We are Accredited for RACGP and ACRRM GPR

What does this mean?

Tamsin Cockayne (NTGPE)Theresa Waye (ACRRM)Natasha Pavlin ( RACGP)

Learning Objectives

• Develop an improved understanding of the ACRRM and RACGP programs and the support required at the Practice level to deliver them

• Share ideas with other NT Supervisors and Medical Educators about supporting Registrars from both Colleges

• Explore how to find information for both Colleges

Training Pathways

Three Topics

• College Assessments

• RPL

• Curriculum

Table Discussion 1: College Assessment

• What are the Assessments of each College?

• Have you participated in them as a Supervisor or other role?

• Have you helped GPR prepare for them?

Assessment Stages

• Primary Curriculum assessment for all registrars

• Advanced Specialised Training assessment specific to the discipline chosen from the ten disciplines recognised

Primary Curriculum Assessment

• miniCEX: mini clinical evaluation exercise• StAMPS: structured assessment using multiple

patient scenarios• MCQ: multiple choice questions• MSF: multi-source feedback • Logbook: procedural skills

Principles of Assessment

DOES(Action)

SHOWS HOW(Performance)

KNOWS HOW(Competence)

KNOWS(Knowledge)

StAMPS, MiniCEX

MSF, MiniCEX, Logbook

StAMPS

Miller 1990 MCQ

VALIDITY

Eligibility

• MCQ & MSF – 12 Months of training time completed (CCT)

• MiniCEX & StAMPS – 24 Months of training time completed (CCT & PRRT)

• AST Assessment – Upon completion of training time

* MCQ & MiniCEX should be attempted after or during the GP term

MCQ – Multiple Choice Question • 125 Questions• 3 hours• clinical vignettes across the primary curriculum• Conducted online• Encouraged to complete first• Offered twice a year • Check the Assessment page on the ACRRM website for enrolment

dates

Feedback from colleagues and patients.

The assessment is most suitable to be undertaken in a teaching post accredited for Primary Rural and Remote Training.

Enrol at any time directly through Client Focused Evaluations Program (CFEP) to undertake the MSF assessment.

Encouraged to do early in training.

This requires submission to ACRRM of:

1. Completed MSF report covering the two components;2. Completed reflective exercise; and3. Evidence of discussion with a Medical Educator and remediation if required.

MSF - Multi Source Feedback

MiniCEX- Mini Clinical Evaluation Exercise

• An ACRRM appointed assessor visits you in your workplace

• Most suited to being undertaken in a general practice but can be undertaken in Emergency departments and other settings.

• Assesses you on nine separate patient interactions.

• Assesses:– communication skills,

– history taking,

– physical examination,

– clinical management/ clinical judgment in a rural context, and

– Overall clinical competence

• Recommend undertake after MCQ

• Enrolments open twice a year,

• Check the Assessment page on the ACRRM website for enrolment dates

StAMPS -Structured Assessments using Multiple Patient Scenarios

• StAMPS is a unique examination which blends the formats of an Objective Structured Clinical Examination (OSCE) and a traditional viva vocè examination

• StAMPS scenarios are designed to reflect real life situations where clinical management must often proceed prior to a definitive diagnosis being made

• Eight scenarios of 10 minutes duration

• Opportunity to explain the rationale behind their thinking

• Encourage to undertake after MCQ

• A range of preparation support available

• Offered twice a year

• Check the Assessment page on the ACRRM website for enrolment dates

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Assessment Support

ACRRM offers varies types of pre-assessment support to registrars:

• StAMPS mock exams (about 4/5 a year) – currently for PC StAMPS but also development for AST StAMPS – some scenarios are on site and some are set up remotely.

• PC & EM StAMPS Practice scenarios

• PC & EM StAMPS 8 week online study groups

• MCQ Sample Questions – 10 on ACRRM website (public) and 50 released to enrolled candidates

• RRMEO modules – can also be used for exam preparation

• MCQ & StAMPS exam preparation information regarding exam format, logistics

• Assessment handbook, recommended reading list, and much more on the Assessment page on ACRRM website:

https://www.acrrm.org.au/assessment

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2015 Assessment Cost

Assessment Fees

• MCQ - $1,202

• MSF - $352 (includes DISQ & CFET)

• miniCEX - $1990

• StAMPS - $2410

Assessment Support programs

• Assessment information session - $100 (covers 2 sessions)

• StAMPS Mock Exams - $550

• Study Groups - $800

RACGP Assessment

Three exam segments:

Applied Knowledge Test (AKT) – multiple choice test conducted online

Key Feature Problems (KFP) – multiple choice and short answer test conducted online

Objective Structured Clinical Exam (OSCE) – a series of 14 clinical cases conducted with examiners and role players.

AKT

What does the AKT aim to do?

To assess the breadth and application of contextual knowledge required for certification to enter unsupervised general practice.

All questions in the AKT are clinically based to reduce the likelihood of testing facts in isolation from the clinical context. The level of applied knowledge assessed in this exam is that required for functioning as an unsupervised general practitioner within Australia.

AKT

How is the AKT structured?

Online exam – sat in multiple sites around Australia.

150 questions in 4 hours - 80 extended matching type ( EMQ )

- 70 single best answer type ( SBA )

All questions are of equal value There is NO negative marking in the AKT – we strongly urge

candidates to attempt all questions

AKT

Who is eligible to sit?

For a GP registrar – must have completed three 13 week terms of active training by the date of the AKT and two of these terms must be in GPT1.

- Their RTP also has to deem them ready to sit.

- They must hold current medical registration (true for all candidates and all three parts of the exam).

KFP

Objective

To assess clinical decision making skills in general practice cases.

Exam format

A ‘key feature’ is a critical step in the resolution of a clinical problem in the context of everyday general practice. A KFP question consists of a clinical case scenario followed by questions that focus only on those critical steps.

KFP

How is the KFP structured?

Three and a half hour online exam offered on the same day and sites as the AKT.

The KFP contains 26 cases of equal value. Most cases contain more than one part, following a logical sequence.

There are two question types:

1. ‘write-in’ questions (short answer questions)

2. ‘completion’ questions (select responses from a list).

KFP

Each question specifies number of responses.

Extra responses are penalised in what equates to ~0.25% of a mark per extra response.

OSCE

Objective

To assess applied knowledge, clinical reasoning, clinical skills, communication skills and professional attitudes in the context of consultations, patient exams and peer discussions.

This is a clinical consulting performance assessment.

OSCE

The OSCE reflects aspects of a typical session of general practice in Australia.

The gender and age distribution of cases is selected to match Australian epidemiological data.

The OSCE includes 14 clinical cases of either 8 minutes or 19 minutes duration, with rest stations interspersed between the clinical stations. It will take candidates approximately 4 hours to complete all OSCE stations.

Scoring and marking

The stations are run by GP examiners and role players. Most questions are independently marked by two examiners and there is additionally a QA examiner who assesses how each case is being run.

Every station has a different marking schedule. A station that calls for a focus on history taking will have a marking schedule that is weighted towards this aspect, whereas a station where developing a management plan is being examined will have a marking schedule that reflects the importance of this element.

Scoring and marking

Furthermore, if a station presents a diagnostic problem in which candidates are required to take a patient history and discuss differential diagnoses with the patient, simply arriving at the ‘correct’ diagnosis may not be enough to pass this station. Elements such as taking a comprehensive medical history and demonstrating communication skills may also contribute to a candidate’s score.

Scoring and marking

All three exams have a rigorous standardisation process applied.

Each year the exam is “blueprinted” according to the domains of general practice and the breadth and frequency of presentations in general practice.

The pass mark will vary each year according to the exam and to the cohort who sit it – it is set at the level required to be considered competent for unsupervised general practice in Australia.

How often and where can they be sat

Venues for the AKT/KFP in February and August 2015:

Alice Springs (NT)*; Adelaide (SA); Brisbane (QLD); Broken Hill (NSW)*; Broome (WA)*; Bundaberg (QLD)*; Cairns (QLD) *; Canberra (ACT); Carnarvon (WA) *; Darwin (NT); Hobart (TAS); Melbourne (VIC); Mildura (VIC) *; Perth (WA); Sydney (NSW); Townsville (QLD); Wagga Wagga (NSW)*; Warrnambool (VIC) *

NB all those with an * have limited capacity

How often and where can they be sat

Venues for the OSCE in May 2015:

Adelaide, Brisbane, Melbourne, Canberra, Perth, Sydney, Townsville

Venues for the OSCE in August 2015:

Adelaide, Brisbane, Melbourne, Sydney

Venues for the OSCE in November 2015:

Adelaide, Darwin, Hobart, Launceston, Canberra, Brisbane, Melbourne, Perth, Sydney, Townsville

• What is your role in prep as a GP Supervisor and Clinic?

Table Discussion 2: Recognition of Prior Learning

- What is it?

- What can be sought by GPR?

- What does NTGPE support?

- What is the process?

Recognition of Prior Learning

• Training time will be reduced if ACRRM determines that experience prior to commencing training is equivalent to training requirements

• Acknowledges experience, training and assessment that applicants have already undertaken which may provide exemptions from training time, assessment or other components of FACRRM training.

• A maximum of 3 years RPL will be awarded.• Requests for additional RPL should be provided to the RTP by the registrar.

© ACRRM 34

Evidence required

Evidence required for each post or training stage for which recognition is being sought:

• Verification of employment through providing one of the following:

o Hospital record of employment including rotations covered; o Statement of service; o Letter from employer confirming length of employment, patient numbers, demographics and diagnostic categories for applicants in VMO positions (if applicable); o Letter demonstrating clinical privileges at a local hospital (if applicable); or o Verification of Clinical Experience using the ACRRM proforma.

• Confirmation of satisfactory performance in clinical work through one of the following:

o Supervisor report; o Reference; or o Verification of Clinical Experience Proforma.

• Certified copies of original certificates for medical qualifications and courses

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Other Medical qualifications

• Registrars who hold the JCCA certificate for Anaesthetics or DRANZCOG Advanced Certificate for Obstetrics & Gynaecology have met the training and assessment requirements for these AST.

• Registrars who hold another specialist qualification for example FACEM, FRACS may be exempt from training and assessment in the relevant AST discipline.

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Experience to count

• Appropriate employment level - The position held must be at a level relevant to the stage of

training for which RPL is being requested.

• Accredited by ACRRM or in a post that the applicant can demonstrate would meet ACRRM standards

• Overseas experience completed in New Zealand, Canada, Ireland, the United Kingdom or the USA may be considered.

• Experience gained in other countries is considered on a case by case basis.

• Registrars must be able to provide evidence of satisfactory performance in the post they would like considered towards training.

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Application Process

• Encouraged to apply within the first 3 months of training

• Assessment by training provider

• Application sent to the College with all supporting

documentation

• Must be in word format and signed

• College assesses application

- Coordinator

- DOE

- Censor

- Returned to RTP

© ACRRM 38

FAQ

• Will my time as a medical student count? No

• Can my intern terms count towards CCT? Yes

• When should I apply for RPL? Ideally within the first 3 months of their training

• What do I need to supply as evidence? Supervisor reports, certificates, statement of service,

clinical privileges.

• Can my RTP decide to not accept the Colleges RPL decision? They can recommend that the

College only RPL a certain amount of time but this should be discussed with you prior to the

application being submitted

• Will all my time be recognised? Up to 3 years but some RTPs have their own requirements.

RACGP RPL- Hospital terms, ESP and ARST only- Not H terms- Max 12 months ESP and Hospital terms combined- Assessed after 6 months in training program- Eligible for 2 parts

- Training credit- +/- Time credit

What happens if they get training credit but not time credit

NTGPE role in RPL

• Review and recommend for individual GPR learning needs

• Assess after 6 months in community terms• RACGP vs ACRRM processing

EDU 018 – NTGPE RPL policy http://ntgpe.org/sites/default/files/About-us/Policy/EDU018%20-%20Recognition%20of%20Prior%20Learning

%20Policy%20-%20Final%202014%20Jun%2009.pdf

Table Discussion 3: Curricula

• Are the Colleges’ curricula different?

• How can you find them?

• What is the content of them?

• How do we deliver it/them in the NT?

ACRRM Curricula• Primary Curriculum: describes the set of learning outcomes for

independent rural and remote practice

• Advanced Specialised Training curricula: describes the set of learning outcomes for advanced specialised practice in ten disciplines

Purpose

The Curriculum defines the scope and standards for independent general practice anywhere in

Australia, with a particular focus on rural and remote settings. It sets out the outcomes expected at

the ACRRM Fellowship (FACRRM) level.

The Curriculum is a fundamental resource for rural registrars, supervisors and educators, providing a

clear framework from which to plan and deliver educational and assessment activities leading to the

FACRRM. It has been designed to promote transparency, clarity, consistency and academic rigor in

these educational processes.

© ACRRM 43

Curriculum Framework

The Curriculum is structured according to the following elements:

• Principles – 11 principles that form the conceptual and practical foundation for the

Curriculum;

• Learning abilities – 73 generic abilities which define the abilities that registrars must

demonstrate, organised within the seven domains of rural and remote general practice; and

• Curriculum statements – 18 statements that describe the relevant content in the major

medical disciplines or practice areas. The curriculum statements contain abilities organised

within the seven domains of rural and remote general practice and essential knowledge and

skills.

© ACRRM 44

The following 11 principles underpin the Curriculum

1. Grounding in professional standards

2. Responsiveness to community needs

3. Responsiveness to the rural & remote context

4. Outcome focus

5. Focus on experiential learning

6. Applicability to practice

7. Validity, reliability & educational soundness

8. Appropriateness & acceptability of delivery & assessment methods

9. Use of information technology

10. Articulation with advanced studies

11. Contribution to improving workforce capacity

© ACRRM 45

Abilities and Domains

• The ability statements are high-level statements which describe the generic abilities that general

practitioners require to be able to work anywhere in Australia and particularly in rural and remote settings.

The ACRRM assessment blueprint is mapped to the ability statements. These overarching abilities are then

applied to different age groups, disciplines or topic areas in the curriculum statements. This provides

further detail in each statement of the standard that ACRRM expects registrars to attain by Fellowship.

• The abilities are organised under the seven domains that describe the different contexts of practice.

Building on the Third Edition of the Primary Curriculum 2009, these domains were refined through

consultation with a diverse group of rural and remote general practitioners, and by referring to the

Australian and international literature that describes this unique and evolving field of general practice.

They do not represent the traditional ‘domains of learning’ often found in medical and other health

professional curricula, but are ‘domains of practice’.

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The Seven Domains

1. Provide medical care in the ambulatory and community setting

2. Provide care in the hospital setting

3. Respond to medical emergencies

4. Apply a population health approach

5. Address the health care needs of culturally diverse and disadvantaged

groups

6. Practise medicine within an ethical, intellectual and professional

framework

7. Practise medicine in the rural and remote context

© ACRRM 47

Curriculum Statements

The content that must be learned and demonstrated at Fellowship level is organised into 18 curriculum statements

according to major medical disciplines or practice areas. The areas covered by the curriculum statements are:

1. Aboriginal and Torres Strait Islander Health 2. Adult Internal Medicine 3. Aged Care 4. Anaesthetics 5. Business and Professional Management 6. Child and Adolescent Health 7. Dermatology 8. Information Management and Information Technology9. Mental Health 10. Musculoskeletal Medicine11. Obstetrics and Women’s Health12. Ophthalmology13. Oral Health 14. Palliative Medicine 15. Radiology 16. Rehabilitation Medicine 17. Research and Teaching18. Surgery

Core ClinicalTraining

Primary Rural and Remote

Training

Advanced SpecialisedTraining

12 Months 24 Months 12 Months

In an accredited Hospital, terms in:• General medicine• Obstetrics and

gynaecology• Anaesthetics• General surgery• Paediatrics• Emergency medicine

In posts accredited by ACRRM; these may include:

• General practices• Hospitals• Aboriginal Medical Service• Retrieval services

• Minimum 6 months in community primary care

• Minimum 6 months hospital and emergency care

• Minimum 12 months rural and remote context

In one of the following disciplines :•Aboriginal and Torres Strait

Islander Health•Academic Practice•Adult Internal Medicine•Anaesthetics•Emergency Medicine•Mental Health•Obstetrics & Gynaecology•Paediatrics•Population Health•Remote Medicine• Surgery (24 months)

AST curriculumPrimary curriculum

Assessment, RRMEO Modules, EM courses

RACGP Curricula- Overall- ARST

- OUTCOMES BASED – what does this mean

How do we deliver this in the NT

• Clinics and supervisors• myGPcommunity formative activities• Workshops• Resources in myGPcommunity

NTGPE Curriculum ref No.

NTGPE Curriculum name ACRRM name RACGP name

1 Aboriginal and Torres Strait Islander health Aboriginal and Torres Strait Islander Health Aboriginal and Torres Strait Islander health

2 Adult internal medicine/Chronic Conditions Adult internal med Chronic conditions

3 Aged Care Aged Care Aged Care4 Children and young people's health Child and adolescent health Children and young people's health5 Critical thinking and research Research and Teaching Critical thinking and research6 Dermatology Dermatology Dermatology7 Disability and Rehab Rehabilitation Disability8 Self care and doctors' health Business and professional management Doctors' health9 Drug and alcohol medicine Mental health Drug and Alcohol

10 E-health Information management and technology E-health11 Emergency Adult internal medicine Acute serious illness and trauma12 Eye, ear and oral health Ophthalmology, Oral health Eye and ear medicine13 Genetics Child and adolescent health Genetics14 Mens' health Adult internal medicine Mens' health15 Mental health Mental Health Mental health16 Multicultural Health Aboriginal and Torres Strait Islander Health Multicultural health17 Multidisciplinary care and team work Business and Professional Management Multidisciplinary care18 Musculoskeletal medicine Musculoskeletal medicine Musculoskeletal medicine19 Occupational medicine Adult Internal Medicine Occupational medicine20 Palliative care Palliative care Palliative care21 Pain management Anaesthetics Pain Management22 Population health and public health Business and Professional Management Population health and public health23 Practice management Business and Professional Management Practice management24 Minor Procedural skills Surgery Procedural skills25 Quality and safety Business and Professional Management Quality and safety26 Pharmacology and integrative

medicine Adult internal medicine Quality use of medicines27 Radiology Radiology Rural general practice28 Rural and remote general practice Business and Professional Management Rural general practice29 Sexual health Adult internal medicine Sexual health30 Surgical presentations Surgery Procedural skills

31 Teaching, mentoring and leadership in general practice research and teaching Teaching, mentoring and leadership in general practice

32 Undifferentiated conditions Adult internal medicine Undifferentiated conditions33 Women's health Obstetrics/ Women's health Women's health

myGPcommunity

RESOURCES

• Websites:www.racgp.org.auwww.acrrm.org.au

www.ntgpe.org

NTGPE docs- GPR handbook- Policies- myGPcommunity