1. We are Accredited for RACGP and ACRRM GPR What does this mean?
Tamsin Cockayne (NTGPE)
Theresa Waye (ACRRM)
Natasha Pavlin ( RACGP)

2. 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

3. Training Pathways

5. Three Topics
College Assessments
RPL
Curriculum

6. 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?

7. Assessment Stages Primary Curriculum assessment for all registrars
Advanced Specialised Training assessment specific to the discipline chosen from the ten disciplines recognised

8. 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

9. SHOWS HOW (Performance) KNOWS HOW (Competence)
Principles of Assessment
DOES (Action)
SHOWS HOW (Performance)
KNOWS HOW (Competence)
KNOWS (Knowledge)
VALIDITY
MSF, MiniCEX, Logbook
StAMPS, MiniCEX
StAMPS
Miller 1990
MCQ

10. 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

11. 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

12. MSF - Multi Source Feedback
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; and 3. Evidence of discussion with a Medical Educator and remediation if required.

13. 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

14. 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

15. Assessment Support https://www.acrrm.org.au/assessment
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:
© ACRRM

16. 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
© ACRRM

17. 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.
Nastasha can you make some notes to speak to each including

18. 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.

19. AKT How is the AKT structured?
Online exam – sat in multiple sites around Australia.
150 questions in 4 hours 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

20. 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).

21. 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.

22. 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).

23. KFP
Each question specifies number of responses. Extra responses are penalised in what equates to ~0.25% of a mark per extra response.

24. 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.

25. 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.

26. 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.

27. 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.

28. 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.

29. 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

30. 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

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

32. Table Discussion 2: Recognition of Prior Learning
What is it?
What can be sought by GPR?
What does NTGPE support?
What is the process?

33. 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.

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
© ACRRM

35. 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.
© ACRRM

36. 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.
© ACRRM

37. 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.
© ACRRM

39. 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

40. 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

41. 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?

42. 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.

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
Grounding in professional standards
Responsiveness to community needs
Responsiveness to the rural & remote context
Outcome focus
Focus on experiential learning
Applicability to practice
Validity, reliability & educational soundness
Appropriateness & acceptability of delivery & assessment methods
Use of information technology
Articulation with advanced studies
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’.
© ACRRM

46. The Seven Domains
Provide medical care in the ambulatory and community setting
Provide care in the hospital setting
Respond to medical emergencies
Apply a population health approach
Address the health care needs of culturally diverse and disadvantaged groups
Practise medicine within an ethical, intellectual and professional framework
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:
Aboriginal and Torres Strait Islander Health
Adult Internal Medicine
Aged Care
Anaesthetics
Business and Professional Management
Child and Adolescent Health
Dermatology
Information Management and Information Technology
Mental Health
Musculoskeletal Medicine
Obstetrics and Women’s Health
Ophthalmology
Oral Health
Palliative Medicine
Radiology
Rehabilitation Medicine
Research and Teaching
Surgery
© ACRRM

48. Assessment, RRMEO Modules, EM courses
Core
Clinical
Training
Primary
Rural and Remote
Training
Advanced Specialised
Training
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)
Primary curriculum
AST curriculum
Assessment, RRMEO Modules, EM courses

49. RACGP Curricula
Overall
ARST
OUTCOMES BASED – what does this mean

50. How do we deliver this in the NT
Clinics and supervisors
myGPcommunity formative activities
Workshops
Resources in myGPcommunity

51. NTGPE Curriculum ref No.
NTGPE Curriculum name
ACRRM name
RACGP name 1
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 4
Children and young people's health
Child and adolescent health 5
Critical thinking and research
Research and Teaching 6
Dermatology 7
Disability and Rehab
Rehabilitation
Disability 8
Self care and doctors' health
Business and professional management
Doctors' health 9
Drug and alcohol medicine
Mental health
Drug and Alcohol 10
E-health
Information management and technology 11
Emergency
Adult internal medicine
Acute serious illness and trauma 12
Eye, ear and oral health
Ophthalmology, Oral health
Eye and ear medicine 13
Genetics 14
Mens' health 15
Mental Health 16
Multicultural Health
Multicultural health 17
Multidisciplinary care and team work
Business and Professional Management
Multidisciplinary care 18
Musculoskeletal medicine 19
Occupational medicine
Adult Internal Medicine 20
Palliative care 21
Pain management
Anaesthetics
Pain Management 22
Population health and public health 23
Practice management 24
Minor Procedural skills
Surgery
Procedural skills 25
Quality and safety 26
Pharmacology and integrative medicine
Quality use of medicines 27
Radiology
Rural general practice 28
Rural and remote general practice 29
Sexual health 30
Surgical presentations 31
Teaching, mentoring and leadership in general practice
research and teaching 32
Undifferentiated conditions 33
Women's health
Obstetrics/ Women's health

52. myGPcommunity

53. RESOURCES Websites: www.racgp.org.au www.acrrm.org.au www.ntgpe.org
NTGPE docs
GPR handbook
Policies
myGPcommunity