RACGP provides further support for remote registrars

General practice registrars in remote settings now have more support available to them, following the release of the RACGP’s Guidelines for remote supervision.
 
Remote supervision enables registrars to work in locations that do not have a GP supervisor able to provide onsite support, and according to the college, using a comprehensive and well-supported supervision model is vital.
 
As RACGP National Lead Medical Educators for remote supervision, Dr Tim Linton and Dr Jill Benson are well-informed of the advantages and challenges to training remotely. Both were involved in developing the guidelines and Dr Linton told newsGP that remote supervision provides ‘wonderful options’ for registrar training where it would not otherwise have been possible.
 
‘The robust and evidence-based guidelines are designed to establish and maintain an offsite supervision model,’ he said.
 
‘We believe that this form of supervision can be as good as, if not better than traditional onsite supervision.’
 
The remote supervision guidelines are designed to provide guidance for registrars, practices and supervisors in situations where the supervisor is not onsite at the same practice as the registrar for the majority of time.
 
How this looks will be different in every location, according to Dr Benson, but safety for the patient, registrar and practice, as well as the importance of a good training experience, remain central.
 
‘Flexibility is the hallmark of the remote supervision guidelines, but there is a clear underlying structure that ensures we have the right supervisor, registrar and location,’ she said.
 
‘[It also ensures] that any potential risks have been identified, there is a supportive onsite team, a strong educational alliance is built between the registrar and the supervisor, and the supervisor is supported and paid for their time.’
 
Dr Benson also points out that due to an ageing general practice workforce, many practices no longer have an onsite accredited supervisor.
 
‘Remote supervision will allow the expertise of those GPs to continue to be utilised if they choose to remotely supervise registrars in their old practices,’ she said.
 
Various models of remote supervision of general practice registrars have been occurring in Australia for many years, and while the RACGP recognises that there may be some reservations around the safety of remote supervision, there is no evidence of increased harm compared with onsite supervision.
 
‘Good remote supervision may be better than poor onsite supervision, and is definitely better than no supervision,’ the guidelines state.
 
Such a model also contributes to addressing the workforce shortage faced by rural and remote communities – as demonstrated by the recent placement of a registrar in the New South Wales town of Armidale, currently experiencing a shortage of GPs. While Armidale is not a typical location for remote supervision, this model is enabling the practice to remain open and continue providing care to their patients and community.
 
Following initial development, the guidelines were evaluated and revised to establish a rollout that is now underway across rural and remote locations nationwide.
 
Dr Linton said they are designed to be flexible and contextualised to each location because each setting will be different.
 
‘The guidelines allow for contextual needs and conditions. They provide support for supervision above the normal AGPT [Australian General Practice Training] guidelines to allow for the challenges that the remote model brings,’ he said.
 
‘They are a basis for effective supervision, understanding that the locations chosen have unique needs and challenges.
 
‘Some sites will have other GPs available for support if needed, and blended models can be used. Others will have special requirements for areas like cultural mentoring, patient demographic determined skill development, geographic specific needs, and so on.’ 
 
Local rural teams will also have ‘a major role’ in designing appropriate and supportive placements, Dr Linton said.
 
Supported models of training that arm registrars with the skills for the increased scope of practice required in regional, rural and remote settings has also been shown to benefit communities, with those who trained in such areas of need more likely to continue to work there upon completing training.
 
‘The ultimate aim of supporting a registrar in a rural or remote location is that the registrar stays there after they have Fellowed,’ Dr Benson said.
 
‘In both of the program’s pilot locations [Walgett, NSW and Norfolk Island] the registrar has stayed on, as they both said they had “never been so well supervised in my life”, and obviously enjoyed the location and the team they were working with.’
 
While there are many benefits to training and working remotely, the potential isolation some registrars can experience has been identified as a key risk by the RACGP. To help combat its impact, the supervision program enables ongoing support for safety, wellbeing and professional development from the remote supervisor, onsite team, the practice and community.
 
‘We are aware that remote settings can be challenging in many ways,’ Dr Linton said.
 
‘Demands on family life, administrative concerns, loneliness and feelings of isolation can be areas that need care and appropriate support.
 
‘Despite these, we have found that remote work can be a profoundly satisfying experience, can develop resilience and personal growth, and can be an adventure in cultural understanding and relationship building that is not possible in typical urban practice. 
 
‘We look forward very much to helping facilitate these experiences and to assist in ensuring that the placements are safe, educationally satisfying and memorable.’
 
Having worked in remote areas for most of her general practice life, Dr Benson agrees the experience is richly rewarding, and she wants to share this with the GPs of the future.
 
‘It gives me a diversity to my work that has kept me resilient and enthusiastic,’ she said.
 
‘Giving registrars the opportunity to experience a supported general practice experience in rural and remote areas is immensely satisfying, as I’m hoping we can build a workforce of young GPs who are flourishing in these areas. 
 
‘It has been wonderful working with such a great team developing guidelines that are evidence-based and practical, and then successfully rolling them out in places that would otherwise be unable to have a registrar.’
 
Application of the guidelines will vary and depends on the training program, eg AGPT Program, Fellowship Support Program (FSP), Remote Vocational Training Scheme (RVTS) and the registrar context. More information is available on the RACGP website.
 
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