‘Seeing people excited about general practice is the best thing’

It’s been almost one year since the specialist medical colleges officially reassumed responsibility of general practice training in Australia.
 
So how have medical educators delivering the training found the past 12 months?
 
A crucial part of the program, remote supervision, has been headed up Dr Jill Benson and Dr Tim Linton, the RACGP’s National Lead Medical Educators in this space. So far they both rate the supervision program as successful in establishing more opportunities to attract and support registrars, while helping to address GP shortages in small towns.  
 
‘We want the remote supervision to be gold standard, to be as good as, if not better than face-to-face supervision – and I think we’ve done that,’ Dr Benson told newsGP.
 
‘When we look at the people and places, registrars, supervisors, practices, teams, that have been doing remote supervision, they’ve all been excellent.’
 
Dr Linton told newsGP being involved in the unique model of training has been rewarding.
 
‘It really feels like a training program which can provide options, so it feels wonderful to connect dots to actually make something work for the community and for the training,’ he said. 
 
‘The highlights for me have been working in a team which is a lot of fun … and in one particular case the registrar said her experience was “the best”, and that makes us feel validated in terms of rolling out the model.’ 
 
Both believe that remote supervision has helped get registrars into places that wouldn’t necessarily otherwise have one, or a GP at all.
 
‘[Remote supervision] means there’s a broader spectrum of exciting places and registrars to train,’ Dr Benson said.
 
‘We’ve also helped overburdened supervisors, because just through their clinical care, sometimes the paperwork … can feel a bit overwhelming when you’re really busy.
 
‘A blended model, where there’s a supervisor who’s not working in the practice, who can do education and some of the training as a supervisor, has been really helpful.’  
 
Having always wanting to be a GP because of the variety it offers, Adelaide-based Dr Benson has spent a lot of her career working with refugees and in remote Aboriginal communities, alongside medical education, doctors’ health, volunteer roles overseas, and as an academic with a PhD in public health.
 
Being a remote supervisor adds to her love of ‘having several hats in different jobs’.
 
‘I really like people and I am a natural fidget, so just doing one thing is not my cup of tea,’ she said.
 
‘Being a mentor for an enormous number of young doctors, I really love that – it’s the thing that gives me a real buzz because watching people be as excited about general practice as I am, really, that’s the best thing.
 
‘And I would like more people to be excited about general practice because I see is as the best career in the world.’ 
 
For Dr Linton, one focus for the year ahead is to encourage more registrars and supervisors to consider remote supervision.
 
‘This year we would like to provide opportunities for registrars who want an adventure,’ he said.
 
‘There’s so much in Australia that could be so rewarding if people are prepared to step outside the big cities [and experience] incredible rural parts of the country. We’re looking for the right people to fill those spaces.’

With a diversity of general practice training locations across Australia, remote supervision is demonstrating the help it brings to address workforce shortages, according to both Drs Linton and Benson, by not only bringing more young doctors to small towns facing a lack of GPs, but attracting them to stay on after they complete training.

‘One of the advantages of college-led training is that registrars can now move about the country, whereas that was really quite difficult before,’ Dr Benson said.
 
‘So now, we can give registrars who live in the middle of Melbourne the opportunity to do some really well-supported training in the Northern Territory, for instance, which broadens their view of what general practice is. And they might stay there because they fall in love with the amazing colours of the Territory.’
 
Dr Linton said they are also focusing on keeping practices and communities sustainable.
 
‘We’re looking at practices where there are people who have been close to retirement and struggling with their future because if they leave it probably means the town won’t have a GP, and finding ways of supporting people in their situations,’ he said. 
 
Dr Linton has experienced first-hand the rewards of working in different locations as a GP.
 
After graduating from medicine in 1980 he worked for three years in Australia before moving to Nepal for 10 years for what was ‘an incredibly rich and rewarding experience’.
 
‘The sense of being a generalist in that context was quite powerful, and I’ve never really wanted to go to anything apart from general practice, because that really confirmed the beauty of it,’ he said. 
 
After Nepal he spent 20 years in Gippsland in Victoria doing mostly obstetrics, then moved to the Northern Territory to supervise registrars.
 
‘Over that time, I saw the value of having a strong relationship with the training doctor and being a role model for some, and a mentor, and a friend in some situations too,’ he said.
 
‘So when this opportunity to be a remote supervisor came up, it was a really good one for me to move into, and it’s been fabulous meeting Jill in that process.’
 
While his clinical work is slowing down, Dr Linton still works at an Aboriginal health service in Yarrabah, just outside of Cairns, in addition to running the Remote Supervision Program with Dr Benson.
 
Remote supervision is helping small towns to fill a GP shortage, according to the RACGP.

Reflecting on the past year as an overall success, including developing and releasing remote supervision guidelines to further support supervisors and placement of registrars, both say they have also faced some hurdles.

‘Our biggest challenge has been that people don’t quite understand remote supervision,’ Dr Benson said.
 
‘We are supplying the water, but we don’t supply the horses. There aren’t enough horses and we can’t make them drink. We’re just setting up the practices – we don’t supply the registrars and even if there are lots of registrars, we can’t make them decide to come to that place, it’s still their decision.
 
‘But what we’d like is there to be more water – more options for registrars.’
 
Dr Benson is also aware that while the remote supervision model may appear laden with too many rules, it’s important to have ‘lots of’ safety nets because the supervisor isn’t onsite.
 
‘We really want to make sure that registrar is safe, the patients are safe, and that the registrar has a good training experience,’ she said.
 
‘In order to do that, we’ve built up guidelines and documents to help us decide whether there’s extra things that need to happen for the supervisor, the registrar, the practice. So that’s been a bit of a challenge as well.’ 
 
Dr Linton agrees.
 
‘That’s a challenge of selling it as a creative option which needs to be thought about much more than it really is,’ he said.
 
‘Last year was the first year with the new structure with college-led training, and I think a lot of people still seem busy but also a bit unsure of their own roles in the process and struggling with maintaining their work role without wanting to take on extra.
 
‘Some people have seen the remote supervision option as an optional extra on top of an already very busy workload, and we’ve been aware of that – not wanting to push things too hard.
 
‘We’re hoping that overall, 2024 will be perhaps more of the same successes, so then we can be more active in promoting this as a possibility for training.’ 

More information about the RACGP’s Remote Supervision Program and accompanying guidelines are available on the college website.
 
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