ISSUE TWO Events Update GP S YNERGY i n f ocu s Registrar Events Supervisor Events • Pre-Exam Workshop: Mock Clinical Exam (SYD/ • GP Supervisor Development Weekend NE-NW GPRs) (SYD/NE-NW GPS) 3 October 2009, 9.30am to 12.30pm, 1.00pm to 26 - 27 September 2009 9.00am-5.00pm, 4.30pm, Balmain Tamworth • Day Release Workshop (SYD GPRs) • GP Supervisor Development Weekend 7 October 2009, 9.00am to 1.00pm, 1.30pm to (SYD/NE-NW GPS) 5.00pm, Balmain 17 - 18 October 2009, 9.00am-5.00pm, • Pre-Exam Workshop : Mock Clinical Exam 9.00am-1.00pm, Sydney (NE-NW GPRs) • Combined GPS/GPR Workshop (SYD GPRs/GPS) 16 October 2009, 9.00am, UDRH, Tamworth 18 November 2009, 6.30pm for 7.00pm to 9.00pm, • GPR Teleconference (NE-NW GPRs) Sydney 20 October 2009, 9.00am - 10.30am • GP Synergy Seasonal Celebration Icebergs Club • CPR Refresher Course (SYD/NE-NW GPRs) (SYD/NE-NW GPS) Contact 28 October 2009 5.00pm - 7.00pm, North Ryde • GPR 3 Day Combined Workshop (SYD/NE-NW 26 November 2009 7.00pm, Bondi • Seasonal Celebration & Graduation Dinner GP Synergy GPRs) 28 - 30 October 2009 9.00am - 5.00pm daily, (SYD/NE-NW GPS) 11 December 2009 7.00pm to 10.00pm, Tamworth North Ryde • Day Release Workshop (SYD GPRs) New Cohort 2010.1 Events Sydney Office 4 November 2009 9.00am to 1.00pm, 1.30pm to 5.00pm, Balmain • Transition into GP Training (SYD General 37 Booth Street • Transition into Independent Practice Pathway GPRs) 7 November 2009, 9.00am to 1.00pm, 1.30pm to Balmain NSW 2041 (SYD/NE-NW GPRs) 11 November 2009 7.00pm to 9.00pm, Balmain 5.00pm, 6.00pm Dinner, Balmain T + 61 2 9818 4433 F + 61 2 9818 3311 • GPR Teleconference (NE-NW GPRs) • Basic & Advanced Workshop / Orientation Work 17 November 2009, 9.00am - 10.30am shop (NE-NW Rural Pathway GPRs) 11-12 December 2009, 9.00am to 5.00pm, • Combined GPS/GPR Workshop (SYD GPRs) Tamworth 18 November 2009 7.00pm to 9.00pm, Balmain New England / • Expand Workshop (SYD/NE-NW GPRs) • Seasonal Celebration & Graduation Dinner SYDNEY & NEW ENGLAND/NORTHWEST (NE- NW GPR) North West Office 30 November 2009 7.00pm to 9.00pm, Balmain 11 December 2009 7.00pm to 10.00pm, Tamworth • Day Release Workshop (SYD GPRs) 2 December 2009 9.00am to 1.00pm, Level 1, 35 Heber Street GP Re-entry Workshops 1.30pm to 5.00pm, Balmain Moree NSW 2400 • Re-entry Workshop: Hyperlipidaemia THIS ISSUE PO Box 838 • GPR Teleconference (NE-NW GPRs) (2009.3 Cohort) 15 December 2009, 9.00am - 10.30am 8 October 2009, 1.00pm to 2.30pm • 2010 GP Training Applications Moree NSW 2400 • Re-entry Workshop: Mental Health (2009.3 Cohort) • Staff Update T + 61 2 6752 7354 29 October 2009, 1.00pm to 2.30pm • Recent Events F + 61 2 6752 8400 • Re-entry Workshop: Dysglycaemia (2009.3 Cohort) 19 November 2009, 1.00pm to 2.30pm • Aboriginal Health Review www.gpsynergy.com.au firstname.lastname@example.org Welcome to 2010 Registrars New Training Practices: Currently taking expressions of interest and Federal Budget Update With an increase in trainee applications for 2010, GP Synergy is actively seeking new teaching practices in the New England/North West region of NSW (our rural territory) and I’d like to extend a warm welcome to our newest cohort of GP Registrars who commence their training in in the Canterbury local government area of Sydney. These are the areas of greatest medical 2010. Congratulations on your success in entering a stimulating and opportune career. workforce shortage and medical service need within our boundaries and we have a strong commitment to supporting practices in these areas to become accredited teaching practices. JOHN OLDFIELD Chief Executive Officer We have a large number of currently accredited teaching practices in other areas of GP This is the first selection and intake process we have undertaken as the new GP Synergy following the Synergy and hence we are not currently actively recruiting additional teaching practices in amalgamation of Sydney Institute of General Practice Education and Training (SIGPET) and New England Area these areas. Training Service (NEATS). I am pleased to say our coming together has been a very positive and successful venture to date. The quality and quantity of applications to both General Pathways and Rural Pathways has exceeded our own expectations. We Teaching the next generation of GPs can be a rewarding and fulfilling experience which really look forward to supporting you in your career goals and will do our utmost to prepare you for fellowship and your ongoing profession. enhances the daily routine of General Practice and capitalises on your expertise and experience. Your practice may already train Registrars and you may be interested in becoming At the time of writing this article we have filled all General Pathway positions including the Composite Stream. The Composite Stream is a new formally accredited as a GP Supervisor or you may already be a Supervisor in a training practice sub-pathway that is well supported and integrated in the education program. GP Registrars who undertake this stream will complete a year of and know of other GP’s and practices that might like to become involved. Alternatively, your Full Time training in our New England / Northwest region. This rotation also counts towards the rural component of training. practice may not have been involved in training before and would like to consider taking on this new role. Registrars in the Sydney stream are also encouraged to consider the increasing training opportunities, integration and support that is now available for GP Synergy Registrars who are on rural rotation. We have developed considerable support structures for those who undertake their New training practices train only those Registrars who have already had 12 months FTE training in General Practice and are known as a Level 2 Training Practice. Support on the local level is given on an ongoing basis by staff and Medical Educators throughout the GP Synergy region. rural rotation in the GP Synergy catchment. As a Level 2 Training Practice Supervisor, you would be required to:- Our Rural Pathway applications and selection results have been very successful and advertising the breadth of opportunities of our Rural Pathway has been the bigger challenge for GP Synergy. We have completed first round selection and have already filled 12 of the available 18 positions. We 1. Be available for clinical guidance and support for the GP Registrar, contactable at any time and be on-site with the Registrar at least some of enter second round with a very healthy application pool and are confident that we will fill remaining positions on offer. the time; 2. Set aside one hour every week for a full time Registrar (half an hour for a part time Registrar) to discuss cases and topics, and review In this era of reform, Primary Care (and General Practice in particular) is in the spotlight. As part of the reforms, Primary Care is stated to be the the Registrar’s performance and development as a GP. This can be in the form of a variety of activities including sitting in on Registrars cornerstone solution for the future health care needs of the Australian community. Strengthening this sector is a key tenant to the reforms. I have consultation and vice-versa, case/topic discussion, joint visits, etc; no doubt these reforms will greatly influence the future of General Practice. 3. Spend some time in activities which develop your skills as a clinical teacher such as participating in paid GP Synergy GP Supervisor Development activities; As part of this reform process changes have been announced in the Federal Budget that affect the Australian General Practice Training (AGPT) 4. Participate in assessment activities of the Registrar; program. They include changes to the previous Rural, Remote and Metropolitan Areas (RRMA) classification which has been in place since 1994 5. Assist the Registrar develop and review their learning plan; and no longer reflects the changed population density and access. RRMA is to be replaced by the Australian Standard Geographical (ASGC) 6. Agree to and conform to the National Terms and Conditions document for Registrar placements. Remoteness Area (RA) Classification. GP Synergy is developing support structures in line with the new RA classification model. The new system is aimed at providing enhanced financial support that is linked to the remoteness of training locations which by definition are areas of medical Training practices and Supervisors are fully supported by GP Synergy, with teacher training provided for all new Supervisors. New Supervisors service need. will also be nominated an experienced Supervisor mentor and our large portfolio of teaching resources and comprehensive workshop program provides ongoing professional development and networking opportunities. Along with changes to the RRMA classification there are substantial changes to the Registrar Rural Incentive Payments Scheme (RRIPS) which will take effect on 1 July 2010. Changes are aimed at incentivising longer tenure in rural areas and are more in line with those payments afforded to To find out more, download an information flyer on the GP Synergy website at www.gpsynergy.com.au or contact Regional Business Manager, practicing GPs. Pat Worthing on 6752 7354 or email@example.com for New England/Northwest enquiries or Dr Linda Mann on 02 9818 4433 or lindam@ gpsynergy.com.au for Canterbury enquiries. Another key initiative announced in the budget is changes to the training pathways in what is described as return for service given commonwealth funding of the AGPT program. The government has announced changes to the rural and outer metropolitan training requirement of which all GP Registrars are currently required to complete a 6 month rotation. This system is likely to be disbanded in favour of 12 months completion of Invitation to attend: Clinical Teacher Training Workshop training in designated areas of medical service need. We do know that designated areas of medical service need will include RA classification 2 to GP Synergy would like to extend an invitation to all currently accredited GP Synergy Supervisors and new /prospective Supervisors to attend the annual GP Synergy Clinical 4 being outer metro and rural areas. However we are hopeful that this may also be extended to metropolitan facilities that service specific medical Teacher Training Workshop. needs under local policy. Unfortunately the government is yet to announce its final policy on this matter. We are mindful to ensure Registrars are Now in its 7th year, over 170 GPs have participated in this enjoyable, intensive workshop covering 4 core clinical teaching skills. The workshop is designed to be stimulating and suitable for Supervisors across the spectrum of experience - those new to GP Supervision have found this a great way of obtaining some immediately useful skills, and experienced afforded the most appropriate and supportive transition to any new arrangements when announced. Supervisors have all found this a great way to refine and expand existing competencies. Date: March – Saturday. Exact date TBC. I wish to thank our staff, directors and colleague’s for their tremendous contributions which have brought about such a fantastic result in this Time: 8.30am to 5.00pm, followed by dinner. year’s selection and intake process. And again to our newest cohort, thanks for choosing GP Synergy. Venue: Moree, NSW Participating Supervisors will receive a financial stipend for their attendance, with accommodation and travel expenses also reimbursed. The workshop attracts 40 CPD points and www.gpsynergy.com.au meets the RACGP requirement for all Level 1 GP Supervisor Trainers to attend a recognised teacher training event. Further details about this workshop will be sent shortly. For more information in the interim or to RSVP, please contact Eliza Canty on firstname.lastname@example.org Staff Changes Welcome Since our last edition there have been some changes in GP Synergy staffing. GP Synergy’s Director of Training, Dr Jeremy Bunker, was recently to new staff diagnosed with lung cancer and immediately commenced treatment. Jeremy is doing very well and shares his story with us overleaf. Whilst Jeremy As well as saying farewell to several staff is on extended leave, we have been most fortunate to have highly respected GP Supervisor and Board Member, Dr Linda Mann re-organise her members, GP Synergy is excited to welcome busy professional commitments to step into the Acting DOT role during Jeremy’s absence. On behalf of all GP Synergy staff, Registrars, Supervisors several new staff to the GP Synergy team:- and Board Members we would like to express our sincere gratitude to Linda for stepping into the role so swiftly and effectively. Jeremy is Dr Eszter Fenessey continuing to contribute when he can, so we are reaping the benefits of having two highly experienced, committed and extraordinary individuals MBBS DCH PGCert TESOL FRACGP contributing to the role. Medical Educator email@example.com In clinical practice for over 20 Jeremy’s Story: Beyond empathy - Staff Farewells: years, Eszter has a long history of involvement in all levels of experiencing it yourself. Celebrating the contribution of Louise Stone and Kate Beardmore to GP Synergy clinical education, spanning across USYD, UNSW, RACGP, GPEA, WentWest and now GP from Dr Jeremy Bunker on behalf of GP Synergy Synergy. She is an AMC and RACGP examiner with clinical It’s been an interesting past few months. My professional satisfaction in early May in recognising interests in mental health, paediatrics and women’s health Dr Louise Stone Dr Kate Beardmore and is currently completing a module on Transcultural that a triad of rapidly developing stridor, dysphonia and cough represented a potentially Kate Beardmore is the sort of person Mental Health and has completed a post grad cert in significant diagnosis, was undermined by the fact that these symptoms were mine. Louise Stone has worked as Senior Teaching English. Medical Educator with our organisation GP Synergy is proud to be associated Dr Russell King The CT showing a left hilar mass suggestive of bronchogenic carcinoma was the start of a since the inception of regionalised with. Kate trained with SIGPET, and has MB BS MRCP FRACGP developed into a wonderful general journey that has taken me through the removal of my left lung, and chemotherapy for a locally training in 2003. SIGPET and GP Synergy Medical Educator practitioner, with a bit of help from us, firstname.lastname@example.org advanced lung cancer. I have seen the system from the other side, and experienced symptoms, bear the hallmarks of her remarkable A GP supervisor for over 10 procedures, intimations of mortality, and decision making that I previously empathised with as skills as a GP, a teacher, an educator, and but largely because of her intellect, years, Russell has experience as commitment, warmth and other a doctor rather than dealt with as a patient. a strategic thinker. I regret sincerely her an urban and rural GP ranging attributes. from inner London to the Northern Territory. He also has departure, but derive some significant past experience as a GP anaesthetist and GP obstetrician. I am now remarkably and irredeemably acquainted with dyspnoea, post thoracotomy pain, consolations - her work over the last six years will continue to shape Kate has been pivotal in shaping one of the priorities of GP Synergy, Russell currently works as a GP in Tamworth and as a tutor nausea, malaise and tiredness, and with confronting my own physical and emotional frailties. and sustain us, and she is moving on to a new professional challenge at UNE. which is to give GPs – particularly GP Registrars - opportunities to I have done extremely well and have been very well treated by a system with some flaws but that will make great use of her skills - Louise has been appointed develop as teachers and educators. Kate has worked with us as Dr Roland Loeve MBBS,FRACGP,FAFMM,Grad Cert Pain many more strengths. My most difficult time was the two days between radiological diagnosis Senior Medical Advisor to General Practice Education and Training, Registrar Liaison Officer, and then as one of the inaugural Registrar Medicine. and engaging with the system that would sort out my bronchoscopy, the stenting of my left and her ability to think penetratingly, strategically and practically medical educators, in the latter role working part time in assisting Medical Educator main bronchus, the biopsy and the team decision making about an attempt to obtain surgical (and with lashings of humour!) will benefit the Australian GP training with the design and delivery of the education program. This is a email@example.com clearance of my cancer. Those days were bridged by my GP - and I will out her now: Marilyn Graduating from UNSW in community as a whole. tough gig – to continue to work and train in general practice while 1981, Roland has worked as McMurchie. She provided exactly what I needed at that time which was energetic advocacy working very part time in a training organisation – Kate needed to be a GP since 1983. The majority and an obvious and unrelenting interest in my well being. I was really proud of the profession of Louise has been a friend, mentor and valued colleague to Registrars, very self directed to make this role work – and she was, and she did! of this time was in a partnership/associateship. He now General Practice, as represented by Marilyn and will always be grateful for what she represented works solo predominantly in Occupational Medicine Supervisors, SIGPET and GP Synergy staff, and the wider general Kate helped establish a tradition of which we are now very proud – of utilizing his Musculoskeletal training (non procedural). and what she gave me. She found the fantastic respiratory physician who mobilised the services, practice and vocational training community. As well as facilitating the Registrars actively involved in creating the teaching program, in the the team, and the opinions that I needed. training of a large number of fine GPs, Louise has been responsible course of which becoming the medical educators, clinical teachers Dr Vanessa Moran for many of the formal education program successes, and training and reflective practitioners of the future. BSc(Hons) MBBS,FRACGP,Dip.Paed. I am not sure what all this means for my working life yet. I suppose realistically that if there is innovations which have emanated from GP Synergy. She has had (UNSW) Medical Educator cancer progression - local recurrence or distant metastasis - my working life will end, and a new the signal attribute of being able to deal with the complexities of Those of you who have been to Kate’s immunisation workshop, or firstname.lastname@example.org phase will begin... But I am hopeful of a cure and work to some extent is part of that cure, so I training at the day to day level while being able to think and innovate benefitted from the exam preparation workshops or individual Graduating from USYD in 2003, hope to be doing the work I so enjoy doing with GP Synergy for a while yet, and won’t feel too more broadly. SCRIPT is but one of her achievements – a guide for coaching in consultation skills, will have had first hand experience of Vanessa worked at both RPA Hospital & Sydney Children’s guilty that its therapy that I am being paid to undertake! Registrars, Supervisors and Educators to the RACGP curriculum, with her skills as an educator. Hospital before completing her Diploma of Paediatrics in a clear exposition of the competencies required, and how these 2006. After spending some time in Moree as a GP Registrar, What has helped me most over recent months - in addition to a responsive, functional health Family responsibilities, work as a GP, and well, life, mean that Kate has Vanessa moved back to the Inner West to complete her may be acquired, for safe, sustaining general practice. SCRIPT makes system - has been the uplifting support from my partner, my children, my family and my friends stopped regular work with GP Synergy. I thank Kate for all she has GP training, becoming a Fellow of the RACGP at the end sense of learning in and for general practice, with a clear exposition of 2008. and colleagues. I thank all of you who I know through my work with GP Synergy or in my life as done over the last 4 years, and I am quietly confident the connection of the contribution of experiential, workplace based learning, the with GP Synergy is suspended rather than broken. So – very much au Dr Hadia Muhktar a GP, for what you have given me over the last two months - the positive thoughts, the prayers , formal education program, self directed learning, and practice based Bsc (Hons), MB BS (Melb), FRACGP, Dip the emails, the cards, the letters, the flowers, the fruits, the visits, the chocolates, the words, the revoir, Kate. Not goodbye. teaching to our development as effective GPs. Ger. Med, LLB (Hons) (Melb) Grad Cert hugs... Health Prof Ed (Monash) Liza Gabriel Medical Educator We will miss Louise of course – and she is irreplaceable. I am comforted email@example.com GP Synergy has been wonderfully served by our medical education team under the leadership After taking maternity leave to spend by the fact that we keep in touch. I thank Louise for her contributions A GP for over 25 years, Hadia of Linda Mann in taking up what I have been unable to do over the last two months. While I time with her youngest child, Liza was awarded GP of the year in and gifts, and look forward to continuing to benefit from them! For recognise that I am not indispensible I have actually been doing quite a lot over the last seven Gabriel our Communications Officer has 1995 by Australian Doctor. She holds a diploma in geriatric those of you who would like to contact Louise – to wish her well, to medicine and a grad cert in health professional education. years so my sudden absence was noticed! I would also like to thank John Oldfield who has run decided not to return to her GP Synergy reminisce, or to pick her brains – her email address is available via the She was admitted as a legal practitioner in 2002 and to true to type in providing unconditional support for my absence-from-and-return-to-work-plans. role. We wish Liza her every success in practise as a Barrister and Solicitor in the Supreme Court in GPET website, and yes, I have used it already. And to all the other staff in GP Synergy, who have simultaneously dealt with the catastrophic her future endeavours and thank her for 2003. She has been a member of the Medical Practitioners her invaluable contributions. Liza’s areas Board of Victoria for 8 years and is currently a member of health problems of a long term colleague (yes I am talking about me again), and the workload the Professional Services Review Panel. of responsibility will now be overseen by implications of my prolonged absence. GP Synergy also welcomes Dr Ian Kamerman (GP Marketing & Events Manager, Kate Supervisor Liaison Officer) and Dr Wicky Wong (Registrar Froggatt. Liaison Officer). See the following pages for more details Dr Jeremy Bunker about these two new staff members. GP Registrars in Focus GPR Register in Focus: Registrar Liaison Officer Update Dr Gabrielle De Giorgio GP Registrar The year has flown by very quickly and it has been great seeing everyone at the different workshops and Advanced Term, Sydney catching up with many of you over the phone. However, all good things must come to an end and I am happy to announce that Dr Wicky Wong will be taking over as RLO. Why did you decide to become a GP? As a child I was inspired by my uncle, who is a GP. I wanted to be like him DR GABRIELLE DE GIORGIO and do a good morning’s work then go next door to eat meatballs at my Nonna’s house. When I was a medical Although Wicky is based in Sydney, his role extends to providing support and advocacy for all Registrars across student I had difficulty deciding which field I liked best and wanted to take a general approach. I also wanted DR VANESSA SIU both GP Synergy regions. Registrars in either Sydney or New England/Northwest region are encouraged to a job flexible enough to give me time to play music when I felt like it. By the time I was an RMO I just wanted RLO contact Wicky at any time if they have any training related queries on firstname.lastname@example.org or 02 9818 my own chair to sit on, an opportunity to eat lunch and never to hear the sound of a pager again! 4433. Wicky will also be attending the 3 day workshop in October (28-30 Oct) and I encourage all Basic and Advanced Registrars attending from both regions to catch up with him during the workshop. It would also What do you enjoy about being an urban GP? I enjoy the fact that you can play a role in the coordination of patient care. You are the first point of call be great to have another RLO based in New England and anyone with interest is invited to approach GP Synergy or myself for an obligation free for patients and can follow them up from the early stages of their illness and give them support the whole way through. I am concerned about discussion to find out more about what’s involved. the fact that specialists can tend to concentrate on their designated body part, sometimes to the detriment of the patient as a whole. GPs can be an advocate for the patient. In my final months as RLO I have been liaising with many of you and relevant stakeholders about a number of issues. These include ensuring all What are some of the challenges of being a GP? Time management is a challenge. It is hard to keep to a 15 minute appointment when a patient Registrars receive high quality and required in-practice teaching; communicating and lobbying changes to the FRACGP exam and representing comes in with a shopping list of things to do. It is also extremely difficult to know something about everything in medicine and I often find myself Registrars interests regarding reimbursements and advocacy across the regions. hiding in another room looking up certain guidelines. You are never ready for what can walk into your room next. Thank you to all Subsequent Registrars who completed the remuneration survey. This has been useful information that assists other Subsequent Where are you currently training? Leichhardt, Sydney Registrars and Registrars about to go into Subsequent terms with their negotiations. What’s your current training practice/s like? My practice is a busy, friendly family practice in Sydney’s Inner West. There are 6 doctors, 4 practice nurses It has been a pleasure being RLO and I know that Wicky will do a great job as he takes over. and reception staff. There is a treatment room where skin procedures and nurse clinics are run. There is also a very nice sunny tea room at the back where you can go to relax when time permits. GP Registrar in Focus: . What types of patients do you see? Being a female registrar I tend to see my fair share of “smears, tears and baby fears” I also see a lot of children because they tend to be the walk in patients. However, I am still exposed to a wide variety of people. Dr Janaki Sureshwaran GP Registrar, Subsequent Term, New England/Northwest In a typical day, what types of cases would you treat? In one day I treat anything ranging from simple things eg. URTI, to diagnosing weird things like Merkel Cell Carcinomas. Why did you decide to become a GP? I decided to become a GP because I wanted to treat the patient as a whole, that is, to treat from birth to death; to treat patients at home, at institutions, in hospital; and to treat family & What do you think makes a good Supervisor? Someone who is approachable and not too uptight. DR JANAKI friends. What kind of in-practice teaching do you receive? I am lucky enough to have excellent supervision, not only from my supervisor, but from all the SURESHWARAN doctors in the practice. I have weekly formal teaching sessions with my supervisor but a lot of corridor teaching as well. What do you enjoy about being an rural GP? Being a rural GP is a challenging career which also creates feelings of familiarity, respect, friendliness & simplicity. It is more a way of life than a job. Would you recommend General Practice as a career to others? I would definitely recommend it if you are after a flexible, challenging job which is What are some of the challenges of being a GP? As a (rural) GP we do have some challenges. These include housekeeping for multiple tasks in one rarely boring (except for the paper work sometimes). patient, struggling at times to balance family & work, experiencing frustration waiting for access for specialist services, motivating some difficult patients to involve them into their own health care and so on. Where are you currently training? Wee Waa in New England/Northwest. What’s your current training practice/s like? Small but well established busy practice which currently employs 2 Doctors (my Supervisor & myself ), with 3 part time supportive Nurses (including 1 diabetic educator), a Practice Manager & 3 friendly Receptionists. We have access to a weekly USS service & every day pathology services are available within the practice. Once a week radiology services are available in our hospital & regular radiology services (including CT scan) are available in the next town only 30min away. A Psychologist and Podiatrist also visit the surgery regularly. What types of patients do you see? We see a mixture of patients visiting the surgery from the town & catchment areas. Patients ages vary from newborn to elderly. Exam Preparation In a typical day, what types of cases would you treat? People receive treatment in our surgery for acute & chronic conditions. In a typical day we see patients for infections, minor surgical problems, routine reviews, travel advice, immunisations, antenatal care, wound dressings, chronic disease Mock Exams for 2009.2 Exam Participants: management plans, workcover, referrals, scripts, medical certificates & so on. GP Synergy is currently running its pre-exam workshop series for GP Registrars in Sydney and New England/Northwest which will be concluding with a mock exam in Sydney on Sat 3 October and in Tamworth on Fri 16 October. For more information contact Eliza Canty What do you think makes a good Supervisor? Accessible, easy to approach, confident, knowledgeable, open with comments and advice are some of on email@example.com the basic expectations of Registrars from their Supervisors. CPR Refresher Course: What kind of in-practice teaching do you receive? I have access to formal & informal teaching, corridor teaching, observation of procedures and/ All Registrars must complete a CPR refresher course within 12 months of sitting the clinical exam. GP Synergy subsidises all GP Synergy or assistance in procedures. Also as a team we are involved in NPCC, clinical audits, accreditation, staff meetings (including once weekly clinical Registrars attendance fees and will be running a session during the 3 day workshop in North Ryde on Wed 28 Oct. To RSVP please contact meeting in the hospital) & meetings with drug reps on regular basis. firstname.lastname@example.org Would you recommend General Practice as a career to others? Yes! As this is where you find completeness & satisfaction of work. GP Supervisors in Focus Dr Louise Fisher GP Supervisor - New England/Northwest GP Supervisor Medical Educator Update Tell us a bit about you... Married with 2 girls, 8 years as rural GP, initially a Registrar then a Supervisor for the Hello again everyone! As many of you may be now aware, GP Synergy has been encouraging Supervisors to last 2 1/2 years. enhance their registrar teaching through the Clinical Teaching Support Program. This has involved myself, as the GP Supervisor Medical Educator, coming out to your practices to outline what GP Synergy has to offer Why did you decide to become a GP? Variety! Not good at choosing between things so this way I don’t have and to assist you in any way to help you with your teaching. As part of this I have been outlining how to to! develop a formal Clinical Teaching Plan, that is, to plan your teaching over the term. The visits have been very DR JAMES BEST What do you enjoy about being a rural GP? Good mix of chronic and acute medicine, lumps & bumps, nice people. well received, and it is very interesting to see the variety and creativity that abounds out there in practices GPSME & GP Supervisor with many different styles of practice and teaching. I have found, pleasingly, that many practices have various What do you enjoy about being a GP Supervisor? Seeing registrars confidence develop with increasing competency forms of planned teaching already. However, having the opportunity to ‘plug the holes’ on the awareness what GP Synergy has to offer, including outlining the Supervisor workshops for the year, what is available in the GPS toolkit and the upcoming Supervisor weekend workshops in Tamworth and Sydney, has proven to be worthwhile. The program will continue to be rolled out over the next What do you think makes a good Supervisor? Availability for on the spot advice, encouragement, willingness to learn from registrars also. few months, including a planned expansion of this to practices in the New England / North West areas. If you have any questions or would like to organise a visit to your practice, please feel free to contact me on email@example.com What types of teaching activities do you typically undertake with your Registrars? Availability for on the spot advice, encouragement, willingness to learn from registrars also. Do you have any suggestions for ways Registrars can maximize their in-practice teaching experience? Not to work too much. You need time for Dr Tony Andrew reflection and study and a life. GP Supervisor - Sydney Anything else to add? Don’t be in too much of a rush. Tell us a bit about you... After graduating from University I joined the established family printing business and, as I did not envisage staying in medicine, I completed an MBA. After five years I joined Roche Pharmaceuticals and established the diagnostics division in 1970. GP Supervisor Liason Officer: Dr Ian Kamerman In 1973 I returned to medicine and completed my residency years at the Mater Hospital. I moved into General G’day. My name is Ian Kamerman and I am your new GP Supervisor Liaison Officer (GPSLO) at GP Synergy. Practice two years later in Mosman, and then started Cremorne Medical Practice in 1976. Having undertaken this role within NEATS the role is not a new one for me, but it is of course a newer, larger The skills I learnt in my MBA allowed me to identify opportunities for improved management and service in region. Firstly a bit about myself. I’m married with two children and work in a teaching practice in Tamworth. General Practice, and subsequently enhanced my professional satisfaction. I have spent time with the FRACGP I have been involved in GP training for roughly 12 years. Our practice takes medical students, Junior Doctors Practice Management Committee and National Public Relations Committee, and was a founding director of GPA Accreditation Plus in 1997 which through the PGPPP and GP Registrars. was established to provide an alternative to AGPAL. I am currently on the Board of the National GP Supervisors Association and am the Immediate past Chair. Recently I have been a GP Supervisor since 2006 having previously been one between 1982 and 1987 with the Family Medicine Program. For GP Training to work it is essential that Supervisors are well supported. My view about the role of the GPSLO is that it has a major function to act as a resource and a conduit of information for Supervisors. It is important Why did you decide to become a GP? I was exposed to General Practice at an early age as my father was a GP, and as a 35 year old resident I felt I was that I can get feedback from individual Supervisors to shape the program and to provide Supervisor support too old to commence a specialist training program. from a regional and a national level. Conversely I can also bring a national and regional perspective to assist individual Supervisors training within their practices. I look forward to meeting GP Synergy Supervisors at our What do you enjoy about being an urban GP? I enjoy the ever improving technology and the enhanced quality of care it can provide to the up coming Supervisor Professional Development weekends in Tamworth and Sydney. community. Since my first day in General Practice I have been impressed by the good nature of the majority of patients and their ability and desire to get on with their lives. It is a privilege to assist where appropriate. What do you enjoy about being a GP Supervisor? The sharing of knowledge and experience. The Registrars are constantly refreshing and GP Supervisor Development Weekend/s stimulating. Learning & Behavioural Difficulties in Childhood What do you think makes a good Supervisor? Being able to receive and offer feedback in an encouraging manner and assisting Registrars to develop their particular skills. Last chance to RSVP One of the keystones of our practice is the assumption that there is always a better way to do things. Registrars are a key element of this We all get heart sink situations, both as clinicians and supervisors. One has to be the disruptive child, with parents that aren’t coping, who philosophy. will be in the practice for years to come. Do you have the skills you need to manage this? Also, do you have the skills to impart these skills What types of teaching activities do you typically undertake with your Registrars? All Doctors regularly undertake informal (doorway) and formal to the registrar, who needs to have a good basis for their own later practice? Come to this workshop, and learn how you and your registrar meetings (clinical and small group learning sessions) as well as one-on-one discussions with the Registrar and Supervisor, which are primarily can avoid a sunken heart. determined by Registrars learning needs. Sat 17 Oct & Sun 18 Oct (includes a dinner on Sat night and accommodation asrequired) – Potts Points, Sydney Do you have any suggestions for ways Registrars can maximize their in-practice teaching experience? Joint consultations where the Registrar and the Supervisor both take turns in watching and managing each other’s consultations. To RSVP contact Eliza Canty on 9818 4433 or firstname.lastname@example.org Any additional comments? Becoming a GP Supervisor was one of the best decisions for our practice! Moree Health Harvest Moree at glance Alas, the lovely four seater red baron reminiscent plane pictured Moree is at the centre of one of the richest agricultural shires in the country. Its chief Looking for more left is not GP Synergy’s new company transport but that belonging to Peter Birch of “Warrena” property and B&W Rural crops are grain and cotton with cattle and sheep growing other strong industries. Sitting atop a large artesian basin it has a plentiful water supply and is famous for its educational (a large Agricultural trading company based in Moree). As a wonderful finale to the Moree Health Harvest weekend Peter hot mineral springs spa baths. It is a unique town, with a large Aboriginal population and many large and prosperous farming properties, a strong café culture and designer and networking kindly offered to take GP Synergy staff and Concord Hospital Junior Doctors on a scenic flight over the region. boutiques. opportunities? Community Profile Population 10740. 83.6% Australian born, 17.6% Indigenous. Age profile 0-24: 35.5%, 25- All Registrars training in GP Synergy regions are Held in May and coinciding with the town’s annual Moree on a 64: 53.4% 65+: 11.1%. able to join for free the local Division of General Plate food festival, the Moree Health Harvest was the brain child Practice in that region. of New England/Northwest GP Dr Scott Finlay. A Sydney North Shore Futures Broker in his former life, Scott completed his GP Location/Transport Each Division holds regular educational events which provide an excellent learning forum and Training in 2007 with procedural skills posts in Obstetrics and • 507kms from Sydney (8hr drive) opportunity to meet and network with General Anaesthetics. • 3hr drive to Tamworth. Practitioner colleagues. Upon completion of his training, Scott began working as a • Closest airport is Moree Airport - 5mins from town centre. To find out more, visit your local Divisions website procedural GP in the town of Moree in a practice with 5 Doctors • Qantas operates flights daily (with exception of Sat) to Sydney (flight time 90 mins) or contact GP Synergy for more information. and GP Registrars. Here he became aware of the many changes • Country Link operate a daily service to Sydney (see www.countrylink.info for more taking place in the General Practice training environment information). New England/Northwest within the New England region. These changes included the Region: establishment of a new medical school at UNE and the merger RRMA/RRIPS/RA Category Barwon Division of GP of the vocational training providers SIGPET and NEATS. Scott saw • RRMA - 4 www.barwondgp.org.au an opportunity (and a need) to bring together educators, health • RRIS – Category C Moree and surrounds professionals and students from around the region to discuss • RA – 3 these changes and their impact on the future primary health New England Division of GP care provision for the New England/Northwest region. www.nedgp.org.au From left: GPET Chair A/Prof Simon Willcock with GP Synergy staff Dr Jeremy Health Services Armidale and surrounds Bunker, Dr Linda Mann and Felicity Gemmell-Smith The result was the Moree Health Harvest – a health education • Moree Hospital provides acute medical, surgical and maternity in-patient services. forum featuring guest presenters such as Associate Professor Lyn Emergency Department, chemotherapy services and a range of North West Slopes Division of GP Fragar AO (Director, Australian Centre for Agricultural Health and diagnostic imaging (x-ray,CT scan, mammography, ultrasound) www.nwsdgp.org.au Safety), Professor John Fraser (Head of School UNE Rural Medical and pathology services are available to non in-patients. It has around Tamworth and surrounds School), Dr Penny Paliadelis (Deputy Head of School, Nursing, 54 beds- including 6 renal dialysis. School of Health, UNE), Dr Jeremy Bunker (Director of Training, • Specialists visit Moree on a regular basis. Sydney Region: GP Synergy, New England/North-West, Sydney), Associate • Pius X Aboriginal Health Service. Central Sydney GP Network Professor Austin Curtin (Chair of the executive Committee • Moree Community Health Service operates a large range of nursing and allied health www.csgpn.com.au IRCST), Lorna MacLellan (RN MV MNP – Convenor of Master of services Inner West and surrounds Nursing (NursPrac) Program School of Nursing and Midwifery Eastern Sydney Division of GP University of Newcastle) and Associate Professor Simon Willcock Regional Highlights: www.esdgp.org.au (Associate Dean, Post Grad Education, University of Sydney, Chairman GPET). • Events: Moree Regional Art Gallery, Opera in the Paddock Delungra, Cotton Cup Eastern suburbs (February), Blues in the Bush (March), Superstar for kids (March), Moree on a Plate (May), Australian Cotton Trade Show (May), Moree Agricultural Show GP Network Northside The event generated lively discussion and attracted attendees www.gpnn.org.au (May), Picnic Races (June – July), Harmony on the Plains (October), Golden Grain/ from all over the state, including Junior Doctors from Sydney North Western Sydney Cotton Festival (November). Mungindi Music Festival (October), Healing hospitals and local hospitals, UNE Medical students, GP Registrars Waters Festival incorporating the Australian Wool Fashion Awards and other health professionals, who had the opportunity to Manly Warringah Division of GP (Sept/Oct), Art Deco Festival (October). meet and mingle with likeminded individuals and experience www.mwdgp.com.au what the New England/Northwest region has to offer. • Shopping outlets include: Coles, Woolworths, Assefs, Boutique clothes stores, popular Manly Warringah area Medical Students Kristina Turner & Madeline Flowers picking cafe culture. oranges on “Glen Prairie” - the Kirkby family’s property - the oranges For more information about the Moree Health Harvest, please • Regional Highlights: Moree Spa Baths, Moree Golf Club, Trawalla Pecan Nut Farm, Northern Sydney GP Network are a joint project with the Department of Primary Industries. contact Dr Scott Finlay - email@example.com Waa Gorge, Lighting Ridge, home of “Australian Centre for Agricultural Health and www.nsgpn.org.au . Safety” North Shore South Eastern Sydney Division of GP Useful Links www.sesdgp.com.au www.moreetourism.com.au www.moreensw.com www.barwondgp.org.au www.gpsynergy.com.au South Eastern suburbs Poetry, drug paraphernalia and Other highly commended entries specific to presentations included:- In addition to the Haiku competition, Registrars were also asked to participate a visual quiz. Developed by ACRRM as part of their Telederm and Radiography online educational series, GP Registrars were asked questions about 14 images displayed for the duration of the workshop with answers revealed in a large group session on the final day. The quiz generated much debate and interest amongst Registrars (as well as speakers relaxation techniques – ENT Presentation: and Educators). An example of one quiz question is below. Standing in Bunnings a Woodstock revival or GP training Thinking of ruptured eardrums workshop? Staring at BluTak Questions: Dermatology Presentation: These lesions have been present for about three Twice a year, GP Regional Training Providers (RTPs) GP Synergy, GP Training – valley to coast Pigmented lesions months. They are very itchy and not responded and North Coast GP Training come together to host a 3 day intensive workshop for their Basic Look for the “ugly duckling” to multiple courses of oral antibiotics, topical and Advanced GP Registrars. Year after year, we have been fortunate to have a number of ABCDE steroids and topical antifungal creams. expert guest presenters participate in these workshops, sharing their expertise and knowledge with the Registrars. On behalf of all three RTPs we would like to formally thank the following Mental Health Presentation: 1. Describe the lesions. individuals for their continuing support and contribution to the May three day workshop with Slow breathing technique 2. What is your diagnosis? special thanks to this year’s keynote speaker, the highly respected and renowned, Prof John Three seconds in, then three out 3. What would you like to know about the Murtagh. Anxiolysis previous topical steroid treatment? 4. What is a common complication of this condition? • ENT: Dr Ron Bova – ENT, Head and Neck Surgeon at St Vincent’s Hospital Opthalmology Presentation: 5. Who gets this condition mainly? • Gastroenterology: Dr Simon Benstock – Consultant Physician and Specialist Gastroenterologist Another red eye? • Dermatology: Dr Keng Chen – Medical Officer in the Department of Dermatology at Westmead Glaucoma or iritis? Hospital; and Consultant Dermatologist at the Skin and Cancer Foundation Australia. AAAGH! Send to David • Doctors Health: Dr Hilton Koppe – NCGPT Medical Educator and GP, Special Interest Doctors Health & Wellbeing Refugee Health Presentation: • Ophthalmology: Dr David Ng – David is a comprehensive ophthalmologist with a special interest Our lucky country in diabetic eye disease and small incision cataract surgery Overrun by refugees • Mental Health: Dr Craig Wilson – General psychiatrist with an interest in mood disorders caring They should be welcome for inpatients and outpatients • Addiction Medicine: Dr Ray Seidler – GP, specialist in addiction medicine Addiction Medicine Presentation: • Paediatric Dentistry: A/Prof Richard Widmer – Associate Clinical Professor in Paediatric Dentistry, Drugs are our work life For more information about this ACRRM educational resource, please contact ACRRM on firstname.lastname@example.org The University of Sydney, and Director of the Dental Department at The Children’s Hospital at Abuse can be difficult Westmead Help us Doctor Ray • Cervical Spine: A/Prof Simon Willcock – Chair, Board of General Practice Education & Training Doctors Health Presentation: winter months. It is also described in patients taking isotretinoin, interferon and infliximab. Limited (GPET), Associate Dean (Postgraduate Medical Education and Training) Associate We care for others 5. Older men [>60’s] and atopic women in their 20’s. In the older men it is usually associated with dry skin. It will thus often be worse in the drier Professor and Head, Discipline of General Practice, Northern Clinical School University of Sydney • Refugee Health: Dr Mitchell Smith - Director of the NSW Refugee Health Service Ourselves perhaps not so much Let’s us all do yoga become more raised. 4. Secondary infection with staphylococcus aureus. This will result in a worsening of symptoms, oozing, yellow crusting and the lesions will In addition to the comprehensive workshop program delivered by the above speakers, there were also a number of side activities that took place. The first was a Haiku poetry competition Paediatric Dentistry Presentation: often consider recurrence a sign of treatment failure rather then an expected event. in which Program Coordinator, Dr Louise Stone asked Registrars to write a ‘haiku’ about one of Temporary teeth e. Did the condition clear/improve and then recur? This condition is one that recurs after therapy [as with a lot of other skin diseases]. Patients the ideas or concepts presented in the workshop. Haiku is a form of Japanese poetry with a set Just like Sakura blossoms d. How long did the treatment persist. This can be slow to respond, so if the steroid was only used for a few days response may not be seen. poetic form. There are three lines with a set number of syllables in each line (5, 7, 5). are deciduous c. Was occlusion used. This also increases efficacy. achieve higher levels of steroid i the skin and hence enhanced effect. The winner of the competition was Helen Gorgievski from Valley to Coast who wrote: Keynote Speaker: b. Was it an ointment or a cream. Creams have lesser ability to penetrate the active molecule into the skin. An ointment being occlusive will Professor Murtagh hydrocortisone or 1/5 strength betnovate/celestone then there is little chance of efficacy. Quiet, unassuming man a. Strength of the steroid used. To make an impact you will need to use a potnet steroid i.e. elocon/diprosone/betnovate etc. If it was 1% Fountain of wisdom “How can I help you?” I’d want to know the following: Gastroenterology Presentation: 3. This is a difficult condition to treat but there will usually be a response to appropriate topical steroid treatment. Responsibility sits Young girl, overweight Results showed fatty liver Better call her back 2. This is discoid or nummular eczema. Nummular means coin shaped. On daunted shoulders 1. There are multiple, well circumcised round/oval areas of scaling erythema. The basic process looks eczematous. Suggested answers Aboriginal Health Both NEATS and SIGPET have always had a strong commitment to the delivery of effective and relevant aboriginal health education for our Registrars. The merger of the two organizations earlier this year brought together aboriginal urban and rural health education and below is an update on some indigenous health initiatives that have been extended and developed since the amalgamation. The Aboriginal and Torres Strait Islander Committee. The Aboriginal and Torres Strait Islander committee is a sub committee of the Board of GP Synergy and its role is to:- • Ensure Aboriginal input into the cultural education and development of GP registrars. • Identify and ensure the implementation of the RACGP and ACRRM curricula geared towards training in Aboriginal and Torres Strait Islander Health and incorporating and reflecting local priorities and concerns. • Examine all of GP Synergy’s educational activities and programs so as to ensure that all recognise and help address the concerns and needs of Aboriginal and Torres Strait Islanders in a culturally sensitive and appropriate way. • Establish formal and effective relationships between GP Synergy and other organisations and individuals which strive for improvement in the health of the Aboriginal community and which facilitate effective Aboriginal and Torres Strait Islander Health training. • Develop procedures for the recruitment of GP registrars to work in the Aboriginal Medical Services and to support the cultural mentors who in turn support them. GP Synergy recognises: i. the need for Aboriginal Medical Services to employ registrars who are appropriately sensitive and responsive to the needs of its clients ii. the attractiveness of these posts and the training opportunities offered to registrars iii. the need to maintain continuity of supply and support. “Working in an AMS” DVD To highlight the wide and varied range of experiences to be gained by working in an Aboriginal Medical Services, whilst reinforcing the complexities • Identify ways in which the needs and aspirations of the Aboriginal and Torres Strait Islander community can be incorporated into the of providing services to culturally different groups of people, a DVD entitled, “Working in an AMS” has now been completed and will be due for governance and operations of GP Synergy. release very soon. The focus of the DVD is the Indigenous Medical Services in the New England North West node of GP Synergy and will be available shortly online on GP Synergy’s website with DVD copies available for Registrars. The inaugural meeting of the committee will be held in September with representatives from a number of AMS plus other Indigenous community organizations including:- • Pius X Indigenous Corporation, Moree. • Redfern AMS • La Perouse Community Health Clinic • Roy Thorne House, Moree. • Poche Centre University of Sydney • A medical educator with expertise in Aboriginal Health education and training • A director of GP Synergy • A member of GP Synergy’s operational staff (the Director of Training or his or her nominee) • A representative of the AH&MRC. • GP Synergy, Indigenous Liaison Officer. If you would like more information about the committee, please contact Aboriginal and Torres Strait Islander Officer, Val Dahlstrom on email@example.com The ‘Borroloola’ Experience My AMS Experience: Subsequent/GP Term 3 Registrars and those awaiting completion may like to contemplate Dr Heather Carr– spending time practising at Borroloola, a town 1000km from Darwin which has support from Tamworth AMS one of our practices, Inner West General Practice (IWGP). This town of 1-2000 people, largely “It’s been a fabulous term so far, I’ve really Check out the community visit policy on GPRime Aboriginal (depending on the season) has a Health Centre, largely manned by Remote Area Nurses, who work independently, and see many patients themselves. Doctors provide second enjoyed it. It’s been a great opportunity to learn more about Aboriginal culture and opinions, and work within the public health context that dominates the health care here. We under i-forms for examples of useful aboriginal can be available for any emergency (the nurses are the ambulance drivers, triage, nurses and disease. There lots of support and access to other facilities – such as access to transport colleagues) if we want to, undertake effective chronic disease treatment and prevention, and health education resources add a level of expertise, as experienced city doctors, that compliments the good remote medical skill of the rest of the medical team. IWGP pays a set wage, and travel and accommodation is and visiting specialists coming to the site’. included. Interested? Contact Dr Linda Mann (firstname.lastname@example.org), who wrote this from there, after coming home from a day on a station, by the Robinson River.