A critical element of GP training is the practice placement. This is when GP registrars enter the busy environment of a working practice to receive on-the-job instruction, supervision and support from established GPs.
GPTQ has a network of more than 400 training practices in South East Queensland, where our training team of close to 900 GPs (also known as GP supervisors) are at work. And it isn’t just the registrars who benefit.
We spoke to two of our esteemed GP supervisors, Dr Steve Kearney and Dr Sue Masel, about the value GPs and their practices can derive from participating in GP registrar training.
Sue Masel, Practice Principal, Goondiwindi Medical Centre
GPTQ GP Supervisor and Rural Supervisor Liaison Officer
Steve Kearney, Practice Principal, Ningi Doctors
Brisbane North District Supervisor Liaison Officer
1. Learning is a two-way street
It may be a little known quote, but celebrated English singer-songwriter Phil Collins got it right when he said: “In learning you will teach, and in teaching you will learn.”
Steve and Sue are certainly singing from Phil’s song sheet.
“In our practice we really value the contemporary knowledge and experiences our registrars bring with them,” Steve says.
“Most have just finished their degree and have had a couple of years working with public hospital specialists. This exposure offers insights into areas of medicine we may not be experiencing in our daily practice lives anymore,” he says.
“Right now, for example, we have a registrar with us who nearly completed emergency medicine training and we recently had a registrar with extensive experience in paediatrics, so we can draw on that knowledge at the same time that we’re teaching them about general practice.”
Steve is quick to add: “I believe all registrars have something to bring to a practice—the important thing is always to be listening for it.”
Sue agrees, explaining that at Goondiwindi Medical Centre registrars—or ‘learners’, as she often refers to them—and supervisors regularly come together for debriefing sessions, which always starts with a registrar sharing a tip of the week.
“I don’t think I have ever come away from one these catch ups without learning something new—whether it be a clinical tool, or a simple piece of information that holds value for the practice, such as finding out there is a new rheumatologist consulting in nearby Toowoomba with a short patient list.”
Similarly, the propensity to ‘review’ and ‘refresh’ on a regular basis is noted by both as a healthy bi-product of training GP registrars.
“Our teaching role gives us ongoing opportunities to refresh our skills and knowledge,” Steve explains.
“Sometimes, following many years of practice, we can occasionally go into an auto pilot frame of mind. Training registrars works to prevent that from occurring—driving us to always be thinking about why we do what we do.”
2. You can strengthen the practice scaffolding
Introducing one or multiple registrars into a busy practice environment can add an extra layer of complexity that some GPs might feel is too much to cope with.
But, as Sue explains, by building ‘learners’ into the organisational framework there is scope to iron out the kinks and achieve an enhanced work flow.
“For sure, both you and your team have to be super organised to have learners functioning within the practice environment,” Sue says.
“And everybody has to understand their role in the supervision of learners for it to work effectively.”
At Goondiwindi Medical Centre an orientation week schedule has been established for new learners, which introduces them to every aspect of the business—they spend time sitting at the front desk with administration staff, shadow the practice’s nurses, and meet with the practice manager in order to understand how every role works within the practice’s patient care and business model.
The key, Sue says, is putting the necessary time and effort into truly integrating learners into the practice’s operations.
“The setting up phase is complex,” she concedes.
“But, if you are able to spread out responsibility for learners across the team, then the load is shared and is therefore easier to carry.
“Once you have a system up and running it isn’t difficult to maintain and that sense of organisation and security from having a clear framework to work in flows through to the registrars—they are more confident and really feel that they can contribute.”
Steve agrees, highlighting the positive impact integrating registrars into a practice can have on the teamwork dynamic.
“When you are training registrars the whole practice has to work as a team to support them,” he says.
“There may even be times where a challenge is the thing that brings this to the fore.
“Perhaps a registrar isn’t adhering to guidelines, or is approaching situations in a way that does not sit well with the practice ethos. The ‘team’ really needs to come together to work through this, while continuing to support and guide the registrar,” he says.
3. A different angle might solve the puzzle
While it is true years of experience will build a doctor’s knowledge bank and hone their ability to practise, ask any medico and they’ll tell you: a second opinion or fresh perspective will never be discounted.
Which is why Sue and Steve both appreciate that registrars are likely to approach clinical and consulting situations from a different angle.
“If you have been seeing a patient for 20 years you know them well and sometimes you make assumptions or stop noticing things,” Sue says.
“A registrar seeing the same patient might pick up on something I don’t. At our practice we call it having a second set of eyes on the problem and it can be a very valuable tool in a long-established practice.”
At Ningi Doctors Steve says registrars regularly handle walk-in consultations (patients who have never visited the practice before), which is a case load different to that of established GPs in the practice, who see long-term patients.
He says this expands his thinking as a GP supervisor.
“You end up in much broader discussions with registrars than you would if you were singularly focused on your own case load,” he explains.
“Here at our practice we also hold a case of the week discussion with our registrars. They put forward a case that has challenged them and we walk through the different ways we could approach it.”
4. It could be your perfect match
Welcoming GP registrars into a practice can be a valuable recruitment pathway: successful training placements may lead to a registrar joining the practice permanently post-Fellowship and the local community, wherever it may be, gaining a doctor long-term.
Steve says a key benefit of recruiting this way is that both parties—the registrar and the practice—have an opportunity to find out whether they make a good fit.
“I guess you could describe it as a ‘try before you buy’ scenario,” he says.
“Throughout their training a registrar is on a journey to discovering where their niche will be in general practice. Experiencing different placements allows them to figure out what sort of environment they work best in and where they will get the most career fulfilment,” he explains.
“Conversely, the GPs in an established practice are looking to bring a new person into the fold who will integrate well into their environment and hopefully bring a dynamic that will further enhance theirs.”
Steve adds that while making a long-term match often isn’t the end goal with training placements, the connections that come out of the experience nearly always enrich the practice.
5. Variety keeps life interesting
General practice isn’t for the faint hearted. From the moment your first patient of the day walks through the door to the second your last one leaves, the pace is unforgiving. Building variation into your work schedule can help stave off both mental and physical fatigue.
“One of the joys of general practice for me is the variety of work I get to do being in a rural setting,” Sue says.
“I see training registrars as something that expands on that. It builds different elements into my week that call on my skills in a range of ways—and I never get bored.”
For example, Sue says, she looks forward to the dedicated skin cancer clinic she provides for the registrars training in her practice.
“It’s not consulting and it isn’t the hospital medicine that makes up part of my week—and I love both of those aspects—it is something different again and I really like that,” she says.
Steve enjoys the lighter tone working with registrars can bring to the work day.
“There is scope to have fun with it,” he explains.
“Patients who are aware of the supervisor-registrar dynamic often enjoy seeing the registrar learning.
“They may even test them with a tricky presentation or two and give feedback to me informally, which is nice. Generally, they enjoy seeing registrars developing their skills and confidence as much as I do,” Steve says.
6. Giving back is good for the soul
Steve notes that a big part of teaching in medicine is giving back to the profession; paying forward the knowledge and skills a career as a GP has instilled in you.
“And it is nice to help people,” he adds.
“As doctors we often work long hours so our ability to give back to the community, other than what we do in our daily work, is limited.”
“Helping registrars to become good doctors is a great way for us to do that bit more.”
“What better contribution could you make?” he asks.