3.3
• RACGP Training Organisations Critical Incident Reporting Guideline

From here all critical incidents, adverse events or serious issues will be referred to as “the incident”.

4. Policy

1. MCCC seeks to develop a transparent, fair, and supportive culture whereby the integrity of the organisation and its accredited training posts is preserved, and incidents are responded to in a thoughtful and supportive manner.
2. The National Law is to protect the public from harm. Conduct which has the potential to cause harm to patients should be treated as notifiable.
3. MCCC is required to report critical incidents or serious issues (as defined by the respective Colleges) to the Colleges as they occur and has some additional annual reporting requirements in relation to the RACGP.
4. MCCC can only fulfil its obligations if stakeholders, especially supervisors who work within MCCC’s accredited training posts and registrars enrolled in the Australian General Practice Training (AGPT) program, act in accordance with their aforementioned responsibilities.
5. There is an expectation that all training posts have internal policies and procedures to deal with “near misses”, “adverse events” and “critical incidents” and these will be adhered to, along with reporting of relevant incidents to MCCC.
6. MCCC provides all parties with the relevant and timely support as required. This includes, but is not limited to, contact with Registrar Liaison Officers (RLOs), Supervisor Liaison Officers (SLOs), Training Advisors (TAs), Registrar Education and Practice Support (REAPs) officers, Pastoral and Learning Support (PALS) medical educators and the Regional Head of Education (RHE). Individualised and confidential psychological support is also available as required.
7. In addition, the RHE will ensure that any relevant details of the incident are discussed by the appropriate Medical Educator/s, so that suitable support is given to the affected party/parties and agreed actions are implemented. Outcomes of this discussion and the support offered will be documented.
8. When dealing with incidents MCCC employees and other parties must adhere to the National Privacy Principles and protect the confidentiality of those involved.
9. MCCC maintains a confidential and secure Incidents Register for all incidents, regardless of whether the incident is deemed critical or not, detailing the support and notification of any actions taken pertaining to the incident. The MCCC Incident Register is maintained by the Executive Assistant to the Director of Medical Education and Training (EA DMET). The Director of Medical Education and Training (DMET) has ultimate responsibility for the Incidents Register, and who has access to this Register. Access to others may be granted by the DMET, where the primary purpose of accessing that information is to address the incident.  The relevant College will be notified as required by their procedures.
10. All incidents are documented in accordance with the procedure and reported as appropriate to the nature of the incident.

5. Procedure 

1. As soon as any party (registrar, supervisor, member of the supervisory team, medical educator) becomes aware that an incident that meets the definitions outlined in the relevant College guidelines/standards has occurred the relevant Regional Head of Education (RHE) must be notified immediately.
2. The RHE will contact the relevant party and discuss the incident with them and address any concerns, offer support to the party/parties as required and assist with the reporting process.
3. EDF 028 Adverse event, critical incident and serious issue reporting form must be completed by the relevant party/parties and returned to the RHE as soon as practicable following first contacting the RHE.
4. All reportable incidents will be discussed with the DMET. If the issue is reportable to the RACGP the DMET will discuss the situation or event with the Victorian Censor outlining the steps taken by MCCC.
5. All incidents will then be discussed at the Critical incidents and Adverse Events Meeting, which forms part of the REx meeting, with the addition of the PALS lead.
6. If the incident is deemed to meet the relevant Colleges criteria for reporting and related to an:
   1. RACGP registrar, the relevant RHE will complete the RACGP RTO Critical Incident / Adverse Event Report form will be sent to the EA to the DMET who will forward to the RACGP (Criticalincidents@racgp.org.au).
   2. ACRRM registrar, the relevant RHE will complete, online, the ACRRM College’s Serious issues reporting form. This form will be directly sent to ACRRM.
7. The RHE will notify the relevant party/parties, where applicable, of the outcome of the College’s review, even if no further action is deemed necessary.
8. Where follow up is required, the EA DMET will notify the relevant person to ensure that the follow up has occurred and any outstanding requirements have been met.
9. Once all requirements have been met, the REx, as part of the Critical incidents and Adverse Events Meeting will discuss the outcomes. If agreed that all requirements are met, the incident will be closed.
10. If it’s an internal RTO incident, then the DMET and/or the CEO must be notified immediately. If deemed critical then the MCCC Executive will address the incident and inform the relevant College’s utilising the relevant College form, as previously described. Follow up will be addressed by the MCCC Executive as required and once all requirements have been met, the MCCC Executive and any other relevant party will discuss the outcomes. If agreed that all requirements are met, the incident will be closed.

6. Document history

Version	Summary of changes
1.0	First version
2.0	Second version
3.0	Third version
4.0	Aligned with 2020 RACGP/ACRRM guidelines
5.0	Aligned with 2021 RACGP guidelines

Professional Behaviour Policy and Procedure

Last updated: December 2018

Relevant resources

Good Medical Practice: A Code of Conduct for Doctors in Australia

HR 021 MCCC Code of Conduct Policy (available at Practice)

Handbook- A Guide for MCCC Training Practices

Fair Work Australia Act (2009)

ACCRM Policies

1. Purpose

Murray City Country Coast General Practice Training (MCCC) is committed to quality general practice training and to providing patients and their communities with high quality general practitioners (GPs) who consistently demonstrate appropriate professional behaviours.

The purpose of this policy is to support and promote these behaviours for all persons involved in MCCC.

2. Scope

This policy applies equally to all persons who are involved in general practice training being GP supervisors (GPS), practice managers (PM0, medical educators (ME), program management staff and to the recipients of training GP registrars (GPR).

3. Rationale

Inappropriate professional behaviour can have a significant impact on the efficiency, effectiveness and functioning of a training program, education event, general practice or other workplace.

The MCCC Professional Behaviour Policy:

• Identifies the expected professional behaviours considered necessary for an effective training program and within the general practice training setting;
• Outlines the processes and steps required to develop a culture of ongoing professionalism within the organization commencing at the time of induction of registrars (GPR) new staff and new training practices into the program;
• Commits adequate resources to the early identification of, and response to, professional behaviour problems;
• Provides appropriate support mechanisms for those identified with problems.

4. Background

General practitioners ….”have a unique societal role as professionals who are dedicated to the health and caring of others. Their work requires the mastery of a complex body of knowledge and skills, as well as the art of medicine. As such, the professional role is guided by codes of ethics and a commitment to clinical competence, the embracing of appropriate attitudes and behaviours, integrity, altruism, personal wellbeing and to the promotion of public good within their domain. These commitments form the basis of a social contract between a physician and society.”  (1)

Whilst this definition was developed for family physicians from the specialist competencies of CanMEDS 2000, it embodies the principles of professional behaviour promoted in this policy. Such a philosophy implies that being a professional is more than simply doing the job. There is evidence that practitioners subject to disciplinary action by a medical board often have been identified with prior unprofessional behaviour in medical school (2). The importance placed on professional behaviour by regulatory and educational bodies in Australia can be seen by examining their websites, including:

• Australian Health Professional Registration Agency Health Professions accreditation guidelines provide a definition and the competencies required for each health discipline (3)
• Australian Medical Council Code of Conduct (4)

• Royal Australian College of General Practitioners curriculum – Professional and Ethical Role (5)

Whilst many people involved in MCCC are medical practitioners, there are various other staff and professions that are also involved. These other groups and professions also have codes or conduct or the like, for example the Australian Association of Practice Managers has a Code of Ethical Conduct (6)). This policy relies on numerous frameworks that guide conduct and behaviours that foster the professional development of our GP Registrars.

5. Policy

Professional behaviour means

1. Respect for others
2. Responsibility and integrity
3. A commitment to quality
4. A commitment to continuing self –improvement
5. Absence of deceptive or criminal behaviours (7)

Attributes of professional behaviour

For all MCCC staff and contractors, however engaged (program management staff, MEs, GPRs, and GPSs and other contractors):

1. Insight and reflective abilities: insight into one’s own behaviour and how it impacts on others
2. Openness to ideas and change and feedback
3. Respect for others
4. Competence in one’s allocated duties
5. Commitment to one’s work with exercise of a strong work ethic (appearance and dress, attendance, punctuality, preparation, adherence to timelines)
6. Confidentiality with respect to personal and sensitive information
7. Trustworthiness and reliability
8. Integrity and honesty
9. Morality and ethics: adherence to regulations, ethical and legal guidelines; not engaging in criminal or deceptive behaviour.
10. Accountability for one’s actions
11. Responsibility: to one’s colleagues and the organization. This encompasses adherence to MCCC practice policies (the latter is with respect to clinical rotations) and all manner of communications (verbal, non-verbal, written, electronic, social media and networking)
12. Ability to work co-operatively with colleagues and other staff

For health professionals (in addition to the above)

1. Care and compassion for patients
2. Duty of care to patients, the community and society in general
3. Presence and undivided attention to the patient
4. Responsibility to the profession and professional colleagues
5. Exercise of appropriate professional boundaries
6. Compliance with legal obligations of a health professional

6. Processes

Processes have been developed in parallel with this policy:

1. To foster a culture of professionalism within the organisation
2. To ensure MCCC staff, GPRs and MCCC training practices are informed about and understand the rationale and contents of this policy
3. To monitor and address problematic situations and clear breaches of policy.

7. References

• Frank, JR. (Ed) 2005. The CanMEDS 2005 Physician Competency Framework. Better Standards. Better physicians. Better care. Ottawa: The Royal College of Physicians and Surgeons of Canada. Page 23, viewed 8 September 2014.
• Papadakis et al, NEJM 2005:353:2673-82
• Available at:https://www.ahpra.gov.au/Education/Accreditation-standards.aspx
• Available at: http://www.medicalboard.gov.au/Codes-Guidelines-Policies.aspx
• Available at: http://curriculum.racgp.org.au/
• Available at:(http://www.aapm.org.au/About-AAPM/Code-of-Ethical-Conduct
• Faculty Development as an Instrument of Change: A Case Study on Teaching Professionalism. Steinert, Yvonne PhD; Cruess, Richard L. MD; Cruess, Sylvia R. MD; Boudreau, J Donald MD; Fuks, Abraham MD. Academic Medicine: November 2007 – Volume 82 – Issue 11 – p 1057-1064

8. Document history

Version	Summary of changes
1.0	First version
2.0	Second version
3.0	Third version

MCCC Professional Behaviour Policy: Procedures

Last updated: December 2018

Relevant resources

Good Medical Practice: A Code of Conduct for Doctors in Australia 2017

Handbook- A Guide for MCCC Training Practices 2018

National Terms and Conditions for the Employment of Registrars (NTCER) 2017-2018

Fair Work Australia Act (2009) www.fwa.gov.au

RACGP Standards for General Practice Training 2^nd edition

ACCRM Operational Policies (Available at: https://www.acrrm.org.au/operational-policies)

Individual Practice Policy and Procedure Manuals (available at practice)

EDF 001 Training and Supervision Agreement (provided to Practices at start of program)

TRF 003 MCCC Registrar Agreement (provided to Registrars at start of program)

TR 001 Complaints Policy and Procedure

TR 022 MCCC Professional Behaviour Policy

ED 005 Registrar in Difficulty Procedure

ED 008 Registrar Wellbeing Policy and Procedure

ED 012 Out-of-Practice Education Attendance Policy

ED 016 Practice and Supervisor Monitoring and Support Procedures

HR 014 Staff Induction Procedure

HR 021 MCCC Code of Conduct Policy

HR 024 Prevention of Bullying, Harassment and Workplace Violence Policy

1. Purpose

This document is to be read in conjunction with TR 022 MCCC Professional Behaviour Policy and has four components:

1. Expectations of standards of professional behaviour considered appropriate for an effective training program.
2. Development of culture
3. Processes for the identification of, and response to, professional behaviour problems which may arise.
4. Provision of appropriate support mechanisms for those identified with problems.

2. Scope

This procedure applies equally to all persons who are involved in general practice training being GP supervisors (GPS), practice managers (PM), medical educators (ME), program management staff and to the recipients of training – GP registrars (GPR).

3. Procedure

• Expectations of standards of professional behaviours considered appropriate for an effective training program – for all MCCC staff and registrars (program management staff, MEs, GPSs, PMs and GPRs at all levels):
  • Personal and interpersonal behaviour:
    • Demonstrate respect for all professional colleagues at MCCC and staff within the practice environment
    • Honesty and integrity in all training matters
    • Exercising of confidentiality and respect in all matters pertaining to personal information known about colleagues, registrars and training practices
    • Punctuality in all work and training activities
    • Commencement, completion or attendance at all workshops at the scheduled time
    • Accountable and responsible in all training matters
    • Participation and enthusiasm in team activities with colleagues
    • Adherence to professional boundaries
    • Prompt notification to senior staff and/or colleagues where circumstances interfere with the ability to carry out work duties with comply with training requirements
  • Contractual obligations, policies and regulations (compliance with the employment agreement/ contract and the agreed role description):
    • Adherence to all DoH and MCCC policies
    • Informing of CEO/DMET/Regional Manager /appropriate person of all matters of importance which arise in relation to professional work
    • Compliance with documented employment agreement and agreed position description and HR policies
    • Completion of written reports by the required deadline
    • Adequate documentation of training events and issues
    • Appropriate incident reporting and documentation
  • Responsibility to the training practice and practice staff:
    • Attendance at practice visits punctually and adhere to practice appearance, dress and behaviour code
    • Communicate appropriately and in a professional manner within MCCC and its training practices as required
    • Fulfil MCCC’s obligations to the training practices
    • Facilitation of introduction transition for registrars, supervisors, practice managers who are new to the general practice and the training practice itself
    • Demonstration of respect for all medical colleagues and practice staff in the practice environment
    • Undertake duties pertaining to training practices in accord with MCCC policies, procedures and contracted requirements
  • Responsibility to the registrar by MCCC, MEs and GPS’:
    • Provision of suitable orientation for all new staff, particularly GPRs
    • Introduction to all practice policies and guidelines
    • Adherence to MCCC policy, MCCC TRF 0003 Registrar Agreement and NTCER 2017 & 2018 Training Years
    • Compliance with RACGP Standards for General Practice Training 2nd edition
    • Ensure, as much as possible, a broad clinical experience and range of patients
    • Provision of suitable role- modelling for GPRs registrars in all behaviours

NOTE: Management processes within a MCCC training practice are under the auspices of the GPS and the principals of the practice. This document does not seek to dictate to training practices their expectations of appropriate behaviour.  However, where the behaviour of individuals within the practice affects the contract for and the delivery of training, this policy would be applicable.

• Development of a culture of ongoing professionalism within MCCC.
  • Orientation of new MCCC staff: Discussion of professional behaviour standards is an essential and integral component of the induction process for new staff – please also refer to HR 014 Staff Induction Procedure. A copy of TR 022 MCCC Professional Behaviour Policy and TR 023 MCCC Professional Behaviour Policy: Procedures will be provided at commencement of employment and discussed with the new employee. Other documents that will be provided are HR 021 Code of Conduct Policy and H 0024 Prevention of Bullying, Harassment and Workplace Violence Policy. MCCC will ensure that staff sign their Induction Checklist indicating that they have been provided with these documents.
  • Orientation of new registrars in training practices: MCCC strongly recommends to its training practices that a discussion of the professional behaviour expectations of a new GPR in the practice is undertaken at orientation.
  • Induction of new practices, new supervisors and PMs into MCCC: An introduction to the MCCC professional behaviour policy will be an essential component of this process.
  • Development of a culture of professional behaviour within the organisation: The DMET or their delegate will discuss MCCC expectations of professional behaviour and the issue of professional behaviour at the GPT1 Orientation workshop and introductory workshops for GPSs.
  • Ongoing regular professional development: The subject of professional behaviour will be considered in professional development for GPSs GPRs, MEs, PMs and program management staff from time to time.
  • Modelling professional behaviour: An expectation exists that all staff will model appropriate professional behaviour at all times in the workplace and MCCC training practices.
• Processes for the identification of and response to professional behaviour problems which arise.
  • Identification and Processes for Reporting

Within MCCC, any staff member, ME, GPR, GPS or PM in any area is entitled to raise a professional behaviour concern pertaining to a working colleague or GPR. Concerns raised by staff of training posts need to relate to matters pertaining to MCCC work. Generally, MCCC staff will choose to report issues with their line manager but also have the option of reporting to any member of the MCCC Executive or the Manager- People and Culture. Registrars may also wish to seek advice from the RLO and Supervisors from the SLO. Where a matter relates to registrars in difficulty, PALS advice may also be sought.

• • Description of infringements and Response

Overarching principal

Minor breaches ideally are addressed and resolved within the situation where they arise. Otherwise formal reporting to the higher level of seniority will be necessary.

Description of Minor Infringements	Description of Major Infringements
Personal and interpersonal behaviour:	Personal and interpersonal behaviour:
·                One-off complaints from program management or training post staff in relation to professional behaviour domains including: ·                Interpersonal issues with MCCC education or program staff or with colleagues in the training post environment ·                Recurrent lack of punctuality in any work task ·                Inappropriate personal appearance and presentation appropriate to the requirements of the work environment	·                Recurring complaints from program or training post staff in relation to serious breaches of professional behaviour domains ·                Ongoing interpersonal problems with MCCC education or administrative staff or with colleagues in the training that are adversely affecting working relationships ·                Any form of abuse or ongoing serious bullying of another GPR, training post staff member or MCCC staff member

Examples of Minor and Major Infringements and Responses by Grouping
	Examples	Process
GPR
Minor Infringement – Training Administration Related	·      Failure to complete AGPT training requirements over course of training – timelines and deadlines will be provided for each activity ·      Late or failure of submission of documents required for RPL without valid reason offered ·      Late submission of initial assessment activities without valid reason offered ·      Late submission of peer learning workshop catch up modules without valid reason offered	·      The following escalation process will be followed for Registrars who are deemed to have minor breeches in their professional behaviour related to a Training Administration matter. MCCC expects that the behaviour will stop and/or the mandatory requirements will be met and that the registrar will comply with the requirements as outlined below: Step 1 – MCCC will run a report around the 10th of each month to identify outstanding requirements for registrars. If there are outstanding activities on this report, the Training Support Officer (TSO) will email to the Registrar and copy in their Practice Manager. Step 2 – The report will be re-run after 7 days. If there are still outstanding activities on the report. The TSO will pass this information to the Registrar Education and Training Support Coordinator (REAPS) who will ring the registrar. The REAPS will outline the requirements, negotiate timeframes for expected actions and ensure that the Registrar and Practice is aware that the matter will escalate if not resolved; Step 3 – If still no resolution, within 3 days, the Regional Head of Education will contact the Registrar and reiterate the requirements and timeframes. A visit to the Registrar’s practice and involvement of the GP Supervisor may be required; Step 4 – if the issue remains unresolved, the DMET will arrange a meeting with the Registrar with the involvement of others as deemed necessary. Step 5 – if the Registrar fails to comply with the plan as outlined by the DMET, then the registrar may be withdrawn from MCCC Training.
GPR
Minor Infringement – Education or Contract Related	·      Lack of punctuality at workshops or other educational events without valid reason offered. ·      Minor disruptive behaviour at MCCC educational or other events ·      Failure to enrol in RACGP exam by GPT4/extended skills term ·      Disputation about employment agreement due to GPR unreasonably wanting to alter agreement ·      Failure to follow training post policies and procedures ·      Lack of punctuality within the training post as defined by GPR contract. ·      Unreasonable refusal to see patients requiring urgent appointments (such requests should not be any more onerous than for any other doctor at the practice.) ·      Inappropriate interpersonal behaviour within the practice environment	·      The following escalation process will be followed for Registrars who are deemed to have minor breeches in their professional behaviour related to an Education of Contract matter. MCCC expects that the behaviour will stop and/or the mandatory requirements will be met and that the registrar will comply with the requirements as outlined below: Step 1 – The REAPS will contact the Registrar and outline the requirements, negotiate timeframes for expected actions and ensure that the Registrar is aware that the matter will escalate if not resolved; Step 2 – If still no resolution, the Regional Head of Education will contact the Registrar and reiterate the requirements and timeframes. A visit to the Registrar’s practice and involvement of the GP Supervisor may be required; Step 3 – if the issue remains unresolved, the DMET will arrange a meeting with the Registrar with the involvement of others as deemed necessary. Step 4 – if the Registrar fails to comply with the plan as outlined by the DMET, then the registrar may be withdrawn from MCCC Training.
Major Infringement – Training Administration Related	·      Recurrent failure to complete AGPT training requirements over course of training ·      Ongoing non- submission of documents required for RPL despite ongoing requests for same without valid reason offered ·      Non or very late submission of initial assessment activities without valid reason offered	·      Registrars who are deemed to have had major infringements will be asked to meet with the DMET and/or the CEO. ·      If the Registrar fails to comply with the plan as outlined by the DMET, then the registrar may be withdrawn from MCCC Training.

GPR
Minor Infringement – Education or Contract Related	·      Lack of punctuality at workshops or other educational events without valid reason offered. ·      Minor disruptive behaviour at MCCC educational or other events ·      Failure to enrol in RACGP exam by GPT4/extended skills term ·      Disputation about employment agreement due to GPR unreasonably wanting to alter agreement ·      Failure to follow training post policies and procedures ·      Lack of punctuality within the training post as defined by GPR contract. ·      Unreasonable refusal to see patients requiring urgent appointments (such requests should not be any more onerous than for any other doctor at the practice.) ·      Inappropriate interpersonal behaviour within the practice environment	·      The following escalation process will be followed for Registrars who are deemed to have minor breeches in their professional behaviour related to an Education of Contract matter. MCCC expects that the behaviour will stop and/or the mandatory requirements will be met and that the registrar will comply with the requirements as outlined below: Step 1 – The REAPS will contact the Registrar and outline the requirements, negotiate timeframes for expected actions and ensure that the Registrar is aware that the matter will escalate if not resolved; Step 2 – If still no resolution, the Regional Head of Education will contact the Registrar and reiterate the requirements and timeframes. A visit to the Registrar’s practice and involvement of the GP Supervisor may be required; Step 3 – if the issue remains unresolved, the DMET will arrange a meeting with the Registrar with the involvement of others as deemed necessary. Step 4 – if the Registrar fails to comply with the plan as outlined by the DMET, then the registrar may be withdrawn from MCCC Training.
Major Infringement – Training Administration Related	·      Recurrent failure to complete AGPT training requirements over course of training ·      Ongoing non- submission of documents required for RPL despite ongoing requests for same without valid reason offered ·      Non or very late submission of initial assessment activities without valid reason offered	·      Registrars who are deemed to have had major infringements will be asked to meet with the DMET and/or the CEO. ·      If the Registrar fails to comply with the plan as outlined by the DMET, then the registrar may be withdrawn from MCCC Training.

	Examples	Process
GPR
Major Infringement – Education or Contract Related	·      Non or very late submission of peer learning workshop catch up modules without valid reason offered ·      Recurrent extreme lack of punctuality at workshops or other educational events without valid reason offered ·      Non- attendance at peer learning workshops without valid reason offered ·      Major disruptive behaviour at MCCC educational or other events ·      Deliberate disregard of MCCC policy, procedures and /or terms of employment ·      Refusal to see patients with a medical emergency at clinic ·      Consistent refusal to see any patient without a valid reason offered ·      Ongoing Inability to resolve employment agreement issues registrar unreasonably wanting to alter agreement ·      Extreme lack of punctuality within the training post as defined by GPR contract. ·      Ongoing failure to follow practice policies and procedures or serious breaches ·      In appropriate interpersonal behaviour within the practice environment	·      Registrars who are deemed to have had major infringements will be asked to meet with the DMET and/or the CEO. ·      If the Registrar fails to comply with the plan as outlined by the DMET, then the registrar may be withdrawn from MCCC Training.

	Examples	Process
GPS including members of the supervisory team in a training post:
Minor Infringement – Training Administration Related	·      Non-adherence to MCCC policy, MCCC Supervision and Training Agreement and NTCER 2017 – 2018 ·      Non-compliance with RACGP Standards for General Practice Training 2nd edition (as applicable) ·      Non-compliance with ACRRM Standards for Supervisors and Teaching Posts (as applicable) ·      Non-compliance with contract with GPR ·      Late or non- submission of forms or documents required for training without valid reason offered ·      Required data to be submitted to MCCC not received within required time frames ·      Untimely or inaccurate information provided to registrars or training practices	·      Supervisors (or members of the supervisor team in a training post) who are deemed to have minor breeches in their professional behaviour will be invited to meet with Regional Head of Education and/or the REAPS. Following this meeting there will be a list of outcomes which the practice will be expected to comply with.  At this stage, ED0016 Practice and Supervisor Monitoring and Support Procedures will be followed Late or non-submission of forms or documents required for training without a valid reason. Step 1 – MCCC will run a report around the 10th of each month to identify outstanding requirements for Training Practices. If there are outstanding activities on this report, the Training Support Officer (TSO) will email to the Supervisor and copy in their Practice Manager. Step 2 – The report will be re-run after 7 days. If there are still outstanding activities on the report. The TSO will pass this information to the Registrar Education and Training Support Coordinator (REAPS) who will ring the Practice Manager. The REAPS will outline the requirements, negotiate timeframes for expected actions and ensure that the Training Practice is aware that the matter will escalate if not resolved; Step 3 – If still no resolution, within 3 days, the Regional Head of Education will contact the Supervisor and reiterate the requirements and timeframes. Step 4 –GPSs who are deemed to have demonstrated continued breeches in non-compliance will be escalated according to the perceived impact of the infringement, up to and including removal of MCCC supervisor and practice accreditation status

Minor Infringement – Contract or Employment Related

·      Excessive rostering demands on GPR or expectations of hours worked not in keeping with those worked by other GPs ·      Appropriate orientation not provided for GPR ·      Failure of provision of teaching for GPR ·      On-site supervision not provided as required ·      Non-completion of required GPS CPD ·      Complaints from GPRs, program or training post staff in relation to professional behaviour domains

	Examples	Process
GPS including members of the supervisory team in a training post:
Major Infringement – Training Administration Related	·      Recurrent non- submission of forms or documents required for training without valid reason offered ·      Required data to be submitted to MCCC not received on a recurrent basis ·      Recurrent inaccurate information provided to GPRs or training practices	·      GPSs who are deemed to have demonstrated major breeches in their professional behaviour will be asked to meet with the DMET and CEO. ·      The matter will be investigated by MCCC and escalated according to the perceived impact of the infringement, up to and including removal of MCCC supervisor and practice accreditation status
Major Infringement – Contract or Employment Related	·      Serious breaches or recurrent non-adherence to MCCC policy, MCCC Teaching and Supervision Agreement and/or NTCER 2017-2018 ·      Non-compliance with RACGP Standards for General Practice Training 2nd edition ·      Serious breaches or recurrent non-compliance with contract with GPR ·      No orientation provided for new GPRs ·      Recurrent failure of provision of teaching for GPR ·      Recurrent on-site supervision not provided as required ·      Dispute about employment agreement due to GPS unreasonably wanting to alter agreement ·      Recurring complaints of a serious nature from GPRs, program or training post staff in relation to professional behaviour domains ·      Recurrent non-completion of required GPS professional development

	Examples	Process
GPS including members of the supervisory team in a training post:
Major Infringement – Contract or Employment Related (Continued)	·      Complaints of a serious nature from GPRs, program or training post staff in relation to professional behaviour domains ·      Serious interpersonal problems with colleagues, registrars or other MCCC staff that are adversely affecting working relationships Ongoing and serious failure to meet supervision requirements for GPRs	·      GPSs who are deemed to have demonstrated major breeches in their professional behaviour will be asked to meet with the DMET and CEO. ·      The matter will be investigated by MCCC and escalated according to the perceived impact of the infringement, up to and including removal of MCCC supervisor and practice accreditation status

	Examples	Process
MCCC Employees – MEs and Program Management staff
Minor Infringement	·      Non-adherence to MCCC policy ·      Non-compliance with RACGP Standards for General Practice Training 2nd edition (MEs) ·      Data or other information relating to GPRs not actioned within required time frames ·      Untimely or inaccurate information provided to registrars or training practices ·      Lack of punctuality at workshops, ECTVs (MEs) or other MCCC events without valid reason offered ·      Inability to work collaboratively with MCCC colleagues and staff ·      Minor disruptive behaviour at MCCC educational or other events ·      Inappropriate interpersonal behaviour within the MCCC work or training post environment ·      In appropriate interpersonal behaviour pertaining to GPRs, GPSs or any staff in the training post environment ·      Failure to follow training post policies and procedures when in this environment ·      Inappropriate interpersonal behaviour pertaining to patients within the practice environment	·      Depending upon the level of employee and their line management reporting this will either be directed to the REAPS, RHE or executive line manager. ·      Employees who are deemed to have minor breeches in their professional behaviour will be asked to meet with their line manager, HR and/or executive line manager as deemed appropriate. There will be an expectation that the behaviour will stop and that the employee will comply with the requirements as outlined above. ·      If the behaviour does not change then the employee will be invited to speak with the CEO and the respective executive line manager and a plan for resolution agreed. ·      If the employee continues to fail to comply with this plan, then their employment with MCCC GP Training will be withdrawn.

	Examples	Process
MCCC Employees – MEs and Program Management staff
Major Infringement	·      Recurrent non-adherence to MCCC policy ·      Recurrent non-compliance with RACGP Standards for General Practice Training 2nd edition (MEs) ·      Persistent failure to provide required data or other information relating to GPRs within required time frames ·      Untimely or inaccurate information provided to registrars or training practices pertaining to serious issues ·      Recurrent and serious lack of punctuality at workshops, ECTVs or other MCCC events without valid reason offered ·      Recurrent inability to work collaboratively with MCCC colleagues and staff ·      Major disruptive behaviour at MCCC educational or other events ·      Marked in appropriate interpersonal behaviour within the MCCC work or training post environment ·      Marked in appropriate interpersonal behaviour pertaining to GPRs, GPSs or any staff in the training post environment ·      Recurrent of serious failure to follow training post policies and procedures when in this environment ·      Marked in appropriate interpersonal behaviour pertaining to patients within the practice environment	·      MCCC employees who are deemed to have demonstrated major breeches in their professional behaviour will be asked to meet with the respective executive line manager and CEO ·      As employees of MCCC, the relevant HR policies will apply in addition to the applicable Fair Work Australia legislation

• • Issues of criminality and/or Medical Registration:

Issues of criminality are not dealt with under this Policy but should be notified to MCCC’s CEO immediately.

In the case of Medical Practitioners, any changes in AHPRA Registration status must also communicated directly to the CEO and the DMET.

4. Provision of appropriate support mechanisms for those identified with problems

MCCC provides a range of supports to those who are identified with problems. Further information and guidance is provided in the appropriate MCCC Policies and Procedures as listed below. The following table provides a list of the MCCC staff who can be contacted with regard to an explanation of the support which is available and how to access this support.

 

Staff member	Support from
Program Management Staff	REAPS / HR / MCCC Executive
Medical educators	RHE/DMET
Registrars	TA/PALS team/ RLO
Supervisors	SLO / RHE / RM / Education Portfolio Managers / DMET / MCCC Executive
Practice managers	REAPS / RHE / DMET / CEO / GPS

5. Document history

Version	Summary of changes
1.0	First version
2.0	Second version

Privacy Policy

Last Updated: December 2019

1. Purpose

Murray City Country Coast GP Training (“MCCC“, “We“ or “our”) is an organisation which provides educational services to general practice trainees. MCCC also operates a website under the domain name www.mccc.com.au (“Website“).

We recognise the importance of maintaining the privacy of the personal information of our customers and other individuals we deal with.

This Privacy Policy applies to the collection, use and disclosure of personal information by MCCC, and is made in accordance with the Australian Privacy Principles which apply to MCCC pursuant to the Privacy Act 1988 (Cth) (“Privacy Act“).

You agree to the terms of this Privacy Policy by engaging MCCC to provide you with education and training services.

In the event of inconsistency between this Privacy Policy and the Privacy Act, the Privacy Act will prevail.

2. Why is personal information collected by MCCC?

MCCC collects personal information:

1. about individuals who engage us to provide them with services (or who enquire about our services); and
2. about other individuals, where such personal information is relevant to the services we are providing to one of our customers.

3. How is personal information collected by MCCC?

MCCC primarily collects personal information:

1. from an individual directly when details are provided to us in emails, forms, face-to-face meetings, interviews, business cards and telephone conversations;
2. from third parties where such information is relevant to the services we are providing to the customer, for example, when:
   • a customer provides us with personal information about another person; or
   • organisations provide me with information applicable to the delivery of our services.

We will take reasonable steps to notify individuals about our collection of their personal information and will provide all relevant information prescribed under the Privacy Act.

We will only collect personal information by lawful and fair means. We will destroy or de-identify any personal information we receive if we would not ordinarily be permitted to collect that information under the Privacy Act.

4. What kinds of personal information are collected by MCCC?

The personal information we may collect about individuals includes:

1. name;
2. general contact information such as address, telephone, fax and email; and
3. any other details relevant to the services we have been engaged to provide to one of our customers – depending on the matter, this may include details about a range of other relevant personal information. In some cases, we may also collect “sensitive information”, such as information about an individual’s insurance or health information.

5. How is personal information used by MCCC?

When we collect personal information about an individual, we will not use that information for any purpose other than the primary purpose for which it is collected, except as otherwise set out in this Privacy Policy or as permitted or required by the Privacy Act.

6. How is personal information disclosed by MCCC?

We may disclose personal information:

1. about a customer in any manner incidental to our provision of services to the customer;
2. to entities who assist us in providing our services (including hosting and data storage providers); and
3. to the purchaser of all or part of our business operations, if our customer database forms part of the sale.

MCCC will not otherwise use or disclose any information about individuals without their consent, except as otherwise required or permitted under the Privacy Act.

We do not disclose personal information to any recipients located outside Australia except with consent or as required or permitted under the Privacy Act.

7. How does MCCC store personal information?

We will take all reasonable steps to protect personal information from misuse, interference, and loss, and from unauthorised access, modification or disclosure.

We require our employees and contractors to protect the confidentiality of the personal information we hold.

Where we no longer require your personal information, we will take reasonable steps to destroy it. However, note that we are generally required to keep records relating to the services we provide for a period of at least 7 years.

8. How can I access, change or delete MCCC’s records of my personal information?

You may request access to our records of your personal information by contacting me using the details set out below. We will generally make your information available to you within 14 days of receiving your request. However, we may require you to pay a reasonable charge for access. We also reserve the right to refuse access to in certain circumstances permitted by the Privacy Act.

MCCC will use its best endeavours to ensure that the personal information it holds is accurate, complete and up-to-date.

If you wish to update your personal information, please contact MCCC using the details set out below to request an amendment to your record. Where it is established that personal information, we hold about you is not accurate, or up-to-date, we will take all steps necessary to amend it.

9. Changes to the MCCC Policy

We reserve the right to change this Privacy Policy at any time. We will notify you of this by posting an updated version of the policy on the Website.

10. How can I make a query or complaint about privacy?

If you have any enquiries about this Privacy Policy or wish to make a complaint about a matter relating to privacy, please contact us using the details set out below.

To contact MCCC about this Privacy Policy, you can:

• email us at info@mccc.om.au; or
• telephone us on 1300 6222 47.

11. Document history

Version	Summary of changes
1.0	First version

Complaints Policy and Procedure

Last updated: November 2017

Relevant resources

TRF 001 MCCC Complaint Reporting Form

TR 018 MCCC Appeals Policy & Procedure

ACRRM Appeals and Complaints Policies

AGPT Appeals Policy

AGPT Complaints Policy

AGPT Review of Decision – Transition Policy

RACGP Fellowship Pathways Appeals Policy

1. Purpose

To provide a mechanism to deal with complaints raised by complainants involved in any capacity in the MCCC training program in relation to training program issues.

2. Scope

This policy applies to registrars enrolled in the MCCC training program, accredited MCCC GP Supervisors or MCCC training post employees.

3. In practice/Employment matters

MCCC is an organisation that delivers education and training to registrars. Issues that are of an industrial nature are therefore not dealt with by MCCC, who has no jurisdiction in this area. MCCC will however get involved in issues pertaining to education and training matters and matters that lead to noncompliance with RACGP, ACRRM, MCCC or AGPT policy.

4. Obligations

Stakeholders are responsible for addressing complaints early on and MCCC is responsible for ensuring that complaints are dealt with efficiently.

5. Procedure

MCCC Complaints Procedure follows a four-step escalation process:

• • Mediation/discussion with any MCCC staff member
  • Mediation/discussion with Regional Manager and/or Regional Head of Education
  • Mediation/discussion with Executive Review Panel
  • Consideration by the MCCC Appeals Panel

1. As a general principle, MCCC aims to resolve all complaints through an informal mediation and conciliation approach. Any MCCC staff member, in association with senior staff, will endeavour to mediate the complaint.  Records of any meetings will be kept.
2. To assist with this process, MCCC will ensure that the complainant will be offered appropriate support.
3. Complaints will be dealt with efficiently and in a manner that affords natural justice to all parties.
4. Should this first level of mediation be unsuccessful, the stakeholder should discuss with the Regional Manager who may wish to discuss the issue with the Regional Head of Education if relevant.
5. If the complaint is not dealt with to the complainant’s satisfaction, a request for a meeting with the MCCC Executive Review Panel should occur to discuss the details. At this point, the complaint is considered to be formal. Formal complaints must be lodged using the MCCC Complaints reporting form found on the MCCC website and emailed to complaints@mccc.com.au
6. A meeting is arranged between the complainant and the MCCC Executive Review Panel. Arrangements will be made to meet within 15 business days of receipt of the formal complaint.
7. This review panel will make the final decision with regards to the complaint.
8. The complainant is notified of the outcome of this meeting in writing within 48 hours of the meeting being held.
9. If the complainant is in disagreement with the outcome of the MCCC Executive Review Panel then the matter is referred to the MCCC Appeals Panel. Please refer to TR 018 MCCC Appeals Policy & Procedure and TRF 018 MCCC Appeals Form.

6. Document history

Version	Summary of changes
1.0	First version
2.0	Addition of item 10 to complaints procedure
3.0	Addition of timeframes to items 7 and 9 and revised timeframe for item 11 of complaints procedure
4.0	Removal of Appeals Procedure into separate Policy Rename Complaints and Appeals Reporting Form to Complaint Reporting Form Addition of para 4 relating to In Practice/Employment Matters Addition of reference to MCCC’s Registrar Wellbeing Policy

Appeals Policy and Procedure

Last updated: November 2020

Relevant resources

TR 001 MCCC Complaints Policy and Procedure

TRF 018 MCCC Appeals Form

ACRRM Appeals and Complaints Policies

AGPT Appeals Policy

AGPT Complaints Policy

AGPT Review of Decision – Transition Policy

1. Purpose

This policy sets out the circumstances under which a complainant may appeal a decision of the MCCC Executive Review Panel made in accordance with TR 001 MCCC Complaints Policy and Procedure.

2. Scope

This policy applies to registrars enrolled in the MCCC training program, accredited MCCC GP Supervisors or MCCC training post employees.

3. Policy 

1. A registrar may appeal to the Department of Health Appeals Panel (Appeals Panel) in accordance with the AGPT Appeals Policy 2020 after exhausting options under TR 001 MCCC Complaints Policy and Procedure and TR 018 MCCC Appeals Policy.
2. Only decisions made by the MCCC Appeals Panel can be reviewed under the AGPT Appeals Policy 2020.
3. MCCC will cooperate with any appeal process or request for further information when requested by the Appeals Panel in accordance with the AGPT Appeals Policy 2020.

4. Procedure

1. If the complainant is in disagreement with the outcome of the MCCC Executive Review Panel then the matter is referred to the MCCC Appeals Panel.
2. The appeal must be lodged using TRF 018 MCCC Appeals Form within 20 working days of the Executive Review Panel’s decision. New evidence must be available for a review to be considered.
3. On receipt of the formal appeal MCCC will acknowledge receipt via email.
4. Complainants should at this stage be reminded of the support available through MCCC’s including ED 008 Registrar Wellbeing Policy.
5. Within two working days the CEO will form and refer the complaint to an MCCC Appeals Panel consisting of a minimum of three (3) members who have not been involved in the complaint to date. This will include:
   • A Board nominee and two (2) Medical Educators (ME); or
   • A Board nominee, an ME and a GP Supervisor
     • Specific membership of the Panel will be dependent on the nature of the complaint.
6. The complainant and any other related parties may be asked to submit additional evidence or supporting documentation relevant to the complaint.
7. Within 15 working days the Panel will invite the complainant to present and discuss their complaint. The complainant may bring a support person with them however the support person will not be involved in any discussion during the meeting.
8. The Panel will then hear from any other related parties.*
9. A decision will be made based on the submitted evidence and the Panel’s decision will be communicated in writing to the complainant through the CEO within six weeks of referral to the Panel. This is MCCC’s final stage of the procedure of any complaint.
10. Registrars have an additional route to manage a complaint: the AGPT Appeals Process.  If a registrar remains dissatisfied with MCCC’s final response, they can refer the matter to the Department of Health.

*other related parties includes MCCC staff and the MCCC Executive

5. Document history

Version	Summary of changes
1.0	First version
2.0	Second version

Leave and Supervision requirements for GP Supervisors

Last updated: August 2018

Relevant resources

RACGP

ACRRM Standards

ED 026 Blended Supervision Model Policy and Procedure

1. Description

An accredited GP supervisor is a general practitioner or specialist medical practitioner who is accredited by RACGP and/or ACRRM to supervise and train AGPT registrars. A GP supervisor may be accredited as a lead supervisor or an additional supervisor.

The supervision role must be carried out by an accredited supervisor (either lead or additional supervisor) in accordance with RACGP and/or ACRRM Standards and MCCC requirements.

Teaching may be provided by:

• Accredited supervisors
• suitably qualified GPs who are not accredited supervisors and/or
• other health professionals, provided the teaching meets the learning needs of the registrar.

2. On-site supervision requirements

The accredited (lead or additional) supervisor must be providing on-site supervision a minimum of the following time each week when the registrar is working:

• GPT1/PRRT 1: 80%
• GPT2/PRRT 2: 50%
• GPT3/PRRT 3: 25%
• GPT4/ PRRT 4: 25%

3. Off-site supervision requirements

Where the accredited supervisor is not on-site, he/she must be accessible by phone and able to return to the practice promptly to assist the registrar if required. The means of contacting the supervisor must be clear to the registrar and the practice manager.

In some instances, a training post may wish to provide a model of blended/off site supervision, where supervision is provided partly or fully by an accredited supervisor located in another general practice. Such arrangements are specific to individual practices and require prior approval by MCCC (in accordance with policy ED 014 Procedures for Accreditation of Training Posts using a Model of Blended/Off-site Supervision of Registrars) and the RACGP/ACRRM according to their particular requirements.

4. On-call supervision requirements

Registrars undertaking on-call work must be supervised during these periods by an accredited MCCC supervisor. (Hyperlink to on-call policy/guidelines)

As part of accreditation/reaccreditation, all MCCC training posts will be required to detail their on-call rostering and supervision arrangements.

5. GPR supervision arrangements for Supervisor leave

It is the responsibility of the lead supervisor to ensure that the registrar is provided with the required supervision at all times during supervisor leave. Where the lead or an additional supervisor is on planned leave, their responsibilities may need to be allocated to another supervisor. Options for supervisor leave arrangements are shown in Table 1 below.

Table 1 – Options for GPR supervision arrangements during supervisor leave

	Training posts with one accredited supervisor	Training posts with more than one accredited supervisor
Planned Leave	· Registrar takes leave at the same time as the supervisor · Another GP in the practice gains RACGP/ACCRM accreditation to supervise the GPR during the period of leave · The practice employs a locum who is an accredited RACGP/ACRRM supervisor · A short term blended on/off site supervision arrangement with prior approval of MCCC	· Supervision is undertaken by another accredited supervisor in the practice
Unplanned Leave   All training posts need to have a current emergency supervision plan to cover unplanned leave of any supervisor	· Another GP in the practice is accredited and available only to ensure supervision during leave. · An emergency blended/off-site supervision model is in place to be invoked should this situation arise. · The registrar takes unpaid leave while the supervisor is absent. · The registrar is transferred to another training practice.	· Supervision is undertaken by another accredited supervisor in the practice*

* if this is not possible then one of the arrangements for single supervisor practices will be required.

 

All supervisors, registrar(s) and the practice manager must be fully informed of the arrangements for leave cover well in advance.

At the time of accreditation/reaccreditation, all training posts will need to complete a supervision leave plan, describing supervision arrangements during any planned and unplanned supervisor leave.

All training posts need to have a current emergency supervision plan to cover unplanned leave of any supervisor. This is the responsibility of the lead supervisor. All affected parties need to be aware of the changed arrangements prior to and during such leave. 

Training posts with only one supervisor

Where the registrar(s) is a GPT1/PRRT1, the supervisor must not take leave in the first four weeks of the training term.

Single supervisor practices need to ensure their supervisor leave plan is current. MCCC must be provided with an updated copy, should the planned supervision arrangements change.

If the registrar is required to take leave at the same time as the supervisor, they must be informed and agreeable to this requirement at time of interview. This requirement is subsequently to be detailed in writing.

Where it is proposed to use off-site/blended models of supervision, this must be discussed well in advance of the leave with the applicable regional office of MCCC and subsequent application paperwork completed (refer to MCCC policy ED 014 Procedures for Accreditation of Training Posts Using a Model of Blended/off-site Supervision of Registrars). MCCC staff will ascertain whether the relevant college needs to be advised.

Solo practices, (where the only GP is also the supervisor) must provide a notification of leave form (attached) to the relevant MCCC regional office outlining supervision and teaching arrangements over this time. This must be submitted a minimum of two weeks prior to the intended leave.

Unplanned Leave

Supervisor unplanned leave may occur due to illness, family issues or other unanticipated reasons. Where the supervision of the registrar is impacted, MCCC should be promptly notified.

In training posts where there is only one supervisor, or at which no accredited supervisor is available to provide the required supervision, the following options may be included in the emergency supervision plan:

1. Another GP in the practice is accredited and available to ensure supervision only during leave. This GP is aware of the responsibilities involved.
2. An emergency blended/off-site supervision model is in place to be invoked should this situation arise.
3. The registrar takes unpaid leave while the supervisor is absent.
4. The registrar is transferred to another training practice. For RACGP registrars this must be for a minimum of one month and for ACRRM registrars a minimum of 3 months. There may be delays while arranging Medicare provider numbers.

Where a registrar works without the supervision of an accredited supervisor, RACGP/ACRRM will not recognise this time as registrar training time.

6. Teaching requirements during supervisor leave

Arrangements for teaching during any supervisor leave are the responsibility of the lead supervisor, who must ensure all parties are aware of any changed teaching arrangements.

Options include:

1. Teaching is completed with another supervisor with no disruption to the teaching schedule.
2. Teaching is provided by a non-accredited GP providing it meets registrar learning needs.
3. Teaching is provided by other health professionals, provided it meets registrar learning needs.

Where these options are not possible and supervisor leave is less than two weeks duration, teaching can be made up before or after the leave period. This must be within four weeks and the registrar must be informed of this arrangement.

Where the leave is more than two weeks duration and the teaching cannot be provided during this time, a formal teaching plan must be provided to MCCC describing how and when the teaching will occur.

7. Document History

Version	Summary of changes
1.0	First version

Supervisor Professional Development

Last updated: September 2021

Relevant resources

ED 029 Management of Training Posts with Identified Issues

ED 016 Practice and Supervisor Monitoring and Support Procedures

ED 032 MCCC Supervisor Competency document

1. Scope

This document outlines the professional development framework and requirements for all MCCC general practice term supervisors

2. Overview

General practice training relies on the apprenticeship model of training to ensure that GP registrars are well supported and educated in the workplace and that our communities receive the best possible care. This requires our supervisors to be the leaders of the primary care supervisory team.

Murray City Country Coast (MCCC) acknowledges the vital role that our supervisors play as clinician educators and mentors.

Consequently, MCCC chooses to invest heavily in supporting our supervisors. We have undertaken focus groups with our Supervisor cohort across the MCCC footprint to increase our understanding of their educational needs and to facilitate the establishment of Regional Supervisor Communities of Practice.

The Supervisor Communities of Practice:

• Enhance and extend knowledge and learning
• Generate and manage a body of knowledge for members to draw on
• Promote consistency of practice whilst recognising the local or regional context
• Innovate and create new ideas, knowledge and practices

The three key elements for our Supervisor Communities of Practice are:

• Established community – to enable interactions, discussions, collaborative activities and relationship building to strengthen and enhance the supervisor role
• Shared commitment to the provision of high-quality supervision for our registrars
• Shared practice (i.e. repertoire of resources) – techniques, tools, experiences, processes or practices which can facilitate the delivery of supervision

We provide professional development (PD) opportunities for supervisors to enhance and maintain skills and knowledge in order to continue performing at a high standard as both supervisor and educator for our GP registrars.

All new supervisors must undertake a New Supervisor Orientation workshop prior to becoming an accredited supervisor. This Workshop is delivered face-to-face or on-line, it may be run regionally or cross regionally according to demand.

A core component of supervisor PD are our regional supervisor workshops (face-to-face or on-line). Each MCCC region offers a local program responsive to the diverse needs of their supervisor cohort.

At MCCC face-to-face/on-line education events, it is expected that supervisors will:-

• Collate points of discussion identified by other (non-attending) supervisors, practice managers or registrars at their practice to enable discussion at face-to-face/on-line workshops.
• Disseminate relevant information on their return to their practice following attendance at a supervisor workshop. The information should be shared with non-attending supervisors, practice managers, registrars and other relevant staff members.

Our supervisor program offers a diversity of formats and content for supervisor PD to accommodate the differing skill level and experience of our supervisor cohort. The MCCC footprint is extensive and our program aims to facilitate cross-regional connections for supervisors who are interested.

In order to ensure standards of training are met, MCCC administers an internal accreditation process for supervisors and practices relating to the completion of PD activities.

3. Aims

The expected outcomes of attending a supervisor PD activity include:

• Update on MCCC as an organisation (e.g. policy changes, mission statement, forward projections, new forms, new guidelines, etc.).
• Update on changes in the training environment within governing bodies and stakeholders (e.g. AGPT, RACGP, ACRRM, etc.).
• The opportunity for effective two-way exchange of information between supervisors and MCCC staff.
• The opportunity for regional supervisors to:
  • Network together;
    1. Intra-regionally
    2. Cross-regionally when possible
       1. Share ideas and resources;
       2. Debriefing with each other regarding issues and problems.

• Educational advancement of skills and knowledge relevant to the role of supervisor and educator.
• An opportunity to liaise with, and give feedback to, the Supervisor Liaison Officer (SLO) and regional supervisor representatives.

4. Communication

MCCC will advertise up-coming events via:-

• SuperCast (MCCC’s podcast dedicated to our supervisors)
• Email to practice manager and supervisor
• MeL under the Supervisor tab for the relevant region
• Supervisor newsletter

5. Professional development requirements

As per the Colleges’ Training Standards, in order to maintain currency and accreditation as a supervisor and a training practice, supervisors must undertake continuing professional development.

To ensure competency of our supervisors, MCCC has developed a framework to support ongoing learning and ensure currency of educational skills.

MCCC supports this by requiring supervisors to undertake professional development as follows:

• Accreditation maintenance:
  • Each supervisor is mandated to complete 4 Mandatory Educational Modules over an 18 month cycle, to ensure accreditation is up to date at the transfer of responsibility for the training program to the colleges (end of 2022). These modules include the following topics:
    1. Benchmarking
    2. Case Discussion
    3. Feedback
    4. Reflective Practice
  • These modules will be reviewed every 6 months to reflect your feedback and to ensure currency and the relevance of the approach to learning.
• Core Supervisor program
  • In addition, each practice must ensure that one of their supervisors attends a minimum of one MCCC facilitated core educational activity (regional/ virtual cross-regional supervisor workshop/small group meeting, as described below) each 12 months. Some flexibility may be permitted on a case by case basis for small and solo practices if these requirements impose unreasonable pressures on the supervisor and the practice.
  • Regional programs will be developed to address the needs of each supervisor cohort. The content will be designed to support supervisors to both acquire and maintain the necessary skills to ensure that they maintain their competencies as outlined in MCCC Supervisor Competency document (ED 032). A variety of formats for the educational program have been developed to extend our reach to all supervisors who interact with our registrars.
  • A cross-regional virtual conference may occur on an annual basis. This will promote cross-regional networking and utilise the wealth of educational expertise from across MCCC footprint. External keynote speakers, presenters and facilitators may also be involved.
  • Completion of MCCC educational events will be eligible for College CPD points, via quick log/manual up-load. MCCC will provide a certificate of attendance for MCCC hosted events
• Elective Extension program
  • For those supervisors wishing to/directed to undertake further professional development, these are some opportunities that are available:
  • MCCC
    1. Masterclasses to enhance teaching skills
    2. Journal club
    3. Video club
    4. rECTV with review
    5. Peer support/mentoring program
    6. Secondary supervisor engagement program
    7. Selection interviewer
    8. Small group supervisor activities
    9. GP research
  • External Provider
    1. College (ACRRM and/or RACGP) examiner
    2. University training courses for Medical student teaching
    3. Academic qualifications for Medical Education
    4. GPSA webinars
    5. Relevant conferences (e.g. GPTEC, AMEE)

6. Remuneration for Supervisor PD

MCCC will:

Remunerate supervisors attending face-to-face/on-line professional development activities for their time and, when relevant, kilometres travelled to and from the event when the distance is greater than 160km return, provided no other travel restrictions apply.  (as per MCCC travel policy)

• Provide accommodation for face-to-face professional development supervisor activities where the supervisor resides more than 90 minutes from the venue (excluding small group local evening meetings for which no accommodation subsidy will be available). There will be a limited budget available for accommodation per event.

Access to remuneration:

• Each practice will be funded to send one supervisor (plus additional supervisors on a pro-rata basis according to Practice Registrar FTE numbers / individual need) to MCCC facilitated Supervisor PD events.
• There will be a budgetary cap per supervisor per year. Once the cap has been reached there may be further opportunities for funded attendance dependent on finances. It may be possible for Supervisors to self-fund attendance if there is capacity at the workshop.
• Supervisors will be paid for completion of the mandatory modules
• Funds available for supporting supervisor PD may vary subject to yearly budgeting
• MCCC medical educators with a dual role as a Supervisor will
  • Be paid as a medical educator for attendance if they are substantially involved in educational delivery
  • Will receive a Certificate of Attendance
  • Attendance will count as Supervisor Professional Development whether they are delivering education or attending as a Supervisor

7. Internal MCCC accreditation process

MCCC facilitated activities – MCCC staff will be responsible for collecting supervisor attendance details at face-to-face/on-line supervisor workshops/activities and small group meetings and will provide that information to the regional Education and Program Support Officers (EPSO) to record participation.

The regional MCCC EPSO will provide practices with an annual PD activity statements to ensure supervisors are aware of their requirements for accreditation.

8. Outcome

Failure to meet Supervisor and Practice PD requirements may affect on-going training practice accreditation.

9. Supervisor in difficulty

When a Supervisor has been identified as “in difficulty” they may be directed to undertake further professional development activities as deemed appropriate.

Funding to support these activities will vary according to the nature of the interventions required.

10. Document history

Version	Summary of changes
1.0	First version
2.0	Second version
3.0	Third version

Financial Support and Safety for out-of-practice events – supervisors and registrars

Last updated: February 2021

Relevant resources

MCCC Registrar Handbook

ED 012 Out of Practice Education Attendance Policy

TR 004 Fatigue Management Guideline

Form EDF 013A – Registrar Expense Reimbursement claim form

Form EDF 013B – Supervisor Expense Reimbursement claim form

1. Purpose

To provide an overview of policy and procedure in relation to out of practice events held by MCCC for Supervisors and Registrars.  It details the safety measures taken and financial support provided by MCCC when:

1. GP Supervisors are attending ‘out-of-practice’ professional development associated with their roles as Supervising GPs within MCCC accredited training posts employing registrars in the AGPT program.
2. Registrars are attending ‘Out of Practice’ learning programs and educational events.

2. Scope

GP Supervisors:

MCCC offers periodic ‘Out of Practice’ regional events which fit the definition of professional development and are aimed to support Accredited Training Posts through an increased understanding of the AGPT program, MCCC policies and procedures, competence, skill and effectiveness in employing and training GP Registrars. As these PD events normally occur in a regional location away from the practice environment they provide opportunity for the Supervisor to network and engage with peers, MCCC management and staff.

 Registrars:

MCCC provides out-of-practice education for Registrars comprising a series of workshops which align with the curricula from both RACGP and ACRRM. Attendance at all scheduled learning activities is compulsory for Registrars (Refer MeL – MCCC e-learning platform)

3. Policy

MCCC is committed to creating a workplace that is safe, healthy and injury-free.  Health and safety is our first priority. Safety is essential to all business functions and this includes workshops held for Supervisors and Registrars.

MCCC recognises that travelling long distances may be required to attend these events. Fatigue management and safety at ‘out of practice’ events is considered critical to the wellbeing of MCCC stakeholders. Overnight accommodation and meals for Supervisors and Registrars travelling more than 80kms from their practice to attend out-of-practice events is supported by MCCC.

Supervisors are remunerated for professional development as outlined in practice agreements including attendance time and kilometre allowance for distances in excess of 80 km from place of practice to the event venue.

Registrars travelling to out-of-practice events are not remunerated for travel time, attendance time nor kilometre allowance.

Supervisor agreement: 

MCCC has a signed agreement with accredited training practices to pay Supervisors and Practices through Recipient Created Tax Invoices (RCTIs).

Supervisor workshops:

MCCC staff will provide attendance sheets at respective events for mandatory Supervisor signature plus insertion of kilometres to/from the event from the Supervisor’s place of practice. MCCC Finance will then initiate payment to the Supervisor if all supplier details have been provided previously to MCCC, such as Supervisor or Practice ABN, GST (must be registered), bank details.

Accommodation booking for Supervisors who have indicated attendance and are eligible will be co-ordinated and paid for by MCCC as organisers of the event. Breakfast is usually included and sometimes dinner forms part of the accommodation costs.

Registrar workshops:

Registrars’ wellbeing at mandatory out-of-practice educational events (e.g. workshops) is a prime example of where health and safety responsibilities intersect, especially in relation to fatigue. Training posts, particularly in rural Victoria, may be a significant distance from the training venue. The NTCER is clear that a Registrar’s roster should consider the issue of fatigue in relation to the distance that a Registrar needs to travel to attend “educational releases” (section 16), and that a Registrar should discuss fatigue management with the relevant person at their practice. Some safeguards might be not being on-call the night before a workshop and allowing travel time to and from a workshop during work hours if the distance to be travelled is significant.

Registrars who are required to travel more than 80 km from their practice to a workshop may be offered accommodation paid for by MCCC. This is the case whether a workshop is scheduled for one or more days.

At the end of a workshop a Registrar may be eligible for an additional night of funded accommodation if travelling home poses a risk to the Registrar’s safety.

Eligibility may depend on:

• Seasonal considerations (i.e. the amount of daylight).
• The distance to be travelled.
• The number of people travelling together to the same or close-by destination.
• Arrangements with the Registrar’s training post.

It is the Registrar’s responsibility to initially discuss requests for paid accommodation with the relevant local Workshop Coordinator. Note that MCCC does not pay Registrar travel time/mileage/ reimbursement to workshops or other educational events. Immediate family members may stay in any approved accommodation, but any associated additional costs are to be met by the registrar (e.g. cots for children, food, cleaning, etc.).

If an eligible Registrar requests workshop accommodation and then does not use it or cancels it, the Registrar may be required to reimburse MCCC for any costs incurred.

4. Document history

Version	Summary of changes
1.0	First version
2.0	Second version
3.0	Third version

TR 011 Education Funding for New Practices Policy

Last updated: September 2019

Relevant resources

TRF 011 New Practice : Claim for Expense Reimbursement

1. Purpose

To provide information on the funding available to new accredited practices to assist with registrar in-practice education and training.

2. Scope

This policy and procedure is applicable to all registrars where Murray City Country Coast GP Training (MCCC) is the host registered Regional Training Organisation (RTO).

3. Policy

1. Training practices are eligible for reimbursement of educational items if the following conditions are met:
   • The training practice has been accredited by Murray City Country Coast GP Training (MCCC).
   • The training practice has a registrar at the time of the application.
   • The training practice has not previously accessed educational reimbursement funding.
2. Practices may apply for up to $2,500 in reimbursement funding.
   • This may include more than one item.
   • Payment will be once off. If the full amount is not claimed, a second claim will not be allowed.

4. Procedure

1. Practices will submit a New Practice Expense Claim Form, complete with supporting documents, to the local Regional Manager.
   • If the items are on the approved list (Appendix A), the application will be recorded, authorised and sent for payment.
   • If an item is not on the approved list or has not been pre-approved by the Chief Executive Officer (CEO) or Director of Corporate and Business Operations (DCBO), the application will be forwarded to the CEO or DCBO for a decision.
     • The CEO or DCBO will advise whether the item is approved.
     • CEO/ DCBO approval relates only to the educational content and does not mean that more than the maximum amount will be reimbursed.
2. Applications for items on the prohibited list (Appendix A) or that are not approved by the CEO/ DCBO will not be authorised for payment, and the Regional Manager will inform the practice of this.

5. Document history

Version	Summary of changes
1.0	First version
2.0	Scope statement amended

MCCC Supervisor Standards

Last updated: June 2020

Relevant resources

RACGP Standards for General Practice Training, 2nd edition – Supervision and the practice environment.

ACRRM Supervisor and Training Post standards. MCCC Supervisor Handbook.

MCCC Supervisor Handbook.

1. Context

MCCC supervisors are required to meet the training standards for the College responsible for the training pathway of their incumbent registrar. Both ACRRM and RACGP have outlined their expectations for supervisors in their Training Standards Documents.

Medical educators representing the MCCC Accreditation and Supervisor Support groups met to develop a set of standards specific for MCCC Supervisors that incorporated all the College requirements and expanded upon them to contextualise the standards for MCCC placements.

The process involved an initial parallel documentation of the Colleges’ Standards in a format compatible with identification and subsequent merging of equivalent requirements. Outlying standards were then reviewed by the representative group and modified and enhanced to address the MCCC supervisor context.

All MCCC Supervisor standards, as a minimum, meet the standards of both Colleges.

2. Scope

All MCCC registrars undertake training placements supervised by accredited MCCC Supervisors. This document outlines the expectations of competencies for persons fulfilling this role for placements in general practice terms, extended skills and remote supervision. Satisfactory attainment and maintenance of these competencies is an integral component of continuing supervisor accreditation.

3. Supervisor standards documents

• Supervision of General Practice Term

 

Category	Standards and Requisite Competencies
1. Patient Safety and Care	The supervisor assesses registrar safety and competence in common and higher-risk clinical presentations.

 

Supervisors identify and manage risks using well-defined practices and safety- management systems to address: A. Registrar working conditions including: ·         Caseloads that match registrar ability and Colleges’ standards ·         Staffing, rosters and times of workforce shortages ·         On-call, afterhours and extended hours ·         Challenging environments, emergencies, nursing homes and hospital work ·         Registrars in alternative supported training placements including telehealth     B. Higher risk and complex presentations including: ·         Establishing privacy/confidentiality limitations ·         Emergency situations o   Trauma assessment ·         Diagnosing – malignancies o   serious/life threatening conditions o   paediatric presentations ·         Cervical screening tests ·         Antenatal care ·         Safe prescribing and deprescribing ·         Conducting procedures, including consent   Supervision is provided to registrars to match registrar needs: ·         Whenever requested in clinical situations ·         In emergency situations ·         On site availability: 100% for the first month, 80% for the next 5 months, 50% for second 6 months, 25% thereafter. ·         When off-site, supervision is available by phone/remotely and the supervisor or delegate can attend if the situation requires it ·         Guidance by all members of the general practice supervision team   The supervisor ensures the practice meets both registrar and patient needs by: ·         functioning unimpeded in the absence of the registrar

 

·         informing patients that they will be seeing a registrar and if the patient declines, enabling them to see another doctor ·         teaching and practicing in a culturally safe manner

 

 

2. Educating the Trainee

Supervisory model (remote, team, blended) must match needs and competency of the registrar; any deviation from this model requires approval     Training and learning are targeted to those issues identified in individual registrar’s learning needs using a variety of teaching methods: ·         Direct observation ·         Joint/wave/parallel consultations ·         Case-based teaching ·         Topic tutorials including supervisor teaching tools ·         Review of recorded consults ·         Teaching clinical and practical procedures ·         Random case analysis ·         Scenario discussions ·         Clinical audits ·         Referral letter, prescribing and clinical notes review.   The supervisor provides ·         feedback ·         clinical guidance ·         supervision ·         support for the registrar.   The general practice supervision team provides in-practice, one-on-one teaching and corridor advice ·         Total teaching time matches level of training ·         Protected and uninterrupted teaching time is delivered one-on-one, minimum 1 hour per week for the first 12 months, 45 mins for GPT/PRRT term 3 ·         Remainder of teaching time will include observed supervisor consultations with feedback, small group discussions with members of the supervision team, educational practice meetings, journal club, discussions resulting from clinical consultations, critical incident debriefing and joint nursing home and home visits

 

·         Whilst corridor teaching may form a large part of in practice supervision, it can only be recorded as 10% of paid teaching time.     The supervisor provides/facilitates/coordinates structured educational activities commensurate with the registrar’s stage of training and experience ·         The practice infrastructure supports learning and teaching ·         The supervisor involves other members of the practice in generating a supervision team to ensure a whole of practice approach to teaching.     The supervisor: ·         Attends New Supervisor Workshops before becoming accredited to supervise ·         Has appropriate knowledge, skills and attitude as both supervisor and clinician ·         Engages in ongoing development of teaching skills ·         Participates in professional development for supervisors as outlined in MCCC policy (ED 025)     The training post provides: ·         Patient-centred care and promotes continuity of care ·         Acute, chronic and preventive care ·         Experience in working in health teams ·         Unless an Extended Skills Post, is not a referral-based service, hospital or limited to one discipline.   A. For RACGP registrars: ·         Is accredited to RACGP practice standards, and if an Extended Skills Post, accredited by the appropriate governing body and MCCC.   B. For ACRRM registrars, is: ·         Community primary care ·         Hospital and emergency facilities ·         Health facilities providing care in rural and remote contexts, where the post is in an MMM 4-7 (and in some circumstances, MMM 3) areas ·         Accredited by ACRRM. The supervisor assesses the registrar’s competency with high risk situations and provides a tailored framework for risk mitigation and is available in emergency situations.

 

In multi-supervisor practices, no disruption to teaching or supervision should occur if the lead supervisor is on leave.   In single supervisor practices ·         Leave up to two weeks – a supervisory delegate must be nominated, MCCC informed and the “missed teaching time” caught up when the supervisor resumes work ·         Leave is >2 weeks – a substitute accredited supervisor must be available so that no disruption to supervision will occur. MCCC must be informed. Non-GPs can act as supervisors in Extended Skills Posts

3. Supporting the Trainee and Monitoring Progress

The lead supervisor ensures: ·         Registrars are employees of practices ·         A formal employment contract with the registrar is in place ·         Registrar Medicare provider number and insurance are valid prior to commencing work ·         Supervisor’s MDO is aware that they are supervising registrars ·         The registrar is oriented to the practice by supervisor, practice manager and nursing staff using MCCC Orientation checklist as a guide ·         Orientation commences on day one of the placement and continues for at least the first month ·         RCTIs are accurate and signed on time ·         Minimum consulting hours match the registrar’s employment status (full vs part time) ·         Practices provide 0.5 hours/day of paid administration time ·         Registrars are rostered to attend mandated out-of-practice learning ·         ECTVs can be booked and supervisors are available for post-visit discussion.   The supervisor meets early with the registrar to ·         Appraise the registrar’s skills and experience ·         Discuss how the training post can meet individual registrar’s training needs ·         Ensure the practice infrastructure supports learning and teaching ·         Help the registrar identify their learning needs and develop their learning plans ·         Negotiate methods and frequency of communication with the registrar

 

·         Ensures registrars are able to attend educational activities and emergency skills training as required ·         Ensures appropriate caseloads as per RACGP/ACCRM standards and that matches the registrar’s ability ·         Ensures safe working hours, travelling hours, after hours, fatigue management and a safe working environment (See Standard 1) ·         Assesses the registrar’s competency with high risk situations and provides a tailored framework for risk mitigation (See Standard 1).   The supervisor conducts and records assessment activities and determines level of competence and progress throughout the placement with: A. Formative assessments of the registrar in accordance with their stage of learning ·         Supervisor reports for Initial and Further Assessment and end of term, Post ECTV discussion with visiting ME and registrar, ·         For ACRRM registrars, in addition to the above: Mini-CEX; AST formative assessment; Logbook completion ·         Provides assessment feedback to MCCC in a timely fashion B. Clinical guidance, supervision and support for the registrar ·         Identifies registrars’ strengths and weaknesses ·         Provides career advice and helps the registrar to develop their learning plan ·         Demonstrates procedures for managing aggressive or violent patients ·         Provides oversight, guidance and feedback on pastoral and professional matters ·         Ensures that their clinical workload is commensurate with providing accessible and timely supervision.   The supervisor organises their own clinical workload to be compatible with teaching commitments. ·         Complies with the limits set on the number of registrars a supervisor can be responsible for at any one time ·         Creates a Teaching Plan that including nominating an additional (accredited or provisional) supervisor when the lead supervisor is not available ·         Offers registrars the opportunity to debrief ·         Recognises registrar training is an activity for the whole practice and encourages open communication with the whole practice team ·         Provides levels of supervision commensurate with registrar experience and needs (See Standard 1)

 

·         Provides training resources according to College and MCCC requirements (See Appendix 1).

4. Promoting High Standards

Training posts seek registrars’ feedback on quality and suitability of the training post and education.   Supervisors will use registrar feedback to improve the available training experience provided by their practice.   Supervisors will feed back on the models of in-practice teaching and how this meets individual registrar’s needs, citing strengths and weaknesses of different approaches ·         Supervisors use a wide range of educational resources including GPSA, ACRRM, RACGP provided resources, MCCC specific resources including MCCC topic library ·         Registrar training is provided by the whole general practice supervision team including allied health, nurses and practice managers.   The supervisor provides ·         Feedback and detailed advice to registrars ·         Opportunity to debrief ·         Encourage questions ·         Oversight, guidance and feedback on pastoral and professional matters ·         Patient feedback regarding registrar performance; for ACRRM registrars this is formal multi-source feedback and is part of assessment.   The supervisor participates in ongoing clinical professional development and: ·         Is accredited by MCCC ·         Has full and unrestricted registration as a GP Specialist with AHPRA ·         For RACGP supervisors, the nominated lead supervisor for each registrar in a general practice placement will be an experienced and credentialed specialist GP ·         For ACRRM supervisors, has had 5 years FTE experience in rural/remote medicine ·         Participates in professional development for supervisors ·         Is enthusiastic about general practice and teaching ·         Provides professional role modelling as a clinician and educator ·         Is a fellow of the appropriate college as pertains to Advanced Specialist Training or Extended Skills Posts.

 

·         For ACRRM supervisors, has had 5 years FTE experience in rural/remote medicine.

5. Identifying and Managing Trainee Problems

Supervisors identify, respond to and report on critical incidents ·         Any critical incident must be reported to MCCC. ·         Problems and disputes should be addressed according to agreed practice and MCCC policies ·         Problem resolution should be evaluated for its effectiveness to inform further quality improvement ·         Supervisors also undertake strategies to prevent problems occurring in training. ·         Supervisors will approach problems in a structured manner by identifying the issue, understanding the underlying causes, creating an appropriate management plan and documenting the process.   Where a concern exists about registrar performance, and in-house discussions have failed to achieve resolution, the supervisor will contact: ·         MCCC Medical educator ·         Regional Head of Education. Supervisors understand the Mandatory Reporting regulations and where a registrar engages in Notifiable Conduct, contacts both MCCC and AHPRA   Supervisors identify and address registrar stress and fatigue in accordance with MCCC policy

 

 

Category

Competencies: where standards are not met

1. Patient Safety and Care

The supervisor does not assess registrar safety and competence in common and higher-risk clinical presentations or does so in only limited scenarios   The supervisor manages risks sub optimally by frequently or consistently: ·         Assigning caseloads beyond the registrar’s ability and Colleges’ standards ·         Rostering registrars to excessive hours, on call, extended hours or unsupported shifts ·         Assigns challenging environments including telehealth, emergencies, nursing homes and hospital work without orientation and support ·         Allows registrars to consult higher risk and complex presentations without adequate training and supervision.   Supervision is frequently unavailable, limited or given reluctantly whenever requested by registrars, and particularly in emergency situations and:

 

·         Fails to include appropriate onsite supervision, being 100% first month, 80% for the next 5 months, 50% second 6 months, 25% thereafter ·         Does not include reliable remote access and support when the supervisor is off-site.   The supervisor applies pressure to the registrar to forfeit leave when unwell, bereaved or unfit to practice.   The supervisor demonstrates culturally unsafe practices or attitudes.

2. Educating the Trainee

Supervisory model frequently does not match the needs and competency of the registrar.   Registrar training and learning is frequently/consistently limited to informal discussion, tutorial format or opportunistic advice and does not draw on the variety of recommended teaching methods.   The supervisor’s feedback is frequently not based on observable evidence, is personal in nature, does not include collegiate discussion with the registrar or does not provide ideas on how to improve.   The general practice supervision team frequently/consistently fails to provide the requisite in-practice, one-on-one teaching and corridor advice or counts corridor teaching as more than 10% of the total teaching time.   The supervisor frequently/consistently provides education based on the supervisor’s preferences rather than the registrar’s needs.   The supervisor has not/does not complete the New Supervisor workshop/webinar and does not engage in professional development for supervisors as outlined in MCCC policy.   The training post provided is not accredited by its governing College and/or does not provide the registrar with a broad range of general practice clinical experience including continuity of care.   With regards teaching and supervision during lead supervisor leave: ·         Teaching and supervision is disrupted or not provided during supervisor absences or;   In single supervisor practices ·         “Missed teaching time” is not caught up when the supervisor resumes work if absence was <2 weeks or; ·         A substitute accredited supervisor was not available to ensure that supervision and teaching continued if supervisor absence was >2 weeks.

 

3. Supporting the Trainee and Monitoring Progress

The lead supervisor has not personally ensured the following requirements have been met: ·         Registrars are employees of practices ·         A formal employment contract with the registrar is in place ·         Registrar Medicare provider number and insurance are valid prior to commencing work ·         Supervisor’s MDO is aware that they are supervising registrars ·         The registrar is oriented to the practice by supervisor, practice manager and nursing staff using MCCC Orientation checklist as a guide ·         Orientation commences on day one of the placement and may take up to one month to complete (depending on registrar’s training experience and learning needs) ·         RCTIs are accurate and signed on time ·         Minimum consulting hours match the registrar’s employment status (full vs part time) ·         Practices provide 0.5 hours/day of paid administration time ·         Registrars are rostered to attend mandated out-of-practice learning ·         ECTVs can be booked and supervisors are available for post-visit discussion.   The supervisor does not meet early with the registrar to discuss registrar skills, experience and learning needs and does not ensure appropriate caseloads, safe and fair working hours, and a framework for managing high- risk situations.   The supervisor/practice does not support the registrar to attend out of practice teaching, or makes registrar access to learning from the whole teaching team unduly difficult.   The supervisor frequently fails to conduct and/or record assessment activities and progress via the methods proscribed by the relevant College and does not submit those assessments to MCCC.   The supervisor provides insufficient or untimely levels of support and guidance regarding registrar learning gaps, pastoral concerns, difficult patient encounters.   The supervisor’s own clinical workload is not compatible with teaching commitments by: ·         supervising too many registrars or ·           being unavailable for supervision due to excessive patient numbers

 

	The supervisor draws on resources that are not recognised as evidence-based in teaching, or provides a level of teaching and support that is not commensurate with the registrar’s experience and needs
4. Promoting High Standards	The supervisor does not receive feedback from the registrar in a collegiate manner, or creates an environment in which feedback is discouraged.   Teaching within the practice is restricted to the supervisor only and other teaching team members do not provide support.   The teaching environment discourages questions or opportunities to debrief, or sets an example of clinical care, professionalism and risk management that is not acceptable by the profession’s standards.
5. Identifying and Managing Trainee Problems	The supervisor does not follow the critical incident reporting and management procedures as required by MCCC.   The supervisor does not undertake strategies to reduce the risk of critical or near-miss events.   The supervisor does not report concerns about registrar performance (including clinical performance, stress and fatigue) to MCCC when that problem becomes apparent.   The supervisor is not aware of/fully informed regarding Mandatory Reporting regulations as they pertain to both MCCC and AHPRA.

• Supervision of Extended Skills posts

 

Category

Extended skills Standards and Competencies

1. Patient Safety and Care

The supervisor assesses registrar safety and competence in both common and higher-risk clinical presentations.   Supervisors identify and manage risks using well-defined practices and safety- management systems to address.   Registrar working conditions including: ·         Caseloads that match registrar ability and Colleges’ standards ·         Staffing, rosters and times of workforce shortages ·         On-call, afterhours and extended hours ·         Challenging environments or new clinical settings. ·         Registrars in alternative supported training placements including extended skills in Hospital or Community settings.

 

Higher risk and complex presentations including: ·         Establishing privacy/confidentiality limitations ·         Emergency situations ·         Safe prescribing and deprescribing ·         Conducting procedures, including consent, where relevant to placement.   Supervision is provided to registrars to match registrar needs: ·         Whenever requested in clinical situations ·         In emergency situations ·         When off-site, supervision is available by phone/remotely and the supervisor or delegate can attend if the situation requires it.   The supervisor ensures the placement meets both registrar and patient needs by: ·         informing patients that they will be seeing a registrar and if the patient declines, enabling them to see another doctor ·         teaching and practicing in a culturally safe manner.

2. Educating the Trainee

Supervisory model must match needs and competency of the registrar.   Training and learning are targeted to those issues identified in individual registrar’s learning needs.   The supervisor provides: ·         feedback ·         clinical guidance ·         supervision ·         support for the registrar. The     supervisor    provides/facilitates/coordinates    educational     activities commensurate with the registrar’s stage of training and experience: ·         The placement infrastructure supports learning and teaching ·         Where appropriate, the supervisor involves other members of the placement team.   The supervisor has appropriate knowledge, skills and attitude as both supervisor and clinician.   The Extended Skills post is accredited by the appropriate governing body and MCCC.

 

The supervisor assesses the registrar’s competency with high risk situations and provides a tailored framework for risk mitigation and is available in emergency situations.   In multi-supervisor posts, no disruption to teaching or supervision should occur if the lead supervisor is on leave.   Non-GPs can act as supervisors in Extended Skills Posts.

3. Supporting the Trainee and Monitoring Progress

The lead supervisor ensures: ·         A formal employment contract with the registrar is in place ·         Registrar Medicare provider number, when required, and insurance are valid prior to commencing work ·         Supervisor’s MDO is aware that they are supervising registrars The registrar is oriented to the placement by the supervisor, and other relevant team members, for example, practice manager and / or nursing and support staff.   Orientation commences on day one of the placement.   Rostered hours match the registrar’s employment status (full versus part- time).   The supervisor meets early with the registrar to: ·         Appraise the registrar’s skills and experience ·         Discuss how the training placement can meet individual registrar’s training needs ·         Ensure the practice infrastructure supports learning and teaching ·         Help the registrar identify their learning needs and develop their learning plans ·         Negotiate methods and frequency of communication with the registrar ·         Ensures appropriate caseload that matches the registrar’s ability ·         Ensures safe working hours, travelling hours, after hours, fatigue management and a safe working environment (See Standard 1) ·         Assesses the registrar’s competency with high risk situations and provides a tailored framework for risk mitigation (See Standard 1)   The supervisor conducts and records assessment activities and determines level of competence and progress throughout the placement: ·         The Supervisor completes MCCC end of term reports ·         For ACRRM registrars, in addition to the above: Mini-CEX; AST formative assessment; Logbook completion may be required

 

·         The Supervisor provides feedback to MCCC if concerns regarding Registrars arise. Concerns may relate to clinical competency, professionalism or wellbeing.   The Supervisor provides clinical guidance, supervision and support for the registrar: ·         Identifies registrars’ strengths and weaknesses ·         Provides career advice and helps the registrar to develop their learning plan ·         Demonstrates procedures for managing aggressive or violent patients ·         Provides oversight, guidance and feedback on pastoral and professional matters ·         Ensures that their own clinical workload is commensurate with providing accessible and timely supervision.   The supervisor availability is consistent with supervision and teaching commitments: ·         Creates a Teaching Plan that includes nominating an additional (accredited) supervisor when the lead supervisor is not available ·         Offers registrars the opportunity to debrief ·         Recognises registrar training is an activity for the whole Extended skill placement team and encourages open communication with the whole placement team ·         Provides levels of supervision commensurate with registrar experience and needs (See Standard 1) ·         Provides training resources relevant to the post/specialty

4. Promoting High Standards

·         Training posts seek registrars’ feedback on quality and suitability of the training placement and education. ·         Supervisors will use registrar feedback to improve the available training experience provided by the placement   The supervisor provides: ·         Feedback and detailed advice to registrars ·         Opportunity to debrief ·         Opportunity for and encouragement of questions ·         Oversight, guidance and feedback on pastoral and professional matters ·         Patient feedback regarding registrar performance (for ACRRM registrars this is formal multi-source feedback and is part of assessment)

 

The supervisor is accredited by MCCC: ·         Is enthusiastic about teaching ·         Provides professional role modelling as a clinician and educator ·         Is a fellow of the appropriate college as pertains to Advanced Specialist Training or Extended Skills Placement. ·         For ACRRM supervisors, has had 5 years FTE experience in their specific discipline

5. Identifying and Managing Trainee Problems

Supervisors identify, respond to and report on critical incidents: ·         Any critical incident must be reported to MCCC. ·         Problems and disputes should be addressed according to agreed practice and MCCC policies ·         Problem resolution should be evaluated for its effectiveness to inform further quality improvement ·         Supervisors also undertake strategies to prevent problems occurring in training. ·         Supervisors will approach problems in a structured manner by identifying the issue, understanding the underlying causes, creating an appropriate management plan and documenting the process   Where a concern exists about registrar performance, and discussion utilising in-house resources has failed to achieve resolution, the supervisor will contact: ·         MCCC Medical educator ·         Regional Head of Education Supervisors understand the Mandatory Reporting regulations and where a registrar engages in Notifiable Conduct, contacts both MCCC and AHPRA.   Supervisors identify and address registrar stress and fatigue in accordance with MCCC policy.

 

 

Category

Competencies: Where standards are not met

1. Patient Safety and Care

The supervisor does not assess registrar safety and competence in common and higher-risk clinical presentations or does so in only limited scenarios   The supervisor manages risks sub-optimally by frequently or consistently: ·         Assigning caseloads beyond the registrar’s ability and Colleges’ standards ·         Rostering registrars to excessive hours, on call, extended hours or unsupported shifts

 

	·         Assigns challenging environments without orientation and support ·         Allows registrars to consult higher risk and complex presentations without adequate training and supervision   Supervision is frequently unavailable, limited or given reluctantly when requested by registrars, and particularly in emergency situations.   The placement does not include reliable remote access and support when the supervisor is off-site.   The supervisor applies pressure to the registrar to forfeit leave when unwell, bereaved or unfit to practice.   The supervisor demonstrates culturally unsafe practices or attitudes.
2. Educating the Trainee	Supervisory model frequently does not match the needs and competency of the registrar.   The supervisor’s feedback is frequently not based on observable evidence, is personal in nature, does not include collegiate discussion with the registrar or does not provide ideas on how to improve.   The supervisor frequently/consistently provides education based on the supervisor’s preferences rather than the registrar’s needs. The training post provided is not accredited by its governing College. Supervision is disrupted or not provided during supervisor absences.
3. Supporting the Trainee and Monitoring Progress	The lead supervisor has not personally ensured the following requirements have been met: ·         A formal employment contract with the registrar is in place ·         Registrar Medicare provider number and insurance are valid prior to commencing work ·         Supervisor’s MDO is aware that they are supervising registrars ·         The registrar is oriented to the post by supervisor and nursing and support staff ·         Orientation commences on day one of the post ·         Rostered working hours match the registrar’s employment status (full vs part time) ·         Where required, Registrars are rostered to enable attendance at mandated out-of-placement learning.   The supervisor does not: ·         Meet early with the registrar to discuss registrar skills, experience and learning needs

 

	·         Ensure appropriate caseload, safe and fair working hours, and a framework for managing high-risk situations.   The supervisor/practice does not support the registrar’s learning, or makes registrar access to learning from the whole teaching team unduly difficult.   The supervisor frequently fails to conduct and/or record assessment activities and progress via the methods proscribed by the relevant College and does not submit those assessments to MCCC.   The supervisor provides insufficient or untimely levels of support and guidance regarding registrar learning gaps, pastoral concerns, difficult patient encounters.   The supervisor is frequently unavailable for teaching and support.   The supervisor draws on resources that are not recognised as evidence- based in teaching, or provides a level of teaching and support that is not commensurate with the registrar’s experience and needs.
4. Promoting High Standards	The supervisor does not seek and respond to feedback from the registrar in a collegiate manner, or creates an environment in which feedback is discouraged.   The teaching environment discourages questions or opportunities to debrief, or sets an example of clinical care, professionalism and risk management that is not acceptable by the profession’s standards.
5. Identifying and Managing Trainee Problems	The supervisor does not follow the critical incident reporting and management procedures as required by MCCC.   The supervisor does not undertake strategies to reduce the risk of critical or near-miss events.   The supervisor does not report concerns about registrar performance (including clinical performance, stress and fatigue) to MCCC when that problem becomes apparent. The supervisor is not aware of/fully informed regarding Mandatory Reporting regulations as they pertain to both MCCC and AHPRA.

 

• Supervision in a remote setting

 

Element of Telehealth	Requisite Standards and Competencies	Where Competencies are not Met
Pre-session	Supervisor and registrar(s) are aware of the MCCC Telehealth.   Policy TR 024 and have completed the appropriate MCCC telehealth forms if	The MCCC Telehealth policy is not adhered to and appropriate forms are not completed.

 

	working off-site (TRF027 “Telehealth Application for Registrars working Off- site”).   The supervisor meets face to face with the registrar (on-line using videoconferencing, if face to face is unavailable) to establish: ·         Goals for supervision ·         Expectations and roles of both registrar and supervisor when telehealth is conducted ·         A basis of mutual respect and trust to the relationship.   The supervisor provides clear guidance about selecting the best telehealth modality for a presenting complaint and when a face to face consult must be arranged.   The supervisor is competent in the use of telehealth technology and ensures the registrar is appropriately trained to manage the platform and utilise a backup plan for disasters.	The supervisor does not adequately establish mutual and clear expectations and goals for supervision early in term with the registrar.   The supervisor omits to actively develop the supervisor-registrar relationship such that mutual respect and trust is not adequately established.   The supervisor demonstrates inflexibility when considering the most appropriate modality for supervision.   The supervisor does not ensure there is a backup plan in the event of a catastrophic failure of the communication modality, or does not adequately train the registrar to respond to system failures.
In-session	The supervisor prepares registrars for and provides appropriate feedback regarding: ·         The missing communication and non-verbal cues in telehealth ·         Managing silence ·         Avoiding distractions or multi- tasking during telehealth consults ·         Speaking etiquette and turn- taking ·         Maintaining                          clear documentation ·         Maintaining       confidentiality and online security ·         Allowing for additional time	The supervisor undertakes tele supervision in a chaotic manner without reference to educational principles such as feedback and collegiate learning.   The supervisor provides insufficient advice about or exhibits poor role- modelling regarding the missing communication cues in the telehealth medium, taking time for reflection during supervision and/or multitasking during the sessions.

 

Post-session

The supervisor allows time for clinical supervision and debriefing in the telehealth context and is available for ad hoc supervision.   The supervisor monitors the effectiveness of the telehealth platform, the supervisory input, the registrar safety and experience.

The supervisor frequently fails to allow time for supervision and has limited accessibility/availability at ad hoc times.   The supervisor inadequately guides the registrar to manage on-line security, safety and privacy issues.   The supervisor does not monitor and evaluate the supervisory interaction to ensure that the learner’s expectations and goals are being met.

4. Document history

Version	Summary of changes
1.0	First version

Telehealth Policy

Last updated: March 2020

Relevant resources

TRF 027 Telehealth Application for Registrars working off-site OH&S Off Site checklist

Standards for General Practice Training – 2^nd Edition

COVID19 Related Training Advice RACGP

ACRRM COVID FAQ

Addendum to RACGP position on training policies as they relate to COVID (002)

1. Purpose

In the current COVID-19 health crisis, Murray City Country Coast GP Training (MCCC) recognises that GP registrars may be required to undertake teleconsultations. These consultations may occur while onsite at the practice or offsite if a registrar is in self-isolation. MCCC, RACGP and ACCRM consider teleconsultations during the COVID-19 health crisis an appropriate clinical activity for GP registrars, provided that the registrar remains in a safe and supported training environment in line with the requirements of the RACGP and ACRRM. It is anticipated that telehealth consultations will be incorporated into the RCTI reporting process.

2. Scope

This policy relates to telehealth activities specific to the COVID-19 health crisis and is applicable to registrars undertaking telehealth consultations either in their practice or while in self-isolation, when they are well.

3. Policy and procedure

Prior to a registrar commencing telehealth consultations the following principles must be met:

1. The registrar has been assessed as being competent to perform telehealth consultations
2. The registrar’s wellbeing must be addressed and there is a fatigue management plan in place
3. There is a risk management plan in place to address the registrar’s and patient’s safety
4. The telehealth Medicare item numbers are understood and used correctly
5. Adequate support and supervision are provided to the This includes the provision of in- practice education in line with the registrar’s level of training.
6. The registrar is given the opportunity to review their telehealth consultations with their This can be achieved in several ways including, but not restricted to, daily debrief, selected case analysis at teaching sessions, as part of random case analysis at a usual teaching session, or at other opportune times.

In addition, below are the more specific requirements for in practice telehealth consultations or off-site work utilising telehealth.

In-practice on-site consultations

When telehealth consultations are conducted in a GP registrar’s usual practice site:

1. the registrar has access to their usual supervision as required for their level of training and their level of competence
2. no more than 4 consultations, of any format, are undertaken per hour except in exceptional circumstance in line with the Colleges’ Standards
3. As per MCCC correspondence, MCCC will need to be notified if in-practice on-site consultations are occurring and if this changes to let MCCC know by email

Off-site consultations

When telehealth consultations are conducted at a site other than the registrar’s normal practice* (including their home):

1. An application to undertake telehealth consultations is required to be approved by MCCC prior to Please complete TRF 027 Telehealth Application for Registrars working off- site.
2. An MCCC accredited supervisor must be available and has capacity to link into the consultation for a 3-way conversation
3. The registrar has access to the patient’s medical history
4. The registrar feels medically well enough to work and has the right to decline to undertake the work
5. The registrar’s workload is managed and that their wellbeing is taken into consideration. No more than 4 consultations, of any format, are undertaken per hour except in exceptional circumstance in line with the Colleges Standards
6. The off-site location is appropriate for consulting and has the following:
   1. Dedicated private area for consultations to ensure patient privacy and confidentiality is maintained
   2. The room meets OH&S** requirements
   3. Telehealth consultations are documented, and numbers are reflected in the RCTI’s.
   4. Agreement with Practice to provide Telehealth consultations taking into consideration industrial relations and The National Terms and Conditions for the Employment of Registrars (NTCER) requirements

*other site refers to sites in Australia only.

**Registrar wellbeing is an intersection of the responsibilities of MCCC, accredited training posts, and the individual registrar. As employers of registrars, training posts have occupational health and safety obligations that are governed by Federal and State legislation. Both ACRRM and the RACGP set standards to ensure the occupational health and safety of a practice team. Specific sections of The National Terms and Conditions for the Employment of Registrars (NTCER) similarly addresses issues related to the health and safety of registrars.

4. Document history

Version          Summary of changes

1.0                    First version