Life-long learning

Dr Brendan Grabau (PhD)Director of Education RACGP

The future

• The next triennia QA & CPD• gplearning and on-line services• IMGs• Certificate of General Practice• Alternative routes to fellowship• Role for training in future GPET RTPs,

Divisions,• CBT• Re-credentialing. Do we need re-

assessment? • Government reform

Curriculum – changes 2009• Covers the Journey of General

PracticeAND

• The Context of General Practice

• Learning guides are under development for all statements

• Available online www.racgp.org.au/curriculum

General Practice as a Speciality• In Australia, general practice recognised as a

specialty by a range of criteria including by statute.– 1989, changes to the Health Insurance Act 1973

have led to the establishment of a separate listing of general practitioners who met the RACGP training, experience and assessment requirements

– 2003, the AMC, in line with its national processes for the review and accreditation of specialist education and training programs, accredited the RACGP education and training programs for general practitioners

– A third group of non-specialists practice in the specialty of general practice, but FRACGP or recognised general practitioners (not specialists)

• referred to as 'other medical practitioners' or non-vocational registered general practitioners.

Learning life of GPs• In Australia, the stages of the general practitioner's

learning life have been identified as the:– Medical student – Pre-vocational doctor– Vocational general practice registrar– Continuing professional development stage

• Some students may enter at different parts:– For example, IMGs (depending on qualifications and

experience).

• Due to the comprehensive nature of general practice, some of these steps crossover with training pathways to other medical specialities and therefore have competing training priorities.

Medical student• Medical student teaching in Australia has undergone major change in recent times.• Consistent with the principle of the journey of general practice, medical student

teaching now emphasises:– Active learning, – Learning of key principles and – Preparation for lifelong learning.

• Content of medical courses has changed– Evidence based medicine, – Rapid increase in medical knowledge, – New developments (molecular medicine and genetics),– consumers and regulatory bodies.

• Places where medical students are trained have also changed– Community health settings, – Doctors' private rooms and private hospitals, – Small urban and rural hospitals, and – Traditional tertiary teaching hospitals.

• Medical students changed– Half of Australia's medical schools only admit graduates,– More diverse age group– More than half are female– Higher proportion of rural and indigenous students– Cultural diversity of students matches the changing ethnic mix of Australia.

Medical students 2• In addition, some medical courses are undergraduate

while other courses are postgraduate

• Around 30% of Australian medical graduates are currently entering general practice

• Largest proportion of students entering a medical speciality

• General practice teaching therefore has an obvious place in undergraduate medical curricula

• However, these learning requirements needs of

students planning careers outside of general practice, (students who are undecided on career paths)

General Practice – foundation discipline

Principles of life-long learning• Over a GP's professional lifetime, each level of

learning builds upon the previous learning level, and assumes that all previous requirements have been met.

• In reality, the path is continuous rather than consisting of discrete steps.

• Most learning levels will overlap to some extent so that:– a medical student may have a special interest – a prevocational doctor may have a special interest in

public health, but have decided to train as a vocationally general practitioner

• The curriculum requirements must be met at each level to ensure that minimum core competencies are reached at each stage of the learning lifecycle.

Lifelong learning 2

Adult learning principles

• This RACGP Curriculum for Australian General Practice is based on the following key adult learning educational concepts and principles applied across the general practitioner learning lifetime:

– needs focused training (directed towards meeting health care needs/priorities of Australians

– learning as a continuum - integrates vocational training with undergraduate, postgraduate and continuing medical education

– lifelong learning - encourages a commitment to continuous improvement of knowledge and skills

– experiential learning - emphasises training as a real world supervised clinical experience with patients

– purpose driven learning - clearly states purposes and curriculum requirements, to enable learners make informed choices about learning pathways

Adult learning principles cont..• integrated training - balances and integrates

experiential, information based and reflective learning

• adult learning - uses of models of learning based on recognition of different learning styles and needs

• self directed learning - expects adult learners to exercise significant autonomy about their learning

• Feedback - requires high quality and regular feedback to learners on their performance

• Assessment - regular assessment of learner achievement of curriculum learning objectives during and at the end of training.

Role of RACGP in curriculum developemnt• The RACGP’s role is to set and

maintain the standards for general practice care, education, training and research. These standards have been incorporated into every part of the new curriculum.

• Our mission is to improve the health and wellbeing for all Australians by supporting general practitioners (GPs), GP registrars, junior doctors and medical students by:

RACGP curriculum

• The RACGP Curriculum for Australian General Practice is a set of standards that articulates the required knowledge, skills and attitudes necessary for a competent, unsupervised GP to care for their patients and support the current and future goals of the Australian health care system.

Curriculum development

• The RACGP Curriculum for Australian General Practice was developed:– The common learning objectives – Individual curriculum statements grouped

under:• Problems• Patients• Populations• Processes of care

– Teaching and learning approaches and feedback and assessment mechanisms

Aims • The curriculum aims to:

– provide the basis for education and training of medical practitioners to undertake competent, unsupervised general practice in Australia

– define the discipline and education scope of that discipline to meet the community’s primary health care needs

– support the current and future goals of the Australian health care system

– support patient’s health needs

• The curriculum review has been an open, transparent and robust process in which GPs, governments, regulators, and other general practice stakeholders and community groups have been able to influence curriculum

What is new

• The new curriculum builds upon the achievements of the previous RACGP curriculum in three major areas: – the domains of general practice– learning lifecycle levels from medical

student, through prevocational and vocational training and beyond into continuing professional development, and

– the changing context of general practice

• The new curriculum has also expanded from 14 to 34 statements.

Curriculum framework• The new curriculum framework contains three layers:

– A. The context of general practice • Clinical context into which the knowledge and skills

detailed in the domains are applied

– B. The lifecycle of general practice• In Australia, the stages of the GP’s learning life have

been identified as medical student through to continuing professional development (Fellowship). These stages reflect the journey of general practice, professionally and educationally.

– C. The domains of general practice• The five domains of general practice which

represent the critical areas of knowledge, skills and attitudes necessary for competent unsupervised general practice.

Who uses curriculum• New curriculum is primarily aimed at;

– medical student, – junior doctors, – GP registrars in vocational training, – vocational GPs and – medical practitioners in unsupervised general

practice (continuing professional development).

– However, the RACGP curriculum provides a pathway for:

• overseas trained doctors, • educators, • general practice organisations, • the community, health organisations and

consumer groups.

Statements 1

• People and their populations

– Aboriginal health – Aged care – Children's and young people's health – Disability – Doctor's health – Genetics – Men's health – Multicultural health – Population health and public health – Rural general practice – Women's health

Statements 2• Presentations

– Acute and serious illness – Chronic diseases – Dermatology – Drug and alcohol – Eye and ear medicine – Mental health – Pain management – Musculoskeletal medicine – Occupational health and safety – Oncology – Palliative care – Sexual health – Sports medicine

Statements 3

• Processes of general practice

– Critical thinking and research – Dealing with undifferentiated problems in

general practice – GP's as teachers and mentors – Health informatics – Integrative medicine – Patient safety – Practice management

Curriculum 1

• Curriculum details the knowledge, skills and attitudes necessary for:– essential reference for general practice registrars– general practice supervisors– medical educators– regional training providers and – anyone involved in implementing the training of

future general practitioners.

• Learning objectives for medical students and prevoc doctors to general practitioners.

Curriculum 2• Emphasis on:

– Self directed learning– Development of critical self reflection and lifelong

learning skills– Maintenance of professional practice standards.

• Training placements are undertaken in RACGP-accredited posts (community practices and hospital based posts).

• In general practice posts, general practice registrars (ie. participants in the Training Program) are assigned a supervisor (supervision, guidance and feedback).

• Medical educators, external clinical teachers, GP mentors and training advisors provide additional teaching, support and feedback.

General practice educators and lifelong learning• Maintenance of high quality general practice education and

training depends upon recruitment and training of educators • The nature of this teaching varies from informal settings to

strictly regulated training programs (summative examination processes)

• In reality, each level is often involved in the education of those in earlier lifecycle stages

• Attention to the levels of training and teaching skills required

at each level of the learning life • Continuing professional development, general practitioners

may consider their role in teaching medical students, or general practice registrars, and may need to examine their skill requirements.

5 domains of general practice• Domain 1 - Communication skills and the patient-doctor

relationship eg. communication skills, patient centredness, health promotion, whole person care

• Domain 2 - Applied professional knowledge and skills

- eg. physical examination and procedural skills, medical conditions, decision making

• Domain 3 - Population health and the context of general practice- eg. epidemiology, public health, prevention, family influence on health, resources

• Domain 4 - Professional and ethical role- eg. duty of care, standards, self appraisal, teacher role, research, self care, networks

• Domain 5 - Organisational and legal dimensions - eg. information technology, records, reporting, confidentiality, practice management.

'Star of general practice' -development of new curriculum

• Combining the domains of general practice with lifelong learning provides a powerful conceptual framework for positioning the RACGP Curriculum for General Practice in the Australian clinical context in which the knowledge and skills are applied

• This framework enables educators to flexibly train general practitioners across the diverse and wide range of clinical presentations

• Even though local practice characteristics, regional clinical trends or national characteristics may vary, this model provides a common ground for the essential discipline of general practice knowledge

Star of general practice

Standards

• Processes for next triennial RTP accreditations currently being discussed

• New streamlined process of visits and accreditation for Training practices and supervisors

• Group working towards a Chapter of Medical Education in the RACGP

Moving forward• The next triennia or quin-quennium QA &

CPD• Gplearning and ClinEd• IMGs• Certificate of General Practice• Alternative routes to fellowship

– PBA, MAP• Role for training in future GPET RTPs,

Divisions,• CBT• Re-credentialing. Do we need re-

assessment • Government reform